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https://www.readbyqxmd.com/read/28086979/b-cell-repertoires-in-hla-sensitized-kidney-transplant-candidates-undergoing-desensitization-therapy
#1
John F Beausang, H Christina Fan, Rene Sit, Maria U Hutchins, Kshama Jirage, Rachael Curtis, Edward Hutchins, Stephen R Quake, Julie M Yabu
BACKGROUND: Kidney transplantation is the most effective treatment for end-stage renal disease. Sensitization refers to pre-existing antibodies against human leukocyte antigen (HLA) protein and remains a major barrier to successful transplantation. Despite implementation of desensitization strategies, many candidates fail to respond. Our objective was to determine whether measuring B cell repertoires could differentiate candidates that respond to desensitization therapy. METHODS: We developed an assay based on high-throughput DNA sequencing of the variable domain of the heavy chain of immunoglobulin genes to measure changes in B cell repertoires in 19 highly HLA-sensitized kidney transplant candidates undergoing desensitization and 7 controls with low to moderate HLA sensitization levels...
January 13, 2017: Journal of Translational Medicine
https://www.readbyqxmd.com/read/28077080/should-patients-older-than-65-years-be-offered-a-second-kidney-transplant
#2
Kristian Heldal, Anders Hartmann, Kjersti Lønning, Torbjørn Leivestad, Anna V Reisæter, Pål-Dag Line, Hallvard Holdaas, Karsten Midtvedt
BACKGROUND: Age and number of recipients in need of kidney re-transplantation are increasing. Re-transplantation practices and outcomes in elderly recipients are not previously explored. We aimed to retrospectively evaluate the outcomes of recipients 65 years and older receiving their second deceased donor allograft. METHODS: The study was designed as a retrospective registry based study. All recipients 65 years or older who received a deceased donor kidney transplant at Oslo University Hospital between 2000 and 2014 were included in the study...
January 11, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28075034/abdominal-lean-muscle-is-associated-with-lower-mortality-among-kidney-waitlist-candidates
#3
Jayme E Locke, J Jeff Carr, Sangeeta Nair, James G Terry, Rhiannon D Reed, Grant D Smith, Dorry L Segev, Vineeta Kumar, Cora E Lewis
Morphometric assessments, such as muscle density and body fat distribution, have emerged as strong predictors of cardiovascular risk and post-operative morbidity and mortality. To date, no study has examined morphometric mortality risk prediction among kidney transplant (KT) candidates. KT candidates, waitlisted 2008-2009 were identified (n=96) and followed to the earliest of transplant, death, or administrative end of study. Morphometric measures, including abdominal adipose tissue, paraspinous and psoas muscle composition, and aortic calcification were measured from CTs...
January 11, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28069404/calculated-panel-reactive-antibody-with-decimals-a-refined-metric-of-access-to-transplantation-for-highly-sensitized-candidates
#4
Evan P Kransdorf, Marcelo J Pando
The use of the calculated panel reactive antibody (CPRA) value and the implementation of allocation points for sensitized candidates by the United Network for Organ Sharing (UNOS) have improved access to kidney transplantation for highly sensitized candidates (98% CPRA and above). Despite this, a large population of highly sensitized candidates remain awaiting transplantation. To better define this population, we propose the use of two refinements of the standard UNOS CPRA, the CPRA with decimals or CPRAd, and the likelihood of a compatible donor (LCD)...
January 6, 2017: Human Immunology
https://www.readbyqxmd.com/read/28062570/moving-biomarkers-toward-clinical-implementation-in-kidney-transplantation
#5
Madhav C Menon, Barbara Murphy, Peter S Heeger
Long-term kidney transplant outcomes remain suboptimal, delineating an unmet medical need. Although current immunosuppressive therapy in kidney transplant recipients is effective, dosing is conventionally adjusted empirically on the basis of time after transplant or altered in response to detection of kidney dysfunction, histologic evidence of allograft damage, or infection. Such strategies tend to detect allograft rejection after significant injury has already occurred, fail to detect chronic subclinical inflammation that can negatively affect graft survival, and ignore specific risks and immune mechanisms that differentially contribute to allograft damage among transplant recipients...
