scholarly journals P1643TORQUE TENO VIRUS FOR RISK STRATIFICATION OF SUBCLINICAL GRAFT REJECTION AFTER KIDNEY TRANSPLANTATION- A PROSPECTIVE STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Konstantin Doberer ◽  
Georg A Böhmig ◽  
Elisabeth Puchhammer-Stöckl ◽  
Gregor Bond
Keyword(s):  
Kidney Transplantation ◽  
Graft Rejection ◽  
Graft Function ◽  
Type I ◽  
Kidney Graft ◽  
Protocol Biopsy ◽  
Patients At Risk ◽  
Subclinical Rejection ◽  
High Level ◽  
A Prospective Study

Abstract Background and Aims Non-invasive monitoring strategies are insufficient to detect patients at risk for subclinical graft rejection after kidney transplantation. The highly prevalent and non-pathogenic Torque Teno virus (TTV) reflects the immunocompetence of its host: high level viraemia indicates strong and low level viraemia weak immunosuppression, respectively. Thus TTV replication might serve as a candidate for immunologic monitoring. Method To analyze the association between TTV and subclinical kidney graft rejection, an interim analysis of the prospective “TTV POET” cohort study (DRKS00012335) was performed including data available until 31/01/2019. All consecutive kidney graft recipients transplanted at the Medical University Vienna since 01/12/2016 (n=308) with a protocol biopsy 12 months after transplantation (n=47; median 12.4 months) and stable graft function were included. Biopsy results according to current BANFF classification were analyzed in the context of peripheral blood TTV levels quantified by PCR. Results Graft function was excellent (median eGFR MDRD: 57 ml/min/1.73m2, urinary PKR: 92 mg/g). Twenty recipients (43%) had subclinical rejection (borderline TCMR, n=16; ABMR, n=3; TCMR type I, n=1). TTV level quantified at the date of biopsy was lower in recipients with rejection compared to recipients without rejection. The risk for rejection increased by 11% with each log level decrease in TTV copies/ml (RR 0.89, 95% CI 0.85-0.93; p<0.001). Differences in TTV levels were evident not only at the date of biopsy, but already 6 weeks earlier. Patients with biopsies showing chronic leasons, suggesting ongoing allo-reactivity, had a longer period of time with TTV levels <1x106 copies/ml. Conclusion Our data suggests an association between TTV level and subclinical graft rejection at 12 months after kidney transplantation. Future clinical trials are necessary to test the potential of TTV guided immunosuppression to reduce subclinical rejection.

scholarly journals B-cell activating factor BAFF as a novel alert marker for the immunological risk stratification after kidney transplantation

2021 ◽  
Author(s):  
Antonia Margarete Schuster ◽  
N. Miesgang ◽  
L. Steines ◽  
C. Bach ◽  
B. Banas ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
B Cell ◽  
Graft Function ◽  
Risk Profile ◽  
Kidney Transplant Recipients ◽  
Post Transplantation ◽  
Antibody Mediated Rejection ◽  
B Cell Activating Factor ◽  
Medium Risk ◽  
Patients At Risk

AbstractThe B cell activating factor BAFF has gained importance in the context of kidney transplantation due to its role in B cell survival. Studies have shown that BAFF correlates with an increased incidence of antibody-mediated rejection and the development of donor-specific antibodies. In this study, we analyzed a defined cohort of kidney transplant recipients who were treated with standardized immunosuppressive regimens according to their immunological risk profile. The aim was to add BAFF as an awareness marker in the course after transplantation to consider patient’s individual immunological risk profile. Included patients were transplanted between 2016 and 2018. Baseline data, graft function, the occurrence of rejection episodes, signs of microvascular infiltration, and DSA kinetics were recorded over 3 years. BAFF levels were determined 14 d, 3 and 12 months post transplantation. Although no difference in graft function could be observed, medium-risk patients showed a clear dynamic in their BAFF levels with low levels shortly after transplantation and an increase in values of 123% over the course of 1 year. Patients with high BAFF values were more susceptible to rejection, especially antibody-mediated rejection and displayed intensified microvascular inflammation; the combination of high BAFF + DSA puts patients at risk. The changing BAFF kinetics of the medium risk group as well as the increased occurrence of rejections at high BAFF values enables BAFF to be seen as an awareness factor. To compensate the changing immunological risk, a switch from a weaker induction therapy to an intensified maintenance therapy is required.

