Renal Transplant Patients Research Articles

Effects of different sensitization events on HLA alloimmunization in renal transplant cases; a retrospective observation in 1066 cases

BackgroundPatients awaiting solid organ transplantation may develop anti-HLA antibodies after sensitization events such as transfusions, pregnancies, or previous transplantations. However, the effects of a particular sensitization event on HLA alloimmunization have not been well studied in parallel using cell-based assays and solid-phase assays. In this study, we evaluated and compare how different sensitization events affect the HLA antibody screening (HLA-Ab) and donor specific antibody (DSA) status in solid renal organ transplantation patients. MethodsHLA antibody (HLA-Ab) screening tests like complement-dependent cytotoxicity crossmatch (CDC-XM), flow cytometry crossmatch (FC-XM) and Luminex panel-reactive antibody (L-PRA) were performed in all 1066 patients (635 males and 431 females). If any of these tests turned out to be positive, a Luminex single antigen bead (L-SAB) assay was performed for DSA identification. Test positive rates and antibody strengths were analyzed according to the different sensitization events and gender. ResultsIn this study, HLA-Ab screening tests positive rates (L-PRA, FC-XM and CDC-XM) were significantly higher in patients with previous transplantation (73.91%, 100% and 56.52% p < 0.001), previous pregnancy (57.46%, 70.14% and 18.85% p < 0.001) or blood transfusion (27.33%, 35.55% and 7.33% p < 0.001) compared with patients without a sensitizing event (6.17%, 13.58% and 1.09). In this study, re-transplantation group showed significantly stronger antibody strength (DSA) than non sensitized group (class I and II MFI 11418.04, 17,837.78 vs class I and II MFI 2659, 3329; P < 0.001) and those with single sensitization events of transfusion (class I and II MFI 11418.04, 17,837.78 vs class I and II MFI 5790.26, 6004.16; P < 0.001) or pregnancy (class I & II MFI 11418, 17,837 vs class I and II MFI 8631.71, 7253.29; P < 0.001). ConclusionsPregnancy and blood transfused had high allo-immunization rate for class I HLA antigens. While re-transplantation patients had high allo-immunization rate for both the HLA classes (HLA- class I and HLA- class II). Re-transplantation group showed significantly stronger antibody strength, followed by pregnancy and then transfusion.

Prognosis and Treatment for Active and Chronic Antibody-Mediated Rejection in Renal Transplant Recipients; Single Center Experience

The aim of the study was to evaluate the prognostic factors and treatment alternatives of antibody-mediated rejection (ABMR) in renal transplant patients. Three thousand renal transplant patients were included in the study. The patients were first divided into 2 groups. Group 1: ABMR [-] recipients (n=2871), Group 2: ABMR (+) recipients (n=129). ABMR patients were compared among themselves by dividing them into 3 subgroups (early-active, late-active, chronic-active). The study was performed retrospectively. Different combinations of methylprednisolone, intravenous immunoglobulin (IVIG), rituximab, plasmapheresis (PP), anti-thymocyte globulin (ATG) were used in the treatment and the results were compared. Graft survival and functions were worse and the rates of CAD, delayed graft function, BK virus, and cytomegalovirus higher in patients with ABMR. Also, graft survival was lower in patients with serum creatinine ≥3 (P=0.001), GFR <30 (P <0.001), and spot urine protein to creatinine ratio ≥1 (P = 0.042) at the time of diagnosis. High interstitial fibrosis and tubular atrophy scores in chronic ABMR cases and high intimal arteritis scores in active ABMR cases were poor prognostic factors. The study showed that ABMR has a poor prognosis in terms of clinical parameters, and treatment should be individualized according to pathologic findings and graft functions at the time of diagnosis. Pulse methylprednisolone and IVIG should be used in the treatment of all ABMR patients, but PP, rituximab, and ATG should be used in selected cases. ABMR has a poor prognosis and treatment should be individualized.

Retrospective Study from a Single Center in Romania of 347 Renal Transplant Patients Treated with Tacrolimus, Mycophenolate, and Steroids to Evaluate the Association Between Anti-HLA Antibodies and 5-Year Graft Survival.

