Delayed Kinetics of IgG, but not IgA, Anti-spike Antibodies in Transplant Recipients following SARS-CoV-2 Infection

Background: Kidney organ transplant recipients are at increased risk of severe outcomes during COVID-19. Antibodies directed against the virus are thought to offer protection, but a thorough characterization of anti-SARS-CoV-2 immune globulin isotypes in kidney transplant recipients following SARS-CoV-2 infection has not been reported. Methods: We performed a cross-sectional study of 49 kidney transplant recipients and 42 immunocompetent controls at early (≤14 days) or late (>14 days) time points after documented SARS-CoV-2 infection. Using a validated semi-quantitative Luminex-based multiplex assay, we determined IgM, IgG, IgG1-4 and IgA antibodies against 5 distinct viral epitopes. Results: Kidney transplant recipients showed lower levels of total IgG anti-trimeric spike (S), S1, S2, and receptor-binding domain (RBD), but not nucleocapsid (NC) at early versus late time points after SARS-CoV-2 infection. Early levels of IgG anti-spike protein epitopes were also lower than in immunocompetent controls. Anti-SARS-CoV-2 antibodies were predominantly IgG1 and IgG3 with modest class switching to IgG2 or IgG4 in either cohort. Later levels of IgG anti-Spike, S1, S2, RBD and NC were not significantly different between cohorts. There was no significant difference in the kinetics of either IgM or IgA anti-Spike, S1, RBD or S2 based on timing after diagnosis or transplant status. Conclusions: Kidney transplant recipients mount early anti-SARS-CoV-2 IgA and IgM responses while IgG responses are delayed compared to immunocompetent individuals. These findings might explain the poor outcomes in transplant recipients with COVID-19.

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Identification of Risk Factors for Multiple Non-Melanoma Skin Cancers in Italian Kidney Transplant Recipients

Medicina ◽

10.3390/medicina55060279 ◽

2019 ◽

Vol 55 (6) ◽

pp. 279 ◽

Cited By ~ 1

Author(s):

Elisa Zavattaro ◽

Paolo Fava ◽

Federica Veronese ◽

Giovanni Cavaliere ◽

Daniela Ferrante ◽

...

Keyword(s):

Risk Factors ◽

Kidney Transplant ◽

Organ Transplant ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Skin Cancers ◽

Increased Risk ◽

History Of ◽

Solar Lentigo ◽

Melanoma Skin

Background and objectives: Non-melanoma skin cancers (NMSCs) represent the most frequently encountered malignancy in organ transplant recipients and their incidence increases proportionally to the duration of immunosuppression. Furthermore, patients of this group often develop multiple and more aggressive cancers and, to date, risk factors for the development of multiple NMSCs have not been yet established. The present study aimed to identify risk factors for multiple NMSCs in a cohort of Italian kidney transplant recipients (KTRs). Materials and Methods: We consecutively included all KTRs referring to two post-transplant outpatient clinics of North-Western Italy between 2001 and 2017. In this cohort, we evaluated different clinical (endogenous and exogenous) risk factors in order to establish their correlation with NMSCs. Results: 518 KTRs were included, of which 148 (28.6%) developed keratinocyte cancers, with a single tumor in 77 subjects, two skin cancers in 31 patients, 3 in 21 patients, whereas at least 4 NMSCs developed in 19 KTRs. We observed an increased risk of the development of cutaneous neoplasms for the male gender, old age at transplantation (>50 years), light phototype, solar lentigo, history of sunburns, or chronic actinic damage. Considering patients affected by multiple keratinocyte neoplasms, we observed a significant association of actinic damage and solar lentigo with an increased risk of NMSCs; their significance was confirmed even at the multivariable model. Conclusions: Our results confirm the role played by chronic cutaneous actinic damage in carcinogenesis on KTRs and highlight the significance of individualized periodic dermatological screening.

