Pretransplant Dialysis Research Articles

Hospital readmission for acute kidney injury is independently associated with de novo end-stage renal disease after liver transplantation.

End-stage renal disease (ESRD) after liver transplantation (LT) is associated with high morbidity and mortality. The consequences of hospitalizations for post-LT acute kidney injury (AKI) are poorly understood. Using linked Medicare claims and transplant registry data, we analyzed adult liver alone recipients not receiving pre-transplant dialysis between 1/1/2007-12/31/2016. Covariate-adjusted Cox proportional hazards models stratified by center evaluated factors associated with AKI readmission during the first post-LT year, and whether AKI readmission was associated with de novo early (<1y) or late (≥1y) ESRD post-LT. The cohort included 10,559 patients and was 64.5% male, 72.5% White, 8.1% Black and 14.0% Hispanic with median age 62 years. Overall, 2,875 (27.2%) patients had ≥1 AKI hospitalization during the first year. eGFR at LT was associated with AKI readmission (aHR 1.16 per 10mL/min/1.73m2 decrease; p<0.001). The aHR for early ESRD in patients with ≥1 AKI readmission <90 days post-LT was 1.90 (p<0.001). The aHRs for late ESRD with 1 and ≥2 prior AKI readmissions were 1.57 and 2.80 respectively (p<0.001). AKI readmissions in the first post-LT year impact over one-quarter of recipients. These increase the risk of subsequent ESRD, but may represent an opportunity to intervene and mitigate further renal dysfunction.

Predicting graft survival in paediatric kidney transplant recipients using machine learning.

Identification of factors that affect graft survival in kidney transplantation can increase graft survival and reduce mortality. Artificial intelligence modelling enables impartial evaluation of clinician bias. This study aimed to examine factors that affect the survival of grafts in paediatric kidney transplantation through the use of machine learning. A retrospective review was conducted on records of paediatric patients who underwent kidney transplantation between 1994 and 2021 and had post-transplant follow-up > 12months. The nearest neighbour method was used to impute missing fields from a total of 48 variables in the dataset. Models including Naive Bayes, logistic regression, support vector machine (SVM), multi-layer perceptron, and XGBoost were trained to predict graft survival. The study used 80% of the patients for training and the remaining 20% for testing. Modelling success was evaluated based on accuracy and F1 score metrics. The study analysed 465 kidney transplant recipients. Of these, 56.7% were male. The mean age at transplantation was 12.08 ± 5.01years. Of the kidney transplants, 73.1% (n = 339) were from living donors, 34.5% (n = 160) were pre-emptive transplants, and 2.2% (n = 10) were second-time transplants. The machine learning model identified several features associated with graft survival, including antibody-mediated rejection (+ 0.7), acute cellular rejection (+ 0.66), eGFR at 3years (+ 0.43), eGFR at 5years (+ 0.34), pre-transplant peritoneal dialysis (+ 0.2), and cadaveric donor (+ 0.2). The successes of the logistic regression and SVM models were similar. The F1 score was 91.9%, and accuracy was 96.5%. Machine learning can be used to identify factors that affect graft survival in kidney transplant recipients. By expanding similar studies, risk maps can be created prior to transplantation.

Evolving Trends and Impact of Waitlist Transfusion on Recipient Outcomes Following Heart Transplantation.

This study evaluates the clinical trends, risk factors, and impact of waitlist blood transfusion on outcomes following isolated heart transplantation. The UNOS registry was queried to identify adult recipients from January 1, 2014, to June 30, 2022. The recipients were stratified into two groups depending on whether they received a blood transfusion while on the waitlist. The incidence of waitlist transfusion was compared before and after the 2018 allocation policy change. The primary outcome was survival. Propensity score-matching was performed. Multivariable logistic regression was performed to identify predictors of waitlist transfusion. A sub-analysis was performed to evaluate the impact of waitlist time on waitlist transfusion. From the 21 926 recipients analyzed in this study, 4201 (19.2%) received waitlist transfusion. The incidence of waitlist transfusion was lower following the allocation policy change (14.3%vs. 23.7%, p < 0.001). The recipients with waitlist transfusion had significantly reduced 1-year posttransplant survival (88.8%vs. 91.9%, p < 0.001) compared to the recipients without waitlist transfusion in an unmatched comparison. However, in a propensity score-matched comparison, the two groups had similar 1-year survival (90.0%vs. 90.4%, p=0.656). Multivariable analysis identified ECMO, Impella, and pretransplant dialysis as strong predictors of waitlist transfusion. In a sub-analysis, the odds of waitlist transfusion increased nonlinearly with longer waitlist time. There is a lower incidence of waitlist transfusion among transplant recipients under the 2018 allocation system. Waitlist transfusion is not an independent predictor of adverse posttransplant outcomes but rather a marker of the patient's clinical condition. ECMO, Impella, and pretransplant dialysis are strong predictors of waitlist transfusion.

