scholarly journals Calcium and phosphate levels after kidney transplantation and long-term patient and allograft survival

2020 ◽  
Author(s):  
Julio Chevarria ◽  
Donal J Sexton ◽  
Susan L Murray ◽  
Chaudhry E Adeel ◽  
Patrick O’Kelly ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Transplant ◽  
Graft Failure ◽  
Graft Function ◽  
Renal Transplant Recipients ◽  
Post Transplant ◽  
All Cause Mortality ◽  
Transplant Function ◽  
The Republic ◽  
The Impact

Abstract Background Non-traditional cardiovascular risk factors, including calcium and phosphate derangement, may play a role in mortality in renal transplant. The data regarding this effect are conflicting. Our aim was to assess the impact of calcium and phosphate derangements in the first 90 days post-transplant on allograft and recipient outcomes. Methods We performed a retrospective cohort review of all-adult, first renal transplants in the Republic of Ireland between 1999 and 2015. We divided patients into tertiles based on serum phosphate and calcium levels post-transplant. We assessed their effect on death-censored graft survival and all-cause mortality. We used Stata for statistical analysis and did survival analysis and spline curves to assess the association. Results We included 1525 renal transplant recipients. Of the total, 86.3% had hypophosphataemia and 36.1% hypercalcaemia. Patients in the lowest phosphate tertile were younger, more likely female, had lower weight, more time on dialysis, received a kidney from a younger donor, had less delayed graft function and better transplant function compared with other tertiles. Patients in the highest calcium tertile were younger, more likely male, had higher body mass index, more time on dialysis and better transplant function. Adjusting for differences between groups, we were unable to show any difference in death-censored graft failure [phosphate = 1.14, 95% confidence interval (CI) 0.92–1.41; calcium = 0.98, 95% CI 0.80–1.20] or all-cause mortality (phosphate = 1.10, 95% CI 0.91–1.32; calcium = 0.96, 95% CI 0.81–1.13) based on tertiles of calcium or phosphate in the initial 90 days. Conclusions Hypophosphataemia and hypercalcaemia are common occurrences post-kidney transplant. We have identified different risk factors for these metabolic derangements. The calcium and phosphate levels exhibit no independent association with death-censored graft failure and mortality.

scholarly journals Autoantibodies to Apolipoprotein A-1 as Independent Predictors of Cardiovascular Mortality in Renal Transplant Recipients

2019 ◽  
Vol 8 (7) ◽  
pp. 948 ◽  
Author(s):  
Josephine L.C. Anderson ◽  
Sabrina Pagano ◽  
Julien Virzi ◽  
Robin P.F. Dullaart ◽  
Wijtske Annema ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Transplant ◽  
Graft Failure ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Hdl Functionality ◽  
All Cause Mortality ◽  
Cvd Mortality

Renal transplant recipients (RTRs) are known to have a high cardio-vascular disease (CVD) burden only partly explained by traditional CVD risk factors. The aim of this paper was therefore to determine: i) the prognostic value of autoantibodies against apoA-1 (anti-apoA-1 IgG) for incidence of CVD mortality, all-cause mortality and graft failure in RTR. Four hundred and sixty two (462) prospectively included RTRs were followed for 7.0 years. Baseline anti-apoA-1 IgG were determined and associations with incidence of CVD mortality (n = 48), all-cause mortality (n = 92) and graft failure (n = 39) were tested. Kaplan–Meier analyses demonstrated significant associations between tertiles of anti-apoA-1 IgG and CVD mortality (log rank test: p = 0.048). Adjusted Cox regression analysis showed a 54% increase in risk for CVD mortality for each anti-apoA-1 IgG levels standard deviation increase (hazard ratio [HR]: 1.54, 95% Confidence Interval [95%CI]: 1.14–2.05, p = 0.005), and a 33% increase for all-cause mortality (HR: 1.33; 95%CI: 1.06–1.67, p = 0.01), independent of CVD risk factors, renal function and HDL function. The association with all-cause mortality disappeared after excluding cases of CVD specific mortality. The sensitivity, specificity, positive predictive value, and negative predictive value of anti-apoA-1 positivity for CVD mortality were 18.0%, 89.3%, 17.0%, and 90.0%, respectively. HDL functionality was not associated with anti-apoA-1 IgG levels. This prospective study demonstrates that in RTR, anti-apoA-1 IgG are independent predictors of CVD mortality and are not associated with HDL functionality.

scholarly journals Right Ventricular Dysfunction and Adverse Outcomes after Renal Transplantation

2021 ◽  
Vol 11 (2) ◽  
pp. 109-118
Author(s):  
Megan S. Joseph ◽  
Francis Tinney ◽  
Abhijit Naik ◽  
Raviprasenna Parasuraman ◽  
Milagros Samaniego-Picota ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Right Ventricular ◽  
Graft Failure ◽  
Graft Function ◽  
Systolic Pressure ◽  
Right Ventricular Dysfunction ◽  
Adverse Outcomes ◽  
Renal Transplant Recipients ◽  
End Point ◽  
The Impact

