Use of 12-Month Renal Function and Baseline Clinical Factors to Predict Long-Term Graft Survival

2012 ◽  
Vol 93 (2) ◽  
pp. 172-181 ◽  
Author(s):  
Mark A. Schnitzler ◽  
Krista L. Lentine ◽  
David Axelrod ◽  
Adrian Gheorghian ◽  
Min You ◽  
...  
Keyword(s):  
Renal Function ◽  
Graft Survival ◽  
Clinical Factors

Early measurement of interstitial fibrosis predicts long-term renal function and graft survival in renal transplantation

1996 ◽  
Vol 83 (8) ◽  
pp. 1082-1085 ◽  
Author(s):  
M. L. Nicholson ◽  
T. A. McCulloch ◽  
S. J. Harper ◽  
T. J. Wheatley ◽  
C. M. Edwards ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Transplantation ◽  
Graft Survival ◽  
Interstitial Fibrosis ◽  
Early Measurement

The First Year Renal Function as a Predictor of Long-Term Graft Survival After Kidney Transplantation

2009 ◽  
Vol 41 (2) ◽  
pp. 648-650 ◽  
Author(s):  
I. Helal ◽  
E. Abderrahim ◽  
F. Ben Hamida ◽  
M. Ounissi ◽  
S. Essine ◽  
...  
Keyword(s):  
Renal Function ◽  
Kidney Transplantation ◽  
Graft Survival ◽  
First Year

scholarly journals Preimplantation Biopsy Predicts Delayed Graft Function, Glomerular Filtration Rate and Long-Term Graft Survival of Transplanted Kidneys

2016 ◽  
Vol 2 (1) ◽  
pp. pocj.5000192
Author(s):  
José A. Pedroso ◽  
Konstantinos Giannakakis ◽  
Evaldo Favi ◽  
Maria P. Salerno ◽  
Gionata Spagnoletti ◽  
...  
Keyword(s):  
Renal Function ◽  
Graft Survival ◽  
Patient Survival ◽  
Interstitial Fibrosis ◽  
Graft Function ◽  
Histological Finding ◽  
Delayed Graft Function ◽  
Increased Risk ◽  
Preimplantation Biopsy

Background The predictive value of preimplantation biopsies for long-term graft function is often limited by conflicting results. The aim of this study was to evaluate the influence of time-zero graft biopsy histological scores on early and late graft function, graft survival and patient survival, at different time points. Methods We retrospectively analyzed 284 preimplantation biopsies at a single center, in a cohort of recipients with grafts from live and deceased donors (standard and nonstandard), and their impact in posttransplant renal function after a mean follow-up of 7 years (range 1–16). Implantation biopsy score (IBS), a combination score derived from 4 histopathological aspects, was determined from each sample. The correlation with incidence of delayed graft function (DGF), creatinine clearance (1st, 3rd and 5th posttransplant year) and graft and patient survival at 1 and 5 years were evaluated. Results Preimplantation biopsies provided somewhat of a prognostic index of early function and outcome of the transplanted kidney in the short and long term. In the immediate posttransplantation period, the degree of arteriolosclerosis and interstitial fibrosis correlated better with the presence of DGF. IBS values between 4 and 6 were predictive of worst renal function at 1st and 3rd years posttransplant and 5-year graft survival. The most important histological finding, in effectively transplanted grafts, was the grade of interstitial fibrosis. Patient survival was not influenced by IBS. Conclusions Higher preimplantation biopsy scores predicted an increased risk of early graft losses, especially primary nonfunction. Graft survival (at 1st and 5th years after transplant) but not patient survival was predicted by IBS.

scholarly journals The Power of Renal Function Estimation Equations for Predicting Long-Term Kidney Graft Survival

Medicine ◽  
2016 ◽  
Vol 95 (7) ◽  
pp. e2682 ◽  
Author(s):  
Hoon Young Choi ◽  
Dong Jin Joo ◽  
Mi Kyung Song ◽  
Myoung Soo Kim ◽  
Hyeong Cheon Park ◽  
...  
Keyword(s):  
Renal Function ◽  
Graft Survival ◽  
Kidney Graft ◽  
Function Estimation ◽  
Estimation Equations

scholarly journals Use of a Processed Hematopoietic Stem Cell Product (FCRx) in Unmatched Related and Unrelated Donor — Recipient Pairs Is Associated with High Levels of Donor Chimerism and Donor-Specific Tolerance to Kidney Allografts

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 202-202
Author(s):  
Joseph R. Leventhal ◽  
John P. Galvin ◽  
James Mathew ◽  
Lorenzo Gallon ◽  
Kadiyala Ravindra ◽  
...  
Keyword(s):  
Renal Function ◽  
Stem Cell ◽  
Autoimmune Disease ◽  
Graft Survival ◽  
Graft Versus Host Disease ◽  
Living Donor ◽  
Standard Of Care ◽  
Graft Versus Host ◽  
Patient And Graft Survival

