2019 SCIENCELINE

Journal of Life Science and Biomedicine

J Life Sci Biomed, 9 (4): 96-101, 2019

License: CC BY 4.0

ISSN 2251-9939

Characteristics and early clinical outcomes of

patients undergoing living-related kidney

transplantation

Feruz Gafurovich NAZIROV¹, Fazliddin Shamsitdinovich BAKHRITDINOV², Ravshan Aliyevich IBADOV³,

Zokhidjon Turdaliyevich MATKARIMOV², Azamat Sayfullayevich SUYUMOV², Jasur Gaybillayevich SOBIROV²,

Sardor Khamdamovich IBRAGIMOV³^

¹Director of Republican Specialized Scientific-Practical Medical Center of Surgery named after Academician V.Vakhidov, Tashkent, Uzbekistan

²Department of Vascular Surgery and Kidney Transplantation, Republican Specialized Scientific-Practical Medical Center of Surgery named after

Academician V.Vakhidov, Tashkent, Uzbekistan

³Intensive Care Unit, Republican Specialized Scientific-Practical Medical Center of Surgery named after Academician V.Vakhidov, Tashkent,

Uzbekistan

^Corresponding author’s Email: dr.sardor.ibragimov@gmail.com

ABSTRACT

Original Article

PII: S225199391900015-9

Aim. This study aimed to access early outcomes of living-related kidney transplantation. Methods. The

results of treatment of 159 patients (135 males and 24 females) with chronic renal disease during 2010-

2018, have been investigated. Two new and traditional methods have been studied. New optimized

method was performed for the main group (n=98) observed since February 2018, while the comparison

group (n=61) from 2010 to February 2018 was operated in the traditional way. The characteristics of the

patients were compared using the Wilcoxon rank-sum test or the Fisher’s exact test as appropriate. All

tests were two-sided, and P<0.05 was considered statistically significant. Analyses were performed

using the R statistical package. Results. In 149 (93.7%) cases, the functional activity of the kidney

transplants was assessed as a primary functioning graft with 95 (96.9%) cases in the main group and 54

(88.5%) in comparison group (P=0.048). Delayed graft function was detected in 2 (2.0%) recipients of the

main group and in 5 (8.2%) cases of the comparison group. In the postoperative period, a significant

decrease in creatinine level was observed in the main group of recipients and on the 1st day it was

221.0±58.7μmol/L, whereas in the comparison group the index was 569.3±84.6 μmol/L (P<0.001). 3-4 days

after surgery, the level of blood creatinine in the main group was significantly (P<0.01) lower than the

comparison group (149.6±25.6 vs. 343.6±69.4 μmol/L). On the first day after surgery, there was also a

significant decrease (P<0.05) in urea level of the main group (11.4±1.61 mmol/L) in comparison with the

comparative group (15.4±0.84 mmol/L). At the time of hospital discharge of recipients, the level of urea

was within normal limits and equal to 8.3±0.80 mmol/L and 9.0±0.95 mmol/L in the main and

comparison groups, respectively (P>0.05). Hemodialysis was required in 3 (3.1%) recipients from the

main group and 3 (4.9%) from the comparison group. The need for corticosteroid therapy was observed

in 2 (2.0%) cases of the main group and in 3 (4.9%) cases from the comparison group. Conclusion. The

effectiveness of improved approaches to patient management and surgical tactics of related kidney

transplantation has been proved, taking into account the verification of the graft functional activity on

the main clinical and biochemical data of the terminal stage of chronic renal failure regression.

Rec.

Rev.

Pub.

06 June 2019

15 July 2019

25 July 2019

Keywords

Kidney Transplantation,

Living-Related Renal

Transplant Recipients,

Early Clinical Outcomes

INTRODUCTION

Kidney transplantation is the treatment of choice for chronic kidney disease. The risk of death for kidney

transplant recipients (KTRs) is less than half of that for dialysis patient. Any differences in patient survival

attributable to different immunosuppressive medication regimens are substantially smaller than the survival

difference between dialysis and transplantation. Specifically, marginally inferior immunosuppressive

medication regimens will result in substantially better patient outcomes than dialysis. Thus, it is better to

perform kidney transplantation even with an inferior immunosuppressive regimen, than to avoid

transplantation altogether [1 ].

