P1798MYCOPHENOLIC ACID TROUGH CONCENTRATION AND DOSE ARE ASSOCIATED WITH HEMATOLOGIC ABNORMALITIES BUT NOT REJECTION IN KIDNEY TRANSPLANT RECIPIENTS

Abstract Background and Aims Little is known regarding the safe fixed dose of mycophenolic acid (MPA) for preventing biopsy-proven acute rejection (BPAR) in kidney transplant recipients (KTRs). We investigated the correlation of MPA trough concentration (MPA C0) and dose with renal transplant outcomes and adverse events. Method This study included 79 consecutive KTRs who received MPA with tacrolimus (TAC) and corticosteroids. The MPA C0 of all the enrolled KTRs was measured, which was determined monthly by using particle-enhanced turbidimetric inhibition immunoassay for 12 months, and clinical data were collected at each time point. The clinical endpoints included BPAR, any cytopenia, and BK or cytomegalovirus infections. Results No differences in MPA C0 and dose were observed between KTRs with or without BPAR or viral infections under statistically comparable TAC concentrations. MPA C0 was significantly higher in patients with leukopenia (P = 0.021) and anemia (P = 0.002) compared with those without cytopenia. The MPA dose was significantly higher in patients with thrombocytopenia (P = 0.002) compared with those without thrombocytopenia. MPA C0 ≥ 3.5 µg/mL was an independent risk factor for leukopenia (adjusted odds ratio [AOR] 3.80, 95% confidence interval [CI] 1.24–11.64, P = 0.019) and anemia (AOR 5.90, 95% CI 1.27–27.51, P = 0.024). An MPA dose greater than the mean value of 1188.8 mg/day was an independent risk factor for thrombocytopenia (AOR 3.83, 95% CI 1.15–12.78, P = 0.029). However, an MPA dose less than the mean value of 1137.3 mg/day did not increase the risk of BPAR. Conclusion Either a higher MPA C0 or dose was associated with an increased risk of cytopenia, but neither a lower MPA C0 nor dose was associated with BPAR within the first year of transplantation. Hence, a reduced MPA dose with TAC and corticosteroids might be safe in terms of reducing hematologic abnormalities without causing rejection.

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Glomerular C3 Deposition Is an Independent Risk Factor for Allograft Failure in Kidney Transplant Recipients With Transplant Glomerulopathy

Kidney International Reports ◽

10.1016/j.ekir.2019.01.018 ◽

2019 ◽

Vol 4 (4) ◽

pp. 582-593 ◽

Cited By ~ 3

Author(s):

Sarah E. Panzer ◽

Emily Joachim ◽

Sandesh Parajuli ◽

Weixiong Zhong ◽

Brad C. Astor ◽

...

Keyword(s):

Risk Factor ◽

Kidney Transplant ◽

Independent Risk Factor ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Allograft Failure ◽

Transplant Glomerulopathy

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Is delayed graft function associated with ureteral stenosis in the kidney transplant recipient? A case-control study

Canadian Urological Association Journal ◽

10.5489/cuaj.5794 ◽

2019 ◽

Vol 13 (11) ◽

Cited By ~ 1

Author(s):

Axel Cayetano-Alcaraz ◽

Juan Sebastian Rodriguez-Alvarez ◽

Mario Vilatobá-Chapa ◽

Josefina Alberú-Gómez ◽

Bernardo Gabilondo-Pliego ◽

...

