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Yang SM, Song SE, Jung JY, Ju JW, Sohn JY, Lee HJ, Kim WH. Comparison of two different preload targets of stroke volume variation during kidney transplantation: a randomised controlled trial. Singapore Med J 2024:00077293-990000000-00146. [PMID: 39267428 DOI: 10.4103/singaporemedj.smj-2023-150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 09/13/2024] [Indexed: 09/17/2024]
Abstract
INTRODUCTION Maintaining adequate preload during kidney transplantation (KT) is important for graft function. We evaluated whether a high or low normal target for a dynamic preload index of stroke volume variation (SVV) would impact graft function during living donor KT. METHODS We compared haemodynamic management algorithms using two different targets of SVV: SVV6% group (n = 30) versus SVV12% group (n = 30). Crystalloids were administered to achieve SVV less than the assigned target. Neutrophil gelatinase-associated lipocalin (NGAL) level at the end of surgery was compared. We also compared the incidence of delayed graft function (DGF), daily serum creatinine level and glomerular filtration rate (GFR) until 2 weeks postoperatively. RESULTS The total amount of crystalloids administered was significantly different between the SVV6% and SVV12% groups (median [interquartile range] 2,250 [1,700-3,600] vs. 1,350 [1,050-1,900], P < 0.001). There was no significant difference in NGAL level at the end of the operation between the SVV6% and SVV12% groups (395 [234-560] vs. 518 [346-654], P = 0.115). The incidence of DGF was not significantly different, and there was no significant difference in the postoperative serum creatinine levels or GFR between the groups. CONCLUSIONS Our randomised trial demonstrated that an SVV target of either 6% or 12% could be adequate as a preload management target for postoperative graft function during living donor KT. However, given the low incidence of DGF in living donor KT and type II error, our study should be interpreted carefully and further studies for deceased donor KT are required.
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Affiliation(s)
- Seong-Mi Yang
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Seung Eun Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji-Yoon Jung
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae-Woo Ju
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Young Sohn
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ho-Jin Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Won Ho Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Doerr JM, Juenemann M, Becker A, Nahrgang C, Rainer L, Liese J, Hecker A, Wolter M, Weimer R, Karakizlis H. Cognitive profile of kidney transplant patients and impact of deceased vs. living donor transplantation. J Nephrol 2024:10.1007/s40620-024-02004-8. [PMID: 38990265 DOI: 10.1007/s40620-024-02004-8] [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: 01/26/2024] [Accepted: 06/10/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND It is important to learn more about the prevalence, severity and characteristics (i.e., which cognitive abilities are especially affected) of cognitive impairment in kidney transplant patients. Furthermore, the impact of living vs. deceased donor renal transplantation on cognitive outcome in this patient group needs further studies. METHODS Fifty-nine patients (43 men, age 55 ± 13 years) who received a deceased donor or living donor kidney transplant, completed a comprehensive neuropsychological test assessment. Neuropsychological tests explored the cognitive domains of verbal and visual memory, attention, and executive functions. RESULTS Fifteen percent of the patients had mild, 25% moderate, and 15% severe cognitive impairment. The level of domain-specific cognitive deficit differed between verbal memory, attention, and executive functions (χ2(2) = 7.11, p = 0.029). On average, patients showed the highest deficit in executive functions, and the lowest deficit in verbal memory. Patients who received a kidney graft from a deceased donor were more likely to have a cognitive impairment than those who received a kidney graft from a living donor (OR = 3.03, 95% CI [0.99,9.32], Wald χ2(1) = 3.74, p = 0.053). This effect was independent of time on dialysis as well as of creatinine levels, or creatinine clearance. CONCLUSIONS Our results show that in kidney transplant patients with cognitive impairment, the cognitive domain of executive functions is the most affected one. This might be detrimental for quality of life. The fact that patients who received living donor kidneys seem to do better in terms of cognition than patients with deceased donor kidneys deserves more attention in future research.
