Search Results (35)

Background and Objectives: Glucose instability has been established to be related to postoperative morbidity and mortality in liver transplantation. To date, the impact of maintaining optimal blood glucose (BG) levels on the incidence of acute kidney injury (AKI) following liver transplantation (LT) remains unclear. This study aimed to determine the impact of optimal BG level after reperfusion (REP BG) on the incidence of AKI after living donor LT (LDLT). Materials and Methods: This study retrospectively reviewed 3331 patients who underwent LDLT between January 2008 and December 2019. Patients were divided into optimal (110 mg/dL < BG < 180 mg/dL) and non-optimal (BG < 110 mg/dL or >180 mg/dL) REP BG groups. Multivariable logistic regression analysis was performed to assess factors associated with AKI. Propensity score matching (PSM) was used to compare the incidence of AKI, AKI severity, and progression to chronic kidney disease (CKD) between the groups. Results: The incidence of AKI was 66.7%. After PSM, patients in the optimal REP BG group showed a lower incidence of AKI (66.5% vs. 70.6%, p = 0.032). Multivariable logistic regression analysis showed that the non-optimal REP BG group was independently associated with a higher risk of AKI (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.02–1.45; p = 0.037) compared to the optimal group. Similarly, the risks of severe AKI (OR, 1.32; 95% CI, 1.11–1.58; p = 0.002) and progression to CKD (OR, 1.19; 95% CI, 1.01–1.41; p = 0.039) were significantly higher in the non-optimal group after PSM. Conclusions: Maintenance of an optimal REP BG was associated with a significantly lower incidence of AKI and a reduced risk of progression to CKD within 1 year after LDLT. Full article

Objectives: Chronic Hepatitis B virus (HBV) infection is a significant global health issue, with dialysis patients at increased risk and reduced response to HBV vaccination. The effects of HBV serological status on kidney transplant outcomes, particularly for patients with resolved or inactive HBV infection, needs more data, especially from current era. This study evaluated the impact of chronic and non-active HBV infection on patient and graft survival after kidney transplantation. Methods: Retrospective analysis was conducted of kidney-only transplant recipients at our center from 1 January 1990 to 31 August 2019 (end of observation). Patients were grouped by their HBV serostatus before transplantation into three categories: HBV negative (HBsAg−/Anti-Hbc−), non-active HBV infection (HbsAg−/Anti-Hbc+) and chronic HBV infection (HbsAg+/Anti-Hbc+). Primary outcomes included patient survival, graft survival, and overall graft and patient survival, analyzed using Kaplan–Meier (KM) curves, log-rank tests, Restricted mean survival times (RMST), and Accelerated failure time (AFT) models. Results: Among 2490 patients, 2197 were HBV negative, 218 had non-active HBV, and 75 had chronic HBV. Over a mean follow-up of 8.1 years, mortality and graft failure rates were highest in chronic HBV patients (49% and 37%), followed by non-active HBV (39% and 29%) and HBV-negative patients (30% and 20%). KM analysis revealed significantly lower overall survival rates for chronic HBV and non-active HBV groups compared to HBV-negative patients (p = 0.006). RMST confirmed significant reductions in survival for the non-active group (12.57 vs. 14.17 years, p = 0.007). Cox regression and AFT models identified older recipient/donor age, Hepatitis-C-virus coinfection, and broad antigen mismatches as negative predictors, while living donors improved outcomes. Conclusions: While unadjusted Kaplan–Meier curves and RMST analysis suggested differences in patient and graft survival, further thorough multivariable AFT analysis did not show a significant association between non-active or chronic HBV infection and patient or graft survival after kidney transplantation. Full article

Living kidney transplantation yields better outcomes for recipients than deceased donation, though it may present long-term challenges for donors. This study assessed the quality of life (QoL) of living kidney donors in Greece using the SF-36 questionnaire and examined associated sociodemographic and clinical factors. This cross-sectional study included 242 clinically stable kidney donors from Laiko General Hospital’s Kidney Donor Outpatient Clinic in Athens. Data on demographics, comorbidities, laboratory parameters, and QoL were collected. Spearman’s correlation coefficients were used to identify associations between QoL scores and influencing factors. The majority of donors were female (73.55%). Donors reported high QoL, with median PCS and MCS scores of 55.27 (49.08–57.73) and 54.17 (46.64–59.93), respectively. Male donors had higher PCS and MCS scores than females (p = 0.028 and p = 0.004). Laparoscopic nephrectomy was associated with better mental health and physical outcomes compared to open surgery (p < 0.001). Higher education and eGFR correlated with better PCS scores, while older age negatively affected QoL (p < 0.05). Living kidney donors reported a satisfactory level of overall QoL post-donation. Lower QoL scores were correlated with the female gender, older age, and open nephrectomy. These findings may further reinforce support for our current organ donation policy. Non-modifiable factors appear to influence donor quality of life. These findings reinforce the current organ donation policy while emphasizing the need for careful pre-transplant counseling and ongoing monitoring post-donation. Full article

