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Foote JB, Bikhet MH, Hansen-Estruch C, Javed M, Ayares D, Hara H, Humar A, Eckhoff DE, Cooper DKC. Observations on hydronephrosis after pig kidney transplantation in baboons. Xenotransplantation 2022; 29:e12779. [PMID: 36156826 PMCID: PMC9771893 DOI: 10.1111/xen.12779] [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: 06/01/2022] [Revised: 07/29/2022] [Accepted: 09/01/2022] [Indexed: 01/15/2023]
Abstract
We have seen hydronephrosis (obstructive nephropathy) at necropsy in 3 of 11 (21%) genetically-engineered pig kidneys that functioned in baboons for >36 days, even when the clinical and histopathological features of rejection were minimal. We briefly report one such case and illustrate the macroscopic and microscopic appearances of such a kidney and ureter. The causes of the observed changes remain uncertain. In our small experience, there seems to be no correlation between the development of hydronephrosis and (i) the surgical technique, (ii) the genotype of the pig, (iii) the length of the pig ureter, or (iv) the immunosuppressive and anti-inflammatory therapy administered. We suggest that the distal ureteric thickening may be the result of an inflammatory response. In two cases, we resolved the problem by carrying out a secondary side-to-side anastomosis between the proximal pig ureter and the baboon bladder.
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Affiliation(s)
- Jeremy B Foote
- Department of Microbiology and Animal Resources Program, University of Alabama, at Birmingham, Birmingham, Alabama, USA
| | - Mohamed H Bikhet
- Xenotransplantation Program, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christophe Hansen-Estruch
- Xenotransplantation Program, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mariyam Javed
- Xenotransplantation Program, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Hidetaka Hara
- Xenotransplantation Program, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Abhinav Humar
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Devin E Eckhoff
- Xenotransplantation Program, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David K C Cooper
- Xenotransplantation Program, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Diena D, Messina M, De Biase C, Fop F, Scardino E, Rossetti MM, Barreca A, Verri A, Biancone L. Relationship between early proteinuria and long term outcome of kidney transplanted patients from different decades of donor age. BMC Nephrol 2019; 20:443. [PMID: 31791270 PMCID: PMC6889703 DOI: 10.1186/s12882-019-1635-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 11/21/2019] [Indexed: 01/13/2023] Open
Abstract
Background Proteinuria after kidney transplantation portends a worse graft survival. However the magnitude of proteinuria related to patient and graft survival and its correlation with donor and recipient characteristics are poorly explored. Methods This study investigated the impact of post transplant proteinuria in the first year in 1127 kidney transplants analyzing the impact of different donor ages. Proteinuria cut off was set at 0.5 g/day. Results Transplants with proteinuria > 0.5 g/day correlated with poor graft and patient outcome in all donor age groups. In addition, 6-month-1-year proteinuria increase was significantly associated with graft outcome, especially with donors > 60 years old (p < 0.05; Odd Ratio 1.8). 1-year graft function (eGFR < or ≥ 44 ml/min) had similar impact to proteinuria (≥ 0.5 g/day) on graft failure (Hazard Ratio 2.77 vs Hazard Ratio 2.46). Low-grade proteinuria (0.2–0.5 g/day) demonstrated a trend for worse graft survival with increasing donor age. Also in kidney-paired analysis proteinuria ≥0.5 effect was more significant with donors > 50 years old (Odd Ratio 2.3). Conclusions Post-transplant proteinuria was increasingly harmful with older donor age. Proteinuria ≥0.5 g/day correlates with worse outcomes in all transplanted patients. Prognostic value of proteinuria and eGFR for graft and patient survival was comparable and these two variables remain significant risk factors even in a multivariate model that take into consideration the most important clinical variables (donor age, rejection, delayed graft function and cytomegalovirus viremia among others).
