CEL solution was shown to be as effective as UW in both liver and kidney preservation. In LT patients, biliary function recovery is significantly better in the CEL group. CEL solution represents an efficacious option in multiorgan harvesting.
At present dialysis solutions with different glucose concentrations are used for the peritoneal equilibration test (PET) and Fast-PET in peritoneal dialysis (PD). We compared the results of two Fast-PETs, using 1.36 and 3.86% solutions sequentially in 30 patients on PD treatment, to obtain information on peritoneal transport (D/P-4 h) and ultrafiltration rates. Creatinine, phosphorus and urea D/P-4 h in the two Fast-PETs were not statistically different, unlike those for potassium, β2-microglobulin and glucose. The creatinine and phosphorus D/ P-4 h values in particular proved to be uninfluenced by the different dialysis solutions. The lack of correlation between the two Fast-PET ultrafiltration values confirmed the difficulty in interpreting this parameter, above all in the case of non-homologous Fast-PETs. We obtained useful indications for comparing different Fast-PET results, but were unable to reach a decisive conclusion regarding the best of the two dialysis solutions for this test.
The importance of the donor/recipient body weight ratio (DRBWR) as a cause of kidney graft loss was evaluated in 112 non-diabetic, ciclosporin-treated, first cadaver kidney transplant recipients. According to the DRBWR, the patients were divided into three groups: ‘low’ ( < 0.80), ‘medium’ (0.81-1.20), and ‘high’ ( > 1.20). The three groups did not differ in patient or graft survival, and the DRBWR was not a predictor of graft failure at multivariate analysis (Cox models), even after only patients with graft survivals > 1 year were considered. The three groups did not differ in glomerular filtration rate (GFR) and proteinuria 6-60 months after renal transplantation. When the 55 patients with a follow-up period > 4 years were considered, no differences between groups were found in GFR or GFR evolution over time. Hypertension was significantly less frequent in group ‘high’ (Mantel-Cox p = 0.04), but very likely as a consequence of uneven recipient gender (an independent predictor of hypertension at multivariate analysis) distribution between groups, the significance being lost when survival curves were rebuilt by stratifying for recipient gender. DRBWR never resulted as a significant predictor of GFR at multivariate analysis when GFR values 6-60 months after transplantation were analyzed. We conclude that the DRBWR has no major effects on kidney graft function and survival in the short to medium term.
The influence of donor age on the outcome of kidney transplantation (TX) was evaluated in 169 patients who received a primary cadaver kidney transplant at our center between September 16,1984, and December 31,1990. All the patients received cyclosporin A as part of the immunosuppressive protocol. Patients were grouped according to donor age: low donor age (LDA; donor age range 12-25 years), medium donor age (MDA; range 26-50 years) and high donor age (HDA; range 51-66 years). There were no differences between groups in graft and patient survival, and multivariate analysis did not show any effect of donor age on those parameters. Proteinuria/day and number of rejection episodes did not differ between groups either. Immediate diuresis was more frequent in group LDA than in the other two groups (73.8, 54.7 and 57.1%, respectively; p < 0.05) and immediate diuresis resulted as a weak positive prognostic factor for graft outcome at multivariate analysis (p = 0.05). At both univariate and multivariate analyses, donor age resulted inversely correlated with creatinine clearance (CCr) at every period after TX but the 5th year, with r2 from 0.12 to 0.23 (p < 0.01). The LDA group had significantly better CCrthan the HDA group at every period after TX but for the 5th year (the MDA group behaved intermediately). Moreover, in the 65 patients with a follow-up of 4 years or more, not only did the LDA group have the best CCr (LDA vs. MDA and HDA: p < 0.02) but also CCr remained roughly stable with time in groups LDA and MDA while it declined progressively with time in group HDA. The influence of donor age on hypertension after TX was negligible when compared to that of dialytic age and recipient sex. Our data show that kidneys from donors 12-25 years old give the best functional results, while those from donors over 50 are associated with the lowest kidney function. Moreover, if the reduced frequency of immediate diuresis and the progressive decline of CCr with time are taken into account, kidneys from donors over 50 are also probably associated with reduced graft survival in the long term (after the 10th year). We suggest that kidneys from donors over 50 may be used, but they should be probably given to patients with a life expectation of no more than 10-15 years.
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