Poor Graft Survival Research Articles

Long-term Clinical Outcomes and Predictive Factors for Living-donor Liver Transplant Recipients With Biliary Strictures.

Biliary strictures frequently occur in living-donor liver transplant (LDLT) recipients. However, long-term clinical outcomes and their associated factors are unclear. We analyzed an historical cohort of 228 recipients who underwent LDLT with post-liver transplantation biliary strictures. Endoscopic retrograde cholangiography or percutaneous transhepatic biliary drainage were performed to treat biliary strictures. Patients that experienced persistent jaundice over 3 mo after the initial treatment were defined as a remission-failure group. Median observation period was 8.5 y after the diagnosis of biliary stricture. The 15-y graft survival (GS) rate was 70.6%, and 15-y rate of developing portal hypertension (PH) was 26.1%. Remission failure occurred in 25.0% of study participants. In the multivariate analysis, biopsy-proven acute rejection, and portal vein/hepatic artery abnormalities were risk factors for remission failure. Development of PH, retransplantation, and death were significantly more frequent in the remission-failure group. Remission failure and PH were associated with poor GS. In multivariate analyses, hepatic artery abnormality and biloma were common significant factors that were associated with a poor GS and development of PH. The insufficient blood supply reflected by hepatic artery abnormality and biloma might be the most important factor that can predict poor long-term survival in LDLT patients with biliary strictures. Future large-scale prospective studies are needed to validate our observations.

Increasing Living Liver Donor Pools: Liver Paired Exchange Versus ABO-incompatible Living Donor Liver Transplantation.

Increasing Living Liver Donor Pools: Liver Paired Exchange Versus ABO-incompatible Living Donor Liver Transplantation.

Relatively Poor Long-term Outcomes Following Liver Transplantation for NASH in the United States.

Nonalcoholic steatohepatitis (NASH) continues to increase in frequency as an indication for liver transplantation (LT). Data on long-term outcomes for these patients are limited. We aimed to compare long-term patient and graft survival in patients undergoing LT for NASH in the United States to other indications. We analyzed data from the Scientific Registry of Transplant Recipients of adult patients who underwent primary deceased-donor LT from January 1, 2005, to December 31, 2019. NASH has increased as an indication for LT by 4.5-fold, from 5.2% in 2005 to 23.4% in 2019. Patient (61.2%) and graft survival (59.2%) at 10 y are significantly poorer for NASH than for all other indications other than alcohol. Patients transplanted for NASH have higher body mass index (32.2 versus 27.6) and greater frequency of diabetes (13% versus 11.6%) than any other indication ( P < 0.001). Portal vein thrombosis, location in intensive care unit, dialysis, and pre-LT diabetes ( P < 0.001 for all) are independently predictive of patient death and graft loss. Body mass index is not predictive. NASH patients undergoing simultaneous liver kidney have markedly worse 10-y patient and graft survival than liver-only (52.3% versus 62.1%). Graft loss was attributed to recurrence of NASH in <1% of patients. LT for NASH is associated with relatively poor long-term patient and graft survival when compared with patients transplanted for other indications, NASH patients undergoing simultaneous liver kidney have the worst long-term outcomes.

Left lateral segment pediatric liver transplantation: a 25 year experience at Mount Sinai.

Outcomes of left lateral segment (LLS) grafts in pediatric recipients were compared between living (LD-LLS) and deceased donor (DD-LLS) grafts. 195 LLS grafts (99DD-LLS-96LD-LLS) were analyzed with a median follow-up of 9.1years. The primary endpoints were overall patient/graft survival. LD-LLS grafts were younger (0.9vs.1.4years, p=0.039), more likely to have a fulminant liver failure (17.9%vs.5.3%,p=0.002), less likely to have a metabolic disorder (6.3%vs.25.5%,p=0.002), and less likely to be undergoing retransplantation (5.3% vs.16.2%,p=0.015). There was a trend toward decreased hepatic artery thrombosis in LD-LLS grafts (6.6% vs. 15.5%,p=0.054). No differences in the overall biliary complications occurred. The LD-LLS group had prolonged survival compared to the DD-LLS group with 10-year survival rates of 81%, and 74% (p=0.005), respectively. LD-LLS grafts had longer graft survival compared to DD-LLS grafts (10-year graft survival 85%vs.67%,p=0.005). Recipient age >1year (HR 2.39,p=0.026), aortic reconstruction (HR 2.12,p=0.046) and vascular complication (HR 3.12,p<0.001) were independent predictors of poor patient survival. Non-biliary liver disease (HR 2.17,p=0.015), DD-LLS (HR 2.06,p=0.034) and vascular complication (HR 4.61,p<0.001) were independent predictors of poor graft survival. The use of SLT remains a viable option with excellent long-term outcomes. We show improved graft and patient survival with living donor grafts.

