Post-kidney Transplant Patients Research Articles

Safety and efficacy of semaglutide in post kidney transplant patients with type 2 diabetes or Post-Transplant diabetes

ObjectiveType 2 diabetes mellitus (T2DM) and post-transplant diabetes mellitus (PTDM) are common in renal transplant recipients. Semaglutide has demonstrated efficacy and safety in patients with T2DM. To date, only a limited number of studies have investigated its use in renal transplant patients. This study assessed the safety and efficacy of semaglutide in post-renal transplant patients. MethodsA retrospective study was conducted at. The subjects of the study were adults and adolescents (>14 years) who had undergone a kidney transplant and had pre-existing T2DM or PTDM. The study subjects were given semaglutide during the study period, from January 2018 to July 2022. The data were collected over a period of 18 months. ResultsA total of 39 patients were included, 29 (74 %) of whom were male. A significant decrease in hemoglobin A1c (HbA1c) was observed during the follow-up period when compared to baseline (8.4 %±1.3 % at baseline vs. 7.4 %±1.0 % at 13–18 months (p < 0.001). A significant reduction in weight was also noted at follow-up as compared to baseline (99.5 kg ± 17.7 vs 90.7 kg ± 16.8 at 13–18 months (p < 0.001). No significant changes were found in renal graft function markers. ConclusionSemaglutide was found to significantly reduce HbA1c levels and weight in post renal transplant patients with diabetes. No significant changes in markers of renal graft function were observed.

Changes in antibody titer after four and five doses of the SARS-CoV-2 vaccine in Japanese post-kidney transplant patients.

Immunosuppressed patients exhibit low antibody acquisition rates following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. Kidney transplant recipients previously exhibited low antibody acquisition rates after two vaccine doses, which increased after the third dose. We evaluated antibody titers of Japanese post-kidney transplant patients after the fourth and fifth vaccinations. Antibody titers for SARS-CoV-2 spike protein were measured between 3 weeks and 3 months after the fourth or fifth vaccination. Increased antibody acquisition rates were observed after the fourth (75.0% antibody-positive) and fifth (81.5% antibody-positive) vaccinations. The antibody-acquired group after the fourth vaccination exhibited a higher body mass index and estimated glomerular filtration rate (eGFR) than the non-acquired group. A higher eGFR was associated with antibody acquisition after the fifth vaccination. In Japanese post-kidney transplant patients, the antibody acquisition rate increased with each vaccine additional dose. Additional vaccinations are recommended to protect against SARS-CoV-2 infection.

A case of late-onset organizing pneumonia following COVID-19 infection in a post-kidney transplant patient.

A 50-year-old man who had undergone a living-donor kidney transplant 12years prior for chronic renal failure due to autosomal dominant polycystic kidney disease contracted coronavirus disease 19 (COVID-19). He had a positive antigen test, mild symptoms, sore throat, and fever of 37.9℃. The patient was treated with molnupiravir for 5days, and the symptoms disappeared 5days after onset. However, 10days after onset, he developed a fever of approximately 37℃ and a non-productive cough; 27days after onset, the patient was hospitalized for anorexia and a worsening respiratory condition. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigen test results on admission were negative, and no antiviral medications were administered against SARS-CoV-2. Computed tomography revealed extensive ground-glass opacities in both lung fields. The patient was treated with steroid pulse therapy, ceftriaxone, atovaquone, azithromycin, and respiratory management using a high-flow nasal cannula. The combined therapies were successful, and the patient was managed with a nasal oxygen cannula after 3days. Oxygen administration was discontinued after 6days of hospitalization, and the patient was discharged after 14days. Based on the laboratory findings, bacterial, interstitial, and Pneumocystis pneumonia were unlikely. The success of the steroid pulse therapy suggested that respiratory failure was caused by pneumonia due to the immune response after COVID-19 infection.

