1
|
Diego EM, Fernández Bravo M, Kammar Garcia A, Guerrero Gutiérrez MA, Cendejas Rios E, Escorza Molina CA, Meza Comparan HD, Mancilla-Galindo J, Noriega Salas L, Bernaldez Gómez G, Díaz JSS. Role of Renal Venous Oxygen Pressure for Renal Function Monitoring After Related Living-Donor Kidney Transplantation: Cohort Study. Transplant Proc 2024; 56:23-30. [PMID: 38246804 DOI: 10.1016/j.transproceed.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/01/2023] [Accepted: 11/30/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Monitoring of renal function after kidney transplantation (KT) is performed by measuring serum creatinine (SCr), urine volumes (UV), and glomerular filtration rate (GFR). Other methods based on oxygen metabolism, such as the renal venous oxygen pressure (PrvO2), may be useful. The aim of this study was to explore the correlation between PrvO2 and SCr, UV, and GFR 5 days after KT (SCr5, UV5, and GFR5, respectively). METHODS We conducted a prospective cohort study in adults scheduled for living donor KT. A venous blood sample was taken from the renal vein after declamping the renal artery, and blood gas determinations were made. Correlation analyses between PrvO2 and SCr5, UV5, and GFR5 were done by calculating Spearman's correlation coefficient with generalized linear models (GLM). A Spearman's correlation analysis was performed between the percentage decrease in SCr (%ΔSCr) and PrvO2. A GLM was also performed to determine the association of PrvO2 with slow graft function (SGF). RESULTS The study included 42 patients, of whom 67% were men. The median age was 31 years (IQR, 27-43.5). PrvO2 was negatively correlated with SCr5 (ρ = -0.53, P = .003), and positively correlated with GFR5 (ρ = 0.49, P = .001) and %ΔSCr (ρ = 0.47, P = .002). A higher PrvO2 was associated with an increase in GFR in univariable (β = 1.24, 95% CI, 0.56-1.93, P = .001) and multivariable (β = 1.24, 95% CI, 0.53-1.94, P = .001) analyses. No association was found between PrvO2 and SGF. CONCLUSION PrvO2 could be used to monitor renal function in the first 5 days after related living-donor KT, given its good correlation with SCr and GFR.
Collapse
Affiliation(s)
- Escarramán Martínez Diego
- Department of Anesthesia, Centro Medico Nacional Hospital de Especialidades "La Raza," IMSS, Mexico City, Mexico.
| | - Monserrat Fernández Bravo
- Department of Anesthesia, Centro Medico Nacional Hospital de Especialidades "La Raza," IMSS, Mexico City, Mexico
| | - Ashuin Kammar Garcia
- Dirección de Investigación, Instituto Nacional de Geriatría, Mexico City, Mexico
| | | | - Emilio Cendejas Rios
- Department of Anesthesia, Unidad Medica de Especialidad No. 25 IMSS, Monterrey, Nuevo León, Mexico
| | | | - Héctor David Meza Comparan
- Department of Neurocritical Care Surgery, University of Florida Health, Gainesville, Florida, United States of America
| | - Javier Mancilla-Galindo
- Postgraduate Division, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Lorena Noriega Salas
- Department of Transplantation, Centro Medico Nacional Hospital de Especialidades "La Raza," IMSS, Ciudad de México, México
| | - Germán Bernaldez Gómez
- Department of Transplantation, Centro Medico Nacional Hospital de Especialidades "La Raza," IMSS, Ciudad de México, México
| | | |
Collapse
|
2
|
Bellini MI, Nozdrin M, Pengel L, Knight S, Papalois V. Risks for donors associated with living kidney donation: meta-analysis. Br J Surg 2022; 109:671-678. [PMID: 35612960 PMCID: PMC10364766 DOI: 10.1093/bjs/znac114] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/30/2021] [Accepted: 03/21/2022] [Indexed: 08/02/2023]
Abstract
BACKGROUND Living kidney donation risk is likely to differ according to donor's demographics. We aimed to analyse the effects of age, sex, body mass index (BMI) and ethnicity. METHODS A systematic review and meta-analysis was undertaken of the effects of preoperative patient characteristics on donor kidney function outcomes, surgical complications, and hypertension. RESULTS 5129 studies were identified, of which 31 met the inclusion criteria, mainly from the USA and Europe. The estimated glomerular filtration rate (eGFR) in donors aged over 60 years was a mean of 9.54 ml per min per 1.73 m2 lower than that of younger donors (P < 0.001). Female donors had higher relative short- and long-term survival. BMI of over 30 kg/m2 was found to significantly lower the donor's eGFR 1 year after donation: the eGFR of obese donors was lower than that of non-obese patients by a mean of -2.70 (95 per cent c.i. -3.24 to -2.15) ml per min per 1.73 m2 (P < 0.001). Obesity was also associated with higher blood pressure both before and 1 year after donation, and a higher level of proteinuria, but had no impact on operative complications. In the long term, African donors were more likely to develop end-stage renal disease than Caucasians. CONCLUSION Obesity and male sex were associated with inferior outcomes. Older donors (aged over 60 years) have a larger eGFR decline than younger donors, and African donors have a higher incidence of ESRD than Caucasians.
