Post-kidney Transplant Period Research Articles

THU275 Tacrolimus Levels And Kidney Function In Kidney Transplanted (KT) Patients With Diabetes On Glucagon Like-1 Receptor Agonists (GLP1-RA)

Abstract Disclosure: M.S. Campana: None. V. Kumar: None. D. Redden: None. H.J. Zelada Castro: None. Introduction: Uncontrolled Diabetes after solid-organ transplantation is associated with an increased risk of cardiovascular disease and renal graft loss. GLP1-RA are commonly used in the management of diabetes in non-transplanted populations because of cardio-metabolic benefits; however, their impact on tacrolimus absorption and kidney function in the post-transplant period has not been adequately studied. We aim to describe the association of blood tacrolimus levels, dose adjustments and kidney function in KT participants with diabetes who received GLP1-RA to participants who did not. Methods: We analyzed 50 adults with diabetes who underwent KT from 08/2020 to 08/2022 at UAB-Transplant Institute. 25 participants on insulin ± oral antidiabetic medications initiated GLP1RA (cases) and 25 participants on insulin ± oral antidiabetic did not start GLP1RA (controls). GLP1RA was started 7.72 months±5.26 after KT and 88% of them were on GLP1RA for the first time. Case group did not report active gastrointestinal symptoms and were educated to eat small-meal portions. We assessed number of times tacrolimus were at target [4-7 ng/ml], above or below target, number of times tacrolimus doses were adjusted, GFR and rejection rates (kidney biopsy) before GLP1RA therapy, 3 and 6 months after. For the comparison of categorical variables between groups, we used Pearson’s Chi-Square Test. Due to observed deviations from normality; we compared the distributions of counts and continuous outcomes between groups using Wilcoxon Rank Sum Tests. All tests were conducted using SAS 9.4. Results: KT participants (case, control) were predominantly of age (56.28 years, 57.40 years (p=0.66)), male (64%, 64% (p=1.0)), African American (60%, 84% (p=0.23)) and with a transplant rejection rate of 16% vs. 20% (p=0.71). There was a statistical difference in creatinine, GFR, and tacrolimus dose adjustments between the two groups. 1) Creatinine: Cases (at 6 months,1.48 mg/dL ± 0.41), Controls (at 6 months, 2.74 ± 2.38) (p=0.03). 2) GFR: Cases (at 6 months, 53.44 ml/min ± 15.89 ), Controls (at 6 months, 40.34 ± 17.75) (p=0. 038). 3) Number of Times Tacrolimus levels were out of range: Cases (at 3 months, 1.44 ± 1.08), Controls (at 3 months, 2.08 ± 0.81) (p= 0.02). 4) Number of times tacrolimus dose was increased: Cases (at 6 months, 0.12 ± 0.33), Controls (at 6 months, 0.36 ± 0.49) (p=0.04). None of the participants developed significant gastrointestinal side effects and the rate of GLP1RA discontinuation was 0%. Conclusion: Participants who took GLP1RA had better-preserved kidney function compared to those who did not, especially in the early post-kidney transplant period. Contrary to concern for altered tacrolimus absorption, patients treated with GLP1RA did not appear to have altered absorption requiring dose adjustment and can be used safely with minimal side effects and better efficacy compared to standard-of-care treatment. Presentation: Thursday, June 15, 2023

Transfused Red Blood Cell Characteristics and Kidney Transplant Outcomes Among Patients Receiving Early Posttransplant Transfusion

Red blood cell transfusion (RBCT) is frequently required in the early post-kidney transplant period, but long-term outcomes associated with RBCT is controversial. Therefore, it may be relevant to investigate the association between RBCT characteristics and transplant outcomes. To study the association between RBC storage duration and transplant outcomes. This was a nationwide retrospective cohort study based on data linking between 2 prospective French nationwide registries. Clinical transplant parameters, outcomes, and RBCT characteristics were extracted from the CRISTAL registry of the Agence de la Biomédecine and the national database of the Etablissement Français du Sang. All 12 559 patients having received a first kidney transplant in France between January 1, 2002, and December 31, 2008, were included. Patients were followed up from transplant to graft loss, death with a functional graft, or data retrieval in June 2016. Data were analyzed from April 2019 to June 2022. Clinical outcomes of transplant recipients who underwent early RBCT were analyzed considering transfusion characteristics. Cox proportional hazards regression models were fitted to evaluate transplant failure defined as graft loss or death with a functional graft. Among 12 559 patients who underwent kidney transplant, 3483 received an RBCT during the first 14 days posttransplant. The median (IQR) age of patients was 53.0 (41.5-61.2) years, and 1929 patients (55.4%) were male. Median (IQR) follow-up was 7.8 (7.6-8.0) years. In multivariable analysis, longer (vs shorter) storage duration of transfused RBC was associated with a decrease in risk of transplant failure (hazard ratio, 0.99; 95% CI, 0.98-1.00 for each additional storage day; P = .06). Patients transfused with at least 1 RBC unit stored for more than 20 days had a 5% absolute decrease in transplant failure at 3 years and 7% at 5 years compared with those who received RBC stored for less than 20 days. In this study, longer RBC storage duration was associated with a decreased risk of transplant failure among patients who received kidney transplants and RBC transfusions. Preferential use of RBC with longer storage duration might improve kidney graft survival following transplant and transfusion.

