scholarly journals 946. Epidemiology and Long-term Outcomes of BK Polyomavirus Nephropathy in Kidney Solid Organ Transplant Recipients at Texas Children’s Hospital

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S566-S566
Author(s):  
Kristen Valencia Deray ◽  
Kathleen Hosek ◽  
Daniel Ruderfer ◽  
Sarah J Swartz ◽  
Claire Bocchini
Keyword(s):  
Medical Care ◽  
Kidney Transplant ◽  
Graft Failure ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Graft Dysfunction ◽  
Long Term Outcomes ◽  
Post Transplant ◽  
Bk Polyomavirus

Abstract Background BK Polyomavirus (BKPyV) is an important cause of graft dysfunction and premature graft failure in pediatric kidney transplant recipients (PKTR). Contemporary data on BK viral associated nephropathy (BKVAN) in PKTR are limited. We sought to determine the frequency, associations with, and long-term outcomes of BKVAN in PKTR. Methods A retrospective cohort study of PKTR ≤21 years of age transplanted from 2011-2018 was completed. Primary outcome was BKVAN and secondary outcomes included graft dysfunction and failure. Associations with BKVAN were measured using chi square and Fisher exact tests. Time to BKVAN and graft failure were assessed using Kaplan-Meier plots. Results Among 200 PKTR, 16 (8%) developed BKVAN at a median of 228 days post-transplant. Median (IQR) age at time of transplant for patients with BKVAN was 14 (7-17) years of age. Of those who developed BKVAN, 13/16 (81%) were biopsy proven, 2/16 (13%) were probable and 1/16 (6%) was presumptive. Treatment of BKVAN included reduced immunosuppression (12, 75%), ciprofloxacin (11, 69%), intravenous immunoglobulin (7, 44%), and leflunomide (4, 25%). Simultaneous rejection therapy occurred in two patients (13%). Notably, three patients with BKVAN had negative BKPyV plasma viral loads. Median (IQR) BKPyV viral load in those with positive PCRs was 82,000 (19,315 – 1,106,283) copies/milliliter. Median (IQR) time to clearance of BKPyV from the plasma was 425 (261 – 858) days. There was no association between age at time of transplant, repeat kidney transplant, donor type, underlying diagnosis at time of transplant, HLA mismatch, mode of dialysis, or steroid free immunosuppression and the development of BKVAN. Mean percent change in eGFR yearly post-transplant was -0.066 for those with BKVAN versus -0.091 for those without BKVAN (p=0.35). Graft failure was experienced in 1/16 (6%) PKTR with BKVAN but was not related to BKVAN. There was no difference in time to graft failure (Figure 1, p=0.64) in those who developed BKVAN versus those who did not. Conclusion BKVAN continues to occur in PKTR. No associations were found with the development of BKVAN in our cohort. PKTR with BKVAN did not have an increased rate of eGFR decline nor did they develop graft failure more quickly than those without BKVAN. Disclosures Sarah J. Swartz, MD, Education grant sponsored by Amgen; awarded by Renal Physicians Association (Other Financial or Material Support, Attended Renal Physician Association PAL (Pediatric Advocacy Leadership) Forum in Jun 2019; Program sponsored by Education grant from Amgen, awarded by the Renal Physicians Association for participation)Vifor Fresensius Medical Care Renal Pharma (Scientific Research Study Investigator, Multi-center site PI for phase 3 study to investigate the safety and efficacy of PA21 (Velphoro) and calcium acetate (Phoslyra) sponsored by Vifor Fresensius Medical Care Renal Pharma funded Sept 2016-Oct 2019)

scholarly journals Lifestyle, Inflammation, and Vascular Calcification in Kidney Transplant Recipients: Perspectives on Long-Term Outcomes

2020 ◽  
Vol 9 (6) ◽  
pp. 1911 ◽  
Author(s):  
Camilo G. Sotomayor ◽  
Charlotte A. te Velde-Keyzer ◽  
Martin H. de Borst ◽  
Gerjan J. Navis ◽  
Stephan J.L. Bakker
Keyword(s):  
Risk Factors ◽  
Kidney Transplantation ◽  
Kidney Disease ◽  
Kidney Transplant ◽  
Vascular Calcification ◽  
Graft Failure ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Long Term Outcomes