Outcomes and Allograft Survival of Patients Who Underwent a Second Kidney Transplant and Were Followed Up for 10 Years

Kidney transplantation is the treatment of choice for end-stage kidney disease, and a second transplantation becomes an opportunity for a better chance for long-term survival and quality of life. This study aimed to evaluate the outcomes and graft survival of patients transplanted a second time in comparison with single kidney transplant patients. This retrospective observational study was conducted using a cohort of kidney transplant patients from 2008 to 2018. Fifty patients who underwent first transplant were randomly selected as group 1 (G1), and 31 patients who received a second kidney transplant as group 2 (G2). Outcomes, graft, and patient survival were assessed. G2 patients had higher proportions of rejection episodes and graft loss than G1. Fifteen (48.39%) patients from G2 maintained functioning grafts during follow-up, while 16 (51.61%) lost their grafts. The 10-year graft survival rate for patients with first transplant was 76.66%; it was 46.09% for retransplanted patients (P=0.005). There was no statistically significant difference in patient survival between G1 and G2. Allograft survival rates of the first and second transplant with living donors had no statistically significant difference, but for deceased donors, poor graft survival was observed for the second allograft.

MO979: Influence of BK Virus Plasma Viral Load in Kidney Transplant Outcomes

Abstract BACKGROUND AND AIMS BK virus infection (BKi) is an important cause of kidney transplant (KT) loss. Besides to reducing immunosuppression, the rest of the therapies have not shown a clear benefit. Our purpose is to analyze the risk factors for BKi and the influence of BK plasma viral load on KT outcomes. METHOD Prospective cohort study of KT with BKi, defined by the presence of BK viremia in ≥3 consecutive determinations, from 01 January 2010 to 31 December 2020. BK viremia was determined every 10 days during the first 3 months, at 6th month, 12th month and in case of impaired renal function. In patients with positive viremia, immunosuppressive therapy was changed (reduction/discontinuation of mycophenolate and/or switching to everolimus). Patients with high-level viremia (≥10 000 copies/mL) and low-level viremia (&amp;lt;10 000 copies/mL) were compared. To identify risk factors for BKi, for each KT with BKi, we selected two matched controls and performed a logistic regression analysis. Graft survival was analyzed according to BK viremia (high-level, low-level and negative) using Kaplan–Meier and Cox regression analysis was performed to determine risk factors for graft survival. RESULTS 849 KT were performed, of which 67 (7.9%) presented BKi. Six KT were excluded due to incomplete data. Finally, 61 KT BKi (n = 27, high-level viremia; n = 34 low-level viremia) and 122 controls were analyzed. The median post-KT time to BKi was 2 months. In the multivariable analysis, male recipient, older age and re-KT were risk factors for BKi. Proven BK-associated nephropathy was diagnosed in five KT recipients and nine patients had persistent BK viremia, all of them from the high plasma viral loads group. Only one patient lost the graft due to BK-associated nephropathy. Patients with low-level viremia had worse renal function one month after KT than controls but without differences at the first year. Patients with high-level viremia had worse renal function one year after KT and worse graft survival than recipients with low-level viremia and controls (P = 0.037). In the multivariable analysis, when we analyzed exclusively patients with BKi, high-level viremia was a risk factor for kidney graft survival (HR: 16.31; P = 0.034). CONCLUSION BKi is not an uncommon complication after KT. Only high BK viral load was associated with BK-associated nephropathy, persistent viremia, and poorer graft survival. BK viremia &amp;lt;10 000 copies/mL did not affect KT outcomes. Therefore, monitoring BK plasma viral loads and changes in immunosuppression to reduce viremia are effective strategies to minimize the impact of BK virus on graft survival.

