P1661EVOLUTION OF RENAL FUNCTION IN RENAL TRANSPLANTED DONORS PATIENTS IN ASYSTOLE TYPE II. IS THERE A CORRELATION BETWEEN HISTOPATHOLOGY PARAMETERS OF THE DONOR BIOPSY AND THE GRAFT SURVIVAL? EXPERIENCE IN OUR CENTER

Abstract Background and Aims With the aim of increasing the number of kidney transplant donors (RT), the use of organs from cadaver donors in asystole (DA) type II of Maastricht has been enhanced in recent years.The important ischemia that this type of donation entails makes it especially complex, resulting in a higher incidence of delayed renal function and non-primary graft function, compared to the TR from donor in brain death.We present our experience with the Mastricht DA type II TR since the beginning of our program in 2013 Method 108 patients with type II performed between January 2010 and June 2019, median follow-up 30 months. Results : mean age of the donor 42 years, 65% blood group A, mean Cr at the first month of 3 mg/dl, at the 3rd month of 1.9 mg/dl and currently 1.6 mg/dl. Mean ange of the receptor 46 years, time on dialysis 30 months, 1st transplant all, except 1. PRAc pre TR was < 25%, initial immunosuppression with thymoglobulin, steroids, mycophenolate, and delayed introduction of tacrolimus. 10% never function; 73.5% delayed renal function. 7.2% acute rejection. Survivors of the 1st, 3rd and 5th year recipients are 98%, 98% and 86% respectively. In a innovative way, it has been registered the correlation between histopathology parameters of the donor biopsy and the graft survival. Conclusion RT with type II DA has more incidence of delayd renal function and non-primarygraft function, however results in survival and kidney function in our center are very acceptable, comparable to donors in brain death.

Download Full-text

MO941CLINICAL OUTCOMES IN KIDNEY RE-TRANSPLANTATION

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab110.0020 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Clara Pardinhas ◽

Rita Leal ◽

Francisco Caramelo ◽

Teofilo Yan ◽

Carolina Figueiredo ◽

...

Keyword(s):

Acute Rejection ◽

Kidney Transplant ◽

Graft Survival ◽

Graft Failure ◽

Graft Function ◽

Delayed Graft Function ◽

First Year ◽

Kidney Transplant Recipients ◽

Post Transplant

Abstract Background and Aims As kidney transplants are growing in absolute numbers, so are patients with failed allografts and thus potential candidates for re-transplantation. Re-transplantation is challenging due to immunological barriers, surgical difficulties and clinical complexities but it has been proven that successful second transplantation improves life expectancy over dialysis. It is important to evaluate re-transplantation outcomes since 20% of patients on the waiting list are waiting for a second graft. Our aim was to compare major clinical outcomes such as acute rejection, graft and patient survival, between patients receiving a first or a second kidney transplant. Method We performed a retrospective study, that included 1552 patients submitted to a first (N=1443, 93%) or a second kidney transplant (N=109, 7%), between January 2008 and December 2018. Patients with more than 2 grafts or multi-organ transplant were excluded. Demographic, clinical and histocompatibility characteristics of both groups were registered from our unit database and compared. Delayed graft function was defined has the need of dialysis in the first week post-transplant. All acute rejection episodes were biopsy proven, according to Banff 2017 criteria. Follow-up time was defined at 1st June 2020 for functioning grafts or at graft failure (including death with a functioning graft). Results Recipients of a second graft were significantly younger (43 ±12 vs 50 ± 13 years old, p<0.001) and there were significantly fewer expanded-criteria donors in the second transplant group (31.5% vs 57.5%, p<0.001). The waiting time for a second graft was longer (63±50 vs 48±29 months, p=0.011). HLA mismatch was similar for both groups but PRA was significantly higher for second KT patients (21.6±25% versus 3±9%; p<0.001). All patients submitted to a second KT had thymoglobulin as induction therapy compared to 16% of the first KT group (p<0.001). We found no difference in primary dysfunction or delayed graft function between groups. Acute rejection was significantly more frequent in second kidney transplant recipients (19% vs 5%, p<0.001), being 10 acute cellular rejections, 7 were antibody mediated and 3 were borderline changes. For the majority of the patients (85%), acute rejection occurred in the first-year post-transplant. Death censored graft failure occurred in 236 (16.4%) patients with first kidney transplant and 25 (23%) patients with a second graft, p=0.08. Survival analysis showed similar graft survival for both groups (log-rank p=0.392). We found no difference in patients’ mortality at follow up for both groups. Conclusion Although second graft patients presented more episodes of biopsy proven acute rejection, especially at the first-year post-transplant, we found no differences in death censored graft survival or patients’ mortality for patients with a second kidney transplant. Second transplants should be offered to patients whenever feasible.

