scholarly journals Impact of hyperuricemia on long-term clinical outcomes of renal transplant recipients: a systematic review and meta-analysis

2021 ◽  
Vol 24 ◽  
pp. 292-307
Author(s):  
Hui Yang ◽  
Qing Chen ◽  
Aiwen Huang ◽  
Xiaojia Yu ◽  
Gang Chen ◽  
...  
Keyword(s):  
Uric Acid ◽  
Renal Transplant ◽  
Clinical Outcomes ◽  
Cardiovascular Event ◽  
Graft Loss ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Increased Risk ◽  
Significant Difference

Purpose: To evaluate the effect of hyperuricemia on clinical outcomes of renal transplant recipients (RTRs). Methods: A literature search of PubMed, Cochrane, Embase was conducted up to March 20, 2020. The primary outcome was the estimated glomerular filtration rate (eGFR). The second outcomes were the risk of graft loss, death, cardiovascular event and the level of triglyceride. The following search terms were utilized: ((Hyperuricemic group) OR (Hyperuricaemia) OR (Hyperuric) OR (Urea acid) OR (Uric acid) OR (Acid urate) OR (Urate) OR (Gout)) and ((Transplantation) OR (Transplantations) OR (Transplant) OR (Transplants) OR (Graft)). Results: 28 studies with 18224 patients were eligible for inclusion. There was no significant difference in eGFR (<12 months, p=0.07), the risk of graft loss (<60 months, p=0.07) and death (<60months, p=0.19) between the hyperuricemic and normouricemic group in the early post-transplantation period. But increased uric acid levels contributed to the long-term decline of eGFR, the risk of graft loss and death increased after transplantation. Hyperuricemia increased the risk of cardiovascular event with no significant difference in the level of triglyceride between the two groups. Conclusions: Increased uric acid levels contributed to the long-term decline of eGFR, increased risk of graft loss and death after transplantation. Although there was no significant effect on triglyceride, hyperuricemia increased the risk of cardiovascular event.

scholarly journals Post-transplantation plasma malondialdehyde is associated with cardiovascular mortality in renal transplant recipients: a prospective cohort study

2020 ◽  
Vol 35 (3) ◽  
pp. 512-519 ◽  
Author(s):  
Manuela Yepes-Calderón ◽  
Camilo G Sotomayor ◽  
Rijk O B Gans ◽  
Stefan P Berger ◽  
Henri G D Leuvenink ◽  
...  
Keyword(s):  
Ascorbic Acid ◽  
Renal Function ◽  
Renal Transplant ◽  
Cardiovascular Mortality ◽  
Graft Loss ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Plasma Ascorbic Acid ◽  
Targeted Interventions

Abstract Background In renal transplant recipients (RTRs), cardiovascular mortality is the most common cause of long-term renal graft loss. Oxidative stress (OS) has been associated with cardiovascular disease and is known to be enhanced in RTRs. We aimed to prospectively investigate whether the concentration of the OS biomarker malondialdehyde (MDA) is associated with long-term risk of cardiovascular mortality in a large cohort of RTRs. Methods The plasma MDA concentration was measured using the thiobarbituric acid reaction assay in 604 extensively phenotyped RTRs with a functioning allograft for ≥1 year. The association between MDA and cardiovascular mortality was assessed using Cox proportional hazard regression analyses in the overall cohort and within subgroups according to significant effect modifiers. Results Median circulating MDA concentration at baseline was 5.38 [interquartile range (IQR) 4.31–6.45] μmol/L. During a follow-up period of 6.4 (IQR 5.6–6.8) years, 110 (18%) RTRs died, with 40% of deaths due to cardiovascular causes. MDA concentration was significantly associated with the risk for cardiovascular mortality {hazard ratio [HR] 1.31 [95% confidence interval (CI) 1.03–1.67] per 1-SD increment}, independent of adjustment for potential confounders, including renal function, immunosuppressive therapy, smoking status and blood pressure. The association between MDA concentration and the risk for cardiovascular mortality was stronger in RTRs with relatively lower plasma ascorbic acid concentrations [≤42.5 µmol/L; HR 1.79 (95% CI 1.30–2.48) per 1-SD increment] or relatively lower estimated glomerular filtration rates [≤45 mL/min/1.73 m2; HR 2.09 (95% CI 1.45–3.00) per 1-SD increment]. Conclusions Circulating MDA concentration is independently associated with long-term risk for cardiovascular mortality, particularly in RTRs with relatively lower ascorbic acid concentrations or renal function. Further studies are warranted to elucidate whether OS-targeted interventions could decrease cardiovascular mortality in RTRs.

