Nicolas Muruve

Beneficial effects of the bioflavonoids curcumin and quercetin on early function in cadaveric renal transplantation : A randomized placebo controlled trial

Background. The bioflavonoids quercetin and curcumin are renoprotective natural antioxidants. We wished to examine their effects on early graft function (EF). Methods. Between September 2002 and August 2004, 43 dialysis dependent cadaveric kidney recipients were enrolled into a study using Oxy-Q which contains 480 mg of curcumin and 20 mg of quercetin, started after surgery and taken for 1 month. They were randomized into three groups: control (placebo), low dose (one capsule, one placebo) and high dose (two capsules). Delayed graft function (DGF) was defined as first week dialysis need and slow function (SGF) as Cr >2.5 mg/dl by day 10. Category variables were compared by chi squared and continuous variables by Kruskal-Wallis. Results. There were four withdrawals: one by patient choice and three for urine leak. The control group had 2/14 patients with DGF vs. none in either treatment group. Incidence of EF was control 43%, low dose 71% and high dose 93% (P=0.013). Serum creatinine was significantly lower at 2 days (control 7.6±2.1, low 5.4±0.6, high 3.96±.35 P=0.0001) and 30 days (control 1.82±.16, low 1.65±.09, high 1.33 ±.1, P=0.03). Acute rejection incidence within 6 months was control 14.3%, low dose 14.3% and high dose 0%. Tremor was detected in 13% of high dose patients vs. 46% of others. Urinary HO-1 was higher in bioflavonoid groups. Conclusion. Bioflavonoid therapy improved early graft function. Acute rejection and neurotoxicity were lowest in the high dose group. These bioflavonoids improve early outcomes in cadaveric renal transplantation, possibly through HO-1 induction.

Increased access to transplantation for blood group B cadaveric waiting list candidates by using A2 kidneys: time for a new national system?

Since blood group B end‐stage renal disease (ESRD) patients have less access to donor kidneys and a higher minority composition than any other blood group, the United Network for Organ Sharing (UNOS) approved a voluntary national kidney allocation variance to allow organ procurement organizations (OPOs) to preferentially allocate A2 and A2B kidneys to B candidates.

Genitourinary malignancies in solid organ transplant recipients.

Malignancy is a recognized complication of transplantation. Genitourinary cancers are the second most common tumors in transplant recipients with prostate cancer and renal cell carcinoma the most common. Unlike the more common skin malignancies, genitourinary tumors have a significant impact on both graft and patient survival. Surgical and radiation treatments need to consider the location of heterotopic transplants and administration of chemotherapy may need alteration in light of immunosuppression being used. The major genitourinary malignancies and their management will be reviewed in this article with emphasis on the concerns that arise in a transplant recipient.

Are wedge biopsies of cadaveric kidneys obtained at procurement reliable

BACKGROUND Single wedge biopsy of cadaveric kidneys from donors older than 55 is currently the standard method of evaluating their viability for transplantation. The degree of glomerulosclerosis presently determines whether a kidney can be transplanted, but most biopsies sample only the subcapsular region and may not accurately represent the true renal architecture. Our study evaluated the accuracy of transplant suitability determinations based upon the single wedge biopsy of cadaveric kidneys. METHODS We took kidneys that were refused by UNOS centers on the basis of biopsy results, examined their histology in detail, and reviewed donor medical histories. Sections were taken from the upper, lower, and mid-portion of each kidney and stained with the periodic acid Schiff stain. Percentage and location of glomerulosclerosis and other relevant pathology were then determined in each section. We compared our findings with the results of the original wedge biopsies obtained at the time of procurement. RESULTS Nine kidneys were obtained and examined. The wedge biopsies at the time of procurement showed glomerulosclerosis ranging from 8 to 36% (median 17%). The multiple kidney sections we analyzed showed fewer sclerosed glomeruli, ranging from 3 to 15% (median 7%, P<0.001), with most of the sclerosed glomeruli identified located in the immediate subcapsular region (P<0.001). CONCLUSIONS Wedge biopsies of donor kidneys can overestimate the total amount of glomerulosclerosis, apparently because of a predominance of sclerosis in the kidneys subcapsular region, the area predominantly sampled by the usual wedge biopsy. These inappropriately high estimates of glomerulosclerosis can result in refusal of kidneys that might be suitable for transplantation.

HLA Points Assigned in Cadaveric Kidney Allocation Should Be Revisited: An Analysis of HLA Class II Molecularly Typed Patients and Donors

The points now assigned for the quality of HLA match have received significant scrutiny to be modified in an effort to help reduce disparity in access to kidneys of minority groups, and since differences in graft survival between groups of patients in each of the HLA matched groups is less now than in the past.