Background: High-volume online hemodiafiltration (OL-HDF) has proven to be the most efficient dialysis modality and to offer better clinical outcomes in patients on hemodialysis. Longer and more frequent dialysis sessions have demonstrated clinical and survival benefits. Methods: A single-center observational study of the first one hundred patients on nocturnal every-other-day OL-HDF was conducted with the aim of reporting the experience with this treatment schedule and evaluating analytical and clinical outcomes as well as the patient and technique survival. Results: Nocturnal OL-HDF on alternate days was highly accepted, with no adverse symptoms, good clinical tolerance, and maintained active work in 62%. Kt, and the convective volume increased from 67.6 ± 12 L to 105.4 ± 11.7 L, and from 27.1 ± 4.6 L to 48.1 ± 6.4 L, respectively, from the baseline to 24 months. An improved calcium–phosphate balance and blood pressure control were observed, as the use of phosphate binders and antihypertensive medications decreased from 76.7% to 3.3% and from 56.7% to 28.3%, respectively. Furthermore, 58.3% of patients required phosphate supplementation in the dialysis fluid to prevent intradialytic hypophosphatemia. Additionally, doses of iron and erythropoiesis-stimulating agents were reduced. The global patient survival was 94% at the end of the follow-up. It was higher in those on the transplant waiting list, with 98.1% survival compared to 84.6% in non-wait-listed patients at 24 months. The main reason for treatment discontinuation was kidney transplantation, accounting for 78.4% of the 88 withdrawals, while death was the leading cause of discontinuation in non-listed patients (41.6%). Conclusions: Nocturnal every-other-day OL-HDF is a well-tolerated dialysis regimen that offers significant clinical benefits, which may positively impact morbidity and mortality. Additionally, it allows patients to integrate the treatment into their social and occupational lives. Full article

Background/Objectives: ABO-incompatible live-donor kidney transplantation (ABOi-LDKT) has become an established treatment for end-stage renal disease. Non-inferiority in the long-term graft function compared to ABO-compatible live-donor kidney transplantations (ABOc-LDKTs) has been shown. However, the assumed burden due to complications owing to increased immunosuppression inherent to ABOi-LDKTs has not yet been quantified. The aim of this study was to determine if ABOi-LDKT recipients suffer from additional morbidity and whether the resulting burden is justified. Methods: We retrospectively analyzed 45 matched pairs of ABOi-LDKTs and ABOc-LDKTs transplanted over a twenty-year period from January 2000 to March 2020. The number and duration of postoperative readmissions, surgical complication rates according to Clavien–Dindo and its comprehensive complication index (CCI), kidney function, occurrence of new-onset diabetes, and infections as well as tumor incidence were analyzed. Results: Patient and graft survival, as well as graft function, were comparable between the two groups. There were no significant differences in terms of complications, readmission rates, and length of readmission, as well as infection and rejection rates. The median CCIs for ABOi-LDKTs and ABOc-LDKTs at primary discharge and 3, 6, 12, and >12 months were 20.9 vs. 20.9 (p = 0.363), 31.4 vs. 33.7 (p = 0.438), 33.7 vs. 33.7 (p = 0.875), 20.9 vs. 33.1 (p = 0.25), and 27.1 vs. 31.9 (p = 0.163), respectively. Conclusions: ABOi-LDKT seems safe, with comparable outcome, complication, and readmission rates to ABOc-LDKT. In recipients with ABOi living donors, transplantation should not be delayed solely due to concerns over increased perioperative risks. Full article

