Skip directly to content

PubMed Kidney Transplant

Subscribe to PubMed Kidney Transplant feed PubMed Kidney Transplant
NCBI: db=pubmed; Term=kidney transplant
Updated: 57 min 45 sec ago

Liver involvement in kidney disease and vice versa.

57 min 45 sec ago
Related Articles

Liver involvement in kidney disease and vice versa.

Pediatr Nephrol. 2017 Jun 23;:

Authors: Van Hoeve K, Mekahli D, Morava E, Levtchenko E, Witters P

Abstract
The liver and kidneys are often similarly affected by a single disease. This is the case in metabolic, immunological, toxic, and infectious diseases, and in the different congenital malformation syndromes. Also, an enzymatic defect in an otherwise healthy liver or the consequences of advanced liver disease by itself can cause kidney disease as a secondary phenomenon. In this review, we describe numerous pathogenic mechanisms leading to dysfunction or malformations of the liver and kidneys in children. We encourage multidisciplinary management for optimal care. A combined liver-kidney transplantation is sometimes needed.

PMID: 28646278 [PubMed - as supplied by publisher]

A potential role of the unfolded protein response in post-transplant cancer.

57 min 45 sec ago
Related Articles

A potential role of the unfolded protein response in post-transplant cancer.

Clin Sci (Lond). 2017 Jul 01;131(13):1429-1436

Authors: Bodeau S, Sauzay C, Pluquet O, Choukroun G, Galmiche A

Abstract
Cancer is one of the major causes of mortality in organ transplant patients receiving immunosuppressive regimen based on Cyclosporin A (CsA). Organ transplantation and chronic immunosuppression are typically associated with skin cancers (both squamous cell carcinoma and melanoma) and renal cell carcinoma (RCC). Recent studies have shown that in addition to its immunosuppressive effects, accounted for by the inhibition of calcineurin and the modulation of the transcriptional programme of lymphocytes, CsA also directly stimulates the growth and aggressive behaviour of various cancer cells. Using renal carcinogenesis as an example, we discuss the current evidence for a role of cellular proteostasis, i.e. the regulation of the production, maturation and turnover of proteins in eukaryotic cells, in tumorigenesis arising under conditions of chronic immunosuppression. We present the recent studies showing that CsA induces the unfolded protein response (UPR) in normal and transformed kidney cells. We examine how the UPR might be important, considering in particular the genomic analyses showing the existence of a correlation between the levels of expression of the actors of the UPR, the chaperones of the endoplasmic reticulum (ER) and the aggressiveness of renal carcinoma. The UPR may offer a possible explanation for how immunosuppressive regimens based on CsA promote renal carcinogenesis. We discuss the opportunities offered by this biological knowledge in terms of screening, diagnosis and treatment of post-transplant cancers, and propose possible future translational studies examining the role of tumour proteostasis and the UPR in this context.

PMID: 28645931 [PubMed - in process]

Gastrointestinal stromal tumors (GIST) presenting in the liver: Diagnostic, prognostic and therapeutic issues.

57 min 45 sec ago
Related Articles

Gastrointestinal stromal tumors (GIST) presenting in the liver: Diagnostic, prognostic and therapeutic issues.

Clin Res Hepatol Gastroenterol. 2017 Jun 20;:

Authors: Joyon N, Dumortier J, Aline-Fardin A, Caramella C, Valette PJ, Blay JY, Scoazec JY, Dartigues P

Abstract
CONTEXT: Extra-gastrointestinal stromal tumors (E-GIST) presenting in the liver are exceedingly rare and raise difficult diagnostic and therapeutic challenges.
METHODS: We report on two cases of liver E-GIST with different clinical presentations. We describe their clinical and imaging features, their histopathological and molecular characteristics, their treatment and their course.
RESULTS: The first case was that of a 56-year-old male presenting with a 10-cm liver mass; the initial diagnosis, made in 1986 from a biopsy sample, was leiomyosarcoma; liver transplantation was performed in 1987; no extra-hepatic tumor was found; the course was uneventful until 1999, when tumor recurrence was diagnosed along the initial biopsy route; after reevaluation of available material, the definitive pathological diagnosis was GIST; imatinib treatment resulted in major response; the patient died of end-stage kidney disease 22 years after the initial diagnosis and 9 years after tumor recurrence. The second case is that of a 59-year-old female presenting with a 23-cm abdominal mass connected to the liver; on biopsy, the tumor was diagnosed as epithelioid GIST with exon 11 KIT mutation; imatinib treatment resulted in stable disease.
CONCLUSIONS: The diagnosis of E-GIST must be for any sarcoma presenting in the liver and confirmed by immunohistochemical and molecular techniques. Treatment might require aggressive strategies, which can be successful despite apparently adverse histoprognostic factors.