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Affiliation(s)
- Davide Diena
- Renal Transplant Center "A. Vercellone", Nephrology, Dialysis and Renal Transplant Division, "Città della Salute e della Scienza Hospital", Department of Medical Sciences, University of Turin, Corso Dogliotti14, 10126, Torino, Italy
| | - Maria Messina
- Renal Transplant Center "A. Vercellone", Nephrology, Dialysis and Renal Transplant Division, "Città della Salute e della Scienza Hospital", Department of Medical Sciences, University of Turin, Corso Dogliotti14, 10126, Torino, Italy
| | - Consuelo De Biase
- Renal Transplant Center "A. Vercellone", Nephrology, Dialysis and Renal Transplant Division, "Città della Salute e della Scienza Hospital", Department of Medical Sciences, University of Turin, Corso Dogliotti14, 10126, Torino, Italy
| | - Fabrizio Fop
- Renal Transplant Center "A. Vercellone", Nephrology, Dialysis and Renal Transplant Division, "Città della Salute e della Scienza Hospital", Department of Medical Sciences, University of Turin, Corso Dogliotti14, 10126, Torino, Italy
| | - Edoardo Scardino
- Renal Transplant Center "A. Vercellone", Nephrology, Dialysis and Renal Transplant Division, "Città della Salute e della Scienza Hospital", Department of Medical Sciences, University of Turin, Corso Dogliotti14, 10126, Torino, Italy
| | - Maura M Rossetti
- Renal Transplant Center "A. Vercellone", Nephrology, Dialysis and Renal Transplant Division, "Città della Salute e della Scienza Hospital", Department of Medical Sciences, University of Turin, Corso Dogliotti14, 10126, Torino, Italy
| | - Antonella Barreca
- Division of Pathology, "Città della Salute e della Scienza Hospital", Department of Medical Sciences, University of Turin, Turin, Italy
| | - Aldo Verri
- Department of Vascular Surgery, "Città della Salute e della Scienza Hospital", University of Turin, Turin, Italy
| | - Luigi Biancone
- Renal Transplant Center "A. Vercellone", Nephrology, Dialysis and Renal Transplant Division, "Città della Salute e della Scienza Hospital", Department of Medical Sciences, University of Turin, Corso Dogliotti14, 10126, Torino, Italy.
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Cayetano-Alcaraz A, Rodriguez-Alvarez JS, Vilatobá-Chapa M, Alberú-Gómez J, Gabilondo-Pliego B, Rodríguez-Covarrubias F, Morales-Buenrostro LE, Méndez-Probst CE. Is delayed graft function associated with ureteral stenosis in the kidney transplant recipient? A case-control study. Can Urol Assoc J 2019; 13:E361-E365. [PMID: 30817285 DOI: 10.5489/cuaj.5794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Ureteral stricture (US) in the kidney transplant recipient is a rare complication that can lead to morbidity and graft loss. Risk factor recognition is crucial in the prevention and management of this entity. Delayed graft function (DGF), as defined by the need for dialysis in the first week after transplantation, has been proposed as a risk factor in previous studies. Our objective is to determine the impact of DGF in US development in kidney transplant patients. METHODS We designed a matched case-control study. US cases in kidney transplant recipients were identified in the 2008-2017 period. We defined US as the rise in serum creatinine associated with findings suggesting obstruction in ultrasound, scintigraphy, or retrograde pyelogram; any other cause of graft dysfunction was excluded. Controls were defined as kidney transplant recipients from the same population and period without US, matched in a 1:2 fashion by age, sex, and donor type. RESULTS From 532 kidney transplant patients, 31 cases and 62 controls were included. Cumulative US incidence was 58 per 1000 cases. When calculating for odds ratio (OR), post-operative urinoma (OR 3.2; 95% confidence interval [CI] 2.36-4.37) and ureteral duplication (OR 3.29; 95% CI 2.40-4.51) were associated with an increased risk for US, while DGF was not found to be statistically significant as a risk factor (OR 3.3; 95% CI 0.96-11.52). No statistically significant differences were found between groups in other pre- and post-transplant-related factors CONCLUSIONS:: DGF was not associated with US in our cohort; however, ureteral duplication and postoperative urinoma were associated with an increased risk of graft ureteral stenosis development.
