MO959KIDNEY TRANSPLANT TRANSITION FROM PEDIATRIC TO ADULT FACILITY CARE: DIFFICULTIES AND RISK FACTORS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Francesca Tinti ◽  
Luca Salomone ◽  
Michele Ferrannini ◽  
Annalisa Noce ◽  
Sandro Mazzaferro ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Medical Care ◽  
De Novo ◽  
Transition Process ◽  
Adherence Rate ◽  
Post Transplant ◽  
Transplant Centre ◽  
Increased Risk ◽  
Transplant Complications

Abstract Background and Aims Kidney transplantation (KTx) in pediatric ages is successful, leading to optimal patients and graft survival with indication, in adolescent age, to transition toward an adult transplant facility. To date, the transition process of adolescents and young adults with KTx is not well defined. Transfer to a different medical facility marks a vulnerable phase in the adolescents’ lives with an increased risk for non-adherence and allograft failure. Some studies report unexpected loss rates in kidney grafts as high as 24%–42% within 3 years after transfer. In addition, some studies show that the age ranging from 18 to 26 years is the age in which graft losses are most concentrated, an age that coincides with the transition. Several makers have been shown to influence non-adherence rate in kidney transplanted patients during transition: a bad doctor-patient relationship, the absence of specialized centers capable to face these particular needs and care requests, the lack of psychological support, and a low availability of specialized nurses. Moreover, many patients are lost to follow-up as the result of breakdowns in the transition and transfer to adult medical care. Method In this study we enrolled patients transited from the pediatric transplant Centre to the adult transplant nephrological facility between 2017 and 2020. Data of KTx, baseline renal disease, post-transplant medications and post-transplant complications were recorded. Follow-up of renal function were performed and analyzed during the transition process and forward during the adult follow-up. Results Data of 19 patients (pts) were analysed. Six were male (31.6%) and 13 female (68.4%). The cause of renal dysfunction was malformations in 10 patients (52.6%), glomerulonephritis (GN) in 5 pts (26.3%) and genetic syndromes in 4 pts (21.1%). They received the kidney transplantation at a median age of 12 years [IQR 10-18]. Median age at transition resulted 31 years [interquartile range (IQR) 30-33]. Seven pts (36.8%) had a history of post-transplant lymphoproliferative disease (PTLD). All patients were receiving steroids, 11 pts (57.9%) cyclosporine A and 8 pts (42.2%) tacrolimus; only 9 pts (47.4%) were receiving mycophenolate or azathioprine. The median follow-up at the adult Transplant Centre was 1 year [IQR 1-2]. After transition, five patients experienced complications: 2 pts developed PTLD de novo, 2 pts had a recurrence of native GN after reduction of immunosuppression for PTLD and pregnancies (one pt underwent re-tx), 1 pt experienced an acute cellular rejection after transition to another Centre and is developing ESRD. The median eGFR slightly decreased from baseline at transition to the last follow-up (80 ml/min/1.73 m2 at baseline [55-112]; 74 ml/min/1.73m2 at last follow-up [35-98]) but this was not significant (p=0.127). Conclusion Our results confirm that the transition from pediatric to adult transplant Centre is not a simple process. Several factors linked to the patient and to the kidney have to be considered in the development of post-transplant complications: the age of transplantation with long term immunosuppression; infections typical of pediatric ages that may develop in adulthood, such as EBV, that force to modulate immunosuppression exposing the patient to increased risk of rejection or recurrence of native disease; the exposure to different immunological stimuli and physiological events such as pregnancies in female patients. These patients may develop complications linked to non-adherence and low compliance to immunosuppressive medications, but also complications typical of adult age, like arterial hypertension, obesity, diabetes, and dyslipidemias. Therefore, defining effective practices for recipient transition and transfer from pediatric to adult medical care are essential to optimize the KTx patients follow-up and outcome.

scholarly journals Kidney Transplantation in Patients with HIV

Kidney360 ◽  
2020 ◽  
Vol 1 (7) ◽  
pp. 705-711
Author(s):  
Deirdre Sawinski
Keyword(s):  
Kidney Transplantation ◽  
Hepatitis C ◽  
Metabolic Complications ◽  
Post Transplant ◽  
Increased Risk ◽  
Transplant Complications

