scholarly journals Recurrence of FSGS after Kidney Transplantation in Adults

2020 ◽  
Vol 15 (2) ◽  
pp. 247-256 ◽  
Author(s):  
Audrey Uffing ◽  
Maria José Pérez-Sáez ◽  
Marilda Mazzali ◽  
Roberto C. Manfro ◽  
Andrea Carla Bauer ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Graft Loss ◽  
Small Sample ◽  
Glomerular Disease ◽  
Response To Treatment ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Post Transplant ◽  
Native Kidney

Background and objectivesFSGS recurrence after kidney transplantation is a major risk factor for graft loss. However, the natural history, clinical predictors, and response to treatment remain unclear because of small sample sizes and poor generalizability of single-center studies, and disease misclassification in registry-based studies. We therefore aimed to determine the incidence, predictors, and treatment response of recurrent FSGS in a large cohort of kidney transplant recipients.Design, setting, participants, & measurementsThe Post-Transplant Glomerular Disease (TANGO) project is an observational, multicenter, international cohort study that aims to investigate glomerular disease recurrence post-transplantation. Transplant recipients were screened for the diagnosis of idiopathic FSGS between 2005 and 2015 and details were recorded about the transplant, clinical outcomes, treatments, and other risk factors.ResultsAmong 11,742 kidney transplant recipients screened for FSGS, 176 had a diagnosis of idiopathic FSGS and were included. FSGS recurred in 57 patients (32%; 95% confidence interval [95% CI], 25% to 39%) and 39% of them lost their graft over a median of 5 (interquartile range, 3.0–8.1) years. Multivariable Cox regression revealed a higher risk for recurrence with older age at native kidney disease onset (hazard ratio [HR], 1.37 per decade; 95% CI, 1.09 to 1.56). Other predictors were white race (HR, 2.14; 95% CI, 1.08 to 4.22), body mass index at transplant (HR, 0.89 per kg/m2; 95% CI, 0.83 to 0.95), and native kidney nephrectomies (HR, 2.76; 95% CI, 1.16 to 6.57). Plasmapheresis and rituximab were the most frequent treatments (81%). Partial or complete remission occurred in 57% of patients and was associated with better graft survival.ConclusionsIdiopathic FSGS recurs post-transplant in one third of cases and is associated with a five-fold higher risk of graft loss. Response to treatment is associated with significantly better outcomes but is achieved in only half of the cases.

scholarly journals Current Pharmacological Intervention and Medical Management for Diabetic Kidney Transplant Recipients

Pharmaceutics ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 413
Author(s):  
Theerawut Klangjareonchai ◽  
Natsuki Eguchi ◽  
Ekamol Tantisattamo ◽  
Antoney J. Ferrey ◽  
Uttam Reddy ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Pharmacological Intervention ◽  
Diabetic Patients ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Kidney Allograft ◽  
Post Transplant ◽  
Glucose Management

Hyperglycemia after kidney transplantation is common in both diabetic and non-diabetic patients. Both pretransplant and post-transplant diabetes mellitus are associated with increased kidney allograft failure and mortality. Glucose management may be challenging for kidney transplant recipients. The pathophysiology and pattern of hyperglycemia in patients following kidney transplantation is different from those with type 2 diabetes mellitus. In patients with pre-existing and post-transplant diabetes mellitus, there is limited data on the management of hyperglycemia after kidney transplantation. The following article discusses the nomenclature and diagnosis of pre- and post-transplant diabetes mellitus, the impact of transplant-related hyperglycemia on patient and kidney allograft outcomes, risk factors and potential pathogenic mechanisms of hyperglycemia after kidney transplantation, glucose management before and after transplantation, and modalities for prevention of post-transplant diabetes mellitus.

FC 124PATTERNS OF RENAL OSTEODYSTROPHY ONE YEAR AFTER KIDNEY TRANSPLANTATION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Hanne Skou Jørgensen ◽  
Geert Behets ◽  
Patrick D'Haese ◽  
Pieter Evenepoel
Keyword(s):  
Kidney Transplantation ◽  
Bone Turnover ◽  
Kidney Transplant ◽  
Renal Osteodystrophy ◽  
Bone Disease ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Post Transplant ◽  
Steroid Dose ◽  
Bone Biopsies