Download Full-text

MO975INFLUENCE OF THE TYPE OF DIALYSIS ON SHORT-TERM KIDNEY TRANSPLANT RESULTS. EXPERIENCE OF OUR CENTER

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab110.0054 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Maria Lanau Martinez ◽

Marta Artamendi Larrañaga ◽

Celia Garijo Pacheco ◽

Iñigo Gaston Najarro ◽

Guillermo Pereda Bengoa ◽

...

Keyword(s):

Renal Function ◽

Kidney Transplantation ◽

Acute Rejection ◽

Graft Function ◽

Vascular Complications ◽

Group Versus ◽

Infectious Complications ◽

Delayed Graft Function ◽

Dialysis Technique

Abstract Background and Aims Kidney transplantation (KT) is considered to be the best option for renal replacement therapy (RRT) in patients with advanced chronic kidney disease, surpassing any dialysis technique in quality and life expectancy. However, results in terms of how pre-KT dialysis technique influences graft and recipient survival are mixed. Some studies show a higher incidence of vascular complications in the immediate post-transplant period and higher rates of acute rejection in patients coming from peritoneal dialysis (PD) versus those coming from hemodialysis (HD) while others observe a lower incidence of delayed graft function in the PD group of patients versus those on HD. Our objective is to analyze if there are differences in immediate post-kidney transplantation and at 6 months of follow-up depending on the pre-KT dialysis technique, PD versus HD. Method Observational study of all patients with KT of cadaveric donor from the beginning of the KT program in our Center, from August 2011 to August 2019. We analyzed the characteristics of donors and recipients according to the technique (PD/HD), the evolution and complications in the immediate post-KT, as well as results at 6 months of follow-up in terms of complications, renal function and survival of the recipient and the graft. For statistical analysis we used SPSS 25. We compared qualitative variables by means of Xi2 test, and quantitative variables by t of Student, or U of Mann-Whitney if the variables did not follow a normal distribution. A value of p <0.05 was considered significant. Results 121 patients were included, 71 of whom were in the HD group, versus 50 who were in the PD group. The recipients in the HD group were significantly older (57.2 vs 51.6 years, p 0,02) and stayed on dialysis longer (33.8 vs 26.8 months). We observed no difference in the recipient's cardiovascular history, except for increased smoking in the HD group (52.1% vs. 24%). The donor-recipient immune profile was similar in both groups. As for the incidence of delayed graft function, it was significantly lower in the PD group (14.9% vs 34.3%), finding no difference in renal function at hospital discharge or in days of admission. In the first 6 months of follow-up, we found no differences in terms of vascular, urological or infectious complications. There were also no differences in the incidence of acute rejection, renal function measured by creatinine (HD 1.47 vs DP 1.50 mg/dl) and proteinuria (HD 200 vs DP 216 mg/24 hours). Graft and recipient survival at 6 months of TR follow-up were similar in both groups. Conclusion In our experience, we have not found differences in the evolution at 6 months of the KT according to the modality of dialysis , nor greater incidence of vascular, immunological or other complications, with a survival of graft and receptor superimposable between both groups, PD or HD.

Download Full-text

MO970GRAFT OUTCOME AFTER ACUTE REJECTION: A CASE CONTROL STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab110.0049 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Safa Fattoum ◽

Mohamed Mongi Bacha ◽

Tasnim Mosbahhi ◽

Nesrine Braiek ◽

Ezzedine Abderrahim ◽

...

Keyword(s):

