USE OF METHOTREXATE, WHATEVER KIDNEY FUNCTION, WITH A SIMPLE ALGORITHM, RADICALLY CHANGES THE PROGNOSIS OF POST‐TRANSPLANT CNS LYMPHOMAS

Objective Successful simultaneous pancreas and kidney transplantation (SPK) or pancreas transplantation alone (PTA) restores glycemic control. Diabetes and impaired kidney function are common side effects of immunosuppressive therapy. This study addresses glucometabolic parameters and kidney function during the first year. Methods We examined 67 patients with functioning grafts (SPK n = 30, PTA n = 37) transplanted between September 2011 and November 2016 who underwent repeated oral glucose tolerance tests (OGTTs) 8 and 52 weeks after transplantation. Another 19 patients lost their graft the first year post-transplant and 28 patients did not undergo repeated OGTTs and could not be studied. All patients received ATG induction therapy plus tacrolimus, mycophenolate and prednisolone. Glomerular filtration rate was measured before and 8 and 52 weeks after transplantation by serum clearance methods. Results From week 8 to 52 after transplantation, mean fasting glucose decreased (SPK: 5.4 ± 0.7 to 5.1 ± 0.8 mmol/L, PTA: 5.4 ± 0.6 to 5.2 ± 0.7 mmol/L; both P < 0.05), and also 120-min post-OGTT glucose (SPK: 6.9 ± 2.9 to 5.7 ± 2.2 mmol/L; P = 0.07, PTA: 6.5 ± 1.7 to 5.7 ± 1.2 mmol/L; P < 0.05). Fasting C-peptide levels also decreased (SPK: 1500 ± 573 to 1078 ± 357 pmol/L, PTA: 1210 ± 487 to 1021 ± 434 pmol/L, both P < 0.005). Measured GFR decreased from enlistment to 8 weeks post transplant in PTA patients (94 ± 22 to 78 ± 19 mL/min/1.73 m2; P < 0.005), but did not deteriorate from week 8 to week 52 (SPK: 55.0 ± 15.1 vs 59.7 ± 11.3 ml/min/1.73 m²; P = 0.19, PTA: 76 ± 19 vs 77 ± 19 mL/min/1.73 m²; P = 0.74). Conclusion Glycemic control and kidney function remain preserved in recipients with functioning SPK and PTA grafts 1 year after transplantation.

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Post-Transplant Renal Artery Stenosis: Impact of Therapy on Long-Term Kidney Function and Blood Pressure Control

The Journal of Urology ◽

10.1016/s0022-5347(01)66030-0 ◽

1996 ◽

Vol 155 (6) ◽

pp. 1860-1864 ◽

Cited By ~ 61

Author(s):

Bashir R. Sankari ◽

Michael Geisinger ◽

Margaret Zelch ◽

Ben Brouhard ◽

Robert Cunningham ◽

...

Keyword(s):

Blood Pressure ◽

Renal Artery ◽

Renal Artery Stenosis ◽

Kidney Function ◽

Blood Pressure Control ◽

Pressure Control ◽

Artery Stenosis ◽

Post Transplant ◽

Transplant Renal Artery Stenosis

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One-year post-transplant hyperglycemia aggravated kidney function in diabetic patients

Diabetes Research and Clinical Practice ◽

10.1016/s0168-8227(16)31003-8 ◽

2016 ◽

Vol 120 ◽

pp. S43

Author(s):

Takako Yonemoto ◽

Hiroshi Hatakeyama ◽

Kouhei Saitoh ◽

Chika Kyo ◽

Rieko Umayahara ◽

...

Keyword(s):

Kidney Function ◽

Diabetic Patients ◽

Post Transplant ◽

One Year

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Polycystic liver and kidney disease: post-transplant kidney function in patients receiving pre-emptive kidney transplantation

Transplant International ◽

10.1111/j.1432-2277.2007.00601.x ◽

2008 ◽

Vol 21 (3) ◽

pp. 263-267 ◽

Cited By ~ 6

Author(s):

Adrian P. Martin ◽

Michael Bartels ◽

Adrien Kiehle ◽

Johann Hauss ◽

Josef Fangmann

Keyword(s):

Kidney Transplantation ◽

Kidney Disease ◽

Kidney Function ◽

Post Transplant ◽

Polycystic Liver ◽

Liver And Kidney ◽

Transplant Kidney

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Abstract 126: Effect of Immunosuppressive Therapy, Clinical, and Demographic Parameters on Kidney Function After Cadaveric Renal Transplant

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.11.suppl_1.126 ◽

2018 ◽

Vol 11 (suppl_1) ◽

Author(s):

Justin Muste ◽

Eugene Pashkovetsky ◽

Stephani Wang ◽

Monika Misak ◽

Nikolaos Chandolias ◽

...

