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kidney transplant rejection management

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https://www.readbyqxmd.com/read/29676031/treatment-of-recurrent-focal-segmental-glomerulosclerosis-post-kidney-transplantation-in-australian-and-new-zealand-children-a-retrospective-cohort-study
#1
Anna Francis, Madeleine Didsbury, Hugh McCarthy, Tonya Kara
Disease recurrence affects around a third of renal transplants for children with FSGS and is associated with poor graft outcomes. Unfortunately, there are no large trials guiding treatment for recurrent FSGS. We aimed to describe current therapies and treatment response for recurrent FSGS in 4 centres in Australia and New Zealand. Data were collected on children (age <18 years) with recurrent FSGS (1990-2015). We reviewed patient charts to obtain clinical information. Ethics approval was obtained from the relevant boards...
April 19, 2018: Pediatric Transplantation
https://www.readbyqxmd.com/read/29669332/paritaprevir-ritonavir-ombitasvir-plus-dasabuvir-regimen-in-the-treatment-of-genotype-1-chronic-hepatitis-c-infection-in-patients-with-severe-renal-impairment-and-end-stage-renal-disease-a-real-life-cohort
#2
Jan Sperl, Miluse Kreidlova, Dusan Merta, Klara Chmelova, Renata Senkerikova, Sona Frankova
BACKGROUND/AIMS: Chronic hepatitis C (HCV) virus infection reactivates under immunosuppressive drugs and therefore has a negative impact on long-term survival of kidney transplant recipients. Treatment-induced clearance of hepatitis C virus (HCV) in kidney transplant candidates prevents virus reactivation after transplantation. Paritaprevir/Ritonavir/Ombitasvir with Dasabuvir (PrOD) represents a highly effective treatment regimen for HCV genotype 1 (GT1), also suitable for patients with end-stage renal disease (ESRD)...
April 13, 2018: Kidney & Blood Pressure Research
https://www.readbyqxmd.com/read/29661460/partial-cystectomy-of-paraganglioma-of-the-urinary-bladder-before-living-kidney-transplantation-case-report
#3
K Kido, S Hatakeyama, I Hamano, H Yamamoto, A Imai, T Yoneyama, Y Hashimoto, T Koie, T Fujita, R Murakami, H Tomita, T Suzuki, S Narumi, C Ohyama
BACKGROUND: Paraganglioma (extra-adrenal pheochromocytoma) of the bladder is a very rare disease, accounting for 0.06% of all bladder tumors. Optimal management of bladder paraganglioma before kidney transplantation is unknown. We report a case of partial cystectomy for urinary bladder paraganglioma before living kidney transplantation. CASE PRESENTATION: A 59-year-old man with a 27-year history of hemodialysis was referred to our department for further examination of a bladder tumor detected during pre-transplantation testing...
April 2018: Transplantation Proceedings
https://www.readbyqxmd.com/read/29589603/acute-kidney-injury-in-kidney-transplant-patients
#4
C Dudreuilh, R Aguiar, M Ostermann
Managing kidney transplant patients in an acute medical unit can be challenging, as patients have a single functioning kidney, underlying chronic kidney disease, and are immunosuppressed. Transplant patients develop AKI for all usual reasons but the differential diagnosis is wider and includes specific problems, such as obstruction of a single functioning kidney, vascular thrombosis, rejection, drug toxicity and drug-induced thrombotic microangiopathy. Septic AKI is common but again, the differential diagnosis of sepsis is wider...
2018: Acute Medicine
https://www.readbyqxmd.com/read/29588161/gene-expression-profiling-scores-in-dual-organ-transplant-patients-are-similar-to-those-in-heart-only-recipients
#5
Sandra A Carey, Kristen M Tecson, Aayla K Jamil, Joost Felius, Theresa K Wolf-Doty, Shelley A Hall
BACKGROUND: Serial gene expression profiling (GEP) may reduce the need for endomyocardial biopsies for detecting acute cellular rejection (ACR) after transplantation, but its performance in dual organ transplant recipients is currently unknown. METHODS: We analyzed 18 months of follow-up in a national cohort of 27 dual organ recipients (18 heart-kidney, 8 heart-liver, 1 heart-lung) matched to 54 heart-only recipients for gender, age, and time to first GEP (AlloMap®) test...
