Search

Background: Because of the shortage of kidneys available for transplantation, we began in 1985 to harvest kidneys from non-heartbeating (NHB) donors., Methods: We compared the results of a group of 66 kidney recipients from NHB donors (NHB group) with 122 kidney recipients from heartbeating donors (HB group). We analyzed, in the NHB group, the influence of ischemia times in graft survival and we tested the best cut-offs by receiver operating characteristic curves. We also studied, using a univariate and multivariate Cox hazard model, the capacity of different variables to predict graft loss., Results: Patient and graft survival were similar in both groups during the follow-up. The percentage of delayed graft function was the only significant difference between both groups (NHB group 62% vs. HB group 32%; P=0.0001). Delayed graft function, in the NHB group, is influenced by the warm ischemia time, which is directly related to the number of days to achieve a serum creatinine<300 mmol/L (P=0.0001). The best cut-off times in this group were 45 min for warm ischemia time and 22 hr for cold ischemia time. Recipients have a greater likelihood of losing the graft beyond those limits (P=0.017, relative risk: 7.3). The incidence of acute rejection was similar in both groups, and it was the only predictor factor of graft loss in the complete series of patients (P=0.0001), in the NHB group (P=0.007), and in the HB group (P=0.02)., Conclusions: Reducing the incidence of acute rejection and shortening ischemia time are conditions needed to guarantee a long graft survival of kidneys from NHB donors.

Objectives: The shortage of renal grafts has led to the search for other alternatives. The use of grafts from non-heart-beating donors (NHBD) can increase the number of transplants 8% to 20%. Clinical studies conducted by different groups, have found that the long-term graft and patient survival are not different from those of recipients of kidneys from heart-beating donors (HBCD)., Methods/results: The long-term results of a group of 52 recipients of NHBD kidneys were compared with those of 98 recipients of HBCD grafts. There were no differences in donor and recipient ages, HLA compatibility, reperfusion and cold ischemia times. There were no differences in the incidence of rejection episodes or non-functioning kidneys. Warm ischemia between 30 to 60 min or < 30 min did not influence the incidence of non-functioning kidneys. However, NHBD graft recipients had a higher incidence of acute tubular necrosis (67% versus 46%), recovers of renal function was slower, the duration of oliguria was longer and dialysis was required. The 8-year actuarial survival data were similar for both groups; 65% for the NHBD and 70% for the HBCD graft recipients., Conclusions: We can conclude that NHBDs are an important source of donor kidneys. The 12 points established by The First International Workshop on Non-Heart-Beating Donors which appear at the end of the present article are embodied in the Treaty of Maastricht regulations of organ transplantation from non-heart-beating donors.

In 661 renal transplantations, 2 potentially migrated tumours (0.38%), 5 preexisting neoplasias (0.76%), and 31 "de novo" tumours were seen in 29 patients (4.4&). Although of very low incidence, the likelihood of tumour migration from elderly donors, given the circumstances surrounding removal, offers a high risk. None of the preexisting neoplasias relapsed following transplant. The highest prevalence was seen in skin (40%), lung (13%), kidney (13%) and bladder (6.6%) "de novo" tumours. Incidence of lymphoma was low. Dominant etiological factors of the recipient were older age, effective and tolerated immunosuppression, viral infections, environmental agents and antigenic stimulation of the graft. Skin lesions have responded well to local treatment, without need to discontinue immunosuppression, a measure that is mandatory in other malignant tumours. Also, the conclusions of a round table during the 25th National Meeting of Urotransplantation of the Spanish Association of Urology held in 1994 on "Oncology and Renal Transplantation" are presented.

The results of treatment by percutaneous transcatheter embolization in eight cases of non-tolerated non-functioning kidney graft are presented. The symptoms resulting from non-tolerance of the renal graft were fever, pain and haematuria. Embolization was well tolerated in all eight cases and the only adverse effect was post-embolization self-limited fever in five cases. The symptoms of non-tolerance of the graft disappeared immediately in all cases, with minimal morbidity and no mortality. In only one patient was it necessary to perform second embolization procedure to achieve permanent control of symptoms. We conclude that percutaneous embolization of non-tolerated non-functioning kidney graft is an effective procedure with significantly less morbidity than with surgical graft nephrectomy.

