scholarly journals Protocol Biopsies on de novo Renal-Transplants at 3 Months after Surgery: Impact on 5-Year Transplant Survival

2021 ◽  
Vol 10 (16) ◽  
pp. 3635
Author(s):  
Florian Terrec ◽  
Johan Noble ◽  
Hamza Naciri-Bennani ◽  
Paolo Malvezzi ◽  
Bénédicte Janbon ◽  
...  
Keyword(s):  
Graft Survival ◽  
Kidney Biopsy ◽  
De Novo ◽  
Immunosuppressive Regimen ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Post Transplantation ◽  
Kaplan Meier ◽  
Single Center Study ◽  
Protocol Biopsies

Background: In many centers, a protocol kidney biopsy (PKB) is performed at 3 months post-transplantation (M3), without a demonstrated benefit on death-censored graft survival (DCGS). In this study, we compared DCGS between kidney transplant recipients undergoing a PKB or without such biopsy while accounting for the obvious indication bias. Methods: In this retrospective, single-center study conducted between 2007 and 2013, we compared DCGS with respect to the availability and features of a PKB. We built a propensity score (PS) to account for PKB indication likelihood and adjusted the DCGS analysis on PKB availability and the PS. Results: A total of 615 patients were included: 333 had a PKB, 282 did not. In bivariate Kaplan–Meier survival analysis, adjusting for the availability of a PKB and for the PS, a PKB was associated with a better 5-year DCGS independently of the PS (p < 0.001). Among the PKB+ patients, 87 recipients (26%) had IF/TA > 0. Patients with an IF/TA score of 3 had the worst survival. A total of 144 patients (44%) showed cv lesions. Patients with cv2 and cv3 lesions had the worst 5-year DCGS. Conclusions: A M3 PKB was associated with improved graft survival independently of potential confounders. These results could be explained by the early treatment of subclinical immunological events. It could be due to better management of the immunosuppressive regimen.

scholarly journals Induction and Donor Specific Antibodies in Low Immunologic Risk Kidney Transplant Recipients

Kidney360 ◽  
2020 ◽  
Vol 1 (12) ◽  
pp. 1407-1418
Author(s):  
Natalie M. Bath ◽  
Arjang Djamali ◽  
Sandesh Parajuli ◽  
Didier Mandelbrot ◽  
Glen Leverson ◽  
...  
Keyword(s):  
Chart Review ◽  
De Novo ◽  
Retrospective Chart Review ◽  
High Volume ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Specific Antibodies ◽  
Kaplan Meier ◽  
Donor Specific Antibodies ◽  
One Year

BackgroundOptimal induction for patients without pretransplant donor-specific antibodies (DSAs) is poorly defined. The goal of this study was to compare the incidence of de novo DSA (dnDSA) and graft outcomes between induction therapies in patients with a negative virtual crossmatch (VXM).MethodsA retrospective chart review was performed, identifying 782 patients with a negative VXM who underwent kidney transplantation at a single, high-volume institution between January 2013 and May 2017. Kaplan–Meier analysis was used to assess the incidence of dnDSA and allograft survival between induction therapies in this group. dnDSA is defined as the development of new post-transplant DSA, at any MFI level.ResultsInduction therapy included alemtuzumab (N=87, 11%), basiliximab (N=522, 67%), and anti-thymocyte globulin (ATG; N=173, 22%). One-year graft survival was similar between groups (alemtuzumab, 100%; basiliximab, 98%; ATG, 99%). Incidence of acute rejection at 1 year was <2% and not different between the three groups. Alemtuzumab was associated with the highest incidence of dnDSA at 14%, compared with 5% and 8% in basiliximab and ATG groups, respectively, at 1 year (P=0.009). In multivariate regression analyses, alemtuzumab retained its significant association with a dnDSA HR of 2.5 (95% CI, 1.51 to 4.25; P=0.0004).ConclusionsIn summary, alemtuzumab was associated with a higher rate of dnDSA development in patients with a negative VXM; however, this finding was not associated with rejection or graft failure.

P1704POST-TRANSPLANTATION LYPMHOPROLIFERATIVE DISORDER (PTLD) RISK AND PROGNOSTIC FACTORS IN KIDNEY AND LIVER TRANSPLANT RECIPIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Rafal Staros ◽  
Bartosz Foroncewicz ◽  
Krzysztof Zieniewicz ◽  
Maciej Kosieradzki ◽  
Sławomir Nazarewski ◽  
...  
Keyword(s):  
Viral Infections ◽  
Response To Treatment ◽  
Rank Test ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Post Transplantation ◽  
Kaplan Meier ◽  
Patients At Risk ◽  
Risk Of Disease ◽  
Liver Transplant Recipients

