MO925VALVULAR HEART DISEASE EVOLUTION IN KIDNEY TRANSPLANT RECIPIENTS AND RELATED RISK FACTORS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Isabel Galceran ◽  
M Dolores Redondo Pachón ◽  
María José Pérez Sáez ◽  
Carlos Arias Cabrales ◽  
Carla Burballa Tarrega ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Disease ◽  
Graft Survival ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Disease Evolution ◽  
Related Risk ◽  
The Moment ◽  
The Impact

Abstract Background and Aims Cardiovascular diseases remains the leading cause of death in recipients of kidney transplantation (KT). Valvular heart disease (VHD) is not an exclusion criteria for KT, however it’s repercussion on KT follow-up has been less studied. Our objective was to analyse the impact of VHD in KT recipients and related risk factors of VHD progression (VHDp). Method Observational retrospective cohort study of all patients who underwent KT at Hospital del Mar (Barcelona, Spain) between January 1980 and December 2018. VHD was defined as presence of aortic stenosis (AS), aortic regurgitation, mitral stenosis, mitral regurgitation, tricuspid stenosis, tricuspid regurgitation or double valve injury of any degree diagnosed by echocardiography. We analysed the VHDp, defined as worsening of the initial valvular degree on heart ultrasound after KT, risk factors related with VHDp, recipients and graft survival. Results During the study period, 1422 patient underwent KT and 48 of them (3.4%) had VHD diagnosed prior to KT. In the median time of follow-up of 56.3 months (IQR25-75 17.7-119 month), 17 patients (35.4%) presented VHDp and 31 patients did not (64.6%). Figure 1 shows the primary outcome in the different types of VHD, AS was the valve with more VHDp after KT. Statistical evaluation revealed that recipients with VHDp had a higher body mass index (BMI) (27.4 ± 6.3 vs 24.3 ± 3.8 kg/m2, p=0.04) and worse PTH control (427.0 ± 309.3 vs 186.2 ± 140.6 pg/ml, p=0.02) at the moment of the KT. Also, patients with VHDp reached a worse nadir glomerular filtration rate (GFR) (44.1 ± 17.5 vs 56.0 ± 13.9 ml/min/1.73m2, p=0.01) during the follow-up, needed more time to reach their nadir GFR (4 [2-13] vs 1.2 [1.0-4.7] months, p<0.001) and required more furosemide dose at that time (72.7 ± 21.7 vs 15.8 ± 5.6 mg/day, p=0.02). At the end of follow-up, 213 KT recipients had died, 16 with preKT-VHD (33.3% of all patients with VHD) and 197 without preKT-VHD (14.3% of all cases without VHD). There was a statistical significant association between preKT-VHD status and all-cause mortality after KT (log rank < 0.001). However, there wasn’t statistical association between preKT-VHD status and death-censored graft survival (log rank = 0.2). Conclusion VHD has a significant impact on increased pos-KT mortality but it is not associated with graft survival. More than one third of recipients with preKT-VHD presented deterioration after KT. We found that increased preKT BMI and PTH, nadir GFR after KT, time to reach this nadir GFR and diuretic dose at that time are related with VHD progression.

scholarly journals Impact of Treating Asymptomatic Bacteriuria in Kidney Transplant Recipients: A Prospective Cohort Study

Antibiotics ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 218
Author(s):  
Sara Fontserè ◽  
Carmen Infante-Domínguez ◽  
Alejandro Suárez-Benjumea ◽  
Marta Suñer-Poblet ◽  
Carmen González-Corvillo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Asymptomatic Bacteriuria ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Symptomatic Urinary Tract Infection ◽  
Clinical Benefits ◽  
Independent Risk Factors ◽  
The Impact ◽  
Microbiological Cure

This study aims to define the epidemiologic, clinical, and microbiological features of asymptomatic bacteriuria (AB) and cystitis in kidney transplantation recipients (KTRs), and to determine the impact of antimicrobial therapy of AB and the risk factors of cystitis. We conducted a prospective observational study of AB and cystitis in KTRs from January to June 2017. One-hundred ninety seven KTRs were included: 175 (88.8%) with AB and 22 (11.2%) with cystitis. The most frequent etiologies were Escherichia coli, Klebsiellapneumoniae, Enterococcusfaecalis, and Pseudomonas aeruginosa. No differences were observed regarding the etiologies, antimicrobial susceptibility patterns, and microbiologic outcomes in AB vs. cystitis. The treatment of AB diminished the microbiological cure and increased the rates of microbiologic relapses and reinfections; in addition, treated AB patients showed a trend of developing symptomatic urinary tract infection in the following six months. The analysis of the data identified the following independent risk factors for cystitis during the six months of follow-up: AB treatment, thymoglobulin induction, previous acute pyelonephritis, and time since transplantation < 1 year. In summary, considering the lack of clinical benefits of treating AB and its impact on cystitis development in the follow-up, we support the recommendation of not screening for or treating AB.