Long-term outcomes and prognostic factors in kidney transplant recipients in Jakarta, Indonesia: a cohort study

ObjectivesTo determine the long-term survival rates and prognostic factors in kidney transplant (KT) recipients in Jakarta, Indonesia.DesignRetrospective cohort study.SettingA KT centre in Jakarta.ParticipantsWe enrolled 754 consecutive adult recipients who underwent...

Biliary complications after adult to adult right-lobe living donor liver transplantation (A-ARLLDLT): Analysis of 245 cases during 16 years period at a single high centre- A retrospective cohort study

ObjectivesBiliary complications (BCs) after adult to adult living donor liver transplantation (A-ALDLT) result in poor graft and patient survival. This study aimed to analyze these complications. MethodsWe retrospectively analyzed BCs in 245 recipients who underwent A-ALDLT using the right–lobe graft during 16 years period in our centre. The overall male/female ratio was 215/30. ResultsOne hundred fifty-five BCs affected 102 of our recipients (95 early (≤3months) and 60 late (≥3months)). They were classified as 67/245(27.3%) early bile leak, 10/245(4.1%) early biliary stricture, 44/245(17.9%) late biliary stricture, 4/245(1.6%) early cholangitis, 10/245(4.1%) late cholangitis, 14/245(5.7%) early biloma, and 6/245(2.4%) late cholangitic abscesses. Multiple biliary anastomoses were independently correlated with Post liver transplantation (LT) overall BCs; moreover, post LT hepatic artery thrombosis or stenosis (HAT/S) was an independent predictor of overall BCs, strictures and leaks. The mortality affected 96(39.2%) cases mostly due to sepsis, bleeding and multi-organ failure (MOF). On the other hand, the biliary related mortality was 10.6% of cases. Multiple cholangitic hepatic abscesses were significant predictors of poor graft and patient outcomes. Conclusions: Multiple biliary anastomoses and post LT HAT/S lead to a poor biliary outcome, furthermore, cholangitis, cholangitic abscesses and sepsis lead to poor graft and patient outcomes, so proper management of those variables is mandatory to improve outcomes after A-ARLLDLT.

Vasopressin for Post-kidney Transplant Hypotension

IntroductionHypotension after deceased donor kidney transplant (DDKT) is a risk factor for delayed graft function (DGF) and poor graft survival (GS). We hypothesize that vasopressin use in hypotensive DDKT recipients (DDKTRs) to increase blood pressure (BP) reduces DGF rates and is safe without increasing mortality.MethodsGroup with vasopressin “study group” (n = 45) was defined as DDKTRs between 2012 and 2017 who required vasopressin for hypotension systolic BP (SBP) <120 mm Hg or diastolic BP (DBP) <60 mm Hg. DDKTRs with no-vasopressin “comparison group” (n = 90) were propensity score-matched DDKTRs between 2012 and 2017 without vasopressin use. Primary outcomes were GS, creatinine and allograft biopsy rate at 1 year, DGF rate, and death during transplant hospitalization.ResultsVasopressin group had lower mean maximum and minimum SBP and DBP in the operating room (OR). Median vasopressin start time post-DDKT was 2 hours (interquartile range [IQR] 1–6), and duration of use was 42 hours (IQR 24–63). DGF, creatinine at 1 year, and allograft biopsy rates were comparable. No deaths occurred during transplant hospitalization. Multivariable analysis did not find an effect of vasopressin use on GS.ConclusionTreatment of hypotensive DDKTRs with vasopressin is safe and facilitated similar graft function and survival with that of nonhypotensive patients. In the absence of a randomized control trial, our study supports the safety of vasopressin therapy to prevent the adverse effects of hypotension.

