Renal Allograft Transplantation Research Articles

Native Kidney Renal Cell Carcinoma in Renal Allograft Transplant Patients - Our Experience.

The immunosuppression administered to renal transplant recipients to safeguard renal function elevates their susceptibility to renal cancer, which is estimated to be 15 times higher than in the general population. The current study aimed to analyze various aspects of native kidney renal cell carcinoma (RCC) in renal transplant recipients. This study involved a retrospective analysis of 11 patients who underwent nephrectomy for RCC in native kidneys among renal transplant recipients at our institution since 1992. Our institutional incidence was 0.4%. Median age at presentation was 57 (49-60) years. The ratio of male: female was 10:1. Most patients were asymptomatic at presentation and native kidney disease before transplantation was undetermined. In our study, the median time interval between diagnosis of RCC and transplant was 9.1 (8.4-11.2) years. All patients underwent native kidney nephrectomy. Clear cell type was more common than papillary type, 3.5 (2.5-4.2). Ten patients were diagnosed with stage I disease and one patient had stage IV disease. Fuhrman nuclear grading revealed low grades in nine patients and three patients had Grade 3. Immunosuppressive therapy modification was done in nine patients. Meticulous follow-up of renal transplant patients is essential for earlier diagnosis and appropriate treatment of native kidney RCC in transplant recipients. Authors recommend every year follow-up in transplant recipients with special emphasis on ultrasound of native kidney.

Native Kidney Renal Cell Carcinoma in Renal Allograft Transplant Patients - Our Experience.

The immunosuppression administered to renal transplant recipients to safeguard renal function elevates their susceptibility to renal cancer, which is estimated to be 15 times higher than in the general population. The current study aimed to analyze various aspects of native kidney renal cell carcinoma (RCC) in renal transplant recipients. This study involved a retrospective analysis of 11 patients who underwent nephrectomy for RCC in native kidneys among renal transplant recipients at our institution since 1992. Our institutional incidence was 0.4%. Median age at presentation was 57 (49-60) years. The ratio of male: female was 10:1. Most patients were asymptomatic at presentation and native kidney disease before transplantation was undetermined. In our study, the median time interval between diagnosis of RCC and transplant was 9.1 (8.4-11.2) years. All patients underwent native kidney nephrectomy. Clear cell type was more common than papillary type, 3.5 (2.5-4.2). Ten patients were diagnosed with stage I disease and one patient had stage IV disease. Fuhrman nuclear grading revealed low grades in nine patients and three patients had Grade 3. Immunosuppressive therapy modification was done in nine patients. Meticulous follow-up of renal transplant patients is essential for earlier diagnosis and appropriate treatment of native kidney RCC in transplant recipients. Authors recommend every year follow-up in transplant recipients with special emphasis on ultrasound of native kidney.

Monoclonal Immunoglobulin Deposition Disease - a Review of Current and Emerging Data

