Outcome Of Renal Transplantation Research Articles

MO981OUTCOMES OF INTERLEUKIN-2 RECEPTOR ANTAGONIST INDUCTION THERAPY IN STANDARD-RISK RENAL TRANSPLANT RECIPIENTS MAINTAINED ON TACROLIMUS - A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Background and Aims Interleukin-2 (IL-2) antagonist has been used as an induction therapy in many centres in calcineurin inhibitor-sparing regimens. Tacrolimus has overwhelmingly replaced cyclosporine in the maintenance immunosuppressive protocols in many transplant centres. The aim of our study and meta-analysis is to explore the effect of IL-2 induction therapy on the rate of rejection and patient and graft survival in standard-risk renal transplant patients with tacrolimus-based maintenance immunotherapy. Secondary aims included assessment of the effect of IL-2 induction therapy on the risk of delayed graft function, cytomegalovirus (CMV) infection, and malignancy. Method We conducted a systematic review in different databases to identify studies and research work that assessed the effect of IL-2 antibody induction therapy on renal transplant outcomes. Inclusion criteria for our meta-analysis were all studies that compared IL-2 induction therapy with placebo or no induction therapy in standard-risk renal transplant recipients on tacrolimus-based maintenance immunosuppressive therapy. Data collected were the name of the first author, journal title, year of publication, country where the study was conducted, number of patients in the IL-2 induction therapy arm and in the placebo arm, number of patients who had biopsy-proven rejection and graft survival in each arm. A random effects model was used for the meta-analysis. We divided the studies included in this meta-analysis into two groups: Group A (included studies that used same dose of tacrolimus in both arms of each study) and Group B (included studies that compared patients who received induction therapy and low dose tacrolimus versus those who received no induction therapy and high dose of tacrolimus). Standard-risk renal transplant was defined as HLA mismatch <5 and PRA<50%. Results In group A, 11 studies were included (n=2886). IL2-RA induction therapy was not associated with significant differences in comparison to no induction therapy in terms of acute rejection rates (Risk Ratio=1.03, 95% Confidence Interval [CI] range: 0.84 - 1.26, I squared=0%, P=0.79), graft survival (Risk Ratio=1.15, 95% CI range: 0.82 to 1.62), delayed graft function (Risk Ratio=1.01, 95% CI range: 0.82 to 1.24), CMV infection (Risk Ratio =1.37, 95% CI range: 0.53 to 3.51) or malignancy (Risk Ratio=1.29, 95% CI range: 0.61 to 2.75). In group B, two studies were included (n=669). There was no difference between both arms in terms of acute rejection rates (Risk Ratio=0.62, with 95% CI range: 0.33 to 1.14) or graft survival (Risk Ratio=1, 95% CI range: 0.57 to 1.74) or delayed graft function (Risk Ratio=0.88, 95% CI range: 0.45 to 1.71). Conclusion IL2-RA induction therapy does not improve outcomes in patients maintained on tacrolimus-based immunotherapy in standard risk population. our results strengthen the argument for individualized medical therapy and the potential tailoring the immunosuppression regimes according to the actual patients, needs.

Impact of C1q fixing donor-specific antibodies on renal transplant outcome.

Not all anti-HLA donor-specific antibodies (HLA-DSAs) are detrimental to renal allograft. In this context, the C1q complement activating ability of antibodies appears to be an important parameter to distinguish clinically inert versus detrimental DSAs. We evaluated sera of 206 consecutive primary live donor renal transplant recipients before transplant and at post-operative day 7, 30, 90, 180 and at the time of graft dysfunction for quantifying HLA-DSAs using single antigen bead assay on a Luminex platform. Patients positive for these antibodies with an MFI >500 were further screened for C1q fixing nature of DSA. Fourteen of the 18 antibody-positive patients had C1q fixing DSA with MFI value >5000. Only 4 antibody-positive patients did not have C1q fixing DSA. The MFI values of DSA detected by C1q assay were generally higher at least by 25% than those detected by the conventional IgG-SAB assay. Twelve of the 14 patients (85.71%) with C1q+ DSA developed antibody-mediated rejection during the mean follow-up period of 21.43±8.03months as compared to none of the four C1q-negative DSA (85.71% vs 0%; P=.001). These results suggest deleterious effect of C1q+ DSA vis-à-vis C1q-negative DSA on renal allograft.

