Thrombotic microangiopathy after kidney transplantation: Analysis of the Brazilian Atypical Hemolytic Uremic Syndrome cohort

Background Atypical Hemolytic Uremic Syndrome (aHUS) is an ultra-rare disease that potentially leads to kidney graft failure due to ongoing Thrombotic Microangiopathy (TMA). The aim was evaluating the frequency of TMA after kidney transplantation in patients with aHUS in a Brazilian cohort stratified by the use of the specific complement-inhibitor eculizumab. Methods This was a multicenter retrospective cohort study including kidney transplant patients diagnosed with aHUS. We collected data from 118 transplant centers in Brazil concerning aHUS transplanted patients between 01/01/2007 and 12/31/2019. Patients were stratified into three groups: no use of eculizumab (No Eculizumab Group), use of eculizumab for treatment of after transplantation TMA (Therapeutic Group), and use of eculizumab for prophylaxis of aHUS recurrence (Prophylactic Group). Results Thirty-eight patients with aHUS who received kidney transplantation were enrolled in the study. Patients’ mean age was 30 years (24–40), and the majority of participants was women (63% of cases). In the No Eculizumab Group (n = 11), there was a 91% graft loss due to the TMA. The hazard ratio of TMA graft loss was 0.07 [0.01–0.55], p = 0.012 in the eculizumab Prophylactic Group and 0.04 [0.00–0.28], p = 0.002 in the eculizumab Therapeutic Group. Conclusion The TMA graft loss in the absence of a specific complement-inhibitor was higher among the Brazilian cohort of kidney transplant patients. This finding reinforces the need of eculizumab use for treatment of aHUS kidney transplant patients. Cost optimization analysis and the early access to C5 inhibitors are suggested, especially in low-medium income countries.

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Efficacy and Safety of Eculizumab in Kidney Transplant Patients With Primary Atypical Hemolytic-Uremic Syndrome

Transplantation Proceedings ◽

10.1016/j.transproceed.2021.09.063 ◽

2021 ◽

Author(s):

Cristina Casas González ◽

Verónica López-Jiménez ◽

Teresa Vázquez-Sánchez ◽

Elena Vázquez-Sánchez ◽

Mercedes Cabello ◽

...

Keyword(s):

Hemolytic Uremic Syndrome ◽

Kidney Transplant ◽

Atypical Hemolytic Uremic Syndrome ◽

Efficacy And Safety ◽

Transplant Patients ◽

Uremic Syndrome ◽

Kidney Transplant Patients

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Outcomes of Kidney Transplant Patients with Atypical Hemolytic Uremic Syndrome Treated with Eculizumab: A Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm8070919 ◽

2019 ◽

Vol 8 (7) ◽

pp. 919 ◽

Cited By ~ 9

Author(s):

Maria L. Gonzalez Suarez ◽

Charat Thongprayoon ◽

Michael A. Mao ◽

Napat Leeaphorn ◽

Tarun Bathini ◽

...

Keyword(s):

Kidney Transplantation ◽

Kidney Transplant ◽

Meta Analysis ◽

Atypical Hemolytic Uremic Syndrome ◽

Incidence Rates ◽

Transplant Patients ◽

Adult Kidney ◽

Prevention And Treatment ◽

Uremic Syndrome ◽

Allograft Loss

Background: Kidney transplantation in patients with atypical hemolytic uremic syndrome (aHUS) is frequently complicated by recurrence, resulting in thrombotic microangiopathy in the renal allograft and graft loss. We aimed to assess the use of eculizumab in the prevention and treatment of aHUS recurrence after kidney transplantation. Methods: Databases (MEDLINE, EMBASE and Cochrane Database) were searched through February 2019. Studies that reported outcomes of adult kidney transplant recipients with aHUS treated with eculizumab were included. Estimated incidence rates from the individual studies were extracted and combined using random-effects, generic inverse variance method of DerSimonian and Laird. Protocol for this systematic review has been registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42018089438). Results: Eighteen studies (13 cohort studies and five case series) consisting of 380 adult kidney transplant patients with aHUS who received eculizumab for prevention and treatment of post-transplant aHUS recurrence were included in the analysis. Among patients who received prophylactic eculizumab, the pooled estimated incidence rates of recurrent thrombotic microangiopathy (TMA) after transplantation and allograft loss due to TMA were 6.3% (95%CI: 2.8–13.4%, I2 = 0%) and 5.5% (95%CI: 2.9–10.0%, I2 = 0%), respectively. Among those who received eculizumab for treatment of post-transplant aHUS recurrence, the pooled estimated rates of allograft loss due to TMA was 22.5% (95%CI: 13.6–34.8%, I2 = 6%). When the meta-analysis was restricted to only cohort studies with data on genetic mutations associated with aHUS, the pooled estimated incidence of allograft loss due to TMA was 22.6% (95%CI: 13.2–36.0%, I2 = 10%). We found no significant publication bias assessed by the funnel plots and Egger’s regression asymmetry test (p > 0.05 for all analyses). Conclusions: This study summarizes the outcomes observed with use of eculizumab for prevention and treatment of aHUS recurrence in kidney transplantation. Our results suggest a possible role for anti-C5 antibody therapy in the prevention and management of recurrent aHUS.