Sclerotherapy of the Post renal Transplant Lymphoceles: A Meta-Analysis

PurposeThis study evaluates the effectiveness of sclerotherapy in treating lymphoceles after kidney transplantation, focusing on factors such as recurrence rates and procedural success. Materials and MethodsRetrospective studies using sclerotherapy as the only form of treatment for post renal transplant lymphoceles were included. All studies used percutaneous transcatheter sclerotherapy as treatment and the success rate of the intervention was recorded. MEDLINE, Embase, and Cochrane Library databases for retrospective research studies that included the keywords “sclerotherapy post renal transplant lymphoceles” were used. 61 references were obtained by manually searching MEDLINE (n=20), Embase (n=41) and Cochrane Library (n=0). After removing 3 duplicates, 50 of the remaining articles were excluded after screening and the remaining studies were extracted for demographic data as well as our primary outcome of success rate of sclerotherapy. ResultsA descriptive analysis of the outcomes and complication rates associated with sclerotherapy interventions for lymphoceles is provided. A high degree of variation across the different studies was uncovered. According to the Kruskal-Wallis test, there was no correlation between the sclerosant used and the sclerotherapy complication rate (p = 0.472) or the success rate (p = 0.591). There was also no correlation between the sex of the patient and the success rate, however there was a significant difference in the complication rate by sex (p < 0.005). ConclusionIn conclusion, different sclerosant products have been used for therapy with no consensus on the most efficacious product as the success rate has been variable. In addition, the sex of the patient may have an influence on the complication rates associated with sclerotherapy for lymphoceles in post-kidney transplant patients.

Diabetic Kidney Disease in Post-Kidney Transplant Patients

Post-transplant diabetes mellitus (PTDM) is a common occurrence in post-kidney transplantation and is associated with greater mortality, allograft failure, and increased risk of infections. The primary goal in the management of PTDM is to achieve glycemic control to minimize the risk of complications while balancing the need for immunosuppression to maintain the health of the transplanted kidney. This review summarizes the effects of maintenance immunosuppression and therapeutic options among kidney transplant recipients. Patients with PTDM are at increased risk of diabetic kidney disease development; therefore, in this review, we focus on evidence supporting the use of novel antidiabetic agents and discuss their benefits and potential side effects in detail.

A case of progressive multifocal leukoencephalopathy in a post-kidney transplant patient with improvement after discontinuation of immunosuppressive drugs and combination therapy with mefloquine and mirtazapine

BackgroundProgressive multifocal leukoencephalopathy is a rare disease, but the prognosis is very poor, especially in the immunosuppressed state with a non-HIV background, and there is no established treatment.Case presentationsA 49-year-old patient who had undergone a renal transplant and was receiving prednisolone and mycophenolate mofetil treatment was admitted for peritoneal dialysis initiation. While hospitalized, he experienced aphasia and other percutaneous symptoms. Magnetic resonance imaging of the brain revealed a subcortical demyelinating lesion. JC virus DNA was identified in cerebrospinal fluid, and he was diagnosed with progressive multifocal leukoencephalopathy. Immunosuppressant was ceased, and he was treated with mefloquine and mirtazapine. The patient subsequently underwent a head MRI scan, confirming lesion reduction, improved activities of daily life, and survival.ConclusionsProgressive multifocal leukoencephalopathy is commonly observed in patients with compromised immune systems, which was the case for this patient due to long-standing immunosuppressive medication usage and end-stage renal failure necessitating dialysis.

A fiducial-based confidence interval for the linear combination of multinomial probabilities.

Across a broad set of applications, system outcomes may be summarized as probabilities in confusion or contingency tables. In settings with more than two outcomes (e.g., stages of cancer), these outcomes represent multinomial experiments. Measures to summarize system performance have been presented as linear combinations of the resulting multinomial probabilities. Statistical inference on the linear combination of multinomial probabilities has been focused on large-sample and parametric settings and not small-sample settings. Such inference is valuable, however, especially in settings such as those resulting from pilot or low-cost studies. To address this gap, we leverage the fiducial approach to derive confidence intervals around the linear combination of multinomial parameters with desirable frequentist properties. One of the original arguments against the fiducial approach was its inability to extend to multiparameter settings. Therefore, the great novelty of this work is both the derived interval and the logical framework for applying the fiducial approach in multiparameter settings. Through simulation, we demonstrate that the proposed method maintains a minimum coverage of , unlike the bootstrap and large-sample methods, at comparable interval lengths. Finally, we illustrate its use in a medical problem of selecting classifiers for diagnosing chronic allograph nephropathy in postkidney transplantpatients.