According to the world medical statistics, organ transplantation of living donors has a lower incidence of

graft rejection, as well as more satisfactory patient survival rates [2, 3, 4 ]. Currently, there is an improvement in

kidney transplantation results, in connection with which more and more patients with end-stage renal disease

prefer kidney transplantation to permanent program dialysis [5, 6 ].

Every year around the world, the number of living kidney donors increases. It is also likely that

laparoscopic donor nephrectomy, which has a shorter duration of disability and fewer days of hospitalization,

will further increase the number of living donors [7, 8 ].

Citation: Nazirov FG, Bakhritdinov FSh, Ibadov RA, Matkarimov ZT, Suyumov AS, Sobirov JG, Ibragimov SKh. 2019. Characteristics and early clinical outcomes

of patients undergoing living-related kidney transplantation. J. Life Sci. Biomed. 9(4): 96-101; www.jlsb.science-line.com

In the conditions of the national health care system, kidney transplantation, as a radical form of treatment

of chronic renal insufficiency, is at the stage of active development. In this connection, the aim of study was

assessment early outcomes of living-related kidney transplantation.

MATERIAL AND METHODS

The results of treatment of 159 patients (135 males and 24 females) with chronic renal disease, which were

observed from 2010 to 2018 in the department of vascular surgery and kidney transplantation of “RSSPMCS

named after academician V. Vakhidov” were used as the main material. In the course of the research, modern

principles of diagnosis and treatment were used, and complaints, objective examination data, laboratory and

instrumental studies, immediate and long-term results of related kidney transplantation were also analyzed.

The main group consisted of 98 cases observed since February 2018, in which kidney transplantation was

performed according to a new optimized method, the comparison group included 61 cases from January 2010 to

February 2018 operated in the traditional way. Among the recipients of both groups, patients aged from 20 to

44 years prevailed. In the majority of cases, surgeries were performed for male recipients - 135 (84.9%) cases.

The main cause (95.6%) of renal failure was chronic glomerulonephritis, chronic pyelonephritis was detected in

1 (0.6%) case, 1 recipient (0.6%) suffered from type I diabetes, in 2 (1.2%) of the cases had urolithiasis, in 1 (0.6%) of

the patient - chronic renal disease of unknown etiology, and in 1 (0.6%) of the cases polycystic kidney disease

was detected.

Statistical analyze

The characteristics of the patients were compared using the Wilcoxon rank-sum test or the Fisher’s exact

test as appropriate. All tests were two-sided, and P<0.05 was considered statistically significant. Analyses were

performed using the R statistical package.

Ethical approval

The review board and ethics committee of RSCS named after acad. V.Vakhidov approved the study

protocol and informed consents were taken from all the participants.

RESULTS AND DISCUSSION

Despite modern advances in immunosuppression and immunological selection, the results of a living-

related kidney transplantation are better than the results of a cadaveric kidney transplant both in the early

periods after surgery and in the long-term period [9, 10 ]. Literature data allow us to conclude that organ

transplantation from a living-related donor is acceptable from a clinical and ethical perspective and turns out to

be the most effective method of treating patients. In most cases, family members of the patient are living

donors, but recently there has been an increase in the number of donors who have no genetic relationship with

the patient (friends, relatives) [6, 8 ].

In our study by analyzing the results of living-related kidney transplantation from the early postoperative

period, it was revealed that during the study period from 2010 to February 2018 (comparison group) a relatively

high frequency of complications was recorded.

Table 1. Complications of immediate post-operative period

Main group

Comparison group

All

Type of complication

Abs.