BackgroundKidney transplantation is the most recommended treatment in chronic kidney disease. The recipient’s immune system reacts to a kidney graft as to an alloantigen by producing antibodies (anti-human leukocyte antigens [HLAs]). Although immunosuppressive therapy is used to overcome this problem, the long-term survival of a kidney graft after 5 years remains low. This retrospective study from a single center in Romania of 347 renal transplant patients treated with tacrolimus, mycophenolate, and steroids aimed to evaluate the association between anti-HLA antibodies and 5-year graft survival.Material/MethodsAnti-HLA antibodies were screened and identified using the Luminex method, while tacrolimus levels were monitored using the chemiluminescent assay.ResultsTwenty-seven patients had pre-existing anti-HLA antibodies, while 320 patients did not. Of the 320 patients, 15% developed anti-HLA antibodies following kidney transplantation. The intrapatient minimum blood level of tacrolimus (cut-off value: 4.6 ng/mL) after transplantation was significantly associated with the risk of de novo anti-HLA antibodies (P<0.001). In patients with or without de novo anti-HLA antibodies, the 5-year allograft survival rate was 77.1% vs 90.8% (P=0.004). After Bonferroni correction, donor age (P=0.001), and donor type (P<0.0001) were statistically associated with the risk of allograft rejection.ConclusionsThis study showed that anti-HLA antibodies at 5 years after kidney transplantation were significantly associated with graft failure. The findings support previous studies and indicate that monitoring of anti-HLA antibodies should be considered in patients with renal transplant.

Early post-transplant urinary tract infection epidemiology and risk factor

Background and objectives: Renal Transplantation became the most successful management for end stage renal failure; postoperative urinary tract infection is the most common complication. The aim is to evaluate the outcome and risk factors of posttransplant urinary tract infection. Methods: This is a prospective study for renal transplant patients between 2018-2019 in Hawler/ Rizgary and Paky hospital. Patients, who underwent renal transplant, with 1 year follow up. Variable risk factors assessment done including chronic renal failure etiology, preoperative dialysis duration, operation time, length of drain and Foley’s catheter, type of immune suppressive therapy used, time and numbers of hospitalization associated with posttransplant urinary tract infection were examined, the relation between the risk factors and urinary tract infection was evaluated. Results: Total of 63 patients was involved, 12 had a total of 24 urinary tract infection attacks; the most common isolated microorganisms were E-coli and Klepsiella. The infection frequently appeared during the first 120 days postoperatively. Among the analyzed variables, there was no significant difference. Assessing all the variables, number of hospitalization after discharge were significantly more frequent in the 12 patients with infection attacks, although 31 patients out of 63 had hospitalized, as compared to patients without infection, but this difference was statistically insignificant. Conclusions: The most significant period for infection in renal transplanted patients after 1 year follow up is the first 4 months postoperatively. Patients who were admitted to hospital for different reasons and those who had preoperative history of urinary tract infection, have a higher risk.

Risk of human papillomavirus infection and cervical intraepithelial lesions in Chinese renal transplant recipients.

ObjectiveWhile human papillomavirus (HPV) infection in women is associated with cervical intraepithelial neoplasia and cervical cancer, HPV testing is not often performed in routine practice for renal transplantation patients. The genotype-specific prevalence of HPV and risk factors for HPV infection are still unclear.MethodsFrom 2010 to 2020, patients receiving renal transplantation surgery (referred to as RTRs), who had been screened for HPV infection one year after transplantation were enrolled. A comparison cohort of four age- and marital status-matched healthy individuals was selected for RTRs. The clinical characteristics and cervical screening results of RTRs were analyzed.ResultsOur study included 196 female renal transplant recipients (RTRs), none of whom had been vaccinated against HPV. Overall high-risk HPV (hrHPV) infection and abnormal cytology rates in the RTR group were 23.5% and 20.9%, respectively. The odds ratios of hrHPV infection and cervical intraepithelial neoplasia grade 2+ in RTRs vs. non-RTRs were 3.033 (95% CI, 2.013-4.568) and 3.628 (95% CI, 1.863-7.067), respectively. The prevalence of HPV16 in RTRs was much higher (30.4% vs. 8.3%, P=0.002). The multi-infection rate was much higher in HPV-infected RTRs (23.9% vs. 1.14%, P<0.001). The only risk factor for hrHPV infection was the duration of immunosuppression, which increased with time.ConclusionRTRs had significantly higher HPV infection rates and increased risks of HPV-related cervical premalignancies and cancers due to the immunosuppressed state. The duration of immunosuppression is a risk factor for transplant recipients. Female RTRs may benefit from more frequent cervical cancer screening after renal transplantation than healthy women. Prospective research on HPV infection dynamics in RTRs and optimal screening methods should be further explored in the future.

