scholarly journals MO968ROUTINE BIOMARKERS FOR THE SEVERITY OF COVID-19 PNEUMONIA MAY PRESENT DIFFERENTLY IN KIDNEY TRANSPLANT RECIPIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Elena Burgos García ◽  
Maria Molina Gomez ◽  
Judit Cacho ◽  
Francisco Javier Juega Mariã‘o ◽  
Laura Cañas Sole ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Ferritin Level ◽  
Clinical Status ◽  
Inflammatory Biomarkers ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Inflammatory Parameters ◽  
Significant Difference ◽  
D Dimer ◽  
Comparative Activity

Abstract Background and Aims The treatment of coronavirus disease (COVID-19) is based on the patient’s clinical status and levels of inflammatory biomarkers. The comparative activity of these biomarkers in KT patients with COVID-19 pneumonia from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and non-SARS-CoV-2 aetiologies is unknown. The aim of this study was to compare the clinical presentation and inflammatory parameters at admission of KT patients with COVID-19 pneumonia and those with non-COVID-19 pneumonia over the same period. Method Biomarkers were measured and compared between KT patients with COVID-19 pneumonia (n=42) and non-COVID-19 pneumonia (n=18) from March to November 2020. Results Both groups showed comparable demographics. The COVID-19 KT patients had fewer neutrophils (4,650 [2,925-9,498] vs. 9,100 [7,170-11,150],p=0.01) than the non-COVID group, although there was no significant difference in the lymphocyte count. Non-COVID-19 pneumonia was associated with a higher d-dimer (962 [427-1,448] vs. 1,704 [868-2,481],p=0.09) and IL-6 (37 [23-10] vs 254 [53-602],p=0.006) levels. The ferritin level was higher in the COVID-19 group (908 [496-1,377] vs. 340 [264-785],p=0.008). Conclusion COVID-19 pneumonia in KT recipients shows a different presentation of inflammatory biomarkers than other non-COVID pneumonias. It could be usefully to identify KT patients with COVID-19.More detailed studies are necessary to understand the presentation of biomarkers in KT with COVID-19.

scholarly journals Tuberculosis Characterization in a Special Population of Kidney Transplant Recipients

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Barbara Reis-Santos ◽  
Ethel Leonor Noia Maciel
Keyword(s):  
Kidney Transplant ◽  
Clinical Presentation ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Careful Evaluation ◽  
Tb Control ◽  
Health History ◽  
Sociodemographic Data ◽  
Clinical Records ◽  
Active Disease

Setting. Tuberculosis clinical presentation is not typical in kidney transplant recipients and the diagnosis of active disease is usually delayed. Objective. To characterize tuberculosis presentation in Brazilian's kidney transplant recipients. Study Design. We analyzed the clinical records of tuberculosis cases regarding sociodemographic data and health history. Results. Thirteen TB cases were identified among 843 transplant recipients. The average time for TB development after transplantation was 4 years. Eight subjects presented pulmonary disease, seven patients required hospitalization Alertness to the possibility of TB and the careful evaluation for possible TB of all kidney transplant recipients with unexplained is vital, as is the related work of transplant and TB control teams and four died as a consequence of TB. Conclusion. The severe consequences of TB in posttransplantation can become critical.

scholarly journals Coronavirus disease 2019 in kidney transplant recipients: a systematic review and meta-analysis

2021 ◽  
Author(s):  
QY Ho ◽  
R Sultana ◽  
TL Lee ◽  
S Thangaraju ◽  
T Kee ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Clinical Presentation ◽  
Meta Analysis ◽  
Kidney Injury ◽  
High Dose ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Presenting Symptoms ◽  
Effect Of Treatment ◽  
Dose Corticosteroid

Introduction: The clinical presentation and outcomes of coronavirus disease 2019 (COVID-19) in kidney transplant recipients (KTRs) have not been well studied. Methods: We performed a meta-analysis to examine the presenting features, outcomes and the effect of treatment on outcomes of KTRs with COVID-19. Database search was performed up to 5 September 2020 through PubMed, EMBASE, Web of Science, SCOPUS, and CENTRAL. Results: Overall, 23 studies (1373 patients) were included in the review and meta-analysis. The most common presenting symptoms included fever (74.0%, 95% confidence interval [CI] 65.3–81.1), cough (63.3% 95% CI 56.5–69.6) and dyspnoea (47.5%, 95% CI 39.6–55.6). Pooled rates of mortality and critical illness were 21.1% (95% CI 15.3-28.4) and 27.7% (95% CI 21.5–34.8) respectively. Acute kidney injury occurred in 38.9% (95% CI 30.6–48.1) and dialysis was required in 12.4% (95% CI 8.3–18.0) of the cases. Discussion: KTRs with COVID-19 have a similar clinical presentation as the general population but have higher morbidity and mortality. It is uncertain whether high dose corticosteroid or hydroxychloroquine reduces the risks of mortality in KTRs with COVID-19.

