Skip directly to content

PubMed Kidney Transplant

Subscribe to PubMed Kidney Transplant feed PubMed Kidney Transplant
NCBI: db=pubmed; Term=kidney transplant
Updated: 1 hour 42 min ago

Kidney transplant outcomes from older deceased donors: A paired kidney analysis by the ERA-EDTA Registry.

Thu, 12/07/2017 - 13:45
Related Articles

Kidney transplant outcomes from older deceased donors: A paired kidney analysis by the ERA-EDTA Registry.

Transpl Int. 2017 Dec 05;:

Authors: Pippias M, Jager KJ, Caskey F, Casula A, Erlandsson H, Finne P, Heaf J, Heinze G, Hoitsma A, Kramar R, Lempinen M, Magaz A, Midtvedt K, Mumford LL, Pascual J, Prütz KG, Sørensen SS, Traynor JP, Massy ZA, Ravanan R, Stel VS

Abstract
As the median age of deceased kidney donors rises, updated knowledge of transplant outcomes from older deceased donors in differing donor-recipient age groups is required. Using ERA-EDTA Registry data we determined survival outcomes of kidney allografts donated from the same older deceased donor (55-70 years), and transplanted into one recipient younger and one recipient of similar age to the donor. The recipient pairs were divided into two groups: group 1; younger (median age: 52 years) and older (60 years), and group 2; younger (41 years) and older (60 years). 1,410 adults were transplanted during 2000-2007. Compared to the older recipients the mean number of functioning graft years at 10-years was six months longer in the group 1 and group 2 younger recipients (p<0.001). Ten-year graft survival was 54% and 40% for the group 1 younger and older recipients, and 60% and 49% for the group 2 younger and older recipients. Paired Cox regression analyses showed a lower risk of graft failure (group 1 younger; adjusted relative risk [RRa]:0.57, 95%CI:0.41-0.79, and group 2 younger; RRa:0.63, 95%CI:0.47-0.85) in younger recipients. Outcomes from older deceased donor allografts transplanted into differing donor-recipient age groups are better than previously reported. These allografts remain a valuable transplant resource, particularly for similar-aged recipients. This article is protected by copyright. All rights reserved.

PMID: 29210108 [PubMed - as supplied by publisher]

Preemptive second kidney transplantation is associated with better graft survival compared to non-preemptive second transplantation: a multicenter French 2000-2014 cohort study.

Thu, 12/07/2017 - 13:45
Related Articles

Preemptive second kidney transplantation is associated with better graft survival compared to non-preemptive second transplantation: a multicenter French 2000-2014 cohort study.

Transpl Int. 2017 Dec 05;:

Authors: Girerd S, Girerd N, Duarte K, Legendre C, Mourad G, Garrigue V, Morelon E, Buron F, Kamar N, Del Bello A, Ladrière M, Kessler M, Frimat L

Abstract
BACKGROUND: The impact of preemptive second kidney transplantation (2KT) on graft and patient survival is poorly established.
METHODS: The association between preemptive 2KT (p2KT, N=93) and outcomes was estimated in a multicenter French cohort of 2KT (N=1314) recipients using propensity score methods.
RESULTS: During follow-up, there were 274 returns to dialysis and 134 deaths. p2KT was associated with lower death-censored graft loss = 0.39[0.18-0.88], p=0.024) and graft failure from any cause including death (HR=0.42[0.22-0.80], p=0.008). Similar associations were observed for death with a functioning graft, although not reaching statistical significance (HR=0.47[0.17-1.26], p=0.13). There was a significant interaction between donor type and p2KT (p for interaction=0.016). Indeed, p2KT was not significantly associated with the risk of graft failure from any cause including death in living-donor 2KT (p=0.39), whereas the association was substantial in the deceased donor subset (HR = 0.30[0.14-0.64], p=0.002). Of note, the adjusted graft survival of p2KT with deceased donor paralleled that of 2KT with living donor, either preemptive or not (93.8% vs. 88.6% at 4 years and 76.1% vs. 70.5% at 8 years, p=0.13).
CONCLUSIONS: This large French multicenter study analyzed using propensity scores suggests that p2KT is associated with better graft prognosis. This article is protected by copyright. All rights reserved.

PMID: 29210106 [PubMed - as supplied by publisher]

Normothermic machine perfusion for the assessment and transplantation of declined human kidneys from donation after circulatory death donors.

Thu, 12/07/2017 - 13:45
Related Articles

Normothermic machine perfusion for the assessment and transplantation of declined human kidneys from donation after circulatory death donors.

