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By Venkatesh Ariyamuthu Transplant Nephrologist at UT Southwestern Medical Center
Joachim H Ix, Ronit Katz, Nisha Bansal, Meredith Foster, Daniel E Weiner, Russell Tracy, Vasantha Jotwani, Jan Hughes-Austin, Dianne McKay, Francis Gabbai, Chi-Yuan Hsu, Andrew Bostom, Andrew S Levey, Michael G Shlipak
BACKGROUND: Kidney tubulointerstitial fibrosis marks risk for allograft failure in kidney transplant recipients, but is poorly captured by estimated glomerular filtration rate (eGFR) or urine albumin-creatinine ratio (ACR). Whether urinary markers of tubulointerstitial fibrosis can noninvasively identify risk for allograft failure above and beyond eGFR and ACR is unknown. STUDY DESIGN: Case-cohort study. SETTING & PARTICIPANTS: The FAVORIT (Folic Acid for Vascular Outcome Reduction in Transplantation) Trial was a randomized double-blind trial testing vitamin therapy to lower homocysteine levels in stable kidney transplant recipients...
March 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Fernando G Cosio, Daniel C Cattran
Recurrent glomerulonephritis (GN) is an important cause of kidney allograft failure, particularly in younger recipients. Approximately 15% of death-censored graft failures are due to recurrent GN, but this incidence is likely an underestimation of the magnitude of the problem. Overall, 18% to 22% of kidney allografts are lost due to GN, either recurrent or presumed de novo. The impact of recurrent GN on allograft survival was recognized from the earliest times in kidney transplantation. However, progress in this area has been slow, and our understanding of GN recurrence remains limited, in large part due to incomplete understanding of the pathogenesis of these diseases...
February 2017: Kidney International
Sandra Amaral, Blayne A Sayed, Nancy Kutner, Rachel E Patzer
Kidney transplantation is the preferred treatment for pediatric end-stage renal disease (ESRD). Preemptive transplantation avoids the increased morbidity and mortality of dialysis. Yet, previous studies have not demonstrated significant graft or patient survival benefits for children undergoing transplantation preemptively versus nonpreemptively. These previous studies were limited by small samples sizes and low rates of adverse events. Here we compared graft failure and mortality rates using Kaplan-Meier methods and Cox regression among a large national cohort of children with ESRD undergoing preemptive versus nonpreemptive kidney transplantation between 2000 and 2012...
November 2016: Kidney International
Peggy Perrin, Clotilde Kiener, Rose-Marie Javier, Laura Braun, Noelle Cognard, Gabriela Gautier-Vargas, Francoise Heibel, Clotilde Muller, Jerome Olagne, Bruno Moulin, Sophie Caillard
BACKGROUND: The management of chronic kidney disease-mineral and bone disorders (CKD-MBD) has recently changed. We investigated the modifications of CKD-MBD with a special focus on the incidence of fractures in the first year after kidney transplantation (KT). METHODS: We retrospectively compared 2 groups of patients who consecutively underwent transplantation at our center 5 years from each other. Group 1 consisted of patients (n=152) transplanted between 2004 and 2006, whereas patients in group 2 (n=137) underwent KT between 2009 and 2011...
August 19, 2016: Transplantation
M L Nogueira, C F Estofolete, A C B Terzian, E P B Mascarin do Vale, R C M A da Silva, R F da Silva, H J Ramalho, I M M Fernandes Charpiot, N Vasilakis, M Abbud-Filho
Public health concerns exist surrounding the epidemic of the Zika virus (ZIKV) and the rapid growth of transplantation in developing countries, including endemic zones of active arbovirus transmission, as well as travel to such regions by potential organ donors and recipients. Few data exist regarding the clinical characteristics of ZIKV infection in immunocompromised hosts. Laboratory screening protocols for transplantation to differentiate ZIKV infections from other endemic viral diseases and for the detection of possible donor-derived infection have not been stated...
March 2017: American Journal of Transplantation
Elena Sánchez-Zapardiel, Esther Mancebo, María Díaz-Ordoñez, Lucía de Jorge-Huerta, Lara Ruiz-Martínez, Antonio Serrano, María J Castro-Panete, Alberto Utrero-Rico, Amado de Andrés, José M Morales, Sara Domínguez-Rodríguez, Estela Paz-Artal
BACKGROUND: Studies analyzing the role of antiendothelial cell antibodies (AECAs) in large series of kidney transplant recipients are scarce, and HLA, MHC (major histocompatibility complex) class I-related chain A (MICA), and angiotensin II type 1 receptor have not been formally excluded as targets. STUDY DESIGN: Retrospective study of a cohort of kidney transplant recipients. SETTING & PARTICIPANTS: 324 kidney transplant recipients who were negative for anti-HLA, anti-MICA, and anti-angiotensin II type 1 receptor antibodies were tested for AECAs in pre- and posttransplantation serum samples...
