scholarly journals Desensitization: Overcoming the Immunologic Barriers to Transplantation

2017 ◽  
Vol 2017 ◽  
pp. 1-11 ◽  
Author(s):  
Supreet Sethi ◽  
Jua Choi ◽  
Mieko Toyoda ◽  
Ashley Vo ◽  
Alice Peng ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Plasma Cells ◽  
Costimulatory Molecule ◽  
End Stage Kidney Disease ◽  
Antibody Mediated Rejection ◽  
Complement Inhibitors ◽  
Increased Risk ◽  
Significant Barrier ◽  
End Stage ◽  
Immunomodulatory Therapies

HLA (Human Leucocyte Antigen) sensitization is a significant barrier to successful kidney transplantation. It often translates into difficult crossmatch before transplant and increased risk of acute and chronic antibody mediated rejection after transplant. Over the last decade, several immunomodulatory therapies have emerged allowing for increased access to kidney transplantation for the immunologically disadvantaged group of HLA sensitized end stage kidney disease patients. These include IgG inactivating agents, anti-cytokine antibodies, costimulatory molecule blockers, complement inhibitors, and agents targeting plasma cells. In this review, we discuss currently available agents for desensitization and provide a brief analysis of data on novel biologics, which will likely improve desensitization outcomes, and have potential implications in treatment of antibody mediated rejection.

scholarly journals CLINICAL CASE OF ABO INCOMPATIBLEKIDNEYTRANSPLANTATTHE О. SHALIMOV’S NATIONAL INSTITUTE OFSURGERYAND TRANSPLANTOLOGYIN UKRAINE

2015 ◽  
pp. 45-48
Author(s):  
R. Zograbian ◽  
V. Zakordonets ◽  
A. Malik ◽  
O. Zakrutko ◽  
L. Tarasenko
Keyword(s):  
Kidney Transplantation ◽  
End Stage Kidney Disease ◽  
Successful Case ◽  
Increased Risk ◽  
The Family ◽  
Related Donor ◽  
Cadaveric Organ ◽  
End Stage ◽  
Living Related ◽  
Living Related Donor

Kidney transplantation is the gold standard for treating end - stage kidney disease. But the lack of cadaveric organ donation in Ukraine makes this operation available only for patients with living related donor. The absence of ABO - compatible living donor in the family is found in 20 - 30% of cases. This is the case for ABO - incompatible transplantation, but it is associated with an increased risk of acute rejection and requires special pre - transplant management. The article describes the first in Ukraine successful case of ABO - incompatible kidney transplantation in A.A. Shalimov’s National Institute of Surgery and Transplantology.

scholarly journals Cardiopulmonary exercise testing (CPET) in patients with end-stage kidney disease (ESKD): principles, methodology and clinical applications of the optimal tool for exercise tolerance evaluation

2021 ◽  
Author(s):  
Eva Pella ◽  
Afroditi Boutou ◽  
Aristi Boulmpou ◽  
Christodoulos E Papadopoulos ◽  
Aikaterini Papagianni ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Exercise Intolerance ◽  
End Stage Kidney Disease ◽  
Exercise Limitation ◽  
Cardiopulmonary Exercise ◽  
Functional Reserves ◽  
Increased Risk ◽  
End Stage

Abstract Chronic kidney disease (CKD), especially end-stage kidney disease (ESKD), is associated with increased risk for cardiovascular events and all-cause mortality. Exercise intolerance as well as reduced cardiovascular reserve are extremely common in patients with CKD. Cardiopulmonary exercise testing (CPET) is a non-invasive, dynamic technique that provides an integrative evaluation of cardiovascular, pulmonary, neuropsychological and metabolic function during maximal or submaximal exercise, allowing the evaluation of functional reserves of these systems. This assessment is based on the principle that system failure typically occurs when the system is under stress and, thus, CPET is currently considered to be the gold-standard for identifying exercise limitation and differentiating its causes. It has been widely used in several medical fields for risk stratification, clinical evaluation and other applications but its use in everyday practice for CKD patients is scarce. This article describes the basic principles and methodology of CPET and provides an overview of important studies that utilized CPET in patients with ESKD, in an effort to increase awareness of CPET capabilities among practicing nephrologists.

Types of erythropoiesis-stimulating agents and risk of end-stage kidney disease and death in patients with non-dialysis chronic kidney disease

2020 ◽  
Author(s):  
Roberto Minutolo ◽  
Carlo Garofalo ◽  
Paolo Chiodini ◽  
Filippo Aucella ◽  
Lucia Del Vecchio ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Primary Endpoint ◽  
End Stage Kidney Disease ◽  
Short Acting ◽  
Erythropoiesis Stimulating Agents ◽  
Increased Risk ◽  
Significant Difference ◽  
Long Acting ◽  
End Stage