Individuals with HIV are at increased risk for ESKD. Kidney transplantation is the best treatment for ESKD in the HIV+ population. Despite reduced access to transplantation, patients who are HIV+ have excellent outcomes and clearly benefit from receiving one. Common post-transplant complications and management concerns, including the optimal antiretroviral regimen, immunosuppression protocols, infectious prophylaxis, hepatitis C coinfection, metabolic complications, and malignancy are all discussed.

scholarly journals P1634TIME-UPDATED SERUM CALCIUM AND PHOSPHATE ARE ASSOCIATED WITH GRAFT AND PATIENT OUTCOMES AFTER KIDNEY TRANSPLANTATION

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Willemijn Van der Plas ◽  
António W Gomes-Neto ◽  
Stefan P Berger ◽  
Schelto Kruijff ◽  
Stephan Bakker ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Patient Outcomes ◽  
Serum Calcium ◽  
First Year ◽  
Regression Analyses ◽  
Phosphate Homeostasis ◽  
Post Transplant ◽  
Increased Risk ◽  
The Relationship

Abstract Background and Aims Disturbances in calcium-phosphate homeostasis are common after kidney transplantation. The clinical implications of changes in calcium-phosphate homeostasis after transplantation are unclear. The aim of this study was to assess the relationship between time-updated serum calcium and phosphate levels and subsequent graft and patient outcomes. Method Kidney transplant recipients with ≥2 serum calcium and phosphate measurements were included from a large single-center cohort; only first transplants were considered. Patients with graft failure <3 months were excluded, as were measurements obtained when eGFR was <15 mL/min/1.73m2 or during intensive care unit admission. Normocalcemia was defined as (albumin-corrected) calcium between 2.20 and 2.60 mmol/L (8.8-10.4 mg/dL), and normophosphatemia as 0.70-1.50 mmol/L (2.17-4.64 mg/dL). Time-updated multivariable Cox regression analyses and time-updated restricted cubic splines analyses were performed to assess the relationship between post-KTx serum corrected calcium and phosphate levels and mortality and death-censored graft failure (DCGF). Final models were adjusted for recipient age, sex, BMI, eGFR, proteinuria, systolic BP (all time-updated), antihypertensive drug use, recipient CMV status, donor age, sex, and status (living or post-mortal), cold and warm ischemia times, HLA mismatches, primary kidney disease, and serum phosphate (in calcium analyses) or corrected calcium (in phosphate analyses). Results A total of 2,769 patients with 138,496 serum corrected calcium and phosphate levels post-KTx were included (median [IQR] 43 [31-61] measurements per patient). Mean age was 47 ± 14 yrs, 42.3% was female, and 19% underwent a pre-emptive transplantation. Hypercalcemia was more common in the first year (15%) and declined to ∼5% during long-term follow-up; hypocalcemia occurred in ∼10% throughout. Hypophosphatemia (24.3%) and hyperphosphatemia (15.5%) were particularly common during the first 30 days post-transplant, and stabilized at ∼10% and ∼5% after the first year. During median follow-up of 16.3 (8.7 – 25.2) years, 477 patients (17.2%) developed DCGF and 1050 (37.9%) patients died. In multivariable regression analyses, post-transplant hypocalcaemia was associated with an increased risk of DCGF (fully adjusted hazard ratio [HR] 2.01 [95% CI 1.61-2.50], P<0.0001; Figure 1A), but not mortality (HR 1.06 [95% CI 0.88-1.27], P=0.55; Figure 1B). Post-transplant hypercalcaemia was associated with an increased risk of mortality (HR 1.77 [95% CI 1.44-2.17], P<0.0001), but not DCGF (HR 0.79 [95% CI 0.48-1.32], P=0.37). Patients with post-KTx hyperphosphatemia were at increased risk of both DCGF (HR 37.12 [95% CI 30.33-45.42], P<0.0001; Figure 1C) and mortality (HR 3.17 [95% CI 1.65-3.86], P<0.0001; Figure 1D). Patients with hypophosphataemia had a lower risk of developing DCGF (HR 0.48 [95% CI 0.28-0.81], P<0.01), but not mortality (HR 0.92 [95% CI 0.72-1.18], P=0.42). Similar results were obtained in sensitivity analyses in a subgroup with parathyroid hormone data available (N=1,412) or after exclusion of the highest and lowest 0.5% of calcium or phosphate levels. Conclusion Post-transplant hypocalcaemia and hyperphosphatemia are associated with an increased risk of DCGF, while hypophosphataemia was linked with a lower DCGF risk. Hypercalcaemia and hyperphosphataemia were associated with an increased mortality risk. These findings underline the relevance of keeping calcium and phosphate within normal range after kidney transplantation.

