scholarly journals Metagenomic Virome Sequencing in Living Donor and Recipient Kidney Transplant Pairs Revealed JC Polyomavirus Transmission

2018 ◽  
Vol 69 (6) ◽  
pp. 987-994 ◽  
Author(s):  
Peter W Schreiber ◽  
Verena Kufner ◽  
Kerstin Hübel ◽  
Stefan Schmutz ◽  
Osvaldo Zagordi ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Living Donor ◽  
Virus Transmission ◽  
Donor Strain ◽  
Metagenomic Sequencing ◽  
Jc Polyomavirus ◽  
Living Kidney Donor ◽  
Living Kidney Donors

AbstractBackgroundBefore kidney transplantation, donors and recipients are routinely screened for viral pathogens using specific tests. Little is known about unrecognized viruses of the urinary tract that potentially result in transmission. Using an open metagenomic approach, we aimed to comprehensively assess virus transmission in living-donor kidney transplantation.MethodsLiving kidney donors and their corresponding recipients were enrolled at the time of transplantation. Follow-up study visits for recipients were scheduled 4–6 weeks and 1 year thereafter. At each visit, plasma and urine samples were collected and transplant recipients were evaluated for signs of infection or other transplant-related complications. For metagenomic analysis, samples were enriched for viruses, amplified by anchored random polymerase chain reaction (PCR), and sequenced using high-throughput metagenomic sequencing. Viruses detected by sequencing were confirmed using real-time PCR.ResultsWe analyzed a total of 30 living kidney donor and recipient pairs, with a follow-up of at least 1 year. In addition to viruses commonly detected during routine post-transplant virus monitoring, metagenomic sequencing detected JC polyomavirus (JCPyV) in the urine of 7 donors and their corresponding recipients. Phylogenetic analysis confirmed infection with the donor strain in 6 cases, suggesting transmission from the transplant donor to the recipient, despite recipient seropositivity for JCPyV at the time of transplantation.ConclusionsMetagenomic sequencing identified frequent transmission of JCPyV from kidney transplant donors to recipients. Considering the high incidence rate, future studies within larger cohorts are needed to define the relevance of JCPyV infection and the donor’s virome for transplant outcomes.

scholarly journals Has the UK living kidney donor population changed over time? A cross-sectional descriptive analysis of the UK living donor registry between 2006 and 2017

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e033906
Author(s):  
Phillippa K Bailey ◽  
Katie Wong ◽  
Matthew Robb ◽  
Lisa Burnapp ◽  
Alistair Rogers ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Kidney Failure ◽  
Living Donor ◽  
Kidney Donor ◽  
Living Kidney Donor ◽  
Cross Sectional ◽  
Kidney Donors ◽  
Living Kidney Donors ◽  
The Uk ◽  
Over Time

BackgroundA living-donor kidney transplant is the best treatment for most people with kidney failure. Population cohort studies have shown that lifetime living kidney donor risk is modified by sex, age, ethnicity, body mass index (BMI), comorbidity and relationship to the recipient.ObjectivesWe investigated whether the UK population of living kidney donors has changed over time, investigating changes in donor demographics.DesignWe undertook a cross-sectional analysis of the UK living kidney donor registry between January 2006 to December 2017. Data were available on living donor sex, age, ethnicity, BMI, hypertension and relationship to recipient.SettingUK living donor registry.Participants11 651 consecutive living kidney donors from January 2006 to December 2017.Outcome measuresLiving kidney donor demographic characteristics (sex, age, ethnicity, BMI and relationship to the transplant recipient) were compared across years of donation activity. Donor characteristics were also compared across different ethnic groups.ResultsOver the study period, the mean age of donors increased (from 45.8 to 48.7 years, p<0.001), but this change appears to have been limited to the White population of donors. Black donors were younger than White donors, and a greater proportion were siblings of their intended recipient and male. The proportion of non-genetically related non-partner donations increased over the 12-year period of analysis (p value for linear trend=0.002).ConclusionsThe increasing age of white living kidney donors in the UK has implications for recipient and donor outcomes. Despite an increase in the number of black, Asian and minority ethnic individuals waitlisted for a kidney transplant, there has been no increase in the ethnic diversity of UK living kidney donors. Black donors in the UK may be at a much greater risk of developing kidney failure due to accumulated risks: whether these risks are being communicated needs to be investigated.