December 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Denis Viglietti, Alexandre Loupy, Dewi Vernerey, Carol Bentlejewski, Clément Gosset, Olivier Aubert, Jean-Paul Duong van Huyen, Xavier Jouven, Christophe Legendre, Denis Glotz, Adriana Zeevi, Carmen Lefaucheur
The diagnosis system for allograft loss lacks accurate individual risk stratification on the basis of donor-specific anti-HLA antibody (anti-HLA DSA) characterization. We investigated whether systematic monitoring of DSA with extensive characterization increases performance in predicting kidney allograft loss. This prospective study included 851 kidney recipients transplanted between 2008 and 2010 who were systematically screened for DSA at transplant, 1 and 2 years post-transplant, and the time of post-transplant clinical events...
February 2017: Journal of the American Society of Nephrology: JASN
Falk Hiepe, Andreas Radbruch
Autoantibodies are secreted by plasma cells and have an essential role in driving the renal manifestations of autoimmune diseases such as systemic lupus erythematosus and antineutrophil cytoplasmic autoantibody-associated vasculitis. Effective depletion of autoreactive plasma cells might be the key to curative treatment of these diseases. Two major plasma-cell compartments exist: short-lived plasmablasts or plasma cells, which result from differentiation of activated B cells, and long-lived plasma cells, which result from secondary immune responses...
April 2016: Nature Reviews. Nephrology
William F Clark, Shih-Han S Huang, Michael W Walsh, Myriam Farah, Ainslie M Hildebrand, Jessica M Sontrop
The purpose of this review is to examine the evidence supporting the application of plasma exchange in renal disease. Our review focuses on the following 6 most common renal indications for plasma exchange based on 2014 registry data from the Canadian Apheresis Group: (i) thrombotic thrombocytopenic purpura (TTP)/hemolytic uremic syndrome; (ii) renal transplantation, (iii) anti-neutrophil cytoplasm antibodies-associated vasculitis, (iv) cryoglobulinemia, (v) focal segmental glomerulosclerosis, and (vi) Goodpasture syndrome...
November 2016: Kidney International
Gautam R Shroff, Charles A Herzog
Coronary revascularization decisions for patients with CKD stage 5D present a dilemma for clinicians because of high baseline risks of mortality and future cardiovascular events. This population differs from the general population regarding characteristics of coronary plaque composition and behavior, accuracy of noninvasive testing, and response to surgical and percutaneous revascularization, such that findings from the general population cannot be automatically extrapolated. However, this high-risk population has been excluded from all randomized trials evaluating outcomes of revascularization...
December 2016: Journal of the American Society of Nephrology: JASN
Sunil V Badve, Elaine M Pascoe, Michael Burke, Philip A Clayton, Scott B Campbell, Carmel M Hawley, Wai H Lim, Stephen P McDonald, Germaine Wong, David W Johnson
BACKGROUND AND OBJECTIVES: Emerging evidence from recently published observational studies and an individual patient data meta-analysis shows that mammalian target of rapamycin inhibitor use in kidney transplantation is associated with increased mortality. Therefore, all-cause mortality and allograft loss were compared between use and nonuse of mammalian target of rapamycin inhibitors in patients from Australia and New Zealand, where mammalian target of rapamycin inhibitor use has been greater because of heightened skin cancer risk...
October 7, 2016: Clinical Journal of the American Society of Nephrology: CJASN
James E Tooley, Daniel D Bohl, Sanjay Kulkarni, Manuel I Rodriguez-Davalos, Abeel Mangi, David C Mulligan, Peter S Yoo
BACKGROUND: Cardiovascular disease is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD). In fact, death from cardiovascular disease is the number one cause of graft loss in kidney transplant (KTx) patients. Compared to patients on dialysis, CKD patients with KTx have increased quality and length of life. It is not known, however, whether outcomes of coronary artery bypass graft (CABG) surgery differ between CKD patients with KTx or on dialysis...
October 2016: Clinical Transplantation
Michelle M O'Shaughnessy, Sai Liu, Maria E Montez-Rath, Colin R Lenihan, Richard A Lafayette, Wolfgang C Winkelmayer
Differences in kidney transplantation outcomes across GN subtypes have rarely been studied. From the US Renal Data System, we identified all adult (≥18 years) first kidney transplant recipients (1996-2011) with ESRD attributed to one of six GN subtypes or two comparator kidney diseases. We computed hazard ratios (HRs) for death, all-cause allograft failure, and allograft failure excluding death as a cause (competing risks framework) using Cox proportional hazards regression. Among the 32,131 patients with GN studied, patients with IgA nephropathy (IgAN) had the lowest mortality rates and patients with IgAN or vasculitis had the lowest allograft failure rates...
February 2017: Journal of the American Society of Nephrology: JASN
Robert R Redfield, Joseph R Scalea, Tiffany J Zens, Didier A Mandelbrot, Glen Leverson, Dixon B Kaufman, Arjang Djamali
BACKGROUND: We sought to determine whether the mode of sensitization in highly sensitized patients contributed to kidney allograft survival. METHODS: An analysis of the United Network for Organ Sharing dataset involving all kidney transplants between 1997 and 2014 was undertaken. Highly sensitized adult kidney transplant recipients [panel reactive antibody (PRA) ≥98%] were compared with adult, primary non-sensitized and re-transplant recipients. Kaplan-Meier survival analyses were used to determine allograft survival rates...
