scholarly journals SARS-CoV-2 Antibody Response in Patients Undergoing Kidney Transplantation

2021 ◽  
Author(s):  
Michelle Lubetzky ◽  
Ashely Sukhu ◽  
Zhen Zhao ◽  
Sophie Rand ◽  
Vijay Sharma ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Induction Therapy ◽  
Antibody Test ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Dialysis Patients ◽  
Antibody Testing ◽  
Post Transplant ◽  
Undergo Kidney Transplantation ◽  
Before And After

Abstract The response of the immune system to COVID-19 in end stage kidney disease patients who undergo kidney transplantation has yet to be described. We report data on 72 patients who underwent SARS-CoV-2 antibody testing both before and after kidney transplantation and were followed for a median of 186 days (range 83, 277). Of the 25 patients with a positive antibody test at the time of transplant, 17 (68%) remained positive after transplantation. Patients were significantly more likely to have a persistently positive test if they reported a symptomatic COVID-19 infection prior to transplant (p=0.01). SARS-CoV-2 IgG index values were measured in a subset of kidney transplant recipients and compared to wait -listed dialysis patients. These assays demonstrated a more significant decline in IgG (58% versus 14% p = 0.008) in transplant recipients when compared to dialysis patients tested during the same time period. Additional analysis of the quality of the immune response measuring the binding of SARS-CoV-2 antibodies to the receptor-binding domain (RBD binding), the antibody neutralizing capability, and the antibody avidity demonstrated a more pronounced effect when comparing pre-transplant values to post-induction therapy/post transplant values. The attenuated IgG response seen in transplant patients compared to dialysis patients after induction therapy requires further study. These data have important implications for post-transplant management of vaccinated dialysis patients.

scholarly journals Current Pharmacological Intervention and Medical Management for Diabetic Kidney Transplant Recipients

Pharmaceutics ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 413
Author(s):  
Theerawut Klangjareonchai ◽  
Natsuki Eguchi ◽  
Ekamol Tantisattamo ◽  
Antoney J. Ferrey ◽  
Uttam Reddy ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Pharmacological Intervention ◽  
Diabetic Patients ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Kidney Allograft ◽  
Post Transplant ◽  
Glucose Management

Hyperglycemia after kidney transplantation is common in both diabetic and non-diabetic patients. Both pretransplant and post-transplant diabetes mellitus are associated with increased kidney allograft failure and mortality. Glucose management may be challenging for kidney transplant recipients. The pathophysiology and pattern of hyperglycemia in patients following kidney transplantation is different from those with type 2 diabetes mellitus. In patients with pre-existing and post-transplant diabetes mellitus, there is limited data on the management of hyperglycemia after kidney transplantation. The following article discusses the nomenclature and diagnosis of pre- and post-transplant diabetes mellitus, the impact of transplant-related hyperglycemia on patient and kidney allograft outcomes, risk factors and potential pathogenic mechanisms of hyperglycemia after kidney transplantation, glucose management before and after transplantation, and modalities for prevention of post-transplant diabetes mellitus.

FC 124PATTERNS OF RENAL OSTEODYSTROPHY ONE YEAR AFTER KIDNEY TRANSPLANTATION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Hanne Skou Jørgensen ◽  
Geert Behets ◽  
Patrick D'Haese ◽  
Pieter Evenepoel
Keyword(s):  
Kidney Transplantation ◽  
Bone Turnover ◽  
Kidney Transplant ◽  
Renal Osteodystrophy ◽  
Bone Disease ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Post Transplant ◽  
Steroid Dose ◽  
Bone Biopsies