<b><i>Introduction:</i></b> Pulmonary hypertension is common among patients with end-stage renal disease, although data regarding the impact of right ventricular (RV) failure on postoperative outcomes remain limited. We hypothesized that echocardiographic findings of RV dilation and dysfunction are associated with adverse clinical outcomes after renal transplant. <b><i>Methods:</i></b> A retrospective review of adult renal transplant recipients at a single institution from January 2008 to June 2010 was conducted. Patients with transthoracic echocardiograms (TTEs) within 1 year leading up to transplant were included. The primary end point was a composite of delayed graft function, graft failure, and all-cause mortality. <b><i>Results:</i></b> Eighty patients were included. Mean follow-up time was 9.4 ± 0.8 years. Eight patients (100%) with qualitative RV dysfunction met the primary end point, while 39/65 patients (60.0%) without RV dysfunction met the end point (<i>p</i> = 0.026). Qualitative RV dilation was associated with a significantly shorter time to all-cause graft failure (<i>p</i> = 0.03) and death (<i>p</i> = 0.048). RV systolic pressure was not measurable in 45/80 patients (56%) and was not associated with outcomes in the remaining patients. <b><i>Conclusion:</i></b> RV dilation and dysfunction are associated with adverse outcomes after renal transplant. TTE assessment of RV size and function should be a standard part of the pre-kidney transplant cardiovascular risk assessment.

Vaccination titres pre- and post-transplant in paediatric renal transplant recipients and the impact of immunosuppressive therapy

2018 ◽  
Vol 33 (5) ◽  
pp. 897-910 ◽  
Author(s):  
Britta Höcker ◽  
Martin Aguilar ◽  
Paul Schnitzler ◽  
Lars Pape ◽  
Martin Bald ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Immunosuppressive Therapy ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Post Transplant ◽  
The Impact

A comprehensive genotype–phenotype interaction of different Toll-like receptor variations in a renal transplant cohort

2010 ◽  
Vol 119 (12) ◽  
pp. 535-544 ◽  
Author(s):  
Bernd Krüger ◽  
Miriam C. Banas ◽  
Andreas Walberer ◽  
Carsten A. Böger ◽  
Stefan Farkas ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Acute Rejection ◽  
Graft Function ◽  
Major Adverse Cardiovascular Events ◽  
Renal Transplant Recipients ◽  
Nucleotide Polymorphisms ◽  
Toll Like Receptor ◽  
Receptor System ◽  
Cardiovascular Morbidity And Mortality ◽  
The Impact

To date, the impact of the TLR (Toll-like receptor) system on early and late kidney transplantation outcome, such as ARE (acute rejection episodes) or cardiovascular morbidity and mortality, has still not been elucidated conclusively. Genetically determined alterations in TLR expression exhibit a possibility to evaluate their role in transplantation. In the present study, we sought to determine a comprehensive genotype–phenotype association with early and late allograft outcomes. We studied 11 SNPs (single nucleotide polymorphisms) in TLR2, TLR3, TLR4, TLR5, TLR9 and within a co-molecule CD14 in 265 patients receiving their first kidney transplant and the association of these with the occurrence of DGF (delayed graft function), ARE or MACE (major adverse cardiovascular events). ARE were significantly more frequent in patients carrying the TLR3 TT/CT allele (43.8 compared with 25.8%; P=0.001) as were rates of DGF (21.4 compared with 12.0%; P=0.030). Furthermore, TLR9 was significantly involved in the occurrence of MACE (TLR9 −1237; P=0.030). Interestingly, there was no significant effect of any TLR polymorphism on graft survival or renal function and the incidence of any infection, including CMV (cytomegalovirus) infection. In conclusion, our present study in renal transplant recipients suggests that the TLR system may be involved in both acute rejection and MACE. Modulation of the TLR system may be a promising target in future therapeutic strategies.

scholarly journals Initial mycophenolate dose in tacrolimus treated renal transplant recipients, a cohort study comparing leukopaenia, rejection and long-term graft function

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Vatsa Dave ◽  
Kevan R. Polkinghorne ◽  
Khai Gene Leong ◽  
John Kanellis ◽  
William R. Mulley
Keyword(s):  
Renal Function ◽  
Cohort Study ◽  
Renal Transplant ◽  
Graft Function ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Post Transplantation ◽  
Post Transplant ◽  
Increased Risk

Abstract The evidence supporting an initial mycophenolate mofetil (MMF) dose of 2 g daily in tacrolimus-treated renal transplant recipients is limited. In a non-contemporaneous single-centre cohort study we compared the incidence of leukopaenia, rejection and graft dysfunction in patients initiated on MMF 1.5 g and 2 g daily. Baseline characteristics and tacrolimus trough levels were similar by MMF group. MMF doses became equivalent between groups by 12-months post-transplant, driven by dose reductions in the 2 g group. Leukopaenia occurred in 42.4% of patients by 12-months post-transplant. MMF 2 g was associated with a 1.80-fold increased risk of leukopaenia compared to 1.5 g. Rejection occurred in 44.8% of patients by 12-months post-transplantation. MMF 2 g was associated with half the risk of rejection relative to MMF 1.5 g. Over the first 7-years post-transplantation there was no difference in renal function between groups. Additionally, the development of leukopaenia or rejection did not result in reduced renal function at 7-years post-transplant. Leukopaenia was not associated with an increased incidence of serious infections or rejection. This study demonstrates the initial MMF dose has implications for the incidence of leukopaenia and rejection. Since neither dose produced superior long-term graft function, clinical equipoise remains regarding the optimal initial mycophenolate dose in tacrolimus-treated renal transplant recipients.

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