Cold Ischemia Timeas a Risk Factor ror Graft Dysfunction Types in Kidney Transplant Recipients variată am constatat că timpul de ischemie rece a fost un factor de risc independent pentru DGF [HR = 1,003, 95% CI = 1,001-1,006, p = 0,01], dar nu şi pentru SGF. Concluzie: În concluzie, am constatat că diferitele tipuri de disfuncţie ale grefei renale sunt asociate cu un timp de ischemie rece ridicat şi timpul de ischemie rece a fost un factor de risc important pentru DGF, dar nu si al SGF la beneficiarii de transplant renal.

Perioperative acid-base disturbance could be informative regarding the possible slow graft function (SGF) or delayed graft function (DGF) development. There is a lack of data regarding the relationship between perioperative acid-base parameters and graft dysfunction in kidney transplant (KT) recipients. We aim to determine the incidence of graft dysfunction types and the association between them and acid-base parameters. We performed a prospective, cohort study on 54 adults, KT recipients, between 1^st of January 2019 and 31^st of December 2019. Graft function was defined and classified in three categories: immediate graft function (IGF) (serum creatinine < 3 mg/dL at day 5 after KT), SGF (serum creatinine ≥ 3mg/dL at day 5 or ≥ 2.5mg dL at day 7 after KT) and DGF (the need for at least one dialysis treatment in the first week after kidney transplantation). Among the 54 KT recipients, the incidence of SGF and DGF was 13% and 11.1%, respectively. SGF was significantly associated with lower intraoperative pH (7.26± 0.05 vs 7.35± 0.06, p= 0.004), preoperative and intraoperative base excess (BE) [−7.0 (−10.0 ߝ −6.0) vs −3.4 (−7.8 ߝ − 2.1) mmol/L, p= 0.04 and −10.3 (−11.0 ߝ −9.1) vs −4.0 (−6.3 ߝ − 3.0) mmol/L, p= 0.002, respectively] and serum bicarbonate (HCO3⁻) (16.0± 2.7 vs 19.3± 3.4 mmol/L, p= 0.01 and 14.1± 1.9 vs 18.8± 3.2 mmol/L, p= 0.002 respectively), compared to IGF. DGF was significantly associated with lower intraoperative values of pH (7.27± 0.05 vs 7.35± 0.06, p= 0.003), BE [−7.1 (−10.9 ߝ −6.1) vs −4.0 (−6.3 ߝ − 3.0) mmol/L, p= 0.02] and HCO3⁻ (15.9± 2.4 vs 18.8± 3.2 mmol/L, p=0.02) compared to IGF. No differences were observed between SGF and DGF patients in any of the perioperative acid-base parameters. In conclusion we found that kidney graft dysfunction types are associated with perioperative acid-base parameters and perioperative metabolic acidosis could provide important information to predict SGF or DGF occurrence.

Fabry disease (FD) is a rare, X-linked, lysosomal storage multisystemic disorder which may lead to kidney failure and require kidney transplantation (KT). Data on long-term kidney allograft outcomes and the evolution of systemic FD under dis-ease-specific therapy after KT remain limited. We retrospectively evaluated six kidney transplant recipients (KTRs) with FD followed in our center for median tine after KT of 7 years (range, 4-13). Five patients (83.3%) were males and five had a classic Fabry phe-notype. At last follow-up patient survival was 100% and five out of six KTR had a func-tional kidney graft. Among KTRs with a functioning graft, the median change is esti-mated glomerular filtration rate from 1-year to last follow-up was +3.3 ml/min/1.73m2 (range, -50.7 to +10.5), while proteinuria remained low. One patient developed late an-tibody-mediated rejection with de novo donor-specific antibodies and graft loss at 8 years post-transplantation. Five KTRs were receiving enzyme replacement therapy at the time of KT. Three patients were subsequently switched to migalastat and two later returned to enzyme replacement therapy. Lyso-Gb3 and cardiac structural parameters showed heterogenous longitudinal trajectories despite generally preserved kidney graft function. No cardiovascular events occurred during follow-up. These findings support KT as an effective renal replacement therapy in FD and highlight the need for contin-uous Fabry-specific therapy and multidisciplinary surveillance after transplantation.

Kidney transplantation is the treatment of choice for end-stage renal disease, although delayed graft function remains a frequent early complication with important clinical implications. Because early graft recovery depends on adequate perfusion, careful perioperative volume assessment and hemodynamic optimization are essential. Conventional markers such as interdialytic weight gain and estimated dry weight provide only indirect information on intravascular volume and may lead to pre-transplant misclassification of volume status. Complementary tools, including bioimpedance, natriuretic peptides, and congestion-focused ultrasound, may improve characterization of fluid distribution and hemodynamic stress, but none reliably define effective graft perfusion. Pressure-based parameters remain central to perioperative management; however, mean arterial pressure reflects systemic perfusion pressure and may be preserved despite reduced renal blood flow. Central venous pressure is an imprecise surrogate of intravascular volume and fluid responsiveness, with inconsistent associations with clinical outcomes across studies. In this context, flow-guided strategies based on dynamic indices of fluid responsiveness provide a more direct assessment of circulatory adequacy and have been associated, in selected studies, with improved early graft outcomes. Overall, the evidence supports a multimodal approach integrating volume assessment tools with pressure- and flow-oriented monitoring to optimize graft perfusion and early transplant outcomes.