Abstract P691: Clinical Significance of Systolic and Diastolic Blood Pressures as Stroke Risks After Kidney Transplantation

Introduction: SBP is commonly utilized for BP control in stroke, but the clinical significance of DBP in kidney transplant recipients (KTR) is unknown. Hypothesis: We hypothesize that DBP at the time of stroke presentation is also associated with risk factor of stroke in KTR. Methods: This is a nested case-control study using a closed cohort of end-stage kidney disease patients undergoing kidney transplantation (KT) over a 12-year period. Stroke was diagnosed from brain imaging lesions consistent with localized neurological deficits. One case was matched with three controls based on age and date of KT identified at the same time when the first episode of CVA of each case occurred (incidence density sampling method). Results: Of all 752 KTR, 5 stroke cases and 15 controls were identified during the last 2 years of a study period. Mean age±SD was 45±16 VS 47± 12 years. Mean SBP of cases and controls were not significantly different (SBP±SD: 159±24 VS. 135±29 mmHg, p 0.109); whereas, mean DBP of the cases were significantly higher (DBP±SD: 93±7 and 76±13 mmHg; p 0.015) (Figure 1). Compared with the controls, cases’ SBP was 24 mmHg greater, but was not significant; whereas, DBP was 17 mmHg significantly higher (β 24.61; p 0.109; 95%CI -6.07, 55.29) and (β 17; p 0.015; 95%CI 3.69, 30.31). After adjusted by gender, race, body mass index, presence or absence of diabetes, hyperlipidemia, coronary artery disease, and atrial fibrillation, duration after KT, serum calcium and phosphorus, both SBP and DBP were 61 and 28 mmHg significantly higher, respectively among cases compared to the controls (β 61.11; p 0.011; 95%CI 20.31, 101.92) and (β 28.11; p 0.001; 95%CI 16.23, 39.10). Conclusion: Although SBP is known to be associated with stroke, DBP at the time of presentation for stroke is also associated with stroke in KTR. Epidemiological studies comparing SBP and DBP for outcomes of stroke in this population will further identify appropriate BP control and may change clinical practice.

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Kidney Transplantation 1: An Overview--Recipient Evaluation and Immunosuppression

10.2310/im.1324 ◽

2017 ◽

Author(s):

Belinda T. Lee ◽

Anil Chandraker ◽

Jamil Azzi ◽

Martina M McGrath

Keyword(s):

Kidney Transplantation ◽

Human Leukocyte ◽

Basic Knowledge ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Early Management ◽

Leukocyte Antigen ◽

Medical Evaluation ◽

Stage Renal Disease ◽

End Stage

Kidney transplantation remains the optimal renal replacement therapy for patients with end-stage renal disease (ESRD). A timely referral to kidney transplantation and a thorough pretransplantation evaluation ensure improvement in the morbidity and mortality of ESRD patients. Basic knowledge of immune biology and an in-depth understanding of the different induction and maintenance therapies used post kidney transplantation are imperative for optimal patient management. In this review, we discuss the multidisciplinary process of pretransplantation evaluation of kidney transplant recipients. We also discuss state-of–the-art early management post kidney transplantation with the different immunosuppressive therapies currently available. This review contains 3 figures, 11 tables, and 106 references. Key words: crossmatch, donor-specific antibody, immunosuppression, human leukocyte antigen, immunosuppression, induction, maintenance, medical evaluation, transplantation

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Early-Onset Coronary Artery Disease after Pediatric Kidney Transplantation: Implicating the Angiogenesis Inhibitor, Endostatin

The American Surgeon ◽

10.1177/000313481107700629 ◽

2011 ◽

Vol 77 (6) ◽

pp. 731-735 ◽

Cited By ~ 1

Author(s):

Corey W. Iqbal ◽

Patrick G. Dean ◽

Michael B. Ishitani

Keyword(s):

Kidney Transplantation ◽

Liver Transplant ◽

Kidney Transplant ◽

Angiogenesis Inhibitor ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Pediatric Kidney Transplantation ◽