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Affiliation(s)
- Johanna Marie Doerr
- Department of Neurology, Justus-Liebig-University of Giessen, Giessen, Germany.
| | - Martin Juenemann
- Department of Neurology, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Anna Becker
- Department of Internal Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Christian Nahrgang
- Department of Internal Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Lucy Rainer
- Department of Internal Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Juliane Liese
- Department of General, Visceral, Thoracic, and Transplant Surgery, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Andreas Hecker
- Department of General, Visceral, Thoracic, and Transplant Surgery, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Martin Wolter
- Department of Internal Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Rolf Weimer
- Department of Internal Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Hristos Karakizlis
- Department of Internal Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
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Egli H, Burla N, Breuer E, Baron C, Hübel K, de Rougemont O, Seeger H, Vetter D. Persisting Hypercalcemia and Hyperparathyroidism after Kidney Transplantation Have a Negative Impact on Graft and Patient Survival. Diagnostics (Basel) 2024; 14:1358. [PMID: 39001249 PMCID: PMC11240723 DOI: 10.3390/diagnostics14131358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 06/12/2024] [Accepted: 06/20/2024] [Indexed: 07/16/2024] Open
Abstract
Hyperparathyroidism (HPT) with hypercalcemia, often deemed irreversible and detrimental to graft survival post-kidney transplantation (KT), prompts pre-transplant parathyroidectomy in hypercalcemic patients. In this retrospective analysis of 1212 kidney transplant recipients (KTRs) between 2006 and 2019, the incidence and effect of persistent HPT and hypercalcemia on graft and patient survival, and risk factors for persistence were analyzed until 60 months of follow up (FU). At KT, 5.7% (n = 69) had no HPT, 32.7% (n = 396) had HPT without hypercalcemia and 37.0% (n = 448) had HPT with hypercalcemia. At 2 years FU, 26.4% (n = 320) of patients had no HPT and 6% (n = 73) had HPT with hypercalcemia. Dialysis and dialysis duration were linked to HPT development, while dialysis, KT waiting time and donor type correlated with persisting hypercalcemia after KT. KTRs with normalized PTH and recovered hypercalcemia had improved death-censored graft survival (p < 0.001) and overall patient survival (p < 0.001). HPT with hypercalcemia is frequent at time of KT with normalization of PTH and calcium in a substantial proportion of patients after a KT. These findings question the routine pre-KT parathyroidectomy for suspected parathyroid autonomy. Persisting HPT, especially with hypercalcemia, adversely affects graft and patient survival, suggesting the need for more aggressive treatment of HPT, especially in cases of persisting hypercalcemia.
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Affiliation(s)
- Hannes Egli
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland; (H.E.); (N.B.)
| | - Naomi Burla
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland; (H.E.); (N.B.)
| | - Eva Breuer
- Department of Visceral and Transplant Surgery, University Hospital Zurich, 8032 Zurich, Switzerland; (E.B.); (C.B.); (O.d.R.)
| | - Camilla Baron
- Department of Visceral and Transplant Surgery, University Hospital Zurich, 8032 Zurich, Switzerland; (E.B.); (C.B.); (O.d.R.)
| | - Kerstin Hübel
- Department of Nephrology, University Hospital Zurich, 8091 Zurich, Switzerland; (K.H.); (H.S.)
| | - Olivier de Rougemont
- Department of Visceral and Transplant Surgery, University Hospital Zurich, 8032 Zurich, Switzerland; (E.B.); (C.B.); (O.d.R.)
| | - Harald Seeger
- Department of Nephrology, University Hospital Zurich, 8091 Zurich, Switzerland; (K.H.); (H.S.)
| | - Diana Vetter
- Department of Visceral and Transplant Surgery, University Hospital Zurich, 8032 Zurich, Switzerland; (E.B.); (C.B.); (O.d.R.)
