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Recipient characteristics and morbidity and mortality after liver transplantation.

Sun, 02/18/2018 - 13:45
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Recipient characteristics and morbidity and mortality after liver transplantation.

J Hepatol. 2018 Feb 14;:

Authors: Asrani SK, Saracino G, O'Leary JG, Gonzales S, Kim P, McKenna G, Klintmalm G, Trotter J

Abstract
BACKGROUND: Over the last decade, liver transplantation of sicker, older non-hepatitis C cirrhotics with multiple co-morbidities has increased in the United States.
METHODS: We sought to identify a parsimonious set of recipient factors among HCV negative adult transplant recipients associated with significant morbidity and mortality within 5 years after liver transplantation using national (n=31,829, 2002-2015) and center specific data. Coefficients of relevant recipient factors were converted to weighted points and scaled from 0-5. Recipient factors associated with graft failure included: ventilator support (5 pts; HR 1.59, 95% CI 1.48-1.72); recipient age >60 years (3 pts; HR 1.29, 95% CI 1.23-1.36); hemodialysis (3 pts; HR 1.26, 95% CI 1.16-1.37); diabetes (2 pts; HR 1.20, 95% CI 1.14-1.27); or serum creatinine ≥1.5mg/dL without hemodialysis (2 pts; HR 1.15, 95% CI 1.09-1.22).
RESULTS: Graft survival within 5 years based on points (any combination) was 77.2% (0-4), 69.1% (5-8) and 57.9% (>8). In recipients with > 8 points, graft survival was 42% (MELD<25) and 50% (MELD 25-35) in recipients receiving donors with donor risk index >1.7. In center specific data within the first year, subjects with ≥ 5 points (vs. 0-4) had longer hospitalization (11 vs. 8 days, p<0.01), higher admissions for rehabilitation (12.3% versus 2.7%, p<0.01), and higher incidence of cardiac disease (14.2% vs. 5.3%, p<0.01) and stage 3 chronic kidney disease (78.6% vs. 39.5%, p=0.03) within 5 years.
CONCLUSION: The impact of co-morbidities in a MELD based organ allocation system needs to be reassessed. The proposed clinical tool may be helpful for center specific assessment of risk of graft failure in non HCV patients and discussion regarding relevant morbidity in selected subsets.
LAY SUMMARY: Over the last decade, liver transplantation of sicker, older patient with multiple co-morbidities has increased. In this study, we show that a set of recipient factors (recipient age>60 years, ventilator status, diabetes, hemodialysis and creatinine>1.5mg/dL) can help identify patients that may not do well after transplant. Transplanting sicker organs in patients with certain combinations of these characteristics further leads to lower survival.

PMID: 29454069 [PubMed - as supplied by publisher]

Estimated GFR in stable older kidney transplant recipients - are present algorithms valid? A national cross-sectional cohort study.

Sun, 02/18/2018 - 13:45
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Estimated GFR in stable older kidney transplant recipients - are present algorithms valid? A national cross-sectional cohort study.

Transpl Int. 2018 Feb 17;:

Authors: Heldal K, Midtvedt K, Hartmann A, Reisaeter AV, Heldal TF, Bergan S, Salvador CL, Åsberg A

Abstract
Several equations have been developed for estimated glomerular filtration rate (eGFR) in patients with chronic kidney disease (CKD), but none were developed based on data from elderly kidney transplant recipients (KTR). The primary aim of this study was to evaluate different creatinine based equations in stable elderly KTR. A national cross-sectional study was performed using data from 263 consecutive kidney transplant recipients 60 years or older who performed a routine GFR measurement one year after engraftment. GFR was measured by iohexol clearance calculation based on two samples. eGFR was calculated from a range of different creatinine based equations using information obtained at the time of GFR measurement. Bias, precision, and accuracy were evaluated for each equation. All equations apart from Nankivell had accuracy > 80%. The BIS1, FAS, LMRCR and Cockcroft & Gault equations in recipients older than 70 years and the FAS, LMRCR and MDRD in recipients 60-69 years old had non-significant bias. The CKD-EPI had significant bias in both groups. If one should choose a single equation for follow-up of individual CKD progression in all recipients ≥ 60 years, the FAS or LMRCR equations are probably the best alternatives. This article is protected by copyright. All rights reserved.

PMID: 29453878 [PubMed - as supplied by publisher]

Immune System and Kidney Transplantation.

Sun, 02/18/2018 - 13:45
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Immune System and Kidney Transplantation.