Collapse
Affiliation(s)
- Maria Irene Bellini
- Correspondence to: Maria Irene Bellini, Department of Surgical Sciences, Terza Clinica Chirurgica, Sapienza University, Viale Regina Elena 324, 00161 Roma, Italy (e-mail: )
| | | | - Liset Pengel
- Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Simon Knight
- Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | |
Collapse
|
3
|
Denic A, Rule AD, Gaillard F. Kidney glomerular filtration rate plasticity after transplantation. Clin Kidney J 2022; 15:841-844. [PMID: 35498905 PMCID: PMC9050537 DOI: 10.1093/ckj/sfab267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Indexed: 11/15/2022] Open
Abstract
Since the first living donor kidney transplantation about six decades ago, significant progress has been made in terms of extending allograft survival. However, to date, only a small number of studies have compared the functional changes of the donated kidney to that of the remaining kidney. Although relatively small, the study by Gonzalez Rinne et al. demonstrated the adaptive capacity of the transplanted kidney in 30 donor-recipient pairs. The glomerular filtration rate (GFR) in both donors and recipients was obtained 12 months after transplantation and the authors identified three scenarios: (i) where donors had a higher GFR than recipients; (ii) where donors had a lower GFR than recipients; and (iii) where donors had a similar GFR to recipients. The mechanisms mediating GFR adaptability after kidney transplantation seem to be associated with body surface area (including sex differences in body surface area). Microstructural analysis of human and animal models of renal physiology provides some clues to the physiological adaptation of the transplanted organ. The nephron number from endowment and age-related loss and the adaptive ability for compensatory glomerular hyperfiltration likely play a major role.
Collapse
Affiliation(s)
- Aleksandar Denic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | | |
Collapse
|
4
|
Yılmaz VT, Tulum G, Dandin Ö, Kısaoğlu A, Cüce F, Ergin T, Özel D, Demiryılmaz İ, Koçak H, Aydınlı B, Osman O. Comparison of tomographic kidney volumes measured by semi-automatic segmentation method with scintigraphic split renal function in predicting posttransplant kidney functions. Clin Physiol Funct Imaging 2022; 42:250-259. [PMID: 35377515 DOI: 10.1111/cpf.12754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/16/2022] [Accepted: 03/28/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In this study, it was aimed to compare scintigraphic split renal function (SRF) and computed tomographic (CT) kidney volumes by semi-automatic segmentation method in predicting graft functions after kidney transplantation. METHODS 112 patients (77 males, 35 females) who had a living donor kidney transplant between 2015 and 2017 in our center were included in the study. While SRF was calculated with technetium-99m-diethylenetriaminepentaacetic acid (99m Tc-DTPA) scintigraphy, CT angiography was used for volumetric calculations. RESULTS CT-volumetric measurements, especially renal cortical volume (RCV:103.8 ± 20 mL) and ratio to body mass index (RCV/BMI:4.45±1.3) were found to be more significant than 99m Tc-DTPA-SRF in predicting graft functions. The correlations between SRF and RCV with 6th month eGFR (rSRF:0.052, rRCV:0.317, p=0.041) and 1st year eGFR (rSRF:0.104, rRCV:0.374, p=0.033) were found to be more significant in favor of RCV. The correlation between SRF/BMI and RCV/BMI with 1st, 6th and 12th month eGFR (respectively, p=0.02/0.048/0.024) were found to be more significant in favor of RCV/BMI. Although univariate analysis showed a significant relationship between most volumetric measurements and 1st year graft functions, in multivariate analysis only RCV (OR: 1.04(1.01-1.07), p=0.023) and RCV/BMI (OR: 2.5(1.27-5.39), p=0.013) showed a significant relationship between graft functions. CONCLUSION In our study, it was shown that CT-based renal volumetric measurements, especially RCV and RCV/BMI, predicted graft functions more strongly than scintigraphic 99m Tc-DTPA-SRF. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Vural Taner Yılmaz
