2-Day-Old’s Kidneys Transplanted In China

 

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They were only 4 centimeters (1.57 inches) long, but surgeons in China nevertheless managed to transplant the kidneys of a two-day-old baby into a nine-year-old girl dying of chronic renal failure.

The procedure was performed recently in the Second Xiagya Hospital of Central South University in Changsha.

This teaching hospital, in central China’s Hunan Province, is big on transplants, even teeny tiny ones.

The kidney recipient, identified by the Chinese news agency Xinhau under the pseudonym Huang Jing, had kidney disease since she was a toddler, and her development was affected. Her new kidneys will, all being well, continue to grow for several months until they reach ‘normal’ size for her age.

After the surgery, ‘Huang’ said, “I am very happy and [I] want to go to school,” the news agency reported recently.

It went on to quote the head of the hospital’s transplant surgery team, Peng Longkai, that kidney transplants for young patients are a challenge due to the complexity of the operation and the tiny blood vessels involved.

The donor in this case died from anoxic encephalopathy, neonatal asphyxia and lung infection, and her parents decided to donate her kidneys to “let her stay in the world in another way.”

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Some Anemia Drugs’ Risks Can Outweigh Benefits: New Study

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Costly drugs used to address anemia in Chronic Kidney Disease (CKD) patients have been found to offer more risks than benefits. In a report on a study published this month in Annals of Internal Medicine, HealthDay said that contrary to previous thinking, drugs called erythropoietin-stimulating agents (ESAs) are not particularly effective in improving CKD patients’ quality of life.

But this class of medications, one intended benefit of which is to raise patients’ hemoglobin, the protein that carries oxygen in the blood, can in some instances – when the hemoglobin level is raised too much – increase patients’ risk of heart attacks, strokes and blood clots.

Drugs in this class include the injectables called Procrit, Epogen, and Aranesp.

Dr. Navdeep Tangri, an attending doctor at Seven Oaks General Hospital Renal Program in Winnipeg, Manitoba, Canada, was senior researcher on the study. He said its findings should “close the book on the idea that these drugs help with exhaustion and improve patients’ quality of life.”

Nevertheless, another expert said, in certain circumstances – where the patients are younger and more active, for example – some users of ESAs do feel somewhat better.

The U.S. Food and Drug Administration says the only reason ESAs should be prescribed is because they do seem to be effective in reducing the need in CKD patients for blood transfusions – a particular concern for individuals awaiting a kidney transplant because multiple transfusions can cause the immune system to generate antibodies with the potential to attack a donor kidney, said Dr. Jeffrey Berns, president of the National Kidney Foundation and a professor of medicine at the University of Pennsylvania.

In Berns’ view, HealthDay noted, it makes sense that these medications would not change day-to-day life for many people with chronic kidney disease, especially those on dialysis. Such patients are often older, have heart disease or other medical conditions, and are mostly sedentary.

“It’s not realistic to expect that you’ll improve their quality of life by raising their hemoglobin a little,” Berns said.

But, he added, younger patients who are still physically active and have full-time jobs or families to take care of may feel the difference when their hemoglobin is at 9 instead of 11.

For their study, Tangri and his colleagues pooled results of clinical trials that tested ESAs and aimed for either relatively higher or lower hemoglobin targets. On average, patients in the higher-target groups got their hemoglobin to between 10 and 14, while those with lower targets had levels between 7 and 12.

Overall, the researchers found, patients with higher hemoglobin reported no bigger gains in quality of life.

There was some evidence that among patients not on dialysis, higher hemoglobin led to bigger improvements in their physical functioning and energy levels. But, Tangri said, the average differences did not appear “clinically meaningful.”

He said the evidence does not support the idea that for certain patients, treatment should be “individualized” to reach a relatively higher hemoglobin level.

Berns disagreed — in part, he said, because the studies have included few younger, healthier patients.

“One of the challenges we have is that a study, or a meta-analysis of studies, tells us about the average for a group of patients,” Berns said. “That doesn’t necessarily tell me what to do with the patient in front of me.”