Metabolic Complications and Kidney Transplantation: Focus on Glycaemia and Dyslipidaemia

2020 ◽  
Vol 18 (3) ◽  
pp. 273-281 ◽  
Author(s):  
Panagiotis Anagnostis ◽  
Stavroula Α. Paschou ◽  
Eleftherios Spartalis ◽  
Gerardo Sarno ◽  
Paride De Rosa ◽  
...  
Keyword(s):  
Graft Function ◽  
Current Data ◽  
Optimal Management ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Cvd Risk ◽  
Oral Hypoglycaemic Agents ◽  
Metabolic Complications ◽  
Increased Risk ◽  
Regimen Modification

Post-transplant diabetes mellitus (PTDM) and dyslipidaemia are the most common metabolic complications in kidney transplant recipients (KTR). They are associated with a higher risk of lower graft function and survival, as well as an increased risk of cardiovascular disease (CVD). The aim of this review is to provide current data on the epidemiology, pathophysiology and optimal management of these two principal metabolic complications in KTR. Several risk factors in this metabolic milieu are either already present or emerge after renal transplantation, such as those due to immunosuppressive therapy. However, the exact pathogenic mechanisms have not been fully elucidated. Awareness of these disorders is crucial to estimate CVD risk in KTR and optimize screening and therapeutic strategies. These include lifestyle (preferably according to the Mediterranean pattern) and immunosuppressive regimen modification, as well as the best available anti-diabetic (insulin or oral hypoglycaemic agents) and hypolipidaemic (e.g. statins) regimen according to an individual’s metabolic profile and medical history.

scholarly journals Graft Function, Albuminuria, and the Risk of Hemorrhage and Thrombosis After Kidney Transplantation

2020 ◽  
Vol 7 ◽  
pp. 205435812095219
Author(s):  
Rachel Jeong ◽  
Robert R. Quinn ◽  
Pietro Ravani ◽  
Feng Ye ◽  
Manish M. Sood ◽  
...  
Keyword(s):  
Cohort Study ◽  
Venous Thrombosis ◽  
Kidney Transplant ◽  
Graft Function ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Post Transplant ◽  
Increased Risk ◽  
Lower Egfr ◽  
Risk Of Hemorrhage

Background: Compared to the general population, kidney transplant recipients are at increased risk of hemorrhage and thrombosis. Whether this risk is affected by graft function and albuminuria is unknown. Objective: To determine the association between graft function and albuminuria and the risk of post-transplant hemorrhage and thrombosis. Design: Retrospective cohort study. Setting: We used linked health care databases in Alberta, Canada. Patients/sample/participants: We included adult kidney transplant recipients from 2002 to 2015 with a functioning graft at 1 year. Measurements: Estimated glomerular filtration rate (eGFR) and albuminuria measurements at 1 year post-transplant were used to categorize recipients (eGFR: ≥45 vs. <45 mL/min/1.73 m2; albuminuria: absence vs. presence). We determined the rates of post-transplant hemorrhage and venous thrombosis based on validated diagnostic and procedural codes. Methods: We determined the association between categories of eGFR and albuminuria and post-transplant hemorrhage and venous thrombosis using Poisson regression with log link. Results: Of 1284 kidney transplant recipients, 21% had an eGFR <45 mL/min/1.73 m2 and 40% had presence of albuminuria at 1 year post-transplant. Over a median follow-up of 6 years, there were 100 hemorrhages (12.6 events per 1000 person-years) and 57 venous thrombosis events (7.1 events per 1000 person-years). The age- and sex-adjusted rate of hemorrhage and thrombosis was over 2-fold higher in recipients with lower eGFR and presence of albuminuria compared to higher eGFR and no albuminuria (hemorrhage: incidence rate ratio, IRR, 2.6, 95% confidence interval [CI]: 1.5-4.4, P = .001; thrombosis: IRR, 2.3, 95% CI: 1.1-5.0, P = .046). Limitations: Complete relevant medication information, such as anticoagulants, were not available in our datasets. Due to sample size, this study was underpowered to conduct a fully adjusted analysis. Conclusion: Among kidney transplant recipients, lower eGFR and presence of albuminuria at 1 year post-transplant were associated with an over 2-fold higher risk of hemorrhage and venous thrombosis. Graft function and albuminuria at 1 year post-transplant are important prognostic factors in determining risk of post-transplant hemorrhage and venous thrombosis. Further research, including medication data, are needed to further delineate outcomes and safety. Trial registration: Not applicable (cohort study).

scholarly journals Is delayed graft function associated with ureteral stenosis in the kidney transplant recipient? A case-control study

