Function In Renal Transplant Recipients Research Articles

Comprehensive Approaches to Urolithiasis in Renal Transplants: A Narrative Review.

This review addresses the management of urolithiasis in renal transplant recipients, a notably vulnerable group due to the unique anatomical and physiological alterations of the transplanted organ. The prevalence of nephrolithiasis in these patients varies between 0.1% and 6.3%, with a significant impact on graft longevity and function. Surgical access complications due to the renal graft's position on the iliac vessels and the variety of urinary anastomoses complicate the treatment approaches. This study evaluates the effectiveness and outcomes of percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS), two primary minimally invasive strategies for managing graft stones. Through a narrative review using the PubMed and EMBASE databases, it was found that PCNL offers high stone-free rates especially beneficial for large stones, whereas URS provides a less invasive option with a lower risk of complications for small stones. Both techniques require tailored approaches based on stone composition-mostly calcium oxalate-and specific patient anatomical factors. This review underscores the importance of early diagnosis, appropriate treatment selection, and continuous post-treatment monitoring to mitigate risks and promote long-term renal function in transplant recipients.

Association of IL-1β rs16944 and IL-1RN rs2234663 gene polymorphisms with graft function in renal transplant recipients

BackgroundAfter renal transplantation, renal graft function affects both patient and graft survival. There is growing evidence of the genetic association between interleukin-1β (IL-1β) or its receptor antagonist (IL-1RN) and graft function in renal transplantation. The objective of this study is to investigate the role of the recipient IL-1β and IL-1RN gene polymorphisms and their haplotypes on renal graft outcome.MethodsUsing PCR, IL-1β (− 511C/T) and IL-1RN (86 bp VNTR) gene polymorphisms were determined in 31 renal allograft recipients; eight cases with stable allograft function and 23 cases with early renal dysfunction as well as 26 age- and gender-matched healthy controls.ResultsA statistically significant difference in IL-1 β (− 511C/T) gene polymorphisms and IL-1RN/IL-1β haplotypes was observed on comparing renal allograft recipients with stable allograft function and those with early renal allograft dysfunction. However, the difference in the frequency distribution of IL-1RN gene polymorphisms, between these two groups, did not reach statistical significance. Also, no statistically significant difference was observed in comparing these two gene polymorphisms and their haplotypes between renal allograft recipients and healthy controls.ConclusionThe IL-1β − 511 CT/TT polymorphic genotypes and IL-1RN/IL-1β polymorphic haplotypes are associated with early renal allograft dysfunction. These are observational data that can be repeated in larger studies. If the results obtained are consistent, this might open doors to personalized medicine where clinicians can take necessary measures to identify the renal transplant recipients’ genotypes at risk of mounting an increased inflammatory response and hence administer the appropriate immunosuppressive protocol.

Association of Three Different Dietary Approaches to Stop Hypertension Diet Indices with Renal Function in Renal Transplant Recipients.

Several dietary indices assess the impacts of the Dietary Approaches to Stop Hypertension (DASH) diet on health outcomes. We explored DASH adherence and renal function among 85 Taiwanese renal transplant recipients (RTRs) in a cross-sectional study. Data collection included demographics, routine laboratory data, and 3-day dietary records. Three separate DASH indices, that defined by Camões (based on nine nutrients), that defined by Fung (using seven food groups and sodium), and that modified by Fung (as above but separated for men and women) were used. Renal function was ascertained through the estimated glomerular filtration rate (eGFR) from patients' medical records. Participants' mean age was 49.7 ± 12.6 years and eGFR was 54.71 ± 21.48 mL/min/1.73 m2. The three established DASH diet indices displayed significant correlations (r = 0.50-0.91) and indicated the nutritional adequacy of the diet. Multiple linear regressions indicated a significant positive association between higher DASH scores for each index and increased eGFR. In addition, RTRs in the highest DASH score tertile had higher eGFR rates than those in the lowest tertile, regardless of confounding variables. Adherence to a DASH-style diet correlated with better renal function among RTRs. Educating RTRs about the DASH diet may prevent graft function deterioration.

