Association between Circulating Thrombopoietin Levels and Cardiovascular Risk Prediction Scores in Renal Transplant Recipients

2015 ◽  
Vol 41 (2) ◽  
pp. 147-155 ◽  
Author(s):  
Holly Mansell ◽  
Hamdi Elmoselhi ◽  
Ahmed Shoker
Keyword(s):  
Renal Transplant ◽  
Cardiovascular Events ◽  
Stepwise Regression ◽  
Major Adverse Cardiovascular Events ◽  
Inflammatory Factor ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Cardiovascular Risk Prediction ◽  
History Of ◽  
The Impact

Background/Aims: The 7-year Major Adverse Cardiovascular Events Calculator (CRCRTR-MACE) predicts cardiovascular events (CVE) in renal transplant recipients (RTR), and thrombopoietin (TPO) is a humoral inflammatory factor implicated in cardiovascular disease (CVD). The aim of the study was to determine if circulating TPO levels in stable RTR are positively associated with variable(s) in the CRCRTR-MACE score. Methods: CRCRTR-MACE scores were calculated in 95 stable RTR. TPO levels were measured by multiplexed fluorescent bead-based immunoassay in all patients and 48 controls. Multivariate analysis (MVA) was performed between TPO and CV risk variables and patient demographics. Stepwise regression with backward elimination of insignificant variables estimated the impact of risk variables on TPO levels. Significance was defined at p < 0.05. Normalized data were presented as mean ± SD and non-normalized data as median (maximum to minimum). Results: The risk of a CVE within 7 years as predicted by the median was 9.97% (range 1.93-84.2). The percentage of patients who were above 20% risk for a CVE was 28.4%. Control TPO level of 170.41 (4.4-995.9) pg/ml was significantly lower than that of 237.90 (32.77-1,386.79) pg/ml in RTR (p = 0.010). TPO level correlated significantly with the total CRCRTR-MACE score (R = 0.310, p = 0.004), smoking (p = 0.009) and eGFR (R = -0.275, p = 0.012) but not with age, diabetes, LDL level or history of CVE. Only the total CRCRTR-MACE score (p = 0.013) and smoking (p = 0.009) remained significant in the MVA. Stepwise regression estimated that smoking increased TPO levels by 206.28 pg/ml and each 10% increase in CRCRTR-MACE score increased TPO levels by an additional 44.4 pg/ml. Conclusion: TPO levels are increased in RTR with high CRCRTR-MACE, particularly in smokers with diminished eGFR. Circulating TPO may serve as a biomarker and treatment target for CVD in RTR.

scholarly journals A Review of Enteric-coated Mycophenolate Sodium for Renal Transplant Immunosuppression

2009 ◽  
Vol 1 ◽  
pp. CMT.S2218 ◽  
Author(s):  
Nathan Newbold ◽  
Brianna Riley ◽  
Karen Hardinger
Keyword(s):  
Renal Transplant ◽  
Mycophenolic Acid ◽  
Renal Transplant Recipients ◽  
Inosine Monophosphate Dehydrogenase ◽  
Transplant Recipients ◽  
Gastrointestinal Complications ◽  
Mycophenolate Sodium ◽  
Delayed Release ◽  
Enteric Coated ◽  
The Impact

Mycophenolic acid inhibits an enzyme, inosine monophosphate dehydrogenase (IMPDH), blocking purine synthesis of lymphocytes and therefore functioning as an effective immunosuppressive agent in transplantation. Currently, there are two available forms of mycophenolic acid (MPA) available; mycophenolate mofetil (MMF) and enteric-coated, delayed-release mycophenolate sodium (EC-MPS). Both products are approved for prophylaxis of organ rejection in renal transplant recipients. The use of MPA may be associated with adverse gastrointestinal effects which can lead to a reduction of the dose or discontinuation of therapy. Enteric-coated MPS was developed to reduce the upper gastrointestinal side effects due to its delayed release in the small intestines. Similar systemic MPA exposure is provided by oral administration of MMF 1000 mg daily and EC-MPS 720 mg, which contain near equimolar MPA content. Clinical trials in renal transplant recipients have demonstrated that EC-MPS is therapeutically equivalent to MMF when used at the time of transplantation and when used for conversion for gastrointestinal complications. The available literature regarding the incidence and severity of gastrointestinal adverse effects and the impact on quality of life remains controversial. Prospective, randomized trials of the available MPA formulations are warranted to further explore the gastrointestinal adverse effect profiles.

Vaccination titres pre- and post-transplant in paediatric renal transplant recipients and the impact of immunosuppressive therapy

2018 ◽  
Vol 33 (5) ◽  
pp. 897-910 ◽  
Author(s):  
Britta Höcker ◽  
Martin Aguilar ◽  
Paul Schnitzler ◽  
Lars Pape ◽  
Martin Bald ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Immunosuppressive Therapy ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Post Transplant ◽  
The Impact

scholarly journals A need-adapted transition program after pediatric kidney transplantation

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Susanne Rieger ◽  
Dirk Bethe ◽  
Angela Bagorda ◽  
Dorothea Treiber ◽  
Jörg Beimler ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Transition Process ◽  
Transition Program ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Adult Care ◽  
Increased Risk ◽  
Pediatric Renal Transplant ◽  
The Individual ◽  
The Impact

AbstractA successful transition of renal transplant recipients from pediatric to adult care requires a structured, need-adapted and multidisciplinary approach to preserve renal graft function during this critical period of life. In this article we present our clinical protocol for transition from pediatric to adult care, which we developed on the basis of the International Society of Nephrology (ISN)/International Pediatric Nephrology Association (IPNA) consensus guidelines influenced by our own experience. This transition program was established in our center in July 2017. The entire transition process is structured and accompanied by a transition key worker (social worker). From 12 years of age we train pediatric renal transplant recipients in medical knowledge, self-management skills and networking with self-help groups. The training is adapted to the individual patient‘s intellectual ability, lasts about 10 years and takes place with increasing intensity. Repeatedly we perform standardized informational interviews and check patient’s knowledge of transplant-related topics. Psychosocial and educational issues are evaluated concomitantly. The actual transfer takes place in a pediatric-adult-transition clinic. Relevant medical and psychosocial aspects are discussed and the future treatment regimen is established. The date of transfer is adapted to the individual patient’s need; it varies between 18 and 24 years of age. In periods of increased risk for non-adherence the transfer is postponed to intensify the efforts for training and assistance. After transfer a standardized evaluation of each individual patient takes place focusing on medical and psychosocial issues and on satisfaction with the transition process. Collection of these data is still in progress and will be analyzed systematically at a later stage in order to evaluate the impact of this new transition program on the stability of transplant function. That analysis might serve as a basis for negotiations about refunding with health insurance companies.

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