Kidney Transplantation 1: An Overview--Recipient Evaluation and Immunosuppression

2013 ◽  
Author(s):  
Jamil Azzi ◽  
Belinda T. Lee ◽  
Anil Chandraker
Keyword(s):  
Kidney Transplantation ◽  
Primary Care Physicians ◽  
Human Leukocyte ◽  
Visual Aids ◽  
Coordinated Care ◽  
Comprehensive Overview ◽  
Successful Transplantation ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Half a century after the first successful kidney transplantation, we still stand at the crossroads of immunology and transplantation, where science meets art in the management of complex end-stage renal disease (ESRD) patients. Successful transplantation requires not only a lifetime’s commitment from patients but also a multidisciplinary approach, bringing together surgeons, transplant nephrologists, primary care physicians, scientists, and nurses to provide coordinated care. Although transplantation is the treatment of choice for the vast majority of ESRD patients, many patients remain on dialysis due to a relative imbalance between demand for and supply of suitable organs. This chapter provides a comprehensive overview of recipient evaluation and immunosuppression. Risk factors that prohibit transplantation are discussed, as are human leukocyte antigen/ABO compatibility, transplant immunobiology, induction therapy, maintenance therapy, transplantation for special populations, and future directions in the field. Tables outline Amsterdam Living Donation Forum guidelines, ABO blood group compatibilities, and pretransplant immunologic testing. Visual aids include graphs, charts, cell illustrations, and an evaluative algorithm. This chapter contains 10 figures, 3 tables, 101 references, and 5 Board-styled MCQs.

Kidney Transplantation: An Overview--Recipient Evaluation and Immunosuppression

2018 ◽  
Author(s):  
Jamil Azzi ◽  
Belinda T. Lee ◽  
Anil Chandraker
Keyword(s):  
Kidney Transplantation ◽  
Primary Care Physicians ◽  
Human Leukocyte ◽  
Visual Aids ◽  
Coordinated Care ◽  
Comprehensive Overview ◽  
Successful Transplantation ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Half a century after the first successful kidney transplantation, we still stand at the crossroads of immunology and transplantation, where science meets art in the management of complex end-stage renal disease (ESRD) patients. Successful transplantation requires not only a lifetime’s commitment from patients but also a multidisciplinary approach, bringing together surgeons, transplant nephrologists, primary care physicians, scientists, and nurses to provide coordinated care. Although transplantation is the treatment of choice for the vast majority of ESRD patients, many patients remain on dialysis due to a relative imbalance between demand for and supply of suitable organs. This chapter provides a comprehensive overview of recipient evaluation and immunosuppression. Risk factors that prohibit transplantation are discussed, as are human leukocyte antigen/ABO compatibility, transplant immunobiology, induction therapy, maintenance therapy, transplantation for special populations, and future directions in the field. Tables outline Amsterdam Living Donation Forum guidelines, ABO blood group compatibilities, and pretransplant immunologic testing. Visual aids include graphs, charts, cell illustrations, and an evaluative algorithm. This chapter contains 10 figures, 3 tables, 101 references, and 5 Board-styled MCQs.

Kidney Transplantation 1: An Overview--Recipient Evaluation and Immunosuppression

2017 ◽  
Author(s):  
Belinda T. Lee ◽  
Anil Chandraker ◽  
Jamil Azzi ◽  
Martina M McGrath
Keyword(s):  
Kidney Transplantation ◽  
Human Leukocyte ◽  
Basic Knowledge ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Early Management ◽  
Leukocyte Antigen ◽  
Medical Evaluation ◽  
Stage Renal Disease ◽  
End Stage

Kidney transplantation remains the optimal renal replacement therapy for patients with end-stage renal disease (ESRD). A timely referral to kidney transplantation and a thorough pretransplantation evaluation ensure improvement in the morbidity and mortality of ESRD patients. Basic knowledge of immune biology and an in-depth understanding of the different induction and maintenance therapies used post kidney transplantation are imperative for optimal patient management. In this review, we discuss the multidisciplinary process of pretransplantation evaluation of kidney transplant recipients. We also discuss state-of–the-art early management post kidney transplantation with the different immunosuppressive therapies currently available. This review contains 3 figures, 11 tables, and 106 references. Key words: crossmatch, donor-specific antibody, immunosuppression, human leukocyte antigen, immunosuppression, induction, maintenance, medical evaluation, transplantation

scholarly journals Nationwide Glaucoma incidence in end stage renal disease patients and kidney transplant recipients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jong Joo Moon ◽  
Yong Woo Kim ◽  
Baek-Lok Oh ◽  
Kyungdo Han ◽  
Dong Ki Kim ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Open Angle Glaucoma ◽  
Angle Closure ◽  
Healthy Controls ◽  
Kidney Transplant Recipients ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

