Duration Of Pretransplant Dialysis Research Articles

#2562 Effect of rituximab on post-transplant outcome in highly sensitized patients

Abstract Background and Aims Pre-transplant sensitization is important risk factor for the development of antibody-mediated rejection (ABMR) and can result in inferior long-term allograft survival in kidney transplantation (KT). The aim of this study was to investigate the effect of pre-transplant Rituximab infusion on the clinical outcome in highly sensitized patients. Method The study included 128 consecutive recipients who received renal transplant between 05/2022 and 12/2023, of them 68 patients showed the result of panel-reactive antibody higher than 30%, but showed negative crossmatch test before transplantation. Out of them, 44 patients who took pre-transplant Rituximab at a dose of 375 mg/m2 belonged to Rituximab group and remained 24 patients were regarded as control group. We compared the development of ABMR, the change of allograft function and allograft survival rate between 2 groups after KT. Results Between two groups, no difference was found in baseline characteristics such as age at KT, gender, pre-transplant dialysis duration, primary renal disease. The mean value of PRA and HLA mismatching number, the type of main immunosuppressive agent did not differ as well. After KT, the development of ABMR was significantly lower in Rituximab group (5/44 (11.4%)) compared to control group (10/24 (41.7%), p < 0.005) and total rejection rate showed lower tendency in Rituximab group as well (p = 0.052). However, the incidence of CMV, fungal or bacterial infections was similar between the groups. Allograft function assessed by MDRD eGFR at 14 days after KT was significantly higher in Rituximab group compared to control group, but at 6 and 12 months from KT, it did not differ between two groups. Allograft rejection free survival was significantly higher in Rituximab group compared to control group (p < 0.05). Conclusion In sensitized patients with high PRA but negative crossmatch, Rituximab was effective to prevent the development of ABMR without an increased incidence of opportunistic infections.

Effect of Pretransplant Dialysis Method and Vintage on Early Clinical Outcomes of Kidney Transplantation

Pre-transplantation dialysis duration and modality may affect patients' long-term (mortality and graft failure) and short-term (delayed graft function) outcomes after kidney transplantation. We aimed to assess the impact of the method and duration of dialysis therapy on the graft function in the first 6 months post-transplant. The analysis included 122 kidney transplant patients (109 from a deceased donor and 13 from a living donor). Before transplantation, 91 were on hemodialysis (HD), 19 were on peritoneal dialysis (PD), and 9 received preemptive transplants. The incidence of delayed graft function (DGF) and creatinine levels at discharge and 6 months after transplantation were assessed. PD and HD patients did not differ in age, number of mismatches, and cold ischemia time (CIT), but they had a significantly shorter dialysis vintage (18.3 ± 25.7 vs 39.6 ± 34.3 months, P = .01) and a lower incidence of DGF (5% vs 37%, P = .006). The duration of hospitalization and creatinine concentration at discharge and after 6 months were similar. Preemptively transplanted patients had a significantly shorter CIT (ND vs DO - 576 ± 362 vs 1113 ± 574, P = .01; ND vs HD - 576 ± 362 vs 1025 ± 585 minutes, P = .01). DGF did not occur in any of the patients transplanted preemptively. They had slightly shorter hospitalization times and, compared to HD, better graft function at discharge. After 6 months, creatinine levels were comparable to HD and PD. Patients dialyzed for less than 12 months, regardless of the method, had a lower incidence of DGF. Peritoneal dialysis and a short duration of pre-transplant dialysis may improve the early results of kidney transplantation.