Performance of Creatinine and Cystatin C-Based Equations to Estimate Kidney Function in Renal Transplant Recipients

Background: Numerous equations are applied in order to estimate the glomerular filtration rate (GFR). Objectives: This study aimed to spot the optimal equation that accurately estimates GFR and, therefore, the chronic kidney disease (CKD) stage in renal transplant patients. Methods: This cross-sectional study was conducted on 58 renal transplant patients. Their venous blood samples were obtained for serum creatinine and cystatin C determination used to calculate estimated GFR (eGFR). The average contrast of GFR in each equation was calculated using the Bland-Altman method. The correlation, bias, imprecision, and 10% and 30% accuracy were compared between the eGFR cystatin C and creatinine. Concordance between both equations for CKD staging was assessed. The classification of patients was also investigated. Results: Bland-Altman plots and bias demonstrated that eGFR by the abbreviated modification of diet in renal disease (Ab-MDRD) was the most accurate compared with chronic kidney disease epidemiology collaboration (CKD-EPI) cystatin C, followed by CKD-EPI eGFR creatinine. With reference to CKD-EPI cystatin C, the imprecision of the equations was approximately similar to Ab-MDRD, and CKD-EPI creatinine is still better than the Cockcroft-gault (CG) formula. They also showed good 30% accuracy. Finally, our finding suggested that Ab-MDRD and CKD-EPI eGFR creatinine might be the best-performing equation in the classification of the CKD stages in a cutoff of 60 mL/min/1.73 m2. Conclusions: Due to the high cost and potential delay in measuring cystatin C, it would be much more appropriate to measure Ab-MDRD; after that, CKD-EPI eGFR creatinine as an alternative approach in order to facilitate rapid clinical decision in renal transplant patients.

Effect of Post-Transplant Cardiac Angiographic Procedures on Post-Transplant Renal Function

Cardiac interventions often are performed before and after renal transplant for coronary artery disease. The aim of this study was to investigate whether post-transplant cardiac coronary procedures affect post-transplant renal function. We retrospectively included renal transplant recipients who underwent renal transplant procedures at Baskent University between April 28, 1997 and January 20, 2020. We analyzed the effect of cardiac catheterization in renal transplant recipients between 6 and 12 months post-transplant with post-transplant renal function assessed by glomerular filtration rate (GFR). We compared the effect of the type of coronary intervention on GFR change in group 1, whereby group 1 was divided into 2 subgroups (coronary artery bypass grafting [CABG] and stenting). Group 1 included patients who underwent cardiac intervention, whereas group 2 included those who had not undergone cardiac intervention. In all, 108 patients underwent coronary angiography; 45 (41.7%) had normal coronaries or minimal coronary artery disease (CAD); 37 (34.3%) underwent stent implantation; 26 (24.1%) underwent CABG. The mean post- transplantation GFR of all patients after cardiac catheterization was 84.26+25.91 (mL/min/1.73 m2). The final, after 12 months mean GFR of all patients was 69.55+27.05. The final GFR was significantly lower than the initial post-renal GFR value in patients who underwent cardiac intervention but not in non-intervened patients. Invasive cardiac revascularization procedures showed a negative effect on post-transplant renal function in renal transplant recipients. All renal transplant recipients who underwent cardiac intervention survived the intervention, and there was no mortality. The reason for this outcome was assumed to be because of the short follow-up period.

Home-based exercise program improves normal right ventricle function in renal transplant recipients.

Right ventricular function is strongly associated with clinical outcomes in populations at high cardiovascular risk. Renal Transplant Recipients have multiple coexisting comorbidities potentially involved in the biventricular dysfunction including the right ventricular chamber. Speckle tracking echocardiography is recently used to investigate the normal function of this chamber. The study aims to verify whether global longitudinal strain carries clinical and prognosis implications in the renal transplant recipients during 1 year of regular unsupervised physical activity and compared to a control group. A group of 50 transplant recipients, aged 49.6±11.5 was submitted for 1 year to a moderate intensity of mixed exercise. All the subjects were followed by echocardiographic exam every 6 months, only 25 subjects with a high quality of image were investigated by 2D Speckle tracking strain analysis with the measurement calculated at T0, T6, and T12 months. Renal transplant recipients started with low values of right ventricle global longitudinal strain compared to health controls; it increased significantly (P<0.01) after 12 months of exercise, restoring the normal range. Moderate intensity of physical exercise, despite unsupervised, support a normal RV ventricular performance in renal transplant recipients' strain analysis contribute to plan a correct follow-up, with prognostic impact in these patients practicing physical exercise.

