scholarly journals Transition of renal patients using AlloSure® into community kidney care (TRACK): a new protocol for long-term allograft surveillance in renal transplant recipients. (Preprint)

2020 ◽  
Author(s):  
Bethany Dale ◽  
Subhassih Bose ◽  
Sheng Kuo ◽  
Alana Burns ◽  
Pierre Daou ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Immune System ◽  
Renal Transplant ◽  
Kidney Transplant ◽  
Kidney Function ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Allograft Survival ◽  
Post Transplant

BACKGROUND End Stage Kidney Disease (ESKD) patients require complex and expensive medical management. Kidney transplantation remains the treatment of choice for ESKD and is considered superior to all other modalities of renal replacement therapy (RRT) or dialysis. However, access to kidney transplant is limited by critical supply-demand making it extremely important to ensure longevity of transplanted kidneys. This is prevented through life-long immunosuppression, with caution not to overly suppress the immune system, resulting in toxicity and harm. Transition of care to community nephrologists after initial kidney transplantation and monitoring at a transplant center is an important process to ensure delivery of effective and patient-centric care closer to home. Once transplanted, laborious surveillance of the immune system and monitoring for potential rejection and injury is undertaken through an armamentarium of screening modalities. Post-transplant surveillance for kidney function and injury remained key to follow up care. While kidney function, quantified by estimated glomerular filtration rate (eGFR) and serum creatinine (SCr), and kidney injury, measured by proteinuria and hematuria, are standard biomarkers used to monitor injury and rejection post-transplant, they have recently been demonstrated to be inferior in performance to that of AlloSure® (CareDx, Inc. Brisbane, CA), circulating donor-derived cell-free DNA (dd-cfDNA). OBJECTIVE The outcomes and methods of monitoring renal transplant recipients (RTR) post-transplant have remained stagnant over the past 15 years. The aim of this study is to consider intensive surveillance using AlloSure® dd-cfDNA in an actively managed protocol assessing whether it increases long-term allograft survival in kidney transplant recipients compared with current standard clinical care in community nephrology. METHODS The study protocol will acquire data from a phase IV observational trial to assess a cohort of 2500 RTR patients managed using AlloSure® dd-cfDNA and patient care managers versus 1000 propensity matched historic controls using UNOS SRTR data. Data will be managed in a centralized electronic data server. RESULTS The primary outcome will be superior allograft survival, as a composite of return to dialysis, re-transplant, death due to allograft failure and death with a functional graft DWFG (infection, malignancy, and cardiovascular death). The secondary endpoints will assess improved kidney function through decline in eGFR and immune activity through development of donor specific antibody (DSA). CONCLUSIONS Based on a significant literature base, we believe implementing the surveillance of dd-cfDNA in the kidney transplant population will have a positive impact on graft survival. Through early identification of rejection and facilitating timely intervention, prolongation of allograft survival versus those not managed by dd-cfDNA surveillance protocol should be superior.

scholarly journals Post-transplant distal limb syndrome: clinical diagnosis and long-term outcome in 37 renal transplant recipients

2008 ◽  
Vol 21 (6) ◽  
pp. 547-553 ◽  
Author(s):  
Frank-Peter Tillmann ◽  
Marcus Jäger ◽  
Dirk Blondin ◽  
Martin Oels ◽  
Lars-Christian Rump ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Clinical Diagnosis ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Distal Limb ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Post Transplant

scholarly journals Efficacy and Safety of Sitagliptin for the Treatment of New-Onset Diabetes after Renal Transplantation

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Brian P. Boerner ◽  
Clifford D. Miles ◽  
Vijay Shivaswamy
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Kidney Transplant ◽  
Hemoglobin A1c ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
First Line ◽  
New Onset

New-onset diabetes after transplantation (NODAT) is a common comorbidity after renal transplantation. Though metformin is the first-line agent for the treatment of type 2 diabetes, in renal transplant recipients, metformin is frequently avoided due to concerns about renal dysfunction and risk for lactic acidosis. Therefore, alternative first-line agents for the treatment of NODAT in renal transplant recipients are needed. Sitagliptin, a dipeptidyl-peptidase-4 (DPP-4) inhibitor, has a low incidence of hypoglycemia, is weight neutral, and, in a small study, did not affect immunosuppressant levels. However, long-term sitagliptin use for the treatment of NODAT in kidney transplant recipients has not been studied. We retrospectively analyzed renal transplant recipients diagnosed with NODAT and treated with sitagliptin to assess safety and efficacy. Twenty-two patients were started on sitagliptin alone. After 12 months of followup, 19/22 patients remained on sitagliptin alone with a significant improvement in hemoglobin A1c. Renal function and immunosuppressant levels remained stable. Analysis of long-term followup (32.5±17.8 months) revealed that 17/22 patients remained on sitagliptin (mean hemoglobin A1c < 7%) with 9/17 patients remaining on sitagliptin alone. Transplant-specific adverse events were rare. Sitagliptin appears safe and efficacious for the treatment of NODAT in kidney transplant recipients.

scholarly journals Long-term follow-up of renal transplant recipients treated with losartan for post-transplant erythrosis