Perception on Preparation for Transplantation and Medication Adherence: An Exploratory Study of Post Kidney Transplant Patients in Nigeria

Background: Many patients suffering from renal failure have embraced kidney transplant instead of dialysis despite huge financial implications. However, post kidney transplant patients (PKTPs) require strict adherence to immunosuppressant medications to prevent rejection of the allograft. Encounters during patients’ medication refill suggest information gaps about medication use burden. &#x0D; Objectives: This study was set to explore PKTPs perspective on their preparation for transplant and determine possible information gaps during preparation for transplant. &#x0D; Methods: This study was conducted by qualitative methods using in-depth interviews. Eighteen PKTPs were purposely recruited from their refill facility in Lagos and interviewed using an open-ended interview guide. The interviews were recorded, transcribed verbatim, coded, and analyzed using thematic analysis. &#x0D; Findings: The main information received during preparation bordered mostly on expectation of improved quality of life, financial implication, and the need to maintain the new kidney using medications. While some respondents ambiguously stated that the team ‘did their best’ in preparing them for transplant, six respondents regretted not having information about the life-long use of medications until after the transplant. Some respondents totally adhered to their medications, never missing a dose; others missed some doses unintentionally while some others deliberately missed their doses just to save cost. All respondents’ experience of a better quality of life after transplant was as expected. &#x0D; Conclusion: This study revealed that some respondents experienced information gaps concerning life-long use of medications post-transplant. The experience of very improved quality of life post-transplant seemed to be the driving force for medication adherence.

Early retinal neurovascular findings in post-transplant diabetes mellitus patients without clinical signs of diabetic retinopathy

BackgroundPost-transplant diabetes mellitus (PTDM) is a specific subtype of diabetes with an uncertain impact on mortality and morbidity in post-transplant patients. Diabetic retinopathy is the most common microvascular complication of diabetes mellitus, but the long-term clinical progression in PTDM is unknown. New technologies are being used to assess pre-clinical signs of retinal changes, such as swept-source optical coherence tomography (OCT) and OCT-angiography. The aim of this study was to detect pre-clinical structural and vascular changes in the retina using swept-source-OCT and OCT-angiography in patients with PTDM.MethodsIn this retrospective cohort study, post-kidney transplant patients were divided into PTDM and non-PTDM (control) groups. Both eyes of eligible PTDM patients and controls were included in this study. Inner retinal layer thickness was measured with swept-source-OCT. Retinal capillary density and the foveal avascular zone were measured with OCT-angiography.ResultsIn the PTDM group, reduced thickness was found in the inferior ganglion cell layer plus inner plexiform layer (95% CI -8.76 to -0.68; p = 0.022) and the temporal inferior segment (95% CI -10.23 to -0.76; p = 0.024) of the inner retina, as well as in the retinal nerve fiber layer in the temporal (95% CI -34.78 to -9.28 p = 0.001) and temporal inferior segments (95% CI -33.26 to -5.03 p = 0.008). No significant differences were found in the vascular capillary plexus between groups at all depths, segments, or foveal avascular zone (p = 0.088).ConclusionsAccording to OCT-angiography, PTDM patients had reduced inner neurosensory retinal layers but no significant change in vascular density, which suggests that early neuroretinal degeneration might occur prior to vascular changes secondary to PTDM. Prospective studies could help elucidate the clinical course of retinal neuropathy and microvascular pathology in PTDM and provide a better understanding of PTDM complications.

Investigation of Underlying Biological Association and Targets between Rejection of Renal Transplant and Renal Cancer.