The Spectrum of Ocular Manifestations among Renal Transplant Recipients

Purpose: The study aims to report various ocular manifestations among renal transplant recipients. Methods: The cross-sectional study was conducted on renal transplant patients, with at least 4 months of posttransplant duration, attending a nephrology clinic. A comprehensive ophthalmic evaluation was performed to record various ocular manifestations. The statistical association between ocular findings and pretransplant as well as posttransplant duration was assessed. Results: One hundred and twenty-three eyes of 62 patients, with a mean age of 37.6 ± 8.2 years and functional graft, were included in the study. Diabetic nephropathy was found to be the most common underlying cause of end-stage renal disease (ESRD) and renal transplant. Hypertensive retinopathy (37.4%) was found to be the most frequent ophthalmic manifestation, followed by diabetic retinopathy (24.39%), dry eye (22.76%), cataract (18.69%), and change in refractive error (17.89%). The occurrence of hypertensive retinopathy and refractive power change was found to be significantly associated with pretransplant dialysis duration. In contrast, concerning the posttransplant period, the frequency of all the major ocular manifestations, except the dry eye, was observed to be statistically significant. Conclusion: Patients with ESRD and renal transplant should be advised to undergo regular comprehensive eye examinations. Many ocular manifestations are preventable and/or treatable, thus interdisciplinary partnership between nephrologists and ophthalmologists is warranted to improve vision and quality of life in transplant recipients.

Characteristics of Kidney Transplant Recipients with Prolonged Pre-Transplant Dialysis Duration as Identified by Machine Learning Consensus Clustering: Pathway to Personalized Care.

Longer pre-transplant dialysis duration is known to be associated with worse post-transplant outcomes. Our study aimed to cluster kidney transplant recipients with prolonged dialysis duration before transplant using an unsupervised machine learning approach to better assess heterogeneity within this cohort. We performed consensus cluster analysis based on recipient-, donor-, and transplant-related characteristics in 5092 kidney transplant recipients who had been on dialysis ≥ 10 years prior to transplant in the OPTN/UNOS database from 2010 to 2019. We characterized each assigned cluster and compared the posttransplant outcomes. Overall, the majority of patients with ≥10 years of dialysis duration were black (52%) or Hispanic (25%), with only a small number (17.6%) being moderately sensitized. Within this cohort, three clinically distinct clusters were identified. Cluster 1 patients were younger, non-diabetic and non-sensitized, had a lower body mass index (BMI) and received a kidney transplant from younger donors. Cluster 2 recipients were older, unsensitized and had a higher BMI; they received kidney transplant from older donors. Cluster 3 recipients were more likely to be female with a higher PRA. Compared to cluster 1, cluster 2 had lower 5-year death-censored graft (HR 1.40; 95% CI 1.16-1.71) and patient survival (HR 2.98; 95% CI 2.43-3.68). Clusters 1 and 3 had comparable death-censored graft and patient survival. Unsupervised machine learning was used to characterize kidney transplant recipients with prolonged pre-transplant dialysis into three clinically distinct clusters with variable but good post-transplant outcomes. Despite a dialysis duration ≥ 10 years, excellent outcomes were observed in most recipients, including those with moderate sensitization. A disproportionate number of minority recipients were observed within this cohort, suggesting multifactorial delays in accessing kidney transplantation.

