scholarly journals Impact of Timely Public Health Measures on Kidney Transplantation in Austria during the SARS-CoV-2 Outbreak—A Nationwide Analysis

2020 ◽  
Vol 9 (11) ◽  
pp. 3465
Author(s):  
Bruno Watschinger ◽  
Clara Watschinger ◽  
Roman Reindl-Schwaighofer ◽  
Elias L. Meyer ◽  
Andras T. Deak ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Case Fatality ◽  
Organizational Structures ◽  
Kidney Transplant Recipients ◽  
Healthcare Facilities ◽  
Transplant Patients ◽  
Kidney Transplant Patients ◽  
The Government ◽  
Considerable Morbidity

SARS-CoV-2 led to considerable morbidity/mortality worldwide and tremendously impacted on daily life. Strict lockdown measures were implemented early to contain the viral outbreak in Austria. Massive changes in organizational structures of healthcare facilities followed with unclear implications on the care of non-COVID-19-affected patients. We studied the nationwide impact of COVID-19 on kidney transplantation in Austria during the first six months of 2020. Concurrent with general lockdown measures, all kidney transplant activity was suspended from 13 March to 9 April. Nevertheless, between January and June, total transplant (p = 0.48) and procured donor organ numbers (p = 0.6) did not differ significantly from earlier years. Ten (0.18%) of 5512 prevalent Austrian kidney transplant recipients were diagnosed with SARS-CoV-2. The case fatality rate (one death; 10%) in renal transplant patients was less than in other countries but higher than in Austria’s general population (2.4%). We conclude that early and strict general lockdown measures imposed by the government allowed an early, however cautious, re-opening of Austrian transplant programs and played a crucial role for the favorable outcomes of SARS-CoV-2 in Austrian kidney transplant patients. Even though it may be uncertain whether similar results may be obtainable in other countries, the findings may support early intervention strategies during similar episodes in the future.

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.

scholarly journals 530. COVID-19 in kidney transplant recipients: Single-center experience and case-control study

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S332-S332
Author(s):  
Anna Hardesty ◽  
Aakriti Pandita ◽  
Yiyun Shi ◽  
Kendra Vieira ◽  
Ralph Rogers ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Case Control Study ◽  
Clinical Course ◽  
Case Series ◽  
Case Fatality ◽  
Case Control ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Transplant Patients ◽  
Control Study

Abstract Background Organ transplant recipients (OTR) are considered high-risk for morbidity and mortality from COVID-19. Case-fatality rates (CFR) vary significantly in different case series, and some patients were still hospitalized at the time of analyses. To our knowledge, no case-control study of COVID-19 in OTR has been published to-date. Methods We captured kidney transplant recipients (KTR) diagnosed with COVID-19 between 3/1 and 5/18/2020. After exclusion of KTR on hemodialysis and off immunosuppression (IS), we compared the clinical course of COVID-19 between hospitalized KTR and non-transplant patients, matched by sex and age (controls). All patients were discharged from the hospital or died. Results 16 KTR had COVID-19. All 3 KTR off IS, who were excluded from further analyses, survived. Median age was 54 (range: 34–65) years; 5/13 KTR (38.4%) were men. Median time from transplant was 41 (range: 1–203) months. Two KTR, both transplanted >10 years ago, were managed as outpatients. IS was reduced in 12/13 (92.3%), most often by discontinuation of the antimetabolite. IL6 levels were >1,000 (normal: < 5) pg/mL in 3 KTR. Tacrolimus or sirolimus levels were >10 ng/mL in 6/9 KTR (67%) (Table 1). Eleven KTR were hospitalized (84.6%) and matched with 44 controls. One KTR, the only one treated with hydroxychloroquine, died (CFR 5.8%; 7.6% in KTR on IS; 9% in hospitalized KTR on IS). Four controls died (CFR: 9%; state CFR: 5.2%; inpatient CFR: 16.6%). There were no significant differences in length of stay or worst oxygenation status between hospitalized KTR and controls. Four KTR (30.7%), received remdesivir, 4 convalescent plasma, 3 (23%) tocilizumab. KTR received more often broad-spectrum antibiotics, convalescent plasma or tocilizumab, compared to controls (Table 2). Table 1 Table 2 Conclusion Unlike early reports from the pandemic epicenters, the clinical course and outcomes of KTR with COVID-19 in our small case series were comparable to those of non-transplant patients. Calcineurin or mTOR inhibitor levels were high, likely due to diarrhea and COVID-19-related hepatic dysfunction. Extremely high IL6 levels were common. The role of IS and potential benefits from investigational treatments remain to be elucidated. A larger multi-institutional study is underway. Disclosures All Authors: No reported disclosures

scholarly journals Effect of Remdesivir on COVID-19 PCR Positivity and Cycle Threshold in Kidney Transplant Recipients

