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See detailCholecaciferol in haemodialysis patients: a randomized, double-blind, proof-of-concept and safety study
DELANAYE, Pierre ULg; WEEKERS, Laurent ULg; WARLING, Xavier et al

in Nephrology Dialysis Transplantation (2013), 28(7), 1779-1786

Background. The role of cholecalciferol supplementation in end-stage renal disease (ESRD) patients has been questioned. The objective of this randomized double-blinded study is to assess whether ... [more ▼]

Background. The role of cholecalciferol supplementation in end-stage renal disease (ESRD) patients has been questioned. The objective of this randomized double-blinded study is to assess whether cholecalciferol therapy can increase serum 25-hydroxyvitamin D [25(OH)D] levels in haemodialysed patients and the safety implications of this therapy on certain biological parameters and vascular calcifications score. Methods. Forty-three haemodialysis patients were randomized to receive placebo or cholecalciferol (25 000 IU) therapy every 2 weeks. The biological parameters, serum calcium, phosphorus, 25(OH)D and parathormone (PTH) levels, were monitored monthly for 12 consecutive months. Vascular calcifications were assessed by lateral X-ray radiography. Results. At baseline, the mean serum 25(OH)D levels were low and similar in both groups. Thirty patients (16 treated and 14 placebo) completed the study: 11 patients died (5 placebo and 6 treated), 1 patient dropped out and 1 patient was transplanted (both from the placebo group). After 1 year, the percentage of 25(OH)D deficient patients was significantly lower in the treated group. None of the patients developed hypercalcaemia. The PTH levels tended to increase over the study period under placebo and to decrease in the cholecalciferol group. The median changes in PTH levels from baseline to 1 year were statistically different between the two groups [+80 (−58 to 153) and −115 (−192 to 81) under placebo and cholecalciferol treatment, respectively, P = 0.02].The calcification scores increased equivalently in both groups (+2.3 per year). Conclusions. Cholecalciferol is effective and safe, and does not negatively affect calcium, phosphorus, PTH levels and vascular calcifications. Additional studies are needed to compare the impacts of nutritional and active vitamin D agents on vascular calcification and mortality. [less ▲]

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See detailMasked hypertension is associated with a high cardiovascular risk in hypertensive kidney transplant recipients
XHIGNESSE, Patricia ULg; Saint-Remy, Annie ULg; BONVOISIN, Catherine ULg et al

Poster (2013, June 16)

Objective: High blood pressure (BP) is a major risk factor for graft function in kidney transplant recipients (KTs) Our aim was to evaluate BP control in the office, but also in the ambulatory and home ... [more ▼]

Objective: High blood pressure (BP) is a major risk factor for graft function in kidney transplant recipients (KTs) Our aim was to evaluate BP control in the office, but also in the ambulatory and home settings, in stable KTs, ali treated for hypertension, and to characterize patients with masked hypertension (MHT). Design and Method: Three BP measurement techniques were used in 70 late KT patients, (mean age 56.5 years; 43 males): ambulatory BP monitoring (ABPM-Spacelab 90207) office (OBP) and home BP monitoring (HBPM)- (OMRON M6). Carotid­ femoral pulse wave velocity was measured (Sphygmocor) as weil as a calcification score (arteries) and the systolic ankle brachial index (ABI) as recommended. The period since transplantation was 6.9±6.6 years, the mean GFR was 65.6±24±ml/min, Body Mass Index was 25.8±4.7 kg/m2 and the number of antihypertensive drug was 2.1±1 pills/d. Results: Uncontrolled hypertension (HTN) remained frequent in our treated population, 46 % were still hypertensive in the office, 39% using ABPM and 43% with HBPM. The proportion of MHT was 22% whatever the out-of-clinic method used, with more males, more overweight (BMI between, 25-30). lnterestingly when compared with controlled KTs (i.e both OBP and Daytime ABP controlled or both OBP and HBP controlled), using either ABPM or Home BP, patients with MHT had significantly higher PWV, a higher aortic augmentation pressure (AP), a higher calcification score and a higher ABI. However we did not find any significant impact of graft survival, immunosuppressive drugs, smoking habits, diabetes, or alcohol use. Conclusion: A high percentage of uncontrolled HTN was noted by OBP, but also by ABPM and HBPM despite antihypertensive treatment. MHT was frequently observed in KTs. This particular HT subtype, either defined by OBP vs ABPM or by OBP vs HBP, was significantly associated with major markers of arterial stiffness. So, MHT is associated with a high cardiovascular (cv) risk and therefore has to be manage to reduce incidence of cv events and graft loss. [less ▲]

