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infection and kidney allograft

G Varela-Fascinetto, C Benchimol, R Reyes-Acevedo, M Genevray, D Bradley, J Ives, H T Silva
This multicenter, open-label study evaluated the tolerability of extended prophylaxis with valganciclovir in pediatric kidney transplant recipients at risk of CMV disease. Fifty-six patients aged 4 months to 16 years received once-daily valganciclovir oral solution and/or tablets, dosed by BSA and renal function, for up to 200 days. The most common AEs on treatment were upper respiratory tract infection (33.9%), urinary tract infection (33.9%), diarrhea (32.1%), leukopenia (25.0%), neutropenia (23.2%), and headache (21...
October 17, 2016: Pediatric Transplantation
Sandesh Parajuli, Dana F Clark, Arjang Djamali
Patients with CKD are at increased risk for cardiovascular events, hospitalizations, and mortality. Kidney transplantation (KTx) is the preferred treatment for end-stage kidney disease. Although comorbidities including anemia and bone and mineral disease improve or are even halted after KTx, kidney transplant recipients carry higher cardiovascular mortality risk than the general population, as well as an increased risk of infections, malignancies, fractures, and obesity. When comparing CKD with CKD after transplantation (CKD-T), the rate of decline of estimated glomerular filtration rate (eGFR) is significantly lower in CKD-T...
September 2016: Advances in Chronic Kidney Disease
Cyril Garrouste, Dany Anglicheau, Nassim Kamar, Claire Bachelier, Joseph Rivalan, Bruno Pereira, Sophie Caillard, Julien Aniort, Philippe Gatault, Martin Soubrier, Johnny Sayegh, Charlotte Colosio, Anthony Buisson, Eric Thervet, Nicolas Bouvier, Anne Elisabeth Heng
Anti-tumor necrosis factor-α (TNFα) therapy has improved the prognosis of many chronic inflammatory diseases. It appears to be well-tolerated by liver-transplant patients. However, their use and their safety in kidney-transplant patients have yet to be determined.In this retrospective study, we identified 16 adult kidney-transplant patients aged 46.5 years (34-51.8) who received anti-TNFα therapy from 7 kidney transplantation centers. The indications for this treatment included: chronic inflammatory bowel disease (n = 8), inflammatory arthritis (n = 5), AA amyloidosis (n = 1), psoriasis (n = 1), and microscopic polyangiitis (n = 1)...
October 2016: Medicine (Baltimore)
Mareen Matz, Christine Lorkowski, Katharina Fabritius, Kaiyin Wu, Birgit Rudolph, Stefan Frischbutter, Susanne Brakemeier, Jens Gaedeke, Hans-H Neumayer, Mir-Farzin Mashreghi, Klemens Budde
Cellular and antibody-mediated rejection processes and also interstitial fibrosis/tubular atrophy (IFTA) lead to allograft dysfunction and loss. The search for accurate, specific and non-invasive diagnostic tools is still ongoing and essential for successful treatment of renal transplanted patients. Molecular markers in blood cells and serum may serve as diagnostic tools but studies with high patient numbers and differential groups are rare. We validated the potential value of several markers on mRNA level in blood cells and serum protein level in 166 samples from kidney transplanted patients under standard immunosuppressive therapy (steroids±mycophenolic acid±calcineurin inhibitor) with stable graft function, urinary tract infection (UTI), IFTA, antibody-mediated rejection (ABMR), and T-cell-mediated rejection (TCMR) applying RT-PCR and ELISA...
September 29, 2016: Transplant Immunology
Darlene Vigil, Nikifor K Konstantinov, Marc Barry, Antonia M Harford, Karen S Servilla, Young Ho Kim, Yijuan Sun, Kavitha Ganta, Antonios H Tzamaloukas
Nephropathy secondary to BK virus, a member of the Papoviridae family of viruses, has been recognized for some time as an important cause of allograft dysfunction in renal transplant recipients. In recent times, BK nephropathy (BKN) of the native kidneys has being increasingly recognized as a cause of chronic kidney disease in patients with solid organ transplants, bone marrow transplants and in patients with other clinical entities associated with immunosuppression. In such patients renal dysfunction is often attributed to other factors including nephrotoxicity of medications used to prevent rejection of the transplanted organs...
September 24, 2016: World Journal of Transplantation
Sourabh Chand, David Atkinson, Clare Collins, David Briggs, Simon Ball, Adnan Sharif, Kassiani Skordilis, Bindu Vydianath, Desley Neil, Richard Borrows
BACKGROUND: Causes of "true" late kidney allograft failure remain unclear as study selection bias and limited follow-up risk incomplete representation of the spectrum. METHODS: We evaluated all unselected graft failures from 2008-2014 (n = 171; 0-36 years post-transplantation) by contemporary classification of indication biopsies "proximate" to failure, DSA assessment, clinical and biochemical data. RESULTS: The spectrum of graft failure changed markedly depending on the timing of allograft failure...