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Patterns of ocular morbidity among kidney transplant recipients in Ethiopia

International Journal of Scientific Reports ◽

10.18203/issn.2454-2156.intjscirep20210543 ◽

2021 ◽

Vol 7 (3) ◽

pp. 155

Author(s):

Lemlem Tamrat ◽

Ewenat Gebrehanna

Keyword(s):

Kidney Transplant ◽

Dry Eye ◽

Organ Transplant ◽

Renal Diseases ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Cross Sectional ◽

Medical College ◽

Transplant Patients ◽

Kidney Transplant Patients

Background: Of all organ transplant procedures renal transplantation has become a very successful and routine procedure. Saint Paul’s Hospital Millennium Medical College is a pioneer and is the only center providing kidney transplant in Ethiopia. Even if this is a life changing and exiting addition to the countries’ health service coverage, its long term outcomes including various complications is not yet assessed. Therefore, the aim of this study is to describe ocular morbidities among kidney transplant recipients in Ethiopia. Methods: Cross sectional descriptive study was undertaken from October 2017 to December 2018. Results: There were a total of 135 individuals who underwent renal transplant procedure including 95 (70.4%) male and 40 (29.6 %) female. The median age was 32 years. The cause of renal diseases is not known in majority 112 (83%) of the study subjects. More than 95% of all the study subjects were on multiple immunosuppressant therapy. Of all the individuals examined 128 (94.8%) of them have one or more ocular morbidities. Dry eye 76 (50.7%), optic neuropathies 12 (8%), retinal pigmentary changes 11 (7.3%) and cataract 9 (6%) were frequently observed eye morbidities. There were no significant sight threatening conditions observed in relation to the immunosuppressive therapy or the diseases itself.Conclusions: Dry eye is the commonest eye morbidity among kidney transplant patients.

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Urinary Carnosinase-1 Excretion is Associated with Urinary Carnosine Depletion and Risk of Graft Failure in Kidney Transplant Recipients: Results of the TransplantLines Cohort Study

Antioxidants ◽

10.3390/antiox10071102 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1102

Author(s):

Angelica Rodriguez-Niño ◽

Diego O. Pastene ◽

Adrian Post ◽

M. Yusof Said ◽

Antonio W. Gomes-Neto ◽

...

Keyword(s):

Kidney Transplant ◽

Graft Failure ◽

Cox Regression ◽

Carbonyl Stress ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Increased Risk ◽

High Concentrations ◽

Kidney Function Decline

Carnosine affords protection against oxidative and carbonyl stress, yet high concentrations of the carnosinase-1 enzyme may limit this. We recently reported that high urinary carnosinase-1 is associated with kidney function decline and albuminuria in patients with chronic kidney disease. We prospectively investigated whether urinary carnosinase-1 is associated with a high risk for development of late graft failure in kidney transplant recipients (KTRs). Carnosine and carnosinase-1 were measured in 24 h urine in a longitudinal cohort of 703 stable KTRs and 257 healthy controls. Cox regression was used to analyze the prospective data. Urinary carnosine excretions were significantly decreased in KTRs (26.5 [IQR 21.4–33.3] µmol/24 h versus 34.8 [IQR 25.6–46.8] µmol/24 h; p < 0.001). In KTRs, high urinary carnosinase-1 concentrations were associated with increased risk of undetectable urinary carnosine (OR 1.24, 95%CI [1.06–1.45]; p = 0.007). During median follow-up for 5.3 [4.5–6.0] years, 84 (12%) KTRs developed graft failure. In Cox regression analyses, high urinary carnosinase-1 excretions were associated with increased risk of graft failure (HR 1.73, 95%CI [1.44–2.08]; p < 0.001) independent of potential confounders. Since urinary carnosine is depleted and urinary carnosinase-1 imparts a higher risk for graft failure in KTRs, future studies determining the potential of carnosine supplementation in these patients are warranted.

