scholarly journals MO964DEATH WITH GRAFT FUNCTION AMONG EGYPTIAN KIDNEY TRANSPLANT RECIPIENTS: A SINGLE CENTER EXPERIENCE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Mostafa Gamal ◽  
Ahmed Mohamed Salah ◽  
Yasser Hendy ◽  
Ayman Refaie
Keyword(s):  
Diabetes Mellitus ◽  
Causes Of Death ◽  
Graft Loss ◽  
Graft Function ◽  
First Year ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Serious Infections

Abstract Background and Aims Kidney transplantation is the optimal treatment of end stage renal disease (ESRD). Despite improvements in patient selection and management, every transplant carries risk of graft loss. Death with graft function (DWGF) is an important cause of long-term loss of grafts and patients. In this study, we investigated clinical characteristics and causes of DWGF among a cohort of 2953 Egyptian kidney transplant recipients. Method A total of 291 recipients who died with graft function (DWGF) were evaluated regarding causes and timing of death. Causes of death were investigated in different eras of immunosuppression; era 1 (1976-1995): steroid and azathioprine, era 2 (1996-2005): cyclosporine-based and era 3 (2006-2018): tacrolimus-based. Demographic data, original kidney disease, pre- and post-transplant co-morbidities, immunosuppression regimens, biopsy proven acute rejection episodes and graft function at last follow up were analyzed. Results Proportion of DWGF in total graft loss had changed over time. In our retrospective study, it decreases from 29.5% in era 1 to 13.7% in the most recent era of kidney transplantation. Most patients in DWGF group had diabetes mellitus, hypertension, frequently experienced more infections and more rejection episodes. cyclosporine-based immunosuppression was more prevalent. A total of 291 patients (9.9%) died with graft function. DWGF was responsible for 58.3% of a total of 499 deaths (figure 1). For this group of patients, median serum creatinine at last follow up was 1.7 mg/dl (range: 0.2 - 7 mg/dl). Out of 291 recipients who died with functioning graft, 53 patients (18.2%) died within the first year, 55 (18.9%) died within 1-5 years, 75 (25.8%) died within 5-10 years while 108 patients (37.1%) died after 10 years post transplantation. The majority of DWGF was secondary to cardio-vascular diseases (CVD) (30.9%) and serious infections (29.2%) (figure 2). Death due to malignancy was lowest within the first year (1.9%), increased thereafter but unexpectedly malignancy (22.2%) was the third main cause of death in the late period after transplantation (figure 3). Conclusion DWGF accounts for 24.5% of total graft loss. The most common cause is cardiovascular disease followed by serious infections. Pre-transplant diabetes mellitus, steroid dose and infections had most significant association with DWGF. Understanding different causes of death according to the time after transplantation is mandatory in order to improve the long-term outcomes.

scholarly journals Trends in the Causes of Death among Kidney Transplant Recipients in the United States (1996–2014)

2018 ◽  
Vol 48 (6) ◽  
pp. 472-481 ◽  
Author(s):  
Ahmed A. Awan ◽  
Jingbo Niu ◽  
Jenny S. Pan ◽  
Kevin F. Erickson ◽  
Sreedhar Mandayam ◽  
...  
Keyword(s):  
United States ◽  
Kidney Transplant ◽  
Cardiovascular Mortality ◽  
Causes Of Death ◽  
Graft Loss ◽  
Graft Function ◽  
The United States ◽  
Mortality Data ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

Background: Death with graft function remains an important cause of graft loss among kidney transplant recipients (KTRs). Little is known about the trend of specific causes of death in KTRs in recent years. Methods: We analyzed United States Renal Data System data (1996–2014) to determine 1- and 10-year all-cause and cause-specific mortality in adult KTRs who died with a functioning allograft. We also studied 1- and 10-year trends in the various causes of mortality. Results: Of 210,327 KTRs who received their first kidney transplant from 1996 to 2014, 3.2% died within 1 year after transplant. Cardiovascular deaths constituted the majority (24.7%), followed by infectious (15.2%) and malignant (2.9%) causes; 40.1% of deaths had no reported cause. Using 1996 as the referent year, all-cause as well as cardiovascular mortality declined, whereas mortality due to malignancy did not. For analyses of 10-year mortality, we studied 94,384 patients who received a first kidney transplant from 1996 to 2005. Of those, 22.1% died over 10 years and the causative patterns of their causes of death were similar to those associated with 1-year mortality. Conclusions: Despite the downtrend in mortality over the last 2 decades, a significant percentage of KTRs die in 10-years with a functioning graft, and cardiovascular mortality remains the leading cause of death. These data also highlight the need for diligent collection of mortality data in KTRs.

