PP106. Risk of long term renal graft loss after pregnancy in renal transplant recipients immunosuppressed with calcineurin inhibitors

Abstract Background In renal transplant recipients (RTRs), cardiovascular mortality is the most common cause of long-term renal graft loss. Oxidative stress (OS) has been associated with cardiovascular disease and is known to be enhanced in RTRs. We aimed to prospectively investigate whether the concentration of the OS biomarker malondialdehyde (MDA) is associated with long-term risk of cardiovascular mortality in a large cohort of RTRs. Methods The plasma MDA concentration was measured using the thiobarbituric acid reaction assay in 604 extensively phenotyped RTRs with a functioning allograft for ≥1 year. The association between MDA and cardiovascular mortality was assessed using Cox proportional hazard regression analyses in the overall cohort and within subgroups according to significant effect modifiers. Results Median circulating MDA concentration at baseline was 5.38 [interquartile range (IQR) 4.31–6.45] μmol/L. During a follow-up period of 6.4 (IQR 5.6–6.8) years, 110 (18%) RTRs died, with 40% of deaths due to cardiovascular causes. MDA concentration was significantly associated with the risk for cardiovascular mortality {hazard ratio [HR] 1.31 [95% confidence interval (CI) 1.03–1.67] per 1-SD increment}, independent of adjustment for potential confounders, including renal function, immunosuppressive therapy, smoking status and blood pressure. The association between MDA concentration and the risk for cardiovascular mortality was stronger in RTRs with relatively lower plasma ascorbic acid concentrations [≤42.5 µmol/L; HR 1.79 (95% CI 1.30–2.48) per 1-SD increment] or relatively lower estimated glomerular filtration rates [≤45 mL/min/1.73 m2; HR 2.09 (95% CI 1.45–3.00) per 1-SD increment]. Conclusions Circulating MDA concentration is independently associated with long-term risk for cardiovascular mortality, particularly in RTRs with relatively lower ascorbic acid concentrations or renal function. Further studies are warranted to elucidate whether OS-targeted interventions could decrease cardiovascular mortality in RTRs.

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Replacement of calcineurin inhibitors with everolimus: Long-term impact in renal transplant recipients – A single center study

Indian Journal of Transplantation ◽

10.1016/j.ijt.2015.10.015 ◽

2015 ◽

Vol 9 (4) ◽

pp. 144-151

Author(s):

Kesiraju Sailaja ◽

Uma Maheswar Rao Chikkam ◽

Purna Paritala ◽

Shreedhar Reddy ◽

V.S. Reddy ◽

...

Keyword(s):

Renal Transplant ◽

Calcineurin Inhibitors ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Single Center ◽

Single Center Study ◽

Long Term Impact ◽

Center Study

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Increased Risk of All-Cause Mortality and Renal Graft Loss in Stable Renal Transplant Recipients With Hyperparathyroidism

Transplantation Journal ◽

10.1097/tp.0000000000000583 ◽

2015 ◽

Vol 99 (2) ◽

pp. 351-359 ◽

Cited By ~ 56

Author(s):

Hege Pihlstrøm ◽

Dag Olav Dahle ◽

Geir Mjøen ◽

Stefan Pilz ◽

Winfried März ◽

...

Keyword(s):

Renal Transplant ◽

Graft Loss ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Renal Graft ◽

Increased Risk ◽

All Cause Mortality

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Hyperparathyroidism in Stable Renal Transplant Recipients Is Associated With All-Cause Mortality and Renal Graft Loss.

Transplantation Journal ◽

10.1097/00007890-201407151-00388 ◽

2014 ◽

Vol 98 ◽

pp. 126

Author(s):

H. Pihlstrom ◽

D. Dahle ◽

G. Mjoen ◽

S. Pilz ◽

W. Maerz ◽

...

Keyword(s):

Renal Transplant ◽

Graft Loss ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Renal Graft ◽

All Cause Mortality

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Early postoperative C-terminal agrin fragment (CAF) serum levels predict graft loss and proteinuria in renal transplant recipients

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2015-0369 ◽

2016 ◽

Vol 54 (1) ◽

Cited By ~ 4

Author(s):

Dominik Steubl ◽

Anna Vogel ◽

Stefan Hettwer ◽

Susanne Tholen ◽

Peter B. Luppa ◽

...

