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Clinical Outcomes of Kidney Transplantation in Patients With Biopsy-Proven Glomerulonephritis

Sun, 31 Dec 2017 15:00:00 GMT

Title: Clinical Outcomes of Kidney Transplantation in Patients With Biopsy-Proven Glomerulonephritis Author(s): H. Park; W.Y. Park; S.S. Kang; S.M. Yeo; S. Han; S.B. Par; K. Jin Abstract: BACKGROUND: The clinical outcomes after kidney transplantation (KT) according to the types of glomerulonephritis (GN) as the cause of end-stage renal disease (ESRD) are various, but there are not many studies on this. METHODS: Among 1,253 patients who had KT between November 1982 and January 2017, 183 recipients with biopsy-proven GN as the primary cause of ESRD were enrolled. We analyzed the incidence of recurrent GN and the factors associated with recurrence and graft and patient survivals. RESULTS: The types of GN were 95 IgA nephropathy, 47 focal segmental glomerulosclerosis, 14 membranous proliferative GN, 9 membranous GN, 8 lupus nephritis, 6 rapid progressive GN, and 4 Alport syndrome. The mean follow-up duration was 103 ± 81.7 months. Recurrence was reported in 36 patients, of which 20 grafts failed due to recurrence. The age of patients with GN recurrence was significantly younger than that of patients without GN recurrence (P = .030). The graft failure rate of KT recipients with recurrent GN was significantly higher than that of the recipients without recurrent GN (55.6% vs 18.4%, P < .001). In multivariate analysis, recurrence of primary GN, the number of HLA mismatches at AB, delayed graft function, and acute rejection were independent risk factors for graft failure. CONCLUSION: Recurrent GN remains a significant cause of graft loss in KT recipients. Surveillance of GN recurrence in the KT recipients with biopsy-proven GN can reduce allograft dysfunction.

Successful En-Bloc Kidney Transplantation from a 5-Month-Old Donor to a 63-Year Old Recipient: A Case Report

Sat, 31 Dec 2016 15:00:00 GMT

Title: Successful En-Bloc Kidney Transplantation from a 5-Month-Old Donor to a 63-Year Old Recipient: A Case Report Author(s): Kang Seong Sik; Park, Ha Yeon; Yeo, Sang Mok; Park, Woo Yeong; Han, Seungyeup; Park, Sung Bae; Park, Ui Jun; Kim, Hyoung Tae; Yoon, Jeongsoo; Jin, Kyubok Abstract: Introduction : Pediatric deceased donor kidney transplantation (DDKT) has been increasing gradually as a donor pool expansion method. In addition, the outcomes of pediatric DDKT over the last 20 years have shown excellent results with an active practice of en-bloc KT (EBKT) which increases kidney volume. We report pediatric en-bloc KT performed with organ donation from the youngest 5-month-old infant in our institution. Presentation of Case : En-block kidney of a 5-month-old female infant with a body weight of 3.2 kg diagnosed with brain death due to hypoxic injury was transplanted into a 63-year old female patient with a body weight of 56 kg, who was receiving continuous ambulatory peritoneal dialysis (CAPD) for IgA nephropathy end-stage renal disease. The human leukocyte antigen mismatches were 3 and both panel reactive antibody and donor-specific antibody were negative. Basiliximab was used as the induction immunosuppressant. Results : Cold ischemia times were 187 minutes. Both kidneys weighed 56 g and distal ends of the donor aorta and vena cava were anastomosed to internal iliac artery and external iliac vein of the recipient. Tacrolimus, mycophenolate mofetil, and prednisolone were used as the maintenance immunosuppressant. Postoperative renal doppler sonography showed mild hydronephrosis in one kidney and small amount perinephric free fluid collection, but both improved in follow-up examination. On the 20th day of KT, the serum creatinine level decreased to 1.23 mg/dL with estimated glomerular filtration (eGFR) 44.1 mL/min/1.73 m2 and CAPD catheter was removed. At 5 months after KT, serum creatinine was 0.90 mg/dL and eGFR was 63.0 mL/min/1.73 m2. Conclusion : This case report highlights the successful KT to an adult with en-bloc kidney of a 5-month-old infant. And long-term follow-up on whether small kidneys of 56 g adapt appropriately and function well in adult is needed.

