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Hepatitis C Virus infection in the immunocompromised host: a complex scenario with variable clinical impact.

Fri, 08/10/2012 - 19:06
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Hepatitis C Virus infection in the immunocompromised host: a complex scenario with variable clinical impact.

J Transl Med. 2012 Aug 3;10(1):158

Authors: Zignego AL, Giannini C, Gragnani L, Piluso A, Fognani E

Abstract
ABSTRACT: The relationship between Hepatitis C Virus (HCV) infection and immunosuppression is complex and multifaceted. Although HCV-related hepatocytolysis is classically interpreted as secondary to the attack by cytotoxic T lymphocytes against infected cells, the liver disease is usually exacerbated and more rapidly evolutive in immunosuppressed patients. This generally occurs during the immunosuppression state, and not at the reconstitution of the host response after immunosuppressive therapy discontinuation. The field of immunosuppression and HCV infection is complicated both by the different outcome observed in different situations and/or by contrasting data obtained in the same conditions, with several still unanswered questions, such as the opportunity to modify treatment schedules in the setting of post-transplant follow-up. The complexity of this field is further complicated by the intrinsic tendency of HCV infection in itself to lead to disorders of the immune system. This review will briefly outline the current knowledge about the pathogenesis of both hepatic and extrahepatic HCV-related disorders and the principal available data concerning HCV infection in a condition of impairment of the immune system. Attention will be especially focused on some conditions - liver or kidney transplantation, the use of biologic drugs and cancer chemotherapy - for which more abundant and interesting data exist.

PMID: 22863056 [PubMed - as supplied by publisher]

Conditioned Mesenchymal Stem Cells Attenuate Progression of Chronic Kidney Disease through Inhibition of Epithelial-to-Mesenchymal Transition and Immune Modulation.

Fri, 08/10/2012 - 19:06
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Conditioned Mesenchymal Stem Cells Attenuate Progression of Chronic Kidney Disease through Inhibition of Epithelial-to-Mesenchymal Transition and Immune Modulation.

J Cell Mol Med. 2012 Aug 2;

Authors: Chang JW, Tsai HL, Chen CW, Yang HW, Yang AH, Yang LY, Wang PS, Ng YY, Lin TL, Lee OK

Abstract
Mesenchymal stem cells (MSCs) have been shown to improve the outcome of acute renal injury models; but whether MSCs can delay renal failure in chronic kidney disease (CKD) remains unclear. In the present study, the MSCs were cultured in media containing various concentrations of basic fibroblast growth factor, epidermal growth factor and ascorbic acid 2-phosphate to investigate whether hepatocyte growth factor (HGF) secretion could be increased by the stimulation of these growth factors. MSCs. Then TGF-β1 treated renal interstitial fibroblast (NRK-49F), renal proximal tubular cells (NRK-52E), and podocytes were co-cultured with conditioned MSCs in the absence or presence of ascorbic acid 2-phosphate to quantify the protective effects of conditioned MSCs on renal cells. Moreover, male Sprague-Dawley rats were treated with 1×10(6) conditioned MSCs immediately after 5/6 nephrectomy and every other week through the tail vein for 14 weeks. It was found that basic fibroblast growth factor, epidermal growth factor and ascorbic acid 2-phosphate promoted HGF secretion in MSCs. Besides, conditioned MSCs were found to be protective against TGF-β1 induced epithelial-to-mesenchymal transition of NRK-52E and activation of NRK-49F cells. Furthermore, conditioned MSCs protected podocytes from TGF-β1-induced loss of synaptopodin, fibronectin induction, cell death and apoptosis. Rats transplanted with conditioned human MSCs had a significantly increase in creatinine clearance rate, decrease in glomerulosclerosis, interstitial fibrosis and increase in CD4+CD25+Foxp3+ regulatory T cells counts in splenocytes. Together, our studies indicated that conditioned MSCs preserve renal function by their anti-fibrotic and anti-inflammatory effects. Transplantation of conditioned MSCs may be useful in treating CKD. © 2012 The Authors Journal of Cellular and Molecular Medicine © 2012 Foundation for Cellular and Molecular Medicine/Blackwell Publishing Ltd.