PMID: 28645742 [PubMed - as supplied by publisher]

alfapump System vs. Large Volume Paracentesis for Refractory Ascites: A Multicenter Randomized Controlled Study.

57 min 45 sec ago
Related Articles

alfapump System vs. Large Volume Paracentesis for Refractory Ascites: A Multicenter Randomized Controlled Study.

J Hepatol. 2017 Jun 20;:

Authors: Bureau C, Adebayo D, de Rieu MC, Elkrief L, Valla D, Peck-Radosavljevic M, McCune A, Vargas V, Simon-Talero M, Cordoba J, Angeli P, Rosi S, MacDonald S, Malago M, Stepanova M, Younossi ZM, Trepte C, Watson R, Borisenko O, Sun S, Inhaber N, Jalan R

Abstract
BACKGROUND AND AIMS: Patients with refractory ascites (RA) require repeated large volume paracenteses (LVP), which involves frequent hospital visits and is associated with poor quality-of-life. This study assessed safety and efficacy of an automated, low-flow pump (alfapump [AP]) compared with LVP [SoC].
METHODS: Randomized, controlled trial, in 7 centers, with 6M patient observation. Primary outcome was time to first LVP. Secondary outcomes included paracentesis requirement, safety, health-related quality-of-life (HRQoL), and survival. Nutrition and hemodynamics were assessed in a sub-study at 3M.
RESULTS: 60 patients randomized and 58 were analyzed (27-AP, 31-SoC, mean age 61.9y, mean MELD 11.7). Eighteen patients were included in the sub-study. Compared with SoC, median time to first LVP was not reached after 6 months in the AP group, meaning a significant reduction in LVP requirement for the AP patients (AP, median not reached; SoC, 15.0 days (95%CI 13.0, 22.0); HR: 0.13, p<0.001), and Chronic Liver Disease Questionnaire (HRQoL) score (p<0.05 between treatment arms). Improvements in nutritional parameters were observed for hand-grip strength (p=0.044) and body mass index (p<0.001) in the sub-study. Compared with SoC, more AP patients reported adverse events (AEs; 96.3% vs. 77.4%, p=0.057) and serious AEs (85.2 vs. 45.2%, p=0.002). AEs consisted predominantly of acute kidney injury in the immediate post-operative period, and re-intervention for pump related issues, and were treatable in most cases. Survival was similar in AP and SoC.
CONCLUSIONS: The AP system is effective in reducing need for paracentesis and improving HRQoL in cirrhotic patients with RA. Although the frequency of SAEs (and by inference hospitalizations) were significantly higher in the AP group, they were generally limited and did not impact survival. www.clinicaltrials.gov#NCT01528410 LAY SUMMARY: The alfapump moves abdominal fluid into the bladder from where it is then removed by urination. Compared with standard treatment, the alfapump reduces the need for large volume paracentesis (manual fluid removal by needle) in patients with medically untreatable ascites. This can improve life quality for these patients.

PMID: 28645737 [PubMed - as supplied by publisher]

Catheter-based renal denervation as therapy for chronic severe kidney-related pain.

57 min 45 sec ago
Related Articles

Catheter-based renal denervation as therapy for chronic severe kidney-related pain.

Nephrol Dial Transplant. 2017 Jun 22;:

Authors: de Jager RL, Casteleijn NF, de Beus E, Bots ML, Vonken EE, Gansevoort RT, Blankestijn PJ

Abstract
Background: Loin pain haematuria syndrome (LPHS) and autosomal dominant polycystic kidney disease (ADPKD) are the most important non-urological conditions to cause chronic severe kidney-related pain. Multidisciplinary programmes and surgical methods have shown inconsistent results with respect to pain reduction. Percutaneous catheter-based renal denervation (RDN) could be a less invasive treatment option for these patients.
Methods: Our aim was to explore the change in perceived pain and use of analgesic medication from baseline to 3, 6 and 12 months after RDN. Patients with LPHS or ADPKD, who experienced kidney-related pain ≥3 months with a visual analogue scale (VAS) score ≥ 50/100 could be included. Percutaneous RDN was performed with a single-electrode radiofrequency ablation catheter.
Results: RDN was performed in 11 patients (6 with LPHS and 5 with ADPKD). Perceived pain declined in the whole group by 23 mm (P = 0.012 for the total group). In patients with LPHS and ADPKD, the median daily defined dosage of analgesic medication decreased from 1.6 [interquartile range (IQR) 0.7-2.3] and 1.4 (IQR 0.0-7.4) at baseline to 0.3 (IQR 0.0-1.9; P = 0.138) and 0.0 (IQR 0.0-0.8; P = 0.285) at 12 months, respectively. Mean estimated glomerular filtration rate decreased in the whole group by 5.4 mL/min/1.73 m 2 at 6 months compared with baseline (P = 0.163).
Conclusions: These results suggest that percutaneous catheter-based RDN reduces pain complaints and the use of analgesic medication in patients with LPHS or ADPKD. The present results can serve as the rationale for a larger, preferably randomized (sham) controlled study.

