Renal transplantation at the jeddah kidney center

Renal transplantation is the optimal treatment for patients with end-stage renal failure. During the period 1991 to 1995, a total of 279 renal transplantations were performed at the Jeddah Kidney Center. They included 115 kidneys from cadaveric donors and 164 living related donor transplants. There were 160 males and 119 females; age of the patients ranged between 4 and 45 years. During the follow-up period, 32 grafts were lost and 26 patients died. The overall 5-year graft and patient survival rates were 79.2% and 90.7% respectively. Sepsis and pulmonary embolism constituted the common causes of death.

The Diagnosis of Acute Renal Allograft Rejection Using T-lymphocyte Subsets in the Peripheral Blood: A Better Test Now?

Measuring the T-lymphocyte subsets CD4/CD8 ratio is known to be useful in the early diagnosis of acute rejection. A ratio of 1.3 or more is said to indicate the presence of acute rejection, but the sensitivity and specificity rates of the test are too low to render it of diagnostic value. We revisited this test on twenty-three renal allograft recipients who developed graft dysfunction within the first three months following transplantation. All cases were investigated thoroughly to identify the cause of graft dysfunction. Two groups of patients were identified. Group 1: patients confirmed to have acute rejection as the cause of graft dysfunction (13 patients); and group 2: patients found to have other causes of graft dysfunction (10 patients). Results of subsets with cluster of differentiation ratio CD4/CD8 were correlated with incidence of acute rejection. Of the 13 patients with acute rejection 10 revealed a CD4/CD8 ratio more than 1.7, while in the other three CD4/CD8 ratio was less than 1.7. In the second group of 10 patients in whom the cause of graft dysfunction was not acute rejection, the CD4/CD8 ratio was less than 1.7 in all cases. Our study indicates that T-lymphocyte subset ratio is useful in diagnosing acute rejection with a sensitivity and specificity of 81% and 100% respectively when the cutoff point is taken as 1.7. Studies with larger series of patients are needed to confirm this observation.

Early changes in volume and function of the remaining kidney after unilateral donor nephrectomy

The early changes that occur in the volume and function of the remaining kidney, after uni-nephrectomy for organ donation, were studied in 25 living donors. Serum creatinine (S Cr), creatinine clearance (Cr Cl), renographic clearance tests for total and split renal functions as well as renal volume using ultrasound were determined before and three months after donation. In 76% of the donors, Se Cr showed an increase after kidney donation, but all values were within normal range. The total kidney function in terms of Cr Cl, showed a drop of 36% from the pre-donation value. After three months post donation, the clearance of the remaining kidney increased by 5% to 64% (mean 34%) of the pre-donation values, measured by Tc 99m DTPA renography. Compensatory hypertrophy of the remaining kidney also occurred as evidenced by the ultrasound evaluation which showed an increase in the renal volume by 15%. Our study shows that compensatory changes occur early i.e., within the first three months after uni-nephrectomy. However, prolonged follow-up of these donors is necessary to assess the long-term structural and functional changes in the remaining kidney.

Impact of donor source on short-term outcome of renal transplantation in children

Renal transplantation is the ideal renal replacement therapy for children with endstage renal disease (ESRD). Follow-up of pediatric transplant recipients is tedious because of special problems like non-compliance to treatment and a very active immunological status. Twenty-five pediatric patients with ESRD who received kidney transplants in four different centers were followed up at the Jeddah Kidney Center, Saudi Arabia for a mean period of 22 months. The donor source for transplantation was as follows: living related (LR) in seven, cadaveric (CAD) and living unrelated (LUR) in nine patients each. The overall graft survival was 88% and patient survival 100% at the end of the follow-up period. Living related kidney recipients exhibited 100% graft survival at 22 months and also had the best kidney function. All the graft losses were due to irreversible rejection episodes. Medical complications were common and comprised of hypertension (82%), infection (52%) and rejection (44%). Recipients of LR donor kidneys had the lowest incidence of these complications. Surgical problems encountered were few and minor and needed only conservative management. In our experience, children having renal transplantation have an excellent outcome at short-term particularly with LR donors.

Residual renal function after living related kidney donation. Is it enough? An early report

The utilization of living's kidneys as renal replacement for Chronic Renal Failure (CRF) patients was debated for long time. However, the lack of renal pool in one hand and the proper employment of modern investigatory armamentarium in another hand could justify such donation. Living related donors (LRD) are subjected to extensive non invasive investigations to assess their general fitness for donation and split renal function. The impact of uni-nephrectomy on the renal function was studied in 25 LRD. Serum Creatinine (S. Cr.) Creatinine Clearance (Cr. Cl.) and renographic clearance tests for total and split renal function and renal volume using ultrasound were determined before and 3 months after donation. An initial increase in s.cr was seen in 76% of donors, but all levels are within normal range. Total kidney function by cr.cl showed significant drop by 36% of the pre donated value. Remaining kidney clearance increased by 5% to 64% with an average of 34% of the pre donated level as measured by Tc 99m DTPA renography. Following nephrectomy, compensatory hypertrophy of the remaining kidney attributed to an increase in the renal volume of 15%. In conclusion, kidney donation from living's is safe. Cr. clearance using the chemical method is a good screening test for potential LRD and for monitoring the renal function after donation. Renographic clearance using Tc 99m DTPA is as excellent useful test for split renal function in LRD work up. Long-term follow up might be needed.