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Emerging biomarkers of chronic kidney disease in children.

Mon, 06/19/2017 - 12:45

Emerging biomarkers of chronic kidney disease in children.

Pediatr Nephrol. 2017 Jun 17;:

Authors: Greenberg JH, Kakajiwala A, Parikh CR, Furth S

Abstract
Chronic kidney disease (CKD) has become a significant public health concern, as it is associated with substantial morbidity. Prior research has evaluated multiple novel CKD biomarkers to supplement serum creatinine and proteinuria. The ultimate goal of this research is to find biomarkers that can be used to accurately predict CKD progression and to better time outpatient follow-up, and referral for transplant. Also, an optimal panel of biomarkers can augment the predictive value of proteinuria and serum creatinine by enriching patient enrollment in clinical trials. In this review, we discuss salient findings on 12 candidate plasma and urine biomarkers and their reported association with CKD. We explore the common pathways of CKD progression and the pathophysiologic processes of tubulointerstitial injury, inflammation, repair, and fibrosis that are potentially classified by specific biomarkers. We describe both pediatric and adult findings and highlight the paucity of pediatric research in CKD progression. It will be important for cohorts with longitudinal follow-up to evaluate these CKD biomarkers for potential use in pediatric clinical trials and routine CKD management.

PMID: 28624980 [PubMed - as supplied by publisher]

Steady-state pharmacokinetics of mycophenolic acid in renal transplant patients: exploratory analysis of the effects of cyclosporine, recipients' and donors' ABCC2 gene variants, and their interactions.

Mon, 06/19/2017 - 12:45

Steady-state pharmacokinetics of mycophenolic acid in renal transplant patients: exploratory analysis of the effects of cyclosporine, recipients' and donors' ABCC2 gene variants, and their interactions.

Eur J Clin Pharmacol. 2017 Jun 18;:

Authors: Božina N, Lalić Z, Nađ-Škegro S, Borić-Bilušić A, Božina T, Kaštelan Ž, Trkulja V

Abstract
PURPOSE: The study aims to evaluate the impact of recipients' and donors' polymorphisms in multidrug resistance-associated protein 2 (MRP2) gene ABCC2 -24C>T and 1249G>A on disposition of mycophenolic acid (MPA) and their interaction with cyclosporine (CsA) (compared to tacrolimus, TAC) in stable de novo adult renal transplant patients of Croatian origin.
METHODS: A total of 68 recipient-donor pairs were genotyped. Steady-state pharmacokinetics of MPA was assessed by the model-independent method.
RESULTS: Adjusted for MPA formulation, renal function, type of calcineurin inhibitor and recipients' and donors' genotypes at the two loci, donors' A-allele at 1249G>A was associated with a reduced peak (29%) and early (AUC0-2, 33%) exposure and increased MPA clearance (26%). Donors' A-allele combined with CsA was associated with 78% higher MPA clearance, 49% lower early and 48% lower total exposure as compared to wild type homozygosity + TAC. Recipients' SNPs per se did not reflect on MPA disposition. However, A-allele at 1249G>A + CsA (compared to wild type + TAC) was associated with a numerically greater increase in MPA clearance (59 vs. 41%), reduction in total exposure (36 vs. 27%) and increase in absorption rate (C max/AUC) (56 vs. 37%) than observed for the main effect of CsA. Less pronounced effects were observed for the combination of variant allele at -24C>T and CsA.
CONCLUSION: Considering MPA disposition, data indicate: donors' ABCC2 1249G>A polymorphism increases clearance and reduces exposure; CsA increases clearance and reduces exposure by inhibiting MRP2 in the gut, the liver, and the kidney; donors' ABCC2 1249G>A polymorphism enhances the renal CsA effect, while recipients' polymorphism seems to enhance the liver and the gut CsA effects.

PMID: 28624888 [PubMed - as supplied by publisher]

Association of Genetic Polymorphisms of Macrophage Inhibitory Factor (MIF) and B-cell activating factor (BAFF) with the Detection of Donor Specific Antibodies in Kidney Allograft Recipients.

Mon, 06/19/2017 - 12:45

Association of Genetic Polymorphisms of Macrophage Inhibitory Factor (MIF) and B-cell activating factor (BAFF) with the Detection of Donor Specific Antibodies in Kidney Allograft Recipients.