January 6, 2017: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/28058214/older-candidates-for-kidney-transplantation-who-to-refer-and-what-to-expect
#6
REVIEW
Beatrice P Concepcion, Rachel C Forbes, Heidi M Schaefer
The number of older end-stage renal disease patients being referred for kidney transplantation continues to increase. This rise is occurring alongside the continually increasing prevalence of older end-stage renal disease patients. Although older kidney transplant recipients have decreased patient and graft survival compared to younger patients, transplantation in this patient population is pursued due to the survival advantage that it confers over remaining on the deceased donor waiting list. The upper limit of age and the extent of comorbidity and frailty at which transplantation ceases to be advantageous is not known...
December 24, 2016: World Journal of Transplantation
https://www.readbyqxmd.com/read/28052609/optn-srtr-2015-annual-data-report-kidney
#7
A Hart, J M Smith, M A Skeans, S K Gustafson, D E Stewart, W S Cherikh, J L Wainright, A Kucheryavaya, M Woodbury, J J Snyder, B L Kasiske, A K Israni
The first full year of data after implementation of the new kidney allocation system reveals an increase in deceased donor kidney transplants among black candidates and those with calculated panel-reactive antibodies 98%-100%, but a decrease among candidates aged 65 years or older. Data from 2015 also demonstrate ongoing positive trends in graft and patient survival for both deceased and living donor kidney transplants, but the challenges of a limited supply of kidneys in the setting of increasing demand remain evident...
January 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28052605/optn-srtr-2015-annual-data-report-early-effects-of-the-new-kidney-allocation-system
#8
A Hart, S K Gustafson, M A Skeans, P Stock, D Stewart, B L Kasiske, A K Israni
In December 2014, a new kidney allocation system (KAS) was implemented in the United States in an attempt to improve access to transplant for historically underrepresented groups, and to incorporate longevity matching such that donor kidneys with the longest projected graft survival are given to recipients with the longest projected patient survival. The development of organ allocation policies is often guided by simulated allocation models, computer programs that simulate the arrival of donated organs and new candidates on the waiting list over a 1-year period to project outcomes under a new allocation method...
January 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28039956/longitudinal-analysis-of-living-donor-kidney-transplant-rates-in-pediatric-candidates-in-the-united-states
#9
Douglas S Keith, Gayle Vranic, John Barcia, Victoria Norwood, Angie Nishio-Lucar
Among adults, living donor kidney transplant rates began declining in the United States after 2004 but whether a similar decline is occurring in the pediatric candidates has not been well studied. Share 35, a change in allocation rules implemented in October of 2005, may also have influenced rates of living donation. We sought to determine whether a decline in rates was occurring in pediatric candidates and whether the Share 35 program was the cause of the decline. All children listed for a kidney transplant or transplanted with a living donor without listing between 1996 and 2011 were identified in the United States (N=14 911) of which 6046 had received a living donor transplant during follow-up...
December 30, 2016: Pediatric Transplantation
https://www.readbyqxmd.com/read/28028050/new-organ-allocation-system-for-combined-liver-kidney-transplants-and-the-availability-of-kidneys-for-transplant-to-patients-with-stage-4-5-ckd
#10
William S Asch, Margaret J Bia
A new proposal has been created for establishing medical criteria for organ allocation in recipients receiving simultaneous liver-kidney transplants. In this article, we describe the new policy, elaborate on the points of greatest controversy, and offer a perspective on the policy going forward. Although we applaud the fact that simultaneous liver-kidney transplant activity will now be monitored and appreciate the creation of medical criteria for allocation in simultaneous liver-kidney transplants, we argue that some of the criteria proposed, especially those for allocating a kidney to a liver recipient with AKI, are too liberal...
December 27, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/28009780/kidney-transplant-with-low-levels-of-dsa-or-low-positive-b-flow-crossmatch-an-underappreciated-option-for-highly-sensitized-transplant-candidates
#11
Carrie Schinstock, Manish Gandhi, Wisit Cheungpasitporn, Donald Mitema, Mikel Prieto, Patrick Dean, Lynn Cornell, Fernando Cosio, Mark Stegall
BACKGROUND: Avoiding donor specific antibody (DSA) is difficult for sensitized patients. Improved understanding of the risk of low level DSA is needed. METHODS: We retrospectively compared the outcomes of 954 patients transplanted with varied levels of baseline DSA detected by single antigen beads and B flow cytometric crossmatch (XM). Patients were grouped as follows: -DSA/-XM, +DSA/-XM, +DSA/low+XM, +DSA/high+XM, and -DSA/+XM and followed for a mean of 4.1±1...