#4769 EFFECT OF EXTREMELY LONG DIALYSIS VINTAGE ON RENAL ALLOGRAFT SURVIVAL: A SINGLE-CENTER EXPERIENCE

Abstract Background and Aims Dialysis vintage is long in kidney transplant recipients (KTRs) due to the donor shortage in Turkey. We assessed the effect of pre-transplant dialysis duration (more than 10 years) on the outcomes of renal allografts. Method We retrospectively evaluated 480 KTRs who were grafted between January 2009 and October 2020 at Ankara University School of Medicine, Ibni Sina Hospital. KTRs were divided into two groups according to the duration of pre-transplant dialysis treatment: Group A, ≥10 years and Group B, <10 years. Data on demographics, comorbidities, immunologic properties and graft survivals were compared between the two groups. Results Group A included 60 patients and dialysis vintage was 288±60 months (Table 1). 420 patients in Group B had an average of 19 months period of dialysis treatment. While cadaveric transplantation was 78.3% in Group A, it was much lower in Group B (11.2%, p<0.001). Most of the patients were on hemodialysis treatment (95.0% vs. 58.3%, respectively, P = .001). Recipients’ age (P = .001), HLA mismatch number (P = .008) and PRA positivity (P = .001) were significantly higher in Group A. Although anti-human T-thymocyte globulin had been mostly chosen for induction therapy in Group A (p<0.001); almost all patients were under standard triple maintenance immunosuppression therapy. First year and late acute rejection rates were similar between two groups (p=1.000 and P = .407, respectively). Clinically important difference was demonstrated in graft loss, which was mostly seen in the ≥10 years dialysis group (Group A, 18.3% vs. Group B, 8.3%, P = .014). The 1-, and 5- years graft survival rates were 91.4%, and 81.3%, respectively, in Group A and 97.4%, and 93.4%, respectively, in Group B (P = .034 and P = .029, respectively). Patient loss was significantly higher in Group A (Group A, 28.3% vs. Group B, 14.3%, P = .018). Conclusion We demonstrated that pre-transplant dialysis duration for more than 10 years has adverse effects on post-transplant graft and patient outcomes, accompanied by high immunological risk. Updates of organ allocation system considering sensitized candidates and strategies to expand donor pool and donation rates are needed to reduce waiting times on dialysis.

Effect of pretransplant dialysis vintage on clinical outcomes in deceased donor kidney transplant

The waiting time for deceased donor kidney transplants (DDKT) is increasing. We evaluated DDKT prognosis according to the pretransplant dialysis vintage. A total of 4117 first-time kidney transplant recipients were enrolled from a prospective nationwide cohort in Korea. DDKT recipients were divided into tertiles according to pretransplant dialysis duration. Graft failure, mortality, and composite were compared between DDKT and living donor kidney transplant (LDKT) recipients. Pretransplant dialysis vintage was longer annually in DDKT recipients. In the subdistribution of the hazard model for the competing risk, the first tertile did not show an increased risk of graft failure compared with LDKT recipients; however, the second and third tertile groups had an increased risk of graft failure compared to LDKT recipients (adjusted hazard ratio [aHR] 3.59; 95% confidence interval [CI] 1.69–7.63; P < 0.001; aHR 2.37; 95% CI 1.06–5.33; P = 0.037). All DDKT groups showed a significantly higher risk of patient death than LDKT, with the highest risk in the third tertile group (aHR 11.12; 95% CI 4.94–25.00; P < 0.001). A longer pretransplant dialysis period was associated with a higher risk of the composite of patient death and graft failure in DDKT recipients. DDKT after a short period of dialysis had non-inferior results on graft survival compared with LDKT.

A Multiparametric Nomogram for Predicting Delayed Graft Function in Adult Recipients of Pediatric Donor Kidneys

Delayed graft function (DGF) is one of the most common postoperative complications after kidney transplantation. The ability to predict DGF after transplantation can greatly aid clinical decision-making. Several models have been proposed to predict DGF in adult recipients of adult donor kidneys, but there is currently no model to predict DGF in adult recipients of pediatric donor transplants. Therefore, based on our medical records, we retrospectively investigated the pretransplant risk factors of DGF in transplants from pediatric donors to adult recipients. Our center is in compliance with national laws, the Declaration of Istanbul, and the Helsinki Congress. The donors used by us were organs donated after the death of citizens and the participants were neither paid nor coerced. A retrospective review of 84 adult patients who received pediatric donor kidneys at a single center from April 4, 2015 to November 17, 2021 was conducted to investigate the pretransplant risk factors for the development of DGF. DGF was observed in 45 of 68 patients (66.17%) in the training group and 9 of 16 patients (56.25%) in the validation group. Multivariate logistic analysis showed that kidney donor profile index, cold ischemia time, number of human leukocyte antigen mismatches, and pretransplant dialysis duration were significant independent risk factors for DGF. By integrating these 4 factors, we constructed a nomogram model to predict DGF. According to the prediction model, the area under the curve of DGF of the training group and validation group was 0.899 and 0.905, respectively. We have constructed a novel, reliable, and accurate visual nomogram that provides a practical tool for predicting DGF in adult recipients of pediatric donor kidneys.