Hum Immunol. 2017 Jun 14;:

Authors: Chang Y, Shah T, Min DI

Abstract
The posttransplant development of donor specific antibodies (DSA) initiates the antibody mediated rejection (AMR), which is associated with the increased rate of graft loss. One of the characteristics of AMR is the infiltration of innate immune system including macrophages, monocytes, neutrophils or NK cells. Macrophage inhibitory factor (MIF) and B-cell activating factor (BAFF) are well known cytokines that are associated with the activation of the innate immune system which can damage kidney allograft. In this article, the association of the genetic polymorphisms of MIF and BAFF with the development of DSA including Class I and II in kidney transplant patients is investigated. A total of 231 renal transplant patients between 2008 and 2012 at St. Vincent Medical Center, CA were studied in a retrospective study design. DSA were determined by Luminex technology, and single nucleotide polymorphisms (SNP) of MIF and BAFF were determined by the real time PCR based on 5' nuclease allelic discrimination assay. The genetic polymorphisms of MIF rs1007888 (C/T) was associated with increased risk of positive DSA detection (p = 0.04) after transplantation, and consistently significant after 1 year (p = 0.016). Furthermore, the presence of C allele were associated with the increased risk of Class I DSA detection (OR 1.816, CI 1.141-2.889, p=0.011). Also, genetic polymorphisms of BAFF rs12583006 were associated with the increased risk of Class II DSA detection (p=0.033). In conclusion, the genetic polymorphisms of MIF and BAFF may increase the risk of posttransplant development of DSA. This result suggests the association between the development of posttransplant DSA and the activation of innate immune system.

PMID: 28624489 [PubMed - as supplied by publisher]

Acute kidney injury after liver transplantation: Recent insights and future perspectives.

Mon, 06/19/2017 - 12:45

Acute kidney injury after liver transplantation: Recent insights and future perspectives.

Best Pract Res Clin Gastroenterol. 2017 Apr;31(2):161-169

Authors: de Haan JE, Hoorn EJ, de Geus HRH

Abstract
Acute kidney injury (AKI) is a common postoperative complication after liver transplantation (LT). The occurrence of postoperative AKI after LT (Post-LT AKI) is associated with inferior patient and graft outcomes. Post-LT AKI is multifactorial in origin and has been related to the severity of liver disease, pre-LT renal dysfunction, graft quality, perioperative events and toxicity of immunosuppressive therapy. Furthermore it is thought that hepatic ischaemia reperfusion injury might be a driving force in the aetiology of post-LT AKI. Novel biomarkers for AKI are emerging and can be useful for early identification and characterization of AKI. There is a clear need for strategies aimed at preventing or treating post-LT AKI. Several pharmacological and non-pharmacological interventions have been studied, but so far failed to show any benefit in the prevention of post-LT AKI. Further studies are needed to develop and evaluate new interventions aimed at preventing post-LT AKI and improve patient outcomes.

PMID: 28624104 [PubMed - in process]

Level of acceptance of islet cell and kidney xenotransplants by personnel of hospitals with and without experience in clinical xenotransplantation.

Sun, 06/18/2017 - 12:45
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Level of acceptance of islet cell and kidney xenotransplants by personnel of hospitals with and without experience in clinical xenotransplantation.

Xenotransplantation. 2017 Jun 17;:

Authors: Abalovich A, Matsumoto S, Wechsler CJ, Carulla ME, Siciliano ME, Sznaider D, Denner J, Elliott RB

Abstract
BACKGROUND: Recently, significant progress in both safety and efficacy has been achieved in the field of xenotransplantation, as exemplified by results from the first clinical trials of porcine islet transplantation. It would be of interest to learn whether the attitude of the clinical staff involved in such trials changes as the trials are carried out in their own hospital.
METHODS: One hundred and four clinical staff members from the Eva Peron Hospital of San Martin (Buenos Aires, Argentina) where clinical trials of islet xenotransplantation have been performed and 92 similar staff members from the Diego Thompson Hospital (Buenos Aires, Argentina) where no such xenotransplantation has been carried out participated in the study. Data were collected anonymously using questionnaires.
RESULTS: Statistically significant differences between the acceptance of xenotransplantation by clinical personnel in a hospital that had carried out clinical xenotransplantation trials were observed when compared with the acceptance of a similar staff from the hospital that had not carried out such trials.
CONCLUSION: This study shows that involvement in clinical xenotransplantation trials significantly changes the attitude of the clinical staff towards this technology and suggests that better information given to the society may increase acceptance of the xenotransplantation.

