scholarly journals Delayed Graft Function and Acute Rejection in Kidney Transplant Patients with Positive Panel-Reactive Antibody and Negative Donor-Specific Antibodies

2020 ◽  
Vol 12 (4) ◽  
Author(s):  
Ha Nguyen Thi Thu ◽  
Manh Bui Van ◽  
Dung Nguyen Thi Thuy ◽  
Kien Truong Quy ◽  
Duc Nguyen Van ◽  
...  
Keyword(s):  
Acute Rejection ◽  
Kidney Transplant ◽  
Kidney Function ◽  
Graft Function ◽  
Post Transplantation ◽  
Transplant Patients ◽  
Kidney Transplant Patients ◽  
Group 2 ◽  
Reactive Antibody ◽  
Group 1

Background: Delayed graft function (DGF) and acute rejection (AR) are common complications in kidney transplant patients. Objectives: The study evaluated DGF and AR in highly sensitized patients and their effects on kidney function for six months post-transplantation. Methods: We enrolled 95 patients with kidney transplants from living donors who were divided into two groups. Group 1 included 47 highly sensitized patients with panel reactive antibody (PRA) < 20.0% and negative donor-specific antigen, and group 2 included 48 patients with negative PRA. All patients were followed for the state of DGF, AR, and kidney function for six months. Results: Group 1 showed a significantly higher proportion of DGF and AR than group 2 (27.7% versus 2.1%, P < 0.001 and 14.9% versus 2.1%, P = 0.031, respectively). The rates of positive PRA in DGF and AR patients were significantly higher than those in non-DGF and non-AR patients (92.9% versus 42.0%, P < 0.001 and 87.5% versus 46.0%, P = 0.031, respectively). Transplanted kidney function was significantly worse in patients with PRA and DGF and/or AR than in patients with negative PRA and non-DGF and non-AR only in the seventh-day post-transplantation. Conclusions: Kidney transplant in highly sensitized patients with positive PRA was related to the increased ratio of DGF and AR.

scholarly journals Risk factors for complications and graft failure in kidney transplant patients with sepsis

2018 ◽  
Author(s):  
Syuan-Hao Syu ◽  
Yung-Wei Lin ◽  
Ke-Hsun Lin ◽  
Liang-Ming Lee ◽  
Chi-Hao Hsiao ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Graft Failure ◽  
Peripheral Vascular ◽  
Hepatitis C Infection ◽  
Factors Associated ◽  
Transplant Patients ◽  
Kidney Transplant Patients ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Immunosuppressive therapies decreased the incidence of acute kidney rejection after kidney transplantation, but also increased the risk of infections and sepsis. This study aimed to identify the risk factors associated with complications and/or graft failure in kidney transplant patients with sepsis. A total of 14,658 kidney transplant patients with sepsis, identified in the National Inpatient Sample (NIS) database (data from 2005–2014), were included in the study and classified into three groups: patients without complications or graft failure/dialysis (Group 1), patients with complications only (Group 2), and patients with complications and graft failure/dialysis (Group 3). Multinomial logistic regression analyses were conducted to evaluate factors associated with kidney transplant recipients. Multivariate analysis showed that, compared to Group 1, patients from Group 2 or Group 3 were more likely to be Black and to have cytomegalovirus infection, coagulopathy, and glomerulonephritis (p ≤ 0.041). Also, Group 2 was more likely to have herpes simplex virus infection, and Group 3 was more likely to have hepatitis C infection and peripheral vascular disorders, compared to Group 1 (p ≤ 0.002). In addition, patients from Group 3 were more likely to be Black and to have hepatitis C infection, peripheral vascular disorders, coagulopathy, and hypertension compared to Group 2 (p ≤ 0.039). Age and female gender were associated with lower odds of complications after kidney transplantation regardless of graft rejection/dialysis (p ≤ 0.049). Hyperlipidemia and diabetes decreased the chance of complications and graft failure/dialysis after kidney transplant (p < 0.001). In conclusion, the study highlights that black race, male gender, and specific comorbidities can increase the risk of complications and graft failure in kidney transplant patients with sepsis.

scholarly journals Clinical Relevance of Corticosteroid Withdrawal on Graft Histological Lesions in Low-Immunological-Risk Kidney Transplant Patients