Introduction Monoclonal immunoglobulin deposition disease (MIDD) is a rare complication of abnormal B and plasma cells, characterized by non-fibrillar, Congo-red negative deposits of monoclonal immunoglobulin molecules. These include light chain (LCDD), heavy chain (HCDD), or combined (LHCDD), and can involve several organs, most notably the kidney. Clone directed treatments for MIDD, including chemotherapy and autologous stem cell transplantation (ASCT), are used to reduce abnormal immunoglobulin deposition and restore organ function. Organ transplantation is considered in select cases. However, data is limited in terms of prognosis, association of MIDD with other hematological disorders, and outcomes in the evolving treatment landscape. Objectives The primary aim of this scoping review is to identify and collate existing data on clinical manifestations, disease associations, and treatment options in MIDD. This will help provide evidence-based recommendations and inform future research. Methods We conducted a literature search through EMBASE, MEDLINE, and CINAHL. Identified studies were imported onto Covidence and screened by two independent reviewers. Primary studies of patients with MIDD were included. Conference abstracts and dissertations were included if they synthesized data on MIDD. Case reports, reviews, and guideline reports were excluded. Outcomes of interest include disease type, risk factors, systemic manifestations, natural history, and prognosis. Data was also collected on disease association, intervention (observation, immunosuppression, chemotherapy, ASCT, organ transplantation, novel agents), and prognostic variables. Standardized scoping review methodology and PRISMA guidelines were used for protocol development. Results A total of 16,673 records were identified through literature search, of which 125 were used. Most studies were case series, with larger retrospective cohort studies providing data on treatment options and transplantation in MIDD. Grey literature search was also performed and yielded no additional results. LCDD was identified as the most common MIDD subtype. Organ involvement was most commonly renal, followed by hepatic and cardiac. Study endpoints included overall survival, renal survival (i.e., time to initiation of renal replacement therapy), hematologic response, and organ response. Biochemical parameters such as serum creatinine and proteinuria were measured. Single organ involvement was more common than multi-organ, and disease response was primarily assessed using laboratory parameters. There was substantial heterogeneity in treatment. These included corticosteroids, plasma exchange, and chemotherapy - typically bortezomib-containing regimens - followed by ASCT in eligible patients. Renal response rates of up to 79% (n=28) were noted in a larger patient cohort. Patients who demonstrated renal response fared better than non-renal responders did (overall survival of 87% vs 60% at 27.3 months, n=255). In patients who underwent ASCT (either as consolidation or in the case of relapse/progression), most patients achieved hematologic CR (71%, n=14). ASCT was relatively well-tolerated, with early transplant-related mortality limited to one patient across 9 studies with data on ASCT (n=69). Patients appeared to have more favorable outcomes with MIDD/MGRS compared to MIDD in the setting of myeloma (VGPR/CR 58.9% vs 47.9%, n=255). Renal response appeared to correlate with deeper hematologic responses. Post renal transplant allograft loss has been noted upon MIDD relapse. Discussion Limited data exists on MIDD and its subtypes. Potential reasons include newer classification schema, low incidence, disease heterogeneity, need for histopathologic diagnosis, and frequently asymptomatic initial course. This scoping review outlines patient characteristics, disease subtypes, and outcomes with treatment options including ASCT and organ transplantation. MIDD appears to respond to chemotherapy and ASCT; however, responses depend on the subtype, associated disease process, and degree of organ involvement. Renal response may have significant prognostic implications. Limitations of this review include a paucity of prospective data, lack of studies using novel plasma cell-directed therapies, and small sample sizes. Further data analysis is ongoing, and emerging prospective data is of interest.

#5999 GRADES II-III INTRA-ABDOMINAL HYPERTENSION INCREASE THE RISK OF GRAFT LOSS OR DEATH AFTER KIDNEY TRANSPLANTATION

Abstract Background and Aims Intra-abdominal hypertension (IAH) is common among post-surgical, critically ill and kidney transplant patients, and is associated with acute kidney injury and increased morbidity and mortality. We aimed to describe the medium-term effect of IAH on graft and patient survival after deceased-donor kidney transplantation. Method 192 consecutive patients who received a cadaveric renal allograft transplant at our hospital were included in this study. IAP was measured every 8h for at least the first 72h after surgery using the urinary bladder technique, and an average value was obtained. Patients were followed up for 24 months or until a composite outcome (defined as graft loss or recipient death) occurred. Clinical, anthropometric, and analytical data was extracted from our hospital's database. Statistical analysis was performed using IBM SPSS Statistics 22. The study was approved by the local ethics committee. Results 192 patients were included. Relevant clinical and anthropometric data are summarized in Table 1. Patients with grades II or III IAH were more frequently male, had longer dialysis vintage, received more frequently hemodialysis as renal replacement therapy and suffered delayed graft function, graft loss or death more repeatedly. In Kaplan-Meier analysis, grade II IAH or higher were associated with lower composite-outcome free survival (Log-Rank: 8.053; p = 0.018) (Figure 1). Conclusion Grade II-III IAH appear to be a risk factor for graft loss or recipient death in our sample of deceased donor kidney transplant recipients. Monitoring of intra-abdominal hypertension could provide useful information to identify patients at higher risk of post-transplant complications.