Böbrek Nakli Alıcılarında Düşme: Geleneksel Derleme

Kidney transplantation is the gold standard treatment for end stage renal disease. Despite the improvement in survival and quality of life, the prevalence of falls is higher in kidney transplant recipients. Factors that increase the risk for falls include female gender, older age, impaired balance control, lower ankle dorsiflexion muscle strength, high serum creatinine levels, and the use of antidiabetic medications. Functional limitations, fatigue, low cardio-respiratory fitness, changes in mineral metabolism lead to bone mineral disease in chronic kidney disease and can finally play an important role in occurrence of accidental falls in pre-transplantation period. Fractures without dislocations or head injury-related hemorrhages constitute a majority for the serious fall-related injury types. In addition to many factors such as cumulative dose of corticosteroids, younger age at transplantation, hyperparathyroidism, vitamin D deficiency and renal osteodystrophy, risk of falls also contribute to increased post-transplantation bone loss and fracture risk. Hip fractures requiring hospitalization in the post-kidney transplant period are associated with a higher risk of mortality. It is important to understand the underlying mechanisms for falls in kidney transplant recipients in order to prevent severe injuries including fractures and decrease healthcare costs. The awareness of healthcare professionals should be increased for falls in this specific population to design multidisciplinary therapeutic approaches including risk factor assessment, exercise programs and patient and caregiver education not only for kidney transplant recipients but also for the patients waiting on a transplantation list.

344.7: Early Post-operative Thrombotic Microangiopathy in Deceased Donor Kidney Transplant: Case Series