Background: Even today, a non-invasive biomarker to identify donors with enhanced risk for renal impairment is missing. Dickkopf 3 (DKK3) can cause tubulointerstitial fibrosis and is associated with rapid eGFR loss. The aim of our work was to analyze whether DKK3 can be used as a non-invasive alert marker for an increased risk of loss of kidney function in living kidney donors (LKDs). Methods: All donors who were examined between July 2022 and June 2023 (n = 117) were included. DKK3 was measured in the urine. The collected patient-related data were compared with parameters before donation. The study cohort was stratified by DKK3 values (</≥200). Results: In the follow-up, 89 donors had a DKK3 value < 200 (group 1) and 28 donors had a DKK3 value ≥200 (group 2). During post-donation follow-up, renal function in group 1 was significantly better than that in group 2 (p = 0.01), although no difference in renal function before donation was detected (p = 0.84). Group 2 showed also a greater eGFR loss over time than group 1. Conclusions: LKDs with elevated DKK3 levels in the FU had impaired kidney function without evidence of increased risk factors pre-donation. DKK3 can represent a possible monitoring tool for kidney function in LKDs. Full article

Background and Objectives: Postreperfusion syndrome (PRS) is a significant challenge in liver transplantation (LT), leading to severe circulatory and metabolic complications. Ischemic preconditioning (IPC), including remote IPC (RIPC), can mitigate ischemia-reperfusion injury, although its efficacy in LT remains unclear. This study evaluated the impact of paired RIPC, involving the application of RIPC to both the recipient and the living donor, on the incidence of PRS and the need for rescue epinephrine during living-donor LT (LDLT). Materials and Methods: This retrospective observational cohort analysis included 676 adult patients who had undergone elective LDLT between September 2012 and September 2022. After applying exclusion criteria and propensity score matching (PSM), 664 patients were categorized into the paired RIPC and non-RIPC groups. The primary outcomes were the occurrence of PRS and the need for rescue epinephrine during reperfusion. Results: The incidence of PRS and the need for rescue epinephrine were significantly lower in the paired RIPC group than in the non-RIPC group. Furthermore, the incidence of postoperative acute kidney injury was lower in the paired RIPC group. Multivariable logistic regression adjusted for propensity scores indicated that paired RIPC was significantly associated with a reduced occurrence of PRS (odds ratio: 0.672, 95% confidence interval: 0.479–0.953, p = 0.021). Conclusions: Paired RIPC, involving both the recipient and the living donor, effectively reduces the occurrence of PRS and the need for rescue epinephrine during LDLT. These findings suggest that paired RIPC protects against ischemia-reperfusion injury in LDLT. Future randomized controlled trials are needed to verify our results and to explore the underlying mechanisms of the protective effects of RIPC. Full article

Living donor kidney transplantation (LDKT) currently represents the treatment of choice for patients with end-stage renal failure. LDKT is a serious event with profound psychological, interpersonal, familial, and social implications. Over the last few years, there has been an exponential growth in living donation programs involving genetically and emotionally related donors, as well as people who donate to an unrelated and unknown subject. The implementation of paired exchange programs, Samaritan donation, and preemptive transplantation raise further ethical issues, which are inextricably linked to the unique psychosocial context of both the donor and the recipient. The present narrative review aims to provide an update on the main ethical challenges related to LDKT. We conducted a comprehensive literature search in PubMed/Medline. The results of the most relevant studies were narratively synthesized from a psychosocial perspective around the four principles of biomedical ethics: autonomy, beneficence, non-maleficence, and justice. Finally, we discussed the potential future directions to provide an effective, patient-centered, and ethical psychosocial assessment and follow-up of living donors and recipients that underwent LDKT. Full article

Kidney transplant recipients are at an increased risk of hospitalisation and death from SARS-CoV-2 infection, and standard two-dose vaccination schedules are typically inadequate to generate protective immunity. Gut dysbiosis, which is common among kidney transplant recipients and known to effect systemic immunity, may be a contributing factor to a lack of vaccine immunogenicity in this at-risk cohort. The gut microbiota modulates vaccine responses, with the production of immunomodulatory short-chain fatty acids by bacteria such as Bifidobacterium associated with heightened vaccine responses in both observational and experimental studies. As SCFA-producing populations in the gut microbiota are enhanced by diets rich in non-digestible fibre, dietary supplementation with prebiotic fibre emerges as a potential adjuvant strategy to correct dysbiosis and improve vaccine-induced immunity. In a randomised, double-bind, placebo-controlled trial of 72 kidney transplant recipients, we found dietary supplementation with prebiotic inulin for 4 weeks before and after a third SARS-CoV2 mRNA vaccine to be feasible, tolerable, and safe. Inulin supplementation resulted in an increase in gut Bifidobacterium, as determined by 16S RNA sequencing, but did not increase in vitro neutralisation of live SARS-CoV-2 virus at 4 weeks following a third vaccination. Dietary fibre supplementation is a feasible strategy with the potential to enhance vaccine-induced immunity and warrants further investigation. Full article

