scholarly journals High platelet turnover and reactivity in renal transplant recipients patients

2010 ◽  
Vol 104 (10) ◽  
pp. 804-810 ◽  
Author(s):  
Rossella Marcucci ◽  
Anna Maria Gori ◽  
Roberto Caporale ◽  
Alessandra Fanelli ◽  
Rita Paniccia ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Treatment Group ◽  
Renal Transplant ◽  
Platelet Reactivity ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Control Subjects ◽  
Immature Platelet Fraction ◽  
Group A ◽  
Group B

SummaryRenal transplant recipients (RTRs) patients are at increased risk of cardiovascular morbidity and mortality. We aimed this study to assess reticulated platelets (RP), platelet reactivity and von Willebrand factor (vWF) levels in RTRs patients. In 150 RTRs patients [84 (56%) not on acetylsalicylic acid (ASA) treatment, group A; 66 (44%) on ASA 100 mg treatment, group B] and in 60 healthy control subjects, RP were measured by a Sysmex XE-2100 and were expressed as the percentage of RP of the total optical platelet count (immature platelet fraction; IPF), as the percentage of RP highly fluorescent (H-IPF) and as the absolute number of RP (IPF#). Platelet function was assessed by optical aggregometry (PA) induced by 1 mmol arachidonic acid (AA-PA), 2 and 10 μM ADP (ADP2-PA and ADP10-PA) and 2 μg/ml collagen (Coll-PA). vWF levels were measured by using a miniVidas analyser. Group A and group B showed significant higher values of RP than controls. At a multiple linear regression analysis IPF and IPF# were significantly and positively related to collagen-PA. By analysing group B according to residual platelet reactivity (RPR), we observed a significant higher number of RP among patients with RPR by collagen. Moreover at a multiple logistic regression analysis, IPF# significantly affected the risk of having a RPR by collagen. With regard to vWF, RTRs patients showed higher levels than control subjects. We documented a higher platelet turn-over in both groups of RTRs patients and increased platelet reactivity in RTRs patients not on ASA therapy than controls.

Diagnostic significance of some urinary enzymes for detecting acute rejection crises in renal-transplant recipients: alanine aminopeptidase, alkaline phosphatase, gamma-glutamyltransferase, N-acetyl-beta-D-glucosaminidase, and lysozyme.

1986 ◽  
Vol 32 (10) ◽  
pp. 1807-1811 ◽  
Author(s):  
K Jung ◽  
J Diego ◽  
V Strobelt ◽  
D Scholz ◽  
G Schreiber
Keyword(s):  
Alkaline Phosphatase ◽  
Renal Transplant ◽  
Acute Rejection ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Urinary Enzymes ◽  
Gamma Glutamyltransferase ◽  
Alanine Aminopeptidase ◽  
Group A ◽  
Group B

Abstract We compared the diagnostic validity of five urinary enzymes--alanine aminopeptidase (EC 3.4.11.2), alkaline phosphatase (EC 3.1.3.1), gamma-glutamyltransferase (EC 2.3.2.2), N-acetyl-beta-D-glucosaminidase (EC 3.2.1.30), and lysozyme (EC 3.2.1.17)--as indicators of acute rejection crises in renal-transplant recipients. In 82 patients (group A), the excretion of each of these five enzymes was measured daily from transplantation until discharge from hospital. In another 69 patients (group B), enzyme determinations were made when the patient came for regular checkups (about every four to eight weeks). We used an "activity ratio" (the activity measured at a particular time compared with the activity on the preceding determination) value of 1.5 as the decision point. In group A, use of this discrimination point for alanine aminopeptidase, gamma-glutamyltransferase, and N-acetyl-beta-D-glucosaminidase yielded a specificity and sensitivity of about 90%. In group B, only alanine aminopeptidase had a greater diagnostic sensitivity than creatinine alone. Evidently, measurement of alanine aminopeptidase can be a helpful indicator of acute rejection crises, when interpreted in combination with other available relevant clinical, biochemical, and immunological data.