JNMA J Nepal Med Assoc. 2017 Oct-Dec;56(208):482-486

Authors: Shrestha BM

Abstract
The immune system recognises a transplanted kidney as foreign body and mounts immune response through cellular and humoral mechanisms leading to acute or chronic rejection, which ultimately results in graft loss. Over the last five decades, there have been significant advances in the understanding of the immune responses to transplanted organs in both experimental and clinical transplant settings. Modulation of the immune response by using immunosuppressive agents has led to successful outcomes after kidney transplantation. The paper provides an overview of the general organisation and function of human immune system, immune response to kidney transplantation, and the current practice of immunosuppressive therapy in kidney transplantation in the United Kingdom.

PMID: 29453486 [PubMed - in process]

Expression and significance of Sirt1 in renal allografts at the early stage of chronic renal allograft dysfunction.

Sat, 02/17/2018 - 13:45

Expression and significance of Sirt1 in renal allografts at the early stage of chronic renal allograft dysfunction.

Transpl Immunol. 2018 Feb 13;:

Authors: Xia Y, Deng J, Zhou Q, Shao X, Yang X, Shao M, Zou H

Abstract
OBJECTIVE: To investigate the expression and significance of Sirt1 in renal allografts at the early stage of chronic renal allograft dysfunction (CRAD).
METHODS: CRAD rat models were established using classical orthotopic F344-Lewis kidney transplantation. F344 and Lewis uninephrectomized rats were used as controls. Twelve weeks after the operation, the rats were sacrificed for renal function, histological, immunohistochemistry and molecular biological analyses.
RESULTS: The 24-h urinary protein excretion and serum creatinine levels, urine microalbumin/creatinine ratios, and Banff score sums were significantly increased in the CRAD group compared with those in the F344 and Lewis control groups. The degree of mononuclear cell infiltration and interstitial fibrosis (IF) was higher in the CRAD group than in the control groups. Sirt1, TGF-β1, MCP-1, ICAM-1 expression was up-regulated in CRAD. Furthermore, Sirt1 expression was negatively correlated with the 24-h urinary protein excretion and serum creatinine levels, Banff score sums, mononuclear cell infiltration and IF severity, and TGF-β1, MCP-1 and ICAM-1 expression levels.
CONCLUSION: Sirt1 might be involved in the pathogenic process of IF and inflammation at the early stage of CRAD. Thus, Sirt1 represents a novel therapeutic strategy and target for the early prevention and treatment of CRAD.

PMID: 29452170 [PubMed - as supplied by publisher]

Expression patterns of Toll like receptor (TLR)-2, TLR-4 and myeloid differentiation primary response gene 88 (MYD88) in renal transplant patients developing allograft dysfunction; a cohort study.

Sat, 02/17/2018 - 13:45

Expression patterns of Toll like receptor (TLR)-2, TLR-4 and myeloid differentiation primary response gene 88 (MYD88) in renal transplant patients developing allograft dysfunction; a cohort study.

Transpl Immunol. 2018 Feb 13;:

Authors: Hosseinzadeh M, Ahmadpoor P, Yekaninejad MS, Pourrezagholi F, Foroughi F, Ghorbanpour M, Barabadi M, Shahbaz SK, Solgi G, Amirzargar A

Abstract
This cohort intends to determine the sequential dynamic changes in Toll-like receptor (TLR)-4, TLR-2, and myeloid differentiation primary response gene 88 (MYD88) mRNA expressions in PBMCs and biopsy samples from kidney allograft recipients in relation to graft function. This study enrolled 52 renal transplant patients, 27 with well functioning graft (WFG) and 25 graft dysfunction (GD). Peripheral blood samples pre- and post-transplantation (days 2, 90 and 180) were collected to analyze mRNA expression levels of TLR-2, TLR-4, and MYD88 genes in relation to allograft function during one-year follow up. The mean dynamic changes of post-transplant TLR-2, TLR-4, and MYD88 mRNA expressions were significantly higher in GD compared to WFG patients (P = .001). ROC curve analysis based on glomerular filtration rate (GFR) index showed the area under curve (AUC) values for the genes: TLR-2(0.89;P < .001), TLR-4(0.86;P < .001), and MYD88(0.75;P = .003) in the third month post-transplantation for GD diagnosis. The calculated AUCs for the expressions of genes in allograft biopsies were 0.94(TLR-2), 0.95(TLR-4), and 0.98(MYD88) in the sixth month post-transplant based on pathology report (P < .001). Our results indicate that sequential monitoring of the expression patterns of TLR-2, TLR-4, and MYD88 in PBMCs and biopsy samples could be considered as predictive biomarkers for early and late kidney allograft function.