Control Subjects ◽

Artery Disease ◽

Liver Transplant Recipients

Pediatric kidney transplant recipients have a higher rate of coronary artery disease (CAD) as adults. The angiogenesis inhibitor, endostatin, has been implicated in the development of atherosclerosis. Endostatin levels will vary between adult patients who received a kidney transplant as a child. We conducted a study in young adult patients who had undergone pediatric kidney (n = 12) or liver transplantation (n = 8). Coronary arterial calcification was measured using electron beam CT. Values were compared with age-matched control subjects from an epidemiologic database. Serum endostatin levels were measured using enzyme-linked immunosorbent assay. Risk factors for atherosclerosis were assessed. Kidney transplant recipients had a higher rate of CAD compared with liver transplant recipients (33 vs 0%, P = 0.03). Mean (± standard error of mean) serum endostatin levels were higher in kidney transplant recipients compared with liver transplant recipients (26 ± 7 vs 14 ± 3 ng/mL, P = 0.04) and control subjects (26 ± 7 vs 11 ± 1 ng/ mL, P = 0.01). Pediatric kidney transplantation is associated with a higher rate of adult-onset CAD compared with liver transplantation. Endostatin levels were greater in kidney transplant recipients compared with liver transplant recipients and healthy control subjects. Endostatin may play a role in the development of atherosclerosis after kidney transplantation and may serve as a biomarker for atherosclerotic disease.

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Recurrence of immunoglobulin A nephropathy after kidney transplantation: a narrative review of the incidence, risk factors, pathophysiology and management of immunosuppressive therapy

Clinical Kidney Journal ◽

10.1093/ckj/sfaa060 ◽

2020 ◽

Vol 13 (5) ◽

pp. 758-767

Author(s):

Barbara Infante ◽

Michele Rossini ◽

Adelaide Di Lorenzo ◽

Nicola Coviello ◽

Castellano Giuseppe ◽

...

Keyword(s):

Kidney Transplantation ◽

Renal Disease ◽

Immunosuppressive Treatment ◽

Graft Loss ◽

Immunoglobulin A ◽

Supportive Therapy ◽

Kidney Graft ◽

Immunoglobulin A Nephropathy ◽

Kidney Transplant Recipients ◽

End Stage

Abstract Glomerulonephritis (GN) is the underlying cause of end-stage renal failure in 30–50% of kidney transplant recipients. It represents the primary cause of end-stage renal disease for 25% of the dialysis population and 45% of the transplant population. For patients with GN requiring renal replacement therapy, kidney transplantation is associated with superior outcomes compared with dialysis. Recurrent GN was previously considered to be a minor contributor to graft loss, but with the prolongation of graft survival, the effect of recurrent disease on graft outcome assumes increasing importance. Thus the extent of recurrence of original kidney disease after kidney transplantation has been underestimated for several reasons. This review aims to provide updated knowledge on one particular recurrent renal disease after kidney transplantation, immunoglobulin A nephropathy (IgAN). IgAN is one of the most common GNs worldwide. The pathogenesis of IgAN is complex and remains incompletely understood. Evidence to date is most supportive of a several hit hypothesis. Biopsy is mandatory not only to diagnose the disease in the native kidney, but also to identify and characterize graft recurrence of IgAN in the kidney graft. The optimal therapy for IgAN recurrence in the renal graft is unknown. Supportive therapy aiming to reduce proteinuria and control hypertension is the mainstream, with corticosteroids and immunosuppressive treatment tailored for certain subgroups of patients experiencing a rapidly progressive course of the disease with active lesions on renal biopsy and considering safety issues related to infectious complications.

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Nationwide Glaucoma incidence in end stage renal disease patients and kidney transplant recipients

Scientific Reports ◽

10.1038/s41598-021-86846-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jong Joo Moon ◽

Yong Woo Kim ◽

Baek-Lok Oh ◽

Kyungdo Han ◽

Dong Ki Kim ◽

...

Keyword(s):

Kidney Transplantation ◽

Renal Disease ◽

End Stage Renal Disease ◽

Open Angle Glaucoma ◽

Angle Closure ◽

Healthy Controls ◽

Kidney Transplant Recipients ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

AbstractGlaucoma shares common risk factors with chronic kidney disease (CKD) but previous cross-sectional studies have demonstrated discrepancies in the risk of glaucoma in CKD patients. This study enrolled kidney transplantation recipients (KTRs) (n = 10,955), end stage renal disease (ESRD) patients (n = 10,955) and healthy controls (n = 10,955) from National Health Insurance Service database of the Republic of Korea. A Cox proportional hazard regression model was used to calculate the hazard ratios (HR) for primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) incidences. The incidence of POAG was higher in ESRD patients (3.36/1,000 person-years, P < 0.0001) and KTRs (3.22 /1,000 person-years, P < 0.0001), than in healthy controls (1.20/1,000 person-years). However, POAG risk showed no significant increase in either ESRD patients (P = 0.07) or KTRs (P = 0.08) when adjusted for the confounding factors. The incidence of PACG was significantly higher in ESRD patients (0.41/1,000 person-years) than in healthy controls (0.14/1,000 person-years, P = 0.008). The PACG incidence was significantly lower in KTRs than in ESRD patients (HR = 0.35, P = 0.015). In conclusion, this nationwide cohort study demonstrated that kidney transplantation can reduce the risk of PACG but not POAG in ESRD patients.

