scholarly journals SP5.2.1 Renal Transplant Outcomes Through the COVID-19 Pandemic at a London Transplant Centre

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Sara Mahdibeiraghdar ◽  
Abbas Ghazanfar ◽  
Sarah Heap ◽  
Abul Siddiky ◽  
Claire Fraser Taylor ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Graft Loss ◽  
Outcome Data ◽  
Adverse Outcomes ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Jugular Vein Thrombosis ◽  
Post Transplant ◽  
Significant Difference ◽  
The Impact

Abstract Aims The aim of this audit was to establish the impact of COVID-19 on the outcomes of renal transplant recipients in the post-transplant period at our centre, through the 2020 calendar year. Methods Living donor and deceased donor renal transplant recipients in the period of interest were identified and any complications or adverse outcomes were reviewed and compared to outcome data from the previous year. Results A total of 88 renal transplants were performed in 2020. Fifty-five cases were performed after reopening the Unit. Five patients tested positive for COVID-19 in the post-transplant period. One patient was admitted to the Intensive Care Unit and subsequently died from related complications. Another patient suffered from internal jugular vein thrombosis shortly after testing positive and could be attributed to the hypercoagulable state post-infection. A total of 4 deaths and 1 graft loss were recorded within 2020. This compares to 1 death, 2 graft losses and 1 primary non-function in 172 transplants in 2019. Of the 4 deaths, one was directly linked to COVID-19. The other 3 deaths could be indirectly linked to the disruptions that were made in the healthcare system during this period in adapting to the pandemic. Conclusions It was anticipated that COVID-19 will directly and indirectly affect patient outcomes from surgery during this period. This was clearly seen at this Unit, with mortality rates having increased almost eight-fold in the post-transplant period compared to the same period in the previous year. However, no significant difference was seen with graft losses.

Vaccination titres pre- and post-transplant in paediatric renal transplant recipients and the impact of immunosuppressive therapy

2018 ◽  
Vol 33 (5) ◽  
pp. 897-910 ◽  
Author(s):  
Britta Höcker ◽  
Martin Aguilar ◽  
Paul Schnitzler ◽  
Lars Pape ◽  
Martin Bald ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Immunosuppressive Therapy ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Post Transplant ◽  
The Impact

scholarly journals P1767ERALY VERSUS LATE GRAFT PYELONEPHRITIS- A RETROSPECTIVE ANALYSIS OF GRAFT AND PATIENT OUTCOME

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Anupma Kaul ◽  
Thomas Mathews ◽  
Dharmendra Bhaduria ◽  
Narayan Prasad ◽  
Amit Gupta
Keyword(s):  
Renal Transplant ◽  
Graft Survival ◽  
Patient Survival ◽  
Univariate Analysis ◽  
Graft Loss ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Significant Difference ◽  
Dj Stent ◽  
Baseline Characteristics

Abstract Background and Aims Acute graft pyelonephritis(AGPN) is thought to affect the graft and patient survival among the renal transplant recipients.Our objective was to compare these outcomes in those having early AGPN(<6 months from transplant) versus those having late AGPN(>6months from transpant) Method This retrospective study analysed 150 patients who had AGPN over a period of 8 years from 2005 to 2013.They were divided into early AGPN group and late AGPN group .Their baseline characteristics were compared.Predictors of graftloss and mortality were compared using logistic regression analysis.Graft survival and patient survival wereanalysed using Kaplan-Meyer survival plots Results A total of 150 patients with AGPN were analysed.Of these 55.3%(n=83) had early AGPN and 44.7%(n=67) had late AGPN.These two groups were comparable regarding baseline characteristics and immunosuppression.13.3%(n=11) patients in early AGPN group had CMV disease during follow up compared to 3%(n=2) in late AGPN group(p<0.05).26.5%(n=22) in the early AGPN group had prolonged foley’s catheterization(>5days) following transplant surgery compared to 7.5%(n=5) in late AGPN group(p<0.05).38.6%(n=32) in the early AGPN group had prolonged DJ stent in-situ(>2weeks) following transplant surgery compared to 19.4%(n=13) in the late AGPN group(p<0.05).Recurrent GPN was more common in the late AGPN group than the early AGPN group-35.8%(n=24) verus 18.1%(n=15).Predictors for graft loss was assessed in patients with AGPN and presence of renal abscess was predictive of graft loss in univariate analysis(HR-6.129 ,95 % CI 1.776-21.154,p-0.004).There were no significant predictors of mortality in univariateanalysis.KaplanMeiyer survival analysis showed decreased death censored graft survival in the early AGPN group(p-0.035).There was no significant difference in the patient survival among two groups. Conclusion Occurrence of early AGPN has significant impact on long term graft survival in renal transplant recipients with no significant effect on patient survival.This study underlines the paramount importance of prevention of UTIs in renal transplant recipients.