2019 ◽  
Vol 13 (11) ◽  
Author(s):  
Axel Cayetano-Alcaraz ◽  
Juan Sebastian Rodriguez-Alvarez ◽  
Mario Vilatobá-Chapa ◽  
Josefina Alberú-Gómez ◽  
Bernardo Gabilondo-Pliego ◽  
...  
Keyword(s):  
Risk Factor ◽  
Kidney Transplant ◽  
Kidney Transplant Recipient ◽  
Graft Function ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Transplant Patients ◽  
Increased Risk ◽  
Kidney Transplant Patients ◽  
Control Study

Introduction: Ureteral stricture (US) in the kidney transplant recipient is a rare complication that can lead to morbidity and graft loss. Risk factor recognition is crucial in the prevention and management of this entity. Delayed graft function (DGF), as defined by the need for dialysis in the first week after transplantation, has been proposed as a risk factor in previous studies. Our objective is to determine the impact of DGF in US development in kidney transplant patients. Methods: We designed a matched case-control study. US cases in kidney transplant recipients were identified in the 2008–2017 period. We defined US as the rise in serum creatinine associated with findings suggesting obstruction in ultrasound, scintigraphy, or retrograde pyelogram; any other cause of graft dysfunction was excluded. Controls were defined as kidney transplant recipients from the same population and period without US, matched in a 1:2 fashion by age, sex, and donor type. Results: From 532 kidney transplant patients, 31 cases and 62 controls were included. Cumulative US incidence was 58 per 1000 cases. When calculating for odds ratio (OR), post-operative urinoma (OR 3.2; 95% confidence interval [CI] 2.36–4.37) and ureteral duplication (OR 3.29; 95% CI 2.40–4.51) were associated with an increased risk for US, while DGF was not found to be statistically significant as a risk factor (OR 3.3; 95% CI 0.96–11.52). No statistically significant differences were found between groups in other pre- and post-transplant-related factors. Conclusions: DGF was not associated with US in our cohort; however, ureteral duplication and postoperative urinoma were associated with an increased risk of graft ureteral stenosis development.

scholarly journals Association of non-HLA antibodies against endothelial targets and donor-specific HLA antibodies with antibody-mediated rejection and graft function in pediatric kidney transplant recipients

2021 ◽  
Author(s):  
Alexander Fichtner ◽  
Caner Süsal ◽  
Britta Höcker ◽  
Susanne Rieger ◽  
Rüdiger Waldherr ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Graft Function ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Hla Antibodies ◽  
Antibody Mediated Rejection ◽  
Peritubular Capillaries ◽  
Increased Risk ◽  
Antibody Positivity ◽  
Hla Antibody

Abstract Background Non-HLA antibodies against endothelial targets have been implicated in the pathogenesis of antibody-mediated rejection (ABMR), but data in pediatric patients are scarce. Methods We retrospectively analyzed a carefully phenotyped single-center (University Children’s Hospital Heidelberg, Germany) cohort of 62 pediatric kidney transplant recipients (mean age at transplantation, 8.6 ± 5.0 years) at increased risk of graft function deterioration. Patients had received their transplant between January 1, 1999, and January 31, 2010. We examined at time of late index biopsies (more than 1-year post-transplant, occurring after January 2004) the association of antibodies against the angiotensin II type 1 receptor (AT1R), the endothelin type A receptor (ETAR), the MHC class I chain-like gene A (MICA), and vimentin in conjunction with overall and complement-binding donor-specific HLA antibodies (HLA-DSA) with graft histology and function. Results We observed a high prevalence (62.9%) of non-HLA antibody positivity. Seventy-two percent of HLA-DSA positive patients showed additional positivity for at least one non-HLA antibody. Antibodies against AT1R, ETAR, and MICA were associated with the histological phenotype of ABMR. The cumulative load of HLA-DSA and non-HLA antibodies in circulation was related to the degree of microinflammation in peritubular capillaries. Non-HLA antibody positivity was an independent non-invasive risk factor for graft function deterioration (adjusted hazard ratio 6.38, 95% CI, 2.11–19.3). Conclusions Our data indicate that the combined detection of antibodies to HLA and non-HLA targets may allow a more comprehensive assessment of the patients’ immune responses against the kidney allograft and facilitates immunological risk stratification.

scholarly journals Post-Transplant Diarrhea is Associated with Increased Rejection in Lung Transplant Recipients: A Retrospective Review

2021 ◽  
Author(s):  
Aruj Choudhry ◽  
Andrew Leopold ◽  
Alexandra Selby ◽  
Padma Chamarthy ◽  
Emily Friedman ◽  
...  
Keyword(s):  
Retrospective Review ◽  
Lung Transplant ◽  
Tertiary Care ◽  
Graft Function ◽  
Organ Transplant ◽  
Solid Organ ◽  
Care Hospital ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Increased Risk

