scholarly journals Posttransplant Allosensitization in Low Immunological Risk Kidney and Kidney-Pancreas Graft Recipients

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Jorge Malheiro ◽  
Sandra Tafulo ◽  
Leonídio Dias ◽  
La Salete Martins ◽  
Isabel Fonseca ◽  
...  
Keyword(s):  
Risk Factor ◽  
Graft Loss ◽  
Graft Function ◽  
Kidney Graft ◽  
Hla Antibodies ◽  
Luminex Assay ◽  
Screening Protocol ◽  
Antibody Positivity ◽  
Cox Analysis ◽  
Pancreas Graft

Introduction. Posttransplantation allosensitization prevalence and effect on kidney grafts outcomes remain unsettled.Methods. Between 2007 and 2012, 408 patients received a primary kidney graft (with 68 patients also receiving a pancreas graft) after a negative cytotoxic crossmatch. All patients had a pretransplant negative anti-HLA screening and 0% panel reactive antibodies. We analyzed retrospectively the results of anti-HLA antibodies screening by Luminex assay, performed between 6 and 24 months after transplant, and searched for the risk factors for antibody positivity and its impact on kidney graft outcomes.Results. Anti-HLA antibodies prevalence at 6 months was 17.4%. Previous steroid-insensitive acute rejection was the only risk factor for both anti-HLA classes detected antibodies. Antithymocyte globulin induction was also a risk factor for anti-HLA-I antibodies. Antibody positivity status was associated with reduced graft function at 12 months and graft survival at 5 years (91.5% versus 96.4%,P=0.03). In multivariable Cox analysis, delayed graft function (HR = 6.1,P<0.01), HLA mismatches>3 (HR = 10.2,P=0.03), and antibody positivity for anti-HLA class II (HR = 5.1,P=0.04) or class I/II (HR = 13.8,P<0.01) were independent predictors of graft loss.Conclusions. Allosensitization against HLA classII±Iafter transplant was associated with adverse kidney graft outcomes. A screening protocol seems advisable within the first year in low immunological risk patients.

scholarly journals Impact of Early Pancreatic Graft Loss on Outcome after Simultaneous Pancreas–Kidney Transplantation (SPKT)—A Landmark Analysis

2021 ◽  
Vol 10 (15) ◽  
pp. 3237
Author(s):  
Lukas Johannes Lehner ◽  
Robert Öllinger ◽  
Brigitta Globke ◽  
Marcel G. Naik ◽  
Klemens Budde ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Graft Survival ◽  
Graft Loss ◽  
Type I ◽  
Kidney Graft ◽  
Landmark Analysis ◽  
Pancreas Kidney Transplantation ◽  
Simultaneous Pancreas Kidney ◽  
Simultaneous Pancreas Kidney Transplantation ◽  
Pancreas Graft

(1) Background: Simultaneous pancreas–kidney transplantation (SPKT) is a standard therapeutic option for patients with diabetes mellitus type I and kidney failure. Early pancreas allograft failure is a complication potentially associated with worse outcomes. (2) Methods: We performed a landmark analysis to assess the impact of early pancreas graft loss within 3 months on mortality and kidney graft survival over 10 years. This retrospective single-center study included 114 adult patients who underwent an SPKT between 2005 and 2018. (3) Results: Pancreas graft survival rate was 85.1% at 3 months. The main causes of early pancreas graft loss were thrombosis (6.1%), necrosis (2.6%), and pancreatitis (2.6%). Early pancreas graft loss was not associated with reduced patient survival (p = 0.168) or major adverse cerebral or cardiovascular events over 10 years (p = 0.741) compared to patients with functioning pancreas, after 3 months. Moreover, kidney graft function (p = 0.494) and survival (p = 0.461) were not significantly influenced by early pancreas graft loss. (4) Conclusion: In this study, using the landmark analysis technique, early pancreas graft loss within 3 months did not significantly impact patient or kidney graft survival over 10 years.

scholarly journals Post-Transplant Natural Antibodies Associate with Kidney Allograft Injury and Reduced Long-Term Survival

2018 ◽  
Vol 29 (6) ◽  
pp. 1761-1770 ◽  
Author(s):  
Sarah B. See ◽  
Olivier Aubert ◽  
Alexandre Loupy ◽  
Yokarla Veras ◽  
Xavier Lebreton ◽  
...  
Keyword(s):  
Risk Factor ◽  
Confidence Interval ◽  
Graft Loss ◽  
Hazard Ratio ◽  
Natural Antibodies ◽  
Kidney Graft ◽  
Pathogenic Potential ◽  
Term Survival ◽  
Cox Regression Analysis ◽  
Post Transplant