Subcutaneous hematoma

1,0%

0,0%

2,0%

3,1%

1,0%

0,0%

4,1%

2,0%

1,6%

3,3%

8,2%

1,6%

6,6%

4,9%

1,3%

2,5%

5,0%

1,3%

0,6%

5,0%

3,1%

Subcutaneous seroma

Lymphorrhea

Hematoma in the graft bed

Wound suppuration

Deep wound infection

Failure of ureterocystanastomosis

Bronchopulmonary complications

Acute cardiovascular failure with a functioning transplant

Citation: Nazirov FG, Bakhritdinov FSh, Ibadov RA, Matkarimov ZT, Suyumov AS, Sobirov JG, Ibragimov SKh. 2019. Characteristics and early clinical outcomes

of patients undergoing living-related kidney transplantation. J. Life Sci. Biomed. 9(4): 96-101; www.jlsb.science-line.com

Table 1 reflects the complications observed in the early post-op period in the group of renal transplant

recipients. Thus, a hematoma in the transplant bed developed in 3 (3.1%) patients of the main group and in 5

(8.2%) cases of the comparison group, making 5.0% of the total number of kidney transplant surgeries. Also,

among the significant complications, bronchopulmonary complications can be identified with the development

of acute respiratory failure, which were recorded in 8 (5.0%) cases, in 4 (4.1%) cases among recipients of the main

group and in 4 (6,6 %) - comparison group. In the main group of recipients 2 (2.0%) cases of acute cardiovascular

insufficiency were noted, in the comparison group it was 3 (4.9%) cases.

In 149 (93.7%) cases, the functional activity of the kidney transplants was assessed as a primary

functioning graft (Table 2), with 95 (96.9%) cases in the main group versus the comparison group (54 (88.5%);

p=0.048). Delayed graft function was detected in 2 (2.0%) recipients of the main group and in 5 (8.2%) cases of

the comparison group.

Table 2. Graft functional activity

Main group

Comparison group

All

Items

Abs.

149

93,7%

96,9%

88,5%

Primary functioning graft

χ²test =3,916; Df=1; р=0,048

Delayed graft function

Acute Graft Rejection

Total

2,0%

1,0%

8,2%

3,3%

4,4%

1,9%

100,0%

159

100,0%

Acute graft rejection was observed after 3 (1.9%) surgeries, while 2 (3.3%) cases were in recipients of the

comparison group. In order to assess the kidney transplant function, we studied the dynamics of creatinine

(µmol/L) and urea indices in recipients.

Figure 1 showed that the differences in baseline creatinine values in the studied groups were not

statistically significant (P>0.05) and amounted to 883.2±24.6 and 923.4±36.0 μmol/L in the main and comparison

groups, respectively. In the postoperative period, a significant decrease in creatinine level was observed in the

main group of recipients and on the 1st day it was 221.0±58.7 μmol/L, whereas in the comparison group the

index was 569.3±84.6 μmol/L (P<0.001). 3-4 days after surgery, the level of blood creatinine in the main group

was 149.6±25.6 μmol/L, significantly lower than the comparison group (343.6±69.4; P<0.01).

1,000

923.4

Comparative day

Main group

Т = 0,92; P>0,05

883.2

800

600

400

200

Т = 3,38; P<0,001

569.3

Т = 2,62; P<0,01

343.6

Т = 2,49; P<0,05

Т = 0,25; P>0,05

221.0

177.4

104.1

100.1

149.6

126.2

before surgery

1st day postop

3-4th day postop

6-8th day postop At the time of discharge

Figure 1. Dynamics of creatinine (µmol/L) after a related kidney transplant

Citation: Nazirov FG, Bakhritdinov FSh, Ibadov RA, Matkarimov ZT, Suyumov AS, Sobirov JG, Ibragimov SKh. 2019. Characteristics and early clinical outcomes

of patients undergoing living-related kidney transplantation. J. Life Sci. Biomed. 9(4): 96-101; www.jlsb.science-line.com

It was also of interest to analyze the dynamics of urea indicators after living-related kidney

transplantation, which is shown in figure 2. Thus, it can be noted that the differences in baseline values in the

studied groups were not statistically significant (P>0.05) and amounted to 24.8±0.87 and 26.0±1.13 μmol/L in the

main and comparison groups, respectively. From the presented dynamics, it can be seen that on the first day

after surgery there was a decrease in urea levels to 11.4±1.61 mmol/L for the main group and to 15.4±0.84

mmol/L for the comparison group (P<0.05). At the time of discharge of recipients from the hospital, the level of

urea was within normal limits and equal to 8.3±0.80 mmol/L and 9.0±0.95 mmol/L in the main and comparison

groups, respectively (P>0.05).

