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Donor Tissue Characteristics Influence Cadaver Kidney Transplant Function and Graft Survival but Not Rejection
RENAL TRANSPLANTATION AND RENOVASCULAR HYPERTENSION
Urogenital Diaphragm: An Erroneous Concept Casting Its Shadow Over the Sphincter Urethrae and Deep Perineal Space P. MIRILAS AND J. E. SKANDALAKIS, Centers for Surgical Anatomy and Technique, Emory University School of Medicine, Atlanta, Georgia, and Department of Anatomy-Embryology, University of Crete Medical School, Heraklion, Crete, Greece J Am Coll Surg, 198: 279 –290, 2004 No Abstract Editorial Comment: For those who are detail oriented and/or anatomy scholars this is an interesting article that reviews from a historical and contemporary standpoint the various concepts regarding the “urogenital diaphragm” that, using a phrase of the authors, seems to be “buried in the shadows of misinformation.” One cannot summarize thoughts about this structure, described in all anatomy books in one way or another, in a short comment, but the main point is that there is no horizontal muscular structure that runs across the pelvis of the human male and female corresponding to that seen in many anatomical renderings. Alan J. Wein, M.D.
RENAL TRANSPLANTATION AND RENOVASCULAR HYPERTENSION Donor Tissue Characteristics Influence Cadaver Kidney Transplant Function and Graft Survival but Not Rejection S. GOURISHANKAR, G. S. JHANGRI, S. M. COCKFIELD AND P. F. HALLORAN, Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada J Am Soc Nephrol, 14: 493– 499, 2003 Acute injury and age are characteristics of transplanted tissue that influence many aspects of the course of a renal allograft. The influence of donor tissue characteristics on outcomes can be analyzed by studying pairing, the extent to which two kidneys retrieved from the same cadaver donor manifest similar outcomes. Pairing studies help to define the relative role of donor-related factors (among pairs) versus non-donor factors (within pairs). This study analyzed graft survival for 220 pairs of cadaveric kidneys for the similarity of parameters reflecting function and rejection. It also examined whether the performance of one kidney was predicted by the course of its “mate,” the other kidney from that donor. Parameters reflecting function showed sustained pairing posttransplantation, as did graft survival. In contrast, measures of rejection strongly affected survival but showed no pairing. Surprisingly, the survival of a kidney was predicted by the early performance of its mate, an observation we term the “mate effect.” Six-month graft survival and renal function were reduced in grafts for which the mate kidney displayed any criteria for functional impairment (dialysis dependency, low urine output [⬍/⫽ 1 L] in the first 24 h posttransplant or day-7 serum creatinine ⬎/⫽ 400 micro mol/L), even for kidneys which themselves lacked those criteria. Rejection measures did not demonstrate the mate effect. In conclusion, kidney transplant function is strongly linked to donor-related factors (age, brain death). In contrast, rejection affects survival and function, but it is not primarily determined by the characteristics of the donor tissue. Graft survival reflects both of these influences. Editorial Comment: This is an interesting pairing study. The authors looked at the fate of 220 donor pairs of kidneys to see if the outcome in one mate would correlate with the outcome in the other. The hypothesis of the study is that the condition of the kidney in the donor (physiological fitness) predicts long-term functional outcome independent of recipient specific issues. Graft survival and serum creatinine were similar in the recipients of kidneys from one donor. Kidney survival was strongly predicted by the early performance of the mate, termed the “mate effect.” Rejection was not significantly paired and did not predict the course of the mate, but was considered to be a recipient specific event. These findings support the notion that intrinsic donor tissue characteristics are important in determining function and outcome. These characteristics include nonimmune variables such as magnitude of ischemia/reperfusion injury, nephron number, senescence and the tissue capacity for repair. These factors will likely become the subjects of expanded research as acute rejection rates have diminished significantly in the last 15 years. David A. Goldfarb, M.D.
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Urogenital Diaphragm: An Erroneous Concept Casting Its Shadow Over the Sphincter Urethrae and Deep Perineal Space P. MIRILAS AND J. E. SKANDALAKIS, Centers for Surgical Anatomy and Technique, Emory University School of Medicine, Atlanta, Georgia, and Department of Anatomy-Embryology, University of Crete Medical School, Heraklion, Crete, Greece J Am Coll Surg, 198: 279 –290, 2004 No Abstract Editorial Comment: For those who are detail oriented and/or anatomy scholars this is an interesting article that reviews from a historical and contemporary standpoint the various concepts regarding the “urogenital diaphragm” that, using a phrase of the authors, seems to be “buried in the shadows of misinformation.” One cannot summarize thoughts about this structure, described in all anatomy books in one way or another, in a short comment, but the main point is that there is no horizontal muscular structure that runs across the pelvis of the human male and female corresponding to that seen in many anatomical renderings. Alan J. Wein, M.D.
RENAL TRANSPLANTATION AND RENOVASCULAR HYPERTENSION Donor Tissue Characteristics Influence Cadaver Kidney Transplant Function and Graft Survival but Not Rejection S. GOURISHANKAR, G. S. JHANGRI, S. M. COCKFIELD AND P. F. HALLORAN, Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada J Am Soc Nephrol, 14: 493– 499, 2003 Acute injury and age are characteristics of transplanted tissue that influence many aspects of the course of a renal allograft. The influence of donor tissue characteristics on outcomes can be analyzed by studying pairing, the extent to which two kidneys retrieved from the same cadaver donor manifest similar outcomes. Pairing studies help to define the relative role of donor-related factors (among pairs) versus non-donor factors (within pairs). This study analyzed graft survival for 220 pairs of cadaveric kidneys for the similarity of parameters reflecting function and rejection. It also examined whether the performance of one kidney was predicted by the course of its “mate,” the other kidney from that donor. Parameters reflecting function showed sustained pairing posttransplantation, as did graft survival. In contrast, measures of rejection strongly affected survival but showed no pairing. Surprisingly, the survival of a kidney was predicted by the early performance of its mate, an observation we term the “mate effect.” Six-month graft survival and renal function were reduced in grafts for which the mate kidney displayed any criteria for functional impairment (dialysis dependency, low urine output [⬍/⫽ 1 L] in the first 24 h posttransplant or day-7 serum creatinine ⬎/⫽ 400 micro mol/L), even for kidneys which themselves lacked those criteria. Rejection measures did not demonstrate the mate effect. In conclusion, kidney transplant function is strongly linked to donor-related factors (age, brain death). In contrast, rejection affects survival and function, but it is not primarily determined by the characteristics of the donor tissue. Graft survival reflects both of these influences. Editorial Comment: This is an interesting pairing study. The authors looked at the fate of 220 donor pairs of kidneys to see if the outcome in one mate would correlate with the outcome in the other. The hypothesis of the study is that the condition of the kidney in the donor (physiological fitness) predicts long-term functional outcome independent of recipient specific issues. Graft survival and serum creatinine were similar in the recipients of kidneys from one donor. Kidney survival was strongly predicted by the early performance of the mate, termed the “mate effect.” Rejection was not significantly paired and did not predict the course of the mate, but was considered to be a recipient specific event. These findings support the notion that intrinsic donor tissue characteristics are important in determining function and outcome. These characteristics include nonimmune variables such as magnitude of ischemia/reperfusion injury, nephron number, senescence and the tissue capacity for repair. These factors will likely become the subjects of expanded research as acute rejection rates have diminished significantly in the last 15 years. David A. Goldfarb, M.D.
1219