Management of chronic renal allograft dysfunction and when to re-transplant

Baker, Richard J.; Marks, Stephen D.

doi:10.1007/s00467-018-4000-9

Cited by 9 publications

(5 citation statements)

References 27 publications

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“…Kidney transplantation is the treatment of choice for patients with end‐stage kidney disease (ESKD), offering survival and quality of life advantages compared to dialysis 1 . Severe ischemic reperfusion injury following allograft implantation can result in significant renal tubular cell dysfunction and continued need for supportive renal replacement therapy in the early postoperative period 2–4 . Delayed graft function (DGF)—where a transplant recipient continues to require dialysis following transplantation—is a common complication of ischemia reperfusion injuries 5,6 .…”

Section: Introductionmentioning

confidence: 99%

Financial impact of delayed graft function in kidney transplantation

Kim

Zheng

King

et al. 2020

Clinical Transplantation

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Increased utilization of suboptimal organs in response to organ shortage has resulted in increased incidence of delayed graft function (DGF) after transplantation. Although presumed increased costs associated with DGF are a deterrent to the utilization of these organs, the financial burden of DGF has not been established. We used the Premier Healthcare Database to conduct a retrospective analysis of healthcare resource utilization and costs in kidney transplant patients (n = 12 097) between 1/1/2014 and 12/31/2018. We compared cost and hospital resource utilization for transplants in high‐volume (n = 8715) vs low‐volume hospitals (n = 3382), DGF (n = 3087) vs non‐DGF (n = 9010), and recipients receiving 1 dialysis (n = 1485) vs multiple dialysis (n = 1602). High‐volume hospitals costs were lower than low‐volume hospitals ($103 946 vs $123 571, P < .0001). DGF was associated with approximately $18 000 (10%) increase in mean costs ($130 492 vs $112 598, P < .0001), 6 additional days of hospitalization (14.7 vs 8.7, P < .0001), and 2 additional ICU days (4.3 vs 2.1, P < .0001). Multiple dialysis sessions were associated with an additional $10 000 compared to those with only 1. In conclusion, DGF is associated with increased costs and length of stay for index kidney transplant hospitalizations and payment schemes taking this into account may reduce clinicians’ reluctance to utilize less‐than‐ideal kidneys.

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Section: Introductionmentioning

confidence: 99%

Financial impact of delayed graft function in kidney transplantation

Kim

Zheng

King

et al. 2020

Clinical Transplantation

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“…3 Chronic renal allograft dysfunction (CRAD) is one of the leading challenges facing the long-term survival of patients following renal allograft transplantation. 4 The cause of CRAD is multifactorial and involves both immune-dependent and immune-independent factors. The immune-dependent factors include acute and chronic rejection, whereas the nonimmune factors include ischemia-reperfusion injury, nephrotoxicity of the calcineurin inhibitor, renal artery stenosis, hyperlipidemia, and hypertension.…”

Section: Introductionmentioning

confidence: 99%

Inhibition of Glycogen Synthase Kinase 3β Alleviates Chronic Renal Allograft Dysfunction in Rats

et al. 2020

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Background. Chronic renal allograft dysfunction (CRAD) is a major condition that impedes the long-term survival of renal allografts. However, the mechanism of CRAD is obscure, and the effective strategies for controlling the progression of CRAD are lacking. The present study used a CRAD rat model to assess the effect of glycogen synthase kinase 3β (GSK-3β) inhibition on the development of CRAD. Methods. A classical F334-to-LEW orthotopic renal transplantation was performed on the CRAD group. The treatment group was treated with the GSK-3β inhibitor 4-benzyl-2-methyl-1,2,4-thiadiazolidine-3,5-dione for 12 consecutive weeks following renal transplantation. The study included uninephrectomized F344 and Lewis rats as control subjects. Twelve weeks post surgery, the rats were retrieved for analysis of renal function, urine protein levels, histological, immunohistochemical, and molecular biological parameters. Results. Administration of 4-benzyl-2-methyl-1,2,4thiadiazolidine-3,5-dione inactivated GSK-3β and thereby improved renal function, attenuated proteinuria, and reduced renal tissue damage in CRAD rats. Besides, inactivation of GSK-3β inhibited nuclear factor-κB activation, macrophage infiltration, and expression of multiple proinflammatory cytokines/chemokines. Inhibition of GSK-3β also decreased the levels of malondialdehyde, increased superoxide dismutase levels, upregulated the expression of heme oxygenase-1 and NAD(P)H quinone oxidoreductase-1, and enhanced nuclear translocation of nuclear factor erythroid 2-related factor 2 in the kidneys of CRAD rats. Conclusions. Inhibition of GSK-3β attenuates the development of CRAD by inhibiting inflammation and oxidant stress. Thus, GSK-3β inhibition may represent a potential therapeutic strategy for the prevention and treatment of CRAD.

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“…Since KT increases the duration and quality of life of patients, it is the best treatment option for ESRD patients. Despite the advance of KT and immunosuppressive strategies in recent decades, chronic allograft dysfunction remains the biggest concern of these patients, their families, and physicians [ 20 ]. Early diagnosis of CKR is important for the success of treatment and in fact, the focus of management of these patients is on early diagnosis, prevention, and monitoring after KT.…”

Section: Discussionmentioning

confidence: 99%

Salivary and serum periostin in kidney transplant recipients

et al. 2023

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Introduction End-stage renal disease (ESRD) treatment includes dialysis and kidney transplantation. Transplant rejection is a major barrier to transplant success. One of the markers mentioned in previous studies on renal function in patients with renal failure for various reasons is periostin (POSTN). The expression of POSTN correlates with interstitial fibrosis and reduced renal function. One of the limitations in this regard is the effect of oral lesions on the POSTN level. This study was conducted aimed to measure the relationship between salivary and serum POSTN and renal function in patients with a history of a kidney transplant, taking into account all the conditions affecting POSTN. Methods In this study, serum and saliva samples were taken from 23 transplant patients with normal function (NF) and 29 transplant patients with graft failure (GF). At least one year had passed since the transplant. Before sampling, a complete oral examination was performed. Salivary and serum POSTN was examined by ELISA. The results were analyzed by SPSS software. Results The POSTN level in the serum of the NF group (191.00 ± 33.42) was higher than GF patients (178.71 ± 25.68), but the difference was not significant (P = 0.30). Salivary POSTN in NF patients (2.76 ± 0.35) was significantly higher than GF patients (2.44 ± 0.60) (P = 0.01). Conclusions The superiority of saliva as a diagnostic fluid includes ease of collection and storage, and non-invasiveness, all of which can lead to the replacement of blood with this bio-fluid. The significant results of salivary POSTN may be due to the lack of serum disturbing factors. Saliva is an ultra-filtered fluid from serum and therefore there are fewer proteins and polysaccharides attached to biomarkers in saliva and the accuracy of measuring these biomarkers in the saliva is more valuable than serum.

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Management of chronic renal allograft dysfunction and when to re-transplant

Cited by 9 publications

References 27 publications

Financial impact of delayed graft function in kidney transplantation

Financial impact of delayed graft function in kidney transplantation

Inhibition of Glycogen Synthase Kinase 3β Alleviates Chronic Renal Allograft Dysfunction in Rats

Salivary and serum periostin in kidney transplant recipients

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