Glomerular Filtration Rate (GFR), as one of the main indicator of kidney transplant function, was also

evaluated by in the dynamics of the postoperative period. A graphical representation of the dynamics of

changes in the GFR calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula

is shown in Figure 3.

In the main group significantly better GFR values were observed already on the 1st day after surgery

relative to the comparison group and averaged 67.5±2.97 ml/min (P<0.01). At the time of discharge, the GFR was

equal to 95.4±2.63 and 88.9±3.94 ml/min in the main and comparison groups, respectively (P>0.05).

Comparative day

Main group

Т = 0,84; P>0,05

26.0

24.8

Т = 2,20; P<0,05

Т = 2,60; P<0,01

15.4

11.4

Т = 0,14; P>0,05

14.9

Т = 0,56; P>0,05

9.6

10.5

9.0

8.3

9.4

before surgery

1st day postop

3-4th day postop

6-8th day postop

At the time of

discharge

Figure 2. Dynamics of urea (mmol/L) after living-related renal transplantation

100

95.4

88.9

Т = 2,75; P<0,01

67.5

Т = 1,37; P>0,05

50.1

Т = 0,21; P>0,05

Comparative day

Main group

6.1

before surgery

6.0

1st day postop

At the time of discharge

Figure 3. Dynamics of GFR (CKD-EPI) (ml / min) after related renal transplantation

Citation: Nazirov FG, Bakhritdinov FSh, Ibadov RA, Matkarimov ZT, Suyumov AS, Sobirov JG, Ibragimov SKh. 2019. Characteristics and early clinical outcomes

of patients undergoing living-related kidney transplantation. J. Life Sci. Biomed. 9(4): 96-101; www.jlsb.science-line.com

5,000

4,000

3,000

2,000

1,000

Т = 0,84; P>0,05

4,254.3

Т = 0,46;

P>0,05

Т = 0,44;

P>0,05

Т = 0,82;

P>0,05

3,025.0

2,810.4

3,542.3

2,560.3

2,430.6

2,370.1

2,215.8

Т = 0,72;

P>0,05

342.4

Comparative day

Main group

326.8

before surgery

1st day postop

3-4th day postop

6-8th day postop

At the time of

discharge

Figure 4. Dynamics of daily diuresis (ml)

When analyzing the indices of daily diuresis in the studied groups of recipients, positive dynamics was

revealed in the main and comparison groups without significant difference. So, on the 1st day after surgery, the

daily output increased from 326.8±16.3 ml to 4254.4±318.9 ml in the main group and from 342.4±14.2 ml to

3542.3±567.4 ml in the comparison group (P>0.05). By the time of the discharge of the recipients, the daily

diuresis was 2215.8±129.5 ml and 2370.1±136.1 ml in the main and comparison groups, respectively (Figure 4).

Data of times of creatinine normalization in the studied groups are reflected in table 3. Thus, in 137 (86.2%)

of the total number of patients, creatinine normalization lasted up to 5 days in the postoperative period, 88

(89.8%) and 49 (80.3%) recipients from the main and comparison groups, respectively. On days 6-7 after surgery,

normal creatinine values were 2 (2.0%) recipients from the main group and 2 (3.3%) from the comparison group.

In 4 (2.5%) cases out of the total number studied, it took 10 or more days to normalize creatinine.

Hemodialysis was required in 3 (3.1%) recipients from the main group and 3 (4.9%) from the comparison

group. The need for corticosteroid therapy was observed in 2 (2.0%) cases of the main group and in 3 (4.9%)

cases from the comparison group (Table 3).

Table 3. The timing of the normalization of creatinine

Main group

Comparison group

All

Items

Abs.

137

Up to 5 days

6-7 days

8-9 days

10 or more days

Hemodialysis was required

It took a pulsotherapy

89,8%

2,0%

1,0%

2,0%

3,1%

80,3%

3,3%

4,9%

86,2%

2,5%

1,9%

2,5%

3,8%

3,1%

2,0%

CONCLUSION

The development of a national school of living-related kidney transplantation made it possible to achieve an

earlier normalization of the main clinical and biochemical parameters (P<0.05-0.001) and thereby improve the

early postoperative indicators of normal functional activity of the graft at the time of discharge from 90.2% (in

the comparison group) to 94.9% (in the main group).

