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kidney transplant rejection management

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https://www.readbyqxmd.com/read/29176362/significance-of-biologics-in-renal-transplantation-past-present-and-future
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
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
https://www.readbyqxmd.com/read/28790293/-critical-care-managements-after-lung-transplantation
#11
Masaki Anraku
Lung transplantation is a viable treatment option for patients with end-stage lung diseases such as interstitial pneumonia/pulmonary fibrosis, emphysema, pulmonary hypertension, and so on. Collecting available clinical, physiological, serological, and surgical information of both donor and recipient is vital when planning relevant postoperative managements. The goal of the managements is to keep the transplanted lung (s) functional while preventing/treating infection, rejection, and ischemiareperfusion lung injury...
July 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/28719391/pediatric-and-congenital-hand-transplantation
#12
Sandra Amaral, L Scott Levin
PURPOSE OF REVIEW: We review the approach and challenges associated with pediatric hand transplantation, including new knowledge gleaned from our recent case of bilateral hand-forearm transplantation in an 8-year old child. RECENT FINDINGS: Bilateral heterologous hand-forearm transplantation was performed in a child with a prior kidney transplant in July 2015. The initial surgery necessitated a large team of experts in microvascular surgery, transplant surgery, orthopedics and plastic surgery as well as pediatric anesthesia...
July 14, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28708813/application-and-interpretation-of-histocompatibility-data-in-liver-transplantation
#13
Russell N Wesson, Eric W Etchill, Jacqueline Garonzik-Wang
PURPOSE OF REVIEW: There has been a resurgence of interest in histocompatibility as it applies to liver transplantation. The association of persistent and de-novo donor specific antibody (DSA) and outcomes after liver transplantation continues to be investigated. RECENT FINDINGS: Consensus continues to evolve regarding the existence of acute and chronic antibody-mediated rejection (AMR) and pathogenicity of DSA and associated pathologic findings after liver transplantation...
July 13, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28686681/kir-and-their-hla-class-i-ligands-two-more-pieces-towards-completing-the-puzzle-of-chronic-rejection-and-graft-loss-in-kidney-transplantation
#14
Roberto Littera, Gianbenedetto Piredda, Davide Argiolas, Sara Lai, Elena Congeddu, Paola Ragatzu, Maurizio Melis, Elisabetta Carta, Maria Benigna Michittu, Donatella Valentini, Luisella Cappai, Rita Porcella, Francesco Alba, Maria Serra, Valentina Loi, Roberta Maddi, Sandro Orrù, Giorgio La Nasa, Giovanni Caocci, Roberto Cusano, Marcella Arras, Mauro Frongia, Antonello Pani, Carlo Carcassi
BACKGROUND: Kidney transplantation is a life-saving treatment for patients with end-stage renal disease. However, despite progress in surgical techniques and patient management, immunological rejection continues to have a negative impact on graft function and overall survival. Incompatibility between donors and recipients for human leukocyte antigens (HLA) of the major histocompatibility complex (MHC) generates a series of complex cellular and humoral immune response mechanisms that are largely responsible for rejection and loss of graft function...
2017: PloS One
https://www.readbyqxmd.com/read/28640530/how-does-age-affect-the-outcome-of-kidney-transplantation-in-elderly-recipients
#15
Flavia Neri, Lucrezia Furian, Francesco Cavallin, Matteo Ravaioli, Cristina Silvestre, Paola Donato, Gaetano La Manna, Antonio Daniele Pinna, Paolo Rigotti
The aging of the on-dialysis population raises the issue of whether to propose elderly patients for kidney transplantation and how to manage their immunosuppression. This study aimed to analyze the outcome of kidney transplantation on an Italian series of elderly recipients. We included in this retrospective study all patients over 60 years, receiving a deceased-donor kidney transplantation from January 2004 to December 2014 in two north Italian Centers. We analyzed the correlation of recipient age with graft's and patient's survival, delayed graft function, acute cellular rejection (ACR), surgical complications, infections, and glomerular filtration rate...
