scholarly journals Long-Term Outcomes in 831 Kidney Transplant Recipients with 20 Years of Graft Function

2021 ◽  
Vol 8 ◽  
Author(s):  
Varvara Kirchner ◽  
Kristen Gillingham ◽  
Oscar Serrano ◽  
Srinath Chinnakotla ◽  
Ty Dunn ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Graft Survival ◽  
Interstitial Fibrosis ◽  
Graft Loss ◽  
Graft Function ◽  
Solid Organ ◽  
Kidney Transplant Recipients ◽  
Long Term Outcomes ◽  
Tubular Atrophy

An understanding of long-term outcomes for kidney transplant(KTx) recipients who survive with graft function beyond a specific time posttransplant is the first step in creating protocols to optimize care for current and improve outcomes for future recipients. We studied 831KTx recipients-580 living donor(LD); 251 deceased donor(DD)—with graft survival(GS) >20 years.  For primary LD recipients, 25-year patient survival(PS) was 83%; 35-year, 59%.  Their 25-year death-censored graft survival(DCGS) was 89%; 35-year, 72%.   DD recipients had lower PS(P<0.01), DCGS(P<0.01).   After 20 years, two major causes of graft loss(GL) were death with function(DwF)(58%, LD; 58%, DD) and interstitial fibrosis and tubular atrophy(IFTA)(22%, LD; 23%, DD).  Two major causes of DwF were cancer(31%, LD; 31%, DD) and cardiovascular disease(CVD)(19%, LD;17%, DD).  Per multivariate analysis(MVA), risk factors for GL after 20 years in pre–calcineurin inhibitor(CNI) era were human leukocyte antigen(HLA) mismatches >3 antigens, pretransplant type 1 diabetes mellitus(DM1); in CNI era, a history of rejection, female gender.  New comorbidities after 20 years were common: CVD(13%, non-DM1;18%, DM1), infections(27%, non-DM1;37%, DM1), 20-29 years posttransplant.  Cancer after 20 years included: nonmelanotic skin cancer,22%; solid organ,7%; post-transplant lymphoproliferative disease(PTLD),2%.  To improve long-term outcomes, clinical trials on prevention, recognition, and treatment of new comorbidities are needed.

scholarly journals Association of Slow Graft Function with Long-Term Outcomes in Kidney Transplant Recipients

2018 ◽  
Vol 23 ◽  
pp. 224-231 ◽  
Author(s):  
Connie J. Wang ◽  
Ahmad Tuffaha ◽  
Milind A. Phadnis ◽  
Jonathan D. Mahnken ◽  
James B. Wetmore
Keyword(s):  
Kidney Transplant ◽  
Graft Function ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Long Term Outcomes

Long-term survival of kidney grafts in lupus nephritis: a Mexican cohort

Lupus ◽  
2018 ◽  
Vol 27 (8) ◽  
pp. 1303-1311 ◽  
Author(s):  
J C Ramirez-Sandoval ◽  
H Chavez-Chavez ◽  
M Wagner ◽  
O Vega-Vega ◽  
L E Morales-Buenrostro ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Kidney Transplant ◽  
Graft Survival ◽  
Immunosuppressive Treatment ◽  
Graft Loss ◽  
Matched Pair ◽  
Long Term Outcomes ◽  
Term Survival

Kidney transplant for patients with lupus nephritis (LN) has satisfactory outcomes in studies with short-term or mid-term follow up. Nevertheless, information about long-term outcomes is scarce. We performed a retrospective matched-pair cohort study in 74 LN recipients compared with 148 non-LN controls matched by age, sex, immunosuppressive treatment, human leukocyte antigen (HLA) matches, and transplant period in order to evaluate long-term outcomes of kidney transplant in LN recipients. Matched pairs were predominantly females (83%), median age at transplant surgery of 32 years (interquartile range 23–38 years), and 66% received a graft from a living related donor. Among LN recipients, 5-, 10-, 15-, and 20-year graft survival was 81%, 79%, 57% and 51%, respectively, and it was similar to that observed in controls (89%, 78%, 64%, and 56%, respectively). Graft loss (27% vs. 21%, p = 0.24) and overall survival ( p = 0.15) were not different between LN recipients and controls. Also, there was no difference in episodes of immunological rejection, thrombosis, or infection. Only six LN recipients had biopsy-proven lupus recurrence and three of them had graft loss. In a cohort with a long follow up of kidney transplant recipients, LN recipients had similar long-term graft survival and overall outcomes compared with non-lupus recipients when predictors are matched between groups.

scholarly journals Early renal function trajectories, cytomegalovirus serostatus and long-term graft outcomes in kidney transplant recipients