Analysis of the indications for transplantectomy and its complications over a 12-year period. Over a total of 159 failure grafts, we performed 53 transplantectomies (33.3%). The percentage of complications was 16.9%. Three patients died (5.6%) during the more or less immediate post-operative period. In our experience, consistent and prolonged maintenance of immunosuppression should avoid the need for transplantectomy in a high percentage of grafts. Only 15 transplantectomies were made on 104 failure grafts after 6 months (14.4%). Our short but successful experience with embolization of 2 rejected grafts confirms the validity of this conservative alternative versus conventional surgical transplantectomy in selected cases.

Forty-three biopsies were performed between 30 and 60 min after reperfusion. Patients (22 males/21 females, mean age 41 +/- 12 years, mean donor age 32 +/- 14 years) were treated either with antilymphocytic globulin, cyclosporin, and prednisolone (24 cases), or OKT3, cyclosporin, and prednisolone (19 cases). Ten patients had delayed post-transplant renal function (DPRF), defined as haemodialysis requirements after surgery, and seven patients had acute rejection 11 +/- 16 days post-transplant. Kidneys were perfused with a hypertonic solution containing mannitol. All patients were followed up for at least 30 months. During follow-up, five patients lost their grafts due chronic rejection, two patients due to noncompliance and one due to recurrence of focal segmental glomerulosclerosis. One patient died from heart infarction. Biopsies were stained with H&E, Masson's trichrome, periodic acid-Schiff (PAS) and silver methenamine. Interstitial fibrosis, interstitial oedema, tubular vacuolization, and peritubular capillary oedema were measured using a semiquantitative scale. Five 400 x magnification micrographs of cortical interstitium from silver-methenamine-stained sections were used to measure percentage of interstitial surface with a morphometer. Interstitial surface was 18.7 +/- 6.2% (range 3.2-35.3%). A positive correlation was found between interstitial surface and donor age (r = 0.469, P = 0.0015). No relationship was found between warm and cold ischaemia times and tubular vacuolization or peritubular capillary oedema.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation on the incidence of Acute Renal Failure (ARF) from a total of 41 corpse renal graft receptors, 20 of which received perfusion with mannitol solution at 400 mOsm/kg (Group 1) and 21 the same mannitol solution plus allopurinol (Group 2). No significant differences were present between both groups when they were analyzed for ARF incidence (15% vs 23.8%); overall incidence was 19.5%. 24-hour initial diuresis was shown to be an excellent predictor for long-term graft functionality. We can conclude that the addition of mannitol to the perfusion solution contributes decisively to reduce post-transplantation ARF, while addition of allopurinol does not have further beneficial effects.

Retrospective analysis of the results from corpse renal transplantation, under immunosuppressive therapy with cyclosporin in a group of 58 elderly receptors (greater than or equal to 50 yr). The results are compared with those obtained in 152 receptors under 50 year of age transplanted during the same period of time (1984-1988). No statistical differences were seen between both groups regarding immunosuppressive therapy, number of transfusions, HLA histocompatibility, number of transplantations and percentage of hypersensitive patients. Incidence of rejection is significantly higher in the younger patients group, as well as graft loss due to immunological reasons. Mortality was significantly higher in the elderly group. Actuarial survival of the graft after two years is similar in both groups. It is concluded that in the era of cyclosporin, the receptor's age should still be considered a risk factor and, therefore, that maximum precautions should be taken in order to detect any additional risk factor within this group in a strategy to improve their survival.

Extensive literature review on the current state of organs preservation; solutions and methodology. Major advances in immunosuppression methods and the ongoing increase in the number of renal transplants encourage the search and investigation of better preservation techniques. Continuous pulsatile perfusion and perfusion plus hypothermal storage represent the two most frequently used techniques nowadays. In spite of the advantages shown by the former in the case of prolonged cold ischemia, hypothermal storage remains as a practical technique widely used in our environment.