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See detailINFUSION OF THIRD-PARTY MESENCHYMAL STEM CELLS (MSC) AFTER KIDNEY AND LIVER TRANSPLANTATION: A PHASE I-II, OPEN-LABEL, CLINICAL STUDY (EudraCT 2011-001822-81 & NCT01429038)
DETRY, Olivier ULg; DELBOUILLE, Marie-Hélène ULg; LECHANTEUR, Chantal ULg et al

Poster (2013, May 30)

MSC cells have demonstrated significant immunosuppressive effects in various in vivo and in vitro studies. This study aims to be the first evaluation of the safety and tolerability of third party MSC ... [more ▼]

MSC cells have demonstrated significant immunosuppressive effects in various in vivo and in vitro studies. This study aims to be the first evaluation of the safety and tolerability of third party MSC infusion after cadaveric kidney and liver transplantation in a prospective phase I-II study, taking advantage of our centre expertise and experience in MSC use in graft-versus-host disease (GVHD) after bone marrow transplantation and using an already functioning GMP-compliant laboratory producing clinical-grade MSC. Secondary end-points will help to evaluate the immunosuppressive potential of MSC after organ transplantation, and the opportunity to develop larger randomised, controlled, phase III trials. After successful transplantation, 10 liver and 10 kidney transplant recipients under standard immunosuppression (tacrolimus, MMF, steroids) will receive an intravenous infusion of 1.5-3x106/kg of third-party MSC on post-operative day 3±2. These patients will be prospectively compared to 10 liver and 10 kidney recipients who meet the inclusion criteria but deny MSC infusion. Safety will be assessed by recording side effects, including opportunistic infections and cancers. Immunosuppressive potential will be evaluated by rejection episode rates, by graft/patient survivals, by immunohistology of 3-months kidney and 6-month liver graft biopsies and by in vitro evaluation of the immunity profile of the recipients. In a second step, reduction (kidney) and progressive weaning (liver) of immunosuppression will be attempted in recipients who received MSC. This ongoing study is supported by research grants from the CHU of Liège, University of Liège, and by the Senior Clinical Research Grant from ESOT. The first patients were included and treated in early 2012, and final results expected in late 2013. [less ▲]

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See detailWhat's New in Renal and Pancreatic Transplantation in 2011?
WEEKERS, Laurent ULg

in Transplantation Proceedings (2012), 44(9), 27842786

At the 11th meeting of the SFT Congress in Montpellier, several presentations were devoted to humoral rejection of kidney transplants, new immunosuppressive drugs, cancer after transplantation, and second ... [more ▼]

At the 11th meeting of the SFT Congress in Montpellier, several presentations were devoted to humoral rejection of kidney transplants, new immunosuppressive drugs, cancer after transplantation, and second pancreas transplantations. The main information drawn from these papers is summarized in this brief review. [less ▲]

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See detailInfusion of third party mesenchymal stem cells (MSC) after kidney and liver transplantation: a phase I-II, open-label, clinical study
DETRY, Olivier ULg; DELBOUILLE, Marie-Hélène ULg; LECHANTEUR, Chantal ULg et al

Conference (2012, October 19)

MSC cells have demonstrated significant immunosuppressive effects in various in vivo and in vitro studies. This study aims to be the first evaluation of the safety and tolerability of third party MSC ... [more ▼]