December 22, 2016: Transplantation
https://www.readbyqxmd.com/read/28009759/outcomes-of-simultaneous-liver-kidney-transplantation-in-patients-with-hepatocellular-carcinoma
#12
Nicole Rich, Bekir Tanriover, Amit G Singal, Jorge A Marrero
BACKGROUND: The frequency of simultaneous liver kidney (SLK) transplantation has increased following the implementation of the model for end-stage liver disease system for liver transplantation (LT). There is a paucity of data evaluating SLK outcomes in patients undergoing LT for hepatocellular carcinoma (HCC). Our aim was to compare outcomes between patients with HCC who underwent SLK and those who received SLK for other indications. METHODS: We performed a retrospective analysis of adult recipients receiving SLK between 2002 and 2013 from the United Network for Organ Sharing registry...
January 2017: Transplantation
https://www.readbyqxmd.com/read/28008340/fractional-excretion-of-sodium-in-hepatorenal-syndrome-clinical-and-pathological-correlation
#13
Ali A Alsaad, Hani M Wadei
AIM: To determine the accuracy of fractional excretion of sodium (FeNa) in the diagnosis of hepatorenal syndrome (HRS). METHODS: Eighty-eight liver transplantation candidates with renal dysfunction and/or proteinuria were included in the study sample. The baseline characteristics of the patients were obtained. All the 88 patients underwent iothalamate glomerular filtration rate testing, 24-h urine collection for urinary sodium and protein excretions, random urine for sodium and creatinine testing, and percutaneous kidney biopsy...
December 8, 2016: World Journal of Hepatology
https://www.readbyqxmd.com/read/27990485/the-association-between-broad-antigen-hla-mismatches-eplet-hla-mismatches-and-acute-rejection-after-kidney-transplantation
#14
Hung Thanh Do Nguyen, Germaine Wong, Jeremy R Chapman, Stephen P McDonald, Patrick T Coates, Narelle Watson, Graeme R Russ, Lloyd D'Orsogna, Wai Hon Lim
BACKGROUND: Epitope matching, which evaluates mismatched amino acids within antigen-antibody interaction sites (eplets), may better predict acute rejection than broad antigen matching alone. We aimed to determine the association between eplet mismatches and acute rejection in kidney transplant recipients. METHODS: The association between eplet mismatches, broad antigen mismatches and acute rejection was assessed using adjusted Cox proportional hazard regression...
December 2016: Transplantation Direct
https://www.readbyqxmd.com/read/27988992/outcomes-in-the-highest-panel-reactive-antibody-recipients-of-deceased-donor-kidneys-under-the-new-kidney-allocation-system
#15
Sandesh Parajuli, Robert R Redfield, Brad C Astor, Arjang Djamali, Dixon Kaufman, Didier A Mandelbrot
Since the institution of the new kidney allocation system in December 2014, kidney transplant candidates with the highest calculated panel reactive antibodies (cPRA) of 99-100 have been transplanted at much higher rates. However, concerns have been raised that outcomes in these patients might be impaired due to higher immunological risk and longer cold ischemia times resulting from long-distance sharing of kidneys. Here we compare outcomes at the University of Wisconsin between study patients with cPRA 99-100 and all other recipients of deceased donor kidneys transplanted between 12/04/2014 and12/31/2015...
December 17, 2016: Clinical Transplantation
https://www.readbyqxmd.com/read/27955974/increased-access-to-transplantation-of-highly-sensitized-patients-under-the-new-kidney-allocation-system-a-single-center-experience
#16
Adriana I Colovai, Maria Ajaimy, Layla G Kamal, Peter Masiakos, Shirley Chan, Christina Savchik, Michelle Lubetzky, Graciela de Boccardo, Alesa Courson, Attasit Chokechanachaisakul, Jay Graham, Stuart Greenstein, Milan Kinkhabwala, Juan Rocca, Enver Akalin
We aimed to investigate the impact of the new kidney allocation system (KAS) on the rate of transplantation of sensitized patients at our center. Pre-KAS and post-KAS intervals were Jan 1(st) to Dec 3(rd) 2014 and Jan 1(st) 2015 to Dec 3(rd) 2015, respectively. The number of deceased-donor crossmatches performed by flow cytometry increased from 715 pre-KAS to 1188 post-KAS. The percent of crossmatches performed for sensitized patients with calculated panel reactive antibody (cPRA) >0% increased from 19% pre-KAS to 26% post-KAS (p<0...