Abstract Background and Aims Post-transplantation lymphoprolipherative disorder [PTLD] is a serious, potentially fatal complication of transplantation [Tx], pathogenesis of which remains to be fully understood. Due to the intrinsic difficulty of assembling a large cohort of rare disease patients, most research papers have investigated PTLD in the general graft recipient population. They report however, that the relative risk of disease development significantly varies in relation to the type of transplanted organ, with multiorgan and intestinal graft recipients possessing the highest risk (RR=239.5), liver (RR=29.9) and the lowest for kidney transplant recipients (RR=12.6). The aim of this study was to investigate the factors contributing to the development, course, treatment and outcomes of PTLD and compare their impact on the populations of liver [LTR] and kidney [KTR] transplant recipients. Method In this retrospective cohort study we have included all KTRs and LTRs diagnosed with PTLD at our centres between 2002 and 2017. The following data were collected from the patients’ medical records: immunosuppression (IS), viral infections, PTLD type, treatment and outcomes. Mann-Whitney U-test was used to assess the differences in group composition, and the Log-rank test was used to compare Kaplan-Meier curves. Statistical analysis was performed in R version 3.2.3., p-values below .05 were considered statistically significant. Results We have identified 23 LTR and 16 KTR who matched our inclusion criteria. The mean age was 40.69 years. 61.5% of the patients were male, 38.5% female. Analysis of Kaplan-Meier curves revealed that PTLD occurred earlier in: LTRs (p&lt;.001); patients above the median age of 45 years at Tx (p=.002); patients whose IS regimens at the time of PTLD diagnosis contained tacrolimus [TAC] (p&lt;.001) or did not contain cyclosporin [CsA]. Among KTRs PTLD was diagnosed earlier in males (p&lt;0.05), patients over 45 years at Tx (p&lt;0.05), and those receiving TAC-containing IS regimens at PTLD diagnosis (p&lt;0.05). These factors were not statistically significant for LTRs, among whom PTLD development was affected by the presence of MMF in IS regimens at diagnosis (p&lt;0.05). Survival time was longer for patients receiving MMF-containing IS regimens (p&lt;0.05). LTRs were more likely than KTRs to achieve complete remission in response to treatment (p&lt;0.05). Conclusion Our results indicate, that in comparable KTR and LTR populations, the course of PLTD and response to treatment vary significantly. Factors such as patients’ age at transplantation, sex, type of maintenance IS have a different impact depending on graft type. In our opinion these findings, when applied to further research, could enhance our ability to identify patients at risk and potentially lead to the formation of more personalised guidelines to the diagnosis and treatment of PTLD.

scholarly journals MP29-18 ANALYSIS OF DE NOVO UROLOGIC CANCER IN KIDNEY TRANSPLANT RECIPIENTS: SINGLE CENTER STUDY OF 3,951 CASES

2016 ◽  
Vol 195 (4S) ◽  
Author(s):  
Jaeyoon Jung ◽  
Sangjun Yoo ◽  
Se Young Choi ◽  
Wonseok Choi ◽  
Jae Hyeon Han ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
De Novo ◽  
Transplant Recipients ◽  
Single Center ◽  
Kidney Transplant Recipients ◽  
Single Center Study ◽  
Urologic Cancer ◽  
Center Study

scholarly journals Effect of Preformed or De Novo Anti-HLA Antibodies on Function and Graft Survival in Kidney Transplant Recipients

2018 ◽  
Vol 23 ◽  
pp. 457-466 ◽  
Author(s):  
Marcos Vinicius de Sousa ◽  
Ana Claudia Gonçalez ◽  
Ricardo de Lima Zollner ◽  
Marilda Mazzali
Keyword(s):  
Kidney Transplant ◽  
Graft Survival ◽  
De Novo ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Hla Antibodies

scholarly journals BK Polyomavirus Micro-RNAs: Time Course and Clinical Relevance in Kidney Transplant Recipients

Viruses ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 351
Author(s):  
Baptiste Demey ◽  
Véronique Descamps ◽  
Claire Presne ◽  
Francois Helle ◽  
Catherine Francois ◽  
...  
Keyword(s):  
Viral Replication ◽  
Kidney Transplant ◽  
Clinical Relevance ◽  
Graft Loss ◽  
First Year ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Post Transplantation ◽  
Bk Polyomavirus ◽  
Micro Rnas

Background: Kidney transplant recipients (KTRs) are exposed to a high risk of BK polyomavirus (BKPyV) replication, which in turn may lead to graft loss. Although the microRNAs (miRNAs) bkv-miR-B1-3p and bkv-miR-B1-5p are produced during the viral cycle, their putative value as markers of viral replication has yet to be established. In KTRs, the clinical relevance of the changes over time in BKPyV miRNA levels has not been determined. Methods: In a retrospective study, we analyzed 186 urine samples and 120 plasma samples collected from 67 KTRs during the first year post-transplantation. Using a reproducible, standardized, quantitative RT-PCR assay, we measured the levels of bkv-miR-B1-3p and bkv-miR-B1-5p (relative to the BKPyV DNA load). Results: Detection of the two miRNAs had low diagnostic value for identifying patients with DNAemia or for predicting DNAuria during follow-up. Seven of the 14 KTRs with a sustained BKPyV infection within the first year post-transplantation showed a progressive reduction in the DNA load and then a rapid disappearance of the miRNAs. DNA and miRNA loads were stable in the other seven KTRs. Conclusions: After the DNA-based diagnosis of BKPyV infection in KTRs, bkv-miR-B1-3p and bkv-miR-B1-5p levels in the urine might be valuable markers for viral replication monitoring and thus might help physicians to avoid an excessive reduction in the immunosuppressive regimen.

