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Aim: To evaluate graft and patient outcomes following kidney transplantation in end stage kidney disease (ESKD) secondary to hyperoxaluria using the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. Background(s): Hyperoxaluria has presented a challenge for transplant physicians given the risk of disease recurrence in the graft. There has been no analysis of transplant and patient outcomes using the ANZDATA registry. Method(s): This cohort study compared the outcomes of all patients with ESKD secondary to hyperoxaluria who received a kidney transplant in Australia and New Zealand between 1965 and 2015 to propensity score matched controls with ESKD secondary to reflux nephropathy. The primary outcome measure was graft survival. Secondary outcomes included estimated glomerular filtration rate (eGFR), acute rejection and patient survival. Result(s): Nineteen kidney transplants were performed in 16 patients with hyperoxaluria between September 1965 and December 2015. Median graft survival was 1.8 years (IQR 0.4-10.6) in hyperoxaluria recipients compared to 6.8 years (IQR 2.7-13.0) in reflux nephropathy controls. Compared to reflux nephropathy, hyperoxaluria was not associated with an increased risk of graft failure (SHR 2.43, 95% CI 0.94-6.22, p=0.07). The most common cause of graft failure in the hyperoxaluria cohort was recurrent disease in contrast to chronic allograft nephropathy for reflux nephropathy recipients. Hyperoxaluria was associated with a higher post-transplant serum creatinine, but not with an increased risk of acute rejection or death. Conclusion(s): Compared to reflux nephropathy, ESKD secondary to hyperoxaluria was not associated with inferior graft survival, patient survival, or acute rejection risk. However, post-transplant serum creatinine was higher and there was a shorter time to graft failure.

Aim: Case report of renal re-transplantation, reported only once previously. Report: A middle aged recipient received a kidney transplant from a deceased multi-organ donor. After initially doing well, the patient suffered cardiac arrest several days post-operatively and sustained hypoxic brain injury and was declared brain dead. Following the family's consent, the allograft kidney was retrieved and re-transplanted into a man with end-stage renal failure secondary to reflux nephropathy. The lungs were used in a separate recipient but the liver was not transplanted due to suspicion of fatty changes based on macroscopic appearance. Histological analysis of the liver more than 24 hours after transplantation of the other organs revealed coagulative parenchymal necrosis with nuclear inclusions and moderate parenchymal cholestasis, suggestive of herpes viral hepatitis. Examination of the renal implantation biopsy showed histiocytes with enlarged nuclei containing viral inclusions in the capsular fibrous tissue, with positive immunostaining for herpes simplex virus (HSV). Valaciclovir was started immediately after obtaining histological evidence of donor HSV infection and this was subsequently converted to intravenous ganciclovir. Our recipient had pre-formed IgG antibodies to HSV-1 and HSV-2, and was IgM negative pretransplant. HSV viraemia was detected day 5 post-transplant with a viral load of 7688 copies/mL by polymerase chain reaction (PCR) assay. He completed a 30-day course of intravenous ganciclovir before switching to valganciclovir as standard cytomegalovirus prophylaxis. The HSV PCR became undetectable on day 7 of IV ganciclovir and has remained undetectable. The patient remains well with an estimated glomerular filtration rate of 61 mL/min/1.73 m2 and further investigation of the apparent viral transmission is underway. Conclusion(s): We report good short term results of renal re-transplantation and HSV transmission by transplantation.

Aim: Case report of renal re-transplantation, reported only once previously. Report: A middle aged recipient received a kidney transplant from a deceased multi-organ donor. After initially doing well, the patient suffered cardiac arrest several days post-operatively and sustained hypoxic brain injury and was declared brain dead. Following the family's consent, the allograft kidney was retrieved and re-transplanted into a man with end-stage renal failure secondary to reflux nephropathy. The lungs were used in a separate recipient but the liver was not transplanted due to suspicion of fatty changes based on macroscopic appearance. Histological analysis of the liver more than 24 hours after transplantation of the other organs revealed coagulative parenchymal necrosis with nuclear inclusions and moderate parenchymal cholestasis, suggestive of herpes viral hepatitis. Examination of the renal implantation biopsy showed histiocytes with enlarged nuclei containing viral inclusions in the capsular fibrous tissue, with positive immunostaining for herpes simplex virus (HSV). Valaciclovir was started immediately after obtaining histological evidence of donor HSV infection and this was subsequently converted to intravenous ganciclovir. Our recipient had pre-formed IgG antibodies to HSV-1 and HSV-2, and was IgM negative pretransplant. HSV viraemia was detected day 5 post-transplant with a viral load of 7688 copies/mL by polymerase chain reaction (PCR) assay. He completed a 30-day course of intravenous ganciclovir before switching to valganciclovir as standard cytomegalovirus prophylaxis. The HSV PCR became undetectable on day 7 of IV ganciclovir and has remained undetectable. The patient remains well with an estimated glomerular filtration rate of 61 mL/min/1.73 m2 and further investigation of the apparent viral transmission is underway. Conclusion(s): We report good short term results of renal re-transplantation and HSV transmission by transplantation.