2016: PloS One
Edward J Filippone, John L Farber
Membranous nephropathy (MN) may occur in a kidney transplant as recurrence of the original disease (rMN) or as a de novo MN (dnMN). rMN often occurs early, within the first year, and often in a mild or subclinical fashion. Recurrence cannot be predicted by clinical features at the time of transplantation. The natural history is increasing proteinuria over time, with less chance for spontaneous remission compared to primary MN (pMN). Antiphospholipase A2 receptor (PLA2R) antibodies should be evaluated in all patients with pMN at the time of transplantation and serially...
September 20, 2016: Clinical Transplantation
D R Andes, N Safdar, J W Baddley, B Alexander, L Brumble, A Freifeld, S Hadley, L Herwaldt, C Kauffman, G M Lyon, V Morrison, T Patterson, T Perl, R Walker, T Hess, T Chiller, P G Pappas
BACKGROUND: Invasive candidiasis (IC) is a common cause of mortality in solid organ transplant recipients (OTRs), but knowledge of epidemiology in this population is limited. METHOD: The present analysis describes data from 15 US centers that prospectively identified IC from nearly 17,000 OTRs. Analyses were undertaken to determine predictors of infection and mortality. RESULTS: A total of 639 cases of IC were identified. The most common species was Candida albicans (46...
September 19, 2016: Transplant Infectious Disease: An Official Journal of the Transplantation Society
J Radtke, N Dietze, L Fischer, E-G Achilles, J Li, S Scheidat, F Thaiss, B Nashan, M Koch
BACKGROUND: BK polyomavirus (BKV) infection and BKV nephropathy (BKVN) are risk factors for allograft function and survival. METHODS: We retrospectively analyzed BK viremia and BKVN in 348 patients who received a kidney transplantation donated after brain death (n = 232) or living donation (n = 116) between 2008 and 2013. 266 patients were treated with standard immunosuppression consisting of basiliximab induction, calcineurin inhibitor (CNI), and mycophenolate (MPA, n = 219) or everolimus (n = 47)...
September 17, 2016: Transplant Infectious Disease: An Official Journal of the Transplantation Society
Thomas Schachtner, Maik Stein, Petra Reinke
The number of kidney transplant recipients (KTRs) after nonrenal solid organ transplantation (SOT) has increased to almost 5%. Knowledge on patient and allograft outcomes, infections, and alloreactivity, however, remains scarce. We studied 40 KTRs after nonrenal SOT. 720 primary KTRs and 119 repeat KTRs were used for comparison. Samples were collected pretransplantation, at +1, +2, and +3 months posttransplantation. Alloreactive and CMV-specific T-cells were measured by interferon-γ Elispot assay. Patient survival in KTRs after SOT, primary and repeat KTRs was comparable...
September 17, 2016: Transplant International: Official Journal of the European Society for Organ Transplantation
T Schachtner, P Reinke
BACKGROUND: Because of the strikingly increased risk of post-transplant lymphoproliferative disorder (PTLD) in Epstein-Barr virus (EBV)-seronegative kidney transplant recipients (KTRs) from EBV-seropositive donors - EBV(D(+) R(-) ), special strategies need to be defined to prevent EBV transmission and EBV viremia. METHODS: We studied all KTRs at our center between 2008 and 2012. Seventeen of 402 KTRs (4.2%) were identified as EBV(D(+) R(-) ), among which 5 KTRs received kidneys from living donors and 12 KTRs from deceased donors...
September 15, 2016: Transplant Infectious Disease: An Official Journal of the Transplantation Society
Pearlie P Chong, David van Duin, Jessica L Sonderup, Wendy J Grant, Andre C Kalil, Diana F Florescu
Solid organ transplant (SOT) recipients may develop protracted diarrheal illness from norovirus. We performed a retrospective chart review between January 2010 and April 2014 to identify predictors of persistent diarrhea in transplant recipients with norovirus enteritis. A total of 152 SOT recipients with mean age of 31.5 years (SD 23.1) were included: 43.4% male, 34.2% pediatric patients. Allograft types were abdominal 136 (89.5%) (kidney [39.5%], liver-small bowel [23%], other [27%]) and thoracic 16 (10...
October 6, 2016: Clinical Transplantation
H Maekawa, M Yazawa, K Koitabashi, N Imai, H Kawarazaki, R Nakazawa, H Sasaki, T Chikaraishi, Y Shibagaki
BACKGROUND: Hepatitis B virus (HBV) infection is a risk factor of mortality in kidney transplant recipients. However, information on the risk of HBV reactivation in kidney recipients with prior resolved HBV infection is limited. This study aimed to evaluate the safety of simply monitoring viral and liver markers in living donor kidney transplantation (LDKT) recipients with prior resolved HBV infection. METHODS: We retrospectively examined the clinical records of LDKT recipients...
July 2016: Transplantation Proceedings
Sawinski D, Patel N, Appolo B, Bloom Rd
BACKGROUND: Hepatitis C (HCV) infection is prevalent in the renal transplant population but direct acting antiviral agents (DAA) provide an effective cure of HCV infection without risk of allograft rejection. METHODS: We report our experience treating 43 renal transplant recipients with 4 different DAA regimens. RESULTS: 100% achieved a sustained viral response by 12 weeks after therapy and DAA regimens were well tolerated. Recipients transplanted with a HCV+ donor responded equally well to DAA therapy those transplanted with a kidney from a HCV negative donor, but recipients of HCV+ organs experienced significantly shorter wait-times to transplantation, 485 days (IQR 228-783) versus 969 days (IQR 452-2008) p=0...
