scholarly journals Evaluation of the effectiveness of prophylactic strategies for cytomegalovirus infection in pediatric kidney recipients

2021 ◽  
Vol 23 (4) ◽  
pp. 13-18
Author(s):  
O. M. Tsirulnikova ◽  
P. M. Gadzhieva ◽  
I. A. Miloserdov ◽  
D. A. Saydulaev ◽  
I. E. Pashkova
Keyword(s):  
Kidney Transplantation ◽  
Individual Characteristics ◽  
Artificial Organs ◽  
Renal Transplant Recipients ◽  
Kidney Graft ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Cmv Infection ◽  
Effective Prevention ◽  
Kidney Recipients

Cytomegalovirus (CMV) infection is the most severe viral infection in renal transplant recipients, which can occur in the post-transplant period in both adult and pediatric recipients. Developing and applying an effective prevention and treatment strategy for pediatric renal graft recipients is a priority. Objective: to compare the effectiveness of the protocols used for the prevention of CMV infection in pediatric kidney transplant recipients.Materials and methods. The study enrolled 118 patients who underwent primary kidney transplantation at Shumakov National Medical Research Center of Transplantology and Artificial Organs. Based on retrospective analysis, all recipients were divided into two groups, depending on the prophylactic strategy after kidney transplantation. The followup period for pediatric kidney recipients ranged from 108 to 1803 (623.5 ± 379.5) days. CMV infection activity was monitored by polymerase chain reaction.Results. The frequency of CMV infection activation episodes at 3 and 6 months was independent of the prophylaxis strategy used. The recurrence rate of CMV infection one year after surgery was significantly lower (p = 0.037) with Strategy 2. No cases of CMV syndrome or CMV disease, graft dysfunction, or chronic rejection associated with CMV infection were reported. Increasing the dose of antiviral drugs in Strategy 1 did not increase the risk of cytotoxicity and nephrotoxicity, which are reversible (creatinine levels were not significantly different in the study groups at 3, 6, 12 months, p = 0.542, p = 0.287, p = 0.535, respectively). The incidence of kidney graft rejection did not increase in patients with lower doses of immunosuppressants in Strategy 2.Conclusion. Both prophylactic strategies are effective in pediatric kidney recipients. However, the choice of a strategy depends on the individual characteristics of the patient and requires a personalized approach.

scholarly journals Post-transplant monitoring of lymphocyte counts predict the occurrence of CMV infection in early phase of kidney transplantation

2020 ◽  
Author(s):  
Sujuan Feng ◽  
Jing Yang ◽  
Xiaodong Zhang
Keyword(s):  
Kidney Transplantation ◽  
Peripheral Blood ◽  
Operating Characteristic ◽  
Roc Curves ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Cmv Infection ◽  
Post Transplantation ◽  
Cmv Dnaemia

Abstract Objectives The aim of this study was to assess whether monitoring of the number of lymphocytes in peripheral blood was helpful for evaluating the risk of cytomegalovirus (CMV) infection after kidney transplantation. Methods The total numbers of lymphocyte in peripheral blood were measured at baseline and posttransplant months 1, 3 and 6. Risk factors for DNAemia in KTRs were analyzed using univariate logistic regression analyses. Areas under receiver operating characteristic (ROC) curves were applied to assess the accuracy of lymphocyte counts for predicting CMV DNAemia. Results After follow-up 6 months, CMV replication was detected in 12 (31.6%) kidney transplant recipients (KTRs). The total lymphocyte counts were significantly decreased in KTRs with CMV DNAemia in 1, 3 and 6 months. There was a negative correlation between CMV copies and the lymphocyte counts in 1, 3 and 6 months post-transplantation, and the decrease of lymphocyte counts in the 6 months post-transplantation was the risk factor of CMV DNAemia in the KTR. Patients with lymphocyte counts 1.085×109 cells/L had higher cumulative incidence of CMV infection.Conclusions The lymphocyte counts post kidney transplantation may be used as a simple and effective indicator for monitoring the CMV infection status in KTR and for predicting the risk of CMV DNAemia.

