Renal transplantation from non-heart beating donors

Slides:



Advertisements
Similar presentations
Chronic Renal Failure for General Practice
Advertisements

Immunology of Renal Transplant
David Taber, Charles Bratton, Angello Lin, John McGillicuddy, Kenneth Chavin and Prabhakar Baliga.
Chronic Kidney Disease Manju Sood GPST3. What is CKD? Chronic renal failure is the progressive loss of nephrons resulting in permanent compromise of renal.
Tuesday Case Conference May Biopsy finding LM –Glomeruli are normal in size to mildly enlarged Mild enlargement of the mesangial areas with occasional.
End Stage Renal Disease in Children. End stage kidney disease occurs when the kidneys are no longer able to function at a level that is necessary for.
KIDNEY FOUNDATION MISSION St. Gregorios Dayabhavan Kunigal.
A Randomized Trial of Protocol-Based Care for Early Septic Shock Andrea Caballero, MD January 15, 2015 LSU Journal Club The ProCESS Investigators. N Engl.
The Value of Zero-Hour Implantation Biopsies Volker Nickeleit Nephropathology Laboratory, Department of Pathology The University of North Carolina, Chapel.
AKI Definitions Stuart L. Goldstein, MD Professor of Pediatrics University of Cincinnati College of Medicine Director, Center for Acute Care Nephrology.
Kidney, Pancreas & Intestinal Transplantation Mr James Gilbert Consultant Transplant & Vascular Access Surgeon.
Charcot neuroarthropathy after Simultaneous Pancreas Kidney transplantation: risk factors and evolution of prevalence over 20 years. Prof. Dr. GA Matricali.
What makes a pancreas allograft marginal? Peter J Friend University of Oxford.
Monica Colvin-Adams, MD Assistant Professor of Medicine Advanced Heart Failure and Transplantation University of Minnesota Compassionate Allowances Outreach.
Transplant of marginal/NHBD kidneys and outcomes: kidney David Talbot.
Chronic Kidney Disease Jacqueline Annand – CKD Nurse Mary Simpson – CKD Nurse Joyce Mackie – Pre Dialysis/Transplant liaison Sister.
Sum Scores and Scores of Individual Components in Clinical Practice and Clinical Trials Lillian W. Gaber University of Tennessee.
E CASE 1 Case For Discussion DEPARTMENT OF PATHOLOGY ARMED FORCES MEDICAL COLLEGE, PUNE.
Horizon Scanning on organ perfusion
Prevalance of Chronic Kidney Disease 26 million people have diagnosed chronic kidney 26 million people have diagnosed chronic kidney disease (CKD) ( National.
Pancreatic and Islet Cell Transplantation. GENERAL PRINCIPLES Pancreas graft survival rates have significantly improved over the past decade, and now.
1 Endocrine Involvement: 1. ADH antidiuretic hormone (vasopressin) is a peptide hormone secreted by the pituitary gland regulates the amount of water excreted.
Native and transplant kidney pathology Case 8 Erik Heyerdahl Strøm Dept. of Pathology Oslo University Hospital Rikshospitalet Oslo, Norway ECP Helsinki.
Comparison of HTK and UW in Abdominal Transplantation Dr. Richard S. Mangus, MD MS Indiana University, School of Medicine.
Renal Transplantation Basic Science Review 11/23/05.
Strategies for Maximizing Outcomes in Liver Transplantation James D. Eason, M.D. Chief of Transplantation / Professor of Surgery University of Tennessee.
+ Liver Transplantation for PSC Patients A Transplant Surgeon’s Perspective Tiffany Anthony, MD Annette C. and Harold C. Simmons Transplant Institute Baylor.
Protein casts, nodular glomerulosclerosis in a graft biopsy samples Agnieszka Perkowska-Ptasinska Transplantation Institute, Medical University of Warsaw,
1 Influence of donor & recipient risk factors and the choice of immunosuppression Long term outcome after renal transplantation Influence of donor & recipient.
New Perspective for Expanding Donor’s Pool - Resuscitation Kidney In Uncontrolled Donors by Normothermic Perfusion “In Situ” with Oxygenation and Leucocyte.
J Winterbottom 2005 Chronic Renal Failure Jean Winterbottom Clinical Educator MRI.
Kidney Function Tests. Kidney Function Tests Contents: Kidney functions Functional units Renal diseases Routine kidney function tests Serum creatinine.