AbstractGlaucoma shares common risk factors with chronic kidney disease (CKD) but previous cross-sectional studies have demonstrated discrepancies in the risk of glaucoma in CKD patients. This study enrolled kidney transplantation recipients (KTRs) (n = 10,955), end stage renal disease (ESRD) patients (n = 10,955) and healthy controls (n = 10,955) from National Health Insurance Service database of the Republic of Korea. A Cox proportional hazard regression model was used to calculate the hazard ratios (HR) for primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) incidences. The incidence of POAG was higher in ESRD patients (3.36/1,000 person-years, P < 0.0001) and KTRs (3.22 /1,000 person-years, P < 0.0001), than in healthy controls (1.20/1,000 person-years). However, POAG risk showed no significant increase in either ESRD patients (P = 0.07) or KTRs (P = 0.08) when adjusted for the confounding factors. The incidence of PACG was significantly higher in ESRD patients (0.41/1,000 person-years) than in healthy controls (0.14/1,000 person-years, P = 0.008). The PACG incidence was significantly lower in KTRs than in ESRD patients (HR = 0.35, P = 0.015). In conclusion, this nationwide cohort study demonstrated that kidney transplantation can reduce the risk of PACG but not POAG in ESRD patients.

scholarly journals P1312EFFECT OF KIDNEY TRANSPLANTATION RATE ON THE ARTERIOVENOUS FISTULA RATE IN PREVALENT HEMODIALYSIS PATIENTS: ANALYSIS OF DATA FROM THE CATALAN RENAL REGISTRY (1997-2017)

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Ramon Roca-Tey ◽  
Jordi Comas ◽  
Jaume Tort
Keyword(s):  
Kidney Transplantation ◽  
Arteriovenous Fistula ◽  
Kidney Graft ◽  
Fistula Rate ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients ◽  
Determining Factor ◽  
Tunneled Catheter ◽  
Over Time