Background: Transplant associated thrombotic microangiopathy (TA-TMA) is well recognized as a serious complication of renal transplantation. TA-TMA is characterized by injury of arterioles and capillaries and encompasses syndromes of thrombocytopenia, microangiopathic hemolytic anemia(MAHA) and variable degrees of kidney graft dysfunction. TA-TMA can be classified into recurrent TMA (from underlying complement mutations) and de novo TMA. The incidence of de novo TMA ranges from 3-14%. Causes of de novo TMA include immunosuppressive drugs (tacrolimus, mTOR inhibitors, valgancyclovir), ischemia reperfusion injury, viral infections (CMV, Parvovirus B19, HIV, HHV-6) and antibody-mediated rejection. We have found that many of these cases also have very low levels of ADAMTS13 but do not meeting clinical criteria for TTP. If the latter is secondary to endothelial damage vs consumption process is still unknown. Objective: The purpose of this study was to identify if any specific risk factors or variables are associated with TA-TMA in the setting of deceased donor kidney transplantation (DDKT). Methods: We retrospectively collected data on 11 patients who were diagnosed with TA-TMA in the immediate post operative period (defined as less than 2 weeks from transplant date) since January, 2017. We analyzed donor characteristics including age, type of deceased donor, last known platelet count, biopsy features, pump parameters, cold ischemia time (CIT), warm ischemia time (WIT), reperfusion injury (RI) described at transplant surgery. Recipient variables included baseline platelet count on admission, the post-op day of diagnosis and at resolution (defined as platelet count > 100K and no need for additional transfusion), the use of thymoglobulin, ADAMS13 activity, changes in maintenance immunosuppression, evidence of post op bleeding, delayed graft function (DGF) and its recovery, and renal function at 1 and 3 months post transplant (Table). Results: 72% of the kidneys were from donation after cardiac death donors (DCD). The mean arterial pressure on the perfusion pump was 39 ± 7 mmHg and the flow was 148 ± 35 ml/sec. 81 % of the donor biopsies showed mild ATN, 72% had evidence of atherosclerosis and 54% of fibrosis and only one showed fibrin thrombi in the glomerulus. The mean CIT and WIT were 1913 ± 423 and 27 ± 32 min, respectively. The mean donor platelet count and baseline recipient’s platelet count were 209 ± 210 and 166 ± 71 x 10(3)/mcl, respectively. The TA-TMA event occurred on post op day 3± 1.3 with a mean platelet count of 45 ± 19 x 10(3)/mcl. ADAMTS 13 level was <10% in 54% of the cases and LDH level 2880 ± 55 U/L. 3 patients received FFP infusions, 5 received plasmapheresis and 3 received conservative treatment. The microangiopathic hemolytic anemia recovered in 10 ± 2.4 days to a platelet count of 130 ± 67 x 10(3)/mcl. There were 6 cases of post op bleeding (55%) with 4 requiring surgical intervention and 4 cases of RI (36%). Of the 8 patients that sustained DGF, 6 recovered at one month, one recovered at 3 months post transplant (having history of low C3 and late biopsy proven TMA) and one died. The mean SCr and eGFR at 1 and 3 months were 2± 1.1, 51 ± 34 and 1 ± 0.5 mg/dl and 66± 30 ml/min, respectively.There were no statistical differences on the above parameters when the patients were grouped by the presence of post operatory bleeding. However, when we added the reperfusion injury factor, we found a lower ADAMTS 13 levels of 17 ±7 UI/dl in the non bleeding group who sustained RI (60%) vs 21± 37 UI/dl in the bleeding group who had only one patient with RI (17%) (p=0.24). Conclusions: TA-TMA in the immediate postoperative period can be difficult to diagnose and treat. Our findings demonstrated that 55% of the cases were associated with post operatory bleeding leading to the reduction of ADAMTS 13 levels, most likely by platelet consumption. 36% were related to reperfusion injury where the consumption of ADAMTS 13 could be explained by direct endothelial damage. None of the patients needed other than conservative therapy. This data needs to be correlated in a larger cohort. In this context we are planning to prospectively study ADAMTS 13 activity in the immediate post kidney transplant period.

Abstract P153: Heart Rate And Systolic Hypertension At Early Post-kidney Transplant Period

Introduction: Sympathetic nervous system activation may be assessed by increased heart rate, which is associated with worsened cardiovascular and renal outcomes in general population. We aim to examine association between heart rate and blood pressure in kidney transplant recipients. Methods: A single center retrospective cohort study examines association of average successive heart rate (ASHR), which was defined as the average heart rate between successive office heart rate, with systolic blood pressure (SBP) and diastolic blood pressure (DBP) at 12-, 24-, 36-, and 48-weeks post-transplant by using multiple linear regression. Association of the ASHR with systolic hypertension (SHTN) and diastolic hypertension (DHTN) defined as SBP ≥130 and DBP ≥80 mmHg, respectively, were tested by multiple logistic regression. Results: Of all 105 kidney transplant recipients, mean age±SD was 54±12 years old and 61% was female. ASHR were 80±9, 79±10, 78±11, 76±11 beats/minutes at 12, 24, 36, and 48 weeks, respectively (p 0.509); therefore, ASHR was categorized into low and high ASHR groups (&lt;80 and ≥80 beats/minute). The corresponding SBP were 136±17, 135±19, 132±16, 133±16 mmHg (p 0.356) and DBP were 80±11, 80±12, 78±11, 71±11 mmHg, respectively (p 0.644). With adjustment for age, gender, body mass index, type of kidney transplant, and induction immunosuppressive medications, at 24-week post-transplant, every 10 beats/minute increase in ASHR was associated with 4.4 mmHg decrease in SBP (β adjusted -0.440; p 0.016; 95%CI -0.796, -0.084) and high ASHR group was associated with 0.32-time lower odds of developing SHTN (OR adjusted 0.324; p 0.022; 95%CI 0.124, 0.852). There was no statistically significant association between ASHR and SBP at other post-transplant periods as well as between ASHR and DBP. Conclusions: Increased or high heart rate is associated with lower SBP or SHTN, but not DBP or DHTN at early post-transplant period. This association in an opposite direction among kidney transplant recipients may indicate different effects of sympathetic nervous system activation on blood pressure. Changes in immunological and non-immunological factors may contribute to the findings at different post-transplant periods.

