Post-kidney Transplant Research Articles

Risk factors for hip and vertebral fractures in chronic kidney disease: the CRIC study.

Fracture risk is high in chronic kidney disease (CKD) and underlying pathophysiology and risk factors may differ from the general population. In a cohort study of 3939 participants in the chronic renal insufficiency cohort (CRIC), we used Cox regression to test associations of putative risk factors with the composite of first hip or vertebral fracture assessed using hospital discharge codes. Mean age was 58years, 45% were female, 42% were Black, and 13% were Hispanic. There were 82 hip and 24 vertebral fractures over a mean (SD) 11.1 (4.8) years (2.4 events per 1000 person-years [95% CI: 2.0, 2.9]). Measured at baseline, diabetes, lower body mass index (BMI), steroid use, proteinuria, and elevated parathyroid hormone (PTH) were each associated with fracture risk after adjusting for covariates. Lower time-updated estimated glomerular filtration rate (eGFR) was associated with fractures (HR 1.20 per 10mL/min/1.73m2 lower eGFR; 95% CI: 1.04, 1.38) as were lower time-updated serum calcium and bicarbonate concentrations. Among time-updated categories of kidney function, hazard ratios (95% CI) for incident fracture were 4.53 (1.77, 11.60) for kidney failure treated with dialysis and 2.48 (0.86, 7.14) for post-kidney transplantation, compared with eGFR ≥60. Proton pump inhibitor use, dietary calcium intake, measures of vitamin D status, serum phosphate, urine calcium and phosphate, and plasma fibroblast growth factor-23 were not associated with fracture risk. In conclusion, lower eGFR in CKD is associated with higher fracture risk, which was highest in kidney failure. Diabetes, lower BMI, steroid use, proteinuria, higher serum concentrations of PTH, and lower calcium and bicarbonate concentrations were associated with fractures and may be modifiable risk factors.

Renal Transplant in Elderly End-Stage Renal Disease Patients: Impact of Comorbidities and Posttransplant Adverse Events on Outcomes.

Elderly renal transplant continues to be debated because of age-related factors affecting transplant success and long-term prognosis. We investigated the effects ofrecipient age and predictors of renal transplant outcomes in elderly renal transplant recipients. We retrospectively analyzed 506 patients who had a first renal transplant between January 2010 and December 2020; there were 165 recipients aged ≥60 years (elderly) and 341 recipients aged <60 years (young).We collected recipient, donor, and transplant characteristics and assessed 1-, 3-, and 5-year overall patient and death-censored graft survival and risk factors influencing outcomes ofrenal transplant in elderly recipients. Elderly recipients showed significantly lower 1-, 3-, and 5-year patient survival rates (96.3%, 89.8%, 80.9%) than young recipients (98.8%, 98.5%, 97.8%; P < .001). However, death-censored graft survival rates were not significantly different (P = .459) between elderly (96.3%, 94.3%, 93.2%) and young recipients (97.7%, 97.0%, 93.9%). Advanced recipient age was identified as an independent risk factor for patient survival, irrespective of donor age. In elderly recipients, male gender (hazard ratio 2.013; 95% CI, 1.110-3.649), pretransplant cardiovascular disease (hazard ratio 1.774; 95% CI, 1.030-3.553), and posttransplant chestinfection (hazard ratio 2.421; 95% CI, 1.439-4.076) were significant predictors of inferior patient survival. Proteinuria at 1 month (hazard ratio 1.006; 95% CI, 1.000-1.011) and low estimated glomerular filtration rate at 3 months (hazard ratio 0.943; 95% CI, 0.899-0.988) posttransplant were early predictors of worse death-censored graft survival. Elderly renaltransplantrecipients showed promising 5-year patient and death-censored graft survival, exceeding 80%, despite higher mortality risk compared with young recipients. Optimizing outcomes of elderly renal transplant necessitates a multifaceted approach encompassing meticulous pretransplant cardiovascular disease assessment, rigorous posttransplant chest infection prevention and management, and proactive monitoring for early posttransplant kidney dysfunction, to permit timely intervention.

