Long-term Outcome Of Renal Transplantation Research Articles

Longitudinal monitoring of Torque Teno virus DNAemia in kidney transplant recipients correlates with long-term complications of inadequate immunosuppression.

Optimization of individual immunosuppression, which reduces the risks of both graft loss and patients' death, is considered the best approach to improve long-term outcomes of renal transplantation. Torque Teno Virus (TTV) DNAemia has emerged as a potential biomarker reflecting the depth of therapeutic immunosuppression during the initial year post-transplantation. However, its efficacy in long-term monitoring remains uncertain. In a cohort study involving 34 stable kidney transplant recipients and 124 healthy volunteers, we established lower and upper TTV DNAemia thresholds (3.75-5.1 log10 cp/mL) correlating with T-cell activatability, antibody response against flu vaccine, and risk for subsequent serious infections or cancer over 50 months. Validation in an independent cohort of 92 recipients confirmed that maintaining TTV DNAemia within this range in >50% of follow-up time points was associated with reduced risks of complications due to inadequate immunosuppression, including de novo DSA, biopsy-proven antibody-mediated rejection, graft loss, infections, or cancer. Multivariate analysis highlighted "in-target" TTV DNAemia as the sole independent variable significantly linked to decreased risk for long-term complications due to inadequate immunosuppression (odds ratio [OR]: 0.27 [0.09-0.77]; p = 0.019). Our data suggest that the longitudinal monitoring of TTV DNAemia in kidney transplant recipients could help preventing the long-term complications due to inadequate immunosuppression.

Oral 11 - Long-term outcomes of renal transplantation in patients with end-stage renal disease (ESRD) due to nephrolithiasis

Oral 11 - Long-term outcomes of renal transplantation in patients with end-stage renal disease (ESRD) due to nephrolithiasis

Poster 3 - Perioperative and long-term outcomes of renal transplantation in patients with cystic fibrosis

Poster 3 - Perioperative and long-term outcomes of renal transplantation in patients with cystic fibrosis

Does Socioeconomic Disadvantage Impact Long-term Renal Transplant Outcomes Despite Excellent Perioperative Results?

Cisneros, Rafael; Ruffolo, Luis MD; Dale, Benjamin Scott; Martens, John MPH; Villa, Mariana Chavez MD; Nair, Amit MBBS, MD, MS; Taylor, Jeremy MD; Kashyap, Randeep MD, MPH; Hernandez-Alejandro, Roberto MD, FACS; Pineda-Solis, Karen MD Author Information

Quality of Life of Post-renal Transplant Patients in Rawalpindi.

Objectives The objective is to assess the overall quality of life (QoL) in patients who had undergone renal transplant within the last three years and correlate this index with various demographic variables such as age, gender, marital status, and education level and to correlate the QoLscore calculated vs. the health status perceived by the patients themselves Materials and methods This was an analytical cross-sectional study, carried out over a period of five months. A total of 123 patients were targeted amongwhich data from 79 patients were gathered including all the patients that underwent kidney transplantation in the past three years at a renal transplant center in CMH, Rawalpindi, Pakistan. Non- Probability convenience sampling was used, and data were collected using the WHOQOL-BREF tool that contained 25 questions targeted to four domains (physical, psychological, social, and environmental). The Questionnaire was administered over the phone with proper consent taken beforehand. Data were analyzed using Excel and SPSS version 23. Results A total of 79 patients were administered the questionnaire with the mean age of our study population being 35±11 years out of which 84.5% were male and 15.5% were female. Patients received the kidney from relative donors (98.4%) with the highest percentage being sister donors (30.9%). The majority of patients reported from Punjab (54.4%), with the rest from far-flung rural areas. An estimated 62.5% of the patients presented with other systemic/psychological disorders such as DM+, IHD, HTN, Hepatitis C, depression, etc. The mean global score of these patients was 79.21 which can be broken down into four domains, physical domain 80.40, psychological domain 78.99, social domain 82.70, and environmental domain 74.75. Conclusion In a developing country such as Pakistan, with most of the patients belonging to lower or middle socioeconomic groups, we believe that the patient's own sense of QoLis overshadowed by the mere exuberance of being given a second chance at life which was portrayed by the discrepancies in the perceived vs actual QoL graph. One common recurring theme that was noticed whilst interviewing the patients was that the difficulties they might have faced post-transplant paled in comparison to how grateful they were to live another day. A positive trend was noticed between the time since transplant and the QoL score which could be attributed to various factors such as the use of aggressive immunosuppressants, fear of injury, fear of transplant rejection, etc. in the first-year post-transplant. Demographic variables such as income, age, location, etc. did not affect the scores of these patients on a great scale. The present study aims to guide cliniciansin the improvement of long-term outcomes of renal transplantation in Pakistan.