scholarly journals Impact of Early Pancreatic Graft Loss on Outcome after Simultaneous Pancreas–Kidney Transplantation (SPKT)—A Landmark Analysis

2021 ◽  
Vol 10 (15) ◽  
pp. 3237
Author(s):  
Lukas Johannes Lehner ◽  
Robert Öllinger ◽  
Brigitta Globke ◽  
Marcel G. Naik ◽  
Klemens Budde ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Graft Survival ◽  
Graft Loss ◽  
Type I ◽  
Kidney Graft ◽  
Landmark Analysis ◽  
Pancreas Kidney Transplantation ◽  
Simultaneous Pancreas Kidney ◽  
Simultaneous Pancreas Kidney Transplantation ◽  
Pancreas Graft

(1) Background: Simultaneous pancreas–kidney transplantation (SPKT) is a standard therapeutic option for patients with diabetes mellitus type I and kidney failure. Early pancreas allograft failure is a complication potentially associated with worse outcomes. (2) Methods: We performed a landmark analysis to assess the impact of early pancreas graft loss within 3 months on mortality and kidney graft survival over 10 years. This retrospective single-center study included 114 adult patients who underwent an SPKT between 2005 and 2018. (3) Results: Pancreas graft survival rate was 85.1% at 3 months. The main causes of early pancreas graft loss were thrombosis (6.1%), necrosis (2.6%), and pancreatitis (2.6%). Early pancreas graft loss was not associated with reduced patient survival (p = 0.168) or major adverse cerebral or cardiovascular events over 10 years (p = 0.741) compared to patients with functioning pancreas, after 3 months. Moreover, kidney graft function (p = 0.494) and survival (p = 0.461) were not significantly influenced by early pancreas graft loss. (4) Conclusion: In this study, using the landmark analysis technique, early pancreas graft loss within 3 months did not significantly impact patient or kidney graft survival over 10 years.

LONG-TERM KIDNEY GRAFT FUNCTION AFTER COMBINED LIVER-KIDNEY TRANSPLANTATION

2008 ◽  
Vol 86 (Supplement) ◽  
pp. 696
Author(s):  
R Ruiz ◽  
B Fischbach ◽  
N Onaca ◽  
G McKenna ◽  
H Randall ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Graft Function ◽  
Kidney Graft

Influence of Donor Nephron Mass Index On Graft Function After Kidney Transplantation: A Prospective Study.

2014 ◽  
Vol 98 ◽  
pp. 588
Author(s):  
J. Liese ◽  
M. Wortmann ◽  
A. Schnitzbauer ◽  
G. Woeste ◽  
I. Hauser ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Prospective Study ◽  
Graft Function ◽  
A Prospective Study

scholarly journals Urinary Biomarkers α-GST and π-GST for Evaluation and Monitoring in Living and Deceased Donor Kidney Grafts

2019 ◽  
Vol 8 (11) ◽  
pp. 1899 ◽  
Author(s):  
Shadi Katou ◽  
Brigitta Globke ◽  
M. Haluk Morgul ◽  
Thomas Vogel ◽  
Benjamin Struecker ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Graft Function ◽  
Rejection Sensitivity ◽  
Deceased Donor ◽  
Urine Samples ◽  
Kidney Graft ◽  
Donor Kidney ◽  
Kidney Recipients ◽  
Deceased Donor Kidney ◽  
Brain Dead

