Encapsulating peritoneal sclerosis after kidney transplantation: Success of medical treatment

Encapsulating peritoneal sclerosis (EPS) is an infrequent but serious complication of long-term peritoneal dialysis (PD). EPS may become clinically apparent when patients are on PD (classical EPS) or after undergoing kidney transplantation (post-transplantation EPS). This presentation of EPS seems to occur shortly after kidney transplantation in former PD patients. In this report, we present our experience in our first case of patient diagnosed with EPS after kidney transplantation

La transition épithélio-mésenchymateuse et la fibrose du transplant rénal

La transition épithélio-mésenchymateuse (TEM) est un processus par lequel les cellules épithéliales différenciées subissent une conversion phénotypique et acquièrent un phénotype de cellules mésenchymateuses. Outre la morphologie allongée, s’y associent une capacité migratoire et une production accrue des composants de la matrice extracellulaire (MEC). Ce phénomène joue un rôle essentiel dans le développement embryonnaire, la cicatrisation et la régénération tissulaire. Certaines études ont suggéré que les cellules épithéliales tubulaires rénales, en réponse à une agression, se transforment en cellules mésenchymateuses, constituant une source importante de nouveaux myofibroblastes qui envahissent l’interstitium rénal et contribuent à la fibrose au sein de celui-ci. Cependant, un nombre croissant de travaux ont remis en question l’existence réelle de ce processus in vivo, qui reste un sujet de débat intense, et pourrait dépendre du modèle étudié. Dans cette revue, nous faisons le point sur le rôle de la TEM dans le développement de la fibrose du greffon rénal, puis nous proposons des approches pour la détection et le traitement de la fibrogenèse rénale, basées sur ce processus de TEM

Risk factors and consequences of delayed graft function

The impact of delayed graft function (DGF) on the outcome of renal transplantation remains controversial. We analyzed the risk factors for DGF and its impact on graft and patient survival. A total of 354 renal transplants performed between June 1986 and April 2000 were analyzed. Variables analyzed included donor and recipient age, method and duration of renal replacement therapy, HLA mismatch, cold and warm ischemia times, biopsy-confirmed acute rejection, length of stay in the hospital, serum creatinine at the end of first hospitalization as well as graft and patient survival at one, three, five and ten years. The study patients were divided into two groups: patients with DGF (G1) and those without DGF (G2). DGF occurred in 50 patients (14.1%), and it was seen more frequently in patients transplanted from deceased donors (60% vs. 40%, P <0.0001). The cause of DGF was acute tubular necrosis, seen in 98% of the cases. Univariate analysis showed a statistically significant difference between the two groups G1 and G2 in the following parameters: average duration on dialysis (52.3 vs. 36.4 months, P = 0.006), HLA mismatch (44.9% vs. 32.11% P = 0.015), donor age (35.9 vs. 40.2 years, P = 0.026), cold ischemia time (23 vs. 18.2 h, P = 0.0016), warm ischemia time (41.9 vs. 38.6 mn, P = 0.046), length of stay in the hospital during first hospitalization (54.7 vs. 33.2 days, P <0.0001), serum creatinine at the end of first hospitalization (140 vs. 112 μmol/L, P <0.0001) and at three months following transplantation (159 vs. 119 μmol/L, P = 0.0002). Multivariate analysis revealed the following independent risk factors for DGF: deceased donor (RR = 13.2, P <0.0001) and cold ischemia time (RR = 1.17, P = 0.008). The graft survival at one, three, five and ten years was 100%, 93%, 88.3% and 78.3% in G1 versus 100%, 95.9% 92.8% and 82.3% in G2; there was no statistically significant difference. The patient survival at one, three, five and ten years was 100%, 91.3%, 83.6% and 74.4% in G1 versus 100%, 95.9%, 94% and 82.6% in G2 with a statistically significant difference (P = 0.04). Prolonged cold ischemia time and transplantation of kidneys from deceased donors were the main risk factors for DGF in our study. Also, DGF significantly affected patient survival but had no influence on graft survival