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jonathan P. Law ◽  
Richard Borrows ◽  
David McNulty ◽  
Adnan Sharif ◽  
Charles J. Ferro
Keyword(s):  
Kidney Transplant ◽  
Graft Survival ◽  
Hazard Analysis ◽  
Graft Loss ◽  
Smooth Curve ◽  
Mortality Data ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Rapid Deterioration

Abstract Background Improved recognition of factors influencing graft survival has led to better short-term kidney transplant outcomes. However, efforts to prevent long-term graft decline and improve graft survival have seen more modest improvements. The adoption of electronic health records has enabled better recording and identification of donor-recipient factors through the use of modern statistical techniques. We have previously shown in a prevalent renal transplant population that episodes of rapid deterioration are associated with graft loss. Methods Estimated glomerular filtration rates (eGFR) between 3 and 27 months after transplantation were collected from 310 kidney transplant recipients. We utilised a Bayesian approach to estimate the most likely eGFR trajectory as a smooth curve from an average of 10,000 Monte Carlo samples. The probability of having an episode of rapid deterioration (decline greater than 5 ml/min/1.73 m2 per year in any 1-month period) was calculated. Graft loss and mortality data was collected over a median follow-up period of 8 years. Factors associated with having an episode of rapid deterioration and associations with long-term graft loss were explored. Results In multivariable Cox Proportional Hazard analysis, a probability greater than 0.8 of rapid deterioration was associated with long-term death-censored graft loss (Hazard ratio 2.17; 95% Confidence intervals [CI] 1.04–4.55). In separate multivariable logistic regression models, cytomegalovirus (CMV) serostatus donor positive to recipient positive (Odds ratio [OR] 3.82; 95%CI 1.63–8.97), CMV donor positive (OR 2.06; 95%CI 1.15–3.68), and CMV recipient positive (OR 2.03; 95%CI 1.14–3.60) were associated with having a greater than 0.8 probability of an episode of rapid deterioration. Conclusions Early episodes of rapid deterioration are associated with long-term death-censored graft loss and are associated with cytomegalovirus seropositivity. Further study is required to better manage these potentially modifiable risks factors and improve long-term graft survival.

scholarly journals SP757The Burden of Delayed Graft Function on Kidney Transplant Recipients and Impact on long-term outcomes

2019 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Mia Vasilj ◽  
Fabian Halleck ◽  
Dmytro Khadzhynov ◽  
Eva Schrezenmeier ◽  
Michael Dürr ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Graft Function ◽  
Delayed Graft Function ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Long Term Outcomes

scholarly journals Urinary MicroRNA-21-5p as Potential Biomarker of Interstitial Fibrosis and Tubular Atrophy (IFTA) in Kidney Transplant Recipients

Diagnostics ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. 113 ◽  
Author(s):  
Michal S. Gniewkiewicz ◽  
Izabela Paszkowska ◽  
Jolanta Gozdowska ◽  
Katarzyna Czerwinska ◽  
Anna Sadowska-Jakubowicz ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Renal Allograft ◽  
Interstitial Fibrosis ◽  
Graft Function ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Tubular Atrophy ◽  
Expression Levels ◽  
Allograft Dysfunction ◽  
Potential Biomarker

Chronic renal allograft dysfunction (CAD) is a major limiting factor of long-term graft survival. The hallmarks of progressive CAD are interstitial fibrosis and tubular atrophy (IFTA). MicroRNAs are small, regulatory RNAs involved in many immunological processes. In particular, microRNA-21-5p (miR-21) is considered to be strongly associated with pathogenesis regarding tubulointerstitium. The aim of this study was to assess urinary miR-21 expression levels in the kidney transplant recipients and determine their application in the evaluation of IFTA and kidney allograft function. The expression levels of miR-21 were quantified in the urine of 31 kidney transplant recipients with biopsy-assessed IFTA (IFTA 0 + I: n = 17; IFTA II + III: n = 14) by real-time quantitative PCR. Urine samples were collected at the time of protocolar biopsies performed 1 or 2 years after kidney transplantation. MicroRNA-191-5p was used as reference gene. MiR-21 was significantly up-regulated in IFTA II + III group compared to IFTA 0 + I group (p = 0.003). MiR-21 correlated significantly with serum concentration of creatinine (r = 0.52, p = 0.003) and eGFR (r = −0.45; p = 0.01). ROC analysis determined the diagnostic value of miR-21 with an area under curve (AUC) of 0.80 (p = 0.0002), sensitivity of 0.86 and specificity of 0.71. miR-21 is associated with renal allograft dysfunction and IFTA. Therefore, it could be considered as a potential diagnostic, non-invasive biomarker for monitoring renal graft function.

scholarly journals Long-Term Outcomes after Acute Rejection in Kidney Transplant Recipients: An ANZDATA Analysis

