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By Venkatesh Ariyamuthu Transplant Nephrologist at UT Southwestern Medical Center
Michele Molinari, Sundaram Hariharan
No abstract text is available yet for this article.
May 1, 2018: Transplantation
Wai H Lim, David W Johnson, Armando Teixeira-Pinto, Germaine Wong
BACKGROUND: Prolonged duration of delayed graft function (DGF) may be associated with adverse allograft outcomes, but the association between threshold duration of DGF, acute rejection and long-term allograft loss remains undefined. We aimed to determine the impact of DGF duration on allograft outcomes and to assess whether this association was mediated by acute rejection. METHODS: Using data from the Australian and New Zealand Dialysis and Transplant (ANZDATA) registry, Cox proportional modelling was used to determine the association between quartiles of DGF duration, acute rejection at 6 months and death-censored graft loss (DCGL)...
May 14, 2018: Transplantation
Frank Stifft, Sander M J van Kuijk, Otto Bekers, Maarten H L Christiaans
Background: Tacrolimus, a drug for prevention of rejection after kidney transplantation, has a narrow therapeutic window and is metabolized by the cytochrome P540 3A (CYP3A) system. Tacrolimus exposure increases after steroid tapering in many patients. The pregnane X receptor (PXR)-a mediator for CYP3A-has a steroid receptor and might regulate CYP3A5 activity depending on single nucleotide polymorphisms (SNPs) of CYP3A5 or PXR. This may contribute to differences in tacrolimus exposure after steroid tapering...
May 3, 2018: Nephrology, Dialysis, Transplantation
Samar M Said, Fernando G Cosio, Anthony M Valeri, Nelson Leung, Sanjeev Sethi, Hassan Salameh, Lynn D Cornell, Mary E Fidler, Mariam P Alexander, Fernando C Fervenza, Maria Eleni Drosou, Da Zhang, Vivette D D'Agati, Samih H Nasr
The characteristics of allograft proliferative glomerulonephritis with monoclonal immunoglobulin G deposits (PGNMID) are not well defined. To better characterize this disease we retrospectively identified 26 patients with allograft PGNMID, including 16 followed with early protocol biopsies. PGNMID was found to be a recurrent disease in most (89%) patients. A diagnostic biopsy was done for proteinuria and/or increased creatinine in most patients. Median time from transplant to diagnostic biopsy was 5.5 months, with detection within three to four months post-transplant in 86% of patients...
April 28, 2018: Kidney International
E G Kamburova, B W Wisse, I Joosten, W A Allebes, A van der Meer, L B Hilbrands, M C Baas, E Spierings, C E Hack, F E van Reekum, A D van Zuilen, M C Verhaar, M L Bots, A C A D Drop, L Plaisier, M A J Seelen, J S F Sanders, B G Hepkema, A J A Lambeck, L B Bungener, C Roozendaal, M G J Tilanus, C E Voorter, L Wieten, E M van Duijnhoven, M Gelens, M H L Christiaans, F J van Ittersum, S A Nurmohamed, N M Lardy, W Swelsen, K A van der Pant, N C van der Weerd, I J M Ten Berge, F J Bemelman, A Hoitsma, P J M van der Boog, J W de Fijter, M G H Betjes, S Heidt, D L Roelen, F H Claas, H G Otten
The presence of donor-specific anti-HLA antibodies (DSAs) is associated with increased risk of graft failure after kidney transplant. We hypothesized that DSAs against HLA class I, class II, or both classes indicate a different risk for graft loss between deceased and living donor transplant. In this study, we investigated the impact of pretransplant DSAs, by using single antigen bead assays, on long-term graft survival in 3237 deceased and 1487 living donor kidney transplants with a negative complement-dependent crossmatch...