2021 ◽  
Vol 10 (9) ◽  
pp. 2005
Author(s):  
Domingo Hernández ◽  
Juana Alonso-Titos ◽  
Teresa Vázquez ◽  
Myriam León ◽  
Abelardo Caballero ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Rejection Rate ◽  
Open Label ◽  
Post Transplantation ◽  
Protocol Biopsy ◽  
Corticosteroid Withdrawal ◽  
Transplant Patients ◽  
Prospective Phase ◽  
Kidney Transplant Patients ◽  
The Impact

The impact of corticosteroid withdrawal on medium-term graft histological changes in kidney transplant (KT) recipients under standard immunosuppression is uncertain. As part of an open-label, multicenter, prospective, phase IV, 24-month clinical trial (ClinicalTrials.gov, NCT02284464) in low-immunological-risk KT recipients, 105 patients were randomized, after a protocol-biopsy at 3 months, to corticosteroid continuation (CSC, n = 52) or corticosteroid withdrawal (CSW, n = 53). Both groups received tacrolimus and MMF and had another protocol-biopsy at 24 months. The acute rejection rate, including subclinical inflammation (SCI), was comparable between groups (21.2 vs. 24.5%). No patients developed dnDSA. Inflammatory and chronicity scores increased from 3 to 24 months in patients with, at baseline, no inflammation (NI) or SCI, regardless of treatment. CSW patients with SCI at 3 months had a significantly increased chronicity score at 24 months. HbA1c levels were lower in CSW patients (6.4 ± 1.2 vs. 5.7 ± 0.6%; p = 0.013) at 24 months, as was systolic blood pressure (134.2 ± 14.9 vs. 125.7 ± 15.3 mmHg; p = 0.016). Allograft function was comparable between groups and no patients died or lost their graft. An increase in chronicity scores at 2-years post-transplantation was observed in low-immunological-risk KT recipients with initial NI or SCI, but CSW may accelerate chronicity changes, especially in patients with early SCI. This strategy did, however, improve the cardiovascular profiles of patients.

scholarly journals Progression of Endothelial Dysfunction, Atherosclerosis, and Arterial Stiffness in Stable Kidney Transplant Patients: A Pilot Study

2019 ◽  
Author(s):  
Joey Junarta ◽  
Nina Hojs ◽  
Robin Ramphul ◽  
Racquel Lowe-Jones ◽  
Juan C Kaski ◽  
...  
Keyword(s):  
Pilot Study ◽  
Kidney Transplant ◽  
Cardiovascular Event ◽  
Intima Media Thickness ◽  
Post Transplantation ◽  
Vascular Abnormalities ◽  
Transplant Patients ◽  
Diabetes Status ◽  
Kidney Transplant Patients ◽  
Event Rates

Abstract Background Kidney transplant patients suffer from vascular abnormalities and high cardiovascular event rates, despite initial improvements post-transplantation. The nature of the progression of vascular abnormalities in the longer term is unknown. This pilot study investigated changes in vascular abnormalities over time in stable kidney transplant patients long after transplantation. Methods Brachial artery flow-mediated dilation (FMD), nitroglycerin-mediated dilation, carotid-femoral pulse wave velocity (cf-PWV), ankle-brachial pressure index, and common carotid artery intima-media thickness (CCA-IMT) were assessed in 18 kidney transplant patients and 17 controls at baseline and 3-6 months after. Results There was no difference in age (51±13 vs. 46±11; P=0.19), body mass index (26±5 vs. 25±3; P=0.49), serum cholesterol (4.54±0.96 vs. 5.14±1.13; P=0.10), systolic blood pressure (BP) (132±12 vs. 126±12; P=0.13), diastolic BP (82±9 vs. 77±8; P=0.10), or diabetes status (3 vs. 0; P=0.08) between transplant patients and controls. No difference existed in vascular markers between patients and controls at baseline. In transplant patients, FMD decreased (-1.52±2.74; P=0.03), cf-PWV increased (0.62±1.06; P=0.03), and CCA-IMT increased (0.35±0.53; P=0.02). No changes were observed in controls. Conclusions Markers of vascular structure and function worsen in the post-transplant period on long-term follow-up, which may explain the continued high cardiovascular event rates in this population.

scholarly journals Immune Response after SARS-CoV-2 Vaccination in Kidney Transplant Patients