Flow cytometry beads rather than the antihuman globulin method should be used to detect HLA Class I IgG antibody (PRA) in cadaveric renal regraft candidates

Abstract: HLA Class I antibody screening can be performed by flow cytometry using a mixture of 30 distinct bead populations each coated with the Class I antigen phenotype derived from different cell lines. In this study we compared the efficacy of Class I antibody screens done by flow cytometry beads with the antihuman globulin (AHG) method for patients awaiting cadaveric renal retransplantation. Class I panel reactive antibody (PRA) screening by flow cytometric beads of 21 regraft serum samples that had all been found to be negative by AHG DTT Class I PRA, revealed that 57.1% (12 of 21) had a flow Class I PRA of ≥ 10%. Furthermore, when five regraft sera with an intermediate PRA were screened (mean AHG DTT PRA = 33.2 ± 13%) the mean flow Class I PRA almost doubled (mean flow PRA = 72.4 ± 10.2%) ( p < 0.01). When active UNOS waiting list regraft candidates, after several months of screening the Class I PRA by flow beads, were divided into the three PRA categories based on their peak flow Class I PRA value (0−20%, 21−79% and ≥ 80%), the incidence of a positive flow cross‐match was 0%, 72% and 85% and the incidence of retransplantation was 60%, 22% and 10%, in each of these groups, respectively. These data provided our histocompatibility laboratory with the rationale to stop performing the AHG PRA and perform only the flow Class I PRA method for regraft candidates.

Successful cadaveric renal transplantation of patients highly sensitized to HLA Class I antigens

The purpose of our investigation was to evaluate long‐term graft survival and the role of histocompatibility in patients who were highly sensitized to human leukocyte antigen (HLA) Class I antigens and received a cadaveric renal transplant. Our multi‐institutional study evaluated 7‐yr graft outcomes and the histocompatibility requirements of 61 (6.1%) highly sensitized (anti‐human globulin panel reactive antibody [AHG PRA], ≥80%) cadaveric renal transplantation patients, transplanted between 1988 and 1997, among 999 consecutive cadaveric renal transplants.One‐ and 7‐yr graft survival in the high PRA group (n=61) was 76 and 59%, and was not significantly different from that in the low PRA group (n=938), 86 and 59% (Wilcoxon=0.11; log‐rank=0.45) (died with a functioning graft [DWFG] not censored). When those data were divided into primary and regrafts, 1‐ and 7‐yr graft outcomes for high and low PRA groups were not significantly different [(primary, 1‐ and 7‐yr survival: high PRA=83 and 74%, n=30, and low PRA=87 and 61%, n=825; log‐rank=0.37 for DWFG not censored) (regrafts, 1‐ and 7‐yr survival: high PRA=70 and 42%, n=31, and low PRA=80 and 43%, n=113; log‐rank=0.36 for DWFG not censored)]. We did observe a subgroup of the high PRA patient group that had inferior graft outcomes. Graft outcome at 1 and 6 yr in the high PRA group for patients who had one to two DR mismatches (65 and 50%, n=41) was significantly worse than for high PRA patients who had zero DR mismatches with their donors (100 and 78%, n=20) (log‐rank=0.01 for DWFG not censored). Furthermore, the mean number of HLA‐A and ‐B mismatches was significantly greater in the high PRA/DR‐mismatched group (1.7±1.2, n=41) compared with the high PRA/zero DR‐mismatched group (0.5±1.1, n=19) (p<0.001). Overall, these data suggest that the patient who is highly sensitized to HLA Class I antigens has a long‐term graft outcome that is equivalent to less sensitized patients, but that HLA‐DR mismatching and a higher degree of Class I mismatching may be poor prognostic indicators in such patients.

ABO blood group influences a candidate's likelihood of receiving an HLA zero antigen mismatch kidney

Abstract:  National sharing of HLA zero‐mismatched kidneys has improved long‐term graft survival. The distribution of those HLA‐matched kidneys by ABO blood group, however, has not been examined.

Point‐of‐care testing in an organ procurement organization donor management setting

Abstract: Purpose:  Our organ procurement organization (OPO) evaluated the clinical and financial efficacy of point‐of‐care testing (POCT) in management of our deceased organ donors.

Case of Subcutaneous Leiomyosarcoma of the Scrotum Presenting as a Sebaceous Cyst in a 71-Year-old Man: A Case Report and Review of the Literature.

Leiomyosarcoma of the scrotum is a rare genital malignancy with approximately 35 reported cases in literature. We present a case of leiomyosarcoma of the scrotum in a 71-year-old man appearing as a sebaceous cyst that later developed ulcerations. However, because the irregular mass developed ulcerations, this should trigger one to consider that lesion is potentially malignant. The pathology report demonstrated malignant spindle cell neoplasm consistent with leiomyosarcoma, which tested positive for desmin and actin stains. On literature review, a study reported a 5-year survival rate of 50%-80%. The clinical features, diagnosis, histopathologic images, and treatment are reviewed.