MSC cells have demonstrated significant immunosuppressive effects in various in vivo and in vitro studies. This study aims to be the first evaluation of the safety and tolerability of third party MSC infusion after cadaveric kidney and liver transplantation in a prospective phase I-II study, taking advantage of our centre expertise and experience in MSC use in graft-versus-host disease (GVHD) after bone marrow transplantation and using an already functioning GMP-compliant laboratory producing clinical-grade MSC. Secondary end-points will help to evaluate the immunosuppressive potential of MSC after organ transplantation, and the opportunity to develop larger randomised, controlled, phase III trials. After successful transplantation, 10 liver and 10 kidney transplant recipients under standard immunosuppression (tacrolimus, MMF, steroids) will receive an intravenous infusion of 1.5-3x106/kg of third-party MSC on post-operative day 3±2. These patients will be prospectively compared to 10 liver and 10 kidney recipients who meet the inclusion criteria but deny MSC infusion. Safety will be assessed by recording side effects, including opportunistic infections and cancers. Immunosuppressive potential will be evaluated by rejection episode rates, by graft/patient survivals, by immunohistology of 3-months kidney and 6-month liver graft biopsies and by in vitro evaluation of the immunity profile of the recipients. In a second step, reduction (kidney) and progressive weaning (liver) of immunosuppression will be attempted in recipients who received MSC. This ongoing study is supported by research grants from the CHU of Liège, University of Liège, and by the Senior Clinical Research Grant from ESOT. The first patients were included and treated in early 2012, and final results expected in late 2013. [less ▲]

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See detailUrinary and dietary sodium and potassium associated with blood pressure control in treated hypertensive kidney transplant recipients: an observational study
Saint-Remy, Annie ULg; SOMJA, Mélanie ULg; Gellner, Karen et al

in BMC Nephrology (2012), 13

Background In kidney transplant (Kt) recipients, hypertension is a major risk for cardiovascular complications but also for graft failure. Blood pressure (BP) control is therefore mandatory. Office BP ... [more ▼]

Background In kidney transplant (Kt) recipients, hypertension is a major risk for cardiovascular complications but also for graft failure. Blood pressure (BP) control is therefore mandatory. Office BP (OBP) remains frequently used for clinical decisions, however home BP (HBP) have brought a significant improvement in the BP control. Sodium is a modifiable risk factor, many studies accounted for a decrease of BP with a sodium restricted diet. Increased potassium intake has been also recommended in hypertension management. Using an agreement between office and home BP, the present study investigated the relations between the BP control in Kt recipients and their urinary excretion and dietary consumption of sodium and potassium. Methods The BP control defined by OBP <140/90 mmHg and HBP <135/85 mmHg was tested in 70 Kt recipients (mean age 56 +/- 11.5 years; mean graft survival 7 +/- 6.6 years) treated with antihypertensive medications. OBP and HBP were measured with a validated oscillometric device (Omron M6(R)). The 24-hour urinary sodium (Na+) and potassium (K+) excretions as well as dietary intakes were compared between controlled and uncontrolled (in office and at home) recipients. Non parametric Wilcoxon Mann--Whitney Test was used for between groups comparisons and Fisher's exact test for frequencies comparisons. Pearson correlation coefficients and paired t-test were used when sample size was >30. Results Using an agreement between OBP and HBP, we identified controlled (21%) and uncontrolled recipients (49%). Major confounding effects susceptible to interfere with the BP regulation did not differ between groups, the amounts of sodium excretion were similar (154 +/- 93 vs 162 +/- 88 mmol/24 h) but uncontrolled patients excreted less potassium (68 +/- 14 vs 54 +/- 20 mmol/24 h; P = 0.029) and had significantly lower potassium intakes (3279 +/- 753 vs 2208 +/- 720 mg/24 h; P = 0.009), associated with a higher urinary Na+/K + ratio. Systolic HBP was inversely and significantly correlated to urinary potassium (r = -0.48; P = 0.002), a positive but non significant relation was observed with urinary sodium (r = 0,30;P = 0.074). Conclusions Half of the treated hypertensive Kt recipients remained uncontrolled in office and at home. Restoring a well-balanced sodium/potassium ratio intakes could be a non pharmacological opportunity to improve blood pressure control. [less ▲]

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See detailResults of kidney transplantation from controlled donors after cardio-circulatory death: a single center experience
Le Dinh, Hieu ULg; WEEKERS, Laurent ULg; BONVOISIN, Catherine ULg et al

in Acta Chirurgica Belgica (2012, May), 112(3), 667

Objectives: The aim of this study was to determine results of kidney transplantation (KT) from controlled donation after cardio-circulatory death (DCD). Primary end-points were graft and patient survival ... [more ▼]

