scholarly journals Comparison of prophylactic versus preemptive treatments in the management of cytomegalovirus infection in renal transplant recipients

2020 ◽  
pp. 67-72
Author(s):  
Cengiz Karaçin ◽  
Emre Yaşar ◽  
Özant Helvacı ◽  
Galip Güz
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Treatment Strategies ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Cmv Infection ◽  
Treatment Protocols ◽  
Preemptive Treatment ◽  
Prophylaxis Group ◽  
Significant Difference

To prevent acute or chronic rejection in renal transplant recipients, immunosuppressive treatments are applied. However, immunosuppressive treatments increase the risk of cytomegalovirus (CMV) infection. The aim of this study was to evaluate the differences in efficacy and cost of prophylactic and preemptive treatment strategies applied in respect of CMV infection to renal transplant recipients. Methods. Patients who underwent renal transplantation in our center between 2010 and 2015, were retrospectively analyzed. The patients were allocated in two groups as those who received prophylaxis or preemptive treatment. A record was made of the kidney function tests (KFT), CMV PCR copy numbers, the presence of CMV infection, antiviral treatments received, and the costs were calculated of the tests and treatments. The groups were compared in respect of CMV infection and costs. Results. A total of 71 patients with a median age of 38 years (range, 19-74 years) were included in the study. The prophylaxis group included 43 patients and the preemptive group included 28 patients. CMV infection was detected in 7 (16.3%) of the prophylaxis group and 2 (7.1%) patients of the preemptive group (p=0.467). The cost per month of the tests and treatment was lower in the preemptive group than in the prophylaxis group (p<0.001). Conclusion. No significant difference was determined between the prophylactic and preemptive treatment protocols in respect of the CMV infection in the intermediate-risk group renal transplantation recipients. Preemptive treatment was seen to be a more cost-effective method than prophylactic treatment in Turkey.

P1763TUBERCULOSIS IN RENAL TRANSPLANT RECEPIENTS - DO RITUXIMAB AND OTHER IMMUNOSUPRESSION HAVE A ROLE?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Anupma Kaul ◽  
Dharmendra Bhaduria ◽  
Narayan Prasad ◽  
Amit Gupta
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Immunosuppressive Agents ◽  
Induction Agent ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Transplant Patients ◽  
Significant Difference ◽  
High Prevalence ◽  
Mean Time

Abstract Background and Aims Rituximab is an anti CD 20 agent used widely in renal transplant recipients. Its use is associated with various infections;however, its association with Tuberculosis (TB) is not well established and has not been studied in post renal transplantation patients. Method This is a single centre, retrospective analysis of 56 renal transplant recipients who received rituximab for various reasons and 287 post renal transplant patients who did not receive rituximab during the study period from January 2013 to June 2017. The association between use of rituximab and incidence of TB was studied. Other factors associated with tuberculosis were also investigated. Results Baseline characteristics were similar in both the groups. Mean time for occurrence of TB was 18.4 + 10.6 months after renal transplantation. Rituximab use was not significantly associated with tuberculosis or any other infection. Higher number of rejection episodes (60% vs 32.72%, p=0.029) was the only factor associated with greater incidence of TB. However, no specific type of rejection was associated with tuberculosis. Use of plasmapheresis in post transplant period for treatment of humoral rejections was associated with significantly higher incidence of TB (33.33% vs 13.41%, p=0.031), however when pre- transplant plasmapheresis was also considered, there was no significant difference. The choice of induction agent was not associated with higher incidence of TB. Conclusion Use of rituximab is not associated with higher incidence of TB when compared to other immunosuppressive agents. Routine screening and prophylaxis may not be advisable especially in a country like India with high prevalence of TB; as it will further delay transplantation and may adversely affect the outcome of the patients.

scholarly journals Improved renal allograft survival for pre-emptive paediatric renal transplant recipients in the UK

2021 ◽  
pp. archdischild-2020-321277
Author(s):  
Matko Marlais ◽  
Kate Martin ◽  
Stephen D Marks
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Transplant ◽  
Renal Allograft ◽  
Cox Regression ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Allograft Survival ◽  
Significant Difference ◽  
Donor Type ◽  
The Uk