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.

Ultra-Processed Food Consumption, Poorer Nutritional Quality, and Lower Muscle Mass in Immediate and Late Postkidney Transplant Periods

To assess the consumption of ultra-processed foods (UPFs) in the immediate (2months after transplantation) and late post-transplant (14months after transplantation) periods among kidney transplant patients and to examine its correlation with nutritional quality and body composition. A cross-sectional analysis of 96 kidney transplant recipients divided into 2 groups: immediate post-transplant (n=71) and late post-transplant (n=25). Sociodemographic, anthropometric, and laboratory data were collected and grouped in a database. Food intake was evaluated by a validated food frequency questionnaire and foods were divided according to the NOVA classification system. The consumption of UPFs was calculated and statistical analyses were performed to evaluate its correlation with nutritional components and body composition. The consumption of UPFs was 649.4 [420.0-1061.72] kcal/day, accounting for 33.3±11.9% of the total daily energy intake. The immediate post-transplant group showed higher total daily energy and UPFs intake compared to the late post-transplant group (P=.002 and P=.046, respectively), although the energy contribution of UPFs was similar between both groups. UPFs intake was positively correlated with higher percentages of total fat, trans fat, saturated, monounsaturated fat, polyunsaturated fat, starch, and sodium (P<.05 for all analyses). An inverse correlation was observed between UPFs consumption and the percentage of protein and carbohydrates in the food intake (P=.025 and P=.008, respectively). In the immediate post-transplant group, a higher intake of UPFs was correlated with lower muscle mass (r=-0.250, P=.037). The findings of this study reveal a pattern of increased consumption of UPFs among kidney transplant patients in comparison to the national average. This higher intake of UPFs was correlated with lower nutritional quality during both periods. Moreover, a significant correlation was observed between UPFs consumption and adverse body composition parameters, specifically in the immediate post-transplant period.

Evaluating Kaposi Sarcoma in Kidney Transplant Patients: A Systematic Review and Meta-Analysis.

Kaposi's sarcoma (KS) is a malignancy that commonly appears as lesions on the skin or mucosal surfaces but can also develop in other organs. This cancer is usually caused by the human herpesvirus 8 (HHV-8), recently known as Kaposi's sarcoma-associated herpesvirus (KSHV). KS is rare in the general population but can develop in kidney transplant recipients with varying incidence due to immunocompromised status from immunosuppression. The main aim of the present systematic review was to identify the prevalence and treatment of KS in kidney transplant patients. PubMed, Cochrane Library, and Google Scholar databases were searched for studies until October 2023. Full-text studies with similar research objectives were included, while non-English articles, reviews, case reports, ongoing clinical trials, and studies evaluating KS in HIV patients or after other solid organ transplants were excluded. All studies were observational; therefore, methodological quality was assessed using the Newcastle-Ottawa Scale. The statistical analyses were performed with the Comprehensive Meta-Analysis (CMA) software (Biostat, Inc.Englewood, NJ). The pooled analysis from the 15 studies includedshowed that KS develops in 1.5% of kidney transplant recipients and is more prevalent in African (1.7%) and Middle Eastern (1.7%) recipients than in Western recipients (0.07%). KS was also significantly more prevalent among male recipients than female recipients (OR: 2.36; p < 0.0001). Additionally, cyclosporine-based immunosuppression accounts for most KS incidences (79.6%) compared to azathioprine-based immunosuppression (28.2%). Furthermore, reduction or withdrawal of immunosuppression alone resulted in 47.8% KS complete remissions. Post-kidney transplantation KS is more frequent among males and patients of Middle Eastern and African origin. However, the gender difference may be attributed to most patients undergoing kidney transplants being male. Therefore, if gender balance is considered in future studies, then the difference might be insignificant. Based on our results, we can concur that the mainstay treatment for post-transplant KS is reduction or withdrawal of immunosuppression. However, the patients should be closely monitored to avoid KS recurrence and kidney rejection. Furthermore, there is an increased risk for KS with the use of cyclosporine-based immunosuppression. However, this does not mean that the withdrawal of this immunosuppression agent might result in improved KS outcomes because the withdrawal of azathioprine with or without cyclosporine reduction has also led to improved outcomes.

