Comparative Effectiveness of Triple Immunosuppressive Therapy Versus Steroid Avoidance or Early Withdrawal Among Kidney Transplant Recipients Over Age 65.

: Kidney transplantation is a preferable treatment of children with end-stage kidney disease. All kidney transplant recipients, including pediatric need immunosuppressive medications to prevent rejection episodes and graft loss. : Induction therapy is used temporarily only immediately following transplantation while maintenance immunosuppressive drugs are started and given long-term. There is currently no consensus regarding the use of induction therapy in children; its use should be decided based on the immunological risk of the child. : The recent progress shows that the recommended strategy is to use as maintenance immunosuppressive therapy a combination of a calcineurin inhibitor (preferably tacrolimus) with an antiproliferative drug (preferably mycophenolate mofetil) with steroids that can be withdrawn early or late in low-risk children. The mTOR-inhibitors (sirolimus, everolimus) are used rarely in pediatrics because of common side effects and no evidence of a benefit over calcineurin inhibitors. The use of calcineurin inhibitors, mycophenolate, and mTOR-inhibitors should be followed by therapeutic drug monitoring. : Immunosuppressive therapy of acute rejection consists of high-dose steroids and/or anti-lymphocyte antibodies (T-cell mediated rejection) or plasma exchange, intravenous immunoglobulines and/or rituximab (antibodymediated rejection). : The future strategies for research are mainly precise characterisation of children needing induction therapy, more specific indications for mTOR-inhibitors and for the far future, the possibility to reach the immuno tolerance.

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P1762THE EFFECT OF IMMUNOSUPPRESSIVE THERAPY ON THE CLINICAL FOLLOW-UP OF BK VIRUS IN KIDNEY TRANSPLANT RECIPIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1762 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Gulay Yilmaz ◽

Volkan Polatkan ◽

Ebru Ozdemir ◽

Turker Erturk ◽

Emel Tatli ◽

...

Keyword(s):

Immunosuppressive Therapy ◽

Kidney Transplant ◽

Antiviral Treatment ◽

Immunosuppressive Treatment ◽

Bk Virus ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Group I ◽

The Mean

Abstract Background and Aims BK virus nephropathy occurs in up to 10% of kidney transplant recipients and can result in graft loss. The reactivation of BK virus is largely asymptomatic, and routine surveillance especially in the first 12-24 months after transplant is necessary for early recognition and intervention. Reduced immunosuppression and antiviral treatment in the early stages may be effective in stopping BK virus replication. This study is designed to investigate the effect of management in immunosuppressive therapy on BK virus titers and graft functions in our kidney transplant group. Method A total of 370 kidney transplant recipients between the ages of 18-69 years and receiving a triple immunosuppressive therapy (Tacrolimus+Mycophenoloic Acid+Prednisolone) were included in the study. Demographic characteristics, BK virus titers, serum creatinine and immunosuppressive drug (Tacrolimus, Everolimus) levels were measured at regular intervals in the first 24 months. Among these patients 43 of them were found to have BK virus positivity. At the time of the detection of BK virus positivity, patients were divided into three groups regarding the change in the immunosuppressive protocols: Group I: Tacrolimus + Everolimus + Prednisolone, Group II: Everolimus + Prednisolone, Group III: Tacrolimus + Prednisolone. BK virus titers and graft functions of all three groups were compared with each other. SPSS 15 for Windows was used for statistical analysis. Results The mean age of the patients was 45.3 years, and the mean duration of transplantation was 16.3 months at the time of the BK virus positivity. During the follow-up, mean Tacrolimus levels were found to be in their highest value (14.1 ng/mL) in the posttransplant three months while BK virus titer reached the highest value (1.1x106 copies/ml) in the posttransplant seven to nine months. Increased creatinine values two months after BK virus positivity were strongly correlated (p = 0.02, p = 0.008, p = 0.05, p = 0.002 at 6th, 9th, 12th and 24th months, respectively). A significant decrease in BK virus titers was observed in all three groups due to reductions in immunosuppressive treatment protocol (p = 0.005, p = 0.003, p = 0.028, in groups I, II, III respectively). Conclusion Our study favors the benefits of the prospective screening for BK virus to identify early viral replication, permit intervention, and prevent progression to nephropathy or allograft loss. The best studied treatment for BK viremia and nephropathy is careful reduction of immunosuppression

