Adult ; Female ; Humans ; Interviews as Topic ; Kidney ; surgery ; Kidney Transplantation ; statistics & numerical data ; Living Donors ; statistics & numerical data ; Male ; Middle Aged

OBJECTIVETo explore the effect of donations after cardiac death (DCD) kidney transplant performed in northwest China and the measures for management of delayed graft function (DGF).

METHODSIn the period of 2011-2013, a total of 51 families of DCD donor gave their consent to organ donation by signing the informed consent with the help by a Red Cross Organization (ROC) coordinator, and 102 kidneys were retrieved by organ procurement organization (OPO) teams. Ninety-four operations of renal transplantation were carried out in our hospital. All the patients were followed-up and based on the occurrence of DGF after transplantation, they were divided into DGF group and non-DGF group for comparative studies.

RESULTSThe success rate of donation after cardiac death was 29.3%, and the incidence of post-transplantation DGF was 27.7%. The 1-year human/kidney survival rate was 98.9%/95.7%. Within six months after the transplant, the values of eGFR in DGF group were significantly lower and serum creatinine significantly higher than those in non-DGF group (P<0.05), but no significant differences were found between the two groups thereafter (P>0.05). The occurrence of DGF in LifePort mechanical perfusion cohorts was significantly lower than that in the simple cold preservation group (21.5% vs. 41.4%, P<0.05).

CONCLUSIONThe overall effect of DCD kidney transplant is good despite a high incidence of early DGF, and we recommend the use of low-temperature mechanical perfusion for storage and transportation of DCD donor kidney.

Adult ; China ; Death ; Delayed Graft Function ; etiology ; Female ; Humans ; Kidney Transplantation ; Male ; Tissue and Organ Procurement ; statistics & numerical data ; Young Adult

BACKGROUNDKidney transplantation (KTx) is the primary therapy for children with renal failure. Unlike KTx in adult patients, it is commonly agreed that pediatric KTx in China is far behind that of America. There has been no systematic analysis of Chinese pediatric KTx reported. This study aimed to demonstrate the current status of pediatric KTx in China.

METHODSRegistry data of pediatric KTx (1983-2012) from Chinese Scientific Registry of Kidney Transplantation (CSRKT) were retrospectively analyzed.

RESULTSThere were 851 pediatric KTx from 102 transplant units. The recipients were (15.4±2.5) years of age, 93.9% of who were over 10 years old. Chronic glomerulonephritis and pyelonephritis accounted for 75.6% of recognized primary diseases. Allografts were from deceased donors (72.2%) or living donation (27.7%). The patient survival for 1, 3, 5, and 10 years was 96.9%, 94.2%, 92.3%, and 92.3% and the graft survival was 94.6%, 91.4%, 86.3%, and 79.2%, respectively. The majority of post-transplant complications were acute rejection and infections. Annual transplant reached the peak in 2008 (n = 114), and decreased sharply in 2006 (n = 41) and 2010 (n = 57). The percentage of pediatric KTx in total KTx was highest in 2007 (1.95%) and decreased to trough level in 2010 (1.0%). Living donation increased by 32.5-folds from 2004 to 2008 and then decreased by 86.6% till 2010. The percentage of living donation in pediatric or total KTx dynamically changed in a similar manner, while living donation ratio in pediatric KTx was much higher.

CONCLUSIONSKidney transplant can provide long-term benefits to pediatric recipients. Rejection and infections are worthy of concern during follow-up. Pediatric kidney transplant in China is very much lagging behind that in developed countries. Living donation played an important role in its development in the past decades. New strategies for implementation are encouraged to increase the priority of uremic children in organ allocation so as to promote its progress in China.

Adolescent ; China ; Female ; Humans ; Kidney Transplantation ; statistics & numerical data ; Male ; Retrospective Studies

BACKGROUNDOur goal was to evaluate the outcomes of kidney transplants from controlled cardiac death donors compared with brain death donors by conducting a meta-analysis of cohort studies.

METHODSThe PubMed database and EMBASE were searched from January 1980 to July 2013 to identify studies that met pre-stated inclusion criteria. Reference lists of retrieved articles were also reviewed. Two authors independently extracted information on the designs of the studies, the characteristics of the study participants, and outcome assessments.

