Effect of Pre-Transplant Dialysis Modality on Kidney Transplantation Outcome

Background The effect of pre-transplant dialysis modality on early graft function is a matter of debate. Although some authors deny the existence of a significant influence, others suggest that peritoneal dialysis (PD) affects early graft function favorably, possibly by contributing to a more physiologic water balance. In the present study, we evaluated the influence of pre-transplant dialysis modality on early and late graft function. Patients and Methods We studied 745 patients who underwent a first renal transplantation during 1983 – 2006, comparing the records of 44 PD patients [26 male; mean age: 26 ± 9 years (range: 8 – 56 years)] who received 36 living related and 8 cadaveric renal transplantations with those of a control group of 44 consecutive hemodialysis (HD) patients [26 male; mean age: 27 ± 11 years (range: 7 – 49 years)] for the index cases. Results The groups showed no significant differences in donor type, human leukocyte antigen matching, immunosuppressive protocols, and duration of dialysis. Also, neither group differed significantly with regard to incidence of delayed graft function, acute tubular necrosis, wound infection, systemic viral and bacterial infections, or acute rejection in the early post-transplant period. In the late post-transplant period, incidences of chronic rejection, graft failure, and malignancies were also similar. During the follow-up period, 3 patients in the PD group experienced acute rejection, 2 developed cytomegalovirus (CMV) disease, and 5 developed various other infections. In the HD group, 4 patients experienced acute rejection, 1 developed CMV disease, and 8 experienced other infections. Five patients in the PD group and one in the HD group died with functioning grafts ( p = 0.09). No differences were noted between the groups in the incidences of post-transplant cardiovascular complications, malignancies, and diabetes mellitus. In the PD group, 33 patients with functioning grafts are still being followed, 6 have returned to dialysis, and 5 have died. In the HD group, 38 patients with functioning grafts are still being followed, 5 have returned to dialysis, and 1 has died. Conclusions As a pre-transplant dialysis modality, neither HD nor PD affects the outcome of renal transplantation.

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Implications of renal transplantation on serum testosterone and preoperative factors affecting its levels in the post-transplant period

Journal of Clinical Urology ◽

10.1177/20514158211040712 ◽

2021 ◽

pp. 205141582110407

Author(s):

Rohit Pratap Singh ◽

Vinay Tomar ◽

Sher Singh Yadav

Keyword(s):

Renal Transplantation ◽

Positive Impact ◽

Graft Function ◽

Human Leukocyte ◽

Serum Testosterone ◽

Level Of Evidence ◽

Factors Affecting ◽

Post Transplant ◽

Testosterone Levels ◽

Postoperative Serum

Objective: Low serum testosterone is highly prevalent in chronic kidney disease patients. The objective of the study was to determine levels of serum testosterone at the time of transplantation, the prevalence of testosterone deficiency/insufficiency in the pre- and post-transplant periods, and its correlation with patients’ age, serum creatinine, duration of preoperative dialysis, human leukocyte antigen (HLA) matching, and graft outcomes. Methods: The study was conducted from January 2019 to April 2020. Forty-five male renal transplant patients were evaluated before and at one and six months following transplant for changes in testosterone and creatinine levels. Six-month follow-up was possible for 28 patients. Result: Renal transplantation resulted in significant improvement in testosterone levels as early as one month after transplantation. The duration of preoperative dialysis and HLA match had a negative and positive impact on postoperative serum testosterone levels, respectively. We did not find any impact of testosterone levels on graft function. Conclusion: Successful transplantation among the study population produced a positive impact on serum testosterone levels. The duration of preoperative dialysis and HLA match had a negative and positive impact on postoperative serum testosterone levels, respectively. Level of evidence: XXX.

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MO941CLINICAL OUTCOMES IN KIDNEY RE-TRANSPLANTATION

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab110.0020 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Clara Pardinhas ◽

Rita Leal ◽

Francisco Caramelo ◽

Teofilo Yan ◽

Carolina Figueiredo ◽

...

Keyword(s):