PMID: 28623861 [PubMed - as supplied by publisher]

Osteonecrosis of the Jaw in a Patient Presenting With Post-Transplantation Lymphoproliferative Disorder Treated With Rituximab: A Case Report.

Sun, 06/18/2017 - 12:45
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Osteonecrosis of the Jaw in a Patient Presenting With Post-Transplantation Lymphoproliferative Disorder Treated With Rituximab: A Case Report.

J Oral Maxillofac Surg. 2017 May 24;:

Authors: Keribin P, Guerrot D, Jardin F, Moizan H

Abstract
Osteonecrosis of the jaw (ONJ) is a rare but potentially severe condition that can be induced by specific treatments. We report the case of a 69-year-old male kidney transplant recipient who presented with ONJ 5 years after transplantation. The patient presented with ulcerations of the oral mucosa related to post-transplantation lymphoproliferative disorder, which was treated with rituximab. Subsequently, ONJ developed. Although rituximab treatment cannot be firmly established as the cause of this condition, similar cases of ONJ have been reported after treatment with this monoclonal antibody. This case raises a potential link between rituximab treatment and ONJ and prompts further studies to investigate the potential impact of rituximab on bone angiogenesis.

PMID: 28623682 [PubMed - as supplied by publisher]

Renal capillary haemangioma associated with renal cell carcinoma and polycythaemia in acquired cystic disease.

Sun, 06/18/2017 - 12:45
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Renal capillary haemangioma associated with renal cell carcinoma and polycythaemia in acquired cystic disease.

BMJ Case Rep. 2017 Jun 16;2017:

Authors: Beamer M, Love M, Ghasemian S

Abstract
Capillary haemangiomas are relatively common tumours, typically occurring in the subcutaneous tissue during childhood. However, visceral occurrence is very rare. These tumours make up a subset of vascular lesions that have previously, although rarely, been described in case reports in association with the kidney. Here we review the literature and describe a capillary haemangioma occurring in the renal hilum found to be coexistent with end-stage renal disease, renal cell carcinoma and polycythaemia. To our knowledge, this is the first case report to describe the occurrence of this tumour in the renal hilum in association with this constitution of renal pathologies.

PMID: 28623191 [PubMed - in process]

Anti-inflammatory profile of paricalcitol in kidney transplant recipients.

Sun, 06/18/2017 - 12:45
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Anti-inflammatory profile of paricalcitol in kidney transplant recipients.

Nefrologia. 2017 Jun 13;:

Authors: Donate-Correa J, Henríquez-Palop F, Martín-Núñez E, Hernández-Carballo C, Ferri C, Pérez-Delgado N, Muros-de-Fuentes M, Mora-Fernández C, Navarro-González JF

Abstract
BACKGROUND AND OBJECTIVES: Paricalcitol, a selective vitamin D receptor activator, is used to treat secondary hyperparathyroidism in kidney transplant patients. Experimental and clinical studies in non-transplant kidney disease patients have found this molecule to have anti-inflammatory properties. In this exploratory study, we evaluated the anti-inflammatory profile of paricalcitol in kidney-transplant recipients.
METHODS: Thirty one kidney transplant recipients with secondary hyperparathyroidism completed 3 months of treatment with oral paricalcitol (1μg/day). Serum concentrations and gene expression levels of inflammatory cytokines in peripheral blood mononuclear cells were analysed at the beginning and end of the study.
RESULTS: Paricalcitol significantly decreased parathyroid hormone levels with no changes in calcium and phosphorous. It also reduced serum concentrations of interleukin (IL)-6 and tumour necrosis factor-alpha (TNF-α) by 29% (P<0.05) and 9.5% (P<0.05) compared to baseline, respectively. Furthermore, gene expression levels of IL-6 and TNF-α in peripheral blood mononuclear cells decreased by 14.1% (P<0.001) and 34.1% (P<0.001), respectively. The ratios between pro-inflammatory cytokines (TNF-α and IL-6) and anti-inflammatory cytokines (IL-10), both regarding serum concentrations and gene expression, also experienced a significant reduction.
CONCLUSIONS: Paricalcitol administration to kidney transplant recipients has been found to have beneficial effects on inflammation, which may be associated with potential clinical benefits.

PMID: 28623033 [PubMed - as supplied by publisher]

New markers of urinary tract infection.

Sun, 06/18/2017 - 12:45
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New markers of urinary tract infection.