Disparities in Access to Timely Waitlisting Among Pediatric Kidney Transplant Candidates.

Kidney transplantation with minimal or no dialysis exposure provides optimal outcomes for children with end-stage kidney disease. We sought to understand disparities in timely access to transplant waitlisting. We conducted a retrospective, registry-based cohort study of candidates ages 3 to 17 added to the US kidney transplant waitlist 2015 to 2019. We defined "preemptive waitlisting" as waitlist addition before receiving dialysis and compared demographics of candidates based on preemptive status. We used competing risk regression to determine the association between preemptive waitlisting and transplantation. We then identified waitlist additions age >18 who initiated dialysis as children, thereby missing pediatric allocation prioritization, and evaluated the association between waitlisting with pediatric prioritization and transplantation. Among 4506 pediatric candidates, 48% were waitlisted preemptively. Female sex, Hispanic ethnicity, Black race, and public insurance were associated with lower adjusted relative risk of preemptive waitlisting. Preemptive listing was not associated with time from waitlist activation to transplantation (adjusted hazard ratio 0.94, 95% confidence interval 0.87-1.02). Among transplant recipients waitlisted preemptively, 68% had no pretransplant dialysis, whereas recipients listed nonpreemptively had median 1.6 years of dialysis at transplant. Among 415 candidates initiating dialysis as children but waitlisted as adults, transplant rate was lower versus nonpreemptive pediatric candidates after waitlist activation (adjusted hazard ratio 0.54, 95% confidence interval 0.44-0.66). Disparities in timely waitlisting are associated with differences in pretransplant dialysis exposure despite no difference in time to transplant after waitlist activation. Young adults who experience delays may miss pediatric prioritization, highlighting an area for policy intervention.

Normalization of impaired glucose tolerance after kidney transplantation is associated with improved β-cell function.

Our previous study revealed that over 50% of recipients with pretransplant impaired glucose tolerance (IGT) improved to normal glucose tolerance after kidney transplantation. However, the mechanism is unclear. We aimed to investigate whether the changes in glucose tolerance are associated with β-cell function and insulin resistance in Japanese kidney transplant recipients with pretransplant IGT. Of the 265 recipients who received kidney transplantation, 54 with pretransplant IGT were included. We divided the recipients into improvement and nonimprovement groups according to the change in the area under the curve for glucose obtained from the oral glucose tolerance test (OGTT). β-Cell function was estimated by the insulin secretion sensitivity index-2 (ISSI-2) and the disposition index (DI). Insulin resistance was estimated by the Matsuda index (MI) and the homeostasis model assessment of insulin resistance (HOMA-IR). ISSI-2 and DI increased significantly after transplantation in the improved group (P < 0.01, P < 0.05, respectively), but not in the nonimproved group. ΔISSI-2 and ΔDI were significantly and positively associated with pretransplant 60-min OGTT plasma glucose levels (both P < 0.01). There were no differences in MI or HOMA-IR between these two groups after transplantation. In recipients not on pretransplant dialysis, a significant negative association was found between Δblood urea nitrogen (BUN) and ΔDI (correlation coefficient = -0.48, P < 0.05). In pretransplant IGT recipients, improvements in glucose tolerance after kidney transplantation were linked to improvements in β-cell function. The higher the 60-min OGTT plasma glucose level, the greater the improvement in posttransplant β-cell function. Improvements in BUN after transplantation were associated with improvements in β-cell function.NEW & NOTEWORTHY In recipients with pretransplant impaired glucose tolerance, improvements in glucose tolerance after kidney transplantation were associated with improvements in β-cell function. The higher the pretransplant 60-min OGTT plasma glucose level, the greater the improvement in posttransplant β-cell function. Although glucose tolerance is known to be impaired after transplantation, the present study focused on the reason for the improvement in glucose tolerance rather than the development of posttransplantation diabetes mellitus.