PMID: 28645206 [PubMed - as supplied by publisher]

Host-related Risk Factors for Adherent Perinephric Fat in Healthy Individuals Undergoing Laparoscopic Living-donor Nephrectomy.

Sat, 06/24/2017 - 12:45
Related Articles

Host-related Risk Factors for Adherent Perinephric Fat in Healthy Individuals Undergoing Laparoscopic Living-donor Nephrectomy.

Surg Laparosc Endosc Percutan Tech. 2017 Jun 21;:

Authors: Narita S, Kumazawa T, Tsuchiya N, Mingguo H, Saito M, Inoue T, Tsuruta H, Numakura K, Maeno A, Nanjo H, Satoh S, Habuchi T

Abstract
PURPOSE: The purpose of this study is to assess the risk factors and characteristics of adherent perinephric fat (APF) in healthy individuals.
PATIENTS AND METHODS: Men who underwent laparoscopic donor nephrectomy were included. Video review was used to divide patients on the basis of APF severity. Relationship between APF scores and clinical and radiographic features was evaluated.
RESULTS: Of the 92 patients, 43 (46.7%) and 8 (8.7%) were categorized as APF and severe APF, respectively. The median total operative time was significantly associated with APF severity. Sex, body mass index, and perinephric fat area, stranding, and thickness were significantly associated with severe APF. In the multivariate analysis, perinephric fat areas and stranding were independent risk factors for severe APF (HR, 1.189 and 14.450, respectively). In the 44 analyzed cytokines, levels of sIL-6R in the perinephric adipose tissue-conditioned medium were significantly higher for APF group than that for non-APF group (P=0.049).
CONCLUSIONS: Host-related risk factors for APF could predict surgical difficulty in patients undergoing partial nephrectomy.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/.

PMID: 28644262 [PubMed - as supplied by publisher]

Non-invasive approaches in the diagnosis of acute rejection in kidney transplant recipients. Part I. In vivo imaging methods.

Sat, 06/24/2017 - 12:45
Related Articles

Non-invasive approaches in the diagnosis of acute rejection in kidney transplant recipients. Part I. In vivo imaging methods.

Clin Kidney J. 2017 Feb;10(1):97-105

Authors: Hanssen O, Erpicum P, Lovinfosse P, Meunier P, Weekers L, Tshibanda L, Krzesinski JM, Hustinx R, Jouret F

Abstract
Kidney transplantation (KTx) represents the best available treatment for patients with end-stage renal disease. Still, full benefits of KTx are undermined by acute rejection (AR). The diagnosis of AR ultimately relies on transplant needle biopsy. However, such an invasive procedure is associated with a significant risk of complications and is limited by sampling error and interobserver variability. In the present review, we summarize the current literature about non-invasive approaches for the diagnosis of AR in kidney transplant recipients (KTRs), including in vivo imaging, gene expression profiling and omics analyses of blood and urine samples. Most imaging techniques, like contrast-enhanced ultrasound and magnetic resonance, exploit the fact that blood flow is significantly lowered in case of AR-induced inflammation. In addition, AR-associated recruitment of activated leukocytes may be detectable by (18)F-fluoro-deoxy-glucose positron emission tomography. In parallel, urine biomarkers, including CXCL9/CXCL10 or a three-gene signature of CD3ε, IP-10 and 18S RNA levels, have been identified. None of these approaches has been adopted yet in the clinical follow-up of KTRs, but standardization of procedures may help assess reproducibility and compare diagnostic yields in large prospective multicentric trials.

PMID: 28643821 [PubMed - in process]

Does wealth make health? Cherchez la renal replacement therapy.

Sat, 06/24/2017 - 12:45
Related Articles

Does wealth make health? Cherchez la renal replacement therapy.