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Barbosa ACS, Mauroner LG, Kumar J, Sims-Lucas S. Delayed graft function post renal transplantation: a review on animal models and therapeutics. Am J Physiol Renal Physiol 2023; 325:F817-F825. [PMID: 37855040 PMCID: PMC10878700 DOI: 10.1152/ajprenal.00146.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023] Open
Abstract
The incidence of end-stage renal disease (ESRD) has been increasing worldwide. Its treatment involves renal replacement therapy, either by dialyses or renal transplantation from a living or deceased donor. Although the initial mortality rates for patients on dialysis are comparable with kidney transplant recipients, the quality of life and long-term prognosis are greatly improved in transplanted patients. However, there is a large gap between availability and need for donor kidneys. This has led to the increase in the use of expanded kidney donor criteria. Allograft dysfunction immediately after transplant sets it up for many complications, such as acute rejection and shorter allograft survival. Delayed graft function (DGF) is one of the immediate posttransplant insults to the kidney allograft, which is increasing in prevalence due to efforts to maximize the available donor pool for kidneys and use of expanded kidney donor criteria. In this review, we discuss the risk factors for DGF, its implications for long-term allograft survival, animal models of DGF, and the therapeutic options currently under evaluation for prevention and management of DGF.
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Affiliation(s)
- Anne C S Barbosa
- Division of Nephrology, Department of Pediatrics, University of Pittsburgh, UPMC Children's Hospital, Pittsburgh, Pennsylvania, United States
| | - Lillian G Mauroner
- Division of Nephrology, Department of Pediatrics, University of Pittsburgh, UPMC Children's Hospital, Pittsburgh, Pennsylvania, United States
| | - Juhi Kumar
- Division of Nephrology, Department of Pediatrics, University of Pittsburgh, UPMC Children's Hospital, Pittsburgh, Pennsylvania, United States
| | - Sunder Sims-Lucas
- Division of Nephrology, Department of Pediatrics, University of Pittsburgh, UPMC Children's Hospital, Pittsburgh, Pennsylvania, United States
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García-Sobrino R, Vazquez-Martul D, Fernández-Rivera C, López-Muñiz A, Balboa-Barreiro V, Suárez-Pascual G, Díaz-Reixa JLP, Chantada-Abal V. Postoperative Events in Incompatible Living Donor Kidney Transplant Recipients Undergoing Prior Desensitization. Transplant Proc 2023; 55:1575-1580. [PMID: 37455168 DOI: 10.1016/j.transproceed.2023.04.047] [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: 03/09/2023] [Accepted: 04/14/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Living donor kidney transplantation (LDKT) is one of the best options for patients with chronic renal failure, but approximately one-third of cases are limited by incompatibility ABO and/or HLA between recipient and donor. This study aims to analyze the surgical complications and bleeding events presented in ABO-incompatible (ABOi) and HLA-incompatible (HLAi) patients within a pre-transplant desensitization program compared with ABO-compatible (ABOc) recipients. MATERIAL AND METHODS We performed a retrospective analysis of ABOi and HLAi recipients undergoing LKDT between 2009 and 2019, resulting in a total of 62 patients that we compared with the same number of ABOc performed consecutively before 2019. The following variables were analyzed: surgical complications, presence, size and rate of reintervention of peri-graft hematomas, and number of transfusions received in the postoperative period. RESULTS No statistical differences were shown in donor and recipient age, BMI, or sex; in the case of pre-surgical hematocrit, the ABOi group presented slightly lower figures. In the incompatible group (ABOi + HLAi), we found a greater number of postoperative surgical complications when analyzing the number of hematomas, size, need for surgical reintervention, and the number of blood units transfused; incompatible patients showed higher rates of hematomas, need for surgical reinterventions, and transfused units (P < .05). CONCLUSION Desensitized patients need more transfusions, have a greater number and size of hematomas, and have higher reintervention rates. Although these are present in greater numbers, we did not observe statistically significant differences in the number of surgical complications.
