Başkent Üniversitesi Yayınları

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Subject: search.filters.subject.Graft survival

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    Clinicoepidemiologic Study of Posttransplant Diabetes After Living-Donor Renal Transplant
    (Başkent Üniversitesi, 2008-03) Elmagd, Mogahid M Abu; Wahab, Ahmad M abd El; AMetwally, Abdel Hameed; Bakr, Mohammed A.
    Objectives: We sought to evaluate posttransplant diabetes mellitus with regard to its incidence, risk factors for occurrence, complications, impact on graft function, and impact on patient and graft survival rates. Materials and Methods: A total of 1580 patients received living-donor renal allografts at Mansoura University, Egypt, between March 1976 and November 2004. Of these, 286 recipients developed diabetes after transplant (diabetic group). These patients were matched with 316 kidney transplant recipients who did not develop diabetes after transplant (control group). A complete clinical history was obtained and a clinical examination was done. Laboratory analyses including urine analysis, complete blood count, total serum cholesterol, fasting and 2-hour postprandial plasma glucose, Hb A1c, serum creatinine, and creatinine clearance were obtained in all patients. In each patient, presence of hepatitis B and C was determined with polymerase chain reaction, and a graft biopsy was obtained to diagnose renal allograft rejection. Results: The onset of diabetes mellitus among our recipients occurred primarily during the first 6 months after transplant (in 52.4% of the patients). Significant correlations were found between posttransplant diabetes mellitus and the recipients’ age (P = .0001), obesity (P = .001), positive family history of diabetes mellitus (P = .001), hepatitis C virus infection (P = .039), cumulative dose of steroids in the first 3 months (P = .047), and calcineurin inhibitor-based immunosuppressive therapy (P = .001). Moreover, posttransplant diabetes mellitus significantly affected rates of coronary heart disease (P = .001), hypertension (P = .02), and hypercholesterolemia (P = .001). Graft survival was similar in both groups until 15-year follow-up, at which time graft survival began to decrease in patients with diabetes mellitus compared with those without diabetes mellitus (43.5% vs 53.6%, P = .013). Similarly, patient survival was similar until 8-year follow-up, at which time survival rates began to decline in patients with diabetes as compared with patients without diabetes (79.9% vs 86.1%, P = .001); this trend continued to the 15-year follow-up (60.6% vs 77.8%, P = .001). Conclusions: Posttransplant diabetes mellitus is a major problem that endangers patient and graft survival. In our population, the incidence of posttransplant diabetes mellitus was 18.2%. Further studies are recommended to screen for patients with impaired fasting glucose and impaired glucose tolerance for prediction, early detection, and better management of posttransplant diabetes mellitus.
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    Risk Factors for Delayed Graft Function Defined as Need for Dialysis or Failure of Creatinine to Fall by 10% in the First 24 Hours After Transplant
    (Başkent Üniversitesi, 2008-03) Stratopoulos, Charalabos; Friend, Peter J.; Sinha, Sanjay; Vaidya, Anil; Muthusamy, Anand; Zilvetti, Miguel; Brockmann, Jens; Roberts, Ian S. D.
    Objectives: Delayed graft function after deceased-donor transplant remains a significant clinical problem. The conventional definition of delayed graft function is the requirement of dialysis within the first week after transplant, but this criterion has many problems that have led to many controversies including those of incidence and significance. Therefore, we sought to identify the possible risk factors of delayed graft function and to investigate their effect on short-term graft survival, according to a composite criterion. Materials and Methods: We reviewed the records of 94 renal transplants obtained from heart-beating deceased donors done at our center during a 2-year period. Variables related to the donor, recipient, and graft were retrospectively collected. Follow-up was 12 months. Delayed graft function was defined as the need for dialysis or the failure of the creatinine level to fall by 10% during the first 24 hours after transplant. To confirm suspected rejection, protocol biopsies were done, irrespective of graft function, on the seventh and 28th days after transplant, or when indicated to confirm suspected rejection. Results: The overall incidence of delayed graft function was 31.9%. Multivariate analysis showed donor age as a significant independent predictor of delayed graft function (OR=1.05, P = .03, 95% CI: 1.01-1.09), whereas donor hypotension was the only independent risk factor associated with a worse 1-year graft survival rate (OR=4.6, P = .021, 95% CI: 1.3-16.5). No association could be established between delayed graft function, acute rejection, and graft survival. Conclusions: Advanced donor age is a predictor of delayed graft function defined as the need for dialysis or the failure of creatinine to fall by 10% during the first 24 hours after transplant. Preventing hemodynamic instability should be an important aspect of donor care.