Abstract The prospect of eliminating the long term costs and side effects of drug-based immunosuppression (IS) is a compelling reason to pursue the establishment of transplant tolerance. Tolerance in kidney transplant (KTx) recipients has been achieved through the infusion of donor HSC under some form of conditioning. The increased upfront cost and intensive treatment required by tolerance induction protocols demands that the long term outcomes be superior to that achieved with SOC IS regimens. Since 2009 we have conducted a Phase 2 trial of combined stem cell/living donor kidney transplantation in mismatched and unrelated subjects where the stated goal has been the establishment of durable donor macrochimerism. Our protocol is based upon tolerogenic CD8+/TCR-facilitating cells (FCRx) and 200 cGy TBI-based nonmyeloablative conditioning. Recipients were conditioned with fludarabine (30mg/m2/dose, days -5,-4,-3), cyclophosphamide (50mg/kg/dose, day-3 and+3), 200 cGy TBI (day-1) followed by a living donor KTx (day0). A G-CSF mobilized peripheral blood mononuclear cell product was apheresed from the donor >2 weeks pre-KTx, processed to remove graft-versus-host disease (GVHD)-producing cells yet retain CD34 + cells and FC, and cryopreserved until administration day+1 post-KTx. MMF and tacrolimus-based immunosuppression (IS) was weaned and discontinued at 1 year if chimerism, normal renal function and normal KTx biopsy were noted. 37 subjects were transplanted between 2009 and 2016. 17 of 37 subjects were transplanted from 0-2 of 6 HLA matched unrelated donors. 26 of 37 subjects achieved high levels of durable donor chimerism and have been removed from all immunosuppression (7-95 months). Durably chimeric subjects show normal yearly protocol biopsies at 6 months, 12 months, and yearly thereafter, while standard of care patients begin to show abnormal biopsies and deterioration of renal function as early as 24 months post-transplant. Among the 26 subjects who were removed from immunosuppression, none have experienced biopsy proven acute rejection, none have lost chimerism, and none have had to have immunosuppression resumed. Patient and graft survival at 5 years post-transplant are similar to standard of care (SOC) subjects. Two cases of graft-versus-host disease (GVHD) have occurred (6% incidence). One subject experienced grade 2 GVHD that responded to therapy and was successfully removed from all immunosuppression. One subject experienced steroid unresponsive grade 3-4 GVHD resulting in death. Among 7 durably chimeric subjects who had an underlying autoimmune disease that caused their renal failure, none have experienced recurrence of the autoimmune disease (expected rate of recurrence 40-60%). In summary, patient and graft survival at five years was comparable between FCRx and SOC pts. Tolerant FCRx subjects had significantly better renal function than SOC. Medical therapy for hypertension and hyperlipidemia was more common in SOC than tolerant FCRx pts. We conclude there are significant long-term medical benefits to establishing tolerance in KTx recipients using the FCRx approach that become apparent within < 5 years. Disclosures Horwitz: Gamida Cell: Research Funding. Ildstad:Regenerex, LLC: Equity Ownership, Other: CEO.

scholarly journals Influence of CYP3A5 Genetic Polymorphism on Long-Term Renal Function in Chinese Kidney Transplant Recipients Using Limited Sampling Strategy and Abbreviated Area Under the Curve for Tacrolimus Monitoring

2020 ◽  
Vol 30 (3) ◽  
pp. 249-253
Author(s):  
Chi Yuen Cheung ◽  
Koon Ming Chan ◽  
Yuen Ting Wong ◽  
Wai Leung Chak ◽  
Otto Bekers ◽  
...  
Keyword(s):  
Renal Function ◽  
Acute Rejection ◽  
Opportunistic Infection ◽  
Graft Survival ◽  
Area Under The Curve ◽  
Kidney Transplants ◽  
Cyp3a5 Genotype ◽  
Significant Difference ◽  
Tacrolimus Dose

Introduction: Although the association between CYP3A5 gene polymorphism and tacrolimus dosing requirements was well established, the impact on how CYP3A5 genotype affects the acute rejection and long-term renal function in patients who received kidney transplants and were treated with tacrolimus remained controversial. Design: Sixty-seven Chinese patients with kidney transplants receiving de novo tacrolimus-based immunosuppressive therapy with known CYP3A5 genotype were divided into 2 groups. Those with at least 1 CYP3A5*1 allele were CYP3A5 expressers while homozygotes for the mutant allele CYP3A5*3 were nonexpressers. Instead of trough level, our center used abbreviated area under the curve for tacrolimus monitoring. Primary outcome was the long-term renal function between both groups while secondary outcomes included the weight-adjusted daily tacrolimus dose, graft survival, incidence of biopsy-proven acute rejection (BPAR), opportunistic infection, and cancer. Results: Thirty-five (52.2%) patients were CYP3A5 expressers while 32 were nonexpressers. Mean daily tacrolimus dose in the CYP3A5 expressers and nonexpressers was 0.08 (0.03) and 0.05 (0.02) mg/kg, respectively ( P < .01). Starting from 1-month posttransplant, the renal function was comparable between both groups, which persisted up to 10-year. Ten patients experienced BPAR rejection and there was no significant difference in the rejection-free survival between both groups ( P = .87). There was also no significant difference in the death-censored graft survival between both groups ( P = .86). Finally, the incidence of opportunistic infection and posttransplant cancer was similar between them. Discussion: There was no significant difference in renal function, graft survival, and acute rejection between CYP3A5 expressers and nonexpressers.

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