Predictors of Short-Term Outcomes in Living Donor Renal Allograft Recipients: A Prospective Study From a Tertiary Care Center in North India.

BackgroundRenal transplantation is the optimal treatment for patients of all ages with end-stage kidney disease. The long-term outcomes of renal transplantation are assessed by graft and patient survival rates. These outcomes are, in turn, influenced by post-transplant events such as delayed graft function, rejections, post-transplant infections, and post-transplant diabetes mellitus (PTDM). Each of these short-term outcomes is, in turn, determined by the interplay of various factors in the pre-, peri-, and post-transplant period. This prospective study was designed to understand the factors affecting short-term outcomes in living donor transplantation and their effect on graft and patient survival.MethodologyA total of 86 patients underwent live donor renal transplantation between January 1, 2015, and March 31, 2016, at a tertiary care hospital in north India. Of these, five were lost to follow-up, and the remaining 81 patients were prospectively followed up to December 31, 2017.ResultsThe majority of the recipients were males (91%) and the donors were females (74%). Spousal and related donors comprised 49% and 51% of donations, respectively. The mean estimated glomerular filtration rate (eGFR) of donors was 98 ± 9.2 mL/minute/1.73m². Induction therapy with basiliximab was given to 21/81 (26%) recipients. The majority of recipients (68/81, 84%) received triple-drug immunosuppression with prednisolone, tacrolimus, and mycophenolate mofetil. Delayed graft function (DGF) occurred in 4/81 (4.9%) cases. Biopsy-proven acute rejections (BPARs) occurred in 15/81 (18.5%) cases, two-thirds of which were acute antibody-mediated rejections (ABMRs). During the follow-up period, 50 episodes of infections occurred in 35/81 (43.2%) recipients, with the most common being urinary tract infection (23/81, 28.5%). PTDM was diagnosed in 22/81 (27.2%) patients beyond six weeks of transplant. On multivariate logistic regression analysis, the most significant predictor of DGF was acute rejections and vice versa. Acute rejections also predicted the occurrence of post-transplant infections. Pre-transplant hepatitis C virus (HCV) infection and cyclosporine-based therapy were significant predictors of PTDM. At the six-month follow-up, 10/81 (12.3%) patients developed graft dysfunction. The predictors of graft dysfunction at six months were recipients of related donors and rural patients. One-year graft survival, death-censored graft survival, and patient survival rates were 85.2%, 92.6%, and 91.3%, respectively. The most common cause of death was post-transplant infections (5/7, 71.4%) of which the majority (4/5, 80%) were fungal infections. On multivariate logistic regression analysis, the most significant predictor of graft loss and patient loss was low pre-transplant donor eGFR and PTDM, respectively.ConclusionsGraft and patient survival in living donor kidney transplantation are influenced by a multitude of interdependent factors during the pre-transplant (donor eGFR, type of donor, socioeconomic status, HCV infection in recipient, type of immunosuppression) and the post-transplant (DGF, rejections, infections, and PTDM) period.

Sub-classification of borderline changes into diffuse or focal and its impact on long-term renal transplant outcomes

