MO939RECURRENCE AND OUTCOME OF ANTI-GLOMERULAR BASEMENT MEMBRANE GLOMERULONEPHRITIS AFTER KIDNEY TRANSPLANTATION: A BELGIAN MULTICENTER STUDY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Sophie Coche ◽  
Ben Sprangers ◽  
Steven Van Laecke ◽  
Laurent Weekers ◽  
Vicky De Meyer ◽  
...  
Keyword(s):  
Basement Membrane ◽  
Graft Survival ◽  
Glomerular Basement Membrane ◽  
Kidney Biopsy ◽  
Graft Loss ◽  
Survival Rates ◽  
Kidney Graft ◽  
Clinical Recurrence ◽  
Patient And Graft Survival

Abstract Background and Aims Recurrence of anti-glomerular basement membrane (anti-GBM) glomerulonephritis in the kidney graft is a rare event, described in limited case reports and registry analysis. The aim of this study was to evaluate in a large cohort of patients with detailed data collection and long follow-up the risk of recurrence of anti-GBM disease and graft loss caused by recurrence, the risk factors associated with clinical recurrence and the long-term patient and graft survival. Method Multicenter retrospective study. Inclusion criteria: patients with anti-GBM glomerulonephritis transplanted with a kidney between 1977 and 2015. Exclusion criteria: systemic vasculitis (except ANCA), lupus erythematosus and cryoglobulinemia. Clinical recurrence was defined as reappearance of signs of glomerulonephritis along with histological signs of proliferative glomerulonephritis and linear IgG staining on kidney biopsy, with or without anti-GBM antibodies. Results Fifty-three patients were included. Clinical recurrence in a first kidney transplant occurred in only one patient five years after transplantation -a prevalence rate of 1.9%- in the context of cessation of immunosuppressive drugs. The graft was lost due to recurrence. Histological recurrence with linear IgG staining on kidney biopsy in the absence of histologic signs of proliferative glomerulonephritis was observed in four patients, in the context of cellular rejection. Two patients lost their kidney graft from severe acute rejection; the others fully recovered. Patient survival was 100%, 94% and 89% at 5, 10 and 15 years, respectively. Overall, death-censored first graft survival rates were 88%, 83% and 79% at 5, 10 and 15 years, respectively. Conclusion Recurrence rate of anti-GBM glomerulonephritis after transplantation is very low, and associated with graft loss. The long-term patient and graft survival rates are excellent.

scholarly journals A functional TGFB1 polymorphism in the donor associates with long-term graft survival after kidney transplantation.

2021 ◽  
Author(s):  
Felix Poppelaars ◽  
Mariana Gaya da Costa ◽  
Bernardo Faria ◽  
Siawosh K. Eskandari ◽  
Jeffrey Damman ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Graft Survival ◽  
Graft Loss ◽  
Kidney Graft ◽  
Genotype Group ◽  
Transplant Survival ◽  
Increased Risk ◽  
The Impact

Introduction Improvement of long-term outcomes in kidney transplantation remains one of the most pressing challenges, yet drug development is stagnating. Human genetics offers an opportunity for much-needed target validation in transplantation. Conflicting data exists about the effect of transforming growth factor beta 1 (TGF-beta1) on kidney transplant survival, since TGF-beta1 has profibrotic and protective effects. We therefore the impact of a recently discovered functional TGBF1 polymorphism on long term kidney graft survival. Methods We performed an observational cohort study analyzing recipient and donor DNA in 1,271-kidney transplant pairs from the University Medical Center Groningen in The Netherlands and associated a low-producing TGBF1 polymorphism (rs1800472 C>T) with 5, 10, and 15-year death-censored kidney graft survival. Results Donor genotype frequencies of s1800472 in TGBF1 differed significantly between patients with and without graft loss (P=0.042). Additionally, the low-producing TGBF1 polymorphism in the donor was associated with an increased risk of graft loss following kidney transplantation (HR 2.13 for the T allele; 95%-CI 1.16-3.90; P=0.015). The incidence of graft loss within 15 years of follow-up was 16.4% in the CC-genotype group and 28.9% in the CT-genotype group. After adjustment for transplant-related covariates, the association between the TGBF1 polymorphism in the donor and graft loss remained significant. In contrast, there was no association between the TGBF1 polymorphism in the recipient and graft loss. Conclusion Kidney allografts possessing a low-producing TGBF1 polymorphism have a higher risk of late graft loss. Our study adds to a growing body of evidence that TGFbeta1 is beneficial, rather than harmful, for kidney transplant survival.

scholarly journals Transplantation outcomes in patients with primary hyperoxaluria: a systematic review