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Affiliation(s)
- Axel Cayetano-Alcaraz
- Department of Urology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Mario Vilatobá-Chapa
- Department of Transplants, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Josefina Alberú-Gómez
- Department of Transplants, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Bernardo Gabilondo-Pliego
- Department of Urology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Imvrios G, Tzitzili E, Pyrpasopoulou A, Miserlis G, Daoudaki M, Fouza A, Mavroudi A, Mouloudi E, Antoniadis N, Salveridis N, Fouzas I. Association of Double-J Stenting in Renal Transplant Patients With Urinary Tract Colonization and Infections in a Multidrug-resistant Microbe Endemic Nosocomial Environment. Transplant Proc 2019; 51:408-412. [PMID: 30879553 DOI: 10.1016/j.transproceed.2019.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE We investigated the association of ureteral stenting after kidney transplantation with the development of urinary tract infections (UTIs) and/or urinary tract colonization, in a hospital environment considered endemic for multidrug resistant (MDR) Gram-negative Enterobacteriaceae. METHODS Seventy-five recipients of deceased donor grafts were divided in groups A and B. Group A (with subgroups A1 and A2) included 45 transplanted patients without urinary stenting, and group B 30 patients with stenting. Subgroup A1 consisted of 30 patients transplanted before 2006, and A2 of 15 patients transplanted after 2006, when MDR, mainly carbapenem-resistant, Enterobacteriaceae, frequency has risen in our hospital. RESULTS The incidence and the number of UTIs per patient were significantly higher in patients without stenting compared to those with stenting. (Group A: 32/45 vs group B: 9/30, P < .001, and group A: 2.86 ± 0.43 vs group B: 0.6 ± 0.19, P < .01 respectively). Patients without stenting tended to have a higher frequency of recurrent UTIs compared to those with stenting (group A: 16/45 vs group B: 4/30, P < .05). Asymptomatic bacteriuria was more frequent in the patients with stent (group A: 8/45 vs group B: 14/30, P < .05). Further sub-comparison of the A1 and A2 subgroups with group B did not change the statistical results. CONCLUSIONS There is no clinically significant association of ureteral stenting after kidney transplantation with the high frequency of MDR Gram-negative bacteria in our hospital.
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Affiliation(s)
- G Imvrios
- Division of Transplantation, Department of Surgery, Hippokration General Hospital, Thessaloniki, Greece
| | - E Tzitzili
- Division of Transplantation, Department of Surgery, Hippokration General Hospital, Thessaloniki, Greece
| | - A Pyrpasopoulou
- Infectious Diseases Unit, Hippokration General Hospital, Thessaloniki, Greece
| | - G Miserlis
- Division of Transplantation, Department of Surgery, Hippokration General Hospital, Thessaloniki, Greece.
| | - M Daoudaki
- Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - A Fouza
- Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - A Mavroudi
- 3rd Paediatric Department, Hippokration General Hospital, Thessaloniki, Greece
| | - E Mouloudi
- Intensive Care Unit, Hippokration General Hospital, Thessaloniki, Greece
| | - N Antoniadis
- Division of Transplantation, Department of Surgery, Hippokration General Hospital, Thessaloniki, Greece
| | - N Salveridis
- Division of Transplantation, Department of Surgery, Hippokration General Hospital, Thessaloniki, Greece
| | - I Fouzas
- Division of Transplantation, Department of Surgery, Hippokration General Hospital, Thessaloniki, Greece
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Hamzaoui M, Francois A, Defortescu G, Etienne I, Laurent C, Bertrand D, Guerrot D. von Brünn Nests Hyperplasia as a Cause of Ureteral Stenosis After Kidney Transplantation. Kidney Int Rep 2017; 2:498-501. [PMID: 29142977 PMCID: PMC5678657 DOI: 10.1016/j.ekir.2016.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Mouad Hamzaoui
- Service de Néphrologie, CHU Hôpitaux de Rouen, Rouen, France
- INSERM Unité 1096, Université de Médecine-Pharmacie de Rouen, Rouen, France
| | - Arnaud Francois
- Service d'Anatomie Pathologique, CHU Hôpitaux de Rouen, Rouen, France
| | | | | | | | | | - Dominique Guerrot
- Service de Néphrologie, CHU Hôpitaux de Rouen, Rouen, France
- INSERM Unité 1096, Université de Médecine-Pharmacie de Rouen, Rouen, France
- Correspondence: Dominique Guerrot, Service de Néphrologie – CHU Hôpitaux de Rouen, 1 rue de Germont, 76031 Rouen Cedex, Rouen, France.Service de Néphrologie – CHU Hôpitaux de Rouen, 1 rue de Germont76031 Rouen CedexRouenFrance
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