Early Post-Transplant Leptin Concentration Changes in Kidney Transplant Recipients.

Background and Objectives: Kidney transplant recipients represent a unique population with metabolic abnormalities, altered nutritional and immune status, as well as an imbalanced regulation of adipocytokine metabolism. Leptin is a hormonally active protein mainly produced by fat tissue that modulates appetite, satiety, and influences growth, energy, and bone metabolism. There has been great interest in the role of this hormone in chronic kidney disease-related protein energy wasting; thus, a positive leptin correlation with body mass index and fat mass was confirmed. This study was designed to determine the association of pre and post-kidney transplant leptin concentration with nutritional status and body composition. Materials and Methods: We studied 65 kidney transplant recipients. Nutritional status was evaluated before kidney transplantation and 6 months later using three different malnutrition screening tools (Subjective Global Assessment Scale (SGA), Malnutrition Inflammation Score (MIS), and Geriatric Nutritional Risk Index (GNRI)), anthropometric measurements, and body composition (bioelectrical impedance analysis (BIA)). Demographic profile, serum leptin levels, and other biochemical nutritional markers were collected. Statistical analysis was performed with R software. Results: Median age of the studied patients was 45 years, 42% were females, and 12% had diabetes. Leptin change was associated with body weight (p < 0.001), waist circumference (p < 0.001), fat mass (p < 0.001) and body fat percentage (p < 0.001), decrease in parathyroid hormone (PTH) (p < 0.001) transferrin (p < 0.001), diabetes mellitus (p = 0.010), and residual renal function (p = 0.039), but not dependent on dialysis vintage, estimated glomerular filtration rate (eGFR), or delayed graft function at any time during the study. After adjustment for age and sex, body mass index (BMI) (p < 0.001), fat mass (p < 0.001), and body fat percentage (p < 0.001) were independent variables significantly associated with post-transplant leptin change. Lower leptin values were found both before and after kidney transplantation in the SGA B group. GNRI as a nutritional status tool was strongly positively related to changes in leptin within the 6-month follow-up period. Conclusions: Kidney transplant recipients experience change in leptin concentration mainly due to an increase in fat mass and loss of muscle mass. GNRI score as compared to SGA or MIS score identifies patients in whom leptin concentration is increasing alongside an accumulation of fat and decreasing muscle mass. Leptin concentration evaluation in combination with BIA, handgrip strength measurement, and GNRI assessment are tools of importance in defining nutrition status in the early post-kidney transplant period.

PCSK9 and inflammatory biomarkers in the early post kidney transplantation period.

Various biomarkers have been studied in the early post-kidney transplantation (post-KTx) period in order to identify potential therapeutic targets for improving long-term graft survival. Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a biomarker that has recently gained interest in cardiovascular disease but its role still remains to be defined post-KTx. We prospectively evaluated the levels of PCSK9, interleukin (IL)-6, WBC and C-reactive protein in seventy-three hemodialysis patients undergoing KTx, at 3 time-points; pre-transplantation (day 0) and at 1 and 6-months post-KTx. All data were also analyzed according to donor-type (living or deceased) and compared with hemodialysis patients on transplant waiting list. At Day 0 there was no difference in WBC, CRP, IL-6 and PCSK9 levels between patients scheduled for transplantation and those who remained on hemodialysis. In transplanted patients WBC, CRP and IL-6 levels were significantly reduced early post-KTx [logIL-6 Day 0: 0.68 (0.33, 0.85) vs. 1-month: 0.57 (0.37, 0.75) vs. 6-months: 0.50 (0.32, 0.69) pg/ml, p=0.01], while PCSK9 levels were significantly increased (Day 0: 199.8±63.0 vs. 1-month: 276.2±79.4 vs. 6-months: 245.9±62.5 ng/ml, p<0.001). In contrast, no change of WBC, CRP, IL-6 and PCSK9 levels was observed in hemodialysis patients on follow-up (p=NS for all). Between living-donor and deceased-donor recipients, analysis showed reduced CRP and increased PCSK9 levels in both groups (p<0.05 for all), while IL-6 levels were reduced in living-donor and increased in deceased-donor recipients 1-month post-KTx. PCSK9 levels were not correlated with renal function, delayed graft function, rejection episodes or inflammatory biomarkers. PCSK9 levels were increased post-KTx independently from renal function and inflammatory biomarkers, in both living and deceased-donor recipients.