Proliferative glomerulonephritis with monoclonal immunoglobulin deposits in the native or posttransplant kidney.

Proliferative glomerulonephritis with monoclonal immunoglobulin deposits in the native or posttransplant kidney.

Pregnancy outcomes post-kidney transplantation across 23 years.

Pregnancy in kidney transplant recipients has become increasingly common. However, pregnancy carries higher risks to these patients compared to the general population. To describe pregnancy outcomes in kidney transplant recipients. We conducted a single-centre retrospective cohort study of kidney transplant recipients who delivered after 20 weeks gestation at a quaternary hospital in Victoria, Australia, between 2000 and 2022 inclusive. The study included 37 pregnancies from 27 patients, accounting for 38 infants. Over half of recorded pregnancies occurred in the past five years (56.8%, n = 21). There were high rates of pre-existing hypertension (75.7%, n = 28). Pregnancy-induced hypertension and pre-eclampsia were common antenatal complications (21.6%, n = 8 and 48.6%, n = 18 respectively). Soluble fms-like tyrosine kinase-1 / placental growth factor ratios were elevated in all patients who developed severe pre-eclampsia (16.2%, n = 6). The median gestational age at birth was 36.4 weeks (range 20-40.4, Q1 32.9, Q3 37.6) and 59.5% (n = 22) of births were preterm. Unplanned caesarean without labour was the most common mode of birth (35.1%, n = 13). The overall caesarean rate was 62.1% (n = 23). Post-partum haemorrhage complicated over half of pregnancies (56.8%, n = 21). Fifty percent (n = 19) of infants were admitted for neonatal care, in particular neonatal intensive care, and had low birthweights under 2500 g. While there was a transient deterioration in kidney function, there was no graft rejection within one year of birth. Clinicians should consider the high rates of pre-existing hypertension, preterm birth, and caesarean birth when counselling and managing pregnant kidney transplant recipients.

Utility of the Interferon-Gamma Enzyme-Linked Immunosorbent Spot Assay to Predict Risk of Cytomegalovirus Infection in Kidney Transplant Recipients.

Non-specific interferon-gamma (IFN-γ) enzyme-linked immunosorbent (ELISpot) responses after solid organ transplant (SOT) and their relationship with cytomegalovirus (CMV) reactivation have hardly been investigated. Adult kidney transplant (KT) recipients underwent measurement of IFN-γ-producing T cells using the ELISpot assay before and 1 month after transplantation. Data for CMV infection episodes were collected. Risk factors for post-transplant CMV infection, based on IFN-γ responses, were analyzed using a Cox proportional hazards model. A total of 93 KT recipients were enrolled in the study and 84 evaluable participants remained at 1 month post KT. Thirty-three (39%) recipients developed subsequent CMV infection within 6 months post-transplant. At 1-month post-transplant, IFN-γ-producing T cells with <250 spot-forming units (SFUs)/2.5 × 105 peripheral blood mononuclear cells (PBMCs) were significantly associated with CMV infection (HR 3.1, 95% CI 1.4-7.1, p = 0.007). On multivariable analysis, posttransplant IFN-γ-producing T cells with <250 SFUs/2.5 × 105 PBMCs remained independently associated with CMV infection (HR 3.1, 95% CI 1.2-7.8, p = 0.019). Conclusions: KT recipients with low IFN-γ-producing T cells measured by the ELISpot assay are more likely to develop CMV infection after transplantation. Therefore, measurement of nonspecific cell-mediated immunity ELISpot responses could potentially stratify recipients at risk of CMV infection (Thai Clinical Trials Registry, TCTR20210216004).