February 21, 2018: American Journal of Transplantation
Paulo N Martins, Margaux N Mustian, Paul A MacLennan, Jorge A Ortiz, Mohamed Akoad, Juan Carlos Caicedo, Gabriel J Echeverri, Stephen H Gray, Reynold I Lopez-Soler, Ganesh Gunasekaran, Beau Kelly, Constance M Mobley, Sylvester M Black, Carlos Esquivel, Jayme E Locke
Blood group B candidates, many of whom represent ethnic minorities, have historically had diminished access to deceased donor kidney transplantation (DDKT). The new national kidney allocation system (KAS) preferentially allocates blood group A2/A2B deceased donor kidneys to B recipients to address this ethnic and blood group disparity. No study has yet examined the impact of KAS on A2 incompatible (A2i) DDKT for blood group B recipients overall or among minorities. A case-control study of adult blood group B DDKT recipients from 2013 to 2017 was performed, as reported to the Scientific Registry of Transplant Recipients...
March 6, 2018: American Journal of Transplantation
Andrew J Cowan, Christopher K Johnson, Edward N Libby
Plasma cell diseases are a class of hematologic diseases that are sometimes present as preexisting diagnoses prior to organ transplantation, causative factors leading to a need for organ transplantation, or may occur posttransplant as part of the spectrum of posttransplant lymphoproliferative disorders. Herein, we review the most common plasma cell diseases, both as coexisting with other causes of organ failure, but also as a primary underlying cause for organ failure. In many cases, treatment of the underlying clonal disease may be indicated before proceeding with organ transplant...
May 2018: American Journal of Transplantation
R A Bray, H M Gebel, R Townsend, M E Roberts, M Polinsky, L Yang, H-U Meier-Kriesche, C P Larsen
BENEFIT and BENEFIT-EXT were phase III studies of cytotoxic T-cell crossmatch-negative kidney transplant recipients randomized to belatacept more intense (MI)-based, belatacept less intense (LI)-based, or cyclosporine-based immunosuppression. Following study completion, presence/absence of HLA-specific antibodies was determined centrally via solid-phase flow cytometry screening. Stored sera from anti-HLA-positive patients were further tested with a single-antigen bead assay to determine antibody specificities, presence/absence of donor-specific antibodies (DSAs), and mean fluorescent intensity (MFI) of any DSAs present...
March 24, 2018: American Journal of Transplantation
Steven Habbous, Eric McArthur, Sisira Sarma, Mehmet A Begen, Ngan N Lam, Braden Manns, Krista L Lentine, Christine Dipchand, Kenneth Litchfield, Susan MacKenzie, Amit X Garg
Living donor kidney transplantation is the most promising way to avoid or minimize the amount of time a recipient spends on dialysis before transplantation. We studied 887 living kidney donors at five transplant centres in Ontario, Canada who started their evaluation and donated between April 2006 and March 2014. Using a series of hypothetical scenarios, we estimated the impact of an earlier living donor evaluation completion and donation on the number pre-emptive transplants, the time spent on dialysis, healthcare cost savings from averted dialysis costs (CAD $2016), and the number of additional transplants...
March 25, 2018: American Journal of Transplantation
Anat R Tambur, Patricia Campbell, Frans H Claas, Sandy Feng, Howard M Gebel, Annette M Jackson, Roslyn B Mannon, Elaine F Reed, Kathryn Tinckam, Medhat Askar, Anil Chandraker, Patricia P Chang, Monica Colvin, Anthony-Jake Demetris, Joshua M Diamond, Anne I Dipchand, Robert L Fairchild, Mandy L Ford, John Friedewald, Ronald G Gill, Denis Glotz, Hilary Goldberg, Ramsey Hachem, Stuart Knechtle, Jon Kobashigawa, Deborah J Levine, Joshua Levitsky, Michael Mengel, Edgar Milford, Kenneth A Newell, Jacqueline G O'Leary, Scott Palmer, Parmjeet Randhawa, John Smith, Laurie Snyder, Randall C Starling, Stuart Sweet, Timucin Taner, Craig J Taylor, Steve Woodle, Adriana Zeevi, Peter Nickerson
The presence of pre-existing (memory) or de novo donor specific HLA antibodies (DSA) is a known barrier to successful long-term organ transplantation. Yet, despite the fact that laboratory tools and our understanding of histocompatibility have advanced significantly in recent years, the criteria to define presence of a DSA and assign a level of risk for a given DSA varies markedly between centers. A collaborative effort between ASHI and the AST provided the logistical support for generating a dedicated multidisciplinary working group, which included experts in histocompatibility as well as renal, liver, heart and lung transplantation...