Abstract Background and Aims Bone disease after kidney transplantation is an issue of growing concern, as prolonged graft survival and older age of recipients necessitate focus on long-term health burdens such as osteoporosis and fractures. Pre-existing type of renal osteodystrophy, post-transplant immunosuppressive treatment, and de novo disturbances of mineral metabolism all contribute to bone disease in kidney transplant recipients. The current pattern of renal osteodystrophy after kidney transplantation is not well characterized. This study reports histomorphometric findings of protocolled bone biopsies in a large cohort of kidney transplant recipients 1 year post-transplant. Method Histomorphometric analysis of transiliac bone biopsies with prior tetracycline labelling was performed in 141 kidney transplant recipients. Biochemical measurements included bioactive parathyroid hormone (PTH), total calcium, phosphate, calcidiol, bicarbonate, and sclerostin. Kruskal-Wallis and Wilcoxon signed rank tests were used to evaluate differences across categories and between groups, respectively. Stepwise multivariate linear regression was performed to identify key demographic and biochemical determinants of bone turnover (bone formation rate, BFR), mineralization (mineralization lag time, Mlt), and volume (Bone area, BAr). Results Mean age was 57±11 years, 71% were men, and all were Caucasian. Mean eGFR was 49±16 (range 19 to 106) ml/min/1.73 m². Hyperparathyroidism (PTH > 1.5xUNL) was seen in 48%, hypercalcemia (>10.3 mg/dL) in 18%, hypophosphatemia (<2.3 mg/dl) in 12%, and vitamin D deficiency (<15 ng/mL) in 4% of patients. Categorization of bone turnover, mineralization, and volume is shown in Figure 1. Bone turnover was normal in the vast majority (71%). Patients with low turnover (26%) had received a higher cumulative steroid dose (2.78 vs 2.34g in low vs non-low turnover; p=0.02). Patients with delayed mineralization (16%) were younger (52 vs 58 yrs, p=0.02) and had received a higher cumulative steroid dose (2.85 vs 2.36g, p=0.003). They had higher levels of PTH (124 vs 53 ng/L, p<0.001), and lower levels of phosphate (2.68 vs 3.18 mg/dL, p<0.001), calcidiol (29 vs 37ug/L, p=0.02), bicarbonate (21.3 vs 23.3 mmol/L, p=0.004), and sclerostin (493 vs 594 pg/mL, p=0.03) compared to patients with normal mineralization. Patients with low bone volume tended to be older (61 vs 56 years, p=0.07). Independent determinants of BFR were PTH (β=0.68, p<0.001) and cumulative steroid dose (β = -0.22, p=0.02). Determinants of Mlt were phosphate (β=-0.48, p=0.001) and cumulative steroid dose (β=0.18, p=0.004), and determinants of BAr were age (β=-0.15, p=0.002), and BMI (β=0.33, p=0.002). Conclusion Bone turnover is normal in the majority of kidney transplant recipients at 1 year post-transplant, despite a high prevalence of hyperparathyroidism. Low levels of bicarbonate, phosphate, and calcidiol may contribute to delayed bone mineralization in kidney transplant recipients.

scholarly journals Source of Post-Transplant Care and Mortality among Kidney Transplant Recipients Dually Enrolled in VA and Medicare

2021 ◽  
pp. CJN.10020620
Author(s):  
Winn Cashion ◽  
Walid F. Gellad ◽  
Florentina E. Sileanu ◽  
Maria K. Mor ◽  
Michael J. Fine ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Confidence Interval ◽  
Kidney Transplant ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Post Transplant ◽  
Administration Hospital