Seizure in the Immediate Postrenal Transplant Period – A Diagnostic and Therapeutic Challenge

ABSTRACT Seizures postkidney transplant occur in 11.4% of recipients and major causes include immunosuppressive drugs, metabolic derangements, central nervous system infections, and posterior reversible encephalopathy syndrome (PRES). PRES is described as an acute clinical-radiological phenomenon commonly associated with hypertensive emergencies, preeclampsia, and neurotoxic effects of immunosuppressive medications. Herein, we describe a young male presenting with seizures 14 h after a successful live-related kidney transplant with magnetic resonance imaging (MRI) of the brain (MRI-T2/FLAIR) showing hyperintense bilateral parietal-occipital and parietal-temporal region suggestive of PRES. The patient was managed without switching or reduction of immunosuppression and the patient recovered with resolution of MRI changes 6 weeks posttransplant with blood pressure control.

Fluorescence spectroscopic profiling of urine samples for predicting kidney transplant rejection

Rejection is the primary factor affecting the functionality of a kidney post-transplant, where its prompt prediction of risk significantly influences therapeutic strategies and clinical outcomes. Current graft health assessment methods, including serum creatinine measurements and transplant kidney puncture biopsies, possess considerable limitations. In contrast, urine serves as a direct indicator of the graft's degenerative stage and provides a more accurate measure than peripheral blood analysis, given its non-invasive collection of kidney-specific metabolite. This research entailed collecting fluorescent fingerprint data from 120 urine samples of post-renal transplant patients using hyperspectral imaging, followed by the development of a learning model to detect various forms of immunological rejection. The model successfully identified multiple rejection types with an average diagnostic accuracy of 95.56 %.Beyond proposing an innovative approach for predicting the risk of complications post-kidney transplantation, this study heralds the potential introduction of a non-invasive, rapid, and accurate supplementary method for risk assessment in clinical practice.

Clinically relevant drug-drug interactions of tacrolimus in the first week post-kidney transplantation recipients

This retrospective observational study aimed to investigate the prevalence and associated risk factors of clinically relevant drug-drug interactions of tacrolimus in kidney transplantation (KT) recipients during the first week post-transplantation. Medical records of tacrolimus-treated KT recipients were reviewed and DDIs were determined using two drug interaction programs. The presence of clinically relevant DDIs was confirmed by evaluating tacrolimus levels (C0) and adverse drug events through the drug interaction probability scale. This study enrolled 142 eligible KT recipients with mean potential DDIs in each patient of 7.8 and a standard deviation of 2.4. The majority type of potential DDIs was in the moderate category (84.0%). The prevalence of clinically relevant DDIs of tacrolimus was 18.6% (95% confidence interval: 11.4%–27.7%). Logistic regression analysis revealed that the number of potential DDIs significantly affected the likelihood of clinically relevant DDIs with tacrolimus, increasing the odds of experiencing clinically relevant immunosuppressant DDIs by 56%. These results provided compelling evidence for the substantial prevalence of clinically relevant DDIs of tacrolimus one-week post-KT and emphasized the importance of a comprehensive understanding of associated risk factors.

The impact of hepatitis B and C positive serologies on the outcomes of non-hepatic solid organ transplantation in the United States.