Nonpruritic hypopigmented macules on an immunocompromised patient

Nonpruritic hypopigmented macules on an immunocompromised patient

A renal transplant patient with COVID-19 presented with acute cellular rejection

A 27-year-old man underwent a deceased kidney transplant. Three days after transplantation, COVID-19 was diagnosed for our patient. Immunosuppressants were reduced and a renal biopsy was conducted, which showed acute T cell-mediated rejection. We intened to share a case to help clinicians to understand the risks that kidney transplant recipients face.

Donor-directed immunologic safety of COVID-19 vaccination in renal transplant recipients

Infection risk and COVID-19 outcomes make SARS-CoV-2 vaccination essential forsolid-organ transplant recipients. Reports of immune activation after vaccination causing graft failure raise concerns, but data are limited. Here, we document graft function, donor-derived-cell-free-DNA(dd-cfDNA), and donor-specific antibodies (DSA) in solid-organ renal transplant recipients after vaccination.Retrospective demographics, graft function, and immunologic parameters were collected in 96 renal transplant patients one month after their second vaccine dose. For-cause biopsies were performed based on clinician judgment.Similar proportions of subjects experienced increases (39.6 %) and decreases (44.8 %) in serum creatinine in the post-vaccination period, p = 0.56. Similar proportions of subjects experienced increases (23 %) and decreases (25 %) in serum ddcfDNA in the post-vaccination period, p = 0.87. Post-vaccination changes in serum creatinine and ddcfDNA (r(95) = −0.04, p = 0.71), serum creatinine and cumulative DSA MFI (r(95) = 0.07, p = 0.56), and ddcfDNA and cumulative DSA MFI(r(95) = 0.13, p = 0.21) were not significantly correlated. Five subjects had increased cumulativeDSA MFI, but there were no de novo cases. Biopsies on three subjects confirmed pre-existing diagnoses.Our study found minimal evidence ofdonor-directed immunologic activity post-vaccination, and all immunologic changesdid not correlate to graft dysfunction. We believe these findings do not amount to evidence ofpost-vaccination deleterious donor-directed activation. SARS-CoV-2 vaccination is immunologically safe and should continue for renal transplant recipients.

Serum Hepcidin and Ferritin Have Not Correlation With Inflammatory Markers in Kidney Transplant Patients

In renal transplant patients, increased ferritin is associated with an increased risk of cardiovascular disease, transplant rejection, and mortality. Serum ferritin elevates in renal transplant patients due to blood product transfusion, inflammation, and malignancies. Hepcidin is also a peptide hormone produced in the liver in response to anemia, hypoxia, or inflammation. The aim of this study was to investigate the relationship between ferritin, hepcidin, iron, TIBC, and serum inflammatory markers in renal transplant patients. The cross-sectional descriptive-analytical study was conducted on 60 renal transplant patients referred to Hazrat-Rasool and Imam-Ali clinics and Al-Mahdi Laboratory of Shahrekord selected by convenience sampling method. Serum ferritin, hepcidin, iron, TIBC, and inflammatory markers levels were determined by standard kits by ELISA. Data were analyzed by SPSS software. Serum iron had a significant negative correlation with erythrocyte sedimentation rate (ESR) (r= -0.418, P=0.001) and a negative correlation with C reactive protein (CRP) (r= - 0.243, P=0.061). TIBC had a significantly negative association with ferritin (r= - 0.27, P=0.037). Ferritin, hepcidin, and TIBC were not significantly correlated with inflammatory factors. The results of the study showed no significant relationship between ferritin, hepcidin, and TIBC with inflammatory factors in renal transplant patients.

