Quality of Life of Living Kidney Donors: A Single-Center Experience

Shrestha, Anne; Vallance, C; McKane, William; Shrestha, Badri Man; Raftery, Andrew T.

doi:10.1016/j.transproceed.2008.03.132

Cited by 54 publications

(50 citation statements)

References 8 publications

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“…[1][2][3][4] PKT is associated with improved patient and graft survival, 5,6 higher return-to-work rates, 7 better quality of life, 8 and lower long-term medical costs compared with transplantation after dialysis initiation. 9 In addition, PKT has several theoretical advantages, most gained simply by dialysis avoidance: decreased incidence of catheter-associated infection, no requirement for permanent vascular access, and a reduction in dialysis-associated cardiovascular events, such as sudden cardiac death or accelerated progression of heart failure.…”

mentioning

confidence: 99%

Trends in the Timing of Pre-emptive Kidney Transplantation

Grams

Massie

Coresh

et al. 2011

Journal of the American Society of Nephrology

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mentioning

confidence: 99%

Trends in the Timing of Pre-emptive Kidney Transplantation

Grams

Massie

Coresh

et al. 2011

Journal of the American Society of Nephrology

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“…1 The present success of RT has evolved through advancements in the milestones of surgical techniques relevant for RT, understanding of the immunologic processes, immunosuppressive agents, tissue typing and crossmatch techniques, and ongoing research in the field of induction of tolerance, xenotransplantation, and organ bioengineering. 2 Experimental RT in rats has played a vital role in enhancing the understanding of the immunologic processes and application of immunosuppressive agents in clinical human RT.…”

Section: Introductionmentioning

confidence: 99%

Surgical Anatomy and Microvascular Surgical Technique Relevant to Experimental Renal Transplant in Rat Employing Aortic and Inferior Venacaval Conduits

Shrestha

Haylor²

2019

Exp Clin Transplant

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Objectives: Rat models of renal transplant are used to investigate immunologic processes and responses to therapeutic agents before their translation into routine clinical practice. In this study, we have described details of rat surgical anatomy and our experiences with the microvascular surgical technique relevant to renal transplant by employing donor inferior vena cava and aortic conduits. Materials and Methods: For this study, 175 rats (151 Lewis and 24 Fisher) were used to establish the FisherLewis rat model of chronic allograft injury at our institution. Anatomic and technical details were recorded during the period of training and establishment of the model. Results: A final group of 12 transplanted rats were studied for an average duration of 51 weeks for the Lewis-to-Lewis isografts (5 rats) and 42 weeks for the Fisher-to-Lewis allografts (7 rats). Functional measurements and histology confirmed the diagnosis of chronic allograft injury. Conclusions: Mastering the anatomic details and microvascular surgical techniques can lead to the successful establishment of an experimental renal transplant model. Key words: Animal model, Kidney transplant, Translational research IntroductionRenal transplant (RT) is the best form of renal replacement therapy for end-stage renal disease because it can improve quality of life, has a survival advantage, and is cost effective. 1 The present success of RT has evolved through advancements in the milestones of surgical techniques relevant for RT, understanding of the immunologic processes, immunosuppressive agents, tissue typing and crossmatch techniques, and ongoing research in the field of induction of tolerance, xenotransplantation, and organ bioengineering. 2 Experimental RT in rats has played a vital role in enhancing the understanding of the immunologic processes and application of immunosuppressive agents in clinical human RT. [3][4][5] For a successful RT in rats, in addition to paying attention to the pre-, intra-, and postoperative care of donors and recipients, a thorough understanding of the details of the anatomy is mandatory to successfully complete donor nephrectomy and recipient RT procedures.In rats, the anatomy of the retroperitoneum and the blood supply to the kidney, ureter, and bladder resemble those of humans; therefore, the principles of dissection during organ retrieval and implantation are similar. Lack of appropriate experience and skill is conducive to complications in donors and recipients and early transplant failure. 6 Our group has been involved in establishing a rat model of chronic allograft injury (CAI), and the experience gained during its successful establishment has been invaluable. Here, we describe the details of the surgical anatomy of the rat and our experience with microvascular surgical techniques of donor nephrectomy and implantation in the recipient by employing donor aortic and inferior vena cava conduits, which are relevant to experimental RT in rats. Materials and Methods AnimalsMale inbred Fisher (RT11v1) and Lewis (...

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“…1 When a kidney is transplanted from a human leucocyte antigen nonidentical donor, the recipient mounts an alloimmune response that leads to T-lymphocyte activation, antibody production, complement activation, allograft rejection, and transplant failure. 2 In recent decades, immunosuppressive drug development has slowed from its accelerated pace in the late 1990s, but it still shows steady growth.…”

Section: Introductionmentioning

confidence: 99%

Untitled

Bakr

Nagib²,

Gheith³

et al. 2017

Exp Clin Transplant

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Objectives: We review different immunosuppressant protocols used for living-donor kidney transplant recipients at our center. Materials and Methods: Many prospective randomized studies from our center have been reported between March 1976 and 2016, with more than 2700 renal transplant procedures conducted. The first study was a prospective randomized trial of azathioprine versus cyclosporine. The second study compared triple therapy (prednisolone + azathioprine + cyclosporine) versus conventional therapy (prednisolone + azathioprine). The third study was a cost-saving study, in which 100 patients received ketoconazole along with the triple regimen. Another trial demonstrated the advantages of a microemulsion form of cyclosporine. A subsequent trial compared calcineurin inhibitor minimization versus avoidance protocols. Rescue therapies were carried out to intensify immunosuppressive regimens after repeated rejection. In addition, steroid-free regimens were evaluated during both short-and long-term treatment. A recent trial reported a step-forward avoidance protocol with a calcineurin inhibitor and a steroid-free regimen, whereas another current study is the TRANSFORM one. The rationale behind antibody therapy was tho roughly evaluated among living-donor renal trans plant recipients with different agents, including basiliximab, daclizumab, antithymocyte globulin, and alemtuzumab.Results: Earlier studies have demonstrated the efficacy of conventional regimens without induction therapy, especially in longer follow-up. The standard triple therapy has emerged with intensified immunosuppressive and lowered dose of each drug, especially cyclosporine. In minimization studies, no significant differences were encountered regarding patient and graft survival, even in the long-term. Steroid avoidance was safe and effective. Calcineurin inhibitors and steroid-free regimens have shown comparable patient and graft survival. Induction therapy has lowered the incidence and severity of acute rejection. Conclusions: A better 5-year graft survival and less posttransplant complications have been achieved with steroid avoidance after induction with basiliximab. Induction therapy did not affect graft and patient survival rates despite lowered incidence and severity of acute rejections.

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Quality of Life of Living Kidney Donors: A Single-Center Experience

Cited by 54 publications

References 8 publications

Trends in the Timing of Pre-emptive Kidney Transplantation

Trends in the Timing of Pre-emptive Kidney Transplantation

Surgical Anatomy and Microvascular Surgical Technique Relevant to Experimental Renal Transplant in Rat Employing Aortic and Inferior Venacaval Conduits

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