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The Rise of the Opioid Epidemic and Hepatitis C Positive Organs: A New Era in Liver Transplantation.

Fri, 10/13/2017 - 12:45

The Rise of the Opioid Epidemic and Hepatitis C Positive Organs: A New Era in Liver Transplantation.

Hepatology. 2017 Oct 10;:

Authors: Gonzalez SA, Trotter JF

Abstract
The use of hepatitis C virus (HCV) positive organs in liver transplantation has increased in the era of direct-acting antiviral therapy. A rising demand for organs, the ability to effectively treat HCV infection in the transplant setting, and an unprecedented increase in HCV positive donors have all contributed to this trend. A recent abrupt rise in opioid use in the US has resulted in a surge of injection drug use, transmission of HCV, and opioid-related overdose deaths. Geographic areas most affected by the opioid epidemic have experienced a rapid increase in recovery and utilization of HCV positive donor organs, in which the proportion of deceased donor liver transplants in the US from donors who are HCV positive has increased nearly two-fold within the last three years. The prospect of expanding the organ donor pool with HCV positive donors and achieving acceptable post-transplant outcomes has generated much interest in the areas of liver, kidney, and thoracic transplantation, including the potential for transplanting organs from HCV positive donors into HCV negative recipients. Developing strategies to ensure appropriate selection of potential recipients of HCV positive organs, initiating timely antiviral therapy, and defining associated risks will be critical in achieving optimal post-transplant outcomes in this setting. This article is protected by copyright. All rights reserved.

PMID: 29023920 [PubMed - as supplied by publisher]

Drug management in acute kidney disease - Report of the ADQI XVI meeting.

Fri, 10/13/2017 - 12:45

Drug management in acute kidney disease - Report of the ADQI XVI meeting.

Br J Clin Pharmacol. 2017 Oct 11;:

Authors: Ostermann M, Chawla LS, Forni LG, Kane-Gill SL, Kellum JA, Koyner J, Murray PT, Ronco C, Goldstein SL, ADQI 16 workgroup

Abstract
AIMS: To summarize and extend the main conclusions and recommendations relevant to drug management during acute kidney disease (AKD) as agreed at the 16(th) Acute Disease Quality Initiative (ADQI) consensus conference.
METHODS: Using a modified Delphi method to achieve consensus, experts attending the 16(th) ADQI consensus conference reviewed and appraised the existing literature on drug management during AKD and identified recommendations for clinical practice and future research. The group focussed on drugs with one of the following characteristics: i) predominant renal excretion; ii) nephrotoxicity; iii) potential to alter glomerular function, and iv) presence of metabolites that are modified in AKD and may affect other organs.
RESULTS: We recommend that medication reconciliation should occur at admission and discharge, at AKD diagnosis and change in AKD phase, and when the patient's condition changes. Strategies to avoid adverse drug reactions in AKD should seek to minimize adverse events from overdosing and nephrotoxicity and therapeutic failure from under-dosing or incorrect drug selection. Medication regimen assessment or introduction of medications during the AKD period should consider the nephrotoxic potential, altered renal and non-renal elimination, the effects of toxic metabolites and drug interactions and altered pharmacodynamics in AKD. A dynamic monitoring plan including repeated serial assessment of clinical features, utilization of renal diagnostic tests and therapeutic drug monitoring should be used to guide medication regimen assessment.
CONCLUSIONS: Drug management during different phases of AKD requires an individualised approach and frequent re-assessment. More research is needed to avoid drug associated harm and therapeutic failure.

PMID: 29023830 [PubMed - as supplied by publisher]

Honokiol Increases CD4+ T Cell Activation and Decreases TNF but Fails to Improve Survival Following Sepsis.

Fri, 10/13/2017 - 12:45

Honokiol Increases CD4+ T Cell Activation and Decreases TNF but Fails to Improve Survival Following Sepsis.