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

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.

scholarly journals COVID-19 in renal transplant recipients and general population: a comparative study of clinical, laboratory, and radiological features, severity, and outcome

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Ali Monfared ◽  
Leila Akhondzadeh ◽  
Mahsa Mousazadeh ◽  
Atefeh Jafari ◽  
Masoud Khosravi ◽  
...  
Keyword(s):  
Renal Transplant ◽  
General Population ◽  
Disease Severity ◽  
Clinical Symptoms ◽  
Adverse Outcomes ◽  
Control Group ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Icu Admission ◽  
Significant Difference

Abstract Introduction Coronavirus disease 2019 (COVID-19), a novel disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to millions of deaths worldwide. Kidney transplant recipients (KTRs) are a fragile population due to their immunosuppressed status. However, there are limited studies available comparing this population with the general population regarding clinical symptoms, and laboratory and imaging features as well as disease severity and clinical outcomes. Methods A total of 24 KTRs and 40 patients from the general population (control group) were enrolled after applying exclusion criteria. Clinical symptoms, laboratory values, and lung involvement patterns in high-resolution computed tomography (HRCT) were compared between KTRs with COVID-19 and their counterparts from the general population. Moreover, the category of disease severity and adverse outcomes such as intensive care unit (ICU) admission, mechanical ventilation (MV), and mortality rate were also compared between these two groups. Results Hypertension was significantly higher among KTRs. Dyspnea was significantly more among the control group (P = 0.045). There was no significant difference in the rest of clinical symptoms (P > 0.05). There was no significant difference in CT features as well, except pleural effusion, which was more prevalent in the control group. A lower absolute lymphocytic count (ALC) and platelet count were observed in KTRs. Renal transplant recipients (RTRs) had a higher elevation in creatinine level than their counterparts. The ICU admission, MV, duration of hospital stay, and mortality as adverse outcomes were not significantly different between the KTR and control groups. Conclusion In conclusion, there was no significant difference in the severity and risk of adverse outcomes, including MV, ICU admission, and mortality between KTRs under chronic immunosuppression and the control group.

scholarly journals Improved renal allograft survival for pre-emptive paediatric renal transplant recipients in the UK

2021 ◽  
pp. archdischild-2020-321277
Author(s):  
Matko Marlais ◽  
Kate Martin ◽  
Stephen D Marks
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Transplant ◽  
Renal Allograft ◽  
Cox Regression ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Allograft Survival ◽  
Significant Difference ◽  
Donor Type ◽  
The Uk

BackgroundThe aim of this study was to investigate whether being on dialysis at the time of renal transplantation affected renal allograft survival in paediatric renal transplant recipients (pRTRs).MethodsRetrospective study of UK Transplant Registry (National Health Service Blood and Transplant) data on all children (aged <18 years) receiving a kidney-only transplant from 1 January 2000 to 31 December 2015. Kaplan-Meier estimates of patient and renal allograft survival calculated and Cox regression modelling accounting for donor type. The relationship between time on dialysis and renal allograft survival was examined.Results2038 pRTRs were analysed: 607 (30%) were pre-emptively transplanted, 789 (39%) and 642 (32%) on peritoneal dialysis and haemodialysis, respectively, at the time of transplantation. Five-year renal allograft survival was significantly better in the pre-emptively transplanted group (90.6%) compared with those on peritoneal dialysis and haemodialysis (86.4% and 85.7%, respectively; p=0.02). After accounting for donor type, there was a significantly lower hazard of 5-year renal allograft failure in pre-emptively transplanted children (HR 0.742, p=0.05). Time spent on dialysis pre-transplant negatively correlated with renal allograft survival (p=0.002). There was no significant difference in 5-year renal allograft survival between children who were on dialysis for less than 6 months and children transplanted pre-emptively (87.5% vs 90.5%, p=0.25).ConclusionsPre-emptively transplanted children have improved 5-year renal allograft survival, compared with children on dialysis at the time of transplantation. Although increased time spent on dialysis correlated with poorer renal allograft survival, there was no evidence that short periods of dialysis pre-transplant affected renal allograft survival.