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Relationship between vitamin D status and immunosuppressive therapy in kidney transplant recipients

Biotechnology & Biotechnological Equipment ◽

10.1080/13102818.2014.995415 ◽

2015 ◽

Vol 29 (2) ◽

pp. 331-335 ◽

Cited By ~ 17

Author(s):

Jean Jeanov Filipov ◽

Borelli Kirilov Zlatkov ◽

Emil Paskalev Dimitrov ◽

Dobrin Svinarov

Keyword(s):

Vitamin D ◽

Immunosuppressive Therapy ◽

Kidney Transplant ◽

Vitamin D Status ◽

Transplant Recipients ◽

Kidney Transplant Recipients

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Clinical factors associated with graft fibrosis in kidney-transplant recipients on steroid-avoidance immunosuppression

Clinical Transplantation ◽

10.1111/j.1399-0012.2007.00786.x ◽

2007 ◽

Vol 22 (3) ◽

pp. 309-315 ◽

Cited By ~ 4

Author(s):

Raymond L. Heilman ◽

Harini A Chakkera ◽

Kunam S Reddy ◽

Thomas V Colby ◽

Adyr A Moss ◽

...

Keyword(s):

Kidney Transplant ◽

Transplant Recipients ◽

Clinical Factors ◽

Kidney Transplant Recipients ◽

Factors Associated ◽

Steroid Avoidance

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Psychological symptoms, quality of life and adherence to immunosuppressive therapy in kidney transplant recipients: a cross-sectional study

Journal of Kidney Care ◽

10.12968/jokc.2020.5.6.264 ◽

2020 ◽

Vol 5 (6) ◽

pp. 264-271

Author(s):

Ujjwal Dahiya ◽

Kamli Prakesh ◽

Sandeep Mahajan ◽

Nand Kumar

Keyword(s):

Quality Of Life ◽

Immunosuppressive Therapy ◽

Kidney Transplant ◽

Psychological Symptoms ◽

Cross Sectional Study ◽

Transplant Recipients ◽

Sectional Study ◽

Kidney Transplant Recipients ◽

Cross Sectional

Aim: To assess psychological symptoms, quality of life and adherence to immunosuppressive therapy in kidney transplant recipients. Design: Cross-sectional study was conducted in kidney transplant recipients. Methods: This cross-sectional study included a total of 96 consecutive patients at least 3 months after kidney transplantation from September 2019 to November 2019. Psychological symptoms (anxiety, stress and depression) were assessed using the Depression, Anxiety and Stress Scale. The World Health Organization Quality of Life Instrument was used to assess quality of life in kidney transplant recipients. Adherence to immunosuppressive therapy was assessed by the Morisky Green Levine (MGL) adherence scale. The demographic and clinical details were assessed with a validated self-structured questionnaire. Results: The study included a young adult male population with a mean age of 38.82±10.53 years. The majority of patients reported at least some psychological abnormalities, with mild stress being the most common and presenting in 73% of patients. Importantly, 29% and 21% of patients reported anxiety and depression. Stress was significantly associated with gender, post-transplantation infection and hospitalisation. Anxiety was significantly associated with low family income and post-transplant complication of infection. Psychological symptoms significantly affected the various domains of quality of life of the patients. None of the surveyed patients had low adherence, while 56 (58.3%) had medium adherence to immunosuppressive therapy. Patients with medium adherence to immunosuppressive therapy had significantly lower scores in physical (p=0.01) and social relationship (p= 0.004) domains of quality of life. Conclusion: A significant number of young and stable kidney transplant recipients have presented with psychological symptoms (mainly depression) that affected their quality of life. The presence of psychological symptoms can not only hamper quality of life, but also affect their compliance to drugs. Impact: Psychological health is an important concern after kidney transplantation. Nurses should include assessment of psychological symptoms in their care that would further help in improving quality of life and adherence to drugs in kidney transplant recipients.

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