- Akdeniz University Medical School, Department of Internal Medicine, Division of Nephrology, Antalya/TURKEY
| | - Gökalp Tulum
- Nisantasi University, Engineering and Architacture Faculty, Department of Mechatronics Engineering, Istanbul/TURKEY
| | - Özgür Dandin
- Akdeniz University Medical School, Department of General Surgery, Antalya/TURKEY
| | - Abdullah Kısaoğlu
- Akdeniz University Medical School, Department of General Surgery, Antalya/TURKEY
| | - Ferhat Cüce
- Health Sciences University Gulhane Training and Research Hospital, Department of Radiology, Ankara/TURKEY
| | - Tuncer Ergin
- Health Sciences University Gulhane Training and Research Hospital, Department of Radiology, Ankara/TURKEY
| | - Deniz Özel
- Akdeniz University Medical School, Department of Biostatistics and Medical Informatics, Antalya/TURKEY
| | - İsmail Demiryılmaz
- Akdeniz University Medical School, Department of General Surgery, Antalya/TURKEY
| | - Hüseyin Koçak
- Akdeniz University Medical School, Department of Internal Medicine, Division of Nephrology, Antalya/TURKEY
| | - Bülent Aydınlı
- Akdeniz University Medical School, Department of General Surgery, Antalya/TURKEY
| | - Onur Osman
- 6Nisantasi University, Engineering and Architacture Faculty, Depatment of Electrical and Electronics Engineering, Istanbul/TURKEY
| |
Collapse
|
5
|
Rinne AG, Sorensen CA, Lima SL, Gil MG, Mena NN, Martín LD, Ramírez A, Morales A, Vega N, Gallego E, Izquierdo EM, Cabello E, Rodríguez AER, González JP, Escamilla B, Cruz C, Tamajón LP, Ramírez AT, Gaspari F, Ortiz A, Porrini E. OUP accepted manuscript. Clin Kidney J 2022; 15:885-894. [PMID: 35498883 PMCID: PMC9050540 DOI: 10.1093/ckj/sfab220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Indexed: 11/22/2022] Open
Abstract
Background In living kidney transplantation there are two different individuals, a healthy donor and a renal transplant recipient. This is an excellent human model to study factors that influence kidney function in the context of reduced renal mass and the adaptation of two comparable kidneys to different metabolic demands. Methods We analyzed the changes in measured glomerular filtration rate (GFR, iohexol) from pretransplantation to 12 months after transplantation in 30 donor–recipient pairs. Each donor was compared with his/her recipient. We defined a priori three different groups based on GFR differences at 12 months: donor > recipient (Group A; 78 ± 8 versus 57 ± 8 mL/min), donor < recipient (Group B; 65 ± 11 versus 79 ± 11 mL/min) and donor ≈ recipient (Group C; 66 ± 7 versus 67 ± 7 mL/min). Other factors like donor/recipient mismatches in body mass index (BMI), surface area and gender were evaluated. Results In Group A donors were mostly male and recipients were female (75% each). Donors had a higher baseline weight than their recipients. During follow-up, weight remained stable in donors but increased 7% in recipients. In Group B donors were mostly female (60%) and recipients male. At baseline, donors had a lower weight than recipients. At 12 months, weight was stable in donors but increased in recipients. In Group C donors were mostly (75%) female and recipients male. At baseline, donors had a higher BMI than their recipients. At 12 months, BMI was stable in donors but increased 14% in recipients. In multivariable analysis, higher GFR at 12 months was associated with higher baseline weight and GFR in donors and with male gender and higher baseline weight in recipients. Conclusions Kidneys from living donors are more ‘plastic’ than originally thought and respond to metabolic demands and weight changes of their new host. These changes should be taken into account when assessing GFR outcomes in this population.