Kidney transplant outcomes in children with simultaneous versus sequential heart-kidney transplants.

Heart transplant recipients frequently require kidney transplantation for concomitant advanced chronic kidney disease. Data on simultaneous (heart and kidney transplants performed simultaneously) versus sequential (heart transplant performed before kidney) heart-kidney transplants in children are limited. Herein, we compare kidney transplant outcomes between the two groups. We used the Scientific Registry of Transplant Recipients to identify all pediatric (age <21 years) heart transplant recipients who also received a kidney transplant within 10 years of the heart transplant. We divided the study cohort into simultaneous heart-kidney and sequential heart-kidney recipients. We compared patient and death-censored graft survival using the Cox regression, adjusting for age at kidney transplant, sex, race, pre-transplant dialysis, donor type, and prior kidney transplant. We evaluated delayed graft function (defined as dialysis within the first week posttransplant) using logistic regression. Our analysis cohort included 165 recipients (86 simultaneous and 79 sequential). The incidence of delayed graft function was higher in simultaneous recipients (22.4 vs. 7.7%, p=0.017), but the difference lost statistical significance on multivariable analysis. We found no difference in patient survival (aHR 0.97; 95% CI 0.39, 2.41; p=0.95) after kidney transplant but higher death-censored kidney graft survival in sequential heart-kidney recipients compared with simultaneous heart-kidney recipients (aHR 4.26; 95% CI 1.21, 14.9; p=0.02). Sequential heart-kidney transplants are associated with higher death-censored kidney allograft survival in children compared with simultaneous heart-kidney transplants.

#2573 Effect of pre-transplant dialysis modalities on delayed graft function

Abstract Background and Aims Kidney transplantation represents the optimal treatment for end-stage renal disease patients. Benefits and disadvantages of different pre-transplant dialysis modalities and the effects on post-transplant outcomes remain unclear, but many authors identify peritoneal dialysis (PD) such a “bridge” versus renal transplantation. Method We analyze a consecutive series of 249 renal transplanted patients (mean age 48 ± 11 years, 67% males) between June 1998 and February 2016 with a low prevalence of comorbidities (diabetes 2%, hypertension 31%, previous cardiovascular events 2%). The median follow-up was 136 months [interquartile range (IR) 91-197 months]. The pre-transplant treatment was hemodialysis (HD) in 215 patients (86%) and peritoneal dialysis (PD) in the remaining 34 patients (14%). The majority of patients received a cadaveric donor organ (219 patients, 88%). Results Delayed Graft Function (DGF) was registered in 151 patients (61%). Analyzing pre-transplant dialysis treatment, 15 patients about 34 (44%) on pre-transplant PD had DGF vs 136/215 (63%) on pre-transplant HD treatment (P = 0.03). Remarkable PD patients were older (48 ± 12 years) than HD patients (44 ± 11 years), but this difference did not rise statistical significance (P = 0.09); similarly the prevalence of living donors were higher (13%) in the group of HD patients respect the group of PD patients (9%, P = 0.53). In a longitudinal analysis the last estimated Glomerular Filtration Rate (eGFR) was lower in patients with DGF (44, IR 19-66 ml/min/1,73 m2) vs patients without DGF (48, IR 35-73 ml/min/1,73 m2, P = 0.04), but no substantial differences was noted at the end of observation in eGFR between the two groups of patients (HD, eGFR 45, IR 25-68 ml/min/1,73 m2 vs PD eGFR 46, IR 24-67 ml/min/1,73 m2). Conclusion Results of this study confirm that PD treatment can be considered an optimal “bridge” for renal transplantation probably because peculiar characteristic of this dialysis modality (such us long term preserved diuresis and residual renal function respect HD patients) impacts positively on recovery of renal function. Further study need to clarify these controversial points.