P1638EARLY RENAL FUNCTION TRAJECTORIES, CYTOMEGALOVIRUS SEROSTATUS AND LONG-TERM GRAFT OUTCOMES IN KIDNEY TRANSPLANT RECIPIENTS: A BAYESIAN ANALYSIS STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Jonathan Law ◽  
Richard Borrows ◽  
David McNulty ◽  
Adnan Sharif ◽  
Charles Ferro
Keyword(s):  
Kidney Transplant ◽  
Graft Loss ◽  
Smooth Curve ◽  
Rapid Progression ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Short Term ◽  
Allograft Function

Abstract Background and Aims Despite significant improvements in short-term kidney transplant survival, long-term graft survival has not improved to the same degree with transplant failure being a top four cause of end-stage renal disease. We previously showed in a prevalent kidney transplant population that most patients do not experience linear renal function trajectories1. Many, instead, have periods of stability whilst others experience rapid progression. We also showed that episodes of rapid progression are associated with graft loss. Understanding trajectories of kidney allograft function is, therefore, key to defining the mechanisms underpinning allograft dysfunction. In this study, we evaluated the allograft function trajectories and associated factors, in an unselected, incident population of kidney allograft recipients in the early period post-transplantation. We also investigate whether episodes of rapid progression or non-progression are associated with graft loss in an extended follow-up period Method Demographic and clinical data were obtained from electronic health records. We used Bayesian smoothing techniques1 to create 10,000 Monte Carlo sample curves for 310 kidney transplant recipients for estimated glomerular filtration rates from 3-27 months after transplantation. This technique produces a smooth curve for each patient that reflects the gradual, longer term changes in eGFR values, rather than the rapid, short-term changes because of clinical and biologic variation as well as other interference including measurement error. The estimated trajectory is a smooth curve, allowing its slope to be calculated month by month. The probability of having an episode of rapid progression (decline greater than 5 ml/min/1.73m2/year in any 1-month period) and non-progression (decline no greater than -1ml/min/1.73m2/year) were calculated. Overall follow-up period was 8 years. Factors associated with having an episode of rapid progression, non-progression, and associations with long-term graft loss were explored. Results A median of 54 eGFR measurements per patient were available from 3-27 months for analysis. 65 patients (21%) had a probability of rapid progression greater than 0.8. During the follow-up period, 34 patients (11%) lost their graft. In multivariable Cox Proportional Hazard analysis, a probability greater than 0.8 of rapid progression was associated with long-term death-censored graft loss (Hazard ratio, 2.17; 95% CI, 1.04-4.55). In separate multivariable logistic regression models, cytomegalovirus serostatus donor positive to recipient positive (Odds ratio [OR], 3.82; 95% CI 1.63-8.97), CMV donor positive (OR 2.06; 95% CI 1.15-3.68), and CMV recipient positive (OR 2.03; 95% CI 1.14-3.60) were associated with having a greater than 0.8 probability of an episode of rapid progression. Having a probability greater than 0.8 of non-progression was not associated graft loss. Conclusion Early episodes of rapid progression are associated with long-term death-censored graft loss and are associated with cytomegalovirus seropositivity. Possible mechanisms include adverse cytomegalovirus-related immunomodulatory effects resulting in increased infections, glomerular injury and allograft vasculopathy. Further investigation into these factors may yield potentially modifiable risk factors and improve graft survival.