Acute Rejection ◽

Kidney Transplant ◽

Graft Survival ◽

Graft Failure ◽

Graft Function ◽

Delayed Graft Function ◽

First Year ◽

Kidney Transplant Recipients ◽

Post Transplant

Abstract Background and Aims As kidney transplants are growing in absolute numbers, so are patients with failed allografts and thus potential candidates for re-transplantation. Re-transplantation is challenging due to immunological barriers, surgical difficulties and clinical complexities but it has been proven that successful second transplantation improves life expectancy over dialysis. It is important to evaluate re-transplantation outcomes since 20% of patients on the waiting list are waiting for a second graft. Our aim was to compare major clinical outcomes such as acute rejection, graft and patient survival, between patients receiving a first or a second kidney transplant. Method We performed a retrospective study, that included 1552 patients submitted to a first (N=1443, 93%) or a second kidney transplant (N=109, 7%), between January 2008 and December 2018. Patients with more than 2 grafts or multi-organ transplant were excluded. Demographic, clinical and histocompatibility characteristics of both groups were registered from our unit database and compared. Delayed graft function was defined has the need of dialysis in the first week post-transplant. All acute rejection episodes were biopsy proven, according to Banff 2017 criteria. Follow-up time was defined at 1st June 2020 for functioning grafts or at graft failure (including death with a functioning graft). Results Recipients of a second graft were significantly younger (43 ±12 vs 50 ± 13 years old, p<0.001) and there were significantly fewer expanded-criteria donors in the second transplant group (31.5% vs 57.5%, p<0.001). The waiting time for a second graft was longer (63±50 vs 48±29 months, p=0.011). HLA mismatch was similar for both groups but PRA was significantly higher for second KT patients (21.6±25% versus 3±9%; p<0.001). All patients submitted to a second KT had thymoglobulin as induction therapy compared to 16% of the first KT group (p<0.001). We found no difference in primary dysfunction or delayed graft function between groups. Acute rejection was significantly more frequent in second kidney transplant recipients (19% vs 5%, p<0.001), being 10 acute cellular rejections, 7 were antibody mediated and 3 were borderline changes. For the majority of the patients (85%), acute rejection occurred in the first-year post-transplant. Death censored graft failure occurred in 236 (16.4%) patients with first kidney transplant and 25 (23%) patients with a second graft, p=0.08. Survival analysis showed similar graft survival for both groups (log-rank p=0.392). We found no difference in patients’ mortality at follow up for both groups. Conclusion Although second graft patients presented more episodes of biopsy proven acute rejection, especially at the first-year post-transplant, we found no differences in death censored graft survival or patients’ mortality for patients with a second kidney transplant. Second transplants should be offered to patients whenever feasible.

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Effectiveness of Valganciclovir 900mg Versus 450mg for Cytomegalovirus Prophylaxis in Renal Transplantation: A Systematic Review and Meta-Analysis

Journal of Pharmacy & Pharmaceutical Sciences ◽

10.18433/j3805b ◽

2017 ◽

Vol 20 ◽

pp. 168 ◽

Cited By ~ 3

Author(s):

Wang Xin ◽

Yang Hui ◽

Zhang Xiaodong ◽

Cui Xiangli ◽

Wang Shihui ◽

...

Keyword(s):

Renal Transplantation ◽

Acute Rejection ◽

Low Dose ◽

Opportunistic Infections ◽

Meta Analysis ◽

High Dose ◽

Renal Transplant Recipients ◽

Significant Difference ◽

Allograft Loss ◽

Cmv Disease

Objectives: Valganciclovir 900 mg/day is approved for cytomegalovirus (CMV) prophylaxis, but 450 mg/day is seems also effective. We systematically reviewed the efficacy and safety of low-dose versus high-dose valganciclovir prophylaxis in renal transplantation recipients. Methods: An electronic search was conducted up to November 29, 2016. The primary outcomes were incidences of CMV, CMV disease, mortality and opportunistic infection. The second outcomes were acute rejection, allograft loss, adverse drug reaction (ADR). Results: 7 cohort studies, all with high quality involving (1431 patients) were included. There was no significant difference of the incidence of following CMV disease (1271 patients, odds ratio [OR] 0.74, 95% confidence interval [CI], 0.38-1.43, p=0.36), acute rejection (1343 patients, OR 0.77, 95%CI 0.53-1.14, p=0.19), allograft loss (1271 patients, OR 0.64, 95%CI 0.31-1.35, p=0.24), mortality (1271 patients, OR 0.55, 95%CI 0.20-1.47, p=0.23) and opportunistic infections (OI) (985 patients, OR 0.76, 95%CI 0.52-1.10, p=0.14) between the low-dose and the high-dose valganciclovir prophylaxis. And no significant difference was observed for premature valganciclovir discontinuation (1010 patients, OR 0.81, 95%CI 0.52-1.25, p=0.33) and the incidence of leukopenia (1082 patients, OR 0.65, 95%CI 0.34-1.22, p=0.18) between the two regimens. Conclusion: 450 mg and 900 mg doses of valganciclovir are equipotent for CMV universal prophylaxis. CMV 450 mg prophylaxis should be used for renal transplant recipients. This article is open to POST-PUBLICATION REVIEW. Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page.

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A Prospective Controlled Trial to Evaluate Safety and Efficacy of in vitro Expanded Recipient Regulatory T Cell Therapy and Tocilizumab Together With Donor Bone Marrow Infusion in HLA-Mismatched Living Donor Kidney Transplant Recipients (Trex001)

Frontiers in Medicine ◽

10.3389/fmed.2020.634260 ◽

2021 ◽

Vol 7 ◽

Author(s):

Rainer Oberbauer ◽

Matthias Edinger ◽

Gabriela Berlakovich ◽

Peter Kalhs ◽

Nina Worel ◽

...

