Skip directly to content

PubMed Kidney Transplant

Subscribe to PubMed Kidney Transplant feed PubMed Kidney Transplant
NCBI: db=pubmed; Term=kidney transplant
Updated: 2 hours 51 min ago

Incidence and outcomes of primary central nervous system lymphoma in solid organ transplant recipients.

Tue, 08/15/2017 - 12:45

Incidence and outcomes of primary central nervous system lymphoma in solid organ transplant recipients.

Am J Transplant. 2017 Aug 14;:

Authors: Mahale P, Shiels MS, Lynch CF, Engels EA

Abstract
Primary central nervous system lymphoma (PCNSL) risk is greatly increased in immunosuppressed HIV-infected people. Using data from the United States transplant registry linked with 17 cancer registries (1987-2014), we studied PCNSL and systemic non-Hodgkin lymphoma (NHL) in 288,029 solid organ transplant recipients. Transplant recipients had elevated incidence for PCNSL compared with the general population (standardized incidence ratio=65.1; N=168), and this elevation was stronger than for systemic NHL (standardized incidence ratio=11.5; N=2,043). Compared to kidney recipients, PCNSL incidence was lower in liver recipients (adjusted incidence rate ratio [aIRR]=0.52), similar in heart and/or lung recipients, and higher in other/multiple organ recipients (aIRR=2.45). PCNSL incidence was higher in Asians/Pacific Islanders than non-Hispanic whites (aIRR=2.09); after induction immunosuppression with alemtuzumab (aIRR=3.12), monoclonal antibodies (aIRR=1.83), or polyclonal antibodies (aIRR=2.03); in recipients who were Epstein-Barr virus-seronegative at the time of transplant and at risk of primary infection (aIRR=1.95); and within the first 1.5 years after transplant (aIRR>2.00). Compared to other recipients, those with PCNSL had increased risk of death (adjusted hazard ratio [aHR]=11.79) or graft failure/retransplantation (aHR=3.24). Recipients with PCNSL also had higher mortality than those with systemic NHL (aHR=1.48). In conclusion, PCNSL risk is highly elevated among transplant recipients, and it carries a poor prognosis. This article is protected by copyright. All rights reserved.

PMID: 28805292 [PubMed - as supplied by publisher]

Practices in the Evaluation of Potential Kidney Transplant Recipients who are Elderly: A Survey of US Transplant Centers.

Tue, 08/15/2017 - 12:45

Practices in the Evaluation of Potential Kidney Transplant Recipients who are Elderly: A Survey of US Transplant Centers.

Clin Transplant. 2017 Aug 14;:

Authors: Mandelbrot DA, Fleishman A, Rodrigue JR, Norman SP, Samaniego M

Abstract
Limited data exists regarding the evaluation and selection of older candidates for transplantation. To help guide the development of program protocols and help define research questions in this area, we surveyed US transplant centers regarding their current practices in the evaluation of older kidney transplant candidates. We emailed a 28-question survey to the medical and surgical directors of 190 adult kidney transplant programs in the US. We received usable responses from 59 programs, a 31.1% response rate. Most (76.3%) programs do not have absolute age cut-offs for listing patients, but for the 22.0% of programs that do have cut-offs, the mean age was 79, range 70-90. Nearly one-third (29.2%) of programs require a minimum life expectancy to list for transplant, reporting a mean of 4.5 years life expectancy, (range 2-10). Programs vary significantly in evaluating candidates living in a nursing home or with cognitive impairments. Practices regarding the evaluation of older transplant candidates vary widely between US programs. Further studies are needed on the impact of age and other comorbidities on transplant outcomes, to help guide decisions on which older patients are most appropriate for transplant listing. This article is protected by copyright. All rights reserved.

PMID: 28805267 [PubMed - as supplied by publisher]

Pregnancy outcomes and impact of pregnancy on graft function in women after kidney transplantation.

Tue, 08/15/2017 - 12:45

Pregnancy outcomes and impact of pregnancy on graft function in women after kidney transplantation.

Clin Transplant. 2017 Aug 14;:

Authors: Mohammadi F, Borg M, Gulyani A, Mcdonald SP, Jesudason S

Abstract
BACKGROUND: Kidney transplantation facilitates pregnancy in women with end-stage kidney disease, however impact of pregnancy on short and longer-term graft function is uncertain.
METHODS: Obstetric, foetal and graft outcomes for pregnancies from a large Australian transplant unit (1976-2015) were reviewed.
RESULTS: There were 56 pregnancies in 35 women with mean age at conception 30.4±0.6 years and mean transplant-pregnancy interval 5.5±0.5 years. The live birth rate (LBR) was 78.9%. Preterm birth (<37 weeks) occurred in 56.5%. Hypertensive disorders affected 76% of women (pre-eclampsia in 30%). Median pre-pregnancy serum creatinine (SCr) was 100 umol/L (interquartile range IQR 80,114 umol/L). One third had deterioration in graft dysfunction during pregnancy; of these 63.2% did not return to baseline. At 2 years post-partum mean serum creatinine was 145±24umol/L. Women with pre-pregnancy SCr >110umol/L had increased risk of pre-eclampsia (OR 4.4; 95% CI 1.2-16.8; p=0.03), preterm birth (OR 5.4; 95% CI 0.5-53; p = 0.04) and low birth-weight babies (OR 1.2; 95% CI 0.5-2.9; p = 0.04). Women with SCr >140mol/L preconception had worst SCr trajectory, including higher rates of graft loss.
CONCLUSIONS: KT pregnancies remain at high risk of obstetric complications, particularly pre-eclampsia. Pre-pregnancy graft function can be used to predict risk of adverse pregnancy outcomes and deterioration in graft function during and after delivery. This article is protected by copyright. All rights reserved.

