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.

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.

Different impact of rATG induction on CMV infection risk in D+R– and R+ KTRs

2019 ◽  
Vol 220 (5) ◽  
pp. 761-771 ◽  
Author(s):  
Hannah Kaminski ◽  
Marta Jarque ◽  
Mathieu Halfon ◽  
Benjamin Taton ◽  
Ludovic Di Ascia ◽  
...  
Keyword(s):  
Interleukin 2 ◽  
Interferon Γ ◽  
Preventive Therapy ◽  
Cell Mediated Immunity ◽  
Specific Cell ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Cmv Infection ◽  
Cmv Dnaemia

Abstract Background Rabbit antithymocyte globulin (rATG) induction is associated with profound immunosuppression, leading to a higher risk of cytomegalovirus (CMV) infection compared with anti–interleukin 2 receptor antibody (anti–IL-2RA). However, this risk, depending on the baseline CMV serological recipient/donor status, is still controversial. Methods The CMV DNAemia-free survival between rATG- and anti–IL-2RA–treated patients was analyzed in donor-positive/recipient-negative (D+R−) and recipient-positive (R+) patients in 1 discovery cohort of 559 kidney transplant recipients (KTRs) and 2 independent cohorts (351 and 135 kidney KTRs). The CMV-specific cell-mediated immunity (CMI) at baseline and at different time points after transplantation was assessed using an interferon γ enzyme-linked immunosorbent spot assay. Results rATG increased the risk of CMV DNAemia in R+ but not in D+R− KTRs. In R+ CMI-positive (CMI+) patients, the CMV DNAemia rate was higher in rATG-treated than in anti–IL-2RA–treated patients; no difference was observed among R+ CMI-negative (CMI−) patients. Longitudinal follow-up demonstrated a deeper depletion of preformed CMV CMI in R+ rATG-treated patients. Conclusions D+R− KTRs have the highest risk of CMV DNAemia, but rATG adds no further risk. Among R+ KTRs, we described 3 groups, the least prone being R+CMI+ KTRs without rATG, then R+CMI+ KTRs with rATG, and finally R+CMI− KTRs. CMV serostatus, baseline CMV-specific CMI, and induction therapy may lead to personalized preventive therapy in further studies.

scholarly journals FC 129CHANGES IN PERIPHERAL NK CELLS IN KIDNEY TRANSPLANT RECIPIENTS WITH AND WITHOUT HLA DSA

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Laura Llinas ◽  
Dolores Redondo Pachon ◽  
Dàlia Raïch Regué ◽  
Maria Jose Perez-Saez ◽  
Sara Sanz ◽  
...  
Keyword(s):  
Nk Cells ◽  
Cell Count ◽  
Kidney Transplant ◽  
Graft Survival ◽  
Peripheral Blood ◽  
Nk Cell ◽  
Cell Phenotype ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

Abstract Background and Aims Antibody-mediated rejection (ABMR) is a frequent cause of renal allograft loss. There is increasing evidence of the role of Natural Killer (NK) cells in the establishment of ABMR damage. Our group described that patients with donor-specific antibodies (DSA) and ABMR present higher proportions of NKG2A+ NK cell subset in peripheral blood than those without HLA DSA or HLA antibodies. Method We selected 177 kidney transplant recipients (KT) with renal biopsies 2011-2017: 77 with ABMR (DSA+: 53, DSA-: 24) and 100 without ABMR (DSA+: 15, DSA-: 85). We assessed graft survival with a median time of follow-up since the renal biopsy of 53 months. In 138 KT we evaluated the peripheral blood NK cell immunophenotyping and its value as a prognostic biomarker. Results Graft survival was worse in ABMR-KT at the end of follow-up (p<0.001) independently of DSA detection (p=0.63). Regarding NK cell immunophenotyping, we observed a lower proportion and absolute NK cell count in ABMR+DSA+-KT and ABMR+DSA--KT compared with ABMR-DSA--KT (p=0.027, p=0.017). ABMR+DSA+-KT showed higher proportion of NKG2A+ NK cells compared with ABMR-DSA--KT (p=0.007). All ABMR+ patients, independently of DSA detection, presented lower absolute NKG2A- NK cell count in comparison with ABMR-DSA--KT (p=0.001, p=0.017). Finally, a proportion of NKG2A- <30% was associated with lower graft survival 36 months after graft biopsy with ABMR (p=0.067) (Figure). Conclusion Graft survival is worse in ABMR+ compared with ABMR- KT independently of DSA detection. Kidney transplant recipients with ABMR show reduced peripheral absolute numbers of NK cells and NKG2A- NK cells regardless of undetectable DSA. This NK cell phenotype associated with a worse medium-term graft survival in cases with ABMR.