March 30, 2018: American Journal of Transplantation
Chris Wiebe, Julie Ho, Ian W Gibson, David N Rush, Peter W Nickerson
The current immunosuppressive pipeline in kidney transplantation is limited. In part, this is due to excellent 1-year allograft outcomes with the current standard of care (i.e. calcineurin inhibitor in combination with anti-proliferative agents). Despite this success, a recent Federal government sponsored systematic review has identified gaps/limits in the evidence of what constitutes optimal calcineurin inhibitor use in the short- and long-term. Moreover, recent empiric approaches to minimize/withdraw/convert from calcineurin inhibitors have come with the price of increased alloreactivity...
March 30, 2018: American Journal of Transplantation
Stuart M Flechner, Alvin G Thomas, Matthew Ronin, Jeffrey L Veale, David B Leeser, Sandip Kapur, John D Peipert, Dorry Segev, Macey L Henderson, Ashton A Shaffer, Matthew Cooper, Garet Hil, Amy D Waterman
The practice of kidney paired donation (KPD) is expanding annually, offering the opportunity for live donor kidney transplantation to more patients. We sought to identify if voluntary KPD networks such as the National Kidney Registry (NKR) were selecting or attracting a narrower group of donors or recipients compared to national registries. For this purpose, we merged data from the NKR database with the SRTR database from February 14, 2008 to February 14, 2017, encompassing the first 9 years of the NKR. When compared to all UNOS live donor transplants (49,610), all UNOS living unrelated transplants (23,319), and all other KPD transplants (4,236), the demographic and clinical characteristics of NKR transplants (2,037) appear similar to contemporary national trends...
March 30, 2018: American Journal of Transplantation
Rajni Chibbar, Glenda R Wright, Pouneh Dokouhaki, Sandi Dumanski, Bhanu Prasad, Michael Mengel, Lynn D Cornell, Ahmed Shoker
IgG4-related disease is a relatively newly described entity that can affect nearly any organ, including the kidneys, where it usually manifests as tubulointerstitial nephritis (IgG4-TIN). The diagnosis can be suggested by characteristic histological features, including an inflammatory infiltrate with increased IgG4-positive plasma cells associated with "storiform" fibrosis. Serum IgG4 is usually elevated. In the native kidney and other organs, there is typically a brisk response to treatment with immunosuppression...
April 1, 2018: American Journal of Transplantation
Otto B van Leeuwen, Rinse Ubbink, Vincent E de Meijer, Robert J Porte
With great interest we have read the article by Xiaoshun He and colleagues regarding their first patient who underwent successful ischemia-free organ transplantation (IFOT).1 This group transplanted a liver donated after brain death to a 51-year-old patient with decompensated cirrhosis and hepatocellular carcinoma without any ischemic episode or interruption of the blood circulation. The graft was procured, ex-situ preserved and implanted under continuous normothermic machine perfusion using the Liver Assist device (Organ Assist, Groningen, The Netherlands)...
April 16, 2018: American Journal of Transplantation
B A Kiberd, K Doucette, A J Vinson, K K Tennankore
Currently many but not all centers transplant HCV viremic positive (+) donor kidneys into HCV+ recipients. Directed donation of HCV+ organs reduces the wait time to transplantation for HCV+ patients. Direct acting antiviral (DAA) therapy has the ability to cure HCV in virtually all infected. Some have suggested that treatment of HCV+ wait listed patients be deferred with the hope that earlier transplantation will provide better outcomes than early DAA therapy. However there are not enough organs to guarantee prompt transplantation for the current wait list of infected candidates...