Shock. 2017 Oct 11;:

Authors: Klingensmith NJ, Chen CW, Liang Z, Burd EM, Farris AB, Arbiser JL, Ford ML, Coopersmith CM

Abstract
Honokiol is a biphenolic isolate extracted from the bark of the magnolia tree that has been used in traditional Chinese and Japanese medicine, and has more recently been investigated for its anti-inflammatory and anti-bacterial properties. Honokiol has previously been demonstrated to improve survival in sepsis models that have rapid 100% lethality. The purpose of this study was to determine the impact of Honokiol on the host response in a model of sepsis that more closely approximates human disease. Male and female C57BL/6 mice underwent cecal ligation and puncture (CLP) to induce polymicrobial intraabdominal sepsis. Mice were then randomized to receive an injection of either Honokiol (120 mg/kg/day) or vehicle and were sacrificed after 24 hours for functional studies or followed 7 days for survival. Honokiol treatment after sepsis increased the frequency of CD4 T cells and increased activation of CD4 T cells as measured by the activation marker CD69. Honokiol also increased splenic dendritic cells. Honokiol simultaneously decreased frequency and number of CD8 T cells. Honokiol decreased systemic TNF without impacting other systemic cytokines. Honokiol did not have a detectable effect on kidney function, lung physiology, liver function or intestinal integrity. In contrast to prior studies of Honokiol in a lethal model of sepsis, Honokiol did not alter survival at seven days (70% mortality for Honokiol vs. 60% mortality for vehicle). Honokiol is thus effective in modulating the host immune response and inflammation following a clinically relevant model of sepsis but is not sufficient to alter survival.

PMID: 29023360 [PubMed - as supplied by publisher]

Renal dysfunction and cirrhosis.

Fri, 10/13/2017 - 12:45

Renal dysfunction and cirrhosis.

Curr Opin Crit Care. 2017 Oct 11;:

Authors: Durand F, Olson JC, Nadim MK

Abstract
PURPOSE OF REVIEW: Hepatorenal syndrome (HRS) does not represent the predominant phenotype of acute kidney injury (AKI) in cirrhosis. Early recognition of HRS helps initiate appropriate therapy. The aims of this review are to present redefinition of AKI, to list new biomarkers, to report recent data on vasopressors in HRS and to propose criteria for simultaneous liver and kidney transplantation (SLKT).
RECENT FINDINGS: Urine output, which was not part of the definition of AKI might be reconsidered as it has an independent prognostic value. Biomarkers (NGAL and IL-18) could help identify ATN. However, cut-off values have to be clarified. Vasopressors with albumin represent first option in HRS. Continuous infusion of terlipressin has a better safety profile than intravenous boluses. SLKT should be considered whenever native kidney recovery is unlikely [i.e. prolonged renal replacement therapy (RRT) and/or GFR less than 25 ml/min for 6 weeks prior to transplantation].
SUMMARY: New definitions and recent biomarkers may help differentiate HRS from ATN at an earlier stage. Urine output should be reconsidered in the definitions. Even in patients who are not candidates for transplantation, a short trial of RRT is justified whenever needed. SLKT should be considered whenever posttransplant renal recovery is unlikely.

PMID: 29023314 [PubMed - as supplied by publisher]

Is Remote Ischemic Conditioning of Benefit to Patients Undergoing Kidney Transplantation?

Fri, 10/13/2017 - 12:45

Is Remote Ischemic Conditioning of Benefit to Patients Undergoing Kidney Transplantation?

J Invest Surg. 2017 Oct 12;:1-3

Authors: Cheungpasitporn W, Khoury NJ, Thongprayoon C, Craici IM

Abstract
Renal ischemia-reperfusion injury (IRI), an inevitable event during kidney transplantation procedure, can result in delayed graft function or even primary nonfunction. In addition to strategies to limit IRI such as advancements in organ allocation systems and preservation of organs, and reduction in cold and warm ischemia time, remote ischemic conditioning (RIC) has attracted much attention in recent years. With promising findings and data suggesting a potential benefit of RIC in animal kidney transplantation models, a few clinical trials have investigated the use of RIC in human kidney transplantation. Unfortunately, the findings from these investigations have been inconclusive due to a number of factors such as diverse time points of RIC, limited sample size, and complexity of kidney transplant patients. This brief commentary aims to discuss the effects of RIC on clinical outcomes and proinflammatory cytokines in patients undergoing kidney transplantation.

PMID: 29023177 [PubMed - as supplied by publisher]

Response to photo-oxidative stress of Pseudomonas aeruginosa PAO1 mutants impaired in different functions.