Elevated plasma free thiols are associated with early and one-year graft function in renal transplant recipients.

Reduced free thiols in plasma are indicative of oxidative stress, which is an important contributor to ischaemia-reperfusion injury (IRI) in kidney transplantation leading to kidney damage and possibly delayed graft function (DGF). In a post-hoc, exploratory analysis of the randomised controlled CONTEXT trial, we investigated whether higher (i.e. less oxidised) plasma levels of free thiols as a biomarker of reduced oxidative stress are associated with a better initial graft function or a higher GFR. Free thiol levels were measured in plasma at baseline, 30 and 90 minutes after reperfusion of the kidney as well as at Day 1, Day 5 and twelve months after kidney transplantation in 217 patients from the CONTEXT study. Free thiol levels were compared to the kidney graft function measured as the estimated time to a 50% reduction in plasma creatinine (tCr50), the risk of DGF and measured GFR (mGFR) at Day 5 and twelve months after transplantation. Higher levels of free thiols at Day 1 and Day 5 are associated with higher mGFR at Day 5 (p<0.001, r2adj. = 0.16; p<0.001, r2adj. = 0.25), as well as with mGFR at twelve months (p<0.001, r2adj. = 0.20; p<0.001, r2adj. = 0.16). However, plasma levels of free thiols at 30 minutes and 90 minutes, but not Day 1, were significantly higher among patients experiencing DGF. Higher levels of plasma free thiols at Day 1 and Day 5, which are reflective of lower levels of oxidative stress, are associated with better early and late graft function in recipients of a kidney graft from deceased donors. ClinicalTrials.gov Identifier: NCT01395719.

Higher CD19+CD25+ Bregs are independently associated with better graft function in renal transplant recipients

BackgroundThe Identification of B cell subsets with regulatory functions might open the way to new therapeutic strategies in the field of transplantation, which aim to reduce the dose of immunosuppressive drugs and prolong the graft survival. CD25 was proposed as a marker of a B-cell subset with an immunosuppressive action termed Bregs. The effect of CD19 + CD25 + Bregs on graft function in renal transplant recipients has not yet been elucidated. We investigated a potential impact of CD19 + CD25 + Bregs on renal graft function as well as a possible interaction of CD19 + CD25 + Bregs with peripheral Tregs in healthy controls, end-stage kidney disease patients (ESKD), and renal transplant recipients. Moreover, we aimed to investigate the association of CD19 + CD25 + Bregs with serum IL-10, TGF-ß1, and IFN-γ in the same study groups.MethodThirty-one healthy controls, ninety renal transplant recipients, and eighteen ESKD patients were enrolled. We evaluated the CD19 + CD25 + Bregs and Treg absolute counts. Next, we investigated CD19 + CD25 + Bregs as predictors of good graft function in multiple regression and ROC analyses. Finally, we evaluated the association between CD19 + CD25+ Bregs and serum IL-10, TGF-ß, and IFN-γ.ResultsESKD patients and renal transplant recipients showed lower counts of CD19 + CD25+ Bregs compared to healthy controls (p < 0.001). Higher CD19 + CD25+ Breg counts were independently associated with a better GFR in renal transplant recipients (unstandardized B coefficient = 9, p = 0.02). In these patients, higher CD19 + CD25+ Bregs were independently associated with higher Treg counts (unstandardized B = 2.8, p = 0.004). In ROC analysis, cut-offs for CD19 + CD25 + Breg counts and serum TGF-ß1 of 0.12 cell/μl and 19,635.4 pg/ml, respectively, were shown to provide a good sensitivity and specificity in identifying GFR ≥ 30 ml/min (AUC = 0.67, sensitivity 77%, specificity 43%; AUC = 0.65, sensitivity 81%, specificity 50%, respectively). Finally, a significant positive association between CD19 + CD25+ Bregs and TGF-ß1 was shown in renal transplant recipients (r = 0.255, p = 0.015).ConclusionsOur findings indicate that higher counts of CD19 + CD25+ Bregs are independently associated with better renal function and higher absolute Treg counts in renal transplant recipients.