286 Dialysis Modality and Hypertension at an Early Post-Kidney Transplant Period: A Propensity Score Weighting

286 Dialysis Modality and Hypertension at an Early Post-Kidney Transplant Period: A Propensity Score Weighting

Severe Intraabdominal Hypertension in Critically Ill COVID-19 Patients With Acute Kidney Injury

Severe Intraabdominal Hypertension in Critically Ill COVID-19 Patients With Acute Kidney Injury

Identifying Early Extraperitoneal High-Volume Urine Leak Post Kidney Transplantation

Transplant clinicians need to be watchful of several potential surgical complications in the early post-transplant period, including haemorrhage, extraperitoneal urine leak, and lymphocele. While haemorrhage and extraperitoneal urine leak usually present in the early post kidney transplant period, lymphoceles usually present 2–6 weeks after transplantation. While the colour and volume of the drained fluid can give some indication of the problem, is not enough evidence for a confident urine leak diagnosis. Further investigations, such as serum biochemical parameter analysis of the drained fluid and ultrasonography, help to identify the true cause. This paper discusses how to identify high-volume extraperitoneal urine leaks in the early post kidney transplant period and considers the differential diagnoses. Different ureteroneocystostomy procedures, including the Lich–Grégoir, Politano–Leadbetter, and U-stitch techniques, are discussed and compared regarding complication rates (especially urine leak and haematuria). The authors also address the management of low- and high-volume extraperitoneal urine leak, the follow-up needed, and the impact of urine leak on graft and patient survival, length of hospital stay, and rate of hospital readmission.

ANGIOTENSIN II RECEPTOR BLOCKER INHIBITOR USE AFTER KIDNEY TRANSPLANTION AND SAFETY: A RANDOMIZED, DOUBLE-BLINDED PLACEBO-CONTROLLED STUDY

Introduction: End stage Renal disease is chronic irreversible renal failure that needed renal replacement therapy and Kidney transplantation in most patiens is the best modality.In transplant centers improvement in graft and patient survival after transplantation is purpose. Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in CKD patients decrease in blood pressure, albuminuria and glomerulosclerosis but data insufficient about their safety in kidney transplant recipients.hyperkalemia and decrease in GFR are most worrisome. In this study we evaluate the safety of ARBs(Losartan)in post transplant. Methods: In this double blinded placebo control trial 70 candidates of first living kidney transplant from November 2013 to December 2015 in Labbafinejad Hospital enrolment 24 were excluded only 54 patients randomly divided .6 days after transplantation 27 patients in group 1 received Losartan 25 mg daily and group 2 placebo until 6 and 12 months post transplant. Whole blood sample before initiation of drug and 6 months later were collected. Kidney biopsy after 6 months in all patients were done. Results: In 54 patients randomized Mean age of patients in losartan group was 42.84 ± 9.2 and in the control group was 35.22 ± 10.4 (p>0.05). Mean donor age was not significantly different with the groups. (31.47 vs. 26.66 years; p>0.05). During the study, there was no significant differences in blood pressure, eGFR, potassium level, and hemoglobin level between the two groups. (Table-2). The difference in eGFR was not significant even at 12 months after transplantation. (72.7 vs 70.9 cc/min in case and control group, respectively; P>0.05).Discussion: According to the results potassium, hemoglobin,AST, ALT and GFR levels did not differ significantly between the groups. There is not different in graft failure incidence and, death in groups. We can successfully use ARBs without risk in the post-kidney transplant period, and benefited from long-term beneficial effects on renal function.

Intra-abdominal hypertension in early post-kidney transplantation period is associated with impaired graft function.

