Browsing by Subject "Kidney Transplantation"

Now showing 1 - 20 of 29

Chronic renal transplant rejection: new clinical insights
(1999-04-15) Vazquez, Miguel A.
Comparison of Pre-Transplant Criteria and Outcomes for Living Donor Kidney Transplant Programs in India and the United States
(2015-01-26) Bansal, Sukriti; Raja, Hari; Rajora, Nilum; Kher, Vijay
BACKGROUND: One of the greatest obstacles to treatment of end stage renal disease globally is organ donor shortage. While some nations (i.e. the US), have primarily cadaveric organ donors, developing nations rely heavily on living donors. This project is a comparison of two kidney transplants programs -- one in the US & one in India -- looking at the pre-transplant criteria of each & assessing the patient outcomes. METHODS: This is a cohort study of living donor kidney transplant patients from St. Paul University Hospital in Dallas, TX & kidney transplant patients from Medanta the Medicity in Gurgaon, India. Data for India was collected from a database of all patients who underwent a kidney transplant at Medanta, selected for patients who fit the following criteria: one cohort of patients had been transplanted the previous month (N=29), one cohort had been transplanted one year prior the date of the study (N=29), & one cohort had been transplanted 3 years prior (N=13). Information from the database was used to calculate patient & graft survival rates for the relevant time periods. Data for St. Paul was obtained from the Scientific Registry of Transplant Recipients, which already had the calculated 1 month, 1 year, & 3 year patient and graft survival rates. Information on pre-transplant criteria was obtained from the transplant teams at each respective institution. RESULTS: The majority of medical pre-operative criteria between the two programs are identical. One significant difference is ABO-incompatible transplants are performed at Medanta, while at St. Paul ABO-incompatible donor/recipient pairs are referred for paired donation. Medanta requires all living donors to be related, while St. Paul will accept unrelated donors. The patient survival rates for St. Paul are 100% (1 mo, N=32), 95.23% (1 yr, N=32) and 85.71 % (3 yr, N=21). Graft survival rates are 100% (1 mo, N=32), 95.24% (1 yr, N=32), and 81.82% (3 yr, N=22). The patient survival rates for Medanta are 100% (1 mo., N=29), 100% (1 yr, N=29), and 100% (3 yr, N=13). Graft survival rates are 100% (1 mo. N=29), 100% (1 yr, N=29), and 100% (3 yr, N=13). For all patients transplanted at Medanta, the overall patient survival rate was 98.40% (N=874) and the overall graft survival rate was 98.51% (N=874). Corresponding data wasn't available for St. Paul. CONCLUSION: While it appears that the 3 year survival rates are better for Medanta than for St. Paul, there is a limitation on making conclusions because this data does not encompass the entire program at Medanta. Further study is needed to truly assess if there is a significant difference. The overall conclusion is that transplant programs in both settings have successful outcomes.
Cross-Sectional Study of The Adipokine Resistin Following Kidney Transplant
(2016-01-19) Le, Dustin; Ikizler, Alp; Birdwell, Kelly
For kidney transplant recipients, cardiovascular disease is the number one cause of mortality. Resistin is a recently discovered adipokine that is associated with inflammation and cardiovascular risk. We hypothesized that resistin blood concentrations would be elevated in kidney transplant recipients compared to the general population. We used a single center cross-sectional study comparing 76 kidney transplant recipients with 42 normal controls over the age of 18. Measurements included demographics, IL-6, resistin, and glomerular filtration rate (calculated through the CKD-EPI equation). Spearman's correlation and linear regression were used for analysis. Kidney transplant recipients were found to be younger (46.9 ± 11.5 vs 58.5 ± 10 years, p < 0.01) and have a higher incidence of diabetes (29% vs 9%, p < 0.05). Resistin was found to be elevated (28.4 ± 11.5 vs 11.1 ± 6.0 ng/mL, p < 0.001) while body mass index (29.7 ± 6.2 vs 29.1 ± 4.4) and IL-6 (7.1 ± 7.5 vs 9.5 ± 13.9 pg/mL) were not statistically different. Resistin levels in kidney transplant recipients were found to be correlated with patient age (p < 0.01) and time since transplant (p < 0.05). Both remained significant when also controlling for race, body mass index, glomerular filtration rate and diabetic status (p < 0.05). When looking at both kidney transplant recipients and controls, age was still a significant determinant as well as being within the transplant recipient group (p < 0.05). In conclusion, resistin is elevated in kidney transplant recipients independent of glomerular function and may play a role in the increased prevalence and incidence of cardiovascular disease.
