Kidney Transplant Waitlist Patients Research Articles

Quantitative Abdominal Arterial Calcification Correlates with Kidney Transplant Waitlist Mortality.

The scarcity of available organs for kidney transplantation has resulted in a substantial waiting time for patients with end-stage kidney disease. This prolonged wait contributes to an increased risk of cardiovascular mortality. Calcification of large arteries is a high-risk factor in the development of cardiovascular diseases, and it is common among candidates for kidney transplant. The aim of this study was to correlate abdominal arterial calcification (AAC) score value with mortality on the waitlist. We modified the coronary calcium score and used it to quantitate the AAC. We conducted a retrospective clinical study of all adult patients who were listed for kidney transplant, between 2005 and 2015, and had abdominal computed tomography scan. Patients were divided into two groups: those who died on the waiting list group and those who survived on the waiting list group. Each 1,000 increase in the AAC score value of the sum score of the abdominal aorta, bilateral common iliac, bilateral external iliac, and bilateral internal iliac was associated with increased risk of death (HR 1.034, 95% CI: 1.013, 1.055) (p = 0.001). This association remained significant even after adjusting for various patient characteristics, including age, tobacco use, diabetes, coronary artery disease, and dialysis status. The study highlights the potential value of the AAC score as a noninvasive imaging biomarker for kidney transplant waitlist patients. Incorporating the AAC scoring system into routine imaging reports could facilitate improved risk assessment and personalized care for kidney transplant candidates.

Development of a calculated panel reactive antibody calculator for the United Arab Emirates: a proof of concept study

Calculated panel reactive antibody (CPRA) is used to help increase sensitized patient’s access to transplantation. United Arab Emirates (UAE) has a diverse resident population hence we developed a UAE–CPRA calculator based on HLA antigen frequencies of the different ethnic groups that represent the UAE population. HLA antigen frequencies at serological split antigen level for HLA-A, -B, -C, -DRB1 and -DQB1 of 1002 healthy unrelated donors were performed. We subsequently compared the performance of the UAE CPRA calculator with the Organ Procurement and Transplantation Network (OPTN) and the Canadian CPRA calculators in 110 Kidney Transplant waitlist patients from January 2016 to December 2018. Lin’s concordance correlation coefficient showed a moderate agreement between the UAE and OPTN calculator (Rc = 0.949, 95% CI 0.929–0.963) and the UAE and Canadian calculators (Rc = 0.952, 95% CI 0.932–0.965). While there continued to be a moderate agreement (Rc = 0.937, UAE versus OPTN calculator) in the lower sensitized group, a poor agreement (Rc = 0.555, UAE versus OPTN calculator) was observed in the higher sensitized group. In this study, we provide a template for countries to develop their own population-specific CPRA calculator. Implementation of the CPRA algorithm based on HLA frequencies of the multi-ethnic UAE population will be more fitting to increase access to transplantation and improve transplant outcomes. Our study demonstrates that the CPRA calculators developed using the data from the western population had poor correlation in our higher sensitized patients disadvantaging them in potential organ allocations systems. We plan to further refine this calculator by using high resolution HLA typing to address the problem of a genetically diverse population.

Diagnostic Yield Among Patients With Diabetic Nephropathy and/or Hypertension: Genetic Testing in Kidney Transplant Waitlist Patients

Diagnostic Yield Among Patients With Diabetic Nephropathy and/or Hypertension: Genetic Testing in Kidney Transplant Waitlist Patients

COVID-19 in Kidney Transplant Recipient and Waitlist Patients: Implications of Chest Radiographic Severity Score.

Purpose:To evaluate the chest radiographic severity score (CXR-SS) for coronavirus disease 2019 (COVID-19) patients who are kidney transplant recipients compared with patients on the waitlist.Study Design and Methods:This retrospective cohort includes 78 kidney transplant recipients (50 men, mean age 59.9±11.9 y) and 59 kidney transplant waitlist patients (33 men, mean age 58.8±10.8 y) diagnosed with COVID-19 between March 15 and May 30, 2020 with reverse transcriptase-polymerase chain reaction. Patient chest radiographs were divided into 6 zones and examined for consolidation. Primary outcome was mortality. Secondary outcomes included hospital admission, intensive care unit (ICU) admission, and intubation. Predictors of our primary and secondary outcomes were identified by bivariate analysis and multivariate regression analysis.Results:No significant difference was found in CXR-SS between 2 groups (P=0.087). Transplant recipients had significantly higher rates of hospitalization (odds ratio, 6.8; 95% confidence interval: 1.7, 39.3; P<0.001), ICU admission (odds ratio, 6.5; 95% confidence interval [CI]: 1.8-35.9; P=0.002), intubation (odds ratio, 11; 95% CI: 2.4-96.9; P=0.001), and mortality (odds ratio, 17; 95% CI: 3.9-153.1; P<0.001). A higher CXR-SS was not predictive of mortality, intubation, or ICU admission. CXR-SS was associated with hospital admission overall (odds ratio, 1.613; 95% CI: 1.04-2.49; P=0.0314).Conclusion:The CXR-SS was not predictive of mortality, ICU admission or intubation in our population. Kidney transplant patients with COVID-19 had near universal hospital admission, more than one-third mortality and about a quarter were intubated and admitted to the ICU—all significantly worse outcomes than for patients on the transplant waitlist.