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Evaluation of Quality of Life among Kidney Transplant Patients- A Cross Sectional Study

10.53350/pjmhs2115113087 ◽

2021 ◽

Vol 15 (11) ◽

pp. 3087-3089

Author(s):

Rashida Jabeen ◽

Kousar Perveen ◽

Muhammad Afzal ◽

Sadia Khan

Keyword(s):

Quality Of Life ◽

Kidney Transplantation ◽

Kidney Transplant ◽

Cross Sectional Study ◽

P Value ◽

Sectional Study ◽

Cross Sectional ◽

Transplant Patients ◽

Kidney Transplant Patients

Kidney transplantation is the famous and most important choice of treatment of renal replacement therapies (RRTs) because of its positive impact on morbidity, survival and cost. The health related quality of life is becoming important outcome. Quality of life is usually impaired in patients who have renal transplant because of renal transplant patients have anxiety, lack of social, physical and emotional support and diminished ability to take care of themselves. The basic purpose of renal transplantation is to achieve maximum quality of life with minimum side effects. Methods: A cross sectional study was conducted at Rukhsana Akhtar Bahria International Orchard Hospital Lahore after approval from institution board of university of Lahore. 36 patients were enrolled in study by using purposive sampling technique. After taking informed consent all Kidney transplant patients aged between 18 years to 60 years, visited the post-transplantation OPD and continuously in follow-up sessions were included in study. A validated and standard WHO questionnaire of “Kidney Disease and Quality of Life (KDQOL-36™)” was used for data collection. Data was entered and analyzed in SPSS version.21.Chi-square test was applied to find out significant association between qualitative variables. P -Value < 0.05will be considered as statistically significant. Results: Majority of patients were from 40-49 years 10(27.0%). Females were more as compared to men (20(55.6) vs 16(44.4%)). 10(27.8) patients can read and write and 8(22.2%) have done matriculation. More patients live in Urban area as compared to rural area(19(52.8%) vs 17(47.2%)).8(22.2%) patients have less than 1 year of post kidney transplantation time and 19(52.8%) have 1 to 3 years. All the seven domains of KDQOL show poor QOL. General Health, Physical function and physical and emotional function shows average QOL and Emotional, social, daily activities and overall KDQOL shows poor QOL. There was insignificant association with age, gender, education; residential area and Post kidney transplantation length of time (years)(p-value > 0.05). Conclusions: After renal transplantation HRQOL becomes very important factor. After kidney transplantation HRQOL depends on many factors. It was concluded from current study that the HRQOL was not as good as it should be. Over the period of transplantation time patient’s quality of life remain same. The society, government, family, and medical staff need to support patients so they can also improve their QOL. Key word: Renal Diseases, Kidney transplant, Quality of life, KDQOL-36

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Nursing Care for Kidney Transplant Patients: A Scoping Review

Aquichan ◽

10.5294/aqui.2021.21.3.6 ◽

2021 ◽

Vol 21 (3) ◽

pp. 1-15

Author(s):

Cintia Capistrano Teixeira Rocha ◽

Alcides Viana da Lima Neto ◽

Ana Beatriz Pereira da Silva ◽

Victor Alexandre Silva Farias ◽

Aurean D’Eça Junior ◽

...