Donald W. Seldin, M.D., Research Symposium finalist presentations
(2021-04-23) Arvind, Ashwini; Elias, Roy; McAdams, Meredith; Salazar, Alonso Pezo; Rao, Shreya; Sheth, Rahul
This edition of the UT Southwestern Internal Medicine Grand Rounds features presentations by the six Foster Fellows selected as finalists from the Sixth Annual Donald W. Seldin, M.D. Research Symposium, which was held on April 23, 2021. These Foster Fellows presented work that spanned the breadth and depth of scholarly activity across the department, and at the close of Grand Rounds, one will be selected as the 2021 Seldin Scholar, in honor of Dr. Donald W. Seldin. The Grand Rounds presentation also includes additional awards honoring Clinical Vignettes and an award for work in Quality and Education at Parkland Hospital.
Donald W. Seldin, M.D., Research Symposium finalist presentations
(2023-05-05) Eleazu, Ijeoma; Ramos, Lisandro Maya; Salcedo Betancourt, Juan; Singh, Sumitabh; Smith, Aaron
This edition of the UT Southwestern Internal Medicine Grand Rounds features presentations by the six Foster Fellows selected as finalists from the Eighth Annual Donald W. Seldin, M.D. Research Symposium, which was held on April 28, 2023. These Foster Fellows presented work that spanned the breadth and depth of scholarly activity across the department, and at the close of Grand Rounds, one will be selected as the 2023 Seldin Scholar, in honor of Dr. Donald W. Seldin. The Grand Rounds presentation includes additional award presentations recognizing Clinical Vignettes, as well as the Award for Research in Quality of Care and Education at Parkland Hospital, the Social Impact Award, and the Award for Basic Science (non-GME).
The end of diabetes and kidney failure: pancreas and kidney transplantation
(2004-04-08) Vazquez, Miguel A.
Expanding living kidney donation: ethical and policy considerations
(2013-02-12) Ross, Lainie Friedman
In 1954 the first successful living donor kidney transplant was performed between identical twins. With the improvement in immunosuppression, ABO compatible friends, spouses and even strangers can now donate kidneys to waitlist candidates. In this lecture, Lainie Friedman Ross, M.D., Ph.D., will discuss some of the ethical and policy challenges that arise by the expansion of living donor kidney transplants including 1) when strangers serve as non-directed donors; 2) when ABO-incompatible donor-recipient pairs trade kidneys; and 3) the new practice of asynchronous kidney chains catalyzed by nondirected donors. But all of these expansions must be understood with a caveat: she concludes by discussing the ethical concerns raised by the practice of living kidney donation, as well as what is known and what is not known about the short- and long-term risks that living donors face and what research is needed to ensure that prospective donors give an informed and voluntary consent.
Kidney and pancreas transplantation for the diabetic patient with renal failure
(2001-04-12) Vazquez, Miguel A.
Kidney transplantation
(1966-01-27) Stastny, Peter
Kidney transplantation in 2014: good news for our patients
(2014-02-14) Vazquez, Miguel A.
Kidney transplantation, 1971
(1971-01-14) Stastny, Peter
Kidney transplantation: improving on a success story
(2009-05-15) Vazquez, Miguel A.