Collapse
Affiliation(s)
- Ana González Rinne
- Department of Nephrology, University Hospital of the Canary Islands, Tenerife, Spain
| | | | - Sergio Luis Lima
- IIS-Fundación Jiménez Diaz, Department of Medicine, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Marta Gómez Gil
- Radiology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - Natalia Negrín Mena
- Research Unit Department, Unidad de Investigación Clínica y Ensayos Clínicos, Hospital Universitario de Canarias, Tenerife, Spain
- LFR Laboratorio de Función Renal, Universidad de La Laguna, Tenerife, Spain
| | - Laura Díaz Martín
- Research Unit Department, Unidad de Investigación Clínica y Ensayos Clínicos, Hospital Universitario de Canarias, Tenerife, Spain
- LFR Laboratorio de Función Renal, Universidad de La Laguna, Tenerife, Spain
| | - Ana Ramírez
- Nephrology Department, Hospital Universitario Insular, Las Palmas de Gran Canaria, Spain
| | - Adelaida Morales
- Nephrology Department, Hospital General de Lanzarote, Arrecife, Spain
| | - Nicanor Vega
- Nephrology Department, Hospital Universitario Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Eduardo Gallego
- Nephrology Department, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
| | | | - Elisa Cabello
- Nephrology Department, Hospital General de La Palma, Santa Cruz de La Palma, Spain
| | | | | | - Beatriz Escamilla
- Department of Nephrology, University Hospital of the Canary Islands, Tenerife, Spain
| | - Coriolano Cruz
- Research Unit Department, Unidad de Investigación Clínica y Ensayos Clínicos, Hospital Universitario de Canarias, Tenerife, Spain
- LFR Laboratorio de Función Renal, Universidad de La Laguna, Tenerife, Spain
| | - Lourdes Pérez Tamajón
- Department of Nephrology, University Hospital of the Canary Islands, Tenerife, Spain
| | - Armando Torres Ramírez
- Department of Nephrology, University Hospital of the Canary Islands, Tenerife, Spain
- Internal Medicine Department, Universidad de La Laguna, ITB Instituto de Tecnologías Biomédicas, Tenerife, Spain
| | - Flavio Gaspari
- LFR Laboratorio de Función Renal, Universidad de La Laguna, Tenerife, Spain
| | - Alberto Ortiz
- IIS-Fundación Jiménez Diaz, Department of Medicine, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Red de Investigación Renal, Instituto Carlos III-FEDER, Madrid, Spain
| | | |
Collapse
|
6
|
Impact of Age Difference, Sex Matching, and Body Mass Index Matching Between Donor and Recipient in Renal Transplant. Transplant Proc 2019; 51:2568-2574. [DOI: 10.1016/j.transproceed.2019.05.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 05/23/2019] [Accepted: 05/29/2019] [Indexed: 01/08/2023]
|
7
|
Thölking G, Schuette-Nuetgen K, Vogl T, Dobrindt U, Kahl BC, Brand M, Pavenstädt H, Suwelack B, Koch R, Reuter S. Male kidney allograft recipients at risk for urinary tract infection? PLoS One 2017; 12:e0188262. [PMID: 29145515 PMCID: PMC5690643 DOI: 10.1371/journal.pone.0188262] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 11/05/2017] [Indexed: 12/31/2022] Open
Abstract
Background Urinary tract infection (UTI) is the most common infection after renal transplantation (RTx). Although female sex is a well-known risk factor for the development of UTI after RTx, the role of the donor sex in this context remains unclear. Methods In this case control study 6,763 RTx cases were screened for UTI when presenting at our transplant outpatient clinics. 102 different RTx patients fulfilled the inclusion criteria and were compared to 102 controls. Data on renal function was prospectively followed for 12 months. Results were compared to a previous RTx cohort from our transplant center. Additionally, we assessed the immunological response of leukocytes from 58 kidney recipients and 16 controls to lipopolysaccharide stimulation. Result After identification by univariate analysis, multivariate logistic regression analysis indicated female sex, minor height, advanced age and male kidney allograft sex to be associated with the occurrence of UTI after RTx. Female recipients who received male grafts had the best renal function 12 months after presentation. However, leukocyte response of recipients to lipopolysaccharide was impaired irrespective of donor and recipient sex to the same extend. Conclusions We conclude from our data that male kidney allografts are associated with the occurrence of UTI after RTx but did not influence the response of leukocytes to lipopolysaccharide. Further prospective studies are needed to identify the underlying mechanisms of higher male kidney donor dependent UTI.