Keyword(s):

Kidney Transplantation ◽

Kidney Transplant ◽

Nursing Care ◽

Scoping Review ◽

Scientific Rigor ◽

Transplant Patients ◽

Primary Health ◽

Study Results ◽

Kidney Transplant Patients ◽

Selection Of

Objectives: Mapping nursing care in kidney transplant patients. Materials and method: A scoping review was conducted according to the recommendations of the Joanna Briggs Institute Reviewers’ Manual. Data were collected through 13 national and international databases from December 2020 to January 2021, following scientific rigor in the selection of the material. The pre-selection was made by reading the title, abstract and introductory text in advance; the materials included in this stage were read in full to define the content for the study. Results: Fifteen studies were included. Of these, 60% are articles; dissertations, manuals, protocols, guidelines and bulletins totaled 40% of the material studied. 86.6% of the material has a quantitative approach. Regarding the methodological design, 73.3% were descriptive/transversal character studies. Regarding the mapping of nursing care, it was possible to divide them into two categories: nursing care after kidney transplantation (immediate, mediated and late) and nursing care after kidney transplantation in primary health/extra-hospital care. Conclusions: It is concluded that the study allowed mapping nursing care to kidney transplant patients in the immediate, late and primary health care periods.

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Conversion from tacrolimus to belatacept improves renal function in kidney transplant patients with chronic vascular lesions in allograft biopsy

Clinical Kidney Journal ◽

10.1093/ckj/sfy115 ◽

2018 ◽

Vol 12 (4) ◽

pp. 586-591 ◽

Cited By ~ 1

Author(s):

María José Pérez-Sáez ◽

Bryant Yu ◽

Audrey Uffing ◽

Naoka Murakami ◽

Thiago J Borges ◽

...

Keyword(s):

Renal Function ◽

Kidney Transplant ◽

Estimated Glomerular Filtration Rate ◽

Graft Loss ◽

Vascular Lesions ◽

First Year ◽

Transplant Patients ◽

Predicting Factors ◽

Allograft Biopsy ◽

Kidney Transplant Patients

AbstractBackgroundConversion from tacrolimus to belatacept has been shown to be beneficial for an increasing number of kidney transplant (KT) patients. Predicting factors for favorable outcomes are still unknown. We aimed to investigate whether histological vascular lesions at the time of conversion might correlate with greater improvement in renal function post-conversion.MethodsThe study was conducted on a retrospective cohort of 34 KT patients converted from tacrolimus to belatacept. All patients underwent an allograft biopsy prior to conversion. We analyzed the evolution of the estimated glomerular filtration rate (eGFR) at 3 and 12 months after conversion.ResultsMedian time to conversion was 6 (2–37.2) months post-transplant. About 52.9% of patients had moderate-to-severe chronic vascular lesions (cv2–3). We observed an increase in eGFR in the whole cohort from 35.4 to 41 mL/min/1.73 m2 at 3 months (P = 0.032) and 43.7 at 12 months (P = 0.013). Nine patients experienced acute rejection post-conversion, with one graft loss observed beyond the first year after conversion. Patients with cv2–3 had significant improvement in eGFR at 12 months (+8.6 mL/min/1.73 m2; 31.6 to 40.2 mL/min/1.73 m2; P = 0.047) compared with those without these lesions (+6.8 mL/min/1.73 m2; 40.9 to 47.7 mL/min/1.73 m2; P = 0.148).ConclusionsConversion from tacrolimus to belatacept has a beneficial effect in terms of renal function in KT patients. This benefit might be more significant in patients with cv in the biopsy.

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P1758TOCILIZUMAB TREATMENT IN DSA POSITIVE ANTIBODY MEDIATED REJECTION AMONG KIDNEY TRANSPLANT RECIPIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1758 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Orsolya Cseprekal ◽

Adrienn Marton ◽

Sara Molnar ◽

Attila Patonai ◽

Attila Fintha ◽

...

Keyword(s):