Clin Kidney J. 2017 Feb;10(1):45-48

Authors: Sanchez-Niño MD, Ortiz A

Abstract
In this issue of CKJ, McQuarrie et al. have explored the relationship between socioeconomic status and outcomes among Scottish patients with a renal biopsy diagnosis of primary glomerulonephritis. Patients in the lower socioeconomic category had a twofold higher risk of death. No significant differences were observed on progression to end-stage renal disease (ESRD) requiring renal replacement therapy (RRT), suggesting that overall medical management was appropriate for all socioeconomic categories. The findings are significant since they come from an ethnically homogeneous population with free access to healthcare; they also relate to a specific aetiology of chronic kidney disease (CKD) expected to be less dependent on unhealthy lifestyles than other more frequent aetiologies that dominate studies of CKD in general, such as diabetic or hypertensive nephropathy. A closer look at the data suggests that living in a high socioeconomic area is associated with lower mortality, rather than the other way round. Furthermore, the differences in mortality were most pronounced during the RRT stage of CKD, providing clues for further research. In this regard, Wilmink et al. and Nee et al. point to access to pre-ESRD nephrology care and to the best kidney transplantation options as modifiable factors to be studied in the realm of T3 translational research to improve CKD patient outcomes.

PMID: 28643820 [PubMed - in process]

Non-invasive approaches in the diagnosis of acute rejection in kidney transplant recipients, part II: omics analyses of urine and blood samples.

Sat, 06/24/2017 - 12:45
Related Articles

Non-invasive approaches in the diagnosis of acute rejection in kidney transplant recipients, part II: omics analyses of urine and blood samples.

Clin Kidney J. 2017 Feb;10(1):106-115

Authors: Erpicum P, Hanssen O, Weekers L, Lovinfosse P, Meunier P, Tshibanda L, Krzesinski JM, Hustinx R, Jouret F

Abstract
Kidney transplantation (KTx) represents the best available treatment for patients with end-stage renal disease. Still, the full benefits of KTx are undermined by acute rejection (AR). The diagnosis of AR ultimately relies on transplant needle biopsy. However, such an invasive procedure is associated with a significant risk of complications and is limited by sampling error and interobserver variability. In the present review, we summarize the current literature about non-invasive approaches for the diagnosis of AR in kidney transplant recipients (KTRs), including in vivo imaging, gene-expression profiling and omics analyses of blood and urine samples. Most imaging techniques, such as contrast-enhanced ultrasound and magnetic resonance, exploit the fact that blood flow is significantly lowered in case of AR-induced inflammation. In addition, AR-associated recruitment of activated leucocytes may be detectable by 18F-fluorodeoxyglucose positron emission tomography. In parallel, urine biomarkers, including CXCL9/CXCL10 or a three-gene signature of CD3ε, CXCL10 and 18S RNA levels, have been identified. None of these approaches has yet been adopted in the clinical follow-up of KTRs, but standardization of analysis procedures may help assess reproducibility and comparative diagnostic yield in large, prospective, multicentre trials.

PMID: 28643819 [PubMed - in process]

Serum microRNAs are altered in various stages of chronic kidney disease: a preliminary study.

Sat, 06/24/2017 - 12:45
Related Articles

Serum microRNAs are altered in various stages of chronic kidney disease: a preliminary study.

Clin Kidney J. 2017 Feb;10(1):30-37

Authors: Brigant B, Metzinger-Le Meuth V, Massy ZA, McKay N, Liabeuf S, Pelletier M, Sallée M, M'Baya-Moutoula E, Paul P, Drueke TB, Burtey S, Metzinger L

Abstract
BACKGROUND: MicroRNAs (miRNAs) are innovative and informative blood-based biomarkers involved in numerous pathophysiological processes. In this study and based on our previous experimental data, we investigated miR-126, miR-143, miR-145, miR-155 and miR-223 as potential circulating biomarkers for the diagnosis and prognosis of patients with chronic kidney disease (CKD). The primary objective of this study was to assess the levels of miRNA expression at various stages of CKD.
METHODS: RNA was extracted from serum, and RT-qPCR was performed for the five miRNAs and cel-miR-39 (internal control).
RESULTS: Serum levels of miR-143, -145 and -223 were elevated in patients with CKD compared with healthy controls. They were further increased in chronic haemodialysis patients, but were below control levels in renal transplant recipients. In contrast, circulating levels of miR-126 and miR-155 levels, which were also elevated in CKD patients, were lower in the haemodialysis group and even lower in the transplant group. Four of the five miRNA species were correlated with estimated glomerular filtration rate, and three were correlated with circulating uraemic toxins.
CONCLUSIONS: This exploratory study suggests that specific miRNAs could be biomarkers for complications of CKD, justifying further studies to link changes of miRNA levels with outcomes in CKD patients.

PMID: 28643818 [PubMed - in process]

Association of Foxp3 Polymorphism With Allograft Outcome in Kidney Transplantation.

Sat, 06/24/2017 - 12:45
Related Articles

Association of Foxp3 Polymorphism With Allograft Outcome in Kidney Transplantation.

