Donor-Derived Myeloid Sarcoma in Two Kidney Transplant Recipients from a Single Donor

We report the rare occurrence of donor-derived myeloid sarcoma in two kidney transplant patients who received organs from a single deceased donor. There was no evidence of preexisting hematologic malignancy in the donor at the time of organ recovery. Both recipients developed leukemic involvement that appeared to be limited to the transplanted organ. Fluorescencein situhybridization (FISH) and molecular genotyping analyses confirmed that the malignant cells were of donor origin in each patient. Allograft nephrectomy and immediate withdrawal of immunosuppression were performed in both cases; systemic chemotherapy was subsequently administered to one patient. Both recipients were in remission at least one year following the diagnosis of donor-derived myeloid sarcoma. These cases suggest that restoration of the immune system after withdrawal of immunosuppressive therapy and allograft nephrectomy may be sufficient to control HLA-mismatched donor-derived myeloid sarcoma without systemic involvement.

Download Full-text

A Systematic Review of COVID-19 Infection in Kidney Transplant Recipients: A Universal Effort to Preserve Patients’ Lives and Allografts

Journal of Clinical Medicine ◽

10.3390/jcm9092986 ◽

2020 ◽

Vol 9 (9) ◽

pp. 2986 ◽

Cited By ~ 2

Author(s):

Smaragdi Marinaki ◽

Stathis Tsiakas ◽

Maria Korogiannou ◽

Konstantinos Grigorakos ◽

Vassilios Papalois ◽

...

Keyword(s):

Kidney Transplant ◽

Distress Syndrome ◽

Kidney Injury ◽

Deceased Donor ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Male Predominance ◽

Transplant Patients ◽

Kidney Transplant Patients ◽

The Mean

The coronavirus disease 2019 (COVID-19) pandemic has posed a significant challenge to physicians and healthcare systems worldwide. Evidence about kidney transplant (KTx) recipients is still limited. A systematic literature review was performed. We included 63 articles published from 1 January until 7 July 2020, reporting on 420 adult KTx recipients with confirmed COVID-19. The mean age of patients was 55 ± 15 years. There was a male predominance (67%). The majority (74%) were deceased donor recipients, and 23% were recently transplanted (<1 year). Most patients (88%) had at least one comorbidity, 29% had two, and 18% three. Ninety-three percent of cases were hospitalized. Among them, 30% were admitted to the intensive care unit, 45% developed acute respiratory distress syndrome, and 44% had acute kidney injury with 23% needing renal replacement therapy. From the hospitalized patients a total of 22% died, 59% were discharged, and 19% were still in hospital at the time of publication. Immunosuppression was reduced in 27%, discontinued in 31%, and remained unchanged in 5%. Hydroxychloroquine was administered to 78% of patients, antibiotics to 73%, and antivirals to 30% while 25% received corticosteroid boluses, 28% received anti-interleukin agents, and 8% were given immunoglobulin. The main finding of our analysis was that the incidence of COVID-19 among kidney transplant patients is not particularly high, but when they do get infected, this is related to significant morbidity and mortality.

Download Full-text

Side Effect Driven Conversion to Belatacept for Kidney Transplant Recipients in a Clinical Setting

Journal of Clinical & Experimental Immunology ◽

10.33140/jcei.05.01.03 ◽

2020 ◽

Vol 5 (1) ◽

Keyword(s):

Adverse Effects ◽

Kidney Transplant ◽

Patient Survival ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Transplant Patients ◽

Immunosuppressive Medication ◽

Maintenance Immunosuppression ◽

Kidney Transplant Patients ◽

One Year

Maintenance immunosuppression after kidney transplantation is critical to graft and patient survival. However, the optimal immunosuppressive medication may differ for patients based on adverse effects. Here we report one-year outcomes of 73 kidney transplant patients converted from tacrolimus to belatacept because of adverse effects at least 90 days after transplant.

Download Full-text

Review of Outcomes after Diagnosis of Malignancy in Kidney Transplant Patients: UNOS Database

Transplantology ◽

10.3390/transplantology2030024 ◽

2021 ◽

Vol 2 (3) ◽

pp. 253-263

Author(s):

Het Patel ◽

Nikhil Agrawal ◽

Voravech Nissaisorakarn ◽

Ridhi Gupta ◽

Francesca Cardarelli

Keyword(s):

Kidney Transplant ◽

Graft Failure ◽

Event Analysis ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Time To Event ◽