PMID: 28805261 [PubMed - as supplied by publisher]

Comparison of intrathecal morphine and surgical-site infusion of ropivacaine as adjuncts to intravenous patient-controlled analgesia in living-donor kidney transplant recipients.

Tue, 08/15/2017 - 12:45

Comparison of intrathecal morphine and surgical-site infusion of ropivacaine as adjuncts to intravenous patient-controlled analgesia in living-donor kidney transplant recipients.

Singapore Med J. 2017 Aug 14;:

Authors: Jun JH, Kim GS, Lee JJ, Ko JS, Kim SJ, Jeon PH

Abstract
INTRODUCTION: This prospective observational study compared the postoperative analgesic effectiveness of intrathecal morphine (ITM) and surgical-site infusion (SSI) of ropivacaine as adjuncts to intravenous (IV) patient-controlled analgesia (PCA) (fentanyl) in living-donor kidney transplant recipients.
METHODS: Patients undergoing living-donor kidney transplantation receiving ITM or SSI in addition to IV PCA were included. Rescue analgesia was achieved with IV meperidine, as required. Primary outcome was pain at rest and when coughing using Numeric Pain Rating Scale (NRS). Patients were assessed for 48 hours after surgery.
RESULTS: 53 patients (ITM, n = 32; SSI, n = 21) were included in the study. The ITM group showed significantly lower NRS at rest, and when coughing for up to 12 hours and 8 hours. NRS scores were comparable between the groups at other times. Postoperative systemic opioid requirements in the first 24 hours were significantly fewer in the ITM group, but there was no significant difference in systemic opioid consumption between the groups on postoperative day (POD) 2. 3 (9.4%) patients in the ITM group presented with bradypnoea and 1 (3.1%) presented with excessive sedation in the first 12 postoperative hours. More patients in the ITM group developed pruritus requiring treatment during the first 24 hours. There were no differences between the groups in terms of other outcomes (e.g. nausea/vomiting, change in pulmonary and kidney functions).
CONCLUSION: ITM, compared with SSI, reduced immediate postoperative pain and IV opioid consumption during POD 1 after living-donor kidney transplantation, but at the cost of increased pruritus and respiratory depression.

PMID: 28805236 [PubMed - as supplied by publisher]

Intravenous immunoglobulins modify relapsing membranous glomerulonephritis after kidney transplantation: a case report.

Tue, 08/15/2017 - 12:45

Intravenous immunoglobulins modify relapsing membranous glomerulonephritis after kidney transplantation: a case report.

Acta Clin Belg. 2017 Aug 14;:1-4

Authors: Steyaert S, Van Dorpe J, Hoorens A, Van Biesen W, Van Laecke S

Abstract
OBJECTIVES: Recurrence of membranous glomerulonephritis after transplant is common and is an important cause of loss of renal graft. This case supports the effect of immunoglobulins in the treatment of this disease after transplantation. It is the first report in the literature with a follow-up of more than 10 years and because of the sustained effect of the immunoglobulins, it strengthens the idea that this can alter long-term outcome.
METHODS: Single case study and search of the literature.
RESULTS: A female transplant recipient, who had an early histologically proven relapse of an idiopathic membranous glomerulonephritis and who was, before transplantation, refractory to various immunosuppressive agents. This relapsing disease has now been stable for over 10 years of intravenous immunoglobulins treatment in conjunction with belatacept and low doses of corticosteroids after gradual withdrawal of mycophenolate mofetil. This report supports the finding that immunoglobulins could influence the course of a relapse of membranous glomerulonephritis after transplantation.
CONCLUSION: This case illustrates that immunoglobulins had long-lasting effects on the renal transplant although the glomerulonephritis had been resistant to other lines of therapy before transplant. We advocate that the use of immunoglobulins as a rescue therapy in refractory idiopathic membranous glomerulonephritis should be further investigated. Presently, existing evidence only comes from retrospective data and non-randomized trials.

PMID: 28805142 [PubMed - as supplied by publisher]

Factors associated with cardiovascular target organ damage in children after renal transplantation.

Tue, 08/15/2017 - 12:45
Related Articles

Factors associated with cardiovascular target organ damage in children after renal transplantation.