Medicina ◽  
2021 ◽  
Vol 57 (12) ◽  
pp. 1327
Author(s):  
Ruta Vaiciuniene ◽  
Brigita Sitkauskiene ◽  
Inga Arune Bumblyte ◽  
Egle Dalinkeviciene ◽  
Edita Ziginskiene ◽  
...  
Keyword(s):  
Mycophenolate Mofetil ◽  
Antibody Response ◽  
Kidney Transplant ◽  
Kidney Function ◽  
Hemoglobin Level ◽  
Total Leucocyte Count ◽  
Binary Logistic Regression Analysis ◽  
Cd8 Cells ◽  
Transplant Patients ◽  
Kidney Transplant Patients

Background and Objectives: The prospective study was conducted to evaluate humoral and cellular immune responses after two doses of BNT162b2 (Pfizer-BioNTech) vaccine and possible relation with other factors (medication, etc.) in kidney transplant patients. Materials and Methods: Out of 167 vaccinated patients, 136 agreed to a follow-up visit three to six weeks after vaccination. Results: Only 39 patients (29%) developed antibody response against SARS-CoV-2 (≥35.2 binding antibody units (BAU)/mL) after full vaccination. Multivariate binary logistic regression analysis showed that predictive factors for good antibody response to the COVID-19 vaccine were better kidney function, higher hemoglobin level, and no use of mycophenolate mofetil for immunosuppression. For seropositive kidney transplant patients there was a significant negative correlation between anti-SARS-CoV-2 antibody titer and CD4/CD8 ratio (Spearman’s correlation coefficient −0.4, p = 0.02), percentage of CD19+ cells (r = −0.37, p = 0.02), and a positive correlation with percentage of CD8+ cells (r = 0.4, p = 0.01). There was an increase of total leucocyte count after vaccination in the total studied population, and in the group of responders. Conclusions: Only one third of kidney transplant patients develop sufficient antibody responses after full COVID-19 vaccination with Pfizer-BioNTech. Better kidney function, higher hemoglobin level, and no use of mycophenolate mofetil for immunosuppression increases the adequacy of response. The antibody titers correlated positively with relative number of CD8+ cells and negatively with CD4/CD8 ratio in responders.

scholarly journals P1694PROGNOSTIC VALUE OF BODY COMPOSITION ON GRAFT FUNCTIONING IN KIDNEY TRANSPLANT PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Zorica Dimitrijevic ◽  
Branka Mitic ◽  
Goran Paunovic ◽  
Karolina Paunovic ◽  
Danijela Tasic ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Kidney Transplant Recipient ◽  
Graft Function ◽  
Skinfold Thickness ◽  
Cross Sectional Study ◽  
Fat Percentage ◽  
Cross Sectional ◽  
Transplant Patients ◽  
Significant Difference ◽  
Kidney Transplant Patients

Abstract Background and Aims Post-transplant weight gain and particularly visceral fat gain has been linked to the development of metabolic disorders and cardiovascular disease. Moreover, the effect of obesity on graft function after kidney transplantation has recently become a subject of interest. The aim of our study was to investigate the association of body mass index (BMI), body fat percentage (BF%) and waist-to-hip ratio (WHR) with the kidney function in kidney transplant patients. Method We conducted a cross-sectional study that enrolled 80 kidney transplant patients aged 23–75 years (mean age 46.7 ± 11.5 years, 60% males). Anthropometric measurements of weight, height, waist, and hip circumferences in addition to skinfold thickness were obtained. BH% was calculated using a 4-site skinfold thickness method calculated through the Jackson-Pollock equation with a Harpenden caliper, utilizing a BF% cutoff of 35% for women and 25% for men to define obesity. Results The calculated BMI in our study group was 32.7±8.7 kg/m2, a mean BF% of 29.9±8.5% and a mean WHR of 0.9±0.1 Statistically significant difference in GFR, BMI, WHR and BF% were observed between males and females (r=0.455, p=0.02; r=0.412, p=0.016; r=0.437, p=0.022; r=0.348, p=0.011), respectively. After adjustment for age, gender, donor group, donor age and years of dialysis before transplantation, higher levels of all obesity measures were related to lower eGFR: BMI per 1 SD (β coefficient −3.883, 95% confidence interval [CI] −5,422 to −3,132), WHR (β coefficient −4.443, 95% CI −6.201 to −3.772), and BF% (β coefficient −3.722, 95% CI −4.332 to −3.461). The combination of higher BF% (BF% &gt;33 kg/m2) and central obesity (WHR &gt;0.85 for women, &gt;0.90 for men) was associated with the lowest eGFR compared with that in lean subjects. Conclusion The combination of high BF% and WHR may be an important risk factor for lower GFR in a kidney transplant recipient.

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