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kidney transplant rejection management

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https://www.readbyqxmd.com/read/29470345/summary-of-2017-fda-public-workshop-antibody-mediated-rejection-in-kidney-transplantation
#1
Ergun Velidedeoglu, Marc W Cavaillé-Coll, Shukal Bala, Ozlem A Belen, Yan Wang, Renata Albrecht
BACKGROUND: Despite major advances in understanding the pathophysiology of antibody mediated rejection (AMR); prevention, diagnosis and treatment remain unmet medical needs. It appears that early T-cell mediated rejection (TCMR), de novo donor specific antibody (dnDSA) formation and AMR result from patient or physician initiated suboptimal immunosuppression, and represent landmarks in an ongoing process rather than separate events. METHODS: On April 12-13, 2017, the Food and Drug Administration (FDA) sponsored a public workshop on AMR in kidney transplantation to discuss new advances, importance of immunosuppressive medication nonadherence in dnDSA formation, associations between AMR, cellular rejection, changes in GFR, and challenges of clinical trial design for the prevention and treatment of AMR...
February 20, 2018: Transplantation
https://www.readbyqxmd.com/read/29446225/impact-of-ureteral-stricture-and-treatment-choice-on-long-term-graft-survival-in-kidney-transplantation
#2
E Arpali, T Al-Qaoud, E Martinez, R R Redfield, G E Leverson, D B Kaufman, J S Odorico, H W Sollinger
We aimed to evaluate the influence of urological complications occurring within the first year after kidney transplantation on long-term patient and graft outcomes, and sought to examine the impact of the management approach of ureteral strictures on long-term graft function. We collected data on urological complications occurring within the first-year post-transplant. Graft survivals, patient survival, and rejection rates were compared between recipients with and without urological complications. Male gender of the recipient, delayed graft function, donor age were found to be significant risk factors for urological complications after kidney transplantation (p<0...
February 15, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29401311/transplantectomy-is-associated-with-presensitization-with-donor-reactive-t-cells-and-graft-failure-after-kidney-retransplantation-a-cohort-study
#3
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
https://www.readbyqxmd.com/read/29374910/-clinical-efficacy-of-tonsillectomy-in-renal-transplant-patients-with-recurrent-iga-nephropathy
#4
L Zhu, H Feng, J D Jia, S Peng, Y Q Li, J F Shao, X F He, Y Guan, H Guo, Z B Lin, G Chen
Objective: To investigate the therapeutic efficacy of tonsillectomy for patients with recurrence of IgA nephropathy (IgAN) after kidney transplantation. Methods: From May 2014, tonsillectomy was performed in 11 renal transplant patients with biopsy-proved recurrent IgAN. In a median follow-up of 14 (4-38) months, data of proteinuria, hematuria, estimated glomerular filtration rate (eGFR), and serum levels of IgA in these patients were compared before and after tonsillectomy.Patient's survival and renal graft survival were also summarized...
January 16, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/29369972/mtor-inhibition-and-kidney-diseases
#5
Maggie K M Ma, Susan Yung, Tak Mao Chan
Mammalian or mechanistic target of rapamycin (mTOR) is a serine-threonine kinase that plays essential roles in cell growth, proliferation, metabolism, and survival. Increased activation of the mTOR pathway is observed in patients and animal models of renal transplant rejection, autosomal dominant polycystic kidney disease, renal cell carcinoma, diabetic nephropathy, lupus nephritis, and angiomyolipoma. Agents that inhibit mTOR, such as sirolimus and everolimus, are incorporated in immunosuppressive regimens to prevent renal allograft rejection and are often used to facilitate calcineurin inhibitor minimization or to reduce the incidence of tumor recurrence...
February 2018: Transplantation
https://www.readbyqxmd.com/read/29331397/persistent-hyperparathyroidism-as-a-risk-factor-for-long-term-graft-failure-the-need-to-discuss-indication-for-parathyroidectomy
#6
Maria Júlia Correia Lima Nepomuceno Araujo, Janaina Almeida Mota Ramalho, Rosilene Motta Elias, Vanda Jorgetti, William Nahas, Melani Custodio, Rosa M A Moysés, Elias David-Neto
BACKGROUND: Although a successful kidney transplant (KTx) improves most of the mineral and bone disorders (MBD) produced by chronic kidney disease (CKD), hyperparathyroidism may persist (pHPT). Current guidelines recommend parathyroidectomy if serum parathormone is persistently elevated 1 year after KTx, because pHPT has been recently associated with poor graft outcomes. However, whether patients with pHPT and adequate renal function are at risk for long-term graft failure is unknown...