Pediatr Nephrol. 2017 Aug 13;:

Authors: Borchert-Mörlins B, Thurn D, Schmidt BMW, Büscher AK, Oh J, Kier T, Bauer E, Baig S, Kanzelmeyer N, Kemper MJ, Büscher R, Melk A

Abstract
BACKGROUND: Cardiovascular disease is the second-most common cause of death in pediatric renal transplant recipients. The aim of this study was to evaluate subclinical cardiovascular target organ damage defined as the presence of arterio- and atherosclerotic lesions and cardiac remodeling and to analyze contributing risk factors in a large cohort of children after renal transplantation (RT).
METHODS: A total of 109 children aged 13.1 ± 3.3 years who had undergone RT at one of three German transplant centers were enrolled in this study. Patients had been transplanted a mean of 5.5 (±4.0) years prior to being enrolled in the study. Anthropometric data, laboratory values and office- and 24-h ambulatory blood pressure monitoring (ABPM) were evaluated. Cardiovascular target organ damage was determined through non-invasive measurements of aortic pulse wave velocity (PWV), carotid intima-media thickness (IMT) and left ventricular mass (LVM).
RESULTS: Elevated PWV or IMT values were detected in 22 and 58% of patients, respectively. Left ventricular hypertrophy was found in as many as 43% of patients. The prevalence of uncontrolled or untreated hypertension was 41%, of which 16% of cases were only detected by ABPM measurements. In the multivariable analysis, higher diastolic blood pressure, everolimus intake and lower estimated glomerular filtration rate were independently associated with high PWV. Higher systolic blood pressure and body mass index were associated with elevated LVM.
CONCLUSIONS: Our results showed an alarming burden of cardiovascular subclinical organ damage in children after RT. Hypertension, obesity, immunosuppressive regimen and renal function emerged as independent risk factors of organ damage. Whereas the latter is not modifiable, the results of our study strongly indicate that the management of children after RT should focus on the control of blood pressure and weight.

PMID: 28804814 [PubMed - as supplied by publisher]

The impact of distance from transplant unit on outcomes following kidney transplantation.

Tue, 08/15/2017 - 12:45
Related Articles

The impact of distance from transplant unit on outcomes following kidney transplantation.

Int J Surg. 2017 Aug 10;:

Authors: Powell-Chandler A, Khalid U, Horvath S, Ilham MA, Asderakis A, Stephens MR

Abstract
BACKGROUND: Following transplantation, many patients travel long distances for follow-up care. Many studies have examined the influence of distance from transplant centre on access to transplantation, but few have examined post-transplant outcomes.
MATERIALS AND METHODS: Distance from transplant centre was calculated for all kidney transplant recipients transplanted over a 5-year period. Outcomes measured were rates of acute rejection, graft and patient survival.
RESULTS: Complete follow up data was available for 571 of the 585 kidney transplants performed over the study period. Distance from home to transplant centre ranged from 1.3 to 257.4 km (median 33.7 km). Patients were divided into quartiles according to their distance from the transplant centre. Distance from the transplant centre did not influence rates of acute rejection (p = 0.102). One-year graft survival for 'nearest' and 'farthest' quartiles was 99% and 97% respectively and five-year graft survival was 78% and 89% respectively (log rank p-value of 0.212). There were no differences in patient survival at 1 and 5 years between the 'nearest' and 'farthest' groups.
CONCLUSION: Distance from transplant centre does not affect early outcomes following kidney transplantation. The centralized practice which involves a low threshold for rapid assessment and readmission of patients post-transplantation appears to provide good outcomes for kidney transplant recipients.

PMID: 28803997 [PubMed - as supplied by publisher]

Systematic review of the methods predictive of the functionality of kidney transplantation.

Tue, 08/15/2017 - 12:45
Related Articles

Systematic review of the methods predictive of the functionality of kidney transplantation.

Actas Urol Esp. 2017 Aug 10;:

Authors: Miret Alomar E, Trilla Herrera E, Lorente Garcia D, Regis Placido L, López Del Campo R, Cuadras Solé M, Pont Castellana T, Moreso Mateos F, Serón Micas D, Morote Robles J

Abstract
CONTEXT: Kidney transplantation from donors with expanded criteria has increased the pool of kidneys at the cost of a higher risk of short and long-term graft dysfunction. The main issue lies in determining which kidneys will offer acceptable function and survival compared with the risk represented by surgery and subsequent immunosuppression.
OBJECTIVE: The objective of our article is to review the current evidence on the tools for predicting the functionality of kidney transplantation from cadaveric donors with expanded criteria and determining the validity for their use in standard practice.
ACQUISITION OF EVIDENCE: We conducted a systematic literature review according to the PRISM criteria, through Medline (http://www.ncbi.nlm.nih.gov) and using the keywords (in isolation or in conjunction) "cadaveric renal transplantation; kidney graft function appraisal, graft function predictors". We selected prospective and retrospective series and review articles. A total of 375 articles were analysed, 39 of which were ultimately selected for review.
SUMMARY OF THE EVIDENCE: The predictors of functionality include the following: The donor risk indices; the calculation of the renal functional weight or the assessment of the nephronic mass; the measurement of vascular resistances during perfusion in hypothermia; the measurement of the donor's biomarkers in urine and in the perfusion liquid; the measurement of functional and reperfusion parameters in normothermia; and the measurement of morphological parameters (microscopic and macroscopic) of the target organ. In this article, we present an explanatory summary of each of these parameters, as well as their most recent evidence on this issue.
DISCUSSION: None of the reviewed parameters in isolation could reliably predict renal function and graft survival. There is a significant void in terms of the macroscopic assessment of kidney transplantation.
CONCLUSIONS: We need to continue developing predictors of renal functionality to accurately define the distribution of each currently available donor kidney.