PMID: 29452169 [PubMed - as supplied by publisher]

ERα promotes murine hematopoietic regeneration through the Ire1α-mediated unfolded protein response.

Sat, 02/17/2018 - 13:45
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ERα promotes murine hematopoietic regeneration through the Ire1α-mediated unfolded protein response.

Elife. 2018 Feb 16;7:

Authors: Chapple RH, Hu T, Tseng YJ, Liu L, Kitano A, Luu V, Hoegenauer KA, Iwawaki T, Li Q, Nakada D

Abstract
Activation of the unfolded protein response (UPR) sustains protein homeostasis (proteostasis) and plays a fundamental role in tissue maintenance and longevity of organisms. Long-range control of UPR activation has been demonstrated in invertebrates, but such mechanisms in mammals remain elusive. Here, we show that the female sex hormone estrogen regulates the UPR in hematopoietic stem cells (HSCs). Estrogen treatment increases the capacity of HSCs to regenerate the hematopoietic system upon transplantation and accelerates regeneration after irradiation. We found that estrogen signals through estrogen receptor α (ERα) expressed in hematopoietic cells to activate the protective Ire1α-Xbp1 branch of the UPR. Further, ERα-mediated activation of the Ire1α-Xbp1 pathway confers HSCs with resistance against proteotoxic stress and promotes regeneration. Our findings reveal a systemic mechanism through which HSC function is augmented for hematopoietic regeneration.

PMID: 29451493 [PubMed - as supplied by publisher]

Are we underestimating the quality of aviremic Hepatitis C positive kidneys? Time to reconsider.

Sat, 02/17/2018 - 13:45
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Are we underestimating the quality of aviremic Hepatitis C positive kidneys? Time to reconsider.

Am J Transplant. 2018 Feb 16;:

Authors: Sibulesky L, Kling CE, Blosser C, Johnson CK, Limaye AP, Bakthavatsalam R, Leca N, Perkins JD

Abstract
KDRI introduced in 2009 included Hepatitis C serologic but not viremic status of the donors. With NAT testing now being mandatory, further evaluation of these donors is possible. We conducted a retrospective matched case-control analysis of adult deceased donor kidney transplants performed between 12/5/2014 to 12/31/2016 with the KDRI score and HCV Ab and NAT testing status obtained from UNOS database. The 205 aviremic Hep C Ab+ NAT - kidney transplants were compared to KDRI matched control kidneys that were Hep C Ab-NAT-. The aviremic HCV kidneys were recovered from donors that were significantly younger, more likely to be white, less likely to have hypertension and diabetes. The majority of the recipients of the aviremic HCV kidneys when compared to matched controls were Hepatitis C positive 90.2% vs 4.3%. The recipients were significantly older, were on dialysis shorter and were transplanted sooner. The graft survival of aviremic HCV kidneys was similar (P<0.08). If the HCV status of the aviremic kidneys were assumed to be negative, 122 more kidneys could have been allocated to patients with EPTS <20. Seven kidneys would no longer have KDPI>85%. Further policies might consider these findings to appropriately allocate these kidneys. This article is protected by copyright. All rights reserved.

PMID: 29451354 [PubMed - as supplied by publisher]

An economic assessment of contemporary kidney transplant practice.

Sat, 02/17/2018 - 13:45
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An economic assessment of contemporary kidney transplant practice.

Am J Transplant. 2018 Feb 16;:

Authors: Axelrod D, Schnitzler MA, Xiao H, Irish W, Tuttle-Newhall E, Chang SH, Kasiske BL, Alhamad T, Lentine KL

Abstract
Kidney transplant is the optimal therapy for end stage renal disease, prolonging survival and reducing healthcare spending. Prior economic analyses of kidney transplant using Markov models, have generally assumed compatible, low risk, donors. The economic implications of using deceased donor kidneys with high kidney donor profile index (KPDI) scores, ABO incompatible or HLA incompatible living donors has not been assessed. The costs of transplant and dialysis were compared using discrete event simulation over a 10-year period, using data from the United States Renal Data System, Vizient™ (Irving, Texas), and literature review. Graft failure rates and expenditures were adjusted for donor characteristics. All transplant options were associated with improved survival compared with dialysis (transplant: 5.20-6.34 quality adjusted life years [QALY] vs. dialysis: 4.03 QALY). Living donor and low KDPI deceased donor transplants were cost saving compared with dialysis, while transplants using high KDPI deceased donor, ABO incompatible or HLA incompatible living donors were cost effective (<$100,000 per QALY). Predicted costs per QALY range from $39,939 for HLA compatible living donor transplant to 80,486 for HLA incompatible donors compared with $72,476 for dialysis. In conclusion, kidney transplant is cost-effective across all donor types despite higher costs for marginal organs and innovative living donor practices. This article is protected by copyright. All rights reserved.