scholarly journals Evaluation of Cumulative Effect of Standard Triple Immunosuppression on Prevention of De Novo Donor Specific Antibodies (dnDSA) Production in Children after Kidney Transplantation—A Retrospective and Prospective Study

Children ◽  
2021 ◽  
Vol 8 (12) ◽  
pp. 1162
Author(s):  
Agnieszka Urzykowska ◽  
Barbara Piątosa ◽  
Urszula Grycuk ◽  
Grzegorz Kowalewski ◽  
Zbigniew Kułaga ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
De Novo ◽  
Cumulative Effect ◽  
Specific Antibodies ◽  
Post Transplant ◽  
Prospective Group ◽  
Risk Patients ◽  
Donor Specific Antibodies ◽  
Median Interval

De novo Donor Specific Antibodies (dnDSA) are associated with inferior graft outcomes. Standard immunosuppression is expected to prevent dnDSA production in low-risk patients. We have evaluated a cumulative effect of a triple immunosuppression (CNI/MMF/Pred), as well as TAC concentration and coefficient of variation on the incidence of dnDSA production. Overall, 67 transplanted patients were evaluated in retrospective (dnDSA for-cause; n = 29) and prospective (dnDSA by protocol; n = 38) groups. In the retrospective group, the eGFR value at first dnDSA detection (median interval—4.0 years post-transplant) was 41 mL/min/1.73 m2; 55% of patients presented biopsy-proven cAMR, and 41% lost the graft within next 2.4 years. Patients from the prospective group presented 97% graft survival and eGFR of 76 mL/min/1.73 m2 at 2 years follow-up, an overall incidence of 21% of dnDSA and 18% of acute (T cell) rejection. None of the patients from the prospective group developed cAMR. Median value of Vasudev score within 2 years of follow-up was not significantly higher in dsDSA negative patients, while median value of TAC C0 > 1–24 months post-transplant was 7.9 in dnDSA negative vs. 7.1 ng/mL in dnDSA positive patients (p = 0.008). Conclusion: dnDSA-negative patients presented a higher exposure to tacrolimus, while not to the combined immunosuppression.

P1791HLA DESENSITIZATION- INDIAN EXPERIENCE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Shyam Bansal ◽  
Ashwini Gade
Keyword(s):  
Kidney Transplantation ◽  
B Cell ◽  
Graft Loss ◽  
Deceased Donor ◽  
Clinical Indication ◽  
Donor Pool ◽  
Post Transplant ◽  
The Mean ◽  
Hla Incompatible