Comparison of Alemtuzumab Versus Basiliximab Induction Therapy in Elderly Kidney Transplant Recipients: A Single-Center Experience

2019 ◽  
pp. 089719001985093
Author(s):  
Idris Yakubu ◽  
Bharath Ravichandran ◽  
Tracy Sparkes ◽  
Rolf N. Barth ◽  
Abdolreza Haririan ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Graft Loss ◽  
Survival Rates ◽  
Optimal Choice ◽  
First Year ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Risk Of Death ◽  
Single Center Experience

Background: The optimal choice of induction immunosuppression for elderly kidney transplant recipients remains unclear. Although alemtuzumab has been associated with escalating risk of death and graft loss in this population, this risk has not been adequately explored. The purpose of this study was to compare the safety and efficacy of alemtuzumab with basiliximab induction in this population. Methods: This is a retrospective matched cohort study of kidney transplant recipients aged ≥65 years. Patients who received alemtuzumab induction were matched (1:2) to a basiliximab control. The primary outcome was allograft survival. The incidence of acute rejection, infection, and all-cause mortality was measured. Results: Fifty-one and 102 patients were included in the alemtuzumab and basiliximab groups, respectively. Baseline demographics were similar between groups, except for more living donor transplant recipients in the alemtuzumab group (26/51 [51%] vs 31/102 [30.4%], P = .02). Acute cellular rejection occurred more frequently within the first year in the basiliximab group ( P = .02). There was no difference in rates of infection within the first year. Graft and patient survival rates were similar over the follow-up period. Patients receiving basiliximab had a higher glomerular filtration rate at 2 years posttransplant (59 mL/min/1.73 m2 vs 49 mL/min/1.73 m2, P = .03). Conclusions: Alemtuzumab induction is associated with similar outcomes to basiliximab in elderly kidney transplant recipients.

scholarly journals BK virus infection and outcome following kidney transplantation in childhood

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
James McCaffrey ◽  
Vijesh J. Bhute ◽  
Mohan Shenoy
Keyword(s):  
Virus Infection ◽  
Kidney Transplant ◽  
Graft Function ◽  
Clinical Intervention ◽  
Bk Virus ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Younger Age

AbstractBK virus associated nephropathy (BKN) is an important cause of kidney allograft failure. In a cohort of paediatric kidney transplant recipients, we aimed to understand the incidence and clinical outcome associated with BKN, as well as identify risk factors for BKN and BK viraemia development. We retrospectively analysed all patients who received a kidney transplant and received follow up care in our centre between 2009–2019. Among 106 patients included in the study (mean follow up 4.5 years), 32/106 (30.2%) patients experienced BK viraemia. The incidence of BKN was 7/106 (6.6%). The median time of BK viraemia development post-transplant was 279.5 days compared to 90.0 days for BKN. Development of BKN was associated with younger age at transplantation (p = 0.013). Development of BK viraemia was associated with negative recipient serology for cytomegalovirus (CMV) at time of transplantation (p = 0.012) and a higher net level of immunosuppression (p = 0.039). There was no difference in graft function at latest follow up between those who experienced BKN and those without BKN. This study demonstrates that BK virus infection is associated with younger age at transplantation, CMV negative recipient serostatus and higher levels of immunosuppression. Judicious monitoring of BK viraemia in paediatric transplant recipients, coupled with timely clinical intervention can result in similar long-term outcomes for BKN patients compared to controls.

scholarly journals Long-Term Outcomes after Acute Rejection in Kidney Transplant Recipients: An ANZDATA Analysis

2019 ◽  
Vol 30 (9) ◽  
pp. 1697-1707 ◽  
Author(s):  
Philip A. Clayton ◽  
Stephen P. McDonald ◽  
Graeme R. Russ ◽  
Steven J. Chadban
Keyword(s):  
Cardiovascular Disease ◽  
Acute Rejection ◽  
Kidney Transplant ◽  
Graft Loss ◽  
Graft Function ◽  
High Rate ◽  
Sensitivity Analyses ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

