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Renal Transplantation

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By Isabel Acosta-Ochoa Nephrology senior staff. Valladolid. Spain
Pauline Vanderweckene, Laurent Weekers, Patrizio Lancellotti, François Jouret
Arteriovenous fistula (AVF) is regarded as the best vascular access for chronic haemodialysis (HD). Still, AVF inherently causes significant haemodynamic changes. Although the necessity for vascular access despite its putative cardiovascular complications favours AVF creation in patients under chronic HD, one may question whether sustaining a functional AVF after successful kidney transplantation extends the haemodynamic threat. Small prospective series suggest that AVF ligation causes rapid and sustained reduction in left ventricular hypertrophy...
June 2018: Clinical Kidney Journal
Federica Zotta, Isabella Guzzo, Federica Morolli, Francesca Diomedi-Camassei, Luca Dello Strologo
BACKGROUND: Kidney transplantation is the best treatment for children with end-stage kidney disease. Early results have improved, but late graft loss is still a major problem. Non-invasive, fully reliable early biomarkers of acute rejection are currently missing. METHODS: Our aim was to evaluate the efficacy of protocol biopsies (PBXs) in a pediatric population. During 11 years, 209 renal transplantations were performed in 204 pediatric patients. Biopsies were performed 3-6 months, 1 year, and 5 years after transplantation...
July 6, 2018: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Haojia Wu, Andrew F Malone, Erinn L Donnelly, Yuhei Kirita, Kohei Uchimura, Sai M Ramakrishnan, Joseph P Gaut, Benjamin D Humphreys
Background Single-cell genomics techniques are revolutionizing our ability to characterize complex tissues. By contrast, the techniques used to analyze renal biopsy specimens have changed little over several decades. We tested the hypothesis that single-cell RNA-sequencing can comprehensively describe cell types and states in a human kidney biopsy specimen. Methods We generated 8746 single-cell transcriptomes from a healthy adult kidney and a single kidney transplant biopsy core by single-cell RNA-sequencing...
July 6, 2018: Journal of the American Society of Nephrology: JASN
Tainá Veras de Sandes-Freitas, Petrucia Maria Antero Pinheiro, Maria Luíza de Mattos Brito Oliveira Sales, Celi Melo Girão, Érika Fernandes Campos, Ronaldo de Matos Esmeraldo
There is no evidence of whether everolimus(EVR) reduces cytomegalovirus(CMV) events in patients receiving steroid-free regimens.Besides, studies evaluating a tacrolimus(TAC) and EVR regimen are limited to 1-year follow-up. In this single-center prospective randomized trial, the incidence of CMV and 3-year efficacy and safety outcomes of EVR were compared to those of mycophenolate sodium(MPS) in a steroid-free regimen based on low-exposure TAC.Both groups received rabbit anti-thymocyte globulin(r-ATG) induction(6mg/kg) and the steroids were withdrawn at day 7...
July 3, 2018: Transplant International: Official Journal of the European Society for Organ Transplantation
Ken Sakai, Hideyo Oguchi, Masaki Muramatsu, Seiichiro Shishido
Accurate interpretation of renal allograft biopsy is necessary to guide therapy, especially when an episode biopsy is taken to rescue the graft. Contrarily, a protocol biopsy is carried out routinely to identify baseline conditions (biopsy at 0 or 1 h), subclinical rejection, histological change under current immunosuppression regimen, drug nephrotoxicity, viral infection, and recurrence of glomerulonephritis. Semiquantitative scoring for active lesions including tubulitis, glomerulitis, capillaritis, arteritis, arteriopathy, and others such as polyomavirus infection are key factors in transplant pathology...
July 2018: Nephrology
Izumi Yamamoto, Takafumi Yamakawa, Ai Katsuma, Mayuko Kawabe, Haruki Katsumata, Aki Mafune Hamada, Yasuyuki Nakada, Akimitsu Kobayashi, Hiroyasu Yamamoto, Takashi Yokoo
The extent of recurrence of original kidney disease after kidney transplantation has been underestimated for several reasons. First, the duration of observation varies among studies. Second, the criteria used to schedule protocol and episode biopsies differ among institutions. And third, diagnostic modalities used for early detection of recurrent original kidney disease also vary. Thus, rates of graft loss attributable to a recurrence of original kidney disease vary among institutions and are often underestimated...
