The Evaluation of the Renal Transplant Candidates: Clinical Practice Guidelines

doi:10.1034/j.1600-6143.2001.0010s2001.x

Cited by 16 publications

(5 citation statements)

References 678 publications

(1,016 reference statements)

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“…The ideal screening strategy is unknown and differs across transplant centers. Current clinical guidelines are based mostly on expert opinion with a low level of evidence, but the general recommendation is the use of a risk-stratified approach in which non-invasive techniques are used first, and coronary angiography is reserved for high-risk patients or when the non-invasive tests are abnormal 5, 23– 26 . However, clinicians need to be aware that the pre-transplant CV evaluation should not be the same as for any other non-cardiac surgery, particularly because of the high risk of severe allograft dysfunction (in 6% to 33% of patients) and allograft loss (in 3% to 12% of patients) if cardiac surgery is required in the post-transplant period 27– 30 .…”

Section: Cardiovascular Diseasementioning

confidence: 99%

Non-immunological complications following kidney transplantation

2019

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Kidney transplantation (KT) is the most effective way to decrease the high morbidity and mortality of patients with end-stage renal disease. However, KT does not completely reverse the damage done by years of decreased kidney function and dialysis. Furthermore, new offending agents (in particular, immunosuppression) added in the post-transplant period increase the risk of complications. Cardiovascular (CV) disease, the leading cause of death in KT recipients, warrants pre-transplant screening based on risk factors. Nevertheless, the screening methods currently used have many shortcomings and a perfect screening modality does not exist. Risk factor modification in the pre- and post-transplant periods is of paramount importance to decrease the rate of CV complications post-transplant, either by lifestyle modification (for example, diet, exercise, and smoking cessation) or by pharmacological means (for example, statins, anti-hyperglycemics, and so on). Post-transplantation diabetes mellitus (PTDM) is a major contributor to mortality in this patient population. Although tacrolimus is a major contributor to PTDM development, changes in immunosuppression are limited by the higher risk of rejection with other agents. Immunosuppression has also been implicated in higher risk of malignancy; therefore, proper cancer screening is needed. Cancer immunotherapy is drastically changing the way certain types of cancer are treated in the general population; however, its use post-transplant is limited by the risk of allograft rejection. As expected, higher risk of infections is also encountered in transplant recipients. When caring for KT recipients, special attention is needed in screening methods, preventive measures, and treatment of infection with BK virus and cytomegalovirus. Hepatitis C virus infection is common in transplant candidates and in the deceased donor pool; however, newly developed direct-acting antivirals have been proven safe and effective in the pre- and post-transplant periods. The most important and recent developments on complications following KT are reviewed in this article.

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Section: Cardiovascular Diseasementioning

confidence: 99%

Non-immunological complications following kidney transplantation

2019

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“…Since then it has become clear that these ‘normal' cut-off values may not apply to special populations. In 2000, the American Society of Transplantation endorsed the initial WHO definition [3]. The pathogenesis of anemia of chronic kidney disease is multifactorial.…”