scholarly journals Impact of antiretroviral therapy on clinical outcomes in HIV+ kidney transplant recipients: Review of 58 cases

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 2893 ◽  
Author(s):  
Rossana Rosa ◽  
Jose F. Suarez ◽  
Marco A. Lorio ◽  
Michele I. Morris ◽  
Lilian M. Abbo ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Acute Rejection ◽  
Clinical Outcomes ◽  
Kidney Transplant ◽  
Graft Survival ◽  
Patient Survival ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Serious Infections ◽  
The Impact

Background: Antiretroviral therapy (ART) poses challenging drug-drug interactions with immunosuppressant agents in transplant recipients.  We aimed to determine the impact of specific antiretroviral regimens in clinical outcomes of HIV+ kidney transplant recipients. Methods: A single-center, retrospective cohort study was conducted at a large academic center. Subjects included 58 HIV- to HIV+ adult, first-time kidney transplant patients. The main intervention was ART regimen used after transplantation.  The main outcomes assessed at one- and three-years were: patient survival, death-censored graft survival, and biopsy-proven acute rejection; we also assessed serious infections within the first six months post-transplant. Results: Patient and graft survival at three years were both 90% for the entire cohort. Patients receiving protease inhibitor (PI)-containing regimens had lower patient survival at one and three years than patients receiving PI-sparing regimens: 85% vs. 100% (p=0.06) and 82% vs. 100% (p=0.03), respectively. Patients who received PI-containing regimens had twelve times higher odds of death at 3 years compared to patients who were not exposed to PIs (odds ratio, 12.05; 95% confidence interval, 1.31-1602; p=0.02).  Three-year death-censored graft survival was lower in patients receiving PI vs. patients on PI-sparing regimens (82 vs 100%, p=0.03). Patients receiving integrase strand transfer inhibitors-containing regimens had higher 3-year graft survival. There were no differences in the incidence of acute rejection by ART regimen. Individuals receiving PIs had a higher incidence of serious infections compared to those on PI-sparing regimens (39 vs. 8%, p=0.01). Conclusions: PI-containing ART regimens are associated with adverse outcomes in HIV+ kidney transplant recipients.

Incidence, Risk Factors, Clinical Management, and Outcomes of Posttransplant Lymphoproliferative Disorder in Kidney Transplant Recipients

2019 ◽  
Vol 29 (2) ◽  
pp. 185-193 ◽  
Author(s):  
Michelle Liu ◽  
Shahid Husain ◽  
Olusegun Famure ◽  
Yanhong Li ◽  
S. Joseph Kim
Keyword(s):  
Risk Factors ◽  
Lymphoproliferative Disorder ◽  
Epstein Barr Virus ◽  
Transplant Recipients ◽  
Posttransplant Lymphoproliferative Disorder ◽  
Kidney Transplant Recipients ◽  
Barr Virus ◽  
Incidence Risk ◽  
Epstein Barr

Background: Posttransplant lymphoproliferative disorder (PTLD) is a severe complication after kidney transplantation. This study examined the incidence, risk factors, clinical management, and outcomes of PTLD in a cohort of kidney transplant recipients. Design: This single-center cohort study included 1642 patients transplanted from January 1, 2000, to December 31, 2012, with follow-up until December 31, 2013. The incidence and risk factors for PTLD were examined using a Cox proportional hazards model. A Cox model was also used to assess the association of PTLD and graft outcomes. Results: Sixteen recipients developed PTLD over follow-up. The incidence rate was 0.18 (95% confidence interval [CI]: 0.11-0.29) cases per 100 person-years. Four were from Epstein–Barr virus (EBV) mismatched (D+/R−) transplants and 12 from EBV-positive recipients (R+). Recipients with D+/R− matches were at a significantly higher risk of developing PTLD than R+ (hazard ratio [HR]: 7.52 [95% CI: 2.42-23.32]). Fifteen cases had immunosuppression reduced, 11 cases were supplemented with rituximab or ganciclovir, 6 cases required chemotherapy or radiation, and 6 cases had tumors excised. By the end of follow-up, 6 patients went into remission, 5 returned to chronic dialysis, and 5 patients died. Patients with PTLD were significantly more likely to have total graft failure (return to chronic dialysis, preemptive retransplant, or death with graft function) than patients without PTLD (HR: 3.41 [95% CI: 1.72-6.78). Discussion: Epstein–Barr virus mismatch continues to be a strong risk factor for developing PTLD after kidney transplantation. Recipients with PTLD have a poor prognosis, as the optimal management remains to be elucidated.