scholarly journals Initial mycophenolate dose in tacrolimus treated renal transplant recipients, a cohort study comparing leukopaenia, rejection and long-term graft function

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Vatsa Dave ◽  
Kevan R. Polkinghorne ◽  
Khai Gene Leong ◽  
John Kanellis ◽  
William R. Mulley
Keyword(s):  
Renal Function ◽  
Cohort Study ◽  
Renal Transplant ◽  
Graft Function ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Post Transplantation ◽  
Post Transplant ◽  
Increased Risk

Abstract The evidence supporting an initial mycophenolate mofetil (MMF) dose of 2 g daily in tacrolimus-treated renal transplant recipients is limited. In a non-contemporaneous single-centre cohort study we compared the incidence of leukopaenia, rejection and graft dysfunction in patients initiated on MMF 1.5 g and 2 g daily. Baseline characteristics and tacrolimus trough levels were similar by MMF group. MMF doses became equivalent between groups by 12-months post-transplant, driven by dose reductions in the 2 g group. Leukopaenia occurred in 42.4% of patients by 12-months post-transplant. MMF 2 g was associated with a 1.80-fold increased risk of leukopaenia compared to 1.5 g. Rejection occurred in 44.8% of patients by 12-months post-transplantation. MMF 2 g was associated with half the risk of rejection relative to MMF 1.5 g. Over the first 7-years post-transplantation there was no difference in renal function between groups. Additionally, the development of leukopaenia or rejection did not result in reduced renal function at 7-years post-transplant. Leukopaenia was not associated with an increased incidence of serious infections or rejection. This study demonstrates the initial MMF dose has implications for the incidence of leukopaenia and rejection. Since neither dose produced superior long-term graft function, clinical equipoise remains regarding the optimal initial mycophenolate dose in tacrolimus-treated renal transplant recipients.

scholarly journals CD8+ T CELL SENESCENCE IS A DISTINCT IMMUNOLOGICAL STATE THAT IDENTIFIES LONG-TERM RENAL TRANSPLANT RECIPIENTS AT INCREASED RISK OF FUTURE MALIGNANCY

2020 ◽  
Vol 104 (S3) ◽  
pp. S106-S106
Author(s):  
Matthew J. Bottomley ◽  
Suzanne Bezstarosti ◽  
Eleni Ieremiah ◽  
Joanna Hester ◽  
Fadi Issa ◽  
...  
Keyword(s):  
T Cell ◽  
Renal Transplant ◽  
Cd8 T Cell ◽  
Cell Senescence ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Increased Risk ◽  
T Cell Senescence

scholarly journals EFFECT OF LEPTIN CONCENTRATIONS AND LEPTIN RECEPTOR GENE POLYMORPHISMS ON THE OUTCOME OF RENAL TRANSPLANTATION

2021 ◽  
Author(s):  
Guadalup García-Pino ◽  
Enrique Luna ◽  
Sonia Mota-Zamorano ◽  
Luz María González ◽  
María Ángeles Tormo ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Acute Rejection ◽  
Clinical Outcomes ◽  
Leptin Receptor ◽  
Renal Transplant Recipients ◽  
Inverse Association ◽  
Transplant Recipients ◽  
Lepr Gene ◽  
Increased Risk