Chronic viral hepatitis B (HBV) and C (HCV) infection could negatively affect outcomes of non-hepatic solid organ transplantations due to the risk of viral reactivation in the presence of immunosuppression. This study aimed to determine post-transplant outcomes in patients with HBV or HCV positivity receiving non-hepatic solid-state organ transplant. Data was collected from the Scientific Registry of Transplant Recipients (SRTR) 2006-2021 for patients (≥18) who received a lung, heart, or kidney single organ transplant in the U.S. Hepatitis C positivity (HCV+) was determined as positive HCV Ab and hepatitis B positivity (HBV+) as positive HBsAg. We included N = 30,872 lung, N = 36,990 heart and N = 280,162 kidney transplant recipients. The prevalence of HBV+ was 1.3% in lung, 1.5% in heart and 1.7% in kidney patients, HCV+ was 2.2%, 2.2% and 5.0%, respectively. Post-transplant survival of patients with vs. without HBV+ was similar in all solid organ transplants (all p > .05). Similarly, there was no difference in post-transplant survival between lung transplant recipients with vs. without anti-HCV (all p > .05). Heart transplant recipients with HCV+ had higher crude post-transplant mortality (all p < .01). Similarly, there was higher post-transplant mortality in kidney transplant recipients with HCV+ (1-year: 6% vs. 3%; 5-year: 21% vs. 13%; 10-year: 47% vs. 31%; all p < .0001). In multivariate analysis controlling for confounders, only the association of HCV+ with higher post-kidney transplant mortality remained significant: adjusted hazard ratio (aHR) (95% CI) = 1.16 (1.12-1.20), p < .0001. There was no association of viral hepatitis seropositivity with the risk of graft failure in all groups (p > .05). In most cases, the presence of HBV or HCV serologies is not associated with adverse post-transplant outcomes in non-hepatic solid organ transplants. However, kidney transplant recipients who are positive for HCV serology have an increased risk for post-transplant mortality.

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.

Pyogenic Granuloma in Kidney Transplant Recipient

Objectives: This manuscript describes a clinical case of pyogenic granuloma with atypical presentation and evolution, and outlines a brief bibliographic review on the nosological entity. Introduction: Pyogenic granuloma is a common benign skin lesion, usually small, with some more common locations and predominance in females in adulthood. It has a correlation with trauma and medications. Its pathophysiology is in the initial stages of understanding. The typical histopathological alteration is a lobular arrangement of capillaries at the base. Treatment is surgical, with a low recurrence rate; there are non-surgical alternatives. Case report: We report a case of a 25-years-old renal transplant patient who develops a giant Pyogenic granuloma in the right forearm after a mild trauma, 2 years after transplantation from a deceased donor. He performs successive surgical excisions, with several recurrences, which disappeared only after discontinuation of tacrolimus and radiotherapy. The peculiarities of this case are: post-kidney transplant status, large size, recurrences after surgery and radiotherapy.. Conclusions: A patient with pyogenic granuloma, with atypical evolution, had a favorable outcome after identification and removal of a causative factor and alternative therapy. However, this report has limited potential for generalization. There are few publications of case series involving unusual situations, in addition do the involvement of the oral mucosa, paraungual/subungual regions and cases in pregnant women. Radiotherapy is a poorly performed intervention, which can be of value in refractory cases. Further studies are needed to achieve a greater understanding of this pathology and to describe treatment alternatives.

Prospective observational study to validate a next-generation sequencing blood RNA signature to predict early kidney transplant rejection

The objective of this study was to validate the performance of Tutivia, a peripheral blood gene expression signature, in predicting early acute rejection (AR) post–kidney transplant. Recipients of living or deceased donor kidney transplants were enrolled in a nonrandomized, prospective, global, and observational study (NCT04727788). The main outcome was validation of the area under the curve (AUC) of Tutivia vs serum creatinine at biopsy alone, or Tutivia + serum creatinine at biopsy. Of the 151 kidney transplant recipients, the mean cohort age was 53 years old, and 64% were male. There were 71% (107/151) surveillance/protocol biopsies and 29% (44/151) for-cause biopsies, with a 31% (47/151) overall rejection rate. Tutivia (AUC 0.69 [95% CI: 0.59-0.77]) and AUC of Tutivia + creatinine at biopsy (0.68 [95% CI: 0.59-0.77]) were greater than the AUC of creatinine at biopsy alone (0.51.4 [95% CI: 0.43-0.60]). Applying a model cut-off of 50 (scale 0-100) generated a high- and low-risk category for AR with a negative predictive value of 0.79 (95% CI: 0.71-0.86), a positive predictive value of 0.60 (95% CI: 0.45-0.74), and an odds ratio of 5.74 (95% CI: 2.63-12.54). Tutivia represents a validated noninvasive approach for clinicians to accurately predict early AR, beyond the current standard of care.