A randomized controlled trial to evaluate efficacy and safety of early conversion to a low-dose calcineurin inhibitor combined with sirolimus in renal transplant patients.

Background:The calcineurin inhibitor (CNI)-based immune maintenance regimen that is commonly used after renal transplantation has greatly improved early graft survival after transplantation; however, the long-term prognosis of grafts has not been significantly improved. The nephrotoxicity of CNI drugs is one of the main risk factors for the poor long-term prognosis of grafts. Sirolimus (SRL) has been employed as an immunosuppressant in clinical practice for over 20 years and has been found to have no nephrotoxic effects on grafts. Presently, the regimen and timing of SRL application after renal transplantation vary, and clinical data are scarce. Multicenter prospective randomized controlled studies are particularly rare. This study aims to investigate the effects of early conversion to a low-dose CNI combined with SRL on the long-term prognosis of renal transplantation.Methods:Patients who receive four weeks of a standard regimen with CNI + mycophenolic acid (MPA) + glucocorticoid after renal transplantation in multiple transplant centers across China will be included in this study. At week 5, after the operation, patients in the experimental group will receive an additional administration of SRL, a reduction in the CNI drug doses, withdrawal of MPA medication, and maintenance of glucocorticoids. In addition, patients in the control group will receive the maintained standard of care. The patients’ vital signs, routine blood tests, routine urine tests, blood biochemistry, serum creatinine, BK virus (BKV)/ cytomegalovirus (CMV), and trough concentrations of CNI drugs and SRL at the baseline and weeks 12, 24, 36, 48, 72, and 104 after conversion will be recorded. Patient survival, graft survival, and estimated glomerular filtration rate will be calculated, and concomitant medications and adverse events will also be recorded.Conclusion:The study data will be utilized to evaluate the efficacy and safety of early conversion to low-dose CNIs combined with SRL in renal transplant patients.Trial registration:Chinese Clinical Trial Registry, ChiCTR1800017277.

Identification of Pathogenic Fungi in Renal Transplant Patients by Conventional and Molecular Methods

Identification of Pathogenic Fungi in Renal Transplant Patients by Conventional and Molecular Methods

Identification of Pathogenic Fungi in Renal Transplant Patients by Conventional and Molecular Methods

Opportunistic fungal infections due to the immune- compromised status of renal transplant patients are related to high rates of morbidity and mortality regardless of their minor incidence. Delayed in identification of invasive fungal infections (IFIs), will lead to delayed treatment and results in high mortality in those populations. The study aimed to assess the frequency of invasive fungal infection in kidney transplant recipients by conventional and molecular methods. This study included 100 kidney transplant recipients (KTR) (75 males, and 25 females), collected from the Centre of Kidney Diseases and Transplantation in the Medical City of Baghdad. Blood samples were collected during the period from June 2018 to April 2019. Twenty one out of 100 renal-transplanted patients were infected with pathogenic fungi, four of the patients were females and 17 were males. There is an observation of a high incidence of fungemia in patients with the abnormal value of blood urea according to PCR and culture results. Referring to fungal isolates the most prevalent was Saccharomyces cerevisiae, which account for 19 isolates out of 21 the other two isolates were Zygosaccharomyces rouxii and Aspergillus flavus. The results of the current study show significant correlation between PCR and culture methods at (P&lt;0.0009).

BI03: Renal transplant patients and photoprotecting: do they practice what we preach?

BI03: Renal transplant patients and photoprotecting: do they practice what we preach?

