Analysis of Kidney Donation and Its Relationship With Graft Failure of the Recipient at 1 Year

INTRODUCTION

Currently, the shortage of organs available for kidney transplantation and a change in donors' and recipients' profiles (elderly, with cardiovascular risk, donors after cardiac death), it is becoming necessary to assess grafts from expanded-criteria donors (ECD) in order to have methods that allow us to predict viability and graft survival.

OBJECTIVE

The aim of this study was to analyze the different methods of renal donor assessment (estimated glomerular filtration rate [eGFR], preimplantation biopsy, and Kidney Donor Profile Index [KDPI] score) as predictors of graft survival and renal function of our recipient at 1 year.

METHODS

We performed a descriptive and retrospective study of 183 deceased donor kidney transplantations performed at our center between 2011 and 2015. We calculated the KDPI scores, donor eGFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration Formula equation, and biopsies were evaluated using Banff classification.

RESULTS

ECDs comprised 59.60%, 93% of donors had an eGFR ≥ 60 mL/min/1.73 m², and 41% presented with a KDPI score ≥ 90%. The most frequent range in the biopsy score was 0-3. The 1-year graft survival rate was 86.90%. Factors that negatively influenced graft survival were donor/recipient age, ECD, KDPI, and cold ischemia time (CIT).

CONCLUSION

Prolonged CIT and KDPI ≥ 90% were donor variables that were related to graft failure at 1 year in our center.

Impact of peritonitis on long-term survival of peritoneal dialysis patients

The impact of each episode of peritonitis on long-term survival of peritoneal dialysis (PD) patients has yet to be defined.

OBJECTIVES

To determine the risk that each episode of peritonitis poses for patient survival and for the PD technique.

PATIENTS

1515 patients included in the Levante registry from 1 January 1993 to 31 December 2005.

METHODS

Retrospective analysis of a multicentre registry using Cox regression for time-dependent variables.

RESULTS

We analysed 1609 episodes of peritonitis in 716 patients (47.2%). In the univariate analysis, each case of peritonitis treated in the outpatient unit was associated with an increase in mortality (hazard ratio [HR] 1.99, P<.001), which was greater for episodes that required hospitalisation (HR 3.62, P<.001). Mortality increased with each successive episode in the same patient. Multivariate analysis confirmed the association of each case of peritonitis with lower long-term survival (HR 2.01, P<.001), with a different risk for episodes due to gram-positive and gram-negative bacteria and fungi (HR 1.73, 2.43 and 5.71, respectively; P<.001). Other variables associated with mortality were age, low residual renal function, absence of vascular access and comorbidity. Peritonitis was the only independent variable associated with technique failure (HR 1.29, P<.001), with a different risk for episodes due to gram-positive and gram-negative bacteria and fungi (HR 1.73, 2.43 and 5.71, respectively; P<.001).

CONCLUSIONS

Episodes of peritonitis negatively influence long-term survival of patients on PD.

Prevalence and risk factors for hepatitis C virus infection in continuous ambulatory peritoneal dialysis patients

BACKGROUND

Studies on hepatitis C virus antibodies (Anti-HCV) in CAPD patients are scarce and include a small number of patients. Nevertheless, risk factors related to Anti-HCV in these patients are still subject to controversy. Purpose of the study. To analyse the incidence and risk factors associated with the presence of Anti-HCV in CAPD patients.

METHODS

We studied 255 patients from five different treatment centres of our region. The analysis was repeated after excluding 161 patients who had previously received haemodialysis treatment at least once. Anti-HCV testing was made by the 2nd-generation ELISA: As a supplementary test we used RIBA-4 in three centers and INNOLIA in the other two. Risk factors were analysed using logistic regression model for multivariate analysis.

RESULTS

In the whole group, 29 patients (11.4%) were anti-HCV positive. Logistic regression analysis determined the following variables as independent risk factors: hepatitis previous to CAPD (P<0.001, odds ratio (OR):44.9), Anti HBc positivity (P=0.019, OR:9. 24), blood transfusions previous to CAPD (P=0.015, OR:1.05) and CAPD duration were excluded, the prevalence of HCV antibodies was 8.5% (8/94). In this group multivariate analysis showed that Anti-HCV positivity correlated with hepatitis previous to CAPD (P<0.0003, OR: 126) and Anti HBc positivity (P=0.002, OR:41.9).

CONCLUSIONS

Our prevalence of hepatitis C virus (HCV) infection in CAPD patients was lower than other renal replacement therapy modalities, and correlated to events occurring mainly before starting CAPD treatment. This technique could be considered as low risk for HCV infection.

Antimicrobial susceptibility patterns and high-level gentamicin resistance among enterococci isolated in a Mexican tertiary care center

AIM

To describe the antimicrobial susceptibility pattern of enterococcal clinical isolates.

SETTING

A 200-bed tertiary-care center in Mexico City.

STUDY DESIGN

Prospective surveillance of enterococcal clinical isolates identified according to Facklam's method since 1990. Susceptibility tests were performed by a commercial micromethod, agar diffusion and microbroth dilution. We present data from 1990 to 1992.

RESULTS

A total of 407 enterococci were recovered during the study period: 245 from inpatients and 162 from outpatients; 325 of the isolates were Enterococcus faecalis, 61 E. faecium, seven E. avium, four each for E. raffinosus and, E. hirae; two, E. pseudoavium; and one each E. gallinarum, E. durans; E. mundtii, and E. faecales var asacharolyticus. Resistance to ampicillin and imipenem among E. faecium was 59%. Among E. faecalis, 0.3% were resistant to ampicillin and 2% to imipenem; no beta-lactamase production was detected. All were susceptible to vancomycin. Overall, a 12% high-level gentamicin resistance (HLGR) was found without a difference between species; 25% of bloodstream clinical isolates were HLGR enterococci. More than half (63%) of the HLGR clinical isolates were susceptible to streptomycin; a-hemolysis in human blood agar as well as nitrofurantoin resistance were observed in all E. faecium isolates and in two E. avium.

CONCLUSIONS

In our center, HLGR has a prevalence of 12%. Streptomycin may be a therapeutic alternative in 63% of the HLGR cases. The pattern of hemolysis in human blood agar plus the susceptibility to nitrofurantoin could be used as an initial screening to identify enterococci.