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induction of immunosuppression in renal transplantation

O Konno, T Yokoyama, Y Kihara, Y Nakamura, T Ueno, H Takeuchi, H Iwamoto
BACKGROUND: Extended-release tacrolimus (TacER), administered once daily, offers improved adherence with reduced side effects while still maintaining an immunosuppressive potency equivalent to that of conventional tacrolimus preparations. METHODS: The study included 83 patients who received consecutive living-donor kidney transplants at our facility from June 2013 to December 2016. Comparisons were made between 48 cases of induction with TacER and 35 cases of induction with cyclosporine (CyA)...
October 2018: Transplantation Proceedings
Y Liu, H Liu, Y Shen, Y Chen, Y Cheng
BACKGROUND: Tacrolimus is widely used in renal transplantation to help prevent acute and chronic rejection, but the nephrotoxicity of tacrolimus may compromise renal function. This study investigates the safety and efficacy in delayed initiation of tacrolimus after antilymphocyte induction therapy in kidney transplant recipients. METHODS: This retrospective cohort analysis involved data from 68 kidney transplant recipients receiving standard induction therapy (basiliximab [Simulect] or thymoglobulin) combined with tacrolimus...
October 2018: Transplantation Proceedings
Su Hooi Teo, Kian-Guan Lee, Gek Hsiang Lim, Si Xuan Koo, Maria Erika Ramirez, Khuan Yew Chow, Terence Kee
INTRODUCTION: Data on post-kidney transplantation (KTX) malignancy is limited in our region, leading to challenges in the care of renal allograft recipients. We aimed to examine the epidemiology, risk factors and outcomes of post-KTX patients. METHODS: A retrospective cohort study was conducted of 491 patients who underwent KTX from 1 January 2000 to 31 December 2011. Data linkage analysis was done between our centre and the National Registry of Disease Office to determine the standardised incidence ratio (SIR), standardised mortality ratio (SMR) and risk factors for malignancy after KTX...
October 10, 2018: Singapore Medical Journal
Cornelius C Thaiss, Tetsu Oura, Hajime Sasaki, Abbas Dehnadi, Masatoshi Matsunami, Ivy A Rosales, Benedict A Cosimi, Tatsuo Kawai
BACKGROUND: Although induction of durable mixed chimerism is required for murine skin allograft tolerance, renal allograft tolerance has been achieved after induction of only transient mixed chimerism in nonhuman primates (NHPs) and humans. To better define the level/duration of chimerism required for stable renal allograft tolerance, we retrospectively analyzed these parameters and compared them with transplant outcomes in NHP combined kidney and bone marrow transplant (CKBMT) recipients...
October 8, 2018: Transplantation
Jonna R Bank, Renée Ruhaak, Darius Soonawala, Oleg Mayboroda, Fred P Romijn, Cees van Kooten, Christa M Cobbaert, Johan W de Fijter
BACKGROUND: Urinary tissue inhibitor of metalloproteinases-2 (TIMP-2) and insulin-like growth factor binding protein-7 (IGFBP7) have been validated as biomarkers for acute kidney injury. We investigated the performance of both markers in predicting the occurrence and duration of functionally defined delayed graft function (fDGF) in donation after circulatory death (DCD) kidney transplant recipients. METHODS: Urine samples of 74 DCD recipients were analyzed. TIMP-2 and IGFBP7 were measured with ELISA on postoperative day 1 to 7, day 10, week 6 and month 6 and values were corrected for osmolality (mOsm)...
October 8, 2018: Transplantation
Reza Zonozi, John L Niles, Frank B Cortazar
Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) is the most common cause of rapidly progressive glomerulonephritis. ANCAs play an important role in the pathogenesis and diagnosis of AAV. The classic renal lesion in AAV is a pauci-immune necrotizing and crescentic glomerulonephritis. Treatment is divided into 2 phases: (1) induction of remission to eliminate disease activity and (2) maintenance of remission to prevent disease relapse. AAV patients with end-stage renal disease require modification of immunosuppressive strategies and consideration for kidney transplantation...
November 2018: Rheumatic Diseases Clinics of North America
Cristina Dopazo, Ramón Charco, Mireia Caralt, Elizabeth Pando, José Luis Lázaro, Concepción Gómez-Gavara, Lluis Castells, Itxarone Bilbao
We aimed to evaluate the safety and efficacy of low doses of anti-T-lymphocyte globulin (ATG)-based immunosuppression in preserving renal function and preventing liver rejection in liver transplant (LT) recipients with pretransplant renal dysfunction. We designed a prospective single-center cohort study analyzing patients with pre-LT renal dysfunction defined as eGFR<60 mL/min/1.73m2 , who underwent induction therapy with ATG ( ATG group, n=20) . This group was compared with a similar retrospective cohort treated with basiliximab ( BAS group, n=20 )...