Risk Factors for Premature Coronary Heart Disease after Successful Liver Transplantation in Adults

1996 ◽  
Vol 6 (4) ◽  
pp. 178-187
Author(s):  
Susan L Smith
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Liver Transplantation ◽  
Heart Disease ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Pharmacological Agents ◽  
Premature Coronary Heart Disease

As solid-organ transplantation has evolved into a highly effective treatment for end-stage organ disease, the long-term health implications of chronic exposure of recipients to immunosuppressants and other pharmacological agents are becoming more apparent. Coronary heart disease has long been known to plague kidney transplant recipients and more recently has been found to affect heart transplant recipients disproportionately. Coronary heart disease after liver transplantation, however, is less well known. The purpose of this study was to examine risk factors for premature coronary heart disease in asymptomatic adult recipients of liver transplants. Nutrition-related risk factors for coronary heart disease (obesity and hyperlipidemia) were measured in 29 patients before and after liver transplantation. Changes with respect to primary immunosuppression protocol (cyclosporine plus corticosteroid vs tacrolimus plus corticosteroid) were compared. Risk factors that had not been present before transplantation were apparent in both groups by 6 months after transplantation. Although obesity and hyperlipidemia were not found to be independent risk factors for coronary heart disease, they were clinically important when considered in combination. Cyclosporine was associated with significantly higher serum lipid concentrations than was tacrolimus.

Immunological biomarkers and long term graft survival. Prospective follow-up of 457 kidney transplant recipients

2017 ◽  
Author(s):  
Michał Ciszek ◽  
Krzysztof Mucha ◽  
Bartosz Foroncewicz ◽  
Dorota Żochowska ◽  
Maciej Kosieradzki ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Graft Survival ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

scholarly journals Impact of Acute Rejection on Kidney Allograft Outcomes in Recipients on Rapid Steroid Withdrawal

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
R. L. Heilman ◽  
S. Nijim ◽  
H. A. Chakkera ◽  
Y. Devarapalli ◽  
A. A. Moss ◽  
...  
Keyword(s):  
Acute Rejection ◽  
Kidney Transplant ◽  
Graft Survival ◽  
Control Group ◽  
Steroid Withdrawal ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Protocol Biopsy ◽  
And Control ◽  
The Impact

Background. Our aim was to study the impact of clinical acute rejection (CR) and subclinical rejection (SR) on outcomes in kidney transplant recipients treated with rapid steroid withdrawal (RSW).Methods. All patients who received a living or deceased donor kidney transplant and were treated with RSW were included. The primary outcome was death-censored graft survival. Biopsies with Banff borderline changes were included with the rejection groups.Results. 457 kidney transplant recipients treated with RSW were included; 46 (10%) experienced SR, and 36 (7.8%) had CR. Mean HLA mismatch was significantly higher in the CR group. The Banff grade of rejection was higher in the CR group. There was a larger proportion of patients in both rejection groups with the combination of IFTA and persistent inflammation on the follow-up protocol biopsy done at 1 year. The estimated 5-year death-censored graft survival was 81% in SR, 78% in CR, and 97% in the control group (P<.0001). Significant differences were observed in allograft survival between the CR and control group (HR 9.06, 95% CI 3.39–24.2) and between the SR and control group (HR 4.22, 95% CI 1.30–13.7).Conclusion. Both SR and CR are associated with an inferior graft survival in recipients on RSW.

scholarly journals Antibody Responses after a Third Dose of COVID-19 Vaccine in Kidney Transplant Recipients and Patients Treated for Chronic Lymphocytic Leukemia