Long Hemodialysis Duration Predicts Delayed Graft Function in Renal Transplant Recipients From Living Donor: A Single-Center Study

This study aims to determine the ratio of delayed graft function in renal transplant recipients from living donors and the predictive value of hemodialysis time before transplant for delayed graft function. We conducted a study on 116 adult patients who were diagnosed with end-stage kidney disease and were treated with hemodialysis and transplanted kidneys from living donors for 2 years (from June 2018 to June 2020). Delayed graft function event was collected for each patient. The recipients had a median age of 36.5 years old, in which 55.2% of them were men, 4.3% of them had the diabetic mellitus, and the median hemodialysis duration was 6 months. The ratio of positive panel-reactive antibody was 33.6% and vascular reconstruction of the donor's kidney was 16.4%. The ratio of delayed graft function was 12.2% (14 of 116 patients). Delayed graft function significantly related to positive panel-reactive antibody, long duration of hemodialysis before transplant, and vascular reconstruction of donor's kidney with P < .001. Duration of hemodialysis before kidney transplant had a predictive value for delayed graft function (area under the curve, 0.83; P < .001). Delayed graft function was not rare in renal transplant recipients from living donors. Duration of hemodialysis before kidney transplant was a good predictor for delayed graft function.

Effect of post-perfusion hyperoxemia on early graft function in renal transplant recipients: a retrospective observational cohort study.

The effects of hyperoxemia on the transplanted grafts arouse interest nowadays, particularly intraoperative hyperoxemia, on transplant kidney function and survival in the 1-year post-operative period. We aimed to investigate the effect of post-perfusion (5 min after perfusion) hyperoxemia on early graft function and survival in renal transplant recipients. Two hundred forty-seven living donor kidney transplant recipients were included in the study. Patients were divided into the three groups according to their partial arterial oxygen pressure in post-perfusion blood gas samples: group 1: normoxia (n = 52, PaO2 pressure: < 120 mmHg, 103 ± 13); group 2: moderate hyperoxemia (n = 121, PaO2: 120-200 mmHg, 169 ± 21); group 3: severe hyperoxemia (n = 74, PaO2: > 200 mmHg, 233 ± 25). Graft functions (serum creatinine levels, estimated-glomerular filtration rate values, spot urine protein/creatinine ratio), survival rates, and groups' clinical outcomes were compared in the first year after transplantation. Graft survival rates were similar in the groups and the rate of BK virus viremia was the lowest in the group 3 (groups 1, 2, and 3: 15.4% (n = 8), 6.6% (n = 8), 1.4% (n = 1), respectively, P: 0.009). Serum creatinine and proteinuria levels were lower, and estimated-glomerular filtration rate values were higher in group 3. A negative correlation between partial arterial oxygen pressure and serum creatinine levels and a positive correlation with estimated-glomerular filtration rate value were noted. These results were confirmed by univariate and multivariate analyses. We demonstrated that the kidney transplant recipients with post-perfusion hyperoxemia have better early graft functions and lower BK virus viremia rates. ClinicalTrials.gov Identifier: NCT04420897.

Renal Transplantation Improves Erectile Function in Patients with End-Stage Renal Disease: A Systematic Review and Meta-Analysis.

Erectile dysfunction has a lower prevalence in renal transplant recipients compared to dialysis patients. Despite this observation, the effect of renal transplantation on erectile function remains unknown. We aimed to assess the role of renal transplantation on erectile function and to determine potential factors improving or deteriorating erectile dysfunction. We conducted a systematic review and random effects meta-analysis of observational studies comparing erectile function preoperatively and postoperatively in renal transplant recipients (PROSPERO ID: CRD42020189580). Records reporting relevant outcomes were identified through search of PubMed®, Embase®, Cochrane Library and Scopus® databases from inception to September 2020. Judgment of the strength of evidence was performed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. We included 20 studies with 1,695 renal transplant recipients. At postoperative evaluation the number of patients with erectile dysfunction was reduced (RR 1.21, 95% CI 1.02-1.45, I2=88%). Renal transplant recipients reported an improvement in erectile function (RR 2.53, 95% CI 1.44-4.44, I2=90%) and the mean International Index of Erectile Function score increased by 3.04 points (95% CI 0.63-5.45, I2=96%) after renal transplantation. These effects were not demonstrated in the sensitivity analysis. In individuals reporting severe erectile dysfunction, no favorable effect of renal transplantation was observed (RR 1.51, 95% CI 0.85-2.68, I2=33%). For all outcomes the strength of evidence was considered low or very low due to methodological concerns and high heterogeneity among the included studies. Renal transplantation improves erectile function and the risk of erectile dysfunction reduces postoperatively compared to preoperatively. However, evidence on the matter is mostly based on low quality data. More studies with standardized outcomes are needed to validate and strengthen our findings.

