Background. Considerable differences exist among the living donor Kidney Exchange Programmes (KEPs) that are in use and being built in Europe, contributing to a variation in the number of living donor transplants (Newsletter Transplant; International figures on donation and transplantation 2016). Efforts of European KEPs to exchange (best) practices and share approaches to address challenges have, however, been limited. Methods. Experts from 23 European countries, collaborating on the European Network for Collaboration on Kidney Exchange Programmes Cooperation on Science and Technology Action, developed a questionnaire to collect detailed information on the functioning of all existing KEPs in Europe, as well as their opportunities and challenges. Following a comparative analysis, results were synthesized and interpreted by the same experts. Results. The practices, opportunities and challenges reported by 17 European countries reveal that some of the 10 operating programs are mature, whereas others are in earlier stages of development. Over 1300 transplants were performed through existing KEPs up to the end of 2016, providing approximately 8% of their countries’ living kidney donations in 2015. All countries report challenges to either initiating KEPs or increasing volumes. Some challenges are shared, whereas others differ because of differences in context (eg, country size, effectiveness of deceased donor program) and ethical and legal considerations (eg, regarding living donation as such, nonrelated donors, and altruistic donation). Transnational initiatives have started in Central Europe, Scandinavia, and Southern Europe. Conclusions. Exchange of best practices and shared advancement of national programs to address existing challenges, aided by transnational exchanges, may substantially improve access to the most (cost) effective treatment for the increasing number of patients suffering from kidney disease.
Malignancies are one of the three major causes of renal recipient´s death with a functioning graft after cardiovascular diseases and infections. Among the variety of risk factors, including conventional and specific to transplant recipients, the duration of immunosuppressive therapy, the intensity of therapy, and the type of immunosuppressive agent all have an impact on development of post-transplant malignancy. The aim of our retrospective study was to document the incidence, the type of malignancies, the patient/graft survival in the group of kidney transplant recipients in Slovak Republic, and to identify the factors which influenced the outcome. We analyzed the data of 1421 patients who underwent renal transplantation from deceased or living donors in the period from 2007 to 2015 in the Slovak transplant centers. The incidence of malignant tumors was 6%, the malignancy was diagnosed in 85 patients at the age of 54.1 ± 9.8 years, more frequently in men (68.2 %; P < 0.0001). The mean time of malignancy occurrence was 45 months after transplantation. The most frequent malignancies were skin cancers- basal cell carcinoma (BCC) in 17.6%, squamous cell carcinoma (SCC) in 8.2%, and malignant melanoma (MM) in 2.4% of patients, followed by non-skin tumors such as renal cell carcinoma (RCC) in 16.5%, cancer of colon in 12.9%, prostatic cancer in 9.4%, breast cancer in 9.4%, cancer of lung in 7.1%, post-transplant lymphoproliferative disease (PTLD) in 2.4%, cancer of urine bladder in 2.4%, and cancer of sublingual gland in 1.17% of patients. Surgical treatment was used in 40% of patients, chemotherapy in 7.1%, radiotherapy in 2.4%, treatment with biological agents in 15.3%, combined therapy in 29.4% and palliative treatment in 5.9% of patients. 55.3% of patients underwent conversion from other immunosuppressive agents into mTORi at the time of malignancy occurrence. The remission was achieved in 48.2% of patients, 28.2% of patients were in the oncology treatment in the end of the year 2015, and 23.5% of patients died. There was no difference in the kidney function at the time of malignancy occurrence (s-creat 133.7 ± 59.8 µmol/l) and one year later (s-creat 131.1 ± 47.9 µmol/l) (P = 0.7768). The patients after successful treatment more frequently suffered from BCC (P = 0.0140), did not undergo palliative treatment (P = 0.0033), but were more frequently treated surgically (P < 0.0001).
BackgroundCalcineurin inhibitors (CNI) are fundamental part of maintenance immunosuppresion in kidney transplantation. Current recommendations for the clinical practice1,2 have led to the change of initial CNI in our centre during the last years.PurposeThe use of tacrolimus as primary CNI has increased from 48% of patients in 2008 to 90% of patients in 2013 in our centre. The aim of our retrospective analysis was to analyse the impact of initial CNI on short term graft outcomes.Material and methods320 kidney transplant recipients were included into the study. Tacrolimus (TAC) as initial CNI was administered in 171 patients and cyclosporine A (CsA) in 149 patients transplanted in 2008–2013 period. CNI were combined with corticosteroids and mycophenolate mophetil or mycophenolic acid in all patients, induction immunossuppressive therapy was not applied. Statistical analysis was performed using Pearson’s χ2 test, Fisher’s exact test and Kaplan-Meier survival analysis.ResultsMean follow up of the patients was 201.7 weeks in TAC patients and 186.8 weeks in CsA patients (ns). Early acute rejection was confirmed in 54.6% of patients using TAC and 45.4% of patients on CsA (ns). Graft survival at 1 and 3 years was 95.7% and 94.0% in TAC group and 85.5% and 84.2% in CsA group (p = 0.006 and p = 0.015). When controlled for age, degree of sensitisation and number od HLA mismatches, the type of CNI was independent predictor for graft survival (HR 2.63 for TAC, p = 0,011). Overall patient survival was significantly better in TAC group (p < 0.001), even when controlled for age (HR 3.45, p = 0.002). Interestingly, in a subgroup of patients older than 50 years the graft survival in both treatment groups was not different.ConclusionOur kidney transplant recipients in the TAC group had higher 1-year graft survival. In our opinion, tacrolimus should be preffered CNI especially in younger kidney transplant recipients.References and/or AcknowledgementsEkberg H, Tedesco-Silva H, Demirbas A et al. Reduced exposure to calcineurin inhibitors in renal transplantation. N Engl J Med 2007;357:2562–2575KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients, Am J Transp 2009; 9(Suppl 3):S10-S13No conflict of interest.
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