Abstract Background and Aims Bone disease after kidney transplantation is an issue of growing concern, as prolonged graft survival and older age of recipients necessitate focus on long-term health burdens such as osteoporosis and fractures. Pre-existing type of renal osteodystrophy, post-transplant immunosuppressive treatment, and de novo disturbances of mineral metabolism all contribute to bone disease in kidney transplant recipients. The current pattern of renal osteodystrophy after kidney transplantation is not well characterized. This study reports histomorphometric findings of protocolled bone biopsies in a large cohort of kidney transplant recipients 1 year post-transplant. Method Histomorphometric analysis of transiliac bone biopsies with prior tetracycline labelling was performed in 141 kidney transplant recipients. Biochemical measurements included bioactive parathyroid hormone (PTH), total calcium, phosphate, calcidiol, bicarbonate, and sclerostin. Kruskal-Wallis and Wilcoxon signed rank tests were used to evaluate differences across categories and between groups, respectively. Stepwise multivariate linear regression was performed to identify key demographic and biochemical determinants of bone turnover (bone formation rate, BFR), mineralization (mineralization lag time, Mlt), and volume (Bone area, BAr). Results Mean age was 57±11 years, 71% were men, and all were Caucasian. Mean eGFR was 49±16 (range 19 to 106) ml/min/1.73 m². Hyperparathyroidism (PTH > 1.5xUNL) was seen in 48%, hypercalcemia (>10.3 mg/dL) in 18%, hypophosphatemia (<2.3 mg/dl) in 12%, and vitamin D deficiency (<15 ng/mL) in 4% of patients. Categorization of bone turnover, mineralization, and volume is shown in Figure 1. Bone turnover was normal in the vast majority (71%). Patients with low turnover (26%) had received a higher cumulative steroid dose (2.78 vs 2.34g in low vs non-low turnover; p=0.02). Patients with delayed mineralization (16%) were younger (52 vs 58 yrs, p=0.02) and had received a higher cumulative steroid dose (2.85 vs 2.36g, p=0.003). They had higher levels of PTH (124 vs 53 ng/L, p<0.001), and lower levels of phosphate (2.68 vs 3.18 mg/dL, p<0.001), calcidiol (29 vs 37ug/L, p=0.02), bicarbonate (21.3 vs 23.3 mmol/L, p=0.004), and sclerostin (493 vs 594 pg/mL, p=0.03) compared to patients with normal mineralization. Patients with low bone volume tended to be older (61 vs 56 years, p=0.07). Independent determinants of BFR were PTH (β=0.68, p<0.001) and cumulative steroid dose (β = -0.22, p=0.02). Determinants of Mlt were phosphate (β=-0.48, p=0.001) and cumulative steroid dose (β=0.18, p=0.004), and determinants of BAr were age (β=-0.15, p=0.002), and BMI (β=0.33, p=0.002). Conclusion Bone turnover is normal in the majority of kidney transplant recipients at 1 year post-transplant, despite a high prevalence of hyperparathyroidism. Low levels of bicarbonate, phosphate, and calcidiol may contribute to delayed bone mineralization in kidney transplant recipients.

scholarly journals Source of Post-Transplant Care and Mortality among Kidney Transplant Recipients Dually Enrolled in VA and Medicare

2021 ◽  
pp. CJN.10020620
Author(s):  
Winn Cashion ◽  
Walid F. Gellad ◽  
Florentina E. Sileanu ◽  
Maria K. Mor ◽  
Michael J. Fine ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Confidence Interval ◽  
Kidney Transplant ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Post Transplant ◽  
Administration Hospital

Background and objectivesMany kidney transplant recipients enrolled in the Veterans Health Administration are also enrolled in Medicare and eligible to receive both Veterans Health Administration and private sector care. Where these patients receive transplant care and its association with mortality are unknown.Design, setting, participants, & measurementsWe conducted a retrospective cohort study of veterans who underwent kidney transplantation between 2008 and 2016 and were dually enrolled in Veterans Health Administration and Medicare at the time of surgery. We categorized patients on the basis of the source of transplant-related care (i.e., outpatient transplant visits, immunosuppressive medication prescriptions, calcineurin inhibitor measurements) delivered during the first year after transplantation defined as Veterans Health Administration only, Medicare only (i.e., outside Veterans Health Administration using Medicare), or dual care (mixed use of Veterans Health Administration and Medicare). Using multivariable Cox regression, we examined the independent association of post-transplant care source with mortality at 5 years after kidney transplantation.ResultsAmong 6206 dually enrolled veterans, 975 (16%) underwent transplantation at a Veterans Health Administration hospital and 5231 (84%) at a non–Veterans Health Administration hospital using Medicare. Post-transplant care was received by 752 patients (12%) through Veterans Health Administration only, 2092 (34%) through Medicare only, and 3362 (54%) through dual care. Compared with patients who were Veterans Health Administration only, 5-year mortality was significantly higher among patients who were Medicare only (adjusted hazard ratio, 2.2; 95% confidence interval, 1.5 to 3.1) and patients who were dual care (adjusted hazard ratio, 1.5; 95% confidence interval, 1.1 to 2.1).ConclusionsMost dually enrolled veterans underwent transplantation at a non–Veterans Health Administration transplant center using Medicare, yet many relied on Veterans Health Administration for some or all of their post-transplant care. Veterans who received Veterans Health Administration–only post-transplant care had the lowest 5-year mortality.