BackgroundBorderline changes (BL) with stable renal function is a controversial category in renal transplantation, given its contradictory outcomes. The aim of this study was to compare the clinical outcomes of BL in patients with stable renal function classified as focal and diffuse according to the extent of tubulitis. MethodsPatients with no history of rejection with a surveillance graft biopsy at 3 or 12 months showing BL (n = 40), acute cellular rejection (n = 20) or normal biopsies (n = 20), were included in this study. Biopsies with BL were divided into diffuse BL (BLD) and focal BL (BLF) according to the extent of tubulitis. Because of the low frequency of subclinical ACR (ACRND) (n = 12), biopsies with ACR and graft dysfunction (ACRD) (n = 8) were also included. A composite outcome that included the presence of rejection in subsequent biopsies, graft loss, patient death, decrease in GFR ≥30% or presence of de novo DSA (dnDSA) during the first year of follow-up was evaluated. ResultsThe primary composite outcome occurred in five patients of each of the Normal, BLF and ACRND, eight patients with BLD and six patients with ACRD (p = 0.105). A trend towards more rejection episodes was observed in the ACRND and ACRD. Also, a shorter time to rejection in the BLD, ACRND and ACRD groups compared to BLF and Normal groups (p = 0.039) was observed. During the first year of follow-up, no patient in the ACRND group developed dnDSA, compared to 15–25% in the other groups. The median time of dnDSA development in the BLF group was 45 months, and in the BLD group was 10 months (p = 0.020). ConclusionClassifying BL biopsies with stable renal function into focal and diffuse categories, is a simple and feasible strategy that helps to differentiate between BLD with a phenotype that shows a trend towards worse outcomes, and BLF that behaves more similar to normal biopsies.

Future strategies to improve short- and long-term outcomes of renal transplantation in dogs

ABSTRACT: Transplants for cats with naturally occurring renal disease have been introduced into clinical practice, but canine renal transplantation represents a greater challenge because of the lack of a balanced immunosuppressive protocol, difficulty in selecting compatible canine kidney donors, and absence of transplantation monitoring protocols. This and other important factors will be discussed in this review to help improve short- and long-term outcomes for renal transplantation in dogs.

Graft and survival outcome in renal transplant patients receiving cyclosporine and azathioprine versus tacrolimus and mycophenolate mofetil: A single-center retrospective observational study

There is paucity of data on long-term outcome of renal transplantation across different immunosuppression groups. Rationale and Objective: The study looks at long-term outcomes in renal transplant patients receiving azathioprine, cyclosporine combination (Group 1) with mycophenolate mofetil and tacrolimus (Group 2) with terms of patients and graft survival. We also analyzed the spectrum of infections across the two groups. Study Design: A retrospective observational study was conducted from 1995 to 2014 at St. John's Medical College and Hospital, Bengaluru. Patients received treatment as per standard protocol. Setting and Participants: Renal transplant recipients who regularly visited outpatient department. Analytical Approach: Statistical analysis was done by using SPSS 19 software. Continuous variables were analyzed using Student's t-test. Pearson's correlation test used for correlating variables. Kaplan–Mere curve used for calculating survival. Primary Outcomes: Rejection rates were similar across both the groups. The patient survival was 65% and 70% in Group 1 and 2 at 5 years, respectively. Graft survival was 65% and 75% in Group 1 and 2 at 5 years. Secondary Outcome: Bacterial and fungal infections were more common in Group 1, whereas viral infections were more in Group 2. In addition, infections tend to occur early in Group 2. Limitations: Single center, retrospective study. Conclusion: Patient and graft survival were similar across both the groups.

Long-term outcomes of renal transplantation in pediatric patients

Long-term outcomes of renal transplantation in pediatric patients

Renal transplantation in patients with an augmentation cystoplasty.

BackgroundThe effects of renal transplantation in patients with augmentation cystoplasty are still controversial. We retrospectively analyzed nine patients who underwent renal transplantation after augmentation cystoplasty.MethodsA total of nine patients who underwent augmentation cystoplasty prior to renal transplantation between January 1990 and May 2020 were reviewed. Basic information on augmentation cystoplasty, transplant procedures, and long-term outcomes of renal transplantation were analyzed.ResultsThe bowel segments utilized for augmentation cystoplasty were the stomach in two patients (one patient needed revision using the ileum), the ileum in four patients, the ileocolic pouch in one patient, the sigmoid in one patient, and the ureter in one patient. All the cystoplasties were performed prior to renal transplantation. The mean follow-up period after transplantation was 161 months (range, 2–341 months). Two patients had an episode of acute rejection each; however, their graft functions were well-maintained. Five patients had recurrent urinary tract infections, and three of these patients progressed to allograft failure. One patient died from bladder cancer with a functioning graft. Five of nine patients showed well-maintained graft function.ConclusionsRenal transplantation after bladder augmentation surgery is a major operation requiring a high level of surgical skill. Based on our long-term experiences, we recommend diligent postoperative monitoring for urinary tract infections, optimal catheter use, and use of appropriate antibiotic prophylaxis to avoid severe complications.

