Long-Term Outcomes among Kidney Transplant Recipients and after Graft Failure: A Single-Center Cohort Study in Brazil

Bicalho, Paula Rebello; Requião-Moura, Lúcio R.; Arruda, Érika Ferraz de; Chinen, Rogério; Mello, Luciana Garcia de; Bertocchi, Ana Paula Fernandes; Naka, Erika Lamkowski; Tonato, Eduardo José; Pacheco-Silva, Álvaro

doi:10.1155/2019/7105084

Cited by 27 publications

(23 citation statements)

References 39 publications

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“…The overall rate of acute rejection episodes (ARE) was 3.9% during the first year of renal transplant. Bicalho PR et al [18] in a recent study from Brazil reported ARE in 18.3% out of 944 patients with RT. Davidson et al [6] found that 29.7% of renal transplant patients developed ARE during the first year.…”

Section: Discussionmentioning

confidence: 92%

The Experience and Outcome of Renal Transplantation in Yemen

Abu-Asba¹,

Nono²,

Badani³

et al. 2019

IJCU

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Access to renal transplantation in the developing world remains limited It remains the treatment of choice for endstage kidney disease. This procedure not only improves quality of life, but also markedly increases patients' survival rates. Therefore, this study aimed to evaluate clinical outcomes of renal transplants in our center and to compare the outcomes between the patients who received induction therapy and those patients without such induction. It was a retrospective study conducted at Al Thawra General Hospital, Sana'a on 154 patients. Data were collected on all patients who underwent a renal transplant from 2004 to t 2015. Analyses were performed to assess baseline characteristics, graft and patient survival, as well as the outcomes of patients who given induction therapy. A total of 154 renal transplants were carried out at Al Thawra center. The mean age of patients was 32.42 ± 10.4 years (rang 14-66) and the male sex was predominant accounting for 72.7%. There were 93.5% of patients on dialysis and the dialysis time was ≥ 3 years in 72%. The major causes of end-stage kidney disease (ESKD) were chronic pyelonephritis (77.9%), hypertension (13%), glomerulonephritis (3.9%) and diabetes mellitus (2.4%). During the first year following renal transplants, 6 patients (3.9%) complicated by acute rejection episodes that did not reach statistical significance (P > 0.05). It is found that the mortality rate during the 1 st , 5 th , and 10 th years was 1.9%, 9% and 14.9%respectively and the infectious conditions were the most frequent cause of death (13%) followed by cardiovascular events (3.9%) and others (2.5%). Although, the process of renal transplants in Yemen started slowly with the initial support and cooperation of the Egyptians' transplant surgeons, the overall outcomes are satisfactory and comparable to the universal reports.

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Section: Discussionmentioning

confidence: 92%

The Experience and Outcome of Renal Transplantation in Yemen

Abu-Asba¹,

Nono²,

Badani³

et al. 2019

IJCU

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“…In the second group, the clinical characteristics were collected over the time while the recipients had functioning grafts, such as: type of immunosuppression; delayed graft function (DGF) defined as dialysis requirement in the first week after transplantation; acute rejection (cellular or antibody-mediated) proved by biopsy or clinically defined; CMV infection and post-transplant diabetes; time for GL and its etiology categorized by chronic rejection, acute rejection, thrombosis, recurrence of underlying renal disease, and others. The type of GL was categorized as a failure (when the recipients had a functioning graft loss) or primary absence of graft function (in cases of thrombosis and primary nonfunction) according to previously published data [ 12 ]. Details about immunosuppression approach and prophylaxis are presented in S2 Appendix .…”