Long-term Prognosis of BK Virus Associated Nephropathy in Kidney Transplant Recipients

Sun, 31 Dec 2017 15:00:00 GMT

Title: Long-term Prognosis of BK Virus Associated Nephropathy in Kidney Transplant Recipients Author(s): Woo Yeong Park; Seong Sik Kang; Kyubok Jin; Sung Bae Park; Misun Choe; Seungyeup Han Abstract: BACKGROUND: The long-term prognosis of BK virus-associated nephropathy (BKVAN) in kidney transplant recipients (KTRs) is uncertain. We evaluated the long-term prognosis in KTRs with BKVAN and the clinical significance of BKVAN on post-transplant clinical outcome. METHODS: We retrospectively analyzed the medical records of 582 patients who underwent kidney transplant (KT) between 2001 and 2014. We divided the patients into a BKVAN group (15 patients) diagnosed by allograft biopsy and a control group (356 patients). RESULTS: The incidence of BKVAN was 4.0%, and the mean follow-up duration was 93.1 ± 52.3 months. Median time from KT to BKVAN diagnosis was 5.9 months (interquartile range [IQR], 4.4-8.7). In the BKVAN group, 9 (60.0%) KTRs with combined acute rejection progressed to graft failure, and the median time from BKVAN diagnosis to graft failure was 36.2 months (IQR, 9.7-65.5). Death-censored graft survival rate and patient survival rate in the BKVAN group were significantly lower than those in the control group. BKVAN and rejection were independent risk factors for graft failure. In the subgroup analysis, death-censored graft survival rate of KTRs with BKVAN with acute rejection was significantly worst in comparison with similar patients without BKVAN regardless of acute rejection (P < 0.001). CONCLUSION: The long-term prognosis of BKVAN with acute rejection was very poor because of graft failure caused by inadequate treatment for acute rejection considering BKVAN. Therefore, we should carefully monitor the allograft status of KTRs through regular surveillance tests after treatment for BKVAN with acute rejection.

Long-Term Outcomes of Kidney Transplantation with Primary Glomerulonephritis

Sun, 31 Dec 2017 15:00:00 GMT

Title: Long-Term Outcomes of Kidney Transplantation with Primary Glomerulonephritis Author(s): Sangmok Yeo; Hayeon Park; Seong Sik Kang; Woo Yeong Park; Kyubok Jin; Seungyeup Han; Sung Bae Park Abstract: Introduction The clinical outcomes after kidney transplantation (KT) vary according to the types of glomerulonephritis (GN) causing end-stage renal disease (ESRD). In addition, the recurrence of GN has a significant impact on the outcomes of KT. In the present study, we evaluated clinical outcomes of KT in patients with biopsy-proven GN. Methods All KT recipients who had biopsy proven GN and had been transplanted between Nov. 1982 and Jan. 2017 were enrolled. We investigated the incidence of recurrent GN and analyzed the factors associated with recurrence, allograft survival, and patient survival. Results Of 1253 patients who received KT, 183 had a biopsy-proven GN as the cause of ESRD. The types of GN were immunoglobulin A nephropathy (IgAN) in 95 patients, focal segmental glomerulosclerosis (FSGS) in 47, membranous proliferative glomerulonephritis (MPGN) in 14, membranous glomerulonephritis (MGN) in 9, lupus nephritis in 8, rapid progressive glomerulonephritis (RPGN) in 6, and alport syndrome in 4. The mean follow up duration was 103 ± 81.7 months. Recurrent GN occurred in 36 patients (19.7%) and recurrence rate was 25.5% in FSGS, 22.2% in MGN, 21.4% in MPGN and 20.0% in IgAN. The recurrence of GN was more common in younger patients at the time of KT (p=0.03). Twenty of the 36 patients with recurrent GN lost their allograft due to recurrence. Discussion The rate of graft failure in recipients with recurrence was higher than those without recurrence (55.6%, 18.4%, p=0.000). The recurrence of GN rather than the type of GN was a significant risk factor for allograft loss. (adjusted hazard ratio 1.89 [1.004-3.368]). Conclusion The recurrence of GN was significant risk factor for allograft loss. In particular, younger recipients were more likely to go through recurrence after KT. Further studies are required to evaluate optimal strategies to prevent and treat recurrent GN after KT.