Background The development of antibodies specific to HLA expressed on donor tissue (donor-specific antibodies [DSAs]) is a prominent risk factor for kidney graft loss. Non-HLA antibodies with pathogenic potential have also been described, including natural antibodies (Nabs). These IgG Nabs bind to immunogenic self-determinants, including oxidation-related antigens.Methods To examine the relationship of Nabs with graft outcomes, we assessed Nabs in blinded serum specimens collected from a retrospective cohort of 635 patients who received a transplant between 2005 and 2010 at Necker Hospital in Paris, France. Serum samples were obtained immediately before transplant and at the time of biopsy-proven rejection within the first year or 1 year after transplant. Nabs were detected by ELISA through reactivity to the generic oxidized epitope malondialdehyde.Results Univariate Cox regression analysis identified the development of post-transplant Nabs (defined as 50% increase in reactivity to malondialdehyde) as a significant risk factor for graft loss (hazard ratio, 2.68; 95% confidence interval, 1.49 to 4.82; P=0.001). Post-transplant Nabs also correlated with increased mean Banff scores for histologic signs of graft injury in post-transplant biopsy specimens. Multivariable Cox analyses confirmed Nabs development as a risk factor independent from anti-HLA DSAs (hazard ratio, 2.07; 95% confidence interval, 1.03 to 4.17; P=0.04). Moreover, patients with Nabs and DSAs had a further increased risk of kidney graft loss.Conclusions These findings reveal an association between Nabs, kidney graft injury, and eventual graft failure, suggesting the involvement of Nabs in immune mechanisms of rejection.

scholarly journals Pretransplant human leukocyte antigen antibodies detected by single-antigen bead assay are a risk factor for long-term kidney graft loss even in the absence of donor-specific antibodies

2016 ◽  
Vol 29 (9) ◽  
pp. 988-998 ◽  
Author(s):  
Rudolf Richter ◽  
Caner Süsal ◽  
Stefanie Köhler ◽  
Sara Qidan ◽  
Alicia Schödel ◽  
...  
Keyword(s):  
Risk Factor ◽  
Human Leukocyte Antigen ◽  
Graft Loss ◽  
Human Leukocyte ◽  
Kidney Graft ◽  
Specific Antibodies ◽  
Leukocyte Antigen ◽  
Single Antigen ◽  
Donor Specific Antibodies

Hypercholesterolemia is a Risk Factor for Kidney Graft Loss from Chronic Rejection.

1999 ◽  
Vol 67 (7) ◽  
pp. S87
Author(s):  
K. Martin Wissing ◽  
Daniel Abramowicz ◽  
Pierre Vereerstraeten
Keyword(s):  
Risk Factor ◽  
Chronic Rejection ◽  
Graft Loss ◽  
Kidney Graft

scholarly journals BK Virus and Cytomegalovirus Coinfections in Kidney Transplantation and Their Impact on Allograft Loss

2021 ◽  
Vol 10 (17) ◽  
pp. 3779
Author(s):  
Sabina Herrera ◽  
Javier Bernal-Maurandi ◽  
Frederic Cofan ◽  
Pedro Ventura ◽  
Maria Angeles Marcos ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Allograft Rejection ◽  
Cytomegalovirus Infection ◽  
Graft Loss ◽  
Graft Function ◽  
Bk Virus ◽  
Kidney Graft ◽  
Acute Allograft Rejection ◽  
Kidney Transplant Recipients ◽  
Cmv Infection

We aimed to ascertain the interaction and effects of combined reactivations of BK virus and cytomegalovirus on kidney graft function. All consecutive kidney transplant recipients (KTR) between 2003 and 2016 were included. Of 1976 patients who received a kidney transplant, 23 (1.2%) presented BKV-associated nephropathy (BKVAN). Factors independently associated with BKVAN were diabetes mellitus (odds ratios (OR) 3.895%, confidence intervals (CI) (1.4–10.5)), acute allograft rejection (OR 2.8 95%, CI (1.1–7.6)) and nephrostomy requirement (OR 4.195%, CI (1.3–13)). Cytomegalovirus infection was diagnosed in 19% of KTR patients. Recipients with BKVAN presented more frequently with cytomegalovirus (CMV) infection compared to patients without BKVAN (39% vs. 19%, p = 0.02). Acute allograft rejection (OR 2.95%, CI (1.4–2.4)) and nephrostomy requirement (OR 2.95%, CI (1.2–3)) were independently associated with CMV infection. Sixteen patients (69%) with BKVAN had graft dysfunction at one-year post-transplant and eight of them (35%) lost their graft. Patients presenting with BKVAN and graft loss presented more frequently a cytomegalovirus infection (OR 2.295%, CI (1.3–4.3)). In conclusion, we found a relation between CMV infection and graft loss in patients presenting BKVAN, suggesting that patients with CMV reactivation should be actively screened for BKV.