BackgroundDeclining rates of acute rejection (AR) and the high rate of 1-year graft survival among patients with AR have prompted re-examination of AR as an outcome in the clinic and in trials. Yet AR and its treatment may directly or indirectly affect longer-term outcomes for kidney transplant recipients.MethodsTo understand the long-term effect of AR on outcomes, we analyzed data from the Australia and New Zealand Dialysis and Transplant Registry, including 13,614 recipients of a primary kidney-only transplant between 1997 and 2017 with at least 6 months of graft function. The associations between AR within 6 months post-transplant and subsequent cause-specific graft loss and death were determined using Cox models adjusted for baseline donor, recipient, and transplant characteristics.ResultsAR occurred in 2906 recipients (21.4%) and was associated with graft loss attributed to chronic allograft nephropathy (hazard ratio [HR], 1.39; 95% confidence interval [95% CI], 1.23 to 1.56) and recurrent AR beyond month 6 (HR, 1.85; 95% CI, 1.39 to 2.46). Early AR was also associated with death with a functioning graft (HR, 1.22; 95% CI, 1.08 to 1.36), and with death due to cardiovascular disease (HR, 1.30; 95% CI, 1.11 to 1.53) and cancer (HR, 1.35; 95% CI, 1.12 to 1.64). Sensitivity analyses restricted to subgroups with either biopsy-proven, antibody-mediated, or vascular rejection, or stratified by treatment response produced similar results.ConclusionsAR is associated with increased risks of longer-term graft failure and death, particularly death from cardiovascular disease and cancer. The results suggest AR remains an important short-term outcome to monitor in kidney transplantation and clinical trials.

scholarly journals Indicators of monocyte-derived component of the immune system in patients with satisfactory renal graft function

2020 ◽  
Vol 22 (2) ◽  
pp. 53-62
Author(s):  
S. V. Zybleva ◽  
S. L. Zyblev
Keyword(s):  
Kidney Transplant ◽  
Negative Correlation ◽  
Graft Function ◽  
Control Group ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Post Transplant ◽  
Long Term Follow Up

Objective: to study the indicators of the monocyte-derived component of the immune system in kidney transplant recipients with satisfactory early and delayed renal transplant function. Materials and methods. The study involved 76 kidney transplant recipients. Concentrations of serum creatinine (sCr), serum urea (sUr) and serum cystatin C (sCysC) were measured. CD14+mid/high and CD14+low were isolated from CD14+ monocytes. CD64- and CD86-expressing cell counts were determined for each subpopulation. Immunological examination was performed before surgery, as well as at days 1, 3, 7, 30, 90, 180 and 360 after surgery. Results. There was significant imbalance between the two monocyte subpopulations before transplantation and in the early post-transplant period (first 3 months). By the end of a 6-month follow-up period, the percentage of CD14+ cells had normalized. The dynamics of the subclasses of CD86-expressing monocytes in the post-transplant period is somewhat different from the dynamics of the total count for these monocytes. However, by the end of a 6-month follow-up period, these biomarkers returned to normal for the group of healthy individuals (CD14+mid/highCD86+ p180 = 0.079; CD14+lowCD86+ p180 = 0.789). CD14+lowCD64+ level was significantly higher in the kidney transplant group than in the control group during the entire follow-up period (p0 = 0.0006, p1 = 0.0001, p7 = 0.005, p30 = 0.005, p90 = 0.007, p180 = 0.0002, p360 = 0.001). On the other hand, CD14+mid/highCD64+ count for up to 180 days was not significantly different from that of the control group (p0 = 0.561, p1 = 0.632, p7 = 0.874, p30 = 0.926, p90 = 0.912), with subsequent significant increase by day 360 of follow-up (p180 = 0.01, p360 = 0.003). We observed a negative correlation between CD14+lowCD86+ level at day 0 and sCr levels at day 7 (r = –0.4; p = 0.008) and day 360 (r = –0.34; p = 0.042) and sCysC level at day 7 (r = –0.57; p = 0.014). A negative correlation was also found between CD14+lowCD86+ at day 1 and sCr levels at day 7 (r = –0.4; p = 0.005) and day 360 (r = –0.39; p = 0.02). There was positive correlation between the CD14+lowCD64+ subpopulation index at day 0 and sCr (r = 0.54; p = 0.008) and sCysC (r = 0.6; p = 0.008) levels at day 7, and also between the CD14+lowCD64+ count at day 1 and sCr (r = 0.55; p < 0.0001) and sCysC (r = 0.58; p = 0.004) levels at day 7. CD14+mid/highCD64+ at day 0 negatively correlated with sCysC level at day 360 (r = –0.85; p = 0.015), while CD14+mid/highCD64+ at day 7 positively correlated with sCysC level at day 360 (r = 0.50; p = 0.016). Conclusion. Before transplant surgery, CD14+mid/high, CD14+mid/highCD86+ , and CD14+lowCD86+ counts were reduced, while those of CD14+low, CD14+mid/highCD64+ and CD14+lowCD64+ were increased. By the 6-month follow-up, all these subpopulations except CD14+mid/highCD64+ had reached values for healthy people. Positive correlation between CD14+mid/high, CD14+lowCD64+ , CD14+mid/highCD86+ , CD14+mid/highCD64+ counts in the early post-transplant period and sCr/sCysC levels in long-term follow-up, as well as negative correlation between CD14+low, CD14+lowCD86+ counts in the early post-transplant period and sCr/sCysC levels in long-term follow-up can serve as a predictor of renal graft function.

