Fernando Abreu

First Year Renal Function as a Predictor of Kidney Allograft Outcome

BACKGROUND Several factors are known to have detrimental effects on kidney allograft function in the first year posttransplantation, which has been reported to be an important factor influencing long-term graft survival. OBJECTIVES The objectives of this study were to evaluate risk factors for lower estimated glomerular filtration rate (eGFR) at 3 and 12 months posttransplantation and analyze the influence of first year allograft function on graft and patient survivals. PATIENTS We performed a retrospective review of the clinical data from 433 cadaveric donor kidney transplantations in adults performed in our unit from May 1989 to May 2007. RESULTS Donor female gender and nontraumatic cause of death, panel-reactive antibody (PRA) titer > or =50%, acute rejection episodes, and delayed graft function (DGF) were significant risk factors for a decreased eGFR at one year posttransplantation. Recipient and donor age showed negative correlations with eGFR at 3 and 12 months. A logistic regression model showed acute rejection episodes, DGF, donor age > or =55 years, donor female gender, and nontraumatic cause of donor death to be independent adverse risk factors for eGFR <60 mL/min at 3 and 12 months. Lower eGFRs at 3 and 12 months were associated with poorer allograft survival when data were censored for death with a functioning graft and patient survival. Multivariate analysis revealed that PRA titer > or =50%, acute rejection episodes, and eGFR <30mL/min at 12 months had adverse effects on allograft survival. CONCLUSION Several factors influence kidney allograft function in the first year after transplantation. Kidney allograft function at 12 months predicted long-term graft survival.

Influence of dialysis duration and modality on kidney transplant outcomes.

BACKGROUND The influence of pretransplantation dialysis on kidney transplant outcomes has been the subject of longstanding interest. Although increased time on dialysis prior to kidney transplantation is associated with decreased graft and patient survivals, analyses of the impact of dialysis modality on kidney allograft outcome have produced conflicting results. OBJECTIVE The objective of this study was to evaluate the influence of dialysis duration and modality on the function and survival of renal allografts. PATIENTS We retrospectively reviewed the clinical data of 421 adults who received first kidney transplantations from cadaveric heart-beating donors performed in our unit from May 1989 to May 2007. Three hundred seventy-four patients (88.8%) were on hemodialysis (HD) prior to kidney transplantation, including 247 patients (58.7%) on treatment for at least 24 months. RESULTS Patients with a dialysis duration > or =24 months were significantly older (45.9 vs 42.8 years; P = .013). Renal function at 3, 12, 60, and 96 months was similar between the 2 groups. Longer duration on dialysis was associated with poorer overall graft and patient survivals. No differences were observed in renal function or graft and patient survivals comparing HD or peritoneal dialysis (PD). Multivariate analysis confirmed the lack of correlation between dialysis duration or modality and allograft failure. CONCLUSION Longer dialysis duration influenced overall graft and patient survival. However, dialysis modality showed no influence on graft function or survival.

Impact of Donor Age on Renal Allograft Function and Survival

BACKGROUND The lack of cadaveric donors coupled with a rapidly growing number of potential recipients have stimulated the implementation of several strategies, including the acceptance of older donors, to increase the organ pool and reduce the waiting list for kidney transplantation. However several studies have demonstrated higher incidences of delayed graft function and poor graft outcomes among kidneys harvested from older donors. OBJECTIVE The objective of this study was to evaluate the influence of donor age on the function and long-term survival of renal allografts. PATIENTS We performed a retrospective review of the clinical data from 441 adult kidney transplantation from cadaveric heart-beating donors performed in our unit from May 1989 to May 2007. RESULTS Recipients of kidney allografts from older donors were significantly older (49.2 vs 43.7 years; P < .0001) and had a higher incidence of delayed graft function (15.1% vs 5.4%; P = .005). Renal function was superior following kidney transplantation using younger donors not only at 3 months (P < .0001) and 12 months (P < .0001) posttransplantation, but also upon long-term follow-up at 60 months (P < .0001) and 96 months (P = .030). Allograft survival censored for death with a functioning graft and patient survival were not different when comparing older versus younger donors. Multivariate analysis confirmed the lack of correlation between donor age and allograft failure. CONCLUSION Donor age showed no influence on allograft survival. However, kidney allografts from older donors displayed lower first year and long-term renal function.

Fungal peritonitis in peritoneal dialysis patients: is previous antibiotic therapy an essential condition?