Kidney Transplant ◽

Graft Loss ◽

Graft Function ◽

Treatment Protocol ◽

Case Series ◽

Class I ◽

Antibody Mediated Rejection ◽

Series Analysis ◽

Transplant Patients ◽

Kidney Transplant Patients

Abstract Background and Aims Pretransplant or de novo donor specific antibodies (DSA) may lead to active or chronic active antibody mediated rejection (a and cABMR) as leading cause of graft loss after kidney transplantation. There is no treatment protocol approved for ABMR. Anti Il-6 tocilizumab (TCZ), inhibitor of DSA production, is a potential approach to stabilize kidney allograft function, however, evidence based results are not available. In our retrospective case series analysis, we assessed the changes in DSA and eGFR during and at the end of treatment with TCZ. Method In our single center case series analysis, 10 kidney transplant patients with biopsy proven ABMR (aABMR 6, cABMR 4, age 43±10.5ys, 6 males, time since transplantation 18(2-119)months, 7 first transplant, serum creatinine 224±80 umol/L at baseline) were studied between January 2017 – June 2019. Total plasma exchange (PE) (5x) was followed by TCZ (8 mg/kg, 1x monthly for 6 months) in case of a and cABMR. Intravenous immunoglobulin (IVIG, 1gr/kg) was added in case of aABMR. Routine laboratory parameters and DSA were reported retrospectively. Results 6 aABMR patients completed the treatment protocol. Class I DSA decreased significantly (MFI 4457(635-14084) vs. 877(595-5678); p=0.007), but Class II DSA remained the same during the treatment (MFI 4725 (586-17615) vs. 8097 (671-14636) p=NS). eGFR of aABMR patients and 1 cABMR patient were stabilized. 3 cABMR patients returned to dialysis. Reversible elevation of liver transaminases were detected in three patients. There was no any serious adverse event recorded. Conclusion The opportunely timed TCZ seems to be effective in reducing Class I DSA and stabilize graft function in patients with aABMR. Further studies are needed to prove the long-term efficacy and the exact role of TCZ in cABMR among kidney transplant patients.

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Pretransplant dialysis treatment and vascular calcification of the iliac artery and abdominal aorta in kidney transplant patients

Renal Replacement Therapy ◽

10.1186/s41100-021-00349-5 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Kentaro Nakai ◽

Shutaro Yamamoto ◽

Megumi Inoue ◽

Chiaki Kohara ◽

Tomoya Shukuri ◽

...

Keyword(s):

Cardiovascular Disease ◽

Kidney Transplantation ◽

Kidney Transplant ◽

Vascular Calcification ◽

Treatment Modality ◽

Rapid Progression ◽

Dialysis Modality ◽

Dialysis Treatment ◽

Transplant Patients ◽

Kidney Transplant Patients

Abstract Introduction Patients with chronic kidney disease often suffer from cardiovascular disease, and vascular calcification has been identified as one of the risk factors for cardiovascular disease. We aimed to examine the effect of dialysis treatment before kidney transplantation on graft survival, vascular calcification, and its progression after kidney transplantation. Methods Among the 102 patients who underwent kidney transplant between 2008 and 2017, two patients were excluded for moved and lost to follow-up and primary nonfunction. The clinical characteristics and laboratory data were assessed according to pretransplant treatment modality. Rapid progression of vascular calcification was defined when patients showed an increase in the highest tertile of progression of each iliac artery calcification thickness (IACT) and aortic calcification index (ACI). Results Cox proportional hazard models did not show any significant association between pretransplant treatment modality and graft survival to the doubling of creatinine from nadir creatinine during the first 3 months after kidney transplantation. At baseline, the IACT was significantly higher in hemodialysis patients than in preemptive kidney transplant patients, whereas the ACI was comparable among the pretransplant treatment modality groups. IACT was independently associated with dialysis vintage. There was no significant association between rapid progression of vascular calcification (IACT and ACI) and dialysis modality. Conclusions Dialysis modality was an independent factor related to IACT, whereas there was no legacy effect for the progression of vascular calcification after kidney transplantation.

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Use of Nurse Practitioners in Pediatric Kidney Transplant: A Model for Providing Comprehensive Care to Children and Families

Progress in Transplantation ◽

10.1177/152692481102100409 ◽

2011 ◽

Vol 21 (4) ◽

pp. 306-311

Author(s):

Jessica Brennan ◽

Marilyn McEnhill

Keyword(s):

Kidney Transplantation ◽

Kidney Transplant ◽

Nurse Practitioners ◽

Nurse Practitioner ◽

Comprehensive Care ◽

Pediatric Nurse ◽

Transplant Patients ◽

Kidney Transplant Patients ◽

Pediatric Nurse Practitioners

It is well documented that kidney transplantation is the treatment of choice for children with end-stage renal disease. Pediatric kidney transplant patients are a complex population because of their need for lifelong immunosuppression, potential for delayed growth and development, and increased risk of heart disease and cancer. Although many large pediatric kidney transplant programs use nurse practitioners, the role of the nurse practitioner is still emerging in relation to the transplant coordinator role. This article describes the practice of pediatric nurse practitioners caring for children who require a kidney transplant and why nurse practitioners are ideal for providing comprehensive care to this population. Transplant programs are regulated by the United Network for Organ Sharing and the Centers for Medicare and Medicaid Services. Both organizations require transplant programs to designate a transplant coordinator with the primary responsibility of coordinating clinical aspects of transplant care. Incorporating transplant coordinator activities into the role of the pediatric nurse practitioner is discussed as a model for providing care throughout the process of kidney transplantation. Transplant pediatric nurse practitioners are in a unique position to expand the care for pediatric kidney transplant patients by assuming the role of clinician, educator, administrator, and coordinator.