Outcomes of Percutaneous Peritoneal Dialysis Catheters Insertion by Interventional Radiologists: A Single-Institution Experience

Abstract Objectives This article evaluates the short- and long-term outcomes of percutaneous peritoneal dialysis (PD) catheters inserted by interventional radiology service and analyzes the factors that affect the sustainability of patent and functional PD catheters. Materials and Methods Retrospective single-institution study between April 2015 and February 2021. A total of 131 patients (75 males) were enrolled with mean age of 50 ± 19.6 years with an average body mass index (BMI) of 28 ± 7 kg/m2. Technical and clinical success were evaluated. Catheter-related complications were classified into mechanical and nonmechanical categories, including infectious complications. Indications for removal were analyzed. Results Technical and clinical success were 100%. The average dwelling time for the entire cohort was 497.5 ± 462.3 days. Forty-six patients (35%) were on PD at the last follow-up with an average dwelling time of 492 days. PD-related complications were reported in 79/131 (60.3%) patients, including peritonitis (40.46%; 53/131), followed by malposition/migration (12.21%; 16/131), tunnel/exit site infection (10.69%; 14/131), and dysfunction (12.21%; 16/131). The incidence of peritonitis within 30 days postinsertion was 9.43% (5/53). The average interval between insertion and migration was 100.5 ± 144.8 days (95% confidence interval, 6.9–14.4). There was a trend for a higher rate of malposition/migration in patients with higher BMI (p = 0.0561). Causes for PD catheters removal were: (1) infection-related (24.4%; 32/131), (2) renal transplant recipients (16%; 21/131), (3) mechanical complications (13.7%; 18/131), and (4) patient's preference (7.6%; 10/131). Conclusion Percutaneous PD catheter placement by interventional radiologists provides acceptable long-term outcomes and complication rates that meet the recommended standards.

COVID-19 vaccination antibody responses in patients with aplastic anaemia and paroxysmal nocturnal haemoglobinuria

COVID-19 vaccination antibody responses in patients with aplastic anaemia and paroxysmal nocturnal haemoglobinuria

BI01: Dupilumab in the management of atopic dermatitis in an immunosuppressed renal transplant patient

BI01: Dupilumab in the management of atopic dermatitis in an immunosuppressed renal transplant patient

The Frequency of Lymphocele and its Management in Post Renal Transplant Patients in a Tertiary Care Hospital of Khyber Pakhtunkhwa, Pakistan

Objective&#x0D; To assess the frequency of lymphocele and its management in patients with live renal transplant.&#x0D; Introduction&#x0D; Renal transplant is the treatment of choice for patient with ESRD. Although it improve quality and increase life expectancy but it is not without major and minor complications one of that complication is lymphocele that cause that cause severe morbidity and even graft dysfunction. We conducted this study to find the frequency of lymphocele in patients undergoing renal transplant.&#x0D; Material and Methods&#x0D; This is a retrospective study conducted in the Institute of Kidney Diseases and Transplant. The files of all those patients were analyzed who underwent live donor renal transplant from Jan 2015 to July 2020. The demographic and all relevant data were entered in a proforma. For analysis we entered data in SPSS version .&#x0D; &#x0D; Results&#x0D; From Jan 2015 to July 2020 42 renal transplants were performed. Male patients were 32 (76 %) and female were 10 (23.8%) ratios male to female 3.2 to 1. Mean age 37.5 years (range 50 to 25 years). Of these 5 (11.9%) patients developed lymphocele 3 patients (7.1%) developed mild lymphocele without any renal dysfunction that treated conservatively while two (4.7%) presented with hydronephrosis and renal dysfunction one of this respond to percutaneous aspiration and tetracycline installation while one after failed response to percutaneous aspiration and sclerotherapy treated by laparoscopic interaperitoneal drainage.&#x0D; Conclusion&#x0D; Lymphocele is one of the common cause of renal transplantation that respond to different treatment modalities range from conservative to minimally invasive or major intervention in the form of open surgical technique or laparoscopic intervention.

الحدوث وعوامل الخطورة لطفيل الأبواغ الخفية بين مرضى نقص المناعة في مدينة إب – اليمن