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Effects of bisphosphonates on long-term kidney transplantation outcomes

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa371 ◽

2020 ◽

Author(s):

Seung Hwan Song ◽

Hoon Young Choi ◽

Ha Yan Kim ◽

Chung Mo Nam ◽

Hyeon Joo Jeong ◽

...

Keyword(s):

Kidney Transplantation ◽

Graft Survival ◽

Graft Failure ◽

Case Control ◽

Bisphosphonate Therapy ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Nested Case Control ◽

Reduced Risk

Abstract Background Bisphosphonates are administered to post-transplantation patients with mineral and bone disorders; however, the association between bisphosphonate therapy and long-term renal graft survival remains unclear. Methods This nested case-control study investigated the effects of bisphosphonates on long-term graft outcomes after kidney transplantation. We enrolled 3,836 kidney transplant recipients treated from April 1979 to June 2016 and matched patients with graft failure to those without (controls). Annual post-transplant bone mineral density assessments were performed, and recipients with osteopenia or osteoporosis received bisphosphonate therapy. The associations between bisphosphonate use, and long-term graft outcomes and graft survival were analyzed using conditional logistic regression and landmark analyses, respectively. Results A landmark analysis demonstrated that the death-censored graft survival was significantly higher in bisphosphonate users than in non-users in the entire cohort (log-rank test, P < .001). In the nested case-control matched cohort, bisphosphonate users had a significantly reduced risk of graft failure than did non-users (odds ratio, 0.38; 95% confidence interval, 0.30–0.48). Bisphosphonate use, increased cumulative duration of bisphosphonate use over one year, and increased cumulative bisphosphonate dose above the first quartile were associated with a reduced risk of graft failure, after adjustments. Conclusions Bisphosphonates may improve long-term graft survival in kidney transplant recipients.

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P1732RECURRENCE OF GLOMERULONEPHRITIS POST TRANSPLANT

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1732 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Umesh Lingaraj ◽

Ricken Mehta ◽

Shivaprasad SM ◽

Kishan A ◽

Leelavathi V ◽

...

Keyword(s):

Kidney Transplantation ◽

Renal Disease ◽

Kidney Transplant ◽

End Stage Renal Disease ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Post Transplant ◽

Stage Renal Disease ◽

End Stage

Abstract Background and Aims Glomerulonephritis (GN) is a major cause of end stage renal disease (ESRD)1. It represents the primary cause of end stage renal disease (ESRD) for 25% of the dialysis population1 and 45% of the transplant population. For patients with GN requiring renal replacement therapy, kidney transplantation is associated with superior outcomes compared with dialysis2. The possibility of recurrence of the original disease after transplantation was described in a seminal paper more than 40 years ago, and it is now clear that all forms of GN may recur after kidney transplantation.3 To study the recurrence of glomerulonephritis post-transplant in a tertiary care centre. Method 120 renal transplant recipients were analyzed from September 2015 to August 2019 at the Institute of Nephro-Urology, Bangalore. It was a retrospective analysis of data Results 120 adult patients underwent kidney transplantation, out of these 70 had GN as primary cause of kidney disease. 85.8% were males, 14.2 % females. 58.9 % were biopsy proven GN, remaining 41.1 % diagnosed based on history and clinical presentation. All but one patient had their first transplant. Out of these kidney transplant recipients 08 (11.4%) had recurrence of GN. From these 4/08 was recurrent IgA N, 2/08 were PGNMID, 1/08 MGN, 1/08 aHUS. Graft loss due to recurrent GN was seen in 1/08 patients (12.5%). Conclusion Our study showed that 11.4 % of kidney transplant recipients with GN as their cause of ESRD had recurrent GN post kidney transplantation. IgAN was the most type of GN that recurred most frequently followed by PGNMID. Recurrence of GN was in par with other studies and did not affect graft survival