2021 ◽  
Vol 2 (3) ◽  
pp. 291-293
Author(s):  
Ryan J. Winstead ◽  
Johanna Christensen ◽  
Sara Sterling ◽  
Megan Morales ◽  
Dhiren Kumar ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Cycle Threshold ◽  
Transplant Patients ◽  
Kidney Transplant Patients ◽  
Polymerase Chain ◽  
New Diagnosis ◽  
The Impact ◽  
Median Change

Information regarding Coronavirus disease 2019 in the transplant population is lacking. Recently it has been suggested that cycle threshold values obtained on polymerase chain reaction tests may serve as a marker of disease severity with lower values (i.e., higher viral load) being associated with higher mortality. This study was done to assess the impact of remdesivir use on the time to a negative COVID-19 PCR as well as the degree of change between two Ct’s based on treatment. A total of 30 kidney transplant patients with a new diagnosis of COVID-19 were assessed. Serial PCR results were followed from the time of diagnosis then every 2–4 weeks until negative. In patients who received remdesivir immediately after COVID-19 confirmation compared to no remdesivir, time to negative PCR was not statistically different with a median duration of 57 days in both groups (p = 0.369). The change in the Ct between the first and the second PCR test was also not statistically different between groups with a median change of 18.4 cycles in the remdesivir group and 15.7 cycles without remdesivir (p = 0.516). The results of this small single-center analysis suggest that remdesivir may not be beneficial in shortening time to a negative COVID-19 PCR.

Evaluation of Quality of Life among Kidney Transplant Patients- A Cross Sectional Study

2021 ◽  
Vol 15 (11) ◽  
pp. 3087-3089
Author(s):  
Rashida Jabeen ◽  
Kousar Perveen ◽  
Muhammad Afzal ◽  
Sadia Khan
Keyword(s):  
Quality Of Life ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Cross Sectional Study ◽  
P Value ◽  
Sectional Study ◽  
Cross Sectional ◽  
Transplant Patients ◽  
Kidney Transplant Patients

Kidney transplantation is the famous and most important choice of treatment of renal replacement therapies (RRTs) because of its positive impact on morbidity, survival and cost. The health related quality of life is becoming important outcome. Quality of life is usually impaired in patients who have renal transplant because of renal transplant patients have anxiety, lack of social, physical and emotional support and diminished ability to take care of themselves. The basic purpose of renal transplantation is to achieve maximum quality of life with minimum side effects. Methods: A cross sectional study was conducted at Rukhsana Akhtar Bahria International Orchard Hospital Lahore after approval from institution board of university of Lahore. 36 patients were enrolled in study by using purposive sampling technique. After taking informed consent all Kidney transplant patients aged between 18 years to 60 years, visited the post-transplantation OPD and continuously in follow-up sessions were included in study. A validated and standard WHO questionnaire of “Kidney Disease and Quality of Life (KDQOL-36™)” was used for data collection. Data was entered and analyzed in SPSS version.21.Chi-square test was applied to find out significant association between qualitative variables. P -Value < 0.05will be considered as statistically significant. Results: Majority of patients were from 40-49 years 10(27.0%). Females were more as compared to men (20(55.6) vs 16(44.4%)). 10(27.8) patients can read and write and 8(22.2%) have done matriculation. More patients live in Urban area as compared to rural area(19(52.8%) vs 17(47.2%)).8(22.2%) patients have less than 1 year of post kidney transplantation time and 19(52.8%) have 1 to 3 years. All the seven domains of KDQOL show poor QOL. General Health, Physical function and physical and emotional function shows average QOL and Emotional, social, daily activities and overall KDQOL shows poor QOL. There was insignificant association with age, gender, education; residential area and Post kidney transplantation length of time (years)(p-value > 0.05). Conclusions: After renal transplantation HRQOL becomes very important factor. After kidney transplantation HRQOL depends on many factors. It was concluded from current study that the HRQOL was not as good as it should be. Over the period of transplantation time patient’s quality of life remain same. The society, government, family, and medical staff need to support patients so they can also improve their QOL. Key word: Renal Diseases, Kidney transplant, Quality of life, KDQOL-36

scholarly journals A Systematic Review of COVID-19 Infection in Kidney Transplant Recipients: A Universal Effort to Preserve Patients’ Lives and Allografts