P1664ASSOCIATED WITH SERUM MYOSTATIN LEVEL WITH GAIT SPEED IN RENAL TRANSPLANT RECIPIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Chi-Chong Tang ◽  
Jia-Sian Hou ◽  
Yu-Chi Chang ◽  
Chia-Wen Lu ◽  
Ming-Che Lee ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Mycophenolate Mofetil ◽  
Renal Transplant ◽  
Gait Speed ◽  
Filtration Rate ◽  
Walking Speed ◽  
Estimated Glomerular Filtration Rate ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Speed Test

Abstract Background and Aims Walking speed test is a usefulness tool for cardiovascular risk stratification in older adults. The inhibition of myostatin in adult significantly increases muscle mass and confers benefits upon measures of performance and metabolism. The present study evaluated the relationship between walking speed test and serum myostatin levels in renal transplant recipients. Method Fasting blood samples were collected from 84 renal transplant recipients. Handgrip strength (HGS) was measured using a Jamar Plus Digital Hand Dynamometer for assessment of muscle strength. Gait speed was measured by walking 6 meters at the usual speed. Gait speed < 1 m/s was defined as low gait speed group according to the European Working Group on Sarcopenia in Older People (EWGSOP) criteria. Serum myostatin levels were measured using a commercial enzyme-linked immunosorbent assay. Results Thirty-one renal transplant recipients (36.9%) had low gait speed, and they included a lower percentage of use of mycophenolate mofetil (p = 0.003), higher percentage of use of steroid (p = 0.037), older age (p = 0.0090, higher body weight (p = 0.044), body mass index (p = 0.017), skeletal muscle index (p = 0.027), serum triglyceride (p = 0.029), glucose (p = 0.007), blood urea nitrogen (p = 0.041), cystatin C (p = 0.015), while lower estimated glomerular filtration rate from serum creatinine (eGFRcre, p = 0.047) and estimated glomerular filtration rate from serum cystatin C (eGFRcys, p = 0.006) compared with renal transplant recipients with normal gait speed. After adjusting for cofounders associated with low gait speed in these patients by multivariable logistic regression analysis, serum myostatin levels (Odds ratio (OR): 0.943, 95% confidence interval (CI): 0.898–0.990, p = 0.018), and mycophenolate mofetil used (OR: 0.199, 95% CI: 0.050–0.795, p = 0.022) were independently associated with low gait speed in renal transplant recipients. The area under the receiver-operating characteristic (ROC) curve indicates the diagnostic power of serum myostatin levels at predicting low gait speed of renal transplant recipients was 0.769 (95% CI: 0.664-0.854, p < 0.001). Multivariable forward stepwise linear regression analysis also showed that serum myostatin levels (β = 0.353, adjusted R2 change: 0.245, p = 0.001) was positively associated with gait speed values in renal transplant recipients. Conclusion In this study, serum myostatin levels is found to be positively correlated with gait speed values and is identified as serum low myostatin levels is associated with low gait speed in renal transplant patients.

scholarly journals Factors Associated with Uncontrolled Hypertension among Renal Transplant Recipients Attending Nephrology Clinics in Nairobi, Kenya

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Mary N. Kubo ◽  
Joshua K. Kayima ◽  
Anthony J. Were ◽  
Seth O. McLigeyo ◽  
Elijah N. Ogola
Keyword(s):  
Blood Pressure ◽  
Regression Analysis ◽  
Renal Transplant ◽  
Pressure Control ◽  
Uncontrolled Hypertension ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Factors Associated ◽  
Poor Blood Pressure Control ◽  
Male Sex