Long-Term Renal Transplant Outcome in Patients With Posterior Urethral Valves. Prognostic Factors Related to Bladder Dysfunction Management.

Introduction: To obtain a successful renal transplant (RT) outcome in patients with posterior urethral valves (PUV), it is necessary to accomplish an adequate bladder dysfunction treatment. Our aim was to determine prognostic factors related to bladder dysfunction management in long-term RT outcome in patients with PUV.Methods: A retrospective review of patients with PUV who received a first RT after 1985 in our institution with at least 5 years of follow-up was performed. Variables analyzed included prenatal diagnosis, age of diagnosis, initial presentation and management, bladder dysfunction treatment, other surgical treatments, pre-transplant dialysis, age of transplantation, type of donor, immunosuppression regimen, vascular and urological complications, rejections episodes, and graft survival.Results: Fifty-one patients were included in the analysis. Prenatal diagnosis was done in 37.3%. Median age of diagnosis was 0.30 (0–88) months. Initial presentation was vesicoureteral reflux (VUR) in 78% and obstructive ureterohydronefrosis in 35.3%. Initial management was valve ablation (29.4%), pyelo-ureterostomy (64.7%), and vesicostomy (5.9%). In 33.3%, a type of bladder dysfunction treatment was performed: 21.6% bladder augmentation (BA), 15.7% Mitrofanoff procedure, 17.6% anticholinergic drugs, and 27.5% clean intermittent catheterization (CIC). Pre-transplant dialysis was received by 66.7%. Transplantation was performed at 6.28 ± 5.12 years, 62.7% were cadaveric and 37.3% living-donor grafts. Acute rejection episodes were found in 23.6%. Urological complications included recurrent urinary tract infections (UTIs) (31.4%); native kidneys VUR (31.4%); graft VUR (45.1%); and ureteral obstruction (2%). Vascular complications occurred in 3.9%. Mean graft survival was 11.1 ± 6.9 years. Analyzing the prognostic factor that influenced graft survival, patients with had CIC or a Mitrofanoff procedure had a significant better long-term graft survival after 10 years of follow-up (p < 0.05), despite of the existence of more recurrent UTIs in them. A better graft survival was also found in living-donor transplants (p < 0.05). No significant differences were observed in long-term graft survival regarding native kidneys or graft VUR, BA, immunosuppression regimen, or post-transplant UTIs.Conclusion: Optimal bladder dysfunction treatment, including CIC with or without a Mitrofanoff procedure, might result in better long-term graft survival in patients with PUV. These procedures were not related to a worse RT outcome in spite of being associated with more frequent UTIs.

Effect of leptin concentrations and leptin receptor gene polymorphisms on the outcome of renal transplantation.

Leptin is a pro-inflammatory adipocytokine implicated in cardiovascular disease, insulin resistance, obesity and chronic kidney disease. In a cohort of 236 renal transplant recipients, we aimed to determine whether circulating leptin concentrations and/or three polymorphisms in the leptin receptor (LEPR) gene, namely rs1137100, rs1137101 and rs1805094, were related to clinical outcomes in renal transplantation. Plasma leptin concentrations were measured by ELISA. Genetic variants were determined by conventional real-time PCR assays, and statistical associations with clinical outcomes were obtained by logistic regression modelling. Patients with elevated leptin levels were at higher risk of acute rejection (OR = 1.03 (1.01-1.05), p = 0.03) and displayed worse renal clearance (p = 0.001) than patients with lower levels. Leptin levels were not significantly affected by any of the three LEPR SNPs. The rs1137101 G variant showed an inverse association with the risk of delayed graft function (DGF) (OR = 0.42 (0.22-0.81), p = 0.009), whilst the homozygous rs1805094 CC genotype was associated with increased risk of acute rejection (OR = 11.38 (2.15-60.16), p = 0.004). A statistically significant association was also observed between the rs1137100 GG genotype and better renal function [mean difference vs. AA/AG = 20.20 (4.91-35.49) ml/min, p = 0.010]. Our results show that both leptin plasma concentrations and polymorphisms in the LEPR gene may affect clinical outcomes in renal transplant recipients, suggesting that the determination of these parameters could be useful in predicting post-transplant adverse events.