PMID: 29451350 [PubMed - as supplied by publisher]

Deleterious Effect of Anti-Angiotensin II Type 1 Receptor Antibodies Detected Pretransplant on Kidney Graft Outcomes is Both Proper and Synergistic WITH DONOR-SPECIFIC ANTI-HLA ANTIBODIES.

Sat, 02/17/2018 - 13:45
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Deleterious Effect of Anti-Angiotensin II Type 1 Receptor Antibodies Detected Pretransplant on Kidney Graft Outcomes is Both Proper and Synergistic WITH DONOR-SPECIFIC ANTI-HLA ANTIBODIES.

Nephrology (Carlton). 2018 Feb 16;:

Authors: Malheiro J, Tafulo S, Dias L, Martins S, Fonseca I, Beirão I, Castro-Henriques A, Cabrita A

Abstract
AIM: Both donor-specific antibodies (DSA) and anti-angiotensin II type 1 receptor antibodies (AT1R-abs) have been associated with poor graft outcomes after kidney transplantation (KT). We aimed to understand the impact of pretransplant AT1R-abs with or without concomitant DSA on KT outcomes.
METHODS: Seventy-six patients transplanted in 2009 were studied. DSA (MFI>1000) and/or AT1R-abs (>10UI) were detected by solid-phase assays in pre-KT sera. Multivariable Cox regression models were used to determine independent predictors of outcomes: acute rejection (AR) and graft failure.
RESULTS: At transplant, 48 patients were AT1R-abs (-)/DSA (-), 12 AT1R-abs (+)/DSA (-), 9 AT1R-abs (-)/DSA (+) and 7 AT1R-abs (+)/DSA (+). Incidence of acute rejection at 1-year increased from 6% in AT1R-abs (-)/DSA (-), to 35% in AT1R-abs (+)/DSA (-), 47% in AT1R-abs (-)/DSA (+) and 43% in AT1R-abs (+)/DSA (+) (P<0.001). No difference in DSA strength and C1q-binding ability was observed between AT1R-abs (-) /DSA (+) and AT1R-abs (+)/DSA (+) patients. Graft survival at 6-years was the lowest in AT1R-abs (+)/DSA (+) (57%), followed by AT1R-abs (+)/DSA (-) (67%), and higher in AT1R-abs (-)/DSA (-) (94%) and AT1R-abs (-)/DSA (+) (89%) patients (P=0.012). AT1R-abs (+)/DSA (-) (HR=6.41, 95% CI: 1.43-28.68; P=0.015) and AT1R-abs (+)/DSA (+) (HR=7.75, 95% CI: 1.56-38.46; P=0.012) were independent predictors of graft failure.
CONCLUSIONS: AR incidence and graft failure were associated with both DSA and AT1R-abs. These results demonstrate a proper negative effect of AT1R-abs on graft outcomes, besides a synergistic one with DSA. Pretransplant AT1R-abs should be acknowledge to better stratify patients' immunological risk.

PMID: 29451342 [PubMed - as supplied by publisher]

Control release of mitochondria-targeted antioxidant by injectable self-assembling peptide hydrogel ameliorated persistent mitochondrial dysfunction and inflammation after acute kidney injury.

Sat, 02/17/2018 - 13:45
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Control release of mitochondria-targeted antioxidant by injectable self-assembling peptide hydrogel ameliorated persistent mitochondrial dysfunction and inflammation after acute kidney injury.