Objectives: The aim of this study was to determine results of kidney transplantation (KT) from controlled donation after cardio-circulatory death (DCD). Primary end-points were graft and patient survival, and post-transplant complications. The influence of delayed graft function (DGF) on graft survival and DGF risk factors were analyzed as secondary end-points. Methods: This is a retrospective mono-center review of a consecutive series of 80 DCD-KT performed at the University Hospital of Sart Tilman, University of Liège, between Jan 2005 and Dec 2011. Mean patient follow-up was 28.5 months. Results: Overall graft survival was 93.7%, 89.5%, 85% and 81.3% at 3 months, 1 year, 3 and 5 years, respectively. Death-censored graft survival at the corresponding time points was 93.7%, 93.7%, 90.8% and 90.8%. Main cause of graft loss was patient’s death with a functioning graft. No primary non-function grafts were encountered. Renal graft function was suboptimal at hospital discharge, but nearly normalized at 3 months. DGF was observed in 36% of all DCD-KT. DGF significantly increased post-operative length of hospitalization, but had no deleterious impact on graft function or survival. Donor body mass index (BMI) ≥30 kg/m2, recipient BMI ≥30 kg/m2 and pre-transplant dialysis duration significantly increased the risk of DGF in a multivariate logistic regression analysis (p < 0.05). Conclusions: Despite a higher rate of DGF, controlled DCD-KT offers a valuable contribution to the pool of deceased donor kidney grafts, with comparable mid-term results to those procured after brain death. [less ▲]

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See detailDietary and urinary excretion of sodium and potassium associated with blood pressure control in treated hypertensive kidney transplant patients
Saint-Remy, Annie ULg; SOMJA, Mélanie ULg; BONVOISIN, Catherine ULg et al

Conference (2012, April 26)

Abstract Background. In kidney transplant (kt) recipients , hypertension is a major risk for cardiovascular complications but also for graft failure. Blood pressure (BP) control is therefore mandatory ... [more ▼]

Abstract Background. In kidney transplant (kt) recipients , hypertension is a major risk for cardiovascular complications but also for graft failure. Blood pressure (BP) control is therefore mandatory. Office BP (OBP) remains the most frequently used for clinical decisions, however home BP (HBP) have brought a significant improvement in the BP control. Sodium is a modifiable risk factor, many studies accounted for a decrease of BP with a sodium restricted diet. Increased potassium intake has been also recommended in hypertension management. Using an agreement between office and home BP, the present study investigated the relations between the BP control in kt recipients and their urinary excretion and dietary consumption of sodium and potassium. Methods. The BP control defined by OBP <140/90 mmHg and HBP <135/85 mmHg was measured in 70 kt recipients (mean age 56 ± 11.5 years; mean graft survival 7 ± 6.6 years) treated with antihypertensive medications. OBP and HBP were measured with a validated oscillometric device (Omron M6â). 24-hour urinary sodium (Na+) and potassium (K+) excretion as well as dietary intakes (food recall) were compared between controlled and uncontrolled (in office and at home) recipients. Non parametric Wilcoxon Mann-Whitney Test was used for between groups comparisons and Fisher’s exact test for frequencies comparisons. Results. Using an agreement between OBP and HBP, we identified controlled (21%) and uncontrolled recipients (49%). Major confounding effects susceptible to interfere with the BP regulation did not differ between groups, the amounts of sodium excretion were similar (154 ± 93 vs 162 ± 88 mmol/24h) but uncontrolled patients excreted less potassium (68 ± 14 vs 54 ± 20 mmol/24h; P=0.029) and had significantly lower intakes (3279 ± 753 vs 2208 ± 720 mg/24h; P=0.009), resulting in a higher Na+/K+ ratio. Systolic HBP was inversely and significantly correlated to urinary potassium when age, BMI and urinary sodium were controlled (r= -0.46; P=0.002). When age, BMI and urinary potassium were controlled, a positive relation was observed with urinary sodium (P=0.042). Conclusions. Half of the treated hypertensive kt recipients remained uncontrolled in office and at home. Restoring a well-balanced sodium/potassium ratio intakes could be a non pharmacological opportunity to improve blood pressure control. [less ▲]

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See detailDelayed graft function does not harm the future of donation-after- cardiac-death kidney transplants
LeDinh, H; WEEKERS, Laurent ULg; BONVOISIN, Catherine ULg et al