Section: Methodsmentioning

confidence: 99%

“…Despite this, long-term grafts and patient survival have not been followed in the same way, and GL due to chronic dysfunction and death with a functioning graft remain the main causes of long-term graft losses [9]. In emerging and developing countries, where transplantation has increased over the last few decades, death due to infections is the main cause of graft losses, while chronic dysfunction is the primary cause in countries with a high human development index [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Long-term outcomes after kidney transplant failure and variables related to risk of death and probability of retransplant: Results from a single-center cohort study in Brazil

et al. 2021

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Background Returning to dialysis after kidney graft loss (GL) is associated with a high risk of mortality, mainly in the first 3–6 months. The follow-up of patients with GL should be extended to better understand crude patient outcomes, mainly in emerging countries, where the transplantation activity has increased. Methods This is a historical single-center cohort study conducted in an emerging country (Brazil) that included 115 transplant patients with kidney allograft failure who were followed for 44.1 (21.4; 72.6) months after GL. The outcomes were death or retransplantation after GL calculated by Kaplan-Meier and log-rank tests. Proportional hazard ratios for death and retransplantation were assessed by Cox regression. Results The 5-year probability of retransplantation was 38.7% (95% CI: 26.1%-51.2%) and that of death was 37.7% (95% CI: 24.9%-50.5%); OR = 1.03 (95% CI: 0.71–1.70) and P = 0.66. The likelihood of retransplantation was higher in patients who resumed dialysis with higher levels of hemoglobin (HR = 1.22; 95% CI = 1.04–1.43; P = 0.01) and lower in blood type O patients (HR = 0.48; 95% CI = 0.25–0.93; P = 0.03), which was associated with a lower frequency of retransplantation with a subsequent living-donor kidney. On the other hand, the risk of death was significantly associated with Charlson comorbidity index (HR for each point = 1.37; 95% CI 1.19–1.50; P<0.001), and residual eGFR at the time when patients had resumed to dialysis (HR for each mL = 1.14; 95% CI = 1.05–1.25; P = 0.002). The trend toward a lower risk of death when patients had resumed to dialysis using AV fistula access was observed (HR = 0.50; 95% CI 0.25–1.02; P = 0.06), while a higher risk seems to be associated with the number of previous engraftment (HR = 2.01; 95% CI 0.99–4.07; P = 0.05). Conclusions The 5-year probability of retransplantation was not less than that of death. Variables related to the probability of retransplantation were hemoglobin level before resuming dialysis and ABO blood type, while the risk of death was associated with comorbidities and residual eGFR.

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“…While dialysis techniques replace lost filtration capacities, which help remove toxins and regulate blood pressure and pH, transplantation is the ultimate solution to reinstate all innate kidney functions. Unfortunately, the severe global shortage of transplantable kidneys [6], as well as organ rejection [7] limit this ideal option and accentuate the demand for alternative solutions.…”

Section: Introductionmentioning

confidence: 99%

Modeling changes in vascular and extracellular matrix integrity that can occur in decellularized kidneys after implantation

Corridon

2021

Preprint

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A method was established to identify alterations in vascular patency and extracellular matrix integrity of decellularized porcine kidney scaffolds. These scaffolds were perfused with blood at physiologically normal (500 and 650 ml/min) and abnormal (200 ml/min) rates. Variations in venous outflow were then assessed over 24 hours. Angiographic data confirmed that standard arterial branching patterns and the integrity of the extracellular matrix were considerably disrupted. Scaffolds subjected to normal arterial perfusion rates observed drops in venous outflow across the 24 hours. These reductions rose from roughly 40% after 12 hours to 60% after 24 hours. At the end of the test period, regardless of the underlying damage that occurred, the kidneys appeared intact on the surface, and there were no apparent signs of clotting. In comparison, venous flow rates decreased by 80 to 100% across the 24 hours in acellular scaffolds subjected to a far lower perfusion rate of 200 ml/min. These kidneys also appeared intact after 24 hours of perfusion, but presented several arterial, venous, and ureteral clots. The results of this study provide insight into circumstances that limit scaffold viability and provide a simplified model to analyze other conditions that can better prepare scaffolds for long-term transplantation.

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Long-Term Outcomes among Kidney Transplant Recipients and after Graft Failure: A Single-Center Cohort Study in Brazil

Cited by 27 publications

References 39 publications

The Experience and Outcome of Renal Transplantation in Yemen

The Experience and Outcome of Renal Transplantation in Yemen

Long-term outcomes after kidney transplant failure and variables related to risk of death and probability of retransplant: Results from a single-center cohort study in Brazil

Modeling changes in vascular and extracellular matrix integrity that can occur in decellularized kidneys after implantation

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