January 10, 2018: Surgery
https://www.readbyqxmd.com/read/29316017/a-comparison-of-graft-and-patient-outcomes-following-kidney-transplantation-in-extended-hour-and-conventional-haemodialysis-patients
#7
Emily J See, Carmel M Hawley, Yeoungjee Cho, Nigel D Toussaint, John Wm Agar, Elaine M Pascoe, Wai H Lim, Ross S Francis, Michael G Collins, David W Johnson
AIM: Differences in early graft function between kidney transplant recipients previously managed with either haemodialysis (HD) or peritoneal dialysis are well described. However, only two single-centre studies have compared graft and patient outcomes between extended hour and conventional HD patients, with conflicting results. METHODS: This study compared the outcomes of all extended hour (≥24 hours/week) and conventional HD patients transplanted in Australia and New Zealand between 2000 and 2014...
January 8, 2018: Nephrology
https://www.readbyqxmd.com/read/29291208/hepatitis-c-infection-in-renal-transplantation-pathogenesis-current-impact-and-emerging-trends
#8
REVIEW
Sailaja Kesiraju, Praneeth Srikanti, S Sahariah
Prevalence of hepatitis C infection, which is associated with mortality and morbidity, is higher in chronic kidney disease patients on hemodialysis and transplant recipients when compared to non HCV infected patients. In addition to the conventional risk factors, HCV infection maybe an additional risk factor in the development of chronic kidney disease. HCV causes adverse effects leading to the poor long term outcome in renal transplant recipients; hepatitis C infection can cause both hepatic as well as extra hepatic complications...
September 2017: Virusdisease
https://www.readbyqxmd.com/read/29260318/the-utility-of-surveillance-biopsies-in-pediatric-kidney-transplantation
#9
Vikas R Dharnidharka, Neil Vyas, Joseph P Gaut, Leslie Walther, S Paul Hmiel
BACKGROUND: Surveillance biopsies (SBs) are performed in some pediatric kidney transplant programs, based on data obtained in earlier immunosuppressive eras that the treatment of subclinical acute rejection results in better graft survival. The benefit of SBs for patients on modern immunosuppression regimens is unclear. We have therefore evaluated the clinical utility of SBs in a population of children receiving a kidney transplant. METHODS: We have performed SBs at 3, 6 and 12 months post-transplantation as standard of care at our institution since 2013 in patients on a regimen of rabbit anti-thymocyte globulin, tacrolimus, mycophenolate and rapid steroid taper (RST; steroids maintained in some exceptions)...
December 19, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/29246419/hla-epitope-matching-in-kidney-transplantation-an-overview-for-the-general-nephrologist
#10
REVIEW
Matthew Sypek, Joshua Kausman, Steve Holt, Peter Hughes
Rapid changes in tissue-typing technology, including the widespread availability of highly specific molecular typing methods and solid-phase assays for the detection of allele-specific anti-HLA antibodies, make it increasingly challenging to remain up to date with developments in organ matching. Terms such as epitopes and eplets abound in the transplantation literature, but often it can be difficult to see what they might mean for the patient awaiting transplantation. In this review, we provide the historical context for current practice in tissue typing and explore the potential role of HLA epitopes in kidney transplantation...
December 12, 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/29176362/significance-of-biologics-in-renal-transplantation-past-present-and-future
#11
Ivica Grgic, Anil Chandraker
PURPOSE OF REVIEW: Finding the right immunosuppressive approach for the individual transplant patient is of utmost importance. In truth, a 'one size fits all' does not exist, and as patients differ, so should therapeutic suppression of the immune system be individualized. For over three decades, biologics have been a central component of transplant immunosuppression. Our growing knowledge of immunological processes combined with biotechnological advances is leading to promising new therapeutic concepts and possibilities including novel biologics...