Abstract Background Despite the widespread use of erythropoiesis-stimulating agents (ESAs) to treat anaemia, the risk of adverse outcomes associated with the use of different types of ESAs in non-dialysis chronic kidney disease (CKD) is poorly investigated. Methods From a pooled cohort of four observational studies, we selected CKD patients receiving short-acting (epoetin α/β; n = 299) or long-acting ESAs (darbepoetin and methoxy polyethylene glycol-epoetin β; n = 403). The primary composite endpoint was end-stage kidney disease (ESKD; dialysis or transplantation) or all-cause death. Multivariable Cox models were used to estimate the relative risk of the primary endpoint between short- and long-acting ESA users. Results During follow-up [median 3.6 years (interquartile range 2.1–6.3)], the primary endpoint was registered in 401 patients [166 (72%) in the short-acting ESA group and 235 (58%) in the long-acting ESA group]. In the highest tertile of short-acting ESA dose, the adjusted risk of primary endpoint was 2-fold higher {hazard ratio [HR] 2.07 [95% confidence interval (CI) 1.37–3.12]} than in the lowest tertile, whereas it did not change across tertiles of dose for long-acting ESA patients. Furthermore, the comparison of ESA type in each tertile of ESA dose disclosed a significant difference only in the highest tertile, where the risk of the primary endpoint was significantly higher in patients receiving short-acting ESAs [HR 1.56 (95% CI 1.09–2.24); P = 0.016]. Results were confirmed when ESA dose was analysed as continuous variable with a significant difference in the primary endpoint between short- and long-acting ESAs for doses >105 IU/kg/week. Conclusions Among non-dialysis CKD patients, the use of a short-acting ESA may be associated with an increased risk of ESKD or death versus long-acting ESAs when higher ESA doses are prescribed.

Trajectories of glomerular filtration rate and progression to end stage kidney disease after kidney transplantation

2021 ◽  
Vol 99 (1) ◽  
pp. 186-197 ◽  
Author(s):  
Marc Raynaud ◽  
Olivier Aubert ◽  
Peter P. Reese ◽  
Yassine Bouatou ◽  
Maarten Naesens ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Kidney Transplantation ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
End Stage Kidney Disease ◽  
End Stage

Heparin Leakage by Advective-Diffusive Transport in Central Venous Catheters

2013 ◽  
Author(s):  
Patrick M. McGah ◽  
Michael Barbour ◽  
Alberto Aliseda ◽  
Kenneth W. Gow
Keyword(s):  
Blood Flow ◽  
Kidney Disease ◽  
Central Venous Catheters ◽  
Artificial Kidney ◽  
Diffusive Transport ◽  
End Stage Kidney Disease ◽  
Central Venous ◽  
Increased Risk ◽  
End Stage

Central venous catheters (CVCs) are used as a way to provide adequate access of blood flow for hemodialysis, a common treatment for end-stage kidney disease. During hemodialysis, the catheter must circulate up to 300 mL/min [1] of blood flow to the extracorporeal artificial kidney. Catheters contain two lumens: the inflow lumen provides flow to the artificial kidney, and the outflow lumen returns it to the patient’s circulation. Although catheters are used in the treatment of patients of all ages, this study is motivated by the use of central venous catheters for pediatric applications; the catheter types and calibers available for children are much more limited than for adults, thereby placing children in a further disadvantage and potentially subjecting them to increased risk of complications.

scholarly journals Cerebral blood flow regulation in end-stage kidney disease

2020 ◽  
Vol 319 (5) ◽  
pp. F782-F791
Author(s):  
Justin D. Sprick ◽  
Joe R. Nocera ◽  
Ihab Hajjar ◽  
W. Charles O’Neill ◽  
James Bailey ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Kidney Disease ◽  
Cerebral Oxygenation ◽  
Cerebrovascular Reactivity ◽  
Regulatory Mechanisms ◽  
End Stage Kidney Disease ◽  
Increased Risk ◽  
End Stage

Patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD) experience an increased risk of cerebrovascular disease and cognitive dysfunction. Hemodialysis (HD), a major modality of renal replacement therapy in ESKD, can cause rapid changes in blood pressure, osmolality, and acid-base balance that collectively present a unique stress to the cerebral vasculature. This review presents an update regarding cerebral blood flow (CBF) regulation in CKD and ESKD and how the maintenance of cerebral oxygenation may be compromised during HD. Patients with ESKD exhibit decreased cerebral oxygen delivery due to anemia, despite cerebral hyperperfusion at rest. Cerebral oxygenation further declines during HD due to reductions in CBF, and this may induce cerebral ischemia or “stunning.” Intradialytic reductions in CBF are driven by decreases in cerebral perfusion pressure that may be partially opposed by bicarbonate shifts during dialysis. Intradialytic reductions in CBF have been related to several variables that are routinely measured in clinical practice including ultrafiltration rate and blood pressure. However, the role of compensatory cerebrovascular regulatory mechanisms during HD remains relatively unexplored. In particular, cerebral autoregulation can oppose reductions in CBF driven by reductions in systemic blood pressure, while cerebrovascular reactivity to CO2 may attenuate intradialytic reductions in CBF through promoting cerebral vasodilation. However, whether these mechanisms are effective in ESKD and during HD remain relatively unexplored. Important areas for future work include investigating potential alterations in cerebrovascular regulation in CKD and ESKD and how key regulatory mechanisms are engaged and integrated during HD to modulate intradialytic declines in CBF.