Drug Deliv. 2018 Nov;25(1):546-554

Authors: Zhao M, Zhou Y, Liu S, Li L, Chen Y, Cheng J, Lu Y, Liu J

Abstract
Persistent mitochondrial injury occurs after acute kidney injury (AKI) and mitochondria-targeted antioxidant Mito-2,2,6,6-tetramethylpiperidine-N-oxyl (TEMPO) (MT) has shown benefits for AKI, but its efficiency is limited by short half-life and side effect in vivo. Self-assembling peptide (SAP) hydrogel is a robust platform for drug delivery. This study aims to develop an SAP-based carrier to slow release MT for enhancing its long-term therapeutic potency on AKI. The KLD with aspartic acid (KLDD) was designed. The microstructure and in vitro release of MT was assayed. The protective role of MT-loaded SAP (SAP-MT) hydrogel on renal mitochondrial injury, tubular apoptosis, and inflammation was evaluated in mice at five days after ischemia-reperfusion injury (IRI). Our results showed that KLDD could self-assemble into cross-linked nanofiber hydrogel and it had lower release rate than free MT and KLD hydrogel. Compared to IRI and free MT mice, SAP-MT mice exerted reduced renal mitochondria-produced ROS (mtROS) and improved mitochondrial biogenesis and architecture. Consequently, SAP-MT mice showed less renal tubular cell apoptosis, kidney injury marker kidney injury molecule-1 (Kim-1) expression, lower level of pro-inflammatory factors expression, and macrophages infiltration than those of IRI and free MT mice. This study suggested that SAP-MT ameliorated IRI due to its extended mitochondrial protection role than free MT and thus improved the long-term outcomes of AKI.

PMID: 29451033 [PubMed - in process]

Mycobacterium abscessus Complex Infections: A Retrospective Cohort Study.

Sat, 02/17/2018 - 13:45
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Mycobacterium abscessus Complex Infections: A Retrospective Cohort Study.

Open Forum Infect Dis. 2018 Feb;5(2):ofy022

Authors: Sfeir M, Walsh M, Rosa R, Aragon L, Liu SY, Cleary T, Worley M, Frederick C, Abbo LM

Abstract
Background: Infections caused by Mycobacterium abscessus group strains are usually resistant to multiple antimicrobials and challenging to treat worldwide. We describe the risk factors, treatment, and clinical outcomes of patients in 2 large academic medical centers in the United States.
Methods: A retrospective cohort study of hospitalized adults with a positive culture for M. abscessus in Miami, Florida (January 1, 2011, to December 31, 2014). Demographics, comorbidities, the source of infection, antimicrobial susceptibilities, and clinical outcomes were analyzed. Early treatment failure was defined as death and/or infection relapse characterized either by persistent positive culture for M. abscessus within 12 weeks of treatment initiation and/or lack of radiographic improvement.
Results: One hundred eight patients were analyzed. The mean age was 50.81 ± 21.03 years, 57 (52.8%) were females, and 41 (38%) Hispanics. Eleven (10.2%) had end-stage renal disease, 34 (31.5%) were on immunosuppressive therapy, and 40% had chronic lung disease. Fifty-nine organisms (54.6%) were isolated in respiratory sources, 21 (19.4%) in blood, 10 (9.2%) skin and soft tissue, and 9 (8.3%) intra-abdominal. Antimicrobial susceptibility reports were available for 64 (59.3%) of the patients. Most of the isolates were susceptible to clarithromycin, amikacin, and tigecycline (93.8%, 93.8%, and 89.1%, respectively). None of the isolates were susceptible to trimethoprim/sulfamethoxazole, and only 1 (1.6%) was susceptible to ciprofloxacin. Thirty-six (33.3%) patients early failed treatment; of those, 17 (15.7%) died while hospitalized. On multivariate analysis, risk factors significantly associated with early treatment failure were disseminated infection (odds ratio [OR], 11.79; 95% confidence interval [CI], 1.53-81.69; P = .04), acute kidney injury (OR, 6.55; 95% CI, 2.4-31.25; P = .018), organ transplantation (OR, 2.37; 95% CI, 2.7-23.1; P = .005), immunosuppressive therapy (OR, 2.81; 95% CI, 1.6-21.4; P = .002), intravenous amikacin treatment (OR, 4.1; 95% CI, 0.9-21; P = .04), clarithromycin resistance (OR,79.5; 95% CI, 6.2-3717.1, P < .001), and presence of prosthetic device (OR, 5.43; 95% CI, 1.57-18.81; P = .008). Receiving macrolide treatment was found to be protective against early treatment failure (OR, 0.13; 95% CI, 0.002-1.8; P = .04).
Conclusions: Our cohort of 108 M. abscessus complex isolates in Miami, Florida, showed an in-hospital mortality of 15.7%. Most infections were respiratory. Clarithromycin and amikacin were the most likely agents to be susceptible in vitro. Resistance to fluoroquinolone and trimethoprim/sulfamethoxazole was highly common. Macrolide resistance, immunosuppression, and renal disease were significantly associated with early treatment failure.

PMID: 29450214 [PubMed]

Transplant Center Variability in Disparities for African-American Kidney Transplant Recipients.