Fri, 10/13/2017 - 12:45

Response to photo-oxidative stress of Pseudomonas aeruginosa PAO1 mutants impaired in different functions.

Microbiology. 2017 Oct 12;:

Authors: Orlandi VT, Bolognese F, Martegani E, Cantaluppi V, Medana C, Barbieri P

Abstract
Clinicians often have to deal with infections that are difficult to control because they are caused by superbugs resistant to many antibiotics. Alternatives to antibiotic treatment include antimicrobial photodynamic therapy (aPDT). The photodynamic process causes bacterial death, inducing oxidative stress through the photoactivation of photosensitizer molecules in the presence of oxygen. No PDT-resistant bacteria have been selected to date, thus the response to photo-oxidative stress in non-phototrophic bacteria needs further investigation. The opportunistic pathogen Pseudomonas aeruginosa, in particular, has been shown to be more tolerant to PDT than other micro-organisms. In order to find any genetic determinants involved in PDT-tolerance, a panel of transposon mutants of P. aeruginosa PAO1 involved in the quorum sensing signalling system and membrane cytoplasmic transport were photoinactivated as part of this study. Two pseudomonas quinolone signalling (PQS) knock-out mutants, pqsH(-) and pqsC(-), were as PDT-sensitive as the PAO1 wild-type strains. Two PQS hyperproducer variants, pqsA(-) and rsaL(-), were shown to be more tolerant to photo-oxidative stress than the wild-type strain. In the pqsA(-) mutant, the hyperpigmentation due to the presence of phenazines could protect cells against PDT stress, while in rsaL(-) no pigmentation was detectable. Furthermore, a mutant impaired in an ATP-binding cassette transport involved in maintaining the asymmetry of the outer membrane was significantly more tolerant to photo-oxidative stress than the wild-type strain. These observations support the involvement of quorum sensing and the importance of the bacterial cell envelope when dealing with photo-oxidative stress induced by photodynamic treatment.

PMID: 29022867 [PubMed - as supplied by publisher]

Deriving and understanding the risk of post-transplant recurrence of nephrotic syndrome in the light of current molecular and genetic advances.

Fri, 10/13/2017 - 12:45
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Deriving and understanding the risk of post-transplant recurrence of nephrotic syndrome in the light of current molecular and genetic advances.

Pediatr Nephrol. 2017 Oct 11;:

Authors: Bierzynska A, Saleem MA

Abstract
After renal transplantation, recurrence of the original disease is the second most common cause of graft loss, after rejection. The most dramatic manifestation of this phenomenon is in patients with nephrotic syndrome (NS). NS is a descriptive term describing a clinical picture centred on proteinuria arising from damage to the glomerular filtration barrier (GFB). There are many different drivers of that damage, ranging from immune dysregulation to genetic disorders and chronic disease/infections. The main categories in childhood are "idiopathic" (presumed immune mediated) and genetic NS, with further stratification of the idiopathic group according to steroid responses. A significant proportion of patients with NS progress to established renal failure, requiring transplantation, and one of the most difficult clinical scenarios faced by nephrologists is the recurrence of the original disease in up to 50% of patients, usually rapidly post-transplant. This is thought to be the archetypal "circulating factor" disease, in which as yet unknown circulating plasma "factor(s)" in the recipient target the donor kidney. The ability to predict in advance which patients will suffer recurrence would enhance our ability to counsel patients and families, and potentially identify those patients before transplant for tailored immunosuppressive preparation. Until very recently, stratification based on clinical categorisations has been poor in being able to predict those patients in whom disease will recur, and laboratory biomarkers are yet to be adequately refined. However, by mapping our growing understanding of disease mechanisms to clinical phenotypes, and with greatly improved genetic diagnostics, we have made progress in being able to stratify patients more specifically, and allow better predictive algorithms to be developed. Using our knowledge of podocyte biology, circulating factor-induced specific biomarkers are also being tested. This review is aimed at outlining those advances, and suggesting how we can move further forward in both clinical and biological markers of disease type.

PMID: 29022104 [PubMed - as supplied by publisher]

Small round tumour cells (CD38, CD 79a positive) in the adrenal gland.

Fri, 10/13/2017 - 12:45
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Small round tumour cells (CD38, CD 79a positive) in the adrenal gland.