DECLARATIONS

Acknowledgements

This work was supported by Republican specialized scientific–practical medical center of surgery named

after academician V.Vakhidov, Tashkent, Uzbekistan

Citation: Nazirov FG, Bakhritdinov FSh, Ibadov RA, Matkarimov ZT, Suyumov AS, Sobirov JG, Ibragimov SKh. 2019. Characteristics and early clinical outcomes

of patients undergoing living-related kidney transplantation. J. Life Sci. Biomed. 9(4): 96-101; www.jlsb.science-line.com

100

Authors’ Contributions

All authors contributed equally to this work.

Competing interests

The authors declare that they have no competing interests.

REFERENCES

1. Tang M, Li T, Liu H. A Comparison of Transplant Outcomes in Peritoneal and Hemodialysis Patients: A Meta-Analysis.

Blood Purif. 2016; 42(2):170-6. (Search Google Scholar ; Export Citation as EndNote )

2. Cozzi E, Biancone L, López-Fraga M, et al. Long-term outcome of living kidney donation: position paper of the European

Committee on Organ Transplantation, Council of Europe. Transplantation. 2016; 100: 270–271. (Search Google Scholar ;

Export Citation as EndNote )

3. Ghazanfar A, Tavakoli A, Zaki MR et al: The outcomes of living donor renal transplants with multiple renal arteries: A

large cohort study with a mean follow-up period of 10 years. Transplant Proc, 2010; 42: 1654–58. (Search Google Scholar

; Export Citation as EndNote )

4. Huang N, Foster MC, Lentine KL, et al. Estimated GFR for living kidney donor evaluation. Am J Transplant. 2016; 16:171–

180. (Search Google Scholar ; Export Citation as EndNote )

5. Fernández Fresnedo G, de la Oliva Valentín M, Cruzado JM, et al. [Objectives and methodology of S.E.N-ONT guidelines

for living donor kidney transplantation]. Nefrologia. 2010; 30(Suppl 2):1–2. (Search Google Scholar ; Export Citation as

EndNote )

6. Lanot A, Bouvier N, Chatelet V, Lecouf A, Tillou X, Hurault de Ligny B. Outcome of living kidney donors for

transplantation. Nephrol Ther. 2017 Nov; 13(6):448-459. (Search Google Scholar ; Export Citation as EndNote )

7. Cooper M, Kramer A, Nogueira JM, Phelan M: Recipient outcomes of dual and multiple renal arteries following 1000

consecutive laparoscopic donor nephrectomies at a single institution. Clin Transplant, 2013; 27: 261–66. (Search Google

Scholar ; Export Citation as EndNote )

8. Rodríguez Faba O, Boissier R, Budde K, et al. European Association of Urology Guidelines on Renal Transplantation:

Update 2018. Eur Urol Focus. 2018 Mar; 4(2):208-215. (Search Google Scholar ; Export Citation as EndNote )

9. Budde K, Lehner F, Sommerer C, et al. Five-year outcomes in kidney transplant patients converted from cyclosporine to

everolimus: the randomized ZEUS study. Am J Transplant. 2015; 15:119–28. doi:10.1111/ajt. 12952. Epub 2014 Dec 17.

(Search Google Scholar ; Export Citation as EndNote )

10. Filiopoulos V, Boletis JN. Renal transplantation with expanded criteria donors: Which is the optimal

immunosuppression? World J Transplant 2016; 6(1): 103-114. (Search Google Scholar ; Export Citation as EndNote )

Citation: Nazirov FG, Bakhritdinov FSh, Ibadov RA, Matkarimov ZT, Suyumov AS, Sobirov JG, Ibragimov SKh. 2019. Characteristics and early clinical outcomes

of patients undergoing living-related kidney transplantation. J. Life Sci. Biomed. 9(4): 96-101; www.jlsb.science-line.com

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