Abstract Background Diarrhea causes significant morbidity among solid organ transplant recipients. It is described in liver and kidney transplant recipients, but not in lung transplant (LTx) recipients. The primary aim of this study was to characterize diarrhea in LTx recipients. Methods Retrospective review was performed for all patients undergoing LTx at our tertiary care hospital between 01/2011 and 02/2019. Electronic medical records were reviewed for the development of diarrhea. Results A total of 564 patients (66.3% male, mean age 64.4 ± 8.8 years) underwent LTx during the 8-year study period, with 289 patients (51.2%) experiencing post-LTx diarrhea. The most common etiologies of diarrhea were medication-induced (33.6%) and CDI (15.6%). Mycophenolate mofetil (MMF) was the most common cause of medication induced diarrhea (33.3%). Diarrhea and age were significantly associated with increased LTx rejection rates in multivariate analysis (Diarrhea OR = 2.26, 95% CI = 1.48–3.45; Age OR = 0.98, 95% CI = 0.95-1.0). Conclusions Diarrhea is common in LTx recipients, with medication-induced diarrhea being the most common etiology. Diarrhea and younger age were associated with an increased risk of LTx rejection. Recognizing the causes of diarrhea in LTx recipients is important for early diagnosis and treatment, leading to greater quality of life and improved graft function.

scholarly journals Pretransplant Serum Uromodulin and Its Association with Delayed Graft Function Following Kidney Transplantation—A Prospective Cohort Study

2021 ◽  
Vol 10 (12) ◽  
pp. 2586
Author(s):  
Stephan Kemmner ◽  
Christopher Holzmann-Littig ◽  
Helene Sandberger ◽  
Quirin Bachmann ◽  
Flora Haberfellner ◽  
...  
Keyword(s):  
Risk Factors ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Graft Function ◽  
Delayed Graft Function ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Operating Characteristics ◽  
Lower Odds ◽  
Increased Risk

Delayed graft function (DGF) following kidney transplantation is associated with increased risk of graft failure, but biomarkers to predict DGF are scarce. We evaluated serum uromodulin (sUMOD), a potential marker for tubular integrity with immunomodulatory capacities, in kidney transplant recipients and its association with DGF. We included 239 kidney transplant recipients and measured sUMOD pretransplant and on postoperative Day 1 (POD1) as independent variables. The primary outcome was DGF, defined as need for dialysis within one week after transplantation. In total, 64 patients (27%) experienced DGF. In multivariable logistic regression analysis adjusting for recipient, donor and transplant associated risk factors each 10 ng/mL higher pretransplant sUMOD was associated with 47% lower odds for DGF (odds ratio (OR) 0.53, 95% confidence interval (95%-CI) 0.30–0.82). When categorizing pretransplant sUMOD into quartiles, the quartile with the lowest values had 4.4-fold higher odds for DGF compared to the highest quartile (OR 4.41, 95%-CI 1.54–13.93). Adding pretransplant sUMOD to a model containing established risk factors for DGF in multivariable receiver-operating-characteristics (ROC) curve analysis, the area-under-the-curve improved from 0.786 [95%-CI 0.723–0.848] to 0.813 [95%-CI 0.755–0.871, p = 0.05]. SUMOD on POD1 was not associated with DGF. In conclusion, higher pretransplant sUMOD was independently associated with lower odds for DGF, potentially serving as a non-invasive marker to stratify patients according to their risk for developing DGF early in the setting of kidney transplantation.

scholarly journals MO962EPIDEMIOLOGY AND CLINICAL RELEVANCE OF ACUTE KIDNEY INJURY IN KIDNEY TRANSPLANT RECIPIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Greta Rosso ◽  
Gabriele Guglielmetti ◽  
Umberto Morosini ◽  
Marco Quaglia ◽  
Guido Merlotti ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Kidney Transplant ◽  
Graft Function ◽  
Kidney Injury ◽  
University Hospital ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Increased Risk ◽  
Kdigo Guidelines