Experience with Calcineurin Inhibitor-Free Immunosuppression in Kidney Transplantation with Marginal Donors Oppenheimer F, Saval N, Gutierrez A, Cam pistol.
Study of cytokine gene polymorphism and graft outcome in live-donor kidney transplantation By Rashad Hassan MD Amgad El-Agroudy, Ahmad Hamdy, Amani Mostafa.
Severe vascular lesions and poor functional outcome
Interactive Case Discussion Case 6 Dr Megha S Uppin Asst Prof Dept of Pathology Nizam’s Institute of Medical Sciences Hyderabad.
Lung Transplantation Biology
References Results Methods Purpose Incidence and Clinical Course of Acute Kidney Injury in Adult Patients with Severe Trauma SeungJee Ryu*, Young Ok Kim*,
RAPAMUNE ® TM 1 Randomization Variable Day* to Day 386 Randomization Variable Day* to Day 386 RAPA, C min, TN0.765 CsA, C min, TN0.201 Gender0.117 Increasing.
M ORNING R EPORT February 17, R ENAL T RANSPLANTS Most frequent transplant 45% of all pediatric transplants 7% of renal transplants ≤ 17y 3 year.
Fioretti S.; Antik A; Busto S; Bacque MC; Schiavelli R; Domenech A; Vallejos A. Analysis of Kidneys Procured by the Transplant Institute and DGF in Transplant.
Immunology of transplantation. Types of transplantation Autotransplantation –within one organism Allotransplantation- between one species Xenotransplantation-
Fabry disease in donor kidneys with 3 and 12 years follow-up after transplantation Willy Aasebø 1, Erik H. Strøm 2, Torstein Hovig 2, Liv H. Undset 1 Arvid.
2-4. Estimated Renal Function Estimated GFR = 1.8 x (Cs) x (age) Cockcroft-Gault eq. – Estimated creatine clearance (mL/min) = (140 – age x body weight,
Advanced Therapies Lee R. Goldberg, MD, MPH Medical Director, Heart Failure and Cardiac Transplant Program University of Pennsylvania.
Addenbrooke’s Hospital Rosie Hospital INTRODUCTION The cumulative incidence of chronic renal impairment in intestinal transplantation is 0.25 at 72 months;
Dr. Aya M. Serry Renal Failure Renal failure is defined as a significant loss of renal function in both kidneys to the point where less than 10.
Histological markers of CNI nephrotoxicity: Specific or not specific? Marion Rabant MD, Renaud Snanoudj MD, Virginie Royal MD, C. Girardin, E.Morelon MD.
Implementation of RRT improved the survival rate significantly, when blood urea nitrogen or serum creatinine was still low level. However, most of those.
Lab (5): Renal Function test (RFT) (Part 2) T.A Nouf Alshareef T.A Bahiya Osrah KAU-Faculty of Science- Biochemistry department Clinical biochemistry lab.
Impact of Recipient and Donor Non-immunological factors on the Outcome of Expanded Criteria Deceased Donors Kidney Transplantation Dr Hajar Al Hayyan.
به نام دوست. C ASE PRESENTATION Dr.Pardis Nematollahi By : Amir vard.
Diabetes and the Kidney Richard Kingston Department of Renal Medicine Kent and Canterbury Hospital.
Therapeutic Hypothermia in Deceased Organ Donors and Kidney-Graft Function R3 김동연 /Prof. 정경환 N Engl J Med 373;5 July 30, 2015.
RENAL FAILURE & TRANSPLANTATION RENAL FAILURE & TRANSPLANTATION.
Pathology of Renal Transplantation
INTRODUCTION. The annual incidence of liver transplant outcomes in South America has been unknown. So far direct correlations have been reported between.
Presentation by JoAnn Czech RN/CDS St. Cloud Hospital.
Improving Outcomes in DCD Renal Transplantation Reference: Hoogland ERP, Snoeijs MGJ, van Heurn LWE. DCD kidney transplantation: Results and measures to.
ACTIVATION OF MITOCHONDRIAL APOPTOTIC PATHWAY IN CADAVER KIDNEY
BUONA FUNZIONE RENALE DEI TRAPIANTI RENALI DA DONATORI ANZIANI VALUTATI CON CLEARANCE DELLA CREATININA SECONDO GAULT-COCKCROFT, CON DATI ECOGRAFICI E CON.
Lab (5): Renal Function test (RFT) (Part 2)
Careggi University Hospital–
Enterprise | Interest Nothing to disclose.
T. Rana, L. Szabo, A. Asderakis, E. Ablorsu
Case 5 Helmut Hopfer Institute of Pathology, University Hospital Basel
Volume 58, Issue 6, Pages (December 2000)
Volume 55, Issue 2, Pages (February 1999)
Demographic Characteristics of Cohort
Presentation transcript:

Renal transplantation from non-heart beating donors M L Nicholson P N Furness* Departments of Transplant Surgery and *Pathology Leicester General Hospital UK The University of Leicester

The problem - 1

The problem - 2

Sources of asystolic donors in Leicester Irreversible cardiorespiratory arrest Accident & Emergency department – failed resuscitation after MI Medical wards – catastrophic intracerebral haemorrhage with ‘coning’

Leicester selection criteria for NHBDs Age<60 Warm ischaemic time <40 minutes No history of renal impairment No uncontrolled hypertension No complicated insulin dependent diabetes No systemic sepsis or malignancy

A & E suture room

Mechanical cardiopulmonary resuscitation device (a.k.a. ‘The Thumper’)

Correct positioning of aortic catheter

Cyclosporin protocol

Acute rejection rates 32.6% 28.6% 46.9% 12.1% 5.2% 14.3% HBD N=224 NHBD N=77 LD N=49 Acute rejection 32.6% 28.6% 46.9% Requiring ATG 12.1% 5.2% 14.3%

Early graft function rates HBD N=224 NHBD N=77 LD N=49 Primary non-function 2.7% 9.1% 2% Delayed graft function 21.0% 84.4% 4.1% Initial function 76.3% 6.5% 93.9%

Graft function

Graft survival

NEWCASTLE DATA: KM - Survival curves With thanks to: Gok MA Buckley PE Mohamed MAS Balupuri S Shenton BK Robertson H Soomro N Manas D Talbot D Liver / Renal Transplant Unit, The Freeman Hospital, Newcastle Upon Tyne, UK NEWCASTLE DATA: KM - Survival curves

NEWCASTLE DATA: Creatinine Clearance (Cockroft & Gault)

Biopsy results: a ‘typical’ case, 1 week

Same case, 3 months Hypertrophy of tubules Little fibrosis

Biopsy results: a ‘good’ case 1 week 1 month

Biopsy results: a ‘bad’ case. Pre-perfusion:

1 week:

3 weeks:

2 months:

Sirius Red analysis - normal kidney

Sirius Red analysis - fibrotic kidney

Interstitial collagen volume fraction (Sirius Red, polarized light) Conventional and NHBD kidneys, 6 month protocol biopsies % P<0.05

Conclusions: Non-heart beating donor kidneys Increased PNF rate (decreases with experience) High DGF rate; dialysis usually needed Slightly higher serum creatinine, may compensate Slightly more interstitial fibrosis at 6 months Indistinguishable graft survival rate at 5 years Biopsy does not help with donor selection (?) Protocol biopsies detect acute rejection at unchanged rate Biopsy helps to distinguish PNF and DGF, but care needed