Eight-Year Results of an IgA- and IgM-Enriched Human Immunoglobulin-Based Therapy for Early Detectable Anti-HLA Donor Specific Antibodies After Lung Transplantation

<h3>Purpose</h3> The development of anti-HLA donor specific antibodies early after lung transplantation (eDSA) has been associated with antibody-mediated rejection (AMR) and poor graft survival. At our institution, since 2013, successive infusions of IgA- and IgM-enriched human intravenous immunoglobulins (IgGAM, first infusion: 2gr/kg, then 0.5gr/kg once every 4 weeks for a maximum of 6 months) formed the backbone of eDSA therapy. Actually, patients with only evidence of eDSA (possible subclinical AMR) are treated with IgGAM only. Patients with concomitant graft dysfunction (possible clinical AMR) or preformed DSA (positive virtual crossmatch) receive additionally plasmapheresis (PE) or immunoabsorption before the first IgGAM dose, and a single dose of anti-CD20 antibody (Rituximab) thereafter. Aims of this study were to present the 8-year results of the IgGAM-based therapy. <h3>Methods</h3> Records of patients transplanted between 02/2013 and 10/2021 were reviewed. Outcomes were compared between patients with eDSA and treated with IgGAM (IgGAM group) and without eDSA (control group)<i>.</i> Median (IQR) follow-up was 45 (21-72) months. <h3>Results</h3> During the study period, among the 994 transplanted patients, 250 (25%) patients formed the IgGAM group and 721 (73%) the control group. The remaining 23 (2%) patients (14 patients with eDSA but not treated, and 9 patients treated only with tPE and Rituximab) were excluded. Fifty-Five IgGAM patients (22%) showed pre-formed eDSA and 41 (16%) patients showed possible clinical AMR. Median time to eDSA detection was 14 days after transplantation. At follow-up end, treatment was completed in 229 (92%) patients (still on treatment, n=8; in-hospital deaths, n=4; treatment interrupted earlier as intended by protocol, n=9). In these patients, IgGAM treatment cleared eDSA in 208 (91%) patients, 29 (14%) patients showing eDSA recurrence a median of 12 months after treatment end. In IgGAM vs. control patients and at 5- and 8-year follow-up, respectively, graft survival (%) was 77 vs. 76 and 68 vs. 67 (p=0.53), and freedom from CLAD was 73 vs. 72 and 65 vs. 62 (p=0.76), respectively. <h3>Conclusion</h3> After lung transplantation, a treatment protocol for eDSA based on IgGAM yielded high eDSA clearance. Patients with eDSA and IgGAM-treatment have good 8-year graft survival similar to control patients.

Lung Transplant Recipients Developing Early DSAs within the First Month Are Characterized by a Higher Frequency of Naïve and a Lower Frequency of Memory B Cells

<h3>Purpose</h3> After lung transplantation (LuTx), the development of early donor-HLA-specific antibodies (eDSA) has been shown to be associated with antibody-mediated rejection (AMR) and poor graft survival. Since 2013, patients with eDSA within the first month after LuTx are treated with IgA/IgM-enriched intravenous immunoglobulins (IgGAM), in clinical AMR combined with anti-CD20 antibody (Rituximab). We hypothesize a different distribution and kinetics of IgD⁺CD27^- naïve B cells vs. IgD^-CD27^+/- memory B cell subsets in recipients with or without eDSA. <h3>Methods</h3> In a pilot study of 62 LuTx recipients, B cell subsets were by analyzed in blood pre, post (T0), 24 hours (T24) and 3 weeks after LuTx by flow cytometry using CD19, CD20, IgD, CD24, CD27, CD38 antibodies. Frequencies of B cell subsets were compared between two groups, eDSA-positive (n=14, 22,6%) and -negative (n=48, 77,4%) patients and healthy donors (n=30). <h3>Results</h3> Prior to LuTx, patients with end-stage lung disease showed significantly higher proprotions of IgD⁺CD27^- naïve B cells compared to HC (p<0.001). At T0, T1 and T24, patients with eDSAs showed significantly higher frequencies of naïve and lower frequencies of IgD^-CD27⁺ memory B cells (both p< 0.001) compared to eDSA-negative patients. These IgD⁺CD27^- naïve B cells displayed high CD24 and CD38 expression, which was stable also at 3 wks. A transient increase in IgD⁺CD27⁺ switch memory B cells was detected at T0 in both groups, returning to baseline levels at T24. <h3>Conclusion</h3> Lung transplant recipients show remarkable dynamics of naïve, memory and switch memory B cells within the first 3 wks. In both groups, we saw a shift in the B cell population: increased naïve B cells and decreased memory B cells, which was more pronounced in the eDSA group. Based on our preliminary data, a more refined B cell monitoring with additional markers may be able to identify patients with a higher risk for eDSA development. The impact of the treatment regimen on these B cell subsets is currently investigated.