The aim of this study was to analyze the value of urine α- and π-GST in monitoring and predicting kidney graft function following transplantation. In addition, urine samples from corresponding organ donors was analyzed and compared with graft function after organ donation from brain-dead and living donors. Urine samples from brain-dead (n = 30) and living related (n = 50) donors and their corresponding recipients were analyzed before and after kidney transplantation. Urine α- and π-GST values were measured. Kidney recipients were grouped into patients with acute graft rejection (AGR), calcineurin inhibitor toxicity (CNI), and delayed graft function (DGF), and compared to those with unimpaired graft function. Urinary π-GST revealed significant differences in deceased kidney donor recipients with episodes of AGR or DGF at day one after transplantation (p = 0.0023 and p = 0.036, respectively). High π-GST values at postoperative day 1 (cutoff: >21.4 ng/mg urine creatinine (uCrea) or >18.3 ng/mg uCrea for AGR or DGF, respectively) distinguished between rejection and no rejection (sensitivity, 100%; specificity, 66.6%) as well as between DGF and normal-functioning grafts (sensitivity, 100%; specificity, 62.6%). In living donor recipients, urine levels of α- and π-GST were about 10 times lower than in deceased donor recipients. In deceased donors with impaired graft function in corresponding recipients, urinary α- and π-GST were elevated. α-GST values >33.97 ng/mg uCrea were indicative of AGR with a sensitivity and specificity of 77.7% and 100%, respectively. In deceased donor kidney transplantation, evaluation of urinary α- and π-GST seems to predict different events that deteriorate graft function. To elucidate the potential advantages of such biomarkers, further analysis is warranted.

P1667ANALYSIS OF RISK FACTORS FOR CMV DISEASE IN KIDNEY TRANSPLANT PATIENTS - SINGLE CENTER STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Vladimir Hanzal ◽  
Janka Slatinska ◽  
Petra Hruba ◽  
Ondrej Viklicky
Keyword(s):  
Risk Factors ◽  
Kidney Transplantation ◽  
Multivariable Analysis ◽  
Graft Function ◽  
Kidney Graft ◽  
Cmv Infection ◽  
Post Transplantation ◽  
Increased Risk ◽  
Cmv Disease ◽  
Cmv Prophylaxis

Abstract Background and Aims Cytomegalovirus (CMV) disease and infection negatively influence outcome of kidney transplantation. The aim of this retrospective study was to analyze risk factors for CMV disease and its influence on kidney graft function and survival. Method 1050 patients underwent kidney transplantation from January 2014 to December 2018 and received calcineurin inhibitor, mycophenolate mofetil and steroid-based immunosuppression. Recipients with PRA>20% received rATG while others had received basiliximab as induction. 825 out of 1050 patients (78.6%) received CMV prophylaxis (D+/R-, n=173; R+, n=652). Patients were followed up to 71 months /median 38 months/. Results CMV tissue invasive disease occurred in 49 out of 1050 patients (4.7%), while CMV infection in 87 patients (8.3%). CMV disease, but not CMV infection, had significant negative influence on graft survival at 5 years post transplantation (p=0.0029). Patients with CMV disease had significantly worse graft function at 4 years post transplantation (p<0.0001). CMV disease occurred in 31 out of 173 patients (17.9%) in D+/R- group vs. 18 out of 652 patients (2.8%) in R+ group. Incidence of CMV infection was 30/173 patients (17.3%) in D+/R- group vs. 57/652 patients (8.7%) with induction therapy. Shortening of CMV prophylaxis was found in 82 patients (9.9%). Leukopenia (≤ 2.0 x 109/L) was observed in 97 (11.7%) patients from those who received CMV prophylaxis, Its shortening significantly increased risk for both CMV infection (20,7% vs. 7.2%, p<0,0001) and CMV disease (8,5% vs. 4,2%, p=0,04). Among most significant risk factors for CMV disease in univariable analysis were CMV mismatch (OR 11, 95% CI: 5,9-20,4; p<0,0001), delayed graft function (OR 2,8, 95% CI: 1,6-5,1; p<0,0001, cadaveric donor (OR 6, 95% CI: 1,5-25,1; p=0,00013) and shortening of CMV prophylaxis (OR 2.1, 95% CI: 0,91-4,86; p=0,08). Multivariable analysis revealed as independent significant predictors of CMV disease DGF (OR 2,29, 95% CI: 1,2-4,3; p=0,01) and CMV mismatch (OR 10,8, 95% CI: 5,7-20,6; p<0.0001) in a model adjusted for type of donor, prophylaxis shortening and leukopenia. Conclusion CMV mismatch is the main independent predictor of CMV disease after kidney transplantation in multivariable analysis.