Acute Rejection ◽

Graft Survival ◽

Functional Recovery ◽

Graft Function ◽

Early Period ◽

Transplant Patients ◽

Graft Outcome ◽

Group A ◽

Group B ◽

Over Time

Abstract Background and Aims Although Acute rejection (AR) is a complication associated with the early period after kidney transplantation (KT), its complications are mostly seen after a long term. The aim of this study was to evaluate graft outcome after AR. Method It was a longitudinal, retrospective, analytical study including kidney transplant patients followed up in our department between 1986 and 2019. Our population was divided in 2 groups: group A (129 KT complicated by at least one episode of AR) and group B (491 KT not complicated by AR). Results AR was responsible of immediate loss of 2 grafts. Chronic graft dyfonction was more frequent in group A (44,1% versus 17,4%, p<0,0001). Creatininemia levels were significantly higher at 3, 6 months, 1 year and 2 years (respectively p =0,0113 ; <0,0001 ; 0,0003 and 0,0172) after KT. The percentage of patients having creatinine levels > 130 µmol/l was higher in group A at 3, 6 months, 1 year, 2 years, 3 years and 5 years (respectively p =0,0186 ; 0,001 ; <0,0001 ; 0,0115 ; 0,0073 and 0,0255). Graft survival was better in group B (p<0,0001). In group A, AR recurrence was responsible of a worser survival (p<0,0001). Over time, graft survival improved in the 2 groups. Complete functional recovery survival was similar to graft with no rejection but with impared graft function. The worst graft survival was noted if the functional recovery was absent. Conclusion Even if graft outcome after AR has improved over time, its deleterious effect is still inevitable. So AR must be prevented in order to enhance graft outcome.

Download Full-text

P1619OUTCOME OF HIGH DONOR-RECIPIENT AGE GAP IN LIVE-DONOR RENAL TRANSPLANTS IN TACROLIMUS ERA

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa143.p1619 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Hatem Kaies Ibrahim Elsayed Ali ◽

Ahmed Daoud ◽

Karim Soliman ◽

Mahmoud Mohamed ◽

Asam Murtaza

Keyword(s):

Renal Transplant ◽

Acute Rejection ◽

Graft Survival ◽

Age Difference ◽

Live Donor ◽

Renal Transplants ◽

Transplant Patients ◽

Age Gap ◽

Group A ◽

Recipient Age

Abstract Background and Aims High donor-recipient age gap among deceased-donor renal transplant patients leads to worse outcomes. However, the impact of this gap among live-donor renal transplants is unclear. The aim of this study is to assess the effect of this age gap on graft survival and acute rejection rates among renal transplants in tacrolimus era. Method 14390 live-donor renal transplant patients who received a single organ transplant, had no previous renal transplants, discharged on tacrolimus-based immunotherapy and were registered in the Organ Procurement Transplantation Network from January 2000 till June 2017 were included in the study. Donor–recipient age difference was divided into 5 groups; group A (difference <−10,n=4375), group B (difference from -10 to 10,n=7229), group C (difference between 10-20, n=861), group D ( difference between 20–29, n=1406) and group E (difference ≥30 years, n=519). Poisson regression analysis was used to assess effect of age gap on acute rejection rates. Kaplan-Meier survival curves and Cox hazard regression analysis were used to assess this effect on graft survival. Results Regarding graft survival, groups with age difference ≥30 years and between 20-29 years showed a significantly higher risk of graft loss when compared to group with age difference <−10 (HR equals 4.6 and 3.8 respectively). Groups with age difference between 10 to 20 years and between -10 to 10 years showed no significant difference in graft survival when compared to same group (HR equals 1.03 and 0.95 respectively). Groups B,C,D,E were not associated with increased risk of acute rejection episodes when compared to group A (IRR=1.001, 1.001, 1.022, 1.027 respectively). Conclusion Donor-recipient age difference up to 20 years has similar renal transplant outcomes to those receiving kidneys from younger donors and therefore, should not be precluded from paired kidney donation programs. The donor-recipient age difference above 20 years is associated with worse outcomes in terms of graft survival.

Download Full-text

Defining the Molecular Mechanisms Responsible for the ABO High Expresser Phenotype.

Blood ◽

10.1182/blood.v114.22.2119.2119 ◽

2009 ◽

Vol 114 (22) ◽

pp. 2119-2119

Author(s):

Diarmaid O Donghaile ◽

Vince P Jenkins ◽

Rachel McGrath ◽

Lisa Preston ◽

Roger JS Preston ◽

...

Keyword(s):