Kidney graft function before pregnancy as a predictor of graft, maternal and fetal outcomes in pregnant renal transplant recipients

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Filipe S. Mira ◽  
Joana Oliveira ◽  
Filipa Sousa ◽  
Dora Antunes ◽  
Ana Carolina Figueiredo ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Graft Function ◽  
Adverse Outcomes ◽  
Hypertensive Disorder ◽  
Renal Transplant Recipients ◽  
Kidney Graft ◽  
Transplant Recipients ◽  
Graft Dysfunction ◽  
Kidney Transplant Recipients

Abstract Objectives Maternal and fetal complications can occur in pregnant kidney transplant recipients. Since these are high-risk pregnancies, they require a multidisciplinary follow-up to prematurely detect adverse events. Identifying factors that would affect fetal, maternal and graft outcomes is essential to further stratify the risk of pregnant kidney transplant recipients. Methods All pregnancies in kidney transplant recipients followed in a single center for 30 years were included. Data included previous transplant information and blood and urine tests performed before pregnancy. Impact of graft function on fetal, maternal and graft outcomes was evaluated. Results There were 41 pregnancies among 34 patients. Mean gestational age of 35 ± 3 weeks. Caesarean section was performed in 69.4% of patients. Five pregnancies were unsuccessful (12.2%). Four patients suffered an acute graft dysfunction (9.8%) and 12 (29.3%) had a serious maternal hypertensive disorder (preeclampsia, eclampsia or HELLP syndrome). Graft function before pregnancy showed significant correlation with adverse outcomes. Conclusions A proteinuria >669 mg/g, serum creatinine >1.75 mg/dL and glomerular filtration rate <36.2 mL/min/1.73 m2 before pregnancy were correlated to graft dysfunction during pregnancy. Similar values of proteinuria were also associated with a risk of maternal hypertensive disorders and pregnancy failure. Therefore, in patients with proteinuria and graft dysfunction, follow-up should be stricter to quickly detect complications.

MO945SERUM AND URINE LEUCINE RICH ALPHA-2-GLYCOPROTEIN-1 IS ASSOCIATED WITH KIDNEY TRANSPLANT INJURY AND FAILURE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Aiga Vasiļvolfa ◽  
Juta Kroiča ◽  
Anna Popova ◽  
Kārlis Rācenis ◽  
Baiba Šlisere ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Kidney Injury ◽  
Kidney Graft ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Positive Correlation ◽  
Post Transplant ◽  
Time Period ◽  
Serum And Urine

Abstract Background and Aims Kidney transplantation is the treatment of choice for most of the patients with end stage chronic kidney disease. To improve patient and graft survival, early diagnostics and discovery of specific biomarkers is important. Leucine rich alpha-2-glycoprotein-1 (LRG-1) is an innovative, non-invasive biomarker that is elevated in case of angiogenesis, inflammation and kidney injury. Aim was to evaluate biomarker LRG-1 level in serum and urine in kidney transplant recipients in accordance with kidney injury markers and time period after kidney transplantation. Method In the study 35 patients were enrolled. Patients had functioning kidney grafts and they were more than one year post transplant. We detected patient serum and urine LRG-1 levels, using ELISA. Correlation between serum LRG-1, urine LRG-1 and kidney graft structural and functional damage markers was performed. Also, we compared serum LRG-1 levels between subgroups (patients &gt;5 years post transplant and ≤ 5 years post transplant). Results Serum LRG-1 had positive correlation with serum cystatin-C (r=0,46, p&lt;0,01), serum urea (r=0,53, p&lt;0,01) and negative correlation with eGFR (r= -0,39, p=0,02). Patients with &gt;5 years post transplant had higher serum LRG-1 level compared with patients ≤5 years post transplant (p&lt;0,01). Serum LRG-1 had positive correlation with a longer time period after transplantation (r=0,53, p=0,01). Urine LRG-1 had correlation with proteinuria (r=0,58, p&lt;0,01) and NGAL level in urine (r=0,44, p&lt;0,01). The most common maintenance immunosuppressive regimen was therapy with tacrolimus, mycophenolate and prednisolone (48,6%). Conclusion Higher serum LRG-1 level correlates with decreased kidney transplant function and with longer time period after transplantation. Higher LRG-1 level in serum and urine is related to kidney transplant injury and failure. Urine LRG-1 can be a useful biomarker for tubular dysfunction in kidney transplant recipients.