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Changes in quality of life (QoL) and other patient-reported outcome measures (PROMs) in living-donor and deceased-donor kidney transplant recipients and those awaiting transplantation in the UK ATTOM programme: a longitudinal cohort questionnaire survey with additional qualitative interviews

BMJ Open ◽

10.1136/bmjopen-2020-047263 ◽

2021 ◽

Vol 11 (4) ◽

pp. e047263

Author(s):

Andrea Gibbons ◽

Janet Bayfield ◽

Marco Cinnirella ◽

Heather Draper ◽

Rachel J Johnson ◽

...

Keyword(s):

Kidney Transplant ◽

Outcome Measures ◽

Deceased Donor ◽

Patient Reported Outcome Measures ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Structured Interviews ◽

Cross Sectional ◽

Post Transplant ◽

Patient Reported

ObjectiveTo examine quality of life (QoL) and other patient-reported outcome measures (PROMs) in kidney transplant recipients and those awaiting transplantation.DesignLongitudinal cohort questionnaire surveys and qualitative semi-structured interviews using thematic analysis with a pragmatic approach.SettingCompletion of generic and disease-specific PROMs at two time points, and telephone interviews with participants UK-wide.Participants101 incident deceased-donor (DD) and 94 incident living-donor (LD) kidney transplant recipients, together with 165 patients on the waiting list (WL) from 18 UK centres recruited to the Access to Transplantation and Transplant Outcome Measures (ATTOM) programme completed PROMs at recruitment (November 2011 to March 2013) and 1 year follow-up. Forty-one of the 165 patients on the WL received a DD transplant and 26 received a LD transplant during the study period, completing PROMs initially as patients on the WL, and again 1 year post-transplant. A subsample of 10 LD and 10 DD recipients participated in qualitative semi-structured interviews.ResultsLD recipients were younger, had more educational qualifications and more often received a transplant before dialysis. Controlling for these and other factors, cross-sectional analyses at 12 months post-transplant suggested better QoL, renal-dependent QoL and treatment satisfaction for LD than DD recipients. Patients on the WL reported worse outcomes compared with both transplant groups. However, longitudinal analyses (controlling for pre-transplant differences) showed that LD and DD recipients reported similarly improved health status and renal-dependent QoL (p<0.01) pre-transplant to post-transplant. Patients on the WL had worsened health status but no change in QoL. Qualitative analyses revealed transplant recipients’ expectations influenced their recovery and satisfaction with transplant.ConclusionsWhile cross-sectional analyses suggested LD kidney transplantation leads to better QoL and treatment satisfaction, longitudinal assessment showed similar QoL improvements in PROMs for both transplant groups, with better outcomes than for those still wait-listed. Regardless of transplant type, clinicians need to be aware that managing expectations is important for facilitating patients’ adjustment post-transplant.

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Exhaled Hydrogen as a Marker of Intestinal Fermentation Is Associated with Diarrhea in Kidney Transplant Recipients

Journal of Clinical Medicine ◽

10.3390/jcm10132854 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2854

Author(s):

Fernanda Rodrigues ◽

J. Swarte ◽

Rianne Douwes ◽

Tim Knobbe ◽

Camilo Sotomayor ◽

...

Keyword(s):

Small Bowel ◽

Kidney Transplant ◽

Surrogate Marker ◽

Bacterial Overgrowth ◽

Dietary Factors ◽

Multivariable Logistic Regression Analysis ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Increased Risk ◽