BackgroundThe aim of this study was to investigate whether being on dialysis at the time of renal transplantation affected renal allograft survival in paediatric renal transplant recipients (pRTRs).MethodsRetrospective study of UK Transplant Registry (National Health Service Blood and Transplant) data on all children (aged <18 years) receiving a kidney-only transplant from 1 January 2000 to 31 December 2015. Kaplan-Meier estimates of patient and renal allograft survival calculated and Cox regression modelling accounting for donor type. The relationship between time on dialysis and renal allograft survival was examined.Results2038 pRTRs were analysed: 607 (30%) were pre-emptively transplanted, 789 (39%) and 642 (32%) on peritoneal dialysis and haemodialysis, respectively, at the time of transplantation. Five-year renal allograft survival was significantly better in the pre-emptively transplanted group (90.6%) compared with those on peritoneal dialysis and haemodialysis (86.4% and 85.7%, respectively; p=0.02). After accounting for donor type, there was a significantly lower hazard of 5-year renal allograft failure in pre-emptively transplanted children (HR 0.742, p=0.05). Time spent on dialysis pre-transplant negatively correlated with renal allograft survival (p=0.002). There was no significant difference in 5-year renal allograft survival between children who were on dialysis for less than 6 months and children transplanted pre-emptively (87.5% vs 90.5%, p=0.25).ConclusionsPre-emptively transplanted children have improved 5-year renal allograft survival, compared with children on dialysis at the time of transplantation. Although increased time spent on dialysis correlated with poorer renal allograft survival, there was no evidence that short periods of dialysis pre-transplant affected renal allograft survival.

scholarly journals A clinical study of cutaneous manifestations in renal transplant recipients

2019 ◽  
Vol 5 (1) ◽  
pp. 160
Author(s):  
Pradeep Vittal Bhagwat ◽  
R. Rajagopal ◽  
P. S. Murthy ◽  
R. S. V. Kumar
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Viral Infections ◽  
Fungal Infections ◽  
Common Finding ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Drug Induced ◽  
Cutaneous Manifestations ◽  
Dermatological Examination

<p class="abstract"><strong>Background:</strong> Chronic renal failure is becoming common entity with increased incidence of diabetes mellitus and resulting diabetic nephropathy. With the availability of renal transplantation services in many centers, increased availability of donors, improved surgical technique and availability of better drugs, the survival of renal transplant recipients has increased. The objective of the study was to study the cutaneous manifestations in renal transplant recipients.</p><p class="abstract"><strong>Methods:</strong> Fifty consenting, consecutive renal transplant recipients attending the OPD and in-patients at Command Hospital Air Force, Bangalore during July 2001 to March 2003 were included in the study. Detailed history was taken and clinical examination was carried out with special emphasis on the Dermatological examination. Relevant investigations were carried out.<strong></strong></p><p class="abstract"><strong>Results:</strong> A total of 50 renal transplant recipients were studied of which 42 (84%) were males and 8 (16%) were females. The age of patients ranged from 16 years to 60 years. Infections were the most common finding, encountered in 38 (76%) patients, followed by drug induced manifestations in 24 (48%) patients. Cellulitis was noted in 1 (2%) patient, viral infections were seen in 18 (36%) patients, fungal infection was the commonest in this study, encountered in 38 (76%) patients. Monomorphic acne was seen in 13 (26%) patients. Hypertrichosis/hirsutism were the commonest drug induced manifestation in this study, seen in 16 (32%) patients.</p><p class="abstract"><strong>Conclusions:</strong> In patients with renal transplantation, superficial fungal infections and viral infections of the skin are seen more commonly. Monomorphic acne and hypertrichosis due to immunosuppressive are also seen frequently. These changes are moderately influenced by the immunosuppressive regimen used.</p>

scholarly journals Explained and Unexplained Ischemic Heart Disease Risk after Renal Transplantation

2000 ◽  
Vol 11 (9) ◽  
pp. 1735-1743 ◽  
Author(s):  
BERTRAM L. KASISKE ◽  
HARINI A. CHAKKERA ◽  
JOSEPH ROEL
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Renal Transplantation ◽  
Relative Risk ◽  
Renal Transplant ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Calcium Channel Antagonists ◽  
Relative Risks ◽  
Cholesterol Levels