Ann Lab Med. 2017 Sep;37(5):420-425

Authors: Park H, Lee N, In JW, Roh EY, Park KU, Shin S, Yang J, Song EY

Abstract
BACKGROUND: Forkhead box P3 (Foxp3) is the most reliable marker for regulatory T cells, which play an important role in maintaining renal allograft tolerance. Recently, Foxp3 polymorphisms have been reported to be associated with graft outcome in kidney transplantation. We analyzed the association of Foxp3 polymorphisms with renal allograft outcome.
METHODS: Foxp3 polymorphisms (rs3761548 A/C, rs2280883 C/T, rs5902434 del/ATT, and rs2232365 A/G) were tested by PCR with sequence-specific primers (PCR-SSP) in 231 adult kidney transplantation recipients from 1996-2004 at Seoul National University Hospital.
RESULTS: Patients with the rs3761548 CC genotype showed better graft survival than those with the AC or AA genotype (log rank test, P=0.03). Patients with the rs3761548 CC genotype also showed a lower rate of recurrence of the original glomerular disease than those with the AC or AA genotype (P=0.01). The frequency of acute rejection (AR) in patients with the rs2280883 TT genotype was lower than that in patients with the rs2280883 CT or CC genotype (26.9% vs 53.3%, P=0.038). Patients with the rs2280883 TT genotype also showed better graft survival than those with the CT or CC genotype (P=0.03).
CONCLUSIONS: Foxp3 rs3761548 CC and rs2280883 TT genotypes were associated with superior graft outcome of kidney transplantation. Further studies involving a larger number of patients are needed.

PMID: 28643491 [PubMed - in process]

Deep neuromuscular blockade improves surgical conditions during low-pressure pneumoperitoneum laparoscopic donor nephrectomy.

Sat, 06/24/2017 - 12:45
Related Articles

Deep neuromuscular blockade improves surgical conditions during low-pressure pneumoperitoneum laparoscopic donor nephrectomy.

Surg Endosc. 2017 Jun 22;:

Authors: Özdemir-van Brunschot DMD, Braat AE, van der Jagt MFP, Scheffer GJ, Martini CH, Langenhuijsen JF, Dam RE, Huurman VA, Lam D, d'Ancona FC, Dahan A, Warlé MC

Abstract
BACKGROUND: Evidence indicates that low-pressure pneumoperitoneum (PNP) reduces postoperative pain and analgesic consumption. A lower insufflation pressure may hamper visibility and working space. The aim of the study is to investigate whether deep neuromuscular blockade (NMB) improves surgical conditions during low-pressure PNP.
METHODS: This study was a blinded randomized controlled multicenter trial. 34 kidney donors scheduled for laparoscopic donor nephrectomy randomly received low-pressure PNP (6 mmHg) with either deep (PTC 1-5) or moderate NMB (TOF 0-1). In case of insufficient surgical conditions, the insufflation pressure was increased stepwise. Surgical conditions were rated by the Leiden-Surgical Rating Scale (L-SRS) ranging from 1 (extremely poor) to 5 (optimal).
RESULTS: Mean surgical conditions were significantly better for patients allocated to a deep NMB (SRS 4.5 versus 4.0; p < 0.01). The final insufflation pressure was 7.7 mmHg in patients with deep NMB as compared to 9.1 mmHg with moderate NMB (p = 0.19). The cumulative opiate consumption during the first 48 h was significantly lower in patients receiving deep NMB, while postoperative pain scores were similar. In four patients allocated to a moderate NMB, a significant intraoperative complication occurred, and in two of these patients a conversion to an open procedure was required.
CONCLUSIONS: Our data show that deep NMB facilitates the use of low-pressure PNP during laparoscopic donor nephrectomy by improving the quality of the surgical field. The relatively high incidence of intraoperative complications indicates that the use of low pressure with moderate NMB may compromise safety during LDN. Clinicaltrials.gov identifier: NCT 02602964.

PMID: 28643056 [PubMed - as supplied by publisher]

Tacrolimus Updated Guidelines through popPK Modeling: How to Benefit More from CYP3A Pre-emptive Genotyping Prior to Kidney Transplantation.

Sat, 06/24/2017 - 12:45
Related Articles

Tacrolimus Updated Guidelines through popPK Modeling: How to Benefit More from CYP3A Pre-emptive Genotyping Prior to Kidney Transplantation.