Br J Surg. 2017 Dec 06;:

Authors: Hosgood SA, Thompson E, Moore T, Wilson CH, Nicholson ML

Abstract
BACKGROUND: A significant proportion of donation after circulatory death (DCD) kidneys are declined for transplantation because of concerns over their quality. Ex vivo normothermic machine perfusion (NMP) provides a unique opportunity to assess the quality of a kidney and determine its suitability for transplantation.
METHODS: In phase 1 of this study, declined human DCD kidneys underwent NMP assessment for 60 min. Kidneys were graded 1-5 using a quality assessment score (QAS) based on macroscopic perfusion, renal blood flow and urine output during NMP. In phase 2 of the study, declined DCD kidneys were assessed by NMP with an intention to transplant them.
RESULTS: In phase 1, 18 of 42 DCD kidneys were declined owing to poor in situ perfusion. After NMP, 28 kidneys had a QAS of 1-3, and were considered suitable for transplantation. In phase 2, ten of 55 declined DCD kidneys underwent assessment by NMP. Eight kidneys had been declined because of poor in situ flushing in the donor and five of these were transplanted successfully. Four of the five kidneys had initial graft function.
CONCLUSION: NMP technology can be used to increase the number of DCD kidney transplants by assessing their quality before transplantation.

PMID: 29210064 [PubMed - as supplied by publisher]

Autologous arteriovenous fistulas for hemodialysis using microsurgery techniques in children weighing less than 20 kg.

Thu, 12/07/2017 - 13:45
Related Articles

Autologous arteriovenous fistulas for hemodialysis using microsurgery techniques in children weighing less than 20 kg.

Pediatr Nephrol. 2017 Dec 05;:

Authors: Karava V, Jehanno P, Kwon T, Deschênes G, Macher MA, Bourquelot P

Abstract
BACKGROUND: This study aimed to describe the efficiency and longevity of arteriovenous fistula (AVF) for hemodialysis (HD) in children weighing ≤20 kg.
METHODS: We collected data of all AVFs created using microsurgery techniques between 1988 and 2015. Success was considered as the ability to use the AVF for HD. Primary and secondary patency rates were measured.
RESULTS: Forty-eight AVFs (35 forearm, 13 upper arm) were created in 41 children with a median weight of 13.5 kg (range 5.5-20). The need for a second AVF was significantly higher in younger and thinner children at the time of AVF creation (p = 0.046 and p = 0.019, respectively). Successful use for HD occurred in 42 AVFs (87.5%), while six (12.5%) resulted in failure for early thrombosis or nonmaturation. Median time to first cannulation was 18.8 weeks (range 2-166.3). Primary and secondary patency rates at 1, 5, and 10-year follow-ups were 54.2%, 29.2%, and 13.7%; and 85.4%, 57.7%, and 33%, respectively. Almost one third of thromboses after first AVF cannulation were observed at kidney transplantation (KT) perioperatively. At the end of the follow-up (median duration 5.07 years, range 0-17.95), one patient was still on HD via AVF, two died of unrelated reason, and 38 were transplanted-one of whom returned to HD with a new AVF.
CONCLUSIONS: AVF using microsurgery techniques is feasible in young children, showing an early failure rate of 12.5%. Time to first cannulation may be rather long, but secondary patency is excellent. Thrombosis rate is high during KT.

PMID: 29209823 [PubMed - as supplied by publisher]

Association of kidney fibrosis with urinary peptides: a path towards non-invasive liquid biopsies?

Thu, 12/07/2017 - 13:45
Related Articles

Association of kidney fibrosis with urinary peptides: a path towards non-invasive liquid biopsies?

Sci Rep. 2017 Dec 05;7(1):16915

Authors: Magalhães P, Pejchinovski M, Markoska K, Banasik M, Klinger M, Švec-Billá D, Rychlík I, Rroji M, Restivo A, Capasso G, Bob F, Schiller A, Ortiz A, Perez-Gomez MV, Cannata P, Sanchez-Niño MD, Naumovic R, Brkovic V, Polenakovic M, Mullen W, Vlahou A, Zürbig P, Pape L, Ferrario F, Denis C, Spasovski G, Mischak H, Schanstra JP

