Poor Long-Term Renal Allograft Survival in Patients with Chronic Antibody-Mediated Rejection, Irrespective of Treatment—A Single Center Retrospective Study

The Banff 2017 report permits the diagnosis of pure chronic antibody-mediated rejection (cAMR) in absence of microcirculation inflammation. We retrospectively investigated renal allograft function and long-term outcomes of 67 patients with cAMR, and compared patients who received antihumoral therapy (cAMR-AHT, n = 21) with patients without treatment (cAMRwo, n = 46). At baseline, the cAMR-AHT group had more concomitant T-cell-mediated rejection (9/46 (19.2%) vs. 10/21 (47.6%); p = 0.04), a higher g-lesion score (0.4 ± 0.5 versus 0.1 ± 0.3; p = 0.01) and a higher median eGFR decline in the six months prior to biopsy (6.6 vs. 3.0 mL/min; p = 0.04). The median eGFR decline six months after biopsy was comparable (2.6 vs. 4.9 mL/min, p = 0.61) between both groups, and three-year graft survival after biopsy was statistically lower in the cAMR-AHT group (35.0% vs. 61.0%, p = 0.03). Patients who received AHT had more infections (0.38 vs. 0.20 infections/patient; p = 0.04). Currently, antihumoral therapy is more often administered to patients with cAMR and rapidly deteriorating renal function or concomitant TCMR. However, long-term graft outcomes remain poor, despite treatment.

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Long-term renal allograft function under maintenance immunosuppression with cyclosporin A or azathioprine: A single center, five-year follow-up study

Transplant International ◽

10.1111/j.1432-2277.1991.tb01972.x ◽

1991 ◽

Vol 4 (1) ◽

pp. 166-172 ◽

Cited By ~ 1

Author(s):

Rolf Linder ◽

Anders Lindholm ◽

Anthony Restifo ◽

Frans Duraj ◽

Carl-Gustav Groth

Keyword(s):

Cyclosporin A ◽

Renal Allograft ◽

Single Center ◽

Follow Up Study ◽

Maintenance Immunosuppression ◽

Allograft Function

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Renal function in patients receiving long-term cyclosporine therapy.

Journal of the American Society of Nephrology ◽

10.1681/asn.v48s17 ◽

1994 ◽

Vol 4 (8) ◽

pp. S17

Author(s):

D H Van Buren ◽

J F Burke ◽

R M Lewis

Keyword(s):

Renal Function ◽

Prospective Studies ◽

Renal Allograft ◽

Transplant Recipients ◽

Cyclosporine Therapy ◽

Allograft Function ◽

Serial Serum ◽

Toxic Nephropathy ◽

Subsequent Stabilization

The site at which the vasomotor effects of cyclosporine are associated with acute nephrotoxicity appears to be the afferent arteriole. Proposed mechanisms mediating these effects include sympathetic nerve stimulation, disruption of the balance between vasodilating and vasoconstricting prostaglandins, hypersensitivity to vasoactive peptides, and endothelin release. These mechanisms mediate cyclosporine-associated intrarenal vasoconstriction, yet the causal relationship between these changes and the obliterative vasculopathy seen in association with chronic progressive renal allograft dysfunction is uncertain. Histologic findings seen in chronic progressive renal dysfunction are nonspecific and cannot be correlated solely with cyclosporine use. Retrospective studies analyzing both aggregate serial serum creatinine and reciprocal creatinine determinations did not report a pattern of progressive attrition consequent to toxic nephropathy. Prospective studies with serial GFR determinations with various reference substances found no progressive deterioration in allograft function. Both the retrospective and prospective studies indicate that the attrition of renal allograft function associated with cyclosporine use reflect the chronic effects of immunologic injury. Renal function in extrarenal transplant recipients immunosuppressed with cyclosporine can be characterized by an initial decline in native renal function followed by subsequent stabilization beyond the first 6 months. There does not appear to be an inordinate rate of progression to ESRD.

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Slope of changes in renal function in the first year post-transplantation and one-yr estimated glomerular filtration rate together predict long-term renal allograft survival

Clinical Transplantation ◽

10.1111/j.1399-0012.2009.01186.x ◽

2010 ◽

Vol 24 (6) ◽

pp. 862-868 ◽

Cited By ~ 19

Author(s):

Jianyong Wu ◽

Hui Li ◽

Hongfeng Huang ◽

Rending Wang ◽

Yimin Wang ◽

...

