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Ortved M, Dagnæs-Hansen J, Stroomberg HV, Kistorp T, Rohrsted M, Sørensen SS, Røder A. Open-label randomised clinical trial investigating whether robot-assisted kidney transplantation can reduce surgical complications compared to open kidney transplantation (ORAKTx): study protocol for a randomised clinical trial. Trials 2025; 26:8. [PMID: 39762978 PMCID: PMC11702044 DOI: 10.1186/s13063-024-08706-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 12/18/2024] [Indexed: 01/11/2025] Open
Abstract
BACKGROUND Kidney transplantation is the ultimate treatment for end-stage kidney disease. Function of the kidney graft is not only dependent on medical factors but also on a complication-free surgical procedure. In the event of major surgical complications, the kidney graft is potentially lost and the patient will return to the waiting list which may be long. To optimise peri-operative care and reduce complications, robot-assisted kidney transplantation (RAKT) has been introduced as an alternative to open kidney transplantation (OKT), but to our knowledge, no randomised clinical trials (RCT) have compared RAKT to OKT. In this study, we will explore whether robot-assisted surgery can reduce 30-day surgical complications compared to open surgery in kidney transplantation. METHODS This is a single-site, open-label, randomised clinical trial comparing RAKT to OKT. Participants are adult recipients of kidney transplantation recruited from Copenhagen University Hospital - Rigshospitalet, Denmark. The study plans to include 106 participants who will be randomised in a 1:1 manner between OKT and RAKT. Primary outcomes are vascular- and major surgical complications at 30 days post-operatively. Participants will be followed for 2 years to evaluate secondary outcomes including recovery, late complications and kidney graft function. This is designed as a superiority trial and planned analyses will follow intention-to-treat principles. DISCUSSION Studies indicate RAKT can reduce several surgical complications, but the lack of RCTs limits the extrapolation of these results to justify replacing an open approach with a robot-assisted one. Ultimately, the introduction of new surgical techniques should be as vigorously tested as any other new treatments. However, reducing surgical complications that compromise graft viability could lead to improved patient care and survival. TRIAL REGISTRATION The trial was prospectively registered with ClinicalTrials.gov on February 15th, 2023, with the identifier NCT05730257.
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Affiliation(s)
- Milla Ortved
- Urological Research Unit, Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Julia Dagnæs-Hansen
- Urological Research Unit, Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hein V Stroomberg
- Urological Research Unit, Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Biotech Research & Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark
| | - Thomas Kistorp
- Department of Anaesthesiology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Malene Rohrsted
- Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Søren Schwartz Sørensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Nephrology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital- Rigshospitalet, Copenhagen, Denmark
| | - Andreas Røder
- Urological Research Unit, Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Yazdanpanah S, Shafiekhani M, Ahmadi M, Zare Z, Nikoupour H, Arabsheybani S, Geramizadeh B, Anbardar MH, Chamanpara P, Badali H, Moghadami M, Pakshir K, Zomorodian K. Clinical characteristics and outcomes of colonization and infection by yeast species in solid organ transplant recipients: Molecular identification and antifungal susceptibility patterns of isolates. Med Mycol 2024; 63:myae118. [PMID: 39663216 DOI: 10.1093/mmy/myae118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 10/23/2024] [Accepted: 12/10/2024] [Indexed: 12/13/2024] Open
Abstract
Fungal infections are serious complications after solid organ transplantation, with high mortality and morbidity. Given the importance of the local epidemiological data and also extensive prophylactic regimens in solid organ transplant (SOT) recipients, this study aimed to investigate the clinical characteristics and resistance patterns of yeast isolates in SOT recipients at a main referral transplant center in Iran. Of the 275 recipients enrolled, 22 (8%) had at least one positive yeast culture at a median of 5 days after transplantation. Bacterial infection and reoperation were significantly associated with colonization or infection caused by yeast species (P = .001). Moreover, mortality and length of ICU/hospital stay were significantly higher in patients with positive yeast cultures (P < .05). The most frequent species isolated was Candida albicans (50%), followed by C. glabrata (22.7%). Of species with definite breakpoints, the fluconazole-resistant rate was 23%. Caspofungin and amphotericin B showed potent activity against all isolates. Regarding the high risk of fungal infections, awareness of local epidemiological trends and resistance patterns can help improve outcomes in SOT recipients.
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Affiliation(s)
- Somayeh Yazdanpanah
- Department of Medical Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojtaba Shafiekhani
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ahmadi
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Zare
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamed Nikoupour
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Arabsheybani
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bita Geramizadeh
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad-Hossein Anbardar
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parisa Chamanpara
- Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Badali
- Department of Molecular Microbiology & Immunology, and South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Mohsen Moghadami
- Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Keyvan Pakshir
- Department of Medical Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Basic Sciences in Infectious Diseases Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamiar Zomorodian
- Department of Medical Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Basic Sciences in Infectious Diseases Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Oomen L, Bootsma-Robroeks CMHHT, Bouts AHM, Carbonell Pradas M, Gander R, Kienzl-Wagner K, König P, Pereira PL, Dunand O, Mosca SMFS, Pac M, Podracka L, Prytula AA, Sangermano M, Vitkevic R, Zieg J, van der Zanden LFM, Feitz WFJ, de Wall LL. Pediatric kidney transplantation in Europe, a clinical snapshot pilot. Front Pediatr 2024; 12:1432027. [PMID: 39513158 PMCID: PMC11540619 DOI: 10.3389/fped.2024.1432027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 10/07/2024] [Indexed: 11/15/2024] Open
Abstract
Background Pediatric kidney transplantations are rarely performed, and there is limited knowledge about the diversity in current clinical practices across Europe. This study aims to explore the utility of clinical snapshot studies in identifying these disparities, establishing a foundation for future snapshot studies and standardization efforts. Methods A pilot clinical snapshot study was conducted, with invitations extended to all 109 pediatric kidney transplant centres in Europe. Each participating centre provided pre-, peri-, and postoperative data concerning their most recent thirty transplantations. The primary outcomes encompassed the evaluation of disparities in donor-recipient selection, surgical techniques, post-operative drainage procedures, and immunosuppressive therapy protocols. Secondary outcomes involved the analysis of rejection rates, incidence of infections, and graft survival. Results The study involved 439 patients from fifteen centres (14%) in twelve countries, with varying transplant volumes (range 1-29 transplantations per year) and follow-up periods. Significant differences were found among centres in terms of donor types, cold and warm ischemia time, pre-emptive transplant rates, and kidney transplant drainage methods. The rate of living donors varied between 3% and 90% and the median duration of cold ischemia ranged was 770 min after deceased donation and 147 min after living donation. Basiliximab was the dominant induction therapy, yet steroid withdrawal varied widely. Infection, rejection, and graft survival rates also varied significantly between centres. Conclusion This study revealed substantial variation in clinical practices among European centres performing pediatric kidney transplantations. These findings could serve as a stimulus for international dialogue and collaboration.
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Affiliation(s)
- Loes Oomen
- Division of Pediatric Urology, Department of Urology, Radboudumc Amalia Children’s Hospital, Nijmegen, Netherlands
| | - Charlotte M. H. H. T. Bootsma-Robroeks
- Department of Pediatric Nephrology, Radboudumc Amalia Children’s Hospital, Nijmegen, Netherlands
- Department of Pediatrics, Pediatric Nephrology, Beatrix Children’s Hospital, University of Groningen, University Medical Centre Groningen,Groningen, Netherlands
| | - Antonia H. M. Bouts
- Department of Pediatric Nephrology, Emma Children’s Hospital, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Mar Carbonell Pradas
- Department of Pediatric Surgery, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Romy Gander
- Pediatric Urology and Renal Transplant Unit, Department of Pediatric Surgery, University Hospital Vall d´Hebron Barcelona, Barcelona, Spain
| | - Katrin Kienzl-Wagner
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Paul König
- Department of Urology and Pediatric Urology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | - Olivier Dunand
- Department of Pediatric Nephrology, University Hospital of Réunion, La Réunion, France
| | - Sara M. F. S. Mosca
- Department of Pediatric Nephrology, Centro Materno Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Michal Pac
- Department of Nephrology, Kidney Transplantation and Hypertension, Children’s Memorial Health Institute, Warsaw, Poland
| | - Ludmila Podracka
- 1st Dept Pediatric Children’s Hospital, Comenius University, Bratislava, Slovakia
| | - Agnieszka A. Prytula
- Department of Paediatric Nephrology and Rheumatology, Ghent University Hospital, ERKNet Centre, Ghent, Belgium
| | - Maria Sangermano
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Women’s and Children’s Health, Padua University Hospital, Padua, Italy
| | - Renata Vitkevic
- Department of Pediatrics, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Jakub Zieg
- Department of Pediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia
| | | | - Wout F. J. Feitz
- Division of Pediatric Urology, Department of Urology, Radboudumc Amalia Children’s Hospital, Nijmegen, Netherlands
| | - Liesbeth L. de Wall
- Division of Pediatric Urology, Department of Urology, Radboudumc Amalia Children’s Hospital, Nijmegen, Netherlands
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Teh JW, Mac Gearailt C, Lappin DWP. Post-Transplant Bone Disease in Kidney Transplant Recipients: Diagnosis and Management. Int J Mol Sci 2024; 25:1859. [PMID: 38339137 PMCID: PMC10856017 DOI: 10.3390/ijms25031859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 01/24/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
Kidney transplantation is the preferred gold standard modality of treatment for kidney failure. Bone disease after kidney transplantation is highly prevalent in patients living with a kidney transplant and is associated with high rates of hip fractures. Fractures are associated with increased healthcare costs, morbidity and mortality. Post-transplant bone disease (PTBD) includes renal osteodystrophy, osteoporosis, osteonecrosis and bone fractures. PTBD is complex as it encompasses pre-existing chronic kidney disease-mineral bone disease and compounding factors after transplantation, including the use of immunosuppression and the development of de novo bone disease. After transplantation, the persistence of secondary and tertiary hyperparathyroidism, renal osteodystrophy, relative vitamin D deficiency and high levels of fibroblast growth factor-23 contribute to post-transplant bone disease. Risk assessment includes identifying both general risk factors and kidney-specific risk factors. Diagnosis is complex as the gold standard bone biopsy with double-tetracycline labelling to diagnose the PTBD subtype is not always readily available. Therefore, alternative diagnostic tools may be used to aid its diagnosis. Both non-pharmacological and pharmacological therapy can be employed to treat PTBD. In this review, we will discuss pathophysiology, risk assessment, diagnosis and management strategies to manage PTBD after kidney transplantation.
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Affiliation(s)
- Jia Wei Teh
- Department of Nephrology, Galway University Hospital, H91 YR71 Galway, Ireland
| | - Conall Mac Gearailt
- Department of Rheumatology, Galway University Hospital, H91 YR71 Galway, Ireland
| | - David W. P. Lappin
- Department of Nephrology, Galway University Hospital, H91 YR71 Galway, Ireland
- School of Medicine, University of Galway, H91 TK33 Galway, Ireland
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Acharya S, Lama S, Kanigicherla DA. Anti-thymocyte globulin for treatment of T-cell-mediated allograft rejection. World J Transplant 2023; 13:299-308. [PMID: 38174145 PMCID: PMC10758678 DOI: 10.5500/wjt.v13.i6.299] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/01/2023] [Accepted: 11/17/2023] [Indexed: 12/15/2023] Open
Abstract
Anti-thymocyte globulin (ATG) is a pivotal immunosuppressive therapy utilized in the management of T-cell-mediated rejection and steroid-resistant rejection among renal transplant recipients. Commercially available as Thymoglobulin (rabbit-derived, Sanofi, United States), ATG-Fresenius S (rabbit-derived), and ATGAM (equine-derived, Pfizer, United States), these formulations share a common mechanism of action centered on their interaction with cell surface markers of immune cells, imparting immunosuppressive effects. Although the prevailing mechanism predominantly involves T-cell depletion via the com plement-mediated pathway, alternate mechanisms have been elucidated. Optimal dosing and treatment duration of ATG have exhibited variance across ran domised trials and clinical reports, rendering the establishment of standardized guidelines a challenge. The spectrum of risks associated with ATG administration spans from transient adverse effects such as fever, chills, and skin rash in the acute phase to long-term concerns related to immunosuppression, including susceptibility to infections and malignancies. This comprehensive review aims to provide a thorough exploration of the current understanding of ATG, encom passing its mechanism of action, clinical utility in the treatment of acute renal graft rejections, specifically steroid-resistant cases, efficacy in rejection episode reversal, and a synthesis of findings from different eras of maintenance immunosuppression. Additionally, it delves into the adverse effects associated with ATG therapy and its impact on long-term graft function. Furthermore, the review underscores the existing gaps in evidence, particularly in the context of the Banff classification of rejections, and highlights the challenges faced by clinicians when navigating the available literature to strike the optimal balance between the risks and benefits of ATG utilization in renal transplantation.