Circulating Fibroblast Growth Factor-23 is Associated with Cardiovascular Prognosis and Graft Function in Renal Transplant Recipients.

PurposeThe aim of this study was to evaluate the relationship between Fibroblast Growth Factor-23 (FGF23) serum levels and cardiovascular disease and early graft failure in renal transplant recipients. MethodsThis cross-sectional study was conducted on renal transplant recipients followed by our adult kidney transplant clinic. The patients were divided into two groups according to the mean FGF23 levels (mean FGF23 level=71.2 ± 34.6pg/mL). The patients included in the study were classified as Group 1 (FGF23 <71 pg/mL, n= 42) and Group 2 (FGF23 ≥ 71pg/mL, n= 46) and the data was analyzed as a statistical significance between the two groups. The presence of atherosclerosis was determined by a Doppler ultrasound for evaluate the carotid artery intima-media thickness (CA-IMT). Intrarenal Doppler spectra were obtained with same Doppler ultrasound to determine the renal resistivity index (RRI) for evaluate graft renal failure.ResultsA total of 88 kidney transplantation recipients were included in the study. In the multivariate analysis adjusted for age and gender, the eGFR (β =-0.217, p=0.048), CA-IMT (β =0.318, p=0.009) and RRI (β =0.246, p=0.019) parameters were statistically significant, while the remaining parameters were not statistically significant. In the group analysis, Ca (9.6 ± 0.3 vs. 8.8 ± 0,2, p< 0.05), CA-IMT (0.9 ± 0.2, vs. 0.6 ± 0.3, p< 0.05) and RRI (0.69 ± 0.04 vs. 0.60 ± 0.01, p< 0.05) were significantly higher in the patients in group 2 than the patients in group 1. ConclusionAccording to our results, FGF23 can be considered as a descriptive biomarker for cardiovascular prognosis and graft function for patients with kidney transplantation.

Impact of the use of vasoactive drugs in cardiac death donors on the early postoperative renal function and related complications in renal transplant recipients.

To explore the impact of the use of vasoactive drugs in donation after cardiac death (DCD) donors on graft function, with an attempt to guide the clinical practices of organ preservation and DCD kidney transplantation. The clinical data of 187 DCD donors and 304 recipients who were operated on in our center from February 2018 to May 2019 were retrospectively analyzed. Based on whether vasoactive drugs were used for maintaining blood pressure in DCD donors, the renal donors and recipients were divided into a high-dose group (norepinephrine ≥1.3 µg/kg/min or in combination with dopamine), a low-dose group (norepinephrine <1.3 µg/kg/min or in conjunction with dopamine), and a no-medication group (without the use of vasoactive drugs). The clinical features, post-transplant renal function, and complications were compared among these three groups. The early renal function 1 and 7 days after surgery was significantly superior in the high-dose group and no-medication group (P<0.05) but showed no significant difference between the low-dose group and the no-medication group (P>0.05). Blood urea nitrogen (BUN) on the 1st postoperative days was significantly higher in the high-dose group than in the low-dose group and the no-medication group (P<0.05). Renal function indicators, including serum creatinine (CRE), BUN, and blood uric acid (UA) on the 30th postoperative day, showed no significant difference among these three groups (P>0.05). The incidence of delayed graft function (DGF) after renal transplantation was significantly higher in the high-dose group than in the low-dose group and the no-medication group (P<0.05), whereas there was no significant difference between the groups in the incidences of graft rejection and infections (P>0.05). The use of vasoactive drugs in DCD donors can affect the early recovery of renal function in renal transplant recipients, particularly for those donors who are administered a high dose of vasoactive drugs. Therefore, donor maintenance should be performed cautiously with vasoactive drugs.

