Virtually, all studies reporting the outcomes of living kidney donation beyond the first year from donation were retrospective. In this prospective study, the outcome of 81 consecutive living kidney donors was thoroughly evaluated. Clinical, laboratory, and radiological assessments were carried out at predonation (basal), 3, 6, 12, and 24 months after donation. The mean age at time of donation was 37.8 ± 9.8 years and the majority was females (75.3%). The mean BMI increased significantly after donation (P < 0.04). The mean serum creatinine levels (mg/dl) were 0.75 ± 0.14, 1.01 ± 0.22, 0.99 ± 0.21, 0.98 ± 0.20, and 0.94 ± 0.20 (P < 0.0001). Likewise, the mean levels of measured creatinine clearance (mL/min) were 148.8 ± 35.7, 94.7 ± 26.6, 95.5 ± 24.6, 96.7 ± 20.2, and 101.6 ± 26.2 (P < 0.0001). The mean 24 hours urinary protein excretion (gm/dL) were 0.09 ± 0.03, 0.19 ± 0.18, 0.16 ± 0.09, 0.18 ± 0.25, and 0.17 ± 0.12 (P < 0.0001). There were significant increases in the means of the longitudinal and transverse diameters of the remaining kidney over time (P < 0.001). Out of 42 female donors, eleven female donors have got successful postdonation pregnancies. There were no reported surgical complications, either intra- or postoperative. Long-term follow-up is necessary for all living kidney donors through local institutional and world registries. This trial is registered with ClinicalTrials.gov NCT00813579.
Background and Aims There is a strong evidence of importance of HLA matching in kidney transplantation and associations between HLA-DR mismatches and rejection, transplant glomerulopathy, graft failure, and death with functioning graft following kidney transplantation. Our aim is to evaluate the effect of degree of HLA mismatch on transplant outcome among live donor kidney transplant recepients. Method The current study is a retrospective cohort study which was performed in Urology and Nephrology Center, Mansoura University, Egypt. The study included 2200 kidney transplant recipients who underwent renal transplantation between March 1976 and August 2019. The patients were divided into 3 main groups according to the degree of HLA mismatch: Group I: 0, 1, 2 HLA mismatch (568 patients). Group II: 3 , 4 HLA mismatch (1462 patients). Group III: 5 HLA mismatch (170 patients Results Demographic and medical characteristics were comparable among the 3 groups. Transplantation from unrelated donors was more frequent among group III (p value: 0.001). Ischemia time was comparable and over 90% of the patients had immediate diuresis.The degree of HLA mismatch affected the choice of induction therapy as lymphocyte depleting agent (ATG) was used more frequently in group III while basliximab was used more frequently in group I (p value: 0.001). Patients in group I were maintained on dual immunosuppressive protocols more frequently than the other 2 groups where triple immunosuppressive protocols were commonly used (p value: 0.02).Tacrolimus-based protocol was used more among group I while cyclosporine-based regimen was frequently used among group III (p value: 0.002, 0.001 respectively). acute rejection episodes were more frequent with group II and III. (p value: 0.001). Chronic rejection was revealed in graft biopsies of group II and III more than group I (p value: 0.046). Incidence of post-transplant Hypertension and Diabetes mellitus was higher in group III (p value: 0.004, 0.016 respectively). Median serum creatinine after 1 year follow up didn't differ significantly between the studied groups. However, serum creatinine was higher in group III after 2, 3, 4 and 5 years post transplantation (p value: 0.006) with subsequent lower creatinine clearance (p value: 0.036). The majority of patients were alive with functioning graft at last follow-up especially in group I with statistically significant difference among the 3 groups (p value: 0.001). More patients were alive with failed graft at last follow up in group III than in the other 2 groups with statistically significant difference (p value: 0.003). There was comparable percent of patients among the 3 groups were died either with functioning or with failed graft. On the other hand the 5, 10 and 15 years graft and patient survival showed statistical significant difference among the 3 groups with better survival for group I (p value: 0.04, 0.001) Conclusion The degree of mismatch affected the choice of immunosuppressive regimen. Higher HLA mismatch was associated with higher incidence of diabetes and hypertension and lower patient and graft survival.
Background and Aims Kidney transplantation is the optimal treatment of end stage renal disease (ESRD). Despite improvements in patient selection and management, every transplant carries risk of graft loss. Death with graft function (DWGF) is an important cause of long-term loss of grafts and patients. In this study, we investigated clinical characteristics and causes of DWGF among a cohort of 2953 Egyptian kidney transplant recipients. Method A total of 291 recipients who died with graft function (DWGF) were evaluated regarding causes and timing of death. Causes of death were investigated in different eras of immunosuppression; era 1 (1976-1995): steroid and azathioprine, era 2 (1996-2005): cyclosporine-based and era 3 (2006-2018): tacrolimus-based. Demographic data, original kidney disease, pre- and post-transplant co-morbidities, immunosuppression regimens, biopsy proven acute rejection episodes and graft function at last follow up were analyzed. Results Proportion of DWGF in total graft loss had changed over time. In our retrospective study, it decreases from 29.5% in era 1 to 13.7% in the most recent era of kidney transplantation. Most patients in DWGF group had diabetes mellitus, hypertension, frequently experienced more infections and more rejection episodes. cyclosporine-based immunosuppression was more prevalent. A total of 291 patients (9.9%) died with graft function. DWGF was responsible for 58.3% of a total of 499 deaths (figure 1). For this group of patients, median serum creatinine at last follow up was 1.7 mg/dl (range: 0.2 - 7 mg/dl). Out of 291 recipients who died with functioning graft, 53 patients (18.2%) died within the first year, 55 (18.9%) died within 1-5 years, 75 (25.8%) died within 5-10 years while 108 patients (37.1%) died after 10 years post transplantation. The majority of DWGF was secondary to cardio-vascular diseases (CVD) (30.9%) and serious infections (29.2%) (figure 2). Death due to malignancy was lowest within the first year (1.9%), increased thereafter but unexpectedly malignancy (22.2%) was the third main cause of death in the late period after transplantation (figure 3). Conclusion DWGF accounts for 24.5% of total graft loss. The most common cause is cardiovascular disease followed by serious infections. Pre-transplant diabetes mellitus, steroid dose and infections had most significant association with DWGF. Understanding different causes of death according to the time after transplantation is mandatory in order to improve the long-term outcomes.
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