Moderate hyperhydration is often achieved in the early post-kidney transplantation period. Whether this strategy could lead to the development of intra-abdominal hypertension (IAH) has never been assessed so far. We aimed to study the incidence of IAH after kidney transplantation and its association with graft function recovery. We conducted a prospective monocentric study among patients undergoing kidney transplantation at the University Hospital of Reims between May 2017 and April 2019. Intravesical pressure (IVP) was monitored every 8 h from Day 0 to 3. A total of 107 patients were enrolled. Among 55 patients included in the analysis, 74.5% developed IAH. Body mass index >25 kg/m2 was associated with IAH development {odds ratio [OR] 10.4 [95% confidence interval (CI) 2.0-52.9]; P = 0.005}. A previous history of peritoneal dialysis was protective [OR 0.06 (95% CI 0.01-0.3); P = 0.001]. IAH Grades III and IV occurred in 30.9% of patients and correlated with higher Day 3 creatininaemia (419.6 ± 258.5 versus 232.5 ± 189.4 μmol/L; P = 0.02), higher delayed graft function incidence (41.2 versus 7.9%; P = 0.04), lower Kirchner index measured using scintigraphy (0.47 ± 0.09 versus 0.64 ± 0.09; P = 0.0005) and decreased Day 30 estimated glomerular filtration rate (35.8 ± 18.8 versus 52.5 ± 21.3, P = 0.05). IAH patients had higher fluid balance (P = 0.02). Evolution of IVP correlated with weight gain (P < 0.01) and central venous pressure (P < 0.001). IAH is frequent after kidney transplantation and IAH Grades III and IV are independently associated with impaired graft function. These results question current haemodynamic objectives and raise for the first time interest in intra-abdominal pressure monitoring in these patients. ClinicalTrials.gov identifier: NCT03478176.

Evaluating Factors Associated With Blood Pressure Control in the Early Post-Kidney Transplant Period.

Background: Shortened allograft survival, and cardiovascular morbidity and mortality are consequences of inadequate control of hypertension for kidney transplant recipients (KTRs). Literature suggests the risk is multifactorial, although few studies have evaluated risk factors in relation to guideline recommended blood pressure (BP) goals in the early post-kidney transplant period. This study will elucidate factors associated with controlled BP in KTRs. Methods: Adult KTRs who were transplanted between January 1, 2013, and October 31, 2018, were evaluated. Coprimary outcomes included the proportion of patients who had controlled BP at postoperative day (POD) 30 and identification of the covariates associated with controlled BP at POD 30. Additional outcomes included the proportion of patients who had controlled BP at POD 60 and 90; the difference in the average number of antihypertensive medications taken pretransplant vs POD 30, 60, and 90 for patients with controlled BP at POD 30; antihypertensive use rates pretransplant vs POD 30 and 90; and class of antihypertensive used pretransplant vs POD 30 and 90. Results: At POD 30, 44% (100/226) of patients had controlled BP. The proportion of patients with controlled BP at POD 60 and 90 were 37% (82/220) and 40% (79/196), respectively. In bivariate analyses, lack of recipient hypertension (75% vs 42.5%, P = .04); fewer days on dialysis (1684 vs 2189 days, P = .005); absence of delayed graft function (51.2% vs 35.6%, P = .02); younger donor age (30 vs 40 years, P < .001); absence of donor hypertension (46.9% vs 29.3%, P = .004); and a lower median kidney donor profile index (29% vs 40%, P = .03) were associated with controlled BP at POD 30. In a multivariate analysis, donor age was independently associated with controlled BP at POD 30 (P = .03). Conclusions: This study suggests that younger donor age is associated with controlled BP, and conversely, older donor age is associated with uncontrolled BP in KTRs in the early post-kidney transplant period. Patients receiving a graft from older donors should have their BP closely monitored.

232.3: Angiotensin II receptor blocker inhibitor (ARBs) use after kidney transplantation and safety: A randomized, double-blinded placebo-controlled study.

Labafinejd hospital nephrology group. Background: End stage Renal disease is chronic irreversible renal failure that needed renal replacement therapy and Kidney transplantation in most patients is the best modality. In transplant centers, improvement in graft and patient survival after transplantation is purpose. Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in CKD patients decrease in blood pressure, albuminuria and glomerulosclerosis but data insufficient about their safety in kidney transplant recipients. Hyperkalemia and decrease in GFR are most worrisome. In this study we evaluate the safety of ARBs (Losartan) in post-transplant. Methods: In this double blinded placebo control trial, 70 candidates of first living kidney transplant from November 2013 to December 2015 in Labbafinejad Hospital enrolment. 24 were excluded and 54 patients were randomly divided. 6 days after transplantation, 27 patients in group 1 received Losartan 25 mg daily and group 2 placebo until 6 and 12 months post-transplant. Whole blood sample before initiation of drug and 6 and 12 months later were collected. Kidney biopsy after 6 months in all patients were done. Results: In 54 patients randomized, the mean age of patients in losartan group was 42.84 ± 9.2 and in the control group was 35.22 ± 10.4 (p>0.05). Mean donor age was not significantly different with the groups. (31.47 vs. 26.66 years; p>0.05). During the study, there was no significant differences in blood pressure, eGFR, potassium level, and hemoglobin level between the two groups. (Table-2). The difference in eGFR was not significant even at 12 months after transplantation. (72.7 vs 70.9 cc/min in case and control group, respectively; P>0.05).Table 1: DBP: Diastolic blood pressure; eGFR: estimated glomerular filtration rate; FBS: fasting blood sugar; SBP: systolic blood pressure; SD: standard deviationConclusions: According to the results potassium, hemoglobin, AST, ALT and GFR levels did not differ significantly between the groups. There is not different in graft failure incidence and, death in groups. We can successfully use ARBs without risk in the post-kidney transplant period, and benefited from long-term beneficial effects on renal function. Shahid Beheshti university of medical sciences.

