83 research outputs found
Recommended from our members
Differences in Proinflammatory Cytokines and Monocyte Subtypes in Older as Compared With Younger Kidney Transplant Recipients.
Background:The number of elderly patients with end-stage kidney disease requiring kidney transplantation continues to grow. Evaluation of healthy older adults has revealed proinflammatory changes in the immune system, which are posited to contribute to age-associated illnesses via "inflamm-aging." Immunologic dysfunction is also associated with impaired control of infections. Whether these immunologic changes are found in older kidney transplant recipients is not currently known, but may have important implications for risk for adverse clinical outcomes. Methods:Three months after transplant, innate immune phenotype was evaluated by flow cytometry from 60 kidney transplant recipients (22 older [≥60 years] and 38 younger [<60 years old]). Multiplex cytokine testing was used to evaluate plasma cytokine levels. Younger patients were matched to older patients based on transplant type and induction immune suppression. Results:Older kidney transplant recipients demonstrated decreased frequency of intermediate monocytes (CD14++CD16+) compared with younger patients (1.2% vs 3.3%, P = 0.007), and a trend toward increased frequency of proinflammatory classical monocytes (CD14++CD16-) (94.5% vs 92.1%) (P = 0.065). Increased levels of interferon-gamma (IFN-γ) were seen in older patients. Conclusions:In this pilot study of kidney transplant recipients, we identified differences in the innate immune system in older as compared with younger patients, including increased levels of IFN-γ. This suggests that age-associated nonspecific inflammation persists despite immune suppression. The ability to apply noninvasive testing to transplant recipients will provide tools for patient risk stratification and individualization of immune suppression regimens to improve outcomes after transplantation
Vouchers for Future Kidney Transplants to Overcome “Chronological Incompatibility” Between Living Donors and Recipients
Handbook of kidney transplantation, 4th Ed./ Edit. : Gabriel M. Danovitch
xv, 542 hal. : ill.; 20 cm
Handbook of kidney transplantation, 4th Ed./ Edit. : Gabriel M. Danovitch
xv, 542 hal. : ill.; 20 cm
Effects of water immersion on renal function in the nephrotic syndrome
Effects of water immersion on renal function in the nephrotic syndrome. Nine adult patients with the nephrotic syndrome were studied during 4 hours of water immersion (WI) to the level of the neck in the seated position and under control conditions. During WI, sodium excretion (UNaV) rose from a mean prestudy level of 45.9 ± 18.7 µEq/min to a mean peak level of 242.2 ± 42.8 µEq/min during the 4th hour. During control studies, UNaV was unchanged. During WI, urine volume rose from 1.1 ± 0.4ml/min and reached a peak level of 7.5 ± 0.8ml/min during the 2nd hour. There were also marked increases in free water clearance and potassium excretion. Plasma renin activity fell from a prestudy level of 5.1 ± 1.3 ng/ml/hr to a nadir of 1.9 ± 0.4 ng/ml/hr during the 2nd hour of WI. Levels were unchanged during control studies. There was a considerable variation in the magnitude of the natriuretic effect of WI between the individual patients. Peak levels of UNaV varied from 55.3 to 488 µEq/min, and net negative sodium balance varied from 12.8 to 105mEq. These variations were found to be directly related to the patient's estimated plasma volume, such that y = 19.2x - 211 (r = 0.84) represented the relationship between the plasma volume and the peak UNaV, and y = 1.9x - 41 (r = 0.81) represented the relationship between plasma volume and net negative sodium balance. These studies indicate that in patients with nephrotic syndrome, as in normal subjects, WI provides a potent natriuretic stimulus that results from expansion of the central blood volume. The magnitude of the natriuresis in nephrotic patients is related to their plasma volume, an observation that might help predict therapeutic benefit of the procedure in the individual patient.Effets de l'immersion dans l'eau sur la fonction rénale dans le syndrome néphrotique. Neuf malades adultes atteints de syndrome néphrotique ont été étudiés au cours de 4 heures d'immersion dans l'eau (WI) jusqu'au cou en position assise et dans des conditions contrôles. Au cours de l'immersion l'excrétion de sodium (UNaV) a augmenté d'une valeur moyenne contrôle de 45,9 ± 18,7 µEq/mn à une valeur moyenne de pic de 242,2 ± 42,8 µEq/mn au cours de la quatrième heure. Au cours des études contrôles UNaV était inchangée. Au cours de l'immersion le débit urinaire a augmenté de 1,1 ± 0,4ml/mn et a atteint une valeur de pic de 7,5 ± 0,8ml/mn au cours de la deuxième heure. Une augmentation importante de la clearance de l'eau libre et de l'excrétion de potassium a été observée. L'activité rénine plasmatique a diminué d'une valeur de 5,1 ± 1,3 ng/ml/h avant l'étude à un minimum de 1,9 ± 0,4 ng/ml/h au cours de la deuxième heure de l'immersion. Au cours des études contrôles les valeurs ont été inchangées. Des variations individuelles considérables dans l'amplitude de l'effet natriurétique de l'immersion ont été observées. La valeur de pic de UNaV a varié de 55,3a488a varié de µEq/min, et net négative l'equilibre sodium 12,8mEq à 105mEq. Ces variations ont été corrélées au volume plasmatique estimé des malades de telle sorte que y = 19,2x - 211 (r = 0,84) a représenté la relation entre le volume plasmatique et la valeur de pic de UNaV, et que y = 1,9x - 41 (r = 0,81) a représenté la relation entre le volume plasmatique et le bilan négatif net de sodium. Ces études indiquent que chez des malades atteints de syndrome néphrotique comme chez les sujets normaux l'immersion produit un stimulus natriurétique puissant qui résulte d'une expansion du volume sanguin central. L'importance de la natriurèse chez les malades atteints de syndrome néphrotique était en relation avec leur volume plasmatique, une observation qui peut aider à prédire l'effet thérapeutique de cette manoeuvre pour un malade donné
Banking on living kidney donors - a new way to facilitate donation without compromising on ethical values
For permissions, please e-mail: [email protected]. Public surveys conducted in many countries report widespread willingness of individuals to donate a kidney while alive to a family member or close friend, yet thousands suffer and many die each year while waiting for a kidney transplant. Advocates of financial incentive programs or "regulated markets" in kidneys present the problem of the kidney shortage as one of insufficient public motivation to donate, arguing that incentives will increase the number of donors. Others believe the solutions lie - at least in part - in facilitating so-called "altruistic donation;" harnessing the willingness of relatives and friends to donate by addressing the many barriers which serve as disincentives to living donation. Strategies designed to minimize financial barriers to donation and the use of paired kidney exchange programs are increasingly enabling donation, and now, an innovative program designed to address what has been termed "chronologically incompatible donation" is being piloted at the University of California, Los Angeles, and elsewhere in the United States. In this program, a person whose kidney is not currently required for transplantation in a specific recipient may instead donate to the paired exchange program; in return, a commitment is made to the specified recipient that priority access for a living-donor transplant in a paired exchange program will be offered when or if the need arises in the future. We address here potential ethical concerns related to this form of organ "banking" from living donors, and argue that it offers significant benefits without undermining the well-established ethical principles and values currently underpinning living donation programs
Caution: deceased donor organ commercialism!
In the past 3 years there have been attempts to counter the international campaignagainst a market in organs from the living. In parallel to these attempts,support for a market in organs from the deceased has gained some traction. Inthis article we describe the various forms of this phenomenon, analyze itsimplications, and call upon policy makers to take steps to halt its progress
- …