High Mortality and Graft Loss After Infective Endocarditis in Kidney Transplant Recipients: A Case-Controlled Study From Two Centers

Purpose: Kidney Transplant Recipients (KTRs) tend to develop infections with characteristic epidemiology, presentation and outcome. While infective endocarditis (IE) is among such complications in KTRs, literature is scarce. We describe the presentation, epidemiology, and factors associated with IE in KTRs. Methods: We performed a retrospective case/control study which included patients from two centers. First episodes of definite or possible IE (Duke criteria), in adult KTRs from January 2007 to December 2018 were included, as well as two controls per case, and followed until December 31 2019. Clinical, biological, and microbiological data and the outcome were collected. Survival was studied using the Kaplan-Meier method. Finally, we searched for factors associated with the onset of IE in KTRs by the comparison of cases and controls. Results: Seventeen cases and 34 controls were included. IE was diagnosed after a mean delay of 78 months after KT, mostly on native valves of the left heart only. Pathogens of digestive origin were most frequently involved (six Enterococcus spp, three Streptococcus gallolyticus and one Escherichia coli), followed by Staphylococci (three cases of S. aureus and S. epidermidis each). Among the risk factors evaluated only age was significantly associated with the occurrence of IE in our study (63.8 years for cases vs. 55.6 years for controls, P=0.03) Patient and death-censored graft survival were greatly diminished five years after IE compared to controls being 50.3% vs. 80.6% (p<0.003) and 29.7% vs. 87.5% (p<0.002), respectively. Conclusion: IE in KTRs is a disease that carries significant risks both for the survival of the patient and the transplant.

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High Mortality and Graft Loss after Infective Endocarditis in Kidney Transplant Recipients: A Case-Controlled Study from Two Centers

Pathogens ◽

10.3390/pathogens10081023 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1023

Author(s):

Yanis Tamzali ◽

Clément Danthu ◽

Alexandra Aubry ◽

Romain Brousse ◽

Jean-François Faucher ◽

...

Keyword(s):

Infective Endocarditis ◽

Kidney Transplant ◽

Graft Loss ◽

Study Patient ◽

Controlled Study ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Retrospective Case ◽

Factors Associated ◽

Duke Criteria

Kidney transplant recipients (KTRs) tend to develop infections with characteristic epidemiology, presentation, and outcome. While infective endocarditis (IE) is among such complications in KTRs, the literature is scarce. We describe the presentation, epidemiology, and factors associated with IE in KTRs. We performed a retrospective case/control study which included patients from two centers. First episodes of definite or possible IE (Duke criteria) in adult KTRs from January 2010 to December 2018 were included, as well as two controls per case, and followed until 31 December 2019. Clinical, biological, and microbiological data and the outcome were collected. Survival was studied using the Kaplan–Meier method. Finally, we searched for factors associated with the onset of IE in KTRs by the comparison of cases and controls. Seventeen cases and 34 controls were included. IE was diagnosed after a mean delay of 78 months after KT, mostly on native valves of the left heart only. Pathogens of digestive origin were most frequently involved (six Enterococcus spp, three Streptococcus gallolyticus, and one Escherichia coli), followed by Staphylococci (three cases of S. aureus and S. epidermidis each). Among the risk factors evaluated, age, vascular nephropathy, and elevated calcineurin inhibitor through levels were significantly associated with the occurrence of IE in our study. Patient and death-censored graft survival were greatly diminished five years after IE, compared to controls being 50.3% vs. 80.6% (p < 0.003) and 29.7% vs. 87.5% (p < 0.002), respectively. IE in KTRs is a disease that carries significant risks both for the survival of the patient and the transplant.

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Significant Racial Differences in the Key Factors Associated with Early Graft Loss in Kidney Transplant Recipients

American Journal of Nephrology ◽

10.1159/000363393 ◽

2014 ◽

Vol 40 (1) ◽

pp. 19-28 ◽

Cited By ~ 18

Author(s):

David J. Taber ◽

Kevin Douglass ◽

Titte Srinivas ◽

John W. McGillicuddy ◽

Charles F. Bratton ◽

...