scholarly journals Posttransplant Anemia as a Prognostic Factor of Mortality in Kidney-Transplant Recipients

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Maria Majernikova ◽  
Jaroslav Rosenberger ◽  
Lucia Prihodova ◽  
Miriam Jarcuskova ◽  
Robert Roland ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Transplantation ◽  
Prognostic Factor ◽  
Regression Model ◽  
Cox Regression ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Cox Regression Model ◽  
Risk Of Mortality

Background.Findings on the association between posttransplant anemia (PTA) and mortality in posttransplant patients are scarce. This study explored whether PTA shortly after kidney transplantation (KT) predicts mortality at up to 10 years’ follow-up, stratified for chronic kidney disease (CKD) stages.Methods.PTA was divided into 3 categories according to the hemoglobin (Hb) value: severe (Hb < 10 g/dl), mild (10.0 g/dl ≤ Hb < 11.9 g/dl), or no PTA (Hb ≥ 12 g/dl). CKD stages were estimated using the CKD-EPI formula and divided into 2 groups: CKD1-2 and CKD3–5. Cox regression, stratified according to CKD, was performed to identify whether different categories of PTA predicted mortality in KT recipients.Results.Age, being female, and both mild and severe PTA contributed significantly to the Cox regression model on mortality in CKD1-2. In the Cox regression model for mortality in CKD3–5, age and severe PTA contributed significantly to this model.Conclusion.PTA shortly after KT increased the risk of mortality at up to 10 years’ follow-up. Even mild PTA is associated with a 6-fold higher risk of mortality and severe PTA with a 10-fold higher risk of mortality in CKD1-2. Clinical evaluation and treatment of anemia might reduce the higher risk of mortality in patients with PTA in early stages of CKD after KT.

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.

scholarly journals Development of Self-Management Scale for Kidney Transplant Recipients, Including Management of Post-Transplantation Chronic Kidney Disease

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Shiho Kosaka ◽  
Makoto Tanaka ◽  
Tomoko Sakai ◽  
Shinji Tomikawa ◽  
Kazunari Yoshida ◽  
...  
Keyword(s):  
Factor Analysis ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Intraclass Correlation ◽  
Clinical Importance ◽  
Self Management ◽  
Transplant Recipients ◽  
Validity And Reliability ◽  
Kidney Transplant Recipients ◽  
Post Transplantation

An evaluation scale is indispensable for the promotion of continuing, effective postkidney transplantation self-management behaviors. We aimed to develop and validate a new self-management scale for kidney transplant recipients to improve their long-term outcomes and prevent the recurrence of CKD complications. Two hundred and thirty-nine Japanese patients who had undergone kidney transplantation were recruited from three hospitals. The scale’s validity and reliability were evaluated using exploratory factor analysis and intraclass correlation coefficients. Scale items were selected by considering the findings of a clinical importance survey of 17 experts. Four subscales were identified by the factor analysis: “Self-monitoring” (six items), “Self-care behavior in daily living” (seven items), “Early detecting and coping with abnormalities after kidney transplantation” (four items), and “Stress management” (three items). Cronbach’s alpha coefficients for the subscales ranged from 0.61 to 0.87. A further four items with high clinical importance were added to the scale. The final scale comprised 24 items within four subscales and four single items. The intraclass correlation ranged from 0.88 to 0.95 in each subscale and the weighted kappa coefficient for the single items ranged from 0.33 to 0.72. The validity and reliability of our new self-management scale were confirmed by a patient-based field survey.