scholarly journals Living Donor Kidney Transplantation Improves Graft and Recipient Survival in Patients with Multiple Kidney Transplants

2020 ◽  
Vol 9 (7) ◽  
pp. 2118 ◽  
Author(s):  
Maria Irene Bellini ◽  
Aisling E Courtney ◽  
Jennifer A McCaughan
Keyword(s):  
Kidney Transplantation ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Transplant ◽  
Graft Survival ◽  
Living Donor ◽  
Patient Survival ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

Background: Failed kidney transplant recipients benefit from a new graft as the general incident dialysis population, although additional challenges in the management of these patients are often limiting the long-term outcomes. Previously failed grafts, a long history of comorbidities, side effects of long-term immunosuppression and previous surgical interventions are common characteristics in the repeated kidney transplantation population, leading to significant complex immunological and technical aspects and often compromising the short- and long-term results. Although recipients’ factors are acknowledged to represent one of the main determinants for graft and patient survival, there is increasing interest in expanding the donor’s pool safely, particularly for high-risk candidates. The role of living kidney donation in this peculiar context of repeated kidney transplantation has not been assessed thoroughly. The aim of the present study is to analyse the effects of a high-quality graft, such as the one retrieved from living kidney donors, in the repeated kidney transplant population context. Methods: Retrospective analysis of the outcomes of the repeated kidney transplant population at our institution from 1968 to 2019. Data were extracted from a prospectively maintained database and stratified according to the number of transplants: 1st, 2nd or 3rd+. The main outcomes were graft and patient survivals, recorded from time of transplant to graft failure (return to dialysis) and censored at patient death with a functioning graft. Duration of renal replacement therapy was expressed as cumulative time per month. A multivariate analysis considering death-censored graft survival, decade of transplantation, recipient age, donor age, living donor, transplant number, ischaemic time, time on renal replacement therapy prior to transplant and HLA mismatch at HLA-A, -B and -DR was conducted. In the multivariate analysis of recipient survival, diabetic nephropathy as primary renal disease was also included. Results: A total of 2395 kidney transplant recipients were analysed: 2062 (83.8%) with the 1st kidney transplant, 279 (11.3%) with the 2nd graft, 46 (2.2%) with the 3rd+. Mean age of 1st kidney transplant recipients was 43.6 ± 16.3 years, versus 39.9 ± 14.4 for 2nd and 41.4 ± 11.5 for 3rd+ (p < 0.001). Aside from being younger, repeated kidney transplant patients were also more often males (p = 0.006), with a longer time spent on renal replacement therapy (p < 0.0001) and a higher degree of sensitisation, expressed as calculated reaction frequency (p < 0.001). There was also an association between multiple kidney transplants and better HLA match at transplantation (p < 0.0001). A difference in death-censored graft survival by number of transplants was seen, with a median graft survival of 328 months for recipients of the 1st transplant, 209 months for the 2nd and 150 months for the 3rd+ (p = 0.038). The same difference was seen in deceased donor kidneys (p = 0.048), but not in grafts from living donors (p = 0.2). Patient survival was comparable between the three groups (p = 0.59). Conclusions: In the attempt to expand the organ donor pool, particular attention should be reserved to high complex recipients, such as the repeated kidney transplant population. In this peculiar context, the quality of the donor has been shown to represent a main determinant for graft survival—in fact, kidney retrieved from living donors provide comparable outcomes to those from single-graft recipients.