Early Sonographic Evaluation of Intrarenal Arterial Resistive Index and Long-term Renal Function in Renal Transplant Recipients in South Western Nigeria.

Background:Color Doppler ultrasonography of intrarenal arterial Resistive Index (RI), performed early after kidney transplant, has proven to reliably predict short-term allograft function. The aim of this study was to assess whether early Doppler assessment could correlate with long-term renal function.Methods:This was a retrospective study of intrarenal RI using ultrasound in 41 stable kidney transplant patients who underwent RI assessment within 1 month after the transplant. Color Doppler ultrasonography was done to calculate the intrarenal RI within the first 4 weeks after transplant. The mean values of the intrarenal RI of the interlobar arteries of the allograft kidneys were measured and recorded. The data were analyzed with the aid of computer-based SPSS 20.0 software for windows (IBM, International Business Machines Corporation, Company, Armonk, New York, USA).Results:Older recipient age, active smoking, and proteinuria were associated with a higher intrarenal RI. Multivariate analyses showed that renal RI and donor age were independent predictors of allograft outcome. Kaplan–Meier estimates of cumulative graft survival were significantly worse in patients who had the values of the RI of 0.7 or more than they were in patients who had the values of the RI of <0.7.Conclusion:This study reveals that renal RI determined within the 1st month after renal transplant correlates with long-term allograft function in kidney transplant recipients.

Impact of Subclinical Rejection on Kidney Graft Function

BackgroundIn kidney transplant recipients with borderline infiltration, protocol biopsy results demonstrated the relationship with chronic injury. The purpose of this study was to evaluate the effect of subclinical rejection (SCR) on 6-month protocol biopsy results in long-term renal function in renal transplant recipients with stable graft function. Material and MethodsTransplant protocol biopsies performed in 45 patients with stable renal function were included in this study at 6 months. Biopsy specimens were evaluated for SCR. Study groups were divided into patients with and without SCR. Renal functions were compared with pathologic evaluation. The effect of immunosuppressive regimens on renal function were evaluated in patients with SCR ResultThe median age of patients was 32 years (range, 18-64 years). The median follow-up was 56 months (range, 24-84 months). According to the 6-month protocol biopsy results, 20 of 45 patients (44.4%) met SCR criteria based on Banff 07 parameters. There was not a statistically significant difference in renal function with SCR. ConclusionThe presence of SCR on the 6-month protocol biopsy results in renal transplant recipients with a stable graft function does not cause deterioration in the long-term graft function.

Effect of Fluvastatin on Cardiovascular Complications in Kidney Transplant Patients: A Systemic Review and Meta-analysis

BackgroundHyperlipidemia and cardiovascular disease are risk factors for long-term renal transplant dysfunction. However, no meta-analyses of randomized controlled trials have investigated the effects of statin treatment on graft function in renal transplant recipients. The aim of the present study was to evaluate the effects of statin use on renal transplant patients using a meta-analysis approach. MethodsWe conducted a systematic review and meta-analysis using random effects modeling. We searched the following databases for all studies published through to June 15, 2018: Cochrane Central Register, OVID MEDLINE, Embase, and PubMed. We reviewed all relevant reviews, registered trials, and relevant conference proceedings to compare clinical outcomes and survival between fluvastatin recipients and controls. ResultsFive trials with a total of 3725 patients were included. Glomerular filtration rates, graft loss, tacrolimus level, antibody-mediated rejection, T cell–mediated rejection, proteinuria, fungal infection (candida), and patient survival rates did not differ between the fluvastatin and control groups. However, major adverse cardiovascular events were 1.547 times more common in the control group than in the fluvastatin group (P = .001). ConclusionsFluvastatin use was associated with a reduction in major adverse cardiac events among kidney transplant patients.