Abstract
Chronic kidney disease (CKD) is a prevalent cause of morbidity and mortality worldwide. A hallmark of CKD progression is renal fibrosis characterized by excessive accumulation of extracellular matrix (ECM) proteins. In this study, we aimed to investigate the correlation of the urinary proteome classifier CKD273 and individual urinary peptides with the degree of fibrosis. In total, 42 kidney biopsies and urine samples were examined. The percentage of fibrosis per total tissue area was assessed in Masson trichrome stained kidney tissues. The urinary proteome was analysed by capillary electrophoresis coupled to mass spectrometry. CKD273 displayed a significant and positive correlation with the degree of fibrosis (Rho = 0.430, P = 0.0044), while the routinely used parameters (glomerular filtration rate, urine albumin-to-creatinine ratio and urine protein-to-creatinine ratio) did not (Rho = -0.222; -0.137; -0.070 and P = 0.16; 0.39; 0.66, respectively). We identified seven fibrosis-associated peptides displaying a significant and negative correlation with the degree of fibrosis. All peptides were collagen fragments, suggesting that these may be causally related to the observed accumulation of ECM in the kidneys. CKD273 and specific peptides are significantly associated with kidney fibrosis; such an association could not be detected by other biomarkers for CKD. These non-invasive fibrosis-related biomarkers can potentially be implemented in future trials.

PMID: 29208969 [PubMed - in process]

Etiology of Early Renal Allograft Dysfunction and Comparison between Dysfunction and Function Group: A Single Center Study.

Thu, 12/07/2017 - 13:45
Related Articles

Etiology of Early Renal Allograft Dysfunction and Comparison between Dysfunction and Function Group: A Single Center Study.

Mymensingh Med J. 2017 Oct;26(4):748-755

Authors: Hadiuzzaman KM, Islam SF, Faroque MO, Hossain RM, Munirunnessa M, Selim SI, Morshed M

Abstract
Over a period of two years thirty five renal allograft recipients & donors were evaluated to find out the aetiology of early renal allograft dysfunction, in the Department of Nephrology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from March 2010 to February 2012. A comparison was made between dysfunction & functioning graft group. Mean age of recipients were (36.4±9.4) years, mean age of donors were (41.7±8.3) years, with a male and female ratio of 3:1. Fifty percent recipients showed one heliotype match, ninety percent recipients were anti CMV antibody IgG positive, few were anti CMV antibody IgM positive. All kidney transplant recipients received same immunosuppressive drugs. Primary disease of the renal allograft recipients demonstrates that majority 88.58% had glomerulonephritis, 5.72% had polycystic kidney disease, 2.85% had chronic pyelonephritis and another 2.85% had diabetic nephropathy. Among 35 renal allograft recipients 23(66%) showed early graft dysfunction, 12(34%) showed normal graft function. The etiology of early graft dysfunction showed, 50% developed acute rejection, 17% acute cyclosporine toxicity, 17% acute tubular necrosis, 8% had graft thrombosis and 8% developed recurrent glomerulonephritis. Sub-clinical rejection was detected in 20% cases. Comparison of donor characteristics between dysfunctioning and functioning graft groups revealed that age and sex were identically distributed between the groups (p=0.183 and p=0.087 respectively). The mean serum creatinine of donor was significantly higher in the graft dysfunction group than that in the functioning graft group (113.5±12.6 vs. 99.6±17.3; p=0.025), as well as the mean creatinine clearance rate was significantly less in the former group than that in the later group (82.1±13.5 vs. 93.9±18.6, p=0.040). The mean cyclosporine (C2) level on 7th POD were 1593.2±320.4ng/ml in graft dysfunction group and 1439.1±199.5ng/ml in the functioning graft group which decreased to 1364.8±263.7ng/ml and 1114.2±145.1ng/ml after three months in the dysfunction and the functioning graft groups respectively. There was no significant difference in the cyclosporine level between groups on 7th POD and 14th POD, 1st and 2nd month. However, at 3rd month the level of cyclosporine was higher in the dysfunction group than that in the function group. Proteinuria on 14th POD was almost similar between dysfunction and function graft groups (p=0.704). However, higher incidence of proteinuria was observed in subsequent months in the graft dysfunction group compared to the function graft group. All the postoperative variables like systolic blood pressure, diastolic blood pressure, fever and tremor were higher in dysfunction group in comparison to functioning graft group. Per operative biopsy of donor kidney, some showed increased number of sclerotic glomeruli which is more common in dysfunction group. Among 35 recipients 2(16.7%) died due to infection in dysfunction group compared to 1(4.3%) in functioning graft group.

PMID: 29208861 [PubMed - in process]

In Vivo Visualization of Beta Cells by Targeting of GPR44.