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Affiliation(s)
- Sumit Acharya
- Department of Nephrology, Shahid Dharmabhakta National Transplant Center, Bhaktapur 44800, Nepal
| | - Suraj Lama
- Department of Nephrology, Shahid Dharmabhakta National Transplant Center, Bhaktapur 44800, Nepal
| | - Durga Anil Kanigicherla
- Department of Renal Medicine, Manchester University NHS Foundation Trust, Manchester M13 9WL, United Kingdom
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Kalamara TVN, Zarkada EG, Kasimatis ED, Kofinas AG, Klonizakis PI, Vlachaki EC. Kidney transplantation in an adult with transfusion-dependent beta thalassemia: A challenging case report and literature review. Arch Clin Cases 2023; 10:97-101. [PMID: 37359087 PMCID: PMC10289047 DOI: 10.22551/2023.39.1002.10250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
The markedly increased survival of transfusion-dependent beta thalassemia patients has led to the recognition of new complications, such as renal disorders. Kidney transplantation is nowadays the preferred treatment option for end-stage kidney disease (ESKD). We describe a case of a 49-year-old woman with β-Transfusion Dependent Thalassemia, who developed ESKD as a result of focal segmental glomerulosclerosis and received a deceased-donor kidney transplant following hemodialysis for over a decade. The particular challenges of this case are discussed, including the long-term survival in hemodialysis. Our patient had to overcome multiple obstacles, including hypercoagulability issues presented in the form of thromboembolism, infections, such as hepatitis C and gastroenteritis, and the acute T-cell-mediated rejection, which had to be managed postoperatively. A review of the current literature revealed only one previous report of a thalassemia patient who successfully underwent renal transplantation. More than a year after the transplantation our patient presents with a normal glomerular filtration rate (GFR=62ml/min/1.73m2) and creatinine level (Cr=0.96mg/dL) and is transfused every 3 weeks. In conclusion, renal transplantation is possible in patients with TDT and should not be discouraged. Regular transfusions and optimal follow-up for the elimination of post-transplant complications are required.
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Affiliation(s)
- Tsampika-Vasileia N. Kalamara
- Adults Thalassemia Unit, Second Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Evangelia G. Zarkada
- Adults Thalassemia Unit, Second Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Efstratios D. Kasimatis
- Department of Nephrology, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Athanasios G. Kofinas
- Department of Transplantation and Surgery, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Philippos I. Klonizakis
- Adults Thalassemia Unit, Second Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Efthymia C. Vlachaki
- Adults Thalassemia Unit, Second Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
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Echocardiogram screening in pediatric dialysis and transplantation. Pediatr Nephrol 2023; 38:957-974. [PMID: 36114889 PMCID: PMC9925481 DOI: 10.1007/s00467-022-05721-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 10/14/2022]
Abstract
Transthoracic echocardiography is commonly used to identify structural and functional cardiac abnormalities that can be prevalent in childhood chronic kidney failure (KF). Left ventricular mass (LVM) increase is most frequently reported and may persist post-kidney transplant especially with hypertension and obesity. While systolic dysfunction is infrequently seen in childhood chronic KF, systolic strain identified by speckle tracking echocardiography has been frequently identified in dialysis and it can also persist post-transplant. Echocardiogram association with long-term outcomes has not been studied in childhood KF but there are many adult studies demonstrating associations between increased LVM, systolic dysfunction, strain, diastolic dysfunction, and cardiovascular events and mortality. There has been limited study of interventions to improve echocardiogram status. In childhood, improved blood pressure has been associated with better LVM, and conversion from hemodialysis to hemodiafiltration has been associated with better diastolic and systolic function. Whether long-term cardiac outcomes are also improved with these interventions is unclear. Echocardiography is a well-established technique, and regular use in childhood chronic KF seems justified. A case can be made to extend screening to include speckle tracking echocardiography and intradialytic studies in high-risk populations. Further longitudinal studies including these newer echocardiogram modalities, interventions, and long-term outcomes would help clarify recommendations for optimal use as a screening tool.
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Nie H, Ji W, Cui J, Liang X, Yang X, Bai J, Zhang X. An AIE luminogen self-assembled nanoprobe for efficient monitoring of the concentration and structural transition of human serum albumin. Anal Chim Acta 2022; 1236:340578. [DOI: 10.1016/j.aca.2022.340578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/22/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022]
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Bao K, Chen J, Liu R, Xiang Y, Gao W. Prevalence of HCV Infection Among Hemodialysis Patients in Lanzhou of Northwestern China. Infect Drug Resist 2022; 15:5609-5617. [PMID: 36172622 PMCID: PMC9512538 DOI: 10.2147/idr.s378600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/15/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the prevalence of hepatitis C virus (HCV) infection among hemodialysis (HD) patients in Lanzhou of Northwestern China, we interviewed 565 patients from five randomly sampled HD centers in Lanzhou with a structured questionnaire including sociodemographic characteristics, past medical history and HD-related factors. Methods The testing results of anti-HCV and HCV-RNA in a recent HD from clinical information system were collected. A generalized estimated equation (GEE) logistic regression model was used to identify the determinants of HCV infection among HD patients. Results The prevalence of anti-HCV or HCV-RNA infection among HD patients was 1.77% or 1.42% respectively. GEE model showed that history of kidney transplantation (HCV-RNA: OR=19.79, 95%CI: 12.69–30.85) could dramatically increase the risk of current HCV infection in dialysis patients. Compared with never using of blood products, using of blood products (anti-HCV: OR=2.38, 95%CI: 1.22–4.64; HCV-RNA: OR=15.23, 95%CI: 1.79–129.49) could increase the risk of HCV infection in dialysis patients. Moreover, with the increase of HD duration, the risk increased one time or so (anti-HCV: OR=1.83, 95%CI: 1.22–2.72; HCV-RNA: OR=2.00, 95%CI: 1.11–3.61). Furthermore, dialysis in multiple hospitals possessed more than three times risk of HCV infection (anti-HCV: OR=3.56, 95%CI: 3.11–4.08; HCV-RNA: OR=3.35, 95%CI: 1.88–5.96). Besides, HD patients having the history of acupuncture (HCV-RNA: OR=5.56; 95%CI: 1.16–26.67) or surgery (HCV-RNA: OR=6.39; 95%CI: 2.86–14.29) caused an about-six-times risk of current infections. Conclusion It could be concluded that the prevalence of HCV infection was mild and using of blood products or kidney transplantation, long dialysis duration, dialysis in multiple hospitals, surgery or acupuncture treatment were some risk factors of HCV infection among HD patients in Lanzhou of Northwestern China.
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Affiliation(s)
- Kai Bao
- Institution of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Jijun Chen
- STD and AIDS Prevention and Control Institute, Lanzhou Municipal Center for Disease Control and Prevention, Lanzhou, Gansu, People's Republic of China
| | - Ruifang Liu
- Institution of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, People's Republic of China.,Department of Science and Education, Xi'an No. 5 Hospital, Xi'an, Shanxi, People's Republic of China
| | - Yuanyuan Xiang
- Institution of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Wenlong Gao
- Institution of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, People's Republic of China
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10
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Tsai YY, Lim LM, Kuo HT, Tsai YC. Plasma cell-rich related acute rejection in kidney transplant: A case report and review of the literature. Medicine (Baltimore) 2022; 101:e30493. [PMID: 36086682 PMCID: PMC10980421 DOI: 10.1097/md.0000000000030493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/03/2022] [Indexed: 01/10/2023] Open
Abstract
RATIONALE Plasma cell-rich acute rejection (PCAR), a subtype of T cell-mediated rejection, is a relatively rare type of acute allograft rejection, that is usually associated with a higher rate of graft failure. However, it is difficult to diagnose PCAR precisely. PATIENT CONCERNS A 45-year-old woman who had received a kidney transplant presented with acute kidney injury and uremic symptoms approximately 1 year after transplantation. DIAGNOSIS A renal biopsy was performed and pathological examination revealed marked inflammation with abundant plasma cells in areas within interstitial fibrosis and tubular atrophy. The patient was diagnosed with PCAR and chronic active T cell-mediated rejection (CA-TCMR) grade IA. INTERVENTIONS Immunosuppressants were administered as tacrolimus (2 mg twice daily), mycophenolate mofetil (250 mg twice daily), and prednisolone (15 mg/day) for suspected PCAR. OUTCOMES The patients showed rapid deterioration in kidney function and reached impending graft failure. LESSONS PCAR is often associated with poor graft outcome. The high variability in tacrolimus levels could contribute to poor patient outcomes, leaving aggressive immunosuppressive therapy as the remaining choice for PCAR treatment.
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Affiliation(s)
- Yao-Yu Tsai
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Lee-Moay Lim
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Tien Kuo
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Chun Tsai
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of General Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Okada M, Tominaga Y, Sato T, Tomosugi T, Futamura K, Hiramitsu T, Ichimori T, Goto N, Narumi S, Kobayashi T, Uchida K, Watarai Y. Elevated parathyroid hormone one year after kidney transplantation is an independent risk factor for graft loss even without hypercalcemia. BMC Nephrol 2022; 23:212. [PMID: 35710357 PMCID: PMC9205154 DOI: 10.1186/s12882-022-02840-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background Hypercalcemic hyperparathyroidism has been associated with poor outcomes after kidney transplantation (KTx). However, the clinical implications of normocalcemic hyperparathyroidism after KTx are unclear. This retrospective cohort study attempted to identify these implications. Methods Normocalcemic recipients who underwent KTx between 2000 and 2016 without a history of parathyroidectomy were included in the study. Those who lost their graft within 1 year posttransplant were excluded. Normocalcemia was defined as total serum calcium levels of 8.5–10.5 mg/dL, while hyperparathyroidism was defined as when intact parathyroid hormone levels exceeded 80 pg/mL. The patients were divided into two groups based on the presence of hyperparathyroidism 1 year after KTx. The primary outcome was the risk of graft loss. Results Among the 892 consecutive patients, 493 did not have hyperparathyroidism (HPT-free group), and 399 had normocalcemic hyperparathyroidism (NC-HPT group). Ninety-five patients lost their grafts. Death-censored graft survival after KTx was significantly lower in the NC-HPT group than in the HPT-free group (96.7% vs. 99.6% after 5 years, respectively, P < 0.001). Cox hazard analysis revealed that normocalcemic hyperparathyroidism was an independent risk factor for graft loss (P = 0.002; hazard ratio, 1.94; 95% confidence interval, 1.27–2.98). Conclusions Normocalcemic hyperparathyroidism 1 year after KTx was an independent risk factor for death-censored graft loss. Early intervention of elevated parathyroid hormone levels may lead to better graft outcomes, even without overt hypercalcemia. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02840-5.