Influence of Calcineurin Inhibitor Choice on Outcomes in Kidney Transplant Recipients Aged ≥60 Y: A Collaborative Transplant Study Report.

Patients aged ≥60 y represent the fastest growing population among kidney transplant recipients and waitlist patients. They show an elevated infection risk and are frequently transplanted with multiple human leukocyte antigen mismatches. Whether the choice of calcineurin inhibitor influences graft survival, mortality, or key secondary outcomes such as infections in this vulnerable recipient population is unknown. A total of 31 177 kidney transplants from deceased donors performed between 2000 and 2019 at European centers and reported to the Collaborative Transplant Study were analyzed using multivariable Cox and logistic regression analyses. All recipients were ≥60 y old and received tacrolimus (Tac) or cyclosporine A on an intention-to-treat basis, combined with mycophenolic acid or azathioprine plus/minus steroids. The risk of 3-y death-censored graft loss and patient mortality did not differ significantly between Tac- and cyclosporine A-treated patients (hazard ratio 0.98 and 0.95, P = 0.74 and 0.20, respectively). No difference was found in the overall risk of hospitalization for infection (hazard ratio = 0.95, P = 0.19); however, a lower incidence of rejection treatment (hazard ratio = 0.81, P < 0.001) was observed in Tac-treated patients. Assessment of pathogen-specific hospitalizations revealed no difference in the risk of hospitalization due to bacterial infection (odds ratio = 1.00, P = 0.96), but a significantly higher risk of hospitalization due to human polyomavirus infection was found among Tac-treated patients (odds ratio = 2.45, P = 0.002). The incidence of de novo diabetes was higher for Tac-based immunosuppression (odds ratio = 1.79, P < 0.001). Calcineurin inhibitor selection has no significant influence on death-censored graft survival, mortality, and overall infection risk in ≥60-y-old kidney transplant recipients.

Acceptability of a Mobile-Health Living Kidney Donor Advocacy Program for Black Wait-Listed Patients.

Marked racial disparities exist in rates of living donor kidney transplantation (LDKT). The Living Organ Video Educated Donors (LOVED) program is a distance-based, mobile health program designed to help Black kidney transplant wait-list patients advocate for a living donor. This study reported on the acceptability outcomes to aid in future refinements. Participants were randomized to LOVED (n = 24, mean age = 50.9 SD (9.2) years), male = 50%) and usual care groups (n = 24 (mean age 47.9 SD (10.0), male 50%). Four LOVED groups completed an eight-week intervention that consisted of six online video education modules and eight group video chat sessions led by a Black navigator. Qualitative analysis from post-study focus groups resulted in six themes: (1) video chat sessions provided essential support and encouragement, (2) videos motivated and made participants more knowledgeable, (3) connectivity with tablets was acceptable in most areas, (4) material was culturally sensitive, (5) participation was overall a positive experience and (6) participants were more willing to ask for a kidney now. The video chat sessions were pertinent in participant satisfaction, though technology concerns limited program implementation. Results showed that the LOVED program was acceptable to engage minorities in health behavior changes for living donor advocacy but barriers exist that require future refinement.

The coverage of influenza and pneumococcal vaccination among kidney transplant recipients and waiting list patients: A cross-sectional survey in Denmark.

To characterize level and predictors of influenza and pneumococcal vaccine uptake among Danish kidney transplant recipients (KTR) and kidney transplant waiting list patients (WLP). A cross-sectional survey based on self-reported vaccine uptake including WLP and KTR≤1½ years post transplantation. Descriptive statistics and logistic regression analyses identifying factors associated with influenza vaccine uptake in the latest season were performed. A total of 220 participants were included in the study, 54% KTR and 46% WLP. Self-reported influenza vaccine uptake in the latest season was overall 41.8%. Uptake of influenza vaccine on any prior season apart from the latest season was 53.2% and significantly higher among WLP than KTR (P=.007). Pneumococcal vaccine uptake was only 4% overall. The only factor positively associated with influenza vaccine uptake in the latest season was any prior influenza vaccine uptake (OR 5.79, CI95 2.44-13.76) (P<.001). Recommendations given by other persons (non-physician) were negatively associated with receiving the influenza vaccination in the latest season (OR 0.34, CI95 0.13-0.92) (P=.03). Reasons for not being vaccinated were primarily lack of information, perception of own good health, and fear of adverse reactions. Influenza and pneumococcal vaccine uptakes were suboptimal among Danish WLP and KTR. Increased awareness about guidelines and physicians´ education are warranted.