Clin Chim Acta. 2017 Jun 13;:

Authors: Masajtis-Zagajewska A, Nowicki M

Abstract
Urinary tract infection (UTI) is the most common bacterial infection independent of age. It is also one of the most common causes of hospitalizations for infections among elderly people and the most common indication for antibiotic prescriptions in primary care. Both diagnostics and management of lower and upper urinary tract infections provide challenges in clinical practice due to their high prevalence and recurrence, and worldwide increase of antibiotic resistance. The clinical symptoms of UTI are often uncharacteristic or asymptomatic. The accurate diagnosis and early treatment are crucial due to risk of septicaemia and long-term consequences. Currently the diagnosis of urinary tract infection is based on the presence of clinical symptoms in combination with the results of nitrite strip test indicating the presence of bacteria in urine and semi-quantitative measurement of white blood cells count in urine. Although urine culture is the gold standard in UTI diagnostics it is both time-consuming and costly. Searching for novel biomarkers of UTI has attracted much attention in recent years. The article reviews several promising serum and urine biomarkers of UTI such as leukocyte esterase, C-reactive protein, procalcitonin, interleukins, elastase alpha (1)-proteinase inhibitor, lactofferin, secretory immunoglobulin A, heparin-binding protein, xanthine oxidase, myeloperoxidase, soluble triggering receptor expressed on myeloid cells-1, α-1 microglobulin (α1Mg) and tetrazolium nitroblue test (TNB).

PMID: 28622967 [PubMed - as supplied by publisher]

Morbid obesity and functional status as predictors of surgical complication after renal transplantation.

Sun, 06/18/2017 - 12:45
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Morbid obesity and functional status as predictors of surgical complication after renal transplantation.

Am J Surg. 2017 Jun 08;:

Authors: Veasey TM, Fleming JN, Strout SE, Miller R, Pilch NA, Meadows HB, Mardis CR, Mardis BA, Shenvi S, McGillicuddy J, Chavin KD, Baliga P, Taber DJ

Abstract
BACKGROUND: This study evaluated the impact of body mass index (BMI) and patient functional status on the risk for surgical complications after kidney transplant.
METHODS: This retrospective cohort study of adult kidney transplant recipients grouped patients by baseline Karnofsky status (low function ≤ 70%) and further stratified by morbid obesity (BMI ≥ 35 kg/m(2)) to assess surgical complication risk.
RESULTS: 736 patients were included with surgical complications occurring in 25%. Logistic regression analysis with interaction terms demonstrated that morbid obesity and low functional status conditionally impact risk with an OR of 2.8 [95% CI (1.1-7.3)]. Within the functional status cohort, BMI ≥35 kg/m(2) was associated with increased risk of surgical complication, superficial wound infection, and DGF. Independent predictors for surgical complications included diabetes and morbid obesity with low functional status. There was no significant difference in graft loss or death across the cohorts.
CONCLUSIONS: While neither morbid obesity nor poor functional status alone predicts increased complications, the combined presence is associated with significant increase in risk for surgical complications after renal transplantation.

PMID: 28622834 [PubMed - as supplied by publisher]

Clinical and Biochemical Characteristics of Brain-Dead Donors as Predictors of Early- and Long-Term Renal Function After Transplant.

Sun, 06/18/2017 - 12:45
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Clinical and Biochemical Characteristics of Brain-Dead Donors as Predictors of Early- and Long-Term Renal Function After Transplant.

Exp Clin Transplant. 2017 Jun 16;:

Authors: Kwiatkowska E, Domański L, Bober J, Safranow K, Pawlik A, Ciechanowski K, Wiśniewska M, Kędzierska K

Abstract
OBJECTIVES: Organs from brain-dead donors are the main source of allografts for transplant. Comparisons between living-donor and brain-dead donor kidneys show that the latter are more likely to demonstrate delayed graft function and lower long-term survival. This study aimed to assess the effects of various clinical and biochemical factors of donors on early- and long-term renal function after transplant.
MATERIALS AND METHODS: We analyzed data from kidney recipients treated between 2006 and 2008 who received organs from brain-dead donors. Data from 54 donors and 89 recipients were analyzed.
RESULTS: No relation was observed between donor sodium concentration and the presence of delayed graft function. Donor height was positively correlated with creatinine clearance in recipients in the 1 to 3 months after renal transplant. Donor diastolic blood pressure was negatively correlated with estimated glomerular filtration rate throughout the observation period. Donor age was negatively correlated with the allograft recipient's estimated glomerular filtration rate throughout 4 years of observation. Donor estimated glomerular filtration rate was positively correlated with that of the recipient throughout 3 years of observation.
CONCLUSIONS: The results of this study indicate that various factors associated with allograft donors may influence graft function.