Effect of Utilizing More Than 20-Year Older Deceased Donor Kidneys for Young Recipients: An Analysis of the UK Registry.

Despite the wider acceptance of expanded criteria kidneys and the advances in immunosuppression, clinicians remain sceptical when it comes to accepting kidneys from significantly older donors, especially for the young adult recipient population (age ≤40 years). We utilized prospectively maintained data from the United Kingdom Registry and analyzed the deceased donor renal transplant outcomes for 2 cohorts: (1) young recipients who received either a younger kidney or a kidney from a donor who was less than 20 years older (group <20; n = 2072) and (2) young recipients who received a kidney from donors who were 20 or more years older (group ≥20, n = 764). We used life tables for survival and performed Cox regression analysis to identify significant variables. Median follow-up was 2918 days. The univariate analysis for graft loss showed the strongest predictors to be donor age, recipient age, recipient ethnicity, and delayed graft function, which retained their significance in the multivariate model. Graft survival rates were 94% versus 90% at 1 year, 86% versus 75% at 5 years, and 75% versus 63% at 10 years for group <20 versus group ≥20, respectively. Respective patient survival rates were comparable for both cohorts: 99% versus 98% at 1 year, 97% versus 96% at 5 years, and 91% versus 91% at 10 years. Our analysis showed that allografts from ≥20-year-older deceased donors are beneficial and should be considered for transplant in younger recipients. Allograft survival may be worse compared with survival with younger allografts; however, young recipients do potentially better and survive longer compared with remaining on dialysis.

POS-754 EVALUATING THE OUTCOMES OF KIDNEY TRANSPLANTATION IN SICKLE CELL DISEASE PATIENTS: A SYSTEMATIC REVIEW.

Nephrologists increasingly face the emerging challenge of managing sickle cell disease (SCD) patients with End-stage Renal Disease (ESRD). The increasing cohort of patients is due to improvements in SCD treatment, meaning that more people go on to develop complications such as Sickle Cell-associated Nephropathy (SCAN). Nigeria has the highest burden of SCD in the world, with rising cases of SCAN. In this patient cohort, some authors have recommended kidney transplantation as the choice of renal replacement therapy (RRT). However, the outcomes of renal transplantation in SCD patients have been variable with conflicting data presented in individual studies. We decided to conduct a systematic review to critically evaluate the outcomes of kidney transplantation in sickle cell disease patients and compare data from other countries with Nigeria. We expected that the results of our review would shed more light on kidney transplant outcomes in patients with SCD as well as identify gaps and areas of interest for future studies. We conducted a systematic search of MEDLINE via PubMed to identify studies that reported on outcomes of kidney transplantation in adult SCD patients, restricting results to those published from the year 2000. We then screened papers based on eligibility criteria in stages. First, we screened titles and abstracts based on eligibility. Common reasons for exclusion were studies with participants who did not have SCD and those without any reported outcome measure. Full texts of the remaining articles were subsequently read and selected based on eligibility criteria. We extracted data using a standardised data extraction form and presented our findings in a narrative synthesis. To ensure rigour, we adhered to the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines in conducting and reporting this review. Database search conducted on 1st march 2020 found 88 papers. We also identified 6 additional articles that met the inclusion criteria following bibliographic review of eligible studies. We screened 94 records by title and abstract and removed 76 that did not meet the inclusion criteria. We screened the full-text versions of 18 articles and identified 9 for inclusion in this review. 6 articles were case reports and 3 were statistical studies using registry data. Insights generated from included studies relate to short term outcomes of renal transplant recipients who have SCD, with patient survival ranging from to 90.5% to 100% in the first year post-transplant. However, long term outcomes are significantly lower and can be as low as 55.7% at six years post-transplant. Renal transplantation in SCD presents both benefits and complications which need to be communicated to patients to ensure informed consent. We can mitigate adverse outcomes with adequate preoperative care and multidisciplinary team approach in managing complications on a case-by-case basis.