HLA mismatch is important for 20-year graft survival in kidney transplant patients

BackgroundHuman leukocyte antigens (HLA) matching is gradually being omitted from clinical practice in evaluation for renal allograft transplant. While such practices may yield shorter wait times and adequate short-term outcomes, graft longevity in HLA mismatched patients remains unclear. This study aims to demonstrate that HLA matching may still play an important role in long-term graft survival. MethodsWe identified patients undergoing an index kidney transplant in the United Network for Organ Sharing (UNOS) data from 1990 to 1999, with one-year graft survival. The primary outcome of the analysis was graft survival beyond 10 years. We explored the long-lasting impact of HLA mismatches by landmarking the analysis at established time points. ResultsWe identified 76,530 patients receiving renal transplants in the time frame, 23,914 from living donors and 52,616 from deceased donors. On multivariate analysis, more HLA mismatches were associated with worse graft survival beyond 10 years for both living and deceased donor allografts. HLA mismatch continued to remain an essential factor in the long term. ConclusionsA greater number of HLA mismatches was associated with progressively worse long-term graft survival for patients. Our analysis reinforces the importance of HLA matching in the preoperative evaluation of renal allografts.

Changes and Significance of Interleukin 17 Expression in Patients After Renal Transplantation

The purpose of this study was to investigate the expression and significance of interleukin (IL)-17 in acute rejection after renal transplantation. From September 2019 to December 2021, patients and healthy volunteers who underwent renal allograft transplantation and renal biopsy in our hospital were selected and divided into 4 groups: the stable group (stable) showed no obvious abnormality in renal transplantation pathology; the pathologic diagnosis of acute rejection was the rejection group; the pathologic diagnosis of renal transplantation was immunosuppressive poisoning in the drug group; and the normal group (control) was healthy volunteers. The expression of IL-17 was detected by reverse transcription-polymerase chain reaction, quantitative enzyme-linked immunosorbent assay, and immunohistochemistry. Analysis of the area under the curve and sensitivity and specificity of IL-17 for the diagnosis of acute rejection after raw transplantation was done using receiver operating characteristic curves. Compared with those in the normal group and the stable group, the expression of IL-17 DNA in the blood, the value of IL-17 in the blood, and the integrated optical density value of IL-17 in the transplanted kidney were significantly higher in the rejection group (P < .05). There were no statistically significant differences in the expression of blood IL-17 DNA, the value of blood IL-17, or the integrated optical density value of transplanted kidney IL-17 between the normal group and the stable group (P > .05). IL-17 is involved in acute rejection after renal transplantation. Increased expression of IL-17 is seen in the blood and kidneys of patients with acute rejection after renal transplantation. The detection of IL-17 may provide a theoretical basis for diagnosing and treating acute rejection in human kidney transplantation.

Unraveling the Secrets Behind the Multidrug-Resistant Tuberculosis Treatment Outcome in Chronic Renal Failure Patients Requiring Hemodialysis: A Systematic Review.

Multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR TB) is a global concern, with 450,000 new cases and 191,000 deaths in 2021. TB and chronic kidney disease (CKD) have been associated since 1974, with suggested explanations such as oxidative stress, malnutrition, dysfunction in vitamin D metabolism, and a compromised cell-mediated immune response. End-stage renal failure patients are more likely to acquire drug resistance due to poor adherence, adverse drug reactions, and inappropriate dose adjustment. We then aim to evaluate the therapeutic outcome of multidrug-resistant TB of the lungs in patients who require hemodialysis in terms of successful treatment (cured and treatment completed) and the associated factors for a favorable outcome. Our secondary goal is to identify unfavorable treatment outcomes (treatment failed, patient died, or patient lost to follow-up) and the underlying associated factors. We conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Guidelines for this systematic review. We included adults (>19 years old) with chronic kidney disease who needed hemodialysis and had microbiologically confirmed multidrug-resistant pulmonary TB, excluding patients who had a renal allograft transplant, were on peritoneal dialysis, hadextrapulmonary TB, were childrenand pregnant patients. We searched PubMed, MEDLINE, PubMed Central, ScienceDirect, Public Library of Science (PLOS), and Google Scholar. Keywords were combined with the Boolean "AND" operator to gather results as well as the medical subject heading (MeSH) search strategy. After screening study articles by reading their titles and abstracts, the following tools were used to assess the risk of bias: the Newcastle-Ottawa scale for observational studies, the Assessment of Multiple Systematic Reviews (AMSTAR) checklist for systematic reviews, and the Joanna Briggs Institute (JBI) assessment tool for case reports.Primary and secondary outcomes were assessed, and a conclusion was made. We gathered 21,570 studies from the databases between 2013 and 2023, with 30,062 total participants. There were eight eligible studies for review. Patients with CKD, particularly those on dialysis, are at increased risk of TB due to a combination of factors that contribute to immunosuppression. TB reactivation is common in chronic renal failure patients. Diagnostic samples such as sputum and pleural fluid had lower sensitivity rates compared to tissue samples, which led to delays in diagnosis and treatment and, most importantly, contributed to drug resistance. All new dialysis patients should undergo interferon-gamma release assay testing. TB-infected patients with severe renal disease (eGFR 30 ml/min) had increased morbidity and mortality; however, the use of directly observed treatment, short-course (DOTS), and renal-dose adjustment of anti-TB medications significantly reduced these risks. Drug-induced hepatitis and cutaneous reactions were common adverse effects of anti-TB medications. A therapeutic drug monitoring guideline is required to reduce these adverse events and even mortality. Additional research is required to assess the safety and efficacy of therapeutic regimens, as well as their outcomes, in this population with multidrug-resistant TB.