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Affiliation(s)
- Manabu Okada
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Nagoya Daini Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, 4668650, Japan.
| | - Yoshihiro Tominaga
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Nagoya Daini Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, 4668650, Japan
| | - Tetsuhiko Sato
- Department of Diabetes and Endocrinology, Japanese Red Cross Nagoya Daini Hospital, Showa-ku, Nagoya, Aichi, Japan
| | - Toshihide Tomosugi
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Nagoya Daini Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, 4668650, Japan
| | - Kenta Futamura
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Nagoya Daini Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, 4668650, Japan
| | - Takahisa Hiramitsu
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Nagoya Daini Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, 4668650, Japan
| | - Toshihiro Ichimori
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Nagoya Daini Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, 4668650, Japan
| | - Norihiko Goto
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Nagoya Daini Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, 4668650, Japan
| | - Shunji Narumi
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Nagoya Daini Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, 4668650, Japan
| | - Takaaki Kobayashi
- Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Kazuharu Uchida
- Department of Renal Transplant Surgery, Masuko Memorial Hospital, Nakamura-ku, Nagoya, Aichi, Japan
| | - Yoshihiko Watarai
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Nagoya Daini Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, 4668650, Japan
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12
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Chukwu CA, Spiers HV, Middleton R, Kalra PA, Asderakis A, Rao A, Augustine T. Alemtuzumab in renal transplantation. Reviews of literature and usage in the United Kingdom. Transplant Rev (Orlando) 2022; 36:100686. [DOI: 10.1016/j.trre.2022.100686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 11/24/2022]
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13
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Abu El Hawa AA, Bekeny JC, Dekker PK, Zolper EG, Tirrell AR, Kennedy CJ, Walters ET, Bovill JD, Fan KL, Attinger CE, Steinberg JS, Abrams PL, Evans KK. Surgical Management of Lower Extremity Wounds in the Solid Organ Transplant Patient Population: Surgeon Beware. Adv Wound Care (New Rochelle) 2022; 11:10-18. [PMID: 33487096 PMCID: PMC9831248 DOI: 10.1089/wound.2020.1380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Objective: To evaluate our institutional outcomes of surgical management of lower extremity (LE) wounds in the solid organ transplant recipient population. Approach: An 8-year retrospective review was conducted for all solid organ transplantation (SOT) recipients with LE wounds necessitating surgical management at our tertiary limb salvage center. Outcomes of interest included wound healing, surgical treatment, progression to amputation, and amputation level. Factors contributing to amputation progression were analyzed. The article adheres to the Strengthening the Reporting of Observational Studies in Epidemiology statement. Results: Sixty-four SOT recipients underwent surgical management for their LE wounds between 2010 and 2018. Median number of surgeries per patient was 5 (interquartile range = 2-8); 47 of 64 patients (73.4%) underwent amputation, and 17 of 64 patients (26.6%) underwent nonamputation surgical management. In the amputation group, the majority of primary amputations were minor (42/47, 89.4%); 24 of 42 (57.1%) patients progressed to a higher amputation level, 16 of 42 (38.1%) healed after their index procedure, and 2 of 42 (4.8%) were lost to follow-up (LTFU) after their primary minor amputation. Five of 47 (10.6%) patients undergoing amputations required primary below-knee amputations. In the nonamputation group, 15 of 17 (88.2%) healed, 1 of 17 (5.9%) expired, and 1 of 17 (5.9%) was LTFU. Innovation: To identify the outcomes of patients undergoing surgical management for LE wounds after SOT and elucidate clinical factors that impact the rate of limb salvage. Conclusions: This is the first comprehensive analysis of LE wounds in the transplant population. Our analysis indicates high rates of failed minor amputation, and frequent progression to major amputation in SOT patients. Preexisting comorbidities and immunosuppressive regimens complicate limb salvage; therefore, further research is warranted to optimize surgical LE wound management in this population.
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Affiliation(s)
| | - Jenna C. Bekeny
- Department of Plastic and Reconstructive Surgery and MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Paige K. Dekker
- Department of Plastic and Reconstructive Surgery and MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Elizabeth G. Zolper
- Department of Plastic and Reconstructive Surgery and MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Abigail R. Tirrell
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Christopher J. Kennedy
- Department of Plastic and Reconstructive Surgery and MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Elliot T. Walters
- Department of Plastic and Reconstructive Surgery and MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - John D. Bovill
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Kenneth L. Fan
- Department of Plastic and Reconstructive Surgery and MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Christopher E. Attinger
- Department of Plastic and Reconstructive Surgery and MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - John S. Steinberg
- Department of Plastic and Reconstructive Surgery and MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Peter L. Abrams
- Department of Transplant Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Karen K. Evans
- Department of Plastic and Reconstructive Surgery and MedStar Georgetown University Hospital, Washington, District of Columbia, USA.,Correspondence: Georgetown University Hospital, 3800 Reservoir Road, NW, Washington, DC 20007, USA .
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14
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Kielar M, Dumnicka P, Ignacak E, Będkowska-Prokop A, Gala-Błądzińska A, Maziarz B, Ceranowicz P, Kuśnierz-Cabala B. Soluble Complement Component 1q Receptor 1 (sCD93) Is Associated with Graft Function in Kidney Transplant Recipients. Biomolecules 2021; 11:1623. [PMID: 34827620 PMCID: PMC8615695 DOI: 10.3390/biom11111623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022] Open
Abstract
Cluster of differentiation 93 (CD93), also known as complement component 1q receptor 1 is a transmembrane glycoprotein expressed in endothelial and hematopoietic cells and associated with phagocytosis, cell adhesion, angiogenesis and inflammation. The extracellular part, soluble CD93 (sCD93), is released to body fluids in inflammation. Data on sCD93 in kidney diseases are limited. Our aim was to evaluate serum sCD93 in long-term kidney transplant recipients as a marker of inflammation and endothelial dysfunction that may be potentially useful in early recognition of graft dysfunction. Seventy-eight adult patients with functioning kidney graft and stable clinical state were examined at least one year after kidney transplantation. Serum sCD93 was measured by enzyme immunosorbent assay. Estimated glomerular filtration rate (eGFR) and albuminuria or proteinuria were assessed at baseline and over one-year follow-up. Increased sCD93 was associated with lower baseline eGFR independently of the confounders. Moreover, sCD93 was negatively associated with eGFR during one-year follow-up in simple analysis; however, this was not confirmed after adjustment for confounders. Baseline sCD93 was positively associated with baseline albuminuria and with increased proteinuria during the follow-up. Serum sCD93 was not correlated with other studied inflammatory markers (interleukin 6, C-reactive protein, procalcitonin and C3 and C4 complement components). To the best of our knowledge, this is the first report regarding the concentrations of sCD93 in kidney transplant recipients and one of the first reports showing the inverse association between sCD93 and renal function. Serum sCD93 should be further evaluated as a diagnostic and prognostic marker in renal transplantation.
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Affiliation(s)
- Małgorzata Kielar
- Medical Diagnostic Laboratory with a Bacteriology Laboratory, St. Louis Regional Children’s Hospital, 31-503 Kraków, Poland;
| | - Paulina Dumnicka
- Department of Medical Diagnostics, Faculty of Pharmacy, Jagiellonian University Medical College, 30-688 Kraków, Poland
| | - Ewa Ignacak
- Chair and Department of Nephrology, Faculty of Medicine, Jagiellonian University Medical College, 30-688 Kraków, Poland; (E.I.); (A.B.-P.)
| | - Alina Będkowska-Prokop
- Chair and Department of Nephrology, Faculty of Medicine, Jagiellonian University Medical College, 30-688 Kraków, Poland; (E.I.); (A.B.-P.)
| | | | - Barbara Maziarz
- Chair of Clinical Biochemistry, Department of Diagnostics, Faculty of Medicine, Jagiellonian University Medical College, 31-066 Kraków, Poland; (B.M.); (B.K.-C.)
| | - Piotr Ceranowicz
- Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, 31-531 Kraków, Poland;
| | - Beata Kuśnierz-Cabala
- Chair of Clinical Biochemistry, Department of Diagnostics, Faculty of Medicine, Jagiellonian University Medical College, 31-066 Kraków, Poland; (B.M.); (B.K.-C.)
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15
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Henin E, Govoni M, Cella M, Laveille C, Piotti G. Therapeutic Drug Monitoring Strategies for Envarsus in De Novo Kidney Transplant Patients Using Population Modelling and Simulations. Adv Ther 2021; 38:5317-5332. [PMID: 34515977 DOI: 10.1007/s12325-021-01905-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Tacrolimus, the cornerstone of transplantation immunosuppression, is a narrow therapeutic index drug with a low and highly variable bioavailability. Therapeutic drug monitoring based on trough level assessment is mandatory in order to target a personalised exposure and avoid both rejection and toxicity. Population pharmacokinetic (POPPK) models might be a useful tool for improving early attainment of target range by guiding initial doses until steady state is reached and trough levels can be reliably used as surrogate marker of exposure. Here we present the first POPPK for predicting the initial doses of the once-daily prolonged release tacrolimus Envarsus (LCPT) in adult kidney recipients. METHODS The model was developed exploiting the data from a recent pharmacokinetic randomised clinical study, in which 69 de novo kidney recipients, 33 of whom treated with LCPT, underwent an intensive blood sampling strategy for tacrolimus including four complete pharmacokinetic profiles. RESULTS The complex and prolonged absorption of LCPT is well described by the three-phase model that incorporates body weight and CYP3A5 genotype as significant covariates accounting for a great proportion of the inter-patient variability: in particular, CYP3A5*1/*3 expressors had a 66% higher LCPT clearance. We have then generated by simulation a personalised dosing strategy based on the model that could improve the early attainment of therapeutic trough levels by almost doubling the proportion of patients within target range (69.3% compared to 36.1% with the standard body weight-based approach) on post-transplantation day 4 and significantly reduce the proportion of overexposed patients at risk of toxicity. CONCLUSIONS A POPPK model was successfully developed for LCPT in de novo kidney recipients. The model could guide a personalised dosing strategy early after transplantation. For the model to be translated into clinical practice, its beneficial impact of earlier attainment of therapeutic trough levels should be demonstrated on hard clinical outcomes in further studies.
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Affiliation(s)
| | - Mirco Govoni
- Global Clinical Development, Chiesi Farmaceutici S.p.A., Parma, Italy
| | - Massimo Cella
- Global Clinical Development, Chiesi Farmaceutici S.p.A., Parma, Italy
| | | | - Giovanni Piotti
- Global Clinical Development, Chiesi Farmaceutici S.p.A., Parma, Italy.
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16
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Ky TQ, Park JM, McMurry KA, Tischer SM, Fitzgerald LJ, Cotiguala L. Oropharyngeal candidiasis outcomes in renal transplant recipients receiving nystatin versus no antifungal prophylaxis. Transpl Infect Dis 2021; 23:e13559. [PMID: 33387388 DOI: 10.1111/tid.13559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/15/2020] [Accepted: 12/29/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare the incidence of oropharyngeal candidiasis (OC), or thrush, in renal transplant recipients receiving nystatin versus no antifungal prophylaxis. METHODS This was a single-center, retrospective, non-inferiority study of adult renal transplant recipients (RTRs) who received nystatin for 30 days for OC prophylaxis (nystatin group) or no antifungal prophylaxis therapy (No PPX group). The primary outcome was the incidence of OC within 3 months post-transplant. Secondary outcomes included time to OC occurrence and severity of OC. The pre-specified non-inferiority margin was 10%. RESULTS The incidence of OC within 3 months post-transplant among 257 RTRs was 7.8% (10/128) in the No PPX group and 4.7% (6/129) RTRs in the nystatin group, a risk difference of 3.2% (95% CI, -2.7% to 9.1%, non-inferiority P = .04). The median time to OC was 7.5 days (IQR 6.3-34.3 days) in the nystatin group and 9.5 days (IQR 5.3-30.5 days) in the No PPX group (P = .64). Esophageal candidiasis was observed in 10% (1/10) of RTRs with OC in the No PPX group compared to 16.7% (1/6) RTRs in the nystatin group (P = 1.00). All RTRs with OC achieved symptom resolution with fluconazole and/or nystatin. Two patients in the No PPX group required readmission for decreased oral intake, and OC was diagnosed and treated during their hospital day. CONCLUSIONS In this retrospective study of adult RTRs, the absence of antifungal prophylaxis demonstrated non-inferiority to 30-day nystatin prophylaxis at reducing the incidence of OC within 3 months of transplant. OC prophylaxis may not be warranted after renal transplant.