scholarly journals P1706THE GRAFT SURVIVAL OF KIDNEY TRANSPLANTATION ACCORDING TO ETHNICITY IN KIDNEY TRANSPLANT RECIPIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Yeonsoon Jung ◽  
Jisu Kim ◽  
Haesu Jeon ◽  
Ye Na Kim ◽  
Ho Sik Shin ◽  
...  
Keyword(s):  
African American ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Graft Survival ◽  
Cox Regression ◽  
Patient Survival ◽  
Graft Loss ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Data Set

Abstract Background African American kidney transplant recipients experience disproportionately high rates of graft loss. The aim of this analysis was to use a UNOS data set that contains detailed baseline and longitudinal clinical data to establish and quantify the impact of the current overall graft loss definition on suppressing the true disparity magnitude in US AA kidney transplant outcomes. Methods Longitudinal cohort study of kidney transplant recipients using a data set created by United Network for Organ Sharing (UNOS), including 266,128 (African American 70,215, Non-African American 195,913) transplant patient between 1987 and December 2016. Multivariable analysis was conducted using 2-stage joint modeling of random and fixed effects of longitudinal data (linear mixed model) with time to event outcomes (Cox regression). Results 195,913 non-African American (AA) (73.6%) were compared with 70,215 AA (26.4%) recipients. 10-year-graft survival of AA in all era is lower than that of non-AA (31% in deceased kidney transplants (DKT) AA recipient and 42% in living kidney transplantation (LKT) non-AA recipient). 10-year-patient survival of AA with functioning graft in all era is similar that of non-AA. Multivariate Cox regression of factors associated with patient survival with functioning graft are acute rejection within 6 months, DM, hypertension and etc. Pre-transplant recipient BMI in AA show the trend as a protective factor in patient survival with functioning graft although not significantly in statistics Conclusions African American kidney transplant recipients experience a substantial disparity in graft loss, but not patient death with functioning graft.

MO945SERUM AND URINE LEUCINE RICH ALPHA-2-GLYCOPROTEIN-1 IS ASSOCIATED WITH KIDNEY TRANSPLANT INJURY AND FAILURE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Aiga Vasiļvolfa ◽  
Juta Kroiča ◽  
Anna Popova ◽  
Kārlis Rācenis ◽  
Baiba Šlisere ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Kidney Injury ◽  
Kidney Graft ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Positive Correlation ◽  
Post Transplant ◽  
Time Period ◽  
Serum And Urine

Abstract Background and Aims Kidney transplantation is the treatment of choice for most of the patients with end stage chronic kidney disease. To improve patient and graft survival, early diagnostics and discovery of specific biomarkers is important. Leucine rich alpha-2-glycoprotein-1 (LRG-1) is an innovative, non-invasive biomarker that is elevated in case of angiogenesis, inflammation and kidney injury. Aim was to evaluate biomarker LRG-1 level in serum and urine in kidney transplant recipients in accordance with kidney injury markers and time period after kidney transplantation. Method In the study 35 patients were enrolled. Patients had functioning kidney grafts and they were more than one year post transplant. We detected patient serum and urine LRG-1 levels, using ELISA. Correlation between serum LRG-1, urine LRG-1 and kidney graft structural and functional damage markers was performed. Also, we compared serum LRG-1 levels between subgroups (patients >5 years post transplant and ≤ 5 years post transplant). Results Serum LRG-1 had positive correlation with serum cystatin-C (r=0,46, p<0,01), serum urea (r=0,53, p<0,01) and negative correlation with eGFR (r= -0,39, p=0,02). Patients with >5 years post transplant had higher serum LRG-1 level compared with patients ≤5 years post transplant (p<0,01). Serum LRG-1 had positive correlation with a longer time period after transplantation (r=0,53, p=0,01). Urine LRG-1 had correlation with proteinuria (r=0,58, p<0,01) and NGAL level in urine (r=0,44, p<0,01). The most common maintenance immunosuppressive regimen was therapy with tacrolimus, mycophenolate and prednisolone (48,6%). Conclusion Higher serum LRG-1 level correlates with decreased kidney transplant function and with longer time period after transplantation. Higher LRG-1 level in serum and urine is related to kidney transplant injury and failure. Urine LRG-1 can be a useful biomarker for tubular dysfunction in kidney transplant recipients.

