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Background: The negative impact of tobacco smoking on renal function has been widely studied. However, there is limited knowledge about the effect of smoking on pre-operative and post-operative renal function in living kidney donors. Objective: The objective of the study was to evaluate the short- and mid-term impact of smoking on donor renal function. Methods: This is a retrospective study of 308 patients who underwent living donor nephrectomy (LDN) at a tertiary referral hospital. We compared baseline characteristics as well as functional outcomes following LDN according to history of tobacco smoking. Estimated glomerular filtration rate (eGFR) was calculated with the modification of diet in renal disease equation in 6 time periods: pre-operative, 1 week, 1 month, 6 months, 12 months, and 24 months after surgery. We performed a Kaplan-Meier analysis for chronic kidney disease (CKD) outcome and binary logistic regression analysis to identify risk factors associated with CKD at 24 months of follow-up. Results: Among donors, 106 (34.4%) reported a smoking history before nephrectomy. Smoking donors had worse pre-operative eGFR than non-smokers (90 ± 26.3 mL/min/1.73m2 vs. 96 ± 27 mL/min/1.73 m2, respectively; p = 0.02) and lower eGFR at 1 week (p = 0.01), 1 month (p ≤ 0.01), 6 months (p = 0.01), and 12 months (p = 0.01) after LDN. Tobacco smoking (OR 3.35, p ≤ 0.01) and age ≥ 40 years at donation (OR 6.59, p ≤ 0.01) were associated with post-operative development of CKD at 24 months after LDN. Conclusions: Living kidney donors with a tobacco smoking history had an increased risk of developing chronic kidney disease following nephrectomy. Smoking-cessation strategies should be implemented.
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Humanos , Adulto , Fumar/efeitos adversos , Transplante de Rim , Doadores Vivos , Insuficiência Renal Crônica/epidemiologia , Rim/fisiopatologia , Estudos Retrospectivos , Centros de Atenção Terciária , Fumar Tabaco , Taxa de Filtração Glomerular , NefrectomiaRESUMO
BACKGROUND: The negative impact of tobacco smoking on renal function has been widely studied. However, there is limited knowledge about the effect of smoking on pre-operative and post-operative renal function in living kidney donors. OBJECTIVE: The objective of the study was to evaluate the short- and mid-term impact of smoking on donor renal function. METHODS: This is a retrospective study of 308 patients who underwent living donor nephrectomy (LDN) at a tertiary referral hospital. We compared baseline characteristics as well as functional outcomes following LDN according to history of tobacco smoking. Estimated glomerular filtration rate (eGFR) was calculated with the modification of diet in renal disease equation in 6 time periods: pre-operative, 1 week, 1 month, 6 months, 12 months, and 24 months after surgery. We performed a Kaplan-Meier analysis for chronic kidney disease (CKD) outcome and binary logistic regression analysis to identify risk factors associated with CKD at 24 months of follow-up. RESULTS: Among donors, 106 (34.4%) reported a smoking history before nephrectomy. Smoking donors had worse pre-operative eGFR than non-smokers (90 ± 26.3 mL/min/1.73m2 vs. 96 ± 27 mL/min/1.73 m2, respectively; p = 0.02) and lower eGFR at 1 week (p = 0.01), 1 month (p ≤ 0.01), 6 months (p = 0.01), and 12 months (p = 0.01) after LDN. Tobacco smoking (OR 3.35, p ≤ 0.01) and age ≥ 40 years at donation (OR 6.59, p ≤ 0.01) were associated with post-operative development of CKD at 24 months after LDN. CONCLUSIONS: Living kidney donors with a tobacco smoking history had an increased risk of developing chronic kidney disease following nephrectomy. Smoking-cessation strategies should be implemented.
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Transplante de Rim , Rim/fisiopatologia , Doadores Vivos , Insuficiência Renal Crônica , Fumar , Adulto , Taxa de Filtração Glomerular , Humanos , Nefrectomia , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos , Fumar/efeitos adversos , Centros de Atenção Terciária , Fumar TabacoRESUMO
INTRODUCTION: Ureteral stricture (US) in the kidney transplant recipient is a rare complication that can lead to morbidity and graft loss. Risk factor recognition is crucial in the prevention and management of this entity. Delayed graft function (DGF), as defined by the need for dialysis in the first week after transplantation, has been proposed as a risk factor in previous studies. Our objective is to determine the impact of DGF in US development in kidney transplant patients. METHODS: We designed a matched case-control study. US cases in kidney transplant recipients were identified in the 2008-2017 period. We defined US as the rise in serum creatinine associated with findings suggesting obstruction in ultrasound, scintigraphy, or retrograde pyelogram; any other cause of graft dysfunction was excluded. Controls were defined as kidney transplant recipients from the same population and period without US, matched in a 1:2 fashion by age, sex, and donor type. RESULTS: From 532 kidney transplant patients, 31 cases and 62 controls were included. Cumulative US incidence was 58 per 1000 cases. When calculating for odds ratio (OR), post-operative urinoma (OR 3.2; 95% confidence interval [CI] 2.36-4.37) and ureteral duplication (OR 3.29; 95% CI 2.40-4.51) were associated with an increased risk for US, while DGF was not found to be statistically significant as a risk factor (OR 3.3; 95% CI 0.96-11.52). No statistically significant differences were found between groups in other pre- and post-transplant-related factors CONCLUSIONS:: DGF was not associated with US in our cohort; however, ureteral duplication and postoperative urinoma were associated with an increased risk of graft ureteral stenosis development.