Transplant Patients ◽

Kaplan Meier ◽

Lung Malignancy ◽

Kidney Transplant Patients

Malignancy is the third major cause of death among transplant recipients. Patient and kidney transplant outcomes after the diagnosis of malignancy are not well described. We reviewed incidences and outcomes of colorectal, lung, PTLD, and renal malignancy after transplant among patients who received a transplant from January 2000 to December 2018 using the UNOS/OPTN database. Incidence of each malignancy was measured at 5 years and 10 years of transplant. The Kaplan–Meier curve was used for time-to-event analysis (graft and patient outcomes). Additionally, we sought to identify the causes of graft failure among these recipients. We found that 12,764 (5.5%) patients suffered malignancy, excluding squamous and basal cell skin carcinoma after transplant. During the first 5 years of transplant, incidence of colorectal, lung, PTLD, and renal malignancies was 2.99, 9.21, 15.61, and 8.55 per 10,000 person-years, respectively. Rates of graft failure were 10.3%, 7.6%, 19.9%, and 18.8%, respectively, among these patients at 5 years. Mortality rate was highest among patients who suffered lung malignancy (84%), followed by colorectal (61.5%), PTLD (49.1%), and renal (35.5%) at 5 years after diagnosis of malignancy. In conclusion, kidney transplant recipients diagnosed with lung malignancy have the lowest graft survival, compared to PTLD, colorectal, and renal malignancy. PTLD has the highest incidence rate in the first 5 years of transplant.

Download Full-text

Changes in quality of life (QoL) and other patient-reported outcome measures (PROMs) in living-donor and deceased-donor kidney transplant recipients and those awaiting transplantation in the UK ATTOM programme: a longitudinal cohort questionnaire survey with additional qualitative interviews

BMJ Open ◽

10.1136/bmjopen-2020-047263 ◽

2021 ◽

Vol 11 (4) ◽

pp. e047263

Author(s):

Andrea Gibbons ◽

Janet Bayfield ◽

Marco Cinnirella ◽

Heather Draper ◽

Rachel J Johnson ◽

...

Keyword(s):

Kidney Transplant ◽

Outcome Measures ◽

Deceased Donor ◽

Patient Reported Outcome Measures ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Structured Interviews ◽

Cross Sectional ◽

Post Transplant ◽

Patient Reported

ObjectiveTo examine quality of life (QoL) and other patient-reported outcome measures (PROMs) in kidney transplant recipients and those awaiting transplantation.DesignLongitudinal cohort questionnaire surveys and qualitative semi-structured interviews using thematic analysis with a pragmatic approach.SettingCompletion of generic and disease-specific PROMs at two time points, and telephone interviews with participants UK-wide.Participants101 incident deceased-donor (DD) and 94 incident living-donor (LD) kidney transplant recipients, together with 165 patients on the waiting list (WL) from 18 UK centres recruited to the Access to Transplantation and Transplant Outcome Measures (ATTOM) programme completed PROMs at recruitment (November 2011 to March 2013) and 1 year follow-up. Forty-one of the 165 patients on the WL received a DD transplant and 26 received a LD transplant during the study period, completing PROMs initially as patients on the WL, and again 1 year post-transplant. A subsample of 10 LD and 10 DD recipients participated in qualitative semi-structured interviews.ResultsLD recipients were younger, had more educational qualifications and more often received a transplant before dialysis. Controlling for these and other factors, cross-sectional analyses at 12 months post-transplant suggested better QoL, renal-dependent QoL and treatment satisfaction for LD than DD recipients. Patients on the WL reported worse outcomes compared with both transplant groups. However, longitudinal analyses (controlling for pre-transplant differences) showed that LD and DD recipients reported similarly improved health status and renal-dependent QoL (p<0.01) pre-transplant to post-transplant. Patients on the WL had worsened health status but no change in QoL. Qualitative analyses revealed transplant recipients’ expectations influenced their recovery and satisfaction with transplant.ConclusionsWhile cross-sectional analyses suggested LD kidney transplantation leads to better QoL and treatment satisfaction, longitudinal assessment showed similar QoL improvements in PROMs for both transplant groups, with better outcomes than for those still wait-listed. Regardless of transplant type, clinicians need to be aware that managing expectations is important for facilitating patients’ adjustment post-transplant.

Download Full-text

530. COVID-19 in kidney transplant recipients: Single-center experience and case-control study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.724 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S332-S332

Author(s):

Anna Hardesty ◽

Aakriti Pandita ◽

Yiyun Shi ◽

Kendra Vieira ◽

Ralph Rogers ◽

...

Keyword(s):

Kidney Transplant ◽

Case Control Study ◽

Clinical Course ◽

Case Series ◽

Case Fatality ◽

Case Control ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Transplant Patients ◽