scholarly journals Post-Transplant Diabetes Mellitus and Prediabetes in Renal Transplant Recipients: An Update

Nephron ◽  
2021 ◽  
pp. 1-13
Author(s):  
Ana Elena Rodríguez-Rodríguez ◽  
Esteban Porrini ◽  
Mads Hornum ◽  
Javier Donate-Correa ◽  
Raúl Morales-Febles ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Renal Transplant ◽  
Cell Function ◽  
Cell Damage ◽  
Current Evidence ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Post Transplant ◽  
Β Cell Function

Post-transplant diabetes mellitus (PTDM) is a frequent and relevant complication after renal transplantation: it affects 20–30% of renal transplant recipients and increases the risk for cardiovascular and infectious events. Thus, understanding pathogenesis of PTDM would help limiting its consequences. In this review, we analyse novel aspects of PTDM, based on studies of the last decade, such as the clinical evolution of PTDM, early and late, the reversibility rate, diagnostic criteria, risk factors, including pre-transplant metabolic syndrome and insulin resistance (IR) and the interaction between these factors and immunosuppressive medications. Also, we discuss novel pathogenic factors, in particular the role of β-cell function in an environment of IR and common pathways between pre-existing cell damage and tacrolimus-induced toxicity. The relevant role of prediabetes in the pathogenesis of PTDM and cardiovascular disease is also addressed. Finally, current evidence on PTDM treatment is discussed.

scholarly journals Calcium and phosphate levels after kidney transplantation and long-term patient and allograft survival

2020 ◽  
Author(s):  
Julio Chevarria ◽  
Donal J Sexton ◽  
Susan L Murray ◽  
Chaudhry E Adeel ◽  
Patrick O’Kelly ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Transplant ◽  
Graft Failure ◽  
Graft Function ◽  
Renal Transplant Recipients ◽  
Post Transplant ◽  
All Cause Mortality ◽  
Transplant Function ◽  
The Republic ◽  
The Impact

Abstract Background Non-traditional cardiovascular risk factors, including calcium and phosphate derangement, may play a role in mortality in renal transplant. The data regarding this effect are conflicting. Our aim was to assess the impact of calcium and phosphate derangements in the first 90 days post-transplant on allograft and recipient outcomes. Methods We performed a retrospective cohort review of all-adult, first renal transplants in the Republic of Ireland between 1999 and 2015. We divided patients into tertiles based on serum phosphate and calcium levels post-transplant. We assessed their effect on death-censored graft survival and all-cause mortality. We used Stata for statistical analysis and did survival analysis and spline curves to assess the association. Results We included 1525 renal transplant recipients. Of the total, 86.3% had hypophosphataemia and 36.1% hypercalcaemia. Patients in the lowest phosphate tertile were younger, more likely female, had lower weight, more time on dialysis, received a kidney from a younger donor, had less delayed graft function and better transplant function compared with other tertiles. Patients in the highest calcium tertile were younger, more likely male, had higher body mass index, more time on dialysis and better transplant function. Adjusting for differences between groups, we were unable to show any difference in death-censored graft failure [phosphate = 1.14, 95% confidence interval (CI) 0.92–1.41; calcium = 0.98, 95% CI 0.80–1.20] or all-cause mortality (phosphate = 1.10, 95% CI 0.91–1.32; calcium = 0.96, 95% CI 0.81–1.13) based on tertiles of calcium or phosphate in the initial 90 days. Conclusions Hypophosphataemia and hypercalcaemia are common occurrences post-kidney transplant. We have identified different risk factors for these metabolic derangements. The calcium and phosphate levels exhibit no independent association with death-censored graft failure and mortality.

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