Abstract. Whether the high incidence of ischemic heart disease (IHD) among renal transplant patients can be attributed to the same risk factors that have been identified in the general population is unclear. The risk for major IHD events occurring >1 yr after transplantation among 1124 transplant recipients was estimated by using the risk calculated from the Framingham Heart Study (FHS). The FHS risk predicted IHD (relative risk, 1.28; 95% confidence interval, 1.20 to 1.40; P < 0.001); however, the FHS risk tended to underestimate the risk of IHD for renal transplant recipients. This was largely attributable to increased risks associated with diabetes mellitus and, to a lesser extent, age and cigarette smoking for renal transplant recipients. For men, the relative risks for diabetes mellitus were 2.78 (1.73 to 4.49) and 1.53 for the transplant recipient and FHS populations, respectively; the relative risks for age (in years) were 1.06 (1.04 to 1.08) and 1.05, respectively, and those for smoking were 1.95 (1.20 to 3.19) and 1.69, respectively. For women, the relative risks for diabetes mellitus were 5.40 (2.73 to 10.66) and 1.82, respectively. There was a tendency for the risk associated with cholesterol levels to be higher for transplant recipients, compared with the FHS population, but the risks associated with high-density lipoprotein cholesterol levels and BP appeared to be comparable. Independent of these and other risk factors, the adjusted risk of IHD for the transplant recipient population has decreased. Compared with the era before 1986, transplantation between 1986 and 1992 was associated with a lower relative risk of 0.60 (0.39 to 0.92); transplantation after 1992 was associated with an even lower relative risk of 0.27 (0.11 to 0.63) for IHD. Of concern was the fact that dihydropyridine calcium channel antagonists were associated with an increased risk for IHD (relative risk, 2.26; 95% confidence interval, 1.24 to 4.12; P = 0.008), and this association was independent of other antihypertensive agents and risk factors. Therefore, although the FHS risk predicts IHD after renal transplantation, it tends to underestimate the risks, especially the risk associated with diabetes mellitus. The unexpected finding that dihydropyridine calcium channel antagonists were associated with an increased IHD risk merits further evaluation.

scholarly journals Barriers and Facilitators of Fruit and Vegetable Consumption in Renal Transplant Recipients, Family Members and Healthcare Professionals—A Focus Group Study

Nutrients ◽  
2019 ◽  
Vol 11 (10) ◽  
pp. 2427 ◽  
Author(s):  
Boslooper-Meulenbelt ◽  
Patijn ◽  
Battjes-Fries ◽  
Haisma ◽  
Pot ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Healthcare Professionals ◽  
Vegetable Consumption ◽  
Family Members ◽  
Fruit And Vegetable Consumption ◽  
Barriers And Facilitators ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Fruit And Vegetable

Low fruit and vegetable consumption is associated with poor outcomes after renal transplantation. Insufficient fruit and vegetable consumption is reported in the majority of renal transplant recipients (RTR). The aim of this study was to identify barriers and facilitators of fruit and vegetable consumption after renal transplantation and explore if certain barriers and facilitators were transplant-related. After purposive sampling, RTR (n = 19), their family members (n = 15) and healthcare professionals (n = 5) from a Dutch transplant center participated in seven focus group discussions (three each for RTR and family members, one with healthcare professionals). Transcripts were analyzed using social cognitive theory as conceptual framework and content analysis was used for identification of themes. Transplant-related barriers and facilitators were described separately. In categorizing barriers and facilitators, four transplant-related themes were identified: transition in diet (accompanied by, e.g., fear or difficulties with new routine), physical health (e.g., recovery of uremic symptoms), medication (e.g., cravings by prednisolone) and competing priorities after transplantation (e.g., social participation activities). Among the generic personal and environmental barriers and facilitators, food literacy and social support were most relevant. In conclusion, transplant-related and generic barriers and facilitators were identified for fruit and vegetable consumption in RTR. The barriers that accompany the dietary transition after renal transplantation may contribute to the generally poorer fruit and vegetable consumption of RTR. These findings can be used for the development of additional nutritional counseling strategies in renal transplant care.

Successful Triplet Pregnancy following Renal Transplantation

1980 ◽  
Vol 25 (4) ◽  
pp. 320-322 ◽  
Author(s):  
A. B. MacLean ◽  
F. Sharp ◽  
J. D. Briggs ◽  
S. G. MacPherson
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Clinical Course ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Triplet Pregnancy ◽  
Successful Case

There are now many reported successful pregnancies to renal transplant recipients, but this is believed to be the first reported successful case of triplets. The clinical course, complications and management of the pregnancy are described.

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.

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