Keyword(s):

Risk Factor ◽

Kidney Transplant ◽

Kidney Transplant Recipient ◽

Graft Function ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Transplant Patients ◽

Increased Risk ◽

Kidney Transplant Patients ◽

Control Study

Introduction: Ureteral stricture (US) in the kidney transplant recipient is a rare complication that can lead to morbidity and graft loss. Risk factor recognition is crucial in the prevention and management of this entity. Delayed graft function (DGF), as defined by the need for dialysis in the first week after transplantation, has been proposed as a risk factor in previous studies. Our objective is to determine the impact of DGF in US development in kidney transplant patients. Methods: We designed a matched case-control study. US cases in kidney transplant recipients were identified in the 2008–2017 period. We defined US as the rise in serum creatinine associated with findings suggesting obstruction in ultrasound, scintigraphy, or retrograde pyelogram; any other cause of graft dysfunction was excluded. Controls were defined as kidney transplant recipients from the same population and period without US, matched in a 1:2 fashion by age, sex, and donor type. Results: From 532 kidney transplant patients, 31 cases and 62 controls were included. Cumulative US incidence was 58 per 1000 cases. When calculating for odds ratio (OR), post-operative urinoma (OR 3.2; 95% confidence interval [CI] 2.36–4.37) and ureteral duplication (OR 3.29; 95% CI 2.40–4.51) were associated with an increased risk for US, while DGF was not found to be statistically significant as a risk factor (OR 3.3; 95% CI 0.96–11.52). No statistically significant differences were found between groups in other pre- and post-transplant-related factors. Conclusions: DGF was not associated with US in our cohort; however, ureteral duplication and postoperative urinoma were associated with an increased risk of graft ureteral stenosis development.

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SP717Sclerostin Is an Independent Risk Factor for All-cause Mortality in Older Kidney Transplant Recipients and Graft Loss in Younger Kidney Transplant Recipients

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfz103.sp717 ◽

2019 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Shufei Zeng ◽

Torsten Slowinski ◽

Wolfgang Pommer ◽

Ahamed Hasan A. ◽

Mohamed Gaballa M.s. ◽

...

Keyword(s):

Risk Factor ◽

Kidney Transplant ◽

Independent Risk Factor ◽

Graft Loss ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

All Cause Mortality

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Sclerostin is an independent risk factor for all-cause mortality in kidney transplant recipients

Clinical and Experimental Nephrology ◽

10.1007/s10157-020-01956-y ◽

2020 ◽

Vol 24 (12) ◽

pp. 1177-1183

Author(s):

Shufei Zeng ◽

Torsten Slowinski ◽

Wolfgang Pommer ◽

Ahmed A. Hasan ◽

Mohamed M. S. Gaballa ◽

...

Keyword(s):

Risk Factor ◽

Renal Transplant ◽

Kidney Transplant ◽

Independent Risk Factor ◽

Cox Regression ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Kaplan Meier ◽

All Cause Mortality

Abstract Background Sclerostin is a hormone contributing to the bone-vascular wall cross talk and has been implicated in cardiovascular events and mortality in patients with chronic kidney disease (CKD). We analyzed the relationship between sclerostin and mortality in renal transplant recipients. Methods 600 stable renal transplant recipients (367men, 233 women) were followed for all-cause mortality for 3 years. Blood and urine samples for analysis and clinical data were collected at study entry. We performed Kaplan–Meier survival analysis and Cox regression models considering confounding factors such as age, eGFR, cold ischemia time, HbA1c, phosphate, calcium, and albumin. Optimal cut-off values for the Cox regression model were calculated based on ROC analysis. Results Sixty-five patients died during the observation period. Nonsurvivors (n = 65; sclerostin 57.31 ± 30.28 pmol/L) had higher plasma sclerostin levels than survivors (n = 535; sclerostin 47.52 ± 24.87 pmol/L) (p = 0.0036). Kaplan–Meier curve showed that baseline plasma sclerostin concentrations were associated with all-cause mortality in stable kidney transplant recipients (p = 0.0085, log-rank test). After multiple Cox regression analysis, plasma levels of sclerostin remained an independent predictor of all-cause mortality (hazard ratio, 1.011; 95% CI 1.002–1.020; p = 0.0137). Conclusions Baseline plasma sclerostin is an independent risk factor for all-cause mortality in patients after kidney transplantation.

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