Keyword(s):

Renal Function ◽

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Filtration Rate ◽

Renal Allograft ◽

Estimated Glomerular Filtration Rate ◽

First Year ◽

Allograft Survival ◽

Post Transplantation

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Long-Term Outcomes of Transsphenoidal Surgery for Management of Growth Hormone–Secreting Adenomas: Single-Center Results

10.1055/s-0040-1702475 ◽

2020 ◽

Author(s):

Mohammed Asha ◽

Hirokazu Takami ◽

Carlos Velasquez ◽

Selfy Oswari ◽

Joao Paulo Almeida ◽

...

Keyword(s):

Growth Hormone ◽

Transsphenoidal Surgery ◽

Single Center ◽

Long Term Outcomes ◽

Growth Hormone Secreting Adenomas

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Surgery for Aortic and Aortic Valve Pathology in Bicuspid and Tricuspid Valves Has Excellent Short- and Long-Term Outcomes: A Single-Center Experience

10.1055/s-0040-1705405 ◽

2020 ◽

Author(s):

K. Penov ◽

E. Westarp ◽

D. Radakovic ◽

V. Sales ◽

N. Madrahimov ◽

...

Keyword(s):

Aortic Valve ◽

Single Center ◽

Long Term Outcomes ◽

Single Center Experience ◽

Short And Long Term ◽

Valve Pathology

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Faculty Opinions recommendation of Catheter ablation for the treatment of electrical storm in patients with implantable cardioverter-defibrillators: short- and long-term outcomes in a prospective single-center study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1100303.576920 ◽

2008 ◽

Author(s):

Jesus Almendral

Keyword(s):

Catheter Ablation ◽

Electrical Storm ◽

Implantable Cardioverter Defibrillators ◽

Single Center ◽

Long Term Outcomes ◽

Single Center Study ◽

Short And Long Term ◽

Cardioverter Defibrillators ◽

Center Study

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Assessment of Kidney Function After Transcatheter Aortic Valve Replacement

Canadian Journal of Kidney Health and Disease ◽

10.1177/20543581211018029 ◽

2021 ◽

Vol 8 ◽

pp. 205435812110180

Author(s):

Orit Kliuk-Ben Bassat ◽

Sapir Sadon ◽

Svetlana Sirota ◽

Arie Steinvil ◽

Maayan Konigstein ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Kidney Function ◽

Transcatheter Aortic Valve Replacement ◽

Kidney Injury ◽

Single Center ◽

Transcatheter Aortic Valve ◽

Single Center Study ◽

Center Study

Background: Transcatheter aortic valve replacement (TAVR), although associated with an increased risk for acute kidney injury (AKI), may also result in improvement in renal function. Objective: The aim of this study is to evaluate the magnitude of kidney function improvement (KFI) after TAVR and to assess its significance on long-term mortality. Design: This is a prospective single center study. Setting: The study was conducted in cardiology department, interventional unit, in a tertiary hospital. Patients: The cohort included 1321 patients who underwent TAVR. Measurements: Serum creatinine level was measured at baseline, before the procedure, and over the next 7 days or until discharge. Methods: Kidney function improvement was defined as the mirror image of AKI, a reduction in pre-procedural to post-procedural minimal creatinine of more than 0.3 mg/dL, or a ratio of post-procedural minimal creatinine to pre-procedural creatinine of less than 0.66, up to 7 days after the procedure. Patients were categorized and compared for clinical endpoints according to post-procedural renal function change into 3 groups: KFI, AKI, or preserved kidney function (PKF). The primary endpoint was long-term all-cause mortality. Results: The incidence of KFI was 5%. In 55 out of 66 patients patients, the improvement in kidney function was minor and of unclear clinical significance. Acute kidney injury occurred in 19.1%. Estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 was a predictor of KFI after multivariable analysis (odds ratio = 0.93 to develop KFI; confidence interval [95% CI]: 0.91-0.95, P < .001). Patients in the KFI group had a higher Society of Thoracic Surgery (STS) score than other groups. Mortality rate did not differ between KFI group and PKF group (43.9% in KFI group and 33.8% in PKF group) but was significantly higher in the AKI group (60.7%, P < .001). Limitations: The following are the limitations: heterozygous definitions of KFI within different studies and a single center study. Although data were collected prospectively, analysis plan was defined after data collection. Conclusions: Improvement in kidney function following TAVR was not a common phenomenon in our cohort and did not reduce overall mortality rate.

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