#2106 Higher daily protein intake can reduce the risk of infections in kidney transplant recipients during the early post-transplant period

Abstract Background and Aims Kidney transplantation (KT) is considered the most effective treatment for end-stage renal disease (ESRD), and it significantly contributes to enhancing the quality of life and extending the survival of patients with ESRD. After kidney transplantation, the early and heavy use of immunosuppressants and glucocorticoids can affect the recipients' immune status to varying degrees, increasing the risk of postoperative infections caused by a wide range of pathogens. Thus, the prevention and management of infectious diseases are major factors contributing to improved outcomes in kidney transplantation. Protein-energy wasting (PEW) is commonly observed in uremic patients, and it may persist even after they have undergone kidney transplantation (KT). And PEW is a significant factor in the progression of chronic kidney disease (CKD). Providing appropriate dietary guidance and intervention is essential for enhancing the immune status of recipients, promoting a positive nitrogen balance in the body, minimizing infections, and safeguarding graft function. This study aimed to investigate the relationship between daily protein intake (DPI) and postoperative infections at 3 months post-transplant, which may establish a foundation for the early postoperative protein intake regimen, reducing the incidence of postoperative infections, and improving the early prognosis of kidney transplantation. Method This is a retrospective observational study. 176 kidney transplant recipients (KTRs) who underwent kidney transplant in West China Hospital from December 2021 to June 2022 were included and followed up regularly. 24-hour urine urea data were collected at months 1 and 3 post-transplant to calculate their DPI. These KTRs were further divided into two groups according to the recommended DPI for KTRs by the 2021 Practice Guidelines for the Nutritional Management of Chronic Kidney Disease, namely high intake group (Group 1, with DPI ≥ 1.4 g/kg·d, n = 66) and low intake group (Group 2, with DPI &amp;lt; 1.4 g/kg·d, n = 110). Occurrence of hospitalization and postoperative infections within 3 months were recorded. Multiple logistic regression was utilized to analyze the association between DPI and early postoperative infections at 3 months post-transplant. Results Mean DPI levels at month 1 post-transplant were 1.58 ± 0.22 g/kg·d in Group 1 and 1.02 ± 0.31 g/kg·d in Group 2, respectively (P &amp;lt; 0.05), this huge difference in DPI between the two groups continued to month 3. There was no significant difference in age, gender, pre-transplant body mass index (BMI), dialysis type and time, donor type, or the ratio of delayed graft function (DGF) between the two groups. There was a statistically significant difference in the percentage of hospitalization between the two groups during the postoperative period of 3 months (P = 0.027). Pneumonia was the most common reason of hospitalization after transplantation, followed by urinary tract infection. The results of multiple logistic regression analysis showed that higher DPI in the early post-transplant period was a protective factor for infection after kidney transplantation. Conclusion In the early post-transplant period, consuming higher levels of dietary protein may reduce the risk of infections and complications, and help preserve the function of the transplanted kidney.

#2736 Higher daily protein intake can reduce the risk of infections in kidney transplant recipients during the early post-transplant period

Abstract Background and Aims Kidney transplantation (KT) is considered the most effective treatment for end-stage renal disease (ESRD), and it significantly contributes to enhancing the quality of life and extending the survival of patients with ESRD. After kidney transplantation, the early and heavy use of immunosuppressants and glucocorticoids can affect the recipients' immune status to varying degrees, increasing the risk of postoperative infections caused by a wide range of pathogens. Thus, the prevention and management of infectious diseases are major factors contributing to improved outcomes in kidney transplantation. Protein-energy wasting (PEW) is commonly observed in uremic patients, and it may persist even after they have undergone kidney transplantation (KT). And PEW is a significant factor in the progression of chronic kidney disease (CKD). Providing appropriate dietary guidance and intervention is essential for enhancing the immune status of recipients, promoting a positive nitrogen balance in the body, minimizing infections, and safeguarding graft function. This study aimed to investigate the relationship between daily protein intake (DPI) and postoperative infections at 3 months post-transplant, which may establish a foundation for the early postoperative protein intake regimen, reducing the incidence of postoperative infections, and improving the early prognosis of kidney transplantation. Method This is a retrospective observational study. 176 kidney transplant recipients (KTRs) who underwent kidney transplant in West China Hospital from December 2021 to June 2022 were included and followed up regularly. 24-hour urine urea data were collected at month 3 post-transplant to calculate their DPI. These KTRs were further divided into two groups according to the recommended DPI for KTRs by the 2021 Practice Guidelines for the Nutritional Management of Chronic Kidney Disease, namely high intake group (Group 1, with DPI ≥ 1.4 g/kg·d, n = 66) and low intake group (Group 2, with DPI &amp;lt; 1.4 g/kg·d, n = 110). Occurrence of postoperative infections events within 3 months were recorded. Multiple logistic regression was utilized to analyze the association between DPI and early postoperative infections at 3 months post-transplant. Results Mean DPI levels at month 3 post-transplant were 1.75 ± 0.56 g/kg·d in Group 1 and 0.98 ± 0.24 g/kg·d in Group 2, respectively. There was no significant difference in age, gender, pre-transplant body mass index (BMI), dialysis type and time, donor type, or the ratio of delayed graft function (DGF) between the two groups. There was a statistically significant difference in the percentage of hospitalization for infections between the two groups during the postoperative period of 3 months (P = 0.027). Pneumonia was the most common reason of rehospitalization after transplantation, followed by urinary tract infection. The results of multiple logistic regression analysis showed that higher DPI in the early post-transplant period was a protective factor for infection after kidney transplantation. Conclusion In the early post-transplant period, consuming higher levels of dietary protein can reduce the risk of infections and complications, and help preserve the function of the transplanted kidney.

