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.

Mesangial sclerosis in a patient with type 1 diabetes following simultaneous pancreas-kidney transplantation despite maintenance of normoglycemia: a case report

Background Simultaneous pancreas-kidney transplantation is considered a curative treatment for type 1 diabetes complicated by end-stage kidney disease. We report herein a case of mesangial sclerosis in a patient who underwent successful kidney-pancreas transplantation despite well-controlled glucose and excellent pancreatic allograft function. Case presentation A 76-year-old type 1 diabetic man who underwent a simultaneous pancreas-kidney transplantation 19 years prior presented with persistent nephrotic range proteinuria although creatinine was at his baseline (normal) level. Hemoglobin A1c and fasting glucose were well controlled without the use of insulin or oral antihyperglycemic agents. Serum lipase and amylase were within the reference range and there was no evidence of donor-specific antibodies. Kidney allograft biopsy was performed to evaluate proteinuria and showed diffuse capillary loop thickening and diffuse moderate to severe mesangial sclerosis resembling diabetic nephropathy. Conclusions This case demonstrates a case of mesangial sclerosis resembling diabetic nephropathy in a patient with good glucose control after simultaneous pancreas-kidney transplantation with excellent pancreatic allograft function.

Excessive Positive Fluid Balance Has A Negative Effect On Short-Term Renal Outcomes After Kidney Transplantation

Background: Optimized postoperative fluid management is important for maintaining early allograft function after kidney transplantation (KT). However, there is still no clear guidance regarding fluid treatment after KT. In this study, we investigated the effect of perioperative fluid balance on postoperative allograft function.Methods: Recipients who underwent KT between March 2012 and August 2018 were included, and their medical records were reviewed retrospectively. We calculated fluid balance, which is the difference between total input and output during the 3 days after KT, and analyzed the change in estimated glomerular filtration rate (eGFR) according to fluid balance.Results: A total of 178 patients were included after excluding those with delayed graft function or urine output <2000 ml on the first day after KT. Among them, 116 received kidneys from living donors and 62 received kidneys from deceased donors. The total fluid balance up to day 3 was 4,236.9 ± 2830.4 ml. Old age, high body mass index (BMI), excessive positive fluid balance of the recipient, and high final creatinine of the donor were significantly associated with low eGFR at 1 week. In addition, old age, BMI, and fluid balance of the recipient predicted the 1-month eGFR. In multivariate analysis, an excessive positive fluid balance was an independent predictor of low 1-week eGFR (p=0.031). Conclusions: This study demonstrated that excessive positive fluid balance can negatively affect early graft function after KT. Proper fluid management strategies based on volume conditions may provide important therapeutic opportunities to improve early renal outcomes after KT.

Prolonged islet allograft function is associated with female sex in patients after islet transplantation

Background Islet transplantation (ITx) has proved to be effective in preventing severe hypoglycemia and improving metabolic control in selected subjects with T1D. Long-term graft function remains a challenge. Estrogens have been shown to protect β-cells from metabolic stresses and improve revascularization of transplanted human islets in the mouse. We aimed to evaluate the influence of sex in allograft survival of ITx recipients. Methods We analyzed a retrospective cohort of ITx recipients (n=56) followed-up for up to 20 years. Allograft failure was defined as a stimulated C-peptide &lt;0.3 ng/ml during a mixed-meal tolerance test. Subjects were divided into recipients of at least one female donor (Group 1) and recipients of male donors only (Group 2). Results Group 1 subjects (n=25) were aged 41.5 ± 8.4 years and Group 2 subjects (n=22) 45.9 ± 7.3 years (P= 0.062). Female recipient frequency was 44.8% (n=13) in Group 1 and 55.2% (n=16) in Group 2 (P=0.145). Group 2 developed graft failure earlier than Group 1 [680 (286 – 1624) vs. 1906 (756 – 3256) days, P= 0.038]. We performed additional analyses on female recipients only from each group (Group 1, n= 16, Group 2, n=20). Female recipients in Group 1 exhibited prolonged allograft function compared to Group 2, after adjustment for confounders (OR: 28.6, CI: 1.3 – 619.1; P &lt; 0.05). Conclusion Recipients of islets from at least one female donor exhibited prolonged graft survival compared to recipients of islets from exclusively male donors. In addition, female recipients exhibited prolonged survival compared to male recipients following ITx of at least one female donor.