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Kidney transplantation using complement inhibitor in a patient suffering from atypical hemolytic-uremic syndrome associated with factor H antibodies: successful prevention of recurrence of the underlying disease

Russian Journal of Transplantology and Artificial Organs ◽

10.15825/1995-1191-2020-2-132-138 ◽

2020 ◽

Vol 22 (2) ◽

pp. 132-138

Author(s):

E. I. Prokopenko ◽

S. A. Pasov ◽

A. V. Vatazin ◽

A. Ya. Tsalman ◽

T. E. Pankratenko ◽

...

Keyword(s):

Kidney Transplantation ◽

Hemolytic Uremic Syndrome ◽

Complement Activation ◽

Atypical Hemolytic Uremic Syndrome ◽

Underlying Disease ◽

Factor H ◽

Inhibitor Therapy ◽

Complement Inhibitor ◽

Post Transplant ◽

Uremic Syndrome

Atypical hemolytic-uremic syndrome (aHUS) is an extremely rare complement-mediated disease that belongs to the group of thrombotic microangiopathies (TMA). It often reoccurs after kidney transplantation (KT). Previously, KT was considered contraindicated in both children and adults with aHUS due to high (up to 50% and above) incidence of early graft loss associated with post-transplant recurrent TMA. Introduction of specific complement inhibitor therapy into clinical practice has improved outcomes in patients with aHUS and has significantly reduced the risk of post-transplant recurrence of underlying disease. We describe the clinical observation of a 20-year-old female patient with aHUS associated with antibodies to factor H, a major regulator of complement activation. The patient underwent KT and eculizumab was used for prophylactic purposes. In the postoperative period, the patient developed ureteral necrosis that required reconstructive surgery, followed by graft pyelonephritis. Despite postoperative complications, which were highly likely to trigger uncontrolled complement activation, TMA recurrence was avoided due to early treatment of the complications and prophylactic use of complement inhibitor therapy.

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Impact of Timely Public Health Measures on Kidney Transplantation in Austria during the SARS-CoV-2 Outbreak—A Nationwide Analysis

Journal of Clinical Medicine ◽

10.3390/jcm9113465 ◽

2020 ◽

Vol 9 (11) ◽

pp. 3465

Author(s):

Bruno Watschinger ◽

Clara Watschinger ◽

Roman Reindl-Schwaighofer ◽

Elias L. Meyer ◽

Andras T. Deak ◽

...

Keyword(s):

Kidney Transplantation ◽

Kidney Transplant ◽

Case Fatality ◽

Organizational Structures ◽

Kidney Transplant Recipients ◽

Healthcare Facilities ◽

Transplant Patients ◽

Kidney Transplant Patients ◽

The Government ◽

Considerable Morbidity

SARS-CoV-2 led to considerable morbidity/mortality worldwide and tremendously impacted on daily life. Strict lockdown measures were implemented early to contain the viral outbreak in Austria. Massive changes in organizational structures of healthcare facilities followed with unclear implications on the care of non-COVID-19-affected patients. We studied the nationwide impact of COVID-19 on kidney transplantation in Austria during the first six months of 2020. Concurrent with general lockdown measures, all kidney transplant activity was suspended from 13 March to 9 April. Nevertheless, between January and June, total transplant (p = 0.48) and procured donor organ numbers (p = 0.6) did not differ significantly from earlier years. Ten (0.18%) of 5512 prevalent Austrian kidney transplant recipients were diagnosed with SARS-CoV-2. The case fatality rate (one death; 10%) in renal transplant patients was less than in other countries but higher than in Austria’s general population (2.4%). We conclude that early and strict general lockdown measures imposed by the government allowed an early, however cautious, re-opening of Austrian transplant programs and played a crucial role for the favorable outcomes of SARS-CoV-2 in Austrian kidney transplant patients. Even though it may be uncertain whether similar results may be obtainable in other countries, the findings may support early intervention strategies during similar episodes in the future.

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