Post-renal transplant patients have a high likelihood of developing renal cancer. However, the underlying biological mechanisms behind the development of renal cancer in post-kidney transplant patients remain to be elucidated. Therefore, this study aimed to investigate the underlying biological mechanism behind the development of renal cell carcinoma in post-renal transplant patients. Next-generation sequencing data and corresponding clinical information of patients with clear cell renal cell carcinoma (ccRCC) were obtained from The Cancer Genome Atlas Program (TCGA) database. The microarray data of kidney transplant patients with or without rejection response was obtained from the Gene Expression Omnibus (GEO) database. In addition, statistical analysis was conducted in R software. We identified 55 upregulated genes in the transplant patients with rejection from the GEO datasets (GSE48581, GSE36059, and GSE98320). Furthermore, we conducted bioinformatics analyses, which showed that all of these genes were upregulated in ccRCC tissue. Moreover, a prognosis model was constructed based on four rejection-related genes, including PLAC8, CSTA, AIM2, and LYZ. The prognosis model showed excellent performance in prognosis prediction in a ccRCC cohort. In addition, the machine learning algorithms identified 19 rejection-related genes, including PLAC8, involved in ccRCC occurrence. Finally, the PLAC8 was selected for further research, including its clinical and biological role. In all, our study provides novel insight into the transition from the rejection of renal transplant to renal cancer. Meanwhile, PLAC8 could be a potential biomarker for ccRCC diagnosis and prognosis in post-kidney transplant patients.

Dialysis headache: prevalence and clinical presentation in hemodialysis and kidney transplant patients

Introduction Headache is a common symptom among hemodialysis patients, with a prevalence around 70%. Dialysis headache is defined according to International Classification of Headache Disorders (ICHD-3) as a headache without specific characteristics, occurring during and caused by hemodialysis that spontaneously disappears within 72 hours after the dialysis session. There is no consensus on trigger factors or physiopathology. Objective To evaluate prevalence, clinical characteristics, and associated factors with dialysis headache. Methods Observational study with quantitative analysis. Study patients were divided into two groups: (HD) 25 hemodialysis patients and (Tx) 25 early post kidney transplant patients. A structured questionnaire was applied to all patients, including Hospital Anxiety and Depression Scale (HADS) and Epworth Sleepiness Scale. Laboratory data, blood pressure and body weight were analyzed before and after one dialysis session. Results: In group HD, eight patients (32%) had diagnosis of dialysis headache, with pulsating headache (n=6, 75%), photophobia (n=6, 75%), phonophobia (n=4, 50%), and nauseas or vomiting (n=6, 75%), with a mean pain score of 7.75 ± 1.58. Headache group had higher scores of anxieties (7.00 ± 3.93 vs. 3.82 ± 3.23, p=0.03) and sleepiness (9.13 ± 3.94 vs. 4.76 ± 3.85, p=0.01), lower levels of serum calcium (p=0.01), and higher systolic (p=0.02) and diastolic (p=0.02) blood pressure pre dialysis. In group Tx, five patients (20%) reported dialysis headache, with pulsating headache (n=4, 80%), nauseas or vomiting (n=4, 80%), with a mean pain score of 8.0 ± 1.41. Headache group had a higher score of sleepiness (9.20 ± 4.32 vs. 4.80 ± 4.51, p=0.029) and were younger (38.93 ± 14.43 vs. 54.02 ± 8.31, p=0.03). Conclusion Headache is frequent among hemodialysis patients and had similar symptoms of migraine. In this series dialysis headache was associated with higher scores of anxieties and sleepiness, higher blood pressure and lower calcium pre dialysis.

Lived Experiences and Expectations of Postkidney Transplant Patients: A Phenomenological Study

Lived Experiences and Expectations of Postkidney Transplant Patients: A Phenomenological Study

[Curative effect of complete transperitoneal laparoscopic nephroureterectomy in post kidney transplantation patients with upper tract urothelial carcinoma].