Pre-transplant Social Adaptability Index and clinical outcomes in renal transplantation: The Swiss Transplant Cohort study.

The impact of pre-transplant social determinants of health on post-transplant outcomes remains understudied. In the United States, poor clinical outcomes are associated with underprivileged status, as assessed by the Social Adaptability Index (SAI), a composite score of education, employment status, marital status, household income, and substance abuse. Using data from the Swiss Transplant Cohort Study (STCS), we determined the SAI's predictive value regarding two post-transplant outcomes: all-cause mortality and return to dialysis. Between 2012 and 2018, we included adult renal transplant patients (aged≥18years) with pre-transplant assessment SAI scores, calculated from a STCS Psychosocial Questionnaire. Time to all-cause mortality and return to dialysis were predicted using Cox regression. Of 1238 included patients (mean age: 53.8±13.2years; 37.9% female; median follow-up time: 4.4years [IQR: 2.7]), 93 (7.5%) died and 57 (4.6%) returned to dialysis. The SAI's hazard ratio was 0.94 (95%CI: 0.88-1.01; p=.09) for mortality and 0.93 (95%CI: 0.85-1.02; p=.15) for return to dialysis. In contrast to most published studies on social deprivation, analysis of this Swiss sample detected no significant association between SAI score and mortality or return to dialysis.

Renal transplantation outcomes in obese patients: a French cohort-based study

BackgroundWhilst there are a number of publications comparing the relationship between body mass index (BMI) of kidney transplant recipients and graft/patient survival, no study has assessed this for a French patient cohort.MethodsIn this study, cause-specific Cox models were used to study patient and graft survival and several other time-to-event measures. Logistic regressions were performed to study surgical complications at 30 days post-transplantation as well as delayed graft function.ResultsAmong the 4691 included patients, 747 patients were considered obese with a BMI level greater than 30 kg/m2. We observed a higher mortality for obese recipients (HR = 1.37, p = 0.0086) and higher risks of serious bacterial infections (HR = 1.24, p = 0.0006) and cardiac complications (HR = 1.45, p < 0.0001). We observed a trend towards death censored graft survival (HR = 1.22, p = 0.0666) and no significant increased risk of early surgical complications.ConclusionsWe showed that obesity increased the risk of death and serious bacterial infections and cardiac complications in obese French kidney transplant recipients. Further epidemiologic studies aiming to compare obese recipients versus obese candidates remaining on dialysis are needed to improve the guidelines for obese patient transplant allocation.

Chronic transplant glomerulopathy: New insights into pathogenesis

There have been recent significant advances in short-term outcomes in renal transplantation, however, long-term allograft survival remains a challenge. With reported incidences as high of 74.5% of chronic graft loss in patients with biopsies showing transplant glomerulopathy (TG), this syndrome represents an important factor for chronic allograft complications. In this review we show an overview of the novel mechanistic insights into pathogenesis of TG, as well as a brief description of the pathology, diagnosis and newer prognostic indices within TG diagnosis. These data raise intriguing roles for cell-mediated immunity and podocyte stress in TG as well as reinforce previous associations of TG with ABMR. We also delve into management strategies for TG and report the paucity of existing clinical trial data for this prevalent condition in renal transplants.

BK Virus-Associated Nephropathy after Renal Transplantation.