Exploring patient willingness to accept hepatitis C-infected kidneys for transplantation

BackgroundAs organs infected with Hepatitis C virus (HCV) provide an opportunity to expand the donor pool, the primary aim of this study is to explore patient willingness to accept a kidney from HCV-infected donors compared to other high-risk donors.MethodsAn anonymous, electronic survey was sent to all active kidney transplant waitlist patients at a single large volume transplant center. Patients were asked to respond to three hypothetical organ offers from the following: 1) HCV-infected donor 2) Donor with active intravenous drug use and 3) Donor with longstanding diabetes and hypertension.ResultsThe survey was sent to 435 patients of which 125 responded (29% response rate). While 86 out of 125 patients (69%) were willing to accept an HCV-infected kidney, only a minority of respondents were willing to accept a kidney from other high-risk donors. In contrast to other studies, by multivariable logistic regression, age and race were not associated with willingness to accept an HCV-infected kidney.ConclusionsIn this exploratory study, utilization of kidneys from HCV-infected donors to expand the donor pool appears to be an acceptable option to patients.

North African-Mediterranean HLA genetic contribution in a population of the kidney transplant waiting list patients of Canary origin (Gran Canaria).

The peopling of the Canary Islands has been widely debated. The mitochondrial DNA and Y-chromosome data support the idea of a Berber genetic origin coming from the North of Africa (maternal) and a later contribution of the Spanish invaders (paternal). The frequencies of the HLA class II alleles from the Tenerife Island (another Canary Island) have previously been published, postulating a Berber and Atlantic/Iberian contributions to the current population. The HLA class I and class II allele frequencies, haplotype frequencies and phylogenetic comparisons were performed in 215 unrelated individuals from Gran Canaria Island (belonging to the kidney transplant waiting list), with at least three generations of ancestors from Canary Islands, in order to study the different ethnical HLA contributions to the genetic background of the Canary Islanders. Results showed the presence of a compound HLA haplotype of putative Phoenician-Berber origin, A*33:01-C*08:02-B*14:02-DRB1*03:01-DQB1*02:01, likely coming from the combination of haplotypes A*30:02-C*05:01-B*18:01-DRB1*03:01-DQB1*02:01 and A*33:01-C*08:02-B*14:02-DRB1*01:02-DQB1*05:01 of North African (probably Berber) and West Asian Mediterranean (probably Phoenician) origins, respectively. The latter haplotypes and others from the same origin (Berber/Phoenician) are also present in the population studied. Besides, other contributions from the North of Europe, North England-Iberian (Atlantic contribution), and Western Europe/Mediterraneans (Spanish colonization) are also discussed. These data conclude that the current genetic background of the Canary Islands inhabitants has been generated over the years by different ways with an original Phoenician-Berber substrate and several genetic contributions generated in different invasions.

Effectiveness of Multimedia for Transplant Preparation for Kidney Transplant Waiting List Patients

BackgroundA multimedia program could effectively advise patients about preparing for transplantation while on the waiting list for a kidney transplant. This study aimed to compare knowledge about transplant preparation for patients on a kidney transplant waiting list before and after participating in a multimedia program, and to evaluate patient satisfaction with the multimedia program. MethodsResearch design was quasiexperimental with the use of 1 group. Subjects were 186 patients on the kidney transplant waiting list after HLA matching in Ramathibodi Hospital. The questionnaires were developed by the researchers. The statistical tools used were basic statistics, percentage, average, standard deviation, and the difference of score between before and after participation in the multimedia program (t test). ResultsThe evaluation knowledge for transplant preparation for kidney transplant waiting list patients after participating in the multimedia program averaged 85.40%, and there was an increased improvement of score by an average 3.27 out of a possible full score of 20 (P < .05). The result of patient satisfaction for the multimedia program had good average, 4.58.

