Renal transplantation should be considered in patients older than 60 years, since graft survival is excellent in this population. Although these patients have a shorter life expectancy, they benefit from renal transplantation similarly to younger kidney transplant recipients.

Background Spiritual well-being (Sp-WB) is a resource that supports adaptation and resilience, strengthening quality of life (QOL) in patients with cancer or other chronic illnesses. However, the relationship between Sp-WB and QOL in patients with chronic GVHD (cGVHD) remains unexamined. Methods 52 participants completed the Functional Assessment of Chronic Illness Therapy – Spiritual Well-Being (FACIT-Sp) questionnaire as part of a multidisciplinary study of cGVHD. Results Sp-WB was generally high (Mean 37.06, SD 9.5). Those with the lowest Sp-WB had significantly longer time since diagnosis of cGVHD (p=0.05) than those with higher Sp-WB. There were no associations between Sp-WB and demographics, cGVHD severity, or intensity of immunosuppression. Participants with the lowest Sp-WB (N=11) reported inferior physical (p = .0009), emotional (p = .003), social (p = .027), and functional well-being (p = < 0.0001) as well as lower overall QOL (p = <0.0001) compared to those with higher Sp-WB. They also had inferior QOL (M 54.88, S.E. 4.19) relative to population norms (M=80.1, S.E. 0.55). Differences between those with the lowest and those with better Sp-WB consistently exceeded the minimal clinically significant difference for all subscales and for overall QOL. Controlling for physical, emotional and social well-being, Sp-WB was a significant independent predictor of contentment with QOL. Conclusions Our results suggest that Sp-WB is an important factor contributing to the QOL of patients with cGVHD. Research is needed to identify factors that diminish Sp-WB and to test interventions designed to strengthen this coping resource in patients experiencing the late-effects of treatment.

Until the last century, ammonium urate stones were quite common in preindustrial Europe. In contemporary practice these stones are found in developing countries, and are associated with uric acid and ammonium-enriched urine. Such conditions may occur with urealytic infection, resulting in mixed ammonium urate/magnesium ammonium phosphate precipitates and urinary phosphate deficiency of alimentary origin, resulting in precipitates free of magnesium ammonium phosphate, in sterile urine. The latter situation is closely related to a diet poor in phosphate and to a low fluid intake common in endemic lithiasis areas. Ammonium urate and uric acid have different solubility patterns dependent on pH, and consequently treatment will be different in each case.

We have determined the kinetics of the cellular viability ratio (CVR), defined as the number of living cells over the total cell count, in pig kidneys using propidium iodide and fluorescein diacetate staining, as a function of time and preservation conditions. The kidneys were preserved in warm or cold ischemia in order to mimic the conditions of transplantation from non-heart-beating donors or multiple removal with optimal preservation of the graft, respectively. To determine the CVR, the cells were obtained by a fine-needle aspiration biopsy, which minimizes the damage to the graft. A biometric analysis by regression enabled the determination of the time dependence for warm ischemia (CVR(t) = 80.0 x e(-0.733-t)(+2.7/-0.36)) and for cold ischemia (CVR(t) = 80.0 x e(-0.022-t)(+1.57/-0.64)) with a confidence interval of 95%. These master curves allow us to predict, under the described conditions, the CVR after a given ischemia time. The half-life of the cells can be deduced from the time-dependent CVR(t), and is 0.64 hr (38 min) for warm ischemia and 21.4 hr for cold ischemia. Further, the CVR for a given kidney can be used to assess its condition at removal: if the CVR is below 48% at 2 hr after removal, one can conclude that the organ has suffered a period of warm ischemia.

Summary Combined liver–kidney transplantation is considered a low risk for immunologic complication. We report an unusual case of identical ABO liver–kidney recipient without preformed anti‐human leukocyte antigen (HLA) antibodies, transplanted across a T‐ and B‐cell‐negative cross‐match and complicated by early acute humoral and cellular rejection, first in the liver then in the kidney. While analyzing the immunologic complications in our cohort of 12 low‐risk combined liver–kidney recipients, only one recipient experienced a rejection episode without detection of anti‐HLA antibody over time. Although humoral or cellular rejection is rare after combined kidney‐liver transplantation, our data suggest that even in low‐risk recipients, the liver does not always systematically protect the kidney from acute rejection. Indeed, the detection of C4d in the liver should be carefully followed after combined liver–kidney transplantation.