Control Study

Abstract Background Organ transplant recipients (OTR) are considered high-risk for morbidity and mortality from COVID-19. Case-fatality rates (CFR) vary significantly in different case series, and some patients were still hospitalized at the time of analyses. To our knowledge, no case-control study of COVID-19 in OTR has been published to-date. Methods We captured kidney transplant recipients (KTR) diagnosed with COVID-19 between 3/1 and 5/18/2020. After exclusion of KTR on hemodialysis and off immunosuppression (IS), we compared the clinical course of COVID-19 between hospitalized KTR and non-transplant patients, matched by sex and age (controls). All patients were discharged from the hospital or died. Results 16 KTR had COVID-19. All 3 KTR off IS, who were excluded from further analyses, survived. Median age was 54 (range: 34–65) years; 5/13 KTR (38.4%) were men. Median time from transplant was 41 (range: 1–203) months. Two KTR, both transplanted >10 years ago, were managed as outpatients. IS was reduced in 12/13 (92.3%), most often by discontinuation of the antimetabolite. IL6 levels were >1,000 (normal: < 5) pg/mL in 3 KTR. Tacrolimus or sirolimus levels were >10 ng/mL in 6/9 KTR (67%) (Table 1). Eleven KTR were hospitalized (84.6%) and matched with 44 controls. One KTR, the only one treated with hydroxychloroquine, died (CFR 5.8%; 7.6% in KTR on IS; 9% in hospitalized KTR on IS). Four controls died (CFR: 9%; state CFR: 5.2%; inpatient CFR: 16.6%). There were no significant differences in length of stay or worst oxygenation status between hospitalized KTR and controls. Four KTR (30.7%), received remdesivir, 4 convalescent plasma, 3 (23%) tocilizumab. KTR received more often broad-spectrum antibiotics, convalescent plasma or tocilizumab, compared to controls (Table 2). Table 1 Table 2 Conclusion Unlike early reports from the pandemic epicenters, the clinical course and outcomes of KTR with COVID-19 in our small case series were comparable to those of non-transplant patients. Calcineurin or mTOR inhibitor levels were high, likely due to diarrhea and COVID-19-related hepatic dysfunction. Extremely high IL6 levels were common. The role of IS and potential benefits from investigational treatments remain to be elucidated. A larger multi-institutional study is underway. Disclosures All Authors: No reported disclosures

Download Full-text

Effect of Remdesivir on COVID-19 PCR Positivity and Cycle Threshold in Kidney Transplant Recipients

Transplantology ◽

10.3390/transplantology2030028 ◽

2021 ◽

Vol 2 (3) ◽

pp. 291-293

Author(s):

Ryan J. Winstead ◽

Johanna Christensen ◽

Sara Sterling ◽

Megan Morales ◽

Dhiren Kumar ◽

...

Keyword(s):

Kidney Transplant ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Cycle Threshold ◽

Transplant Patients ◽

Kidney Transplant Patients ◽

Polymerase Chain ◽

New Diagnosis ◽

The Impact ◽

Median Change

Information regarding Coronavirus disease 2019 in the transplant population is lacking. Recently it has been suggested that cycle threshold values obtained on polymerase chain reaction tests may serve as a marker of disease severity with lower values (i.e., higher viral load) being associated with higher mortality. This study was done to assess the impact of remdesivir use on the time to a negative COVID-19 PCR as well as the degree of change between two Ct’s based on treatment. A total of 30 kidney transplant patients with a new diagnosis of COVID-19 were assessed. Serial PCR results were followed from the time of diagnosis then every 2–4 weeks until negative. In patients who received remdesivir immediately after COVID-19 confirmation compared to no remdesivir, time to negative PCR was not statistically different with a median duration of 57 days in both groups (p = 0.369). The change in the Ct between the first and the second PCR test was also not statistically different between groups with a median change of 18.4 cycles in the remdesivir group and 15.7 cycles without remdesivir (p = 0.516). The results of this small single-center analysis suggest that remdesivir may not be beneficial in shortening time to a negative COVID-19 PCR.

Download Full-text

Timing of Kidney Clamping and Deceased Donor Kidney Transplant Outcomes

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.03290321 ◽

2021 ◽

pp. CJN.03290321

Author(s):

Simon Ville ◽

Marine Lorent ◽

Clarisse Kerleau ◽

Anders Asberg ◽

Christophe Legendre ◽

...

Keyword(s):

Kidney Transplant ◽

Graft Survival ◽

Ischemia Reperfusion ◽

Multivariable Analysis ◽

Graft Function ◽

Deceased Donor ◽

Kidney Graft ◽

Kidney Transplant Recipients ◽

Heart Beating ◽

Deceased Donor Kidney Transplant

BackgroundThe recognition that metabolism and immune function are regulated by an endogenous molecular clock generating circadian rhythms suggests that the magnitude of ischemia-reperfusion and subsequent inflammation on kidney transplantation, could be affected by the time of the day. MethodsAccordingly, we evaluated 5026 first kidney transplant recipients from deceased heart-beating donors. In a cause-specific multivariable analysis, we compare delayed graft function (DGF) and graft survival according to the time of kidney clamping and declamping. Participants were divided into clamping between midnight and noon (AM clamping group, 65%) or clamping between noon and midnight (PM clamping group, 35%), and similarly, AM declamping or PM declamping (25% / 75%). ResultsDGF occurred among 550 participants (27%) with AM clamping and 339 (34%) with PM clamping (adjusted OR = 0.81, 95%CI: 0.67 to 0.98, p= 0.03). No significant association of clamping time with overall death censored graft survival was observed (HR = 0.92, 95%CI: 0.77 to 1.10, p= 0.37). No significant association of declamping time with DGF or graft survival was observed. ConclusionsClamping between midnight and noon was associated with a lower incidence of DGF whilst the declamping time was not associated with kidney graft outcomes.

Download Full-text