Although more than 40% of patients with a positive virtual crossmatch presented with BK infection/CMV disease, high PRA greater than 80% seemed to be protective.

Patients with an augmented or diverted urinary system are considered higher risk recipients in view of increased technical problems and infective complications. We studied the long-term renal graft function and survival in patients with a pretransplant ileal conduit or ileal/caecocystoplasty. Between 1986 and 1997, 14 of 1253 (1.1%) renal transplant recipients had their transplant ureters anastomosed into an abnormal urinary tract. These consisted of ten ileal conduits and four ileal/caecocystoplasties. Median follow up was 42 months (range 1-156). All ten ileal conduits were discharged with a functioning graft. There was one graft loss chronic rejection and one cardiac death. The median creatinine level was 130 mmol/l and 50% have a urinary infection. All the patients with an ileal/caecocystoplasty were discharged with a functioning graft and these are still functioning; median creatinine of 132 mmol/l and 75% have a urinary infection. One- and 3-year graft survival was 93% and 86%. We conclude that the long-term outcome of renal transplantation in carefully assessed patients with an abnormal urinary tract is satisfactory despite a high incidence of urinary infection.

Background: The effects of delayed graft function on long-term kidney allograft outcomes are poorly defined among simultaneous liver and kidney transplant recipients. Methods: We analyzed data of all simultaneous liver and kidney recipients transplanted at the University of Wisconsin between 2010 and 2017. Risk factors for the development of delayed graft function, kidney graft failure, and patient mortality were outcomes of interest. Results: There were a total of 60 simultaneous liver and kidney recipients; 28 (47%) had delayed graft function. After adjustment for multiple variables, we found that pretransplant dialysis >6 weeks (hazard ratio [HR] = 5.6, 95% CI: 1.23-25.59, P = .02), pretransplant albumin <3 g/dL (HR = 5.75, 95% CI: 1.76-16.94, P = .003), and presence of pretransplant diabetes (HR = 2.5, 95% CI: 0.97-4.77, P = .05) were significantly associated with delayed graft function. Multivariate analysis showed that pretransplant albumin <3 (HR = 4.86, 95% CI: 1.07-22.02, P = .02) was associated with a higher risk of all-cause kidney allograft failure, whereas the duration of delayed graft function (HR = 1.07 per day, 95% CI: 1.01-1.14, P = .01) was associated with a higher risk of death-censored kidney allograft failure. The presence of delayed graft function was not associated with all-cause or death-censored kidney or liver allograft failure. Similarly, the presence of delayed graft function was not associated with patient mortality. Conclusion: The incidence of delayed graft function was high in simultaneous liver and kidney recipients. However, with appropriate management, delayed graft function may not have a negative impact on patient or kidney allograft survival.