Preoperative blood pressure and risk of delayed graft function in deceased donor kidney transplantation.

In kidney transplantation, delayed graft function (DGF) is associated with increased morbidity and a higher risk of graft failure. Prior research suggests that chronic hypotension increases DGF risk, but the relationship of preoperative blood pressure to DGF is unclear. In this single center study of adult deceased donor kidney transplant recipients transplanted between 2015 and 2019, we evaluated the question of whether preoperative mean arterial pressure (MAP) affected DGF risk. Additionally, we investigated whether the risk of DGF was moderated by certain donor and recipient characteristics. For recipient characteristics associated with increased DGF risk and preoperative MAP, we performed a mediation analysis to estimate the proportion of DGF risk mediated through preoperative MAP. Among 562 deceased donor kidney recipients, DGF risk decreased as preoperative MAP increased, with a 2% lower risk per 1mmHg increase in MAP. This increased risk was similar, with no statistically significant interaction effect between preoperative MAP and donor (donation after circulatory death) and recipient characteristics (diabetes, body mass index, and use of anti-hypertensive medications). Preoperative MAP was negativity correlated with recipient BMI and duration of pre transplant dialysis. On mediation analysis, MAP accounted for 12% and 16% of the DGF risk associated with recipient BMI and pre-transplant dialysis duration, respectively. In deceased donor kidney transplantation, each 1mmHg increase in preoperative MAP was associated with 2% lower DGF risk. Preoperative MAP was influenced by recipient BMI and dialysis duration, and likely contributes to some of the high DGF risk from obesity and long dialysis vintage.

Machine Learning-Derived Integer-Based Score and Prediction of Tertiary Hyperparathyroidism among Kidney Transplant Recipients: An Integer-Based Score to Predict Tertiary Hyperparathyroidism.

Tertiary hyperparathyroidism in kidney allograft recipients is associated with bone loss, allograft dysfunction, and cardiovascular mortality. Accurate pretransplant risk prediction of tertiary hyperparathyroidism may support individualized treatment decisions. We aimed to develop an integer score system that predicts the risk of tertiary hyperparathyroidism using machine learning algorithms. We used two separate cohorts: a derivation cohort with the data of kidney allograft recipients (n=669) who underwent kidney transplantation at Severance Hospital, Seoul, Korea between January 2009 and December 2015 and a multicenter registry dataset (the Korean Cohort Study for Outcome in Patients with Kidney Transplantation) as an external validation cohort (n=542). Tertiary hyperparathyroidism was defined as post-transplant parathyroidectomy. The derivation cohort was split into 75% training set (n=501) and 25% holdout test set (n=168) to develop prediction models and integer-based score. Tertiary hyperparathyroidism requiring parathyroidectomy occurred in 5% and 2% of the derivation and validation cohorts, respectively. Three top predictors (dialysis duration, pretransplant intact parathyroid hormone, and serum calcium level measured at the time of admission for kidney transplantation) were identified to create an integer score system (dialysis duration, pretransplant serum parathyroid hormone level, and pretransplant calcium level [DPC] score; 0-15 points) to predict tertiary hyperparathyroidism. The median DPC score was higher in participants with post-transplant parathyroidectomy than in those without (13 versus three in derivation; 13 versus four in external validation; P<0.001 for all). Pretransplant dialysis duration, pretransplant serum parathyroid hormone level, and pretransplant calcium level score predicted post-transplant parathyroidectomy with comparable performance with the best-performing machine learning model in the test set (area under the receiver operating characteristic curve: 0.94 versus 0.92; area under the precision-recall curve: 0.52 versus 0.47). Serial measurement of DPC scores (≥13 at least two or more times, 3-month interval) during 12 months prior to kidney transplantation improved risk classification for post-transplant parathyroidectomy compared with single-time measurement (net reclassification improvement, 0.28; 95% confidence interval, 0.02 to 0.54; P=0.03). A simple integer-based score predicted the risk of tertiary hyperparathyroidism in kidney allograft recipients, with improved classification by serial measurement compared with single-time measurement. Korean Cohort Study for Outcome in Patients with Kidney Transplantation (KNOW-KT), NCT02042963 PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2022_06_10_CJN15921221.mp3.