Cryptosporidium parasite is causing opportunistic Cryptosporidiosis diseases among Immunocompromised patients that lead to acute and persistent diarrhea and health complications, especially in developing countries. This study amid to determine the occurrence of C. parvum among immunocompromised patients presenting at Al- Thawra hospital in Ibb city- Yemen. Sample of the study (87) stool specimens were collected between November 2016 and July 2017. The stool specimens were screened for the C. parvum by using formalin- ether concentration, Ziehl- Neelsen methods, and enzyme- linked immunosorbent assay (ELISA). The required data were obtained by a designed questionnaire. The result revealed that the overall rate of C. parvum was 62 (71.26%) observed among immunocompromised patients and both males and females had nearly equal frequency rates of infection. The highest rate of infection was 80% reported within age less than 10 years and 78.3% among patients who coming from the rural area. Also, it was found 83.33% of infected patients drinking from piped water with significant difference (P&lt;0.05). In addition, 73.81% of individuals contacting animals were positive for infection. The most frequent rate of infection was 53.2% recorded for chronic renal failure, 42% for malignancy, and 4.8% for renal transplant patients. The clinical features most frequently presented were diarrhea, malaise, poor appetite, weight loss, abdominal pain, and fever. Similarly, 90.3% and 97.8% of cases were suffered from semi- liquid diarrhea and acute diarrhea, respectively. Recommendation as described in this study health education programs are needed for preventing and controlling the transmission of Cryptosporidium parasites among weak immune individuals.

Characteristic of medication compliance behavior in renal transplantation patients.

After renal transplantation, patients need to take various immunosuppressant, but the drug compliance is poor. The theory of planned behavior suggests that the past medication behavior and subjective norms of individuals are closely related to medication compliance. This study aims to explore the change of medication compliance behavior and its influenting factors for renal transplantation patients at different stages. This study was a prospective longitudinal study. The Basel Assessment of Adherence with Immunosuppressive Medication Scale (BAASIS), Medication Belief Scale, Social Support Scale and Quality of Life Scale were used to dynamically follow up renal transplantation patients at pre-operation and 1-month, 6-month, and 12-month after transplantation. A total of 300 patients completed the whole follow-up. The percentage of patients with good medication compliance was 97.60%, 87.30% and 84.30% at 1-month, 6-month and 12-month after transplantation respectively. The life quality of the patients was decreased at 6 months after the operation, and the patients with better self-reported life quality had poor medication compliance. After adjusting for demographic data, the risk of medication incompliance in patients with poor medication compliance before operation was 37.646 times than those with good compliance. Patients who did not use medication reminders had high risk (odds ratio=2.467) of drug non-adherence. The risk of drug non-adherence in patients with more postoperative misgivings was 1.265 times compared with that in patients with less postoperative misgivings. The medication compliance decreases with the time of transplantation, but the medication compliance of patients with good self-reported life quality is poor. Medication concerns reduce the compliance behavior. Preoperative medication behavior has a significant predictive effect on postoperative behavior. Medication reminder is a protective factor for promoting compliance. Medical staff should pay more attention to preoperative medication belief, behaviors and reminder of using drug so as to provide precise intervention in the renal transplantation patients.

Knowledge Regarding Post-Operative Care of Patients with Kidney Transplantation among Nurses in Peshawar, Pakistan

OBJECTIVES Kidney transplantation is a surgical procedure and the best treatment choice for end-stage renal disease. This study aims to assess nurses’ level of knowledge regarding post-operative care of patients with kidney transplantation. METHODOLOGY This descriptive cross-sectional was carried out in Hayatabad Medical Complex (HMC) and Rehman Medical Institute (RMI) Peshawar from February 2019 to May 2019. These are tertiary care hospitals; the former is a public sector hospital while the latter is a private sector hospital. A convenient sampling technique was followed and included 109 participants. Data were collected using a structured questionnaire of 25 items related to the care of post-renal transplantation on a Likert Scale. Frequencies and percentages were calculated for demographic variables. The Mean and standard deviation were calculated for knowledge among nurses. A Chi-square test was applied to find an association between demographic variables and level of knowledge. Data were analyzed with SPSS 20. RESULTS Of the total number of participants 109, 23 (26.6%) were females, and 77 (73.3%) were male. The mean score of knowledge was 11.59±3.391 out of 25. Of the participants, 62(56.9%) fell into the poor score, and the average score was awarded by 44 (40.4%), while 3 participants (2.8%) scored good knowledge. CONCLUSION The nurses demonstrate poor knowledge regarding post-operative care of patients with kidney transplantation. Education and experience play an essential role in enhancing the education of nursing staff working in kidney transplantation units. Formal training needs to be imparted to provide quality care to renal transplantation patients.