PP88 An Exploratory Analysis Of The Potential Cost-Benefit Of Delaying Kidney Disease Progression In Australia

IntroductionChronic Kidney Disease (CKD) is a condition that leads to end-stage renal disease (ESRD), characterized by a gradual loss of kidney function. In 2021, the healthcare system expenditure of CKD in Australia was estimated to be over AUD2.3 billion (USD1.5 billion), largely attributed to Kidney Replacement Therapy (KRT, dialysis or kidney transplantation). This exploratory analysis aims to calculate the cost-benefit to the Australian healthcare system should KRT be delayed.MethodsThe prevalence of ESRD with and without KRT between 2016 and 2021 was estimated, and a simple linear regression model was created to estimate the prevalence of ESRD with KRT between 2022 and 2026. The projected cost of KRT management in 2022 was calculated, enabling an approximate cost benefit presented as the number of patients needed to reduce expenditure by AUD1 million (USD0.7 million).ResultsIn 2021, it was calculated that 34,554 patients live with ESRD in Australia, of which 28,542 patients are on KRT. The number of new patients on KRT increases linearly by an average of 943 patients per year and provided a model with a strong goodness-of-fit (R2 = 0.99); predicting that the prevalence of patients on KRT is estimated to increase to 33,417 patients by 2026. Dialysis accounts for the highest cost associated with ESRD management, estimated to be AUD87,975/year/patient (USD58,253), and accounts for over AUD1.3 billion (USD0.9 billion) in annual expenditure. When considering the proportion of patients receiving KRT undergoing dialysis (52.6%), first-year renal transplant (3.4%), and post-kidney transplantation (43.9%), in 2022, the average annual cost per patient receiving KRT is estimated to be AUD57,565 (USD38,109). The prevention of KRT in 17.4 patients in 2022, decreasing to 15.4 patients in 2026, has the potential to save AUD1 million/year (USD0.7 million).ConclusionsThe prevalence of ESRD in Australia increases linearly and contributes to a significant cost to the Australian healthcare system. In 2022, preventing KRT in 17.4 patients (0.06%) can equate to a saving of AUD1 million/year (USD0.7 million), further decreasing to 15.4 patients (0.05%) in 2026.

Assessing survival post-kidney transplantation in Australia: A multivariable prediction model.

Kidney transplantation remains the preferred standard of care for patients with kidney failure. Most patients do not access this treatment and wide variations exist in which patients access transplantation. We sought to develop a model to estimate post-kidney transplant survival to inform more accurate comparisons of access to kidney transplantation. Development and validation of prediction models using demographic and clinical data from the Australia and New Zealand Dialysis and Transplant Registry. Adult deceased donor kidney only transplant recipients between 2000 and 2020 were included. Cox proportional hazards regression methods were used with a primary outcome of patient survival. Models were evaluated using Harrell's C-statistic for discrimination, and calibration plots, predicted survival probabilities and Akaike Information Criterion for goodness-of-fit. The model development and validation cohorts included 11 302 participants. Most participants were male (62.8%) and Caucasian (79.2%). Glomerulonephritis was the most common cause of kidney disease (45.6%). The final model included recipient, donor, and transplant related variables. The model had good discrimination (C-statistic, 0.72; 95% confidence interval (CI) 0.70-0.74 in the development cohort, 0.70; 95% CI 0.67-0.73 in the validation cohort and 0.72; 95% CI 0.69-0.75 in the temporal cohort) and was well calibrated. We developed a statistical model that predicts post-kidney transplant survival in Australian kidney failure patients. This model will aid in assessing the suitability of kidney transplantation for patients with kidney failure. Survival estimates can be used to make more informed comparisons of access to transplantation between units to better measure equity of access to organ transplantation.