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Affiliation(s)
| | - Dario Vazquez-Martul
- Department of Urology, Complexo Hospitalario Universitario A Coruña, A Coruña, España.
| | | | - Andrés López-Muñiz
- Department of Nephrology, Complexo Hospitalario Universitario A Coruña, A Coruña, España
| | - Vanesa Balboa-Barreiro
- Unit of Biostatistics and Epidemiology, Complexo Hospitalario Universitario A Coruña, A Coruña, España
| | - Germán Suárez-Pascual
- Department of Urology, Complexo Hospitalario Universitario A Coruña, A Coruña, España
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Lv K, Wu Y, Lai W, Hao X, Xia X, Huang S, Luo Z, Lv C, Qing Y, Song T. Simpson's paradox and the impact of donor-recipient race-matching on outcomes post living or deceased donor kidney transplantation in the United States. Front Surg 2023; 9:1050416. [PMID: 36700016 PMCID: PMC9869683 DOI: 10.3389/fsurg.2022.1050416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/15/2022] [Indexed: 01/11/2023] Open
Abstract
Background Race is a prognostic indicator in kidney transplant (KT). However, the effect of donor-recipient race-matching on survival after KT remains unclear. Methods Using the United Network for Organ Sharing (UNOS) database, a retrospective study was conducted on 244,037 adults who received first-time, kidney-alone transplantation between 2000 and 2019. All patients were categorized into two groups according to donor-recipient race-matching, and the living and deceased donor KT (LDKT and DDKT) were analyzed in subgroups. Results Of the 244,037 patients, 149,600 (61%) were race-matched, including 107,351 (87%) Caucasian, 20,741 (31%) African Americans, 17,927 (47%) Hispanics, and 3,581 (25%) Asians. Compared with race-unmatching, race-matching showed a reduced risk of overall mortality and graft loss (unadjusted hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.84-0.87; and unadjusted HR 0.79, 95% CI: 0.78-0.80, respectively). After propensity score-matching, donor-recipient race-matching was associated with a decreased risk of overall graft loss (P < 0.001) but not mortality. In subgroup analysis, race-matching was associated with higher crude mortality (HR 1.12, 95% CI: 1.06-1.20 in LDKT and HR 1.11, 95% CI: 1.09-1.14 in DDKT). However, race-matching was associated with a decreased risk of graft loss in DDKT (unadjusted HR 0.97, 95% CI: 0.96-0.99), but not in LDKT. After propensity score-matching, race-matching had better outcomes for LDKT (patient survival, P = 0.047; graft survival, P < 0.001; and death-censored graft survival, P < 0.001) and DDKT (death-censored graft survival, P = 0.018). Nonetheless, race-matching was associated with an increased adjusted mortality rate in the DDKT group (P < 0.001). Conclusion Race-matching provided modest survival advantages after KT but was not enough to influence organ offers. Cofounding factors at baseline led to a contorted crude conclusion in subgroups, which was reversed again to normal trends in the combined analysis due to Simpson's paradox caused by the LDKT/DDKT ratio.
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Affiliation(s)
- Kaikai Lv
- Department of Urology, The Third Medical Centre, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China,Medical School of Chinese People’s Liberation Army (PLA), Beijing, China
| | - Yangyang Wu
- Department of Urology, The Third Medical Centre, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China,Medical School of Chinese People’s Liberation Army (PLA), Beijing, China
| | - Wenhui Lai
- Department of Postgraduate, Hebei North University, Zhangjiakou, China
| | - Xiaowei Hao
- Department of Urology, The Third Medical Centre, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China,Medical School of Chinese People’s Liberation Army (PLA), Beijing, China
| | - Xinze Xia
- Department of Urology, Shanxi Medical University, Taiyuan, China
| | - Shuai Huang
- Department of Postgraduate, Hebei North University, Zhangjiakou, China
| | - Zhenjun Luo
- Affililated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Chao Lv
- Medical School of Chinese People’s Liberation Army (PLA), Beijing, China
| | - Yuan Qing
- Department of Urology, The Third Medical Centre, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China,Medical School of Chinese People’s Liberation Army (PLA), Beijing, China,Correspondence: Tao Song Qing Yuan
| | - Tao Song
- Department of Urology, The Third Medical Centre, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China,Medical School of Chinese People’s Liberation Army (PLA), Beijing, China,Correspondence: Tao Song Qing Yuan
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7