Keyword(s):

Bone Marrow ◽

Kidney Transplant ◽

Graft Function ◽

Control Group ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Post Transplant ◽

Donor Bone Marrow ◽

Living Donor Kidney Transplant

Background: The induction of donor-specific immunological tolerance could improve outcome after kidney transplantation. However, no tolerance protocol is available for routine clinical use. Chimerism-based regimens hold promise, but their widespread application is impeded in part by unresolved safety issues. This study tests the hypothesis that therapy with polyclonal recipient regulatory T cells (Tregs) and anti-IL6R (tocilizumab) leads to transient chimerism and achieves pro-tolerogenic immunomodulation in kidney transplant recipients also receiving donor bone marrow (BM) without myelosuppressive conditioning of the recipient.Methods/design: A prospective, open-label, controlled, single-center, phase I/IIa academic study is performed in HLA-mismatched living donor kidney transplant recipients.Study group: Recipients of the study group receive in vitro expanded recipient Tregs and a donor bone marrow cell infusion within 3 days after transplantation and tocilizumab for the first 3 weeks post-transplant. In addition they are treated with thymoglobulin, belatacept, sirolimus, and steroids as immunosuppression. Starting 6 months post-transplant, sirolimus and steroids are withdrawn in a step-wise manner in stable patients.Control group: Recipients of the control group are treated with thymoglobulin, belatacept, sirolimus, and steroids as immunosuppression. Co-primary endpoints of safety (impaired graft function [eGFR <35 mL/min/1.73 m2], graft-vs.-host disease or patient death by 12 months) and efficacy (total leukocyte donor chimerism within 28 days post-transplant) are assessed. Secondary endpoints include frequency of biopsy-proven acute rejection episodes and subclinical rejection episodes on surveillance biopsies, assessment of kidney graft function, and the evaluation whether the study protocol leads to detectable changes in the immune system indicative of pro-tolerogenic immune modulation.Discussion: The results of this trial will provide evidence whether treatment with recipient Tregs and donor BM is feasible, safe and efficacious in leading to transient chimerism. If successful, this combination cell therapy has the potential to become a novel treatment option for immunomodulation in organ transplantation without the toxicities associated with myelosuppressive recipient conditioning.Trial registration: European Clinical Trials Database EudraCT Nr 2018-003142-16 and clinicaltrials.gov NCT03867617.

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Impact of selected factors on early graft function in patients after renal transplantation

Transplantation Proceedings ◽

10.1016/s0041-1345(03)00798-x ◽

2003 ◽

Vol 35 (6) ◽

pp. 2167-2169 ◽

Cited By ~ 7

Author(s):

J Sienko ◽

M Wisniewska ◽

M Ostrowski ◽

K Ciechanowski ◽

K Safranow ◽

...

Keyword(s):

Renal Transplantation ◽

Graft Function ◽

Early Graft

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2659. Retrospective Review of Biopsy Proven Acute Graft Pyelonephritis in Renal Transplant Patients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2337 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S930-S930

Author(s):

Harry Ross Powers ◽

Walter Hellinger ◽

Cherise Cortese ◽

Hani M Wadei

Keyword(s):

Risk Factors ◽

Acute Rejection ◽

Serum Creatinine ◽

Potential Risk ◽

Medical Center ◽

Graft Function ◽

Post Transplant ◽

Histologic Evidence ◽

Potential Risk Factors ◽

Acute Graft

Abstract Background There are few studies of histologic acute graft pyelonephritis (HAGPN) following kidney transplant (KT). The goals of this study are to determine incidence, identify potential risk factors and describe outcomes of HAGPN in a large cohort of KT recipients. Methods Renal allograft biopsies of all patients undergoing first KT at our medical center between 2008 and 2017 were reviewed. HAGPN was defined as the presence of neutrophils within the interstitium and tubules (casts). Medical charts of patients with HAGPN were reviewed. Episodes of bacteriuria (≥10:5 cfu/mL growth in culture) were classified as urinary tract infection (UTI) or asymptomatic bacteruria (ASB) based upon documented symptoms. An episode of acute rejection was defined as pulse parenteral immunosuppressive therapy for histologic evidence of rejection. Results HAGPN was identified in 43 of 1,391 (3.1%) KT recipients at a median of 298 days post-transplant. There were no significant differences between recipient age or gender, donor age or transplant type (deceased, living related, living unrelated) between recipients with and without HAGPN. Urologic malformation was diagnosed in 14 (33%) by day 30 post-transplant. Twenty-five (58%), 17 (40%), and 13 (30%) sustained one or more episodes of acute rejection, UTI and ASB, respectively, prior to HAGPN. At diagnosis of HAGPN, 28 (65%), 7 (16%), and 16 (37%) had histologic evidence of rejection, UTI and ASB, respectively. Twenty-two (51%) and 37 (86%) were treated with pulse immunosuppression and antibiotics, respectively. Median nadir serum creatinine before HAGPN was 1.1 mg/day while median serum creatinine at 6 and 12 months after HAGPN were 1.5 and 1.6. Three patients (7%) developed graft failure within 1 year after HAGPN. Conclusion HAGPN is an infrequent complication of KT. A majority of patients with HAGPN have histologic evidence of rejection and either UTI or ASB at diagnosis, though over 40% have neither UTI nor ASB. When rejection accompanying HAGPN is routinely treated with pulse immunosuppression and antibiotic therapy is administered, graft function is preserved for most patients but a minority (7%) loses graft function within 1 year. Potential risk factors to be assessed in further study include post-transplant urologic dysfunction, acute rejection and UTI. Disclosures All authors: No reported disclosures.