Renal Cysts in Living Donor Kidney Transplantation: Long-Term Follow-up in 25 Patients

2009 ◽  
Vol 41 (10) ◽  
pp. 4047-4051 ◽  
Author(s):  
D. Grotemeyer ◽  
A. Voiculescu ◽  
F. Iskandar ◽  
M. Voshege ◽  
D. Blondin ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Living Donor ◽  
Renal Cysts ◽  
Donor Kidney ◽  
Living Donor Kidney Transplantation ◽  
Long Term Follow Up ◽  
Donor Kidney Transplantation ◽  
Living Donor Kidney

scholarly journals P1660ACCESS TO KIDNEY TRANSPLANTATION IN THE UK CHINESE POPULATION: A UK RENAL REGISTRY ANALYSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Katie Wong ◽  
Fergus Caskey ◽  
Yoav Ben-Shlomo ◽  
Anna Casula ◽  
Pippa Bailey
Keyword(s):  
Logistic Regression ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Chinese Population ◽  
Living Donor ◽  
Donor Kidney ◽  
Chinese Ethnicity ◽  
The Uk ◽  
To Receive ◽  
Living Donor Kidney

Abstract Background and Aims Previous UK Renal Registry (UKRR) analyses and the Access to Transplantation and Transplant Outcome Measures (ATTOM) study have shown ethnic disparity in access to kidney transplants in the UK, but access to transplantation for the UK Chinese population has not been investigated In this UKRR analysis, we compared the likelihood of kidney transplantation between the UK White and UK Chinese renal populations, aiming to investigate whether there was evidence of ethnic disparity in access to kidney transplantation for this specific ethnic group. Method Data on all adult patients &gt;=18 years who started renal replacement therapy (RRT) between 1/1/97 and 31/12/16 were extracted from the UKRR. Patients with ethnicity recorded as anything other than “Chinese” or “White” were excluded from analysis. Patients with ethnicity data missing were also excluded. Patients aged &gt;= 75 years at the start of RRT were excluded because of the high prevalence of comorbidity which decreases the likelihood of transplantation and the very small proportion of patients receiving a kidney transplant in the UK in this age group. Socioeconomic status (SES) was measured using country-specific Index of Multiple Deprivation (IMD) quintiles derived from patient postcodes (1= most deprived, 5= least deprived). The independent variable of interest was Chinese ethnicity (Chinese vs White). Multivariable logistic regression models were used to investigate the relationship between Chinese ethnicity and being listed on the deceased donor transplant waiting list i) at start of RRT ii) 2 years after start of RRT iii) pre-emptive kidney transplantation, iv) kidney transplantation at 3 years after start of RRT, and v) living-donor kidney transplantation. The models were run unadjusted and then adjusted for the confounders, specified a priori, age, sex, primary renal disease and SES. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using robust standard errors to account for clustering by renal centre. Results The dataset comprised of 92,857 incident RRT patients. 0.5% (n=501) were of Chinese ethnicity, 76% (n=70,575) were White. The findings of the multivariable logistic regression analyses are presented in Table 1. Even after adjustment for potential confounders UK Chinese patients had lower odds of being waitlisted at the start of RRT (OR 0.71, [95% CI 0.54-0.94]) but were more likely to be waitlisted at 2 years (OR 1.28, [95% CI 1.02-1.61]) compared to White patients. UK Chinese individuals were also less likely to receive a pre-emptive kidney transplant (OR 0.47, [95% CI 0.29-0.78]), less likely to be transplanted within 3 years of starting RRT (OR 0.69, [95% CI 0.52-0.92]) or have a living-donor kidney transplant(LDKT) (OR 0.39, [95% CI 0.26-0.59]) compared to White patients. Conclusion This is the first study that has shown that UK Chinese renal patients are less likely to have the opportunity to receive a living or deceased kidney transplant. Future research needs to test whether later presentation or more rapid progression of renal disease could explain these observations. The higher odds of transplant listing at 2 years suggests fitness for transplantation is not a significant barrier. The reasons why this ethnic group are less likely to receive a LDKT is also not well understood. Understanding whether these disparities reflect modifiable policy, health system or donor/recipient level barriers will help ensure equitable access to transplantation.

scholarly journals Living Kidney Donors Who Develop Kidney Failure: Excerpts of Their Thoughts

