Renal dysfunction frequently occurs during the periods preceding and following orthotopic liver transplantation (OLT), and in many cases, renal replacement therapy (RRT) is required. Information regarding the duration of RRT and the rate of kidney function recovery after OLT is crucial for transplant program management. We evaluated a sample of 155 stable patients undergoing post-intensive care hemodialysis (HD) from a patient population of 908 adults who underwent OLT. We investigated the average time to renal function recovery (duration of RRT required) and determined the risk factors for remaining on dialysis > 90 days after OLT. Log-rank tests were used for univariate analysis, and Cox proportional hazards models were used to identify factors associated with the risk of remaining on HD. The results of our analysis showed that of the 155 patients, 28% had pre-OLT diabetes mellitus, 21% had pre-OLT hypertension, and 40% had viral hepatitis. Among the patients, the median MELD (Model for End-Stage Liver Disease) score was 27 (interquartile range [IQR] 22-35). When they were listed for liver transplantation, 32% of the patients had serum creatinine (Scr) levels > 1.5 mg/dL or were on HD, and 50% had serum creatinine (Scr) levels > 1.5 mg/dL or were on HD at the time of OLT. Of the transplanted patients, 25% underwent pre-OLT intermittent HD, and 14% and 41% underwent continuous renal replacement therapy (CRRT) pre-OLT and post-OLT, respectively. At 90 days post-OLT, 118 (76%) patients had been taken off dialysis, and 16 (10%) patients had died while undergoing HD. The median recovery time of these post-OLT patients was 33 (IQR 27–39) days. In the multivariate analysis, fulminant hepatic failure as the cause of liver disease (p<0.001), the absence of pre-OLT hypertension (p = 0.016), a lower intraoperative fresh-frozen plasma (FFP) transfusion volume (p = 0.019) and not undergoing pre-OLT intermittent HD (p = 0.032) were associated with performing RRT for less than 90 days. Therefore, a high proportion of OLT patients showed improved renal function after OLT, and those who were diagnosed with fulminant hepatic failure, had no pre-OLT hypertension, received a lower transfused volume of intraoperative FFP and did not undergo pre-OLT intermittent HD had a higher probability of recovery.

Chronic kidney disease is a problem that has grown in recent decades worldwide. The National Kidney Foundation (NKF) estimates that the number of patients will double in the next 10 years. Dialysis and kidney transplantation are the treatments used for chronic kidney disease. There is hope in slowing down chronic kidney disease or even stopping its progression. Bioengineering and cell therapy are the main fields in kidney regeneration research using three-dimensional matrices in which cells are cultured, an ideal solution for scarcity organs for kidney transplantation. The difficulty in re-creating a functional kidney due to the complexity of its three-dimensional structure and its composition of different cell types and that can be incorporated in vivo with low immunogenicity is a very difficult task. Therefore, the aim of the present study was to meet the enormous demand for new treatments, developing strategies of tissue engineering on the basis of the decellularization of the porcine kidney performed through a new cell removal protocol. We determined the effective removal of cells by histologic and immunohistochemical analyses, showing the preservation of type IV collagen and fibronectin. Therefore, this method is a quick way to obtain decellularized porcine kidneys for future recellularization studies.

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uma terapia alternativa/coadjuvante para a recuperação do parênquima renal. Este estudo possibilitou identificar as principais áreas de depósito de pesquisas, assim como o crescente interesse de inovações nessa área.