Vaccines ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1055
Author(s):  
Julien Marlet ◽  
Philippe Gatault ◽  
Zoha Maakaroun ◽  
Hélène Longuet ◽  
Karl Stefic ◽  
...  
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Kidney Transplant ◽  
Lymphocytic Leukemia ◽  
Antibody Responses ◽  
Moderate Increase ◽  
Immunocompromised Patients ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
The Impact

The impact of a third dose of COVID-19 vaccine on antibody responses is unclear in immunocompromised patients. The objective of this retrospective study was to characterize antibody responses induced by a third dose of mRNA COVID-19 vaccine in 160 kidney transplant recipients and 20 patients treated for chronic lymphocytic leukemia (CLL). Prevalence of anti-spike IgG ≥ 7.1 and ≥ 30 BAU/mL after the third dose were 47% (75/160) and 39% (63/160) in kidney transplant recipients, and 57% (29/51) and 50% (10/20) in patients treated for CLL. Longitudinal follow-up identified a moderate increase in SARS-CoV-2 anti-spike IgG levels after a third dose of vaccine in kidney transplant recipients (0.19 vs. 5.28 BAU/mL, p = 0.03) and in patients treated for CLL (0.63 vs. 10.7 BAU/mL, p = 0.0002). This increase in IgG levels had a limited impact on prevalence of anti-spike IgG ≥ 30 BAU/mL in kidney transplant recipients (17%, 2/12 vs. 33%, 4/12, p = 0.64) and in patients treated for CLL (5%, 1/20 vs. 45%, 9/20, p = 0.008). These results highlight the need for vaccination of the general population and the importance of non-medical preventive measures to protect immunocompromised patients.

scholarly journals FC 129CHANGES IN PERIPHERAL NK CELLS IN KIDNEY TRANSPLANT RECIPIENTS WITH AND WITHOUT HLA DSA

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Laura Llinas ◽  
Dolores Redondo Pachon ◽  
Dàlia Raïch Regué ◽  
Maria Jose Perez-Saez ◽  
Sara Sanz ◽  
...  
Keyword(s):  
Nk Cells ◽  
Cell Count ◽  
Kidney Transplant ◽  
Graft Survival ◽  
Peripheral Blood ◽  
Nk Cell ◽  
Cell Phenotype ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

Abstract Background and Aims Antibody-mediated rejection (ABMR) is a frequent cause of renal allograft loss. There is increasing evidence of the role of Natural Killer (NK) cells in the establishment of ABMR damage. Our group described that patients with donor-specific antibodies (DSA) and ABMR present higher proportions of NKG2A+ NK cell subset in peripheral blood than those without HLA DSA or HLA antibodies. Method We selected 177 kidney transplant recipients (KT) with renal biopsies 2011-2017: 77 with ABMR (DSA+: 53, DSA-: 24) and 100 without ABMR (DSA+: 15, DSA-: 85). We assessed graft survival with a median time of follow-up since the renal biopsy of 53 months. In 138 KT we evaluated the peripheral blood NK cell immunophenotyping and its value as a prognostic biomarker. Results Graft survival was worse in ABMR-KT at the end of follow-up (p&lt;0.001) independently of DSA detection (p=0.63). Regarding NK cell immunophenotyping, we observed a lower proportion and absolute NK cell count in ABMR+DSA+-KT and ABMR+DSA--KT compared with ABMR-DSA--KT (p=0.027, p=0.017). ABMR+DSA+-KT showed higher proportion of NKG2A+ NK cells compared with ABMR-DSA--KT (p=0.007). All ABMR+ patients, independently of DSA detection, presented lower absolute NKG2A- NK cell count in comparison with ABMR-DSA--KT (p=0.001, p=0.017). Finally, a proportion of NKG2A- &lt;30% was associated with lower graft survival 36 months after graft biopsy with ABMR (p=0.067) (Figure). Conclusion Graft survival is worse in ABMR+ compared with ABMR- KT independently of DSA detection. Kidney transplant recipients with ABMR show reduced peripheral absolute numbers of NK cells and NKG2A- NK cells regardless of undetectable DSA. This NK cell phenotype associated with a worse medium-term graft survival in cases with ABMR.