Objective.To determine the factors associated with poor blood pressure control among renal transplant recipients in a resource-limited setting.Methods. A cross-sectional study was carried out on renal transplant recipients at the Kenyatta National Hospital. Sociodemographic details, blood pressure, urine albumin : creatinine ratio, and adherence using the MMAS-8 questionnaire were noted. Independent factors associated with uncontrolled hypertension were determined using logistic regression analysis.Results. 85 subjects were evaluated. Mean age was 42.4 (SD ± 12.2) years, with a male : female ratio of 1.9 : 1. Fifty-five patients (64.7%) had uncontrolled hypertension (BP ≥ 130/80 mmHg). On univariate analysis, male sex (OR 3.7, 95% CI 1.4–9.5,p=0.006), higher levels of proteinuria (p=0.042), and nonadherence to antihypertensives (OR 18, 95% CI 5.2–65.7,p<0.001) were associated with uncontrolled hypertension. On logistic regression analysis, male sex (adjusted OR 4.6, 95% CI 1.1–19.0,p=0.034) and nonadherence (adjusted OR 33.8, 95% CI 8.6–73.0,p<0.001) were independently associated with uncontrolled hypertension.Conclusion. Factors associated with poor blood pressure control in this cohort were male sex and nonadherence to antihypertensives. Emphasis on adherence to antihypertensive therapy must be pursued within this population.

scholarly journals MO012IS IT SAFE TO USE INTERLEUKIN-2 RECEPTOR ANTAGONIST INDUCTION THERAPY IN 2DR MISMATCH RENAL TRANSPLANTS IN TACROLIMUS ERA?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Hatem Kaies Ibrahim Elsayed Ali ◽  
Ahmed Daoud ◽  
Mahmoud Mohamed ◽  
Karim Soliman
Keyword(s):  
Regression Analysis ◽  
Mycophenolate Mofetil ◽  
Renal Transplant ◽  
Acute Rejection ◽  
Receptor Antagonist ◽  
Graft Survival ◽  
Induction Therapy ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Maintenance Immunosuppression

Abstract Background and Aims 2DR HLA mismatch indicates high immunological risk renal transplant. Induction therapy with rabbit Anti-thymocyte Globulin (r-ATG) and IL-2 Receptor Antagonist (IL-2RA) resulted in marked reduction of acute allograft rejection rate and improved graft survival. However, the outcomes in 2DR (HLA-DR) mismatched renal transplant recipients (RTRs) in the era tacrolimus-mycophenolate mofetil maintenance immunosuppression remains understudied. Method Using data from the United States organ procurement and transplantation network, all 2 DR mismatched RTRs with panel reactive antibodies &lt;20% maintained on tacrolimus and mycophenolate mofetil immunotherapy between 2000 and 2017 were retrospectively reviewed. Data including age, sex, gender, ethnicity, functional status, diabetes, body mass index, cold ischemia time, number of previous transplants, panel reactive antibodies, donor type, donor age, HLA-mismatches, number of acute rejection episodes, induction therapies, maintenance immunotherapy, recipients and graft survival were collected. Based on induction therapies administered, RTRs were divided into 2 groups: (r-ATG) and IL-2RA groups. Poisson regression analysis was used to assess effect of induction therapies on acute rejection episodes. Cox hazard regression analysis was used to assess effect of different induction therapies on patient and graft survival Results 3379 patients received IL2-RA while 3677 patients received ATG for induction. There were no significant differences between both groups in terms of acute rejection episodes (95% CI ranges from 0.95 to 1.068, P=0.805), graft survival (95% CI: 0.91 - 1.06, P=0.712), or patient survival (95% CI: -0.949 - 1.12, P=0.43) . Conclusion This study revealed no significant difference in acute rejection episodes, patient or graft survival when utilizing ATG vs IL-2RA in 2DR HLA mismatched renal transplant recipients with PRA&lt;20%, in the tacrolimus-based maintenance immunosuppression era. Therefore, IL2-RA is a safe induction therapy in this group of patients and non-inferior to –ATG induction therapy.

scholarly journals Use of Laboratory Assays To Predict Cytomegalovirus Disease in Renal Transplant Recipients

1998 ◽  
Vol 36 (9) ◽  
pp. 2681-2685 ◽  
Author(s):  
Cheuk Yan William Tong ◽  
Luis Cuevas ◽  
Helen Williams ◽  
Ali Bakran
Keyword(s):  
Renal Transplant ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Active Infection ◽  
Specific Immunoglobulin ◽  
Group A ◽  
Definition Of ◽  
A Prospective Study ◽  
Cmv Disease ◽  
Positive Results