scholarly journals Outcomes of Kidney Transplant Recipients with Sickle Cell Disease: An Analysis of the 2000–2019 UNOS/OPTN Database

2021 ◽  
Vol 10 (14) ◽  
pp. 3063
Author(s):  
Napat Leeaphorn ◽  
Charat Thongprayoon ◽  
Pradeep Vaitla ◽  
Panupong Hansrivijit ◽  
Caroline C. Jadlowiec ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Graft Survival ◽  
Patient Survival ◽  
Transplant Recipients ◽  
Cell Disease ◽  
Kidney Transplant Recipients ◽  
Allograft Survival ◽  
End Stage Kidney Disease ◽  
Kidney Recipients ◽  
End Stage

Background: Lower patient survival has been observed in sickle cell disease (SCD) patients who go on to receive a kidney transplant. This study aimed to assess the post-transplant outcomes of SCD kidney transplant recipients in the contemporary era. Methods: We used the OPTN/UNOS database to identify first-time kidney transplant recipients from 2010 through 2019. We compared patient and allograft survival between recipients with SCD (n = 105) vs. all other diagnoses (non-SCD, n = 146,325) as the reported cause of end-stage kidney disease. We examined whether post-transplant outcomes improved among SCD in the recent era (2010–2019), compared to the early era (2000–2009). Results: After adjusting for differences in baseline characteristics, SCD was significantly associated with lower patient survival (HR 2.87; 95% CI 1.75–4.68) and death-censored graft survival (HR 1.98; 95% CI 1.30–3.01), compared to non-SCD recipients. The lower patient survival and death-censored graft survival in SCD recipients were consistently observed in comparison to outcomes of recipients with diabetes, glomerular disease, and hypertension as the cause of end-stage kidney disease. There was no significant difference in death censored graft survival (HR 0.99; 95% CI 0.51–1.73, p = 0.98) and patient survival (HR 0.93; 95% CI 0.50–1.74, p = 0.82) of SCD recipients in the recent versus early era. Conclusions: Patient and allograft survival in SCD kidney recipients were worse than recipients with other diagnoses. Overall SCD patient and allograft outcomes in the recent era did not improve from the early era. The findings of our study should not discourage kidney transplantation for ESKD patients with SCD due to a known survival benefit of transplantation compared with remaining on dialysis. Urgent future studies are needed to identify strategies to improve patient and allograft survival in SCD kidney recipients. In addition, it may be reasonable to assign risk adjustment for SCD patients.

scholarly journals Review of Outcomes after Diagnosis of Malignancy in Kidney Transplant Patients: UNOS Database

2021 ◽  
Vol 2 (3) ◽  
pp. 253-263
Author(s):  
Het Patel ◽  
Nikhil Agrawal ◽  
Voravech Nissaisorakarn ◽  
Ridhi Gupta ◽  
Francesca Cardarelli
Keyword(s):  
Kidney Transplant ◽  
Graft Failure ◽  
Event Analysis ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Time To Event ◽  
Transplant Patients ◽  
Kaplan Meier ◽  
Lung Malignancy ◽  
Kidney Transplant Patients

Malignancy is the third major cause of death among transplant recipients. Patient and kidney transplant outcomes after the diagnosis of malignancy are not well described. We reviewed incidences and outcomes of colorectal, lung, PTLD, and renal malignancy after transplant among patients who received a transplant from January 2000 to December 2018 using the UNOS/OPTN database. Incidence of each malignancy was measured at 5 years and 10 years of transplant. The Kaplan–Meier curve was used for time-to-event analysis (graft and patient outcomes). Additionally, we sought to identify the causes of graft failure among these recipients. We found that 12,764 (5.5%) patients suffered malignancy, excluding squamous and basal cell skin carcinoma after transplant. During the first 5 years of transplant, incidence of colorectal, lung, PTLD, and renal malignancies was 2.99, 9.21, 15.61, and 8.55 per 10,000 person-years, respectively. Rates of graft failure were 10.3%, 7.6%, 19.9%, and 18.8%, respectively, among these patients at 5 years. Mortality rate was highest among patients who suffered lung malignancy (84%), followed by colorectal (61.5%), PTLD (49.1%), and renal (35.5%) at 5 years after diagnosis of malignancy. In conclusion, kidney transplant recipients diagnosed with lung malignancy have the lowest graft survival, compared to PTLD, colorectal, and renal malignancy. PTLD has the highest incidence rate in the first 5 years of transplant.

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