F. Macário

Renal transplantation with expanded criteria donors: the experience of one portuguese center

BACKGROUND The shortage of kidneys available for transplantation has led to enlarged criteria donors (ECD): namely, donors older than 60 years or aged between 50 and 59 years with 2 of the following characteristics-hypertension, predonation serum creatinine level higher than 1.5 mg/dL or cerebrovascular disease as the cause of death. The aim of this study was to analyze renal transplants using ECD compared with standard criteria donors (SCD) concerning the incidences of delayed graft function (DGF), acute rejection episodes (ARE), and patient and graft survivals. MATERIALS AND METHODS This retrospective study of 409 cadaveric renal transplants over the last 4 years identified ECD in contrast with SCD. RESULTS Of the transplants, 24.4% used ECD. The baseline characteristics of recipients of ECD versus SCD kidneys were similar, except for age and cold ischemia time. Comparing ECD and SCD, we observed an higher incidence of DGF (35% vs 18%), occurrence of ARE (34.4% vs 16.6%), average serum creatinine levels at 6 (1.87 vs 1.4 mg/dL), and 12 months (1.88 vs 1.43 mg/dL) as well as lower graft survival at 1 (82% vs 91%) and 3 years (75% vs 84%) after transplantation. Recipient survival at 1 year was not different. Multivariate analysis identified recipient age, cold ischemia time, ARE, and DGF as risk factors for graft failure. CONCLUSIONS Renal transplantation with grafts from ECD shows significantly worse outcomes with higher rates of DGF and ARE, worse graft function, and lower graft survival.

The Prognostic Value of Pre-implantation Graft Biopsy on the Outcomes of Renal Transplantations

INTRODUCTION The pre-implantation graft biopsy is an important tool for the selection of donors, providing objective information about graft function outcomes. The degree of histological lesions is related to the incidence of delayed graft function (DGF) and long-term survival of the graft. MATERIALS AND METHODS We analyzed 30 graft biopsy specimens by a semi-quantitative evaluation of chronic lesions. We evaluated the clinical characteristics of recipients, the presence of DGF, and the renal function in the immediate posttransplantation period, as well as month 3 and month 6 after transplantation. RESULTS Histological evaluation showed glomerulosclerosis score 0 in 77% versus score of 1 in 23%; fibrosis score 0 in 46.5% versus score 1 in 46.5% and score 2 in 7%; tubular atrophy score 0 in 53.5% versus score 1 in 36.5% and score 2 in 10%; vascular score 0 in 17% versus score 1 in 50% and score 2 in 33%. Approximately 33% of patients displayed DGF and 13% acute rejection episodes. There was a positive correlation between the presence of interstitial fibrosis and serum creatinine values at 3 (P = .01) and 6 months (P = .02). No correlation was observed between graft function and the presence of tubular atrophy, glomerulosclerosis, and vascular changes. CONCLUSION We observed that a large number of graft biopsy specimens (83%) displayed vascular changes related to the age of the donor. Only a minor degree of interstitial fibrosis, was related to better graft function. The presence of tubular atrophy, vascular changes, and glomerulosclerosis showed no impact on short-term graft function.

Induction With Basiliximab in Renal Transplantation

INTRODUCTION The use of monoclonal antibodies in renal transplantation for induction therapy has been associated with a marked reduction in acute rejection rates with an impact on graft and patient survivals. OBJECTIVE We sought to evaluate the efficacy of renal transplant induction protocols using Basiliximab based on the rates of acute rejection episodes (ARE) and delayed graft function (DGF) of infectious complications in the first 6 months posttransplant, as well as patient and graft survivals. METHODS We retrospectively evaluated all renal transplants performed between 2000 and 2008 that were primary grafts from cadaveric heart-beating donors, into recipients with a panel reactive antibody titer <5% and who were treated with an immunosuppression scheme based on cyclosporine, mycophenolate mofetil/mycophenolic acid plus corticosteroids, with (group 1) or without basiliximab (group 2). RESULTS We enrolled 52 recipients in group 1 (induction with basiliximab) and 189 in group 2 (without basiliximab). The baseline characteristics were similar among the groups, except for time on dialysis which was longer in group 1 and the number of HLA matches, which was lower in group 1. The ARE rate was lower among group 1 (7.8% vs 27.8%; P = .001); rates of DGF and infectious complications were similar. There was no significant difference in graft and patient survivals. CONCLUSION In this study, induction with basiliximab was associated with a reduced rate rate of ARE, despite a lower number of HLA matches and a longer previous time on dialysis. The use of this induction modality was not associated with a greater rate of infectious complications.