De Novo Minimal Change Disease following Vaccination with the Pfizer/BioNTech SARS-CoV-2 Vaccine in a Living Kidney Donor

Coronavirus disease 2019 has developed as a pandemic. Immunization with the introduction of vaccines against COVID-19 seems be the only way to end this pandemic. We report on a case of a kidney donor, who developed minimal change disease (MCD) within 4 days post-vaccination with the SARS-CoV-2 BNT162b2 mRNA vaccine (Pfizer/BioNTech). She donated her kidney to her husband 4 years ago. After receiving the 1st vaccine dose, she presented with nephrotic syndrome, with complete remission 5 days later. She proceeded with the second dose of the BNT162b2 vaccine at the appointed time. Two days later, she presented with a relapse of full-blown nephrotic syndrome with preserved renal function. We performed an ultrasound-guided percutaneous kidney biopsy and the final diagnosis was consistent with minimal change disease. Oral prednisolone was promptly initiated at a dosage of 1 mg/kg daily and complete remission was achieved 10 days later. More data about this rare appearance of de novo glomerular diseases after SARS-CoV-2 vaccination are emerging and should be interpreted rigorously.

RELATIONSHIP BETWEEN WARM ISCHEMIC TIME AND RESISTIVE INDEX ON CREATININ REDUCTION RATIO DAY TWO AFTER LIVING KIDNEY DONOR TRANSPLANTATION

Kidney transplantation (KT) may improve kidney function, via filtration, excretion, and hormonal function better than other kidney replacement therapies. Many factors may cause graft rejection or delayed graft function which may decrease the prognosis for graft survival. This study aims to determine associated factors of serum creatinine reduction ratio day 2 (CRR2) after living kidney donor transplants. This research used a retrospective cohort study design, with total sampling based on complete documents was done. A total 44 respondents (from 2012 to January 2020) and 22 respondents (based on the complete Resistive Index (RI) were recorded since 2018). Early Graft Function was defined using CRR2. Immediate Graft Function (IGF) was defined if CRR2 > 30% and Delayed Graft Function (DGF) if CRR2 ≤ 30%. The results of Multiple logistic regression analysis from 44 samples showed that Warm Ischemic Time (WIT) ≤ 40 minutes was significantly associated with IGF (OR 10.78; 95%CI: 1.66 to 70.16; p=0.01). A result with 22 samples showed that, only RI ≤ 0.7was significantly associated with IGF (OR 0.11; 95%CI: 0.03-0.41; p=0.002). In conclusion, WIT and RI influence on EGF with parameters CRR2 of living-donors. KT Patients with WIT ≤40 minutes and RI ≤0.7 had a higher risk of IGF.

Challenging (Organ and Global) Boundaries

The original living kidney paired exchanges (KPE) involved two donors who were ABO- or crossmatch incompatible with their intended recipients but were compatible with the other’s recipient such that they could “swap” kidneys. This chapter examines the ethical issues raised by two novel expansions of KPE: bi-organ (also known as trans-organ) exchange involving a living liver donor (donor-L)-kidney recipient (recipient-K) and a living kidney donor (donor-K)-liver recipient (recipient-L), and global kidney exchange (GKE) between a living kidney donor-recipient pair from a low to middle income country and living kidney donor-recipient pair(s) from a high income country. Although this chapter describes a case report of an ethical bi-organ exchange, bi-organ exchanges and GKE are usually unjust because they challenge the fair selection of donors. Bi-organ exchanges and GKE also raise significant deferential and infrastructural vulnerability challenges that threaten the donor’s ability (autonomy) to provide a voluntary and informed consent.

Is It Time to Utilize Genetic Testing for Living Kidney Donor Evaluation?

Living donor kidney transplantation is an effective strategy to mitigate the challenges of solid organ shortage. However, being a living kidney donor is not without risk, as donors may encounter short- and long-term complications including the risk of developing chronic kidney disease, end-stage kidney disease, hypertension, and possible pregnancy-related complications. Although the evaluation of potential living donors is a thorough and meticulous process with the intention of decreasing the chance of complications, particularly in donors who have lifetime risk projection, risk factors for kidney disease including genetic predispositions may be missed because they are not routinely investigated. This type of testing may not be offered to patients due to variability and decreased penetrance of symptoms and lack of availability of appropriate genetic testing and genetic specialists. We report a case of a middle-aged woman with a history of gestational diabetes and preeclampsia who underwent an uneventful living kidney donation. She developed postdonation nonnephrotic range proteinuria and microscopic hematuria. Given the risk of biopsy with a solitary kidney, genetic testing was performed and revealed autosomal dominant Alport syndrome. Our case underscores the utility of genetic testing. Hopefully, future research will examine the incorporation of predonation genetic testing into living kidney donor evaluation.