October 2016: Nephrology, Dialysis, Transplantation
Bertram L Kasiske, Rajiv Kumar, Paul L Kimmel, Todd E Pesavento, Roberto S Kalil, Edward S Kraus, Hamid Rabb, Andrew M Posselt, Teresa L Anderson-Haag, Michael W Steffes, Ajay K Israni, Jon J Snyder, Ravinder J Singh, Matthew R Weir
Previous studies have suggested that kidney donors may have abnormalities of mineral and bone metabolism typically seen in chronic kidney disease. This may have important implications for the skeletal health of living kidney donors and for our understanding of the pathogenesis of long-term mineral and bone disorders in chronic kidney disease. In this prospective study, 182 of 203 kidney donors and 173 of 201 paired normal controls had markers of mineral and bone metabolism measured before and at 6 and 36 months after donation (ALTOLD Study)...
October 2016: Kidney International
Bekir Tanriover, Vishal Jaikaransingh, Malcolm P MacConmara, Justin R Parekh, Swee-Ling Levea, Venkatesh K Ariyamuthu, Song Zhang, Ang Gao, Mehmet U S Ayvaci, Burhaneddin Sandikci, Nilum Rajora, Vaqar Ahmed, Christopher Y Lu, Sumit Mohan, Miguel A Vazquez
BACKGROUND AND OBJECTIVES: IL-2 receptor antagonist (IL2-RA) is recommended as a first-line agent for induction therapy in renal transplantation. However, this remains controversial in deceased donor renal transplantation (DDRT) maintained on tacrolimus (TAC)/mycophenolic acid (MPA) with or without steroids. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We studied the United Network for Organ Sharing Registry for patients receiving DDRT from 2000 to 2012 maintained on TAC/MPA at transplantation hospital discharge (n=74,627) to compare outcomes of IL2-RA and other induction agents...
September 7, 2016: Clinical Journal of the American Society of Nephrology: CJASN
Philip F Halloran, Konrad S Famulski, Jeff Reeve
Progress in renal transplantation requires improved understanding and assessment of rejection and injury. Study of the relationship between gene expression and clinical phenotypes in kidney transplant biopsy samples has led to the development of a system that enables diagnoses of specific disease states on the basis of messenger RNA levels in the biopsy sample. Using this system we have defined the molecular landscape of T cell-mediated rejection (TCMR), antibody-mediated rejection (ABMR), acute kidney injury (AKI), and tubular atrophy and interstitial fibrosis...
September 2016: Nature Reviews. Nephrology
Monika Huber, Stephan Kemmner, Lutz Renders, Uwe Heemann
Belatacept was developed to minimize cardiovascular risk and nephrotoxicity associated with calcineurin inhibitor (CNI)-based immunosuppression. Recently, 7-year data from the Belatacept Evaluation of Nephroprotection and Efficacy as First-line Immunosuppression Trial (BENEFIT), a phase III study comparing belatacept with cyclosporine, have been published. While during the first year of belatacept the risk of acute rejection episodes was elevated, this seemingly had marginal consequences for long-term graft survival and function as well as patient survival...
December 2016: Nephrology, Dialysis, Transplantation
Ronald P Pelletier, Todd E Pesavento, Amer Rajab, Mitchell L Henry
BACKGROUND: Deceased donor (DD) kidney quality is determined by calculating the Kidney Donor Profile Index (KDPI). Optimizing high KDPI (≥85%) DD transplant outcome is challenging. This retrospective study was performed to review our high KDPI DD transplant results to identify clinical practices that can improve future outcomes. METHODS: We retrospectively calculated the KDPI for 895 DD kidney recipients transplanted between 1/2002 and 11/2013. Age, race, body mass index (BMI), retransplantation, gender, diabetes (DM), dialysis time, and preexisting coronary artery disease (CAD) (previous myocardial infarction (MI), coronary artery bypass (CABG), or stenting) were determined for all recipients...
August 2016: Clinical Transplantation
Jeffrey A Klein, Stevan A Gonzalez, Bernard V Fischbach, Angelito F Yango, Arthi Rajagopal, Kim M Rice, Muhammad Saim, Yousri M Barri, Larry B Melton, Goran B Klintmalm, Arun Chandrakantan
Renal cell carcinoma (RCC) has a high incidence in the kidney transplant population and annual surveillance detects these tumors early in their natural history. Minimal guidelines exist regarding RCC surveillance in ESRD patients awaiting transplant. A retrospective review of our kidney transplant database examined the outcomes of annual ultrasonographic surveillance during initial kidney transplant evaluation and upon annual reassessment. Of 2642 patients listed for transplant, 145 patients were found to have masses during initial kidney transplant evaluation or annual imaging consistent with new complex cystic disease or RCC...
August 2016: Clinical Transplantation
2016-06-19 03:09:49
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