scholarly journals FUNCTIONAL INDEPENDENCE, ACCESS TO KIDNEY TRANSPLANTATION, AND WAITLIST MORTALITY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S494-S495
Author(s):  
Nadia M Chu ◽  
Stephanie Sison ◽  
Abimereki Muzaale ◽  
Christine Haugen ◽  
Jacqueline Garonzik Wang ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Kidney Disease ◽  
Activities Of Daily Living ◽  
Competing Risks ◽  
Mortality Risk ◽  
Daily Living ◽  
Functional Independence ◽  
End Stage Kidney Disease ◽  
End Stage ◽  
Waitlist Mortality

Abstract Although functional independence is a health priority for patients with advanced CKD, 50% of those who progress to end-stage kidney disease (ESKD) develop difficulties carrying-out essential day-to-day activities. Functional independence is not routinely assessed at kidney transplant (KT) evaluation; therefore, it is unclear what percentage of candidates are functionally independent and whether independence is associated with access to KT and waitlist mortality. We studied a prospective cohort of 3,168 ESKD participants (1/2009-6/2018) who self-reported functional independence in basic Activities of Daily Living (ADL) and more complex Instrumental Activities of Daily Living (IADL). We estimated adjusted associations between functional independence (separately) and listing (Cox), waitlist mortality (competing risks), and transplant rates (Poisson). At evaluation, 92.4% were independent in ADLs, but only 68.5% were independent in IADLs. Functionally independent participants had a higher chance of listing for KT (ADL:aHR=1.55,95%CI:1.30-1.87; IADL:aHR=1.39,95%CI 1.26-1.52). Among KT candidates, ADL independence was associated with lower waitlist mortality risk (SHR=0.66,95%CI:0.44-0.98) and higher rate of KT (IRR=1.58,95%CI:1.12-2.22); the same was not observed for IADL independence (SHR=0.86,95%CI:0.65-1.12; IRR=1.01,95%CI:0.97-1.19). ADL independence was associated with better KT access and lower waitlist mortality; clinicians should screen KT candidates for ADL independence, and identify interventions to maintain independence to improve waitlist outcomes.

SO061SEX DIFFERENCES IN MORTALITY AMONG PEOPLE WITH END-STAGE KIDNEY DISEASE: DO WOMEN ALWAYS LIVE LONGER?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Nicole De La Mata ◽  
Grace Macleod ◽  
Patrick Kelly ◽  
Brenda Rosales ◽  
Philip Masson ◽  
...  
Keyword(s):  
Sex Differences ◽  
Kidney Transplantation ◽  
General Population ◽  
Excess Mortality ◽  
Relative Survival ◽  
Average Life ◽  
End Stage Kidney Disease ◽  
Life Years ◽  
Life Years Lost ◽  
End Stage

Abstract Background and Aims Female life expectancies consistently exceed males in the general population. Yet, this survival advantage may not persist in the presence of a chronic disease due to sex-based differences or healthcare inequities. We aimed to explore sex differences in survival among people with end-stage kidney disease (ESKD) compared to the general population. Method We included the entire ESKD population in Australia, 1980-2013 and New Zealand, 1988-2012 from the Australian and New Zealand Dialysis and Transplant Registry. These were linked to national death registers to ascertain deaths and their causes. We estimated relative measures of survival, including standardized mortality ratios (SMR), cumulative relative survival and expected life years lost, using general population data (adjusting for country, age, sex and calendar year) to account for background mortality. Results Of the 60,823 ESKD patients, there were 25,042 females (41%) and 35,781 males (59%). Overall 34,417 deaths occurred over the 368,719 person-years of follow-up where a similar proportion of females (57%) and males (56%) died. While mortality sex differences within the ESKD population were minor, once compared to the general population female ESKD patients had greater excess deaths, worse relative survival and greater life years lost compared to male ESKD patients. Female ESKD patients had 12 times (SMR:11.5; 95%CI:11.3-11.7) and males had 7 times (SMR:6.7; 95%CI:6.7-6.8) the expected deaths, with the greatest sex disparity among younger ages and from cardiovascular disease. Relative survival was consistently lower in females (0.57, 95%CI:0.57-0.58 in males vs 0.54, 95%CI:0.54-0.55 in females at 5 years), where the excess mortality was 9% higher (95%CI:7-12%) in female ESKD patients (Fig 1A), adjusting for year and age. The average life years lost for female ESKD patients was 4-5 years greater than male ESKD patients (Average life years lost 25.9 years, 95%CI:25.1-26.7 in males and 31.4 years, 95%CI:30.5-32.1 in females aged 15 years at ESKD) (Fig 1B). Kidney transplantation reduced the sex differences in excess mortality, with similar relative survival (p=0.42; Fig 1C) and average life years lost reduced to 3-4 years for females (Fig 1D). Conclusion The impact of ESKD is more profound for women than men with greater excess mortality, however kidney transplantation attenuates these differences. Our findings show that chronic diseases and sex can compound to produce worse outcomes where women lose their survival advantage in the presence of ESKD.

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