Artificial Intelligence—A Tool for Risk Assessment of Delayed-Graft Function in Kidney Transplant

Delayed-graft function (DGF) might be responsible for shorter graft survival. Therefore, a clinical tool predicting its occurrence is vital for the risk assessment of transplant outcomes. In a single-center study, we conducted data mining and machine learning experiments, resulting in DGF predictive models based on random forest classifiers (RF) and an artificial neural network called multi-layer perceptron (MLP). All designed models had four common input parameters, determining the best accuracy and discriminant ability: donor’s eGFR, recipient’s BMI, donor’s BMI, and recipient–donor weight difference. RF and MLP designs, using these parameters, achieved an accuracy of 84.38% and an area under curve (AUC) 0.84. The model additionally implementing a donor’s age, gender, and Kidney Donor Profile Index (KDPI) accomplished an accuracy of 93.75% and an AUC of 0.91. The other configuration with the estimated post-transplant survival (EPTS) and the kidney donor risk profile (KDRI) achieved an accuracy of 93.75% and an AUC of 0.92. Using machine learning, we were able to assess the risk of DGF in recipients after kidney transplant from a deceased donor. Our solution is scalable and can be improved during subsequent transplants. Based on the new data, the models can achieve better outcomes.

Early Hypertransaminasemia after Kidney Transplantation: Significance and Evolution According to Donor Type

Early hypertransaminasemia after kidney transplantation (KT) is frequent. It has been associated with the crosstalk produced between the liver and the kidney in ischemia-reperfusion situations. However, the influence of the donor type has not been evaluated. We present a retrospective study analyzing the increase in serum aspartate aminotransferase/alanine aminotransferase (AST/ALT) during the first three months post-KT in 151 recipients who received thymoglobulin as induction therapy, either from brain-death donors (DBD, n = 75), controlled circulatory death donors (cDCD, n = 33), or uncontrolled DCD (uDCD, n = 43). Eighty-five KT recipients from DBD who received basiliximab were included as controls. From KT recipients who received thymoglobulin, 33.6/43.4% presented with an increase in AST/ALT at 72 h post-KT, respectively. Regarding donor type, the percentage of recipients who experienced 72 h post-KT hypertransaminasemia was higher in uDCD group (65.1/83.7% vs. 20.3/26% in DBD and 20.7/27.6% in cDCD, p < 0.001). Within the control group, 9.4/12.9% of patients presented with AST/ALT elevation. One month after transplant, AST/ALT values returned to baseline in all groups. The multivariate analysis showed that uDCD recipients had 6- to 12-fold higher risk of developing early post-KT hypertransaminasemia. Early post-KT hypertransaminasemia is a frequent and transient event related to the kidney donor type, being more frequent in uDCD recipients.

Auricular field nerve stimulation using the NSS-2 BRIDGE® device as an alternative to opioids following kidney donor surgery

Objectives The purpose of this study was to investigate the role that the NSS-2 BRIDGE® device, an auricular field nerve stimulator, may play in reducing opioid requirement and pain in kidney donor surgery. It was not a randomized study. Electrophysiologic studies have demonstrated that the stimulation of the cranial nerves produced by the NSS-2 BRIDGE® device modulates the ascending/descending spinal pain pathways, especially at the level of the limbic system. Methods The design compared the effects of the NSS-2 BRIDGE® device (NSS 2-BRIDGE® device group; n=10) to a control group (n=10). In both groups, the surgery was performed using the same standard enhanced recovery after surgery protocol based on the use of a multimodal analgesic approach. For the active treatment group, the NSS-2 BRIDGE® device was placed in the post anesthesia care unit. The primary endpoint was opioid requirement (oral morphine equivalent, OME in mg) at 24 h post-surgery. Secondary endpoints included pain (0–10), at 24 and 48 h, time to discharge from the recovery room, incidence of post-operative nausea and vomiting at 24 h, time to oral intake, time to ambulation, and time to discharge from the hospital. Data was analyzed using unpaired t-test and presented as mean ± standard deviation. Results Compared to control, the use of the NSS-2 BRIDGE® was associated with a 75.4% reduction in OME (33.6 vs. 8.3 mg; p=0.03) and 41.5% reduction in pain (5 vs. 3.28; p=0.06) at 24 h and a 73.3% difference in pain at 48 h (1.6 ± 1.6 vs. 6.0 ± 2.8; p=0.0004). There was no difference in non-opioid analgesics administration between groups. Conclusions The tolerability of NSS-2 BRIDGE® device was reported by most to be excellent. This study suggests that the NSS-2 BRIDGE® device may represent a complementary approach for controlling postoperative opioid consumption and pain in patients undergoing kidney donation.