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Affiliation(s)
- Trung Q Ky
- Department of Pharmacy Services, Michigan Medicine, Ann Arbor, MI, USA
| | - Jeong M Park
- Department of Pharmacy Services, Michigan Medicine, Ann Arbor, MI, USA.,College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Katie A McMurry
- Department of Pharmacy Services, Michigan Medicine, Ann Arbor, MI, USA
| | - Sarah M Tischer
- Department of Pharmacy Services, Michigan Medicine, Ann Arbor, MI, USA
| | | | - Laura Cotiguala
- Department of Pharmacy Services, Michigan Medicine, Ann Arbor, MI, USA
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17
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Ro H, Jeong JC, Kong JM, Min JW, Park SK, Lee J, Koo TY, Yang J, Kim MS, Hwang S, Ahn C. The tacrolimus metabolism affect post‐transplant outcome mediating acute rejection and delayed graft function: analysis from Korean Organ Transplantation Registry data. Transpl Int 2020; 34:163-174. [DOI: 10.1111/tri.13777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/14/2020] [Accepted: 10/21/2020] [Indexed: 01/07/2023]
Affiliation(s)
- Han Ro
- Department of Internal Medicine Gil Hospital Gachon University Incheon Korea
| | - Jong Cheol Jeong
- Department of Internal Medicine Seoul National University Bundang Hospital Seongnam Korea
| | - Jin Min Kong
- Department of Internal Medicine BHS Hanseo Hospital Busan Korea
| | - Ji Won Min
- Department of Internal Medicine Bucheon St. Mary’s Hospital The Catholic University of Korea Bucheon Korea
| | - Sung Kwang Park
- Department of Internal Medicine Chonbuk National University Medical School Jeonju Korea
| | - Joongyub Lee
- Department of Prevention and Management School of Medicine Inha University Hospital Inha University Incheon Korea
| | - Tai Yeon Koo
- Transplantation Research Institute Seoul National University Hospital Seoul Korea
| | - Jaeseok Yang
- Department of Surgery Transplantation Center Seoul National University Hospital Seoul Korea
| | - Myoung Soo Kim
- Department of Surgery Yonsei University College of Medicine Seoul Korea
| | - Seungsik Hwang
- Department of Public Health Sciences Graduate School of Public Health Seoul National University Seoul Korea
| | - Curie Ahn
- Department of Internal Medicine Seoul National University Hospital Seoul National University College of Medicine Seoul Korea
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18
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Cheng S, Tang M, Du J, Yin T. Effects of antifungal drugs on the plasma concentrations and dosage of tacrolimus in kidney transplant patients. Eur J Hosp Pharm 2020; 29:202-206. [PMID: 33020057 DOI: 10.1136/ejhpharm-2020-002385] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Tacrolimus is one of the three basic immunosuppressants used following kidney transplantation, and its plasma concentration is susceptible to antifungal drugs. Abnormal tacrolimus concentrations may lead to adverse outcomes for patients. Adjustment of the tacrolimus dose after administering antifungal drugs to patients with fungal infection after transplantations therefore has important clinical significance. Our objective is to measure the impact of antifungal drugs on the plasma concentration of tacrolimus in kidney transplant patients. METHODS A retrospective study was carried out in 109 kidney transplant recipients treated with a tacrolimus-based regimen and antifungal drugs simultaneously. Tacrolimus levels and dosage requirements were compared before and during antifungal therapy. RESULTS The plasma levels of tacrolimus were significantly increased after the combination with voriconazole and fluconazole (p<0.05). Consequently, the daily dose of tacrolimus was significantly reduced after the combination (p<0.05). However, although the tacrolimus concentration was significantly decreased after the administration of caspofungin (p<0.05), no apparent change in the daily dose of tacrolimus was found. Moreover, there were no significant changes in the tacrolimus levels and the daily dose after the combination with micafungin (p>0.05). CONCLUSIONS Our results suggest that there is considerable variability in the interaction between tacrolimus and different antifungal drugs. The dose of tacrolimus should be reduced by two-thirds and one-third before the combination with voriconazole and fluconazole, respectively. It is not recommended that the dose should be adjusted before combination with other antifungal drugs, and the dose should be adjusted under the guidance of therapeutic drug monitoring.
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Affiliation(s)
- Shuqiao Cheng
- Department of Pharmacy, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Mimi Tang
- Department of Pharmacy, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jie Du
- Department of Pharmacy, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Tao Yin
- Department of Pharmacy, Xiangya Hospital of Central South University, Changsha, Hunan, China
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19
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Pneumocystis pneumonia after lung transplantation: A retrospective multicenter study. Respir Med 2020; 169:106019. [DOI: 10.1016/j.rmed.2020.106019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 05/08/2020] [Accepted: 05/09/2020] [Indexed: 01/14/2023]
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20
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Tinti F, Schiaffini G, Umbro I, Zavatto A, Poli L, Pretagostini R, Garofalo M, Bachetoni A, Lai S, D'Alessandro MD, Mitterhofer AP. Expected and Observed Glomerular Filtration Rates in Kidney Transplant Patients Converted to Once Daily Tacrolimus: 10 Years of Follow-up. Transplant Proc 2020; 52:1547-1551. [PMID: 32307145 DOI: 10.1016/j.transproceed.2020.02.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 02/22/2020] [Indexed: 11/20/2022]
Abstract
The decline of allograft kidney function in the long term remains a significant issue in renal transplantation, with drug nephrotoxicity and cardiovascular complications as important risk factors. Our study aimed to evaluate the estimated glomerular filtration rate (eGFR) trend and metabolic cardiovascular risk factors over 10 years in a cohort of kidney transplant (KT) recipients converted from twice-daily (TD) tacrolimus (Tac) to once-daily (OD)-Tac. We enrolled 55 consecutive KT recipients who had been at the outpatient clinic between 2009 and 2011. Thirty-seven reached the 10-year follow-up. We compared the observed eGFR with the expected eGFR trend described in KT-recipients and monitored blood pressure and metabolic cardiovascular risk factors. The observed eGFR remained stable throughout the complete follow-up (P = .188). The observed decline of eGFR was significantly lower compared with the expected decline for KT patients (P < .001). The blood pressure was maintained within target values. The monitoring of plasma glucose levels demonstrated the stability of median values (P = .686), as well as cholesterol level (P = .250), high-density lipoprotein (HDL) cholesterol (P = .294), and triglycerides (P = .592) throughout the follow-up. The monitoring of tacrolimus plasma level demonstrated that median trough levels remained constant (median values 4.4-5.5 ng/mL) throughout the entire follow-up period (P = .149). We suggest that the reasonable control of metabolic risk factors for cardiovascular disease over long-term follow-up may significantly contribute to the preservation of eGFR compared with the decline expected in KT recipients.
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Affiliation(s)
- Francesca Tinti
- Department of Translational and Precision Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy.
| | - Gabriele Schiaffini
- Department of Translational and Precision Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy
| | - Ilaria Umbro
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Rome, Italy
| | - Assunta Zavatto
- Department of Translational and Precision Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy
| | - Luca Poli
- Department of General Surgery, Organ Transplant Unit, Sapienza University of Rome, Rome, Italy
| | - Renzo Pretagostini
- Department of General Surgery, Organ Transplant Unit, Sapienza University of Rome, Rome, Italy
| | - Manuela Garofalo
- Department of General Surgery, Organ Transplant Unit, Sapienza University of Rome, Rome, Italy
| | - Alessandra Bachetoni
- Clinical Pathology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Silvia Lai
- Department of Translational and Precision Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy
| | | | - Anna Paola Mitterhofer
- Department of Translational and Precision Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy
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Bahena Méndez J, López Y López LR, Sebastián Díaz MA, Trejo Curiel I, Galindo-Lopéz R, Baca Córdova A, Wasung de Lay M, Vázquez Dávila RA, Zarate Rodríguez PA, Carmona-Escamilla MA. Antibody-Mediated Rejection Treatment With Bortezomib in Renal Transplant Recipients: A Single-Center 24-Month Follow-up Case Report. Transplant Proc 2020; 52:1123-1126. [PMID: 32224016 DOI: 10.1016/j.transproceed.2020.01.067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 01/10/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Antibody-mediated rejection (AMR) is related to a poor prognosis in graft survival, with 27% to 40% of patients experiencing graft loss within the first year. The mechanism of damage in AMR is mediated by donor-specific antibodies (DSA). No standard treatment for AMR exists, and conventional management includes high doses of steroids, plasmapheresis, intravenous immunoglobulin, and either rituximab or bortezomib. Because of the high cost of these medications and the lack of prospective studies to evaluate their efficacy and safety, their routine use is limited. In the following study, we describe the use of bortezomib for the treatment of AMR in 5 renal transplant recipients with a 24-month follow-up and compare this case with the reviewed literature. MATERIAL AND METHODS Five cases of AMR diagnosed by biopsy are reported, and these patients received bortezomib at a rate of 1.3 mg/m2 on days 1, 4, 8, and 11; plasmapheresis; and 1 patient received 30 g of intravenous immunoglobulin. RESULTS All patients received his or her first transplant; 4 were from a cadaveric donor, and 1 patient received thymoglobulin at a standard dose. All patients had maintenance therapy based on cyclosporine, mycophenolate mofetil, and prednisone, with an average baseline creatinine level of 1.3 mg/dL. The average days until rejection event were 952 days. DISCUSSION AND CONCLUSION AMR treatment with bortezomib was effective, showing stable renal function at 24 months. Patients had adequate tolerance for administration. So far, these results contrast with the literature reviewed, so additional studies and follow-up are required for a new evaluation.
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Affiliation(s)
- J Bahena Méndez
- Nephrology Fellowship Program, Universidad Nacional Autónoma de México Facultad de Medicina, México City, México
| | - L R López Y López
- Nephrology Fellowship Program, Universidad Nacional Autónoma de México Facultad de Medicina, México City, México
| | - M A Sebastián Díaz
- Nephrology, Hospital Central Sur Alta Especialidad "Picacho," Petróleos Mexicanos, México City, México
| | - I Trejo Curiel
- Nephrology Fellowship Program, Universidad Nacional Autónoma de México Facultad de Medicina, México City, México
| | - R Galindo-Lopéz
- Nephrology Fellowship Program, Universidad Nacional Autónoma de México Facultad de Medicina, México City, México
| | - A Baca Córdova
- Nephrology Fellowship Program, Universidad Nacional Autónoma de México Facultad de Medicina, México City, México
| | - M Wasung de Lay
- Nephrology, Hospital Central Sur Alta Especialidad "Picacho," Petróleos Mexicanos, México City, México
| | - R A Vázquez Dávila
- Transplant, Hospital Central Sur Alta Especialidad "Picacho," Petróleos Mexicanos, México City, México
| | - P A Zarate Rodríguez
- Central Laboratory, Hospital Central Sur Alta Especialidad "Picacho," Petróleos Mexicanos, México City, México
| | - M A Carmona-Escamilla
- Nephrology, Hospital Central Sur Alta Especialidad "Picacho," Petróleos Mexicanos, México City, México.
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Tacrolimus Trough Level at the First Month May Predict Renal Transplantation Outcomes Among Living Chinese Kidney Transplant Patients: A Propensity Score-Matched Analysis. Ther Drug Monit 2020; 41:308-316. [PMID: 31083041 PMCID: PMC6553958 DOI: 10.1097/ftd.0000000000000593] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Supplemental Digital Content is Available in the Text. Background: Monitoring and maintaining a stable tacrolimus trough level is essential because of its narrow therapeutic window and considerable fluctuation in the early phase after kidney transplantation. However, optimal tacrolimus exposure early after transplantation remains unclear among Chinese patients. Methods: In this propensity score–matched cohort study, we thoroughly investigated the association between tacrolimus trough level at the first month and acute rejection (AR) as well as infection within the first year after kidney transplantation. Results: In a first step, a total of 1415 patients were divided into 3 groups according to the receiver operating characteristic curve: low-level group (410 patients with a tacrolimus trough level <5.35 ng/mL at the first month), median-level group (466 patients with a tacrolimus trough level from 5.35 to 7.15 ng/mL), and high-level group (539 patients with a tacrolimus trough level >7.15 ng/mL). Ultimately, 363 and 459 pairs of cases were enrolled by using 2 propensity score matches between low- and median-level groups and between high- and median-level groups, respectively. Compared with patients in the low-level group, patients in the median-level group had lower risk of AR without increased incidence of infection (AR, 12.4% versus 5.7%, P = 0.02; infection, 13.2% versus 13.2%, P = 1.00 for low- and median-level groups, respectively) within the first year. Compared with patients in the high-level group, patients in the median-level group had lower incidence of infection without the growing risk of AR (infection, 17.6% versus 12.2%, P = 0.021; AR, 4.6% versus 5.4%, P = 0.545 for high- and median-level groups, respectively) within the first year. Multilogistic analysis showed that tacrolimus trough levels were an independent factor for AR (odds ratio, 0.749, 95% confidence interval, 0.632–0.888, P = 0.001). Tacrolimus trough levels were also associated with infection (odds ratio 1.110, 95% confidence interval, 1.013–1.218, P = 0.001). Serum creatinine levels were similar among groups. No difference was found in 1-, 3-, and 5-year graft survival and patient survival among groups. Conclusions: The tacrolimus trough level maintained between 5.35 and 7.15 ng/mL at the first posttransplant month may prevent AR without increasing the incidence of infection within the first year after living kidney transplantation among Chinese patients.