Thu, 12/07/2017 - 13:45
Related Articles

In Vivo Visualization of Beta Cells by Targeting of GPR44.

Diabetes. 2017 Dec 05;:

Authors: Eriksson O, Johnström P, Cselenyi Z, Jahan M, Selvaraju RK, Jensen-Waern M, Takano A, Winzell MS, Halldin C, Skrtic S, Korsgren O

Abstract
GPR44 expression has recently been described as highly beta cell selective in the human pancreas and constitutes a tentative surrogate imaging biomarker in diabetes.A radiolabeled small molecule GPR44 antagonist, [11C]AZ12204657, was evaluated for visualization of beta cells in pigs and non-human primates by Positron Emission Tomography (PET) as well as in immunodeficient mice transplanted with human islets under the kidney capsule. In vitro autoradiography of human and animal pancreatic sections from non-diabetic and diabetic subjects, in combination with insulin staining, was performed to assess beta cell selectivity of the radiotracer.Proof-of-principle of in vivo targeting of human islets by [11C]AZ12204657 was shown in the immunodeficient mouse transplantation model. Furthermore, [11C]AZ12204657 bound by a GPR44-mediated mechanism in pancreatic sections from non-diabetic, but not diabetic, humans and pigs. In vivo [11C]AZ12204657 bound specifically to GPR44 in pancreas and spleen and could be competed away dose-dependently in non-diabetic pigs and non-human primates.[11C]AZ12204657 is a first-in-class surrogate imaging biomarker for pancreatic beta cells, by targeting the protein GPR44.

PMID: 29208633 [PubMed - as supplied by publisher]

Bleeding in advanced CKD patients on antithrombotic medication - A critical appraisal.

Thu, 12/07/2017 - 13:45
Related Articles

Bleeding in advanced CKD patients on antithrombotic medication - A critical appraisal.

Pharmacol Res. 2017 Dec 02;:

Authors: Burlacu A, Genovesi S, Goldsmith D, Rossignol P, Ortiz A, Kalra PA, Małyszko J, Banach M, Kanbay M, Covic A

Abstract
Patients with advanced chronic kidney disease (CKD) are at an increased risk of bleeding, especially in the context of the complex therapeutic schemes of coronary artery disease (CAD) (from stable angina to acute coronary syndromes), atrial fibrillation or venous thromboembolism. The bleeding issue increases morbidity and mortality, a serious problem in daily medical practice. However, these patients are largely excluded from major randomized clinical trials, which results in the lack of medical evidence-based foundation for specific recommendations regarding antithrombotic treatment in a high bleeding risk setting. Within this framework, the clinician does not benefit from a clear set of algorithms and measures in the exploration and balancing of bleeding and thrombosis risks. We discuss a diversity of scenarios, encompassing all categories of advanced CKD patients with CAD or/and atrial fibrillation, and with various combinations of drugs, such as antiplatelet therapy or/and oral anticoagulation. Our review highlights the most recent research as well as existing gaps in the recommendations of European Society of Cardiology Guidelines. We evaluate the existence or lack of assessment tools for the bleeding risk, strength, reliability and usefulness of the bleeding risk scores. Also, we identify all the measures recommended after risk evaluation, including specific plans, dose adjustments and particular therapeutic approaches. Finally, we provide with suggestions for improving the management of this patient population.

PMID: 29208494 [PubMed - as supplied by publisher]

Comparison of survival between hemodialysis and peritoneal dialysis patients with end-stage renal disease in the era of icodextrin treatment.

Thu, 12/07/2017 - 13:45
Related Articles

Comparison of survival between hemodialysis and peritoneal dialysis patients with end-stage renal disease in the era of icodextrin treatment.

Eur J Intern Med. 2017 Dec 03;:

Authors: Wang IK, Lin CL, Yen TH, Lin SY, Sung FC

Abstract
BACKGROUND: Icodextrin could reduce the risk of technique failure and improve patient survival in peritoneal dialysis (PD) patients. This study compared the survival between incident hemodialysis (HD) and PD patients, with and without diabetes, in the era of icodextrin treatment.
METHODS: From the Taiwan health insurance database, 53,103 incident end-stage renal disease patients undergoing dialysis were identified from 2005 to 2010. The mortality risks among HD and PD patients with or without icodextrin treatment were compared. The follow-up period started from the date of dialysis initiation to December 31, 2011. The competing-risks regression model was used to estimate the subhazard ratio (SHR) of death with considering renal transplantation as a competing event.
RESULTS: Compared with the corresponding HD patients, mortality risks were higher in diabetic PD patients with icodextrin treatment (Bonferroni adjusted SHR=1.16, 98.3% CI=1.04-1.30) and without the treatment (Bonferroni adjusted SHR=1.35, 98.3% CI=1.16-1.57), particularly for elderly patients. Mortality risks for patients without diabetes were not different among the three cohorts. The time-dependent competing-risks model showed that PD patients with icodextrin treatment exhibited a reduced risk of death for diabetic patients, compared with those without icodextrin treatment (adjusted SHR=0.84, 95% CI=0.72-0.97).
CONCLUSIONS: Icodextrin could attenuate the survival disadvantage for PD relative to HD in diabetic patients, particularly for the elderly patients.

PMID: 29208453 [PubMed - as supplied by publisher]

Kidney Diseases Associated With Alternative Complement Pathway Dysregulation and Potential Treatment Options.

Thu, 12/07/2017 - 13:45
Related Articles

Kidney Diseases Associated With Alternative Complement Pathway Dysregulation and Potential Treatment Options.

Am J Med Sci. 2017 Dec;354(6):533-538

Authors: Sanghera P, Ghanta M, Ozay F, Ariyamuthu VK, Tanriover B

Abstract
Atypical hemolytic uremic syndrome and C3 glomerulopathy (dense deposit disease and C3 glomerulonephritis) are characterized as inappropriate activation of the alternative complement pathway. Genetic mutations affecting the alternative complement pathway regulating proteins (complement factor H, I, membrane cofactor protein and complement factor H-related proteins) and triggers (such as infection, surgery, pregnancy and autoimmune disease flares) result in the clinical manifestation of these diseases. A decade ago, prognosis of these disease states was quite poor, with most patients developing end-stage renal disease. Furthermore, renal transplantation in these conditions was associated with poor outcomes due to graft loss to recurrent disease. Recent advances in targeted complement inhibitor therapy resulted in significant improvement in disease remission, renal recovery, health-related quality of life and allograft survival.

PMID: 29208248 [PubMed - in process]

Clinicopathological Characteristics and Outcomes of Diffuse Crescentic Glomerulonephritis - A Single Center Experience from Southern India.

Thu, 12/07/2017 - 13:45
Related Articles

Clinicopathological Characteristics and Outcomes of Diffuse Crescentic Glomerulonephritis - A Single Center Experience from Southern India.

J Clin Diagn Res. 2017 Sep;11(9):OC21-OC24

Authors: Nagaraju SP, Laxminarayana SLK, Kosuru S, Parthasarathy R, Attur RP, Rangaswamy D, Matteti UV, Guddattu V

Abstract
Introduction: Diffuse Crescentic glomerulonephritis (CrGN) is characterized by rapidly progressive renal failure and has grave prognosis. There is significant regional and temporal variation in aetiology, prevalence and prognosis of diffuse crescentic glomerulonephritis (CrGN) with limited data available in adult Indian population.
Aim: This study aims to identify the aetiology, clinico-pathological features and outcomes of diffuse CrGN in south Indian population.
Materials and Methods: In this retrospective study, clinical records of all adults (>18 years) over a 5-year period (2010-2014) with a histopathological diagnosis of diffuse CrGN (>50% crescents) were reviewed. Clinical, serological, biochemical and histopathological data were collected. Follow-up data at six months including renal outcome and mortality were studied. Data was analysed using SPSS version 15.
Results: There were 29 cases of diffuse CrGN accounting for an incidence of 2.9% among 1016 non-transplant kidney biopsies. The most common cause was pauci-immune crescentic GN. The median creatinine at admission was 7.2 mg/dl {(interquartile range (IR) 3.3 - 10.4)} and 75.9% of patients required haemodialysis at admission. Complete/partial recovery was seen in 34.5%. At the end of six months 31% were dialysis dependent and the mortality was 27.6%. On univariate analysis, the significant predictors of renal loss and mortality were oliguria (p=0.02), requirement of haemodialysis and serum creatinine (p=0.001) at admission (>5.5mg/dl) (p=0.003). Histopathological features did not influence the outcome in our study.
Conclusion: In our cohort, the most common cause for diffuse CrGN is pauci-immune CrGN. Diffuse CrGN carries a poor prognosis. Patients with pauci-immune and AntiGBM disease have worst prognosis compared to immune complex CrGN. The presence of oliguria, high serum creatinine and requirement of haemodialysis at admission are associated with poor outcomes.