Objective: To investigate the efficacy and safety of complete transabdominal laparoscopic nephroureterectomy in treating primary upper tract urothelial carcinoma (UTUC) for post kidney transplantation patients. Methods: The clinical data of patients with primary renal pelvis and ureter tumors after kidney transplantation in Beijing Chaoyang Hospital from May 2016 to December 2019 were retrospectively analyzed. Seventeen patients (including 9 patients in ipsilateral transplanted kidney group and 8 patients in contralateral transplanted kidney group) underwent traditional retroperitoneoscopic nephroureterectomy (TRNU), and 24 patients (including 14 patients in ipsilateral transplanted kidney group and 10 patients in contralateral transplanted kidney group) underwent complete transperitoneal laparoscopic nephroureterectomy (CTNU). The perioperative clinical indicators of all patients were recorded and analyzed, and the surgical indicators of two techniques were compared. Results: Forty-one patients [16 males and 25 females, with a median age of 57 (53, 70) years old] were finally included. The operation time in the contralateral transplanted kidney group [(95±44) min] from CTNU was significantly decreased compared with that in the ipsilateral group from CTNU [(159±49) min] and the contralateral [(196±20) min] or ipsilateral [(205±21) min] groups from TRNU (all P<0.01). The blood loss volume [(84±39) ml vs (106±44) ml vs (109±20) ml vs (112±21) ml, P=0.271] and postoperative hospital stay [(10.6±2.1) d vs (11.8±1.7) d vs (10.3±1.5) d vs (11.4±1.5) d, P=0.171] were not statistically different among these four groups. During the median follow-up of 24 months, 13 patients developed contralateral recurrence or metastasis, 8 patients developed intravesical recurrence, and 5 patients died of UTUC. Conclusions: Single-position complete transabdominal laparoscopic nephroureterectomy for the treatment of primary renal ureteral tumors after kidney transplantation has the advantage of a short operation time, without increasing intraoperative blood loss or perioperative complications. It is suitable for the treatment of urothelial carcinoma after kidney transplantation, especially for the contralateral side of the transplanted kidney.

Acute diabetic foot in post kidney transplantation patients receiving chronic immunosuppression-clinical presentation and outcomes.

Data regarding diabetic foot ulcers in patients after solid organ transplantation, particularly kidney transplantation, are limited. Chronic immunosuppression may be associated with impaired wound healing and a higher risk of amputations. In this study, we characterised the clinical presentation and outcomes of patients after kidney transplantation admitted to the diabetic foot unit, compared to non-kidney-transplant patients. Data on the baseline characteristics, clinical presentation, and outcomes of all patients admitted to the diabetic foot unit of a large tertiary centre between the years 2014 and 2019 were collected. The most recent admission of each patient was considered. Primary outcomes were major amputations and 1year mortality rate. During the study period, 537 patients were hospitalised, 18 of them were receiving immunosuppressive therapy due to kidney transplantation. Baseline characteristics of the patients were broadly similar, except that smoking was reported by 22.0% of the non-transplant patients and by none of the post-transplant patients (p=0.01). Post-transplant patients tended to be younger (59.4±11.1 vs. 65.3±12.2; p=0.07), were more likely to have type-1 diabetes (16.7% vs. 5.2%; p=0.07) and had lower glucose levels upon admission (9.4±4.3 vs. 12.0±6.4mmol/L; p=0.07). Overall, 30% of the patients underwent major amputation, in-patient mortality rate was 9.3%, and 1year mortality rate was 27.2%. Rates were similar in the post-transplant versus the non-post-transplant patients (p=0.83, 1.00, 0.59, respectively). Post-transplant patients did not incur worse outcomes in spite of immunosuppressive therapy. Limb salvage efforts should be pursued in these patients similar to the overall population.

P8.152: Clinical Characteristics and Factors Related to Recurrent Cytomegalovirus Infection Post-kidney Transplant in Adult Patients at Cho Ray Hospital