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Hepatitis C and Kidney Transplantation

International Journal of Nephrology ◽

10.4061/2011/593291 ◽

2011 ◽

Vol 2011 ◽

pp. 1-17 ◽

Cited By ~ 26

Author(s):

Marco Carbone ◽

Paul Cockwell ◽

James Neuberger

Keyword(s):

Kidney Transplantation ◽

Hepatitis C ◽

Kidney Transplant ◽

Hemodialysis Patients ◽

Hcv Infection ◽

Decompensated Cirrhosis ◽

Kidney Transplant Recipients ◽

Transplant Candidates ◽

Related Liver Disease ◽

End Stage

Hepatitis C virus (HCV) infection is relatively common among patients with end-stage kidney disease (ESKD) on dialysis and kidney transplant recipients. HCV infection in hemodialysis patients is associated with an increased mortality due to liver cirrhosis and hepatocellular carcinoma. The severity of hepatitis C-related liver disease in kidney transplant candidates may predict patient and graft survival after transplant. Liver biopsy remains the gold standard in the assessment of liver fibrosis in this setting. Kidney transplantation, not haemodialysis, seems to be the best treatment for HCV+ve patients with ESKD. Transplantation of kidneys from HCV+ve donors restricted to HCV+ve recipients is safe and associated with a reduction in the waiting time. Simultaneous kidney/liver transplantation (SKL) should be considered for kidney transplant candidates with HCV-related decompensated cirrhosis. Treatment of HCV is more complex in hemodialysis patients, whereas treatment of HCV recurrence in SLK recipients appears effective and safe.

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Clinical Significance of Multidetector Coronary Computed Tomography Angiography to Evaluate the Prevalence and Severity of Coronary Artery Disease in Asymptomatic Kidney Transplantation Recipients

Transplantation Proceedings ◽

10.1016/j.transproceed.2014.12.032 ◽

2015 ◽

Vol 47 (3) ◽

pp. 675-678

Author(s):

S.H. Lee ◽

K.H. Huh ◽

B.K. Kim ◽

B.W. Choi ◽

Y.J. Kim ◽

...

Keyword(s):

Computed Tomography ◽

Coronary Artery Disease ◽

Kidney Transplantation ◽

Coronary Artery ◽

Clinical Significance ◽

Computed Tomography Angiography ◽

Coronary Computed Tomography Angiography ◽

Coronary Computed Tomography ◽

Artery Disease

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De novo ulcerative colitis after kidney transplantation treated with infliximab

CEN Case Reports ◽

10.1007/s13730-021-00599-6 ◽

2021 ◽

Author(s):

Rikako Oki ◽

Sumi Hidaka ◽

Akiko Sasaki ◽

Shinichi Teshima ◽

Yasuhiro Mochida ◽

...

Keyword(s):

Ulcerative Colitis ◽

Kidney Transplantation ◽

De Novo ◽

Graft Function ◽

Bloody Diarrhea ◽

Kidney Transplant Recipients ◽

Post Transplantation ◽

Common Causes ◽

Factor Α ◽

End Stage

AbstractDiarrhea is a common complication in kidney transplant recipients. Common causes of diarrhea include infection, side effect from medication, rejection, and malignancy. A less common but important cause of diarrhea is de novo inflammatory bowel disease (IBD). This is unexpected, as these patients are already immunosuppressed. Herein, we present the case of a 45-year-old man with end-stage kidney disease because of focal segmental glomerulosclerosis who underwent preemptive kidney transplantation, with his mother as donor. His immunosuppressive regimen included methylprednisolone, mycophenolate mofetil, and tacrolimus. He had no episodes of graft dysfunction, rejection, or infectious events. Two and a half years post-transplantation, he developed bloody diarrhea. After excluding infections, colonoscopy was performed and revealed edematous mucosa and erythema with pigmentation, which are typical findings in ulcerative colitis. Despite therapy with 5-aminosalicylate and granulocyte monocyte apheresis, he presented with massive bloody diarrhea. We initiated infliximab, an anti-tumor necrosis factor-α (TNF-α) agent. He responded very well and achieved remission within 6 months after initiation of infliximab, while administration of the other immunosuppressants was maintained. His course was uneventful and no complications developed. Management of immunosuppressants for de novo IBD after organ transplantation is complicated, because treatment of IBD, graft function protection, and prevention of infection must be considered. Therefore, cooperation between transplantation physicians and gastroenterologists is essential during therapy.

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