Abstract Background and Aims Very few information about COVID-19 in kidney transplant recipients (KTRs) are known and the available evidence are based on limited case series. In KTRs, Acute Kidney Injury (AKI) of different causes is known to be associated with a decreased graft survival: direct viral infection and local inflammation may potentially lead to a premature loss of graft function and to an increased risk of death in COVID-19 patients. To evaluate prevalence, stage, causes of AKI and mortality in KTRs with a positive pharyngeal swab for SARS-CoV-2 in our transplant center located in a 500-bed University Hospital. Method In March-June 2020, we evaluated in 25 COVID-19 KTRs demographic and transplant characteristics, comorbidities, immunosuppressive therapies (IT). Patients were screened for type of symptoms, management of IT, complications and outcome. AKI was graded according to 2012 KDIGO guidelines and causes were investigated basing on both clinical and laboratory variables. AKI prevalence in KTRs was compared to that observed in the whole hospitalized COVID-19 patients. Results During the first wave of pandemic, a total of 945 patients were admitted to our hospital with a reported AKI prevalence of 37%. AKI classified using 2012 KDIGO guidelines associated with an increased mortality risk in the whole population. In this setting, we observed that 25 KTRs followed-up in our University Hospital had a positive molecular diagnosis for COVID-19: median age was 58 years and 80% were males. Considering the most frequent comorbidities, 100% of KTRs had hypertension and 7/25 (29%) had diabetes. Clinical symptoms at enrollment were fever (95%), cough (47%), dyspnea (30%). Regarding IT, 100% of patients were taking CNI, 64% antimetabolite agents and 76% steroids. Of note, 19/25 patients (76%) were hospitalized and 6/19 (31.5%) were admitted to Intensive Care Unit (ICU). Mean length of hospital stay was 23 days. At admission, all KTRs stopped MMF and increased steroid doses, concomitantly decreasing CNI levels. AKI occurred in 60% of KTRs (12/25), AKI KDIGO grading as follow: stage 1 4/12 (33.3%), stage 2 3/12 (25%), stage 3 5/12 (41.7%); development favored by low eGFR/increased serum creatinine (mean serum creatinine 2.06 mg/dl): 4/25 (16%) required hemodialysis and the most frequent cause of AKI was sepsis or septic shock. Overall mortality in KTRs was 37,5% (9/25): of note, 88% (8/9) of patients with a worse outcome had developed AKI. Conclusion AKI prevalence was significantly higher in KTRs than in non-transplanted COVID-19 patients. AKI development was associated with an increased risk of mortality: of note, mortality rate in KTRs was significantly higher than that observed in the non-transplanted patients. COVID-19 lead to a difficult management of IT, in particular for elevated tacrolimus levels due to associated antiviral and antibiotic therapies. COVID-19-associated AKI in KTRs may lead to an increased risk of rejection and premature loss of graft function with the need of skilled nephrological follow-up.

scholarly journals Post-Transplant Diarrhea is Associated with Increased Rejection in Lung Transplant Recipients: A Retrospective Review

2020 ◽  
Author(s):  
Aruj Choudhry ◽  
Alexandera Selby ◽  
Padma Chamarthy ◽  
Emily Friedman ◽  
Navneet Goraya ◽  
...  
Keyword(s):  
Retrospective Review ◽  
Lung Transplant ◽  
Tertiary Care ◽  
Graft Function ◽  
Organ Transplant ◽  
Solid Organ ◽  
Care Hospital ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Increased Risk

Abstract Background: Diarrhea causes significant morbidity among solid organ transplant recipients. It is well described in liver and kidney transplant recipients, yet data among lung transplant (LTx) recipients is lacking. The primary aim of this study was to characterize diarrhea in LTx recipients. Methods: A retrospective review was performed for all patients undergoing LTx at our tertiary care hospital between 01/2011 and 02/2019. Patient demographics, type of LTx, and transplant indication were noted. Electronic medical records (EMR) were reviewed for the development of diarrhea (defined by clinical assessment and after obtaining diagnostic studies). Clostridiodes difficile infection (CDI) was determined by PCR testing. LTx rejection was determined by board-certified Pulmonologists as documented in the EMR. Results: A total of 564 patients (66.3% male, mean age 64.4 ± 8.8 years) underwent LTx during the 8-year study period, with 289 patients (51.2%) experiencing post-LTx diarrhea. The most commonly identified etiologies of diarrhea were medication-induced (33.6%) and CDI (15.6%). Among patients with medication-induced diarrhea, mycophenolate mofetil (MMF) was the most common offending agent (33.3%). Diarrhea and age were significantly associated with increased LTx rejection rates in multivariate analysis (Diarrhea OR=2.26, 95% CI=1.48-3.45; Age OR=0.98, 95% CI=0.95-1.0).Conclusions: Diarrhea is common in LTx recipients, with medication-induced diarrhea being the most common etiology. Diarrhea and younger age were associated with an increased risk of LTx rejection. Recognizing the causes of diarrhea in LTx recipients is important for early diagnosis and treatment, leading to greater quality of life and improved graft function.

scholarly journals 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 ◽  
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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