Conference (2012, March 29)

Introduction: Delayed graft function (DGF) occurs more frequently in kidney transplants from donation after cardiac death (DCD) than from donation after brain death (DBD). We investigated the effect of ... [more ▼]

Introduction: Delayed graft function (DGF) occurs more frequently in kidney transplants from donation after cardiac death (DCD) than from donation after brain death (DBD). We investigated the effect of DGF on post-transplant outcomes in controlled DCD kidney grafts. Patients and Methods: This single-center retrospective study recruited 80 controlled DCD kidney allo- grafts which have been performed at the University Hospital of Sart Tilman, University of Liège, from Jan 2005 to Dec 2011. Results: Mean patient follow-up was 28.5 months. No primary non-function grafts were encountered. DGF rate was 36%. Overall graft survivals between groups with and without DGF were 92.4% and 95.1% at 1 year, 92.4% and 91.7% at 3 years, and 84.7% and 91.7% at 5 years (p=ns), respectively. Patients with and without DGF had the same survival rates at the corresponding time points (92.4% and 97.1%, 92.4% and 93.7%, and 84.7% and 93.7%, p=ns, respectively). Estimated glomerular filtration rate (eGFR) was significantly lower in DGF group compared to non-DGF group at hospital discharge (29 vs 42 ml/min, p=0.001) and up to 1 year post-transplant (46 vs 53 ml/min, p=0.045), but the differ- ence disappeared afterwards (50 vs 48 ml/min at 3 years, and 54 vs 53 ml/min at 5 years, p=ns). DGF did not increase the risk of acute rejection or surgical complications. 29.6% of recipients with DGF de- veloped acute rejection (biopsy-proven rejection and clinically suspected rejection) compared with 29.2% of recipients without DGF (p=ns). The rate of all surgical complications was 33.3% and 25% in recipients with and without DGF (p=ns). However, DGF prolonged significantly the length of hospitaliza- tion in DGF than non-DGF group (18.9 vs 13 days, p=0.000). Donor BMI 􏰤 30 kg/m2􏰁􏰀􏰚􏰌􏰈􏰏􏰥􏰏􏰌􏰝􏰣􏰀􏰕􏰉􏰂􏰀􏰤 30 kg/m2 and pre-transplant dialysis duration increased the risk of DGF in a multivariate logistic regression analysis. Conclusions: Apart from longer hospital stay, DGF had no deleterious impact on the future of DCD kidney allografts. Comparable graft and patient survival, renal function, rejection rate and surgical com- plications were observed between groups with and without DGF. [less ▲]

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See detailResults of kidney transplantation from controlled donors after cardio-circulatory death: a single center experience.
Ledinh, H.; WEEKERS, Laurent ULg; BONVOISIN, Catherine ULg et al

in Transplant International (2012), 25

The aim of this study was to determine results of kidney transplantation (KT) from controlled donation after cardio-circulatory death (DCD). Primary end-points were graft and patient survival, and post ... [more ▼]

The aim of this study was to determine results of kidney transplantation (KT) from controlled donation after cardio-circulatory death (DCD). Primary end-points were graft and patient survival, and post-transplant complications. The influence of delayed graft function (DGF) on graft survival and DGF risk factors were analyzed as secondary end-points. This is a retrospective mono-center review of a consecutive series of 59 DCD-KT performed between 2005 and 2010. Overall graft survival was 96.6%, 94.6%, and 90.7% at 3 months, 1 and 3 years, respectively. Main cause of graft loss was patient's death with a functioning graft. No primary nonfunction grafts. Renal graft function was suboptimal at hospital discharge, but nearly normalized at 3 months. DGF was observed in 45.6% of all DCD-KT. DGF significantly increased postoperative length of hospitalization, but had no deleterious impact on graft function or survival. Donor body mass index >/=30 was the only donor factor that was found to significantly increase the risk of DGF (P < 0.05). Despite a higher rate of DGF, controlled DCD-KT offers a valuable contribution to the pool of deceased donor kidney grafts, with comparable mid-term results to those procured after brain death. [less ▲]