Introduction: Cytomegalovirus (CMV) is one of the main causes of opportunistic infections after kidney transplantation. Manifestations of CMV disease in post renal transplantation patients are quite discreet, non-specific and difficult to diagnose early. Asymptomatic recurrent CMV infection has been reported remarkably to increase mortality rate and rejection incidence, and effect on graft survival. The recently follow-up and treatment procedures’ changes make it urgent to re-evaluate the incidence and the factors related to the risk of CMV recurrence as well as the clinical characteristics of CMV infection in postkidney transplantation patients. This helps to control the recurrence of CMV infection as well as to diagnose CMV disease early and treat it promptly and appropriately to reduce the mortality rate of patients after transplantation. Method: Objective 1: Retrospective cohort study of adult renal transplant recipients between January 1, 2015 and December 31, 2018. Objective 2: A cross - sectional descriptive study on 22 cases of CMV disease in post kidney transplant patients to present a review of the main clinical aspects of cytomegalovirus infection in renal transplants with a focus on clinical approach and its future perspectives. Results: Objective 1: A total of 365 patients who received a renal transplant at Cho Ray hospital in the study time period were reviewed for the presence of CMV infection occurring less than 540 days after transplant. The recurrent CMV infection was observed in 254 cases (69,6%), but only 3 patients (0,8%) developed CMV disease. Independent risk factors of CMV infection were HLA >80 (HR = 2,309, 95% CI 1,021 – 4,071, p = 0,044), daily oral Prednisone doses used <0,5 mg/kg/day (HR = 0,178, 95% CI 0,084 – 0,374, p <0,001), Tacrolimus whole blood trough concentration ≤10 µg/L (HR = 0,445, 95% CI 0,243 – 0,816, p = 0,009), Cyclosporine wole blood trough concentration >150 µg/L (HR = 4,25, 95% CI 1,97 – 9,2, p < 0,001). Objective 2: Male majority (2/3), with average age of 47,5 ± 4,5. Rate of symptomic recurrence CMV infection in the first 6 months, 6 - 12 months, 1 - 5 years, 5 - 10 years after transplant were 45,4%, 9,1%, 27,3% and 18,2% respectively. Common clinical manifestations are fever 59,1%, respiratory, renal and gastrointestinal manifestations 31,8%, 27,3% and 13,6%, respectively. Two cases of CMV retinitis with typical fundus lesions were treated with intraocular Ganciclovir, however, vision was not fully recovered. Lymphopenia <1.000 cells/mm3 was observed in most cases of CMV disease after kidney transplantation. Quantitative PCR of CMV DNA in plasma ranged from 375 – 6.533.850 copies/mL. 6 of 22 cases of PCR CMV DNA in plasma >4.000 copies/mL, of which 5 severe cases developed rapidlly progressive respiratory failure and 2 deaths. Conclusion: Recurrent CMV infection has a high rate in adult patients after kidney transplantation, so it is necessary to take initiactive for screening, monitoring and treating early to reduce mortality and protect the transplanted kidney. The appropriate dose of immunosuppressants plays an important role in the prevention of recurrent CMV infection and the successful treatment of disease due to it. Key words: Cytomegalovirus, Kidney transplantation, Post-transplant infection. * Deparment of Tropical diseases– Cho Ray Hospital ** Nephrology Surgery – Cho Ray Hospital Coresponding author: Tho A. N. Vo, Deparment of Tropical diseases– Cho Ray Hospital. Email: [email protected]. Mobile: 0983888841.

331.6: Impact of Left Ventricular Ejection Fraction and Previous Cardiac Revascularization on Patient and Graft Survival in Kidney Transplant Receipts

Background: Single center studies have implicated baseline left ventricular ejection fraction (LVEF) and baseline coronary artery disease as strongly associated with post-kidney transplant graft and patient survival, including in limited multivariate models. However, the United States’ Scientific Registry of Transplant Recipients (SRTR) does not directly include any cardiac variables as part of its risk adjustment model, raising the question of whether the current SRTR model fairly risk adjusts potential recipients. Methods: This study used the novel prospective United States National Surgical Quality Improvement Program (NSQIP) Transplant database to assess the impact of LVEF and pre-transplant revascularization on post-transplant outcomes in deceased donor renal transplantation (DDRT). Recipients from 2017-2019 were identified and stratified by LVEF into <50 and 50+ categories. A separate analysis stratified patients into if they had received pre-transplant revascularization, defined as either coronary bypass surgery or percutaneous intervention. Post-transplant outcomes were assessed. Results: A total of 2377 DDRT recipients were included from 29 centers. Mean follow up was 200 days. Only 4.8% had LVEF<50 at transplant, while 13.3% had undergone cardiac revascularization prior to transplant. There were several baseline differences between patients who did and did not have previous revascularization. Previous revascularization was associated with increased risk of requiring cardiac CPR (1.3 vs 0.1%, p=0.002), organ space surgical site infection (3.8 vs 1.1%, p=-0.001), delayed graft function (39.2 vs 28.3%, p<0.001), requiring dialysis at last follow up (5.7 vs 3.9%, p<0.001), myocardial infarction (4.4 vs 0.8%, p<0.001), pneumonia (3.2 vs 1.1%, p=0.011), recatherization (14.2 vs 8.2%, p=0.002), sepsis (4.1 vs 1.7%, p=0.018), septic shock (1.3 vs 0.3%, p=0.036), UTI (10.1 vs 6.1%, p=0.023), and longer ICU stay (0.86 vs 0.47 days, p=0.004). In univariate analysis, previous revascularization was associated with increased hazard of death (HR 2.4, p=0.02) but not graft loss (HR 1.3, p=0.52). In a multivariate model including previous revascularization and existing SRTR variables (age, diabetes, peripheral vascular disease, albumin, KDRI) as predictors, previous revascularization was related to a higher hazard of death (HR 1.43) however this was not a statistically significant finding (p=0.42). Conclusions: We conclude that in the DDRT in patients with previous cardiac revascularization is much more common (13.3%) than in those with LVEF<50 (4.8%). We also demonstrate that previous cardiac revascularization is a powerful predictor of both patient survival and several post-transplant complications. However, we also show that existing variables (e.g. diabetes, PVD, age) in the SRTR risk stratification model largely capture the impact of previous cardiac revascularization on patient survival at least in the early follow up period.