PMID: 28803679 [PubMed - as supplied by publisher]

Factors influencing renal graft survival: 7-Year experience of a single center.

Tue, 08/15/2017 - 12:45
Related Articles

Factors influencing renal graft survival: 7-Year experience of a single center.

Medicina (Kaunas). 2017 Jul 29;:

Authors: Auglienė R, Dalinkevičienė E, Kuzminskis V, Jievaltas M, Peleckaitė L, Gryguc A, Stankevičius E, Bumblytė IA

Abstract
BACKGROUND AND OBJECTIVE: The demand for kidney transplants exceeds the existing supply. This leads to a recently growing interest of research in the area of factors that could prolong graft long-term outcomes and survival. In Lithuania, approximately 90% of kidney transplantations are from deceased donors. Donor organs are received and shared only inside the country territory in Lithuania; therefore, donor data is accurate and precise. This study was performed to present particularities of kidney transplantation data in Lithuania and to identify the effect of donor and recipient factors and histologic findings on renal graft outcomes. The aim of this study was to identify the effect of donor and recipient factors and histologic findings on renal graft outcomes.
MATERIALS AND METHODS: We analyzed the influence of deceased donor and recipient factors and histological findings on the graft function in 186 renal transplant patients. Graft survival was estimated within the first year after transplantation.
RESULTS: The donors and recipients were older in worse eGFR group 1 year after transplantation. Dissimilarity of degree of glomerulosclerosis (GS), interstitial fibrosis (IF) and arteriolar hyalinosis (AH) were significant in inferior and superior renal function groups (GS >20% 11.4 vs. 0%, P=0.017; IF 9.3 vs. 0%, P=0.034; AH 69 vs. 26.2%, P<0.001). Nine independent variables were significantly associated with a worse renal transplant function 1 year posttransplantation: AH (OR=6.287, P<0.001), an episode of urinary tract infection (OR=2.769, P=0.020), acute graft rejection (OR=3.605, P=0.037), expanded criteria (OR=4.987, P=0.001), female gender donors (OR=3.00, P=0.014), cerebrovascular disease caused donor brain death (OR=5.00, P=0.001), donor's age (OR=1.07, P<0.001), and recipient's age (OR=1.047, P=0.022). Worse renal graft survival 1 year posttransplantation was associated with a delayed graft function and a higher level of glomerulosclerosis in time-zero biopsy.
CONCLUSIONS: Donor factors, such as age, female gender, brain death of cerebrovascular cause and expanded criteria donor status had a significant negative impact on the renal graft function 1 year after transplantation. Recipients' age, urinary tract infection and acute graft rejection episodes after transplantation were associated with a worse kidney function 1 year after transplantation. Lower 1-year graft survival was related to a delayed graft function (DGF) and a higher degree of glomerulosclerosis.

PMID: 28802764 [PubMed - as supplied by publisher]

A heart-brain-kidney network controls adaptation to cardiac stress through tissue macrophage activation.

Tue, 08/15/2017 - 12:45
Related Articles

A heart-brain-kidney network controls adaptation to cardiac stress through tissue macrophage activation.

Nat Med. 2017 May;23(5):611-622

Authors: Fujiu K, Shibata M, Nakayama Y, Ogata F, Matsumoto S, Noshita K, Iwami S, Nakae S, Komuro I, Nagai R, Manabe I

Abstract
Heart failure is a complex clinical syndrome characterized by insufficient cardiac function. In addition to abnormalities intrinsic to the heart, dysfunction of other organs and dysregulation of systemic factors greatly affect the development and consequences of heart failure. Here we show that the heart and kidneys function cooperatively in generating an adaptive response to cardiac pressure overload. In mice subjected to pressure overload in the heart, sympathetic nerve activation led to activation of renal collecting-duct (CD) epithelial cells. Cell-cell interactions among activated CD cells, tissue macrophages and endothelial cells within the kidney led to secretion of the cytokine CSF2, which in turn stimulated cardiac-resident Ly6C(lo) macrophages, which are essential for the myocardial adaptive response to pressure overload. The renal response to cardiac pressure overload was disrupted by renal sympathetic denervation, adrenergic β2-receptor blockade or CD-cell-specific deficiency of the transcription factor KLF5. Moreover, we identified amphiregulin as an essential cardioprotective mediator produced by cardiac Ly6C(lo) macrophages. Our results demonstrate a dynamic interplay between the heart, brain and kidneys that is necessary for adaptation to cardiac stress, and they highlight the homeostatic functions of tissue macrophages and the sympathetic nervous system.