After decades of pioneering and improvement, kidney transplantation is now the renal replacement therapy of choice for most patients with end-stage kidney disease (ESKD). Where focus has traditionally been on surgical techniques and immunosuppressive treatment with prevention of rejection and infection in relation to short-term outcomes, nowadays, so many people are long-living with a transplanted kidney that lifestyle, including diet and exposure to toxic contaminants, also becomes of importance for the kidney transplantation field. Beyond hazards of immunological nature, a systematic assessment of potentially modifiable—yet rather overlooked—risk factors for late graft failure and excess cardiovascular risk may reveal novel targets for clinical intervention to optimize long-term health and downturn current rates of premature death of kidney transplant recipients (KTR). It should also be realized that while kidney transplantation aims to restore kidney function, it incompletely mitigates mechanisms of disease such as chronic low-grade inflammation with persistent redox imbalance and deregulated mineral and bone metabolism. While the vicious circle between inflammation and oxidative stress as common final pathway of a multitude of insults plays an established pathological role in native chronic kidney disease, its characterization post-kidney transplant remains less than satisfactory. Next to chronic inflammatory status, markedly accelerated vascular calcification persists after kidney transplantation and is likewise suggested a major independent mechanism, whose mitigation may counterbalance the excess risk of cardiovascular disease post-kidney transplant. Hereby, we first discuss modifiable dietary elements and toxic environmental contaminants that may explain increased risk of cardiovascular mortality and late graft failure in KTR. Next, we specify laboratory and clinical readouts, with a postulated role within persisting mechanisms of disease post-kidney transplantation (i.e., inflammation and redox imbalance and vascular calcification), as potential non-traditional risk factors for adverse long-term outcomes in KTR. Reflection on these current research opportunities is warranted among the research and clinical kidney transplantation community.

Graft Failure Due to Noncompliance Among 628 Kidney Transplant Recipients With Long-term Follow-up

2014 ◽  
Vol 97 (9) ◽  
pp. 925-933 ◽  
Author(s):  
Jeffrey J. Gaynor ◽  
Gaetano Ciancio ◽  
Giselle Guerra ◽  
Junichiro Sageshima ◽  
Lois Hanson ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Graft Failure ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Long Term Follow Up

Association of Factor V Leiden Mutation with Delayed Graft Function, Acute Rejection Episodes and Long-term Graft Dysfunction in Kidney Transplant Recipients

2002 ◽  
Vol 87 (02) ◽  
pp. 194-198 ◽  
Author(s):  
Torsten Slowinski ◽  
Ingeborg Hauser ◽  
Birgit Vetter ◽  
Lutz Fritsche ◽  
Daniela Bachert ◽  
...  
Keyword(s):  
Acute Rejection ◽  
Kidney Transplant ◽  
Graft Function ◽  
Factor V Leiden ◽  
Factor V ◽  
Transplant Recipients ◽  
Graft Dysfunction ◽  
Kidney Transplant Recipients ◽  
Factor V Leiden Mutation

SummaryWe analysed whether the factor V Leiden mutation – the most common hereditary predisposing factor for venous thrombosis – is associated with early and long-term graft dysfunction after kidney transplantation in 394 Caucasian kidney transplant recipients. The presence of factor V Leiden mutation was identified by allele specific PCR. The prevalence of the factor V Leiden mutation was compared to 32216 unselected neonates. The prevalence of the factor V Leiden mutation (GA genotype) was similar in 394 kidney transplant recipients and 32216 neonates. The frequency of known factors predicting long-term graft function were similar in patients with the GA genotype and with the normal factor V gene (GG genotype). The GA genotype was associated with the occurrence of no primary graft function (risk: 2.87; 95% confidence interval: 1.01-8.26; p < 0.05), the number of dialysis after transplantation in patients with no primary graft function until graft function (7.5 ± 2.06 dialysis in GA patients; 4.2 ± 0.36 dialyses in GG patients; p < 0.05), and the risk for at least one acute rejection episode (risk: 3.83; 95% confidence interval: 1.38-10.59; p < 0.02). The slope of 1/creatinine per year was significantly lower in patients with the GA genotype (GA patients: – 0.0204 ± 0.008 dl/mg per year; GG patients: 0.0104 ± 0.004 dl/mg per year; p < 0.02). The annual enhancement of the daily protein excretion rate was elevated in patients with the GA genotype (GA patients: 38.5 ± 16.6 mg/24 h per year; GG patients: 4.9 ± 4.4 mg/24 h per year; p < 0.02). Our study showed that the factor V Leiden mutation is associated with the occurrence of delayed graft function, acute rejection episodes and chronic graft dysfunction after kidney transplantation.