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ABSTRACT Purpose: To provide data of the incidence and management of common urological malignancies in renal transplant recipients. Materials and Methods: We conducted a retrospective analysis of a prospective database from August 1967 to August 2015. A descriptive analysis of the sample was performed. Results: Among 1256 consecutive RTR a total of 88 patients developed malignancies (7%). There were 18 genitourinary tumors in the 16 patients (20.45 % of all malignant neoplasms), incidence of 1.27%. The most common neoplasm encounter was renal cancer (38.8%), followed by urothelial carcinoma (33.3%). Median follow-up of transplantation was 197 months (R, 36-336). Mean time from RT to cancer diagnosis 89±70 months (R, 12-276). CsA and AZA was the most common immunosuppression regimen in 68.75%. Mean follow-up after diagnosis was 103±72 months (R 10-215). Recurrence free survival rate of 100%. Overall survival of 89.5% of the sample; there were two non-related cancer deaths during follow-up. Conclusions: The incidence of neoplasms in RTR was lower than in other series, with favorable functional and oncologic results after treatment. This suggests that actions to reduce the risk of these malignancies as well as a strict follow-up are mandatory for an early detection and treatment.
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Humanos , Masculino , Feminino , Adolescente , Adulto , Idoso , Adulto Jovem , Transplante de Rim/efeitos adversos , Neoplasias Urogenitais/terapia , Neoplasias Urogenitais/epidemiologia , Incidência , Estudos Prospectivos , Estudos Retrospectivos , Transplante de Rim/estatística & dados numéricos , México/epidemiologia , Pessoa de Meia-IdadeRESUMO
PURPOSE: To provide data of the incidence and management of common urological malignancies in renal transplant recipients. MATERIALS AND METHODS: We conducted a retrospective analysis of a prospective database from August 1967 to August 2015. A descriptive analysis of the sample was performed. RESULTS: Among 1256 consecutive RTR a total of 88 patients developed malignancies (7%). There were 18 genitourinary tumors in the 16 patients (20.45% of all malignant neoplasms), incidence of 1.27%. The most common neoplasm encounter was renal cancer (38.8%), followed by urothelial carcinoma (33.3%). Median follow up of transplantation was 197 months (R, 36-336). Mean time from RT to cancer diagnosis 89±70 months (R, 12-276). CsA and AZA was the most common immunosuppression regimen in 68.75%. Mean follow-up after diagnosis was 103±72 months (R 10-215). Recurrence free survival rate of 100%. Overall survival of 89.5% of the sample; there were two non-related cancer deaths during follow up. CONCLUSIONS: The incidence of neoplasms in RTR was lower than in other series, with favorable functional and oncologic results after treatment. This suggests that actions to reduce the risk of these malignancies as well as a strict follow-up are mandatory for an early detection and treatment.
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Transplante de Rim/efeitos adversos , Neoplasias Urogenitais/epidemiologia , Neoplasias Urogenitais/terapia , Adolescente , Adulto , Idoso , Feminino , Humanos , Incidência , Transplante de Rim/estatística & dados numéricos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Adulto JovemRESUMO
PROBLEM: The effect of donor/recipient age disparity on living-donor renal graft function is controversial. The objective of this study is to find new clinical predictors of renal graft function and evaluate the effect of donor/recipient age disparity in our series. METHODS: A retrospective review of our institutional renal transplantation database was performed. We calculated the glomerular filtration rate of our patients with the Chronic Kidney Disease Epidemiology Collaboration formula. Our receptors were categorized using a cut-off of 60 ml/min calculated glomerular filtration rate. An index called "Donor/Recipient Age Index" was created based on the interaction between donor/recipient ages. Univariable and multivariable regression analysis were performed. The Mantel-Cox model was used for statistical analysis. RESULTS: A total of 220 donor/recipient pairs were selected from January 2005 to August 2013. Only 186 pairs completed the one-year follow-up. The mean age of the donors was 35.3 ± 10.4 years and 31.6 ± 11.7 years for the recipients. The Donor/Recipient Age Index significantly predicted a glomerular filtration rate < 60 ml/min at one-year follow-up in univariable (p = 0.02) and multivariable (p = 0.033) regression models. CONCLUSION: We propose the Donor/Recipient Age Index as a significant predictor of long-term graft function.