Recent advances in immunosuppressive therapy have reduced the incidence of acute rejection and improved renal transplantation outcomes. Meanwhile, nephropathy caused by BK virus has become an important cause of acute or chronic graft dysfunction. The usual progression of infection begins with BK viruria and progresses to BK viremia, leading to BK virus associated nephropathy. To detect early signs of BK virus proliferation before the development of nephropathy, several screening tests are used including urinary cytology and urinary and plasma PCR. A definitive diagnosis of BK virus associated nephropathy can be achieved only histologically, typically by detecting tubulointerstitial inflammation associated with basophilic intranuclear inclusions in tubular and/or Bowman’s epithelial cells, in addition to immunostaining with anti-Simian virus 40 large T-antigen. Several pathological classifications have been proposed to categorize the severity of the disease to allow treatment strategies to be determined and treatment success to be predicted. Since no specific drugs that directly suppress the proliferation of BKV are available, the main therapeutic approach is the reduction of immunosuppressive drugs. The diagnosis of subsequent acute rejection, the definition of remission, the protocol of resuming immunosuppression, and long-term follow-up remain controversial.

Renal transplant outcomes in amyloidosis.

Outcomes after renal transplantation have traditionally been poor in systemic amyloid A(AA) amyloidosis and systemic light chain (AL) amyloidosis, with high mortality and frequent recurrent disease. We sought to compare outcomes with matched transplant recipients with autosomal dominant polycystic kidney disease (ADPKD) and diabetic nephropathy (DN), and identify factors predictive of outcomes. We performed a retrospective cohort study of 51 systemic AL and 48 systemic AA amyloidosis patients undergoing renal transplantation. Matched groups were generated by propensity score matching. Patient and death-censored allograft survival were compared via Kaplan-Meier survival analyses, and assessment of clinicopathological features predicting outcomes via Cox proportional hazard analyses. One-, 5- and 10-year death-censored unadjusted graft survival was, respectively, 94, 91 and 78% for AA amyloidosis, and 98, 93 and 93% for AL amyloidosis; median patient survival was 13.1 and 7.9 years, respectively. Patient survival in AL and AA amyloidosis was comparable to DN, but poorer than ADPKD [hazard ratio (HR) = 3.12 and 3.09, respectively; P < 0.001]. Death-censored allograft survival was comparable between all groups. In AL amyloidosis, mortality was predicted by interventricular septum at end diastole (IVSd) thickness >12 mm (HR = 26.58; P = 0.03), while survival was predicted by haematologic response (very good partial or complete response; HR = 0.07; P = 0.018). In AA amyloidosis, recurrent amyloid was associated with elevated serum amyloid A concentration but not with outcomes. Renal transplantation outcomes for selected patients with AA and AL amyloidosis are comparable to those with DN. In AL amyloidosis, IVSd thickness and achievement of deep haematologic response pre-transplant profoundly impact patient survival.

Providers' View on the First Kidney Transplantation Center in Ethiopia: Experience From Past to Present.

Introduction:Transplantation is the optimal management for patients with end-stage renal disease. In Ethiopia, the first national kidney transplantation center was opened at St. Paul’s Hospital Millennium Medical College in September 2015. The aim of this study was to explore providers’ views and experiences of the past to present at this center.Methods:A qualitative study design was employed from 1st November to 15th December, 2019. To ensure that appropriate informants would provide rich study data, 8 health care providers and top management members were purposefully chosen for in-depth interviews. A maximum variation sampling method was considered to include a representative sample of informants. Interviews were digitally audio-recorded, and transcribed verbatim. Transcribed data was coded and analyzed using Qualitative Data Analysis (QDA) Minor Lite software and Microsoft-Excel.Result:The participants (5 males and 3 females) approached were from different departments of the renal transplant center, and the main hospital. Eight main themes and 18 sub-themes were generated initially from all interviews totaling to 109 index codes. Further evaluation and recoding retained 5 main themes, and 14 sub-themes. The main themes are; challenges experienced during and after launching the center, commitment, sympathy and satisfaction, outcomes of renal transplant, actions to improve the quality of service, and how the transplant center should operate. Providers claim that they discharge their responsibilities through proper commitment and compassion, paying no attention to incentive packages. They also explained that renal transplantation would have all the outcomes related to economic, humanistic and clinical facets.Conclusion and Recommendation:A multitude of challenges were faced during and after the establishment of the first renal transplant center in Ethiopia. Providers discharge their responsibility through a proper compassion for patients. Concerned stakeholders should actively collaborate to improve the quality of renal transplant services in the center.

