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Acute kidney rejection

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
Jiang-Tao Tang, Brenda C de Winter, Dennis A Hesselink, Ferdi Sombogaard, Lan-Lan Wang, Teun van Gelder
AIM: Elderly transplant recipients have a lower incidence of acute rejection, and a higher risk to die from infectious complications. Potentially this may be caused by differences in the pharmacokinetics (PK) or pharmacodynamics (PD) of the immunosuppressive drugs they are taking. This study was designed to comprehensively evaluate the influence of age on the PK and PD of mycophenolic acid (MPA). METHODS: In this study the PK and PD of MPA was studied in 26 elderly and 54 younger renal transplant recipients treated with mycophenolate mofetil and tacrolimus...
October 18, 2016: British Journal of Clinical Pharmacology
Isabella Guzzo, Federica Morolli, Francesca Diomedi Camassei, Antonina Piazza, Elvira Poggi, Luca Dello Strologo
BACKGROUND: Several cases of severe antibody-mediated rejection (AMR) secondary to antibodies against the angiotensin II type 1 receptor (AT1R-Ab) have been described with variable outcome. CASE-DIAGNOSIS/TREATMENT: We report the case of a 13-year-old boy whose first kidney transplant failed due to steroid-resistant acute cellular rejection, with the subsequent development of sensitization. He received a second kidney transplant which was complicated by early humoral rejection, with weakly positive staining for the complement degradation product C4d...
October 17, 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Catherine Forconi, Philippe Gatault, Elodie Miquelestorena-Standley, Johan Noble, Sally Al-Hajj, Romain Guillemain, Marc Stern, Thomas Hoffmann, Louis Prat, Caroline Suberbielle, Emeline Masson, Anne Cesbron-Gautier, Catherine Gaudy-Graffin, Alain Goudeau, Gilles Thibault, Fabrice Ivanes, Roseline Guibon, Ihab Kazma, Yvon Lebranchu, Matthias Büchler, Antoine Magnan, Jean-Michel Halimi, Christophe Baron
BACKGROUND: Cytomegalovirus (CMV) has a role in chronic rejection and graft loss in kidney transplant (KTx) and lung transplant (LTx) recipients. In addition, donor CMV seropositivity is an independent risk factor for renal graft loss. The anti-CMV response might modulate this risk. Expression of programmed cell death 1 (PD-1), a receptor involved in viral-specific T-cell exhaustion, is influenced by a single nucleotide polymorphism called PD-1.3 (wild-type allele G, variant allele A)...
August 26, 2016: Journal of Heart and Lung Transplantation
Ahmer M Hameed, Henry C Pleass, Germaine Wong, Wayne J Hawthorne
BACKGROUND: The two main options for renal allograft preservation are static cold storage (CS) and machine perfusion (MP). There has been considerably increased interest in MP preservation of kidneys, however conflicting evidence regarding its efficacy and associated costs have impacted its scale of clinical uptake. Additionally, there is no clear consensus regarding oxygenation, and hypo- or normothermia, in conjunction with MP, and its mechanisms of action are also debated. The primary aims of this article were to elucidate the benefits of MP preservation with and without oxygenation, and/or under normothermic conditions, when compared with CS prior to deceased donor kidney transplantation...
October 2016: Medicine (Baltimore)
Umberto Maggiore, Julio Pascual
Cancer immunotherapy, especially the use of checkpoint inhibitors, is expanding and can be efficacious in organ transplant recipients with malignant neoplasia. In this review, we summarize clinical findings and evolution of several patients treated with CTL4-4 or PD-1 inhibitors reported in the literature. The CTL-4 inhibitor ipilimumab has been safely used in several liver and kidney allograft recipients. PD1-inhibitors look promising for tumor shrinking, but acute rejection is the rule, so they should be avoided in recipients of life-saving organs...
September 2016: Advances in Chronic Kidney Disease
David Wojciechowski, Flavio Vincenti
Kidney transplantation immunosuppression relies on a calcineurin inhibitor backbone. Calcineurin inhibitors have reduced early-acute rejection rates but failed to improve long-term allograft survival. Their nephrotoxicity has shifted the focus of investigation to calcineurin inhibitor-free regimens. Costimulation blockade with belatacept, a second generation, higher avidity variant of CTLA4-Ig, has emerged as part of a calcineurin inhibitor-free regimen. Belatacept has demonstrated superior glomerular filtration rate compared with calcineurin inhibitors albeit with an increased risk of early and histologically severe rejection...