RESULTSNine cohort studies involving 84 398 participants were included in this meta-analysis; 3 014 received kidneys from controlled cardiac death donors and 80 684 from brain death donors. Warm ischemia time was significantly longer for the controlled cardiac death donor group. The incidence of delayed graft function was 2.74 times (P < 0.001) greater in the controlled cardiac death donor group. The results are in favor of the brain death donor group on short-term patient and graft survival while this difference became nonsignificant at mid-term and long term. Sensitivity analysis yielded similar results. No evidence of publication bias was observed.

CONCLUSIONThis meta-analysis of retrospective cohort studies suggests that the outcome after controlled cardiac death donors is comparable with that obtained using kidneys from brain death donors.

Brain Death ; Death ; Humans ; Kidney Transplantation ; statistics & numerical data ; Retrospective Studies ; Tissue Donors

OBJECTIVETo retrospectively investigate the distribution in kidney transplantation for fifteen years in Peking Union Medical College Hospital.

METHODSWe conducted a descriptive research counting up the number of patients who received kidney transplantation each year in our hospital during 1995 and 2010.

RESULTSThe first kidney transplantation in our hospital occurred in the 1960s. The number of kidney transplantation increased until reaching a maximum of 47 grafts in 2001; since then the number fell.

CONCLUSIONSWith the decreased number of kidney transplantation, we have realized the shortage of transplantable organs is very serious. The continuing transplant shortage requires major efforts to expand the donor pool. Donation after cardiac death offers the potential to enlarge the donor pool, but we need to strictly control the criteria for potential donors.

China ; Humans ; Kidney Transplantation ; methods ; statistics & numerical data ; trends ; Postoperative Complications ; epidemiology ; Retrospective Studies ; Time Factors ; Tissue Donors ; statistics & numerical data ; Tissue and Organ Procurement ; statistics & numerical data ; trends ; Treatment Outcome

OBJECTIVE: To evaluate the recovery of patients with end-stage renal disease (ESRD) receiving kidney transplant from cardiac death donors, and to assess graft survival in China from this type of donor. METHODS: A total of 48 cases of patients with ESRD have received the kidneys from cardiac death donors in our hospital between February 2010 and March 2012. We retrospectively analyzed data on the preoperative and postoperative serum creatinine concentrations, on the survival of recipients and allografts with a view to investigating prognoses after this type of kidney transplant. RESULTS: Primary non-function (PNF) did not occur in any of the 48 recipients. Delayed graft function (DGF) occurred in 18 of 48 (37.5%) of kidneys from cardiac death donors, but the occurrence of DGF did not adversely influence patient's survival (P=0.098) or graft survival (P=0.447). Seven of 48 (14.6%) recipients lost their graft. Over a median follow-up period of 8 months (range 0.5-23 months), 39 of 41(95.1%) recipients' graft function had fully recovered. The actuarial graft and patient's survival rates at 1, 3, 6 and 12 months after transplantation were 95.7%, 93.0%, 90.0%, 87.5%, and 100%, 94.9%, 90%, 87.5%, respectively. CONCLUSION As the legislation of donation after brain death (DBD) has not been ratified in China, the use of kidneys from cardiac death donors might be an effective way to increase the number of kidneys available for transplantation here. Our experience indicates good short- and mid-term outcomes with transplants from cardiac death donors.
Adult ; Brain Death ; Cadaver ; Death, Sudden, Cardiac ; Delayed Graft Function ; epidemiology ; Female ; Graft Survival ; Humans ; Kidney Transplantation ; Male ; Middle Aged ; Tissue Donors ; statistics & numerical data

Graft Rejection ; Humans ; Kidney Transplantation ; mortality ; statistics & numerical data ; Patient Care

BACKGROUNDSimultaneous pancreas-kidney transplantation (SPKT) frees the diabetic patient with end-stage nephropathy from dialysis and daily insulin injections. Herein, we review consecutive cases of SPKT with bladder drainage performed at our institution over an 8-year period.

METHODSThe study population included 21 patients (16 males and 5 females) who underwent SPKT between September 2001 and September 2009. Seven patients had type-1 diabetes and 14 had type-2 diabetes. Nineteen patients were on dialysis at the time of transplantation. Donation after cardiac death donors were selected for SPKT. The mean human leukocyte antigen match was 2 (range 0 - 4). SPKT was always performed using bladder drainage and vascular anastomoses to the systemic circulation. Immunosuppressive treatment consisted of anti-lymphocyte globulin induction followed by tacrolimus, mycophenolate mofetil, and prednisone.