PMID: 22862802 [PubMed - as supplied by publisher]

Amelioration of renal damage by administration of anti-thymocyte globulin to potential donors in a brain death rat model.

Fri, 08/10/2012 - 19:06
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Amelioration of renal damage by administration of anti-thymocyte globulin to potential donors in a brain death rat model.

Clin Exp Immunol. 2012 Sep;169(3):330-7

Authors: Cicora F, Stringa P, Guerrieri D, Roberti J, Ambrosi N, Toniolo F, Cicora P, Palti G, Vásquez D, Raimondi C

Abstract
Brain death (BD), a non-immunological factor of renal injury, triggers an inflammatory process causing pathological signs of cell death in the kidney, such as necrosis and apoptosis. Kidneys from brain dead donors show lower success rates than kidneys from living donors and one strategy to improve transplantation outcome is to precondition the donors. For the first time, anti-rat thymoglobulin (rATG) was administered in an experimental brain death animal model to evaluate if it could ameliorate histopathological damage and improve organ function. Animals were divided into three groups: V (n = 5) ventilated for 2 h; BD (n = 5) brain death and ventilated for 2 h; and BD+rATG (n = 5) brain death, ventilated for 2 h, rATG was administered during brain death (10 mg/kg). We observed lower creatinine levels in treatment groups (means): V, 0·88 ± 0·22 mg/dl; BD, 1·37 ± 0·07 mg/dl; and BD+rATG, 0·64 ± 0·02 mg/dl (BD versus BD+rATG, P < 0·001). In the BD group there appeared to be a marked increase of ATN, whereas ATN was decreased significantly in the rATG group (V, 2·25 ± 0·5 versus BD, 4·75 ± 0·5, P < 0·01; BD+rATG, 2·75 ± 0·5 versus BD 4·75 ± 0·5 P < 0·01). Gene expression was evaluated with reverse transcription-polymerase chain reaction; tumour necrosis factor (TNF)-α, interleukin (IL)-6, C3, CD86 showed no significant difference between groups. Increased IL-10 and decreased CCL2 in BD+rATG compared to BD (both cases P < 0·01). Myeloperoxidase was increased significantly after the brain death setting (V: 32 ± 7·5 versus BD: 129 ± 18). Findings suggest that rATG administered to potential donors may ameliorate renal damage caused by BD. These findings could contribute in the search for specific cytoprotective interventions to improve the quality and viability of transplanted organs.

PMID: 22861373 [PubMed - in process]

Rapid T cell repopulation after rabbit anti-thymocyte globulin (rATG) treatment is driven mainly by cytomegalovirus.

Fri, 08/10/2012 - 19:06
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Rapid T cell repopulation after rabbit anti-thymocyte globulin (rATG) treatment is driven mainly by cytomegalovirus.

Clin Exp Immunol. 2012 Sep;169(3):292-301

Authors: Havenith SH, Remmerswaal EB, Bemelman FJ, Yong SL, van Donselaar-van der Pant KA, van Lier RA, Ten Berge IJ

Abstract
Rabbit anti-thymocyte globulin (rATG) induces a long-lasting lymphocytopenia. CD4(+) T cells remain depleted for up to 2 years, whereas the CD8(+) T cell compartment is refilled rapidly by highly differentiated CD27(-) CD45RA(+) CD57(+) effector-type cells. Because the presence of these highly differentiated CD8(+) T cells has been associated with cytomegalovirus (CMV) infection, we questioned to what extent restoration of CMV T cell immunity contributes to the re-emergence of T cells following rATG treatment. We compared T cell repopulation in six CMV-seropositive patients with CMV reactivation (reactivating CMV(+) ) to that in three CMV(+) patients without reactivation (non-reactivating CMV(+) ), and to that in three CMV-seronegative recipients receiving a kidney from a CMV-seronegative donor (CMV(-/-) ). All patients received rATG because of acute allograft rejection. Total CD4 and CD8 counts, frequency and phenotype of virus-specific CD8(+) T cells were determined. In reactivating CMV(+) patients, total CD8(+) T cells reappeared rapidly, whereas in non-reactivating CMV(+) patients they lagged behind. In CMV(-/-) patients, CD8(+) T cell counts had not yet reached pretransplant levels after 2 years. CMV reactivation was indeed followed by a progressive accumulation of CMV-specific CD8(+) T cells. During lymphocytopenia following rATG treatment, serum interleukin (IL)-7 levels were elevated. Although this was most prominent in the CMV-seronegative patients, it did not result in an advantage in T cell repopulation in these patients. Repopulated CD8(+) T cells showed increased skewing in their Vβ repertoire in both CMV(-/-) and reactivating CMV-seropositive patients. We conclude that rapid T cell repopulation following rATG treatment is driven mainly by CMV.

