Should Immunosuppression After Kidney Transplant Be Adjusted Based on Renal Resistance During Pretransplant Hypothermic Machine Perfusion?
| Autor: | Jolanta Gozdowska, Artur Kwiatkowski, Michal Wszola, Marta Serwanska-Swietek, Tomasz Piatek, Piotr Domagala, Magdalena Durlik, Andrzej Chmura, Agata Ostaszewska, Agnieszka Perkowska-Ptasińska |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Graft Rejection Male medicine.medical_specialty medicine.medical_treatment Urology Delayed Graft Function Transplants Kidney Kidney transplant medicine Humans Kidney transplantation Immunosuppression Therapy Transplantation Machine perfusion Receiver operating characteristic business.industry Graft Survival Immunosuppression Organ Preservation Middle Aged medicine.disease Kidney Transplantation Perfusion Female Surgery Graft survival business |
| Zdroj: | Transplantation Proceedings. 51:2676-2682 |
| ISSN: | 0041-1345 |
| DOI: | 10.1016/j.transproceed.2019.01.202 |
| Popis: | Background The hypothermic machine perfusion reduces delayed graft function after kidney transplant and allows, to some extent, predicting early graft function. However, it is difficult to identify exact perfusion criteria with which to exclude kidneys from transplant or modify post-transplant care. The aim of this study was to analyze whether renal resistance during the fourth hour of hypothermic machine perfusion is useful in the prediction of graft survival and acute rejection. Patients and Methods Data on pretransplant hypothermic machine perfusion parameters of 407 transplanted kidneys were available. Receiver operating characteristic curve analysis was performed to find an optimal cutoff value of ratio for predicting a higher risk class of considered group of patients. According to this, patients were divided into 2 groups: those who received kidneys with renal resistance lower than 0.19 mm Hg/mL/min (R1; n = 187) and those who received kidneys with renal resistance equal to or higher than 0.19 mm Hg/mL/min (R2; n = 220). Within R2, we additionally analyzed 2 subgroups: patients who received induction therapy (R2−Ind+; n = 124) and those who did not received induction therapy (R2−Ind−; n = 96). Results Acute rejection in R1 within 1 month post transplant was 2-fold lower compared with R2 and was 6.4% vs 13.1% (P = .03), respectively. One-year graft survival was higher in R1 compared with R2 and was 94.6% vs 88.5% (P = .03), respectively. Acute rejection in the R2−Ind+ subgroup within 1 month post transplant was 2.46-fold lower compared with the R2−Ind− subgroup and was 8% vs 19.7% (P = .01), respectively. Conclusion Immunosuppression treatment after transplant should be adjusted to perfusion parameters. |
| Databáze: | OpenAIRE |
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