Eight laboratory assays, viz., the pp65 direct antigenemia test, a quantitative cytomegalovirus (CMV)-specific immunoglobulin G (IgG) assay (Biomerieux VIDAS), a CMV-specific IgM assay (Biomerieux VIDAS), the Hybrid Capture system (Murex), an in-house PCR with plasma (P-PCR) and leukocytes (L-PCR), and a commercial PCR (Roche AMPLICOR) with plasma (P-AMP) and leukocytes (L-AMP), were compared for their abilities to predict CMV disease before the onset of illness in a prospective study of 37 renal transplant recipients. By using an expanded criterion for active infection (two or more of the markers positive) and a clinical definition of disease, 22 (59%) patients were identified as having active CMV infection and 13 (35%) were identified as having CMV disease. Of the 13 CMV-seronegative recipients who received seropositive kidneys (R− group), 8 had active infection and disease. All assays were 100% specific and 100% predictive of CMV disease in the R− group. The leukocyte PCRs (L-PCR and L-AMP) were the most sensitive assays, had positive results an average of between 8 and 13 days before the onset of illness, and were the assays of choice. The performance of the assays was less satisfactory for the 24 patients who were CMV seropositive before transplantation (R+ group). A negative result was more useful for this group. Overall, P-AMP had the best results, and it could be the assay of choice for monitoring R+ patients. The non-PCR-based methods generally had high specificities but often gave late positive results and were not sensitive enough for use as prediction tools for either group of patients.

Ionized and Total Magnesium Levels in Cyclosporin-Treated Renal Transplant Recipients: Relationship with Cholesterol and Cyclosporin Levels

1993 ◽  
Vol 85 (3) ◽  
pp. 315-318 ◽  
Author(s):  
M. S. Markell ◽  
B. T. Altura ◽  
R. L. Barbour ◽  
B. M. Altura
Keyword(s):  
Renal Transplant ◽  
Total Cholesterol ◽  
Trough Level ◽  
Ionized Calcium ◽  
Renal Transplant Recipients ◽  
Total Calcium ◽  
Transplant Recipients ◽  
Ionized Magnesium ◽  
Control Subjects ◽  
Total Magnesium

1. Ionized magnesium, measured using a newly developed ion-selective electrode, total magnesium, and ionized and total calcium were evaluated in 39 stable, long-term, cyclosporin-treated renal transplant recipients and compared with those of age-matched, non-transplanted control subjects. Total cholesterol, cyclosporin trough level, serum creatinine, time after-transplant and the ratio of ionized calcium to ionized magnesium were also measured in renal transplant recipients and the relationships between these variables and ionized and total magnesium were evaluated. 2. Renal transplant recipients exhibited marked deficits in ionized magnesium, with a mean value of 0.54 ±0.01 mmol/l as compared with 0.61 ± 0.006 mmol/l for normal control subjects (P ≦ 0.05), with a more moderate deficit in total magnesium. Values for ionized and total calcium did not differ. By stepwise linear multiple regression analysis, ionized magnesium was significantly related to cyclosporin trough level and total cholesterol but not to serum creatinine, time after transplant or the dose of cyclosporin. Ionized magnesium correlated inversely with cyclosporin trough level and directly with total cholesterol. The ratio of ionized calcium to ionized magnesium was elevated in renal transplant recipients when compared with control subjects and correlated positively with the cyclosporin trough level. 3. Deficits in ionized magnesium are common during the late post-transplant period in cyclosporin-treated renal transplant recipients. Ionized magnesium may be a more sensitive clinical parameter than total magnesium in this population, in whom total magnesium may be only mildly decreased in the setting of a severe deficit in ionized magnesium. 4. Ionized magnesium correlates with the cyclosporin level. Renal transplant recipients with high cyclosporin levels demonstrate the most severe deficits in ionized magnesium, and this finding could contribute to cyclosporin-induced hypertension and nephrotoxicity. The direct correlation between ionized magnesium and total cholesterol may result from a ‘masked magnesium deficiency’, as has been suggested in animal models, and requires further study. 5. Accelerated atherosclerosis observed after renal transplantation may relate to alterations in ionized magnesium and elevated ratios of ionized calcium to ionized magnesium, which are associated with atherogenesis in other models.