scholarly journals The Association of Long-Functioning Hemodialysis Vascular Access with Prevalence of Left Ventricular Hypertrophy in Kidney Transplant Recipients

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Aureliusz Kolonko ◽  
Agata Kujawa-Szewieczek ◽  
Magdalena Szotowska ◽  
Piotr Kuczera ◽  
Jerzy Chudek ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Left Ventricular Hypertrophy ◽  
Kidney Transplant ◽  
Vascular Access ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Kidney Graft ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Hemodialysis Vascular Access

Left ventricular hypertrophy (LVH) is frequently observed in chronic dialysis patients and is also highly prevalent in kidney transplant recipients. This study evaluates the impact of long-functioning hemodialysis vascular access on LVH in single center cohort of kidney transplant recipients. 162 patients at 8.7 ± 1.8 years after kidney transplantation were enrolled. Echocardiography, carotid ultrasound, and assessment of pulse wave velocity were performed. LVH was defined based on left ventricular mass (LVM) indexed for body surface area (BSA) and height2.7. There were 67 patients with and 95 without patent vascular access. Both study groups were comparable with respect to gender, age, duration of dialysis therapy, and time after transplantation, kidney graft function, and cardiovascular comorbidities. Patients with patent vascular access were characterized by significantly elevated LVM and significantly greater percentage of LVH, based on LVMI/BSA (66.7 versus 48.4%,P=0.02). OR for LVH in patients with patent vascular access was 2.39 (1.19–4.76),P=0.01. Regression analyses confirmed an independent contribution of patent vascular access to higher LVM and increased prevalence of LVH. We concluded that long-lasting patent hemodialysis vascular access after kidney transplantation is associated with the increased prevalence of LVH in kidney transplant recipients.

scholarly journals The NFKB1 Promoter Polymorphism (-94ins/delATTG) Is Associated with Susceptibility to Cytomegalovirus Infection after Kidney Transplantation and Should Have Implications on CMV Prophylaxis Regimens

Cells ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 380
Author(s):  
Hartmuth Nowak ◽  
Svenja Vornweg ◽  
Katharina Rump ◽  
Tim Rahmel ◽  
Matthias Unterberg ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Cox Regression ◽  
Opportunistic Infections ◽  
Late Onset ◽  
Association Studies ◽  
Promoter Polymorphism ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Cmv Infection

Infections with cytomegalovirus (CMV) are one of the most frequent opportunistic infections in kidney transplant recipients. Current risk-adapted CMV chemoprophylaxis regimens are based almost solely on the donor and recipient CMV serostatus. Of note, the NFKB1 -94ins/delATTG promoter polymorphism was recently associated with a higher risk of CMV infection. Since single genetic association studies suffer from poor reliability for drawing therapeutic implications, we performed this confirmatory study and included 256 kidney transplant recipients from 2007 to 2014 in this retrospective study. Patients were genotyped for the -94ins/delATTG NFKB1 promoter polymorphism and followed up for 12 months. The incidence of CMV infection within 12 months after kidney transplantation was 37.5% (33/88) for the ins/ins, 21.5% (28/130) for the ins/del, and 23.7% (9/38) for the del/del genotypes (p = 0.023). Moreover, we evaluated the time of CMV infection onset. Ins/ins carriers had primarily late-onset CMV infection (median 194 days; interquartile range (IQR) 117–267 days) compared with heterozygous (ins/del; median 158 days; IQR 82–195 days) and homozygous deletion allele carriers (del/del; median 95 days; 84–123 days). Multivariate-restricted Cox regression model confirmed the ins/ins genotype to be an independent risk factor for the development of late-onset CMV infections. These findings should have an impact on post-kidney transplantation CMV chemoprophylaxis regimens.