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See detailOutcome of the living kidney donor
DELANAYE, Pierre ULg; WEEKERS, Laurent ULg; DUBOIS, Bernard ULg et al

in Nephrology Dialysis Transplantation (2012), 27(1), 41-50

Renal transplantation from living kidney donors is still relatively marginal in most of the European countries. However, this source of kidney grafts may help to overcome in part the organ donor shortage ... [more ▼]

Renal transplantation from living kidney donors is still relatively marginal in most of the European countries. However, this source of kidney grafts may help to overcome in part the organ donor shortage of cadaveric donors. The living donor strategy implies correct and objective information about donation risks and completely free acceptance of the living candidate of the donation. In this paper, we reviewed the consequences of kidney donation on the living donor health, considering very short term (linked to the surgery), short term (effect of nephrectomy on glomerular filtration rate) and long term (risk of mortality, chronic kidney disease, proteinuria and hypertension) consequences of kidney donation. [less ▲]

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See detailEvolution of Native Kidney Function After Pancreas Transplantation Alone
LE DINH, Hieu; DE ROOVER, Arnaud ULg; COIMBRA MARQUES, Carla ULg et al

in Transplantation Proceedings (2012), 44

Introduction. This study investigated changes in kidney function over time among a cohort of patients undergoing pancreas transplantation alone (PTA) from January 2002 to December 2011. Patients and ... [more ▼]

Introduction. This study investigated changes in kidney function over time among a cohort of patients undergoing pancreas transplantation alone (PTA) from January 2002 to December 2011. Patients and Methods. Ten of eighteen PTA patients bearing functioning grafts for at least 1 year were recruited for the analysis. Primary endpoints were changes in mean serum creatinine (SCr, mg/L) and mean estimated glomerular filtration rate (eGFR) using the 4-variable Levey-MDRD equation (mL/min/1.73 m2) comparing baseline (pretransplantation) to 6-month, 1-year, 3-year, and 5-year posttransplantation values. Mean follow-up time was 75.7 20.5 months (range, 46–106.5). Results. Baseline eGFR was 89.3 27.9 (range, 58–145). eGFR decreased to 75.7 26.2, 71 20.6, 66.5 14.8, and 62.1 11.2 at 6 months, 1, 3, and 5 years representing 15.2%, 20.5%, 15.8%, and 22.6% percentage decreases respectively (P .05 for all pairwise comparisons). The Baseline SCr was 8.6 2.3 mg/L (range, 5–13). SCr progressively increased to 10.1 3, 10.5 3.1, 10.9 3.1, and 11.3 1.7 at 6 months, 1, 3, and 5 years a 17.1%, 22%, 16.6%, and 19.9% increase respectively (P .05 for all pairwise comparisons). One of ten, 2/8, and 3/7 patients displayed an eGFR 60 at transplantation versus 3 and 5 years thereafter, respectively. No patient developed a SCr 25 mg/L or eGFR 30 or needed dialysis or kidney transplantation. Five of ten patients had micro-albuminuria or proteinuria before transplantation. Tacrolimus levels were within recommended therapeutic ranges over time. Conclusion. Kidney function deteriorated significantly after PTA. Understanding of risk factors for the development of renal impairment is important to preserve kidney function and to select appropriate candidates for PTA. [less ▲]

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See detailDelayed graft function does not harm the future of donation-after-cardiac death in kidney transplantation.
Le Dinh, Hieu; WEEKERS, Laurent ULg; BONVOISIN, Catherine ULg et al

in Transplantation Proceedings (2012), 44(9), 2795-802

INTRODUCTION: Delayed graft function (DGF) occurs more frequently in kidney transplants from donation after cardiac death (DCD) than from donation after brain death (DBD). We investigated the effect of ... [more ▼]