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Management of Immunosuppression in Kidney Transplant Recipients Who Develop Malignancy. J Clin Med 2019; 8:jcm8122189. [PMID: 31835895 PMCID: PMC6947374 DOI: 10.3390/jcm8122189] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 12/08/2019] [Accepted: 12/09/2019] [Indexed: 11/17/2022] Open
Abstract
The risk of cancer increases after transplantation. However, the consensus on immunosuppression (IS) adjustment after diagnosis of malignancy is lacking. Our study aims to assess the impact of IS adjustment on mortality of post-kidney transplant patients and allograft outcomes. We retrospectively reviewed the data in our center of 110 subjects. Our results showed IS dose adjustment was not statistically associated with mortality risk (HR 1.94, 95%CI 0.85–4.41, p = 0.12), and chemotherapy was the only factor that was significantly related to mortality (HR 2.3, 95%CI 1.21–4.35, p = 0.01). IS reduction was not statistically associated with worsening graft function (OR 3.8, 95%CI 0.77–18.71, p = 0.10), nor with graft survival (SHR 4.46, 95%CI 0.58–34.48, p = 0.15) after variables adjustment. Creatinine at cancer diagnosis and history of rejection were both negatively associated with graft survival (SHR 1.72, 95%CI 1.28–2.30, p < 0.01 and SHR 3.44, 95%CI 1.25–9.49, p = 0.02). Reduction of both mycophenolate and calcineurin inhibitors was associated with worsening graft function and lower graft survival in subgroup analysis (OR 6.14, 95%CI 1.14–33.15, p = 0.04; HR 17.97, 95%CI 1.81–178.78, p = 0.01). In summary, cancer causes high mortality and morbidity in kidney transplant recipients; the importance of cancer screening should be emphasized.
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Zheng M, Yang H, Li W, Zhou J, Wei J, Wang Z, Guo M, Chen H, Sun L, Han Z, Tao J, Ju X, Tan R, Wei JF, Gu M. A Single-Nucleotide Polymorphism (rs1131243) of the Transforming Growth Factor Beta Signaling Pathway Contributes to Risk of Acute Rejection in Chinese Renal Transplant Recipients. Med Sci Monit 2019; 25:9138-9158. [PMID: 31786580 PMCID: PMC6910173 DOI: 10.12659/msm.918142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 11/15/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Acute rejection (AR) is a common complication of kidney transplantation. The transforming growth factor beta (TGF-ß) signaling pathway has been observed to be involved in several cellular functions. Our study aimed to investigate the correlations between single-nucleotide polymorphisms (SNPs) in TGF-ß-related genes and the risk of AR in renal transplant recipients. MATERIAL AND METHODS This retrospective, single-center study included 200 Chinese renal transplant recipients. All exons, exon/intron boundaries, and flanking regions of the TGF-ß signaling pathway were detected by targeting sequencing (TS) based on next-generation sequencing technology. Tagger SNPs and haplotypes were identified after adjustment. A general linear model (GLM) was used to explore the confounding effect of clinical variables. Five adjusted inheritance models were utilized to investigate the influence of SNPs on AR, and Banff score was applied to evaluate the effect of related SNPs on pathological changes. RESULTS A total of 188 SNPs on TGF-ß genes were detected. Analysis of adjustment led to identification of 31 tagger SNPs and 10 haplotype blocks. After the analysis of a general linear model and 5 sirolimus-adjusted multiple inheritance models, 1 of the SNPs - rs1131243 on the TGF-ßR3 gene - was observed to be significantly associated with the occurrence of AR. Based on Banff score, no significant association was observed between SNPs and pathological changes. CONCLUSIONS In this study, we observed that the SNP rs1131243 on the TGF-ßR3 gene was significantly associated with the occurrence of AR in Chinese renal transplant recipients.
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Affiliation(s)
- Ming Zheng
- Department of Urology, Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, P.R. China
| | - Haiwei Yang
- Department of Urology, Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, P.R. China
| | - Wencheng Li
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, P.R. China
| | - Jiajun Zhou
- Department of Emergency Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, P.R. China
| | - Jintao Wei
- Department of Urology, Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, P.R. China
| | - Zijie Wang
- Department of Urology, Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, P.R. China
| | - Miao Guo
- Research Division of Clinical Pharmacology, Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, P.R. China
| | - Hao Chen
- Department of Urology, Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, P.R. China
| | - Li Sun
- Department of Urology, Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, P.R. China
| | - Zhijian Han
- Department of Urology, Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, P.R. China
| | - Jun Tao
- Department of Urology, Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, P.R. China
| | - Xiaobing Ju
- Department of Urology, Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, P.R. China
| | - Ruoyun Tan
- Department of Urology, Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, P.R. China
| | - Ji-Fu Wei
- Research Division of Clinical Pharmacology, Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, P.R. China
| | - Min Gu
- Department of Urology, Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, P.R. China
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Abstract
PURPOSE OF REVIEW Infections represent a significant source of morbidity and mortality after kidney transplantation in children. We review recent advances in epidemiology, assessment, prevention and treatment for several different infections. RECENT FINDINGS Infections, such as bacterial urinary tract infection or opportunistic viral infection remain common, may be increasing and represent a large proportion of hospitalization. Extended antiviral agent use reduces the incidence of cytomegalovirus disease but its efficacy to reduce Epstein-Barr virus disease remains controversial. Human herpesvirus-6 and hepatitis E virus represent new infections to keep in mind. Ureteral stenting increases the rate of early UTI. Several new vaccines are now available, but rates of complete vaccination pretransplant are low. SUMMARY Infections remain a critical posttransplant issue associated with significant medical burdens. Emerging data on associated risk factors, assessment of and treatment for infections provide clinicians with new knowledge.
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Pehlivan S, Vatansever N, Arslan İ, Yildiz A, Ersoy A. Level of Daily Life Activities and Learning Needs in Renal Transplant Patients. EXP CLIN TRANSPLANT 2019; 18:498-504. [PMID: 30806203 DOI: 10.6002/ect.2018.0151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Transplantation affects the patient's psychological state and daily life activities. Although there are various studies regarding the quality of life of patients, there are limited studies on the daily life activities and learning needs of patients after renal transplant. Here, we investigated the daily life activities and learning needs of patients after renal transplant. MATERIALS AND METHODS This descriptive and cross-sectional study was conducted on 120 renal transplant recipients. Data were collected using the "Patient Information Form," the "Nottingham Extended Activities of Daily Living Scale," and the "The Patient Learning Needs Scale." Data were evaluated with t test, analysis of variance, and Pearson correlation analyses. RESULTS In our patient group, the mean general health score was 6.8 ± 2.34, and the fatigue score was 4.53 ± 2.88. Although 66.7% of our patients reported that they had information about the drugs that they used, 58.3% could not answer questions regarding the most important adverse effects of their drugs. We found that 20% of the patients had a respiratory problem, 34.2% had sexual problems, and 26.7% had sleep problems. The average Nottingham Extended Activities of Daily Living Scale levels were lower in patients with only primary school education, patients who did not work, and patients with other illnesses. Learning needs of patients were as follows in order: quality of life, feelings related to the conditions, treatment, and complications. CONCLUSIONS Our study patients reported that their overall daily life activities and quality of life, given the holistic approach to treatment and care, were good. However, when we examined each activity separately, our findings showed that patients lacked information regarding how to cope with stress, emotions, and the effects of renal transplant on their life.
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Affiliation(s)
- Seda Pehlivan
- From the Department of Internal Medicine Nursing, Faculty of Health Sciences, Uludag University, Bursa, Turkey
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27
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Abstract
Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are the major causes of chronic liver disease. HBV and HCV affect nearly 7% of the world's population. Extra-hepatic complications and particularly renal failure have different mechanisms and manifestations. The underlying mechanism, although differing for each disease, mainly involves the immune system and antibody deposits in the kidney, which can lead to tissue damage. Areas covered: We do not cover in this review hepatorenal syndrome. We report on the renal complications of viral hepatitis (HBV, HCV, hepatitis E), autoimmune hepatitis, cirrhosis, and Wilson's disease. The most frequent renal disorders are those related to HBV, and HCV due to their high prevalence worldwide. Expert commentary: Thanks to generalization of vaccination against HBV, prevalence of HBV-related liver diseases will decrease, and thereby its associated renal involvement such as polyarteritis nodosa (an exceptional condition), and glomerulonephritis such as membranous nephropathy. Thanks to direct acting antiviral agents HCV infection will be cured within the next decade. However, HCV-related cryoglobulinemia with or without renal involvement might evolve on its own after the patient has eliminated HCV, necessitating then rituximab therapy. Conversely, orofecal-transmitted hepatitis viruses such as hepatitis A and hepatitis E are still very prevalent in developing countries; however, they are rarely associated with renal manifestations.
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Affiliation(s)
- Johan Noble
- a Service de Néphrologie, Hémodialyse , Aphérèses et Transplantation rénale , Grenoble-Alpes , France.,b Université Joseph Fourier , Grenoble-Alpes , France
| | - Thomas Jouve
- a Service de Néphrologie, Hémodialyse , Aphérèses et Transplantation rénale , Grenoble-Alpes , France.,b Université Joseph Fourier , Grenoble-Alpes , France
| | - Paolo Malvezzi
- a Service de Néphrologie, Hémodialyse , Aphérèses et Transplantation rénale , Grenoble-Alpes , France.,b Université Joseph Fourier , Grenoble-Alpes , France
| | - Lionel Rostaing
- a Service de Néphrologie, Hémodialyse , Aphérèses et Transplantation rénale , Grenoble-Alpes , France.,b Université Joseph Fourier , Grenoble-Alpes , France
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Abu-Sultaneh S, Hobson MJ, Wilson AC, Goggins WC, Nitu ME, Lutfi R. Practice Variation in the Immediate Postoperative Care of Pediatric Kidney Transplantation: A National Survey. Transplant Proc 2018; 49:2060-2064. [PMID: 29149961 DOI: 10.1016/j.transproceed.2017.09.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 07/01/2017] [Accepted: 09/02/2017] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Advances in organ allocation, surgical technique, immunosuppression, and long-term follow-up have led to a significant improvement in kidney transplant outcomes. Although there are clear recommendations for several aspects of kidney transplant management, there are no pediatric-specific guidelines for immediate postoperative care. The aim of this survey is to examine practice variations in the immediate postoperative care of pediatric kidney transplant patients. METHODS We surveyed medical directors of Pediatric Acute Lung Injury and Sepsis Investigators (PALISI)-affiliated pediatric intensive care units regarding center-specific immediate postoperative management of pediatric kidney transplantation. RESULTS The majority of PALISI centers admit patients to the pediatric intensive care unit postoperatively, and 97% of the centers involve a pediatric nephrologist in immediate postoperative care. Most patients undergo invasive hemodynamic monitoring; 97% of centers monitor invasive arterial blood pressure and 88% monitor central venous pressure. Most centers monitor serum electrolytes every 4 to 6 hours. Wide variation exists regarding blood pressure goal, fluid replacement type, frequency of obtaining kidney ultrasound, and use of prophylactic anticoagulation. CONCLUSION There is consistent practice across PALISI centers in regards to many aspects of immediate postoperative management of pediatric kidney transplantation. However, variation still exists in some management aspects that warrant further discussions to reach a national consensus.
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Affiliation(s)
- S Abu-Sultaneh
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA.
| | - M J Hobson
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
| | - A C Wilson
- Section of Pediatric Nephrology, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
| | - W C Goggins
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - M E Nitu
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
| | - R Lutfi
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
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Leblanc J, Subrt P, Paré M, Hartell D, Sénécal L, Blydt-Hansen T, Cardinal H. Practice Patterns in the Treatment and Monitoring of Acute T Cell-Mediated Kidney Graft Rejection in Canada. Can J Kidney Health Dis 2018; 5:2054358117753616. [PMID: 29479453 PMCID: PMC5818088 DOI: 10.1177/2054358117753616] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 09/21/2017] [Indexed: 01/11/2023] Open
Abstract
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. Design Survey. Setting Patients/Participants Canadian transplant nephrologists and transplant surgeons involved in the management of acute TCMR. Methods and Measurements We developed an anonymous, web-based survey consisting of questions related to the diagnosis, treatment, and monitoring of TCMR. The survey was disseminated on 3 occasions between June and October 2016 through the Canadian Society of Transplantation (CST) kidney group electronic mailing list. Results Forty-seven respondents, mostly transplant nephrologists (97%), originating from at least 18 of the 25 Canadian centers offering adult or pediatric kidney transplantation, participated in the study. Surveillance biopsies were used by 28% of respondents to screen for kidney graft rejection. High-dose steroids were used by most of the respondents to treat clinical and subclinical Banff grade 1A and 1B rejections. Nine percent (95% confidence interval [CI]: 1-17) of practitioners used lymphocyte-depleting agents as the first-line approach for the treatment of Banff grade 1B acute rejection. Eighteen percent (95% CI: 7-29) and 36% (95% CI: 8-65) of respondents reported that they would not use high-dose steroids for treating clinical and subclinical borderline rejections, respectively. Seventy percent (95% CI: 54-83) of respondents answered that there was no indication to assess histological response to treatment independent of the change in kidney function. Limitations The limitations of this study are its limited sample size and the low representation of pediatric specialists. Conclusions There is heterogeneity regarding the use of surveillance biopsies, treatment of borderline rejection, and modalities to monitor treatment response among transplant physicians. Our results illustrate the current state of practice patterns across Canada and can be used to inform the design of future trials.