PMID: 29207754 [PubMed]

A palladium(II)-saccharinate complex of terpyridine exerts higher anticancer potency and less toxicity than cisplatin in a mouse allograft model.

Thu, 12/07/2017 - 13:45
Related Articles

A palladium(II)-saccharinate complex of terpyridine exerts higher anticancer potency and less toxicity than cisplatin in a mouse allograft model.

Anticancer Drugs. 2017 Sep;28(8):898-910

Authors: Cetin Y, Adiguzel Z, Polat HU, Akkoc T, Tas A, Cevatemre B, Celik G, Carikci B, Yilmaz VT, Ulukaya E, Acilan C

Abstract
The main aim of this study is to assess the safety and antitumor efficacy of a palladium(II) (Pd)-saccharinate complex with terpyridine. To characterize the Pd(II) complex in vitro, its cytotoxicity was evaluated using a water-soluble tetrazolium salt cell viability assay and the mechanism of cell death was assessed by DNA fragmentation/condensation and live cell imaging analyses. The antitumor efficacy and safety of the Pd(II) complex in-vivo were examined by analyzing reduction in tumor size, changes in body and organ weight, histopathological analysis of liver, kidney, and tumor sections, and biochemical analysis of serum in C57BL/6 mice. Our results showed that the Pd(II) complex was more cytotoxic to cancer cells than noncancer cell lines and caused cell death through apoptotic pathways. The treatment of the Pd(II) complex in tumor-bearing mice effectively reduced the tumor size at half the dose used for cisplatin. The Pd(II) complex appeared to exert less liver damage than the cisplatin-based complex on changes in the hepatic enzymes levels in the serum. Hence, the complex appears to be a potential chemotherapeutic drug with high antitumor efficacy and fewer hepatotoxic complications, providing an avenue for further studies.

PMID: 28657910 [PubMed - indexed for MEDLINE]

A Red Herring in the Green Grass: Syphilitic Membranous Glomerulonephritis.

Thu, 12/07/2017 - 13:45
Related Articles

A Red Herring in the Green Grass: Syphilitic Membranous Glomerulonephritis.

Am J Med. 2017 Mar;130(3):285-287

Authors: Noutong SA, Chornyy V, Alquadan KF, Ejaz AA, Koratala A

PMID: 27888054 [PubMed - indexed for MEDLINE]

First case report of using Ofatumumab in kidney transplantation AB0 incompatible.

Wed, 12/06/2017 - 13:45
Related Articles

First case report of using Ofatumumab in kidney transplantation AB0 incompatible.

G Ital Nefrol. 2017 Dec 05;34(Nov-Dec):

Authors: Mancianti N, Monaci G, Rollo F, Buracchi P, Guarnieri A, Di Luca M, Martello M, Garosi G

Abstract
Modern methods for desensitization protocol rely heavily on combined apheresis therapy and Rituximab, a chimeric (murine and human) anti-CD20 antibody used in AB0 incompatible kidney transplants. Severe infusion related reactions due to the administration of Rituximab are reported in 10% of patients. These adverse reactions may hinder the completion of the desensitization protocol. Therefore, it's useful to test alternative B cell depleting therapies. Our clinical case focuses on a 41-year-old male who developed an adverse infusion reaction following the administration of Rituximab and was given Ofatumumab as an alternative treatment. Ofatumumab is a fully humanized monoclonal anti-CD20 antibody. As a fully humanized antibody, Ofatumumab may avoid immunogenic reactions. The patient tolerated the administration of the drug showing no signs of adverse side effects and with good clinical efficacy. Our case report suggest that Ofatumumab is a valid alternative B cell depleting agent.

PMID: 29207227 [PubMed - in process]

[Therapy of glucocorticoid induced osteoporosis].

Wed, 12/06/2017 - 13:45
Related Articles

[Therapy of glucocorticoid induced osteoporosis].

G Ital Nefrol. 2017 Dec 05;34(Nov-Dec):

Authors: Arazzi M, Di Fulvio G, Di Pietro LO, Grabocka X, Longo MO, Micioni G, Pezzutto A, Piscitani L, Schiazza A, Silvestri S, Vigilante G, Amoroso L, Bonomini M

Abstract
Glucocorticoid-induced osteoporosis (GIO) is a major cause of secondary osteoporosis that starts early after the beginning of therapy even for low drug doses. Glucocorticoids are used for the treatment of immunologic nephropathies and in the setting of kidney transplant. In clinical practice, a number of algorithms are available; they allow us to estimate the long-term risk of major osteoporotic fracture; but none of them is specific for GIO. To date, the therapeutic approach comprises both general measures aimed at correcting calcium and vitamin D intake, and drugs (bisphosphonates, teriparatide, hormone replacement therapy, denosumab) that ameliorate bone mineral density and patient outcomes.

