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Kidney Allograft Failure

Charat Thongprayoon, Wisit Kaewput, Konika Sharma, Karn Wijarnpreecha, Napat Leeaphorn, Patompong Ungprasert, Ankit Sakhuja, Franco H Cabeza Rivera, Wisit Cheungpasitporn
AIM: To assess outcomes of kidney transplantation including patient and allograft outcomes in recipients with hepatitis B virus (HBV) infection, and the trends of patient's outcomes overtime. METHODS: A literature search was conducted using MEDLINE, EMBASE and Cochrane Database from inception through October 2017. Studies that reported odds ratios (OR) of mortality or renal allograft failure after kidney transplantation in patients with HBV [defined as hepatitis B surface antigen (HBsAg) positive] were included...
February 27, 2018: World Journal of Hepatology
Marianne Yardley, Lars Gullestad, Kari Nytrøen
One of the most important prognostic factors in heart failure patients is physical capacity. Patients with very poor physical performance and otherwise eligible, may be listed as candidates for heart transplantation (HTx). After such surgery, life-long immunosuppression therapy is needed to prevent rejection of the new heart. The dark side of immunosuppression is the increased risk of infections, kidney failure, cancer and advanced atherosclerosis (cardiac allograft vasculopathy), with the two latter conditions as the main causes of later mortality...
February 24, 2018: World Journal of Transplantation
Shaifali Sandal, Steven Paraskevas, Marcelo Cantarovich, Dana Baran, Prosanto Chaudhury, Jean I Tchervenkov, Ruth Sapir-Pichhadze
Renal resistance (RR), of allografts undergoing hypothermic machine perfusion (HMP), is considered a measure of organ quality. We conducted a retrospective cohort study of adult deceased donor kidney transplant (KT) recipients whose grafts underwent HMP. Our aim was to evaluate whether RR is predictive of death-censored graft failure (DCGF). Of 274 KT eligible for analysis, 59% were from ECD. RR was modeled as a categorical variable, using a previously identified terminal threshold of 0.4, and 0.2 mmHg/mL/min (median in our cohort)...
March 1, 2018: Transplant International: Official Journal of the European Society for Organ Transplantation
Shaifali Sandal, Xun Luo, Allan B Massie, Steven Paraskevas, Marcelo Cantarovich, Dorry L Segev
Background: The use of machine perfusion (MP) in kidney transplantation lowers delayed graft function (DGF) and improves 1-year graft survival in some, but not all, grafts. These associations have not been explored in grafts stratified by the Kidney Donor Profile index (KDPI). Methods: We analyzed 78 207 deceased-donor recipients using the Scientific Registry of Transplant Recipients data from 2006 to 2013. The cohort was stratified using the standard criteria donor/expanded criteria donor (ECD)/donation after cardiac death (DCD)/donation after brain death (DBD) classification and the KDPI scores...
February 20, 2018: Nephrology, Dialysis, Transplantation
H L Stevenson, M M Prats, K Isse, A Zeevi, Y Avitzur, V L Ng, A J Demetris
According to the Banff criteria for kidney allografts, isolated vascular or "v" lesions are defined as intimal inflammation, age-inappropriate fibro-intimal hyperplasia, or both, without the presence of associated interstitial T cell-mediated rejection (TCMR). In general, these lesions portend a worse outcome for kidney allografts, particularly in those where the "v" lesions are identified in patients with co-existent donor specific antibodies (DSA) or later after transplantation. Although affected arteries are rarely sampled in liver allograft biopsies, we identified 9 patients at a mean of 1,805 days post-transplantation and compared these to matched controls...
February 21, 2018: American Journal of Transplantation
Vedran Premuzic, Lea Katalinic, Marijan Pasalic, Hrvoje Jurin
Cardiac tamponade caused by perforation of the cardiac wall is a rare complication related to central venous catheter (CVC) placement. A 71-year-old female with a previous history of moderate aortic stenosis and kidney transplantation was admitted to hospital due to global heart failure and worsening of allograft function. Intensified hemodialysis was commenced through a CVC placed in the right subclavian vein. Chest radiography revealed catheter tip in the right atrium and no signs of pneumothorax. Thorough diagnostics outruled immediate life-threatening conditions, such as myocardial infarction and pulmonary embolism...