Graft Survival in Pediatric Heart Retransplantation Can Rival Primary Heart Transplantation

<h3>Purpose</h3> Pediatric heart re-transplantation (re-HTx) has been associated with poorer graft survival when compared to first-time pediatric heart transplants (primary-HTx). Identification of patients who are more likely to benefit from re-HTx could aid clinicians in selecting patients for surgery. <h3>Methods</h3> The United Network for Organ Sharing (UNOS) database was queried to identify patients who underwent re-HTx from 1987 to 2020 and were less than 18-years-old at the time of their primary-HTx. This cohort was propensity matched with a set of primary-HTx patients based on several prognostic indicators. <h3>Results</h3> There were a total of 9,993 primary-HTx and 782 re-HTx. After matching, median graft survival [months (95% CI)] was longer for primary-HTx [129 (116 - 149)] than it was for re-transplants [109 (92 - 126)] with a hazard ratio [HR (95% CI)] of 1.21 (1.1 - 1.4, <i>p</i> = 0.0083). The difference in primary-HTx and re-HTx median graft survival was no longer statistically significant if the interval between primary-HTx and re-HTx was greater than 12 months (HR 1.15 [1.0 - 1.3], <i>p</i> = 0.0602), if re-HTx took place between the ages of 3 to 13 (HR 1.07 [0.89 - 1.3], <i>p</i> = 0.474), or if there were no episodes of acute rejection within the first year of primary-HTx (HR 0.99 [0.75 - 1.3], <i>p</i> = 0.962). If re-HTx took place within 12 months of primary-HTx, median survival dropped to 15 months (3 - 41) with a HR of 2.32 (1.7 - 3.2). <h3>Conclusion</h3> Graft survival is significantly shorter following re-HTx when compared to primary-HTx. However, there are multiple patient cohorts in which re-tx survival is equivalent to primary HTx survival (e.g. patients more than one year out from primary-HTx). Conversely, patients requiring a re-HTx within the first year of their primary-HTx have an abysmal graft survival and re-HTx for these patients may not be prudent. Further study to identify cohorts where re-HTx should and should not be pursued is needed.

Risk Factors for the Development of Early Anti-HLA Donor Specific Antibodies After Lung Transplantation: The Role of Primary Graft Dysfunction

<h3>Purpose</h3> The development of anti-HLA donor specific antibodies (DSA) after lung transplantation has been associated poor graft survival. DSA may develop early after lung transplantation or later, usually when chronic lung allograft dysfunction (CLAD) ensues. Early DSA have recently been considered a product of a memory rather than a de-novo reaction after alloantigen exposure. Aim of this study was to analyse the risk factors for the development of early DSA after lung transplantation. <h3>Methods</h3> Records of patients transplanted at our institution between 01/2013 and 10/2021 were retrospectively reviewed. Patients were controlled for eDSA every two weeks after transplantation until hospital discharge, using the Luminex single-antigen test (mean fluorescence index threshold, 1000). Multivariable binary logistic regression analysis, including variables with univariable p-value <0.10, was performed to identify factors associated with eDSA. Goodness-of-fit of the model was tested using the Hoshmer and Lemeshow (H-L) test. <h3>Results</h3> During the study period, among the 1007 lung-transplanted patients, 275 (27%) patients showed early detectable DSA (preformed, n=56; de-novo, n=254; class I, n=71; class II, n=239). Median (IQR) time to DSA detection was 14 (11-21) days. The binary logistic regression analysis showed that pediatric (<18 years old) transplantation (OR: 2.2, 95%CI: 1.8-2.8, p=0.001), presence of pretransplant HLA antibodies (OR: 2.1, 95%CI: 1.6-2.8, p<0.01), donor lung preservation with Organ Care System (OR: 0.37, 95%CI: 0.14-0.97, p=0.04), and primary graft dysfunction (PGD) score grade 2-3 at 72 hours after transplantation (OR: 1.8, 95%CI: 1.2-1.8, p=0.007) were associated with eDSA detection (H-L statistic, p=0.92). <h3>Conclusion</h3> The graft damage and donor antigen exposure provoked by primary graft dysfunction may lead to eDSA production, that should not be considered only a product of a memory but also of a de-novo reaction (Figure 1).