Current Status of Kidney Graft in 6 Recipients after Pregnancy

1997 ◽  
Vol 10 (3) ◽  
pp. 213-215 ◽  
Author(s):  
V. Mazzarella ◽  
C. Tozzo ◽  
F. Pisani ◽  
G. Tisone ◽  
G. Splendiani ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Graft Loss ◽  
Graft Function ◽  
First Trimester ◽  
Current Status ◽  
Kidney Graft ◽  
Childbearing Age ◽  
Adverse Influence ◽  
University Of Rome

To determine whether pregnancy has an adverse influence on survival or graft function, a retrospective study was conducted. A total of 321 renal transplant(rTx) patients were followed on a day hospital basis of Tor Vergata University of Rome between January 1981 and April 1996. Out of 90 female subjects, 74 of childbearing age (less than 45 years) underwent the study. Six women had 7 pregnancies which resulted in 5 live births and two first trimester abortions. In one case the pregnancy occurred at 4 months after rTx: spontaneous abortion and acute rejection with graft loss occurred, for the four successful pregnancies the preconception serum creatinine (sCr) was 1.34 mg/dl (range: 1.3–1.4) and remained stable at the end of follow-up. The woman with two successful pregnancies had a sCr increase after second pregnancy, but it has remained stable at 4 yrs after rTx. The pt receiving rTx at 1981 with successful pregnancy after two yrs, reached ESRD 7 yrs after delivery because chronic rejection. Our data are consistent with other studies demonstrating no contraindication to pregnancy in women with stable renal transplant and controlled blood pressure. However, careful interdisciplinary monitoring is needed to reduce maternal and fetal risks.

scholarly journals The Value of Graft Implantation Sequence in Simultaneous Pancreas-Kidney Transplantation on the Outcome and Graft Survival

2021 ◽  
Vol 10 (8) ◽  
pp. 1632
Author(s):  
Hans-Michael Hau ◽  
Nora Jahn ◽  
Sebastian Rademacher ◽  
Elisabeth Sucher ◽  
Jonas Babel ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Graft Survival ◽  
Graft Function ◽  
Kidney Graft ◽  
Significant Difference ◽  
Pancreas Kidney Transplantation ◽  
Simultaneous Pancreas Kidney ◽  
Graft Implantation ◽  
Simultaneous Pancreas Kidney Transplantation ◽  
Pancreas Graft

Background/Objectives: The sequence of graft implantation in simultaneous pancreas-kidney transplantation (SPKT) warrants additional study and more targeted focus, since little is known about the short- and long-term effects on the outcome and graft survival after transplantation. Material and methods: 103 patients receiving SPKT in our department between 1999 and 2015 were included in the study. Patients were divided according to the sequence of graft implantation into pancreas-first (PF, n = 61) and kidney-first (KF, n = 42) groups. Clinicopathological characteristics, outcome and survival were reviewed retrospectively. Results: Donor and recipient characteristics were similar. Rates of post-operative complications and graft dysfunction were significantly higher in the PF group compared with the KF group (episodes of acute rejection within the first year after SPKT: 11 (18%) versus 2 (4.8%); graft pancreatitis: 18 (18%) versus 2 (4.8%), p = 0.04; vascular thrombosis of the pancreas: 9 (14.8%) versus 1 (2.4%), p = 0.03; and delayed graft function of the kidney: 12 (19.6%) versus 2 (4.8%), p = 0.019). The three-month pancreas graft survival was significantly higher in the KF group (PF: 77% versus KF: 92.1%; p = 0.037). No significant difference was observed in pancreas graft survival five years after transplantation (PF: 71.6% versus KF: 84.8%; p = 0.104). Kidney graft survival was similar between the two groups. Multivariate analysis revealed order of graft implantation as an independent prognostic factor for graft survival three months after SPKT (HR 2.6, 1.3–17.1, p = 0.026) and five years (HR 3.7, 2.1–23.4, p = 0.040). Conclusion: Our data indicates that implantation of the pancreas prior to the kidney during SPKT has an influence especially on the early-post-operative outcome and survival rate of pancreas grafts.

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