MO014BORDERLINE T-CELL REJECTION IN RENAL TRANSPLANTATION: ARE WE AWARE OF THE REAL IMPACT IN GRAFT SURVIVAL?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Carolina Figueiredo ◽  
Rita Leal ◽  
Clara Pardinhas ◽  
Filipe Mira ◽  
Luís Rodrigues ◽  
...  
Keyword(s):  
T Cell ◽  
Kidney Transplant ◽  
Graft Survival ◽  
Small Sample ◽  
Conservative Approach ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Survival Curves ◽  
Mean Time

Abstract Background and Aims Histological findings that meet criteria for borderline changes “suspicious” for acute T cell mediated rejection (BR) as defined by the Banff Classification (2017) are frequently seen. However, its clinical significance, as well as the appropriate clinical management, are still controversial. Our goal was to compare clinical outcomes of kidney transplant recipients with biopsy proven BR versus acute T cell mediated rejection (aTCMR) and the influence of treating BR rejection in graft outcomes. Method A retrospective cohort study was performed in all kidney transplant recipients with biopsy proven BR and aTCMR between January 2012 and December 2018. Data related to donor and recipient demographics, treatment and subsequent evolution of serum creatinine, proteinuria and graft survival were collected. Mean time at follow up was 31.2 ± 29.1 months. Results We included 91 patients with biopsy proven T cell rejection of which 34 (37.4%) had a BR and 57 (62.6%) aTCMR: 39 (68.4%) IA, 9 (15.8%) IB, 7 (28.1%) IIA and 2 (3.5%) IIB. There was no difference between groups (BR vs aTCMR) regarding age (45,5 vs 48,1, p=0,38), sex (male 73% vs 60%, p=0,27) or race (Caucasian 100% vs 93%, p=0.114). For both groups, deceased donor was more frequent (82% vs 95%, p=0.074), and there was no difference in cytotoxic PRA (mean 4.5 ± 9.2 vs 3.7 ± 12.8, p=0.762) or number of compatibilities (mean 2.2 ± 1.2 vs 2.4 ± 1.3, p=0.539). At the time of rejection diagnosis, the mean time of transplant was similar between groups (32.9 ± 43.6 vs 42.3 ± 67.4 months, p=0.467), but estimated glomerular filtration rate (GFR) was significantly higher in patients with BR when compared to aTCMR (32.0 ± 22.5 vs 19.9 ± 13.1 ml/min/1.73m2, p=0.009). We found no significant difference in proteinuria at the time of biopsy between the 2 groups. Treatment with steroids was started in 20 (58.8%) patients with BR and all the patients with aTCMR were treated with steroids with or without thymoglobulin, depending on the Banff class. Fourteen (41.2%) patients with BR were followed closely with no acute interventions. At 1-year post biopsy, graft survival was 70%, and we found no significantly statistical difference between the two groups (79.4% vs 64.3%, p=0.129). In patients with preserved graft, there was no difference in GFR (41.9 ± 17.7 vs 37.7 ± 19.8, p=0.401) at 12 months post biopsy for both groups. When performing Kaplan-Meyer survival curves at follow-up, we also found no difference between BR and aTCMR (57.6 ± 7.1 vs 43.6 ± 5.5 months, p=0.157) (Figure 1). When analyzing the BR group (N=34) and comparing the patients that were treated (N=20) versus the patients with conservative approach (N=14), we found no difference in demographic features, sCr at biopsy (3.0 ± 1.1 vs 2.8 ± 2.1 mg/dl, p=0.696) and time post-transplant (28.1 ± 43.2 vs 39.7 ± 44.8 months, p=0.454). Graft survival at 1-year was 80% for treated patients and 79% for non-treated patients, p=0.919 and GFR for patients with preserved graft was not different between groups (43.9 ± 21.0 vs 39.7 ± 13.5 ml/min/1.73m2, p=0.572). When performing survival curves, we found that treated patients had almost the double time with functioning graft compared to non-treated patients (71.9 ± 8.5 vs 41.3 ± 6.2 months, p=0.104), although not statistically different probably due to the small sample size (figure 2). Conclusion Our study showed that despite having better GFR at time of biopsy, patients with BR (overall and treated) did not present better graft survival nor graft function at 1 year post biopsy or at follow up, compared with aTCMR. We also found a tendency to better graft survival in patients with BR treated with steroids compared with conservative approach. These results reinforce the importance of borderline rejection in graft outcomes and that the decision of whether to treat or not can influence long-term outcomes.

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