Focus on Transplantation

Longer Pretransplantation Dialysis Exposure Associated with Increased Failure Risk

There are few definitive data on the impact of dialysis exposure prior to nonpreemptive living donor kidney transplantation on allograft outcomes. According to John S. Gill, MD, MS, and colleagues, the mechanisms that underlie the previous findings of the detrimental association of dialysis exposure with transplant failure remain uncertain and may differ between living and deceased donor transplant recipients. In ... Read More »

Obesity and Transplantation Outcomes in Patients with ADPKD

Austin—The rates of renal transplantation among patients with autosomal dominant polycystic kidney disease (ADPKD) are high. Due to the higher incidence of complications post-transplant among patients who are overweight, some patients are required to lose weight prior to being listed for transplant. For patients with local symptoms from organ enlargement, nephrectomy may be performed with transplantation. Data from recent studies ... Read More »

Serum Potassium Levels Pretransplant and Outcomes Posttransplant

Austin—High risks of serum potassium abnormalities are common among patients undergoing hemodialysis; hyperkalemia is particularly common in that patient population. Previous studies have shown that patients with hypo- and hyperkalemia are at increased risk for mortality compared with patients with normokalemia. Potassium regulation can be achieved with kidney transplantation to varying degrees; however, there are few available data on whether ... Read More »

Immediate-Release versus Extended-Release Tacrolimus in African Americans

One-third of deceased donor kidney transplant recipients in the United States are of African ancestry, despite African Americans constituting 13% of the US population. Results of immunosuppression trials are often not generalizable to African American kidney transplant recipients because that patient population is often under-represented in those studies. Compared with kidney transplant recipients of European ancestry, rates of rejection and ... Read More »

Case Study of Patients with Predominant Mesangial C1q Deposits

In 1985, researchers described C1q nephropathy (C1qN). The condition is characterized by (1) the presence of predominant or co-dominant mesangial C1q deposits detected by immunofluorescence microscopy; (2) corresponding mesangial or paramesangial electron-dense deposit (EDD); and (3) absence of clinical and serological evidence of systemic lupus erythematosus (SLE). Patients present with proteinuria in the nephrotic range and are resistant to steroid ... Read More »

Program Streamlining Donor Assessment Process Improves Rate of Living Donor Transplantations

The best outcomes related to patient survival and quality of life for patients with end-stage renal disease (ESRD) are associated with renal transplantation. Greater transplant and patient survival seen in living versus deceased donor transplants; however, efforts to increase rates of living donation need to be balanced with ensuring patient safety via a comprehensive screening process. Prior to 2010 the ... Read More »

Evaluation of RADIANT Community Study Process

Studies of quality improvement interventions at dialysis facilities have shown improvements in end-stage renal disease (ESRD) outcomes and in quality of life of patients with ESRD. However, according to Reem E. Hamoda, MD, and colleagues, those studies focused on effect size in evaluating the success of the intervention, with few data on why the intervention worked or whether the intervention ... Read More »

Impact of Pre-Transplant Vascular Disease on Long-Term Outcomes after Transplantation

Vascular disease is associated with an increased risk of death among dialysis patients on the transplant waiting list. Among candidates for transplantation on the deceased donor waiting list, the annual rate of vascular-related deaths is >8%; the rate increases with cumulative time on dialysis therapy. Even with the modest survival benefit of transplantation for patients with vascular disease, vascular-disease–related death ... Read More »

Donor and Recipient Views on Anonymity Policies in Kidney Donation

In Spain and in the Netherlands, anonymity is maintained for kidney donation from live donors in nondirected (unspecified) and paired exchange (specified indirect) donation. The anonymity is required both prior to and following kidney donation for nondirected and paired exchange proceedings.  In other countries, including the United Kingdom and the United States, there is no requirement of anonymity for those ... Read More »

Patient Networks Promote Living Donor Transplantation Conversations

New Orleans—Ideas, attitudes, and behaviors are known to spread within social networks; however, there are few available data on the structure and influence of social networks within the framework of hemodialysis clinics. Avrum Gillespie, MD, and colleagues utilized a survey and observational data to examine the role of patient hemodialysis social networks and discussions of living donor kidney transplantation. Results ... Read More »