2021 ◽  
Author(s):  
Elisabeth L. Metry ◽  
Liza M. M. van Dijk ◽  
Hessel Peters-Sengers ◽  
Michiel J.S. Oosterveld ◽  
Jaap W. Groothoff ◽  
...  
Keyword(s):  
Graft Survival ◽  
Data Extraction ◽  
Meta Analysis ◽  
Survival Rates ◽  
Primary Hyperoxaluria ◽  
Kidney Graft ◽  
High Quality ◽  
Liver Transplantations ◽  
Using Data ◽  
Patient And Graft Survival

Abstract Background Primary hyperoxaluria type 1 (PH1) is characterized by hepatic overproduction of oxalate and often results in kidney failure. Liver-kidney transplantation is recommended, either combined (CLKT) or sequentially performed (SLKT). The merits of SLKT and the place of an isolated kidney transplant (KT) in selected patients are unsettled. We systematically reviewed the literature focusing on patient and graft survival rates in relation to the chosen transplant strategy. Methods We searched MEDLINE and Embase using a broad search string, consisting of the terms ‘transplantation’ and ‘hyperoxaluria’. Studies reporting on at least four transplanted patients were selected for quality assessment and data extraction. Results We found 51 observational studies from 1975 to 2020, covering 756 CLKT, 405 KT and 89 SLKT, and 51 pre-emptive liver transplantations (PLT). Meta-analysis was impossible due to reported survival probabilities with varying follow-up. Two individual high-quality studies showed an evident kidney graft survival advantage for CLKT versus KT (87% vs. 14% at 15 years, p<0.05) with adjusted HR for graft failure of 0.14 (95% confidence interval: 0.05–0.41), while patient survival was similar. Three other high-quality studies reported 5-year kidney graft survival rates of 48–89% for CLKT and 14–45% for KT. PLT and SLKT yielded 1-year patient and graft survival rates up to 100% in small cohorts. Conclusions Our study suggests that CLKT leads to superior kidney graft survival compared to KT. However, evidence for merits of SLKT or for KT in pyridoxine-responsive patients was scarce, which warrants further studies, ideally using data from a large international registry.

scholarly journals Recipient-Specific Risk Factors Impairing Patient and Graft Outcome after Pediatric Liver Transplantation—Analysis of 858 Transplantations in 38 Years

Children ◽  
2021 ◽  
Vol 8 (8) ◽  
pp. 641
Author(s):  
Christoph Leiskau ◽  
Norman Junge ◽  
Eva-Doreen Pfister ◽  
Imeke Goldschmidt ◽  
Frauke Mutschler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Graft Survival ◽  
Graft Loss ◽  
Single Center ◽  
Vein Thrombosis ◽  
Pediatric Liver ◽  
High Urgency ◽  
Patient And Graft Survival

(1) Background and Aim: Despite excellent long-term results in pediatric liver transplantation (pLTx), mortality and graft loss still are to be diminished. We aim to describe time-dependent changes and long-term outcome of a large single-center pLTx cohort and to identify independent recipient-related risk factors impairing patient and graft survival. (2) Methods: This is a retrospective single-center study analyzing all pediatric liver transplants from 1983–2020. Risk factors for mortality and graft loss were identified by univariable and multi-linear regression analysis. (3) Results: We analyzed 858 liver transplantations in 705 pediatric patients. Five-year patient/graft survival increased from 60.9%/48.0% (1983–1992) to 97.5%/86.5% (OR = 12.5; p < 0.0001/OR = 6.5; p < 0.0001) (2014–2020). Indications changed significantly over time, with a higher proportion of patients being transplanted for malignancies and metabolic disease and indications of PFIC and α1AT-deficiency declining. The era of transplantation (log7.378/9.657; p < 0.0001) and indication of acute liver failure (log = 1.944/2.667; HR = 2.015/1.772; p = 0.0114/0.002) impairs patient/graft survival significantly in the multivariate analysis. Furthermore, patient survival is worsened by re-transplantation (log = 1.755; HR = 1.744; p = 0.0176) and prolonged waiting times in high-urgency status (log = 2.588; HR = 1.073; p = 0.0026), whereas the indication of biliary atresia improved outcome (log = 1.502; HR = 0.575; p = 0.0315). Graft survival was additionally impaired by pre-existing portal vein thrombosis (log = 1.482; HR = 2.016; p = 0.0330). (4) Conclusions: Despite more complex indications, patient and graft survival after pLTx continue to improve.. Acute liver failure remains the indication with poorest outcome, and listing for high urgency liver transplantation should be considered carefully and early to keep waiting time on HU list short. Furthermore, pre-transplant portal vein thrombosis should be prevented whenever possible to improve graft survival.

scholarly journals C4d Deposition in Acute Rejection: An Independent Long-Term Prognostic Factor