Comparison between kidney and liver transplant recipients admitted to a referral center regarding coronavirus-2019 manifestations in the Northeast of Iran during three peaks of pandemic

2021 ◽  
Vol 17 ◽  
Author(s):  
Mohsen Aliakbarian ◽  
Rozita Khodashahi ◽  
Mahin Ghorban Sabbagh ◽  
Hamid Reza Naderi ◽  
Mandana Khodashahi ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
High Risk ◽  
Liver Transplant ◽  
Severe Infection ◽  
Clinical Findings ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Cross Sectional ◽  
Significant Difference ◽  
Liver Transplant Recipients

Background: Transplant recipients are at high risk for severe Coronavirus disease-2019 (COVID-19). Transplant recipients are immune-compromised individuals at high risk for severe infection. This study aimed to compare the presentations and outcomes of liver and kidney transplant recipients who were infected with COVID-19 in the Iranian population. Methods: This cross-sectional study was conducted at Imam Reza and Montaserieh Hospitals affiliated with Mashhad University of Medical Sciences, Mashhad, Iran, between 2020 and 2021. In general, 52 patients were selected and divided into two groups of the kidney (n=28) and liver (n=24) transplantation. Two groups were compared in terms of demographic characteristics and clinical findings. Results: Of 52 patients, severe COVID-19 infection was reported in 61% of the patients. There was no significant difference between the two groups in terms of symptoms, except for cough (χ2=8.09; P=0.004), clinical condition, and laboratory symptoms, except for creatinine (Z=14; P<0.005), alkaline phosphatase (Z=4.55; P=0.03), total bilirubin (Z=8.93; P=0.03), and partial thromboplastin time (Z=5.97; P=0.01). There was no relationship between the outcome and the use of immunosuppressive medications (P>0.05). All patients with kidney transplantation survived, while two cases in the liver transplantation group failed to survive (χ2=2.42; P=0.11). Conclusion: The mortality rate was higher in the liver transplant recipients, compared to the patients who underwent kidney transplantation.

scholarly journals Clinical Response and Pattern of B cell Suppression with Single Low Dose Rituximab in Nephrology

Kidney360 ◽  
2020 ◽  
Vol 1 (5) ◽  
pp. 359-367
Author(s):  
Jacob George ◽  
Sunu Alex ◽  
E.T. Arun Thomas ◽  
Noble Gracious ◽  
Nalanda S. Vineetha ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
B Cells ◽  
B Cell ◽  
Clinical Response ◽  
Low Dose ◽  
Clinical Status ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Cell Percentage ◽  
Steroid Dependent

BackgroundThere is no consensus regarding dose and frequency of rituximab in nephrology with extrapolation of doses used in treating lymphoproliferative disorders. There are no guidelines on targeting initial and subsequent doses on the basis of CD19+ B cells.MethodsInitially, 100 mg rituximab was given to 42 adults with steroid-dependent nephrotic syndrome (SDNS) and frequently relapsing nephrotic syndrome (FRNS), idiopathic membranous nephropathy (MN), and high-immunologic-risk kidney transplantation. Absolute and percentage levels of CD19 B cells and clinical status were assessed at baseline, days 30, 90, and 180, and at 1 year. Subsequent doses of rituximab were on the basis of CD19 B cell reconstitution and clinical response.ResultsCD19 B cell percentage decreased from 16.3 ± 7.6 to 0.3 ± 0.3 (P≤0.001), 1.9 ± 1.7 (P≤0.001), and 4.0 ± 4.5 (P=0.005) by 30, 90, and 180 days, respectively. Suppression of CD19 B cell count below 1% at days 30, 90, and 180 was seen in 40 of 42 (95.2%), 18 of 42 (42.9%), and 7 of 42 (16.7%) patients, respectively. Of 30 with SDNS and FRNS followed up for 1 year, 29 (96.7%) went into remission at day 30. Remission was sustained in 23 (76.6%) at day 180 and 21 (70%) at 1 year. There was a significant decrease (P<0.001) in the dose of steroids needed to maintain remission at 180 days after rituximab (0.27 ± 0.02 mg/kg to 0.02 ± 0.00 mg/kg). CD19 B cell percentage at 90 days correlated with relapse (P=0.001; odds ratio 1.42; 95% confidence interval, 1.25 to 2.57). Eighteen (60%) required an additional dose. Of five with MN, four achieved remission by 6 months, which was sustained in three by 1 year. Of the seven kidney transplant recipients, two had antibody-mediated rejections, although CD19 B cells were suppressed even at 1 year.ConclusionsLow-dose rituximab induces sustained depletion of CD19 B cells for up to 90 days. Its role in preventing relapses in SDNS, FRNS, MN, and rejection needs further study.