Abstract Background and Aims There are many barriers to kidney transplant and one of them is presence of donor specific antibodies (DSAs) in the recipients. Presence of strong DSA is considered a relative contraindication for kidney transplantation, however, if DSAs are of weak to moderate then desensitization is attempted in many centres with good success rate. Desensitizing such patients can be an acceptable approach to increase the donor pool and facilitating transplants. This is a retrospective analysis of patients who underwent desensitization at our centre after availability of luminex single antigen (LSA) assay Method Between April 2014 and December 2018, 825 patients underwent kidney transplantation at our centre. Patients who were CDC negative but positive FCXM were further analysed with LSA to know the presence and strength of DSAs. Our protocol for desensitization consisted of plasmapheresis (PP) 1.5 volume by double filtration on alternate day and low dose IV IG 100 mg/kg after each PP. Whenever MFI was <1000 and/or FCXM was negative, patient was taken for transplant with thymoglobulin induction of 1.5 mg/kg for 2-3 doses. All patients were maintained on triple immunosuppression consisting of tacrolimus, mycophenolate mofetil and corticosteroids. We did not routinely followed DSAs in these patients post-transplant if there was no clinical indication. All adverse events during follow up including new onset diabetes after transplant (NODAT), infections, acute rejections (AR), graft loss and death Results Out of 825 patients, 15 underwent HLA incompatible transplants, of which, 8 were males. All patients were first transplant and 11/13 had history of some sensitizing events in the form of blood transfusion and/or pregnancy. The mean dialysis duration was 8.6 ±14.6 months. FCXM was positive in all the patients with 5 patients had T cell flow positive, 8 had B cell flow positive and 2 had both T & B cell FCXM positivity. Most patients had weak to moderate positive flow cross match. On further evaluation by LSA, all these patients had DSAs, with 3/15 had MFI <1000, 6 had MFI between1000-2000, and remaining 6 had MFI >2000, out of which one patient had MFI of 7195 and six patients had multiple DSAs. These patients underwent desensitization with PP and IVIG and the end point of treatment was either MFI < 1000 or FCXM negative. Post- transplant DSAs were done in patients with high MFI or clinically indicated. Two patients had increase in post-transplant DSA titres requiring post-transplant plasmapheresis. The mean follow up was 29±6 months. On follow up, only 1 patient developed borderline cellular rejection one year after transplant, which responded with pulse steroids. Three patients had biopsy for asymptomatic rise in creatinine but it showed patchy ATN with no evidence of rejection.. One patient developed transient CMV viremia, one patient developed lymph node tuberculosis (TB) and two patients had UTI, all of them responded to treatment. There was no graft or patient loss till last follow up. Conclusion This study shows that HLA desensitisation is feasible and successful in if patients are selected carefully and evaluate thoroughly. HLA incompatible transplant can provide a new lease of life to those patients who would otherwise not get a kidney due to lack of paired exchange and deceased donor program

Long Term Follow Up of De Novo Use of mTOR Inhibitors (mTORi) After Kidney Transplantation.

2014 ◽  
Vol 98 ◽  
pp. 543-544 ◽  
Author(s):  
M. Paula ◽  
P. Hannun ◽  
C. Felipe ◽  
A. Ferreira ◽  
M. Cristelli ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
De Novo ◽  
Mtor Inhibitors ◽  
Long Term Follow Up

Retrospective Comparison of Using or Not Using Donor Lymphocyte Transfusion in the Treatment of Hematological Relapse after Allogeneic Stem Cell Transplantation in 489 Adults with Acute Myeloid Leukemia.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 298-298
Author(s):  
Christoph Schmid ◽  
Myriam Labopin ◽  
Juergen Finke ◽  
Gerhard Ehninger ◽  
Olle Ringden ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
De Novo ◽  
Patient Age ◽  
Entire Cohort ◽  
Post Transplant ◽  
Patient Âgé ◽  
Retrospective Comparison ◽  
De Novo Aml

Abstract Relapsed AML after allogeneic SCT has a poor prognosis. So far, no standard therapy could be defined. Donor lymphocyte transfusion (DLT) has been effective in a minority, however, no data is available to identify patients who will benefit from the procedure. Neither, the outcome of patients treated with or without DLT have been compared. We retrospectively evaluated overall survival (OS) of 489 adults with de novo AML in hematological relapse after SCT, receiving DLT (n=190) or not (n=299). DLT and noDLTgroups were well balanced in terms of patient age (median:37y in both groups), donor age, cytogenetics (good:5vs7%, intermediate:83vs79%, poor:12%vs14%), WBC at diagnosis, donor type (geno-id:71vs72%, MUD:18% both, mismatched:11vs10%), status at transplantation (CR1:38vs41%, CR2:13vs15%, advanced:49vs44%), conditioning, source of stem cells, and time from transplant to relapse (5vs4.5 months). However, DLT patients had a median of 39% BM blasts, as compared to 54% for the noDLT group (p=0.03). Follow-up was 32 and 30 months. Within the DLT group, chemotherapy was additionally given in 130 cases. Nevertheless, only 33% of patients received DLT in CR or aplasia, 67% had measurable disease. AGvHD developed in 41% of patients following DLT. CR and PR were achieved in 31.1% and 4.8% of DLT patients. In a multivariate analysis, younger patient age (<36 years) (HR=1.53,p=0.02) and a longer interval (> 5 months) from transplant to relapse (HR=7.74,p=0.002) were associated with better OS after DLT. When comparing the outcome of patients receiving or not DLT, OS at 2 years was 10±1% for the entire cohort, 18±3% for DLT and 6±1% for noDLT (p<.0001). In a multivariate analysis, use of DLT (HR=2.11,p<0.0001); recipient’s age<36 y (HR=1.69, p<0.001); longer interval (>5 months) from transplant to relapse (HR=2.40, p<0.0001) and number of BM blasts (<48%) at relapse (HR=1.56,p=0.002) were favorable for OS. In this retrospective analysis the results suggest that DLT may be of advantage in the treatment of AML relapse post transplant, at least in younger patients with a longer post transplant remission and relapsing with smaller amounts of blasts in BM. However, patients receiving DLT might represent a positive selection among all relapsed cases, since a considerable number from the noDLT cohort had died too early to proceed to DLT. An intetion-to-treat analysis and further prospective studies should investigate the role of DLT and other approaches, such as second reduced intensity SCT.