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Affiliation(s)
- Julie Leblanc
- Division of Internal Medicine, Department of Medicine, Université de Montréal, Québec, Canada
| | - Peter Subrt
- Canadian National Transplant Research Program, Montreal, Québec, Canada
| | - Michèle Paré
- Institut de recherche en santé publique de l'Université de Montréal, Québec, Canada
| | - David Hartell
- Canadian National Transplant Research Program, Montreal, Québec, Canada
| | - Lynne Sénécal
- Canadian National Transplant Research Program, Montreal, Québec, Canada.,Division of Nephrology, Department of Medicine, Hôpital Maisonneuve-Rosemont, Montreal, Québec, Canada
| | - Tom Blydt-Hansen
- Canadian National Transplant Research Program, Montreal, Québec, Canada.,Division of Pediatric Nephrology, University of British Columbia, Vancouver, Canada
| | - Héloïse Cardinal
- Canadian National Transplant Research Program, Montreal, Québec, Canada.,Division of Nephrology, Centre hospitalier de l'Université de Montréal, Québec, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Québec, Canada
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30
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Araujo MJCLN, Ramalho JAM, Elias RM, Jorgetti V, Nahas W, Custodio M, Moysés RMA, David-Neto E. Persistent hyperparathyroidism as a risk factor for long-term graft failure: the need to discuss indication for parathyroidectomy. Surgery 2018; 163:1144-1150. [PMID: 29331397 DOI: 10.1016/j.surg.2017.12.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 11/28/2017] [Accepted: 12/05/2017] [Indexed: 02/02/2023]
Abstract
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. METHODS Longitudinal follow-up of 911 adults submitted to KTx between January 2005 and December 2014, with estimated glomerular filtration rate (eGFR) ≥ 30 mL/min 1 year after surgery. Clinical and laboratory data were collected from electronic database. Graft failure was defined as return to dialysis. RESULTS Overall, 62% of the patients were classified as having pHPT 1 year after KTx. After a mean follow-up time of 47 months, there were 59 graft failures (49 in pHPT and 10 in non-pHPT group, P = .003). At last follow-up, death-censored graft survival was lower in the pHPT group (P = .009), even after adjustment for age at KTx, donor age, donor type, acute rejection, parathyroidectomy, and eGFR at 1 year after transplantation (odds ratio [OR] 1.99; 1.004-3.971; P = .049). A PTH of 150 pg/mL at 6 months was the best cutoff to predict pHPT at 1 year (specificity = 92.1%). CONCLUSION Having pHPT after a successful KTx increases the long-term risk of death-censored graft failure. This result highlights the need for better recognition and management of CKD-MBD before and during the first year after KTx, and opens a discussion on the more appropriate timing to perform parathyroidectomy.
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Affiliation(s)
- Maria Júlia Correia Lima Nepomuceno Araujo
- Renal Transplantation Service, São Paulo University School of Medicine, São Paulo, Brazil; Nephrology Division, São Paulo University School of Medicine, São Paulo, Brazil
| | - Janaina Almeida Mota Ramalho
- Renal Transplantation Service, São Paulo University School of Medicine, São Paulo, Brazil; Nephrology Division, São Paulo University School of Medicine, São Paulo, Brazil
| | | | - Vanda Jorgetti
- Nephrology Division, São Paulo University School of Medicine, São Paulo, Brazil
| | - William Nahas
- Renal Transplantation Service, São Paulo University School of Medicine, São Paulo, Brazil
| | - Melani Custodio
- Nephrology Division, São Paulo University School of Medicine, São Paulo, Brazil
| | - Rosa M A Moysés
- Nephrology Division, São Paulo University School of Medicine, São Paulo, Brazil.
| | - Elias David-Neto
- Renal Transplantation Service, São Paulo University School of Medicine, São Paulo, Brazil; Nephrology Division, São Paulo University School of Medicine, São Paulo, Brazil
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Hebert SA, Swinford RD, Hall DR, Au JK, Bynon JS. Special Considerations in Pediatric Kidney Transplantation. Adv Chronic Kidney Dis 2017; 24:398-404. [PMID: 29229171 DOI: 10.1053/j.ackd.2017.09.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Universally accepted as the treatment of choice for children needing renal replacement therapy, kidney transplantation affords children the opportunity for an improved quality of life over dialysis therapy. Immunologic and surgical advances over the last 15 years have improved the pediatric patient and kidney graft survival. Unique to pediatrics, congenital genitourinary anomalies are the most common primary diseases leading to kidney failure, many with urological issues. Early urological evaluation for post-transplant bladder dysfunction and emphasis on immunization adherence are the mainstays of pediatric pretransplant and post-transplant evaluations. A child's height can be challenging, sometimes requiring an intra-abdominally placed graft, particularly if the patient is <20 kg. Maintenance immunosuppression regimens are similar to adult kidney graft recipients, although distinctive pharmacokinetics may change dosing intervals in children from twice a day to thrice a day. Viral infections and secondary malignancies are problematic for children relative to adults. Current trends to reduce/remove corticosteroid therapy from post-transplant protocols have produced improved linear growth with less steroid toxicity; although these studies are still ongoing, graft function and survival are considered acceptable. Finally, all children with a kidney transplant need a smooth transition to adult clinics. Future research in pertinent psychosocial aspects and continued technological advances will only serve to optimize the transition process. Although some aspects of kidney transplantation are similar in children and adults, for instance immunosuppression and immunosuppressive regimens, and rejection mechanisms and their diagnosis using the Banff criteria, there are important differences this review will focus on and which continue to drive innovation.
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Tillou X, Timsit MO, Sallusto F, Culty T, Verhoest G, Doerfler A, Thuret R, Kleinclauss F. [Polycystic kidney disease and kidney transplantation]. Prog Urol 2016; 26:993-1000. [PMID: 27665410 DOI: 10.1016/j.purol.2016.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 08/22/2016] [Accepted: 08/22/2016] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To perform a state of the art about autosomal dominant polykystic kidney disease (ADPKD), management of its urological complications and end stage renal disease treatment modalities. MATERIAL AND METHODS An exhaustive systematic review of the scientific literature was performed in the Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using different associations of the following keywords (MESH): "autosomal dominant polykystic kidney disease", "complications", "native nephrectomy", "kidney transplantation". Publications obtained were selected based on methodology, language, date of publication (last 10 years) and relevance. Prospective and retrospective studies, in English or French, review articles; meta-analysis and guidelines were selected and analyzed. This search found 3779 articles. After reading titles and abstracts, 52 were included in the text, based on their relevance. RESULTS ADPKD is the most inherited renal disease, leading to end stage renal disease requiring dialysis or renal transplantation in about 50% of the patients. Many urological complications (gross hematuria, cysts infection, renal pain, lithiasis) of ADPKD required urological management. The pretransplant evaluation will ask the challenging question of native nephrectomy only in case of recurrent kidney complications or large kidney not allowing graft implantation. The optimum timing for native nephrectomy will depend on many factors (dialysis or preemptive transplantation, complication severity, anuria, easy access to transplantation, potential living donor). CONCLUSION Pretransplant management of ADPKD is challenging. A conservative strategy should be promoted to avoid anuria (and its metabolic complications) and to preserve a functioning low urinary tract and quality of life. When native nephrectomy should be performed, surgery remains the gold standard but renal arterial embolization may be a safe option due to its low morbidity.
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Affiliation(s)
- X Tillou
- Service d'urologie et transplantation, CHU Côte de Nacre, 14000 Caen, France
| | - M-O Timsit
- Service d'urologie, hôpital européen Georges-Pompidou, 75015 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - F Sallusto
- Département d'urologie et transplantation, CHU de Toulouse, 31400 Toulouse, France
| | - T Culty
- Service d'urologie, CHU d'Angers, 49100 Angers, France
| | - G Verhoest
- Service d'urologie, CHU de Rennes, 35000 Rennes, France
| | - A Doerfler
- Service d'urologie et transplantation, CHU Côte de Nacre, 14000 Caen, France
| | - R Thuret
- Service d'urologie, CHU Lapeyronie, 34000 Montpellier, France; Université de Montpellier, 34000 Montpellier, France
| | - F Kleinclauss
- Service d'urologie et transplantation, CHRU de Besançon, 3, boulevard A.-Fleming, 25000 Besançon, France; Université de Franche-Comté, 25000 Besançon, France; Inserm UMR 1098, 25000 Besançon, France.
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Paliege A, Bamoulid J, Bachmann F, Staeck O, Halleck F, Khadzhynov D, Brakemeier S, Dürr M, Budde K. [Immunosuppression and its use in kidney transplantation]. Urologe A 2016; 54:1376-84. [PMID: 26459580 DOI: 10.1007/s00120-015-3909-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Current immunosuppressive protocols effectively prevent acute rejection of renal allografts. Extensive drug toxicity and the deleterious effects of long-term immunosuppression are associated with significant morbidity and mortality. OBJECTIVES The purpose of this article is to provide an overview over modern immunosuppressants and their unwanted side effects and to discuss strategies for improved long-term transplant survival. METHODS Review of the current topic-related literature and discussion of our own experience. RESULTS The use of antibody induction together with an initial combination therapy of calcineurin inhibitors, mycophenolate and steroids is recommended and results in excellent early outcomes. Detrimental effects include an increased incidence of infections, malignomas, and cardiovascular diseases. Long-term transplant survival is impaired by extensive drug toxicity and the frequent development of donor specific antibodies. Reduction of overall cumulative exposure to immunosuppressants or the reduction of specific toxic drugs such as calcineurin inhibitors and steroids may improve long-term results. Alternative immunosuppressants like mTOR inhibitors and belatacept appear to be effective and safe but their long-term effects on patient and allograft survival needs to be established in clinical trials. CONCLUSIONS Current immunosuppressants provide effective protection from renal allograft rejection. However, their use is complicated by serious side effects. In the future, development of novel immunosuppressants and optimization of minimization strategies may help to improve long-term success after kidney transplantation.
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Affiliation(s)
- A Paliege
- Medizinische Klinik mit Schwerpunkt Nephrologie, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 10117, Berlin, Deutschland
| | - J Bamoulid
- Medizinische Klinik mit Schwerpunkt Nephrologie, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 10117, Berlin, Deutschland
| | - F Bachmann
- Medizinische Klinik mit Schwerpunkt Nephrologie, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 10117, Berlin, Deutschland
| | - O Staeck
- Medizinische Klinik mit Schwerpunkt Nephrologie, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 10117, Berlin, Deutschland
| | - F Halleck
- Medizinische Klinik mit Schwerpunkt Nephrologie, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 10117, Berlin, Deutschland
| | - D Khadzhynov
- Medizinische Klinik mit Schwerpunkt Nephrologie, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 10117, Berlin, Deutschland
| | - S Brakemeier
- Medizinische Klinik mit Schwerpunkt Nephrologie, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 10117, Berlin, Deutschland
| | - M Dürr
- Medizinische Klinik mit Schwerpunkt Nephrologie, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 10117, Berlin, Deutschland
| | - K Budde
- Medizinische Klinik mit Schwerpunkt Nephrologie, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 10117, Berlin, Deutschland.