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

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

Pre-transplant maintenance dialysis duration and outcomes after kidney transplantation: A multicenter population-based cohort study.

The association between pre-transplant dialysis duration and post-transplant outcomes may vary by the population and endpoints studied. We conducted a population-based cohort study using linked healthcare databases from Ontario, Canada including kidney transplant recipients (n=4461) from 2004 to 2014. Our primary outcome was total graft failure (i.e., death, return to dialysis, or pre-emptive re-transplant). Secondary outcomes included death-censored graft failure, death with graft function, mortality, hospitalization for cardiovascular events, hospitalization for infection, and hospital readmission. We presented results by pre-transplant dialysis duration (pre-emptive transplant, and .01-1.43, 1.44-2.64, 2.65-4.25, 4.26-6.45, and 6.46-36.5 years, for quintiles 1-5). After adjusting for clinical characteristics, pre-emptive transplantation was associated with a lower rate of total graft failure (adjusted hazard ratio [aHR] .68, 95% CI: .46, .99), while quintile 4 was associated with a higher rate (aHR 1.31, 95% CI: 1.01, 1.71), when compared to quintile 1. There was no significant relationship between dialysis duration and death-censored graft failure, cardiovascular events, or hospital readmission. For death with graft function and mortality, quintiles 3-5 had a significantly higher aHR compared to quintile 1, while for infection, quintiles 2-5 had a higher aHR. Longer time on dialysis was associated with an increased rate of several adverse post-transplant outcomes.

Comparative study of the outcomes of the second kidney transplantation from the young deceased donors versus living-unrelated donors

PurposeTo compare the kidney graft function and survival in patients who had second kidney transplantation from living donors versus those who had a second transplant from young deceased donors. MethodsIn this retrospective cohort study, a total of 86 patients who underwent second kidney transplantation in Shariati hospital from 2001 until 2017 were enrolled. Baseline clinical data on the age, sex, type of kidney donor (living unrelated or deceased), duration of pretransplant dialysis, and the length of hospitalization were recorded. As the indicators of the graft function, we used the serum creatinine level and estimated glomerular filtration rate (eGFR) at time intervals during the study. The 1, 5, and 10-year graft survival rates were reported using life tables and the relative hazard ratios of the graft failure were calculated using the forward stepwise Cox proportional hazard model. ResultsForty-six of our patients were men (53.5%), with a mean ± SD age of 44.3 ± 12.3 years at the time of transplantation. The majority of the enrolled patients received the kidney from living unrelated donors (50 vs. 36 patients). In terms of serum creatinine and eGFR, at time intervals, no significant difference was found between the two recipient groups. In the living donor group, the 1, 5, and 10-year graft survival rates of the second transplant were 91% (95%CI: 73–96%), 87% (95%CI: 69–95%), and 82% (95%CI: 59–92%), and for the deceased donor group were 95% (95% CI: 69–99%), 95% (95%CI: 69–99%), and 79% (95%CI: 31–95%), respectively. ConclusionConsidering the long-term outcomes of the second kidney transplantation, in our experience, the graft function and survival, either from the living or deceased donors, were favorable; and the type of organ donation had no significant effect on the risk of graft failure.