IntroductionLeptin is a pro-inflammatory adipocytokine implicated in cardiovascular disease, insulin resistance, obesity and chronic kidney disease.Material and methodsIn a cohort of 236 renal transplant recipients, we aimed to determine whether circulating leptin concentrations and/or three polymorphisms in the leptin receptor (LEPR) gene, namely rs1137100, rs1137101 and rs1805094, were related to clinical outcomes in renal transplantation. Plasma leptin concentrations were measured by ELISA. Genetic variants were determined by conventional real-time PCR assays and statistical associations with clinical outcomes were obtained by logistic regression modelling.ResultsPatients with elevated leptin levels were at higher risk of acute rejection [OR=1.03 (1.01–1.05), p=0.03] and displayed worse renal clearance (p=0.001) than patients with lower levels. Leptin levels were not significantly affected by any of the three LEPR SNPs. The rs1137101 G variant showed an inverse association with the risk of delayed graft function (DGF) [OR=0.42 (0.22-0.81), p=0.009], whilst the homozygous rs1805094 CC genotype was associated with increased risk of acute rejection [OR=11.38 (2.15-60.16), p=0.004]. A statistically significant association was also observed between the rs1137100 GG genotype and better renal function [mean difference vs. AA/AG =20.20 (4.91-35.49) ml/min, p=0.010].ConclusionsOur results show that both leptin plasma concentrations and polymorphisms in the LEPR gene may affect clinical outcomes in renal transplant recipients, suggesting that the determination of these parameters could be useful in predicting post-transplant adverse events.

scholarly journals 2640. Aerosol vs. Oral Ribavirin for the Treatment of Community-Acquired Respiratory Virus Infections in Lung Transplant Recipients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S923-S923
Author(s):  
Emily Mui ◽  
Marisa Holubar ◽  
Roy Lee ◽  
Danielle Pham ◽  
Lina Meng ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Lung Transplant ◽  
Respiratory Virus ◽  
Graft Loss ◽  
Transplant Recipients ◽  
Organ Rejection ◽  
Increased Risk ◽  
Significant Difference ◽  
Lung Transplant Recipients ◽  
Overall Mortality

Abstract Background Community-acquired respiratory virus (CARV) infections are associated with an increased risk of chronic lung allograft dysfunction (CLAD) and graft loss in lung transplant recipients (LTR). Administration of ribavirin by aerosol was the standard of care at Stanford Health Care in the management of CARV infections. Given the sparse evidence of benefit with aerosol ribavirin (AR) and its increasing cost and teratogenic risk for exposed healthcare personnel, AR was restricted to the treatment of respiratory syncytial virus (RSV) in 2016 and was ultimately removed from formulary in 2017. Oral (PO) ribavirin was used at the discretion of the transplant team. The objective of this study was to evaluate the clinical outcomes of AR compared with PO ribavirin in lung transplant recipients. Methods We performed a retrospective cohort analysis of adult lung transplant recipients diagnosed with CARV (metapneumovirus, parainfluenza virus, and RSV) infections treated with either AR or PO ribavirin. The analysis included the first treatment course of ribavirin by either route and patients were excluded if they received ribavirin in the prior 12 months. The primary outcome was the development/progression of CLAD, acute organ rejection, and overall mortality. Results Of 85 patients, 41 received AR and 44 received PO ribavirin. There was no significant difference in the following clinical outcomes with AR and oral ribavirin, respectively: development or progression of CLAD (30 days: 9.7% vs. 4.5%, P = 0.4227; 90 days: 14.6% vs. 6.8%, P = 0.303; 6 months: 17% vs. 9%, P = 0.3413; 12 months: 24% vs. 15.9%, P = 0.4188), acute organ rejection (90 days: 7.3% vs. 4.5%, P = 0.6689; 6 months: 12.1% vs. 9%, P = 0.7329; 12 months: 19.5% vs. 13.6%, P = 0.5635), and overall mortality (30 days: 0% vs. 4.5%, P = 0.4947; 90 days: 7.3% vs. 4.5%, P = 0.6689; 6 months: 7.3% vs. 9%, P = 1.0; 12 months: 7.3% vs. 13.6%, P = 0.4858). There was no observable difference in reported adverse effects between AR and PO ribavirin. Conclusion Lung transplant recipients with CARV infections had similar outcomes when treated with AR or PO ribavirin. Oral ribavirin is a less costly treatment than AR, but the efficacy of ribavirin by any route remains questionable. Disclosures All authors: No reported disclosures.