Front Pharmacol. 2017;8:358

Authors: Woillard JB, Mourad M, Neely M, Capron A, van Schaik RH, van Gelder T, Lloberas N, Hesselink DA, Marquet P, Haufroid V, Elens L

Abstract
Tacrolimus (Tac) is a profoundly effective immunosuppressant that reduces the risk of rejection after solid organ transplantation. However, its use is hampered by its narrow therapeutic window along with its highly variable pharmacological (pharmacokinetic [PK] and pharmacodynamic [PD]) profile. Part of this variability is explained by genetic polymorphisms affecting the metabolic pathway. The integration of CYP3A4 and CY3A5 genotype in tacrolimus population-based PK (PopPK) modeling approaches has been proven to accurately predict the dose requirement to reach the therapeutic window. The objective of the present study was to develop an accurate PopPK model in a cohort of 59 kidney transplant patients to deliver this information to clinicians in a clear and actionable manner. We conducted a non-parametric non-linear effects PopPK modeling analysis in Pmetrics(®). Patients were genotyped for the CYP3A4(∗)22 and CYP3A5(∗)3 alleles and were classified into 3 different categories [poor-metabolizers (PM), Intermediate-metabolizers (IM) or extensive-metabolizers (EM)]. A one-compartment model with double gamma absorption route described very accurately the tacrolimus PK. In covariate analysis, only CYP3A genotype was retained in the final model (Δ-2LL = -73). Our model estimated that tacrolimus concentrations were 33% IC95%[20-26%], 41% IC95%[36-45%] lower in CYP3A IM and EM when compared to PM, respectively. Virtually, we proved that defining different starting doses for PM, IM and EM would be beneficial by ensuring better probability of target concentrations attainment allowing us to define new dosage recommendations according to patient CYP3A genetic profile.

PMID: 28642710 [PubMed - in process]

Cystatin C-Based Equation Does Not Accurately Estimate the Glomerular Filtration in Japanese Living Kidney Donors.

Sat, 06/24/2017 - 12:45
Related Articles

Cystatin C-Based Equation Does Not Accurately Estimate the Glomerular Filtration in Japanese Living Kidney Donors.

Ann Transplant. 2017 Jun 23;22:378-383

Authors: Tsujimura K, Ota M, Chinen K, Adachi T, Nagayama K, Oroku M, Nishihira M, Shiohira Y, Iseki K, Ishida H, Tanabe K

Abstract
BACKGROUND Precise evaluation of a living donor's renal function is necessary to ensure adequate residual kidney function after donor nephrectomy. Our aim was to evaluate the feasibility of estimating glomerular filtration rate (GFR) using serum cystatin-C prior to kidney transplantation. MATERIAL AND METHODS Using the equations of the Japanese Society of Nephrology, we calculated the GFR using serum creatinine (eGFRcre) and cystatin C levels (eGFRcys) for 83 living kidney donors evaluated between March 2010 and March 2016. We compared eGFRcys and eGFRcre values against the creatinine clearance rate (CCr). RESULTS The study population included 27 males and 56 females. The mean eGFRcys, eGFRcre, and CCr were, 91.4±16.3 mL/min/1.73 m² (range, 59.9-128.9 mL/min/1.73 m²), 81.5±14.2 mL/min/1.73 m² (range, 55.4-117.5 mL/min/1.73 m²) and 108.4±21.6 mL/min/1.73 m² (range, 63.7-168.7 mL/min/1.73 m²), respectively. eGFRcys was significantly lower than CCr (p<0.001). The correlation coefficient between eGFRcys and CCr values was 0.466, and the mean difference between the two values was -17.0 (15.7%), with a root mean square error of 19.2. Thus, eGFRcre was significantly lower than CCr (p<0.001). The correlation coefficient between eGFRcre and CCr values was 0.445, and the mean difference between the two values was -26.9 (24.8%), with a root mean square error of 19.5. CONCLUSIONS Although eGFRcys provided a better estimation of GFR than eGFRcre, eGFRcys still did not provide an accurate measure of kidney function in Japanese living kidney donors.

PMID: 28642453 [PubMed - in process]

mir-155 expression is downregulated in kidney transplant patients with human cytomegalovirus infection.

Sat, 06/24/2017 - 12:45
Related Articles

mir-155 expression is downregulated in kidney transplant patients with human cytomegalovirus infection.