MO982COMPARISON OF BASILIXIMAB AND R-ATG  ON ACUTE REJECTION RISK IN HIGH IMMUNOLOGICAL RISK RENAL TRANSPLANT RECIPIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Hatem Kaies Ibrahim Elsayed Ali ◽  
Mahmoud Mohamed ◽  
Nithya Krishnan ◽  
Shafi Malik
Keyword(s):  
Mycophenolate Mofetil ◽  
Renal Transplant ◽  
Acute Rejection ◽  
Lower Risk ◽  
Living Donor ◽  
Graft Function ◽  
Deceased Donor ◽  
Transplant Recipients ◽  
Group A ◽  
Group B

Abstract Background and Aims High Panel Reactive Antibody (PRA) level has been widely accepted as a marker for acute rejection risk following kidney transplantation. PRA&gt;/= 20% is considered a high immunological risk renal transplant. The aim of our study was to assess the risk of acute rejection in kidney transplant recipients (KTR) following Basiliximab induction compared to Rabbit Anti-Thymocyte Globulin (R-ATG) maintained on tacrolimus and mycophenolate mofetil maintenance immunotherapy. Method This was a retrospective observational cohort study using data from the United States Organ Procurement and Transplantation Network, all KTR’s with PRA =/&gt; 20%, who were maintained on tacrolimus and mycophenolate mofetil between September 2017 and September 2019 were included. Follow-up was until September 2020. Data included recipient factors (age, sex, ethnicity, diabetes, body mass index), transplant factors (delayed graft function, cold ischemia time, number of previous transplants, panel reactive antibodies, HLA-mismatches, induction therapy, maintenance immunotherapy and donor factors (donor type, donor age). The cohort were divided into 2 groups; living and deceased donor renal transplants. The groups were further divided by PRA level, each group was divided into 3 subgroups: Group A (low PRA level: PRA range from 20% to 49%), Group B (moderate PRA level: PRA range from 50% to 79%), and Group C (High PRA level: PRA range from 80% to 100%). Multivariable logistic regression models were constructed to assess the effect of induction therapies (Basiliximab versus R-ATG) on acute rejection episodes at 6 months post-transplant. The multivariable model was adjusted for recipient, donor and transplant factors mentioned above. Results Among living donor KTR’s, there was no difference between Basiliximab and R-ATG in acute rejection episodes in any of the three groups, Group A (low PRA level, n=717, OR=1.17, P=0.79, 95%CI:0.34-3.95), Group B (moderate PRA level, n=618, OR=1.51, P=0.58, 95%CI:0.33-6.92) and Group C (high PRA level, n=401, OR=1.17, P=0.85, 95%CI:0.21-6.56) respectively. In contrast, among deceased donor KTR’s R-ATG was associated with lower risk of rejection compared to Basiliximab in all three groups, group A (low PRA level, n=1895, OR=0.52, P=0.03, 95%CI: 0.28-0.94), group B (moderate PRA level, n=1618, OR=0.41, P&lt;0.01, 95%CI: 0.22-0.78) and group C (high PRA level, n=3973, P&lt;0.01, 95%CI: 0.28-0.70). Conclusion This study shows that risk of acute rejection is no different with Basilximab induction compared to R-ATG in high immunological risk living-donor KTR’s at all levels of PRA in the current tacrolimus-mycophenolate mofetil immunosuppression era. However, risk of acute rejection seems to be lower in deceased donor KTR’s having R-ATG induction at all levels of PRA. Delayed graft function is a risk factor for acute rejection, our models did not adjust for dose of R-ATG which may explain the lower risk seen in deceased donor KTR’s, data was not available on donor specific antibodies. In summary, Basiliximab induction has similar acute rejection rates as R-ATG in living donor KTR’s whereas in deceased donor KTR’s R-ATG was found to be better.

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