P1732RECURRENCE OF GLOMERULONEPHRITIS POST TRANSPLANT

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

scholarly journals Incidence and Clinical Significance ofDe NovoDonor Specific Antibodies after Kidney Transplantation

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Sophia Lionaki ◽  
Konstantinos Panagiotellis ◽  
Aliki Iniotaki ◽  
John N. Boletis
Keyword(s):  
Kidney Transplantation ◽  
De Novo ◽  
Human Leukocyte ◽  
Clinical Syndrome ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Chronic Allograft Dysfunction ◽  
Specific Antibodies ◽  
Allograft Dysfunction

Kidney transplantation has evolved over more than half a century and remarkable progress has been made in patient and graft outcomes. Despite these advances, chronic allograft dysfunction remains a major problem. Among other reasons,de novoformation of antibodies against donor human leukocyte antigens has been recognized as one of the major risk factors for reduced allograft survival. The type of treatment in the presence of donor specific antibodies (DSA) posttransplantation is largely related to the clinical syndrome the patient presents with at the time of detection. There is no consensus regarding the treatment of stable renal transplant recipients with circulatingde novoDSA. On the contrast, in acute or chronic allograft dysfunction transplant centers use various protocols in order to reduce the amount of circulating DSA and achieve long-term graft survival. These protocols include removal of the antibodies by plasmapheresis, intravenous administration of immunoglobulin, or depletion of B cells with anti-CD20 monoclonal antibodies along with tacrolimus and mycophenolate mofetil. This review aims at the comprehension of the clinical correlations ofde novoDSA in kidney transplant recipients, assessment of their prognostic value, and providing insights into the management of these patients.

scholarly journals Analysis of chemokines and soluble adhesion molecules in cytomegalovirus-positive renal transplant recipients

2009 ◽  
Vol 4 (02) ◽  
pp. 110-113 ◽  
Author(s):  
Obeid E Obeid ◽  
Alhusain J Alzahrani
Keyword(s):  
Adhesion Molecules ◽  
Kidney Transplant ◽  
Control Group ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Igg Antibodies ◽  
Kidney Transplant Recipients ◽  
Cmv Infection ◽  
Viral Dna ◽  
Soluble Adhesion Molecules

Background: The relationship among cytomegalovirus (CMV) infection and the serum level of chemokines and soluble adhesion molecules is not well studied. This study aimed to assess chemokines and soluble adhesion molecules in CMV-positive Saudi renal transplant recipients. Methodology: The study was conducted in a tertiary hospital in Eastern Saudi Arabia over a 12-month period. All kidney transplant recipients who regularly attended the nephrology clinics were included (n = 150). Randomly selected age- and sex-matched individuals served as a control group (n = 158). CMV antibodies (IgG and IgM), chemokines and soluble adhesion molecules were measured using standard enzyme-linked immunosorbent assay (ELISA). CMV viral DNA was detected using real time polymerase chain reaction (PCR). Results: Of the 150 patients studied, 149 (n = 150) had detectable levels of Anti-CMV IgG antibodies (99.3%). In the control group, 113 (n = 158), blood donors had anti-CMV IgG antibodies (71.5%). Forty-one (n = 150) kidney transplant recipients were positive for anti-CMV IgM antibodies (27.3%), whereas only one (n = 158) blood donor had detectable anti-CMV IgM antibodies. All IgM positive samples contained CMV viral DNA.  MCP-1, IL-8, ICAM-1, and VCAM-1 levels were measured using ELISA. Of those, only MCP-1 and IL-8 were detectable. Eighteen kidney transplant recipients were positive for MCP-1 (12%). All MCP-1 patients were also anti-CMV IgM positive, while 5 patients had detectable levels of IL-8 (3.3%). All these patients were CMV IgM-positive. Conclusions: The increase in chemokine levels during CMV infection may reflect a possible role for these molecules in the immunopathogenesis of CMV infection in this study population.

scholarly journals A Comparison of Different Valgancyclovir Formulations in the Universal 6-Month Prophylaxis Against CMV Infection in Renal Transplant Recipients: A Randomized Single-Centre Study