Effects and outcome of Direct Acting Antiviral Therapy for Eradication of Hepatitis C in Kidney Transplant patients

Aim: To look for effects and graft outcome of Direct Antiviral Agents on Hepatitis C positive Renal Transplant Patients Design: Prospective study Duration &amp; place of study: The study will be conducted in Shaikh Zayed Hospital’s Kidney Transplant Unit, Lahore, and will comprises of consecutive Hepatitis C positive Renal Transplant Recipients from January 2018 to January 2020 Methodology: The Hepatitis C Positive Renal Transplant Recipients will be selected after fulfilling Inclusion and Exclusion Criteria and we will follow the patient for 3 months after initiation of DAA regime. Result: The study included 50 patients average age was 36.1±10.5 years and 32(64%) of them were male and rest were females. Therapy for HCV was 100.0% successful. The total bilirubin levels, hemoglobin, platelet count, serum creatinine and eGFR had no significant change in averages over 12 weeks of treatment. The ALT and AST levels reduced significantly in first 4-week time and then stayed at a level while the ALP levels reduced significantly over all intervals of follow-ups. The albumin levels increased significantly at week 8 and stayed unchanged on week 12 as compared to baseline. The WBC count and blood glucose levels reduced significantly from baseline till end of study. 12th week was compared with baseline, it was observed that among 29 with eGFR &gt;90 at baseline 7(24.1%) had eGFR 60 – 90 and 3(10.3%) had eGFR even less (30 – 60). Conclusion: HCV is a well-recognised risk factor of poor graft survival in kidney transplant patients. In our study it was observed that DAA treatment can resolved HCV infection in kidney Transplant Recipients with significant improvement of liver function without loss of allograft function. Keywords: Hepatitis C, Direct Antiviral Agents, Sustained Virological Response

Primary Focal Segmental Glomerulosclerosis Recurrence After Pediatric Renal Transplantation.

Focal segmental glomerulosclerosis recurrence after renal transplant occurs frequently in pediatric patients and is associated with poor graft survival when patients reach adulthood. We investigated recurrence rates, recurrence risk factors, management strategies, and long-term graft function among pediatric renal transplant recipients with focal segmental glomerulosclerosis as primary disease. We retrospectively evaluated medical records of 34 pediatric patients with primary focal segmental glomerulosclerosis who had undergone renal transplant between 2004 and 2019 at our center. Focal segmental glomerulosclerosis recurrence was diagnosed by the presence of nephrotic range proteinuria after transplant and confirmed by graft biopsy. Preoperative prophylactic plasma exchange was administered to pediatric renal transplant recipients with primary focal segmental glomerulosclerosis. Plasma exchange was also used to treat focal segmental glomerulosclerosis recurrence, with rituximab added if the patient did not respond to plasma exchange. All patients (male-to-female ratio of 19:15) in our group underwent renal transplant. Mean patient age at the time of transplant was 12.72 ± 5.46 years. Twenty-nine patients received living- related donor allografts (85.3%) and 5 received organs from deceased donors (14.7%). We identified focal segmental glomerulosclerosis recurrence in 5 recipients (14.7%). Time from focal segmental glomerulosclerosis diagnosis to end-stage renal disease and duration of dialysis were shorter in the recurrence group than in the nonrecurrence group (48.4 months [range, 2-90 mo] vs 65.1 months [range, 8-123 mo] and 1.41 ± 0.82 vs 3.18 ± 1.88 years, respectively; P < .05). Donor type and transplant age were similar in both groups. Of those with recurrence who had received plasma exchange and rituximab, 3 patients (75%) had complete remission and 1 patient (25%) had partial remission. Prophylactic plasma exchange and the combined plasma exchange-rituximab regimen for treatment of focal segmental glomerulosclerosis recurrence resulted in low recurrence and good remission rates in our pediatric cohort.