2018: Canadian Journal of Gastroenterology & Hepatology
M Wójciak, J Gozdowska, D Dęborska-Materkowska, A Perkowska-Ptasińska, M Kosieradzki, S Nazarewski, M Durlik
INTRODUCTION: Posttransplant lymphoproliferative disorder (PTLD) is a heterogeneous group of lymphoid malignant neoplasms arising after solid organ transplantation or hematopoietic stem cell transplantation. The current World Health Organization classification identified 4 basic histologic types of PTLD: early, polymorphic variant, monomorphic variant, and classical Hodgkin lymphoma-type lesions. METHODS: Data of 12 PTLD cases of was retrospectively analyzed in terms of the transplanted organs, time to diagnosis of PTLD, type of immunosuppressive treatment in regard to the induction treatment and acute transplant rejection, and long-term survival...
September 2018: Transplantation Proceedings
M S Gniewkiewicz, M Czerwińska, J Gozdowska, J Wyzgał, T Grochowiecki, S Nazarewski, M Kosieradzki, M Durlik
BACKGROUND: Simultaneous pancreas-kidney transplantation (SPKT) is the treatment of choice for patients with end-stage renal disease (ESRD) due to type 1 diabetes mellitus (DM1). Since the 1980s, pancreas transplantation has become the most effective strategy to restore normoglycemia in patients with DM1. The aim of this study was to present long-term outcomes data for SPKT. METHODS: We performed a retrospective analysis of 73 SPKT recipients followed in our outpatient center who underwent transplantation between 1988 and 2015...
September 2018: Transplantation Proceedings
Kadiyala V Ravindra, Scott Sanoff, Deepak Vikraman, Ahmad Zaaroura, Aditya Nanavati, Debra Sudan, William Irish
Delayed graft function (DGF) is a risk factor for acute rejection (AR) in renal transplant recipients, and KDIGO guidelines suggest use of lymphocyte-depletion induction when DGF is anticipated. We analyzed the United Network for Organ Sharing/Organ Procurement and Transplantation Network (UNOS/OPTN) database to assess the impact of induction immunosuppression on the risk of AR in deceased kidney recipients based on pretransplant risk of DGF using a validated model. Recipients were categorized into 4 groups based upon the induction immunosuppression: (1) Rabbit anti-thymocyte globulin (rATG); (2) Alemtuzumab (C1H); (3) IL2-receptor antagonists (IL2-RA; basiliximab or daclizumab), and (4) No antibody induction...
September 1, 2018: American Journal of Transplantation
Jacek Wojarski, Sławomir Żegleń, Marek Ochman, Wojtek Karolak
BACKGROUND Sirolimus, a mechanistic target of sirolimus inhibitor, is an immunosuppression medication for patients undergoing heart and abdominal transplantation. Sirolimus-based immunosuppression administered de novo post-lung transplantation is associated with bronchial anastomosis healing-related complications. We hypothesized that sirolimus administration within the first postoperative month in selected lung transplant recipients is safe and may be associated with favorable short-term and long-term outcomes due to its anti-proliferative properties and minimal adverse side effects...
August 23, 2018: Annals of Transplantation: Quarterly of the Polish Transplantation Society
Tetsu Oura, Kiyohiko Hotta, Ivy Rosales, Abbas Dehnadi, Kent Kawai, Hang Lee, A Benedict Cosimi, Tatsuo Kawai
BACKGROUND: We recently reported anti-CD40 monoclonal antibody and rapamycin (aCD40/rapa) to be a reliable, nontoxic, immunosuppressive regimen for combined islet and kidney transplantation (CIKTx) in nonhuman primates (NHPs). In the current study, we attempted to induce allograft tolerance through the mixed chimerism approach using a conditioning regimen with aCD40 and belatacept (Bela). METHODS: Five CIKTx or kidney transplant (KTx) recipients were treated with aCD40/rapa for 4 months...
August 15, 2018: Transplantation
A Furmańczyk-Zawiska, T Bączkowska, D Dęborska-Materkowska, S Nazarewski, M Kosieradzki, M Durlik
BACKGROUND: Optimization of immunosuppressive therapy reduced the incidence of acute rejection, and therefore vascular complications, including graft thrombosis, which have emerged as the main cause of graft loss in the early post-transplant period. A thrombophilic condition may lead to renal graft loss. The aim of the study was to assess renal graft function in thrombophilic renal recipients receiving anticoagulation treatment. METHODS: This is a retrospective study including 29 renal recipients (ktx group) with a history of thrombosis and confirmed thrombophilic factor...
July 2018: Transplantation Proceedings
Michael Stöckle, Kerstin Junker, Paolo Fornara
CONTEXT: Organ transplantation requires immunosuppression, which was regarded as a risk factor for tumor induction and tumor progression in all types of malignancy. Until recently, any form of active neoplasia was, therefore, regarded as contraindicative to organ transplantation. However, there is growing evidence that the increased tumor risk by immunosuppression is restricted to particular subgroups of malignancy, whereas others such as prostate cancer (PCa) are not negatively influenced...
