Blood transfusions in kidney transplant candidates are common and associated with adverse outcomes

Background: Homozygosity for human leukocyte antigens (HLA) has been associated with adverse outcomes after viral infection as well as pregnancy-induced HLA sensitization. We sought to assess the relationship between HLA locus homozygosity and the level of HLA antibody sensitization. Methods: We measured sensitization using the calculated panel reactive antibody (CPRA) value for a large cohort of 147,461 patients added to the US OPTN/UNOS kidney transplant waitlist between December 2014 and December 2019. We used multinomial logistic modeling to compare 62,510 sensitized patients to 84,955 unsensitized controls. Results: We found that the number of homozygous HLA loci was strongly associated with the level of sensitization. Within highly- or extremely-sensitized candidates, women displayed a higher relative abundance of HLA homozygosity at multiple HLA loci as compared to men, with attenuation of this effect in Black candidates. In multinomial logistic modeling, the number of homozygous HLA loci was an independent predictor of sensitization and interacted with female sex but not with other factors associated with sensitization. Conclusions: This study shows that HLA homozygosity is an innate genetic factor that contributes to HLA sensitization, and enhances the effect of pregnancy-related sensitization.

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Limited health literacy and adverse outcomes among kidney transplant candidates

American Journal of Transplantation ◽

10.1111/ajt.14994 ◽

2018 ◽

Vol 19 (2) ◽

pp. 457-465 ◽

Cited By ~ 16

Author(s):

Fatima Warsame ◽

Christine E. Haugen ◽

Hao Ying ◽

Jacqueline M. Garonzik-Wang ◽

Niraj M. Desai ◽

...

Keyword(s):

Health Literacy ◽

Kidney Transplant ◽

Adverse Outcomes ◽

Limited Health Literacy ◽

Transplant Candidates ◽

Limited Health

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To screen or not to screen? The development of a prediction model for aorto‐iliac stenosis in kidney transplant candidates

Transplant International ◽

10.1111/tri.14013 ◽

2021 ◽

Author(s):

Elsaline Rijkse ◽

Hongchao Qi ◽

Shabnam Babakry ◽

Diederik C. Bijdevaate ◽

Hendrikus J.A.N. Kimenai ◽

...

Keyword(s):

Prediction Model ◽

Kidney Transplant ◽

Transplant Candidates

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Abdominal Panniculectomy Can Simplify Kidney Transplantation in Obese Patients

Urologia Internationalis ◽

10.1159/000516678 ◽

2021 ◽

pp. 1-8

Author(s):

Dominik Promny ◽

Theresa Hauck ◽

Aijia Cai ◽

Andreas Arkudas ◽

Katharina Heller ◽

...

Keyword(s):

Wound Healing ◽

Kidney Transplantation ◽

Postoperative Complications ◽

Kidney Transplant ◽

Interdisciplinary Approach ◽

Wound Complications ◽

Obese Patients ◽

Patient Cohort ◽

Transplant Candidates ◽

Stage Renal Disease

Background: Obesity is frequently present in patients suffering from end-stage renal disease (ESRD). However, overweight kidney transplant candidates are a challenge for the transplant surgeon. Obese patients tend to develop a large abdominal panniculus after weight loss creating an area predisposed to wound-healing disorders. Due to concerns about graft survival and postoperative complications after kidney transplantation, obese patients are often refused in this selective patient cohort. The study aimed to analyze the effect of panniculectomies on postoperative complications and transplant candidacy in an interdisciplinary setting. Methods: A retrospective database review of 10 cases of abdominal panniculectomies performed in patients with ESRD prior to kidney transplantation was conducted. Results: The median body mass index was 35.2 kg/m2 (range 28.5–53.0 kg/m2) at first transplant-assessment versus 31.0 kg/m2 (range 28.0–34.4 kg/m2) at panniculectomy, and 31.6 kg/m2 (range 30.3–32.4 kg/m2) at kidney transplantation. We observed no major postoperative complications following panniculectomy and minor wound-healing complications in 2 patients. All aside from 1 patient became active transplant candidates 6 weeks after panniculectomy. No posttransplant wound complications occurred in the transplanted patients. Conclusion: Abdominal panniculectomy is feasible in patients suffering ESRD with no major postoperative complications, thus converting previously ineligible patients into kidney transplant candidates. An interdisciplinary approach is advisable in this selective patient cohort.

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Coronary microvascular dysfunction is associated with degree of anaemia in end‐stage renal disease

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02025-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ashwin Radhakrishnan ◽

Luke C. Pickup ◽

Anna M. Price ◽

Jonathan P. Law ◽

Kirsty C. McGee ◽

...

Keyword(s):

Confidence Interval ◽

Renal Disease ◽

Kidney Transplant ◽

End Stage Renal Disease ◽

Microvascular Dysfunction ◽

Left Ventricular ◽

Coronary Microvascular Dysfunction ◽

Transplant Candidates ◽

Stage Renal Disease ◽

End Stage

Abstract Background Coronary microvascular dysfunction (CMD) is common in end-stage renal disease (ESRD) and is an adverse prognostic marker. Coronary flow velocity reserve (CFVR) is a measure of coronary microvascular function and can be assessed using Doppler echocardiography. Reduced CFVR in ESRD has been attributed to factors such as diabetes, hypertension and left ventricular hypertrophy. The contributory role of other mediators important in the development of cardiovascular disease in ESRD has not been studied. The aim of this study was to examine the prevalence of CMD in a cohort of kidney transplant candidates and to look for associations of CMD with markers of anaemia, bone mineral metabolism and chronic inflammation. Methods Twenty-two kidney transplant candidates with ESRD were studied with myocardial contrast echocardiography, Doppler CFVR assessment and serum multiplex immunoassay analysis. Individuals with diabetes, uncontrolled hypertension or ischaemic heart disease were excluded. Results 7/22 subjects had CMD (defined as CFVR < 2). Demographic, laboratory and echocardiographic parameters and serum biomarkers were similar between subjects with and without CMD. Subjects with CMD had significantly lower haemoglobin than subjects without CMD (102 g/L ± 12 vs. 117 g/L ± 11, p = 0.008). There was a positive correlation between haemoglobin and CFVR (r = 0.7, p = 0.001). Similar results were seen for haematocrit. In regression analyses, haemoglobin was an independent predictor of CFVR (β = 0.041 95% confidence interval 0.012–0.071, p = 0.009) and of CFVR < 2 (odds ratio 0.85 95% confidence interval 0.74–0.98, p = 0.022). Conclusions Among kidney transplant candidates with ESRD, there is a high prevalence of CMD, despite the absence of traditional risk factors. Anaemia may be a potential driver of microvascular dysfunction in this population and requires further investigation.

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