PMID: 28394333 [PubMed - indexed for MEDLINE]

Usefulness of Tacrolimus without Basiliximab in Well-Matched Living-Donor Renal Transplant Recipients in Korea.

Tue, 08/15/2017 - 12:45
Related Articles

Usefulness of Tacrolimus without Basiliximab in Well-Matched Living-Donor Renal Transplant Recipients in Korea.

Exp Clin Transplant. 2016 Aug;14(4):389-93

Authors: Baek CH, Kim JH, Yu H, Shin E, Cho H, Kim H, Yang WS, Han DJ, Park SK

Abstract
OBJECTIVES: Basiliximab is used alongside tacrolimus-based immunosuppression for routine induction therapy, even for well-matched living-donor renal transplant recipients. Because tacrolimus is a different drug from cyclosporine, this study examined the utility of tacrolimus-based immunosuppression without basiliximab for well-matched living-donor renal transplant recipients.
MATERIALS AND METHODS: This prospective study evaluated 36 patients who underwent 1 to 3 human leukocyte antigens mismatched living-donor renal transplants without basiliximab induction therapy between April 2012 and March 2015 (group 1). All transplants were ABO compatible and T-flow negative and were followed until April 2015. Tacrolimus-based triple therapy was used for maintenance immunosuppression. The control group comprised 72 age- and sex-matched patients who underwent 1 to 3 human leukocyte antigens mismatched living-donor renal transplants with basiliximab induction therapy during the same period (group 2).
RESULTS: Two patients in group 1 and 12 patients in group 2 had infection,with cytomegalovirus infection and Pneumocystis pneumonia infection occurring only in group 2 and BK virus and urinary tract infection reported in both groups, with a similar incidence. One patient from group 2 had sepsis. Although the incidence of infection tended to be lower in group 1 than in group 2 (5.6% vs 16.7%), the overall incidence of infection was not significantly different (P=.135). In addition, there were no significant differences in incidence of acute rejection between groups 1 and 2 (2.8% vs 4.2%; P=.699). All patients showed stable renal function after treatment.
CONCLUSIONS: Tacrolimus-based triple drug maintenance immunosuppression without basiliximab might be an optimal treatment choice for individuals undergoing well-matched living-donor renal transplant.

PMID: 27228054 [PubMed - indexed for MEDLINE]

Aldosterone mediates metastatic spread of renal cancer via the G protein-coupled estrogen receptor (GPER).

Tue, 08/15/2017 - 12:45
Related Articles

Aldosterone mediates metastatic spread of renal cancer via the G protein-coupled estrogen receptor (GPER).

FASEB J. 2016 Jun;30(6):2086-96

Authors: Feldman RD, Ding Q, Hussain Y, Limbird LE, Pickering JG, Gros R

Abstract
Although aldosterone is a known regulator of renal and cardiovascular function, its role as a regulator of cancer growth and spread has not been widely considered. This study tested the hypothesis that aldosterone regulates cancer cell growth/spread via G protein-coupled estrogen receptor (GPER) activation. In vitro in murine renal cortical adenocarcinoma (RENCA) cells, a widely used murine in vitro model for the study of renal cell adenocarcinoma, aldosterone increased RENCA cell proliferation to a maximum of 125 ± 3% of control at a concentration of 10 nM, an effect blocked by the GPER antagonist G15 or by GPER knockdown using short interfering (sh) RNA techniques. Further, aldosterone increased RENCA cell migration to a maximum of 170 ± 20% of control at a concentration of 100 nM, an effect also blocked by G15 or by GPER down-regulation. In vivo, after orthotopic RENCA cell renal transplantation, pulmonary tumor spread was inhibited by pharmacologic blockade of aldosterone effects with spironolactone (percentage of lung occupied by metastasis: control = 68 ± 13, spironolactone = 26 ± 8, P < 0.05) or inhibition of aldosterone synthesis with a high dietary salt diet (percentage of lung: control = 44 ± 6, high salt = 12 ± 3, P < 0.05), without reducing primary tumor size. Additionally, adrenalectomy significantly reduced the extent of pulmonary tumor spread, whereas aldosterone infusion recovered pulmonary metastatic spread toward baseline levels. Finally, inhibition of GPER either with the GPER antagonist G15 or by GPER knockdown comparably inhibited RENCA cell pulmonary metastatic cancer spread. Taken together, these findings provide strong evidence for aldosterone serving a causal role in renal cell cancer regulation via its GPER receptor; thus, antagonism of GPER represents a potential new target for treatment to reduce metastatic spread.-Feldman, R. D., Ding, Q., Hussain, Y., Limbird, L. E., Pickering, J. G., Gros, R. Aldosterone mediates metastatic spread of renal cancer via the G protein-coupled estrogen receptor (GPER).

PMID: 26911792 [PubMed - indexed for MEDLINE]

Mortality risk in post-transplantation diabetes mellitus based on glucose and HbA1c diagnostic criteria.

Tue, 08/15/2017 - 12:45
Related Articles

Mortality risk in post-transplantation diabetes mellitus based on glucose and HbA1c diagnostic criteria.