Ten Years of Hematopoietic Stem Cell Transplantation in Patients with Light Chain Amyloidosis: Real World Data from a Health Center in Latin America

Background: Autologous stem cell transplantation (ASCT) is an effective treatment for patients with AL amyloidosis. In recent years, due to the advent of daratumumab-based regimens that achieve fast, deep, and long-lasting hematological responses, the role of ASCT and its optimal timing have been put in discussion. Access to ASCT in Latin America is difficult and specialized transplant centers are scarce, as is access to daratumumab-based chemotherapy regimens. Objectives: To describe the characteristics and evolution of patients with AL amyloidosis who received an autologous stem cell transplantation (ASCT) estimating organic response, overall and progression-free survival. To compare the evolution between patients initially eligible for transplantation and those who were not. Methods: We designed a retrospective cohort study of adult patients with AL Amyloidosis who received an ASCT between 2012 and 2022. Those who did not complete one year of follow-up were excluded. We obtained data from patients enrolled in the Institutional Amyloidosis Registry. Continuous variables were compared with the Student or Mann-Whitney test according to distribution, and categorical variables were compared with chi2 or Fisher. Overall and progression-free survival was estimated using Kaplan Meier. Results: Of 129 patients with AL, 32 received ASCT (24.5%). Twenty were eligible for analysis.The baseline characteristics are shown in table 1. The median time to diagnosis was 14 months (IQR 7-27). At the time of diagnosis, 9 patients (45%) were not eligible for transplantation; in all cases, ineligibility was due to cardiac involvement, with 4 receiving heart transplantation prior to ASCT. The longest time between heart transplantation and ASCT was 348 days. More information on renal and cardiac involvement at diagnosis and at ASCT is shown on table 2. Regarding treatment, 18 patients underwent a single line of chemotherapy with a median of 4 cycles prior to ASCT. All patients received regimens with bortezomib and only 3 added daratumumab. One patient underwent ASCT without hematological response, 7 with a partial response (PR), 5 with very good partial response (VGPR) and 7 with a complete response (CR). The time to best hematological response was not statistically different between patients who did and did not receive daratumumab, probably due to the low number of patients in the daratumumab group. The median age at transplant was 63.5 years old (IQR 50.5-68). Fourteen patients underwent conditioning with full dose melphalan and 6 with reduced dose. There was no statistically significant difference between these groups in terms of relapse and survival. The median number of days of hospitalization for the transplant was 20 (IQR 18-24). Only two patients required intensive care. The median number of transfusions per patient was 5 (IQR 3-9). There were no deaths during hospitalization or in the first 100 days of followup. The median time to engraftment was 12.5 days (IQR 11-14); in patients with cd34 collects &amp;gt; 6.5x10(6), median time to engraftment was 12.2 days (IQR 10.6-13.8), and in patients with cd34&amp;lt; 6.5x10(6), 15.4 days (IQR 9.9-20.9). This difference, as well as the difference in transfusions among the two groups, was not statistically significant. After ASCT, 15 patients obtained CR and 5 VGPR; 8 patients relapsed. The median time to relapse was 6.10 years (IQR 2.28-6.70). Of 9 patients with renal involvement, 7 presented renal response (2 pre and 5 post ASCT). Of the remaining, 1 received a post ASCT kidney transplant. Median time to renal response from start of treatment was 740 days (IQ 400-1736). Amongst the 10 patients with cardiac involvement, 4 underwent pre-ASCT heart transplantation. Of the remaining, 5 (83%) documented cardiac responses with a median of 538 days (IQR 487-611), in 2 cases prior to ASCT. There were no differences in morbidity and mortality between heart transplant recipients and the ones who did not receive a heart transplantation. Only 3 patients died, 2 from causes related to cardiac involvement and one from unrelated causes. Conclusions: ASCT is a safe treatment when performed in an experienced center. It ensures deep responses and prolongs progression-free survival. Patient selection is key to achieve these outcomes. Ineligibility at diagnosis is not related to worse post ASCT morbidity and mortality outcomes. Heart transplantation prior to ASCT is a safe strategy to favor eligibility.