Sat, 02/17/2018 - 13:45
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Transplant Center Variability in Disparities for African-American Kidney Transplant Recipients.

Ann Transplant. 2018 Feb 16;23:119-128

Authors: Taber DJ, Gebregziabher M, Srinivas T, Egede LE, Baliga PK

Abstract
BACKGROUND Disparities research has traditionally focused on patient-level variables to ascertain predominant risk factors driving differences in outcomes for African-American (AA) kidney transplant recipients. Our objectives were to determine the magnitude and impact of transplant center variability for graft outcome disparities. MATERIAL AND METHODS This was a retrospective cohort study analyzing 25 years of U.S. national transplant registry data at both the patient and center levels using univariate descriptive statistics and multivariable modeling. RESULTS A total of 257,024 recipients from 191 centers were analyzed; AAs represented 31.1% of recipients. After adjusting for baseline characteristics, AAs had 42% higher risk of graft loss (aHR 1.42, 95% CI 1.39 to 1.45; p<0.001). Center variability for graft outcome disparities in AAs was significant (race*center interaction term p<0.05), with the aHRs ranging from 0.5 to 4.9; 46% of centers demonstrated a non-statistically significant disparity (aHR p>0.05) and 25% of centers had a large AA disparity (aHR >1.75). In a more recent transplant time period (2000-14), overall racial disparities decreased but center-level disparities increased in variability. Center-level factors significantly associated with increasing disparity included higher acute rejection rates, fewer transplants per year, longer length of stay, lower use of calcineurin inhibitors (CNI), and lower living donor rates. CONCLUSIONS There is evidence of significant center-level variability in graft outcome disparities for AA kidney recipients. Further, there appears to be a number of center-level factors associated with this variability, including acute rejection rates, CNI use, number of transplants per year, and, in recent years, low living donor rates.

PMID: 29449524 [PubMed - in process]

Skin disorders in renal transplant recipients: a retrospective study.

Sat, 02/17/2018 - 13:45
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Skin disorders in renal transplant recipients: a retrospective study.

An Bras Dermatol. 2017 Sep-Oct;92(5):638-641

Authors: Garrido PMC, Borges-Costa J

Abstract
BACKGROUND: Immunosuppressive therapy, which is necessary to avoid graft rejection in renal transplant recipients, presents an increased risk of several pathologies, namely infectious and neoplastic.
OBJECTIVES: To identify the most frequent skin diseases and their clinical and demographical risk factors within a population of renal transplant recipients.
METHODS: A retrospective study of renal transplant recipients referred to dermatology visit and observed for the first time from January 2008 to December 2014.
RESULTS: The study included 197 patients, 120 men (60,9%). Mean age was 50,7 years (±13,4). 12 patients (6,1%) had previous skin cancer. Infections were the most frequent reason of referral (93/197; 44%). From the total referred, 18,3% (36/197) presented pre-cancerous lesions. Malignancy was diagnosed in 36 patients (18,3%), with 29 non-melanoma skin cancers (14,7%) and 7 Kaposi sarcomas (3,6%). Ratio of basal cell carcinoma to squamous cell carcinoma was 1,1:1. Non-melanoma skin cancer was significantly associated with older age (p = 0,002), male gender (p = 0,028), history of previous skin cancer (p = 0,002) and higher duration of immunosuppressive therapy (p<0,001).
STUDY LIMITATIONS: Retrospective study, with data from the first visit in dermatology. We didn't made classification on skin-types.
CONCLUSIONS: The great incidence of cutaneous infections and skin cancer is responsible for a significant morbidity. It is important to assure the regular dermatological follow-up of renal transplant recipients, which will promote the prevention, an early diagnosis and an efficient treatment.

PMID: 29166499 [PubMed - indexed for MEDLINE]

Nudging the Organ Discard Problem.

Sat, 02/17/2018 - 13:45
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Nudging the Organ Discard Problem.

Transplantation. 2017 07;101(7):1518-1519

Authors: White SL

PMID: 28272289 [PubMed - indexed for MEDLINE]

Successful Transplantation of 2 Discolored Kidneys Caused by Myoglobin Casts From a Donor With Rhabdomyolysis.

Sat, 02/17/2018 - 13:45
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Successful Transplantation of 2 Discolored Kidneys Caused by Myoglobin Casts From a Donor With Rhabdomyolysis.

