Clinical Impact of a Protocolized Kidney Donor Follow-up System

BACKGROUND

Adequate kidney donor management after donation is increasingly emphasized due to concerns of renal function impairment after nephrectomy with increasing life expectancy. In this study, the clinical impact of a protocolized kidney donor follow-up system by nephrologists was evaluated.

METHODS

A total of 427 living kidney donors underwent nephrectomy from January 2010 to December 2014 and were followed for at least 2 years at the Samsung Medical Center. Donors were followed-up by nephrologists after the establishment of a donor clinic with systemized protocols in January 2013. The primary outcomes were incidence of post-donation low estimated glomerular filtration rate (eGFR) and renal function adaptability. Secondary outcomes were changes in compliance and incidence of hyperuricemia and microalbuminuria.

RESULTS

The patients were divided into 2 groups according to the time of nephrectomy: the pre-donor clinic period (n = 182) and the donor clinic period (n = 172). Preoperative eGFR in patients in the pre-donor clinic period was higher than that in patients in the donor clinic period. After donation, poor renal adaptation was less frequent in the donor clinic period compared to the pre-donor clinic period. Low eGFR tended to be less common during the donor clinic period. Shorter mean outpatient clinic visit intervals with more visits within 6 months after donation and earlier detection of de novo hyperuricemia were found during the donor clinic period.

CONCLUSION

A protocolized donor clinic run by nephrologists may improve post-nephrectomy renal outcomes and compliance and facilitate better management of potential risk factors of chronic kidney disease in donors.

Predictive Factors of Renal Adaptation After Nephrectomy in Kidney Donors

BACKGROUND

Despite compensatory hyperfiltration in remaining nephrons following donor nephrectomy, some donors show impaired renal adaptation and low estimated glomerular filtration rate (eGFR). We investigated the factors predicting early renal adaptation after nephrectomy and identified kidney donors at risk of inadequate renal adaptation.

METHODS

A total of 265 living kidney donors from 2010 to 2013 were retrospectively analyzed. Renal function was serially followed for 6 months after the operation. Regression analyses were performed to identify the independent predictors of low eGFR (eGFR <60 mL/min/1.73 m²) and impaired renal adaptation (%Modification of Diet in Renal Disease [MDRD] <66% of baseline eGFR).

RESULTS

A total of 148 donors belonged to the low eGFR group, and changes in eGFR (ΔeGFR) at postoperative (PO) 1 day and 1 month were identified as independent predictors of low eGFR. Impaired renal adaptation was related to age, ΔeGFR PO 2-3 days, and ΔeGFR PO 1 month. Early renal adaptation was associated with age, male gender, and residual kidney computerized tomography angiography (CTA) volume. The best sensitivity and specificity were obtained with a cutoff value of ΔeGFR 31 at PO 1 day and 1 month for predicting low eGFR and with a value of ΔeGFR 27 at PO 2-3 days and 1 month for predicting impaired renal adaptation.

CONCLUSIONS

Our study showed that the degree of early renal adaptation determines subsequent renal function in kidney donors. Closer monitoring and management may be required in old or male donors with small residual CTA kidney volume as well as donors with persistent ΔeGFR >27 within 1 month of nephrectomy.

Hormonal differences between female kidney transplant recipients and healthy women with the same gynecologic conditions

BACKGROUND

End-stage renal disease is associated with severe abnormalities in reproductive function. However, the abnormalities are reversed by successful kidney transplantation. The aim of the present study was to compare hormonal levels between recipients with successful kidney transplantations and healthy women with the same gynecologic conditions.

METHODS

The study group consisted of 31 women of reproductive age with end-stage renal disease who underwent successful kidney transplantation. The ratio of the control group, composed of healthy woman, to the study group was 3:1 matched for age and symptoms.

RESULTS

Abnormal bleeding (n = 14) and infertility were the most common gynecologic conditions in kidney transplant recipients. The levels of estrogen (E2) and follicle-stimulating hormone (FSH) in the study group were higher than in the control group, but the levels of progesterone (P4) and luteinizing hormone (LH) were lower in the study group than in the control group. There were no significant differences in prolactin and thyroid-stimulating hormone between the two groups. The incidence of infertility in patients who receive steroid was higher than those with no steroid use (P = .007).

CONCLUSIONS

Compared with healthy age- and symptom-matched women, female kidney transplant recipients have increased levels of E2 and FSH and decreased levels of P4 and LH. These differences in hormone profiles may predispose kidney transplant recipients to increased risk of gynecologic pathologies.

Comparison between thymoglobulin and ATGAM as an induction agent in adult kidney transplantation: a single-center experience

OBJECTIVE

The best antithymocyte globulin (ATG) preparation for induction suppression in kidney transplant recipients is still not clear. The aim of this study was to identify short- and long-term outcomes in kidney transplant recipients who received thymoglobulin or ATGAM as an induction agent.

METHODS

We retrospectively reviewed patients who underwent kidney transplantation from 1996 to 2010. Recipients were classified according to the ATG preparation.

RESULTS

One hundred fifty-two patients (64.4%) received thymoglobulin and 84 (35.6%) received ATGAM. The occurrence of delayed graft function in patients receiving thymoglobulin was higher than in patients receiving ATGAM (P = .005), but serum creatinine levels and acute rejection after kidney transplantation were not different between the two groups. The death-censored graft survival curve in thymoglobulin recipients was higher than in ATGAM recipients (P = .027). Bacterial infection was a predisposing factor for graft survival (P = .008).

CONCLUSION

The efficacy of thymoglobulin induction is generally better than that of ATGAM induction, and prevention of bacterial infections was just as important as the use of ATG because bacterial infection was an important risk factor for graft failure.

[Comparative pharmacokinetics of two sulpiride formulations in healthy volunteers]

Six healthy male volunteers (age: 27.6 +/- 4.7; weight: 74.6 +/- 7.7) participated in a "repeated measure" design for comparing the bioavailability and pharmacokinetic behaviours of the brand-name drug of Dogmatyl and a generic sulpiride formulation. Each subject received a single 400-mg dose of Dogmatyl in tablet form during the first dosing period. After two weeks of washout period, the same dose of a generic preparation was then administered. Blood samples were obtained at 0, 0.5, 1, 1.5, 2, 4, 6, 12 and 24 hours after initial dosing. The concentration of sulpiride was measured by a high pressure liquid chromatographic method using a UV detector. All the data were processed by Keith K.H. Chan and Kenneth Wnuck's method which utilizes KMCP computer software. Pharmacokinetic parameters were calculated, based on one compartment model. The results revealed that the maximal concentration (Cmax) of Dogmatyl and the generic preparation was 1.468 +/- 0.631 and 1.472 +/- 0.608 mcg/ml, the time to reach maximal concentration (Tmax) was 1.5 +/- 0.63 and 1.25 +/- 0.61 hours, the half life (T 1/2) was 8.369 +/- 1.953 and 8.013 +/- 2.602 hours, the area under curve (from 0 to 24 hours) (AUC0-24 hr) was 11.03 +/- 6.78 and 8.27 +/- 2.99 mcghr/ml, and the area under curve (from 0 hour to infinity) (AUC0-hr) was 13.56 +/- 9.09 and 10.11 +/- 4.61 mcghr/ml, respectively. Based on the data, there was no significant difference found between the two groups after statistical analysis with paired t-test (p greater than 0.05). Therefore, the similarity of these two formulations is then suggested by the authors.(ABSTRACT TRUNCATED AT 250 WORDS)