2020 ◽  
Vol 9 (9) ◽  
pp. 2986 ◽  
Author(s):  
Smaragdi Marinaki ◽  
Stathis Tsiakas ◽  
Maria Korogiannou ◽  
Konstantinos Grigorakos ◽  
Vassilios Papalois ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Distress Syndrome ◽  
Kidney Injury ◽  
Deceased Donor ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Male Predominance ◽  
Transplant Patients ◽  
Kidney Transplant Patients ◽  
The Mean

The coronavirus disease 2019 (COVID-19) pandemic has posed a significant challenge to physicians and healthcare systems worldwide. Evidence about kidney transplant (KTx) recipients is still limited. A systematic literature review was performed. We included 63 articles published from 1 January until 7 July 2020, reporting on 420 adult KTx recipients with confirmed COVID-19. The mean age of patients was 55 ± 15 years. There was a male predominance (67%). The majority (74%) were deceased donor recipients, and 23% were recently transplanted (<1 year). Most patients (88%) had at least one comorbidity, 29% had two, and 18% three. Ninety-three percent of cases were hospitalized. Among them, 30% were admitted to the intensive care unit, 45% developed acute respiratory distress syndrome, and 44% had acute kidney injury with 23% needing renal replacement therapy. From the hospitalized patients a total of 22% died, 59% were discharged, and 19% were still in hospital at the time of publication. Immunosuppression was reduced in 27%, discontinued in 31%, and remained unchanged in 5%. Hydroxychloroquine was administered to 78% of patients, antibiotics to 73%, and antivirals to 30% while 25% received corticosteroid boluses, 28% received anti-interleukin agents, and 8% were given immunoglobulin. The main finding of our analysis was that the incidence of COVID-19 among kidney transplant patients is not particularly high, but when they do get infected, this is related to significant morbidity and mortality.

scholarly journals Is delayed graft function associated with ureteral stenosis in the kidney transplant recipient? A case-control study

2019 ◽  
Vol 13 (11) ◽  
Author(s):  
Axel Cayetano-Alcaraz ◽  
Juan Sebastian Rodriguez-Alvarez ◽  
Mario Vilatobá-Chapa ◽  
Josefina Alberú-Gómez ◽  
Bernardo Gabilondo-Pliego ◽  
...  
Keyword(s):  
Risk Factor ◽  
Kidney Transplant ◽  
Kidney Transplant Recipient ◽  
Graft Function ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Transplant Patients ◽  
Increased Risk ◽  
Kidney Transplant Patients ◽  
Control Study

Introduction: Ureteral stricture (US) in the kidney transplant recipient is a rare complication that can lead to morbidity and graft loss. Risk factor recognition is crucial in the prevention and management of this entity. Delayed graft function (DGF), as defined by the need for dialysis in the first week after transplantation, has been proposed as a risk factor in previous studies. Our objective is to determine the impact of DGF in US development in kidney transplant patients. Methods: We designed a matched case-control study. US cases in kidney transplant recipients were identified in the 2008–2017 period. We defined US as the rise in serum creatinine associated with findings suggesting obstruction in ultrasound, scintigraphy, or retrograde pyelogram; any other cause of graft dysfunction was excluded. Controls were defined as kidney transplant recipients from the same population and period without US, matched in a 1:2 fashion by age, sex, and donor type. Results: From 532 kidney transplant patients, 31 cases and 62 controls were included. Cumulative US incidence was 58 per 1000 cases. When calculating for odds ratio (OR), post-operative urinoma (OR 3.2; 95% confidence interval [CI] 2.36–4.37) and ureteral duplication (OR 3.29; 95% CI 2.40–4.51) were associated with an increased risk for US, while DGF was not found to be statistically significant as a risk factor (OR 3.3; 95% CI 0.96–11.52). No statistically significant differences were found between groups in other pre- and post-transplant-related factors. Conclusions: DGF was not associated with US in our cohort; however, ureteral duplication and postoperative urinoma were associated with an increased risk of graft ureteral stenosis development.