1998 ◽  
Vol 11 (4) ◽  
pp. 312-315 ◽  
Author(s):  
Didier Ducloux ◽  
Véronique Fournier ◽  
Catherine Bresson-Vautrin ◽  
Jean-Marc Chalopin
Keyword(s):  
Renal Transplant ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Post Transplant ◽  
Long Term Follow Up

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 Effect of Pregnancy on Long-Term Kidney Function in Renal Transplant Recipients Treated with Cyclosporine and with Azathioprine

2005 ◽  
Vol 5 (11) ◽  
pp. 2732-2739 ◽  
Author(s):  
Thorsten Fischer ◽  
Hans-Hellmut Neumayer ◽  
Ronald Fischer ◽  
Michael Barenbrock ◽  
Hans P. Schobel ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Kidney Function ◽  
Renal Transplant Recipients ◽  
Transplant Recipients

P1732RECURRENCE OF GLOMERULONEPHRITIS POST TRANSPLANT

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Umesh Lingaraj ◽  
Ricken Mehta ◽  
Shivaprasad SM ◽  
Kishan A ◽  
Leelavathi V ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Renal Disease ◽  
Kidney Transplant ◽  
End Stage Renal Disease ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Post Transplant ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims Glomerulonephritis (GN) is a major cause of end stage renal disease (ESRD)1. It represents the primary cause of end stage renal disease (ESRD) for 25% of the dialysis population1 and 45% of the transplant population. For patients with GN requiring renal replacement therapy, kidney transplantation is associated with superior outcomes compared with dialysis2. The possibility of recurrence of the original disease after transplantation was described in a seminal paper more than 40 years ago, and it is now clear that all forms of GN may recur after kidney transplantation.3 To study the recurrence of glomerulonephritis post-transplant in a tertiary care centre. Method 120 renal transplant recipients were analyzed from September 2015 to August 2019 at the Institute of Nephro-Urology, Bangalore. It was a retrospective analysis of data Results 120 adult patients underwent kidney transplantation, out of these 70 had GN as primary cause of kidney disease. 85.8% were males, 14.2 % females. 58.9 % were biopsy proven GN, remaining 41.1 % diagnosed based on history and clinical presentation. All but one patient had their first transplant. Out of these kidney transplant recipients 08 (11.4%) had recurrence of GN.  From these 4/08 was recurrent IgA N, 2/08 were PGNMID, 1/08 MGN, 1/08 aHUS. Graft loss due to recurrent GN was seen in 1/08 patients (12.5%). Conclusion Our study showed that 11.4 % of kidney transplant recipients with GN as their cause of ESRD had recurrent GN post kidney transplantation. IgAN was the most type of GN that recurred most frequently followed by PGNMID. Recurrence of GN was in par with other studies and did not affect graft survival

scholarly journals Physical Activity and the Development of Post-Transplant Diabetes Mellitus, and Cardiovascular- and All-Cause Mortality in Renal Transplant Recipients

2020 ◽  
Vol 9 (2) ◽  
pp. 415 ◽  
Author(s):  
Oyuntugs Byambasukh ◽  
Maryse C. J. Osté ◽  
António W. Gomes-Neto ◽  
Else van den Berg ◽  
Gerjan Navis ◽  
...  
Keyword(s):  
Physical Activity ◽  
Diabetes Mellitus ◽  
Renal Transplant ◽  
Mortality Data ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Post Transplant ◽  
Glucose Levels ◽  
All Cause Mortality

(1) Background: Little is currently known about the health impacts of daily-life moderate-to-vigorous physical activity (MVPA) in relation to the development of post-transplant diabetes mellitus (PTDM) and the long-term survival of renal transplant recipients (RTRs). (2) Methods: We analyzed self-reported data on MVPA within non-occupational and occupational domains, estimated with the SQUASH questionnaire, from a prospective cohort study of RTRs (n = 650) with a functioning graft exceeding 1 year. PTDM diagnoses were based on plasma glucose levels (≥126 mg/dL), HbA1c (≥6.5%), and the use of antidiabetic medication. Mortality data were retrieved from patient files up to the end of September 2015. (3) Results: During a median follow-up period of 5.3 years, 50 patients (10%) developed PTDM and 129 (19.8%) died. Of these deaths, 53 (8.9%) were caused by cardiovascular disease. Cox regression analyses showed that higher MVPA levels among patients were associated with a lower risk of PTDM (hazard ratio (HR); 95% confidence interval (95%CI) = 0.49; 0.25–0.96, p = 0.04), cardiovascular- (0.34; 0.15–0.77, p = 0.01), and all-cause mortality (0.37; 0.24–0.58, p < 0.001) compared with No-MVPA patients, independently of age, sex, and kidney function parameters. Associations of MVPA with cardiovascular and all-cause mortality remained significant and materially unchanged following further adjustments made for transplant characteristics, lifestyle factors, metabolic parameters, medication use, and creatinine excretion (muscle mass). However, the association between MVPA and PTDM was no longer significant after we adjusted for metabolic confounders and glucose levels. (4) Conclusion: Higher MVPA levels are associated with long-term health outcomes in RTRs.

scholarly journals SP793Costs of long-term post-transplant care in renal transplant recipients

2019 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Anna Łabuś ◽  
Mariusz Niemczyk ◽  
ŁUkasz Czyżewski ◽  
Magda Fliszkiewicz ◽  
Andrzej Kulesza ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Post Transplant
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