Transpl Immunol. 2017 Jun 19;:

Authors: Bergallo M, Gambarino S, Montanari P, Daprà V, Rassu M, Galliano I, Ravanini P

Abstract
MicroRNAs are small, noncoding RNAs that control expression of target genes through inhibiting protein translation or inducing degradation of mRNA transcripts of target genes. According to the latest update, 2578 unique mature miRNAs are currently annotated in the human genome and participate in the regulation of multiple events, such as cellular proliferation or apoptosis. Herpesvirus family comprehends many viruses able to control and modulate host-cell processes permitting the survival by a latency phase after primary infection. Recently has been attested that Human Cytomegalovirus, which belongs to Herpesvirus family, can alter human miRNAs expression in vitro, and, in particular, downregulate mir-155 expression. In this study 20 kidney transplant patients positive to Human Cytomegalovirus infection and 11 negative were enrolled. The patients' positive to Human Cytomegalovirus infections have been subdivided into two groups: one group including patients with a low viral load and one including patients with a high viral load. The mir-155 expression profile has been evaluated by a stem-loop Real Time PCR in all these conditions to observe differences among the groups and compare the results obtained with the literature. The comparison between kidney transplant patients negative to Human Cytomegalovirus infection and patients with a high viral load showed a not significant difference in terms of mir-155 expression. However, considering low viral load group or the group including both high and low viral load patients, mir-155 expression levels decreased significantly. Considering this data together, it is possible confirm data published before and assert that Human Cytomegalovirus is responsible of mir-155 downregulation.

PMID: 28642130 [PubMed - as supplied by publisher]

Peripheral blood regulatory T cell counts as a predictive biomarker for the outcome of kidney transplant: A systematic review.

Sat, 06/24/2017 - 12:45
Related Articles

Peripheral blood regulatory T cell counts as a predictive biomarker for the outcome of kidney transplant: A systematic review.

Med Clin (Barc). 2017 Jun 19;:

Authors: Herrera-Gómez F, Vásquez-Seoane M, Del Aguila W, Martín-García D, Maurtua-Briseño Meiggs Á, González-López A, Andrés-Martín B, Nava-Rebollo Á, Casquero-Fernández F, Pascual-Núñez P, Grande-Villoria J, Bustamante-Bustamante J, Ochoa-Sangrador C, Lambert C, Mendiluce-Herrero A

Abstract
BACKGROUND AND OBJECTIVE: Circulating regulatory T cells could become a suitable biomarker for kidney recipients. The objective of this study was to evaluate the effect of mammalian target of rapamycin (mTOR) inhibitors on regulatory T cell numbers, and the clinical interest of this effect.
MATERIAL AND METHODS: Systematic review of published and unpublished studies. Worldwide databases or repositories. Randomised controlled trials and cohort studies comparing regulatory T cell counts and rejection episodes between patients with and without mTOR inhibitors were searched. Correlation of regulatory T cells-glomerular filtration rate might be supplied. Co-dependency regulatory T cells-mTOR inhibitors efficacy was evaluated.
RESULTS: Five trials and 9 studies were included. Clinical differences made it difficult to obtain quantitative estimates of the effect of immunosuppression on regulatory T cell numbers. Nevertheless, we found that there are higher regulatory T cell numbers under treatment with sirolimus or everolimus. Rejection episodes were similar under calcineurin inhibitors and mTOR inhibitors despite different regulatory T cell numbers. Pooled correlation regulatory T cells-glomerular filtration rate was, prospectively 0.114 (95% confidence interval [95% CI] 0.062-0.406), and retrospectively 0.13 (95% CI 0.0-0.361). There is direct evidence although of low level (biomarker-stratified randomisation) on the co-dependency regulatory T cells-mTOR inhibitors efficacy.
CONCLUSIONS: Regulatory T cells counts may be associated with better outcomes under treatment with mTOR inhibitors (anti-rejection efficacy), considering that there is a relationship between these cells and kidney graft function.
REGISTRATION: PROSPERO (CRD42016046285).

PMID: 28641881 [PubMed - as supplied by publisher]

Alloimmunization After Cryopreserved Arterial Allografts in a Patient on a Kidney Transplantation Waiting List.

Sat, 06/24/2017 - 12:45
Related Articles

Alloimmunization After Cryopreserved Arterial Allografts in a Patient on a Kidney Transplantation Waiting List.

Transplantation. 2017 Jul;101(7):e225-e227

Authors: Garrouste C, Rosset E, Quainon F, Aniort J, Heng AE

PMID: 28640792 [PubMed - in process]

How does age affect the outcome of kidney transplantation in elderly recipients?

Sat, 06/24/2017 - 12:45
Related Articles

How does age affect the outcome of kidney transplantation in elderly recipients?