PMID: 22861369 [PubMed - in process]

Does reduction in mycophenolic acid dose compromise efficacy regardless of tacrolimus exposure level? An analysis of prospective data from the Mycophenolic Renal Transplant (MORE) Registry.

Fri, 08/10/2012 - 19:06
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Does reduction in mycophenolic acid dose compromise efficacy regardless of tacrolimus exposure level? An analysis of prospective data from the Mycophenolic Renal Transplant (MORE) Registry.

Clin Transplant. 2012 Aug 2;

Authors: Langone A, Doria C, Greenstein S, Narayanan M, Ueda K, Sankari B, Pankewycz O, Shihab F, Chan L

Abstract
Prospective data are lacking concerning the effect of reduced mycophenolic acid (MPA) dosing on efficacy and the influence of concomitant tacrolimus exposure. The Mycophenolic Renal Transplant (MORE) Registry is a prospective, observational study of de novo kidney transplant patients receiving MPA therapy under routine management. The effect of MPA dose reduction, interruption, or discontinuation (dose changes) was assessed in 870 tacrolimus-treated patients: 375 (43.1%) reduced tacrolimus (≤7 ng/mL at baseline) and 495 (56.9%) standard tacrolimus (>7 ng/mL); enteric-coated mycophenolate sodium 589 (67.7%) and mycophenolate mofetil 281 (32.3%). During baseline to month 1, months 1-3, months 3-6, and months 6-12, 9.3% (78/838), 16.6% (132/794), 20.7% (145/701), and 13.1% (70/535) patients, respectively, required MPA dose changes. These patients experienced an increased risk of biopsy-proven acute rejection at one yr with tacrolimus exposure either included in the model (hazard ratio [HR] 2.60, 95% CI 1.28-5.29, p = 0.008) or excluded (HR 2.58, 95% CI 1.28-5.23, p = 0.008). MPA dose changes were significantly associated with one yr graft failure when tacrolimus exposure was included (HR 2.23; 95% CI 1.01-4.89, p = 0.047) but not when tacrolimus exposure was excluded (HR 2.16; 95% CI 0.99-4.79; p = 0.054). These results suggest that reducing or discontinuing MPA can adversely affect graft outcomes regardless of tacrolimus trough levels.

PMID: 22861144 [PubMed - as supplied by publisher]

The relative importance of donor age in deceased and living donor kidney transplantation.

Fri, 08/10/2012 - 19:06
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The relative importance of donor age in deceased and living donor kidney transplantation.

Transpl Int. 2012 Jul 31;

Authors: Laging M, Kal-van Gestel JA, van de Wetering J, Ijzermans JN, Weimar W, Roodnat JI

Abstract
In deceased donor kidney transplantation donor age is known to influence graft survival. The influence of living donor age on graft survival is questioned. We compared the influence of living and deceased donor age on the outcome of renal transplantation. All 1821 transplants performed in our center between 1990 and 2009 were included in the analysis. Observation was until April 2012. A total of 941 patients received a deceased donor kidney and 880 a living donor kidney. In multivariate Cox analysis, recipient age, maximum and current panel reactive antibodies, transplant year, HLA-mismatches, donor age, donor gender, donor type, delayed graft function, and calcineurin inhibitor (CNI) and prednisone as initial immunosuppression were found to have a significant influence on death-censored graft failure. The influence of both living and deceased donor age followed a J-shaped curve, above 30 years the risk increased with increasing age. Donor type and donor age had an independent influence. The graft failure risk of deceased donor transplantation is almost twice that of living donor transplantation so that a 60-year-old living donor kidney has the same graft failure risk as a 20-year-old deceased donor kidney.