Non-Heart Beating Donor Kidney Transplantation Is not Associated with An Increased Risk of Post-Transplant Infection

2012 ◽  
Vol 94 (10S) ◽  
pp. 552
Author(s):  
M. Fernández-Ruiz ◽  
F. López-Medrano ◽  
E. González ◽  
N. Polanco ◽  
J. M. Herrero-Martínez ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Donor Kidney ◽  
Post Transplant ◽  
Increased Risk ◽  
Heart Beating ◽  
Donor Kidney Transplantation

scholarly journals Latent tuberculosis screening before kidney transplantation in the South of Brazil

2021 ◽  
Author(s):  
Gisele Meinerz ◽  
Cynthia Keitel da Silva ◽  
Damaris Mikaela Balin Dorsdt ◽  
Julia Bertoni Adames ◽  
Julio Pasquali Andrade ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Latent Tuberculosis ◽  
Tuberculin Test ◽  
Tuberculosis Screening ◽  
Post Transplant ◽  
Ltbi Screening ◽  
Interferon Gamma Release Assays ◽  
High Incidence ◽  
South Of Brazil

Abstract Background: Tuberculosis (TB) is a prevalent infection after kidney transplantation (KT) in high-burden countries. Latent tuberculosis infection (LTBI) screening includes previous TB history, chest radiograph findings, and tuberculin test (TST) and/or interferon-gamma release assays (IGRAs) results. We aimed to compare our routine LTBI screening of KT candidates and living donors (LD) with their IGRA results, and evaluate if this would improve isoniazid (INH) treatment referral. Methods: We evaluated adult KT candidates and LD with complete routine LTBI screening and QuantiFERON-TB® Gold In-Tube (QFT) testing. Blood samples were collected from April 4th, 2014 to October 31st, 2018, with follow-up until October 31st, 2019. Results: There were 116 KT recipients, with 30% QFT-positive results. Positive QFT was associated with past TB history (p=0.007), positive TST (p<0.0001), residual radiographic lesions (p=0.003), and diabetes (p=0.035). There were 25 LD, 40% had positive QFT. Positive QFT was associated with a positive TST (p=0.002). Positive QFT results increased INH referral in 80%. Post-transplant TB incidence was 2.6% in a median follow-up of 2 (1-33) months. No variables were associated with post-transplant TB. TB patients had inferior, although non-significant, 5-year graft survival (66.7% vs. 76.5%) (p = 0.402). Conclusion: In the present study, the association of QFT to our routine LTBI screening incremented INH treatment referral, but there was still a high incidence of post-transplant TB, possibly related to other forms of infection, such as new exposure and donor transmission.

scholarly journals An EBMT Prospective Non-Interventional Study of Outcomes and Toxicity of Allogeneic Stem Cell Transplantation in Chronic Myeloid Leukemia Patients Previously Treated with Second Generation Tyrosine Kinase Inhibitors