scholarly journals P1640COLONIZATION AND INFECTION WITH ESBL-PRODUCING AND CARBAPENEM-RESISTANT ENTEROBACTERIACIEAE IN KIDNEY TRANSPLANT RECIPIENTS: RISK FACTORS, IMPACT OF RENAL GRAFT FUNCTION AND USE OF HOSPITAL RESOURCES

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Alessandra Palmisano ◽  
Eleonora Salsi ◽  
Paride Fenaroli ◽  
Anna Maria Degli Antoni ◽  
Ilaria Gandolfini ◽  
...  
Keyword(s):  
Risk Factors ◽  
Kidney Transplant ◽  
Graft Function ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Post Transplantation ◽  
Renal Graft ◽  
Carbapenem Resistant ◽  
Hospital Resources

Abstract Background and Aims ESBL-producing and carbapenem resistant (CR) Enterobacteriaceae are a common cause of severe infection, morbidity and mortality in kidney transplant recipients (KTR). Few studies have investigated the risk factors for ESBL-producing/CR Enterobacteriaceae colonization and infection in this group of patients, the effect of colonization and infection on KTR’s renal graft function, and the use of hospital resources. Method Retrospective follow-up study on a consecutive series of patients undergoing kidney transplantation at Parma University Hospital (Italy) between January-2016 and December-2018. We performed a multivariable-adjusted analysis of the predictive factor associated with MDR infection/colonization via general linear models for prevalence- and risk- ratio. Renal function (eGFR) decline was compared by mixed-effects random-coefficients models, hospital resources by negative binomial regression. Results We enrolled 180 KTR (mean recipient’s age: 52.4 [SD 12.4]; males 65%; mean donor’s age: 54.6 [SD 15.6]) and followed them up for 2-years post transplantation. Cumulative prevalence of colonization 3-months post-transplantation and cumulative incidence of infection were 26.1% and 9.4% for ESBL, and 4.4% and 1.6% for CR. ESBL colonization was associated with hemodialysis vs peritoneal dialysis (93% vs 70% non-colonized; adjusted RR 0.21 [95% CI: 0.06 to 0.98]), dialysis vintage (mean months: 65 vs 42; adjusted associated with being above the median, RR 2.17 [95% CI: 1.32 to 3.55]) and retention of ureteral stent for more than one month after transplant (28% vs 12%; adjusted RR 2.09 [95% CI: 1.27 to 3.44]) ; ESBL infection was associated with retention of ureteral stent (47% vs 13%; adjusted RR 4.89 [95% CI 2.11 to 11.35]) whereas CR colonization was associated with surgical complication during transplant admission (50% vs 15%; adjusted RR 4.61 [95% CI 1.28 to 16.66]). Two patients (both with CR) died over the study follow-up, whereas none of the patients lost the graft. CR infection was associated lower baseline (3-months post-transplantation) eGFR compared to the other groups (-28.4mL/min/1.73m2 [95% CI: -50.5 to -6.3]); a numerically more rapid decline (up to - 5mL/min/year) of eGFR, albeit not statistically significant, was observed in patients with CR colonization compared to non-colonized at 2 years of follow-up. In comparison with non-colonized patients, adjusted mean days of carbapenem treatment in ESBL/CR colonized/infected was 5.7 vs 0.7 (P=0.003); length-of-hospital stay 5.8 vs 1.0 (P=0.055); days on drug-resistant-infection intravenous-outpatient-therapy 20.7 vs 0.1 (P= 0.008). Conclusions The study shows that ESBL and CR colonization and infection in KTR are statistically associated with longer hemodialysis vintage, urological procedures, and surgical complications. They cause an increase in the hospital resources use and may jeopardize transplant outcomes.