April 24, 2018: American Journal of Transplantation
Mary G Bowring, Allan B Massie, Rebecca Craig-Schapiro, Dorry L Segev, Lauren Hersch Nicholas
In the United States, the Centers for Medicare and Medicaid Services (CMS) use Systems Improvement Agreements (SIAs) to require transplant programs repeatedly flagged for poor-performance to improve performance or lose CMS funding for transplants. We identified 14 kidney transplant (KT) programs with SIAs and 28 KT programs without SIAs matched on waitlist volume and characterized kidney acceptance using SRTR data from 12/2006-3/2015. We used difference-in-differences linear regression models to identify changes in acceptance associated with an SIA independent of program variation and trends prior to the SIA...
May 2, 2018: American Journal of Transplantation
Jenna Combs, Anna Kagan, Mark Boelkins, Lisa Coscia, Michael Moritz, R Michael Hofmann
Impaired fertility is common among patients with chronic organ failure, including end stage renal disease (ESRD). Women of child-bearing age undergoing transplantation may experience rapid return of fertility. Pregnancy post-transplant presents numerous risks for the patient, fetus, and allograft. Maternal risks include hypertension and preeclampsia. Allograft risks include acute rejection and failure of the organ, and fetal risks include miscarriage, birth defects from immunosuppressants, premature delivery, and low birth weight...
May 2, 2018: American Journal of Transplantation
Flavio Vincenti, Klemens Budde, Pierre Merville, Fuad Shihab, V Ram Peddi, Malay Shah, Kate Wyburn, Elisabeth Cassuto-Viguier, Alexander Weidemann, Misun Lee, Teresa Flegel, Jay Erdman, Xuegong Wang, Christopher Lademacher
Cytomegalovirus (CMV) is a latent infection in most infected individuals, but can be pathogenic in immunocompromised kidney transplant recipients. ASP0113 is a DNA-based vaccine for the prevention of CMV-related mortality and end-organ disease in transplant recipients. The efficacy, safety, and immunogenicity of ASP0113 was assessed in a phase 2, double-blind, placebo-controlled study in CMV-seronegative kidney transplant recipients receiving a kidney from a CMV-seropositive donor. Transplant recipients were randomized (1:1) to receive five doses of ASP0113 (5 mg; n=75) or placebo (n=74) on Days 30/60/90/120/180 post transplant, and received prophylactic valganciclovir/ganciclovir 10-100 days post transplant...
May 9, 2018: American Journal of Transplantation
Zhiyong Guo, Uu En Fung, Yunhua Tang, Qiang Zhao, Zhiheng Zhang, Zebin Zhu, Shanzhou Huang, Linhe Wang, Yixi Zhang, Jie Yang, Weiqiang Ju, Dongping Wang, Lu Yang, Maogen Chen, Linwei Wu, Yi Ma, Anbin Hu, Guodong Chen, Xiaopeng Yuan, Changjie Cai, Xiaofeng Zhu, Changxi Wang, Xian C Li, Jiefu Huang, Xiaoshun He
We would like to thank Otto van Leeuwen and colleagues for their interests in our paper titled "The First Case of Ischemia-Free Organ Transplantation (IFOT) in Human: A Proof of Concept"[1,2]. We appreciate that their team considers our innovation of IFOT "a milestone in the history of organ transplantation". All conventional transplant procedures require cessation of blood supply to the donor organs, a period in which the organs become cold and hypoxic. This article is protected by copyright...
May 15, 2018: American Journal of Transplantation
D A Axelrod, M A Schnitzler, T Alhamad, F Gordon, R D Bloom, G P Hess, H Xiao, M Nazzal, D L Segev, V R Dharnidharka, A S Naik, N N Lam, R Ouseph, B L Kasiske, C Durand, K L Lentine
Direct-acting antiviral medications (DAAs) have revolutionized care for hepatitis C positive (HCV+) liver (LT) and kidney (KT) transplant recipients. SRTR registry data were integrated with national pharmaceutical claims (2007-2016) to identify HCV treatments before 1/2014 (pre-DAA) and after (post-DAA), stratified by donor (D) and recipient (R) serostatus and payer. Pre-DAA, 18% of HCV+ LT recipients were treated within 3 years and without differences by donor serostatus or payer. Post-DAA, only 6% of D-/R+ recipients, 19...
April 27, 2018: American Journal of Transplantation
2018-04-29 14:55:46
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