Β2-Microglobulin Post Kidney Transplantation as A Predictor of Subsequent Kidney Allograph Dysfunction

Background: Long-term outcome in renal transplantation is heterogeneous, and predicting success is challenging. Serum β2-microglobulin (β2MG), a novel marker of kidney function, predicts mortality and kidney failure in the general population, and its elevation following transplantation is a marker of acute rejection. Objective: To determine whether serum beta-2-micro-globulin one three-year post-transplant period could predict the decline in GFR over a follow-up period of six months. Patients and methods: This study was carried out at the National Institute of Nephrology and Urology, Cairo, Egypt. The patients were subjected to different demographic, clinical, biochemical, ultrasonographic, and endoscopic findings. In this study, 42 primary kidney transplant recipients were included. Results: The results showed a significant increase in serum β2-microglobulin level between renal transplant recipients with unstable kidney functions in comparison to renal transplant recipients with stable kidney function. The results showed serum β2-microglobulin level could be a good predictor of renal graft outcomes. Measurements of serum levels of beta 2 micro-globulin could be more sensitive and more specific than serum creatinine as renal function tests for early prediction of graft dysfunction. Conclusion: In this study, we found an association between serum level of β2MG in the late post-transplant period and a subsequent decline in kidney allograft function within a short time-frame. The overall results show that a higher serum level of β2MG after a single measurement at different intervals of the late post-transplant period independently predicts the lower eGFR. Thus, higher serum β2MG is a risk factor for graft function, particularly with longer follow-up.

Re: Long-Term Outcome of Renal Transplantation in Patients with Congenital Lower Urinary Tract Malformations: A Multicenter Study.

Re: Long-Term Outcome of Renal Transplantation in Patients with Congenital Lower Urinary Tract Malformations: A Multicenter Study.

Long-term Outcome of Renal Transplantation in Patients with Congenital Lower Urinary Tract Malformations: A Multicenter Study.

Renal insufficiency can occur in patients with congenital lower urinary tract malformations (LUTM) even when managed during infancy. Data in the current literature concerning this subject remain sparse. The aim of this study was to report the feasibility and long-term results of renal transplantation during adulthood in patients with a congenital LUTM. A retrospective multicenter study from 3 French renal transplant centers was conducted, including 123 transplantations on 112 patients with LUTM (1996-2016). Graft survival, patient survival, and complications were analyzed. Results were stratified according to the underlying uropathy and the type of initial management during childhood or before transplantation. In this study, patients suffering from posterior urethral valves (n = 49), spina bifida (n = 21), central neurogenic bladder (n = 13), bladder exstrophy (n = 14), prune belly syndrome (n = 12), Hinman syndrome (n = 6), urogenital sinus (n = 4), and other pathologies (n = 4) were included. The mean age at transplantation was 32.1 years old (±11.2). The mean follow-up period was 7.2 years. Patient survival at 1, 5, 10, and 15 years was 97.4%, 93.0%, 89.4%, and 80.0%, respectively. Graft survival at 1, 5, 10, 15, and 20 years was 96.6%, 87.6%, 77.3%, 60.6%, and 36.4%, respectively. Enterocystoplasty and continent urinary diversions exposed grafts to more frequent acute pyelonephritis (P = 0.02). There was no difference in graft survival when transplantation was performed on an enterocystoplasty or urinary diversions compared with a native bladder, provided a well-conducted bladder management. Even though enterocystoplasty and continent urinary diversions exposed grafts to more frequent acute graft pyelonephritis, patient and graft survival rates in LUTM at 10 years were similar to other kidney transplantations on native bladders.