Assessment of delayed graft function using susceptibility-weighted imaging in the early period after kidney transplantation: a feasibility study.

This study aimed to explore the feasibility of susceptibility-weighted imaging (SWI) for evaluating delayed graft function (DGF) during the early posttransplantation period. Sixty-nine recipients who accepted allograft renal transplantation underwent SWI during the second posttransplantation week. Renal allograft function was estimated via the glomerular filtration rate. Recipients with and without DGF were identified. For each transplanted kidney, the presence of abnormal signal intensity lesions (ASILs), excluding benign lesions, on SWI was assessed. Renal allograft function was compared between the recipients with and without ASILs. The correlation between ASILs and renal allograft function was tested by Spearman's rank correlation analysis. Thirty-four recipients were diagnosed with DGF, while 35 recipients showed no DGF. In the DGF group, 16 recipients had low-intensity ASILs, primarily at the corticomedullary junction of transplanted kidneys on SWI, and no ASILs were found in 18 recipients. In the non-DGF group, none of the recipients showed ASILs on SWI. In the DGF group, the renal allograft function among the 16 recipients with low-intensity ASILs was significantly lower than that among the other 18 recipients (8.5±4.2 vs. 19.7±9.7 mL/min, P<0.001). The presence of low-intensity ASILs on SWI showed a moderate negative correlation with renal allograft function in recipients with DGF (r=-0.553, P=0.001). SWI can be used to evaluate DGF in the early post-kidney transplantation period.

Clinical Utility of Epstein-Barr Virus Viral Load Monitoring and Risk Factors for Posttransplant Lymphoproliferative Disorders After Kidney Transplantation: A Single-Center, 10-Year Observational Cohort Study.

BackgroundPosttransplant lymphoproliferative disease (PTLD) is an important cause of morbidity and mortality in solid organ transplants. Epstein Barr virus (EBV) plays a major role in PTLD development. Guidelines recommend EBV viral load (VL) monitoring in high-risk populations in the first year.MethodsRetrospective observational study in all adult patients who had at least 1 EBV-VL performed in the postkidney transplant (KT) period from January 2005 to December 2014 at the Policlinico Modena Hospital. We compared patients with negative EBV-DNA to patients with positive EBV-DNA and we described PTLD developed in the study period.ResultsOne hundred ninety (36.3%) KT patients of 523 were screened for EBV-DNA with 796 samples. One hundred twenty-eight (67.4%) of 190 tested patients presented at least 1 positive sample for EBV. Older age, the use of sirolimus, everolimus, and steroids were associated with EBV-DNA positivity in the univariate analysis. Nine (1.7%) of 523 patients had PTLD. Incidence rate of PTLD in the KT cohort was 0.19/100 person year follow-up (95% confidence interval, 0.09-0.37). One of 9 patients developed early PTLD and was a high-risk patient. Only this PTLD case was positive for EBV. No PTLD case had an EBV-VL superior to 4000 copies/mL.ConclusionsOur results suggest that the keystone of PTLD diagnosis is the clinical suspicion. Our study suggests that, in line with guidelines, EBV-VL assays may be avoided in low-risk patients in the absence of a strong clinical PTLD suspicion without increasing patients' risk of developing PTLD. This represents a safe and cost-saving clinical strategy for our center.

Unusual presentation of mucormycosis

Early post-kidney transplant period is at high risk of acquiring fungal infections due to maximum immunosuppression. We are reporting case of a 39-year-old male who did well for 16 years after renal transplantation, and then had gastric mucormycosis mimicking acute pancreatitis while on low dose maintenance immunosuppression. At admission, his clinical and laboratory parameters were suggestive of the acute pancreatitis but further worsening needed invasive investigations. Endoscopy was done and histopathology of large irregular gastric ulcer with yellow base and raised margin and tissue staining confirmed the fungus. Subsequent treatment with combined fungal therapy of amphotericin and posaconazole did not save our patient. The case highlights that mucor can present late when on low dose immunosuppression and can mimic acute pancreatitis.