Hypothermic Machine Perfusion in DCD Kidney Transplantation: A Single Center Experience

2015 ◽  
Vol 96 (2) ◽  
pp. 148-151 ◽  
Author(s):  
Liyu Yao ◽  
Honglan Zhou ◽  
Yuantao Wang ◽  
Gang Wang ◽  
Weigang Wang ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Graft Function ◽  
Postoperative Recovery ◽  
Donation After Cardiac Death ◽  
Machine Perfusion ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Single Center Experience ◽  
Hypothermic Machine Perfusion ◽  
Significant Difference

Introduction: Donation after cardiac death (DCD) began in 2011 after the program hosted by the First Affiliated Hospital of Sun Yat-sen University in China. The aim of this study is to report on our experience regarding the method of preserving donated kidneys for DCD kidney transplantation. Material and Methods: A total of 37 donors and 73 primary kidney transplant recipients during the period 2011-2014 in the Urology Center of the First Hospital of Jilin University were enrolled in the study. Recipients were assigned to traditional static cold storage (SCS) group and hypothermic machine perfusion (HMP) group based on the preservation environment of donated kidneys after organ harvest. Clinical data were collected for each group. Result: The HMP group had a lower rate of delayed graft function (DGF), better postoperative recovery and kidney function compared with that of SCS group. There is no significant difference in postoperative rejection incidence between the 2 groups. Conclusions: DCD kidneys stored by hypothermic machine contribute to a lower rate of DGF and promoted the rehabilitation progress.

scholarly journals Clinical Presentation of Acute Pulmonary Embolism in Patients with Coronavirus Disease 2019 (COVID-19)

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Nonso Osakwe ◽  
Douglas Hart
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Distress Syndrome ◽  
Clinical Presentation ◽  
Clinical Status ◽  
Treatment Decision ◽  
Laboratory Findings ◽  
Anticoagulation Treatment ◽  
D Dimer

The clinical management of severely ill patients with COVID-19-related acute respiratory distress syndrome (ARDS) presents significant challenges. Many COVID-19 patients with ARDS also present with laboratory findings significant for derangement in coagulation function. In this report, we describe acute pulmonary embolism in three patients with COVID-19. We assessed the role of D-dimer assay and anticoagulation treatment in these patients. The aim of this case report is to increase awareness about the use of D-dimer in addition to patient’s clinical status for making treatment decision in COVID-19 patients.

STABIL-study: The Course of Therapy, Safety and Pharmacokinetic Parameters of Conversion of Prograf® to Tacrolimus HEXAL®/Crilomus® in Renal Transplant Recipients – an Observational Study in Germany

2021 ◽  
Vol 16 ◽  
Author(s):  
Lukas J. Lehner ◽  
Klaus Kalb ◽  
Karl Weigand ◽  
Ulrich Pein ◽  
Peter Schenker ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Safety Data ◽  
Quality Data ◽  
Tacrolimus Concentration ◽  
Pharmacokinetic Parameters ◽  
Therapeutic Drug ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Significant Difference

Background/Objective: Tacrolimus HEXAL®/Crilomus® is an approved generic immunosuppressant for the prevention and treatment of rejection following renal transplantation. For safe and socioeconomically efficient conversion from the innovator to generic formulation, high-quality data are necessary, in view of the different and country-specific comorbidities and pharmacokinetics in kidney transplant recipients. Patients and Methods: From 2014 to 2017, we enrolled 32 kidney transplant recipients, receiving newly prescribed Tacrolimus HEXAL®/Crilomus® in 5 German centers. Efficacy and safety data were collected over 6-8 months and retrospectively compared to the period prior to conversion. Results: The mean tacrolimus trough level was 4.91 ng/mL standard deviation (SD) (SD ±1.7) before and 5.06 ng/mL (SD ±1.97) after conversion. Mean tacrolimus trough concentration-dose-ratio (+/- SD) was 187.1 ng/mL/mg/kg/day (SD 99.2) for the reference and 205.1 ng/mL/mg/kg/day (SD 133) for the generic product, resulting in a non-significant difference of 18.0 ng/mL/mg/kg/day (SD 71.8) (p=0.84, Wilcoxon V=180). Overall, dosing had to be changed in 4 (14.8%) patients. Graft function remained stable and no rejections occurred. Conclusion: In conclusion, conversion to the generic tacrolimus formulation can be considered safe and feasible in long-term kidney transplant recipients in Germany. As suggested by guidelines, a vigilant therapeutic drug monitoring is recommended to account for possible tacrolimus concentration variability on the individual patient level.

scholarly journals Prophylactic or Early Use of Eculizumab and Graft Survival in Kidney Transplant Recipients With Atypical Hemolytic Uremic Syndrome in the United States: Research Letter