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Hosseini-Moghaddam SM, Alhomayeed B, Soliman N, Weir MA, House AA. Primary Epstein-Barr virus infection, seroconversion, and post-transplant lymphoproliferative disorder in seronegative renal allograft recipients: a prospective cohort study. Transpl Infect Dis 2016; 18:423-30. [PMID: 27016725 DOI: 10.1111/tid.12533] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 09/29/2015] [Accepted: 01/20/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Epstein-Barr virus (EBV)-seronegative renal transplant recipients are at risk of post-transplant lymphoproliferative disorder (PTLD). We compared primary EBV infection, seroconversion, and PTLD in EBV-seronegative patients who received renal allograft from seropositive or seronegative donors (D+/R- and D-/R-, respectively). METHODS We prospectively followed 25 D+/R- and 8 D-/R- recipients. We followed patients from January 1999 to June 2009 with clinical visits, monthly EBV polymerase chain reaction tests, and serologic tests for a period of 1 year after kidney transplantation and on an individual basis thereafter. RESULTS Three patients (9%) developed PTLD including 2 early-onset (<12 months) and 1 late-onset (>12 months) disease. In D+/R- and D-/R- patients, the frequencies of PTLD (8% vs. 12.5%, P = 0.7), EBV seroconversion (64% vs. 50%, P = 0.4), and EBV viremia (40% vs. 25%, P = 0.6) were not significantly different. Clinical, serologic, and virologic surveillance as well as reduction in immunosuppression after evidence of primary EBV infection resulted in a PTLD rate of 9%, despite a seroconversion rate of 60.6%. Rate of graft loss after reduction in immunosuppression was 10% (2 of 20), which was not significantly different from 13 patients without EBV seroconversion (no graft loss, P = 0.5). Rates of viremia, seroconversion, and PTLD in D+/R- and D-/R- patients appear to be similar. CONCLUSIONS The incidence of PTLD in renal transplants ranges from 0.5% to 2.9%. Our data show a significantly higher rate in EBV-seronegative renal allograft recipients, suggesting the need for close surveillance. Our data also suggest that donors for EBV-seronegative recipients may be accepted irrespective of positive or negative serostatus, with ongoing surveillance important in either circumstance.
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Affiliation(s)
- S M Hosseini-Moghaddam
- Multi-organ Transplant Program, University Hospital, London, Ontario, Canada.,Program of Experimental Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Division of Infectious Diseases, Western University, London, Ontario, Canada
| | - B Alhomayeed
- Department of Nephrology, King Fahad Hospital, Medinah Munawrah, Saudi Arabia
| | - N Soliman
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - M A Weir
- Multi-organ Transplant Program, University Hospital, London, Ontario, Canada.,Program of Experimental Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Division of Nephrology, Western University, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - A A House
- Multi-organ Transplant Program, University Hospital, London, Ontario, Canada.,Program of Experimental Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Division of Nephrology, Western University, London, Ontario, Canada
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Filler G, Melk A, Marks SD. Practice recommendations for the monitoring of renal function in pediatric non-renal organ transplant recipients. Pediatr Transplant 2016; 20:352-63. [PMID: 26917052 DOI: 10.1111/petr.12685] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2016] [Indexed: 02/04/2023]
Abstract
The management of non-renal pediatric solid organ transplant recipients has become complex over the last decade with innovations in immunosuppression and surgical techniques. Post-transplantation follow-up is essential to ensure that children have functioning allografts for as long as possible. CKD is highly prevalent in these patients, often under recognized, and has a profound impact on patient survival. These practice recommendations focus on the early detection and management of hypertension, proteinuria, and renal dysfunction in non-renal pediatric solid organ transplant recipients. We present seven practice recommendations. Renal function should be monitored regularly in organ transplant recipients, utilizing assessment of serum creatinine and cystatin C. GFR should be calculated using the new Schwartz formula. Transplant physicians should also monitor blood pressure using automated oscillometric devices and confirm repeated abnormal measures with manual blood pressure readings and ambulatory 24-h blood pressure monitoring. Proteinuria and microalbuminuria should also be assessed regularly. Referrals to a pediatric nephrologist should be made for non-renal organ transplant recipients with repeated blood pressures >95th percentile using the Fourth Task Force reference intervals, microalbumin/creatinine ratio >32.5 mg/g (3.7 mg/mmol) creatinine on repeated testing and/or GFR <90 mL/min/1.73 m(2) .
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Affiliation(s)
- Guido Filler
- Department of Paediatrics, Schulich School of Medicine & Dentistry, London, ON, Canada.,Department of Medicine, Schulich School of Medicine & Dentistry, London, ON, Canada.,Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Anette Melk
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Stephen D Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Xiong J, Wang Y, Zhang Y, Nie L, Wang D, Huang Y, Feng B, Zhang J, Zhao J. Lack of Association between Interleukin-10 Gene Polymorphisms and Graft Rejection Risk in Kidney Transplantation Recipients: A Meta-Analysis. PLoS One 2015; 10:e0127540. [PMID: 26035439 PMCID: PMC4452718 DOI: 10.1371/journal.pone.0127540] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 04/16/2015] [Indexed: 12/21/2022] Open
Abstract
Background Interleukin-10 (IL-10) is an important immunomodulatory cytokine. Several studies focused the association between IL-10 promoter gene polymorphisms and graft rejection risk in kidney transplantation recipients. However, the results of these studies remain inconclusive. The aim of this study was to conduct a meta-analysis to further assess the associations. Methods The PubMed, Embase, and Ovid Medline databases were searched. Two independent authors extracted data, and the effects were estimated from an odds ratio (OR) with 95% confidence intervals (CIs). Subgroup and sensitivity analyses identified sources of heterogeneity. Results A total of 16 studies including 595 rejection patients and 1239 stable graft patients were included in order to study the IL-10 -1082 (rs1800896 G/A), -819 (rs1800871 C/T), -592 (rs1800872 C/A) and IL-10 (-1082,-819,-592) polymorphisms. The -1082 G/A polymorphism was not associated with an increased graft rejection risk (OR = 1.03; 95%CI, 0.85–1.25, P = 0.74 for GA+AA vs. GG model). Moreover, all of the -819 C/T (OR = 1.06, 95%CI, 0.79–1.42, P = 0.70 for TA+TT vs. CC model), -592 C/A (OR = 1.10, 95% CI, 0.85–1.42, P = 0.47 for AC+AA vs. CC model) and IL-10 (-1082,-819,-592) polymorphisms (OR = 1.00, 95%CI, 0.79–1.27, P = 0.98 for I+L vs. H model) did not increase the graft rejection risk. In addition, we also performed subgroup analysis by ethnic group (mainly in Europeans or Asians) and rejection type (acute or chronic). There was also lack of evidence of a significant association between the IL-10 gene polymorphism and graft rejection risk. The present meta-analysis indicated that the IL-10 gene polymorphism was not associated with graft rejection risk in kidney transplantation recipients. Conclusion This meta-analysis found evidence that the IL-10 polymorphism does not increase the risk of graft rejection in kidney transplantation recipients. Further chronic rejection and other ethnic population studies are needed to confirm our results.
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Affiliation(s)
- Jiachuan Xiong
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China
| | - Yiqin Wang
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China
| | - Ying Zhang
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China
| | - Ling Nie
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China
| | - Daihong Wang
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China
| | - Yunjian Huang
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China
| | - Bing Feng
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China
| | - Jingbo Zhang
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China
| | - Jinghong Zhao
- Department of Nephrology, Institute of Nephrology of Chongqing and Kidney Center of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China
- * E-mail:
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Hall EC, Engels EA, Pfeiffer RM, Segev DL. Association of antibody induction immunosuppression with cancer after kidney transplantation. Transplantation 2015; 99:1051-7. [PMID: 25340595 PMCID: PMC4405385 DOI: 10.1097/tp.0000000000000449] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Induction immunosuppression is a mainstay of rejection prevention after transplantation. Studies have suggested a connection between antibody induction agents and cancer development, potentially limiting important immunosuppression protocols. METHODS We used a linkage of U.S. transplantation data and cancer registries to explore the relationship between induction and cancer after transplantation. A total of 111,857 kidney recipients (1987-2009) in the Transplant Cancer Match Study, which links the Scientific Registry for Transplant Recipients and U.S. Cancer Registries, were included. Poisson regression models were used to estimate adjusted incidence rate ratios (aIRR) of non-Hodgkin lymphoma (NHL) and other cancers with increased incidence after transplantation (lung, colorectal, kidney, and thyroid cancers, plus melanoma). RESULTS Two thousand seven hundred sixty-three cancers of interest were identified. Muromonab-CD3 was associated with increased NHL (aIRR, 1.37; 95% CI, 1.06-1.76). Alemtuzumab was associated with increased NHL (aIRR, 1.79; 95% CI, 1.02-3.14), colorectal cancer (aIRR, 2.46; 95% CI, 1.03-5.91), and thyroid cancer (aIRR, 3.37; 95% CI, 1.55-7.33). Polyclonal induction was associated with increased melanoma (aIRR, 1.50; 95% CI, 1.06-2.14). CONCLUSION Our findings highlight the relative safety with regard to cancer risk of the most common induction therapies, the need for surveillance of patients treated with alemtuzumab, and the possible role for increased melanoma screening for those patients treated with polyclonal anti-T-cell induction.
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Affiliation(s)
- Erin C Hall
- 1 Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD. 2 Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD. 3 Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
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Viral surveillance and subclinical viral infection in pediatric kidney transplantation. Pediatr Nephrol 2015; 30:741-8. [PMID: 25125226 PMCID: PMC6192669 DOI: 10.1007/s00467-014-2866-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 05/19/2014] [Accepted: 05/21/2014] [Indexed: 12/20/2022]
Abstract
The more potent immunosuppressive therapy that has successfully reduced the incidence of acute rejection and improved graft outcomes has also resulted in a higher incidence of viral complications. Sensitive molecular methods now allow for the detection of subclinical viral infection, which is increasingly recognized due to the adoption of routine post-transplant viral surveillance protocols. The goal of viral surveillance is the detection of subclinical viral infection that triggers an intervention; one that either prevents progression to viral disease or leads to early diagnosis of viral disease, which is associated with improved outcomes. Knowledge of the epidemiology and natural history of subclinical viral infection and viral disease, as well as patient-specific risk factors, is required to establish the optimal surveillance schedule which achieves the goal of early diagnosis. Evidence that detection of subclinical viral infection can impact viral disease is variable depending on the virus. This review will summarize the current data on the role of viral surveillance for BK virus (BKV), cytomegalovirus (CMV), and the Epstein-Barr virus (EBV) in the pediatric kidney transplant population.
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Intensivbehandlung nach Transplantation solider Organe. DIE INTENSIVMEDIZIN 2015. [PMCID: PMC7124053 DOI: 10.1007/978-3-642-54953-3_90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hashim F, Gregg JA, Dharnidharka VR. Efficacy of Extended Valganciclovir Prophylaxis in Preventing Cytomegalovirus Infection in Pediatric Kidney Transplantation. ACTA ACUST UNITED AC 2014; 7:152-157. [PMID: 25821528 PMCID: PMC4366268 DOI: 10.2174/1874303x01407010152] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 10/01/2014] [Accepted: 10/02/2014] [Indexed: 12/11/2022]
Abstract
Cytomegalovirus (CMV) is one of the most frequent opportunistic infection in renal transplant (RTx)
recipients. Valganciclovir (VGC) has been showed to be safe and highly effective in prophylaxis of CMV infection in
RTx recipients. Recently, an increase in delayed onset CMV disease has been noted with some arguing that longer
prophylaxis may decrease the late-onset disease. We retrospectively tested the hypothesis that extended term prophylaxis (ETP) of VGC for 12 months is more effective
than short term prophylaxis (STP) of 6 months in preventing CMV infection and disease in pediatric RTx performed at the
University of Florida from July 2003 to December 2010. In this period, all recipients underwent prospective CMV PCR
(Polymerase Chain Reaction) monitoring and were maintained on similar immunosuppression. Eighty six patients received RTx during that period. All eligible subjects had to have at least 12 months of graft survival and
18 months of follow up, leaving 73 eligible subjects in final study group. CMV infection or disease occurred in 6/29 (20%) in
the STP group vs 6/44 (14%) in the ETP group with no statistical significant difference (P= 0.42). Donor positive/recipients
negative CMV serology status (D+/R-) were associated with a higher risk of CMV infection in both univariate and
multivariate analysis (P=0.01). Anemia and Leucopenia directly associated with VGC were similar in both groups (P=0.58
and P=0.2 respectively). Biopsy-proven acute rejection was also non-significant in both groups (P=0.39). Although ETP for CMV from 6 months to 12 months is safe and has minimal adverse effect, it did not reduce CMV
infection or disease. Further controlled studies in pediatrics age group are considered to compare longer versus shorter
periods of prophylaxis and their impact on prevention of CMV infection, resistance, cost, and toxicity.