Successful Interim Outcomes of Bortezomib Desensitization on Highly Sensitized Deceased Donor Kidney Transplant Waitlist Patients

Highly sensitized (HS) patients seldom have chance to receive kidney transplant. To increase transplantation rate among those population, previous IV immunoglobulin and rituximab desensitization protocol showed good transplant conversion rate, but also carried moderate rate of antibody mediated rejection. Bortezomib, a proteasome inhibitor can control the production of anti-HLA antibodies through plasma cell apoptosis. A single center waitlist desensitization program was employed to facilitate successful kidney transplantation in HS patients group. We prospectively enrolled 23 patients from Jul 2010 to Dec 2013. Desensitization protocol included two doses of IVIG (2 g/kg), single dose of rituximab (375 mg/m 2 , max 500 mg), and 4 days of bortezomib (1.3 mg/m 2 on days 1,3,7 and 9). Anti-HLA class I and II antibodies were determined by Luminex solid phase bead assay at baseline and M2, M3 and M6. We investigated the difference of transplant conversion rate between desensitized HS patients and non-desensitized HS waitlist patients. Also we analyzed the difference of PRA % values and mean fluorescence intensity (MFI) between pre- and post-desensitization serum. Mean age of treatment group was 48.7±11.2 years old. Male to female ratio was 12:11. O+ blood type patients were 34.8% of patients. Mean duration of previous renal replacement therapy were 153.5±65.5 months. Baseline mean class I and II PRA % values were 86±15.3 and 66±34. Baseline class I and II MFI values were 13,893±6,147 and 12,274±6,891. After desensitization, kidney transplant were successfully performed in 34.8% of patients, compared to 13.8% transplant conversion rate among non-desentized HS controls ( p =0.001 by Log-Rank). Among KT recipients, median duration of waiting after desensitization was 3 months with interquartile range 2-8.1 months. Class I PRA % had showed decreased values until 3 months after desensitization. After 6 months, there were no differences between the class I PRA values between pre-desensitization samples and post-desensitization samples. There were no other differences except class I PRA % values. Desensitization protocol were generally well tolerated, with the completion rate of 92% patients. There were no serious adverse events, but moderate adverse event were in 46%, most commonly fever and diarrhea. Highly sensitized waitlist patients are manageable by desensitization protocol including bortezomib.

What Factors Really Matter? Health-related Quality of Life for Patients on Kidney Transplant Waiting List

Waiting times for kidney transplant are long in Singapore. Healthrelated quality of life (HRQoL) of patients might be affected as a result of the stress of the long wait and the uncertainty of being called to undergo a surgical operation. This study aimed to measure the HRQoL of patients on the kidney transplant waiting list and to identify factors which could impact on the HRQoL scores in this group of patients. This was a cross-sectional study of kidney transplant waiting list patients managed at a tertiary renal unit using the SF-36. A SF-36 normative calculator was used to generate HRQoL scores for the Singapore general population matched with the study cohort's age, gender and ethnicity. There were 265 respondents with a response rate was 81%. Our study shows that HRQoL scores for the kidney transplant waiting list patients were lower than the population norms across all subscales and were clinically significant for General Health, Role Physical, Bodily Pain, Social Functioning and Mental Component Summary scores. Factors such as being Chinese, married, employed and undergoing haemodialysis predicted better HRQoL scores after adjusting for possible confounders. Age, gender, educational level, household income, history of kidney transplant, duration on the transplant waiting list and years on dialysis did not significantly influence SF-36 across all subscales scores. Kidney transplant waiting list patients had worse HRQoL compared to the general population. Factors such as ethnicity, marital status, employment status, and type of dialysis treatment significantly influenced patients' perception of their HRQoL.

Incidence and Prevalence of Cancer in Kidney Transplantation Waiting List Patients: An Italian Experience

Evaluation of kidney transplant candidates is based on strict exclusion of major pathologies, such as neoplastic disease. The aim of this study is to evaluate epidemiological and clinical impact of tumor disease in an Italian renal transplant waiting list and to propose a screening schedule for neoplastic detection. We retrospectively observed data of patients enrolled on the Emilia-Romagna kidney transplant waiting list between 1st August 2008 and 31st December 2010, evaluating the different causes of getting out from the list, the histologic type and incidence of cancer and the correlation between cancer onset and clinical features. The ratio of observed to expected cancer numbers (standardized incidence ratio, SIR), was estimated. We observed 2345 patients; 1297 got out from the waiting list; 57 of them (4,4%) got out because the onset of tumor. The overall incidence rate of cancer was 1354.8 (x 100,000 person-year) (1045.9 person-year in patients awaiting for first transplant(FT), 1851.5 person-year in patients awaiting for second transplant(ST)). The overall prevalence of cancer was 2,43% (2.2% in FT, 3.4% in ST) with a SIR of 1.8; In our population the prevalence of cancers related to ESKD was 52.6% with a SIR of 15.8. Kidney transplant waiting list patients present a higher incidence and prevalence of cancer compared to general population; it could be important to evaluate them for ESKD related malignancies because of their high incidence.