PMID: 22860760 [PubMed - as supplied by publisher]

Post-reperfusion Syndrome during Renal Transplantation: A Retrospective Study.

Fri, 08/10/2012 - 19:06
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Post-reperfusion Syndrome during Renal Transplantation: A Retrospective Study.

Int J Med Sci. 2012;9(5):391-6

Authors: Bruhl SR, Vetteth S, Rees M, Grubb BP, Khouri SJ

Abstract
Post-reperfusion syndrome (PRS) is a serious, widely reported complication following the reperfusion of an ischemic tissue or organ. We sought to determine the prevalence, risk factors and short-term outcomes of PRS related renal transplantation. We conducted a retrospective, case-control study of patients undergoing renal transplantation between July 2006 and March 2008. Identification of PRS was based on a drop in mean arterial pressure by at least 15% within 5 minutes of donor kidney reperfusion. Of the 150 consecutive renal transplantations reviewed, 6 patients (4%) met criteria for post-reperfusion syndrome. Univariate analysis showed that an age over 60, diabetes mellitus, Asian race, and extended criteria donors increased the odds of developing PRS by 4.8 times (95% CI [1.2, 20]; P=.0338), 4.5 times (95% CI [1.11, 18.8]; P=.0378), 35.5 times (95% CI [3.94, 319.8]; P=0.0078) and 9.6 times (95% CI [1.19, 76.28] P=0.0115) respectively. Short term follow-up revealed increased graft failure rate within 6 months (6% vs. 16% P=0.0125) and almost twice the number of hospital days post-transplant in PRS cohorts (5.43 ± 2.29 vs. 10.8 ± 7.29 P=<0.0001). Despite limited reporting, PRS appears to be a relatively common complication of renal transplantation and is associated with increase morbidity.

PMID: 22859898 [PubMed - in process]

A Case of Late Kidney Allograft Failure: A Clinical Pathological Conference from American Society of Nephrology Kidney Week 2011.

Fri, 08/10/2012 - 19:06
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A Case of Late Kidney Allograft Failure: A Clinical Pathological Conference from American Society of Nephrology Kidney Week 2011.

Clin J Am Soc Nephrol. 2012 Aug 2;

Authors: Randhawa P, Mannon RB

PMID: 22859745 [PubMed - as supplied by publisher]

Naked caspase 3 small interfering RNA is effective in cold preservation but not in autotransplantation of porcine kidneys.

Fri, 08/10/2012 - 19:06
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Naked caspase 3 small interfering RNA is effective in cold preservation but not in autotransplantation of porcine kidneys.

J Surg Res. 2012 Jul 26;

Authors: Yang C, Jia Y, Zhao T, Xue Y, Zhao Z, Zhang J, Wang J, Wang X, Qiu Y, Lin M, Zhu D, Qi G, Qiu Y, Tang Q, Rong R, Xu M, Ni S, Lai B, Nicholson ML, Zhu T, Yang B

Abstract
BACKGROUND: Caspase 3 associated with apoptosis and inflammation plays a key role in ischemia-reperfusion injury. The efficacy of naked caspase 3 small interfering RNA (siRNA) has been proved in an isolated porcine kidney perfusion model but not in autotransplantation. MATERIALS AND METHODS: The left kidney was retrieved from mini pigs and infused with the University of Wisconsin solution with or without 0.3mg of caspase 3 siRNA into the renal artery with the renal artery and vein clamped for 24-h cold storage (CS). After right nephrectomy, the left kidney was autotransplanted into the right for 48h without systemic treatment of siRNA. RESULTS: Fluorescent dye-labeled caspase 3 siRNA was visualized in the post-CS kidneys but was weakened after transplantation. The expression of caspase 3 messenger RNA and precursor was downregulated by siRNA in the post-CS kidneys. In the siRNA-preserved posttransplant kidneys, however, the caspase 3 messenger RNA and active subunit were upregulated with further decreased precursor but increased active caspase 3+ cells, apoptotic cells, and myeloperoxidase+ cells. Moreover, the renal tissue damage was aggravated by siRNA, whereas the renal function was not significantly changed. CONCLUSIONS: Naked caspase 3 siRNA administered into the kidney was effective in cold preservation but not enough to protect posttransplant kidneys, which might be because of systemic complementary responses overcoming local effects.