scholarly journals Effect of CYP3A4*22, POR*28, and PPARA rs4253728 on Sirolimus In Vitro Metabolism and Trough Concentrations in Kidney Transplant Recipients

2013 ◽  
Vol 59 (12) ◽  
pp. 1761-1769 ◽  
Author(s):  
Jean-Baptiste Woillard ◽  
Nassim Kamar ◽  
Sandra Coste ◽  
Lionel Rostaing ◽  
Pierre Marquet ◽  
...  
Keyword(s):  
Adverse Events ◽  
Kidney Transplant ◽  
Calcineurin Inhibitor ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Transplant Patients ◽  
Kidney Transplant Patients ◽  
Trough Concentrations ◽  
The Impact

BACKGROUND Recent studies have identified new candidate polymorphisms in the genes related to CYP3A activity or calcineurin inhibitor dose requirements in kidney transplant recipients. These genes and polymorphisms are CYP3A4 (cytochrome P450, family 3, subfamily A, polypeptide 4) (rs35599367-C&gt;T; *22); POR [P450 (cytochrome) oxidoreductase] (rs1057868-C&gt;T; *28); and PPARA (peroxisome proliferator-activated receptor alpha) (rs4253728-G&gt;A). We investigated the impact of these polymorphisms on sirolimus (SRL) in vitro hepatic metabolism, SRL trough concentrations (C0), and SRL adverse events in kidney transplant recipients. METHODS The clinical study included 113 stable kidney transplant patients switched from a calcineurin inhibitor to SRL (SRL C0 measured at 1, 3, and 6 months thereafter). We investigated SRL metabolism in vitro using human liver microsomes derived from individual donors (n = 31). Microsomes and patients were genotyped by use of Taqman® allelic discrimination assays. The effects of polymorphisms and covariates were studied using multilinear regression imbedded in linear mixed-effect models or logistic regressions. RESULTS In vitro, the CYP3A4*22 allele resulted in approximately 20% lower metabolic rates of SRL (P = 0.0411). No significant association was found between CYP3A4, CYP3A5, or PPARA genotypes and SRL dose, C0, or C0/dose in kidney transplant patients. POR*28 was associated with a minor but significant decrease in SRL log-transformed C0 [CT/TT vs CC, β = −0.15 (0.05); P = 0.0197] but this did not have any impact on the dose administered, which limited the relevance of the finding. After adjustment for nongenetic covariates and correction for false discovery finding, none of the single-nucleotide polymorphisms tested showed significant association with SRL adverse events. CONCLUSIONS These recently described polymorphisms do not seem to substantially influence the pharmacokinetics of SRL or the occurrence of SRL adverse events in kidney transplant recipients.

scholarly journals Gene Co-expression Networks Are Associated with Obesity-Related Traits in Kidney Transplant Recipients

2020 ◽  
Author(s):  
Rosario B Jaime-Lara ◽  
Abhrarup Abe Roy ◽  
Yupeng Wang ◽  
Ansley Stanfill ◽  
Ann K Cashion ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Expression Patterns ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Microarray Expression Data ◽  
Transplant Patients ◽  
Clinical Trait ◽  
Kidney Transplant Patients ◽  
Microarray Expression ◽  
Subcutaneous Adipose

Abstract Background Obesity is common among kidney transplant recipients; However biological mediators of obesity are not well understood in this population. Because subcutaneous adipose tissue can be easily obtained during kidney transplant surgery, it provides a unique avenue for studying the mechanisms of obesity for this group. Although differential gene expression patterns were previously profiled for kidney transplant patients, gene co-expression patterns can shed light on gene modules not yet explored on the coordinative behaviors of gene transcription in biological and disease processes from a systems perspective. Methods In this study, we collected 29 demographic and clinical variables and matching microarray expression data for 26 kidney transplant patients. We conducted Weighted Gene Co-expression Network Analysis (WGCNA) for 5,758 genes with the highest average expression levels and related gene co-expression to clinical traits. Results A total of 35 co-expression modules were detected, two of which showed associations with obesity-related traits, mainly at baseline. Gene Ontology (GO) enrichment was found for these two clinical trait-associated modules. One module consisting of 129 genes was enriched for a variety of processes, including cellular homeostasis and immune responses. The other module consisting of 36 genes was enriched for tissue development processes. Conclusions Our study generated gene co-expression modules associated with obesity-related traits in kidney transplant patients and provided new insights regarding the cellular biological processes underlying obesity in this population.