Urol Case Rep. 2018 Jan;16:22-24

Authors: Nigam LA, Vanikar AV, Kanodia KV, Patel RD, Suthar KS

PMID: 29021967 [PubMed]

Successful renal transplant in a pediatric patient with HIV-associated nephropathy.

Fri, 10/13/2017 - 12:45
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Successful renal transplant in a pediatric patient with HIV-associated nephropathy.

Indian J Urol. 2017 Oct-Dec;33(4):328-330

Authors: Sood A, Hakim D, Bose A

Abstract
HIV-associated nephropathy (HIVAN) is a pathological state of the kidneys due to longstanding, uncontrolled HIV infection. With the rapid progression of HIVAN to end-stage kidney failure, there is a significant potential for renal transplantation to improve the quality of life in these patients. Numerous studies have been recently published documenting renal transplantation as a primary treatment for HIVAN. With the use of highly active antiretroviral therapy, allograft and patient survival rates of HIV-infected persons are nearly identical to those who are HIV negative. Our case study documents the successful role of renal transplantation in treating HIVAN in a 9-year-old male child.

PMID: 29021661 [PubMed]

MicroRNA-21 could be a molecular marker to predict the recurrence of nonmuscle invasive bladder cancer.

Fri, 10/13/2017 - 12:45
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MicroRNA-21 could be a molecular marker to predict the recurrence of nonmuscle invasive bladder cancer.

Indian J Urol. 2017 Oct-Dec;33(4):283-290

Authors: Mitash N, Agnihotri S, Tiwari S, Agrawal V, Mandhani A

Abstract
INTRODUCTION: High relapse rate of nonmuscle invasive bladder cancer (NMIBC) is a major challenge. Overexpression of microRNA-21 (miR-21) which targets phosphatase and tensin homolog (PTEN), a gene associated with malignancy, has been reported in the bladder tumor tissue compared to normal mucosa by us and others. We have tested whether miR-21 levels in bladder mucosa could predict tumor recurrence.
METHODS: In a prospective cohort setting, tumor tissues and normal bladder mucosa (NBM) were taken from BC patients during transurethral resection of bladder tumor. Age- and ethnicity-matched NBM from benign prostate hyperplasia patients was taken as controls. The expression of miR-21 was analyzed using quantitative reverse transcription polymerase chain reaction. Patients were followed for 4 years for tumor reoccurrence. Postoperative recurrence were recorded and calculated by Kaplan-Meier curve.
RESULTS: In 31 patients, miR-21 was up-regulated (>4-fold, P = 0.003), and PTEN levels were significantly lower (<7-folds, P = 0.001) in tumor tissue relative to NBM. Moreover, the fold change in miR-21 levels was significantly higher (>3-folds, P = 0.03) in patients showing recurrence compared to those in which tumor did not recur. Further, Kaplan-Meier analysis shows overexpression of miR-21 corresponds to less time to recurrence with higher cumulative hazard.
CONCLUSION: We found overexpression of miR-21 in tumor tissue and its association with recurrence, time to recurrence and invasiveness in BC. Quantification of miR-21 along with other pathological parameters could be more objective molecular approach to predict recurrence in NMIBC.

PMID: 29021651 [PubMed]

Difficult conversations: Australian Indigenous patients' views on kidney transplantation.

Fri, 10/13/2017 - 12:45
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Difficult conversations: Australian Indigenous patients' views on kidney transplantation.