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 628-628
Author(s):  
Eduardo Olavarria ◽  
Michael Schleuning ◽  
Simona Iacobelli ◽  
Jennifer Hoek ◽  
Henric-Jan Blok ◽  
...  
Keyword(s):  
Overall Survival ◽  
Research Funding ◽  
Kinase Inhibitors ◽  
Disease Status ◽  
Free Survival ◽  
Post Transplant ◽  
Previously Treated ◽  
Sequential Combination ◽  
Transplant Complications

Abstract Introduction: Allogeneic stem cell transplantation (SCT) remains a treatment option for patients with chronic myeloid leukemia (CML) that fail to respond to tyrosine kinase inhibitors (TKI). While the use of Imatinib seems to have no adverse impact on outcomes after transplant, little is known on the effects of prior use of second generation TKI (2GTKI). We present the results of a prospective non-interventional study (NIS) performed by the European Group for Blood and Marrow Transplantation (EBMT) of all consecutive allogeneic SCT for patients diagnosed with CML from 2009 to 2013. Methods: A prospective follow up of pre and post-transplant data was carried out by the EBMT Leiden office, including TKI therapy data, MED-B and a specific MED-C post transplant data. A total of 94 EBMT centers from 32 countries included 437 patients. Results: We present the results of the 383 patients that fulfilled all the inclusion criteria and had median follow-up of 37 months (1-77). The median age was 45 years (18-68) and 251 (65%) were males. Disease status at the start of 2GTKI was: First chronic phase - CP1 (123, 46%), Accelerated phase or >CP1 (67, 25%) and blast crisis (75, 28%). The choice of 2GTKI was: Dasatinib (155, 40%), Nilotinib (64, 17%) and a sequential combination of Dasatinib/Nilotinib with or without Bosutinib/Ponatinib (164, 43%). In addition, 29% of patients that received Dasatinib were in CP1 at the start of 2GTKI and at the time of SCT compared with 45% at the start and 40% at SCT for patients treated with Nilotinib. For patients that received both TKI in sequential combination, 63% were in CP1 at the start of 2GTKI but only 46% reached the SCT in CP1. Overall disease status at SCT was CP1 in 139 patients (38%), AP in 163 (45%) and BC in 59 (16%). The median interval from diagnosis to SCT was 22 months (2 - 267) and the median interval between starting 2GTKI and SCT was 10 months (1 - 191). The donor was an HLA identical sibling in 130 cases (35%) and unrelated in 244 (65%). The majority of SCT were performed using PBSC (295, 77%), while 272 (71%) were myeloablative and 111 (29%) reduced intensity conditioning. The EBMT score was low (0-2) in 26 (7%), intermediate (3-4) in 216 (62%) and high (5-7) in 107 (31%). Primary graft failure (PGF) occurred in 10 (3%) cases, while the incidence of acute GVHD was 34% (95% CI 29-39) and chronic GVHD (CGVHD) was 60% at 5 years (95% CI 54-66). CGVHD occurred at a median of 5.7 months (3-61) post SCT. Other post SCT complications included veno-occusive disease of the liver (VOD) in 6 cases (2%) and severe infection in 195 (65%). There were no differences in post-transplant complications amongst the 3 different 2GTKI subgroups. Overall non-relapse mortality was 18% (95% CI 14-22) at 12 months and 24% (95% CI 19-29) at 5 years. Relapse incidence was 36% (95% CI 29-42), overall survival was 56% (95% CI 50-62) and relapse-free survival was 40% (95% CI 33-47) at 5 years. Overall survival was 67% (95% CI 59-75) at 5 years for patients in CP1. No differences in post-transplant outcomes were found amongst the 3 different 2GTKI subgroups. However, the EBMT score, performance status and disease stage at 2GTKI and at SCT were predictive of overall and progression-free survival. Discussion: This prospective study demonstrates the feasibility of performing allogeneic SCT in CML patients previously treated with 2GTKI. The rate of post-transplant complications including graft failure, VOD, infections, GVHD and non-relapse mortality seems comparable to that of patients treated with Imatinib or TKI-naïve. We observed no differences between outcomes for patients receiving Dasatinib, Nilotinib or any other combination of 2GTKI (including Bosutinib and Ponatinib) pre-SCT. However, patients receiving Dasatinib were more likely to proceed to SCT in advanced phase than in CP1. Patients in CP1 have a very good overall survival despite prior treatment with 2GTKI. Of note, even after 2GTKI, the EBMT score remains a strong predictor of overall and disease-free survival for CML patients undergoing allogeneic SCT. Disclosures Schouten: Sanofi: Consultancy; Novartis: Consultancy. de Witte:Novartis: Honoraria, Research Funding; Celgene: Consultancy; Incyte: Consultancy. Kröger:Neovii: Honoraria, Research Funding; Sanofi: Honoraria, Research Funding; Riemser: Honoraria, Research Funding; Novartis: Honoraria, Research Funding.