The increasing prevalence of obesity in developed countries is reflected in the chronic kidney disease, dialysis, and transplant populations. The added risk factor of obesity increases the risk of vascular events, inflammation, insulin resistance, blood pressure, dyslipidemia, and mortality risk. Nephrology center policies may exclude obese people from transplantation programs resulting in many years of dialysis. The case of a 215-kg Australian male who has successfully dialyzed at home for more than 8years will be used to illustrate the important considerations and clinical support that these people require for successful home dialysis treatment. The aim of this paper is to report on a program that has successfully trained 23 obese (body mass index >30) people who commenced on home hemodialysis between 2001 and 2009. Body weight ranged between 94.0 and 215kg (mean 126, SD 26.19) and body mass index ranged between 34.9 and 71 (mean 43.38, SD 9.99) at the start of home training. During the 8.5years of follow-up, average time on home dialysis was 43.7months. Home hemodialysis is a feasible treatment for obese people to facilitate longer and more frequent dialysis, resulting in improved hemodynamic stability and improved quality of life. For obese people with end-stage kidney disease, home hemodialysis has shown to be cost-effective and can result in greater treatment efficacy than in-center hospital dialysis. © 2012 The Authors. Hemodialysis International © 2012 International Society for Hemodialysis.

Crossmatching of potential renal donors against potential renal transplant recipients has been performed for over 40 years and is a mandatory component of the transplant work-up process. However, gone are the days when all that was available was the T-cell complement-dependent cytotoxicity crossmatch. There are now many more options available for determining the likelihood of donor-specific antibody-mediated responses including flow crossmatching and the 'virtual' crossmatch. In addition, assays to determine the extent of sensitization of cell-mediated responses are being examined. This article builds an understanding of modern day crossmatch interpretation using a case-based approach in order to provide a framework for the general nephrologist to determine the likely immune consequences of a particular donor-recipient pairing. © 2010 Asian Pacific Society of Nephrology.

Background: Planned early initiation of dialysis therapy based on estimated kidney function does not influence mortality and major comorbid conditions, but amelioration of symptoms may improve quality of life and decrease costs. Study Design: Patients with progressive chronic kidney disease and a Cockcroft-Gault estimated glomerular filtration rate of 10-15 mL/min/1.73 m2 were randomly assigned to start dialysis therapy at a glomerular filtration rate of either 10-14 (early start) or 5-7 mL/min/1.73 m2 (late start). Setting & Population: Of the original 828 patients in the IDEAL (Initiation of Dialysis Early or Late) Trial in renal units in Australia and New Zealand, 642 agreed to participate in this cost-effectiveness study. Study Perspective & Timeframe: A societal perspective was taken for costs. Patients were enrolled between July 1, 2000, and November 14, 2008, and followed up until November 14, 2009. Intervention(s): Planned earlier start of maintenance dialysis therapy. Outcome(s): Difference in quality of life and costs. Result(s): Median follow-up of patients (307 early start, 335 late start) was 4.15 years, with a 6-month difference in median duration of dialysis therapy. Mean direct dialysis costs were significantly higher in the early-start group ($10,777; 95% CI, $313 to $22,801). Total costs, including costs for resources used to manage adverse events, were higher in the early-start group ($18,715; 95% CI, -$3,162 to $43,021), although not statistically different. Adjusted for differences in baseline quality of life, the difference in quality-adjusted survival between groups over the time horizon of the trial was not statistically different (0.02 full health equivalent years; 95% CI, -0.09 to 0.14). Limitation(s): Missing quality-of-life questionnaires and skewed cost data, although similar in each group, decrease the precision of results. Conclusion(s): Planned early initiation of dialysis therapy in patients with progressive chronic kidney disease ha