BMC Nephrol. 2017 Oct 11;18(1):310

Authors: Devitt J, Anderson K, Cunningham J, Preece C, Snelling P, Cass A

Abstract
BACKGROUND: Indigenous Australians suffer a disproportionate burden of end stage kidney disease (ESKD) but are significantly less likely to receive a transplant. This study explores Indigenous ESKD patients' views on transplantation as a treatment option.
METHODS: The Improving Access to Kidney Transplants (IMPAKT) research program investigated barriers to kidney transplantation for Indigenous Australians. An interview study, conducted in 2005-2006, elicited illness experience narratives from 146 Indigenous patients, including views on transplant. Interviews were conducted at 26 sites that collectively treat the majority of Indigenous ESKD patients. Key themes were identified via team consensus meetings, providing a flexible framework and focus for continued coding.
RESULTS: Four inter-related themes were identified in patient commentary: a very high level (90% of respondents) of positive interest in transplantation; patients experienced a range of communication difficulties and felt uninformed about transplant; family involvement in decision-making was constrained by inadequate information; and patients needed to negotiate cultural and social sensitivities around transplantation.
CONCLUSIONS: Indigenous ESKD patients demonstrated an intense interest in transplantation preferring deceased over living kidney donation. Patients believe transplant is the path most likely to support the re-establishment of their 'normal' family life. Patients described themselves as poorly informed; most had only a rudimentary knowledge of the notion of transplant but no understanding of eligibility criteria, the transplant procedure and associated risks. Patients experienced multiple communication barriers that - taken together - undermine their engagement in treatment decision-making. Families and communities are disempowered because they also lack information to reach a shared understanding of transplantation. Cultural sensitivities associated with transplantation were described but these did not appear to constrain patients in making choices about their own health. Transplant units and local treatment providers should collaborate to develop user-friendly, culturally informed and region-specific patient education programs. Quality improvement cycles should underpin the development of national guidelines for patient education. Noting Indigenous patients' intense interest in transplantation, and nephrologists' concerns regarding poor transplant outcomes, research should prioritise exploring the predictors of transplant outcomes for Indigenous Australians.

PMID: 29020932 [PubMed - in process]

Use of the levonorgestrel 52-mg intrauterine system in adolescent and young adult solid organ transplant recipients: a case series.

Fri, 10/13/2017 - 12:45
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Use of the levonorgestrel 52-mg intrauterine system in adolescent and young adult solid organ transplant recipients: a case series.

Contraception. 2017 Apr;95(4):378-381

Authors: Huguelet PS, Sheehan C, Spitzer RF, Scott S

Abstract
This case series reports on the safety and efficacy of the levonorgestrel 52-mg intrauterine system in adolescent and young adult solid organ transplant recipients. All patients used the device for contraception, with no documented cases of disseminated pelvic infection or unplanned pregnancy.

PMID: 27940059 [PubMed - indexed for MEDLINE]

Relationship between viremia and specific organ damage in Ebola patients: a cohort study.

Thu, 10/12/2017 - 10:01

Relationship between viremia and specific organ damage in Ebola patients: a cohort study.

Clin Infect Dis. 2017 Aug 20;:

Authors: Lanini S, Portella G, Vairo F, Kobinger GP, Pesenti A, Langer M, Kabia S, Brogiato G, Amone J, Castilletti C, Miccio R, Capobianchi MR, Strada G, Zumla A, Di Caro A, Ippolito G, INMI-EMERGENCY EBOV Sierra Leone Study group

Abstract
Background: Pathogenesis of Ebola virus disease remains poorly understood. We used concomitant determination of routine laboratory biomarkers and Ebola viremia to explore the potential role of viral replication in specific organ damage.
Methods: We recruited patients with detectable Ebola viremia admitted to the EMERGENCY ONG ONLUS Ebola Treatment Center in Sierra Leone. Repeated measure of Ebola viremia, ALT, AST, bilirubin, CPK, LDH, aPTT, INR, creatinine and BUN were recorded. Patients were followed-up since admission until death or discharge.
Results: One hundred patients (49 survivors and 51 non-survivors) were included in the analysis. Unadjusted analysis to compare survivors and non-survivors provided evidence that all biomarkers were significantly above the normal range and that the extent of these abnormalities was generally higher in non-survivors than in survivors. Multivariable mixed effect models provided strong evidence for a biological gradient (suggestive of a direct role in organ damage) between the viremia levels and either ALT, AST, CPK LDH, aPTT and INR. In contrast no direct linear association was found between viremia and either creatinine, BUN or bilirubin.
Conclusion: This study provides evidence to support that Ebola virus may have a direct role in muscular damage and imbalance of the coagulation system. We did not found strong evidence suggestive of a direct role of Ebola virus in kidney damage. The role of the virus in liver damage remains unclear, but our evidence suggests that acute severe liver injury is not a typical feature of Ebola virus disease.

PMID: 29020340 [PubMed - as supplied by publisher]

Role of secondary prophylaxis with valganciclovir in the prevention of recurrent cytomegalovirus disease in solid organ transplant recipients.

