A.E Bittar

Kidney graft failure due to noncompliance

RENAL transplantation is the treatment of choice for end-stage renal failure. However, the recipient needs a lifelong intake of immunosuppressive medication for the long-term success of the transplantation. There is a growing awareness of patient noncompliance with immunosuppression, which can result in rejection and graft loss. Recent data show rates of noncompliance ranging from less than 5% to more than 45%; it depends on time posttransplant and evaluation method. Noncompliance is one of the major causes of graft failure among renal transplant recipients. The objective of this study was to evaluate the present rate of graft loss due to noncompliance among our patients and to identify factors associated with noncompliance.

Histopathological analysis of pre-implantation donor kidney biopsies: association with graft survival and function in one year post-transplantation

INTRODUCTION Pre-implantation kidney biopsy is a decision-making tool when considering the use of grafts from deceased donors with expanded criteria, implanting one or two kidneys and comparing this to post-transplantation biopsies. The role of histopathological alterations in kidney compartments as a prognostic factor in graft survival and function has had conflicting results. OBJECTIVE This study evaluated the prevalence of chronic alterations in pre-implant biopsies of kidney grafts and the association of findings with graft function and survival in one year post-transplant. METHODS 110 biopsies were analyzed between 2006 and 2009 at Santa Casa de Porto Alegre, including live donors, ideal deceased donors and those with expanded criteria. The score was computed according to criteria suggested by Remuzzi. The glomerular filtration rate (GFR) was calculated using the abbreviated MDRD formula. RESULTS No statistical difference was found in the survival of donors stratified according to Remuzzi criteria. The GFR was significantly associated with the total scores in the groups with mild and moderate alterations, and in the kidney compartments alone, by univariate analysis. The multivariate model found an association with the presence of arteriosclerosis, glomerulosclerosis, acute rejection and delayed graft function. CONCLUSION Pre-transplant chronic kidney alterations did not influence the post-transplantation one-year graft survival, but arteriosclerosis and glomerulosclerosis is predictive of a worse GFR. Delayed graft function and acute rejection are independent prognostic factors.