A ferroptosis-related gene signature for graft loss prediction following renal allograft

ABSTRACT Allogeneic kidney transplantation (renal allograft) is the most effective treatment for advanced kidney disease. Previous studies have indicated that ferroptosis participates in the progression of acute kidney injury and renal transplant failure. However, few studies have evaluated the prognostic value of ferroptosis on renal transplantation outcomes. In this study, a total of 22 differentially expressed ferroptosis-related genes (DFGs) were identified, which were mainly enriched in infection-related pathways. Next, a ferroptosis-related gene signature, including GA-binding protein transcription factor subunit beta 1 (GABPB1), cyclin-dependent kinase inhibitor 1A (CDKN1A), Toll-like receptor 4 (TLR4), C-X-C motif chemokine ligand 2 (CXCL2), caveolin 1 (CAV1), and ribonucleotide reductase subunit M2 (RRM2), was constructed to predict graft loss following renal allograft. Moreover, receiver operating characteristic (ROC) curves (area under the ROC curve [AUC] > 0.8) demonstrated the accuracy of the gene signature and univariate Cox analysis suggested that the gene signature could play an independent role in graft loss (p < 0.05). Furthermore, the nomogram and calibration plots also indicated the good prognostic capability of the gene signature. Finally, immune-related and cytokine signaling pathways were mostly enriched in renal allograft patients with poor outcomes. Considered together, a ferroptosis-related gene signature and nomogram based on DFGs were created to predict the 1-, 2- and 3- year graft loss probability of renal allograft patients.The gene signature could serve as a valuable biomarker for predicting graft loss, contributing to improving the outcome of allogeneic kidney transplantation.

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.

The impact of Recipient and Donor Characteristics on Kidney Transplant Graft Survival

IntroductionMany factors determine the outcomes of renal transplant, including characteristics of both donors and recipients. Antihuman leukocyte antigen donor-specific antibodies are strongly linked to antibody-mediated rejection and late allograft loss.AimThe aim was to determine the effect of recipient and donor characteristics on kidney transplant graft survival, with special stress on panel-reactive antibodies.Participants and methodsThis study included 168 adult recipient and donor couples. The authors analyzed data of kidney transplants performed between the years of 2008 and 2018 at National Institute of Urology and Nephrology.ResultsThe authors found a significant increase in renal failure in recipients transplanted with unrelated donor kidney and in positive hepatitis C virus antibodies (HCV Abs) recipients (P = 0.002 and 0.001, respectively) and renal complications (P ≤ 0.001). There was also a significant increase in panel-reactive antibody-positive recipients to get renal complications (P = 0.03). There was a significant increase in renal failure with old-aged recipients (P = 0.008) and with increased duration of transplant (P = 0.003). By multivariate regression, the authors deduced that young age decreases graft loss risk (hazard ratio (HR): 0.88; 95% confidence interval (95% CI): 0.79–0.97; P = 0.017). Recipients of unrelated donor graft and HCV infection were associated with higher hazard ratio graft loss (HR: 13.56; 95% CI: 2.58–71.22; P = 0.002, and HR: 7.96; 95% CI: 1.04–60.44; P = 0.45). Unrelated donors graft were associated with 4 times higher hazard ratio renal complication (HR: 4.18; 95% CI: 2.01–8.72; P = 0.003). HCV infection increases risk three times (HR: 3.24; 95% CI: 1.31–7.99; P = 0.010). Unrelated donor was a significant independent predictor for recipient graft loss risk in a period of more than 5 years after transplantation.ConclusionThe authors concluded that recipient and donor characteristics have important roles on kidney transplant graft survival and also on renal complications.

Does the Microbiome Affect the Outcome of Renal Transplantation?