December 9, 2016: Human Immunology
https://www.readbyqxmd.com/read/27942610/simultaneous-liver-kidney-transplantation-in-liver-transplant-candidates-with-renal-dysfunction-importance-of-creatinine-levels-dialysis-and-organ-quality-in-survival
#17
Bekir Tanriover, Malcolm P MacConmara, Justin Parekh, Cristina Arce, Song Zhang, Ang Gao, Arjmand Mufti, Swee-Ling Levea, Burhaneddin Sandikci, Mehmet U S Ayvaci, Venketash K Ariyamuthu, Christine Hwang, Sumit Mohan, Mutlu Mete, Miguel A Vazquez, Jorge A Marrero
BACKGROUND: The survival benefit from simultaneous liver-kidney transplantation (SLK) over liver transplant alone (LTA) in recipients with moderate renal dysfunction is not well understood. Moreover, the impact of deceased donor organ quality in SLK transplant survival has not been well described in the literature. METHODS: The Scientific Registry of Transplant Recipients was studied for adult recipients receiving LTA (N=2,700) or SLK (N=1,361) transplantation with moderate renal insufficiency between 2003 and 2013...
November 2016: KI Reports
https://www.readbyqxmd.com/read/27932104/short-term-outcomes-of-100-consecutive-kidney-transplantations-in-a-3-year-period-a-single-center-experience
#18
C I Alfaro Sanchez, M J Molina Higueras, J P Moiron Fernandez-Felechosa, J M Mora Gutierrez, P L Martin Moreno, N Garcia Fernandez, F J Lavilla Royo, P Errasti Goenaga
BACKGROUND: The results of kidney transplantation have improved significantly in the last decade with patient and graft survival rates that range from 92% to 95%. METHODS: We analyzed the clinical results in the last 100 consecutive patients with a follow-up of 6-42 months at our institution. We also made a general evaluation of the patients before surgery as candidates for transplantation and divided them into 3 groups (good, moderate, and poor). RESULTS: We had 8 living donors and 92 cadaveric kidney transplantation cases...
November 2016: Transplantation Proceedings
https://www.readbyqxmd.com/read/27899225/humoral-and-cellular-response-after-varicella-vaccination-in-vzv-igg-seronegative-kidney-transplant-candidates
#19
Marcia M L Kho, Joke M Zuijderwijk, Annemiek A van der Eijk, Ronella de Kuiper, Marieken J Boer-Verschragen, Willem Weimar, Nicole M van Besouw
BACKGROUND: In immunocompromised patients, primary infection with VZV may have a disastrous clinical course. Vaccination of VZV-seronegative patients on the waiting list for renal transplantation may prevent severe disease. However, the immunologic response of end-stage renal disease patients to peptide vaccines is far from optimal. Our question was whether end-stage renal disease patients with undetectable VZV-IgG levels were able to mount an adequate humoral and cellular response to a live attenuated varicella vaccine...
January 3, 2017: Vaccine
https://www.readbyqxmd.com/read/27890719/casting-a-smaller-net-into-a-bigger-donor-pool-a-single-center-s-experience-with-the-new-kidney-allocation-system
#20
Julie A Houp, Karl P Schillinger, Andrew J Eckstein, Renato M Vega, Niraj M Desai, Bonnie E Lonze, Annette M Jackson
The new kidney allocation system (KAS) provides additional allocation points for candidates with broad HLA sensitization in an effort to increase transplant rates for this underserved population. Following the implementation of KAS, our center lowered the HLA antibody threshold for listing unacceptable antigens from a cytotoxicity crossmatch level to a flow cytometric crossmatch level increasing Calculated Panel Reactive Antibody (CPRA) values and allocation points, yet restricting acceptable donor HLA phenotypes...
November 24, 2016: Human Immunology
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