July 2018: Nephrology
John D Peipert, Ron D Hays, Satoru Kawakita, Jennifer L Beaumont, Amy D Waterman
BACKGROUND: Kidney transplant is the best treatment for most end-stage renal disease (ESRD) patients, but proportionally few ESRD patients receive kidney transplant. To make an informed choice about whether to pursue kidney transplant, patients must be knowledgeable of its risks and benefits. To reliably and validly measure ESRD patients' kidney transplant knowledge, rigorously tested measures are required. This paper describes the development and psychometric testing of the Knowledge Assessment of Renal Transplantation (KART)...
June 29, 2018: Transplantation
Fatima Warsame, Christine E Haugen, Hao Ying, Jacqueline M Garonzik-Wang, Niraj M Desai, Rasheeda K Hall, Rekha Kambhampati, Deidra C Crews, Tanjala S Purnell, Dorry L Segev, Mara A McAdams-DeMarco
More than one third of U.S. adults have limited health literacy putting them at risk of adverse clinical outcomes. We evaluated the prevalence of limited health literacy among 1,578 adult kidney transplant (KT) candidates (5/2014-11/2017) and examined its association with listing for transplantation and waitlist mortality in this pilot study. Limited health literacy was assessed at KT evaluation using a standard cutoff score≤5 on the Brief Health Literacy Screen (scores range from 0-12, lower scores indicate worse health literacy)...
July 1, 2018: American Journal of Transplantation
Matteo Ravaioli, Vanessa De Pace, Giorgia Comai, Irene Capelli, Olga Baraldi, Antonietta D'Errico, Valentina Rosa Bertuzzo, Massimo Del Gaudio, Chiara Zanfi, Giovanni Liviano D'Arcangelo, Vania Cuna, Antonio Siniscalchi, Gabriela Sangiorgi, Gaetano La Manna
BACKGROUND: Donation after circulatory death (DCD) is a potential source of reducing organ demand. In Italy, DCD requires a 20 minutes no-touch period, that prolongs warm ischemia and increases delayed graft function (DGF) risk and graft loss. We report here our preliminary experience of sequential use of normothermic regional perfusion (NRP), as standard procedure, and hypothermic oxygenated perfusion (HOPE), as an experimental technique of organ preservation, in 10 kidney transplants (KT) from 5 DCD-Maastricht III with extensive functional warm ischemia time (fWIT) up to 325 minutes...
June 29, 2018: Transplant International: Official Journal of the European Society for Organ Transplantation
S Ali Husain, Corey Brennan, Ariane Michelson, Demetra Tsapepas, Rachel E Patzer, Jesse D Schold, Sumit Mohan
Factors that patients value when choosing a transplant center have not been well studied. In order to guide the improvement of patient-facing materials, we conducted an anonymous electronic survey of National Kidney Foundation Patient Panel members that assessed relative importance of patient experience, practical considerations, transplant center reputation, center experience, and waitlist when selecting a transplant center. 409 respondents completed the survey, of whom 68% were kidney transplant recipients and 32% had chronic kidney disease or were on dialysis (CKD)...
June 26, 2018: American Journal of Transplantation
M Kotowski, A Bogacz, J Bartkowiak-Wieczorek, A Bukowska, N Surowiec, K Dziewanowski, B Czerny, E Grześkowiak, M Ostrowski, B Machaliński, J Sieńko
INTRODUCTION: Thanks to new generation sequencing (NGS) and expansion of HLA typing with additional loci, it will be possible to increase the effectiveness of graft survival and to avoid complications related to the immune system. New pharmacogenetic factors are still being researched to develop better immunosuppressive treatment. MATERIAL AND METHODS: The incidence of polymorphic HLA loci variants was established, based on a high-resolution NGS method in kidney graft recipients...
June 21, 2018: Transplantation Proceedings
Koji Nanmoku, Akira Kurosawa, Taro Kubo, Takahiro Shinzato, Toshihiro Shimizu, Takaaki Kimura, Takashi Yagisawa
OBJECTIVES: Although steroid withdrawal has been attempted to ameliorate various complications in kidney transplant recipients, a steroid-sparing strategy has more frequently led to acute rejection. We investigated the use of everolimus to safely overcome steroid withdrawal in kidney transplant recipients with posttransplant diabetes mellitus under maintenance immunosuppressive therapy. MATERIALS AND METHODS: A total of 75 de novo consecutive kidney transplant recipients received conventional immunosuppressive therapy comprising tacrolimus (trough level of 5 ng/mL), mycophenolate mofetil (1000 mg), and methylprednisolone (4 mg)...