The role of the human microbiome in health and disease is becoming increasingly apparent. Emerging evidence suggests that the microbiome is affected by solid organ transplantation. Kidney transplantation is the gold standard treatment for End-Stage Renal Disease (ESRD), the advanced stage of Chronic Kidney Disease (CKD). The question of how ESRD and transplantation affect the microbiome and vice versa includes how the microbiome is affected by increased concentrations of toxins such as urea and creatinine (which are elevated in ESRD), whether restoration of renal function following transplantation alters the composition of the microbiome, and the impact of lifelong administration of immunosuppressive drugs on the microbiome. Changes in microbiome composition and activity have been reported in ESRD and in therapeutic immunosuppression, but the effect on the outcome of transplantation is not well-understood. Here, we consider the current evidence that changes in kidney function and immunosuppression following transplantation influence the oral, gut, and urinary microbiomes in kidney transplant patients. The potential for changes in these microbiomes to lead to disease, systemic inflammation, or rejection of the organ itself is discussed, along with the possibility that restoration of kidney function might re-establish orthobiosis.

Can the Timed Up & Go Test and Montreal Cognitive Assessment predict outcomes in patients waitlisted for renal transplant?

Frail patients who undergo renal transplantation (RT) have more complications; however, little is known if these patients can sustain the wait to RT. We used the Timed Up and Go Test (TUGT) and Montreal Cognitive Assessment (MoCA) to determine outcomes of RT candidates. In this retrospective study, 526 RT candidates underwent TUGT and MoCA (2015-2019) and were divided into "favorable" (transplanted or remained on the list) or "unfavorable" (not listed, removed from list, or died) outcome. Demographics, education, language, comorbidities, dialysis type, use of a walking device, TUGT, and MoCA were compared by outcome. Overall, 230 patients (43.7%) passed TUG, 268 (51%) passed MoCA, 133 (25.3%) passed both, and 161 (30.6%) failed both tests. Multivariate analysis demonstrated age≥65 (OR 1.58, CI 1.03-2.43), cardiac disease (OR 3.09, CI 2.02-4.72), ≥36months on dialysis (OR 1.80, CI 1.24-2.69), EPTS<20% at time of MoCA (OR 0.26, CI 0.07-0.98), and failing TUGT (OR 2.14, CI 1.43-3.19) were associated with unfavorable outcome. Failing MoCA was not associated with outcome. MoCA test results were not associated with RT waitlist outcomes; however, passing the TUGT was associated with receiving RT or remaining on the list. Additional studies are needed to validate this and determine outcome after RT.

Outcomes of renal transplant in elderly

Outcomes of renal transplant in elderly

Outcomes of renal transplantation in children with cystinosis

Outcomes of renal transplantation in children with cystinosis

Using electronic AKI alerts to define the epidemiology of acute kidney injury in renal transplants

BackgroundLittle is known regarding the impact of acute kidney injury (AKI) on renal transplant outcome. Our aim was to define the incidence and outcome of AKI in renal transplant patients using data collected from a national AKI electronic alert systemMethodsThe study represents a prospective national cohort study collecting data on 1224 renal transplants recipients with a functioning renal transplant, between April 2015 and March 2019.ResultsFour hundred forty patients experienced at least one episode of AKI giving an incidence rate of 35.4%. Sixty-four point seven% of episodes were AKI stage 1, 7.3% AKI stage 2 and 28% AKI stage 3. Only 6.2% of episodes occurred in the context of rejection. Forty-three point five% of AKI episodes were associated with sepsis. AKI was associated with pre-existing renal dysfunction, and a primary renal diagnosis of diabetic nephropathy. AKI was more prevalent in recipients from a donor after cardiac death (26.4% vs. 21.4%, p < 0.05) compared to the non-AKI cohort. Following AKI, 30-day mortality was 19.8% and overall mortality was 34.8%, compared to 8.4% in the non AKI cohort (RR 4.06, 95% CI 3.1–5.3, p < 0.001). Graft survival (GS), and death censored graft survival (DCGS) censored at 4 years, in the AKI cohort were significantly lower than in the non AKI group (p < 0.0001 for GS and DCGS).ConclusionThe study provides a detailed characterisation of AKI in renal transplant recipients highlighting its significant negative impact on patient and graft survival.