PMID: 28621640 [PubMed - as supplied by publisher]

Outcome of the Double-J Stent Placement in Pediatric Kidney Transplant: A Single Center Experience.

Sun, 06/18/2017 - 12:45
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Outcome of the Double-J Stent Placement in Pediatric Kidney Transplant: A Single Center Experience.

Exp Clin Transplant. 2017 Jun 16;:

Authors: Sözen H, Özen O, Fidan K, Söylemezoğlu O, Dalgıç A

Abstract
OBJECTIVES: Double J stent placement at kidney transplant may reduce stenosis or leakage complication rates. However, placement may also increase risk for early urinary tract infection (ie, < 3 mo after transplant). In children, the usefulness of double J stent placement is not well defined.
MATERIALS AND METHODS: We analyzed retrospective data from children who received transplants at the Gazi University Transplantation Center and Pediatric Nephrology (Ankara, Turkey) for outcomes related to double J stents. At our center, double J stent placement decision is made by the transplant surgery team during operation. Placements were routinely performed in all transplant recipients. Stent removal occurs within 6 week after transplant.
RESULTS: Among 42 transplants since 2006, early urinary tract infection was seen in 7% and stenosis in 3.6% of patients, with no leakage reported. Mean stent removal time was 6 ± 0.5 weeks. Early urinary tract infection was seen in 3 recipients with posterior urethral valve and neurogenic bladder (2 recipients) and meningoma cells and neurogenic bladder (1 recipient). All 3 recipients with early urinary tract infection received clean intermittent catheterization after transplant for adequate emptying of the bladder. In our study group, stent complications such as migration (2 patients) and hematuria (1 patient) were seen, but crusting, breakage, and stone formation were not seen. The 3 patients with urinary tract infection had neurogenic bladder types, complicating the urine outflow system. Stent placement was not a significant risk factor for early urinary tract infection and but had a protective effect.
CONCLUSIONS: In our study group, we observed no risk factors for routine double J stent placement in pediatric renal transplant procedures. Stent placement was not a risk factor for early urinary tract infection. However, regardless of stent placement, when a recipient had complicated urologic outflow problems, infection became a long-term hurdle.

PMID: 28621639 [PubMed - as supplied by publisher]

Urologic Complications After Renal Transplant: A Single-Center Experience.

Sun, 06/18/2017 - 12:45
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Urologic Complications After Renal Transplant: A Single-Center Experience.

Exp Clin Transplant. 2017 Jun 16;:

Authors: Sözen H, Onaran M, Özen O, Dalgıç A

Abstract
OBJECTIVES: Urologic complications after kidney transplant are associated with significant morbidity, mortality, and prolonged hospital stay. An intervention or second surgical procedure is frequently required. Here, we report urologic complications in adult kidney recipients.
MATERIALS AND METHODS: Since 2006, 171 adult kidney transplant procedures have been performed at the Gazi University Transplantation Center (Ankara, Turkey). Among these patients, there were 65 adult female (38%) and 106 adult male (62%) recipients. Donor source included 61 deceased donations (36%) and 110 living related donations (64%). The Haberal corner-saving technique was used for ureteroneocystostomy anastomosis. All recipients received a calcineurin-based triple immunosuppression regimen. All recipients also received trimethoprim/sulfamethoxazole prophylaxis for 3 months after transplant.
RESULTS: In the 171 adult kidney recipients analyzed for urologic complications, mean age was 32.5 ± 14.1 years (median: 32.5 y; range, 18-67 y); mean donor age was 41 ± 14.2 years (median: 42 y). We focused on 3 specific urologic complications: urine leak, ureteric stenosis, and symptomatic vesicoureteral reflux. In our study group, urologic complications were encountered in 7 patients (4%), with 5 complications detected in the early period and 2 complications detected in the late period. No symptomatic vesicoureteral reflux complications were shown in this study group. Urologic complications did not result in any patient deaths or graft loss.
CONCLUSIONS: In this study, the Haberal corner-saving suture technique with double J stent seemed to have a protective effect for development of urologic complications.