scholarly journals SUN-624 Low Risk of Major Adverse Cardiovascular Events After Pancreas Transplantation Alone

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Ravinder Jeet Kaur ◽  
Byron H Smith ◽  
Shafaq R Rizvi ◽  
Sreedhar Batthula ◽  
Aleksandra Kukla ◽  
...  
Keyword(s):  
Cardiovascular Events ◽  
Pancreas Transplantation ◽  
Graft Failure ◽  
Event Rate ◽  
Major Adverse Cardiovascular Events ◽  
C Peptide ◽  
Duration Of Diabetes ◽  
Post Transplant ◽  
Increased Risk

Abstract INTRODUCTION: Type 1 Diabetes (T1D) patients have an increased risk for major adverse cardiovascular events (MACE). Pancreas Transplantation Alone (PTA) in patients with T1D achieves near normal glucose control for a prolonged period but limited data are available to date regarding MACE during a 10 year follow up period after the procedure. OBJECTIVE: We studied incidence of MACE after PTA in T1D patients over a 10 year follow-up period. METHODS: Retrospectively, we studied 113 T1D recipients of PTA at Mayo Clinic, Rochester with the procedure performed between January 1998 and August 2018 and follow up of at least 1 year. Data were collected before transplantation and up to 10 year follow up after the first PTA. MACE data were gathered until primary non function, re-transplantation, or complete loss of c-peptide (&lt;0.01ng/ml). We report vascular risk factors including hypertension, hyperlipidemia, smoking and BMI along with MACE (defined as cardiac events as unstable angina, Myocardial Infarction (MI), need for re-vascularization, cardiac death, cerebral events as Transient ischemic attack (TIA), stroke, need for re-vascularization and peripheral arterial disease as need for re-vascularization, gangrene and amputation). RESULTS: Eighteen subjects had pre-transplant MACE. A total of 14 subjects had graft failure within 24 to 36 hours due to thrombosis, with 3 in pre-transplant MACE cohort and 11 in no MACE cohort. Thus, we followed 99 subjects for the development of post-transplant MACE for a period of 6.3 ± 3.6 years. T1D subjects with MACE (n=15) had baseline characteristics: Age 48± 7.8 years, gender F/M 9/6,, duration of diabetes 33 ± 12 years, BMI 26± 3.1(Kg/m2), HbA1c 9.3 ± 1.5% and C-peptide 0.09 ng/ml. 84 T1D patients without MACE were age 42 ± 10.6 years, gender F/M 55/29, duration of diabetes 26.5 ± 10.7 years, BMI 26 ± 5.2(Kg/m2), HbA1c 6.7 ± 2.5 and C-peptide 0.09 ng/ml. There are a total of 584 person-years of follow up to first MACE event and 632 person-years of graft failure, death or last follow-up. Nine patients developed 11 MACE events post-PTA. Therefore, the event rate is 1.5 MACE events per 100 person-years for first MACE event and the total event rate is 1.7 MACE events per 100 person-years of follow-up. Age, smoking (yes), gender, duration of diabetes, HTN and Hyperlipidemia presence did not show any significant impact on post-transplant MACE outcome based on univariate Cox regression but the pre-transplant BMI (HR = 1.14; CI = (1.04, 1.26); p = 0.008) and pre-transplant HbA1c (HR = 1.26; CI = (1.06, 1.51); p = 0.01) showed statistically significant impact. CONCLUSIONS: At our center, MACE is low in PTA recipients. There is no impact of presence of pre-transplant MACE on development of post-transplant MACE but pre-transplant BMI and HbA1c account for risk of MACE.

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