Live Donor Renal Transplantation in India: Outcome and Comparison of Different Induction Therapies with a Focus on Gender Bias in Live Donor Renal Transplantation
(2018-03-23) Khan, Maryam Idrees; Nwariaku, Fiemu; Rajora , Nilum; Tanriover , Bekir
BACKGROUND: As of 2014, an estimated 9% of the global population aged 18+ years was affected by diabetes. The World Health Organization (WHO) also estimated around 2.5% of deaths were attributed to diabetes in 2012 and more than 80% of those deaths occurred in low-middle income countries. It is apparent that diabetes and its complications are becoming a global issue as an increasing common, preventable, non-communicable disease. Along with cardiovascular disease, blindness, and neuropathy, end stage renal disease (ESRD) is one of the serious complications that can develop as a result of diabetes. Diabetes is the leading cause of ESRD in both developed countries like the United States and developing countries like India. India is a particularly interesting country to observe given their vast population base, rapid growing economy, genetic predisposition to diabetes and increased insulin resistance. It is estimated that 100,000 patients develop ESRD each year in India with diabetes as the main underlying cause (44% of all ESRD cases). Once a patient develops ESR, renal replacement therapy (RRT) is required to sustain life. RRT consists of three options: 1) hemodialysis (HD), 2) peritoneal dialysis (PD), or 3) renal transplant (RT). Of the three options, renal transplant is considered the best in terms of quality of life and cost effectiveness, but only about 5% of Indian patients with ESRD end up receiving RT. Most RT in India come from living donors rather than cadaveric donors like in the United States. Induction therapy with interleukin-2 receptor alpha chain (IL2-RA) is recommended as a first line agent in LRT however comparative outcomes of induction therapy remains controversial in Indian LRT population. OBJECTIVE: To evaluate patient survival and allograft function in LRT with a specific focus on the Indian population between 2010 and 2014 and to access the impact of different induction therapies on the outcomes of Indian LRT patients. METHODS: A single center (Medanta Medicity, Gurgaon, India) dataset was retrospectively studies for patients receiving LRT from 2010 to 2014 (N=901) to compare effectiveness of IL2-RA to other induction options (no-induction and rabbit anti-thymocyte globulin [r-ATG]). IL2-RA and no induction were chosen for immunologically low risk patients. R-ATG was primarily given to the recipient with PRA>20% and HLA mismatch >5 antigen out of 6. Patient paper charts were analyzed for dates not included in the Medanta database which included follow-up dates with corresponding creatinine levels (at 3 months, 6 months, 1 year, and last follow up), date and type of rejection if applicable, graft loss and death. Patients included in the data set had their last follow up at Medanta within the last 6 months from the time data was collected. The patient data was used to calculate rejection rate, graft failure, and hazard ratio (HR) for overall graft failure. The main outcomes were the risk of acute rejection at one-year and overall allograft failure (graft failure or death) post-transplantation through the end of follow-up. RESULTS: Similar Kaplan Meier curves for overall graft survivals were observed among induction categories. Rejection rate was higher in no-induction and IL2-RA groups (~25%) compared to r-ATG induction. On univariate Cox analysis, compared to no-induction therapy, overall allograft failure was similar among induction categories. Most of the rejections were borderline or Banff Type I acute cellular rejections. CONCLUSION: Compared to no-induction therapy, IL2-RA induction was not associated with better outcomes in Indian LRT recipients. R-ATG appears to be an acceptable and possibly preferred induction alternative for IL2-RA in high rejection risk Indian patients.
Living kidney donation: altruism at its finest ... but what are the risks?
(2017-01-06) Levea, Swee-Ling
Living kidney transplantation: good for recipient, how about donor?
(2008-08-01) Rajora, Nilum
New advances in immunosuppressive therapy for renal transplantation
(1997-04-17) Vazquez, Miguel A.
New immunosuppressive therapies in renal transplantation
(1992-04-16) Lu, Christopher Y.
[News]
(1985-06-17) Rutherford, Susan
[News]
(1984-11-09) Floyd, Carol
[News]
(1989-02-24) Rutherford, Susan