The Relationship

Background: Diarrhea is common among kidney transplant recipients (KTR). Exhaled hydrogen (H2) is a surrogate marker of small bowel dysbiosis, which may drive diarrhea. We studied the relationship between exhaled H2 and diarrhea in KTR, and explored potential clinical and dietary determinants. Methods: Clinical, laboratory, and dietary data were analyzed from 424 KTR participating in the TransplantLines Biobank and Cohort Study (NCT03272841). Fasting exhaled H2 concentration was measured using a model DP Quintron Gas Chromatograph. Diarrhea was defined as fast transit time (types 6 and 7 according to the Bristol Stool Form Scale, BSFS) of 3 or more episodes per day. We studied the association between exhaled H2 and diarrhea with multivariable logistic regression analysis, and explored potential determinants using linear regression. Results: KTR (55.4 ± 13.2 years, 60.8% male, mean eGFR 49.8 ± 19.1 mL/min/1.73 m2) had a median exhaled H2 of 11 (5.0–25.0) ppm. Signs of small intestinal bacterial overgrowth (exhaled H2 ≥ 20 ppm) were present in 31.6% of the KTR, and 33.0% had diarrhea. Exhaled H2 was associated with an increased risk of diarrhea (odds ratio 1.51, 95% confidence interval 1.07–2.14 per log2 ppm, p = 0.02). Polysaccharide intake was independently associated with higher H2 (std. β 0.24, p = 0.01), and a trend for an association with proton-pump inhibitor use was observed (std. β 0.16 p = 0.05). Conclusion: Higher exhaled H2 is associated with an increased risk of diarrhea in KTR. Our findings set the stage for further studies investigating the relationship between dietary factors, small bowel dysbiosis, and diarrhea after kidney transplantation.

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The effect of anti-thymocyte globulin and everolimus on the kinetics of cytomegalovirus viral load in seropositive kidney transplant recipients without prophylaxis

Transplant Infectious Disease ◽

10.1111/tid.12919 ◽

2018 ◽

Vol 20 (4) ◽

pp. e12919 ◽

Cited By ~ 4

Author(s):

Geovana Basso ◽

Claudia Rosso Felipe ◽

Marina Pontello Cristelli ◽

Juliana Mansur Siliano ◽

Laila Viana ◽

...

Keyword(s):

Viral Load ◽

Kidney Transplant ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Kinetics Of

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An Exploratory Correlational Study in the Use of Mobile Technology Among Adult Kidney Transplant Recipients

Progress in Transplantation ◽

10.1177/1526924818800051 ◽

2018 ◽

Vol 28 (4) ◽

pp. 368-375 ◽

Cited By ~ 3

Author(s):

Tara O’Brien ◽

Cynthia L. Russell ◽

Alai Tan ◽

Mallory Washington ◽

Donna Hathaway

Keyword(s):

Kidney Transplant ◽

Mobile Technology ◽

Mobile Apps ◽

Self Management ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Cross Sectional ◽

Adult Kidney ◽

Access Patterns ◽

Management Of Care

Introduction: Rapidly growing use of mobile technology provides a platform for self-management of care support for those with chronic conditions. Few studies have explored the characteristics or access patterns of kidney transplant recipients who use mHealth applications (apps) for self-management of care. Research Questions: The primary aim of this study was to describe demographics, use, barriers, and perceptions of mobile apps for self-management of care among adult kidney transplants recipients. The secondary aim was to compare blood urea nitrogen, glomerular filtration rate, and number of hospitalizations among mHealth app users, other app users, and non-app users. Methods: A cross-sectional design was used to administer the Mobile Application Use among Kidney Transplant Recipients Questionnaire. Descriptive statistics, χ2 statistics, and analysis of variance were used for the primary aim and linear regression was used for the secondary aim. Results: The sample included mostly African American males (n = 123, 75.5%) with a mean age of 50 (13.2) years. Knowledge was the greatest barrier reported by the non-app users (mHealth app users 9%, other app users 12%, non-app users, 49%, P < .001). Significantly fewer hospitalizations were found in the mHealth app users compared to other app users (regression coefficient b = −1.2, standard error [SE] = 0.5) and non-app users ( b = −0.9, SE = 0.6), adjusting for patient demographic and clinical characteristics. Discussion: Findings suggest a relationship may exist between mHealth app use and a decrease in the number of hospitalizations following kidney transplantation.