Increased Risk of All-Cause Mortality and Renal Graft Loss in Stable Renal Transplant Recipients With Hyperparathyroidism

2015 ◽  
Vol 99 (2) ◽  
pp. 351-359 ◽  
Author(s):  
Hege Pihlstrøm ◽  
Dag Olav Dahle ◽  
Geir Mjøen ◽  
Stefan Pilz ◽  
Winfried März ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Graft Loss ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Renal Graft ◽  
Increased Risk ◽  
All Cause Mortality

scholarly journals SP5.2.1 Renal Transplant Outcomes Through the COVID-19 Pandemic at a London Transplant Centre

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Sara Mahdibeiraghdar ◽  
Abbas Ghazanfar ◽  
Sarah Heap ◽  
Abul Siddiky ◽  
Claire Fraser Taylor ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Graft Loss ◽  
Outcome Data ◽  
Adverse Outcomes ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Jugular Vein Thrombosis ◽  
Post Transplant ◽  
Significant Difference ◽  
The Impact

Abstract Aims The aim of this audit was to establish the impact of COVID-19 on the outcomes of renal transplant recipients in the post-transplant period at our centre, through the 2020 calendar year. Methods Living donor and deceased donor renal transplant recipients in the period of interest were identified and any complications or adverse outcomes were reviewed and compared to outcome data from the previous year. Results A total of 88 renal transplants were performed in 2020. Fifty-five cases were performed after reopening the Unit. Five patients tested positive for COVID-19 in the post-transplant period. One patient was admitted to the Intensive Care Unit and subsequently died from related complications. Another patient suffered from internal jugular vein thrombosis shortly after testing positive and could be attributed to the hypercoagulable state post-infection. A total of 4 deaths and 1 graft loss were recorded within 2020. This compares to 1 death, 2 graft losses and 1 primary non-function in 172 transplants in 2019. Of the 4 deaths, one was directly linked to COVID-19. The other 3 deaths could be indirectly linked to the disruptions that were made in the healthcare system during this period in adapting to the pandemic. Conclusions It was anticipated that COVID-19 will directly and indirectly affect patient outcomes from surgery during this period. This was clearly seen at this Unit, with mortality rates having increased almost eight-fold in the post-transplant period compared to the same period in the previous year. However, no significant difference was seen with graft losses.

MO983EFFICACY AND SAFETY OF SWITCHING TO AZATHIOPRINE FOR MYCOPHENOLATE INDUCED DIARRHEA IN RENAL TRANSPLANT RECIPIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Serhat Sekmek ◽  
Tolga Yildirim ◽  
Neriman Sila Koc ◽  
Ceren Onal ◽  
Jabrayil Jabrayilov ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Renal Transplant ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Graft Loss ◽  
Common Side Effect ◽  
Control Group ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Increased Risk

Abstract Background and Aims Diarrhea is a common side effect of mycophenolate treatment in renal transplant recipients. In patients with mycophenolate induced diarrhea, one of the options is switching mycophenolate to azathioprine. In this study, we aimed to define the safety and efficacy of switching from mycophenolate to azathioprine for mycophenolate related diarrhea in renal transplant recipients. Method A total of 177 patients, 59 of whom were switched to azathioprine due to diarrhea and 118 of which were matched control group without diarrhea that continued mycophenolate treatment, participated in this study. We analyzed the effect of switching to azathioprine from mycophenolate on amelioration of diarrhea and graft survival. Results We observed that 89.8% of the patients who switched to azathioprine due to diarrhea had improved diarrhea complaints. Patients switched to azathioprine due do diarrhea had lower glomerular filtration rate (59 [15-125] vs. 74 [23-150] mL/min, p&lt;0.001) and higher proteinuria (254 [49 – 15.500] mg/day vs. 184 [5 – 2329] mg/day, p&lt;0.001) compared to control group before the switch. When patients switched to azathioprine were compared to a sub-group of 59 control patients who were matched to patients that switched to azathioprine in terms of baseline renal function and proteinuria in addition to demographic parameters, they had higher ten-years graft loss compared to patients that continued mycophenolate (p=0.03) (Figure 1). Particularly in patients with a glomerular filtration rate of less than 30 mL/min at the time of conversion, the risk of early graft loss was high. Conclusion Although switching mycophenolate to azathioprine was an effective approach to improve diarrhea, this approach is associated with increased risk of graft loss.

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