Blood Group ◽

Base Pair ◽

Antigen Expression ◽

Regulatory Elements ◽

Transferase Activity ◽

Type I ◽

Type Ii ◽

Blood Group A ◽

Group A ◽

Abo Genotype

Abstract Abstract 2119 Poster Board II-96 ABO(H) blood group antigen expression on platelets varies widely among normal blood donors. An ABO ‚High Expresser' phenotype (HXP) that exhibits significantly increased A and/or B antigen expression on platelets has been identified in ∼7% of normal donors. HXP has been implicated in both platelet-refractoriness and neonatal alloimmune thrombocytopenic purpura, however, the underlying molecular and genetic elements that mediate this phenomenon are not well-defined. To investigate the mechanisms underlying HXP, blood samples were collected from 231 group A (180 A1and 51 A2) and 310 group O individual apheresis platelet donors. Quantitative expression of platelet A and H antigen were then assessed by flow cytometry of platelet-rich plasma. In total, 10 A1 donors (5.6%) exhibited HXP. Analysis of the platelet A antigen expression in these individuals identified 8 HXP donors who exhibited ‚type I' HXP (normal bimodal population of platelets, but with predominant A antigen expression) whereas 2 individuals exhibited ‚type II' HXP (a single uniform population of platelets, strongly positive for blood group A expression). Both types of HXP were found to be a stable donor characteristic. ABO(H) determinants have also been identified on the N-linked glycans of the plasma von Willebrand factor (VWF), and influence plasma VWF levels and susceptibility to proteolysis by ADAMTS13. To determine whether HXP was platelet-specific, blood group A antigen expression on plasma VWF from group A donors was determined. Interestingly, blood group A antigen expression on plasma VWF was concordantly increased in donors with type I and type II HXP, indicative of increased glycosyltransferase expression in HXP individuals. To ascertain whether increased glycosyltransferase expression contributes to HXP, ABO genotype was determined for all 231 group A donors by PCR-RFLP analysis. Genotype at the ABO locus on 9q34 exerts a dosage effect on glycosyltransferase expression. 80% HXP (all type I) donors were genotyped A1A1. suggesting increased A transferase activity contributes to type I HXP. Despite this, the majority of A1A1individuals (67%) did not exhibit HXP, and 2 HXP donors were found to possess the A2 allele, which expresses limited A transferase enzymatic activity. Collectively, this data clearly demonstrates the contribution of additional factors to ABO genotype that contribute to HXP. To identify additional HXP modifiers, potential enhancer repeat elements upstream of the ABO gene were examined in group A donors, including those with HXP. Typically, A1alleles contain a single 43-base pair repeat within a minisatellite positive regulatory region upstream of the ABO gene. In contrast, A2and O1alleles contain four 43bp repeats, which are associated with a 100-fold enhancement of transcriptional activity. Analysis of this enhancer region demonstrated two HXP donors with A1alleles containing four copies of the 43-base pair repeat. Consequently, this allele would be predicted to modulate A transferase expression via enhanced ABO gene transcription. In conclusion, we have demonstrated the multi-factorial nature of the regulatory elements mediating platelet type I and type II HXP. A1alleles containing novel upstream enhancer repeats identified in donor individuals may represent a novel genetic mediator of HXP, and contribute to the pathophysiology associated with this phenomenon independently of ABO genotype. Disclosures: No relevant conflicts of interest to declare.

Download Full-text

DELAYED GRAFT FUNCTION PREDICTS LONG-TERM KIDNEY GRAFT SURVIVAL INDEPENDENT OF EARLY ACUTE REJECTION OF DISCHARGE CREATININE

Transplantation Journal ◽

10.1097/00007890-199806270-00372 ◽

1998 ◽

Vol 65 (12) ◽

pp. S91

Author(s):

D. Shoskes ◽

M. Cecka

Keyword(s):

Acute Rejection ◽

Graft Survival ◽

Graft Function ◽

Delayed Graft Function ◽

Kidney Graft

Download Full-text

Increased Immunogenicity and Cause of Graft Loss of Old Donor Kidneys

Journal of the American Society of Nephrology ◽

10.1681/asn.v1271538 ◽

2001 ◽

Vol 12 (7) ◽

pp. 1538-1546

Author(s):

JOHAN W. DE FIJTER ◽

MARKO J. K. MALLAT ◽

ILIAS I. N. DOXIADIS ◽

JAN RINGERS ◽

FRITS R. ROSENDAAL ◽

...

Keyword(s):