SP792Frequency of Urinary Tract Infection by Multidrug Resistance Organisms and its Effect on Graft Function in Renal Transplant Recipients

SP792Frequency of Urinary Tract Infection by Multidrug Resistance Organisms and its Effect on Graft Function in Renal Transplant Recipients

Right Ventricle Systolic And Diastolic Function In Renal Transplant Recipients after 12 Months Of Unsupervised Exercise Training

Right Ventricle Systolic And Diastolic Function In Renal Transplant Recipients after 12 Months Of Unsupervised Exercise Training

Monitoring cellular immune function of renal transplant recipients based on adenosine triphosphate (ATP) production by mitogen-induced CD4+ T helper cells

Maintaining the balance between over- and under-immunosuppression has a critical role for successful immunosuppressive therapy after renal transplantation. We studied the predictive value of our functional immune assay, which works based on adenosine triphosphate (ATP) levels, in determining risk of infection and rejection among renal transplant recipients (RTRs). A total of 65 RTRs with less than 1 month (RTRL1) and 48 RTRs with more than 6 months (RTRM6) of post-transplant time, and 56 healthy individuals were included. Upon lymphocyte activation by phytohemagglutinin (PHA), CD4+ T cells were separated using magnetic beads (Dynabeads), the intracellular ATP (iATP) concentrations were measured by luciferin-luciferase reaction, and compared within and between the groups. Activated CD4+ cells iATP production directly correlated with post-transplant time (r = 0.32, P = 0.011). The iATP levels were significantly lower in both RTRL1 and RTRM6 groups compared to control (P < 0.001), and in the RTRL1 group compared to the RTRM6 (P < 0.05). The iATP concentrations were significantly lower in patients who suffered from infection versus the RTRs with stable graft function (SGF). However, the iATP levels were higher in those with allograft rejection episode (ARE). Our optimization experiments showed that best iATP levels cutoffs were 472.5 and 572.5 ng/ml for predicting risk of ARE, and 218.5 and 300.5 ng/ml for predicting risk of developing infection in RTRL1 and RTRM6 patients, respectively. iATP levels measured by immune function assay might be a promising predictive tool for identifying RTRs who are at risk of developing infection or allograft rejection.

Health Related Quality of Life in Post Renal Transplant Patients

Background To study association of health related quality of life (HRQoL) with renal function in renal transplant recipients and to examine which clinical measures after renal transplantation are connected to aspects of their HRQOL. Materials & Methods The study was carried out at IKDRC/ITS, Ahmedabad between 2013 to 2016. Minimum 3 months post transplant was the inclusion criteria for the study. 54 renal transplant patients gave their consent to participate in the study. The responses were summarized and transformed to give eight summary scales which were grouped as physical component summary (PCS) and mental component summary (MCS) to give total HRQoL. Results Out of 54 patients, 74% were male and 26% patients were female. Age distribution was between 18 to 62 years. Most common cause of end stage renal disease was chronic glomerulonephritis (42.6%). 47 patients underwent live related kidney transplant while 7 received kidneys from cadaver. 8 patients out of 54 (14.8%) were well nourished, 45 patients (83.3%) had mild malnutrition and 1 patient (1.85%) had moderate malnutrition. Mental health(MH) and MCS score in males was significantly higher (<0.05) than females. With respect to age, the transplant patients were divided into four groups: younger than 30 years, 30 to 39 years, 40 to 49 years, and 50 years old or older. No differences were found in any scale score between the age groups. The scale scores of PCS in the patients with a creatinine level >2 mg/dL were significantly lower (<0.05) than those of the patients with less than 2mg/dl. Approx. 33.3% patients had an occurrence of clinically defined acute rejection after transplantation. When compared in between patients who had rejection to those who did not, there was no significant difference in MCS and PCS. The scores of the patients with cadaveric transplantation were similar to those who received a living-related transplantation. Longer time since the transplantation operation were associated with lower scores of the Vitality scale (P<0.01). Conclusion In our study, we found that patients with a relatively high serum creatinine level reported more problems with PCS (Physical component score). Mental components were significantly better in males as compare to females. Episodes of hospitalization and rejection episodes did not affect the present HRQoL. Rejection episodes did not affect present HRQoL. Thus we observed that SF-36 V2 (Short form 36 version 2 ) is a good tool to monitor HRQoL of renal transplant recipients.