PMID: 22857917 [PubMed - as supplied by publisher]

Chimerisms in women with end stage renal diseases: Who's who?

Fri, 08/10/2012 - 19:06
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Chimerisms in women with end stage renal diseases: Who's who?

Chimerism. 2012 Apr 1;3(2)

Authors: Albano L, Rak JM, Azzouz DF, Cassuto-Viguier E, Gugenheim J, Lambert NC

Abstract
Many sources of foreign or semi foreign cells, known as microchimerism (Mc), can be found in healthy individuals. We have recently shown in women with end stage renal disease (ESRD) that Mc frequencies and levels are exacerbated prior to kidney transplantation. Is Mc arising from pregnancy a protective factor for renal diseases explaining lower incidence in women? Is Mc helpful in slowing down disease progression? However, natural Mc is not the only actor as post blood transfusion Mc is also found at high levels in women with ESRD. The difficulty is therefore to distinguish the different types of Mc and this is made even more complicated when the recipient receives a potentially chimeric organ. What part does each source of chimerism play in disease and transplant fate, and can one decipher each role knowing that one chimerism may hide another?

PMID: 22854596 [PubMed - as supplied by publisher]

Belatacept.

Fri, 08/10/2012 - 19:06
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Belatacept.

Prescrire Int. 2012 Jul;21(129):173-6

Authors:

Abstract
Immunosuppressive therapy designed to prevent kidney graft rejection usually consists of a triple-drug combination including a corticosteroid, a calcineurin inhibitor (ciclosporin or tacrolimus) and a drug that inhibits cell proliferation (azathioprine or mycophenolate mofetil). Belatacept is closely related to abatacept, an immunosuppressant marketed for rheumatic diseases. It is now authorised in the European Union for the prevention of kidney graft rejection, as a replacement for the calcineurin inhibitor. Two randomised controlled trials compared belatacept (2 doses) versus ciclosporin as part of the immunosuppressive regimen in respectively 666 and 534 patients. After 3 years of follow-up, survival with a functioning graft did not differ between the groups (about 80% in the trial closest to European protocols). Only the use of a high dose of belatacept instead of ciclosporin resulted in better preservation of renal function, but this is not the authorised dose. Lymphomas, particularly those affecting the central nervous system, were more frequent with belatacept in both trials (1.4% versus 0.9%). The risk was particularly high in patients receiving the high dose of belatacept, and in patients who were seronegative for Epstein-Barr virus. Overall, the risk of infections seems to be similar with belatacept and ciclosporin, but certain severe infections were more frequent with belatacept, including progressive multifocal leukoencephalopathy and tuberculosis. Unlike ciclosporin, belatacept plasma concentrations do not need to be monitored. However, intravenous belatacept administration is less convenient than oral ciclosporin administration, especially during long-term treatment. Overall, it is better to continue to use ciclosporin, a better-documented drug, as part of immunosuppressive therapy after kidney transplantation.

PMID: 22852277 [PubMed - in process]

A Knotless Technique for Kidney Transplantation in the Mouse.

Fri, 08/10/2012 - 19:06
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A Knotless Technique for Kidney Transplantation in the Mouse.