Background: The number of kidney transplant recipients over 70 years of age is increasing but detailed data on patient and graft survival in the modern era of immune suppression are few. Methods: A single-center cohort of patients of 70 years and older (n = 349) at time of kidney transplantation from 2010–2020 were followed until January 2023. Results: The median age was 73 years with a median follow-up of 4.3 years. Fifty percent of recipients of a living donor kidney (LDK, n = 143) received their graft pre-emptively. Cumulative death-censored graft survival was excellent in the LDK group and reached 98% at 5 years vs. 85% in the deceased donor kidney (DDK) group. Primary non-function (38%) and rejection (43%) were the major causes of graft loss in the first year after DDK transplantation. Rejection-related graft loss was 4.6% during follow-up. Median recipient survival was superior in the subgroup of pre-emptively transplanted LDK patients compared to non-pre-emptively LDK transplanted patients (11.1 versus 6.2 years). Non-pre-emptively transplanted patients had a significantly increased incidence of infection (HR 3.81, 1.46–9.96) and cardiovascular-related causes of death (HR 3.35, 1.16–9.71). Pre-emptive transplantation was also associated with a significantly improved graft survival in the DDK recipients but this result was confounded by significantly better HLA matching and younger donor age in this group. Conclusions: Pre-emptive LDK transplantation in patients of 70 years or older confers superior graft and recipient survival. Full article

Kidney transplantation is the preferred gold standard modality of treatment for kidney failure. Bone disease after kidney transplantation is highly prevalent in patients living with a kidney transplant and is associated with high rates of hip fractures. Fractures are associated with increased healthcare costs, morbidity and mortality. Post-transplant bone disease (PTBD) includes renal osteodystrophy, osteoporosis, osteonecrosis and bone fractures. PTBD is complex as it encompasses pre-existing chronic kidney disease–mineral bone disease and compounding factors after transplantation, including the use of immunosuppression and the development of de novo bone disease. After transplantation, the persistence of secondary and tertiary hyperparathyroidism, renal osteodystrophy, relative vitamin D deficiency and high levels of fibroblast growth factor-23 contribute to post-transplant bone disease. Risk assessment includes identifying both general risk factors and kidney-specific risk factors. Diagnosis is complex as the gold standard bone biopsy with double-tetracycline labelling to diagnose the PTBD subtype is not always readily available. Therefore, alternative diagnostic tools may be used to aid its diagnosis. Both non-pharmacological and pharmacological therapy can be employed to treat PTBD. In this review, we will discuss pathophysiology, risk assessment, diagnosis and management strategies to manage PTBD after kidney transplantation. Full article

In the evolving landscape of nephrology and kidney transplants, assessing renal functional reserve (RFR) in living kidney donors is essential for ensuring donor safety and successful transplantation. This study explores the use of the Intra-Parenchymal Renal Resistive Index Variation (IRRIV) test, a novel non-invasive method, to measure RFR in living donors. Our observational study included 11 participants undergoing living kidney donations, evaluated using the IRRIV-based Renal Stress Test (RST) before and 12 months post-nephrectomy. The study demonstrated significant changes in creatinine and eGFR CKD-EPI levels post-donation, with an average creatinine rise from 69 to 97 µmol/L and a reduction in eGFR from 104 to 66 mL/min/1.73 m². These variations align with the expected halving of nephron mass post-nephrectomy and the consequent recruitment of RFR and hyperfiltration in the remaining nephrons. This pilot study suggests that the IRRIV-based RST is a practical, safe, and reproducible tool, potentially revolutionizing the assessment of RFR in living kidney donors, with implications for broader clinical practice in donor eligibility evaluation, even in borderline renal cases. Furthermore, it confirms the feasibility of RST in living kidney donors and allows us to assess the sample size in 48 donors for a future study. Full article

