The impact of race‐adjusted GFR estimation on eligibility for simultaneous liver‐kidney transplantation

AbstractThe majority of patients with simultaneous pancreas and kidney transplant (SPKT) required transplantation owing to a long-standing history of insulin-dependent diabetes mellitus (IDDM). The disease causes multiple organ damage, impairs fertility, and affects quality of life. A successful kidney and pancreas transplant can improve health, ameliorate the consequences of pre-existent diabetes, and restore fertility. Good graft function, without any sign of rejection, and stable doses of immunosuppressant drugs are of utmost importance prior to the planned pregnancy. SPKT recipients who become pregnant may be at an increased risk for an adverse outcome and require meticulous multidisciplinary surveillance. We present experiences with SPKT pregnancies, traditional approaches, and recent considerations. In light of complex interactions between new anatomic relations and the impact of developing pregnancy and immunosuppressive medications, special stress is put on the risk of graft rejection, development of pregnancy complications, and potential harmful effects on fetal development. Recent recommendations in management of SPKT recipients who wish to commence pregnancy are presented as well. Key words: transplantation, pregnancy, pancreas, kidney, simultaneous pancreas and kidney transplantation (SPKT)

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The impact of donor urine chemical toxicology analysis on outcomes of kidney transplantation

International Urology and Nephrology ◽

10.1007/s11255-020-02450-w ◽

2020 ◽

Vol 52 (6) ◽

pp. 1173-1178

Author(s):

Karim M. Soliman ◽

Christopher Molini ◽

Tessa Novick ◽

Steven Menez ◽

Tibor Fülöp ◽

...

Keyword(s):

Kidney Transplantation ◽

Chemical Toxicology ◽

The Impact

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Implementation of a Quality Improvement Strategy to Increase Outpatient Kidney Transplant Referrals

10.21203/rs.2.22161/v1 ◽

2020 ◽

Author(s):

Samira Farouk ◽

Sarah Atallah ◽

Kirk N Campbell ◽

Joseph A Vassalotti ◽

Jaime Uribarri

Keyword(s):

Quality Improvement ◽

Kidney Transplantation ◽

Kidney Transplant ◽

Outpatient Setting ◽

Improvement Strategy ◽

Quality Improvement Strategy ◽

Important Barrier ◽

Transplant Evaluation ◽

End Stage ◽

The Impact

Abstract Background: Kidney transplantation remains the optimal therapy for patients with end stage kidney disease (ESKD), though a small fraction of patients on dialysis are on organ waitlists. An important barrier to preemptive kidney transplantation and successful waitlisting is timely referral to a kidney transplant center. We implemented a quality improvement strategy to improve outpatient kidney transplant referrals in a single center academic outpatient nephrology clinic. Methods: Over a 3 month period (July 1 - September 30, 2016), we assessed the baseline kidney transplantation referral rate at our outpatient nephrology clinic for patients 18 - 75 years old with an estimated glomerular filtration rate (eGFR) of less than 20 mL/min/1.73m 2 (2 values over 90 days apart). Charts were manually reviewed by two reviewers to look for kidney transplant referrals and documentation of discussions about kidney transplantation. We then performed a root cause analysis to explore potential barriers to kidney transplantation. Our intervention began on July 1, 2017 and included the implementation of a column in the electronic medical record (EMR) which displayed the patient's last eGFR as part of the clinic schedule. Physicians were given a document listing their patients to be seen that day with an eGFR of < 20 mL/min/1.73m 2 . Results: 54 unique patients with eGFR ≤ 20 ml/min/1.73 m 2 were identified who were seen in the Clinic between July 1, 2016 and September 30, 2016. 29.6% (16) eligible patients were referred for kidney transplantation evaluation. 69.5% (37) of these patients were not referred for kidney transplant evaluation. 46.3% (25) did not have documentation regarding kidney transplant in the EMR. Following the intervention, 66 unique patients met criteria for eligibility for kidney transplant evaluation. Kidney transplant referrals increased to 60.6% (p < 0.001). Conclusions: Our pilot implementation study of a strategy to improve outpatient kidney transplant referrals showed that a free, simple, scalable intervention can significantly improve kidney transplant referrals in the outpatient setting Next steps include further study of the impact of early referral to kidney transplant centers on preemptive and living donor kidney transplantation as well as successful waitlisting.

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Progress in Pediatric Kidney Transplantation

The Open Urology & Nephrology Journal ◽

10.2174/1874303x014070100115 ◽

2014 ◽

Vol 7 (1) ◽

pp. 115-122

Author(s):

Jodi M. Smith ◽

Vikas R. Dharnidharka

Keyword(s):

Kidney Transplantation ◽

Graft Survival ◽

Pediatric Population ◽

Short Term ◽

Allocation Policy ◽

Pediatric Kidney Transplantation ◽

Timely Access ◽

The Impact ◽

Made In

Significant progress has been made in pediatric kidney transplantation. Advances in immunosuppression have dramatically decreased rates of acute rejection leading to improved short term graft survival but similar improvements in long term graft survival remain elusive. Changes in allocation policy provide the pediatric population with timely access to transplant but there remains concern about the impact of less HLA matching and a decrease in living donors. This report presents data from North America on these successes and the ongoing challenges that face the pediatric transplant community.

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Donor genetic variants in interleukin-6 and interleukin-6 receptor associate with biopsy-proven rejection following kidney transplantation.

10.1101/2021.04.17.21255669 ◽

2021 ◽

Author(s):

Felix Poppelaars ◽

Mariana Gaya da Costa ◽

Siawosh K. Eskandari ◽

Jeffrey Damman ◽

Marc A. Seelen

Keyword(s):

Kidney Transplantation ◽

Renal Transplantation ◽

Renal Transplant ◽

Interleukin 6 ◽

Medical Center ◽

Organ Donors ◽

Nucleotide Polymorphisms ◽

Increased Risk ◽

Major Player ◽

The Impact

Rejection after kidney transplantation remains an important cause of allograft failure that markedly impacts morbidity. Cytokines are a major player in rejection, and we, therefore, explored the impact of interleukin-6 (IL6) and IL-6 receptor (IL6R) gene polymorphisms on the occurrence of rejection after renal transplantation. We performed an observational cohort study analyzing both donor and recipient DNA in 1,271 renal transplant-pairs from the University Medical Center Groningen in The Netherlands and associated single nucleotide polymorphisms (SNPs) with biopsy-proven rejection after kidney transplantation. The C-allele of the IL6R SNP (Asp358Ala: rs2228145 A>C, formerly rs8192284) in donor kidneys conferred a reduced risk of rejection following renal transplantation (HR 0.78 per C-allele; 95%-CI 0.67-0.90; P=0.001). On the other hand, the C-allele of the IL6 SNP (at position-174 in the promoter; rs1800795 G>C) in donor kidneys was associated with an increased risk of rejection for male organ donors (HR per C-allele 1.31; 95%-CI 1.08-1.58; P=0.0006), but not female organ donors (P=0.33). In contrast, neither the IL6 nor IL6R SNP in the recipient showed an association with renal transplant rejection. In conclusion, donor IL6 and IL6R genotypes but not recipient genotypes represent an independent prognostic marker for biopsy-proven renal allograft rejection.

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