The feasibility of Technology, Application, Self-Management for Kidney (TASK) intervention in post-kidney transplant recipients using a pre/posttest design

BackgroundWeight gain after a kidney transplant remains a major problem that can lead to adverse effects on morbidity and mortality. The posttransplant phase provides a window of opportunity to improve the engagement of self-management of care for lifestyle modifications for diet and physical activity. The purpose of our study was to (1) test the feasibility of recruitment, retention, and adherence for using the Technology, Application, Self-Management for Kidney (TASK) intervention in post-kidney transplant recipients (≥ 18 years of age) at baseline, 4, 8, and 12 weeks; and (2) estimate the preliminary effects of the TASK intervention in producing change over time for blood pressure (BP), weight, fruits/vegetable intake, fiber intake, sodium intake, self-efficacy to exercise, and perceived stress.MethodsThis study used a 12-week pre/posttest design using to test the feasibility of the TASK intervention. We applied paired t-tests and McNemar’s test to compare the outcomes at weeks 4, 8, and 12.ResultsWe met our recruitment goal (N = 20) and found a 15% attrition rate (n = 3) at Week 12. Adherence rate among the study completers for recording daily food intake was 83–94% over the 12 weeks and for recording daily physical activity was 17–33% over the 12 weeks. We observed improvements over time for BP, weight, fruits/vegetable intake, fiber intake, and sodium intake; these differences were non-significant, although clinically important. We did find a significant difference from baseline to 12 weeks in weight reduction (p = 0.02), self-efficacy to exercise (p = 0.003), and perceived stress (p = 0.04).ConclusionsThe data suggest the TASK intervention was feasible for kidney recipients to use and resulted in weight control, increased self-efficacy to exercise, and decreased perceived stress.Trial registrationClinicalTrials.gov #:NCT05151445

Incidence of Kidney Failure after Primary Organ Transplant.

Careful selection of multiorgan transplant candidates is required to avoid unintended consequences to patients waiting for kidney transplant alone. The need for a safety net among heart and lung transplant recipients is unknown. The objective of this study was to quantify the incidence of kidney failure after liver, heart, or lung transplantation and identify pre-transplant predictors of post-transplant kidney failure. A retrospective cross-sectional study of adults who received liver, heart, or lung transplant between January 1, 2008 and December 31, 2018 was conducted using data from the Scientific Registry of Transplant Recipient and the United States Renal Data System. Post-transplant renal failure was defined as (a) new start of dialysis; (b) estimated glomerular filtration rate of < 25 mL/min; (c) a new waitlisting for a kidney transplant; or (d) receipt of a kidney transplant. The final descriptive cohort 53,620 liver transplant recipients, 22,042 heart transplant recipients, and 10,688 lung transplant recipients. In the first-year post-transplant, the probability of ESKD was comparable among heart transplant recipients (0.036, 95% CI [0.033, 0.038]) and liver transplant recipients (0.033, 95% CI [0.031, 0.035]) but was markedly lower in lung transplant recipients (0.024, 95% CI [0.021, 0.027]). In the second-year post-transplant, the probability of ESKD was comparable among liver (0.016, 95% CI [0.015, 0.017]), lung (0.018, 95% CI [0.015, 0.021]), and heart transplant recipients (0.014, 95% CI [0.013, 0.016]). Candidates for thoracic transplant would likely benefit from a safety net policy similar to the one enacted in 2017 for liver transplant, so as to maintain judicious patient selection for simultaneous multi-organ transplant. National data sources do not currently collect sufficiently reliable follow up data to identify pre-transplant predictors of end stage kidney disease, pointing to a need for transplant centers to consistently report kidney impairment data to national databases.