Section: Introductionmentioning

confidence: 99%

GDF15 Is Related to Anemia and Hepcidin in Kidney Allograft Recipients

et al. 2013

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Anemia is more prevalent in renal transplant recipients than in GFR-matched chronic kidney disease patients. Hepcidin is a small defensin-like peptide whose production by hepatocytes is modulated in response to anemia, hypoxia or inflammation. Growth differentiation factor 15 (GDF15) was recently identified as a hepcidin-suppression factor that is expressed at high levels in patients with ineffective erythropoiesis. The aim of the study was to assess GDF15 levels with relation to iron parameters in 62 stable kidney allograft recipients maintained on triple immunosuppressive therapy. Methods: Complete blood count, urea, creatinine, and iron status were assessed by standard methods. We measured GDF15, hepcidin, hemojuvelin, IL-6 and NGAL with commercially available assays. Results: Mean levels of GDF15, NGAL, hepcidin and hemojuvelin were significantly higher in kidney allograft recipients when compared to the control group (p < 0.001 for all). GDF15 was significantly higher in patients with anemia according to the WHO definition when compared to their nonanemic counterparts (p < 0.05). GDF15 levels were not dependent on the type of immunosuppressive therapy. In univariate analysis GDF15 was related to kidney function (creatinine r = 0.39, p < 0.01, eGFR by MDRD r = -0.37, p < 0.01), urea (r = 0.39, p < 0.01), uric acid (r = 0.42, p < 0.01), hepcidin (r = -0.32, p < 0.01), IL-6 (r = 0.28, p < 0.05), hemoglobin (r = -0.32, p < 0.05), and NGAL (r = -0.35, p < 0.01). GDF15 was not related to serum iron, or ferritin. In multivariate analysis, hepcidin was found to be a predictor of GDF15. In conclusion, our preliminary data may suggest possible mutual relations between GDF15 and hepcidin in patients with kidney disease and that GDF15 might be involved in the pathogenesis of anemia in kidney allograft recipients. However, the role of inflammation should be also elucidated.

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“…[10] The American Society of Transplantation guidelines also pointed out that "there should be no absolute upper age limit for excluding patients whose overall health and life situation suggest that transplantation will be beneficial". [11] In the presented study, the mean age of recipient patients was 43.4±12.93 years and, while the oldest patient was 65 years old, the youngest one was thirteen. Many studies have revealed that kidney transplantation is a safe surgical procedure with a better survival rate compared to hemodialysis for elderly end-stage kidney failure patients.…”

Section: Discussionmentioning

confidence: 60%

Retrospective analysis of the first 100 kidney transplants at XXXXXXX XXXX University, Health Application and Research Center

et al. 2019

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E nd-stage kidney disease is a worldwide health problem that can be defined as a burden, with a prevalence rate of 11-13%. [1] Definitive treatment of end-stage kidney disease is kidney transplantation, which provides better clinical outcomes, including overall survival compared to longterm dialysis treatment. [2, 3] A one-year graft survival rate of the transplanted kidney is increased to over 90% by the advances in tissue sampling and immunosuppression. [4] In 2016, 89.823 kidney transplant surgeries were performed worldwide. 40.2% of these transplants were from living donors and 59.8% were from deceased donors. [5] Clinical results of living donor kidney transplantation are two times better than deceased donor kidney transplantation. [1] Paired kidney exchange transplantation is an al-Objectives: The renal transplant program of Istanbul Okan University Hospital started in August 2017. Five cadaveric and 95 living donor kidney transplants have been performed for over 16 months. In this study, we aimed to share our experiences regarding kidney transplantation. Methods: In this study, a retrospective analysis of 100 patients who underwent kidney transplantation at the Istanbul Okan University over 16 months, the Health Application and Research Center was carried out. Patients' demographics, creatinine levels of donors and recipients, co-morbid conditions, postoperative complications, features of arterial anastomosis and arterial variations observed on computed tomography angiography of donor-patient were assessed. Results: Mean age of donor patients was 44.05±13.76 (18-71) years. All living donors had computed tomography angiography for assessment of the vascular structure of both kidneys. Accessory right kidney artery was the most dominant vascular variation (16.5%). The primary cause of chronic renal disease was diabetes mellitus (36.4%) and hypertension (15.6%). Mean warm and cold ischemia time was 1.82±0.44 (1-3) and 40.25±6.12 (31-57) minutes, respectively. The most observed postoperative complication was stenosis of ureter anastomosis (4.1%). End-to-end arterial anastomosis between renal and internal iliac arteries was the most preferred anastomosis (57.2%). Conclusion: Increasing kidney transplantation, which is the most appropriate treatment in terms of cost-effectiveness, will be beneficial for patient health and economy of the country.

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The Evaluation of the Renal Transplant Candidates: Clinical Practice Guidelines

Cited by 16 publications

References 678 publications

Non-immunological complications following kidney transplantation

Non-immunological complications following kidney transplantation

GDF15 Is Related to Anemia and Hepcidin in Kidney Allograft Recipients

Retrospective analysis of the first 100 kidney transplants at XXXXXXX XXXX University, Health Application and Research Center

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