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Correlation of Prolonged Total Ischemic Time with Body Mass Index in Kidney Transplant: A Single Center Report

BioScientia Medicina ◽

10.32539/bsm.v5i11.367 ◽

2021 ◽

Vol 5 (11) ◽

pp. 1009-1013

Author(s):

Eriawan Agung Nugroho ◽

Erwin Wibowo ◽

Prathita Amanda Aryani

Keyword(s):

Body Mass Index ◽

Kidney Transplantation ◽

Kidney Transplant ◽

Body Mass ◽

The Body ◽

Health Concern ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Ischemic Time ◽

Increased Risk

Background: Chronic kidney disease (CKD) is a rising health concern worldwide, especially in Indonesia. The treatment of choice for end-stage renal disease is Kidney Transplantation.1 Numerous studies showed that prolonged total ischemic ischemic time may cause hypoxia of the graft tissue and increased risk of ischemia and reperfusion injury (IRI) and delayed graft function (DGF).2 Body mass index of kidney transplant recipients may cause prolonged duration of the procedure, as well as prolonged total ischemic time. This study aimed to determine the correlation between prolonged total ischemic time with body mass index. Method: This was an observational and cross-sectional analysis at Kariadi General Hospital Semarang involving patients who underwent kidney transplantation from January 2016 to December 2019. The total ischemic time was recorded intraoperatively. The Body Mass Index data were provided by medical records. The program used to statistically analyze the data was SPSS 23.0, and Spearman was used for hypothesis testing. Result: This study included 25 kidney transplant recipients. The mean total ischemic time was 43,27 ± 6,63 minutes. There was a significant positive correlation between prolonged ischemic time and body mass index (r= 0,506 ; p= 0,010). Conclusion: Prolonged total ischemic time was positively correlated with increased body mass index and these results are statistically significant.

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Venous Thromboembolism and the Risk of Death and Graft Loss in Kidney Transplant Recipients

American Journal of Nephrology ◽

10.1159/000480304 ◽

2017 ◽

Vol 46 (4) ◽

pp. 343-354 ◽

Cited By ~ 6

Author(s):

Ngan N. Lam ◽

Amit X. Garg ◽

Greg A. Knoll ◽

S. Joseph Kim ◽

Krista L. Lentine ◽

...

Keyword(s):

Retrospective Study ◽

Venous Thromboembolism ◽

General Population ◽

Kidney Transplant ◽

Graft Loss ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Risk Of Death ◽

Increased Risk

Background: The implications of venous thromboembolism (VTE) for morbidity and mortality in kidney transplant recipients are not well described. Methods: We conducted a retrospective study using linked healthcare databases in Ontario, Canada to determine the risk and complications of VTE in kidney transplant recipients from 2003 to 2013. We compared the incidence rate of VTE in recipients (n = 4,343) and a matched (1:4) sample of the general population (n = 17,372). For recipients with evidence of a VTE posttransplant, we compared adverse clinical outcomes (death, graft loss) to matched (1:2) recipients without evidence of a VTE posttransplant. Results: During a median follow-up of 5.2 years, 388 (8.9%) recipients developed a VTE compared to 254 (1.5%) in the matched general population (16.3 vs. 2.4 events per 1,000 person-years; hazard ratio [HR] 7.1, 95% CI 6.0-8.4; p < 0.0001). Recipients who experienced a posttransplant VTE had a higher risk of death (28.5 vs. 11.2%; HR 4.1, 95% CI 2.9-5.8; p < 0.0001) and death-censored graft loss (13.1 vs. 7.5%; HR 2.3, 95% CI 1.4-3.6; p = 0.0006) compared to matched recipients who did not experience a posttransplant VTE. Conclusions: Kidney transplant recipients have a sevenfold higher risk of VTE compared to the general population with VTE conferring an increased risk of death and graft loss.

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