Thu, 10/12/2017 - 10:01

Role of secondary prophylaxis with valganciclovir in the prevention of recurrent cytomegalovirus disease in solid organ transplant recipients.

Clin Infect Dis. 2017 Aug 07;:

Authors: Gardiner BJ, Chow JK, Price LL, Nierenberg NE, Kent DM, Snydman DR

Abstract
Background: Cytomegalovirus (CMV) is a major contributor to morbidity and mortality in solid organ transplant recipients (SOTR). Ganciclovir and valganciclovir are highly effective antiviral drugs whose role in primary prophylaxis and treatment of CMV disease is well established. The objective of this study was to examine the effect of secondary prophylaxis (SP) on the risk of relapse in SOTR following an episode of CMV disease.
Methods: We performed a retrospective cohort study of SOTR from 1995-2015 and used propensity score based inverse probability of treatment weighting methodology to control for confounding by indication. A weighted Cox model was created to determine the effect of SP on time to relapse within 1 year of treatment completion.
Results: Fifty-two heart, 34 liver, 79 kidney and 5 liver-kidney transplant recipients who completed treatment for an episode of CMV infection/disease were included. One hundred and twenty (70.6%) received SP (median duration 61 days, range 5- 365) and 39 (23%) relapsed. SP was protective against relapse from 0-6 weeks following treatment completion (HR 0.19, 95% CI 0.05-0.69) but after 6 weeks risk of relapse did not significantly differ between the two groups (HR 1.18, 95% CI 0.46-2.99).
Conclusions: Our findings demonstrate that use of SP following treatment of CMV disease did not confer long-term protection against relapse, although it did delay relapse while patients were receiving antivirals. This suggests that SP has limited clinical utility in the overall prevention of recurrent CMV disease.

PMID: 29020220 [PubMed - as supplied by publisher]

Change of sleep quality from pre- to 3 years post-solid organ transplantation: The Swiss Transplant Cohort Study.

Thu, 10/12/2017 - 10:01

Change of sleep quality from pre- to 3 years post-solid organ transplantation: The Swiss Transplant Cohort Study.

PLoS One. 2017;12(10):e0185036

Authors: Burkhalter H, Denhaerynck K, Huynh-Do U, Binet I, Hadaya K, De Geest S, Psychosocial Interest Group, Swiss Transplant Cohort Study

Abstract
BACKGROUND: Poor sleep quality (SQ) is common after solid organ transplantation; however, very little is known about its natural history. We assessed the changes in SQ from pre- to 3 years post-transplant in adult heart, kidney, liver and lung recipients included in the prospective nation-wide Swiss Transplant Cohort Study. We explored associations with selected variables in patients suffering persistent poor SQ compared to those with good or variable SQ.
METHODS: Adult single organ transplant recipients enrolled in the Swiss Transplant Cohort Study with pre-transplant and at least 3 post-transplant SQ assessment data were included. SQ was self-reported pre-transplant (at listing), then at 6, 12, 24 and 36 months post-transplant. A single SQ item was used to identify poor (0-5) and good sleepers (6-10). Between organ groups, SQ was compared via logistic regression analysis with generalized estimating equations. Within the group reporting persistently poor SQ, we used logistic regression or Kaplan-Meier analysis as appropriate to check for differences in global quality of life and survival.
RESULTS: In a sample of 1173 transplant patients (age: 52.1±13.2 years; 65% males; 66% kidney, 17% liver, 10% lung, 7% heart) transplanted between 2008 and 2012, pre- transplant poor SQ was highest in liver (50%) and heart (49%) recipients. Overall, poor SQ decreased significantly from pre-transplant (38%) to 24 months post-transplant (26%) and remained stable at 3 years (29%). Patients reporting persistently poor SQ had significantly more depressive symptomatology and lower global quality of life.
CONCLUSION: Because self-reported poor SQ is related to poorer global quality of life, these results emphasize the need for further studies to find suitable treatment options for poor SQ in transplant recipients.

PMID: 29020112 [PubMed - in process]

Weight Loss in Advanced Chronic Kidney Disease: Should We Consider Individualised, Qualitative, ad Libitum Diets? A Narrative Review and Case Study.