Transpl Int. 2016 May;29(5):568-78

Authors: Eide IA, Halden TA, Hartmann A, Åsberg A, Dahle DO, Reisaeter AV, Jenssen T

Abstract
Current diagnostic criteria for post-transplantation diabetes mellitus (PTDM) are either fasting plasma glucose ≥7.0 mmol/l (≥126 mg/dl) or postchallenge plasma glucose ≥11.1 mmol/l (≥200 mg/dl) 2 h after glucose administration [oral glucose tolerance test (OGTT) criterion]. In this retrospective cohort study of 1632 renal transplant recipients (RTRs) without known diabetes mellitus at the time of transplantation, we estimated mortality hazard ratios for patients diagnosed with PTDM by either conventional glucose criteria or the proposed glycated haemoglobin (HbA1c) criterion [HbA1c ≥6.5% (≥48 mmol/mol)]. During a median follow-up of 7.0 years, 311 patients died. Compared with nondiabetic patients and after adjustment for confounders, patients diagnosed with PTDM based on chronic hyperglycaemia early after transplantation (manifest PTDM) or by the OGTT criterion at 10 weeks post-transplant suffered a higher mortality risk (HR 1.59, 95% CI 1.06-2.38, P = 0.02 and HR 1.56, 95% CI 1.04-2.38, P = 0.03, respectively). In contrast, patients diagnosed with PTDM by the HbA1c criterion at 10 weeks or between 10 weeks and 1 year post-transplant were not associated with mortality (HR 0.96, 95% CI 0.61-1.51, P = 0.86 and 1.58, 95% CI 0.74-3.36, P = 0.24 respectively). After adjustment for confounders and competing risks, only patients with manifest PTDM had a significantly higher cardiovascular mortality risk (subdistributional HR 2.31, 95% CI 1.19-4.47, P < 0.001). Since many cases with PTDM were only identified by the OGTT, we recommend monitoring fasting plasma glucose early after renal transplantation followed by an OGTT at 2-3 months post-transplant in patients without overt diabetes mellitus.

PMID: 26875590 [PubMed - indexed for MEDLINE]

Recurrent Focal Segmental Glomerulosclerosis and Abatacept: Case Report.

Tue, 08/15/2017 - 12:45
Related Articles

Recurrent Focal Segmental Glomerulosclerosis and Abatacept: Case Report.

Exp Clin Transplant. 2016 Aug;14(4):456-9

Authors: Alkandari O, Nampoory N, Nair P, Atta A, Zakaria Z, Mossad A, Yagan J, Al-Otaibi T

Abstract
Focal segmental glomerulosclerosis is a common cause of end-stage renal disease in children. Focal segmental glomerulosclerosis recurrence in renal transplants is a challenging disease, and can cause graft dysfunction and loss. Different therapies exist with varying responses, from complete remission to resistance to all modes of treatment. Abatacept was recently introduced as a treatment for primary focal segmental glomerulosclerosis in native kidneys and in recurrent disease after transplant. We present a pediatric case with immunosuppression-resistant primary NPHS2-negative focal segmental glomerulosclerosis recur-rence after renal transplant. The standard therapy for recurrent focal segmental glomerulosclerosis (rituximab, plasmapheresis, high-dose cyclosporine, and corticosteroids) was tried but failed to induce remission. Abatacept (10 mg/kg) was given at 0, 2, and 4 weeks (total, 3 doses) with no good response. We conclude that abatacept may work in patients with B7-1-positive focal segmental glomerulosclerosis recurrence and its efficacy is uncertain in disease with B7-1-negative or unknown staining status.

PMID: 25432003 [PubMed - indexed for MEDLINE]

Appendicular Sinus as a Cause of Chronic Psoas Abscess in a Renal Transplant Recipient: A Case Report.

Tue, 08/15/2017 - 12:45
Related Articles

Appendicular Sinus as a Cause of Chronic Psoas Abscess in a Renal Transplant Recipient: A Case Report.

Exp Clin Transplant. 2016 Aug;14(4):447-9

Authors: Ghazanfar A, Khan Y, Popoola J

Abstract
A psoas abscess is a condition with vague symptomatology that is associated with potentially life-threatening suppurative myositis of the iliopsoas muscular compartment. Immunocompromised pa-tients run an increased risk of developing suppurative or chronic abscesses from acute foci. The presence of a solid-organ transplant, and the attendant need for immunosuppressant therapies and impaired renal provide additional factors that could contribute to the comorbidities of this condition. Here, we present a 61-year-old white man with a functioning renal transplant who developed a chronic psoas abscess associated with an appendicular sinus that required serial computed tomographic-guided drainages during 8 years. We highlight the difficulties and limitations of managing a psoas abscess. We conclude that a conservative approach toward managing a chronic psoas abscess may be associated with good long-term patient and graft functions, with minimal risk to the patient.

PMID: 25365253 [PubMed - indexed for MEDLINE]

Anesthetic Management for Intestinal Transplantation: a Decade of Experience.