PMID: 28621638 [PubMed - as supplied by publisher]

Surgical Techniques and Procedures for Kidney Transplant Recipients With Severe Atherosclerosis.

Sun, 06/18/2017 - 12:45
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Surgical Techniques and Procedures for Kidney Transplant Recipients With Severe Atherosclerosis.

Exp Clin Transplant. 2017 Jun 16;:

Authors: Nanmoku K, Watarai Y, Narumi S, Goto N, Yamamoto T, Tsujita M, Hiramitsu T, Katayama A, Kobayashi T, Uchida K

Abstract
OBJECTIVES: Atherosclerosis is becoming a more common problem for dialysis patients. Therefore, transplant surgeons are faced with the need to develop surgical techniques and procedures for severe atherosclerosis. This study aimed to clarify the clinical features, the usefulness of examinations, and operative procedures for kidney transplant recipients with the complication of severe atherosclerosis.
MATERIALS AND METHODS: Among 220 kidney transplant candidates, 13 patients (severe atherosclerosis group) were predicted complications due to arterial calcification in the bilateral iliac arterial system using a computed tomographic scan. They were compared with the remaining 207 patients (mild atherosclerosis group) based on patient characteristics. The severe atherosclerosis group was evaluated by additional examination, anastomosis procedure of the graft artery, and patient outcome.
RESULTS: The severe atherosclerosis group had significantly higher rates of mean recipient age, glycosylated hemoglobin A1c, past smoking, and administration of antithrombotics. Past vascular surgery related to atherosclerosis in the aortoiliac region had been performed in 8 patients from the severe atherosclerosis group. A three-dimensional computed tomography angiography and an intraoperative periarterial echography were useful to determine the kidney transplant site. A balloon catheter effectively blocked blood flow. A polytetrafluoroethylene vascular graft was used for bypass between the graft artery and abdominal aorta. All kidney grafts of the severe atherosclerosis group were functioning well.
CONCLUSIONS: Kidney transplant for patients with severe atherosclerosis can be achieved successfully by additional examinations and vascular surgical techniques.

PMID: 28621637 [PubMed - as supplied by publisher]

Is Brain-Dead Donor Fluid Therapy With Colloids Associated With Better Kidney Grafts?

Sun, 06/18/2017 - 12:45
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Is Brain-Dead Donor Fluid Therapy With Colloids Associated With Better Kidney Grafts?

Exp Clin Transplant. 2017 Jun 16;:

Authors: Limnell N, Schramko AA

Abstract
OBJECTIVES: Fluid therapy is required to maintain perfusion to donor organs. Recent reviews on the choices of fluids have emphasized the safety of using crystalloids, as opposed to fluid therapy with colloids, which has been reported to be either unequivocally or potentially harmful in a number of studies on various patient populations. We aimed to analyze whether the type of fluid administered to donors is connected with kidney transplant outcomes.
MATERIALS AND METHODS: A total of 100 consecutive brain-dead multiorgan donors and their respective 181 kidney recipients were studied retrospectively. Data concerning donor fluid therapy, the characteristics of the donors and the recipients, and outcomes after kidney transplant were extracted from organ retrieval and patient records. Cases with early graft function were compared with cases with delayed graft function.
RESULTS: Donors had received both crystalloids and colloids in most cases (84%). Fluid therapy with crystalloids alone was more common among the 40 recipients with delayed (30%) than in the 103 recipients with early graft function (11%) (P = .005). Donor age, time on renal replacement therapy before transplant, and donor fluid therapy with crystalloids alone were independent risk factors for delayed graft function in multivariate analysis.
CONCLUSIONS: Our results suggest that donor fluid therapy including colloids could be beneficial instead of harmful compared with treatment with crystalloids alone. This finding needs to be evaluated in prospective studies.

PMID: 28621636 [PubMed - as supplied by publisher]

The Utility of Screening Colonoscopy During Kidney Transplant Evaluation.

Sun, 06/18/2017 - 12:45
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The Utility of Screening Colonoscopy During Kidney Transplant Evaluation.

