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Aim: Our aim was to clarify the risk factors for graft loss within the first 90 days of kidney transplantation. Methods:We performed an IRB-approved, retrospective review of the United Network for Organ Sharing database (2010)(2011)(2012)(2013)(2014)(2015) and our own single center database (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015). We analyzed risk factors for early graft loss (EGL). EGL was defined as graft loss due to patient death, graft thrombosis, acute rejection, or primary non-function within 90 days of transplantation.Results: At our center, 30 of 676 recipients experienced EGL (4.4%). The most common cause of EGL at our center was recipient death. Demographic variables associated with EGL included: expanded criteria donor (p<0.001), older donors (p=0.003), donors with higher BMI (p=0.004), and higher KDPI (p=0.001). One-, 3-, and 5-year patient survival was lower in recipients with EGL (all p<0.001). Multivariate analysis suggested expanded criteria donor and donor BMI were predictors of EGL (p<0.001).The rate of EGL among patients in the UNOS database was 3.35%, with patient death being the most common cause. Multivariate analysis of the UNOS database revealed only recipient age was a predictor of EGL due to patient death (p<0.001). There were no predictors of EGL due to thrombosis. Previous kidney transplant and recipient age were predictors of EGL due to acute rejection (p=0.002 and p<0.001). Conclusions:Overall between our center and UNOS database, patient death was the most common cause of EGL. Single center and UNOS data suggest that EGL occurs more frequently in recipients of sub-optimal allografts. Additionally, older age and previous transplant is associated with increased risk for EGL.

Objectives: Our aim was to assess outcomes in White and African American kidney transplant recipients after induction with alemtuzumab. Materials and Methods:We performed a retrospective study of 464 patients who received deceased-donor kidney transplants and were induced with alem tuzumab between March 2006 and May 2015. We evaluated ethnic influences on patient and graft survival, delayed graft function, allograft failure, and rejection. Results: There were 337 White (67.3%) and 127 African American (25.3%) patients. We observed no significant differences in 1-, 3-, 5-, and 7-year death-censored graft survival. We also observed no significant differences in 1-, 3-, and 5-year patient survival rates. Having African American ethnicity was not a significant predictor of rejection, graft survival, or patient survival. Conclusions: Our results indicate that recipient ethnicity is not a predictor of rejection, graft survival, or patient survival. White and African American kidney transplant recipients induced with alemtuzumab experienced an equalization of outcomes.

Background: Obesity can be a barrier to live donor selection and there are reports of obese live kidney donors (OLKDs) undergoing bariatric surgery prior to donation. While this practice has potential promise, the risks associated with it are unclear. Thus, our aim was to evaluate the advantages and disadvantages of this practice.Design: Risks and benefits were ascertained from the literature. Analysis of costs and benefits was performed to provide objective data for each scenario.Results: Live kidney donation is associated with superior outcomes compared to deceased donation. However, live donors are at risk of complications that could be exacerbated by obesity. Higher donor body mass index (BMI) has been associated with inferior recipient outcomes. Bariatric surgery (BS) results in decreased mortality and can induce sustained weight loss. Our cost-benefit analysis revealed a benefit-to-cost ratio of 3.64 for BS prior to live donation by OLKDs. We found ratios of 3.19 and 0.97 for live donation with an obese donor and a deceased donor, respectively. Conclusions:Our results suggest that BS for an OLKD has the potential to increase the number of live donors and improve outcomes. However, more data is required; thus we recommend a registry of patients who have undergone both procedures.

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Background: Computed tomography (CT) scans’ predictive value is not well established for screening prior to renal transplantation. The purpose of this study is to measure the extent to which CT findings during transplant evaluation alter candidacy.Methods: Data for 639 renal transplant candidates who underwent CT screening were obtained. Of these, 454 patients had sufficient data and met criterium of having undergone screening CT within six months of official renal transplant evaluation. Transplant status before and after CT imaging was assessed.Results: Those who had screening CTs prior to renal transplantation who were older (p=0.01), had coronary artery disease (p=0.006), or had diabetes mellitus (p=0.042) had significant waitlist status changes. Candidates whose CT findings included vascular calcification or pulmonary nodules were more likely to be permanently excluded from the waitlist (p<0.05). Thirty-two, or 7.0%, had a permanent waitlist status change due to pathologic CT findings that precluded transplantation.Conclusions: Focusing on older patients with coronay artery disease, atherosclerosis, or diabetes would reduce the number of CTs obtained during workup. Candidates with systemic vascular calcification or pulmonary nodules found on subsequent imaging are at the greatest risk for permanent exclusion from renal transplantation.