scholarly journals Induction Immunosuppression in Pediatric Kidney Transplant Recipients Under the Age of 11 with Rabbit Anti-Thymocyte Globulin

2020 ◽  
Vol 3 ◽  
Author(s):  
William Goggins ◽  
Richard Mangus ◽  
Burcin Ekser ◽  
William Goggins
Keyword(s):  
Kidney Transplant ◽  
Graft Survival ◽  
Lymphoproliferative Disorder ◽  
Graft Loss ◽  
Bk Virus ◽  
P Value ◽  
Induction Agent ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Post Transplant

Background:     At the time of kidney transplantation (KT), induction immunosuppression is used to reduce the incidence of early rejection and avoid the use of chronic corticosteroids in maintenance immunosuppression. There is currently no standard of care for induction immunosuppression in the pediatric recipient, instead it is based on institutional preference. In this study, we compare our current induction immunosuppression, rabbit anti-thymocyte globulin (rATG), to our previous induction immunosuppression, Daclizumab in patients under the age of 11.     Methods:     From 07/2004 to 08/2019, 79 patients under the age of 11 have received a KT. 7 patients were excluded from analysis due to Basiliximab induction (n=3), graft loss within 10 days (n=3) and patient death (n=1). 72 patients were analyzed, of which 39 patients (54%) with rATG induction were compared to 33 patients (46%) with daclizumab induction. All patients were maintained on steroid-free immunosuppression regimen after transplant. More than 20 variables were followed, along with rejection, graft failure, and any prevalence of post-transplant lymphoproliferative disorder (PTLD) was recorded (Figure 1).    Results:     Patients demographics were similar in both groups. Graft survival was good and statistically similar up to 5 years. In both groups, serum creatinine levels were similar up to 1 year follow up. Although CMV infection was similar in both groups, BK viremia and BK virus in the urine were more frequent in rATG group. Post-transplant lymphoproliferative disorder was significantly higher in the Daclizumab group (p=0.022), but less acute rejection was observed in the Daclizumab group (Figure 1).     Potential Impact:     Our study suggests that rATG is a safe and effective induction agent in pediatric kidney transplant recipients under the age of 11. Recipients have excellent patient and graft survival. It is associated with strong kidney function and low PTLD. Screening for BK virus in the urine is essential with rATG induction.     Table 1:     Induction Agent  Daclizumab  rATG  p value  Demographics        Number  33  39  N.S.  Sex  15M, 18F  27M, 12F  0.042  Age (years)  5.5 ± 2.7  6.1 ± 2.7  N.S.  Height (m)  1.02 ± 0.23  1.06 ± .21  N.S.  Weight (kg)  18.75 ± 9.93  19.08 ± 6.42  N.S.  Outcomes        Cr 1 month (mg/dL)  0.56 ± .31  0.45 ± .17  0.056  Cr 6 months (mg/dL)  0.54 ± .22  0.52 ± .18  N.S.  Cr 1 year (mg/dL)  0.63 ± .27  0.59 ± .17  N.S.  eGFR 1 month (ml/min/1.73m2)  84.81 ± 27.95  107.08 ± 30.09  0.0019  eGFR 6 months (ml/min/1.73m2)  85.04 ± 27.60  92.48 ± 28.07  N.S.  eGFR 1 year (ml/min/1.73m2)  74.31 ± 26.8  79.3 ± 22.01  N.S.  Rejection 6 months  1 (3.03%)  8 (20.51%)  0.0188  Rejection 1 year  2 (6.06%)  8 (20.51%)  0.0682  Graft Survival 1 year  100% (33/33)  100% (39/39)  N.S.  Graft Survival 3 years  96.97% (32/33)  100% (25/25)  N.S.  Graft Survival 5 years  96.88 (31/32)  100% (22/22)  N.S.  Cases of PTLD  5 (18.18%)  0 (0%)  0.022  Chronic steroid use  2 (6.06%)  2 (5.13%)  N.S.  BK Urine only 1 year  0% (0/33)*  10.26% (4/39)  0.0439  BK Viremia 1 year  3.03% (1/33)*  17.95% (7/39)  0.0356  CMV Viremia 1 year  0% (0/33)  5.13% (2/39)  N.S.  N.S.= Not statistically significant.  *BK screening was not routine during time of daclizumab induction 

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

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