January 2018: Saudi Journal of Anaesthesia
P West-Thielke, K Progar, M Campara, N Jasiak, L Gallon, I Tang, M Spaggiari, I Tzvetanov, E Benedetti
Antibody-mediated rejection (AMR) is one of the leading causes of allograft failure especially in patients undergoing ABO-incompatible (ABOi) renal transplantation. We hypothesized that complement inhibition with eculizumab, a C5 inhibitor, would protect against AMR and maintain graft function in ABOi renal transplant recipients. Four patients undergoing living donor kidney transplant from ABOi donors were treated with a 9-week eculizumab course without therapeutic plasma exchange, intravenous immunoglobulin, or splenectomy...
January 2018: Transplantation Proceedings
P Yooprasert, P Rotjanapan
BACKGROUND: Data on BK virus-associated nephropathy (BKVAN) and treatment strategy in a resource-limited country are scarce. This study aimed to evaluate epidemiology of BKVAN and its situation in Thailand. METHODS: A retrospective analysis was conducted among adult kidney transplant recipients at Ramathibodi Hospital from October 2011 to September 2016. Patients' demographic data, information on kidney transplantation, immunosuppressive therapy, cytomegalovirus and BK virus infections, and allograft outcomes were retrieved and analyzed...
January 2018: Transplantation Proceedings
Thomas Schachtner, Natalie M Otto, Maik Stein, Petra Reinke
Background: The number of kidney transplant recipients (KTRs) being waitlisted for a subsequent transplantation has disproportionately increased to almost 25%. Evidence for the optimal management of the failed allograft, however, remains inconsistent. Methods: We studied 111 KTRs who underwent their second kidney transplantation from 1998 to 2015. In 51/111 KTRs (46%) the failed allograft was removed and in 60/111 (54%) the failed allograft was retained. KTRs with primary non-function and allograft loss <12  months of the first failed allograft were excluded from analysis...
February 1, 2018: Nephrology, Dialysis, Transplantation
John S Gill, Caren Rose, Yayuk Joffres, David Landsberg, Jagbir Gill
BACKGROUND: The impact of dialysis exposure before nonpreemptive living donor kidney transplantation on allograft outcomes is uncertain. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: Adult first-time recipients of kidney-only living donor transplants in the United States who were recorded within the Scientific Registry of Transplant Recipients for 2000 to 2016. FACTORS: Duration of pretransplantation dialysis exposure...
January 27, 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Ilkka Helanterä, Juulia Räihä, Patrik Finne, Marko Lempinen
Although short-term outcome after kidney transplantation has improved, a small proportion of grafts are lost during the first year. We characterize in detail all early graft losses in the current era in a nationwide cohort of kidney transplant recipients. Altogether 2447 kidney transplantations, performed between June 2004 and October 2016, were included. All graft losses (return to dialysis or patient death) occurring during the first post-transplant year were characterized. During the first post-tranplant year, altogether 109 grafts were lost, 67 grafts failed, and 42 patients died...
January 16, 2018: Transplant International: Official Journal of the European Society for Organ Transplantation
Irum Amin, Charlotte Rutter, Adam Barlow, Neil K Russell, J Andrew Bradley, Andrew Jackson, Andrew J Butler
AIM OF THE STUDY: Intestinal transplantation (IT) is a life-saving procedure for carefully selected patients with intestinal failure. We evaluated patients who had undergone simultaneous intestinal and kidney transplantation (SIKT) to determine whether UK guidelines for inclusion of a renal allograft (dialysis dependent or estimated glomerular filtration rate ((eGFR)) < 45 ml/min/1.73 m2) are justified. METHODS: A single centre analysis was undertaken of adults undergoing IT at the Cambridge Transplant Centre between December 2007 and January 2016...
January 15, 2018: Journal of Investigative Surgery: the Official Journal of the Academy of Surgical Research
Jumpei Hasegawa, Kazuho Honda, Kazuya Omoto, Sachiko Wakai, Hiroki Shirakawa, Masayoshi Okumi, Hideki Ishida, Shohei Fuchinoue, Motoshi Hattori, Kazunari Tanabe
BACKGROUND: Plasma cell-rich acute rejection (PCAR) is a rare type of allograft rejection characterized by the presence of mature plasma cells. In general the prognosis of PCAR is poor, and its clinical and pathological features remain unclear. METHODS: We performed a retrospective observational study and compared allograft survival between kidney transplant recipients who developed PCAR and those who did not develop PCAR. We further analyzed clinical and pathological risk factors for allograft failure in PCAR patients...