Background and objectivesMany kidney transplant recipients enrolled in the Veterans Health Administration are also enrolled in Medicare and eligible to receive both Veterans Health Administration and private sector care. Where these patients receive transplant care and its association with mortality are unknown.Design, setting, participants, & measurementsWe conducted a retrospective cohort study of veterans who underwent kidney transplantation between 2008 and 2016 and were dually enrolled in Veterans Health Administration and Medicare at the time of surgery. We categorized patients on the basis of the source of transplant-related care (i.e., outpatient transplant visits, immunosuppressive medication prescriptions, calcineurin inhibitor measurements) delivered during the first year after transplantation defined as Veterans Health Administration only, Medicare only (i.e., outside Veterans Health Administration using Medicare), or dual care (mixed use of Veterans Health Administration and Medicare). Using multivariable Cox regression, we examined the independent association of post-transplant care source with mortality at 5 years after kidney transplantation.ResultsAmong 6206 dually enrolled veterans, 975 (16%) underwent transplantation at a Veterans Health Administration hospital and 5231 (84%) at a non–Veterans Health Administration hospital using Medicare. Post-transplant care was received by 752 patients (12%) through Veterans Health Administration only, 2092 (34%) through Medicare only, and 3362 (54%) through dual care. Compared with patients who were Veterans Health Administration only, 5-year mortality was significantly higher among patients who were Medicare only (adjusted hazard ratio, 2.2; 95% confidence interval, 1.5 to 3.1) and patients who were dual care (adjusted hazard ratio, 1.5; 95% confidence interval, 1.1 to 2.1).ConclusionsMost dually enrolled veterans underwent transplantation at a non–Veterans Health Administration transplant center using Medicare, yet many relied on Veterans Health Administration for some or all of their post-transplant care. Veterans who received Veterans Health Administration–only post-transplant care had the lowest 5-year mortality.

scholarly journals Comparison of clinical outcome of induction immunosuppressive therapy with thymoglobulin and standard therapy in kidney transplantation; a randomized double-blind clinical trial

2019 ◽  
Vol 9 (1) ◽  
pp. e08-e08
Author(s):  
Heshmatollah Shahbazian ◽  
Ali Ghorbani ◽  
Fatemeh Hayati ◽  
Seyed Seifollah Beladi Mousavi ◽  
Leila Sabetnia ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Induction Therapy ◽  
Allograft Rejection ◽  
Control Group ◽  
Case Group ◽  
Transplant Recipients ◽  
Acute Allograft Rejection ◽  
Kidney Transplant Recipients

Introduction: Thymoglobulin is a lymphocyte-depleting polyclonal antibody, administered for induction therapy at the time of kidney transplantation to reduce the risk of acute allograft rejection. The appropriate dosage and duration of therapy is controversial. The higher dosages are associated with infection and malignancy. Objectives: In this study efficacy and safety of lower dosage (in comparison with previous studies) of thymoglobulin in kidney transplant recipients was evaluated. Patients and Methods: In this clinical trial, 106 adult kidney transplant recipients, were randomized before transplantation in two groups (case and control). The case group (53 patients) were received induction therapy with thymoglobulin (1.5 mg/kg/d for 3 days) and the control group (53 patients) were received non-induction regiment. Delayed graft function (DGF), glomerular filtration rate (GFR), acute allograft rejection and thymoglobulin complications were evaluated during the first post-transplantation year. Results: Around 106 kidney transplant recipients were enrolled (71 or 66.98% deceased donor) to the study. No significant statistical differences were found in GFR at the time of discharge from hospital (P=0.399) and at 1 year (P=0.851) and acute allograft rejection (P= 0.304) between two groups. Graft survival (73.5% in case group versus 81.1% in control group, P=0.392) at month 12th was similar among groups. Additionally, no significant differences of acute allograft rejection in recipient from deceased or living donor between two groups were detected. There was a higher incidence of DGF in the control group (26.4%) than the thymoglobulin group (5.8%) and the difference was statistically significant (P= 0.004). Thrombocytopenia (17% versus 49.1%, P<0.001) and leukopenia (11.3% versus 50.9%, P<0.001) were also significantly higher in the case group. Conclusion: While the incidence of DGF was reduced in thymoglobulin group, the short-term acute allograft rejection rate was not reduced compared to the control group. However, our results require further consideration with larger samples

scholarly journals Recurrence of FSGS after Kidney Transplantation in Adults

2020 ◽  
Vol 15 (2) ◽  
pp. 247-256 ◽  
Author(s):  
Audrey Uffing ◽  
Maria José Pérez-Sáez ◽  
Marilda Mazzali ◽  
Roberto C. Manfro ◽  
Andrea Carla Bauer ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Graft Loss ◽  
Small Sample ◽  
Glomerular Disease ◽  
Response To Treatment ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Post Transplant ◽  
Native Kidney