Transplantation. 2017 07;101(7):e221-e222

Authors: Chen CB, Zhou J, Wang XP, Han M, Chen WF, Yuan XP

PMID: 28252561 [PubMed - indexed for MEDLINE]

Renal Function in Type 2 Diabetes Following Gastric Bypass.

Sat, 02/17/2018 - 13:45
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Renal Function in Type 2 Diabetes Following Gastric Bypass.

Dtsch Arztebl Int. 2016 Dec 09;113(49):827-833

Authors: Billeter AT, Kopf S, Zeier M, Scheurlen K, Fischer L, Schulte TM, Kenngott HG, Israel B, Knefeli P, Büchler MW, Nawroth PP, Müller-Stich BP

Abstract
BACKGROUND: Metabolic surgery for obese patients with type 2 diabetes (T2D) yields short- and long-term remission rates of 60-90%. Its effects on diabetesassociated complications such as neuropathy and nephropathy have not been well studied to date. Hardly any data are available on this subject with respect to moderately obese patients (body mass index [BMI] 25-35 kg/m2) with insulin-dependent T2D. Our previous studies suggest that, in such patients, treatment with a Roux-en-Y gastric bypass (RYGB) improves diabetic neuropathy. In this pilot study, we investigate the course of diabetic nephropathy after RYGB surgery.
METHODS: 20 insulin-dependent patients whose T2D was inadequately controlled with medication, and whose BMI was in the range 25-35 kg/m2, were prospectively included in a pilot study. All patients underwent a standardized RYGB operation. Blood and urine tests for renal function were performed before surgery and 12 and 24 months afterward.
RESULTS: The serum creatinine level fell from 0.82 ± 0.23 to 0.69 ± 0.13 mg/dL (p = 0.0025) in the first 12 months after surgery and was unchanged a further 12 months later. The glomerular filtration rate (eGFR) rose in the first 24 months after surgery from 96.4 ± 28.7 to 111.7 ± 23.3 mL/min/1.73 m2 (p = 0.0093). The urinary albumin/creatinine and high-molecular-weight adiponectin/creatinine ratios fell markedly in the first 24 months after surgery (2.89 ± 3.14 versus 1.00 ± 0.24 mg/mmol [p = 0.0491] and 0.18 ± 0.06 versus 0.04 ± 0.01 μg/g [p = 0.0392]).
CONCLUSION: RYGB has positive effects on renal function and may therefore be a good treatment option for moderately obese, insulin-dependent patients whose T2D cannot be adequately controlled with medication. These results still need to be confirmed in randomized, controlled trials with longer periods of followup.

PMID: 28098067 [PubMed - indexed for MEDLINE]

Prognostic impact of SPECT-MPI after renal transplantation.

Sat, 02/17/2018 - 13:45
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Prognostic impact of SPECT-MPI after renal transplantation.

J Nucl Cardiol. 2017 Feb;24(1):295-303

Authors: Abuzeid W, Iwanochko RM, Wang X, Kim SJ, Husain M, Lee DS

Abstract
BACKGROUND: While renal transplantation is increasingly performed for end-stage renal disease, there is a paucity of data on cardiac screening and prognostication post-transplant. We determined the prognostic value of SPECT-MPI in a cohort who underwent renal transplantation.
METHODS: Among 4933 renal transplant recipients identified from the Canadian Organ Replacement Register, we examined outcomes of patients who underwent SPECT-MPI in Ontario, Canada. We determined morbidity and mortality using hospitalization and vital statistics registries, according to SPECT-MPI findings.
RESULTS: We studied 282 renal transplant recipients (median age 46 years [25th, 75th percentile 37, 58]) with detailed SPECT-MPI results available, followed for a median of 5.7 (3.3, 7.7) years. Among those undergoing SPECT-MPI (66% pharmacologic stress), 41% had an abnormal summed stress score (SSS > 0) and 31% demonstrated abnormal summed difference score (SDS > 0). Rates of cardiovascular death were 0.4 per 100 person-years among those with normal stress perfusion (SSS = 0) and 0.4 per 100 person-years with SDS = 0. After adjusting for age, sex, prior myocardial infarction (MI), and cardiac risk factors, an SSS ≥ 4 conferred increased risk of cardiovascular death or cardiovascular hospitalization with adjusted hazard ratios of 2.52 (95% CI 1.41, 4.52, P = .002) for SSS 4-6 and 2.61 (95% CI 1.52, 4.49, P < .001) for SSS ≥ 7. SDS was a significant predictor of cardiovascular death or hospitalization, with adjusted hazard ratios of 2.96 (95% CI 1.72, 5.09, P < .001) for SDS 4-6 and 3.26 (95% CI 1.64, 6.50, P < .001) for SDS ≥ 7.
CONCLUSION: Among renal transplant recipients, SPECT-MPI predicted risk of cardiovascular death and cardiovascular hospitalization events.