Böbrek Nakli Yapılan Hastaların Ameliyat Öncesi ve Sonrası Laboratuvar Bulgularının Retrospektif Analizi

Objective: This study was conducted to review the sociodemographic characteristics of kidney transplant patients and the changes in preoperative and postoperative laboratory findings. Material and Methods: This is a retrospective study including 130 patients who underwent kidney transplantation between January 2015 and June 2019. This research was conducted at the Turgut Özal Medical Center Organ Transplant Hospital between August and December 2019 in the form of a four-month file archive review. File archive was used to access the data. The demographic characteristics of these patients, clinical and laboratory findings, donor characteristics, pre-transplant chronic diseases, pre-transplant dialysis duration and dialysis types were retrospectively analyzed to evaluate post-transplant infection and survival. Results: In the study, it was determined that patient survival rates were higher in transplants from a cadaver donor compared to transplants from a living donor. When the values before and after the transplantation were compared, it was found that the difference between the mean values of albumin, calcium, leukocytes, hemoglobin, hematocrit, platelets and international normalized ratio before and after transplantation was statistically significant. Conclusion: In this patient group, it may be suggested to carry out studies on nursing that provide sustainable, professional, holistic, evidence-based care and raise awareness, and to add the study findings to nursing practices in order to achieve the expected goals in improving the quality of life and survival.

Declining trend of preemptive kidney transplantation and impact of pretransplant dialysis: a Korean nationwide prospective cohort study.

We evaluated the temporal trend of preemptive kidney transplantation (KT) and the effect of pretransplant dialysis duration on post-transplant outcomes. This was a nationwide cohort study of the first-time 3392 living donor KT (LDKT) recipients (2014-2019). The annual changes in proportion of preemptive KT, factors associated with preemptive KT, and post-transplant outcomes were analyzed. Preemptive KT was performed in 816 (24.1%) patients. Annual trend analysis revealed gradual decrease in preemptive KT over time (P=0.042). Among the underlying causes of preemptive KT, the proportion of diabetes increased and that of glomerulonephritis decreased during the study period. Glomerulonephritis as the primary renal disease was a predictor of preemptive KT. Patients with pretransplant dialysis >6months showed increased graft failure risk than preemptive KT in the subdistribution of hazard model for competing risk (adjusted hazard ratio [aHR], 2.53; 95% confidence interval [CI], 1.09-5.87; P=0.031) and in propensity score-matched analysis (aHR, 2.45; 95% CI, 1.02-5.92; P=0.034); however, pretransplant dialysis ≤6months showed comparable graft survival with preemptive KT in both analyses. Preemptive KT declined over successive years, associated with an increase in diabetes and a decrease in glomerulonephritis as underlying causes of KT. Short period of dialysis less than 6months does not affect graft survival compared with preemptive KT; however, longer dialysis decreases graft survival.

Effect of Pretransplant Use of Calcimimetic on Parathyroid Function after Renal Transplantation.

Objective Persistence of hyperparathyroidism (HPT) after renal transplantation leads to undesirable outcomes such as increase in cardiovascular events, graft dysfunction, and increased mortality. Options for therapy include medical management with calcimimetic or operative management. The present study was undertaken to evaluate the natural history of HPT after renal transplantation and to determine risk factors for persistent HPT in the era of calcimimetic. Design The study is a retrospective review of data from 74 consecutive patients who underwent renal transplantation at our institution from April 2011 to November 2019. Methods The natural history of HPT after renal transplantation and associations between intact parathyroid hormone (PTH) level after transplantation and clinical variables such as age, sex, duration of pretransplant dialysis, and use of calcimimetic before transplantation were evaluated. Results Intact PTH decreased after renal transplantation in most of the patients without receiving parathyroidectomy. Known risk factors of persistent HPT did not associate with intact PTH level after renal transplantation in patients who had been receiving calcimimetic before transplantation. Conclusion In conclusion, we have found that HPT after renal transplantation could be managed successfully by medical treatments. When predicting the prognosis of HPT after transplantation, pretransplant use of calcimimetic should be taken into consideration.