Abstract Background Kidney transplantation (KT) is considered to be the best option of renal replacement therapy (RRT) for most end-stage renal disease (ESRD) patients (pts). Furthermore, arteriovenous fistula (AVF) is considered to be the best vascular access (VA) for most hemodialysis (HD) pts. Aims To analyze the effect of KT rate on the AVF rate in prevalent HD pts. In addition, the likelihood of receiving a kidney graft (KG) over time according to the first VA used to start HD program was also evaluated Method Data from the Catalan Registry of ESRD pts treated with either KT or HD were examined for a 20-year period Results The functioning KG rate increased progressively from 40.5% (n=2211) in 1997 to 57.0% (n=6149) in 2017 and, conversely, the AVF rate in prevalent HD patients decreased progressively from 86.0% (n=2609) to 63.2% (n=2546) during the same period (for both comparisons, p &lt; 0.001). The characteristics of all prevalent HD pts dialyzed in 1997 (n=3104) vs 2017 (n=4205) were different regarding age 62.6±15.3 vs 70.3±14.2 yr, diabetic nephropathy (DN) 13.2% vs 21.8% and cardiovascular disease (CD) 67.6% vs 75.8% (for all comparisons, p&lt;0.001). On December 31, 2017 (maximum KT rate), the characteristics of KG recipients were different compared with prevalent HD pts dialyzed through either an AVF or a tunneled catheter (n=1145): age 57.4±14.5 vs 69.9±13.8 vs 72.0±14.6 yr, DN 9.5% vs 21.7% vs 22.5%, CD 38.6% vs 74.3% vs 83.7% (for all comparisons, p&lt;0.001). By analyzing the likelihood of prevalent pts performing HD through an AVF, we saw it was lower in pts with DN (OR: 0.86; 95% CI: 0.79-0.94, p=0.001) and it decreased progressively as they got older (reference &gt;74 yr): &lt;44 yr (OR:1.55, 95% CI: 1.41-1.70, p&lt;0.001), 45-64 yr (OR: 1.47, 95% CI: 1.38-1.56, p&lt;0.001) and 65-74 yr (OR: 1.22, 95% CI: 1.17-1.28, p&lt;0.001). This probability was higher in males (OR: 1.84, 95% CI: 1.73-1.95, p&lt;0.001), pts with polycystic kidney disease (OR: 1.54, 95% CI: 1.35-1.77, p&lt;0.001) and pts without CD (OR: 1.32; 95% CI: 1.27-1.38, p&lt;0.001) and it increased according to the time on RRT (reference &lt; 1 month): &gt;12 m (OR: 2.39, 95% CI: 2.17-2.64, p&lt;0.001). In addition, this likelihood decreased progressively as the percentage of patients with a functioning KG increased (reference &gt;55%): 40-45% (OR: 3.26, 95% CI: 3.05-3.48, p&lt;0.001), 45-50% (OR: 1.82, 95% CI: 1.73-1.92, p&lt;0.001) and 50-55% (OR: 1.27, 95% CI: 1.21-1.33, p&lt;0.001). The rate of prevalent HD pts waitlisted for KT and dialyzed through AVF decreased progressively from 94.5% (639/676, 1997) to 77.9% (491/630, 2017). In parallel, but always remaining at a lower level, the rate of prevalent HD patients not waitlisted for KT and dialyzed through AVF also decreased progressively from 83.6% (1970/2357) to 60.5% (2055/3399) during the same period (for all comparisons, p&lt;0.001). Considering the prevalent HD pts during the period 2014-2017 (n=4029), significant differences were observed between HD pts waitlisted (n=630, 15.6%) and not-waitlisted (n=3399, 84.4%) for KT regarding age (58.2±12.9 vs 72.8±13.1 yr), DN (16.2% vs 23.0%), CD (59.5% vs 80.5%) and distribution of AVF (77.9% vs 60.5%) or tunneled catheter (16.5% vs 30.6%) (for all comparisons, p&lt;0.001). During the period 2012-2014, incident pts starting HD through an AVF (n=1026) had a significant higher likelihood of receiving a KG over time (HR: 1.68, 95% CI: 1.41-2.00, p&lt;0.001) in comparison to pts who initiated HD through a catheter (n=1408). Conclusion 1) The fall of prevalent HD pts with AVF over time could be associated with a progressive worsening of their clinical profiles along with the increasing rate of KG recipients. 2) In addition to some demographic and clinical characteristics of prevalent HD pts, the annual KT rate was also a determining factor in their AVF rate. 3) Starting HD program through an AVF was independently associated with a greater likelihood of receiving a KG over time as compared to starting HD through a catheter.

scholarly journals A survey of waiting lists for kidney transplantation in northeastern Iran

2020 ◽  
Vol 5 (2) ◽  
pp. e20-e20
Author(s):  
Majid Jangi ◽  
Hamed Tabesh ◽  
Mahin Ghorban Sabbagh ◽  
Ebrahim Khaleghi Baigi ◽  
Sayyed Mostafa Mostafavi ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Waiting List ◽  
Unknown Etiology ◽  
Time Period ◽  
The Status ◽  
Linkage Method ◽  
Stage Renal Disease ◽  
Clinical Records ◽  
End Stage ◽  
Esrd Patients

Introduction: End-stage renal disease (ESRD) continues to be a public health challenge. In ESRD patients, renal replacement therapy is essential. Kidney transplantation is considered as an effective therapeutic procedure for ESRD. On the advice of a qualified nephrologist, ESRD patients are registered on a waiting list, seeking organ transplantation. Objectives: This study aimed to report the status of the waiting list for kidney transplantation in the northeastern Iran region, with data covering the time period until 2017. Patients and Methods: The study was conducted at Montaserie hospital in Mashhad, Iran. We reviewed the clinical records of all ESRD patients referred to the hospital, retrospectively. Patients’ data were completed using a data linkage method and analyzed using SPSS version 23. Results: A total of 1956 patients were studied from the waiting list with a mean age of 44.7 ± 14.4 years (3-80 years). The described etiology reveals that the main causes of ESRD were unknown sources (44.1%), diabetes (18.4%) and hypertension (10.9%). Hemodialysis therapy was conducted for 91.1% of the patients. The maximum registered waiting time was 295 months and the minimum was one month, with an average of 63 months. The proportion of patients waiting for the first, second and third kidney transplantation was 86%, 13.2% and 0.7%, respectively. Conclusion: This study highlights that in the population under study, the number of registered patients on the waiting list followed an increasing pattern, while the age of patients decreased. Unfortunately, in most case studies in Iran, the true etiology of nephrology diseases is still unknown. More effort to define the ESRD causes is necessary. The most likely reason for reported cases with unknown etiology is delays in referral problems.

