Short-term Effects of Tolvaptan in Individuals With Autosomal Dominant Polycystic Kidney Disease at Various Levels of Kidney Function

American Journal of Kidney Diseases Short-term Effects of Tolvaptan in Individuals With Autosomal Dominant Polycystic Kidney Disease at Various Levels of Kidney Function

A recent study showed that tolvaptan, a vasopressin V2 receptor antagonist, decreased total kidney volume (TKV) growth and estimated glomerular filtration rate (GFR) loss in autosomal dominant polycystic kidney disease (ADPKD) with creatinine clearance≥60mL/min. The aim of our study was to determine whether the renal hemodynamic effects and pharmacodynamic efficacy of tolvaptan in ADPKD are dependent on GFR.


http://www.ajkd.org/article/S0272-6386(14)01465-6/abstract?rss=yes

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Alberto Reino Buelvas 

Médico Internista Nefrólogo

Outcomes in Kidney Transplant Recipients From Older Living Donors.

Transplantation - Published Ahead-of-Print Outcomes in Kidney Transplant Recipients From Older Living Donors.

Background: Previous studies demonstrate that graft survival from older living kidney donors (LD; age >60 years) is worse than younger LD but similar to deceased standard criteria donors (SCD). Limited sample size has precluded more detailed analyses of transplants from older LD. Methods: Using the United Network for Organ Sharing database from 1994 to 2012, recipients were categorized by donor status: SCD, expanded criteria donor (ECD), or LD (by donor age: <60, 60-64, 65-69, >=70 years). Adjusted models, controlling for donor and recipient risk factors, evaluated graft and recipient survivals. Results: Of 250,827 kidney transplants during the study period, 92,646 were LD kidneys, with 4.5% of these recipients (n = 4,186) transplanted with older LD kidneys. The use of LD donors 60 years or older increased significantly from 3.6% in 1994 to 7.4% in 2011. Transplant recipients with older LD kidneys had significantly lower graft and overall survival compared to younger LD recipients. Compared to SCD recipients, graft survival was decreased in recipients with LD 70 years or older, but overall survival was similar. Older LD kidney recipients had better graft and overall survival than ECD recipients. Conclusions: As use of older kidney donors increases, overall survival among kidney transplant recipients from older living donors was similar to or better than SCD recipients, better than ECD recipients, but worse than younger LD recipients. With increasing kidney donation from older adults to alleviate profound organ shortages, the use of older kidney donors appears to be an equivalent or beneficial alternative to awaiting deceased donor kidneys. (C) 2015 by Lippincott Williams & Wilkins


http://pdfs.journals.lww.com/transplantjournal/9000/00000/Outcomes_in_Kidney_Transplant_Recipients_From.97928.pdf

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Alberto Reino Buelvas 

Médico Internista Nefrólogo

Surgical complications after kidney transplantation: Different impact of immunosuppression, graft function, patient variables and surgical performance

Clinical Transplantation Surgical complications after kidney transplantation: Different impact of immunosuppression, graft function, patient variables and surgical performance

Abstract

The population of kidney transplant (KTx) recipients often has complex medical and immunological conditions. Surgical complications (SC) contribute to the increasing morbidity and costs in these patients.

We analyzed the risk factors for SC in 405 KTx patients treated using defined immunosuppressive regimens according to their clinical and immunological risk profile: 1) standard immunosuppression (SIS) with IL-2 receptor mAb, CNI and a) mycophenolic acid (MPA) or b) mTOR inhibitor; and 2) more intense immunosuppression (IIS) with a) ATG or b) the additional use of plasma exchange and B- and T-cell- depleting agents.