Efficacy and Safety of Antiviral Agents in Preventing Allograft Rejection Following CMV Prophylaxis in High-Risk Kidney Transplantation: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.

Many antiviral agents have been studied in clinical trials for allograft rejection prevention following cytomegalovirus (CMV) prophylaxis in high-risk kidney transplant patients. However, data on the most effective and safest treatment are lacking. We conducted a systematic review and network meta-analysis to rank CMV prophylaxis agents for allograft rejection prevention following CMV prophylaxis in high-risk kidney transplant patients according to their efficacy and safety. We conducted searches on the MEDLINE, Embase, SCOPUS, and CENTRAL databases, as well as the reference lists of selected studies up to December 2021, for published and peer-reviewed randomized controlled trials assessing the efficacy of CMV prophylaxis agents in high-risk kidney transplant patients. Thirteen studies were independently selected by three reviewers and included post-kidney transplant patients indicated for CMV prophylaxis who had been randomized to receive prophylactic antiviral agents or standard of care. The reviewers independently extracted data from the included studies, and direct and network meta-analyses were applied to assess the study outcomes. The probability of efficacy and safety was evaluated, and the drugs were assigned a numerical ranking. We evaluated the risk of bias using the Cochrane Risk of Bias 2.0 tool. The primary outcome was an incidence of biopsy-proven acute rejection, whereas the secondary outcome was a composite of major adverse drug reactions. Each outcome referred to the definition provided in the original studies. Valganciclovir, valacyclovir, and ganciclovir were identified to significantly decrease the incidence of biopsy-proven acute rejection with pooled risk differences (RDs) of −20.53% (95% confidence interval [CI] = −36.09% to −4.98%), −19.3% (95% CI = −32.7% to −5.93%), and −10.4% (95% CI = −19.7% to −0.12%), respectively. The overall major adverse drug reaction was 5.7% without a significant difference when compared with placebo. Valganciclovir had the best combined efficacy and safety among the examined antiviral agents and was the most effective and safest antiviral agent overall for allograft rejection prevention following CMV prophylaxis. Valacyclovir was the optimal alternative antiviral agent for patients who were unable to tolerate intravenous ganciclovir or access oral valganciclovir as financial problem. However, compliance and dose-related toxicities should be closely monitored.

Analysis of the Incidence of Cardiovascular Events inPost-Renal Transplant Patients Treated at a SpecializedService in Blumenau (SC)