Collapse
Affiliation(s)
- Gerold Thölking
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital Münster, Münster, Germany
- * E-mail:
| | - Katharina Schuette-Nuetgen
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital Münster, Münster, Germany
| | - Thomas Vogl
- Institute of Immunology, University of Münster, Münster, Germany
| | - Ulrich Dobrindt
- Institute of Hygiene, University of Münster, Münster, Germany
| | - Barbara C. Kahl
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Marcus Brand
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital Münster, Münster, Germany
| | - Hermann Pavenstädt
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital Münster, Münster, Germany
| | - Barbara Suwelack
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital Münster, Münster, Germany
| | - Raphael Koch
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Stefan Reuter
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital Münster, Münster, Germany
| |
Collapse
|
8
|
Matter YE, Elhadedy MA, Abbas TM, Zahab MA, Fouda MA, Refaie AF, Sheashaa HA, Abbas MH, Denewar AA, Nagib AM. Impact of Sex Disparities on Outcomes of Living-Donor Kidney Transplant in Egypt: Data of 979 Patients. EXP CLIN TRANSPLANT 2017; 16:133-137. [PMID: 28760116 DOI: 10.6002/ect.2016.0253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Renal transplant is the criterion standard for treatment of end-stage renal disease. The effects of disparities between men and women on renal transplant outcomes have been evaluated in many studies but with debatable results. It has been suggested that female kidney donors have poor outcomes after transplant compared with male kidney donors, especially when implanted in a male recipient. The aim of the study was to evaluate the effects of sex on living-donor kidney transplant outcome. MATERIALS AND METHODS The data of 979 patients who underwent living-donor kidney transplant from January 2000 to December 2010 at a single center were reviewed retrospectively. The patients were divided into 4 groups according to recipient and donor sex: male donor-to-male recipient (n = 307), male donor-to-female recipient (n = 132), female donor-to-male recipient (n = 411), and female donor-to-female recipient (n = 129). We compared the demographic characteristics, posttransplant rejection and complications, and graft and patient survival rates among the groups. RESULTS Male recipients were older than female recipients, whereas male donors were younger than female donors (P < .001). No statistically significant differences were shown regarding recipient body mass index, ischemia time and time to diuresis, and acute and chronic rejection rates between the groups. Graft (P = .947) and patient (P = .421) survival rates were comparable between groups. CONCLUSIONS Donor and recipient sex had no significant effect on outcomes of living-donor renal allograft recipients.