Background and objectivesFSGS recurrence after kidney transplantation is a major risk factor for graft loss. However, the natural history, clinical predictors, and response to treatment remain unclear because of small sample sizes and poor generalizability of single-center studies, and disease misclassification in registry-based studies. We therefore aimed to determine the incidence, predictors, and treatment response of recurrent FSGS in a large cohort of kidney transplant recipients.Design, setting, participants, & measurementsThe Post-Transplant Glomerular Disease (TANGO) project is an observational, multicenter, international cohort study that aims to investigate glomerular disease recurrence post-transplantation. Transplant recipients were screened for the diagnosis of idiopathic FSGS between 2005 and 2015 and details were recorded about the transplant, clinical outcomes, treatments, and other risk factors.ResultsAmong 11,742 kidney transplant recipients screened for FSGS, 176 had a diagnosis of idiopathic FSGS and were included. FSGS recurred in 57 patients (32%; 95% confidence interval [95% CI], 25% to 39%) and 39% of them lost their graft over a median of 5 (interquartile range, 3.0–8.1) years. Multivariable Cox regression revealed a higher risk for recurrence with older age at native kidney disease onset (hazard ratio [HR], 1.37 per decade; 95% CI, 1.09 to 1.56). Other predictors were white race (HR, 2.14; 95% CI, 1.08 to 4.22), body mass index at transplant (HR, 0.89 per kg/m2; 95% CI, 0.83 to 0.95), and native kidney nephrectomies (HR, 2.76; 95% CI, 1.16 to 6.57). Plasmapheresis and rituximab were the most frequent treatments (81%). Partial or complete remission occurred in 57% of patients and was associated with better graft survival.ConclusionsIdiopathic FSGS recurs post-transplant in one third of cases and is associated with a five-fold higher risk of graft loss. Response to treatment is associated with significantly better outcomes but is achieved in only half of the cases.

MO945SERUM AND URINE LEUCINE RICH ALPHA-2-GLYCOPROTEIN-1 IS ASSOCIATED WITH KIDNEY TRANSPLANT INJURY AND FAILURE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Aiga Vasiļvolfa ◽  
Juta Kroiča ◽  
Anna Popova ◽  
Kārlis Rācenis ◽  
Baiba Šlisere ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Kidney Injury ◽  
Kidney Graft ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Positive Correlation ◽  
Post Transplant ◽  
Time Period ◽  
Serum And Urine

Abstract Background and Aims Kidney transplantation is the treatment of choice for most of the patients with end stage chronic kidney disease. To improve patient and graft survival, early diagnostics and discovery of specific biomarkers is important. Leucine rich alpha-2-glycoprotein-1 (LRG-1) is an innovative, non-invasive biomarker that is elevated in case of angiogenesis, inflammation and kidney injury. Aim was to evaluate biomarker LRG-1 level in serum and urine in kidney transplant recipients in accordance with kidney injury markers and time period after kidney transplantation. Method In the study 35 patients were enrolled. Patients had functioning kidney grafts and they were more than one year post transplant. We detected patient serum and urine LRG-1 levels, using ELISA. Correlation between serum LRG-1, urine LRG-1 and kidney graft structural and functional damage markers was performed. Also, we compared serum LRG-1 levels between subgroups (patients &gt;5 years post transplant and ≤ 5 years post transplant). Results Serum LRG-1 had positive correlation with serum cystatin-C (r=0,46, p&lt;0,01), serum urea (r=0,53, p&lt;0,01) and negative correlation with eGFR (r= -0,39, p=0,02). Patients with &gt;5 years post transplant had higher serum LRG-1 level compared with patients ≤5 years post transplant (p&lt;0,01). Serum LRG-1 had positive correlation with a longer time period after transplantation (r=0,53, p=0,01). Urine LRG-1 had correlation with proteinuria (r=0,58, p&lt;0,01) and NGAL level in urine (r=0,44, p&lt;0,01). The most common maintenance immunosuppressive regimen was therapy with tacrolimus, mycophenolate and prednisolone (48,6%). Conclusion Higher serum LRG-1 level correlates with decreased kidney transplant function and with longer time period after transplantation. Higher LRG-1 level in serum and urine is related to kidney transplant injury and failure. Urine LRG-1 can be a useful biomarker for tubular dysfunction in kidney transplant recipients.

