Biomedical subjects

Arthur J Matas

Publications and source records attributed to Arthur J Matas.

41 records · Page 3Linked to original sources

PubMed2002

Five preventable causes of kidney graft loss in the 1990s: a single-center analysis.

BACKGROUND: Despite improvements in immunosuppressive protocols and patient care, kidney allografts continue to fail. We studied causes of graft loss for primary kidney transplants in the 1990s to determine major causes and potential interventions. METHODS: Causes of graft loss were reviewed for 1467 primary kidney transplants done at our institution between January 1, 1990, and December 31, 1999. Graft loss for that entire population was studied and then the causes of loss selectively examined at <1 year, 1 to 5 years, and>5 years post-transplant. Finally, causes of loss in the 1990s versus the 1980s were compared. RESULTS: Five major causes of graft loss were noted in the 1990s: thrombosis, acute rejection (either alone or combined with delayed graft function or infection), chronic rejection, death with function, and noncompliance. In the first year post-transplant, thrombosis (25%) and death with function (41%) were the major causes of graft loss. After the first year, chronic rejection and death with function predominated. For recipients dying with graft function, cardiovascular disease was the major cause of death. CONCLUSIONS: This study identified the five major causes of kidney graft loss in the 1990s. Different interventions are required to decrease loss from each of these causes. Future research needs to be directed at such interventions.

Acute Disease↗

PubMed2002

Preemptive kidney transplantation: the advantage and the advantaged.

It remains unclear whether preemptive transplantation is beneficial, and if so, who benefits. A total of 38,836 first, kidney-only transplants between 1995 and 1998 were retrospectively studied. A surprising 39% of preemptive transplants were from cadaver donors, and the proportions of cadaver donor transplants that were preemptive changed little, from 7.3% in 1995 to 7.7% in 1998. Preemptive transplants using cadaver donors were more likely among recipients aged 0 to 17 yr versus 18 to 29 yr (odds ratio [OR], 2.48; 95% confidence interval [CI], 1.94 to 3.17), white versus black (OR, 2.33; 95% CI, 2.03 to 2.68), able to work versus unable to work (OR, 1.42; 95% CI, 1.26 to 1.61), covered by private insurance versus Medicare (OR, 4.77; 95% CI, 4.26 to 5.32), or recipients with a college degree versus no college degree (OR, 1.34; 95% CI, 1.17 to 1.54). Preemptive transplants were less likely for Hispanics versus non-Hispanics (OR, 0.57; 95% CI, 0.50 to 0.67), patients with type 2 versus type 1 diabetes (OR, 0.76; 95% CI, 0.61 to 0.96), and for 2 to 5 HLA mismatches compared with 0 HLA mismatches (OR range, 0.77 to 0.82). In adjusted Cox proportional hazards analysis, the relative risk of graft failure for preemptive transplantation was 0.75 (0.67 to 0.84) among 25,758 cadaver donor transplants and 0.73 (0.64 to 0.83) among 13,078 living donor transplants, compared with patients who received a transplant after already being on dialysis. Preemptive transplantation was associated with a reduced risk of death: 0.84 (0.72 to 0.99) for cadaver donor transplants and 0.69 (0.56 to 0.85) for living donor transplants. Thus, preemptive transplantation, which is associated with improved patient and graft survival, is less common among racial minorities, those who have less education, and those who must rely on Medicare for primary payment. Alterations in the payment system, emphasis on early referral, and changes in cadaver kidney allocation could increase the number of patients who benefit from preemptive transplantation.

Adolescent↗

PubMedDate not supplied

Living or deceased donor kidney transplants for candidates with significant extrarenal morbidity.

BACKGROUND: Individuals with end-stage renal disease (ESRD) must weigh the benefits and risks of dialysis vs. a transplant. However, if the patient has extrarenal morbidity, survival may be limited. We have recommended that, when possible, recipients have a living donor (LD) transplant. However, it could be argued that for recipients with extrarenal morbidity, the potential benefit does not justify the donor risks and that, therefore, recipients with increased risks should be denied an LD transplant. MATERIALS AND METHODS: We studied the outcome of LD vs. deceased donor (DD) transplants in recipients with extrarenal morbidity. For recipients with extrarenal morbidity, patient survival (p < 0.01) and graft survival (p < 0.01) rates were significantly better for LD (vs. DD) transplant recipients. We found no difference in death-censored graft survival rates. CONCLUSION: Kidney transplant recipients with extrarenal morbidity benefit from an LD transplant. Both donor and recipient informed consent is important.

Cadaver↗

PubMedDate not supplied

Risk factors for rising creatinine in renal allografts with 1 and 3 yr survival.

BACKGROUND: Determining factors associated with negative slope of inverse creatinine vs. time (1/Cr vs. t) may help prevent a decline in renal allograft function. METHODS: A total of 1389 adult recipients of primary renal transplants were divided into quartiles based on the slope of 1/Cr vs. t calculated from 6 and 12 months post transplant. A multivariate analysis of risk factors for being in the worst vs. best quartile employed these variables: donor source, HLA mismatch, recipient age, donor age, panel-reactive antibody (PRA), acute rejection (AR), 3-month cyclosporin A (CsA) level, 1-yr CsA level and acute tubular necrosis. Two separate analyses compared risk factors in patients with 1 and 3 yr survival, respectively. RESULTS: In recipients with > or = 1 yr graft survival, high PRA and AR were associated with negative slopes of 1/Cr vs. t. For those with > or = 3 yr graft survival, both AR and 3-month CsA level > 150 ng/mL were significant risk factors, using both 6- and 12-month slopes. Stratification of AR showed 1 AR episode > or = 6 months and multiple AR episodes carried significant risk for negative slopes. CONCLUSION: Optimization of allograft function invokes a conundrum between the needs to avoid both AR and high early CsA levels. We support a policy of carefully balancing these two risks.

Adult↗

PubMedDate not supplied

Surgical complications after kidney transplantation.

Kidney transplants have become common surgical procedures, with thousands performed yearly around the world. The surgical techniques for the transplant are well established and the procedure is associated with high success rates. The complication rate associated with the procedure is low, especially when compared to other abdominal organ transplants such as liver and pancreas transplants. Nonetheless, the detection, accurate diagnosis, and timely management of surgical complications occurring after kidney transplant are important tasks of the team managing these patients. A delay in the diagnosis or management of these complications can result in significant morbidity to the recipient, with risk of graft loss and mortality. Most surgical complications involve either the wound or one of the three anastomoses (renal artery, renal vein, or ureter). Examples include wound infection, renal artery or vein thrombosis, and urine leak. Most of these complications will require surgical or radiologic intervention for appropriate management.

Humans↗