Collapse
Affiliation(s)
- Yasser Elsayed Matter
- From the Nephrology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Kulah E, Ozcelik U, Isiklar I, Cevik H, Bircan HY, Y Karakayali F, Haberal M. Influence of Various Living Donor Kidney Measurements in Relation to Recipient Body Measurements on Posttransplant Allograft Functional Outcomes. EXP CLIN TRANSPLANT 2016; 16:266-273. [PMID: 27356006 DOI: 10.6002/ect.2015.0353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Donor kidney measurements may affect outcomes of transplanted allografts. We tested allograft and recipient measurements on kidney allograft outcomes. In this study, we compared the effects of kidney allograft volumes, which were measured using computed tomographic angiography before transplant, and allograft weight, which was measured during surgery, in relation to the recipient's body weight and body mass index on kidney function at 6 and 12 months after transplant. MATERIAL AND METHODS We included 74 patients (40 female and 34 male patients, mean age of 50.42 ± 9.75 y) in this study. RESULTS Intraoperative allograft weight was 182.68 ± 40.33 g (range, 104-266 g). The allograft volume measured using computed tomographic angiography scanning was 123.34 ± 24.26 mL (range, 78-181 mL). The estimated glomerular filtration rates of the recipients at 6 and 12 months after transplant correlated negatively with age and recipient body mass index but correlated positively with allograft volume/recipient body weight, allograft volume/recipient body mass index, allograft weight, allograft weight/recipient body weight, and allograft weight/recipient body mass index values, as concluded by univariate analyses. From multivariate analyses, we found variables of interest presumed to significantly affect the 12-month estimated glomerular filtration rates, including recipient age, allograft volume/recipient body weight, allograft volume/recipient body mass index, allograft weight, allograft weight/recipient body weight, and allograft weight/recipient body mass index. CONCLUSIONS Transplanted allograft and recipient body values may be used as predictors of estimated glomerular filtration rates 6 and 12 months after transplant.
Collapse
Affiliation(s)
- Eyup Kulah
- >From the Department of Nephrology, Baskent University School of Medicine, Uskukar, Istanbul, Turkey
| | | | | | | | | | | | | |
Collapse
|
10
|
What Should the Serum Creatinine Be After Transplantation? An Approach to Integrate Donor and Recipient Information to Assess Posttransplant Kidney Function. Transplantation 2015; 99:1960-7. [DOI: 10.1097/tp.0000000000000622] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
11
|
Kwakernaak AJ, Toering TJ, Navis G. Body mass index and body fat distribution as renal risk factors: a focus on the role of renal haemodynamics. Nephrol Dial Transplant 2014; 28 Suppl 4:iv42-9. [PMID: 24179015 DOI: 10.1093/ndt/gft331] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Weight excess and/or central body fat distribution are associated with increased long-term renal risk, not only in subjects with renal disease or renal transplant recipients, but also in the general population. As the prevalence of weight excess is rising worldwide, this may become a main renal risk factor on a population basis, even more so because the risk extends to the overweight range. Understanding the mechanisms of this detrimental effect of weight excess on the kidneys is needed in order to design preventive treatment strategies. The increased risk associated with weight excess is partly attributed to associated comorbid conditions, such as hypertension, dyslipidaemia, insulin resistance and diabetes; however, current evidence supports a direct pathogenetic role for renal haemodynamics as well. Weight excess is associated with an altered renal haemodynamic profile, i.e. an increased glomerular filtration rate relative to effective renal plasma flow, resulting in an increased filtration fraction (FF). This renal haemodynamic profile is considered to reflect glomerular hyperfiltration and glomerular hypertension, resulting from a dysbalance between afferent and efferent arterial vasomotor balance. This unfavorable renal haemodynamic profile was found to be associated with renal outcome in experimental models and in human renal transplant recipients, and is associated with a blunted sodium excretion, and reversible by weight loss, renin-angiotensin-aldosterone system blockade or by dietary sodium restriction. More recent evidence showed that a central body fat distribution is also associated with an increased FF, even independent of overall weight excess. In this review, we provide an overview on current literature on the impact of weight excess and central body fat distribution on the renal haemodynamic profile in humans, and its possible role in progressive renal damage.
