Impact of measured versus estimated glomerular filtration rate-based screening on living kidney donor characteristics: A study of multiple cohorts.

Background: Most transplant centers in the Netherlands use estimated glomerular filtration rate (eGFR) for evaluation of potential living kidney donors. Whereas eGFR often underestimates GFR, especially in healthy donors, measured GFR (mGFR) allows more precise kidney function assessment, and therefore holds potential to increase the living donor pool. We hypothesized that mGFR-based donor screening leads to acceptance of donors with lower pre-donation eGFR than eGFR-based screening.

ABO-incompatible kidney transplantation in perspective of deceased donor transplantation and induction strategies: a propensity-matched analysis.

Kidney transplant candidates are blood group incompatible with roughly one out of three potential living donors. We compared outcomes after ABO-incompatible (ABOi) kidney transplantation with matched ABO-compatible (ABOc) living and deceased donor transplantation and analyzed different induction regimens. We performed a retrospective study with propensity matching and compared patient and death-censored graft survival after ABOi versus ABOc living donor and deceased donor kidney transplantation in a nationwide registry from 2006 till 2019.

Multivariate Analysis of Health-related Quality of Life in Donors After Live Kidney Donation.

Background: Live-kidney donation has a low mortality rate. Evidence suggests that live-kidney donors experience a quality of life (QoL) comparable to or even superior to that of the general population. There is limited information on factors associated with a decrease in QoL in particular for baseline factors, which would improve information to the donor, donor selection, and convalescence.

Donor and Recipient Perspectives on Anonymity in Kidney Donation From Live Donors: A Multicenter Survey Study.

Background: Maintaining anonymity is a requirement in the Netherlands and Sweden for kidney donation from live donors in the context of nondirected (or unspecified) and paired exchange (or specified indirect) donation. Despite this policy, some donors and recipients express the desire to know one another. Little empirical evidence informs the debate on anonymity.

Five-year follow-up after live donor nephrectomy - cross-sectional and longitudinal analysis of a prospective cohort within the era of extended donor eligibility criteria.

To establish the outcome of live kidney donors 5 years after donation, we investigated the risk for progressive renal function decline and quality of life (QoL). Data on estimated glomerular filtration rate (eGFR), creatinine, hypertension, QoL and survival were assessed in a prospective cohort of 190 donors, who donated between 2008 and 2010. Data were available for >90%.

More than a decade after live donor nephrectomy: a prospective cohort study.

Previously reported short-term results after live kidney donation show no negative consequences for the donor. The incidence of new-onset morbidity takes years to emerge, making it highly likely that this will be missed during short-term follow-up. Therefore, evidence on long-term outcome is essential.

Randomized controlled trial comparing hand-assisted retroperitoneoscopic versus standard laparoscopic donor nephrectomy.

Background: Laparoscopic donor nephrectomy (LDN) has become the gold standard for live-donor nephrectomy, as it results in a short convalescence time and increased quality of life. However, intraoperative safety has been debated, as severe complications occur incidentally. Hand-assisted retroperitoneoscopic donor nephrectomy (HARP) is an alternative approach, combining the safety of hand-guided surgery with the benefits of endoscopic techniques and retroperitoneal access.

Quality of life of elderly live kidney donors.

Background: Expanding the use of elderly live donors may help meet the demand for kidney transplants. The aim of this study was to quantify the effect of the surgical procedure on the quality of life (QOL) of elderly donors compared with younger donors.

Methods: Alongside three prospective studies (two randomized) running between May 2001 and October 2010, we asked 501 live donors to fill out the Short Form-36 questionnaire preoperatively and at 1, 3, 6, and 12 months postoperatively.

Long-term follow-up of a randomized trial comparing laparoscopic and mini-incision open live donor nephrectomy.

Long-term physical and psychosocial effects of laparoscopic and open kidney donation are ill defined. We performed long-term follow-up of 100 live kidney donors, who had been randomly assigned to mini-incision open donor nephrectomy (MIDN) or laparoscopic donor nephrectomy (LDN). Data included blood pressure, glomerular filtration rate, quality of life (SF-36), fatigue (MFI-20) and graft survival.

Hand-assisted retroperitoneoscopic versus standard laparoscopic donor nephrectomy: HARP-trial.

Background: Transplantation is the only treatment offering long-term benefit to patients with chronic kidney failure. Live donor nephrectomy is performed on healthy individuals who do not receive direct therapeutic benefit of the procedure themselves. In order to guarantee the donor's safety, it is important to optimise the surgical approach.