#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 &amp;lt; 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 &amp;lt; 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.

Electrocardiography-based Artificial Intelligence Algorithms Aid in Prediction of Long-term Mortality After Kidney Transplantation.

Predicting long-term mortality postkidney transplantation (KT) using baseline clinical data presents significant challenges. This study aims to evaluate the predictive power of artificial intelligence (AI)-enabled analysis of preoperative electrocardiograms (ECGs) in forecasting long-term mortality following KT. We analyzed preoperative ECGs from KT recipients at three Mayo Clinic sites (Minnesota, Florida, and Arizona) between January 1, 2006, and July 30, 2021. The study involved 6 validated AI algorithms, each trained to predict future development of atrial fibrillation, aortic stenosis, low ejection fraction, hypertrophic cardiomyopathy, amyloid heart disease, and biological age. These algorithms' outputs based on a single preoperative ECG were correlated with patient mortality data. Among 6504 KT recipients included in the study, 1764 (27.1%) died within a median follow-up of 5.7 y (interquartile range: 3.00-9.29 y). All AI-ECG algorithms were independently associated with long-term all-cause mortality ( P < 0.001). Notably, few patients had a clinical cardiac diagnosis at the time of transplant, indicating that AI-ECG scores were predictive even in asymptomatic patients. When adjusted for multiple clinical factors such as recipient age, diabetes, and pretransplant dialysis, AI algorithms for atrial fibrillation and aortic stenosis remained independently associated with long-term mortality. These algorithms also improved the C-statistic for predicting overall (C = 0.74) and cardiac-related deaths (C = 0.751). The findings suggest that AI-enabled preoperative ECG analysis can be a valuable tool in predicting long-term mortality following KT and could aid in identifying patients who may benefit from enhanced cardiac monitoring because of increased risk.

Pediatric Transplant Experience from a Single Center in South India

Background and Objective: Pediatric renal transplantation is a life-saving procedure for children with end-stage renal disease. This study aims to analyze the outcomes of pediatric renal transplants at our center, focusing on patient demographics, donor sources, surgical techniques, posttransplant complications, graft survival, and rejection rates. Methodology: A retrospective analysis was conducted on 43 pediatric kidney transplant recipients. Data on recipient age, gender, donor type, pretransplant dialysis, donor characteristics, surgical techniques, native kidney disease, induction therapy, maintenance immunosuppression, posttransplant infections, graft survival, and rejection episodes were collected and analyzed. Results: We performed 43 pediatric kidney transplants in total. The average age was 13.7 years (±3.81), with 8 (18.6%) being under the age of ten, 11 (25.6%) being between the ages of eleven and fourteen, and 24 (55.8%) being between the ages of fifteen and eighteen. There were 43 recipients: 27 males and 16 females. There were four (9.3%) deceased donor renal transplants and 39 (90.7%) live-related kidney transplants. Right internal iliac artery and right external iliac vein anastomosis were found in 32 (74.4%) cases, right external iliac artery and right external iliac vein in 9 (20.9%), right common iliac artery and right common iliac vein in 1 (2.3%), and right common iliac and right internal iliac in 1 (2.3%). Induction was used in 27 recipients (62.8%). Graft survival was seen at 1 year in 42 (97.7%) patients and at 5 years in 34 (81%). Biopsy-proven rejection occurred in 22 (51.2%) of the recipients, with antibody-mediated rejection occurring in 8 (18.6%) and cellular rejection occurring in 22 (51.2%). Graft loss was caused by acute cellular rejection in three (23.1%) cases, graft pyelonephritis in 2 (15.4%), and an unknown cause in 2 (15.4%). There were no significant connections with antibody-mediated rejection. Conclusion: Our study provides valuable insights into the outcomes of pediatric renal transplantation at our center. Despite the challenges of graft rejection and posttransplant infections, favorable graft survival rates were achieved. Cellular rejection emerged as a significant risk factor for graft survival, highlighting the importance of effective immunosuppressive management. Our findings emphasize the need for close follow-up, infection control measures, and individualized immunosuppressive strategies to optimize long-term outcomes in pediatric renal transplant recipients. Further research is warranted to refine protocols and address the specific needs of this vulnerable patient population.