INTRODUCTION: Delayed graft function (DGF) occurs more frequently in kidney transplants from donation after cardiac death (DCD) than from donation after brain death (DBD). We investigated the effect of DGF on posttransplantation outcomes among grafts from controlled DCD kidneys. PATIENTS AND METHODS: This single-center retrospective study recruited 80 controlled DCD kidneys transplanted from January 2005 to December 2011. Mean patient follow-up was 28.5 months. RESULTS: There were no primary nonfunction grafts; the DGF rate was 35.5%. Overall graft survival rates between groups with versus without DGF were 92.4% and 95.2% at 1 year, 92.4% and 87.1% at 3 years, and 84.7% and 87.1% at 5 years, respectively (P = not significant (NS)). Patients with versus without DGF showed the same survival rates at the corresponding time 92.4% vs 97.2%, 92.4% vs 93.9%, and 84.7% vs 93.9% (P = NS). Estimated glomerular filtration rate was significantly lower in the DGF compared with the non-DGF group at hospital discharge (29 vs 42 mL/min; P = .00) and at 6 months posttransplantation (46 vs 52 mL/min; P = .04), but the difference disappeared thereafter: 47 vs 52 mL/min at 1 year, 50 vs 48 mL/min at 3 years, and 54 vs 53 mL/min at 5 years (P = NS). DGF did not increase the risk of an acute rejection episode (29.6% vs 30.6%; P = NS) or rate of surgical complications (33.3% vs 26.5%; P = NS). However, DGF prolonged significantly the length of hospitalization in the DGF versus the non- DGF group (18.9 vs 13 days; P = .00). Donor body mass index (BMI) >/= 30 kg/m(2), recipient BMI >/=30 kg/m(2), and pretransplantation dialysis duration increased the risk of DGF upon multivariate logistic regression analysis. CONCLUSIONS: Apart from the longer hospital stay, DGF had no deleterious impact on the future of kidney allografts from controlled DCD, which showed comparable graft and patient survivals, renal function, rejection rates, and surgical complications as a group without DGF. Therefore, DGF should no longer be considered to be a medical barrier to the use of kidney grafts from controlled DCD. [less ▲]

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See detailKidney donation after circulatory death in a country with a high number of brain dead donors: 10 -year experience in Belgium
Jochmans, Ina; Darius, Tom; Kuypers, Dirk et al

in Transplant International (2012), 25

Worldwide shortage of standard brain dead donors (DBD) has revived the use of kidneys donated after circulatory death (DCD). We reviewed the Belgian DCD kidney transplant (KT) experience since its ... [more ▼]

Worldwide shortage of standard brain dead donors (DBD) has revived the use of kidneys donated after circulatory death (DCD). We reviewed the Belgian DCD kidney transplant (KT) experience since its reintroduction in 2000. Risk factors for delayed graft function (DGF) were identified using multivariate analysis. Five-year patient/graft survival was assessed using Kaplan–Meier curves. The evolution of the kidney donor type and the impact of DCDs on the total KT activity in Belgium were compared with the Netherlands. Between 2000 and 2009, 287 DCD KT were performed. Primary nonfunction occurred in 1% and DGF in 31%. Five-year patient and death-censored graft survival were 93% and 95%, respectively. In multivariate analysis, cold storage (versus machine perfusion), cold ischemic time, and histidine-tryptophan-ketoglutarate solution were independent risk factors for the development of DGF. Despite an increased number of DCD donations and transplantations, the total number of deceased KT did not increase significantly. This could suggest a shift from DBDs to DCDs. To increase KT activity, Belgium should further expand controlled DCD programs while simultaneously improve the identification of all potential DBDs and avoid their referral for donation as DCDs before brain death occurs. Furthermore, living donation remains underused. Transplant International ISSN 0934-0874 ª [less ▲]

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See detailAssociation entre le contrôle de la pression artérielle et le rapport sodium/potassium urinaire chez les transplantés rénaux hypertendus
Saint-Remy, Annie ULg; SOMJA, Mélanie ULg; WEEKERS, Laurent ULg et al

Poster (2011, December 15)

Design and method : Office blood pressure (OBP) and home BP (HBP) were measured in 70 kidney transplant patients (KT) (43 men/27 women;KT>1 year), all were treated with antihypertensive drugs (mean number ... [more ▼]