Keyword(s):

Renal Transplant ◽

Predictive Value ◽

Cox Regression ◽

Univariate Analysis ◽

Graft Loss ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Long Term Outcomes

AbstractC-terminal agrin fragment (CAF), cleavage product of agrin, was previously correlated with kidney function in renal transplant patients. This article studies the predictive value of CAF for long-term outcomes in renal transplant recipients.In this observational cohort study, serum CAF, creatinine and blood-urea-nitrogen (BUN) concentrations and eGFR (CKD-EPI) were assessed 1–3 months after transplantation in 105 patients undergoing kidney transplantation. Cox regression models were used to analyse the predictive value of all parameters concerning all-cause mortality (ACM), graft loss (GL), doubling of creatinine/proteinuria at the end of follow-up.Median follow-up time was 3.1 years. The mean concentrations were 191.9±152.4 pM for CAF, 176±96.8 μmol/L for creatinine, 12.6±6.2 mmol/L for BUN and 44.9±21.2 mL/min for CKD-EPI formula, respectively. In univariate analysis CAF and BUN concentrations predicted ACM (CAF: HR=1.003, 1.1-fold risk, p=0.043; BUN: HR=1.037, 1.3-fold risk, p=0.006). Concerning GL, CAF (HR=1.006, 3.1-fold risk, p<0.001), creatinine (HR=2.396, 2.6-fold risk, p<0.001), BUN (HR=1.048, 1.7-fold risk, p=0.001) and eGFR (CKD-EPI) (HR=0.941, 0.45-fold risk reduction, p=0.006) showed a statistically significant association. CAF was the only parameter significantly associated with doubling of proteinuria (HR=1.005, 1.7-fold risk, p<0.001). In multiple regression analysis (CAF only) the association remained significant for GL and doubling of proteinuria but not ACM.Early postoperative serum CAF appears to be a useful tool for the assessment of long-term outcomes in renal transplant recipients. Most importantly it represents a promising predictor for the development of proteinuria.

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Donor P-gp Polymorphisms Strongly Influence Renal Function and Graft Loss in a Cohort of Renal Transplant Recipients on Cyclosporine Therapy in a Long-Term Follow-Up

Clinical Pharmacology & Therapeutics ◽

10.1038/clpt.2010.62 ◽

2010 ◽

Vol 88 (1) ◽

pp. 95-100 ◽

Cited By ~ 50

Author(s):

J-B Woillard ◽

J-P Rerolle ◽

N Picard ◽

A Rousseau ◽

A Guillaudeau ◽

...

Keyword(s):

Renal Function ◽

Renal Transplant ◽

Graft Loss ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Cyclosporine Therapy ◽

Long Term Follow Up

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Impact of hyperuricemia on long-term clinical outcomes of renal transplant recipients: a systematic review and meta-analysis

Journal of Pharmacy & Pharmaceutical Sciences ◽

10.18433/jpps31620 ◽

2021 ◽

Vol 24 ◽

pp. 292-307

Author(s):

Hui Yang ◽

Qing Chen ◽

Aiwen Huang ◽

Xiaojia Yu ◽

Gang Chen ◽

...

Keyword(s):

Uric Acid ◽

Renal Transplant ◽

Clinical Outcomes ◽

Cardiovascular Event ◽

Graft Loss ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Increased Risk ◽

Significant Difference

Purpose: To evaluate the effect of hyperuricemia on clinical outcomes of renal transplant recipients (RTRs). Methods: A literature search of PubMed, Cochrane, Embase was conducted up to March 20, 2020. The primary outcome was the estimated glomerular filtration rate (eGFR). The second outcomes were the risk of graft loss, death, cardiovascular event and the level of triglyceride. The following search terms were utilized: ((Hyperuricemic group) OR (Hyperuricaemia) OR (Hyperuric) OR (Urea acid) OR (Uric acid) OR (Acid urate) OR (Urate) OR (Gout)) and ((Transplantation) OR (Transplantations) OR (Transplant) OR (Transplants) OR (Graft)). Results: 28 studies with 18224 patients were eligible for inclusion. There was no significant difference in eGFR (<12 months, p=0.07), the risk of graft loss (<60 months, p=0.07) and death (<60months, p=0.19) between the hyperuricemic and normouricemic group in the early post-transplantation period. But increased uric acid levels contributed to the long-term decline of eGFR, the risk of graft loss and death increased after transplantation. Hyperuricemia increased the risk of cardiovascular event with no significant difference in the level of triglyceride between the two groups. Conclusions: Increased uric acid levels contributed to the long-term decline of eGFR, increased risk of graft loss and death after transplantation. Although there was no significant effect on triglyceride, hyperuricemia increased the risk of cardiovascular event.

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