Background: An accurate measurement of the glomerular filtration rate (GFR) is essential for detecting renal insufficiency in living kidney donors. Iohexol is a “near-ideal” exogenous filtration marker for GFR measurements that has attracted increasing interest in clinical practice because it is non-toxic, non-radioactive, readily available, and easy to measure. In this study, we aimed to set up a laboratory test to conveniently assess the plasma clearance of iohexol in living kidney donors. Methods: A workflow was established in the institution’s infusion clinic to administer iohexol and to collect three timed blood samples from renal transplant donors. Iohexol was thereafter measured by liquid chromatography–tandem mass spectrometry (LC-MS/MS). The serum proteins were precipitated and the supernatant containing iohexol was diluted prior to the LC-MS/MS analysis. The LC-MS/MS method was developed on a Thermo Vanquish UHPLC coupled with a TSQ Endura triple quadruple mass spectrometer with a total run time of 2.5 min. The analytical performance of the method was assessed. Results: The LC-MS/MS method demonstrated a good analytical performance. To calculate the iohexol clearance rate and the GFR, automated data integration and a result calculation were accomplished by using a custom Python script. Automated result reporting was achieved using a laboratory informatics system (LIS) vendor’s direct media interface. Conclusions: We developed and implemented a laboratory test to assess the plasma clearance of iohexol. A workflow was established in the hospital to reliably measure the GFR in living kidney donors, with a potential to be further expanded into other areas where an accurate GFR measurement is needed. Full article

The purpose of this study is to find out the psychological factor characteristic of non-adherence patients. The study population comprised kidney transplant recipients aged between 18 and 82 years at least 3 months post-transplant who voluntarily agreed to answer a couple of fully anonymous questionnaires that questions pertaining to basic data, type of immunosuppressive drugs taken, and standardized questionnaires. Participants were recruited using direct routine, free-of-charge visits to specialist doctors in transplant clinics. There was no significant difference in the percentage of men and women in both adherence and non-adherence groups. Non-adherence patients were significantly younger compared to adherence patients. There was also a significant difference in the patient’s level of education. Adherence patients were better educated. No significant differences in criteria such as place of residence, having children or a partner, or way of living were observed. However, the emotion scale correlated negatively with the level of life orientation in both groups, but the level of the emotions scale and distractions subscale was negatively correlated with the level of self-esteem only for the adherence group. In future research, it would be worthwhile to focus on lifestyle and health-promoting behaviors in juxtaposition with the propensity for adherence. Full article

Background: Better understanding of the different phenotypes/subgroups of non-U.S. citizen kidney transplant recipients may help the transplant community to identify strategies that improve outcomes among non-U.S. citizen kidney transplant recipients. This study aimed to cluster non-U.S. citizen kidney transplant recipients using an unsupervised machine learning approach; Methods: We conducted a consensus cluster analysis based on recipient-, donor-, and transplant- related characteristics in non-U.S. citizen kidney transplant recipients in the United States from 2010 to 2019 in the OPTN/UNOS database using recipient, donor, and transplant-related characteristics. Each cluster’s key characteristics were identified using the standardized mean difference. Post-transplant outcomes were compared among the clusters; Results: Consensus cluster analysis was performed in 11,300 non-U.S. citizen kidney transplant recipients and identified two distinct clusters best representing clinical characteristics. Cluster 1 patients were notable for young age, preemptive kidney transplant or dialysis duration of less than 1 year, working income, private insurance, non-hypertensive donors, and Hispanic living donors with a low number of HLA mismatch. In contrast, cluster 2 patients were characterized by non-ECD deceased donors with KDPI <85%. Consequently, cluster 1 patients had reduced cold ischemia time, lower proportion of machine-perfused kidneys, and lower incidence of delayed graft function after kidney transplant. Cluster 2 had higher 5-year death-censored graft failure (5.2% vs. 9.8%; p < 0.001), patient death (3.4% vs. 11.4%; p < 0.001), but similar one-year acute rejection (4.7% vs. 4.9%; p = 0.63), compared to cluster 1; Conclusions: Machine learning clustering approach successfully identified two clusters among non-U.S. citizen kidney transplant recipients with distinct phenotypes that were associated with different outcomes, including allograft loss and patient survival. These findings underscore the need for individualized care for non-U.S. citizen kidney transplant recipients. Full article