J Transplant. 2012;2012:127215

Authors: Rong S, Lewis AG, Kunter U, Haller H, Gueler F

Abstract
Mouse models of kidney transplantation are important to study molecular mechanisms of organ transplant rejection as well as to develop new therapeutic strategies aimed at improving allograft survival. However, the surgical technique necessary to result in a viable allograft has traditionally proven to be complex and very demanding. Here, we introduce a new, simple, and rapid knotless technique for vessel anastomosis wherein the last stitch of the anastomosis is not tied to the short end of the upper tie as in the classical approach but is left free. This is a critical difference in that it allows the size of the anastomosis to be increased or decreased after graft reperfusion in order to avoid stenosis or bleeding, respectively. We compared the outcome of this new knotless technique (n = 175) with the classical approach (n = 122) in terms of local thrombosis or bleeding, time for anastomosis, and survival rates. By this modification of the suture technique, local thrombosis was significantly reduced (1.1% versus 6.6%), anastomosis time was less, and highly reproducible kidney graft survival was achieved (95% versus 84% with the classical approach). We believe that this knotless technique is easy to learn and will improve the success rates in the technically demanding model of mouse kidney transplantation.

PMID: 22852070 [PubMed - as supplied by publisher]

Bidirectional alloreactivity: A proposed microchimerism-based solution to the NIMA paradox.

Fri, 08/10/2012 - 19:06
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Bidirectional alloreactivity: A proposed microchimerism-based solution to the NIMA paradox.

Chimerism. 2012 Apr 1;3(2)

Authors: Burlingham WJ, Benichou G

Abstract
The NIMA paradox is the observation that in transplants of allogeneic kidneys or hematopoietic stem cells, siblings benefit from re-exposure to non-inherited maternal antigens (NIMA), whereas re-exposure to a transplant from mother herself, theoretically the ideal "NIMA" donor, does not yield clinical results superior to a father-donated allograft. Recent observations of bidirectional alloreactivity in kidney and cord blood transplantation offer a possible solution to this paradox. If correct, the proposed solution points the way to clinical applications of microchimerism in solid organ and hematopoetic transplants.

PMID: 22850252 [PubMed - as supplied by publisher]

Endocrine-metabolic pathophysiologic conditions and treatment approaches after kidney transplantation.

Fri, 08/10/2012 - 19:06
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Endocrine-metabolic pathophysiologic conditions and treatment approaches after kidney transplantation.

Endocr Pract. 2012 Jul 1;18(4):579-90

Authors: Gosmanova EO, Tangpricha V, Gosmanov AR

Abstract
Objective: To review pathophysiologic conditions and diagnostic and therapeutic approaches in the management of endocrine-metabolic disorders after kidney transplantation (KT).Methods: We discuss the assessment of diabetes mellitus (DM), hyperlipidemia, hypertension, and disturbances of bone and mineral metabolism after KT.Results: KT offers patients with end-stage kidney disease substantial improvement in life expectancy and quality of life. Despite amelioration of renal dysfunction, however, these patients are at risk for the deterioration of existing and the development of new endocrine pathologic conditions. Pretransplant DM and new-onset diabetes after transplantation are associated with worse patient and graft survival. Little is known about preventing new-onset diabetes after transplantation and managing DM shortly after KT. In addition to glycemic control in patients with diabetes, management of cardiovascular risk factors includes appropriate recognition and treatment of hypertension and dyslipidemia. After KT, patients are at considerable risk for derangements in calcium and vitamin D metabolism. Immunosuppressive medications may cause compromised glucose and lipid metabolism, which may, in turn, contribute to the progression of preexisting and the development of new posttransplant endocrinopathies.Conclusion: Clinical care of kidney transplant patients should include a comprehensive endocrine assessment before and after KT in close collaboration with transplant nephrology providers. A referral to an endocrinologist should be initiated early during the pretransplant stage, and collaborative management should be maintained in kidney transplant patients to improve clinical outcomes.

PMID: 22849872 [PubMed - in process]

Post-transplant diabetes mellitus - Risk factors and effects on the function and morphology of the allograft.

Fri, 08/10/2012 - 19:06
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Post-transplant diabetes mellitus - Risk factors and effects on the function and morphology of the allograft.