Immune-Related Genes for Predicting Future Kidney Graft Loss: A Study Based on GEO Database.

ObjectiveWe aimed to identify feature immune-related genes that correlated with graft rejection and to develop a prognostic model based on immune-related genes in kidney transplantation.MethodsGene expression profiles were obtained from the GEO database. The GSE36059 dataset was used as a discovery cohort. Then, differential expression analysis and a machine learning method were performed to select feature immune-related genes. After that, univariate and multivariate Cox regression analyses were used to identify prognosis-related genes. A novel Riskscore model was built based on the results of multivariate regression. The levels of these feature genes were also confirmed in an independent single-cell dataset and other GEO datasets.Results15 immune-related genes were expressed differently between non-rejection and rejection kidney allografts. Those differentially expressed immune-related genes (DE-IRGs) were mainly associated with immune-related biological processes and pathways. Subsequently, a 5-immune-gene signature was constructed and showed favorable predictive results in the GSE21374 dataset. Recipients were divided into the high-risk and low-risk groups according to the median value of RiskScore. The GO and KEGG analysis indicated that the differentially expressed genes (DEGs) between high-risk and low-risk groups were mainly involved in inflammatory pathways, chemokine-related pathways, and rejection-related pathways. Immune infiltration analysis demonstrated that RiskScore was potentially related to immune infiltration. Kaplan-Meier survival analysis suggested that recipients in the high-risk group had poor graft survival. AUC values of 1- and 3-year graft survival were 0.804 and 0.793, respectively.ConclusionOur data suggest that this immune-related prognostic model had good sensitivity and specificity in predicting the 1- and 3-year kidney graft survival and might act as a useful tool for predicting kidney graft loss.

Acute Anti-A/B Antibody-Mediated Rejection After ABO-Incompatible Kidney Transplantation Treated With Bortezomib and Plasmapheresis: A Case Report

ABO-incompatible kidney transplantation (KTP) is effective for avoiding transplantation-related issues. It is a viable alternative to ABO-compatible KTP, as both techniques have similar patient and graft survival rates. However, anti-A/B antibody-mediated rejection (AMR) can occur, resulting in poor long-term graft survival. A 45-year-old man with end-stage renal disease presented with a serum creatinine level of 10.2 mg/dL. We decided to perform KTP with spousal donation. He had panel-reactive antibody class I and II and cross matching test negativity, a 3/6 mismatch on human leukocyte antigen typing, an ABO antibody titer of 1:256, and no donor-specific antibodies. The patient and donor blood types were O+ and A+, respectively. The anti-A/B antibody titer was reduced preoperatively with rituximab (200 mg/body), plasmapheresis, and intravenous immunoglobulin (0.2 mg/kg). Basiliximab and methylprednisolone were used for induction immunosuppression, and tacrolimus, mycophenolate mofetil, and prednisolone were used for maintenance immunosuppression. KTP was successful, and graft function was initially normal. On postoperative day (POD) 5, the serum creatinine level and anti-A/B antibody titer increased from 0.9 mg/dL to 1.9 mg/dL and 1:16 to 1:64, respectively. Graft biopsy revealed acute AMR and tubular injury. We started steroid pulse therapy, plasmapheresis, and subcutaneous bortezomib (2.6 mg, twice a day, every 3 days) with no side effects. The serum creatinine level decreased from 5.7 mg/dL to 1.5 mg/dL on POD 28. Graft biopsy showed no rejection, and normal function was maintained for 40 months. Acute, early anti-A/B AMR was successfully treated with plasmapheresis and bortezomib.

