Renal transplantation in adults

Nieto, Tom; Inston, Nicholas; Cockwell, Paul

doi:10.1136/bmj.i6158

Cited by 10 publications

(9 citation statements)

References 36 publications

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“…Kidney transplantation is the firstchoice treatment for these patients, as it is for patients with other causes of kidney failure (8,9). The occurrence of diabetic nephropathy in renal allografts has been reported both in patients with pretransplant diabetes and in patients with new-onset diabetes after transplantation (10)(11)(12)(13)(14)(15).…”

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confidence: 99%

Occurrence of Diabetic Nephropathy After Renal Transplantation Despite Intensive Glycemic Control: An Observational Cohort Study

et al. 2019

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The kinetics and risk factors of diabetic nephropathy after kidney transplantation remain unclear. This study investigated the posttransplant occurrence of diabetic nephropathy and the contribution of posttransplant glycemic control. RESEARCH DESIGN AND METHODS We performed a single-center prospective cohort study of 953 renal allograft recipients and 3,458 protocol-specified renal allograft biopsy specimens up to 5 years after transplantation. The effects of pretransplant diabetes and glycemic control (glycated hemoglobin levels) on the posttransplant histology were studied. RESULTS Before transplantation, diabetes was present in 164 (17.2%) renal allograft recipients, primarily type 2 (n = 146 [89.0%]). Despite intensive glycemic control (glycated hemoglobin 7.00 6 1.34% [53 6 14.6 mmol/mol], 6.90 6 1.22% [52 6 13.3 mmol/mol], and 7.10 6 1.13% [54 6 12.4 mmol/mol], at 1, 2, and 5 years after transplantation), mesangial matrix expansion reached a cumulative incidence of 47.7% by 5 years in the pretransplant diabetes group versus 27.1% in patients without diabetes, corresponding to a hazard ratio of 1.55 (95% CI 1.07-2.26; P = 0.005). Mesangial matrix expansion was not specific for diabetic nephropathy and associated independently with increasing age. Pretransplant diabetes was associated with posttransplant proteinuria but not with estimated glomerular filtration rate, graft failure, or any other structural changes of the glomerular, vascular, or tubulointerstitial renal compartments. The occurrence of diabetic nephropathy was independent of posttransplant glycated hemoglobin levels. CONCLUSIONS Mesangial matrix expansion, an early indicator of diabetic nephropathy, can occur rapidly in patients with diabetes before transplantation, despite intensive glycemic control. Prevention of diabetic nephropathy requires more than pursuing low levels of glycated hemoglobin.

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confidence: 99%

Occurrence of Diabetic Nephropathy After Renal Transplantation Despite Intensive Glycemic Control: An Observational Cohort Study

et al. 2019

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“…Matchability was calculated from a standardized pool of 10 000 recent donors, from which the numbers of blood group identical donors that recipients are well or favorably HLA-mismatched were counted. This number was converted to a standardized score between 1 and 10, which was used to categorize recipients into 1 of 3 matchability groups; easy, 1 - 3 moderate, 4 - 6 or difficult 7 - 10 to match. Determination of socioeconomic deprivation was based upon the Index of Multiple Deprivation (IMD), a multiple deprivation model calculated at the local level area.…”

Section: Methodsmentioning

confidence: 99%

“…Kidney transplantation is the preferred modality of renal replacement therapy for patients with end-stage kidney failure, and confers significant advantages compared to dialysis with regards to mortality, quality of life and cost effectiveness for the majority of individuals. 1 Careful posttransplant management is key to ensure long-term outcomes are optimal, and clinical practice guidelines have been published to aid those efforts (eg, from the UK Renal Association 2 and Kidney Disease: Improving Global Outcomes [KDIGO] 3 ). However, published guidelines all fail to address an important logistical question; is posttransplant care for patients superior if undertaken at the transplant center compared to repatriation back to referring nontransplant centers?…”

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confidence: 99%

Repatriation of Patients to Referral Centers and Outcomes After Kidney Transplantation: A Single-center Analysis From the United Kingdom

Khalil

Hodson

Anderson

et al. 2018

Transplantation Direct

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BackgroundThe aim of this study was to compare posttransplant outcomes of kidney allograft recipients between those followed up at transplant centers and those that were repatriated back to referral renal units.MethodsWe analyzed data for 1375 consecutive patients transplanted in a single center in the United Kingdom. Patients were stratified into 3 groups: (1) externally referred patients with repatriation back for external follow-up (repatriated, n = 463), (2) externally referred patients not repatriated and followed-up internally at transplant center (nonrepatriated, n = 365), and (3) internally referred patients within transplant center with continued internal transplant center follow-up (internal, n = 547). Patient and death-censored graft survival were compared between groups on both univariable and multivariable analyses.ResultsBaseline comparisons found that the nonrepatriated group had increased risk for prolonged length of stay and delayed graft function compared with repatriated patients. The nonrepatriated group had significantly shorter survival compared to the repatriated patients (90.2% vs 94.1% at 5 years, P = 0.013), which persisted after adjustment for confounders on multivariable analysis (hazard ratio, 1.86; 95% confidence interval, 1.06-3.28; P = 0.032). Death-censored graft survival was not found to differ significantly between the 3 groups (P = 0.192).ConclusionsOur results provide reassurance regarding repatriation of care after kidney transplantation for the United Kingdom. Nonrepatriated patients are identified as a high-risk group for increased mortality, but further investigation is warranted to probe this heterogeneous group and validate in a non-United Kingdom cohort.

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“…Many transplant centres routinely screen men for prostate cancer with serum PSA tests before considering them for a kidney transplant . For those men that are diagnosed with localised prostate cancer, transplantation is typically postponed until the cancer has been treated and the patient has been recurrence‐free for 2–5 years, even if the cancer is of low‐grade and would otherwise be managed with active surveillance (AS) .…”

Section: Introductionmentioning

confidence: 99%