November 25, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/29149976/clinical-challenges-of-tacrolimus-for-maintenance-immunosuppression-post-lung-transplantation
#12
S Ivulich, M Dooley, C Kirkpatrick, G Snell
Lung transplantation (LTx) is a successful treatment option for end-stage lung disease, and immunosuppressant regimens, utilized to prevent rejection of the transplanted graft, are paramount to maintaining long-term graft survival. Immunosuppression can be classified as induction, maintenance, and antirejection therapy. This article focuses on maintenance immunosuppression that includes a combination of a calcineurin inhibitor (CNI), cell cycle inhibitor, and corticosteroid. CNIs remain the cornerstone of immunosuppression following LTx, and tacrolimus is now the preferred CNI, based on a better adverse effect profile and some limited evidence for enhanced efficacy...
November 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/29139625/late-graft-failure-after-kidney-transplantation-as-the-consequence-of-late-versus-early-events
#13
Robert S Gaston, Ann Fieberg, Lawrence Hunsicker, Bertram L Kasiske, Robert Leduc, Fernando G Cosio, Sita Gourishankar, Joseph Grande, Roslyn B Mannon, David Rush, Michael J Cecka, John Connett, Arthur J Matas
Beyond the first posttransplant year, 3% of kidney transplants fail annually. In a prospective, multicenter cohort study, we tested the relative impact of early versus late events on risk of long-term death-censored graft failure (DCGF). In grafts surviving at least 90 days, early events (acute rejection [AR] and delayed graft function [DGF] before day 90) were recorded; serum creatinine (Cr) at day 90 was defined as baseline. Thereafter, a 25% rise in serum Cr or new onset proteinuria triggered graft biopsy (index biopsy, IBx), allowing comparison of risk of DCGF associated with early events (AR, DGF, baseline serum Cr >2...
November 15, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/29053921/integrated-kidney-exosome-analysis-for-the-detection-of-kidney-transplant-rejection
#14
Jongmin Park, Hsing-Ying Lin, Jean Pierre Assaker, Sangmoo Jeong, Chen-Han Huang, Ahmed Kurdi, Kyungheon Lee, Kyle Fraser, Changwook Min, Siawosh Eskandari, Sujit Routray, Bakhos Tannous, Reza Abdi, Leonardo Riella, Anil Chandraker, Cesar M Castro, Ralph Weissleder, Hakho Lee, Jamil R Azzi
Kidney transplant patients require life-long surveillance to detect allograft rejection. Repeated biopsy, albeit the clinical gold standard, is an invasive procedure with the risk of complications and comparatively high cost. Conversely, serum creatinine or urinary proteins are noninvasive alternatives but are late markers with low specificity. We report a urine-based platform to detect kidney transplant rejection. Termed iKEA (integrated kidney exosome analysis), the approach detects extracellular vesicles (EVs) released by immune cells into urine; we reasoned that T cells, attacking kidney allografts, would shed EVs, which in turn can be used as a surrogate marker for inflammation...
October 25, 2017: ACS Nano
https://www.readbyqxmd.com/read/29037222/the-efficacy-and-stability-of-an-information-and-communication-technology-based-centralized-monitoring-system-of-adherence-to-immunosuppressive-medication-in-kidney-transplant-recipients-study-protocol-for-a-randomized-controlled-trial
#15
Hee-Yeon Jung, Sook Jin Seong, Ji-Young Choi, Jang-Hee Cho, Sun-Hee Park, Chan-Duck Kim, Young-Ran Yoon, Hyung-Kee Kim, Seung Huh, Se-Hee Yoon, Jong Soo Lee, Yong-Lim Kim
BACKGROUND: Immunosuppression non-adherence in kidney transplant recipients (KTRs) not only increases the risk of medical intervention due to acute rejection and graft loss but burdens the socioeconomic system in the form of increased healthcare costs. An aggressive preemptive effort by healthcare professionals, geared to ensure adherence to immunosuppressants in KTRs, is significant and imperative. METHODS/DESIGN: This study was designed as a prospective, open-label, multicenter, randomized controlled study aimed at evaluating the efficacy and stability of an information and communication technology (ICT)-based centralized monitoring system in boosting medication adherence in KTRs...