September 2016: Advances in Chronic Kidney Disease
F Toth, G Zadori, R Fedor, L Illesy, M Szabo-Pap, Z Kanyari, D A Kovacs, L Asztalos, B Nemes
INTRODUCTION: Approximately 10% of renal allografts fail during the first year after kidney transplantation (KT) and 3%-5% thereafter yearly. The indication and timing of allograft nephrectomy (AN) is still uncertain in some cases. The aim of this study was to reveal the ratio, etiology, and complications of AN at our center. MATERIAL AND METHODS: This is a retrospective study of all patients who underwent KT at our center between January 1, 2004 and December 31, 2014...
September 2016: Transplantation Proceedings
I Laranjinha, P Matias, C Jorge, R Birne, A Weigert, T Adragão, M Bruges, R A Cabrera, J Cassis, S Ramos, A Nogueira, J Godinho, H Messias, D Machado
BACKGROUND: Kidney transplant (KT) recipients have a higher incidence of malignancy than the general population. Smooth muscle tumors (SMT), including leiomyosarcoma, are rare in kidney transplant recipients, and most cases are associated with Epstein-Barr virus (EBV) infection. CASE REPORT: A 57-year-old man received a deceased donor kidney transplant at the age of 53 years, with 5 human leukocyte antigen (HLA) mismatches. Before the transplantation, the patient was IgG positive for EBV viral capsid antigen (VCA), negative for IgM EBV VCA, and also negative for IgG EBV nuclear antigen (EBNA), suggesting a prior EBV infection...
September 2016: Transplantation Proceedings
S Marques, R Carmo, I Ferreira, M Bustorff, S Sampaio, M Pestana
BACKGROUND: In solid organ transplant patients, 8% of invasive fungal infections are attributed to Cryptococcus. The aim of this study was to determine the frequency, risk factors, clinical characteristics, and outcome of kidney transplant recipients (TR) infected with Cryptococcus. CASE SERIES: Between 2007 and 2014, a total of 500 kidney transplantations were performed at São João Hospital, in Porto, Portugal. Six infections by C. neoformans were reported, an incidence of 1...
September 2016: Transplantation Proceedings
M Pereira, J Guerra, M Neves, J Gonçalves, A Santana, C Nascimento, A G da Costa
INTRODUCTION: The optimal immunosuppressive induction therapy in kidney transplant recipients with low immunologic risk of acute rejection (AR) is still controversial. The use of basiliximab (BSX) has led to a significant decrease of AR with a low side effect profile. OBJECTIVE: This study sought to evaluate predictive risk factors for AR in low immunologic risk patients subjected to immunosuppressive induction therapy with BSX. METHODS: We reviewed all low immunologic risk patients (panel reactive antibody [PRA] level <50%, who had undergone a first deceased-donor transplant) subjected to immunosuppressive induction therapy with BSX, calcineurin inhibitor, mycophenolate mofetil, and prednisolone (n = 346)...
September 2016: Transplantation Proceedings
L V Kroth, F F Barreiro, D Saitovitch, M A Traesel, D O d'Avila, C E Poli-de-Figueiredo
BACKGROUND: The Nephrology Unit at São Lucas Hospital, a University Hospital in Southern Brazil, has recently reached 35 years since its first kidney transplant. Few centers in the area have made a longitudinal analysis of processes, problems, grafts, and patient survival changes along this time. METHODS: A single-center, retrospective study was performed. Data were separated into different eras, based on the nature of immunosuppression used: pre-cyclosporine (1978-1986), cyclosporine (1987-1997), mycophenolate introduction (1998-2002), new immunosuppressant drugs (2003-2007), and the current period (2008-2013)...
September 2016: Transplantation Proceedings
F Salazar Meira, J Zemiacki, A E Figueiredo, L Viliano Kroth, D Saute Kochhann, D O d'Avila, M Traesel, D Saitovitch, C E Poli-de-Figueiredo
BACKGROUND: One of the main postoperative complications of kidney transplant is delayed graft function (DGF), which means absence of graft function after transplant or the need for dialysis during the first week post procedure. The occurrence of DGF currently in our hospital is high and has been attributed to a combination of many factors. The aim of this study was to evaluate the factors associated to DGF and their influence in the outcome of kidney transplants. METHODS: Historical cohort of 150 patients transplanted with live or deceased donor kidneys from 2011 to 2013...
