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Can donor kidneys with asymptomatic small renal stones be safely transplanted?
Indian J Transplant 2009; 3: 26-40
AUC in a significant percentage of Indian renal allograft recipients. Concentration controlled mycophenolate dosing is recommended for renal transplant recipients in India.
Can donor kidneys with asymptomatic small renal stones be safely transplanted ? Parag Gupta, Aneesh Srivastava, Rakesh Kapoor, Deepak Dubey, Anant Kumar SGPGI, Lucknow.
Objective
Abstrcats: XIX Conference of ISOT 2008
31
To assess the impact of protocol biopsies in tacrolimus versus cyclosporine in a live related renal transplant program Jain S. Guleria S, Dinda AK, Mahajan S, Bhowmik D, Gupta S, Agarwal SK, Tiwari SC, Gupta A, Bansal VK, Panigarhi A, Mehra NK. Department of Surgery, Nephrology, Pathology and Transplant Immunology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi
Aim
To report the outcomes of recipients who received kidney transplant from asymptomatic donor with less than 1 cm renal stone.
The aim of the study was to assess the impact of protocol biopsies in tacrolimus versus cyclosporine immunosuppression in a live related renal transplant program.
Material and methonds
Material and methond
From July 1988 to August 2007, 16 patients with end stage renal disease received kidneys from aymptomatic donors with renal stone of less than 1 cm size. The mean age of the donor was 38 years (25 to 65 years), the mean GFR of the transplanted kidney was 40 ml/min, mean size of the stone was 8 mm (from 4 mm to 10mm). Six patients had stones <4mm and 10 patients had 4-10mm stones. Donors with >4 mm stone were subjected to Extra corporeal Lithotripsy and considered for donation if the residual fragments were less than 4mm. During the mean follow up of 5.6 years, the fate of residual stones, renal outcomes and stone related events in the recipients were analysed.
Fifty eight transplant recipients were non randomly allocated to tacrolimus group (n=40) and cycloporine biopsy group (n=18). Other immunosuppressant in these groups consisted of either of mycophenolate mofetil or azathioprine and steroids. Protocol biopsies were conducted in biopsy group at one month, six months and twelve months post transplant with intent to treat. Both groups were analysed at twelve months with respect to graft function and survival.
Results The mean serum creatinine at 1 week, 3 months and 3 years were 1.0 mg/dl, 1.12mg/dl and 1.3 mg/dl respectively. The graft survival at 5 years was 89%. On follow up ultrasound at 3 months 4/16 patients had persistent stone fragments and no patients had stone on ultrasonography at 1 year. None of the recipient had any stone related symptoms or increase in stone size during the follow up. Conclusion Transplantation of kidneys with small, asymptomatic stones in situ can be safely performed.
Results The two groups were similar with respect to mean age, mean tacrolimus levels induction therapy, mean donor age and mean donor glomerular filtration rate. There were forty protocol biopsies conducted at one month, thirty one at six months and twenty six at twelve months in tacrolimus groups. The number in cyclosporine group at similar time was eighteen, fourteen and eleven number in cyclosporine group at similar time was eighteen, fourteen and eleven respectively. The cumulatie rejection rate at twelve months was significantly more in cyclosporine group (10.3% and 23.2% for tacrolimus and cyclosporine, p=0.04). Cumulative calcineurin inhibitor toxicity at twelve months was not statistically different in two groups (6.9% and 14.4% for cyclosporine and tacrolimus, p-0.27). There was no difference in graft survival and function at one year. Conclusion Tacrolimus based immunosuppression is more effective in decreasing sub clinical rejection. But this has not translated into improved graft function at one year. This may be due to higher prevalence of calcineurin inhibitor toxicity in tacrolimus group. However, longer follow up in necessary the assess the true impact.
Copyright © 2009 by The Indian Society of Organ Transplantation
AUC in a significant percentage of Indian renal allograft recipients. Concentration controlled mycophenolate dosing is recommended for renal transplant recipients in India.
Can donor kidneys with asymptomatic small renal stones be safely transplanted ? Parag Gupta, Aneesh Srivastava, Rakesh Kapoor, Deepak Dubey, Anant Kumar SGPGI, Lucknow.
Objective
Abstrcats: XIX Conference of ISOT 2008
31
To assess the impact of protocol biopsies in tacrolimus versus cyclosporine in a live related renal transplant program Jain S. Guleria S, Dinda AK, Mahajan S, Bhowmik D, Gupta S, Agarwal SK, Tiwari SC, Gupta A, Bansal VK, Panigarhi A, Mehra NK. Department of Surgery, Nephrology, Pathology and Transplant Immunology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi
Aim
To report the outcomes of recipients who received kidney transplant from asymptomatic donor with less than 1 cm renal stone.
The aim of the study was to assess the impact of protocol biopsies in tacrolimus versus cyclosporine immunosuppression in a live related renal transplant program.
Material and methonds
Material and methond
From July 1988 to August 2007, 16 patients with end stage renal disease received kidneys from aymptomatic donors with renal stone of less than 1 cm size. The mean age of the donor was 38 years (25 to 65 years), the mean GFR of the transplanted kidney was 40 ml/min, mean size of the stone was 8 mm (from 4 mm to 10mm). Six patients had stones <4mm and 10 patients had 4-10mm stones. Donors with >4 mm stone were subjected to Extra corporeal Lithotripsy and considered for donation if the residual fragments were less than 4mm. During the mean follow up of 5.6 years, the fate of residual stones, renal outcomes and stone related events in the recipients were analysed.
Fifty eight transplant recipients were non randomly allocated to tacrolimus group (n=40) and cycloporine biopsy group (n=18). Other immunosuppressant in these groups consisted of either of mycophenolate mofetil or azathioprine and steroids. Protocol biopsies were conducted in biopsy group at one month, six months and twelve months post transplant with intent to treat. Both groups were analysed at twelve months with respect to graft function and survival.
Results The mean serum creatinine at 1 week, 3 months and 3 years were 1.0 mg/dl, 1.12mg/dl and 1.3 mg/dl respectively. The graft survival at 5 years was 89%. On follow up ultrasound at 3 months 4/16 patients had persistent stone fragments and no patients had stone on ultrasonography at 1 year. None of the recipient had any stone related symptoms or increase in stone size during the follow up. Conclusion Transplantation of kidneys with small, asymptomatic stones in situ can be safely performed.
Results The two groups were similar with respect to mean age, mean tacrolimus levels induction therapy, mean donor age and mean donor glomerular filtration rate. There were forty protocol biopsies conducted at one month, thirty one at six months and twenty six at twelve months in tacrolimus groups. The number in cyclosporine group at similar time was eighteen, fourteen and eleven number in cyclosporine group at similar time was eighteen, fourteen and eleven respectively. The cumulatie rejection rate at twelve months was significantly more in cyclosporine group (10.3% and 23.2% for tacrolimus and cyclosporine, p=0.04). Cumulative calcineurin inhibitor toxicity at twelve months was not statistically different in two groups (6.9% and 14.4% for cyclosporine and tacrolimus, p-0.27). There was no difference in graft survival and function at one year. Conclusion Tacrolimus based immunosuppression is more effective in decreasing sub clinical rejection. But this has not translated into improved graft function at one year. This may be due to higher prevalence of calcineurin inhibitor toxicity in tacrolimus group. However, longer follow up in necessary the assess the true impact.
Copyright © 2009 by The Indian Society of Organ Transplantation