2019 ◽  
Vol 30 (9) ◽  
pp. 1697-1707 ◽  
Author(s):  
Philip A. Clayton ◽  
Stephen P. McDonald ◽  
Graeme R. Russ ◽  
Steven J. Chadban
Keyword(s):  
Cardiovascular Disease ◽  
Acute Rejection ◽  
Kidney Transplant ◽  
Graft Loss ◽  
Graft Function ◽  
High Rate ◽  
Sensitivity Analyses ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

BackgroundDeclining rates of acute rejection (AR) and the high rate of 1-year graft survival among patients with AR have prompted re-examination of AR as an outcome in the clinic and in trials. Yet AR and its treatment may directly or indirectly affect longer-term outcomes for kidney transplant recipients.MethodsTo understand the long-term effect of AR on outcomes, we analyzed data from the Australia and New Zealand Dialysis and Transplant Registry, including 13,614 recipients of a primary kidney-only transplant between 1997 and 2017 with at least 6 months of graft function. The associations between AR within 6 months post-transplant and subsequent cause-specific graft loss and death were determined using Cox models adjusted for baseline donor, recipient, and transplant characteristics.ResultsAR occurred in 2906 recipients (21.4%) and was associated with graft loss attributed to chronic allograft nephropathy (hazard ratio [HR], 1.39; 95% confidence interval [95% CI], 1.23 to 1.56) and recurrent AR beyond month 6 (HR, 1.85; 95% CI, 1.39 to 2.46). Early AR was also associated with death with a functioning graft (HR, 1.22; 95% CI, 1.08 to 1.36), and with death due to cardiovascular disease (HR, 1.30; 95% CI, 1.11 to 1.53) and cancer (HR, 1.35; 95% CI, 1.12 to 1.64). Sensitivity analyses restricted to subgroups with either biopsy-proven, antibody-mediated, or vascular rejection, or stratified by treatment response produced similar results.ConclusionsAR is associated with increased risks of longer-term graft failure and death, particularly death from cardiovascular disease and cancer. The results suggest AR remains an important short-term outcome to monitor in kidney transplantation and clinical trials.

scholarly journals Long term graft survival and graft function following pregnancy in kidney transplant recipients

2019 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Marleen C. van Buren ◽  
Anouk Schellekens ◽  
T. Katrien J. Groenhof ◽  
Franka van Reekum ◽  
Jacqueline van de Wetering ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Graft Survival ◽  
Graft Function ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

Comparing the Effect of rATG Dosing on Long-Term Outcomes in Young (40-59) and Elderly (≥60) Kidney Transplant Recipients

2021 ◽  
Author(s):  
Iman Bajjoka ◽  
Salvatore Serra ◽  
Jade Mourad ◽  
Catherine Crombez ◽  
Mohamed Safwan ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Graft Survival ◽  
Patient Survival ◽  
Statistical Tests ◽  
Survival Rates ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Long Term Outcomes ◽  
Long Term Outcome

Abstract BackgroundAs the number of elderly kidney transplant recipients increases, long-term outcome differences between this population and younger kidney transplant recipients are not well documented. The purpose of the study is to evaluate the effect of rATG dosing on long-term outcomes between elderly and young kidney transplant recipients.MethodsA single-center retrospective analysis of medical records of 688 first-time kidney transplant recipients (KTR) from 2003 to 2014 on a regimen of mycophenolate mofetil, tacrolimus, and steroids was performed. During the 11-year period there were no immunosuppresion protocol changes. Baseline characteristics, first biopsy-proven acute rejection (BPAR), estimated glomerular filtration rates (eGFR), graft survival, and patient survival at discharge and annually up to 5 years post-transplant were analyzed. Various statistical tests including Chi-square test, two-sample t-test, and Mann-Whitney U test were used to compare data obtained from this study.ResultsThe study population was divided into two cohorts: elderly (E-KTR) (≥60 years; n=277) and younger (Y-KTR) (40-59 years; n=411). E-KTR received more expanded criteria donor kidneys (p<0.001) and older donor kidneys (p<0.001). Y-KTR experienced more BPAR in incidence (p<0.001) than E-KTR, however, the severity of BPAR was similar. A difference in eGFR was observed at discharge, where Y-KTR had better eGFR rates than E-KTR (p<0.05). At 5-years, a trend was observed indicating that E-KTR have better eGFR rates than Y-KTR. Despite similar long-term graft survival, patient survival was significantly lower among the elderly patients (p<0.01). An indication for higher mortality rates in E-KTR is due to rATG dosing for which we found that mortality increased with patients who received high rATG doses in comparison to low doses (p<0.05).ConclusionE-KTR had lower patient survival rates yet similar graft survival rates when compared to Y-KTR. Lower survival rates in E-KTR was associated with higher rATG dosing. Larger validation studies need to be performed to assess the benefit of using less harmful immunosuppressants to improve long-term outcomes for E-KTR.

Sign in / Sign up

Export Citation Format

Share Document