Keyword(s):

Diabetes Mellitus ◽

Renal Transplant ◽

Immunosuppressive Therapy ◽

Kidney Transplant ◽

Kidney Function ◽

Medical Center ◽

Suppressive Therapy ◽

Study Cohort ◽

Renal Transplant Recipients ◽

Post Transplant

Background: We compared effects of immunosuppression and co-morbidities on kidney function following renal transplant. Methods: We perfomed retrospective chart review in 211 consecutive renal transplant recipients, treated at a single medical center between 2004 to 2014, who also underwent a post-transplant echocardiogram. Patients were stratified into ESRD/CKD-4 group and CKD1-3 according to standard GFR criteria. The study was approved by IRB. Results: Average age was 52.4 +/- 11.8 years old, 41% were females, 95% with history HTN, 81% with dislipidemia, 20% with CAD, 42% with diabetes mellitus, 26% past smokers, 16% on thyroid replacement therapy, 8% with history of congestive heart failure. The average hemoglobin was 11.9 +/- 2.2 mg/dL. Sixty percent of patients were on triple immunosuppressive therapy. In our study cohort, with an average time post-kidney transplant of 41.7+/-34.8 months, 26.5% patients had ESRD/CKD-4. Female gender (OR 2.26, 95% CI 1.21-4.20; p=0.01), diabetes mellitus (OR 0.502, 95% CI 0.26-0.96; p=0.03), triple immunosuppressive therapy (OR 0.279, CI 0.15-0.23; p<0.0001), and hemoglobin (OR 0.632, 95% CI 0.53-0.76; p<0.0001) were significant independent predictors of post-kidney transplant GFR. In multivariable regression analysis, post-transplant hemoglobin (OR 0.641, 95% CI 0.53-0.77; p<0.0001) and triple immunosuppressive therapy (OR 0.282, CI 0.15-0.53; p=0.0004) were significant predictors of preserved GFR and lower CKD category. Conclusions: Higher Hgb levels and triple immune-suppressive therapy are associated with improved kidney function post-renal transplant. Additional studies are needed to identify causes of decreased hemoglobin in this patient population and to develop treatment strategies aimed at preserving GFR.

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Transition of renal patients using AlloSure® into community kidney care (TRACK): a new protocol for long-term allograft surveillance in renal transplant recipients. (Preprint)

10.2196/preprints.25941 ◽

2020 ◽

Author(s):

Bethany Dale ◽

Subhassih Bose ◽

Sheng Kuo ◽

Alana Burns ◽

Pierre Daou ◽

...

Keyword(s):

Kidney Transplantation ◽

Immune System ◽

Renal Transplant ◽

Kidney Transplant ◽

Kidney Function ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Allograft Survival ◽

Post Transplant

BACKGROUND End Stage Kidney Disease (ESKD) patients require complex and expensive medical management. Kidney transplantation remains the treatment of choice for ESKD and is considered superior to all other modalities of renal replacement therapy (RRT) or dialysis. However, access to kidney transplant is limited by critical supply-demand making it extremely important to ensure longevity of transplanted kidneys. This is prevented through life-long immunosuppression, with caution not to overly suppress the immune system, resulting in toxicity and harm. Transition of care to community nephrologists after initial kidney transplantation and monitoring at a transplant center is an important process to ensure delivery of effective and patient-centric care closer to home. Once transplanted, laborious surveillance of the immune system and monitoring for potential rejection and injury is undertaken through an armamentarium of screening modalities. Post-transplant surveillance for kidney function and injury remained key to follow up care. While kidney function, quantified by estimated glomerular filtration rate (eGFR) and serum creatinine (SCr), and kidney injury, measured by proteinuria and hematuria, are standard biomarkers used to monitor injury and rejection post-transplant, they have recently been demonstrated to be inferior in performance to that of AlloSure® (CareDx, Inc. Brisbane, CA), circulating donor-derived cell-free DNA (dd-cfDNA). OBJECTIVE The outcomes and methods of monitoring renal transplant recipients (RTR) post-transplant have remained stagnant over the past 15 years. The aim of this study is to consider intensive surveillance using AlloSure® dd-cfDNA in an actively managed protocol assessing whether it increases long-term allograft survival in kidney transplant recipients compared with current standard clinical care in community nephrology. METHODS The study protocol will acquire data from a phase IV observational trial to assess a cohort of 2500 RTR patients managed using AlloSure® dd-cfDNA and patient care managers versus 1000 propensity matched historic controls using UNOS SRTR data. Data will be managed in a centralized electronic data server. RESULTS The primary outcome will be superior allograft survival, as a composite of return to dialysis, re-transplant, death due to allograft failure and death with a functional graft DWFG (infection, malignancy, and cardiovascular death). The secondary endpoints will assess improved kidney function through decline in eGFR and immune activity through development of donor specific antibody (DSA). CONCLUSIONS Based on a significant literature base, we believe implementing the surveillance of dd-cfDNA in the kidney transplant population will have a positive impact on graft survival. Through early identification of rejection and facilitating timely intervention, prolongation of allograft survival versus those not managed by dd-cfDNA surveillance protocol should be superior.

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