Prognostic factors for renal transplant graft survival in a retrospective cohort of 1000 cases: The role of desensitization therapy

To review the results of renal transplantation after promulgation of the Human Organ Transplant Act in Taiwan in 1987, we conducted a retrospective study in the first 1000 cases performed in our hospital. Prognostic factors for graft survival were assessed with emphasis on the impact of donor-specific antibody (DSA). Between January 1988 and April 2014, there were 1000 cases of renal transplantation performed in our hospital. Excluding 30 patients of ABO-incompatible transplantation, we reviewed 970 cases of ABO-compatible renal transplantation to analyze the prognostic factors for graft survival. The patients were grouped according to the dates of operations before (the Early group: 503 cases) and after (the Late group: 467 cases) the introduction of detection and desensitization of alloantibody in our hospital in 2004. The overall 5-year graft survival rate were 82.6%, which was significantly lower in the Early group (79.2%) than the Late group (86.3%) (p=0.0012). The 1-year rejection-free survival was significantly lower in the Early group (78.3%) than the Late group (91.2%) (p=0.0165). The difference between the two groups became insignificant when the time of observation extended beyond 12 months. In a multivariate regression model, we identified significant factors for poor graft survival, including HLA mismatches, delayed graft function with or without recovery, and antibody-mediate rejection (AMR). HLA mismatches, delayed graft function with or without recovery, and AMRwere significant factors for poor graft survival. Detection and desensitization of DSA currently might be inadequate to improve the long-term outcome of renal transplantation.

Association of polymorphisms in leptin and adiponectin genes with long-term outcomes in renal transplant recipients.

The effect of polymorphims in leptin and adiponectin genes on long-term outcomes of renal transplantation is unknown. In 349 renal transplant recipients (RTR), we aimed to determine associations between five SNPs in the leptin receptor (LEPR) and adiponectin (ADIPOQ) genes and these outcomes. Follow-up time ranged from 2 to 25 years (mean 10.29 ± 5.16 years). Two SNPs showed associations with long-term outcomes and their statistical significance greatly increased after 39 RTR with a history of cardiovascular events prior to transplantation were removed from the analysis. Adjusted odds ratios (OR) for LEPR rs1805094 and ADIPOQ rs1501299 and risk of graft loss were 0.35 (0.16-0.74) p = 0.006 and 2.37 (1.28-4.37) p = 0.006, respectively. The assessment of risk for global mortality revealed OR values of 0.20 (0.06-0.62), p = 0.005, and 2.43 (1.08-5.44), p = 0.031 for LEPR rs1805094 and ADIPOQ rs1501299, respectively. Our results show that polymorphism in genes involved in leptin and adiponectin function modify long-term outcomes in renal transplantation.

Long-term outcome of renal transplantation: a 10-year follow-up of 765 recipients.

Renal transplantation is a treatment of choice for patients with end‑stage renal disease. The main goal of transplant care is to achieve the best long‑term patient survival (PS) and graft survival (GS). We aimed to assess the impact of various immunosuppression (IS) protocols on PS and GS following renal transplantation. This was a retrospective single‑center cohort study including a total of 765 consecutive adult renal transplant recipients (RTRs) who underwent transplantation between 1998 and 2003. The primary endpoints included PS and GS. The secondary endpoints were graft function determined by estimated glomerular filtration rate and hospitalization length per patient per year. Ten‑year PS and GS rates were 88.6% and 78.7%, respectively. The intent‑to‑treat (ITT) group received IS that was later changed, whereas in the group on randomized therapy (ORT), the same IS protocol was maintained during follow‑up. The ITT group had significantly better PS and GS than the ORT group. In the ITT group, patients treated with a combination of tacrolimus (TAC) and azathioprine (AZA), cyclosporine (CSA) and AZA, or CSA and mycophenolic acid metabolites (MPAs) had significantly better PS than those treated with TAC and MPA. The ORT group receiving AZA in any combination also had significantly better PS than MPA‑treated individuals. The effect of IS protocols on long‑term outcomes varies depending on patient subpopulations. Immunosuppressive therapy solves rejection‑related problems but does not address the increasing mortality of RTRs due to cardiovascular diseases, malignancies, or infections. Therefore, treatment recommendations should be individualized and posttransplant care, provided mainly by internists, should be carefully structured to improve long‑term outcomes of renal transplantation.