2016 ◽  
Vol 43 (6) ◽  
pp. 389-396 ◽  
Author(s):  
Colin M.E. Halverson ◽  
Jackie Y. Wang ◽  
Michael Poulson ◽  
Jennifer Karlin ◽  
Megan Crowley-Matoka ◽  
...  
Keyword(s):  
Decision Making ◽  
Living Donor ◽  
Qualitative Interviews ◽  
Kidney Donors ◽  
Living Kidney Donors ◽  
Physical Support ◽  
Stage Renal Disease ◽  
End Stage

Background: Psychosocial data about living kidney donors have been collected for almost 5 decades now. To date, however, no study has provided any psychosocial follow-up of donors who developed a serious health problem such as end-stage renal disease (ESRD). Methods: Donors who developed ESRD were invited to participate in a qualitative interview if they met one or both of the inclusion criteria: (1) developed ESRD within 10 years of donating and/or (2) lacked health insurance at the time of donation. We contacted 38 individuals who met these criteria, and 22 participated (58%). Two were subsequently excluded from analysis. Results: Twenty qualitative interviews were analyzed. Five findings are described: (1) donors describe the decision-making process as spontaneous and fast; (2) donors describe lack of appreciation for the need for post-donation self-care; (3) donors do not regret donating despite the adverse outcome; (4) donors advise future donors to have in place emotional and physical support post donation; and (5) donors appreciate the opportunity to tell their story from being a living donor to living with ESRD, which virtually all perceive as 2 separate unrelated events. Conclusions: Most donors are positive about their donation decision and experience and would donate again, despite developing ESRD themselves. They propose some important changes to the decision-making and informed-consent processes. Our data are reassuring regarding lack of donor regret, but highlight the need for living donor transplant programs to ensure that living donors understand their long-term risks and receive appropriate life-long follow-up care to minimize these risks.

HIV transmission through living donor kidney transplant – an 11‐year follow up on the recipient and donor

2021 ◽  
Author(s):  
Marcus R. Pereira ◽  
Geoffrey K. Dube ◽  
Luis Tatem ◽  
Daniel Burack ◽  
Russell J. Crew ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Living Donor ◽  
Hiv Transmission ◽  
Donor Kidney ◽  
Living Donor Kidney Transplant ◽  
Living Donor Kidney

scholarly journals The ERA-EDTA Registry Annual Report 2018: a summary

2020 ◽  
Author(s):  
Anneke Kramer ◽  
Rianne Boenink ◽  
Vianda S Stel ◽  
Carmen Santiuste de Pablos ◽  
Filip Tomović ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Kidney Failure ◽  
Survival Probability ◽  
Living Donor ◽  
Annual Report ◽  
Deceased Donor ◽  
Aggregated Data ◽  
Kidney Replacement Therapy

Abstract Background The ERA-EDTA Registry collects data on kidney replacement therapy (KRT) via national and regional renal registries in Europe and countries bordering the Mediterranean Sea. This article summarizes the 2018 ERA-EDTA Registry Annual Report, and describes the epidemiology of KRT for kidney failure in 34 countries. Methods Individual patient data on patients undergoing KRT in 2018 was provided by 34 national or regional renal registries and aggregated data by 17 registries. The incidence and prevalence of KRT, the kidney transplantation activity and the survival probabilities of these patients were calculated. Results In 2018, the ERA-EDTA Registry covered a general population of 636 million people. Overall, the incidence of KRT for kidney failure was 129 per million population (pmp), 62% of patients were men, 51% were ≥65 years of age and 20% had diabetes mellitus as cause of kidney failure. Treatment modality at the onset of KRT was haemodialysis for 84%, peritoneal dialysis for 11% and pre-emptive kidney transplantation for 5% of patients. On 31 December 2018, the prevalence of KRT was 897 pmp, with 57% of patients on haemodialysis, 5% on peritoneal dialysis, and 38% living with a kidney transplant. The transplant rate in 2018 was 35 pmp: 68% received a kidney from a deceased donor, 30% from a living donor, and for 2% the donor source was unknown. For patients commencing dialysis during 2009-2013, the unadjusted 5-year survival probability was 42.6%. For patients receiving a kidney transplant within this period the unadjusted 5-year survival probability was 86.6% for recipients of deceased donor grafts, and 93.9% for recipients of living donor grafts.