March 24, 2018: Transplant Immunology
https://www.readbyqxmd.com/read/29573830/gastric-mucormycosis-in-a-liver-and-kidney-transplant-recipient-case-report-and-concise-review-of-literature
#6
G Alfano, F Fontana, D Francesca, G Assirati, P Magistri, G Tarantino, R Ballarin, G Rossi, E Franceschini, M Codeluppi, G Guaraldi, C Mussini, F Di Benedetto, G Cappelli
Mucormycosis is an uncommonly encountered fungal infection in solid organ transplantation. The infection is severe and often results in a fatal outcome. The most common presentations are rhino-sino-orbital and pulmonary disease. We describe a rare case of gastric mucormycosis in a patient with a combined liver-kidney transplant affected by glycogen storage disease type Ia. A 42-year-old female patient presented with gastric pain and melena 26 days after transplantation. Evaluation with upper endoscopy showed two bleeding gastric ulcers...
April 2018: Transplantation Proceedings
https://www.readbyqxmd.com/read/29552340/a-retrospective-analysis-of-the-utility-and-safety-of-kidney-transplant-biopsies-by-nephrology-trainees-and-consultants
#7
Michael E Reschen, Andrea Mazzella, Edward Sharples
Background and aims: Dysfunction of a kidney transplant often requires histological sampling by percutaneous ultrasound-guided core needle biopsy. Transplant biopsy is more specialized than native kidney biopsy, the indications and complications are less well defined and in England are performed mainly by nephrologists. The aims of the study were to evaluate the adequacy and complication rate in living and deceased donor recipients according to training status of the nephrologist, assess the accuracy of physicians in predicting rejection, the threshold creatinine rise for biopsy, and the change in drug management post-biopsy...
April 2018: Annals of Medicine and Surgery
https://www.readbyqxmd.com/read/29536028/rituximab-and-monitoring-strategies-for-late-antibody-mediated-rejection-after-kidney-transplantation
#8
Sandesh Parajuli, Didier A Mandelbrot, Brenda Muth, Maha Mohamed, Neetika Garg, Fahad Aziz, Robert R Redfield, Weixiong Zhong, Brad C Astor, Arjang Djamali
Background: There is limited information on treatment strategies and monitoring strategies for late antibody-mediated rejection (ABMR) after kidney transplantation. Methods: In this observational and nonrandomized study, we compared 78 patients diagnosed with late ABMR (>3 months after transplant) who were treated with standard of care steroids/IVIG (n = 38) ± rituximab (n = 40) at our center between March 1, 2013 and December 31, 2016. All patients had follow-up biopsy and donor-specific antibodies (DSA) monitoring within 3 to 12 weeks...
December 2017: Transplantation Direct
https://www.readbyqxmd.com/read/29534661/management-of-plasma-cell-rich-acute-rejection-in-living-related-kidney-transplant-role-of-proteasome-inhibitor
#9
Khawar Abbas, Muhammed Mubarak, Mirza Naqi Zafar, Wajiha Musharraf, Mehjabeen Imam, Tahir Aziz, Adibul Hassan Rizvi
OBJECTIVES: Plasma cell-rich acute rejection is an aggressive form of acute rejection that occurs late after transplant and is usually resistant to standard antirejection therapy. This study reports the safety, efficacy, and outcomes of plasma cell-rich acute rejection after treatment with bortezomib, a proteasome inhibitor, in 10 patients after a first living-related renal transplant. MATERIALS AND METHODS: Plasma cell-rich acute rejection was diagnosed using the 2007 Banff classification...
March 9, 2018: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/29479453/practice-patterns-in-the-treatment-and-monitoring-of-acute-t-cell-mediated-kidney-graft-rejection-in-canada
#10
Julie Leblanc, Peter Subrt, Michèle Paré, David Hartell, Lynne Sénécal, Tom Blydt-Hansen, Héloïse Cardinal
Background: One of the goals of the Canadian National Transplant Research Program (CNTRP) is to develop novel therapies for acute rejection that could positively affect graft outcomes with greater efficacy or less toxicity. To develop innovative management strategies for kidney graft rejection, new modalities need to be compared with current clinical practices. However, there are no standardized practices concerning the management of acute T cell-mediated rejection (TCMR). Objectives: To describe clinicians' practice patterns in the diagnosis, treatment, and monitoring of acute TCMR in Canada...
2018: Canadian Journal of Kidney Health and Disease
https://www.readbyqxmd.com/read/29470345/summary-of-2017-fda-public-workshop-antibody-mediated-rejection-in-kidney-transplantation
#11
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...
March 20, 2018: Transplantation
https://www.readbyqxmd.com/read/29446225/impact-of-ureteral-stricture-and-treatment-choice-on-long-term-graft-survival-in-kidney-transplantation
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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)...
May 2018: 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
#20
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
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