Acta Physiol Hung. 2012 Jun;99(2):206-15

Authors: Borda B, Lengyel C, Szederkényi E, Eller J, Keresztes C, Lázár G

Abstract
The incidence of post-transplant diabetes mellitus and its effects on the kidney allograft function and morphology were assessed. Patients were divided into three groups according to their glucose metabolism. Risk factors for diabetes were first assessed, and then changes in renal function were checked. Morphological changes in the allografts were examined by protocol biopsies. The overall incidence of diabetes was 16%. The development of diabetes was influenced significantly by the body mass index, the body weight and the age of the recipient. The incidence of diabetes was 8.6% in patients on cyclosporine A therapy and 28.8% in those on tacrolimus (p < 0.05). As to the morphology of the kidney, a significantly higher proportion of the biopsies showed severe interstitial fibrosis/tubular atrophy (p = 0.0004) and subclinical acute rejection ( p = 0.001) in the diabetic group compared to the normal one. This clinical study has revealed that the adverse effect of diabetes on the allograft can be detected with protocol biopsy before the manifestation of a functional deterioration.

PMID: 22849845 [PubMed - in process]

Renal dysfunction in liver transplant recipients: Evaluation of the critical issues.

Fri, 08/10/2012 - 19:06
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Renal dysfunction in liver transplant recipients: Evaluation of the critical issues.

Liver Transpl. 2012 Jul 30;

Authors: Weber ML, Ibrahim HN, Lake JR

Abstract
Major progress has been made in the field of liver transplantation since the first procedure nearly 50 years ago. Despite these improvements, renal dysfunction before and after liver transplantation remains a major complicating factor associated with increased healthcare costs, morbidity, and mortality. Creatinine-based estimates of renal function are inaccurate in the setting of end stage liver disease and often lead to under-diagnosis and late intervention. This issue is critical as it is important to understand both etiology and chronicity of renal dysfunction prior to liver transplantation as treatment clearly varies, especially in regards to simultaneous liver-kidney transplantation. Given the scarcity of available grafts, identifying appropriate candidates for simultaneous liver kidney transplantation is crucial. Hepatorenal syndrome is common in liver transplantation candidates; however, other etiologies of renal dysfunction need to be considered. Renal dysfunction after liver transplantation is common and may have an acute or chronic presentation. Although calcineurin inhibitors have been associated with post-liver transplant nephrotoxicity, their role may be overestimated and other contributing etiologies should remain in a clinician's differential. Alternatives to calcineurin inhibitors have been evaluated; however, a safe immunosuppressive regimen that achieves preservation of renal function in liver transplant recipients remains to be established. In this review of the literature, renal dysfunction surrounding liver transplantation will be evaluated while highlighting the critical issues which are barriers to improved outcomes. Liver Transpl, 2012. © 2012 AASLD.

PMID: 22847917 [PubMed - as supplied by publisher]

C4d deposits on erythrocytes (EC4d): a new biomarker of antibody-mediated rejection in kidney transplantation.

Fri, 08/10/2012 - 19:06
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C4d deposits on erythrocytes (EC4d): a new biomarker of antibody-mediated rejection in kidney transplantation.

Kidney Int. 2012 Aug;82(4):490-1

Authors: Haidar F, Issa N

PMID: 22846818 [PubMed - in process]

Early assessment and targeted education is imperative in assuring equal, timely access to kidney transplantation.

Fri, 08/10/2012 - 19:06
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Early assessment and targeted education is imperative in assuring equal, timely access to kidney transplantation.

Am J Transplant. 2012 Aug;12(8):2257

Authors: Kucirka LM, Grams ME, Balhara KS, Jaar BG, Segev DL

PMID: 22845914 [PubMed - in process]

Mild rise in creatinine six months post kidney transplant.

Fri, 08/10/2012 - 19:06
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Mild rise in creatinine six months post kidney transplant.

Am J Transplant. 2012 Aug;12(8):2252-4

Authors: Ellis CL, Racusen LC

PMID: 22845913 [PubMed - in process]

Utilization and outcomes of marginal kidneys-using kidney donor risk index to move beyond the current labels.

Fri, 08/10/2012 - 19:06
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Utilization and outcomes of marginal kidneys-using kidney donor risk index to move beyond the current labels.

Am J Transplant. 2012 Aug;12(8):1971-2

Authors: Friedewald JJ

PMID: 22845906 [PubMed - in process]

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