Cytomegalovirus infection in kidney transplant patients: Prevalence, risk factors, and impact on outcome – A local multicentre experience

BackgroundCMV infection prevalence in kidney transplant recipients (KTR) is reported to be high in the literature, reaching rates of over 80%. ObjectivesThe primary endpoints were the evaluation of the prevalence, the risks factors, and the effects of CMV infection on graft function and survival, as well as patient survival at three years after kidney transplantation. Material and methodsWe retrospectively reviewed the medical records of 288 kidney transplant patients operated in three Lebanese transplant centers between 1998 and 2017 with three years of follow-up. The patients were divided into two groups: those free of any CMV infection (271 patients (94%); Group I) and those who suffered from CMV infection (17 patients (6%); Group II). ResultsBaseline demographics of the two groups were similar, including recipient and donor gender and age, cause of renal disease, recipient body mass index, pre-transplant fasting blood sugar and dialysis duration, HLA matching between donor and recipient, degree of sensitization in the recipient, type of CMV prophylaxis, maintenance immunosuppression and immunological characteristics. The prevalence of CMV infection is 5.9% among KTR. There were significant differences between the two groups concerning the type of induction therapy and the duration of anti-CMV prophylaxis. The rate of infected patients and infectious episodes were significantly higher in Group II. At 3-years, graft function and survival, patient survival, and the rate of new-onset diabetes were similar between the two groups. ConclusionThe present study is the first to explore the incidence and risk factors of CMV in kidney transplant patients in Lebanon. Comprehensive nationwide studies are therefore necessary to determine the epidemiology and risk factors of CMV infection after kidney transplantation in Lebanon.

Assessment of risk factors for hospital readmission after kidney transplantation

Background and Purpose: Hospital readmission after kidney transplantation is a real challenge for both patients and healthcare systems. Assessment of the risk factors of readmission after kidney transplantation is vital and can reduce morbidity and cost in transplant recipients and donors. The aim of the current study was to determine the risk factors of hospital readmission in patients undergoing kidney transplantation in Montaserieh Hospital of Mashhad, northeast of Iran.&#x0D; Materials and Methods: This retrospective study included 523 first kidney transplant patients between January 2013 and March 2019 from the Montaserieh Hospital Information System (HIS) of Mashhad, Iran. Every-time readmission was the study primary outcome. Donors and recipient's demographic data, recipient's comorbidities, reasons for end-stage renal disease (ESRD), panel reactive antibody (PRA) status, dialysis parameters, cold ischemic time, and delayed graft function (DGF) were the potential risk factors. Statistical analysis was done using Chi-square and Student's t-test.&#x0D; Results: Data from 523 patients were assessed for potential eligibility. Based on the exclusion criteria, data from 479 patients were included in the final analysis. 174 (36.3%) patients were never readmitted, and 305 (63.7%) were readmitted at least once post-discharge. 39 (12.8%) were readmitted within the first-month post-discharge. Older age, sex, higher prevalence of comorbidities, diabetes and hypertension, duration of primary disease before transplantation, hemodialysis and duration of pre-transplant dialysis, mean pre-transplant platelet count, intraoperative complications, increased cold ischemic time, and delayed graft function were associated with a higher prevalence of readmission (p&lt;0.05).&#x0D; Conclusion Our results showed that different independent variables and patients' comorbidities were important risk factors for readmission after kidney transplantation. Early prediction of these risk factors could result in prevention from readmission in patients undergoing kidney transplantation.

Preemptive Kidney Transplantation Is Associated With Transplantation Outcomes in Children: Results From the French Kidney Replacement Therapy Registry.