The aim of this study was to analyse the clinical and microbiological features of fungal peritonitis, in chronic peritoneal dialysis patients, focusing on non‐traditional risk factors for this feared complication. From 2001 to 2004, five episodes of fungal peritonitis were diagnosed in five different patients, accounting for 4.5% of all peritonitis cases seen during this period. Candida spp. were the most frequent isolates. In all cases, peritoneal dialysis catheter removal and switching to haemodialysis were necessary. In these five cases of fungal peritonitis only one was preceded by antibiotic use, within the previous 3 months, the classical risk factor for fungal peritonitis. Identifying predisposing factors usually not taken into account, may lead to an early diagnosis and to a better understanding of fungal peritonitis pathogenesis.

Autosomal-dominant polycystic kidney disease and kidney transplantation: experience of a single center.

BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) is a hereditary disease that frequently leads to end-stage renal disease and is a common indication for kidney transplantation. We sought to evaluate the demographic characteristics, graft and patient survival, and some posttransplantation complications among ADPKD recipients. METHODS This retrospective study included 445 renal transplant recipients, among whom 48 had ADPKD. We excluded patients with pretransplantation diabetes mellitus. We evaluated patient and graft survivals as well as posttransplantation complications. RESULTS There was no difference between the 2 groups with respect to demographic or transplant characteristics, except for older age among the ADPKD group (51.2 +/- 8.6 years vs 44 +/- 13.1 years; P < .001). We also observed no significant difference with regard to immediate graft function, immunological graft, or patient survival. Although not significant, there was a lower incidence of proteinuria and a greater number of acute rejections among ADPKD patients. As for posttransplantation complications, there was no difference regarding the prevalence of hypertension, but there was more erythrocytosis among the ADPKD group. The incidence of posttransplantation diabetes mellitus was significantly greater in ADPKD patients (33.3% vs 17.1%; P = .009), and remained significant after adjusting for confounding variables by multivariate analysis with an adjusted odds ratio of 2.3 (95% confidence interval, 1.008-5.136; P = .048). CONCLUSION Our results suggested that ADPKD patients display a greater incidence of diabetes mellitus posttransplantation; ADPKD emerged as an independent predictor for this complication.

Diabetes, deafness and renal disease

Abstract Deafness, kidney disease and diabetes are not a usual association, neither is a family history of these diseases. We present the case of a 47-year-old woman with non-nephrotic proteinuria, no haematuria, normal renal function, sensorineural hearing loss, recently diagnosed diabetes and maculopathy. There was a maternal family history of deafness, diabetes and renal disease. Renal biopsy revealed focal and segmental glomerulosclerosis (FSGS), leading to the pursuit of an m.3243A > G mitochondrial mutation and diagnosis of maternally inherited diabetes and deafness. The association of FSGS with mitochondrial diseases is not well known among nephrologists. Its timely diagnosis is important to avoid exposure to ineffective and unnecessary immunosuppression.

Nephrotic syndrome and chronic kidney disease in a young African patient from Saint Thomas and Prince: what is the link?

A 17-year-old black African female from Saint Thomas and Prince with growth failure and a 5-year history of frothy urine and periorbitary oedema was referred to our department for evaluation of renal insufficiency. At admission, the patient was hypertensive and malnourished, and presented with jugular engorgement, pulmonary rales, liver enlarged to 9 cm below the right costal margin and lower leg oedema. Laboratory tests revealed ferropenic anaemia (haemoglobin: 7.4 g/dL; ferritin 24.2 ng/mL, transferrin saturation 4%), eosinophilia (10.5%), renal dysfunction (urea 280 mg/dL, creatinine 7.0 mg/dL), hypoalbuminaemia (2.8 g/dL) and hyperfibrinogenaemia (550 mg/dL). Transaminases and C-reactive protein were on the normal range, and there was no hyperlipidaemia. Urinalysis showed proteinuria (>300 mg/dL) and haematuria (80 erythrocytes/μL), and daily protein excretion was 3.5 g/1.73 m2. Ultrasonography revealed normal renal size and increased cortical echogenicity of the kidneys, hepatosplenomegaly and celiac adenopathies. Chest X-ray revealed cardiomegaly, and ecocardiography showed dilation of left ventricle, low ejection fraction (<10%) and restrictive diastolic filling pattern. The patient started haemodialysis. Further studies were negative for dysproteinaemias, vasculitis, systemic lupus erythematosous and viral infections, including human immunodeficiency virus infection, hepatitis B and hepatitis C. Evaluation of Plasmodium infection and tuberculosis was also negative.