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A path to renal transplantation in Nepal

Journal of Pathology of Nepal ◽

10.3126/jpn.v1i1.4453 ◽

1970 ◽

Vol 1 (1) ◽

pp. 52-55

Author(s):

J Enns ◽

G Aryal

Keyword(s):

Renal Transplantation ◽

Renal Replacement Therapy ◽

Human Leukocyte Antigen ◽

Replacement Therapy ◽

Human Leukocyte ◽

Cost Effective ◽

Leukocyte Antigen ◽

Post Transplant ◽

Stage Renal Disease ◽

End Stage

End Stage Renal Disease affects many people in the world. There are three methods of renal replacement therapy available to patients: Continuous ambulatory peritoneal dialysis, haemodialysis and transplantation. Transplantation is the most viable and cost effective form of renal replacement therapy that is available for these patients. There are 3 factors required to help ensure a successful renal transplantation program: A well legislated donor and recipient program, Human Leukocyte Antigen testing (pre and post transplant), as well as a post transplant follow up program. Keywords: Renal Transplant; South Asia; Nepal; Human Leukocyte Antigen DOI: 10.3126/jpn.v1i1.4453 Journal of Pathology of Nepal (2011) Vol.1, 52-55

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P1656THE IMPACT OF PRE-TRANSPLANT DIALYSIS MODALITY ON EARLY POST-TRANSPLANT PERIOD ADVERSE EVENTS : A PROSPECTIVE COHORT STUDY WITH PROPENSITY SCORE MATCHING

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1656 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Hyo Jin Boo ◽

Wooseong Huh ◽

Yon su Kim ◽

Chul-Woo Yang ◽

Yong-Lim Kim ◽

...

Keyword(s):

Cohort Study ◽

Propensity Score ◽

Acute Rejection ◽

Propensity Score Matching ◽

Graft Function ◽

Total Duration ◽

Early Period ◽

Delayed Graft Function ◽

Dialysis Modality ◽

Composite Outcomes

Abstract Background and Aims Among peritoneal dialysis (PD) or hemodialysis (HD) while waiting for a kidney transplant (KT), which is better in terms of KT outcomes has long been of interest. Nowadays it is difficult to agree on which modality is better. The primary objective of this study was to compare the incidence of composite outcomes (delayed graft function, primary non-function, biopsy-proven acute rejection) within 1 year after primary adult KT between recipients taken PD and HD before KT (PD group vs. HD group, respectively). Method This study was a prospective, multi-sites cohort study. We used a propensity score matching to control for patients characteristics. Results Total 1040 patients were enrolled consecutively. Among them, 1030 patients (248, PD group; 782, HD group) were included in the final analysis. The HD group was older and had higher prevalence of diabetes, higher Charlson comorbidity index score, higher prevalence of positive PRA and more prescription of rituximab than the PD group significantly. After propensity score matching (246, PD group; 476, HD group), there were no differences in baseline characteristics between the two groups. In the whole population, there was no difference in the risk of the composite outcomes between the PD and HD groups (19% vs. 17%, hazard ratio [HR] 1.25, 95% confidence interval [CI] 0.88 ∼ 1.77, p = 0.21). There were also no differences in the risk of each component in the composite outcomes between the two groups. Primary non-function, a component of the composite outcomes did not occur in the both groups. There were no differences in the risks of death, frequency and total duration of re-hospitalization after KT for 1 year, and the changes of eGFR for 1 year between the two groups. The results from the propensity score matched population were consistent with those from the whole population. There was no difference in the risk of the composite outcomes between the PD and HD groups (19% vs. 17%, HR 1.17, 95% CI 0.80 ∼ 1.74, p = 0.43). Conclusion The pre-transplant dialysis modality does not affect the incidences of delayed graft function and acute rejection in early period of KT. (NCT01513707) This study was supported by Baxter Incorporated.

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