PMID: 27663251 [PubMed - indexed for MEDLINE]

Solid organ transplant in individuals with monoclonal B-cell lymphocytosis and chronic lymphocytic leukaemia.

Sat, 02/17/2018 - 13:45
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Solid organ transplant in individuals with monoclonal B-cell lymphocytosis and chronic lymphocytic leukaemia.

Br J Haematol. 2016 07;174(1):162-5

Authors: Strati P, Gharaibeh KA, Leung N, Cosio FG, Call TG, Shanafelt TD

PMID: 26436615 [PubMed - indexed for MEDLINE]

Biomarkers of Operational Tolerance Following Kidney Transplantation - The Immune Tolerance Network Studies of Spontaneously Tolerant Kidney Transplant Recipients.

Fri, 02/16/2018 - 13:45

Biomarkers of Operational Tolerance Following Kidney Transplantation - The Immune Tolerance Network Studies of Spontaneously Tolerant Kidney Transplant Recipients.

Hum Immunol. 2018 Feb 12;:

Authors: Newell KA, Adams AB, Turka LA

Abstract
Studies of kidney transplant recipients who have developed spontaneous and sustained tolerance have revealed an association with B cells. Unexpectedly tolerant individuals are characterized by increased numbers and frequencies of B cells in the blood and increased expression of genes associated with B cells in the blood and urine. Comparisons of the B cell repertoires of tolerant individuals and those receiving immunosuppression reveal that not only are the B cells more numerous but developmental differences result in a repertoire comprised of more naïve and transitional B cells in the tolerant cohort. B cells isolated from tolerant individuals also display functional differences compared to those from individuals receiving immunosuppression. Many of these differences may serve to suppress alloimmunity. Lastly a significant number of transplant recipients receiving standard immunosuppression display B cell-biased patterns of gene expression predictive of tolerance or a pro-tolerogenic state. Interestingly, this pattern is associated with improved renal allograft function. While recent studies have raised the concern that immunosuppressive drugs heavily influence B cell-based "signatures of tolerance", a substantial body of work suggests that differences in B cells may be a useful tool for identifying tolerant kidney transplant recipients or guiding their immunosuppressive management.

PMID: 29448053 [PubMed - as supplied by publisher]

Survival advantage of planned haemodialysis over peritoneal dialysis: a cohort study.

Fri, 02/16/2018 - 13:45

Survival advantage of planned haemodialysis over peritoneal dialysis: a cohort study.

Nephrol Dial Transplant. 2018 Feb 13;:

Authors: Thiery A, Séverac F, Hannedouche T, Couchoud C, Do VH, Tiple A, Béchade C, Sauleau EA, Krummel T, REIN registry

Abstract
Background: Previous studies comparing the outcomes in haemodialysis (HD) with those in peritoneal dialysis (PD) have yielded conflicting results.
Methods: The aim of the study was to compare the survival of planned HD versus PD patients in a cohort of adult incident patients who started renal replacement therapy (RRT) between 2006 and 2008 in the nationwide REIN registry (Réseau Epidémiologie et Information en Néphrologie). Patients who started RRT in emergency or stopped RRT within 2 months were excluded. Adjusted Cox models, propensity score matching and marginal structural models (MSMs) were used to compensate for the lack of randomization and provide causal inference from longitudinal data with time-dependent treatments and confounders including transplant censorship, modality change over time and time-varying covariates.
Results: Among a total of 13 767 dialysis patients, 13% were on PD at initiation of RRT and 87% were on HD. The median survival times were 53.5 months or 4.45 years and 38.6 months or 3.21 years for patients starting on HD and PD, respectively. Regardless of the model used, there was a consistent advantage in terms of survival for HD patients: hazard ratio (HR) 0.76 [95% confidence interval (95% CI) 0.69-0.84] with the Cox model using propensity score; HR 0.67 (95% CI 0.62-0.73) in the Cox model with censorship for each treatment change; and HR 0.82 (95% CI 0.69-0.97) with MSMs. However, MSMs tended to reduce the survival gap between PD and HD patients.
Conclusion: This large cohort study using various statistical methods to minimize the bias appears to demonstrate a better survival in planned HD than in PD.

PMID: 29447408 [PubMed - as supplied by publisher]

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