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Ponticelli C, Reggiani F, Moroni G. Delayed Graft Function in Kidney Transplant: Risk Factors, Consequences and Prevention Strategies. J Pers Med 2022; 12:jpm12101557. [PMID: 36294695 PMCID: PMC9605016 DOI: 10.3390/jpm12101557] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/17/2022] [Accepted: 09/18/2022] [Indexed: 11/24/2022] Open
Abstract
Background. Delayed graft function is a frequent complication of kidney transplantation that requires dialysis in the first week posttransplant. Materials and Methods. We searched for the most relevant articles in the National Institutes of Health library of medicine, as well as in transplantation, pharmacologic, and nephrological journals. Results. The main factors that may influence the development of delayed graft function (DGF) are ischemia–reperfusion injury, the source and the quality of the donated kidney, and the clinical management of the recipient. The pathophysiology of ischemia–reperfusion injury is complex and involves kidney hypoxia related to the duration of warm and cold ischemia, as well as the harmful effects of blood reperfusion on tubular epithelial cells and endothelial cells. Ischemia–reperfusion injury is more frequent and severe in kidneys from deceased donors than in those from living donors. Of great importance is the quality and function of the donated kidney. Kidneys from living donors and those with normal function can provide better results. In the peri-operative management of the recipient, great attention should be paid to hemodynamic stability and blood pressure; nephrotoxic medicaments should be avoided. Over time, patients with DGF may present lower graft function and survival compared to transplant recipients without DGF. Maladaptation repair, mitochondrial dysfunction, and acute rejection may explain the worse long-term outcome in patients with DGF. Many different strategies meant to prevent DGF have been evaluated, but only prolonged perfusion of dopamine and hypothermic machine perfusion have proven to be of some benefit. Whenever possible, a preemptive transplant from living donor should be preferred.
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Affiliation(s)
| | - Francesco Reggiani
- Nephrology and Dialysis Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy
- Correspondence:
| | - Gabriella Moroni
- Nephrology and Dialysis Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
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Karayagiz AH, Besli S, Yilmaz G, Ozdemir E, Cakir U, Berber I. Long-term outcomes of left versus right laparoscopic living donor nephrectomy with multiple renal arteries. Eur Surg Res 2022; 63:46-54. [PMID: 35100577 DOI: 10.1159/000522315] [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: 12/14/2021] [Accepted: 01/24/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The objective of this study is to compare the long-term graft outcomes of left versus right donor nephrectomy with multiple renal arteries, and therefore creating a reference for the expansion of the potential living kidney donor pool. METHODS Laparoscopic live donor nephrectomy cases between May 2010 and October 2020 were included in this retrospective cross-sectional study. The data relating to donor and recipient demographics, surgical and anatomical characteristics, recipient and graft status were retrieved and compared using nonparametric statistical methods and multivariate regression. Analyses were fit for survival factors. RESULTS A total of 1009 recipients were included in this retrospective cross-sectional study with their donors. 16.7% of the donors had been discovered to have more than one renal artery supplying the donated kidney. The acute rejection rate was 12.8%. Death-censored graft survival at post-operative year 5 for single renal artery transplants was 89.6%, 89.5% for left-sided multiple renal arteries, and 88.2% for right-sided ones. CONCLUSIONS Both right donor nephrectomy and left donor nephrectomy are safe procedures with no significant negatively impacted rates for neither survival nor complications of the recipients in the long-term, compared to single renal artery ones.
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Affiliation(s)
- Abdulhak Hamit Karayagiz
- Department of General Surgery, Istanbul Esenyurt Necmi Kadioglu Public Hospital, Istanbul, Turkey
| | - Sevval Besli
- Department of General Surgery, Acibadem University School of Medicine, Istanbul, Turkey
| | - Gulay Yilmaz
- Department of Nephrology, Kidney Transplantation Center, Acibadem International Hospital, Istanbul, Turkey
| | - Ebru Ozdemir
- Department of General Surgery, Kidney Transplantation Center, Acibadem International Hospital, Istanbul, Turkey
| | - Ulkem Cakir
- Department of Nephrology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Ibrahim Berber
- Department of General Surgery, Acibadem University School of Medicine, Istanbul, Turkey
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