March 2018: European Urology Focus
Saira Ajmal, Michael Keating, Mark Wilhelm
Cryptococcal infection has been documented in 2.8% of solid-organ transplant recipients, with the median time to disease onset being 21 months. Renal transplant recipients account for the majority of cases. Most patients present with central nervous system or disseminated disease, with only a minority having cutaneous manifestations. We present the case of a 47-year-old female renal transplant recipient who presented with refractory acute cellulitis 7 months after transplant. She had received thymoglobulin induction and was on a maintenance immunosuppressive regimen of tacrolimus, mycophenolic acid, and prednisone (5 mg/d)...
June 28, 2018: Experimental and Clinical Transplantation
Satoshi Miuma, Hisamitsu Miyaaki, Akihiko Soyama, Masaaki Hidaka, Mitsuhisa Takatsuki, Hidetaka Shibata, Naota Taura, Susumu Eguchi, Kazuhiko Nakao
AIM: Recently, elbasvir/grazoprevir combination therapy (EBR/GZR) was reported to have excellent antiviral effects for chronic genotype 1 hepatitis C virus (HCV) infection. However, it has not been recommended for patients with post-liver transplant (LT) HCV re-infections because of a lack of evidence for effectiveness and drug-drug interactions. METHODS: We report the usage of EBR/GZR in five post-LT HCV re-infected patients with the kinetics of renal function and tacrolimus trough levels during and after therapy...
June 16, 2018: Hepatology Research: the Official Journal of the Japan Society of Hepatology
Michael Eder, Christoph Schwarz, Michael Kammer, Niels Jacobsen, Masouridi Levrat Stavroula, Morton J Cowan, Tepsiri Chongkrairatanakul, Robert Gaston, Rommel Ravanan, Hideki Ishida, Anette Bachmann, Sergio Alvarez, Martina Koch, Cyril Garrouste, Ulrich A Duffner, Brett Cullis, Nicolaas Schaap, Michael Medinger, Søren Schwartz Sørensen, Eva-Maria Dauber, Georg Böhmig, Heinz Regele, Gabriela A Berlakovich, Thomas Wekerle, Rainer Oberbauer
Tolerance induction through simultaneous hematopoietic stem cell and renal transplantation has shown promising results, but it is hampered by the toxicity of preconditioning therapies and graft-versus-host disease (GVHD). Moreover, renal function has never been compared to conventionally transplanted patients, thus, whether donor-specific tolerance results in improved outcomes remains unanswered. We collected follow-up data of published cases of renal transplantations after hematopoietic stem cell transplantation from the same donor and compared patient and transplant kidney survival as well as function with caliper-matched living-donor renal transplantations from the Austrian dialysis and transplant registry...
June 13, 2018: American Journal of Transplantation
G Narayan, R Jha, P Srikant, S Sinha, G Swarnalata, K V V N Raju
Renal transplant recipients are at a higher risk of malignancy. We report our experience and the critical differences in the presentation of malignancy in kidney transplant patients performed at our tertiary care center and followed up over the period of 1990-2015. A total of 338 live donor transplants performed in 332 patients were analyzed. Induction immunosuppression was used in 22 cases with interleukin-2 (IL-2) receptor antibody. Overall 299 patients were continued on calcineurin inhibitor (CNI)-based triple drug immunosuppression, 33 were off CNI with 13 of them receiving sirolimus additionally...
March 2018: Indian Journal of Nephrology
Jose O Reusing, Emanoela B Feitosa, Fabiana Agena, Lígia C Pierrotti, Luiz S F Azevedo, Camille N Kotton, Elias David-Neto
BACKGROUND: Anti-thymocyte globulin (ATG) therapy is a risk factor for cytomegalovirus (CMV) disease in renal transplant (RTx) recipients and therefore antiviral prophylaxis is commonly used. We evaluated the outcome of our current policy of 90 days of CMV prophylaxis in seropositive recipients given ATG and the risk factors for the occurrence of CMV disease after prophylaxis. METHODS: We studied a retrospective cohort of 423 RTx (2010-2014) CMV-seropositive adults given ATG induction therapy...
May 29, 2018: Transplant Infectious Disease: An Official Journal of the Transplantation Society
Jennifer Ziegler, Julie Ho, Ian W Gibson, Jasmir G Nayak, Markus Stein, Andrew Walkty, Pamela Orr
Intravesical Bacillus Camlette-Guérin (BCG) is the treatment of choice for non-muscle invasive bladder cancer, and has been used successfully for over 40 years. A rare and potentially fatal complication of intravesical BCG therapy is BCG-induced sepsis. We report a rare case in which a patient with end-stage renal disease secondary to chronic granulomatous interstitial nephritis underwent remote, pre-transplant intravesical BCG treatment for high-grade non-invasive papillary bladder carcinoma. The patient subsequently received a deceased donor kidney transplant 5 years after BCG therapy, with thymoglobulin induction therapy and standard triple maintenance immunosuppression...
May 29, 2018: Transplant Infectious Disease: An Official Journal of the Transplantation Society
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