PMID: 29207221 [PubMed - in process]

[Donor and recipient selection in living donor kidney transplantation: eligibility].

Wed, 12/06/2017 - 13:45
Related Articles

[Donor and recipient selection in living donor kidney transplantation: eligibility].

G Ital Nefrol. 2017 Dec 05;34(Nov-Dec):

Authors: Gregorini M, Pattonieri EF, Fasoli G, Valente M, La Porta E, Canevari M, Erasmi F, Rampino T

Abstract
This review is intended to be a guide for the physician to evaluate and prepare a donor / recipient couple for living kidney transplantation. Although it is intended to be exhaustive, it will not be able to respond at all possible and different cases, but it may apply at most of them. Renal transplantation is considered the choice treatment for patients with chronic renal failure and if the kidney transplant is performed pre-emptive it is associated with better organ and patient survival. The main aim of the program is to evaluate the risks of donor and recipient and to ensure the donor safety and well-being. Eligibility for living transplant can only be granted when the risks are acceptable, well defined and the couple is adequately informed. The review includes clinical and legal procedures needed to transplantation. Early conditions that contraindicate the transplant must be removed, to avoid unnecessary exams, excessive waste of time, money. The sequence of the exams has been ordered so that costly and invasive surveys are carried out only after other simple and essential investigations have confirmed the transplant suitability. Special attention should be paid to the renal function measurement, proteinuria, hematuria, hypertension, obesity, pre diabetes, renal calculus, and cancers. To give eligibility for living transplant is often not easy, but a careful study can avoid many complications and improve the transplant outcome.

PMID: 29207219 [PubMed - in process]

Novel oral anticoagulants in patients with chronic kidney disease and atrial fibrillation.

Wed, 12/06/2017 - 13:45
Related Articles

Novel oral anticoagulants in patients with chronic kidney disease and atrial fibrillation.

Nephrol Dial Transplant. 2017 Dec 01;:

Authors: Stamellou E, Floege J

Abstract
Atrial fibrillation (AF) is the most frequent arrhythmia in common clinical practice and its prevalence is markedly increased among patients with chronic kidney disease (CKD). The presence of CKD increases the incidence of AF and vice versa. Both AF and CKD increase the risk of stroke or systemic thromboembolism and oral anticoagulation is the mainstay for thromboembolic event prevention in patients with AF. Novel oral anticoagulants (NOACs) are nowadays often used in patients with AF and CKD, but they display a variable degree of renal elimination and the risk of accumulation and bleeding increases among patients with CKD in particular as kidney disease progresses. While recent data have demonstrated that patients with Stage 3 CKD benefit even more from oral anticoagulation therapies in comparison with patients with normal renal function, relatively little is known about the best choice of anticoagulation in patients with advanced and, in particular, end-stage renal disease, as these patients were excluded from all pivotal Phase 3 NOACs trials. This review summarizes current knowledge on the efficacy and safety of these agents in individuals with CKD and provides CKD stage-specific recommendations.

PMID: 29206932 [PubMed - as supplied by publisher]

The human kidney capsule contains a functionally distinct mesenchymal stromal cell population.

Wed, 12/06/2017 - 13:45
Related Articles

The human kidney capsule contains a functionally distinct mesenchymal stromal cell population.

PLoS One. 2017;12(12):e0187118

Authors: Leuning DG, Engelse MA, Lievers E, Bijkerk R, Reinders MEJ, de Boer HC, van Kooten C, Rabelink TJ

Abstract
We recently demonstrated that the adult human kidney cortex contains a perivascular stromal cell (kPSC) that shows organotypic properties and is important for repair and stabilisation of kidney function. Not only the kidney cortex but also the kidney capsule contains stromal cells that are important for the three dimensional organisation of the kidney during nephrogenesis. They provide the barrier function of the capsule which is critical for homeostatic processes such as pressure natriuresis. We postulated that stromal cells derived from the kidney capsule may therefore also have specific properties and functions. To this end, we isolated these capsule mesenchymal stromal cells (cMSC) from human cadaveric kidneys that were not suitable for transplantation. There were several similarities between cMSCs and kPSCs including support of vascular plexus formation, phenotypic marker expression and resistance against myofibroblast transformation. However, compared to kPSCs, cMSCs showed distinct mRNA and miRNA expression profiles, showed increased immunosuppressive capacity, and displayed strongly reduced HGF production, contributing to the inability to enhance kidney epithelial repair. Therefore cMSCs are a distinct, novel human kidney-derived MSC-population and these data underpin the large functional diversity of phenotypic similar stromal cells in relation to their anatomic site, even within one organ.

