HLA incompatible combined liver-kidney transplantation: dynamics of antibody modulation revealed by a novel approach to HLA antibody characterisation.

This case report confirms the utility of simultaneous liver transplantation in allowing successful kidney transplantation in the face of preformed, high levels of DSA, which would under normal circumstances be associated with hyperacute rejection and kidney graft failure. Antibody characterisation in terms of epitope specificity is more accurate and informative than antibodies described as "antigen-specific" and we suggest a method for identifying and tracking these antibodies; i.e.

The brachiobasilic arteriovenous fistula: effect of patient variables.

Purpose: The hemodialysis population is constantly expanding as patients on dialysis have increased longevity and the number of kidneys available for transplantation remains static (1). After radiocephalic and brachiocephalic fistulas have been exhausted the use of the autologous brachiobasilic fistula (BBAVF) should be considered prior to use of a synthetic graft. We present our single center experience of 140 brachiobasilic fistulas in a five-year period and examine any factors that influence patency and long-term function.

Hand-assisted laparoscopic donor nephrectomy: are hand port devices really necessary?

Background: Hand port devices (HPD) are used routinely for hand-assisted laparoscopic surgery including hand-assisted laparoscopic donor nephrectomy (HALDN). However, the cost of such devices may prove prohibitive, particularly in centers with financial constraints. The authors aimed to identify any adverse effects of performing device-free HALDN.

Mitochondrial complex activity in donor renal grafts, cold ischemia time, and recovery of graft function.

Indexed mitochondrial complex activities (MCAi) were determined in biopsies obtained from 52 donor kidneys at the end of cold ischemia (8-32 hr) to see if longer anoxia affected MCAi and accounted for the increased risk of delayed graft function (DGF) in recipients of grafts with longer cold ischemia time (CIT) or from non-heart-beating donors (NHBD). CITs were significantly different between those with and without DGF (P=0.02), being shorter in the latter, but MCAi were similar.

Risk factors for acute rejection in renal transplant recipients experiencing delayed graft function.

Acute rejection (AR) superimposed upon delayed graft function (DGF) following renal transplantation worsens graft outcomes. However, risk factors for AR in patients displaying DGF remain unclear. In this study, 71 patients displaying DGF >/= 5 d were investigated.

Predicting early renal allograft function using clinical variables.

Background: Suboptimal early graft function following renal transplantation remains a significant challenge. It is suggested that clinical variables (or scoring systems based thereon) may predict the occurrence of delayed graft function (DGF), defined as post-operative dialysis requirement. However, data is conflicting, and suboptimal renal function not requiring dialysis has been little investigated.