Clinical and experimental strategies to increase the donor pool in kidney and pancreas transplantation
[eng] INTRODUCTION: Kidney transplantation is the treatment of choice for patients with End-Stage Chronic Kidney Disease, and for those patients with End-Stage Chronic Kidney Disease and diabetes, combined pancreas-kidney transplantation is the treatment with the best survival rates. However, the cu...
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| Tipo de recurso: | tesis doctoral |
| Estado: | Versión publicada |
| Fecha de publicación: | 2024 |
| País: | España |
| Institución: | Universidad de Barcelona |
| Repositorio: | Dipòsit Digital de la UB |
| OAI Identifier: | oai:diposit.ub.edu:2445/213940 |
| Acceso en línea: | https://hdl.handle.net/2445/213940 http://hdl.handle.net/10803/691525 |
| Access Level: | acceso abierto |
| Palabra clave: | Nefrologia Trasplantament d'òrgans Pàncrees Donants d'òrgans Nephrology Transplantation of organs Pancreas Organ donors |
| Sumario: | [eng] INTRODUCTION: Kidney transplantation is the treatment of choice for patients with End-Stage Chronic Kidney Disease, and for those patients with End-Stage Chronic Kidney Disease and diabetes, combined pancreas-kidney transplantation is the treatment with the best survival rates. However, the current shortage of solid organs is the main limitation in responding to the growing number of patients on the waiting list, so strategies are required to increase the number of donors to meet these needs. HYPOTHESIS: In kidney and pancreas transplantation, the acceptance of elderly donors for elderly recipients, pre-dialysis kidney and pancreas transplantation, as well as the acceptance of pancreas from non-diabetic donors with insulin requirements, would be clinical strategies capable of increasing the number of pancreas and kidneys available for transplantation. Likewise, an experimental preclinical strategy consisting of the administration of Yamanaka factors and the implantation of renal tubuloids could constitute a promising strategy to further increase the number of organs suitable for transplantation, being, in the first case, normothermic perfusion a promising platform for the effective and safe study of this therapy. OBJECTIVES: - Objective 1: To evaluate the survival of the elderly recipient and the renal graft after an isolated and simultaneous pancreas-kidney transplant. - Objective 2: To analyze and propose a definition of delayed graft function that allows for the identification of patients at risk of worse post-transplant outcomes. - Objective 3: To assess whether concurrent pancreas-kidney transplantation prior to the start of dialysis provides a survival benefit and facilitates the use of expanded criteria donors without worsening post-transplant outcomes. - Objective 4: To analyze the results in the survival of the recipient and graft after a non-diabetic donor renopancreas transplant with insulin requirements. - Objective 5: To develop and analyze a regenerative therapy strategy based on tubuloids and viral vectors to condition suboptimal kidney grafts. |
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