Incidence, Risk Factors, and Outcomes of Posttransplant Erythrocytosis Among Simultaneous Pancreas-Kidney Transplant Recipients.

Posttransplant erythrocytosis (PTE) is a well-known complication of kidney transplantation. However, the risk and outcomes of PTE among simultaneous pancreas-kidney transplant (SPKT) recipients are poorly described. We analyzed all SPKT recipients at our center between 1998 and 2021. PTE was defined as at least 2 consecutive hematocrit levels of >51% within the first 2 y of transplant. Controls were selected at a ratio of 3:1 at the time of PTE occurrence using event density sampling. Risk factors for PTE and post-PTE graft survival were identified. Of 887 SPKT recipients, 108 (12%) developed PTE at a median of 273 d (interquartile range, 160-393) after transplantation. The incidence rate of PTE was 7.5 per 100 person-years. Multivariate analysis found pretransplant dialysis (hazard ratio [HR]: 3.15; 95% confidence interval [CI], 1.67-5.92; P < 0.001), non-White donor (HR: 2.14; 95% CI, 1.25-3.66; P = 0.01), female donor (HR: 1.50; 95% CI, 1.0-2.26; P = 0.05), and male recipient (HR: 2.33; 95% CI, 1.43-3.70; P = 0.001) to be associated with increased risk. The 108 cases of PTE were compared with 324 controls. PTE was not associated with subsequent pancreas graft failure (HR: 1.36; 95% CI, 0.51-3.68; P = 0.53) or kidney graft failure (HR: 1.16; 95% CI, 0.40-3.42; P = 0.78). PTE is a common complication among SPKT recipients, even in the modern era of immunosuppression. PTE among SPKT recipients was not associated with adverse graft outcomes, likely due to appropriate management.

High Rate of Kidney Graft Failure after Simultaneous Heart-Kidney Transplantation.

The indications and outcomes of Simultaneous heart-kidney transplantation (SHKT) remain sub-optimally defined. Risk factors for renal graft failure after SHKT also remain poorly defined. We analyzed the renal graft outcomes among SHKT recipients using United Network for Organ Sharing database from 2015-2020. To evaluate for factors associated with poor renal outcomes, we compared SHKT and kidney transplantation alone (KTA) recipients using propensity score matching. Among SHKT recipients, rate of primary non-function (PNF) of kidney graft was 3%, 30-day kidney graft failure rate was 7.0%, and the 30-day post-transplant mortality rate was 4.1%. The incidence of delayed kidney graft function (KDGF) was 27.5%. Kidney graft failure was seen early post-SHKT with most common causes of patient death (43.9%) and PNF of kidney graft (41.5%). One-year and two-year patient survival was 89.2% and 86.5%, and one-year and two-year freedom from kidney graft failure was 85.4% and 82.7%, respectively. In subgroup analysis of SHKT recipients, use of pre-transplant mechanical cardiac support (adjusted Odds Ratio (aOR) 2.57, P=0.017), higher cPRA (aOR 1.76, P=0.016), and older donor age per 10 years (aOR 1.94, P=0.001) were associated with PNF. Pre-transplant extracorporeal membrane oxygenation support was associated with the increased risk of 30-day recipient mortality (aOR 5.55, P=0.002). Increased 30-day graft failure was seen in SHKT recipients with pre-transplant mechanical cardiac support (aOR 1.77, P=0.038) and dialysis at time of transplant (aOR 1.72, P=0.044). Multivariable Cox-Hazard analysis demonstrated that SHKT, when compared to KTA, is associated with increased kidney graft failure (Hazard Ratio, 2.56, P<0.001) and recipient mortality (Hazard Ratio: 2.65, P<0.001). SHKT is associated with high rates of kidney graft failure. Identification of risk factors for renal graft failure can help optimize recipient selection for SHKT vs Kidney after HT, especially after introduction of the new safety-net policy.