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Fatores Etários , Taxa de Filtração Glomerular/fisiologia , Transplante de Rim/estatística & dados numéricos , Rim/fisiologia , Doadores Vivos/estatística & dados numéricos , Transplantados/estatística & dados numéricos , Transplantes/fisiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Análise de Regressão , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
INTRODUCTION: Donor-to-recipient gender match and mismatch may be a potential prognostic factor for living donor renal graft function. METHODS: A retrospective review of donor-to-recipient pairs undergoing living donor kidney transplantation was done. They were classified according to gender match as: male-to-male, female-to-female, male-to-female, and female-to-male. Serum creatinine was recorded during one year for donors and for up to four years for recipients. Renal function was evaluated by estimating the glomerular filtration rate with the Chronic Kidney Disease-Epidemiology Collaboration formula. A comparative statistical analysis was performed. RESULTS: The analysis included 217 donor-to-recipient pairs. No significant differences across the four groups in estimated glomerular filtration rate and serum creatinine at any cut-off time point except at day one serum creatinine were found. Recipients had a significant difference in serum creatinine up to the first year of follow-up, with higher values for male recipients; no significant differences were found during the second through fourth year of follow-up. A significant difference was observed in estimated glomerular filtration rate throughout all follow-ups among the four groups, favoring female recipients of male kidneys. CONCLUSIONS: Donor-recipient mismatch may have a deleterious effect over long-term graft function. Female recipients of male kidneys have the best prognosis.
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Transplante de Rim , Rim/fisiologia , Doadores Vivos , Fatores Sexuais , Transplantes/fisiologia , Adulto , Índice de Massa Corporal , Creatinina/sangue , Feminino , Seguimentos , Taxa de Filtração Glomerular/fisiologia , Humanos , Masculino , Prognóstico , Estudos RetrospectivosRESUMO
BACKGROUND: Delayed graft function (DGF) is an early complication of kidney transplant (KT) and it is related to a higher incidence of acute rejection (AR) and lower graft survival. The incidence of DGF ranges from 2 to 29% in different series. Several risk factors for DGF have been described, including inotropic use in the deceased donor, long cold ischemia time, cardiovascular brain death, age > 55 years, hypovolemia, previous transplant, preformed antibodies and OKT3 use. MATERIAL AND METHODS: This study is a retrospective cohort of the kidney transplant recipients (KTR) of deceased donors from 1990 to 2009, at the INCMNSZ. We analyzed the incidence of DGF, risk factors associated to its development, and patient and graft outcome. To compare the groups, we used chi2 test or Student's t test for categorical and numeric variables, respectively. Patient and graft survival were calculated using Kaplan-Meier method; a p value < 0.05 was considered statistically significant. RESULTS: Data from 105 KTR were analyzed. DGF occurred in 21%, AR in 27%, graft loss in 15.2%. The only risk factor associated to DGF was brain death due to vascular disease (p = 0.028). CONCLUSIONS: Brain death due to vascular disease was the only risk factor associated to DGF. A non-significant higher incidence of AR was observed in patients with DGF. Survival was significantly lower in patients who developed DGF compared to those without DGF, and it was not related to renal function.
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Função Retardada do Enxerto/epidemiologia , Sobrevivência de Enxerto , Transplante de Rim/mortalidade , Adulto , Cadáver , Estudos de Coortes , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Taxa de SobrevidaRESUMO
INTRODUCTION: Acute rejection has been identified as the main cause of renal graft dysfunction during the first year after transplantation; it is associated with chronic structural and functional damage, which causes loss of graft and decrease in patient survival. MATERIAL AND METHODS: We performed a retrospective and descriptive research consisting in a review of the final reports of biopsies performed due to renal graft dysfunction during the postransplant period. Patients included were transplanted at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ) from January 2007 to December 2011. RESULTS: A total number of 223 patients underwent renal transplantation during the period considered for this study purpose, 222 biopsies were performed due to renal graft dysfunction in 118 patients (52.9%). 74.5% of patients developed graft dysfunction in the first year after transplantation. The main histopathological findings reported were immunologic events in both living donor (LDRTR) and deceased donor renal transplant recipients (DDRTR), borderline changes were the most common diagnosis. The median time to detect immune events as cause of dysfunction was shorter for DDRTR and they tend to occur in the first 4 months after transplantation. CONCLUSION: We observed an incidence of 11.8% for acute rejection in the first year after transplantation for LDRTR and 17.4% for DDRTR. Further studies are needed to determine the causes of immunological events and their implications in the evolution of renal graft and patient's survival.