PMID: 29206835 [PubMed - in process]

The need and opportunity for donation after circulatory death worldwide.

Wed, 12/06/2017 - 13:45
Related Articles

The need and opportunity for donation after circulatory death worldwide.

Curr Opin Organ Transplant. 2017 Dec 04;:

Authors: Manyalich M, Nelson H, Delmonico FL

Abstract
PURPOSE OF REVIEW: The global shortage of organ donors will not be resolved solely by relying on deceased donation following a brain death determination (DBD). Expansion of deceased donation after circulatory death (DCD) will be needed to address the shortfall of organs for transplantation. Approximately 120 000 organ transplants are performed each year; however, the WHO estimates that this number of transplants only resolves 10% of the annual worldwide transplant need.
RECENT FINDINGS: The report addresses the opportunity of DCD expansion by evaluating the DCD potential that is not being realized, the utility of DCD enabling DBD to emerge in some clinical situations, by the effectiveness of a donor registry in achieving DCD, and by the current clinical research of heart, lung, and liver transplantation from DCD.
SUMMARY: The future of deceased donation must include DCD and ex-vivo organ repair if the organ shortage is to be reconciled even partially to the ongoing demand. Although the religious and legal impediments have been overcome to determine brain death, the possibility of DCD has not been addressed. A program of DCD is feasible in all countries with transplantation services. The excellent results following kidney and lung transplantation suggest opportunities of heart and liver transplantation should be the focus of needed DCD accomplishment in the near future.

PMID: 29206661 [PubMed - as supplied by publisher]

Measurement of sirolimus concentrations in human blood using an automated electrochemiluminescence immunoassay (ECLIA): a multicenter evaluation.

Wed, 12/06/2017 - 13:45
Related Articles

Measurement of sirolimus concentrations in human blood using an automated electrochemiluminescence immunoassay (ECLIA): a multicenter evaluation.

Clin Chem Lab Med. 2017 Dec 05;:

Authors: Stove V, Ramos PA, Wallemacq P, Vogeser M, Schuetzenmeister A, Schmiedel C, Shipkova M

Abstract
BACKGROUND: Therapeutic drug monitoring (TDM) of sirolimus is essential in transplant recipients. We evaluated the performance of a new electrochemiluminescence immunoassay (ECLIA) for measuring sirolimus concentrations in whole blood at five European laboratories.
METHODS: Study assessments included repeatability, intermediate precision and functional sensitivity (concentration at coefficient of variation [CV] of 20%) experiments. Method comparisons with liquid chromatography-tandem mass spectrometry (LC-MS/MS; reference method) and two immunoassays (chemiluminescent microparticle immunoassay [CMIA] and antibody-conjugated magnetic immunoassay [ACMIA]) were performed using native samples from patients with kidney transplants.
RESULTS: Imprecision testing CVs were ≤6.4% and ≤10.7% across the sirolimus concentration range for both repeatability and intermediate precision, respectively. The ECLIA showed excellent functional sensitivity: the CV did not reach 20%; the CV at the assay's limit of quantitation (1.5 μg/L) was 7.0%. Agreement between the ECLIA and LC-MS/MS using native kidney samples was close, with weighted Deming regression analysis yielding a slope of 1.05, an intercept of 0.154 μg/L and a Pearson correlation coefficient (r) of 0.94, while Bland-Altman analysis showed a combined mean bias of 0.41 μg/L (±2 standard deviation [SD], -1.96 to 2.68). The ECLIA also showed good correlation with the two other immunoassays: the CMIA (slope=0.91, intercept=0.112 μg/L and r=0.89) and the ACMIA (slope=0.99, intercept=0.319 μg/L and r=0.97).
CONCLUSIONS: The ECLIA showed good precision, functional sensitivity and agreement with other methods of sirolimus measurement used in clinical practice, suggesting that the assay is suitable for TDM in transplant recipients and provides an alternative to LC-MS/MS.

PMID: 29206642 [PubMed - as supplied by publisher]

Pages