Surgical and Medical Management of Tertiary Hyperparathyroidism

2010 ◽  
Vol 2 (3) ◽  
pp. 105-109 ◽  
Author(s):  
Yoshihiro Tominaga
Keyword(s):  
Clinical Trial ◽  
Kidney Transplantation ◽  
Cardiovascular Events ◽  
Graft Function ◽  
Controlled Clinical Trial ◽  
Kidney Graft ◽  
Common Complication ◽  
Surgical Indications ◽  
Tertiary Hyperparathyroidism ◽  
Persistent Hyperparathyroidism

ABSTRACT Persistent hyperparathyroidism (HPT) after successful kidney transplantation (RTx) (tertiary HPT; THPT) is a common complication in patients with RTx and may affect bone disease, deterioration of graft function and cardiovascular events. Parathyroidectomy (PTx) is the most successful treatment for resolving advanced HPT in patients with THPT. However, the surgical indications for THPT and timing of the operation are problematic because hypercalcemia can be resolved spontaneously. Subtotal and total PTx with autotransplantaion are widely accepted for THPT. The evidence to know which procedure is more appropriated could not be found. Recently the deterioration of kidney graft function after PTx for THPT has been reported and hypoparathyroidism after PTx may be avoided. Recently cinacalcet has been applied for patients with THPT and the medicine can dramaticaly control HPT and hypercalcemia. Possible risks of cinacalcet are hypocalcemia and increased calciuria and the approval for THPT remains highly controversial. A large number of prospective controlled clinical trial should be required.

scholarly journals Prevalence of Vitamin D Deficiency Among Patients After Kidney Transplantation in Latvia

2013 ◽  
Vol 67 (1) ◽  
pp. 35-41
Author(s):  
Ināra Ādamsone ◽  
Inese Folkmane ◽  
Diāna Amerika ◽  
Rafails Rozentāls
Keyword(s):  
Vitamin D ◽  
Kidney Transplantation ◽  
Vitamin D Deficiency ◽  
Graft Function ◽  
Inverse Correlation ◽  
Hypovitaminosis D ◽  
Vitamin D Insufficiency ◽  
Kidney Graft ◽  
Immunosuppressive Medications ◽  
Total Alkaline

Nutritional Vitamin D deficiency is an increasingly recognised condition in chronic kidney disease patients and in patients after kidney transplantation. The main goal of the present study was to estimate the prevalence of hypovitaminosis D in the cohort of kidney grafted patients in Latvia and to determine the relationships between vitamin D level and kidney graft function, time since transplantation, gender, use of particular immunosuppressive medications, and some biochemical parameters. We measured the 25(OH)D serum level in 165 patients. Mean age of patients was 49.7 years (range: 11-80). Median time after transplantation was 6.5 years (range 0.8-16.4 years). Mean 25(OH)D level for all cohort was 22.71 ± 7.06 ng/mL; only 30/165 (18%) of patients were vitamin D sufficient. 71/165 (43%) patients showed insufficient 25(OH)D level, 62/165 (38%) patients were mildly vitamin D deficient, and 2/165 (1%) were severely vitamin D deficient. Serum creatinine level was negatively correlated with 25(OH)D (r = -0.21; P < 0.01). We also observed an inverse correlation between iPTH and 25(OH) D (r = -0.35, P < 0.0001) and between total alkaline phosphatase and 25(OH) D (r = -0.20, P < 0.01). This study confirmed the almost universal prevalence of vitamin D insufficiency among kidney graft recipients and emphasized importance of regular evaluation and proper supplementation of Vitamin D in this population.

