Transplant Proc. 2003 May;35(3):1066.

"Very urgent" kidney transplantation: results from one center.
Costa S, Ventura A, Costa T, Martins L, Henriques A, Sarmento A.

Nephrology Department, Hospital de Santo António, 4050 Porto, Portugal.

PMID: 12947858 [PubMed - indexed for MEDLINE

Costa, S.

Costa, T.

Henriques, A.

Martins, L.

Sarmento, A.

Ventura, A.

Transplantation Proceedings

Repositório Científico do Centro Hospitalar do Porto

“Very Urgent” Kidney Transplantation: Results From One CenterS. Costa, A. Ventura, T. Costa, L. Martins, A. Henriques, and A. SarmentoKIDNEY TRANSPLANTATION (KT) is sometimesthe only option for the treatment of patients withchronic renal failure. In these circumstances, it is per-formed in “very urgent” conditions in recipients, usuallywith several risk factors for KT. These procedures areassociated with a lower degree of recipient/graft compati-bility. To our knowledge, there are few studies publishedabout this circumstance.PATIENTS AND METHODSWe performed a retrospective analysis of the kidney transplantsperformed at our center under “very urgent” conditions.RESULTSBetween 1983 and 2001, a total of 1108 KTs were per-formed at our center. The overall patient and kidney graftsurvivals were 96.1% and 88.4% at 1 year; 89.9% and 77.6%at 5 years; 78.2% and 58.5% at 10 years, respectively. Westudied 19 patients (pts) who undervent “very urgent” KTincluding 14 women (mean age  45.3  13.1 years at dateof transplantation). All grafts were from cadaveric donors,four were second KTs, with a mean time of dialysis being5.9  3.7 years. The reasons for including these pts in a“very urgent” waiting list for KT included exhaustion ofvascular accesses and impossibility of peritoneal dialysis (15pts); high sensitization with a panel reactive antigen (PRA)80% (3 pts); and refusal of dialytic treatment (1 pt).Excluding the hypersensitized patients, the mean time inthe waiting list under “very urgent” conditions was 52.0 36.9 days. Associated co-morbidity factors were ischemicheart disease 21%; cerebrovascular disease 5.2%; diabetes21%; morbid obesity 21%. Seven pts had 1 HLA-A or -Bmatch; 2 pts had 2 HLA-A or -B match; 6 pts had 1HLA-DR match. The PRA was higher than 30% in 52.6%of the pts, and in 20% of these the PRA was 80%. Sevenpts (36.8%) had multiple blood transfusions. The immuno-suppressive protocol was double (Cyclosporine [CyA];prednisone), or triple (CyA, prednisone, azathioprine/MMF) immunosuppression plus ATG in 63% of the pts,triple immunosuppression with anti-CD25 in 15%; anddouble or triple without antilymphocyte antibodies in 21%.In addition, 63.2% had delayed graft function; two-thirdsdue to acute tubular necrosis, one-third due to vascularcauses.Acute rejection episodes were seen in 36.8% of pts,leading to transplantectomy in 15.8%. Nine pts (47.4%)died, four with a functioning kidney. In another 4 pts thedeath was related to the KT. Causes of death were cardio-vascular in 4 pts; hemorrhagic shock, 2 pts; sepsis, 1 pt;calciphylaxis, 1 pt; and hypercalemia, 1 pt.Excluding graft loss due to the death of the recipient (4pts), 9 other grafts were lost due to immediate vascular orimmunologic causes, 21%; cardiovascular, 10.5%; late acuterejection, 5.2%; chronic rejection, 5.2%; infection, 5.2%.Six pts (31.6%) remain alive with a functioning graft. Themean follow-up of these pts is 1000  129 days (2 to 4222days).DISCUSSIONAccepted criteria for “very urgent” KT for a dialysis patientare intractable vascular access failure in the setting of failedperitoneal dialysis or a highly sensitized patient. This typeof transplantation is associated with a higher risk of rejec-tion and graft loss, particularly among the group of highlysensitized patients. In a report from NEOB, the 1-year graftsurvival was 85% for patients with a PRA between 0% and49%, and 76% for patients with PRA greater then 90%.1Approaches to treating these patients, including delivery ofmore aggressive immunosuppressive therapy by administra-tion of ATG, have offered substantial benefit.2 Patients withexhaustion of vascular accesses for dialysis usually haveassociated co-morbidity problems and a higher risk ofcardiovascular and thrombotic events, sometimes due to thepresence of a hypercoagulable state.Finally, “very urgent” kidney transplantation is associ-ated with high morbidity and mortality rates that are,acceptable only in the absence of other treatment options.Inclusion in the “very urgent” waiting list must obey verynarrow criteria and judicious selection.REFERENCES1. Turka LA, Goguen JE, Gagne JE, et al: Transplantation47:234, 19892. Thibaudin D, Alamartine E, de Filippis JP, et al: NephrolDial Transplant 13:711, 1998From the Nephrology Department, Hospital Santo Anto´nio,4050 Porto, Portugal.Address reprint requests to Suzana Costa, Nephrology De-partment, Hospital de Santo Anto´nio, 4050 Porto, Portugal.0041-1345/03/$–see front matter © 2003 by Elsevier Science Inc.doi:10.1016/S0041-1345(03)00308-7 360 Park Avenue South, New York, NY 10010-17101066 Transplantation Proceedings, 35, 1066 (2003)

"Very urgent" kidney transplantation: results from one center.

http://repositorio.chporto.pt/bitstream/10400.16/498/1/pdf%201.3.pdf

"Very urgent" kidney transplantation: results from one center.

Abstract

Similar works

Full text

Available Versions

Repositório Científico do Centro Hospitalar do Porto