scholarly journals Nursing Care for Kidney Transplant Patients: A Scoping Review

Aquichan ◽  
2021 ◽  
Vol 21 (3) ◽  
pp. 1-15
Author(s):  
Cintia Capistrano Teixeira Rocha ◽  
Alcides Viana da Lima Neto ◽  
Ana Beatriz Pereira da Silva ◽  
Victor Alexandre Silva Farias ◽  
Aurean D’Eça Junior ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Nursing Care ◽  
Scoping Review ◽  
Scientific Rigor ◽  
Transplant Patients ◽  
Primary Health ◽  
Study Results ◽  
Kidney Transplant Patients ◽  
Selection Of

Objectives: Mapping nursing care in kidney transplant patients. Materials and method: A scoping review was conducted according to the recommendations of the Joanna Briggs Institute Reviewers’ Manual. Data were collected through 13 national and international databases from December 2020 to January 2021, following scientific rigor in the selection of the material. The pre-selection was made by reading the title, abstract and introductory text in advance; the materials included in this stage were read in full to define the content for the study. Results: Fifteen studies were included. Of these, 60% are articles; dissertations, manuals, protocols, guidelines and bulletins totaled 40% of the material studied. 86.6% of the material has a quantitative approach. Regarding the methodological design, 73.3% were descriptive/transversal character studies. Regarding the mapping of nursing care, it was possible to divide them into two categories: nursing care after kidney transplantation (immediate, mediated and late) and nursing care after kidney transplantation in primary health/extra-hospital care. Conclusions: It is concluded that the study allowed mapping nursing care to kidney transplant patients in the immediate, late and primary health care periods.

scholarly journals Gene Co-expression Networks Are Associated with Obesity-Related Traits in Kidney Transplant Recipients

2019 ◽  
Author(s):  
Rosario B Jaime-Lara ◽  
Abhrarup Abe Roy ◽  
Yupeng Wang ◽  
Ansley Stanfill ◽  
Ann K Cashion ◽  
...  
Keyword(s):  
Gene Ontology ◽  
Weight Gain ◽  
Kidney Transplant ◽  
Expression Patterns ◽  
Enrichment Analysis ◽  
Kidney Transplant Recipients ◽  
Microarray Expression Data ◽  
Transplant Patients ◽  
Clinical Trait ◽  
Kidney Transplant Patients

Abstract Background: Weight gain is often observed following kidney transplantation. Biological mediators of weight gain are not well understood in this population. Because subcutaneous adipose tissue can be easily obtained during kidney transplant surgery, it provides a unique avenue for studying the mechanisms of obesity for this group.Although differential gene expression patterns were previously profiled for kidney transplant patients, gene co-expression patterns can shed light on gene modules not yet explored on the coordinative behaviors of gene transcription in biological and disease processes. Methods: In this study, we collected 29 demographic and clinical variables and matching microarray expression data for 26 kidney transplant patients. We conducted Weighted Gene Co-expression Network Analysis (WGCNA) for 5,758 genes with the highest average expression levels and related gene co-expression to clinical traits. Results: A total of 35 co-expression modules were detected, seven of which showed association with clinical traits. Gene Ontology (GO) enrichment was found for five clinical trait-associated modules. One module consisting of 129 genes was enriched for metabolic and immune processes. The genes within this module were associated with multiple obesity-related traits, and is consistent with findings of previous studies in other clinically obese populations. Conclusions : Our study generatedgene coexpression modules associated with obesity-related traits in kidney transplant patients and provided new insights regarding the cellular biological processes underlying obesity. Trial Registration: N/A Keywords : co-expression modules, obesity, association, enrichment analysis, gene ontology, kidney transplant

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