Possible association between viral infection and poor survival of the corneal graft after penetrating keratoplasty in patients with congenital corneal opacity: a cohort study

BackgroundCongenital corneal opacity (CCO) is a rare disorder. Penetrating keratoplasty (PK) is the main surgical option for CCO, but many factors affect graft survival. Therefore, this study aimed to perform...

Prediction of Graft Survival Post-liver Transplantation by L-GrAFT Risk Score Model, EASE Score, MEAF Scoring, and EAD.

Background: Early allograft dysfunction (EAD) is correlated with poor patient or graft survival in liver transplantation. However, the power of distinct definitions of EAD in prediction of graft survival is unclear.Methods: This retrospective, single-center study reviewed data of 677 recipients undergoing orthotopic liver transplant between July 2015 and June 2020. The following EAD definitions were compared: liver graft assessment following transplantation (L-GrAFT) risk score model, early allograft failure simplified estimation score (EASE), model for early allograft function (MEAF) scoring, and Olthoff criteria. Risk factors for L-GrAFT7 high risk group were evaluated with univariate and multivariable logistic regression analysis.Results: L-GrAFT7 had a satisfied C-statistic of 0.87 in predicting a 3-month graft survival which significantly outperformed MEAF (C-statistic = 0.78, P = 0.01) and EAD (C-statistic = 0.75, P < 0.001), respectively. L-GrAFT10, EASE was similar to L-GrAFT7, and they had no statistical significance in predicting survival. Laboratory model for end-stage liver disease score and cold ischemia time are risk factors of L-GrAFT7 high-risk group.Conclusion: L-GrAFT7 risk score is capable for better predicting the 3-month graft survival than the MEAF and EAD in a Chinese cohort, which might standardize assessment of early graft function and serve as a surrogate endpoint in clinical trial.

Focal Segmental Glomerulosclerosis Superimposed on Transplant Glomerulopathy: Implications for Graft Survival

Introduction: Transplant glomerulopathy (TG) is a morphological lesion resulting from chronic glomerular endothelium injury, and it is strongly associated with poor graft survival. TG coexisting with focal segmental glomerulosclerosis (FSGS) can be found in renal allograft biopsies, but few related studies are available. Methods: Consecutive kidney transplant recipients with biopsy-proven TG were studied retrospectively. Patients concomitant with FSGS were identified and compared with those without FSGS. The influence of FSGS on allograft outcomes was assessed using univariate and multivariate Cox regression models. Results: Of the 66 patients with TG, 40 (60.6%) had concomitant FSGS. TG patients with FSGS had higher proteinuria (median, 2.6 vs. 0.8 g/24 h, p < 0.001) and serum creatinine levels (median, 2.5 vs. 2.1 mg/dL, p = 0.04), lower serum albumin levels, higher chronic glomerulopathy (cg) score, larger glomerular tuft area, lower number of podocytes, and higher incidences of podocyte hyperplasia, pseudotubule formation, and diffuse foot process effacement than those without FSGS (all p < 0.05). The kidney allograft loss rate of patients with FSGS was higher than that of patients without FSGS (65.7% vs. 37.5%, p = 0.03). The presence of FSGS was independently associated with allograft loss in TG (hazard ratio (HR) = 3.42, 95% confidence interval (CI): 1.30–8.98, p = 0.01). Other independent predictors were proteinuria (HR = 1.18, 95% CI: 1.02–1.37, p = 0.02), estimated glomerular filtration rate (HR = 0.94, 95% CI: 0.91–0.97, p < 0.001), and panel reactive antibody (HR = 3.99, 95% CI: 1.14–13.99, p = 0.03). Moreover, FSGS (odds ratio (OR) = 4.39, 95% CI: 1.29–14.92, p = 0.02) and cg (OR = 5.36, 95% CI: 1.56–18.40, p = 0.01) were independent risk factors for proteinuria. Conclusion: In this cohort of patients with TG, the presence of FSGS was strongly associated with more severe clinicopathological features and worse allograft survival.