Victims of cardiac arrest occurring outside the hospital: a source of transplantable kidneys.

Background: The use of non-heart-beating donors could help shorten the list of patients who are waiting for a kidney transplant. Several reports describe acceptable results of transplantations from non-heart-beating donors who had in-hospital cardiac arrest, but few reports describe results of transplantations from non-heart-beating donors who had cardiac arrest that occurred outside of the hospital (Maastricht type I and type II donors).

Objective: To compare graft survival rates among patients receiving kidneys from heart-beating donors versus type I or type II non-heart-beating donors.

Early cyclosporine a withdrawal in kidney-transplant recipients receiving sirolimus prevents progression of chronic pathologic allograft lesions.

Background: Nephrotoxicity of calcineurin inhibitors (CNIs) is partially responsible for the development of chronic allograft nephropathy (CAN). Sirolimus has demonstrated its potential to substitute for CNIs because it lacks significant nephrotoxicity and shows a short-term immunosuppressive capacity comparable with that of cyclosporine. This results in the maintenance of better renal function when cyclosporine is eliminated, but it has not been demonstrated whether this benefit is associated with an improvement in the pathologic substrate and a reduction in CAN.

Significance of nested PCR and quantitative real time PCR for cytomegalovirus detection in renal transplant recipients.

Immunocompromised renal transplant recipients are susceptible to severe cytomegalovirus (CMV) infection that makes its detection important in clinical practice. A total of 536 blood and 536 serum samples from 67 renal transplant recipients who had previously been diagnosed with terminal renal insufficiency were studied for CMV infection. In all samples, serology, shell vial culture, antigenaemia and nested polymerase chain reaction (PCR) in blood and serum were tested, and a real-time quantitative PCR was run on 90 specimens.

Pilot randomized study of early tacrolimus withdrawal from a regimen with sirolimus plus tacrolimus in kidney transplantation.

We performed a randomized trial to compare two regimens of low-risk kidney allograft recipients in the first year after transplantation. Both regimens initially included sirolimus, tacrolimus and steroids; one with long-term maintenance with these drugs vs. tacrolimus withdrawal.

Does donor brain death influence acute vascular rejection in the kidney transplant?

Background: There is increasing experimental evidence to suggest that donor brain death enhances susceptibility to early inflammatory responses such as acute rejection in the kidney transplant. The aim of the present study was to establish whether the injury induced or aggravated by donor brain death could exert an effect on recipient immunologic tolerance by comparing data from patients receiving a kidney from non-heart-beating donors (NHBD) or from brain-dead donors (BDD).

Methods: We reviewed data corresponding to 372 renal transplants performed from January 1996 to May 2002.

Epstein-Barr virus latency in kidney specimens from transplant recipients.

Background: Epstein-Barr virus (EBV) infection is common in immunosuppressed patients and can lead to life threatening lymphoproliferative diseases. Small numbers of cells infected by EBV have been detected in human tissues, transplanted or non-transplanted. Little is known about EBV latency in the allograft kidneys of patients without post-transplant lymphoproliferative disease (PTLD).

Increasing the donor pool using en bloc pediatric kidneys for transplant.

Objectives: En bloc pediatric kidney transplants (EBPKT) are still a subject of controversy. The aim of this study was to determine whether acceptable long-term graft survival and function can be achieved in EBPKT compared with the transplant of single, cadaveric, adult donor kidneys.

Methods: A retrospective review was conducted of 66 recipients of en bloc kidneys from cadaveric pediatric donors and 434 patients who underwent transplantation with a single kidney from an adult donor between January 1990 and May 2002 at the authors' hospital.

Non-heart-beating donors: experience from the Hospital Clinico of Madrid.

Non-heart-beating donors (NHBD) have received attention in the last few years as an alternative source to increase the pool of kidney donors. The majority of reports focus on NHBD from controlled donors, i.e.

Experimental lead nephropathy: treatment with calcium disodium ethylenediaminetetraacetate.

Chronic lead poisoning may cause hypertension, gout, and renal insufficiency. Most experimental poisoning studies have involved the use of high doses over short periods (ie, acute poisoning). Although chelating treatment leads to remission of acute lead nephropathy, its effects in the treatment of chronic poisoning are unclear.

Lead mobilization during calcium disodium ethylenediaminetetraacetate chelation therapy in treatment of chronic lead poisoning.

It has long been established that chronic lead (Pb) poisoning is a cause of renal insufficiency. However, although easily diagnosed, there is still no treatment available that will revert this type of poisoning. We report a study performed on 56 male Wistar rats administered Pb in drinking water (500 ppm Pb acetate) over a 90-day period.

Renal transplantation from non-heart beating donors: a promising alternative to enlarge the donor pool.

The aim of this study was to compare the survival and midterm function of kidneys from non-heart beating donors (NHBD) with those of kidneys from heart beating donors (HBD). From 1989 to 1998, 144 kidneys were procured from NHBD at the Hospital Clínico San Carlos in Madrid, of which 95 were transplanted. The kidney grafts were maintained from the moment of the diagnosis of cardiac arrest until the time of procurement by cardiopulmonary bypass.