[Donor nephrectomy: less fatigue and better quality of life following laparoscopic kidney removal compared with an open procedure by mini-incision: blind randomised study].

Objective: Determining possible differences in living donor nephrectomy procedures: laparoscopy against mini-incision concerning discomfort to the donor and the maintenance of good graft function.

Design: Blind randomized study.

Method: In two university medical centres, one hundred living kidney donors were randomly assigned to either total laparoscopic donor nephrectomy or mini-incision muscle-splitting open donor nephrectomy.

Cost effectiveness of laparoscopic versus mini-incision open donor nephrectomy: a randomized study.

Background: Cost-effectiveness remains an issue surrounding the introduction of laparoscopic donor nephrectomy (LDN).

Methods: In a randomized controlled trial the cost-effectiveness of LDN versus mini-incision open donor nephrectomy (ODN) was determined. Fifty donors were included in each group.

Comparison of laparoscopic and mini incision open donor nephrectomy: single blind, randomised controlled clinical trial.

Objectives: To determine the best approach for live donor nephrectomy to minimise discomfort to the donor and to provide good graft function.

Design: Single blind, randomised controlled trial.

Setting: Two university medical centres, the Netherlands.

The extent of peritubular CD14 staining in renal allografts as an independent immunohistological marker for acute rejection.

Previously, we demonstrated that in acute interstitial rejection, immunohistological staining of renal allograft biopsies with the CD14 mAb WT14, reacting with human monocytes/macrophages, shows a characteristic peritubular increase of positive cells. To test the diagnostic value of this CD14 positivity, we compared, in 154 unselected renal allograft biopsies, the extent of peritubular WT14 staining with (a) the original histological diagnosis, made with knowledge of clinical data, (b) the retrospectively and blindly scored histological diagnosis according to the criteria of the Banff classification, and (c) the eventual clinical diagnosis, which included evaluation of the response to therapy. The extent of peritubular WT14 positivity, blindly scored on cryostat sections of the frozen part of the biopsies, correlated positively with the probability of acute rejection (AR).

Detection of interstitial increase in macrophages, characteristic of acute interstitial rejection, in routinely processed renal allograft biopsies using the monoclonal antibody KP1.

Acute interstitial rejection (AIR) of renal allografts is accompanied by a characteristic peritubular increase in macrophages, which can be identified with the CD14 monoclonal antibody (mAb) WT14 in cryostat sections. Since frozen tissue is not always available, we tested whether this increase can also be demonstrated in Bouin-fixed, paraffin-embedded biopsies, using the CD68 antimacrophage mAb KP1, which can also be applied to paraffin sections. Sections of 16 biopsies with AIR and 11 controls were stained with KP1.

Immunocytology of urinary sediments as a method of differentiating acute rejection from other causes of declining renal graft function.

We have previously reported that during acute rejection of renal allografts T lymphocytosis and increased HLA-DR expression on tubular epithelial cells can be demonstrated in urinary sediments by incubating cytospin preparations with monoclonal antibodies against T cells and HLA-DR antigen in an indirect alkaline phosphatase technique. We now tested whether immunocytological analysis of urinary sediments can be used to differentiate acute rejection from other causes of declining graft function. For this we retrospectively selected, from a series of urinary samples that were taken either at random or as part of a longitudinal study in unselected graft recipients, those specimens that were taken at the time of increasing creatinine levels, and compared the original immunocytological diagnosis, made without knowledge of clinical data, with the final clinical one.

Diagnosis of renal allograft rejection by macrophage immunostaining with a CD14 monoclonal antibody, WT14.

Since acute interstitial rejection (AIR) of renal allografts is accompanied by an increase of macrophages in the graft the diagnostic value of immunohistological staining of biopsy specimens with WT14, a new monoclonal antibody of the CD14 cluster directed against monocytes/macrophages, with increased affinity for activated cells, has been tested retrospectively. With an indirect immunoperoxidase technique on frozen sections a diffuse interstitial increase of WT14-positive cells was seen, with a characteristic peritubular pattern, in all 44 patients with clinically and histologically proven AIR. This pattern was not seen in normal kidneys (n = 10), or in biopsy specimens from patients with proven cyclosporin nephrotoxicity (n = 9), chronic vascular rejection (n = 13), or various other renal diseases (n = 60).