Design and method : Office blood pressure (OBP) and home BP (HBP) were measured in 70 kidney transplant patients (KT) (43 men/27 women;KT>1 year), all were treated with antihypertensive drugs (mean number: 2±1). Mean age: 56±11 years, mean graft survival: 7±6.6 years, mean GFR: 65.6±24 ml/min, diabetes:27% and current smoking:11.5%. HBP (Omron M6) was measured during 7 days following the OBP measurement, mean HBP was calculated from day 2 to day 7. Uncontrolled BP was defined by OBP>=140-90 (>=130-80 when diabetes) and HBP>=135-85 (>=130-80 when diabetes). The day of the OBP measurement and the last day of HBP, patients collected 24h- urine and recorded at the same time their food and beverage consumption. Sodium and potassium were measured in urines and their intakes were quantified through food records. Urinary and diet Na+, K+ did not differ between the two urine collections 7 days apart. Results: 16 patients(23%) had controlled BP (OBP and HBP) while 34 (49%) remained with sustained hypertension (SHT) despite treatment, 14 (20%) had masked uncontrolled hypertension (MHT, OBP<140-90 and HBP>=135-85,130-80 if diabetes for both).When comparing the controlled and SHT, no differences were found with age, graft survival, BMI, GFR, calcineurin inhibitors or number and type of antihypertensive drugs. The groups did not differ by their sodium excretion (154±93 vs 162±88 mmol/24h) but well by their K excretion significantly higher in controlled patients (68±17 vs 53±20 mmol/24h,p=0.018) giving a Na/K ratio higher in SHT (3.2±1.3 vs2.2±1.2,p=0.03). Diet analysis showed significantly higher intakes of K (fruits, vegetables) in controlled patients (3279±753 vs 2208±720 mg/24h,p=0.010) whereas both groups consumed on average 9 g/24h of salt. When controlled for age, BMI and Na excretion, Home systolic BP was inversely and significantly correlated with urinary potassium (- 0.46;P=0.002) while no correlation was found with urinary Na.Conclusions: KT patients remaining hypertensive and well controlled patients had both high salt consumption. However, well controlled patients differed by significant higher potassium intakes and excretion. Urinary Na/K ratio could be a useful tool contributing to an optimal BP control in KT patients. However, impact of increasing potassium intakes on uncontrolled BP in KT has to be validated by prospective randomized studies [less ▲]

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See detailAssociation entre le contrôle de la pression artérielle et le rapport sodium/potassium urinaire chez les transplantés rénaux hypertendus
Saint-Remy, Annie ULg; SOMJA, Mélanie ULg; WEEKERS, Laurent ULg et al

in Archives des Maladies du Coeur et des Vaisseaux (2011, December), Hors série 3

Etude de la relation entre le contrôle de la pression artérielle (PA) mesurée en clinique et/ou à domicile chez des transplantés rénaux (Tr) hypertendus et l'excrétion urinaire du sodium (Na), potassium ... [more ▼]

Etude de la relation entre le contrôle de la pression artérielle (PA) mesurée en clinique et/ou à domicile chez des transplantés rénaux (Tr) hypertendus et l'excrétion urinaire du sodium (Na), potassium (K) et de leur rapport (Na/K urinaire et alimentaire) qui pourrait être un indice utile à prendre en compte dans la recherche d'un contrôle efficace de la PA chez les transplantés rénaux. [less ▲]

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Peer Reviewed
See detailContrôle de la pression artérielle (PA) et mesure de la rigidité artérielle (RA) chez des transplantés rénaux (TR) (étude EPARA)
Gellner, Karen; Saint-Remy, Annie ULg; BONVOISIN, Catherine ULg et al

in Archives des Maladies du Coeur et des Vaisseaux (2011, December), Hors série 3

EPARA a étudié le contrôle de la PA au cabinet de consultation et en dehors, et l'état de rigidité artérielle chez des transplantés rénaux stables, greffés depuis plus d'un an. Le contrôle de la PA est ... [more ▼]

EPARA a étudié le contrôle de la PA au cabinet de consultation et en dehors, et l'état de rigidité artérielle chez des transplantés rénaux stables, greffés depuis plus d'un an. Le contrôle de la PA est loin d‘être satisfaisant dans cette population de TR hypertendus, traîtés pour la plupart, particulièrement à domicile. L‘HTA masquée est fréquente, associée à un risque cardio-vasculaire élevé et une rigidité accrue des grosses artères. La PAS centrale est d‘autant plus élevée que la fonction rénale est mauvaise. Proposer de recourir systématiquement à des mesures ambulatoires de PA est hautement conseillé chez ce type de patients! [less ▲]

Detailed reference viewed: 37 (9 ULg)