September 2016: Transplantation Proceedings
H Si Nga, H M Takase, A M Bravin, P D Garcia, M M Contti, C A Kojima, L G M de Andrade
BACKGROUND: With the increased demand for kidney transplants and the short supply of organs, it is necessary to have a better strategy to evaluate the available organs, especially from donors with acute kidney injury (AKI), because these organs are often rejected for transplantation. METHODS: We evaluated patients undergoing transplantation with kidneys from deceased donors with AKI. The cases were divided into AKI stages according to the Acute Kidney Injury Network (AKIN) criteria...
September 2016: Transplantation Proceedings
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)
Hideki Ishida, Shiro Takahara, Noritoshi Amada, Shinji Tomikawa, Tatsuya Chikaraishi, Kota Takahashi, Kazuhiro Uchida, Takahiro Akiyama, Kazunari Tanabe, Hiroshi Toma
OBJECTIVES: Our objectives were to compare the clinical outcomes of mizoribine (12 mg/kg/d) and mycophenolate mofetil (2000 mg/d) in combination with tacrolimus, basiliximab, and corticosteroids. MATERIALS AND METHODS: We enrolled 83 recipients of living-donor renal transplant (performed between 2008 and 2013) in this study. This prospective multi-institutional randomized comparative study compared mizoribine (n = 41) and mycophenolate mofetil (n = 42) in combination with tacrolimus, basiliximab, and corticosteroids for living-donor renal transplant recipients...
October 2016: Experimental and Clinical Transplantation
Junji Uchida, Tomoaki Iwai, Kazuya Kabei, Shunji Nishide, Takeshi Yamasaki, Nobuyuki Kuwabara, Toshihide Naganuma, Norihiko Kumada, Yoshiaki Takemoto, Tatsuya Nakatanti
INTRODUCTION: We summarized our experience with ABO-incompatible living kidney transplant recipients from spousal donors receiving rituximab. PATIENTS AND METHODS: Between June 2006 and December 2014, 82 patients with end-stage renal disease underwent living donor kidney transplantation at Osaka City University Hospital, of which 23 cases were ABO-incompatible transplantation between spouses with rituximab induction. We analyzed these recipients, focusing on their immunosuppressive protocols, frequency of acute rejections, and patient/graft survivals...
October 13, 2016: Urologia Internationalis
Hessel Peters-Sengers, Stefan P Berger, Martin B A Heemskerk, Doaa Al Arashi, Jaap J Homan van der Heide, Aline C Hemke, Ineke J M Ten Berge, Mirza M Idu, Michiel G H Betjes, Arjan D van Zuilen, Luuk B Hilbrands, Aiko P J de Vries, Azam S Nurmohamed, Maarten H Christiaans, L W Ernest van Heurn, Johan W de Fijter, Frederike J Bemelman
An increasing number of elderly patients (≥65 years) receive a donor kidney from elderly donors after brain death (DBD) or after circulatory death (DCD). These organs are allocated within the Eurotransplant Senior Program, but outcomes must be evaluated. From the Dutch Organ Transplantation Registry, we selected 3597 recipients (≥18 years) who received a first DBD or DCD kidney during 2002-2012, and categorized them as young or elderly recipients receiving a graft from either a young or elderly donor, stratified by donor type...
October 11, 2016: Journal of the American Society of Nephrology: JASN
P García, M Huerfano, M Rodríguez, A Caicedo, F Berrío, C Gonzalez
BACKGROUND: Renal transplantation is the best treatment for end stage renal disease. Acute graft rejection is one of the main complications and may influence graft survival. OBJECTIVE: To determine the incidence and features of acute cellular rejection (ACR) episodes confirmed by biopsy. METHODS: We studied a cohort of 175 patients who underwent renal transplantation between 2004 and 2012 to determine the cumulative incidence of ACR confirmed by biopsy and to identify the associated risk factors using multivariate analysis...
2016: International Journal of Organ Transplantation Medicine
L Rostaing, L Alric, N Kamar
In some parts of the world, hepatitis C virus (HCV) infection remains a huge problem for kidney-transplant candidates and kidney-transplant (KT) recipients. Until 2 years ago, anti-HCV treatment for the general population relied on pegylated-alpha-interferon plus ribavirin, but led to a sustained viral response (SVR) in <50% of cases. This treatment was contraindicated in KT patients because of acute-rejection issues and was poorly tolerated in patients with end-stage renal disease. Over the last year, direct-acting antiviral agents (DAAs) have entered the market and are associated in the general population with a SVR of >90%, whatever the patient's HCV genotype...
October 7, 2016: Transplant International: Official Journal of the European Society for Organ Transplantation
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