statistical difference between groups (p=0.05). The mean of UMAC was 1258.92AE765.19 pg/ml, with significant differences between the groups; although, no differences were found in the UMAC levels with to the degree of fibrosis (p= 0.10), subjects without fibrosis had the lowest levels of UMAC (770.1AE579 vs 1680.31AE490.1 severe fibrosis). The 100% of patients received induction treatment with corticosteroids, 88% ACEI, 84% statins, 16% steriods+CNi, 8% calcium channel blockers. The basal UMAC levels were lower in those subjects with complete response to treatment, with differences between the groups (p= 0.003). UMAC had significant correlation with final proteinuria (r=0.5, p=0.01) and CKD-EPI (r=-0.6, p=0.002). Figure 1 Conclusions: The membrane attack complex represents the final stage of activation of the complement system (C5b-9). Our results showed that high levels of UMAC in patients with FSGF with a statistical correlation, had the worst histological varieties. The patients who had the benign varieties (lower UMAC levels), responded better to treatment, inferring that UMAC could be a prognosis biomarker for treatment response, however, these results must be confirmed with a higher number of patients in prospective cohort methodological studies.
Background and Aims Live donor kidney transplantation remains the mainstay of renal replacement therapy in Sri Lanka. The basic universal pre surgical investigations, human leucocyte antigen (HLA) matching and cross matching are routinely performed, however due to high rates chronic kidney disease (CKD) as well as increasing numbers of, chronic kidney disease unknown etiology (CKDu) in Sri Lanka, there is a possibility of subclinical kidney disease being present in donor kidneys which go undiagnosed. A study of pre-implantation biopsy along with follow-up outcomes of kidney transplant recipients is conducted to identify presence of subclinical kidney disease in a Sri Lankan cohort of patients. Method We collected thirty three (33) live donor pre-implantation biopsies during 4 consecutive months in 2020 as well as 1 month follow-up data. This is part of an ongoing follow-up study which is conducted at National Hospital, Kandy, Sri Lanka. Results Thirty three (33) live donor recipients and their pre-implantation renal biopsy samples were studied. The mean age of the study participants’ was 37.6 (SD 12.5, range 13 - 59) years. A predominant number of male patients were in the sample (n=21, 63.6%). Underlying aetiology of end stage renal disease (ESRD), was predominantly due to chronic hypertension (39.3%; n=13) and diabetic kidney disease (21.2%, n=7) accounting for nearly 60% of the study participants. Among the 33 live donors 1st degree, 2nd degree and non-relative donors were 54.4% (n=18), 18.2% (n=6) and 27.3% (n=9) respectively. Pre-implantation renal biopsy results reported 36.4% (n=12) with abnormal biopsy findings including chronic interstitial nephritis (n=4, 12.1%), interstitial fibrosis (n=6, 18.18%) and acute tubular necrosis (n=2, 6%). Follow-up revealed delayed graft function occurring in 18.2% (n=6) of recipients with 50% (n=3) of them showing abnormalities in the pre-operative donor biopsy sample. At one month follow-up, 48.5% (n=16) reported complications which included graft failure 3% (n=1), all-cause mortality 3% (n=1), acute rejection 39.4% (n=13) and infections 24.2% (n=8). Overall, 37.5% (n=6) of these recipients had abnormal donor biopsy findings, however no significant statistical association was identified. Conclusion Our study identified subclinical kidney disease in donor kidneys despite standard pre-transplant screening. Even though, statistically not significant, recipients with abnormal pre-implantation biopsy findings had adverse short term post-transplant complications.
KT patients were divided in two groups: aKT and non-aKT. Assisted KT patients were defined as dependent patients whose physical or cognitive deficits preclude them to take full responsibility for their care and medication. All 25 patients who were under aKT program where included and a comparative analysis regarding graft failure, all-cause mortality, and combined event (graft failure or death) between both groups was done. Results: Of the 1503 kidney transplants performed during the study period, follow-up was lost in 27 (1.8%). Twenty six KT (1.7%) were performed in 25 patients eligible for inclusion as aKT. At the time of the analysis, 25 (96.2%) of this aKT maintained a functioning graft; the only lost graft was due to chronic rejection 32 months after the first KT in a 13 years old recipient, who subsequently received a second kidney transplant. Dependence causes of aKT patients were: cognitive deficits 18 (72%), blindness 3 (12%), illiteracy 2 (8%) and childwood 2 (8%). Comparing aKT versus non-aKT: 13 (50%) vs 911 pts (62.8%) were male (p = 0.180), the median age at the time of transplantation was 35.8 AE 19.5 years vs 45.2 AE 14.1 years (p = 0.001), the mean follow-up was 10.0 AE 7.2 years vs 8.9 AE 6.5 years (p = 0.445) and 1 (3.8%) vs 361 pts (24.9%) evolved to graft failure (p = 0.010). All cause mortality was observed in 0 (0%) vs 246 pts (17.0%) (p = 0.014) and the combined event was seen in 1 (3.8%) versus 607 patients (41.9%) (p < 0.001). Using Kaplan-Meier analysis, the comparison of both groups revealed a statistically significant difference regarding the graft failure (p = 0.021) and combined event (p = 0.001). Adjusting for age, aKT showed a lower prevalence of both graft failure (p = 0.022) and combined event (p = 0.017). Conclusions: Despite the limited number of patients, our results unveiled non-inferior outcomes in aKT patients. This makes aKT an opportune, reliable and effective alternative for renal replacement therapy in disabled patients. Muldisciplinary assessment of the assistant care provider may be a key step for the success of this program. Further studies are required, especially those including relevant pre and post-transplant clinical data related to graft and patient survival.
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