Exp Clin Transplant. 2017 Jun 16;:

Authors: Zheng Y, Chaung KV, Park PJ, Augustine JJ, Sarabu N, Schulak JA, Sanchez EQ, Humphreville VR, Ammori JB, Woodside KJ

Abstract
OBJECTIVES: Transplant centers often recommend, but not necessarily require, screening colonoscopies for people over 50 years of age in accordance with the US Preventative Services Task Force guidelines for the general population. We sought to identify risk factors affecting colonoscopy results in renal failure patients undergoing kidney transplant evaluation.
MATERIALS AND METHODS: We retrospectively examined patients undergoing kidney transplant evaluation from 2009 to 2012 (n = 469 patients). Comparisons were made between colonoscopy reports categorized as normal (no finding or hyperplastic polyp) or abnormal (adenomatous polyp or carcinoma).
RESULTS: Of 469 patients who met the study criteria, 303 (64.6%) had normal colonoscopies and 166 (35.4%) had abnormal colonoscopies. Logistic regression analysis showed that male sex (odds ratio = 2.09; 95% confidence interval, 1.37-3.20; P = .001) and increasing age (odds ratio = 1.04; 95% confidence interval, 1.01-1.08; P = .019) were more likely to correspond to abnormal findings. Those with dialysis vintage (length of time on dialysis) up to 3 years (odds ratio = 2.10; 95% confidence interval, 1.09-4.06; P = .027) and hypertension as the cause of renal failure (odds ratio = 1.79; 95% confidence interval, 1.05-2.87; P = .002) had more abnormal findings. No differences in length of evaluation, rate of being listed for transplant, and rate of transplant were shown.
CONCLUSIONS: The overall rate of adenomatous findings on colonoscopy was higher among patients with pretransplant end-stage renal disease than in the general population, as shown in other studies. Age, sex, dialysis vintage up to 3 years, and hypertensive renal failure were associated with adenomatous polyps of the colon in this study population. Because adenomatous polyp rates are high in patients with chronic kidney disease who are undergoing transplant evaluation and colonoscopic findings do not appear to delay transplant evaluations or listing rates, screening colonoscopies should be encouraged.

PMID: 28621634 [PubMed - as supplied by publisher]

Fatigue After Liver Transplant and Combined Liver and Kidney Transplant.

Sun, 06/18/2017 - 12:45
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Fatigue After Liver Transplant and Combined Liver and Kidney Transplant.

Exp Clin Transplant. 2017 Jun 16;:

Authors: Benzing C, Krenzien F, Krezdorn N, Wiltberger G, Hinz A, Förster J, Atanasov G, Schmelzle M, Glaesmer H, Hau HM, Bartels M

Abstract
OBJECTIVES: To date, fatigue is still poorly understood in recipients of orthotopic liver transplant and simultaneous/sequential liver and kidney transplant procedures. The present study examined the appearance of fatigue in patients who received orthotopic liver and sequential liver and kidney transplant procedures compared with the general population and the influence of various clinical and socioeconomic factors on fatigue levels.
MATERIALS AND METHODS: The Multidimensional Fatigue Inventory survey was sent to all patients with a history of orthotopic liver and simultaneous/sequential liver and kidney transplant. The results were compared to data from a reference population.
RESULTS: Our survey included 276 eligible patients: 256 recipients (92.7%) of orthotopic liver transplant and 20 recipients (7.3%) of simultaneous/sequential liver and kidney transplant. Significantly lower fatigue scores were found in the general population compared with both transplant groups (P < .001). There were also no significant differences between the transplant groups. Among the clinical and socioeconomic factors, history of hepatocellular carcinoma, chronic kidney disease, age, family status, and education had a significant impact on fatigue levels.
CONCLUSIONS: This is the first study to compare fatigue in recipients of orthotopic liver and simultaneous/sequential liver and kidney transplant. We found that fatigue is an important but still poorly understood outcome after transplant.

PMID: 28621633 [PubMed - as supplied by publisher]

Current evidence on the discontinuation of eculizumab in patients with atypical haemolytic uraemic syndrome.

Sun, 06/18/2017 - 12:45
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Current evidence on the discontinuation of eculizumab in patients with atypical haemolytic uraemic syndrome.