August 4, 2016: Transplantation
Alexandre Jadoul, Pierre Lovinfosse, Laurent Weekers, Pierre Delanaye, Jean-Marie Krzesinski, Roland Hustinx, François Jouret
PURPOSE OF THE REPORT: F-FDG PET/CT has been recently proposed as a noninvasive tool for the diagnosis of renal allograft acute rejection (AR) in kidney transplant recipients (KTRs). Still, the influence of kidney function on F-FDG uptake by renal grafts remains unknown. PATIENTS AND METHODS: We retrospectively identified all KTRs who underwent at least one F-FDG PET/CT. Kidney transplant recipients with documented pyelonephritis or AR were excluded. Estimated glomerular filtration rate (eGFR) was assessed using chronic kidney disease (CKD)-EPI equation...
September 2016: Clinical Nuclear Medicine
Joanna M Schaenman, Yael Korin, Tiffany Sidwell, Fadi Kandarian, Nicholas Harre, David Gjertson, Erik L Lum, Uttam Reddy, Edmund Huang, Phuong T Pham, Suphamai Bunnapradist, Gabriel M Danovitch, Jefferey Veale, H Albin Gritsch, Elaine F Reed
BACKGROUND: BK virus infection remains an important cause of loss of allograft function after kidney transplantation. We sought to determine whether polyfunctional T cells secreting multiple cytokines simultaneously, which have been shown to be associated with viral control, could be detected early after start of BK viremia, which would provide insight into the mechanism of successful antiviral control. METHODS: Peripheral blood mononuclear cells collected during episodes of BK viral replication were evaluated by multiparameter flow cytometry after stimulation by overlapping peptide pools of BK virus antigen to determine frequency of CD8+ and CD4+ T cells expressing 1 or more cytokines simultaneously, as well as markers of T-cell activation, exhaustion, and maturation...
July 7, 2016: Transplantation
Seweryn Bialasiewicz, Gareth Hart, Kimberly Oliver, Shruti P Agnihotri, Igor J Koralnik, Raphael Viscidi, Michael D Nissen, Theo P Sloots, Michael T Burke, Nicole M Isbel, John Burke
BACKGROUND: A number of cerebral manifestations are associated with JC polyomavirus (JCPyV) which are diagnosed by detection of JCPyV in cerebrospinal fluid (CSF), often with the support of cerebral imaging. Here we present an unusual case of a kidney transplant patient presenting with progressive neurological deterioration attributed to JCPyV encephalopathy. METHODS: Quantitative polymerase chain reaction JCPyV was used prospectively and retrospectively to track the viral load within the patient blood, urine, CSF, and kidney sections...
June 30, 2016: Transplantation
Karolina Kłoda, Leszek Domański, Ewa Kwiatkowska, Krzysztof Safranow, Arleta Drozd, Andrzej Ciechanowicz, Kazimierz Ciechanowski
BACKGROUND Immunosenescence is closely linked to chromosome telomere erosion and telomerase activity alterations. The aim of this study was to analyze the associations of relative telomere length (RTL) of a graft with sex, comorbid conditions, post-transplant infections, and CMV reactivation among transplanted kidney recipients. Additionally, the associations of donor and recipient hTERT, BICD1 genes and chromosome 18 polymorphisms with post-transplant infections were analyzed, including the analysis of donor-recipient genotype pairs...
2016: Annals of Transplantation: Quarterly of the Polish Transplantation Society
Robert Y L Wang, Yi-Jung Li, Wei-Chen Lee, Hsin-Hsu Wu, Chan-Yu Lin, Cheng-Chia Lee, Yung-Chang Chen, Cheng-Chieh Hung, Chih-Wei Yang, Ya-Chung Tian
BK virus (BKV) is a polyomavirus that cause of allograft dysfunction among kidney transplant recipients. The role of BKV infection in non-renal solid organ transplant recipients is not well understood neither for the relationship between various BKV strains with occurrence of BKV viral viruria. This study aimed to understand the prevalence of BKV infection and identified of BKV various strains in the urine of liver transplant recipients. There was not significant difference of renal outcome between high BKV viruria and low BKV viruria in the liver transplant recipients...
2016: Scientific Reports
Marco A Lorio, Rossana Rosa, Jose F Suarez, Phillip Ruiz, Gaetano Ciancio, George W Burke, Jose F Camargo
BACKGROUND: HIV infection is associated with high rates of acute rejection following kidney transplantation. The underlying mechanisms for such predisposition are incompletely understood. Pathological immune activation is a hallmark of chronic HIV infection that persists despite effective antiretroviral therapy. We hypothesized that the baseline levels of T cell activation in HIV(+) candidates would correlate with their risk of acute rejection following kidney transplantation. METHODS: Single-center retrospective cohort analysis of HIV(+) adult kidney transplants performed between October 2006 and September 2013...
September 2016: Transplant Immunology
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