Hospital readmissions following HLA-incompatible live donor kidney transplantation: A multi-center study.

Thirty percent of kidney transplant recipients are readmitted in the first month posttransplantation. Those with donor-specific antibody requiring desensitization and incompatible live donor kidney transplantation (ILDKT) constitute a unique subpopulation that might be at higher readmission risk. Drawing on a 22-center cohort, 379 ILDKTs with Medicare primary insurance were matched to compatible transplant-matched controls and to waitlist-only matched controls on panel reactive antibody, age, blood group, renal replacement time, prior kidney transplantation, race, gender, diabetes, and transplant date/waitlisting date.

The Incremental Cost of Incompatible Living Donor Kidney Transplantation: A National Cohort Analysis.

Incompatible living donor kidney transplantation (ILDKT) has been established as an effective option for end-stage renal disease patients with willing but HLA-incompatible living donors, reducing mortality and improving quality of life. Depending on antibody titer, ILDKT can require highly resource-intensive procedures, including intravenous immunoglobulin, plasma exchange, and/or cell-depleting antibody treatment, as well as protocol biopsies and donor-specific antibody testing. This study sought to compare the cost and Medicare reimbursement, exclusive of organ acquisition payment, for ILDKT (n = 926) with varying antibody titers to matched compatible transplants (n = 2762) performed between 2002 and 2011.

Survival Benefit with Kidney Transplants from HLA-Incompatible Live Donors.

Background: A report from a high-volume single center indicated a survival benefit of receiving a kidney transplant from an HLA-incompatible live donor as compared with remaining on the waiting list, whether or not a kidney from a deceased donor was received. The generalizability of that finding is unclear.

Methods: In a 22-center study, we estimated the survival benefit for 1025 recipients of kidney transplants from HLA-incompatible live donors who were matched with controls who remained on the waiting list or received a transplant from a deceased donor (waiting-list-or-transplant control group) and controls who remained on the waiting list but did not receive a transplant (waiting-list-only control group).

Quantifying the risk of incompatible kidney transplantation: a multicenter study.

Incompatible live donor kidney transplantation (ILDKT) offers a survival advantage over dialysis to patients with anti-HLA donor-specific antibody (DSA). Program-specific reports (PSRs) fail to account for ILDKT, placing this practice at regulatory risk. We collected DSA data, categorized as positive Luminex, negative flow crossmatch (PLNF) (n = 185), positive flow, negative cytotoxic crossmatch (PFNC) (n = 536) or positive cytotoxic crossmatch (PCC) (n = 304), from 22 centers.

Laparoendoscopic single-site (LESS) vs laparoscopic living-donor nephrectomy: a systematic review and meta-analysis.

The aim of this study was to provide a systematic review and meta-analysis of reports comparing laparoendoscopic single-site (LESS) living-donor nephrectomy (LDN) vs standard laparoscopic LDN (LLDN). A systematic review of the literature was performed in September 2013 using PubMed, Scopus, Ovid and The Cochrane library databases. Article selection proceeded according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria.

Temsirolimus as base immunosuppressant for a recipient with metastatic renal cancer: adequate immunosuppression and oncological control--case report.

Treating organ recipients who have metastatic renal cell carcinoma (mRCC) is challenging because of the dilemma between transplant-required immunosuppression and cancer control via boosting immunity with immunotherapy. We report such a patient whose case was successfully maintained only with temsirolimus and low-dose steroids, while achieving good allograft function and oncological outcomes. After removal of his primary renal cancer, a kidney recipient was found to have multiple metastases.

The benefits of pulsatile machine perfusion of standard criteria deceased donor kidneys at a geographically remote transplant center.

Benefits of pulsatile machine perfusion (pumping) of standard criteria donor (SCD) kidneys are unclear. Our center is located 4½ hours from our Organ Procurement Organization. We evaluated outcomes of pumping SCD kidneys under such circumstances by conducting a retrospective examination of all SCD kidneys transplanted between January 2007 and March 2012, comparing kidneys pumped (28 [group 1]) versus standard cold storage (77 [group 2]).

Safe initiation of a laparoendoscopic single site living donor nephrectomy program in a small-volume transplant center.

Objective: To describe keys to successful programmatic implementation of laparoendoscopic single-site (LESS)-living donor nephrectomy (LDN) in a small-volume center. Laparoscopic LDN has become the standard of care. Technically challenging LESS-LDN has been limited to high-volume centers.

Association of mycophenolic acid dose with efficacy and safety events in kidney transplant patients receiving tacrolimus: an analysis of the Mycophenolic acid Observational REnal transplant registry.

Background: Dose-finding studies for mycophenolic acid (MPA) in tacrolimus-treated kidney transplant patients are lacking.

Methods: Data from 901 de novo kidney transplant recipients enrolled in the prospective, non-interventional Mycophenolic acid Observational REnal (MORE) transplant registry were analyzed according to baseline daily MPA dose (<2000, 2000 or >2000 mg).

Results: The proportion of patients receiving 2000 and <2000 mg was 77.

Simultaneous laparoendoscopic single-site radical nephrectomy for native kidney and open nonischemic partial nephrectomy to treat concomitant renal cell carcinomas in native and transplant kidneys and to preserve allograft function.

Objective: To report a technique of minimally invasive radical nephrectomy for a native renal cell carcinoma (RCC) and nonischemic open partial nephrectomy for a transplant kidney RCC with only a laparoendoscopic single-site (LESS) incision. Concomitant RCCs in a native and transplant kidneys are very rare. Conventional surgical approach requires a long incision.

Feasibility and safety of retroperitoneoscopic laparoendoscopic single-site nephrectomy: technique and early outcomes.

Unlabelled: What's known on the subject? and What does the study add? Laparoendoscopic single-site (LESS) nephrectomy is feasible to remove diseased kidneys. Most of such procedures previously reported were performed through a transperitoneal (trans-abdominal) approach. We report the feasibility, safety, and techniques of performing such operations without disturbing the bowels (a retroperitoneal LESS approach).

Immunosuppression after kidney transplantation: current stragegies and drug interactions.

The success of kidney transplantation has improved over the last decade largely due to new immunosuppressive agents that resulted in decrease in incidence and severity of acute cellular rejection. Minimizing the adverse effects of immunosuppressive agents is essential to improving long-term survival. This article reviews the current immunosuppressive agents available to the clinician, their side effects and interaction with other medications.

Comparison of ganciclovir- and immune globulin-containing regimens in preventing cytomegalovirus infection in patients with renal transplants.

The effectiveness and costs of ganciclovir compared with intravenous immune globulin (IVIG) in the prevention of cytomegalovirus (CMV) disease were studied. A retrospective analysis was conducted of renal transplant patients treated with ganciclovir during the initial hospital stay followed by three months of acyclovir therapy and a historical control group that received IVIG at one, two, four, six, and eight weeks posttransplant and acyclovir at two weeks posttransplant and continued for three months. The average drug cost for each regimen and the average direct cost of treating CMV disease in each group were calculated.

Post-transplant renal artery stenosis: impact of therapy on long-term kidney function and blood pressure control.

Purpose: We assessed the long-term outcome of different treatment methods for transplant renal artery stenosis.

Materials And Methods: Outcome data for 23 patients with transplant renal artery stenosis treated during a 16-year period were reviewed and analyzed.

Results: There was a higher incidence of renal artery stenosis in cadaveric donor kidneys compared to living donor kidneys (2% versus 0.