scholarly journals Response to Steroid and Immunosuppressive Therapies May Predict Post-transplant Recurrence of Focal Segmental Glomerulosclerosis

2021 ◽  
Author(s):  
Kenichiro Miura ◽  
Taro Ando ◽  
Shoichiro Kanda ◽  
Taeko Hashimoto ◽  
Naoto Kaneko ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Genetic Testing ◽  
Focal Segmental Glomerulosclerosis ◽  
Immunosuppressive Agents ◽  
Recurrence Risk ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Post Transplant ◽  
Segmental Glomerulosclerosis ◽  
Steroid Sensitivity

Abstract Recurrence of focal segmental glomerulosclerosis (FSGS) is a major challenge in kidney transplantation. Several clinical factors, including initial steroid sensitivity, have been associated with increased post-transplant FSGS recurrence risk. However, conflicting data have been reported, possibly due to the heterogeneous pathophysiology of FSGS and the lack of genetic testing of FSGS patients. Further, the response to immunosuppressive therapies have not been evaluated. This study aimed to assess the risk factors for post-transplant recurrence in stringently selected patients based on a comprehensive clinicopathological evaluation and genetic testing. Fifty-nine patients aged 1–25 years at FSGS onset who underwent kidney transplantation between 2002 and 2018 were enrolled. Patients with secondary, familial, syndromic, and genetic FSGS and those who did not undergo genetic testing were excluded. Data from 15 kidney transplant recipients were analyzed. Nine (60%) patients experienced post-transplant FSGS recurrence, while six patients did not. The proportion of patients who achieved complete or partial remission with initial steroid and/or additional therapies with immunosuppressive agents and/or plasmapheresis was significantly higher in the FSGS recurrence group than the group without FSGS recurrence (P=0.04). In conclusion, this study suggests that the response to steroid treatment, other immunosuppressive agents, and/or plasmapheresis may predict post-transplant FSGS recurrence.

P1732RECURRENCE OF GLOMERULONEPHRITIS POST TRANSPLANT

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Umesh Lingaraj ◽  
Ricken Mehta ◽  
Shivaprasad SM ◽  
Kishan A ◽  
Leelavathi V ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Renal Disease ◽  
Kidney Transplant ◽  
End Stage Renal Disease ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Post Transplant ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims Glomerulonephritis (GN) is a major cause of end stage renal disease (ESRD)1. It represents the primary cause of end stage renal disease (ESRD) for 25% of the dialysis population1 and 45% of the transplant population. For patients with GN requiring renal replacement therapy, kidney transplantation is associated with superior outcomes compared with dialysis2. The possibility of recurrence of the original disease after transplantation was described in a seminal paper more than 40 years ago, and it is now clear that all forms of GN may recur after kidney transplantation.3 To study the recurrence of glomerulonephritis post-transplant in a tertiary care centre. Method 120 renal transplant recipients were analyzed from September 2015 to August 2019 at the Institute of Nephro-Urology, Bangalore. It was a retrospective analysis of data Results 120 adult patients underwent kidney transplantation, out of these 70 had GN as primary cause of kidney disease. 85.8% were males, 14.2 % females. 58.9 % were biopsy proven GN, remaining 41.1 % diagnosed based on history and clinical presentation. All but one patient had their first transplant. Out of these kidney transplant recipients 08 (11.4%) had recurrence of GN.  From these 4/08 was recurrent IgA N, 2/08 were PGNMID, 1/08 MGN, 1/08 aHUS. Graft loss due to recurrent GN was seen in 1/08 patients (12.5%). Conclusion Our study showed that 11.4 % of kidney transplant recipients with GN as their cause of ESRD had recurrent GN post kidney transplantation. IgAN was the most type of GN that recurred most frequently followed by PGNMID. Recurrence of GN was in par with other studies and did not affect graft survival

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