Collapse
Affiliation(s)
- Arjan J Kwakernaak
- Division of Nephrology, Department of Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | | |
Collapse
|
12
|
Puelles VG, Douglas-Denton RN, Zimanyi MA, Armitage JA, Hughson MD, Kerr PG, Bertram JF. Glomerular hypertrophy in subjects with low nephron number: contributions of sex, body size and race. Nephrol Dial Transplant 2014; 29:1686-95. [PMID: 24792374 DOI: 10.1093/ndt/gfu088] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND We have shown that low nephron number (Nglom) is a strong determinant of individual glomerular volume (IGV) in male Americans. However, whether the same pattern is present in female Americans remains unclear. The contributions of body surface area (BSA) and race to IGV in the context of Nglom also require further evaluation. METHODS Kidneys without overt renal disease were collected at autopsy in Mississippi, USA. The extremes of female Nglom were used to define high and low Nglom for both sexes. Nglom and IGV were estimated by design-based stereology. A total of 24 African and Caucasian American females (n = 12 per race; 6 per Nglom extreme) were included. These subjects were subsequently matched to 24 comparable males by age and Nglom and to 18 additional males by age, Nglom and BSA. RESULTS IGV average and variance were very similar in female African and Caucasian Americans with high and low Nglom. Males with low Nglom from both races showed greater IGV average and variance than comparable females matched by age and Nglom. These differences in IGV between sexes were not observed in Caucasian Americans with low Nglom that were matched by age, Nglom and BSA. In contrast, glomeruli from African Americans were larger than those from Caucasian Americans, especially in subjects with high Nglom. CONCLUSIONS While female Americans with low Nglom did not show glomerular hypertrophy, comparable males with low Nglom showed marked glomerular hypertrophy that was closely associated with high BSA. Glomerular size in African Americans may be confounded by multiple additional factors.
Collapse
Affiliation(s)
- Victor G Puelles
- Department of Anatomy and Developmental Biology, Monash University, Melbourne, Australia
| | | | - Monika A Zimanyi
- Department of Anatomy and Developmental Biology, Monash University, Melbourne, Australia Department of Anatomy and Pathology, James Cook University, Townsville, Australia
| | - James A Armitage
- Department of Anatomy and Developmental Biology, Monash University, Melbourne, Australia School of Medicine (Optometry), Deakin University, Geelong, Australia
| | - Michael D Hughson
- Department of Pathology, University of Mississippi Medical Center, Jackson, USA
| | - Peter G Kerr
- Department of Nephrology, Monash Health, Melbourne, Australia Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - John F Bertram
- Department of Anatomy and Developmental Biology, Monash University, Melbourne, Australia
| |
Collapse
|
13
|
Donor and recipient size mismatch in adolescents undergoing living-donor renal transplantation affect long-term graft survival. Transplantation 2013; 96:555-9. [PMID: 23838999 DOI: 10.1097/tp.0b013e31829d672c] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Controversies exist in the adult literature regarding the use of kidneys from small donors into larger recipients. Little is known regarding this issue in pediatric kidney transplantation. To assess the impact of donor/recipient size mismatch on long-term renal graft survival in pediatric patients undergoing living-donor renal transplantation. METHODS We reviewed the United Network for Organ Sharing database from 1987 to 2010 for adolescent (11-18 years old) patients who underwent primary living-donor renal transplantation. According to donor/recipient body surface area (BSA) ratio, patients were stratified into two categories: BSA ratio <0.9 and ≥0.9. Graft survival rates were compared between these two groups using Kaplan-Meier survival curves and Cox proportional hazards models. RESULTS Of the 1880 patients identified, 116 (6.2%) had a donor/recipient BSA ratio <0.9 and 1764 (93.8%) had a donor/recipient BSA ratio ≥0.9 group. BSA ratio <0.9 conferred an increased risk of graft loss (adjusted hazard ratio, 1.61; 95% confidence interval, 1.13-2.27; P=0.008). Patients with a donor/recipient BSA ratio ≥0.9 group had a significantly longer graft survival compared with those with a donor/recipient BSA ratio <0.9 after adjustment for donor age and gender, recipient age, gender, ethnicity, cause of renal failure, as well as clinical factors, such as cold and warm ischemia time and HLA mismatch. CONCLUSION We conclude that low donor/recipient BSA ratio was associated with an increased risk of graft loss. Appropriate size matching conferred better long-term graft survival in adolescents receiving live-donor kidney transplants.