scholarly journals Nepalese Kidney Transplant Recipient in a Follow up Clinic: Related and Unrelated Living Donor

2008 ◽  
Vol 47 (171) ◽  
Author(s):  
Ram Krishna Dulal ◽  
S Karki
Keyword(s):  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Kidney Transplant Recipient ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Kidney Donors ◽  
Female Ratio ◽  
Long Run ◽  
The Usa

A cohort retrospective study was conducted on all follow up kidney transplant recipients at Transplant Follow up Clinic from June 16, 2003 to July 15, 2008. The main objective of this study was to find out the demographic pattern of the kidney transplant recipients and type of donors. Among 452 recipients, the transplantation were done in India (449), Germany (2) and in the USA (1) with male to female ratio of 3:1. Kidney donors were unrelated 315 (69.69%), related 134 (29.43%) and some did not disclose 4 (0.88%). Most of the kidney transplantation (93.75%) were done in 45 different hospitals in India and about three quarters (71.7%) of them were operated in the private hospitals in various states of India; only 2 (4.16%) in Germany and 1 (2.08%) in USA. Newar was the largest population 142 (31.4%) and second largest group was Mangol 124 (27.4.4%) that comprised of Gurung, Rai, Magar, Tamang etc. Brahmins were the third largest population 91 (20.1%). In this study the youngest recipients was 14 years and the oldest was of 75 years. The mean age was 41 (SD 13.84). This study showed that 35 (7.7%) died, 8 (1.7%) reported rejection and underwent re-transplantation and 238 patient have lost follow up till early 2008. Kidney transplantation should be promoted as it is cheaper compared to dialysis in the long run. This study found that unrelated kidney donors have outnumbered the related donors in Nepalese kidney transplant recipients which emphasize the importance of unambiguous documentation and also a provision of lawful action against the middle-men if found involved in an illegal kidney related activities in Nepal. Organ transplantation is an important integral part of human health and should be regularize and promote lawfully to protect humans from trafficking for kidney, possible kidnapping, killing and stealing. 

scholarly journals A survey on lymphocyte T CD3, CD4 and CD8 in peripheral blood of kidney transplant recipients using mycophenolic acid

2021 ◽  
Vol 10 (4) ◽  
pp. e41-e41
Author(s):  
Thi Mai Dung Do ◽  
Phan Hai An Ha ◽  
Van Dong Le ◽  
Quang Thuan Huynh
Keyword(s):  
T Lymphocytes ◽  
Kidney Transplant ◽  
Mycophenolic Acid ◽  
Peripheral Blood ◽  
Transplant Rejection ◽  
Fluorescent Light ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Post Transplantation ◽  
Immunological Monitoring

Introduction: Immunological monitoring could indirectly measure the suppressive effects of the drugs and provide early guidance on necessary preventive interventions in transplant recipients. Objectives: Our goal was to determine whether mycophenolic acid (MPA) modulates peripheral blood lymphocyte T in kidney transplant recipients. Patients and Methods: We assessed T lymphocytes CD3, CD4 and CD8 in peripheral blood in 30 donors and 35 recipients one day before and 10 days after transplantation using Becton Dickinson’s direct immune fluorescent light. Results: Comparisons showed that the number of T lymphocytes CD3+, CD4+, CD8+ in peripheral blood of transplant recipients were lower than donors (TCD3 was 1690.31±503.45 versus 2280.73± 522.48; TCD4 was 549.51 ±211.72 cell/µL versus 766.37± 341.72 cell/µL and CD8 was 1134.37 ±431.07 cell/µL versus 1523.4± 349.23 cell/µL with P<0.001; P=0.001 and P= 0.0002 respectively). Additionally, post-transplantation lymphocytes TCD4 decreased in 10/35 of recipients and increased in 22/35 of recipients (P=0.036). Conclusion: The T lymphocytes CD3, CD4 and CD8 in peripheral blood should be monitored at multiple post-transplant times to make early predictions of transplant rejection during follow-up treatment.

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