Kidney Transplantation From Cadaveric Donors Unsuitable for Other Centers and Older Than 60 Years of Age

Prevention of Delayed Graft Function in Kidney Transplant Recipients through a Continuous Infusion of the Prostaglandin Analogue Iloprost: A Single-Center Prospective Study

BACKGROUND

Delayed graft function (DGF) is common after kidney transplantation from deceased donors and may significantly affect post-transplant outcomes. This study aimed to evaluate whether an innovative approach, based on the administration of the intravenous prostaglandin analogue iloprost, could be beneficial in reducing the incidence of DGF occurring after kidney transplantation from deceased donors.

METHODS

This prospective, randomized (1:1), placebo-controlled study enrolled all consecutive patients who received a kidney transplant from a deceased donor from January 2000 to December 2012 and who were treated in the peri-transplant period with the prostaglandin analogue iloprost at 0.27 μg/min through an elastomeric pump (treatment group) or with a placebo (control group).

RESULTS

A total of 476 patients were included: DGF was reported in 172 (36.1%) patients in the entire cohort. The multivariate analysis showed that the donor's age > 70 years (OR 2.50, 95% confidence interval (CI): 1.40-3.05, p < 0.001), cold ischemia time > 24 h (OR 2.60, 95% CI: 1.50-4.51, p < 0.001), the donor's acute kidney injury (OR 2.71, 95% CI: 1.61-4.52, p = 0.021) and, above all, the recipient's arterial hypotension (OR 5.06, 95% CI: 2.52-10.1, p < 0.0001) were the strongest risk factors for developing post-transplant DGF. The incidence of DGF was 21.4% in the treatment group and 50.9% in the control group (p < 0.001). Interestingly, among patients who developed DGF, those who received iloprost had a shorter duration of post-transplant DGF (10.5 ± 8.3 vs. 13.4 ± 6.7, days, p = 0.016).

CONCLUSIONS

This study showed that the use of a continuous infusion of iloprost could safely and effectively reduce the incidence of DGF in recipients of deceased-donor kidneys, allowing a better graft functionality as well as a better graft survival.

Dual kidney transplantation from expanded criteria deceased donors: Initial experience from single center

Aim:

To evaluate results of dual kidney transplantation from expanded criteria deceased donors.

Materials and Methods:

Between January 2000 and December 2009, 23 dual kidney transplantations were performed from expanded criteria deceased donors; 11 were from non-heart-beating donors and 12 from brain-dead heart-beating donors. All transplantations were performed in monolateral iliac fossa.

Results:

Two perioperative deaths occurred due to sepsis and multiorgan failure in non-heart-beating group, and one in brain dead group. One- and five-year graft and patient survival in recipients having organs from brain-death heart-beating group were 91.67%. In non-heart-beating group, 1- and 5-year graft survival was 65.45% and 81.82%, and 1- and 5-year patient survival was 43.64% and 61.36%, respectively.

Conclusion:

Dual kidney transplantation from expanded criteria brain dead donors has better graft and patient survival than from non-heart-beating donors.

Monolateral dual kidney transplantation from marginal donors

BACKGROUND

Dual kidney transplantation (DKT) offers a safe way to face the organ shortage with good short-term and medium-term renal function. However, its application is limited by the longer operating time and the risk of surgical complication. This study reviews our results with DKT performed with an ipsilateral technique in terms of graft loss, graft and patient survival rates, and surgical complications.

PATIENTS AND METHODS

From January 2002 to March 2006, 23 patients underwent DKT through a monolateral Gibson incision with placement of both kidneys.

RESULTS

One primary nonfunction occurred (4%). Delayed graft function was observed in 3 DKT (13.3%). Acute rejection rate was 4.3% (1 patient). All patients are alive at a mean follow-up of 28 months. One-year and 2-year graft survival rates were 100% and 96%, respectively. Mean serum creatinine level at 1-year posttransplantation was 1.3 mg/dL (range, 0.8-2.1 mg/dL). One DKG recipient lost 1 graft, retaining the second normal functioning graft due to ureteral necrosis. The mean hospital stay after transplantation was 15 days (range, 12-34 days).

CONCLUSIONS

Monolateral placement in DKT offers the advantage of a single incision, minimizing the surgical risk. Tailored immunosuppression and careful selection of potential recipients, by excluding those with severe cardiopulmonary pathologies, could significantly improve both patient and graft survival in this group of patients.