Clin Kidney J. 2017 Jun;10(3):310-319

Authors: Macia M, de Alvaro Moreno F, Dutt T, Fehrman I, Hadaya K, Gasteyger C, Heyne N

Abstract
Background. Atypical haemolytic uraemic syndrome (aHUS) is a rare, life-threatening disorder for which eculizumab is the only approved treatment. Life-long treatment is indicated; however, eculizumab discontinuation has been reported. Methods. Unpublished authors' cases and published cases of eculizumab discontinuation are reviewed. We also report eculizumab discontinuation data from five clinical trials, plus long-term extensions and the global aHUS Registry. Results. Of six unpublished authors' cases, four patients had a subsequent thrombotic microangiopathy (TMA) manifestation within 12 months of discontinuation. Case reports of 52 patients discontinuing eculizumab were identified; 16 (31%) had a subsequent TMA manifestation. In eculizumab clinical trials, 61/130 patients discontinued treatment between 2008 and 2015. Median follow-up post-discontinuation was 24 weeks and during this time 12 patients experienced 15 severe TMA complications and 9 of the 12 patients restarted eculizumab. TMA complications occurred irrespective of identified genetic mutation, high risk polymorphism or auto-antibody. In the global aHUS Registry, 76/296 patients (26%) discontinued, 12 (16%) of whom restarted. Conclusions. The currently available evidence suggests TMA manifestations following discontinuation are unpredictable in both severity and timing. For evidence-based decision making, better risk stratification and valid monitoring strategies are required. Until these exist, the risk versus benefit of eculizumab discontinuation, either in specific clinical situations or at selected time points, should include consideration of the risk of further TMA manifestations.

PMID: 28621343 [PubMed - in process]

Follow-up reply to Dr Paul Lawton's "A response to an expanded nationwide view of chronic kidney disease in Aboriginal Australians, Nephrology, 21 (2016), 916-922".

Sun, 06/18/2017 - 12:45
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Follow-up reply to Dr Paul Lawton's "A response to an expanded nationwide view of chronic kidney disease in Aboriginal Australians, Nephrology, 21 (2016), 916-922".

Nephrology (Carlton). 2017 Jul;22(7):574

Authors: Hoy WE, Mott SA, McDonald SP

PMID: 28621005 [PubMed - in process]

Organ Dysfunction and Failure Following Brain Death Do Not Preclude Successful Donation.

Sun, 06/18/2017 - 12:45
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Organ Dysfunction and Failure Following Brain Death Do Not Preclude Successful Donation.

World J Surg. 2017 Jun 15;:

Authors: Essien EI, Parimi N, Gutwald-Miller J, Nutter T, Scalea TM, Stein DM

Abstract
BACKGROUND: Organ dysfunction is common after neurologic determination of death (NDD) but before organ collection. Reliable markers for graft success following transplant of these organs would be useful. We sought to determine the relationship between the donor after neurologic determination of death (DNDD) pathophysiology and successful organ donation.
METHODS: Donor information was obtained through the local organ procurement organization. Donor demographics and clinical data points for cardiovascular, renal, respiratory, hepatic, hematological and neuroendocrine systems were reviewed 12 h before and 12 h after neurologic determination of death was declared. The worst values were utilized for analysis and generation of the organ-specific Sequential Organ Failure Assessment (SOFA) scores. SOFA scores were calculated and used to quantify the degree of organ dysfunction. The NDD non-donors for a specific organ were used as a comparison control group. The control group refers to DNDD patients whose specific organs were not transplanted. Lack of use was mostly due to discard by the transplant team as a result of unsuitability of the organ caused by deterioration or possible donor-specific pathology.
RESULTS: One hundred and five organ donors were analyzed. Mean age was 35.0 (± 13.6), 78.1% male, median GCS 3, interquartile range (IQR) 3-4 and median injury severity score 32 (IQR 25-43). Of the successful donors, organ-specific severe dysfunction (SOFA 3 or 4) occurred in 96, 27.5 and 3.3% of cardiac, lung and liver donors, respectively. There was no significant difference between the levels of organ dysfunction in donors versus non-donors except lung donors, in which the median lowest partial pressure of arterial oxygen-to-fraction of inspired oxygen (P/F) ratio in the non-donor was 194 (IQR 121.8-308.3) compared to the median lowest P/F ratio in the donor which was 287 (IQR 180-383.5), p = 0.02. In the recipients, graft failure 6 months after transplantation was reported in one kidney recipient (0.74%) (peak donor creatinine = 1 mg/dL) and in five pancreas recipients (11.4%). The median peak glucose of the pancreas donors in failed recipients was 178 mg/dL (IQR 157-213), whereas in the functioning recipients, the median glucose of their donors was not different (185 mg/dL, IQR 157-216), p = 0.394.
CONCLUSION: Current measures of organ failure and dysfunction do not predict the success of organ donation. Successful donor management in the face of severe organ dysfunction and failure can result in lives saved.

PMID: 28620674 [PubMed - as supplied by publisher]

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