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Affiliation(s)
- Faris Hashim
- Divisions of Transplant Nephrology, University of Florida College of Medicine, Gainesville, FL USA
| | - Jon A Gregg
- Pediatric Nephrology and Transplant Nephrology, University of Florida College of Medicine, Gainesville, FL USA
| | - Vikas R Dharnidharka
- Divisions of Transplant Nephrology, University of Florida College of Medicine, Gainesville, FL USA
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Chung H, Lam VWT, Yuen LPK, Ryan BJ, O'Connell PJ, Chapman JR, Hawthorne WJ, Pleass HC. Renal transplantation: better fat than thin. J Surg Res 2014; 194:644-652. [PMID: 25634827 DOI: 10.1016/j.jss.2013.12.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 12/09/2013] [Accepted: 12/30/2013] [Indexed: 01/15/2023]
Abstract
BACKGROUND Obesity has been a relative contraindication for renal transplantation. This study evaluates the impact of pretransplant body mass index (BMI) on renal transplant outcomes in a single institution in the era of modern immunosuppression. MATERIALS AND METHODS A 10-y retrospective analysis was undertaken of 454 consecutive patients who received a renal transplant at Westmead Hospital from January 1, 2001 to December 31, 2010. The role of pretransplant BMI on patient survival, graft survival, surgical complications, and postoperative complications was studied. RESULTS The mean age of transplant of this study population was 45.4 ± 13.0 y. Live donation rate was 53.5%, and 60.6% were male. The median preoperative BMI was 25.6 (range, 14.3-51.4). One-year and 5-y patient survival were 97.4% and 86.6%, respectively, whereas 1-y and 5-y death-censored graft survival were 97.1% and 91.9%, respectively. Patients with BMI >30 did not exhibit any significant difference in survival or graft failure but had higher surgical wound infection rates (hazard ratio 3.95, P < 0.01). Patients with preoperative BMI <18.5 were associated with a six-fold increase in both death and death-censored graft failure (P < 0.01). CONCLUSIONS Pretransplant obesity increases wound infection but is not a contraindication to renal transplantation. Future prospective studies are required to further define the impact of low preoperative BMI <18.5.
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Affiliation(s)
- Hsiang Chung
- Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia; Discipline of Surgery, Sydney Medical School, The University of Sydney New South Wales, Australia
| | - Vincent W T Lam
- Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia; Discipline of Surgery, Sydney Medical School, The University of Sydney New South Wales, Australia
| | - Lawrence P K Yuen
- Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Brendan J Ryan
- Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Philip J O'Connell
- Department of Renal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Jeremy R Chapman
- Department of Renal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Wayne J Hawthorne
- Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia; Discipline of Surgery, Sydney Medical School, The University of Sydney New South Wales, Australia
| | - Henry C Pleass
- Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia; Discipline of Surgery, Sydney Medical School, The University of Sydney New South Wales, Australia.
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Urstad KH, Øyen O, Andersen MH, Moum T, Wahl AK. The effect of an educational intervention for renal recipients: a randomized controlled trial. Clin Transplant 2012; 26:E246-53. [PMID: 22686948 DOI: 10.1111/j.1399-0012.2012.01666.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The purpose of this randomized controlled trial was to test the efficacy of an educational intervention on renal recipient's knowledge, compliance, self-efficacy, and quality of life. METHODS In total, 159 renal recipients were randomized to the intervention (N = 77) or control group (N = 82). A total of 139 participants reached second measure point (7-8 wk post-Tx), and 120 participants reached third measure point (six months post-Tx). The intervention consisted of five tailored one-to-one sessions. Primary outcome was measured by a knowledge questionnaire. Secondary outcomes were measured by "The General- Self-efficacy Scale," SF-12 and by number of patient observations (Compliance). RESULTS Significantly higher levels of knowledge were found in the experimental group compared with the control group at both measure points (p = 0.002 and p = 0.004). Compliance was significantly higher in the experimental group at second measure point (p = 0.000). At third measure point, the experimental group reported significantly better scores on self-efficacy (p = 0.036) and mental score of quality of life (p = 0.001). CONCLUSIONS This structured, tailored educational intervention, applied in a 7-8 wk post-transplant period, increased renal recipients' levels of knowledge on both short and long terms. Furthermore, the intervention was beneficial for patients' compliance, self-efficacy, and mental quality of life.
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Affiliation(s)
- Kristin H Urstad
- Department of Health Studies, University of Stavanger, Stavanger, Norway.
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Heemann U, Kliem V, Budde K, Hamza A, Jürgensen JS, Juarez F, Arns W, Rath T, Haller H. Mycophenolate mofetil maintenance therapy in renal transplant patients: long-term results of the TranCept STAY study. Clin Transplant 2012; 26:919-26. [DOI: 10.1111/ctr.12008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Uwe Heemann
- Department of Nephrology; Clinic rechts der Isar; Technical University Munich; Munich; Germany
| | - Volker Kliem
- Department of Internal Medicine and Nephrology; Transplantation Center; Lower Saxony Center for Nephrology; Hann; Muenden; Germany
| | - Klemens Budde
- Department of Nephrology; Charité Campus Mitte; Charité Universitätsmedizin Berlin; Berlin; Germany
| | - Amir Hamza
- Department of Urology and Transplantation; Martin-Luther-University Halle; Halle/Saale; Germany
| | - Jan Steffen Jürgensen
- Department of Nephrology and Intensive Care; Charité Campus Virchow; Charité Universitätsmedizin Berlin; Berlin; Germany
| | - Federico Juarez
- Departamento de Transplantes; Instituto Mexicano del Seguro Social; Hospital de Especialidades 71; Torreon; Coahuila; Mexico
| | - Wolfgang Arns
- Medical Clinic I; Clinic of Cologne; Cologne; Germany
| | - Thomas Rath
- Department of Nephrology; Westpfalz Clinic Kaierslautern; Kaiserslautern; Germany
| | - Hermann Haller
- Department of Nephrology; Medical University Hannover; Hannover; Germany
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Calia R, Lai C, Aceto P, Luciani M, Saraceni C, Lai S, Gargiulo A, Citterio F. Preoperative Psychological Factors Predicting Graft Rejection in Patients Undergoing Kidney Transplant: A Pilot Study. Transplant Proc 2011; 43:1006-9. [DOI: 10.1016/j.transproceed.2011.01.158] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Intensivtherapie nach Transplantation solider Organe. DIE INTENSIVMEDIZIN 2011. [PMCID: PMC7123926 DOI: 10.1007/978-3-642-16929-8_80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Der Intensivmedizin kommt eine zentrale Bedeutung in Rahmen der Transplantationsmedizin zu. Aufgrund ihrer marginalen Organfunktion benötigen die Patienten nicht selten bereits im Vorfeld der Transplantation eine intensivmedizinische Versorgung, zu der dann auch die Evaluation und Listung sowie die Koordination des zeitkritischen Transplantationsablaufs gehören können. Die direkte postoperative Betreuung nach komplexen Organtransplantationen bedarf fast ausschließlich der Versorgung im Rahmen von Überwachungsstationen, in denen sowohl direkt transplantationsassoziierte Komplikationen als auch Nebenerkrankungen eine intensivmedizinische Behandlungen notwendig machen. Sie zielt auf die Stabilisierung der Organfunktion, Behandlung begleitender Organdysfunktionen, adäquate Induktion der Immunsuppression und die möglichst frühe Wiedererlangung der Eigenständigkeit des Transplantierten ab.
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Lichtenstern C, Müller M, Schmidt J, Mayer K, Weigand MA. [Intensive therapy after solid organ transplantation]. Anaesthesist 2010; 59:1135-52; quiz 1153-4. [PMID: 21136032 PMCID: PMC7096098 DOI: 10.1007/s00101-010-1822-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Transplantation medicine is an interdisciplinary task and the priority objective is a fast recovery to patient independence. After kidney transplantation the crucial aims are monitoring of transplant perfusion, maintainance of an adequate volume status and avoidance of nephrotoxic medications. Transplantation for patients with advanced chronic liver failure has become more common since the implementation of the model of end stage liver disease (MELD) allocation system which is associated with more complicated proceedings. The essentials of critical care after liver transplantation are monitoring of transplant function, diagnosis of perfusion or biliary tract problems, specific substitution of coagulation factors and hemodynamic optimation due to avoidance of hepatic congestion. Many patients listed for heart transplantation need preoperative intensive care due to impaired heart function. Postoperatively a specific cardiac support with pulmonary arterial dilatators and inotropics is usually necessary. Lung transplantation aims at an improvement of patient quality of life. Postoperative critical care should provide a limitation of the pulmonary arterial pressure, avoidance of volume overload and rapid weaning from the respirator.
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Affiliation(s)
- C Lichtenstern
- Klinik für Anaesthesiologie und Operative Intensivmedizin, Universitätsklinikum Giessen und Marburg, Standort Giessen, Rudolf-Buchheim Str. 7, 35392, Giessen, Deutschland.
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Urstad KH, Andersen MH, Øyen O, Moum T, Wahl AK. Patients' level of knowledge measured five days after kidney transplantation. Clin Transplant 2010; 25:646-52. [PMID: 21077953 DOI: 10.1111/j.1399-0012.2010.01355.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Kidney recipients' knowledge is important in terms of coping with short-term problems posed by transplantation and the long-term outcome. Little attention has been given to the development of instruments for measuring patient's knowledge in this field. AIM The purpose of this study was to describe the development of a knowledge questionnaire for kidney recipients and to explore possible factors related to the knowledge level. METHODS The sample consisted of 159 kidney recipients at a Norwegian transplant center, answering the questionnaire five d post-transplantation. RESULTS The questionnaire was generated on the basis of literature review and clinical experience - and was pilot tested. Mean score of the questionnaire was 11, of 19 obtainable points. Longer duration of kidney disease was significantly correlated with an increased knowledge level, whereas the longer the time on dialysis prior to transplantation and post-operative complications were found to have significantly negative impact on total knowledge score. CONCLUSIONS The positive impact of disease duration may suggest that insight gained over time makes patients better prepared for the transplantation itself and for life post-transplant. However, the negative impact of dialysis duration could be attributed to impaired cognitive function imposed by chronic dialysis treatment. Further research is needed regarding the questionnaire's responsiveness to educational interventions.
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Deconvoluting post-transplant immunity: cell subset-specific mapping reveals pathways for activation and expansion of memory T, monocytes and B cells. PLoS One 2010; 5:e13358. [PMID: 20976225 PMCID: PMC2954794 DOI: 10.1371/journal.pone.0013358] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Accepted: 08/16/2010] [Indexed: 01/05/2023] Open
Abstract
A major challenge for the field of transplantation is the lack of understanding of genomic and molecular drivers of early post-transplant immunity. The early immune response creates a complex milieu that determines the course of ensuing immune events and the ultimate outcome of the transplant. The objective of the current study was to mechanistically deconvolute the early immune response by purifying and profiling the constituent cell subsets of the peripheral blood. We employed genome-wide profiling of whole blood and purified CD4, CD8, B cells and monocytes in tandem with high-throughput laser-scanning cytometry in 10 kidney transplants sampled serially pre-transplant, 1, 2, 4, 8 and 12 weeks. Cytometry confirmed early cell subset depletion by antibody induction and immunosuppression. Multiple markers revealed the activation and proliferative expansion of CD45RO+CD62L− effector memory CD4/CD8 T cells as well as progressive activation of monocytes and B cells. Next, we mechanistically deconvoluted early post-transplant immunity by serial monitoring of whole blood using DNA microarrays. Parallel analysis of cell subset-specific gene expression revealed a unique spectrum of time-dependent changes and functional pathways. Gene expression profiling results were validated with 157 different probesets matching all 65 antigens detected by cytometry. Thus, serial blood cell monitoring reflects the profound changes in blood cell composition and immune activation early post-transplant. Each cell subset reveals distinct pathways and functional programs. These changes illuminate a complex, early phase of immunity and inflammation that includes activation and proliferative expansion of the memory effector and regulatory cells that may determine the phenotype and outcome of the kidney transplant.
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Knoll GA, Blydt-Hansen TD, Campbell P, Cantarovich M, Cole E, Fairhead T, Gill JS, Gourishankar S, Hebert D, Hodsman A, House AA, Humar A, Karpinski M, Kim SJ, Mainra R, Prasad GVR. Canadian Society of Transplantation and Canadian Society of Nephrology commentary on the 2009 KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Kidney Dis 2010; 56:219-46. [PMID: 20659623 DOI: 10.1053/j.ajkd.2010.05.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 05/14/2010] [Indexed: 01/26/2023]
Affiliation(s)
- Greg A Knoll
- Division of Nephrology, Clinical Epidemiology Program, The Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, USA
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