scholarly journals Propensity-Matched Survival Analysis of Upper Urinary Tract Urothelial Carcinomas between End-Stage Renal Disease with and without Kidney Transplantation

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Hao Lun Luo ◽  
Po Hui Chiang ◽  
Yuan Tso Cheng ◽  
Yen Ta Chen
Keyword(s):  
Kidney Transplantation ◽  
Urinary Tract ◽  
Propensity Score ◽  
Urothelial Carcinoma ◽  
End Stage Renal Disease ◽  
Upper Urinary Tract ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients ◽  
Urinary Tract Urothelial Carcinoma

Urothelial carcinoma is the most common cancer following kidney transplantation (KT) in Taiwan. Unusual presentation of upper urinary tract urothelial carcinoma (UTUC) is noted in Taiwan and China. As the post-KT-UTUC oncological course is not fully understood, the aim of this study is to identify postulated significant differences for the clinical cancer course of UTUC among end-stage renal disease (ESRD) patients with and without KT. From 2005 January to 2016 March, 194 ESRD patients underwent radical nephroureterectomy due to UTUC in our hospital. The parameters were obtained from the chart record and pathology report. SPSS version 21 software was used for all statistical analyses. Unequal matching created study groups wherein a 0.2 caliper width was performed for adjusting these confounding pathological factors. Propensity score-matching cohort was performed for each population first, and then for all the study patients. We observed that the average age of UTUC in ESRD patients after KT was younger than in those without KT. The pathological factors such as stage, bladder cancer history, papillary structure, lymphovascular invasion, and variant histology were equal in these two groups. However, younger onset (p<0.001), more multifocal tumors, and carcinomas in situ were observed in post-KT UTUC (p<0.001 and 0.006, respectively). After adjustment of pathological factors by propensity score-matched analysis, the 5-year systemic UTUC recurrence was significantly more in ESRD after KT compared with ESRD without KT (p=0.03). No obvious difference in 5-year cancer related death could be observed between these two groups (p=0.314). Post-kidney transplantation upper urinary tract urothelial carcinoma in Taiwan is relatively common, has younger onset, and is associated with aggressive pathological features. The oncologic outcome of UTUC after KT is poor in our observation, even after propensity scored-matched analysis. It indicates the immunosuppression status is still associated with more malignant UTUC behavior.

Kidney Transplantation 1: An Overview--Recipient Evaluation and Immunosuppression

2017 ◽  
Author(s):  
Jamil Azzi ◽  
Belinda T. Lee ◽  
Anil Chandraker ◽  
Martina M McGrath
Keyword(s):  
Kidney Transplantation ◽  
Human Leukocyte ◽  
Basic Knowledge ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Early Management ◽  
Leukocyte Antigen ◽  
Medical Evaluation ◽  
Stage Renal Disease ◽  
End Stage

Kidney transplantation remains the optimal renal replacement therapy for patients with end-stage renal disease (ESRD). A timely referral to kidney transplantation and a thorough pretransplantation evaluation ensure improvement in the morbidity and mortality of ESRD patients. Basic knowledge of immune biology and an in-depth understanding of the different induction and maintenance therapies used post kidney transplantation are imperative for optimal patient management. In this review, we discuss the multidisciplinary process of pretransplantation evaluation of kidney transplant recipients. We also discuss state-of–the-art early management post kidney transplantation with the different immunosuppressive therapies currently available. This review contains 3 figures, 11 tables, and 106 references. Key words: crossmatch, donor-specific antibody, immunosuppression, human leukocyte antigen, immunosuppression, induction, maintenance, medical evaluation, transplantation

GI Symptoms and Quality of Life of End Stage Renal Disease (ESRD) Patients as Opposed to After Kidney Transplantation