scholarly journals 1738. Incidence and Outcomes of Hospitalization with Invasive Fungal Infection Among Solid-Organ Transplant Recipients: A Population-Based Cohort Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S636-S636
Author(s):  
Kyla L Naylor ◽  
Alexandra Ouédraogo ◽  
Sarah E Bota ◽  
Shahid Husain ◽  
J Michael Paterson ◽  
...  
Keyword(s):  
Cohort Study ◽  
Graft Failure ◽  
Organ Transplant ◽  
Population Based ◽  
Solid Organ Transplant ◽  
Cumulative Probability ◽  
Solid Organ ◽  
Transplant Recipients ◽  
All Cause Mortality

Abstract Background Invasive fungal infection (IFI) in solid-organ transplant (SOT) recipients is associated with significant morbidity and mortality. The long-term probability of post-transplant IFI is poorly understood. Methods We conducted a population-based cohort study using linked administrative healthcare databases from Ontario, Canada to determine the incidence rate, 1-, 5- and 10-year cumulative probability of IFI-related hospitalization, and 1-year post-IFI all-cause mortality in SOT recipients from 2002 to 2016. We also examined post-IFI death-censored graft failure in renal transplant patients. Results We included 9326 SOT recipients (median follow-up 5.35 years). Overall, the incidence of IFI was 8.3 per 1000 person-years (95% confidence interval [CI]: 7.5–9.1). The 1-year cumulative probability of IFI was 7.4% (95% CI: 5.8–9.3%), 5.4% (95% CI: 3.6–8.1%), 1.8% (95% CI: 1.3–2.5%), 1.2% (95% CI: 0.5–3.2%), and 1.1% (95% CI: 0.9–1.4%) for lung, heart, liver, kidney-pancreas, and kidney-only transplant recipients, respectively. Lung transplant recipients had both the highest incidence rate and the highest 10-year probability of IFI: 43.0 per 1,000 person-years (95% CI: 36.8–50.0) and 26.4% (95% CI: 22.4–30.9%), respectively. Lung transplantation was also associated with the highest 1-year cumulative probability of post-IFI all-cause mortality (40.2%,95% CI: 33.1–48.3%). Among kidney transplant recipients, the 1-year probability of death-censored graft failure after IFI was 9.8% (95% CI: 6.0–15.8%). Conclusion The 1-year cumulative probability of IFI varies widely among SOT recipients. Lung transplantation was associated with the highest incidence of IFI with considerable 1-year all-cause mortality. The findings of this study considerably improved our understanding of the long-term probability of post-transplant IFI. Disclosures All authors: No reported disclosures.

scholarly journals Long-Term Care of the Pediatric Kidney Transplant Recipient

2021 ◽  
pp. CJN.16891020
Author(s):  
Hilda E. Fernandez ◽  
Bethany J. Foster
Keyword(s):  
Transplant Recipient ◽  
Kidney Transplant ◽  
Graft Failure ◽  
Graft Function ◽  
Failure Rates ◽  
Care Providers ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Term Care

Pediatric kidney transplant recipients are distinguished from adult recipients by the need for many decades of graft function, the potential effect of CKD on neurodevelopment, and the changing immune environment of a developing human. The entire life of an individual who receives a transplant as a child is colored by their status as a transplant recipient. Not only must these young recipients negotiate all of the usual challenges of emerging adulthood (transition from school to work, romantic relationships, achieving independence from parents), but they must learn to manage a life-threatening medical condition independently. Regardless of the age at transplantation, graft failure rates are higher during adolescence and young adulthood than at any other age. All pediatric transplant recipients must pass through this high-risk period. Factors contributing to the high graft failure rates in this period include poor adherence to treatment, potentially exacerbated by the transfer of care from pediatric- to adult-oriented care providers, and perhaps an increased potency of the immune response. We describe the characteristics of pediatric kidney transplant recipients, particularly those factors that may influence their care throughout their lives. We also discuss the risks associated with the transition from pediatric- to adult-oriented care and provide some suggestions to optimize transition to adult-oriented transplant care and long-term outcomes.

Long‐term outcomes of pediatric kidney transplant recipients with a pretransplant malignancy

2019 ◽  
Vol 23 (7) ◽  
Author(s):  
Oscar K. Serrano ◽  
Alexis Gannon ◽  
Ayokunle S. Olowofela ◽  
Apoorva Reddy ◽  
Danielle Berglund ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Long Term Outcomes
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