The evolution of donation after circulatory death renal transplantation: a decade of experience

This study compared long-term outcomes of renal transplantation from donors following donation after circulatory death (DCD) with those following donation after brain death (DBD) from one of the largest centres in the UK. Recipients of renal transplants from deceased donors between 2002 and 2014 were identified from a prospectively maintained database. Outcomes were compared between DCD (468) and DBD (905) donors and between standard criteria donors (SCDs) and extended criteria donors (ECDs). Graft survival (GS) and patient survival (PS) from DCD and DBD donors were comparable up to 10 years (GS: 61 versus 55%, P = 0.780; PS: 78 versus 71%, P = 0.285, respectively). Graft function was comparable after 3 months. GS and function were worse in the ECD groups, with no difference between EC-DBD and EC-DCD. PS in the ECD groups was worse than the SCD groups and PS in the EC-DCD group was worse than in the EC-DBD group. DCD donors were an independent risk factor for delayed graft function. Post-operative complications and EC-DCD donation were independent risk factors for reduced GS and PS. This study supports the use of DCD renal grafts with comparable long-term survival and function to DBD grafts. The use of EC-DCD grafts is justified in selected recipients and provides acceptable function and survival advantages over dialysis.

Is big bad or bearable? Long-term renal transplant outcomes in obese recipients.

The global obesity epidemic has implications for kidney transplantation. There are conflicting reports regarding the impact of obesity on long-term post-transplant outcomes. To explore the impact of body mass index (BMI) on long-term outcomes after kidney transplantation. The association between BMI and cardiovascular disease, cancer, post-transplant diabetes mellitus, graft and recipient survival was investigated in recipients who had been transplanted at least ten years previously. All consecutive adult renal transplant recipients who received first, deceased donor, transplants between 1986 and 2005 in Northern Ireland were followed-up until 2016. A total of 328 patients were eligible. Of them, 96 were overweight with a BMI 25.0-29.9kg/m2, and 56 were obese with a BMI exceeding 29.9kg/m2. Median follow-up time was 16.7 years. In multivariate analysis recipient BMI was associated with the development of post-transplant diabetes mellitus (P=0.003), but not with new cardiovascular disease (P=0.78). Cancer was less common in recipients with a higher BMI (hazard ratio (HR) 0.58, P < 0.001). BMI at the time of transplantation did not significantly influence graft (P=0.28) or recipient survival (P=0.13). Increased BMI at time of transplantation is associated with an increased risk of post-transplant diabetes mellitus but not new cardiovascular disease or malignancy. Long-term graft and recipient survival is not impacted. Potential recipients should not be excluded from transplantation solely on the basis of obesity, rather it should be considered as one part of an individualized risk stratification, based on comorbidity and considering the risk of death on maintenance dialysis.

Long-term outcome of renal transplantation from octogenarian donors: A multicenter controlled study.

To assess whether biopsy-guided selection of kidneys from very old brain-dead donors enables more successful transplantations, the authors of this multicenter, observational study compared graft survival between 37 recipients of 1 or 2 histologically evaluated kidneys from donors older than 80 years and 198 reference-recipients of non-histologically evaluated single grafts from donors aged 60 years and younger (transplantation period: 2006-2013 at 3 Italian centers). During a median (interquartile range) of 25 (13-42) months, 2 recipients (5.4%) and 10 reference-recipients (5.1%) required dialysis (crude and donor age- and sex-adjusted hazard ratio [95% confidence interval] 1.55 [0.34-7.12], P=.576 and 1.41 [0.10-19.54], P=.798, respectively). Shared frailty analyses confirmed similar outcomes in a 1:2 propensity score study comparing recipients with 74 reference-recipients matched by center, year, donor, and recipient sex and age. Serum creatinine was similar across groups during 84-month follow-up. Recipients had remarkably shorter waiting times than did reference-recipients and matched reference-recipients (7.5 [4.0-19.5] vs 36 [19-56] and 40 [24-56] months, respectively, P<.0001 for both comparisons). Mean (± SD) kidney donor risk index was 2.57±0.32 in recipients vs 1.09±0.24 and 1.14±0.24 in reference-recipients and matched reference-recipients (P<.0001 for both comparisons). Adverse events were similar across groups. Biopsy-guided allocation of kidneys from octogenarian donors permits further expansion of the donor organ pool and faster access to a kidney transplant, without increasing the risk of premature graft failure.