June 18, 2018: Experimental and Clinical Transplantation
Maria C Haller, Michael Kammer, Rainer Oberbauer
Pre-emptive kidney transplantation is the recommended strategy for patients with end-stage renal failure in all guidelines [Kidney Disease: Improving Global Outcomes (KDIGO), The Australian and New Zealand Dialysis and Transplantation Registry (ANZDATA), European Renal Best Practice Guideline (ERBP), British Transplant Society (BTS)]. This recommendation is intuitive and based on few older studies with considerable limitations. In addition, there is conflicting evidence as to whether the duration of dialysis vintage impacts on graft and patient survival after transplantation...
April 20, 2018: Nephrology, Dialysis, Transplantation
K Dziewanowski, M Myślak, R Drozd, E Krzystolik, A Krzystolik, M Ostrowski, M Droździk, K Tejchman, K Kozdroń, J Sieńko
BACKGROUND: Kidney transplantation is a routine procedure in the treatment of patients with kidney failure and requires collaboration of experts from different disciplines. Improvements in the procedure result from numerous factors. METHODS: The analyzed group consisted of 150 patients divided into 2 equal subgroups: long-term (>15 years) and short-term (<6 years) graft survival. The following factors were taken into consideration: graft survival time, HLA mismatches, recipient sex, sex compatibility, panel reactive antibodies (PRA), cold ischemia time (CIT), and cause of kidney insufficiency...
June 2018: Transplantation Proceedings
O Tiryaki, C Usalan, M Tarakcioglu, S Coban
BACKGROUND: Although nonhuman animal models have strongly suggested that vitamin D suppresses the renin-angiotensin system (RAS) and albuminuria, human data are largely lacking. The aim of this study was to examine the relationship between 25-hydroxyvitamin D [25-(OH)D] level and albuminuria and urinary angiotensinogen (UAGT) level in renal transplant recipients (RTRs). We also planned to investigate the effect of calcitriol treatment on albuminuria and UAGT level in these patients. METHODS AND RESULTS: A total of 124 nondiabetic RTRs participated in this study...
June 2018: Transplantation Proceedings
M Boran, E Boran, M Boran, M Tola
BACKGROUND: The onset of proteinuria in renal transplant recipients may be associated with an increased risk of allograft failure. Little is known about the relationships between factors influencing proteinuria and the Doppler ultrasound (DU) intrarenal resistive index (RI) and pulsatility index (PI) among donor recipients with proteinuria <1000 mg/24 h. METHODS: We assessed correlations between the DU RI and PI and protein content in 93 selected renal transplant recipients: 62 patients with proteinuria 100 to 299 mg/24 h, 16 patients with proteinuria 300 to 499 mg/24 h, and 15 patients with proteinuria 500 to 999 mg/24 h...
June 2018: Transplantation Proceedings
Lara C Pullen
No abstract text is available yet for this article.
June 2018: American Journal of Transplantation
Huan-Tang Lin, Fu-Chao Liu, Jr-Rung Lin, See-Tong Pang, Huang-Ping Yu
OBJECTIVE: Most patients with uraemia must undergo chronic dialysis while awaiting kidney transplantation; however, the role of the pretransplant dialysis modality on the outcomes of kidney transplantation remains obscure. The objective of this study was to clarify the associations between the pretransplant dialysis modality, namely haemodialysis (HD) or peritoneal dialysis (PD), and the development of post-transplant de novo diseases, allograft failure and all-cause mortality for kidney-transplant recipients...
June 4, 2018: BMJ Open
Tanja Abeling, Irina Scheffner, Annika Karch, Verena Broecker, Armin Koch, Hermann Haller, Anke Schwarz, Wilfried Gwinner
Background: Identification and quantification of the relevant factors for death can improve patients' individual risk assessment and decision-making. We used a well-documented patient cohort (n = 892) in a renal transplant programme with protocol biopsies to establish multivariable Cox models for risk assessment at 3 and 12 months post-transplantation. Methods: Patients transplanted between 2000 and 2007 were observed up to 11 years (total observation 5227 patient-years; median 5...
May 31, 2018: Nephrology, Dialysis, Transplantation
Stefan G Tullius, Hamid Rabb
New England Journal of Medicine, Volume 378, Issue 20, Page 1920-1929, May 2018.
May 17, 2018: New England Journal of Medicine
2018-05-21 18:30:51
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