Introduction: The main causes of death in kidney transplant recipients are infectious and cardiovascular diseases, both very common in Brazilian reality. In addition to conventional risk factors, specific risk factors may influence the development of cardiovascular disease in these patients.Objectives:To determine the incidence of cardiovascular events in post-kidney transplant patients, to analyze the cardiovascular risk factors in the first, third and fifth year post-transplant, and to characterize the profile of transplanted people in this study. Methods: Retrospective observational cohort study carried out in patients over 18 years of age who underwent kidney transplantation, from 2010 to 2016, followed up by the Associação Renal Vida, in Blumenau, Santa Catarina state,in Brazil. Results: The sample totaled 577 patients (392 males and 185 females); mean age group of 46.5 years; and 157 deaths, 43 of which were caused by cardiovascular diseases. It was observed that weight, body mass index and high-density lipoprotein (HDL) increased in the first year post-transplantation and stabilized after 36 months. Cholesterol increased in the first year, remained unchanged in the third and decreased in the fifth year. In addition, there was an increase in 64 patients with diabetes mellitus three years after transplantation, which is a risk factor for stroke, congestive heart failure (CHF), peripheral vascular disease and left ventricular hypertrophy in the third year after transplantation. Obesity was found to be a risk factor for acute myocardial infarction (AMI), since 60% of patients who had AMI had a body mass index &gt; 30 kg/m2. In contrast, HDL levels greater than 40 seem to be a protective factor for left ventricular hypertrophy in the third year and for stroke in the fifth year. Age younger than 50 years also seems to be a protective factor for AMI, stroke, CHF and left ventricular hypertrophy in the first 36 months and for CHF after 60 months, as 66.67% of patients with CHF in this period were older than 50 years old. Conclusion: It was observed that part of the risk factors for cardiovascular diseases is modifiable. Thus, maintaining healthy habits, especially over 50 years of age, seems to be a strategy that can improve cardiovascular risk and life expectancy after kidney transplantation.

Factors associated with telemedicine utilization among post-transplant patients at a university kidney and pancreas transplant center.

Telemedicine has become prevalent during the novel-coronavirus disease-2019 (COVID-19) pandemic. The study explored patient factors associated with telemedicine utilization among post-kidney and pancreas transplant patients at a university center. After analyzing 2801 patients and their visits using chi-square test and logistic regression, we found that government-insured (P <.0001) post-kidney and pancreas transplant patients were less likely to use telemedicine. Sex (P = .748), patient race (P = .920), age groups (P = .812), and traveling distance (P = .837) were not associated with telemedicine use. Centers should consider focusing on the subgroup of government-insured patients to improve telemedicine use and future studies should consider exploring barriers for underutilization of telemedicine in this population.

Clinical Course and Outcome of COVID-19 in Kidney Transplant Recipients: A Single-centre Retrospective Observational Study

Introduction: Solid Organ Transplants (SOT) is at increased risk of Coronavirus Disease 2019 (COVID-19) infection, which may result in acute graft dysfunction and even death. While the disease has been well studied in the general population, it is not the case in renal transplant recipients. The poor immunological response of the vaccine in postrenal transplant patients, the emergence of newer strains, and the possibility of a third wave in India, makes it even more important to know more about the course and outcome of the disease in post renal transplant patients. Aim: To evaluate the demographics, clinical presentation, biochemical profile, course of hospitalisation in post kidney transplant patients with COVID-19. Materials and Methods: This retrospective observational study study with 18 patients was conducted in Madurai Medical College, Tamil Nadu, India for duration of four months, from May 2021 to August 2021 and data collection from May 2021 to July 2021 and data analysis in August 2021. All post kidney transplant patients having evidence of COVID-19 were included. Detailed clinical history, biochemical profile, radiological findings, treatment, and final outcomes were collected and compared. Non parametric statistical tests were used, in addition to Chi-square test and odds ratio. Kaplan-Meier plot was used for survival analysis. Results: The most common presentation was fever 15 (83.3%), followed by cough 10 (55.6%). C-reactive Protein (CRP) {65 mg/L (11.48-94.48)}, D-dimer {0.72 mcg/mL (0.59-1.1)}, serum creatinine {3.5 mg/dL (2.12-5.93)}, and platelet count {200,000 cells/cu.mm (1.75-2.22)} and showed statistically significant (p&lt;0.05) association with the outcome. About 15 (83.3%) patients developed Acute Kidney Injury (AKI). Seven patients (38.9%) had stage three AKI necessitating haemodialysis, of which six did not survive. The median survival time was 22 days, with 95% confidence interval (19.792-24.208), with case fatality rate of 33.3%. Conclusion: Postkidney transplant patients are at high risk of contracting COVID-19. CRP, D-dimer, serum creatinine, platelet counts, and arterial oxygen saturation may serve as prognostic markers. Dialysis may be required in view of high incidence of AKI and acute graft dysfunction, though the outcome seems dismal in such patients. Hence, the need for early hospitalisation and more effective treatment protocol is essential to improve outcome.