Keyword(s):

Kidney Transplant ◽

Racial Differences ◽

Graft Loss ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Key Factors ◽

Factors Associated ◽

Early Graft

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Immunosuppressive Management of Pediatric Kidney Transplant Recipients

Current Pharmaceutical Design ◽

10.2174/1381612826666200708133429 ◽

2020 ◽

Vol 26 (28) ◽

pp. 3451-3459

Author(s):

Tomáš Seeman

Keyword(s):

Immunosuppressive Therapy ◽

Kidney Transplant ◽

Induction Therapy ◽

Graft Loss ◽

Calcineurin Inhibitors ◽

Mtor Inhibitors ◽

Therapeutic Drug ◽

High Dose ◽

Transplant Recipients ◽

Kidney Transplant Recipients

: Kidney transplantation is a preferable treatment of children with end-stage kidney disease. All kidney transplant recipients, including pediatric need immunosuppressive medications to prevent rejection episodes and graft loss. : Induction therapy is used temporarily only immediately following transplantation while maintenance immunosuppressive drugs are started and given long-term. There is currently no consensus regarding the use of induction therapy in children; its use should be decided based on the immunological risk of the child. : The recent progress shows that the recommended strategy is to use as maintenance immunosuppressive therapy a combination of a calcineurin inhibitor (preferably tacrolimus) with an antiproliferative drug (preferably mycophenolate mofetil) with steroids that can be withdrawn early or late in low-risk children. The mTOR-inhibitors (sirolimus, everolimus) are used rarely in pediatrics because of common side effects and no evidence of a benefit over calcineurin inhibitors. The use of calcineurin inhibitors, mycophenolate, and mTOR-inhibitors should be followed by therapeutic drug monitoring. : Immunosuppressive therapy of acute rejection consists of high-dose steroids and/or anti-lymphocyte antibodies (T-cell mediated rejection) or plasma exchange, intravenous immunoglobulines and/or rituximab (antibodymediated rejection). : The future strategies for research are mainly precise characterisation of children needing induction therapy, more specific indications for mTOR-inhibitors and for the far future, the possibility to reach the immuno tolerance.

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BK Polyomavirus Micro-RNAs: Time Course and Clinical Relevance in Kidney Transplant Recipients

Viruses ◽

10.3390/v13020351 ◽

2021 ◽

Vol 13 (2) ◽

pp. 351

Author(s):

Baptiste Demey ◽

Véronique Descamps ◽

Claire Presne ◽

Francois Helle ◽

Catherine Francois ◽

...

Keyword(s):

Viral Replication ◽

Kidney Transplant ◽

Clinical Relevance ◽

Graft Loss ◽

First Year ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Post Transplantation ◽

Bk Polyomavirus ◽

Micro Rnas

Background: Kidney transplant recipients (KTRs) are exposed to a high risk of BK polyomavirus (BKPyV) replication, which in turn may lead to graft loss. Although the microRNAs (miRNAs) bkv-miR-B1-3p and bkv-miR-B1-5p are produced during the viral cycle, their putative value as markers of viral replication has yet to be established. In KTRs, the clinical relevance of the changes over time in BKPyV miRNA levels has not been determined. Methods: In a retrospective study, we analyzed 186 urine samples and 120 plasma samples collected from 67 KTRs during the first year post-transplantation. Using a reproducible, standardized, quantitative RT-PCR assay, we measured the levels of bkv-miR-B1-3p and bkv-miR-B1-5p (relative to the BKPyV DNA load). Results: Detection of the two miRNAs had low diagnostic value for identifying patients with DNAemia or for predicting DNAuria during follow-up. Seven of the 14 KTRs with a sustained BKPyV infection within the first year post-transplantation showed a progressive reduction in the DNA load and then a rapid disappearance of the miRNAs. DNA and miRNA loads were stable in the other seven KTRs. Conclusions: After the DNA-based diagnosis of BKPyV infection in KTRs, bkv-miR-B1-3p and bkv-miR-B1-5p levels in the urine might be valuable markers for viral replication monitoring and thus might help physicians to avoid an excessive reduction in the immunosuppressive regimen.