scholarly journals Prognostic value of fractional flow reserve using computed tomography for predicting major adverse cardiac events and mortality in kidney transplant candidates

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
J N D Dahl ◽  
M B N Nielsen ◽  
M B Bottcher ◽  
H B Birn ◽  
P I Ivarsen ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Fractional Flow Reserve ◽  
Fractional Flow ◽  
Prognostic Information ◽  
Coronary Cta ◽  
Flow Reserve ◽  
Transplant Candidates

Abstract Background Coronary artery disease (CAD) is highly prevalent in patients with severe chronic kidney disease (CKD), it is the leading cause of mortality and morbidity in the short and long term among kidney transplant candidates, and the prevalence of CAD is high even after kidney transplantation. Most institutions recommend non-invasive cardiac tests prior to transplantation. Previous studies have indicated that cardiac screening by coronary computed tomography angiography (CTA) in kidney transplant candidates before transplantation yields both diagnostic and prognostic information. Additional analysis by CT-derived fractional flow reserve (FFRct) may improve diagnostic performance and have prognostic information. Purpose To establish the occurrence of major adverse cardiac events (MACE) and all-cause mortality in kidney transplantation candidates undergoing cardiac screening with coronary CTA with additional FFRct. Methods Coronary CTA scans from 340 consecutive kidney transplant candidates (CKD stage 4–5) undergoing cardiac evaluation with coronary CTA as part of the diagnostic work-up, between February 2011 and September 2019, were evaluated with subsequent FFRct analysis, the FFRct results were not clinically available. Patients were categorized into three groups based on distal FFRct; normal FFRct &gt;0.80, moderate FFRct 0.80 to &gt;0.75, low FFRct ≤0.75. Secondary analysis was performed using lesion specific (≥50% stenosis on coronary CTA) FFRct values, with normal FFRct &gt;0.80 and abnormal ≤0.80. The primary end-point was MACE (cardiac death, cardiac arrest, myocardial infarction or revascularization unrelated to baseline work-up). The secondary end-point was all-cause mortality. End-point and baseline data were identified through patient files and registry data. Results Patients had a median age of 53 [45–63], 63% were men, 31% were on dialysis, the median follow-up time was 3.3 years [2.0–5.1]. During follow-up, MACE occurred in 28 patients (8.2%) and 28 patients (8.2%) died. When adjusting for risk factors and kidney transplantation during follow-up, the primary analysis identified increased risk of MACE in patients with lower distal FFRct compared to patients with FFRct &gt;0.80; FFRct 0.80 to &gt;0.75; Hazard ratio (HR): 1.63 (95% CI: 0.48–5.58; p=0.44), and FFRct with FFRct ≤0.75; HR: 3.27 (95% CI: 1.34–7.96; p&lt;0.01). In the secondary analysis based on lesion-specific FFRct values, a FFRct ≤0.80 was associated with a higher risk of MACE compared to FFRct &gt;0.80; HR 3.21 (95% CI 1.01–10.20, p&lt;0.05). There were no significant differences in mortality between groups. Conclusions In kidney transplant candidates, a low FFRct ≤0.75 was predictive of MACE but not mortality. A lesion-specific approach found similar results with increased risk of MACE in patients with lesion-specific FFRct ≤0.80. Thus, FFRct adds prognostic information to the cardiac evaluation of these patients with severe CKD. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): The Private Company, HeartFlow Inc, Redwood City, Califonia US- sponsored the fractional flow reserve using computed tomography scans, with no exchange of financial meansThe Public, Health Research Fund of the Central Denmark Region.- provided parts of the salary for two authors. FFRct distal values – MACE and Mortality FFRct lesion values – MACE and Mortality

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