October 16, 2017: Trials
https://www.readbyqxmd.com/read/28986314/preemptive-anti-cytomegalovirus-therapy-in-high-risk-donor-positive-recipient-negative-cytomegalovirus-serostatus-kidney-transplant-recipients
#16
Jumpei Hasegawa, Shuji Hatakeyama, Sachiko Wakai, Kazuya Omoto, Masayoshi Okumi, Kazunari Tanabe, Makiko Mieno, Hiroki Shirakawa
OBJECTIVES: Universal prophylaxis and preemptive therapy are used to prevent cytomegalovirus (CMV) disease post-transplantation. Data regarding which strategy is superior are sparse, especially in high-risk recipients (donor CMV seropositive (D+) and recipient CMV seronegative (R-)). METHODS: This retrospective, single-center cohort study included recipients who underwent kidney transplantation between 2009 and 2015. The incidence of CMV infection/disease and patient and graft outcomes were analyzed and compared between high-risk recipients (D+/R-) and intermediate-risk recipients (D+/R+ or D-/R+), all managed with preemptive therapy...
October 3, 2017: International Journal of Infectious Diseases: IJID
https://www.readbyqxmd.com/read/28940540/successful-kidney-transplantation-in-a-patient-with-congenital-thrombotic-thrombocytopenic-purpura-upshaw-schulman-syndrome
#17
Hasan Fattah, Dhiren Kumar, James N George, H Davis Massey, Anne L King, Kenneth D Friedman, Gaurav Gupta
BACKGROUND: Congenital thrombotic thrombocytopenic purpura (TTP) may not be recognized until organ failure related to the microvascular thrombosis occurs. Kidney failure may be the initial presenting clinical feature. Kidney transplantation has been contraindicated because of the assumption that the continuing microvascular thrombosis will cause inevitable graft failure. CASE REPORT: We report a 48-year-old nulliparous woman who presented with end-stage kidney disease that was attributed to hypertension...
September 20, 2017: Transfusion
https://www.readbyqxmd.com/read/28880430/human-leukocyte-antigen-sensitization-in-solid-organ-transplantation-a-primer-on-terminology-testing-and-clinical-significance-for-the-apheresis-practitioner
#18
REVIEW
Sarah Abbes, Ara Metjian, Alice Gray, Tereza Martinu, Laurie Snyder, Dong-Feng Chen, Matthew Ellis, Gowthami M Arepally, Oluwatoyosi Onwuemene
The human leukocyte antigen (HLA) system is an important immunologic barrier that must be considered for successful solid organ transplantation. Formation of donor-specific HLA antibodies in solid organ transplantation is an important cause of allograft injury and may contribute to recipient morbidity and mortality. Therapeutic plasma exchange is often requested to lower HLA antibody levels prior to or after transplantation and for management of HLA antibodies in the context of organ rejection. In this review, we summarize the current terminology, laboratory testing, and clinical significance of HLA sensitization in the solid organ transplant population...
October 2017: Therapeutic Apheresis and Dialysis
https://www.readbyqxmd.com/read/28823116/outcomes-of-living-donor-kidney-transplantation-in-diabetic-patients-age-and-sex-matched-comparison-with-non-diabetic-patients
#19
Chung Hee Baek, Hyosang Kim, Seung Don Baek, Mun Jang, Wonhak Kim, Won Seok Yang, Duck Jong Han, Su-Kil Park
Background/Aims: Kidney transplantation (KT) reportedly provides a significant survival advantage over dialysis in diabetic patients. However, KT outcome in diabetic patients compared with that in non-diabetic patients remains controversial. In addition, owing to recent improvements in the outcomes of KT and management of cardiovascular diseases, it is necessary to analyze outcomes of recently performed KT in diabetic patients. Methods: We reviewed all diabetic patients who received living donor KT between January 2008 and December 2011...
August 21, 2017: Korean Journal of Internal Medicine
https://www.readbyqxmd.com/read/28808594/spontaneous-renal-allograft-rupture-caused-by-acute-tubular-necrosis-a-case-report-and-review-of-the-literature
#20
Deepak Shankar Ray, Sharmila Thukral
Renal allograft rupture (RAR) is a rare but lethal complication of renal transplantation. It potentially threatens graft and patient survival. RAR is frequently associated with acute rejection, but other causes like renal vein thrombosis and acute tubular necrosis have also been observed. Most commonly a graft nephrectomy is required, but graft repair can also be attempted in selected cases to salvage the graft. Herein, we describe a rare case of spontaneous renal allograft rupture in the early posttransplant period due to acute tubular necrosis...
2017: Case Reports in Transplantation
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