Illness Narrative: Perceptions and Lived Experiences of Kidney Recipient Clients in Shanghai, China

Terminal kidney disease is a life threatening condition and cause for loss of hope to affected individuals. It affects the individuals physically as well as mentally. The advancement in medical knowledge and technology in transplant surgery has steadily increased the number of kidney recipients. This offers hope for the new lease of life and a wide range of perceptions and experiences with self, society and the new organ. There is minimal research on perceptions and lived experiences of kidney transplant recipients. This study explored the perceptions and lived experiences of individuals with a kidney problem living with a kidney transplant in Shanghai, China. Five in-depth interviews were conducted with five clients. The participant’s age ranged from 25 to 45 years. There were three females and two males. Content analysis using NVivo (11.0) software was applied in data analysis. The findings revealed improved quality of life among kidney recipients; however the clients had low knowledge levels on the condition as well as self care practices in the post transplant period. This caused a lot of psychosocial stress in the clients. The post kidney transplant management strategies should include effective education programs to increase awareness on the condition and self care practices so as to reduce factors associated with psychosocial stress in order to improve the quality of life for the clients in the post kidney transplantation period.

0168: Myocardial infarction after kidney transplantation: age related profile. Analysis from a French nationwide hospital medical information database

Cardiovascular disease accounts for 43% of all deaths in patients with endstage renal disease, and CVD continues to remain the leading cause of mortality and morbidity following renal transplantation. However, the characteristics and the hospital mortality of acute myocardial infarction (AMI) in patients with kidney transplantation (KT) remain to be determined in large scale study. From the French nationwide hospital medical information database, all the consecutive patients hospitalized in the 1546 French hospital/clinics for AMI from 1st January 2005 to 31st December 2009 were included. We compared the specific profile and the hospital mortality of patients with KT to patients without renal failure. Patients with personal past history of renal failure and/ or dialysis were excluded. Among the 329 839 patients with AMI included, 404 (0.1%) patients were after KT. Patients with KT were more frequently men (78.7 vs 66.8%, with p<0.001), markedly younger (58±12 vs 68±11, with p<0.001), and les smoker (5.0 vs 9.1%, with p<0.001) than patients without KT. There was also a higher proportion of hypertension (28.5 vs 23.4%, with p0.017) and a lower proportion of STEMI (75.7 vs 82.7%, with p<0.001) in patients after KT. More than two-thirds of AMI complicating post KT period occured before discharge (67.1%) and 91% in the first year after KT. After adjustment for age, sex and STEMI, in-hospital mortality was higher in KT group (4.2 vs 2.9%), but with p=0.210. From our large scale nationwide study, our work demonstrated that patients with KT complicated by AMI are markedly younger with a specific difference for usual risk factors, but transplant-related risk factors explain also this specificity. We highligts that AMI occurs very early after KT, most often before discharge. To decrease the frequency of MI following renal transplantation, screening of coronaropathy and evaluation of risk factors before KT, as well as after KT must be evaluated.

High Incidence of Bacteriuria in Early Post–Kidney Transplantation; Results From a Randomized Controlled Study

Since the incidence of bacteriuria in kidney transplant recipients varyes according to the study, we examined it among our cases. Our post hoc analysis of data from a single-center, parallel, randomized, controlled, open label study included 90 patients who underwent kidney transplantation at our hospital from April 2010 to January 2011. Patients were randomized to early ureteric stent removal at 8 days versus routine ureteric stent removal at 15 days after kidney transplantation. We identified the incidence of and causative organism for bacteriuria in the early posttransplant period.Seventy-Four patients (58% living donors) participated in this study. The overall incidence of bacteriuria was 56.7% during the first month after kidney transplantation. In patients who had bacteriuria, 48% showed symptomatic urinary tract infection, 40% asymptomatic bacteriuria and 12% urosepsis. The most common organism was Escherichia coli (40%) follow by Klebsiella pneumoniae (19%). The incidence of an ESBL producing organism was 34%. The incidence of bacteriuria was high during the early post–kidney transplant period, requiring increased awareness and surveillance.