Sun, 08/13/2017 - 12:45
Related Articles

Anesthetic Management for Intestinal Transplantation: a Decade of Experience.

Clin Transplant. 2017 Aug 12;:

Authors: Zerillo J, Kim S, Hill B, Shapiro D, Lin HM, Burnham A, Moon J, Iyer K, DeMaria S

Abstract
BACKGROUND: Intestinal transplantation (ITx) is the definitive therapy for patients suffering from intestinal failure. Previous published reports suggest that these cases should be managed peri-operatively with the same intensive monitors and techniques as in liver transplantation.
METHODS: We retrospectively reviewed the anesthetic management of sixty-seven isolated intestinal, intestinal-pancreas and intestinal-kidney transplants over the previous decade (2005-2015) in our tertiary care institution.
RESULTS: Patients were typically managed with a single arterial line, a single central venous catheter and rarely intensive modalities such as a pulmonary artery catheter, a transesophageal echocardiography, a second arterial catheter or central venous catheter, a rapid infusion system, a cell salvage device or viscoelastic testing. Significant hemodynamic derangements were rare and the rate of post reperfusion syndrome (PRS) was 8.96%. Our fluid administration type and volume and transfusion type and volume were similar to previous reports in which more intensive anesthetic management was employed.
CONCLUSION: We demonstrate that intestinal transplantation can safely occur without utilizing the intensive resources requisite for a liver transplant. This article is protected by copyright. All rights reserved.

PMID: 28801969 [PubMed - as supplied by publisher]

Outcomes of Patients With Atypical Hemolytic Uremic Syndrome With Native and Transplanted Kidneys Treated With Eculizumab: A Pooled Post Hoc Analysis.

Sun, 08/13/2017 - 12:45
Related Articles

Outcomes of Patients With Atypical Hemolytic Uremic Syndrome With Native and Transplanted Kidneys Treated With Eculizumab: A Pooled Post Hoc Analysis.

Transpl Int. 2017 Aug 12;:

Authors: Legendre CM, Campistol JM, Feldkamp T, Remuzzi G, Kincaid JF, Lommelé Å, Wang J, Weekers LE, Sheerin NS

Abstract
Atypical hemolytic uremic syndrome (aHUS) often leads to end-stage renal disease (ESRD) and kidney transplantation; graft loss rates are high due to disease recurrence. A post hoc analysis of four prospective clinical trials in aHUS was performed to evaluate eculizumab, a terminal complement inhibitor, in patients with native or transplanted kidneys. The trials included 26-week treatment and extension periods. Dialysis, transplant, and graft loss were evaluated. Study endpoints included complete thrombotic microangiopathy (TMA) response, TMA event-free status, hematologic and renal parameters, and adverse events. Of 100 patients, 74 had native kidneys and 26 in the transplant subgroup had a collective history of 38 grafts. No patients lost grafts and only one with preexisting ESRD received a transplant on treatment. Efficacy endpoints were achieved similarly in both subgroups. After 26 weeks, mean absolute estimated glomerular filtration rate increased from baseline to 61 and 37 mL/min/1.73 m(2) in native (n=71; P<0.0001) and transplanted kidney (n=25; P=0.0092) subgroups. Two patients (one/subgroup) developed meningococcal infections; both recovered, one continued therapy. Eculizumab was well tolerated. Eculizumab improved hematologic and renal outcomes in both subgroups. In patients with histories of multiple graft losses, eculizumab protected kidney function. (ClinicalTrials. gov numbers : NCT00844545, NCT00844844, NCT00838513, NCT00844428, NCT01193348, and NCT01194973) This article is protected by copyright. All rights reserved.

PMID: 28801959 [PubMed - as supplied by publisher]

[Early intervention of BK virus replication promotes stabilization of renal graft function].

Sun, 08/13/2017 - 12:45
Related Articles

[Early intervention of BK virus replication promotes stabilization of renal graft function].

Nan Fang Yi Ke Da Xue Xue Bao. 2017 Aug 20;37(8):1110-1115

Authors: Deng WM, Liu YN, Yu LX, Deng WF, Fu SJ, Xu J, DU CF, Wang YB, Liu RM, Ye GR, Huang G, Miao Y

Abstract
OBJECTIVE: To investigate the optimal time window for intervention of BK virus (BKV) replication and its effect on the outcomes of kidney transplant recipients (KTRs).
METHODS: A retrospective analysis of the clinical data and treatment regimens was conducted among KTRs whose urine BKV load was ≥1.0×10(4) copies/mL following the operation between April, 2000 and April, 2015. KTRs with urine BKV load <1.0×10(4) copies/mL matched for transplantation time served as the control group.
RESULTS: A total of 54 recipients positive for urine BKV were included in the analysis. According to urine BKV load, the recipients were divided into 3 groups: group A with urine BKV load of 1.0×10(4)-1.0×10(7) copies/mL (n=22), group B with urine BKV load >1.0×10(7) copies/mL (n=24), and group C with plasma BKV load ≥1.0×10(4) copies/mL (n=8); 47 recipients were included in the control group. During the follow-up for 3.2-34.5 months, the urine and plasma BKV load was obviously lowered after intervention in all the 54 BKV-positive recipients (P<0.05). Eighteen (81.82%) of the recipients in group A and 19 (79.17%) in group B showed stable or improved estimated glomerular filtration rate (eGFR) after the intervention; in group C, 4 recipients (50%) showed stable eGFR after the intervention. In the last follow-up, the recipients in groups A and B showed similar eGFR with the control group (P>0.05), but in group C, eGFR was significantly lower than that of the control group (P=0.001). The recipients in group A and the control group had the best allograft outcome with stable or improved eGFR.
CONCLUSION: Early intervention of BKV replication (urine BKV load ≥1.0×10(4) copies/mL) in KTRs with appropriate immunosuppression reduction can be helpful for stabilizing the allograft function and improving the long-term outcomes.