2002 ◽  
Vol 13 (1) ◽  
pp. 234-241
Author(s):  
Andrew M. Herzenberg ◽  
John S. Gill ◽  
Ognjenka Djurdjev ◽  
Alex B. Magil
Keyword(s):  
Acute Rejection ◽  
Graft Survival ◽  
Graft Loss ◽  
Survival Rates ◽  
Type I ◽  
Type Ii ◽  
Ischemic Time ◽  
Vascular Rejection ◽  
Cold Ischemic Time

ABSTRACT. Peritubular capillary deposition of C4d has been demonstrated to be associated with both acute humoral and vascular rejection and increased graft loss. Whether it is an independent predictor of long-term graft survival rates is uncertain. The biopsies (n = 126) from all patients (n = 93) with a tissue diagnosis of acute rejection that were performed between July 1, 1995, and December 31, 1997, were classified according to Cooperative Clinical Trials in Transplantation (CCTT) criteria. Fresh frozen tissue was immunostained for C4d. There were 58 patients with CCTT type I (interstitial) rejection and 35 with CCTT type II (vascular) rejection. For 34 patients, at least one biopsy exhibited peritubular C4d deposition (C4d+ group). The C4d+ group had proportionately more female patients (P = 0.003), more patients with high (>30%) panel-reactive antibody levels (P = 0.024), more patients with resistance to conventional antirejection therapy (P = 0.010), and fewer patients with postrejection hypertension (P = 0.021) and exhibited a greater rate of graft loss (38 versus 7%, P = 0.001). Peritubular C4d deposition was associated with significantly lower graft survival rates in the CCTT type I rejection group (P = 0.003) and the CCTT type II rejection group (P = 0.003). Multivariate analyses demonstrated that peritubular C4d deposition (P = 0.0002), donor age (P = 0.0002), cold ischemic time (P = 0.0211), and HLA matches (P = 0.0460) were significant independent determinants of graft survival rates. Peritubular C4d deposition is a significant predictor of graft survival rates and is independent of histologic rejection type and a variety of clinical prognostic factors.

scholarly journals LATE ACUTE REJECTION IN LIVER TRANSPLANT: A SYSTEMATIC REVIEW

2015 ◽  
Vol 28 (3) ◽  
pp. 212-215 ◽  
Author(s):  
Lucas Souto NACIF ◽  
Rafael Soares PINHEIRO ◽  
Rafael Antônio de Arruda PÉCORA ◽  
Liliana DUCATTI ◽  
Vinicius ROCHA-SANTOS ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Acute Rejection ◽  
Liver Transplant ◽  
Graft Survival ◽  
Graft Loss ◽  
Survival Rates ◽  
Clinical Manifestations ◽  
Adequate Treatment ◽  
Pubmed Database ◽  
Patient And Graft Survival

Introduction: Late acute rejection leads to worse patient and graft survival after liver transplantation. Aim: To analyze the reported results published in recent years by leading transplant centers in evaluating late acute rejection and update the clinical manifestations, diagnosis and treatment of liver transplantation. Method: Systematic literature review through Medline-PubMed database with headings related to late acute rejection in articles published until November 2013 was done. Were analyzed demographics, immunosuppression, rejection, infection and graft and patient survival rates. Results: Late acute rejection in liver transplantation showed poor results mainly regarding patient and graft survival. Almost all of these cohort studies were retrospective and descriptive. The incidence of late acute rejection varied from 7-40% in these studies. Late acute rejection was one cause for graft loss and resulted in different outcomes with worse patient and graft survival after liver transplant. Late acute rejection has been variably defined and may be a cause of chronic rejection with worse prognosis. Late acute rejection occurs during a period in which the goal is to maintain lower immunosuppression after liver transplantation. Conclusion: The current articles show the importance of late acute rejection. The real benefit is based on early diagnosis and adequate treatment at the onset until late follow up after liver transplantation.

scholarly journals P1641DONOR ACUTE KIDNEY INJURY HAS A DELETERIOUS IMPACT ON KIDNEY GRAFT SURVIVAL: THE DON-AKI STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Rémi Lenain ◽  
Camille Prouteau ◽  
Nicolas Chatauret ◽  
Aurélie Deshayes ◽  
Yohann Foucher ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Graft Survival ◽  
Organ Procurement ◽  
Graft Loss ◽  
Kidney Injury ◽  
Organ Shortage ◽  
Kidney Graft ◽  
Donor Kidney ◽  
Recovery Group