scholarly journals MP802RECURRENT URINARY TRACT INFECTIONS IN KIDNEY TRANSPLANT RECIPIENTS DURING THE FIRST YEAR INFLUENCE LONG TERM GRAFT FUNCTION

2017 ◽  
Vol 32 (suppl_3) ◽  
pp. iii729-iii729
Author(s):  
Francesco Pesce ◽  
Marida Martino ◽  
Tiziana Rollo ◽  
Marco Fiorentino ◽  
Simona Simone ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Kidney Transplant ◽  
Urinary Tract Infections ◽  
Graft Function ◽  
First Year ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Tract Infections

Long-term follow-up of polyneuropathy in diabetic kidney transplant recipients

Diabetes ◽  
1988 ◽  
Vol 37 (9) ◽  
pp. 1247-1252 ◽  
Author(s):  
J. A. Van der Vliet ◽  
X. Navarro ◽  
W. R. Kennedy ◽  
F. C. Goetz ◽  
J. J. Barbosa ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Diabetic Kidney ◽  
Long Term Follow Up

scholarly journals BK Polyomavirus Micro-RNAs: Time Course and Clinical Relevance in Kidney Transplant Recipients

Viruses ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 351
Author(s):  
Baptiste Demey ◽  
Véronique Descamps ◽  
Claire Presne ◽  
Francois Helle ◽  
Catherine Francois ◽  
...  
Keyword(s):  
Viral Replication ◽  
Kidney Transplant ◽  
Clinical Relevance ◽  
Graft Loss ◽  
First Year ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Post Transplantation ◽  
Bk Polyomavirus ◽  
Micro Rnas

Background: Kidney transplant recipients (KTRs) are exposed to a high risk of BK polyomavirus (BKPyV) replication, which in turn may lead to graft loss. Although the microRNAs (miRNAs) bkv-miR-B1-3p and bkv-miR-B1-5p are produced during the viral cycle, their putative value as markers of viral replication has yet to be established. In KTRs, the clinical relevance of the changes over time in BKPyV miRNA levels has not been determined. Methods: In a retrospective study, we analyzed 186 urine samples and 120 plasma samples collected from 67 KTRs during the first year post-transplantation. Using a reproducible, standardized, quantitative RT-PCR assay, we measured the levels of bkv-miR-B1-3p and bkv-miR-B1-5p (relative to the BKPyV DNA load). Results: Detection of the two miRNAs had low diagnostic value for identifying patients with DNAemia or for predicting DNAuria during follow-up. Seven of the 14 KTRs with a sustained BKPyV infection within the first year post-transplantation showed a progressive reduction in the DNA load and then a rapid disappearance of the miRNAs. DNA and miRNA loads were stable in the other seven KTRs. Conclusions: After the DNA-based diagnosis of BKPyV infection in KTRs, bkv-miR-B1-3p and bkv-miR-B1-5p levels in the urine might be valuable markers for viral replication monitoring and thus might help physicians to avoid an excessive reduction in the immunosuppressive regimen.

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