20 research outputs found
La valutazione clinica del donatore vivente
No full textWhen possible, living donor transplantation represents the best therapeutic strategy for patients suffering from chronic renal failure. Studying the donor allows a complete and thorough clinical, laboratory and instrumental assessment that guarantees good organ function whilst protecting the health of the donor. The main parameters considered within this framework are age, renal function, nephrological complications, comorbidities (diabetes, hypertension, obesity, etc.), malignancies, and infection. Moreover, particular attention is paid to the sociopsychological aspects of the donation, particularly related to the donor, the recipient, and the entire family situation
Long Term Outcomes of Kidney Transplant: Characteristics of Recipients with 20 or More Years of Graft Survival
No full textObjective: Kidney transplant survival in the first year after transplantation has significantly improved, although
long-term results are less encouraging. In recent years the pressure on the scientific community on the need to
refine methods to discover the possible factors that can predict graft survival after 10, 20 years or more after
transplantation is increased. Few previous studies have evaluated patient and laboratory characteristics associated
with optimal long-term graft survival. The objective of this study was to identify possible factors associated with the
survival of the transplanted kidney in the very long term.
Methods: We retrospectively studied adults who had received first-time, single kidney transplants between 1967
and 1991 at S. Orsola Hospital in Kidney Transplant Centre in Bologna. We compared the clinical, immunological,
and laboratory profile of patients whose grafts were still functioning ≥ 20 years after kidney transplantation to those
whose transplants survived <20 years.
Results: We identified 111 patients (24.5%) who received transplants with a functioning graft for 20 or more years
after transplantation. Female gender, living donor, younger donor age, shorter delayed graft function duration (DGF),
lower one-year creatinine and higher one-year eGFR predicted ≥ 20-year functional graft survival in the univariate
analyses. In the multivariate analysis, only female gender, shorter DGF duration and 1-year creatinine and eGFR
remained as significant predictors of graft survival ≥ 20 years.
Conclusions: To our knowledge, this is the first report of 20-year graft survival being associated with one-year
renal function. Accordingly, efforts should be targeted to preserving graft function in the first year after kidney
transplantation. In addition we have identified a population of long-term kidney transplants survivors who will be the
subject of further studies in order to clarify mechanism of immunological tolerance to transplant
Everolimus and minimization of cyclosporine in renal transplantation: 24-month follow-up of the EVEREST study
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Predictive model for delayed graft function based on easily available pre-renal transplant variables.
No full textIdentification of pre-transplant factors influencing delayed graft function (DGF) could have an important clinical impact. This could allow clinicians to early identify dialyzed chronic kidney disease (CKD) patients eligible for special transplant programs, preventive therapeutic strategies and specific post-transplant immunosuppressive treatments. To achieve these objectives, we retrospectively analyzed main demographic and clinical features, follow-up events and outcomes registered in a large dedicated dataset including 2,755 patients compiled collaboratively by four Italian renal/transplant units. The years of transplant ranged from 1984 to 2012. Statistical analysis clearly demonstrated that some recipients' characteristics at the time of transplantation (age and body weight) and dialysis-related variables (modality and duration) were significantly associated with DGF development (p ≤ 0.001). The area under the receiver-operating characteristic (ROC) curve of the final model based on the four identified variables predicting DGF was 0.63 (95 % CI 0.61, 0.65). Additionally, deciles of the score were significantly associated with the incidence of DGF (p value for trend <0.001). Therefore, in conclusion, in our study we identified a pre-operative predictive model for DGF, based on inexpensive and easily available variables, potentially useful in routine clinical practice in most of the Italian and European dialysis units
Reduction of Oxidative Damage Reflects a Better Kidney Transplantation Outcome.
No full textBackground/Aims: DNA fragmentation is one of the typical features of apoptosis, frequently induced by oxidative stress. Increased oxidative stress is known to be related to several pathological processes. In this study, we assessed oxidative damage in the early follow-up period after kidney transplantation measuring DNA oxidation and fragmentation of mononuclear cells and the circulating levels of inflammatory cytokines. Methods: Blood samples from 30 kidney transplant recipients were collected before transplantation and after 2 days, 1 month and 6 months. Oxidative DNA fragmentation was measured by Comet Assay, whereas DNA oxidation was evaluated measuring 8-OHdG leukocyte levels. Serum IL-1β, IL-4, IL-6, IL-8, IL-10, IFN-γ and TNF-α were assayed using a multiplex ELISA analysis. Results: At 6 months after transplantation, a significant reduction in DNA fragmentation and IL-6 plasma levels was observed; DNA oxidation was higher in patients with a worse outcome, with delayed graft function and low nutritional status. We also found a correlation of IL-6 and IL-10 levels with DNA fragmentation and of IL-10 levels with DNA oxidation. Conclusion: Low levels of oxidation and apoptosis at 6 months after transplantation correlate with a better recovery of renal function in kidney allografts. The measurement of cytokine levels confirmed a reduction of inflammatory parameters within 6 months of follow-up
