Ines Mesar

First documented case of successful kidney transplantation from a donor with acute renal failure treated with dialysis

There is a widening gap between the needs and possibilities of kidney transplantation. In order to solve the problem of organ shortage, the selection criteria for kidney donors have been less stringent over the last years. Favorable outcome of renal transplantation from deceased donors with acute renal failure requiring dialysis may have an important role in expanding the pool of donors. We present the case of two renal transplantations from a polytraumatized 20-years old donor with acute renal failure requiring dialysis. One recipient established good diuresis from the first post-transplant day and did not require hemodialysis. The second recipient had delayed graft function and was treated with 8 hemodialysis sessions. The patient was discharged with good diuresis and normal serum creatinine. After two years of follow-up, both recipients have normal graft function. According to our experience, kidneys from deceased young donors with acute renal failure requiring dialysis may be transplanted, in order to decrease the number of patients on transplantation waiting lists.

Rescue therapy with sirolimus in a renal transplant recipient with tacrolimus-induced hepatotoxicity

Abstract Calcineurin inhibitors at elevated serum concentrations frequently cause mild elevation of the liver chemistries. Although rare, severe hepatotoxicity is their serious complication. A 54-year-old man with end-stage renal disease due to chronic glomerulonephritis without biopsy received a renal allograft from the deceased donor. Eleven days after transplantation severe liver injury (AST up to 421 IU/L, ALT 1242  IU/L, and GGT 212 IU/L) with the serum bilirubin within the normal range was recorded. Tacrolimus trough level was 5.5 ng/mL. Liver ultrasound and color-Doppler of the portal system were normal. Liver failure completely resolved after withdrawal of the calcineurin inhibitor and switch to sirolimus. After 9 months of follow-up our patient has excellent graft and liver function. Awareness of the possible association of tacrolimus use with hepatotoxicity is important to timely discontinuation of the causative agent, and to introduce sirolimus as the rescue therapy.

[PP.28.05] CHARACTERISTICS OF BLOOD PRESSURE IN PATIENTS UNDERGOING CHRONIC HEMODIALYISIS

Objective: Cardiovascular (CV) disease is the most important cause of morbidity and mortality among patients with chronic kidney disease particularly in those undergoing chronic hemodialysis (HD). Hypertension (HT), the most important CV risk factor is frequently present and has several particular characteristics. Our aim was to analyze characteristics of HT in our group 194 patients undergoing HD. Design and method: In this study we have analyzed characteristics of HT and arterial stiffness (i.e. PWV) in 194 patients (118 m, 83 w; mean age 63+/-15 y). All patients were dialyzed three times a week with standard bicarbonate hemodialysis solutions and synthetic dialyzers according to the recent international guidelines. All measurements were done mid week day. Blood pressure (BP) was measured with Omron M6 (after dialysis session), ABPM using Spacelab 90207 (24 h) and PWV (before dialysis session) was determined with Arteriograph. Results: Significant difference in BP values measured after dialysis and ABPM were found (day, night, for both systolic and diastolic BP). Only 6.6% patients were normotensive, 63.3% hypertensive, while white coat (WCH) and masked hypertension (MH) were diagnosed in 26.4% and 3.7%, respectively (no gender differences). There were no differences in BP values between men and women, but PWV > 10m/s were found more frequently in men than in women in (m vs. w 56.5% vs.39.7%;p = 0.049; 48.3% in total; 10.4 +/-1.9 vs.9.7+/-1.7;p < 0.01). In logistic regression age was the most important predictor for pathologic values of PWV. WCH had slightly higher values of PWV than normotensives (9.7 +/-2.0 vs.8.5+/-1.3; p = 0.09). PWV in MH was not different compared to the sustained HT (10.2+/-1.7). Non-dipping status was established in 45.3%, extreme dipping in 18.8%, and only 21.6% were dippers. Conclusions: Our results confirmed significant clinical value of ABPM in patients undergoing dialysis. Determination of WCH subjects and non-dippers is of utmost importance for everyday tailoring of therapy. Increased arterial stiffness should be considered as well.