In a mixed effects logistic regression model, we identified the following risk factors for SC: male gender, diabetes and postoperative dialysis. No difference was found between the patients who received SIS with MPA and those who received mTOR inhibitors. The risk of suffering complications with IIS increases with age. In addition to IIS, diabetes was a risk for wound healing disorders. Therapeutic anticoagulation and a third or subsequent retransplantation increased the rate of bleeding. We did not identify immunosuppression or patient demographics as risk factors for lymphoceles or ureter complications; however, we demonstrated that the surgeon had a significant impact on severe complications, especially those of the ureter.

This article is protected by copyright. All rights reserved.

http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fctr.12513

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Alberto Reino Buelvas 

Médico Internista Nefrólogo

I'm sharing "Randomized Trial of Valganciclovir Versus Valacyclovir Prophylaxis for Prevention of Cytomegalovirus in Renal Transplantation."

I thought you would be interested in this article.

Clinical Journal of the American Society of Nephrology : CJASN 2014 Nov 25; Randomized Trial of Valganciclovir Versus Valacyclovir Prophylaxis for Prevention of Cytomegalovirus in Renal Transplantation. Tomas Reischig, Martin Kacer, Pavel Jindra, Ondrej Hes, Daniel Lysak, Mirko Bouda PMID: 25424991

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Alberto Reino Buelvas

The Need for a Standardized Informed Consent Procedure in Live Donor Nephrectomy: A Systematic Review

Transplantation - Current Issue The Need for a Standardized Informed Consent Procedure in Live Donor Nephrectomy: A Systematic Review

BackgroundInformed consent in live donor nephrectomy is a topic of great interest. Safety and transparency are key items increasingly getting more attention from media and healthcare inspection. Because live donors are not patients, but healthy individuals undergoing elective interventions, they justly insist on optimal conditions and guaranteed safety. Although transplant professionals agree that consent should be voluntary, free of coercion, and fully informed, there is no consensus on which information should be provided, and how the donors' comprehension should be ascertained. MethodsComprehensive searches were conducted in Embase, Medline OvidSP, Web-of-Science, PubMed, CENTRAL (The Cochrane Library 2014, issue 1) and Google Scholar, evaluating the informed consent procedure for live kidney donation. The methodology was in accordance with the Cochrane Handbook for Interventional Systematic Reviews and written based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. ResultsThe initial search yielded 1,009 hits from which 21 articles fell within the scope of this study. Procedures vary greatly between centers, and transplant professionals vary in the information they disclose. Although research has demonstrated that donors often make their decision based on moral reasoning rather than balancing risks and benefits, providing them with accurate, uniform information remains crucial because donors report feeling misinformed about or unprepared for donation. Although a standardized procedure may not provide the ultimate solution, it is vital to minimize differences in live donor education between transplant centers. ConclusionThere is a definite need for a guideline on how to provide information and obtain informed consent from live kidney donors to assist the transplant community in optimally preparing potential donors.


http://journals.lww.com/transplantjournal/Fulltext/2014/12150/The_Need_for_a_Standardized_Informed_Consent.3.aspx

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Alberto Reino Buelvas

Summary of the British Transplantation Society Guidelines for Management of the Failing Kidney Transplant

Transplantation - Current Issue Summary of the British Transplantation Society Guidelines for Management of the Failing Kidney Transplant

The British Transplantation Society "Guideline for Transplantation Management of the Failing Kidney Transplant" was published in May 2014. This is the first national guideline in this field. In line with previous guidelines published by the British Transplantation Society, the guideline has used the GRADE system to rate the strength of evidence and recommendations.This article summarizes the Statements of Recommendation contained in the guideline, which provide a framework for the management of the failing kidney graft in the United Kingdom and may be of wide international interest. It is recommended that the full guideline document is consulted for details of the relevant references and evidence base. This may be accessed at: http://www.bts.org.uk/MBR/Clinical/Guidelines/Current/Member/Clinical/Current_Guidelines.aspx


http://journals.lww.com/transplantjournal/Fulltext/2014/12150/Summary_of_the_British_Transplantation_Society.2.aspx

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Alberto Reino Buelvas