Thu, 10/12/2017 - 10:01

Weight Loss in Advanced Chronic Kidney Disease: Should We Consider Individualised, Qualitative, ad Libitum Diets? A Narrative Review and Case Study.

Nutrients. 2017 Oct 11;9(10):

Authors: Irene C, Luigi T, Neve VF, Giuliana T, Valentina C, Stefania S, Barbara PG

Abstract
In advanced chronic kidney disease, obesity may bring a survival advantage, but many transplant centres demand weight loss before wait-listing for kidney graft. The case here described regards a 71-year-old man, with obesity-related glomerulopathy; referral data were: weight 110 kg, Body Mass Index (BMI) 37 kg/m², serum creatinine (sCr) 5 mg/dL, estimated glomerular filtration rate (eGFR) 23 mL/min, blood urea nitrogen (BUN) 75 mg/dL, proteinuria 2.3 g/day. A moderately restricted, low-protein diet allowed reduction in BUN (45-55 mg/dL) and good metabolic and kidney function stability, with a weight increase of 6 kg. Therefore, he asked to be enrolled in a weight-loss program to be wait-listed (the two nearest transplant centres required a BMI below 30 or 35 kg/m²). Since previous low-calorie diets were not successful and he was against a surgical approach, we chose a qualitative, ad libitum coach-assisted diet, freely available in our unit. In the first phase, the diet is dissociated; he lost 16 kg in 2 months, without need for dialysis. In the second maintenance phase, in which foods are progressively combined, he lost 4 kg in 5 months, allowing wait-listing. Dialysis started one year later, and was followed by weight gain of about 5 kg. He resumed the maintenance diet, and his current body weight, 35 months after the start of the diet, is 94 kg, with a BMI of 31.7 kg/m², without clinical or biochemical signs of malnutrition. This case suggests that our patients can benefit from the same options available to non-CKD (chronic kidney disease) individuals, provided that strict multidisciplinary surveillance is assured.

PMID: 29019954 [PubMed - in process]

Management of Patients who Receive an Organ Transplant Abroad and Return Home for Follow-up Care: Recommendations From the Declaration of Istanbul Custodian Group.

Thu, 10/12/2017 - 10:01

Management of Patients who Receive an Organ Transplant Abroad and Return Home for Follow-up Care: Recommendations From the Declaration of Istanbul Custodian Group.

Transplantation. 2017 Oct 11;:

Authors: Domínguez-Gil B, Danovitch G, Martin DE, López-Fraga M, Van Assche K, Morris ML, Lavee J, Erlich G, Fadhil R, Busic M, Rankin G, Al-Rukhaimi M, O Connell P, Chin J, Norman T, Massari P, Kamel R, Delmonico FL, Declaration of Istanbul Custodian Group working group on ethical travel for transplantation.

Abstract
Eradicating transplant tourism depends upon complex solutions that include efforts to progress towards self-sufficiency in transplantation. Meanwhile, professionals and authorities are faced with medical, legal, and ethical problems raised by patients who return home after receiving an organ transplant abroad, particularly when the organ has been obtained through illegitimate means. In 2016, the Declaration of Istanbul Custodian Group convened an international, multidisciplinary workshop in Madrid, Spain, to address these challenges and provide recommendations for the management of these patients, which are presented in this paper. The core recommendations are grounded in the belief that principles of transparency, traceability and continuity of care applied to patients who receive an organ domestically should also apply to patients who receive an organ abroad. Governments and professionals are urged to ensure that, upon return, patients are promptly referred to a transplant center for evaluation and care; not cover the costs of transplants resulting from organ or human trafficking; register standardized information at official registries on patients who travel for transplantation; promote international exchange of data for traceability; and develop a framework for the notification of identified or suspected cases of transnational transplant-related crimes by health professionals to law enforcement agencies.

PMID: 29019810 [PubMed - as supplied by publisher]

Elevated serum osteoprotegerin may predict peripheral arterial disease after kidney transplantation: a single-center prospective cross-sectional study in Taiwan.

Thu, 10/12/2017 - 10:01

Elevated serum osteoprotegerin may predict peripheral arterial disease after kidney transplantation: a single-center prospective cross-sectional study in Taiwan.