Abstract Background and Aims Acute kidney injury (AKI) during organ procurement represents an important cause of discarded kidneys. In the context of organ shortage, the evaluation of such grafts is needed in order to enlarge the donor pool. Although many studies showed an increased risk of delayed graft function when donors present with AKI, long-term impact on graft survival remains controversial. A recent large US registry study concluded that AKI during organ procurement had no deleterious effect on graft survival. However the definition of AKI in this latter study is questionable. Indeed the donor baseline serum creatinine (SCr), according to KDIGO recommendations, is often not available. In this situation, the KDIGO guidelines suggest to estimate the baseline SCr using the MDRD equation, assuming a baseline glomerular filtration rate at 75 mL/min/1.73m? This method was applied in the present study to assess the impact of donor kidney failure on long term kidney allograft survival. Method We analyzed the French national allocation system CRISTAL (Agence de la Biomédecine) data of all the recipients who received a deceased donor kidney graft from 2006 to 2017. 26786 transplant patients from 14899 deceased kidney donors were included. The donors were categorized into four groups. Ongoing AKI at the time of kidney procurement: n=1880 (3373 transplantations, AKI group), AKI with total recovery (normal SCr) at the time of kidney procurement: n=1332 donors (2392 transplantations, recovery group), elevated SCr all along the procedure: n=952 donors (1745 transplantations, unclassified AKI/CKD group) and normal SCr all along the procedure: n=10735 donors (19276 transplantations, no-AKI group). The main outcome was death censored graft survival. Results 4458 graft losses occurred during the study period (648 in the AKI group, 411 in the recovery group, 297 in the unclassified AKI/CKD group and 3102 in the no-AKI group) after a median follow-up time of 5.7 years (3 - 8.9). Multivariate analysis showed a significant increase risk of graft loss for each group when compared to the no-AKI group: HR 1.18 (1.04-1.34), HR 1.15 (1.04-1.28) and HR 1.22 (1.12-1.34) for the unclassified AKI/CKD, recovery and AKI groups, respectively. Regarding the AKI group, the risk of graft loss increased according to the AKI stage (KDIGO 2012): HR 1.20 (1.08-1.32) for stage I AKI and HR 1.31 (1.13-1.53) for stage II-III AKI. Conclusion Donor AKI represents a significant risk factor of graft loss, independently of SCr at the time of procurement. Stage II-III AKI carries a higher risk than stage I AKI suggesting a “dose-effect”. However, considering organ shortage, further studies are required to better allocate these sub-optimal kidneys.

scholarly journals Tumor necrosis factor-α gene polymorphism is associated with short- and long-term kidney allograft outcomes.

2021 ◽  
Author(s):  
Felix Poppelaars ◽  
Mariana Gaya da Costa ◽  
Bernardo Faria ◽  
Siawosh K. Eskandari ◽  
Marc A. Seelen ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Tumor Necrosis Factor ◽  
Graft Survival ◽  
Tumor Necrosis ◽  
Graft Loss ◽  
Tnf Alpha ◽  
Kidney Graft ◽  
Genotype Group ◽  
Necrosis Factor

Introduction Kidney transplantation has excellent short-term results with current immunosuppression regimes, but long-term outcomes have barely improved. Hence, there is a need for new therapeutic options to increase long-term survival of kidney grafts. Drug development for transplantation has slowly plateaued, limiting progress while making drug repurposing an attractive alternative. We, therefore, investigated the impact of tumor necrosis factor-alpha (TNF-alpha) gene (TNF) polymorphisms on kidney graft survival. Methods We performed a prospective cohort study to assess the association of TNF polymorphisms (rs1800629 G>A and rs3093662 A>G) with primary non-function (PNF) and death-censored kidney allograft survival in 1,271 kidney transplant pairs from the University Medical Center Groningen in The Netherlands. Results The G-allele of the TNF rs3093662 polymorphism in donor kidneys was associated with a higher risk of PNF (odds ratio: 2.05; 95%-CI: 1.06-3.97; P = 0.032). Furthermore, the G-allele of this TNF rs3093662 polymorphism in the donor was also associated with worse 5-year, 10-year, and 15-year death-censored kidney graft survival (P<0.05). The cumulative incidence of graft loss was 15.9% in the reference AA-genotype group and 25.2% in the AG/GG-genotype group, respectively. In multivariable analysis, the association between the TNF rs3093662 polymorphism in the donor and 15-year death-censored kidney graft survival remained significant (hazard ratio: 1.51; 95%-CI: 1.05-2.19, P = 0.028). Conclusion Kidney allografts possessing a high-producing TNF polymorphism have a greater risk of immediate and late graft loss. Our study adds to a growing body of literature indicating the potential of TNF-alpha blockade in improving kidney transplantation outcomes.

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.

Influence of specific thoracic donor therapy on kidney donation and long-term kidney graft survival

2016 ◽  
Vol 30 (6) ◽  
pp. 869-875 ◽  
Author(s):  
María A. Ballesteros ◽  
Jorge Duerto Álvarez ◽  
Luis Martín-Penagos ◽  
Emilio Rodrigo ◽  
Manuel Arias ◽  
...  
Keyword(s):  
Graft Survival ◽  
Kidney Donation ◽  
Kidney Graft
Sign in / Sign up

Export Citation Format

Share Document