RESULTSThe mean hospital stay was 45.43 days. After a mean follow-up of 39.4 months, survival rates for patient, kidney, and pancreas were 76.2%, 76.2%, and 66.7% at 1 year; 76.2%, 59.3%, and 55.6% at 5 years; and 57.1%, 39.5%, and 41.7% at 8 years, respectively. Major complications included anastomotic leaks, reflux pancreatitis, and rejection. Six patients died from septic shock (n = 3), duodenal stump leak (1), cardiac arrest (1), or renal failure (1). Eight kidney grafts were lost due to acute rejection (n = 2), chronic rejection (3), and death with a functioning graft (3). Pancreatic graft failure (9) was caused by thrombosis (n = 1), rejection (2), duodenal stump leak (1), and death with a functioning graft (5).

CONCLUSIONSSPKT is a valid therapeutic option for uremic diabetics although few hospitals in China can undertake SPKT.

Adult ; Diabetes Mellitus, Type 1 ; surgery ; Diabetes Mellitus, Type 2 ; surgery ; Female ; Graft Rejection ; Humans ; Immunosuppressive Agents ; therapeutic use ; Kidney Transplantation ; adverse effects ; mortality ; statistics & numerical data ; Male ; Middle Aged ; Pancreas Transplantation ; adverse effects ; mortality ; statistics & numerical data ; Postoperative Complications ; Retrospective Studies ; Treatment Outcome ; Urinary Catheterization

Coronary artery disease remains the leading cause of early death and graft loss in renal transplant patients. The aim of this study was to identify clinical and echocardiographic parameters independently associated with the angiographically-determined severity of coronary atherosclerosis in long-term kidney transplant patients. Fifty-two kidney transplant recipients who underwent elective coronary angiography were reviewed retrospectively. Angiographic severity was evaluated using the modified Gensini index (MGI). The mean age at coronary angiography was 52.5+/-7.9 yr with a mean prior transplant duration of 118.1+/-58.8 months. Pearson correlation analysis demonstrated a positive correlation of MGI with transplant duration before coronary angiography and chronic allograft nephropathy, whereas an inverse correlation was demonstrated with ejection fraction and statin use. On subsequent multivariate linear regression analysis, transplant duration before coronary angiography, statin use, and ejection fraction were independently associated with the severity of coronary atherosclerosis in long-term kidney transplant patients. In summary, our study demonstrates that statin use, ejection fraction, and transplant duration before coronary angiography are independent parameters associated with the severity of coronary atherosclerosis in long-term kidney transplant patients. Further investigation is required to reduce the atherosclerotic burden in kidney transplant patients.
Adult ; Comorbidity ; Coronary Artery Disease/*diagnosis/*epidemiology ; Female ; Humans ; Incidence ; Kidney Transplantation/*statistics & numerical data ; Korea/epidemiology ; Male ; Renal Insufficiency/*epidemiology/*surgery ; Risk Assessment ; Risk Factors ; Statistics as Topic

BACKGROUND/AIMS: Kidney transplantations at our center rely mainly on living donors. The purpose of this study was to suggest future donor supply directions by reviewing changing trends in donor type. METHODS: During the past 40 years, 1,690 kidney transplantations were performed at our center. We divided the follow-up period into four decades and the donor population into three groups: living related, living unrelated, and deceased. We analyzed changing trends in donors from each group for each decade. Patients receiving overseas transplantation were also included. RESULTS: The proportion of living related donors decreased from 84% (54/64) in the 1970s to 61% (281/458) in the 2000s. Living unrelated donors showed a sustained proportion of around 20% after 1990. However, among living unrelated donors, the proportion of spouse donors increased from 4.6% (17/369) in the 1980s to 8.5% (39/458) in the 2000s. Transplants from deceased donors were only 3.3% (12/369) in the 1980s. However the proportion of deceased donors increased gradually, reaching 13.2% (105/799) in the 1990s and 19.9% (91/458) after 2000. Overseas transplantations increased after 2000 and reached 20% of all cases treated in our center during the 2000s. Such transplantations peaked in 2006 and decreased markedly thereafter. CONCLUSIONS: The proportion of each donor type has continuously changed, and the changes were associated with changes in the social structure and system. We expect that this study could be an important reference for other countries to estimate future changes of donor type.
Adult ; Female ; History, 20th Century ; History, 21st Century ; Humans ; Kidney Transplantation/*history/statistics & numerical data/trends ; Korea ; Living Donors/history/statistics & numerical data ; Male ; Middle Aged ; Tissue Donors/*history/statistics & numerical data ; Tissue and Organ Procurement/history/statistics & numerical data/trends