Predictors for postoperative dysphagia in liver transplant recipients.

Liver transplant recipients are at a heightened risk for oropharyngeal dysphagia; identification of those who are at high risk for postoperative dysphagia could reduce hospital costs and length of stay. We sought to identify predictors of dysphagia, in a large cohort of patients who underwent liver transplantation. Electronic medical records were queried for patients undergoing liver transplantation, who underwent instrumental swallowing evaluations. Demographics, functional outcomes, and interventions were collected. Logistic regression analyses were performed to identify predictors of dysphagia. Seven hundred and ninety-five patients met inclusionary criteria. Multivariate analyses found ethnic group (p = .0191), MELD Score (p < 0001), cold ischemia time (p = .0123), and length of intubation (p < .0001) to be predictors of post-operative development of dysphagia. Pre-transplant dialysis (p < .0001), dysphagia related to end stage liver disease (p < .0001), Karnofsky Performance Status Scale (p < .0001), wait time to transplant (p = 0.0173), surgery time (p = 0.0095), tracheostomy (p < 0.0001), and transfusion of intraoperative RBC (p < .0001), intraoperative platelets (p = 0.0018), intraoperative FFP (p = 0.0495), perioperative FFP (p = 0.0002), perioperative platelets (p = 0.0151) and perioperative RBC (p = 0.0002) were variables of significance associated with the development of postoperative dysphagia from univariate analysis. Our results propose a set of predictors that should be considered when identifying post-operative critically ill patients at risk for dysphagia.

Impact of Pretransplant Dialysis Modality on Posttransplant Outcomes: A Single-Center Experience.

It remains unclear whether posttransplant outcomes differ according to the pretransplant dialysis modality (peritoneal dialysis vs hemodialysis). Our aim was to assess posttransplant outcomes in patients with different predialysis modalities. Two thousand two hundred fifty-eight kidney recipients following up in Hamed Alessa Organ transplant center in Kuwait were included and divided into two groups according to pre-transplant dialysis modality: Group 1: those who received hemodialysis (HD) and group 2: those with peritoneal dialysis (PD). Demographics, pretransplant and posttransplant comorbidities, and patient and graft outcomes were studied. There were 1956 patients on hemodialysis, and 302 patients were on peritoneal dialysis. Most were male patients (1456 vs 802 female patients), with comparable mean age (P = .34). Chronic glomerulonephritis and diabetic nephropathy represented the most common original kidney disease before transplant (27.6% and 21.4%, respectively), with higher prevalence of glomerulonephritis in group 1 and diabetic nephropathy in group 2 (P = .001). The 2 groups were comparable with regard to immunosuppression (induction and maintenance) (P > .05). Posttransplant diabetes and hypertension were significantly higher in the hemodialysis group (P = .004 and P = 003, respectively). There was no significant difference between the 2 groups with regard to the graft outcome (P = .86). However, patient survival was significantly higher in the hemodialysis group (81.2% vs 64.4%). Compared with peritoneal dialysis, pretransplant hemodialysis is associated with better posttransplant patient survival despite no difference in the graft outcome. Diabetes-related complications could be attributed to such outcomes.

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.

Pretransplant dialysis vintage and outcomes after kidney transplantation: a retrospective cohort study

Pretransplant dialysis vintage and outcomes after kidney transplantation: a retrospective cohort study

Association Between Pretransplant Dialysis Modality and Long-Term Graft Outcomes

Association Between Pretransplant Dialysis Modality and Long-Term Graft Outcomes