Acute Rejection ◽

Graft Survival ◽

Negative Impact ◽

Graft Loss ◽

Graft Function ◽

Significant Risk ◽

Donor Age ◽

Independent Predictive Factor ◽

Long Term Outcome ◽

Old Donor

Abstract. Donor age was identified recently as a major factor that determines long-term outcome after transplantation, but the mechanism that is responsible for increased graft loss of old donor kidneys is unknown. The influence of donor age on graft survival was assessed retrospectively in 514 consecutive first cadaveric transplants that were treated with cyclosporine maintenance immunosuppression. Donor age ≥50 yr (relative risk [RR] = 1.7; 95% confidence interval [CI], 1.2 to 2.6), acute rejection (RR = 2.0; 95% CI, 1.3 to 3.0), and type of rejection (RR = 3.3; 95% CI, 2.0 to 5.3) had a significant impact on graft survival. However, when subsets of patients who entered subsequent intervals after transplantation were analyzed, donor age was not an independent predictive factor of graft loss. Donor age (RR = 1.53; 95% CI, 1.19 to 1.98), human leukocyte antigen-DR mismatch (RR = 2.28; 95% CI, 1.78 to 2.92), and recipient age (RR = 1.34; 95% CI, 1.05 to 1.72) were associated significantly with acute rejection episodes. Delayed graft function alone was not associated independently with the occurrence of early acute rejection (RR = 1.24; 95% CI, 0.96 to 1.61). The timing of the rejection episodes of old donor kidneys was not different, and the excess rejection prevalence was attributable entirely to interstitial (grade I) types of rejection. Interstitial rejection episodes in kidneys from old donors had a significant (P< 0.05) negative impact on graft survival. Beyond the first year, poor renal function and proteinuria were significant risk factors for graft loss, regardless of rejection. Our data fit best the hypothesis that increased graft loss of older donor kidneys results from an increased incidence of acute interstitial rejection episodes in the early posttransplantation months. It is proposed that kidneys from older donors are more immunogenic than kidneys from young donors and that acute rejection episodes result in functional deterioration. Contrary to interstitial rejection in kidneys from younger donors, kidneys from old donors seem to have an impaired ability to restore tissue.

Download Full-text

Acute Rejection Is a Strong Negative Predictor of Graft Survival in Living-Donor Pediatric Renal Transplant: 10-Year Follow-Up in a Single Mexican Center

Experimental and Clinical Transplantation ◽

10.6002/ect.2017.0265 ◽

2019 ◽

Vol 17 (2) ◽

pp. 170-176 ◽

Cited By ~ 1

Author(s):

Gustavo Martinez-Mier ◽

◽

Marco T. Mendez-Lopez ◽

Ernesto Soto-Miranda ◽

Pedro I. Moreno-Ley ◽

...

Keyword(s):

Renal Transplant ◽

Acute Rejection ◽

Graft Survival ◽

Living Donor ◽

Pediatric Renal Transplant ◽

Negative Predictor

Download Full-text

Late Acute Rejection Occuring in Liver Allograft Recipients

Canadian Journal of Gastroenterology ◽

10.1155/1996/543502 ◽

1996 ◽

Vol 10 (6) ◽

pp. 376-380 ◽

Cited By ~ 6

Author(s):

Eric M Yoshida ◽

Christopher R Shackleton ◽

Siegfried R Erb ◽

Charles H Scudamore ◽

Lynn M Mori Rn ◽

...

Keyword(s):

Acute Rejection ◽

Graft Function ◽

Post Transplantation ◽

Liver Allograft ◽

Prednisone Dose ◽

The Difference ◽

Group 2 ◽

Daily Prednisone

To study the effect of immunosuppressive reduction on the incidence and consequence of late acute rejection (LAR) in liver allograft recipients, mean daily prednisone dose, mean cyclosporine A (CsA) trough and nadir levels were retrospectively reviewed for the nearest 12-week period preceding six episodes of LAR in five liver allograft recipients (group 1). Results were compared with those from a cohort of 12 liver allograft recipients who did not develop LAR (group 2). LAR was defined as acute rejection occurring more than 365 days post-transplantation. Median follow-up for both groups was similar (504 days, range 367 to 1050, versus 511 days, range 365 to 666, not significant). Mean trough CsA levels were lower in patients with LAR compared with those without (224±66 ng/mL versus 233±49 ng/mL) but the difference was not statistically significant. In contrast, mean daily prednisone dose (2.5±1.6 mg/ day versus 6.5±2.9 mg/day, P=0.007) and CsA nadir values (129±60 ng/mL versus 186±40 ng/mL, P=0.03) were significantly lower in patients who developed LAR compared with those who did not. Five of six episodes (83%) of LAR occurred in patients receiving less than 5 mg/day of prednisone, versus a single LAR episode in only one of 12 patients (8%) receiving prednisone 5 mg/day or more (P=0.004). In all but one instance, LAR responded to pulse methylprednisolone without discernible affect on long term graft function. The authors conclude that liver allograft recipients remain vulnerable to acute rejection beyond the first post-transplant year; and reduction of immunosuppressive therapy, particularly prednisone, below a critical, albeit low dose, threshold increases the risk of LAR.

Download Full-text