Kidney transplantation (KT) is the optimal treatment for children with end-stage kidney disease. The aim of this study was to evaluate the impact of preemptive kidney transplantation (PKT) and of pretransplant dialysis duration on graft survival among French pediatric kidney transplant recipients. We analyzed all first pediatric kidney-only transplantations performed in France between 1993 and 2012. A Cox multivariable model was used to investigate the association of PKT and pretransplant dialysis time with the hazard of graft failure defined as death, return to dialysis, or retransplant, whichever occurred first. Patients (n = 1911) were included, of which 380 (19.8%) received a PKT. Median time of follow-up was 7.0 y. PKT was associated with a 55% reduction of the hazard of graft failure at any time after KT compared with patients transplanted after dialysis (hazard ratio, 0.45; 95% confidence interval, 0.33-0.62), after adjustment for recipient sex and age, primary kidney disease, donor age and type (living or deceased donor), number of HLA mismatches, cold ischemia time, and year of transplantation. A reduction of the hazard of graft failure was found in PKT whatever the compared duration of dialysis, even when <6 mo and whatever the dialysis modality. Results were similar in multiple sensitivity analyses. In France, PKT among pediatric patients is associated with a better graft survival when compared with KT after dialysis, even when <6 mo. Based on these findings, we suggest that PKT should be considered as the treatment of choice for children with end-stage kidney disease.

Influence of dialysis duration on outcomes of simultaneous pancreas-kidney transplant.

The objective of this study was to assess how pre-transplant dialysis duration affects transplant outcomes after simultaneous pancreas-kidney transplant (SPK) in patients with type 1 diabetes mellitus (T1DM). Data of 6887 T1DM patients who underwent SPK transplantation between 2008 and 2018 were obtained from the Scientific Registry of Transplant Recipients database. According to pre-transplant dialysis duration, the patients were divided into the preemptive SPK, 0-2years, 2-5years, and >5years dialysis groups. Kaplan-Meier survival analysis was performed to compare patient and graft survival among the groups. Univariate and multivariate Cox regression analyses were used to identify predictors of transplant outcomes. The mean follow-up period was 56.7±34.7months. Compared with no dialysis or preemptive SPK, dialysis for 0-2years was not significantly associated with patient or kidney graft survival, while long-term dialysis of 2-5years and >5years was significantly associated with increased risk of death and kidney graft failure. However, the duration of dialysis was not associated with pancreas graft survival. Long-term dialysis duration before SPK transplant is an independent predictor of patient death and kidney graft failure in T1DM patients.

Kidney Transplant Evaluation and Listing: Development and Preliminary Evaluation of Multimedia Education for Patients.

BackgroundPatient knowledge gaps about the evaluation and waitlisting process for kidney transplantation lead to delayed and incomplete testing, which compromise transplant access. We aimed to develop and evaluate a novel video education approach to empower patients to proceed with the transplant evaluation and listing process and to increase their knowledge and motivation.Material/MethodsWe developed 2 theory-informed educational animations about the kidney transplantation evaluation and listing process with input from experts in transplantation and communication, 20 candidates/recipients, 5 caregivers, 1 anthropologist, 3 community advocates, and 36 dialysis or transplant providers. We then conducted an online pre-post study with 28 kidney transplantation candidates to measure the acceptability and feasibility of the 2 videos to improve patients’ evaluation and listing knowledge, understanding, and concerns.ResultsCompared with before intervention, the mean knowledge score increased after intervention by 38% (5.7 to 7.9; P<0.001). Increases in knowledge effect size were large across age group, health literacy, education, technology access, and duration of pretransplant dialysis. The proportion of positive responses increased from before to after animation viewing for understanding the evaluation process (25% to 61%; P=0.002) and waitlist placement (32% to 86%; P<0.001). Concerns about list placement decreased (32% to 7%; P=0.039). After viewing the animations, >90% of responses indicated positive ratings on trusting the information, comfort level with learning, and engagement.ConclusionsIn partnership with stakeholders, we developed 2 educational animations about kidney transplant evaluation and listing that were positively received by patients and have the potential to improve patient knowledge and understanding and reduce patient concerns.