Clin Transplant. 2017 Jun 22;:

Authors: Neri F, Furian L, Cavallin F, Ravaioli M, Silvestre C, Donato P, La Manna G, Pinna AD, Rigotti P

Abstract
The aging of the on-dialysis population raises the issue of whether to propose elderly patients for kidney transplantation and how to manage their immunosuppression. This study aims to analyze the outcome of kidney transplantation on an Italian series of elderly recipients. We included in this retrospective study all patients over 60 years, receiving a deceased-donor kidney transplantation from January 2004 to December 2014 in two north Italian Centers. We analyzed the correlation of recipient age with graft's and patient's survival, delayed graft function (DGF), acute cellular rejection (ACR), surgical complications, infections and glomerular filtration rate (GFR). Forty hundred fifty two patients with a median age of 65 years were included in the study. One, three and five-year patient's and graft's survival were respectively of 98.7%, 93%, 89% and 94.4%, 87.9%, 81.4%. The increasing recipient age was an independent risk factor only for the patient's (p=0.008) and graft's survival (p=0.002). ACR and neoplasia were also associated to a worse graft survival. The reduced graft survival in elderly kidney recipients seems to be related more to the increasing recipient's age than to the donor's features. In this population the optimization of organ allocation and immunosuppression may be the key factors to endorse improvements. This article is protected by copyright. All rights reserved.

PMID: 28640530 [PubMed - as supplied by publisher]

Using Analytic Morphomics to Describe Body Composition Associated with Post-Kidney Transplantation Diabetes Mellitus.

Sat, 06/24/2017 - 12:45
Related Articles

Using Analytic Morphomics to Describe Body Composition Associated with Post-Kidney Transplantation Diabetes Mellitus.

Clin Transplant. 2017 Jun 22;:

Authors: Cron DC, Noon KA, Cote DR, Terjimanian MN, Augustine JJ, Wang SC, Englesbe MJ, Woodside KJ

Abstract
BACKGROUND: Better risk assessment tools are needed to predict post-transplantation diabetes mellitus (PTDM). Using analytic morphomic measurements from computed tomography (CT) scans, we aimed to identify specific measures of body composition associated with PTDM.
METHODS: We retrospectively reviewed 99 non-diabetic kidney transplant recipients who received pre-transplant CT scans at a single institution between 1/2005 and 5/2014. Analytic morphomic techniques were used to measure abdominal adiposity, abdominal size, and psoas muscle area and density, standardized by gender. We measured the associations of these morphomic factors with PTDM.
RESULTS: One-year incidence of PTDM was 18%. The morphomic factors significantly associated with PTDM included visceral fat area (OR=1.84 per standard deviation increase, p=0.020), body depth (OR=1.79, p=0.035), and total body area (OR=1.67, p=0.049). Clinical factors significantly associated with PTDM included African American race (OR=3.01, p=0.044), hypertension (OR=2.97, p=0.041), and dialysis vintage (OR=1.24 per year on dialysis, p=0.048). Body mass index was not associated with PTDM (OR=1.05, p=0.188). On multivariate modeling, visceral fat area was an independent predictor of PTDM (OR=1.91, p=0.035).
CONCLUSIONS: Analytic morphomics can identify pre-transplant measurements of body composition that are predictive of PTDM in kidney transplant recipients. Pre-transplant imaging contains a wealth of data that may inform PTDM prevention strategies. This article is protected by copyright. All rights reserved.

PMID: 28640481 [PubMed - as supplied by publisher]

Readability, Content Analysis, and Racial/Ethnic Diversity of Online Living Kidney Donation Information.

Sat, 06/24/2017 - 12:45
Related Articles

Readability, Content Analysis, and Racial/Ethnic Diversity of Online Living Kidney Donation Information.

Clin Transplant. 2017 Jun 22;:

Authors: Rodrigue JR, Feranil M, Lang J, Fleishman A

Abstract
More than three-fourths of adults in the US use the internet to access health-related information. Adults exploring the possibility of living donation should have access to online content that is readable and comprehensive. We simulated a search of online information about living kidney donation and evaluated readability, topics covered, and racial/ethnic diversity of 21 websites meeting inclusion criteria (e.g., hosted by a non-profit or patient advocacy organization, English content, based in US). Using standard readability metrics, 62% of sites were classified as "Difficult to read" and none achieved the recommended reading level of 6(th) grade. On average, websites covered 18.5 (62%) of 30 recommended information topics (range: 7 to 28) and only 2.1 (23%) of 9 racial/ethnic diversity items (range: 0 to 6). Overall, the most common non-profit or patient advocacy organization websites do not meet the readability standards established by the National Institutes of Health and the American Medical Association, many lack fundamental information about living kidney donation, and most are not racially/ethnically diverse. We encourage the transplant community to consider playing a more active role in improving the overall quality of online information disseminated to the general public. Further, there is a need to more critically examine the accuracy of online living donation content in future investigations. This article is protected by copyright. All rights reserved.

PMID: 28640438 [PubMed - as supplied by publisher]

Pages