scholarly journals MO937ASSOCIATION OF RENAL ELASTOGRAPHY WITH BANFF MICROVASCULAR INFLAMMATION IN PROTOCOL BIOPSIES FOR SUBCLINICAL RENAL GRAFT REJECTION DIAGNOSIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Lucino Bahena Carrera ◽  
Javier Bastida Alquicira
Keyword(s):  
Graft Rejection ◽  
Kidney Graft ◽  
Non Invasive ◽  
Renal Graft ◽  
Protocol Biopsies ◽  
Subclinical Rejection ◽  
The Mean ◽  
Microvascular Inflammation ◽  
Renal Graft Rejection ◽  
Acute Graft

Abstract Background and Aims The most common cause of renal graft failure is chronic dysfunction in 24.7% and the most common etiology of this is clinical or subclinical rejection. The incidence of subclinical rejection varies from 15 to 50% (25% in protocol biopsies in the first year after transplantation and 35% after two years). Melek E et al have shown that doppler ultrasound is a non-invasive study that, through the resistance index (RI), has traditionally been used for the early diagnosis of acute graft rejection (AR); however, it is influenced by extrarenal systemic factors. Naesens et al published that in 321 kidney transplant recipients, RI wasn´t associated with histological findings of AR in protocol biopsies. Elastography is another ultrasonographic modality for the evaluation of the kidney graft, which measures the stiffness/elasticity of the tissue expressed in Kpa (kilopascals). Stock in 2011 and Kim BJ in 2018 published studies where they showed that increased stiffness was correlated with the diagnosis of kidney graft rejection. The aim of this study was to describe the association between elastography with microvascular inflammation determined by Banff for diagnosis of renal allograft subclinical rejection. Method Observational, analytical and cross-sectional study that included kidney transplant patients who underwent protocol biopsy and renal elastography at the Central Military Hospital in Mexico City between January 2018 and December 2020. The demographic and biochemical characteristics, degree elastography stiffness and Banff 2017 lesions were determined. The sample calculation, determination of correlation degree and ROC curve elaboration were performed. Results We included 146 patients. 56.8% were men; the most common causes of CKD were undetermined and chronic glomerulonephritis with 52.7% and 17.1% respectively. 47.3% were hypertensive at biopsy time and 1.4% had chronic heart failure. The most common immunosuppression schemes were FK/MPA/steroid and FK/mTOR-i/steroid with 60.3% and 13%, respectively. The mean GFR was 65.31 ml/min which shows graft good function. The mean stiffness in the elastography was 15.73 Kpa. The rest of baseline data are shown in Table 1. Had rejection 36.3% of the biopsies, the most frequent chronic AMR C4d- with 15.1% and active AMR C4d- 8.9%. When analyzing the ROC curves, the Banff 2017 lesions AUC values that correlated better with graft stiffness were: v=0.607, i=0.594, g=0.578, C4d deposit=0.519, ptc=0.498. Figure 1. Conclusion Intimal arteritis, inflammation, and glomerulitis are the Banff lesions best associated with elastography graft stiffness in protocol biopsies. Prospective studies are recommended in patients with acute graft dysfunction to find an adequate elastography cut-off value that allows another tool for fast and non-invasive diagnosis of renal graft rejection.

Increase in Proteinuria after Acute Kidney Graft Rejection Is Associated with Decreased Graft Function and Survival

2012 ◽  
Vol 94 (10S) ◽  
pp. 1028-1029
Author(s):  
M. Arnol ◽  
M. Oblak ◽  
G. Mlinšek ◽  
J. Buturovic Ponikvar ◽  
A. Kandus
Keyword(s):  
Graft Rejection ◽  
Graft Function ◽  
Kidney Graft
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