2010 ◽  
Vol 105 ◽  
pp. S389-S390
Author(s):  
Ali Pakravan ◽  
Hisham Hussan ◽  
Giao Vuong ◽  
Matthew Stotts ◽  
Bahar Bastani ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Kidney Transplantation ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Gi Symptoms ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

scholarly journals Evaluation of Human Leukocyte Antigen Class I and Class II in End-Stage Renal Disease Occurrence in Indonesian Transplantation Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Hani Susianti ◽  
Dwi Priyadi Djatmiko ◽  
I Komang Adi Widana ◽  
Deasy Ayuningtyas Tandio ◽  
Catur Suci Sutrisnani ◽  
...  
Keyword(s):  
Renal Disease ◽  
Human Leukocyte Antigen ◽  
End Stage Renal Disease ◽  
Human Leukocyte ◽  
Class I ◽  
Leukocyte Antigen ◽  
Hla Genes ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background. Genetic studies of end-stage renal disease (ESRD), including those of human leukocyte antigen (HLA) genes, have been reported in several populations but have not yet been evaluated in Indonesia. Some studies have reported that these genes had a substantial role in ESRD. This study aims to analyze the association between HLA genes and ESRD within the Indonesian community. Method. A retrospective study to investigate HLA class I and II alleles to find out the distribution of HLA-A, -B, -C, -DPB1, -DQB1, and -DRB1 in renal transplant recipients and to ascertain their role in susceptibility to ESRD was performed on totally 149 subjects, consisting of 69 ESRD patients and 80 healthy controls. HLA typing was determined using Luminex techniques. The allele and haplotype frequencies were compared between ESRD patients and controls. Result. High-frequency alleles were HLA-A ∗ 24 (43.6%), B ∗ 15 (38.2%), C ∗ 08 (30.8%), DRB1 ∗ 12 (47.3%), DQB1 ∗ 03 (50.6%), and DPB1 ∗ 13 (22.5%). HLA-A ∗ 24 p = 0.01 and HLA-B ∗ 35 p = 0.02 were associated with a protective effect, with OR 0.537 (95%CI 0.34–0.86) and 0.316 (95%CI 0.11–0.88), respectively. There were some two-locus haplotypes associated with susceptibility to ESRD, such as B ∗ 15-DRB1 ∗ 12, B ∗ 13-DRB1 ∗ 15, A ∗ 02-B ∗ 15, A ∗ 02-C ∗ 08, and B ∗ 13-DQB1 ∗ 05. HLA-A ∗ 02-B ∗ 15-DRB1 ∗ 12 and A ∗ 24-B ∗ 13-DRB1 ∗ 15 appear to be associated with susceptibility to ESRD. Conclusion. The allele groups of HLA-A ∗ 24 and HLA-B ∗ 35 are associated with protection from ESRD. Meanwhile, HLA-B ∗ 13-DRB1 ∗ 15 and A ∗ 24-B ∗ 13-DRB1 ∗ 15 are the most frequent HLAs associated with ESRD in two-locus and three-locus haplotype, respectively.

scholarly journals Impact of kidney transplantation on the risk of retinal vein occlusion in end-stage renal disease

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jangwook Lee ◽  
Hye Rim Choe ◽  
Sang Hyun Park ◽  
Kyung Do Han ◽  
Dong Ki Kim ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Renal Disease ◽  
Retinal Vein Occlusion ◽  
End Stage Renal Disease ◽  
Charlson Comorbidity Index Score ◽  
Vein Occlusion ◽  
Increased Risk ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

AbstractIt has been known that retinal vein occlusion (RVO) is associated with chronic kidney disease, especially end-stage renal disease (ESRD). However, little is known about the effect of kidney transplantation (KT) on RVO incidence in ESRD patients. This study aimed to compare the incidence of RVO in KT recipients (n = 10,498), matched ESRD patients (n = 10,498), and healthy controls (HCs, n = 10,498), using a long-term population-based cohort. The incidence of RVO was 2.74, 5.68, and 1.02 per 1000 patient-years, for the KT group, the ESRD group, and the HCs group, respectively. Adjusted hazard ratios for RVO development compared to the HCs group, were 1.53 and 3.21, in the KT group and the ESRD group, respectively. In the KT group, multivariable regression analysis indicated that an age over 50, a Charlson Comorbidity Index score over 4, and a history of desensitization therapy were associated with an increased risk of RVO. In summary, KT recipients have a lower risk for development of RVO than ESRD patients treated with dialysis. However, the risk is still higher compared to healthy people who have normal kidney functions.

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