2021 ◽  
Vol 8 ◽  
pp. 205435812110037
Author(s):  
Richard A. Plasse ◽  
Stephen W. Olson ◽  
Christina M. Yuan ◽  
Lawrence Y. Agodoa ◽  
Kevin C. Abbott ◽  
...  
Keyword(s):  
Hemolytic Uremic Syndrome ◽  
Atypical Hemolytic Uremic Syndrome ◽  
Graft Loss ◽  
The United States ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Risk Of Death ◽  
Significant Difference ◽  
Early Use ◽  
Uremic Syndrome

Introduction: Among kidney transplant recipients (KTRs) with end-stage kidney disease (ESKD) due to atypical hemolytic uremic syndrome (aHUS), recurrence is associated with poor allograft outcomes. We compared graft and patient survival of aHUS KTRs with and without prophylactic/early use of eculizumab, a monoclonal antibody that binds complement protein C5, at the time of transplantation. Methods: We conducted a retrospective cohort study using the United States Renal Data System. Out of 123 624 ESKD patients transplanted between January 1, 2008, and June 1, 2016, we identified 348 (0.28%) patients who had “hemolytic uremic syndrome” as the primary cause of ESKD. We then linked these patients to datasets containing the Healthcare Common Procedure Coding System (HCPCS) code for eculizumab infusion. Patients who received eculizumab prior to or within 30 days of transplant represented the exposure group. We calculated crude incidence rates and conducted exact logistic regression, adjusted for recipient age and sex, for the study outcomes of graft loss, death-censored graft loss, and mortality. We also estimated the average treatment effect (ATE) by propensity-score matching, to reduce the bias in the estimated treatment effect on graft loss. Results: Our final study cohort included 335 aHUS KTRs (23 received eculizumab, 312 did not), with a mean duration of follow-up of 5.8 ± 2.7 years. There were no significant differences in baseline demographic and clinical characteristics between the eculizumab versus non-eculizumab group. Patients who received prophylactic/early eculizumab were less likely to experience graft loss compared with those who did not receive eculizumab (0% vs 20%, P = .02), with an adjusted odds ratio of 0.13 ( P = .02). In the propensity-score-matched sample, the ATE (eculizumab vs non-eculizumab) was −0.20 (95% confidence interval [CI] = −0.25 to −0.15, P < .001); thus, treatment was associated with an average of 20% reduction in graft loss. There was no significant difference in the risk of death between the 2 groups. Conclusions: Although there was no significant difference in the risk of death, prophylactic/early use of eculizumab was significantly associated with improved graft survival among aHUS KTRs. Given the high cost of eculizumab, randomized controlled trials are much needed to guide prophylactic strategies to prevent graft loss.

Evaluation of Weight-Based Dose During Transition From Immediate-Release to Extended-Release Tacrolimus in Kidney Transplant Recipients

2021 ◽  
pp. 089719002110210
Author(s):  
Mackenzie Magid ◽  
Scott Sanoff ◽  
Hui-Jie Lee ◽  
Zidanyue Yang ◽  
Jennifer Byrns
Keyword(s):  
Kidney Transplant ◽  
Extended Release ◽  
Immediate Release ◽  
Total Daily Dose ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Therapeutic Level ◽  
Release Formulation ◽  
Significant Difference ◽  
Dosing Strategies

Background: Manufacturer recommendations for conversion from immediate-release to extended-release tacrolimus, Envarsus XR®, suggests 80% of the total daily dose of the immediate-release formulation. This conversion has not consistently achieved therapeutic levels in the kidney transplant population. Objectives: To determine if a reliable weight-based dosing strategy could be utilized to transition kidney transplant patients from immediate-release to extended-release tacrolimus. This may help establish a safe protocol to guide transition between formulations. Methods: Retrospective, single-center study of adult kidney transplant recipients between July 2015 and December 2018. Excluded patients received dual organs, lacked appropriately drawn tacrolimus levels, or were prescribed interacting medications. Patients were identified by querying prescriptions for extended-release tacrolimus and chart review was performed to exclude any patients without sufficient follow-up after transition. Results: 30 patients who transitioned from immediate-release tacrolimus to tacrolimus XR were included in the final analysis. The median weight-based dose of tacrolimus XR that achieved a therapeutic level among the cohort was 0.158 mg/kg/day (Q1-Q3: 0.0587-0.221), which was about 80% of the original median weight-based immediate-release tacrolimus dose. Therapeutic dosing strategies were widely variable, represented by an R2 of 0.33 on linear regression. There was a statistically significant difference in median weight-based dosing strategies among patients of various racial backgrounds (p = 0.0148). Conclusions: A weight-based dose of tacrolimus XR could not reliably predict a therapeutic level among the total cohort due to the wide inter-patient variability. The median weight-based rate of conversion from immediate-release to extended-release tacrolimus was 80%.

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