January 10, 2018: Transplantation
Fedaey Abbas, Mohsen El Kossi, Jon Kim Jin, Ajay Sharma, Ahmed Halawa
In view of the availability of new immunosuppression strategies, the recurrence of allograft glomerulonephritis (GN) are reported to be increasing with time post transplantation. Recent advances in understanding the pathogenesis of the GN recurrent disease provided a better chance to develop new strategies to deal with the GN recurrence. Recurrent GN diseases manifest with a variable course, stubborn behavior, and poor response to therapy. Some types of GN lead to rapid decline of kidney function resulting in a frustrating return to maintenance dialysis...
December 24, 2017: World Journal of Transplantation
Chia-Shi Wang, Jennifer Gander, Rachel E Patzer, Larry A Greenbaum
BACKGROUND: Pediatric patients with focal segmental glomerulosclerosis (FSGS) have high rates of disease recurrence and allograft failure after kidney transplantation, but there are few data for long-term survival posttransplantation. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: 12,303 pediatric patients (aged <18 years), including 1,408 (11%) patients with FSGS, who received a first kidney transplant in 1990 through 2009 and were followed up through June 2015 were identified from the US Renal Data System database...
March 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Badri Man Shrestha, John Haylor
OBJECTIVES: Experimental rat models of renal transplant have played a pivotal role in renal transplant research. Both intraoperative and postoperative complications during donor nephrectomy and implantation in the recipient can be associated with significant morbidity and mortality. The aim of this paper is to discuss the incidence, pathophysiology, and prevention of complications that occurred in the process of establishment of a rat model of chronic allograft injury at our institution...
December 18, 2017: Experimental and Clinical Transplantation
Farsad Eskandary, Heinz Regele, Lukas Baumann, Gregor Bond, Nicolas Kozakowski, Markus Wahrmann, Luis G Hidalgo, Helmuth Haslacher, Christopher C Kaltenecker, Marie-Bernadette Aretin, Rainer Oberbauer, Martin Posch, Anton Staudenherz, Ammon Handisurya, Jeff Reeve, Philip F Halloran, Georg A Böhmig
Late antibody-mediated rejection (ABMR) is a leading cause of kidney allograft failure. Uncontrolled studies have suggested efficacy of the proteasome inhibitor bortezomib, but no systematic trial has been undertaken to support its use in ABMR. In this randomized, placebo-controlled trial (the Bortezomib in Late Antibody-Mediated Kidney Transplant Rejection [BORTEJECT] Trial), we investigated whether two cycles of bortezomib (each cycle: 1.3 mg/m2 intravenously on days 1, 4, 8, and 11) prevent GFR decline by halting the progression of late donor-specific antibody (DSA)-positive ABMR...
February 2018: Journal of the American Society of Nephrology: JASN
Marc E De Broe, Farshad Kajbaf, Jean-Daniel Lalau
BACKGROUND/AIMS: It has become clear that metformin exerts pleiotropic actions beyond its glucose-lowering agent effect. In this review, we summarise the state of the art concerning the potential renoprotective effects of metformin in vitro, animal models and clinical nephrology. METHODS: A literature search was performed in PUBMED, ScienceDirect, between January 1957 and March 2017 using the following keywords: "metformin," "nephroprotection," "renoprotection," "survival," "renal failure," "chronic kidney diseases," "fibrosis," "polycystic kidney disease" and "microalbuminuria...
December 14, 2017: Nephron
(no author information available yet)
Calcineurin inhibitors (CNIs, eg, tacrolimus) reduce short-term kidney transplant failure, but chronic nephrotoxicity may contribute to late transplant loss. Elective conversion to inhibitors of the mammalian target of rapamycin (mTOR, eg, sirolimus) pathway might avoid long-term CNI renal damage and improve outcomes. The 3C Study was a pragmatic randomized controlled trial of sequential randomizations between alemtuzumab and basiliximab induction therapy (at the time of surgery) and between tacrolimus and sirolimus maintenance therapy at 6 months posttransplantation...
December 11, 2017: American Journal of Transplantation
Syed Ali Husain, Mariana C Chiles, Samnang Lee, Stephen O Pastan, Rachel E Patzer, Bekir Tanriover, Lloyd E Ratner, Sumit Mohan
BACKGROUND AND OBJECTIVES: The fraction of kidneys procured for transplant that are discarded is rising in the United States. Identifying donors from whom only one kidney was discarded allows us to control for donor traits and better assess reasons for organ discard. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a retrospective cohort study using United Network for Organ Sharing Standard Transplant Analysis and Research file data to identify deceased donors from whom two kidneys were procured and at least one was transplanted...
January 6, 2018: Clinical Journal of the American Society of Nephrology: CJASN
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