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Query: UMLS:C0022672 (acute tubular necrosis)
 2,175 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Withdrawal of steroid therapy in renal transplant recipients is associated with a risk of acute allograft rejection. To define clinical risk factors for rejection associated with steroid withdrawal, we analyzed the clinical characteristics of 107 patients with drawn from steroid therapy at various times after transplantation. Both univariate and multivariate analyses suggested that the timing of steroid withdrawal is an important predictor of steroid withdrawal failure. Withdrawal of steroids was successful in only 13 of 32 patients (41%) in whom prednisone was discontinued shortly after transplantation. In contrast, steroid withdrawal has been successful in 59 of 75 patients (79%) in whom prednisone was discontinued at least 6 months after transplantation. Black race and donor-recipient racial mismatch also were significant predictors of rejection associated with steroid withdrawal. In patients undergoing steroid withdrawal at least 6 months posttransplant, serum creatinine concentration also correlated independently with the risk of rejection. Neither age, sex, HLA match, pretransplant PRA, source of the allograft (cadaver vs. living relative), acute tubular necrosis, nor the presence of diabetes was predictive of the outcome of steroid withdrawal.
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PMID:Withdrawal of steroids after renal transplantation--clinical predictors of outcome. 173 83

Acute tubular necrosis (ATN) represents a serious problem in kidney transplantation. We have reviewed the causes and effects of ATN on kidney transplant patients treated in our hospital between June 1981 and December 1992. We analyzed 359 consecutive kidney transplants performed in 338 patients (213 male and 125 female). There were 311 first grafts. The actuarial functional graft survival (AFGS) was 85% at 1 year and 58.2% at 10 years. The incidence of long-term chronic rejection, the 1-year creatinine blood level (CBL) and the AFGS are summarized: [table: see text] The donor age and the PRA level were significantly correlated with ATN occurrence. ATN after transplantation was associated with a poorer function and survival of the kidney graft. Better donor and patient selection could decrease the occurrence of ATN, thus improving the graft outcome.
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PMID:[Acute tubular necrosis in patients after kidney transplantation: associated factors and impact on functional survival of the graft]. 856 19

The purpose of this retrospective study was to evaluate results of non-heart-beating donor (NHBD) kidney transplantation. Between Jan 1986 and Dec 1994, 80 out of 582 cadaveric kidneys were harvested from NHBD (31.9 min +/- 24 after cardiac arrest). The results in the NHBD group (76 recipients) were compared with those obtained after transplantation of kidneys harvested from heart-beating donors (HBD) with respect to early graft function, and the graft and recipient's survival. Both groups were matched for sex, age, PRA level, number of HLA mismatches, and cold ischemia time. Triple immunosuppression therapy was used in both groups. Acute tubular necrosis (ATN) was observed significantly more frequently in the NHBD group (50 of 76 recipients vs 33 of 100 in the HBD group). The striking finding of this study was that the occurrence of primary non-function was the same in both groups and that the main cause of it was acute rejection. The 1-year patient and graft survival rates were 98.7% and 81.6% for the NHBD group and 99% and 90% for the HBD group, respectively. There was also no statistical difference in the serum creatinine concentration in both groups. We concluded that despite an increased incidence of ATN in the NHBD kidney recipients, the long-term results are good and comparable with those in the HBD group.
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PMID:Transplantation of kidneys harvested from non-heart-beating donors: early and long-term results. 895 97

Approximately 25-30% or our cadaveric renal transplant recipients have required post-transplant dialysis. In an attempt to discern the etiology, routine biopsies were performed 7-10 d post-transplant and repeated weekly. All patients received a triple-therapy cyclosporine-based regimen with (N = 61) or without (N = 10) antilymphocyte induction. Rejection was classified as 'early' when it appeared on the first biopsy (8.9 +/- 0.3 d), 'delayed' when it appeared only on the second biopsy (17.9 +/- 1.0 d) and persistent when present on both biopsies. Adequate biopsy material was obtained from 71 patients who provided a total of 117 biopsies. Acute tubular necrosis was the most common finding (50%) in the first biopsy, while rejection occurred in 30% of biopsies. Rejection on the first biopsy was strongly associated with primary nonfunction (PNF) (8 of 21 vs. 1 of 40, p < or = 0.0001). In contrast, eight patients without rejection on Biopsy 1 developed delayed rejection on Biopsy 2; only one was associated with PNF. DGF persisted beyond the second week in 38 patients; 17 (38%) of which had rejection. Nine patients had persistent rejection 55% of whom experienced PNF compared to 6% without persistent rejection (p < or = 0.001). The occurrence of early rejection was associated with pretransplant peak PRA levels > 50% (p < or = 0.01). Graft survival for all patients was 79% and 65% at 1 and 2 yr. Rejection influenced 1-yr graft survival for patients with persistent rejection who had 55% incidence of primary nonfunction and 1- and 2-yr graft survival rates of 42% and 37%. These data indicate that early biopsies are useful in unmasking rejection during DGF and at predicting primary nonfunction. Based on these data we recommend the routine utilization of biopsies for all patients with DGF.
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PMID:Routine early biopsy of allografts with delayed function: correlation of histopathology and transplant outcome. 899 56

Rupture of a renal allograft (RAR) is an uncommon but serious complication of renal transplantation. A recent RAR prompted a review of our experience, with the purpose of (1) identifying conditions that may predispose this complication and (2) defining strategies for prevention. A 5-yr, consecutive living-related (LRD) and cadaver donor (CD) cohort of 331 patients was studied retrospectively. Twelve patients (3.6%) had RAR. Donor characteristics, procurement and preservation conditions, and recipient characteristics were major study categories. Data analysis was computer-based and included multivariate analysis. The nine White and two Black cadaver donors were "ideal", mean age 29 yr, with mean high creatinine (CR) of 1.3 and terminal CR of 1.1 mg/dl and mean terminal urine output of 423 ml/min. Nine of 11 CD had low-dose dopamine use (terminal, mean 8, range 5-13 micrograms/kg/min). Eleven of 11 donors had procurement en-bloc, 9 of which were multiple organ procurement. All had 4+/4+ flush and cold storage with UW solution. Mean cold ischemia time (CIT) was 22 h, 28 min (range 15 h, 16 min to 40 h). For patients with RAR mean age was 39 yr; there were 12 Black patients and 7 males, 5 females. HLA match was 1 antigen (AG) for 3, 2 AG for 8, and 4 AG for 1 (mean 1.9). Nine patients had delayed or declining renal function requiring dialysis. The panel reactive antibody was at peak, mean 47% (range 0-100%) and current, mean 18% (range 0-84%). Six of 12 had OKT3 therapy at time of RAR and six had biopsies. Day of RAR was mean 10, median 9 (range 4-21). Pain and drop in hematocrit were observed in most. There was one fatality (8%), and all kidneys were removed. All kidneys showed at least minimal rejection but six had severe acute tubular necrosis (ATN) with edema and minimal rejection. Statistically significant associations with RAR were older recipient age (p = 0.01), donor-recipient race mismatch (White donor to Black recipient) (p = 0.007), and dialysis requirement (p < 0.001). Other variables were not statistically correlated: gender, race, CIT, transplant number, LRD vs. CD, peak or current PRA, and total HLA and BDR mismatch. The data suggest that ATN and rejection act synergistically to cause RAR and that early delayed function requires intensive and perhaps novel immunosuppression, especially in Black recipients.
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PMID:Renal allograft rupture: a clinical review. 899 57