PRILOZI ◽  
2019 ◽  
Vol 40 (3) ◽  
pp. 47-55
Author(s):  
Nikolina Basic-Jukic ◽  
Vesna Furic-Cunko ◽  
Tvrtko Hudolin ◽  
Zoran Zimak ◽  
Jason Kirincich ◽  
...  
Keyword(s):  
High Risk ◽  
Adverse Events ◽  
Kidney Transplant ◽  
De Novo ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Cmv Infection ◽  
Serious Adverse Events ◽  
Data Set

Abstract Introduction: Cytomegalovirus (CMV) is the most common opportunistic infective pathogen in kidney transplant recipients. Valganciclovir (VAL) is commonly used for prophylaxis, especially in high-risk recipients. Generic VAL formulations have become available, but the data about their safety and efficacy are lacking. Methods: Consecutive de novo kidney transplant patients were randomized to generic VAL Valganciklovir Teva® (VT group)(24 patients) or Alvanocyte® (A group), Alvogen (19 patients) or to Valcyte® (V group), Roche (23 patients) in a 18-month open-label study. Universal prophylaxis was used for 6 months after the transplantation. CMV DNA levels were measured at 1,3,6,9,12 and 18 months after the transplantation. All positive measurements of CMV DNA were recorded. Results: Groups did not differ regarding the clinical characteristics or the risk for developing CMV infection in the post-transplant period. CMV replications were most common at 9 months after the transplantation with rates of 9% for the V, 13% for the VT and 26% for the A group (p=0.26). At 12 months, positive CMV DNA was recorded in 22%, 8% and 11 % of patients taking V, VT and A, respectively (p=0.37). Rates of biopsy-proven acute rejection, adverse events, and serious adverse events were similar for all formulations. Lymphocele occurred most commonly in the V group (35%) compared to 17% in VT and 17% in the A group (p=0.23). One patient from each of the A and VT groups developed CMV disease. Additionally, they were the only two patients with CMV DNA copies above 656 IU/ml. Glomerular filtration rates were similar in all groups at all time points, while proteinuria was significantly higher at 12 months in patients who received V 0.32 g/day (0.18 – 0.42), compared to patients on VT 0.2 (0.1 – 0.2), or A 0.2 (0.2 – 0.3), p=0.04. Conclusion: Valgancyclovir efficacy and safety in this limited data set is similar with early administration of V, VT and A after kidney transplantation. Additional studies aimed at elucidating the effectiveness of this treatment regimen in patients who are at high risk for developing CMV infection are necessary to draw further conclusions.

scholarly journals Post-transplant monitoring of lymphocyte counts predict the occurrence of CMV DNAemia in early phase of kidney transplantation

2020 ◽  
Author(s):  
Sujuan Feng ◽  
Jing Yang ◽  
Xiaodong Zhang
Keyword(s):  
Kidney Transplantation ◽  
Peripheral Blood ◽  
Operating Characteristic ◽  
Roc Curves ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Cmv Infection ◽  
Post Transplantation ◽  
Cmv Dnaemia

Abstract Background The aim of this study was to assess whether monitoring of the number of lymphocytes in peripheral blood was helpful for evaluating the risk of cytomegalovirus (CMV) infection after kidney transplantation. Methods The total numbers of lymphocyte in peripheral blood were measured at baseline and posttransplant months 1, 3 and 6. Risk factors for DNAemia in KTRs were analyzed using univariate logistic regression analyses. Areas under receiver operating characteristic (ROC) curves were applied to assess the accuracy of lymphocyte counts for predicting CMV DNAemia. Results After follow-up 6 months, CMV replication was detected in 12 (31.6%) kidney transplant recipients (KTRs). The total lymphocyte counts were significantly decreased in KTRs with CMV DNAemia in 1, 3 and 6 months. There was a negative correlation between CMV copies and the lymphocyte counts in 1, 3 and 6 months post-transplantation, and the decrease of lymphocyte counts in the 6 months post-transplantation was the risk factor of CMV DNAemia in the KTR. Patients with lymphocyte counts 1.085×109 cells/L had higher cumulative incidence of CMV DNAemia.Conclusions The lymphocyte counts post kidney transplantation may be used as a simple and effective indicator for monitoring the CMV DNAemia status in KTR and for predicting the risk of CMV DNAemia.

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