Collapse
|
14
|
Halleck F, Diederichs G, Koehlitz T, Slowinski T, Engelken F, Liefeldt L, Friedersdorff F, Fuller TF, Magheli A, Neumayer HH, Budde K, Waiser J. Volume matters: CT-based renal cortex volume measurement in the evaluation of living kidney donors. Transpl Int 2013; 26:1208-16. [PMID: 24118327 DOI: 10.1111/tri.12195] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 07/21/2013] [Accepted: 09/15/2013] [Indexed: 01/12/2023]
Abstract
Currently, no international standard for the pre-transplant evaluation of living donor renal function exists. Following a standardized questionnaire on current practice in all Eurotransplant (ET) centers, we compared a new CT-based technique to measure renal cortex volume with our standard of DTPA-clearance combined with MAG3-scintigraphy (DTPA × MAG3) and with creatinine-based methods in 167 consecutive living kidney donors. Most ET centers use creatinine-clearance (64%) to measure total renal function and radioistopic methods (82%) to assess split renal function. Before transplantation, CT-measured total cortex volume (r = 0.67; P < 0.001) and estimated GFR using the Cockcroft-Gault formula [eGFR(CG)] (r = 0.55; P < 0.001) showed the strongest correlation with DTPA-clearance. In contrast, the correlation between DTPA-clearance and creatinine clearance was weak (r = 0.21; P = 0.02). A strong correlation was observed between CT-measured split cortex volume and MAG3-measured split renal function (r = 0.93; P < 0.001). A strong correlation was also found between pre-transplant split renal function assessed by eGFR(CG) together with cortex volume measurement and post-transplant eGFR(CG) of both, the donor (r = 0.83; P < 0.001) and the recipient (r = 0.75; P < 0.001). In conclusion CT-based assessment of renal cortex volume bears the potential to substitute existing methods to assess pre-transplant living donor split renal function.
Collapse
Affiliation(s)
- Fabian Halleck
- Department of Nephrology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Choi J, Kwon O. Is the Graft Function of Living Donor Renal Transplants Associated With Renal Mass Matching by Computed Tomography Angiographic Volumetry? Transplant Proc 2013; 45:2919-24. [DOI: 10.1016/j.transproceed.2013.08.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|
16
|
Vavallo A, Lucarelli G, Spilotros M, Bettocchi C, Palazzo S, Selvaggi FP, Battaglia M, Ditonno P. Impact of donor-recipient gender on kidney graft and patient survival: short- and long-term outcomes. World J Urol 2013; 32:709-14. [PMID: 23907660 DOI: 10.1007/s00345-013-1137-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 07/20/2013] [Indexed: 01/24/2023] Open
Abstract
PURPOSE Donor and recipient gender influence on post-transplant kidney and patient survival is still controversial, and the literature data do not present unanimous conclusions. The aim of this study was to evaluate the effect of gender disparities between donor and recipient in 963 kidney transplants performed at our center from January 2000 to December 2010. METHODS The patients were subdivided into four groups according to recipient and donor gender: male donor-to-male recipient (MDMR; n = 305), male donor-to-female recipient (MDFR; n = 203), female donor-to-female recipient (FDFR; n = 206), and female donor-to-male recipient (FDMR; n = 249). Independent sample's t test and one-way ANOVA were used for statistical analyses. Graft and patient survival were calculated by the Kaplan-Meier method and compared using the log rank test. RESULTS There were no statistically significant differences between the groups with regard to age, cold ischemia time, delayed graft function, primary non-function, and episodes of acute and chronic rejection. Moreover, no difference in either graft (p = 0.92) or patient (p = 0.41) survival at 1, 3, and 5 years was observed. However, female recipients had significantly lower serum creatinine values and higher estimated GFR, particularly if they received a male donor kidney, and these findings were stable up to 3-year post-transplantation. CONCLUSIONS No impact of gender on short- or long-term graft and patient survival was observed in deceased kidney transplantation. However, we report a lower creatinine level in the male donors to female recipients group as compared with other recipient-donor gender combinations, although this difference loses statistical significance after the third-year post-transplantation.
Collapse
Affiliation(s)
- Antonio Vavallo
- Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation (DETO), University of Bari, Piazza G. Cesare 11, 70124, Bari, Italy
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Mueller TF, Luyckx VA. The Natural History of Residual Renal Function in Transplant Donors. J Am Soc Nephrol 2012; 23:1462-6. [DOI: 10.1681/asn.2011111080] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|