PeerJ. 2017;5:e3847

Authors: Chen YC, Hsu BG, Ho CC, Lee CJ, Lee MC

Abstract
BACKGROUND: Osteoprotegerin (OPG) is a potential biomarker for severity and complications of cardiovascular diseases. Peripheral arterial disease (PAD) is associated with an increased risk of death in kidney transplantation (KT) patients. This prospective cross-sectional study evaluated the relationship between serum OPG and PAD in KT patients.
METHODS: Seventy-four KT patients were enrolled for this PAD study. Fasting blood samples were obtained to measure serum OPG levels by using enzyme-linked immunosorbent assay kits. The ankle-brachial index (ABI) of less than 0.9 was applied for PAD diagnosis.
RESULTS: Thirteen patients (17.6%) were diagnosed with PAD. Diabetes (P = 0.025), smoking (P = 0.010), and increased OPG levels (P = 0.001) were significantly more frequent in the PAD group. Multivariate logistic regression analysis showed that serum OPG (odds ratio [OR], 1.336; 95% CI [1.108-1.611]; P = 0.002) and diabetes (OR, 7.120; 95% CI [1.080-46.940]; P = 0.041) were independent predictors of PAD in KT patients. The area under the receiver operating characteristic (ROC) curve determined that the probability of a serum OPG level of 7.117 pg/L in predicting PAD in KT patients was 0.799 (95% CI [0.690-0.884]; P < 0.001).
DISCUSSION: Exploration of reliable biomarkers for early identification of vascular risk is crucial for KT patients. Elevated serum OPG levels may predict PAD in KT patients with cutoff value of 7.117 pg/L.

PMID: 29018602 [PubMed]

A Case of Left Renal Vein Ligation in a Patient with Solitary Left Kidney Undergoing Liver Transplantation to Control Splenorenal Shunt and Improve Portal Venous Flow.

Thu, 10/12/2017 - 10:01

A Case of Left Renal Vein Ligation in a Patient with Solitary Left Kidney Undergoing Liver Transplantation to Control Splenorenal Shunt and Improve Portal Venous Flow.

Am J Case Rep. 2017 Oct 11;18:1086-1089

Authors: Martino RB, Júnior ER, Manuel V, Rocha-Santos V, D'Albuquerque LAC, Andraus W

Abstract
BACKGROUND Adequate portal venous flow is required for successful liver transplantation. Reduced venous flow and blood flow 'steal' by collateral vessels are a concern, and when there is a prominent splenorenal shunt present, ligation of the left renal vein has been recommended to improve portal venous blood flow. CASE REPORT A 51-year-old man who had undergone right nephrectomy in childhood required liver transplantation for liver cirrhosis and hepatocellular carcinoma due to hepatitis C virus (HCV) infection. The patient had no other comorbidity and no history of hepatorenal syndrome. At transplantation surgery, portal venous flow was poor and did not improve with ligation of shunt veins, but ligation of the left renal vein improved portal venous flow. On the first and fifth postoperative days, the patient was treated with basiliximab, a chimeric monoclonal antibody to the IL-2 receptor, and methylprednisolone. The calcineurin inhibitor, tacrolimus, was introduced on the fifth postoperative day. On the sixteenth postoperative day, renal color Doppler ultrasound showed normal left renal parenchyma; hepatic Doppler ultrasound showed good portal vein flow and preserved hepatic parenchyma in the liver transplant. CONCLUSIONS This case report has shown that in a patient with a single left kidney, left renal vein ligation is feasible and safe in a patient with no other risk factors for renal impairment following liver transplantation. Modification of postoperative immunosuppression to avoid calcineurin inhibitors in the very early postoperative phase may be important in promoting good recovery of renal function and to avoid the need for postoperative renal dialysis.

PMID: 29018183 [PubMed - in process]

Regarding submission IJS-D-17-00704: High BMI and male sex as risk factor for increased short-term renal impairment in living kidney donors. A response to comments raised.

Thu, 10/12/2017 - 10:01

Regarding submission IJS-D-17-00704: High BMI and male sex as risk factor for increased short-term renal impairment in living kidney donors. A response to comments raised.

Int J Surg. 2017 Oct 07;:

Authors: Unger L, Berlakovich GA

PMID: 29017860 [PubMed - as supplied by publisher]

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