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Time-Varying Proteinuria and the Risk of Cardiovascular Disease and Graft Failure in Kidney Transplant Recipients

Progress in Transplantation ◽

10.1177/15269248211046011 ◽

2021 ◽

Vol 31 (4) ◽

pp. 288-297

Author(s):

Tanya Kuper ◽

Olusegun Famure ◽

Jamie Greenfield ◽

Yanhong Li ◽

Syed Ibrahim ◽

...

Keyword(s):

Kidney Transplant ◽

Graft Failure ◽

Graft Loss ◽

Major Adverse Cardiac Events ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Cardiac Events ◽

Urine Protein ◽

Hazard Ratios ◽

Adverse Cardiac Events

Introduction: Proteinuria is recognized as an independent risk factor for cardiovascular disease in kidney transplant recipients, but previous studies have not considered the impact of changes in urine protein over time. Research Question and Design: We used time-dependent, multivariable Cox proportional hazards models in this observational cohort study of adult kidney transplant recipients to evaluate whether proteinuria measured by dipstick on random spot urine samples starting from 1-month post-transplant was associated with the risk of major adverse cardiac events and graft loss. Results: A total of 144 major adverse cardiac events, defined as acute myocardial infarction, cerebrovascular accident, revascularization, or all-cause mortality, were observed in 1106 patients over 5728.7 person-years. Any level of proteinuria greater or equal to trace resulted in a two-fold increase in the risk of major adverse cardiac events (hazard ratio 2.00 [95% confidence interval 1.41, 2.84]). This relationship was not found to be dose-dependent (hazard ratios of 2.98, 1.76, 1.63, and 1.54 for trace, 1+, 2+, and 3+ urine protein, respectively). There was an increased risk of graft failure with greater urine protein concentration (hazard ratios 2.22, 2.85, 6.41, and 19.71 for trace, 1+, 2+, and 3+, respectively). Conclusion: Urine protein is associated with major adverse cardiac events and graft loss in kidney transplant recipients. The role of interventions to reduce proteinuria on decreasing the risk of adverse cardiovascular and graft outcomes in kidney transplant recipients requires further study.

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C3d-binding Donor-specific HLA Antibody Is Associated With a High Risk of Antibody-mediated Rejection and Graft Loss in Stable Kidney Transplant Recipients: A Single-center Cohort Study

Transplantation Proceedings ◽

10.1016/j.transproceed.2018.06.037 ◽

2018 ◽

Vol 50 (10) ◽

pp. 3452-3459 ◽

Cited By ~ 2

Author(s):

D.R. Lee ◽

B.C. Kim ◽

J.P. Kim ◽

I.G. Kim ◽

M.Y. Jeon

Keyword(s):

Cohort Study ◽

High Risk ◽

Kidney Transplant ◽

Graft Loss ◽

Transplant Recipients ◽

Single Center ◽

Kidney Transplant Recipients ◽

Antibody Mediated Rejection ◽

Hla Antibody

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Pre-transplant soluble CD30 in combination with total DSA but not pre-transplant C1q-DSA predicts antibody-mediated graft loss in presensitized high-risk kidney transplant recipients

HLA ◽

10.1111/tan.12735 ◽

2016 ◽

Vol 87 (2) ◽

pp. 89-99 ◽

Cited By ~ 9

Author(s):

S. M. Schaefer ◽

C. Süsal ◽

G. Opelz ◽

B. Döhler ◽

L. E. Becker ◽

...

Keyword(s):

High Risk ◽

Kidney Transplant ◽

Graft Loss ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Soluble Cd30

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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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