PMID: 28801294 [PubMed - in process]

Impact of Hyperuricemia on Long-term Outcomes of Kidney Transplantation: Analysis of the FAVORIT Study.

Sun, 08/13/2017 - 12:45
Related Articles

Impact of Hyperuricemia on Long-term Outcomes of Kidney Transplantation: Analysis of the FAVORIT Study.

Am J Kidney Dis. 2017 Aug 09;:

Authors: Kalil RS, Carpenter MA, Ivanova A, Gravens-Mueller L, John AA, Weir MR, Pesavento T, Bostom AG, Pfeffer MA, Hunsicker LG

Abstract
BACKGROUND: Elevated uric acid concentration is associated with higher rates of cardiovascular (CV) morbidity and mortality in the general population. It is not known whether hyperuricemia increases the risk for CV death or transplant failure in kidney transplant recipients.
STUDY DESIGN: Post hoc cohort analysis of the FAVORIT Study, a randomized controlled trial that examined the effect of homocysteine-lowering vitamins on CV disease in kidney transplantation.
SETTING & PARTICIPANTS: Adult recipients of kidney transplants in the United States, Canada, or Brazil participating in the FAVORIT Study, with hyperhomocysteinemia, stable kidney function, and no known history of CV disease.
PREDICTOR: Uric acid concentration.
OUTCOMES: The primary end point was a composite of CV events. Secondary end points were all-cause mortality and transplant failure. Risk factors included in statistical models were age, sex, race, country, treatment assignment, smoking history, body mass index, presence of diabetes mellitus, history of CV disease, blood pressure, estimated glomerular filtration rate (eGFR), donor type, transplant vintage, lipid concentrations, albumin-creatinine ratio, and uric acid concentration. Cox proportional hazards models were fit to examine the association of uric acid concentration with study end points after risk adjustment.
RESULTS: 3,512 of 4,110 FAVORIT participants with baseline uric acid concentrations were studied. Median follow-up was 3.9 (IQR, 3.0-5.3) years. 503 patients had a primary CV event, 401 died, and 287 had transplant failure. In unadjusted analyses, uric acid concentration was significantly related to each outcome. Uric acid concentration was also strongly associated with eGFR. The relationship between uric acid concentration and study end points was no longer significant in fully adjusted multivariable models (P=0.5 for CV events; P=0.09 for death, and P=0.1 for transplant failure).
LIMITATIONS: Unknown use of uric acid-lowering agents among study participants.
CONCLUSIONS: Following kidney transplantation, uric acid concentrations are not independently associated with CV events, mortality, or transplant failure. The strong association between uric acid concentrations with traditional risk factors and eGFR is a possible explanation.

PMID: 28801121 [PubMed - as supplied by publisher]

External Iliac Artery Dissection During Kidney Transplant for Polycystic Kidney Disease: A Caveat for Surgeons.

Sat, 08/12/2017 - 12:45
Related Articles

External Iliac Artery Dissection During Kidney Transplant for Polycystic Kidney Disease: A Caveat for Surgeons.

Exp Clin Transplant. 2016 Aug 11;:

Authors: Karusseit VOLOL

Abstract
Autosomal dominant polycystic kidney disease is a common cause of end-stage renal failure and an indication for transplant. The genetic mutation in autosomal dominant polycystic kidney disease also causes vascular abnormalities, mainly aneurysms but also medial dissection. Here, a case of dissection of the recipient artery during a kidney transplant procedure in a patient with autosomal dominant polycystic kidney disease is described. Dissection caused occlusion of both the external iliac artery and the donor renal artery. Occlusion was recognized intraoperatively, and the kidney was salvaged by in situ reperfusion of the kidney with cold preservation solution, excision of the affected recipient arterial segment, and reanastomosis of the donor artery to the internal iliac artery. The external iliac artery defect was replaced with a saphenous vein interposition graft. The transplanted kidney achieved good function. This is the first description of a case of recognition of recipient arterial dissection during a kidney transplant procedure for autosomal dominant polycystic kidney disease. Surgeons should be aware of the phenomenon of arterial dissection in autosomal dominant polycystic kidney disease and should be vigilant while anastomosing the artery during kidney transplant in these patients.

PMID: 28799891 [PubMed - as supplied by publisher]

Pages