October 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28606879/can-immunosuppression-be-stopped-after-liver-transplantation
#16
REVIEW
Pierre-Alain Clavien, Xavier Muller, Michelle L de Oliveira, Philipp Dutkowski, Alberto Sanchez-Fueyo
Liver transplantation has improved dramatically over the past three decades, mainly as a result of advances in surgical techniques and management of post-transplant complications. The focus has now turned towards rescuing additional organs in the face of scarce organ supply, or prevention of long-term toxicity associated with immunosuppression. The liver appears to be privileged in terms of immune tolerance, with a low incidence of antibody-mediated rejection, which is in sharp contrast to other solid organ transplants, such as kidney, lung, and heart transplants...
July 2017: Lancet. Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/28571481/blood-biomarkers-of-kidney-transplant-rejection-an-endless-search
#17
Lola Jacquemont, Jean-Paul Soulillou, Nicolas Degauque
The tailoring of immunosuppressive treatment is recognized as a promising strategy to improve long-term kidney graft outcome. To guide the standard care of transplant recipients, physicians need objective biomarkers that can identify an ongoing pathology with the graft or low intensity signals that will be later evolved to accelerated transplant rejection. The early identification of 'high-risk /low-risk' patients enables the adjustment of standard of caring, including managing the frequency of clinical visits and the immunosuppression dosing...
July 2017: Expert Review of Molecular Diagnostics
https://www.readbyqxmd.com/read/28567331/laparoscopic-management-of-pelvic-organ-prolapse-in-a-kidney-transplant-recipient
#18
Jean Rouffilange, Maxime Deslandes, Laurent Lopez
This is a report of a laparoscopic double mesh sacrocolpopexy performed in the setting of a 73-year-old woman carrying a grafted kidney. The patient had a vaginal prolapse of the anterior and posterior floor without urinary incontinence. Despite immunosuppression due to anti-rejection treatments and the presence of kidney transplant in left iliac fossa, laparoscopic intervention with the introduction of prosthetic material was conducted. The intervention showed no major difficulty in its implementation and the postoperative course was uneventful...
July 2017: Urology Case Reports
https://www.readbyqxmd.com/read/28540837/enterovesical-fistula-after-enteric-conversion-of-a-bladder-drained-pancreatic-allograft-a-case-report
#19
Clifford Akateh, Amer Rajab, Mitchell Henry, Ashraf El-Hinnawi
Since the inception of pancreas transplant as a treatment for type 1 diabetes mellitus, there has been considerable debate about the best way to manage exocrine secretions and monitor patients for graft rejection. For patients who undergo bladder exocrine drainage of a pancreatic allograft, a bladder-to-enteric drainage conversion can serve as a rescue procedure in case of anastomotic leaks or other complications. However, this procedure is associated with its own complications, including a rarely described enterovesical fistula...
May 22, 2017: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/28508971/short-term-outcome-and-quality-of-life-in-kidney-transplant-recipient-with-monoclonal-gammopathy
#20
Masaaki Yanishi, Hiroyasu Tsukaguchi, Takashi Yoshida, Hisanori Taniguchi, Kenji Yoshida, Takao Mishima, Yoshihiro Komai, Kaneki Yasuda, Masato Watanabe, Motohiko Sugi, Hidefumi Kinoshita, Tadashi Matsuda
Monoclonal gammopathy of undetermined significance (MGUS) is the common pre-malignant B cell disorders with a general prevalence of 3-5 % at age over 50. Because of the potential malignant transformation and immune insufficiency, pre-transplant MGUS recipient should be carefully followed after allograft transplantation. The post-transplant prognosis and quality of life (QOL) in patient with MGUS have not yet been fully determined. The aim of this study is to evaluate function and pathology of the renal allograft and self-assessment QOL changes during 2 years after transplantation in our case of MGUS-bearing recipient...
November 2016: CEN Case Reports
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