The increasing prevalence of obesity in developed countries is reflected in the chronic kidney disease, dialysis, and transplant populations. The added risk factor of obesity increases the risk of vascular events, inflammation, insulin resistance, blood pressure, dyslipidemia, and mortality risk. Nephrology center policies may exclude obese people from transplantation programs resulting in many years of dialysis. The case of a 215-kg Australian male who has successfully dialyzed at home for more than 8years will be used to illustrate the important considerations and clinical support that these people require for successful home dialysis treatment. The aim of this paper is to report on a program that has successfully trained 23 obese (body mass index >30) people who commenced on home hemodialysis between 2001 and 2009. Body weight ranged between 94.0 and 215kg (mean 126, SD 26.19) and body mass index ranged between 34.9 and 71 (mean 43.38, SD 9.99) at the start of home training. During the 8.5years of follow-up, average time on home dialysis was 43.7months. Home hemodialysis is a feasible treatment for obese people to facilitate longer and more frequent dialysis, resulting in improved hemodynamic stability and improved quality of life. For obese people with end-stage kidney disease, home hemodialysis has shown to be cost-effective and can result in greater treatment efficacy than in-center hospital dialysis. © 2012 The Authors. Hemodialysis International © 2012 International Society for Hemodialysis.

Crossmatching of potential renal donors against potential renal transplant recipients has been performed for over 40 years and is a mandatory component of the transplant work-up process. However, gone are the days when all that was available was the T-cell complement-dependent cytotoxicity crossmatch. There are now many more options available for determining the likelihood of donor-specific antibody-mediated responses including flow crossmatching and the 'virtual' crossmatch. In addition, assays to determine the extent of sensitization of cell-mediated responses are being examined. This article builds an understanding of modern day crossmatch interpretation using a case-based approach in order to provide a framework for the general nephrologist to determine the likely immune consequences of a particular donor-recipient pairing. © 2010 Asian Pacific Society of Nephrology.

Background: Planned early initiation of dialysis therapy based on estimated kidney function does not influence mortality and major comorbid conditions, but amelioration of symptoms may improve quality of life and decrease costs. Study Design: Patients with progressive chronic kidney disease and a Cockcroft-Gault estimated glomerular filtration rate of 10-15 mL/min/1.73 m2 were randomly assigned to start dialysis therapy at a glomerular filtration rate of either 10-14 (early start) or 5-7 mL/min/1.73 m2 (late start). Setting & Population: Of the original 828 patients in the IDEAL (Initiation of Dialysis Early or Late) Trial in renal units in Australia and New Zealand, 642 agreed to participate in this cost-effectiveness study. Study Perspective & Timeframe: A societal perspective was taken for costs. Patients were enrolled between July 1, 2000, and November 14, 2008, and followed up until November 14, 2009. Intervention(s): Planned earlier start of maintenance dialysis therapy. Outcome(s): Difference in quality of life and costs. Result(s): Median follow-up of patients (307 early start, 335 late start) was 4.15 years, with a 6-month difference in median duration of dialysis therapy. Mean direct dialysis costs were significantly higher in the early-start group ($10,777; 95% CI, $313 to $22,801). Total costs, including costs for resources used to manage adverse events, were higher in the early-start group ($18,715; 95% CI, -$3,162 to $43,021), although not statistically different. Adjusted for differences in baseline quality of life, the difference in quality-adjusted survival between groups over the time horizon of the trial was not statistically different (0.02 full health equivalent years; 95% CI, -0.09 to 0.14). Limitation(s): Missing quality-of-life questionnaires and skewed cost data, although similar in each group, decrease the precision of results. Conclusion(s): Planned early initiation of dialysis therapy in patients with progressive chronic kidney disease ha

Defective valve mechanism at the ureteral orifice leads to backflow of bladder urine into the ureter and renal pelvis, causing hydroureter, hydronephrosis, recurrent pyelonephritis, renal scarring, and reflux nephropathy, and occasionally resulting into end-stage renal failure. VUR in infants often disappeats without surgical treatment, as they grow. Therefore, VUR in early childhood should be observed with prophylactic administration of antibiotics. When urinary tract infection frequently recurs, or when VUR dces not disappear despite of long-term prophylactic treatment, surgical repair is indicated. Results of prophylactic and surgical treatment are presented. The results of surgical repair were very excellent in regard of postoperative recurrence of VUR, postoperative development of stricture and maintenance of the renal function.

Defective valve mechanism at the ureteral orifice leads to backflow of bladder urine into the ureter and renal pelvis, causing hydroureter, hydronephrosis, recurrent pyelonephritis, renal scarring, and reflux nephropathy, and occasionally resulting into end-stage renal failure. VUR in infants often disappeats without surgical treatment, as they grow. Therefore, VUR in early childhood should be observed with prophylactic administration of antibiotics. When urinary tract infection frequently recurs, or when VUR dces not disappear despite of long-term prophylactic treatment, surgical repair is indicated. Results of prophylactic and surgical treatment are presented. The results of surgical repair were very excellent in regard of postoperative recurrence of VUR, postoperative development of stricture and maintenance of the renal function.