Renal Allograft Mucormycosis: An Unusual Case Report

Mucormycosis of the renal allograft is an extremely rare and rapidly fatal infection with an incidence of 0.2−1.2%. The major predisposing risk factors are uncontrolled diabetes mellitus, immunosuppression, anti-rejection treatment, unrelated donors, and cytomegalovirus infection. We describe a case of 27-year-old young adult patient who underwent a live-related renal allograft transplant at our centre and presented 4 weeks post-transplant with high-grade fever and rapid rise in serum creatinine. Initial cultures were repeatedly sterile, and imaging studies were normal. A few days later, he developed graft tenderness, and contrast CT abdomen revealed graft pyelonephritis. He was non-responsive to broad-spectrum antibiotics, and renal function gradually declined to anuric state. Prophylactic antifungal was added and hemodialysis was initiated. A graft biopsy was done, which revealed infiltration of the graft kidney with mucor species. After a week of antifungal treatment, graft nephrectomy was done and dual antifungals were continued. The patient initially improved symptomatically but again deteriorated with new onset fever and pain abdomen. Repeat imaging revealed a moderate intra-abdominal collection managed with per-cutaneous aspiration showing sterile growth and an abdominal drain kept in situ. Four days later, there was an accidental intra-abdominal drain expulsion with oozing of pus with blood which increased acutely with a sudden drop in blood pressure and hematocrit. Emergency exploration was done, which revealed a rent in the external iliac artery. After vascular rent repair surgery, the patient initially showed gradual improvement hemodynamically, but later, he developed superadded bacterial infection at the graft nephrectomy wound site with refractory septic shock and expired. Though early diagnosis, appropriate antifungal agents, and graft nephrectomy may improve the patient outcome, the case fatality rate of renal graft mucormycosis still remains very high.

Pattern of urinary tract and surgical site infection in allograft renal recipient during early postoperative period

A kidney transplant (KT) offers a significant survival benefit and is the only curative treatment for patients with ESRD. Infectious complications are still a leading cause of morbidity and death among transplant patients. This study aimed to assess the organisms and risk factors responsible for urinary tract and surgical site infection in allograft live-related renal transplant recipients during the early post-transplant period. This observational follow-up study was conducted among 20 purposively selected patients who underwent renal allograft transplant surgery from July 2019 to December 2020 in the Department of Urology, BSMMU, Dhaka. Patients with a history of renal transplant recipients or congenital renal anomalies and any urological malignancy were excluded from the study. After kidney transplant, UTI developed in 6 (30%) renal transplant recipients where all were complicated types and occurred between 10 to 14 days postoperatively. UTI was caused by E. coli in 3 (15%) patients, while Klebsiella and Enterococci were causative organisms for 1 (5%) and 2 (10.0%) patients, respectively. SSI developed in 3 (15%) renal transplant recipients where two were superficial, and one was deep. SSI occurred between 5-8 days postoperatively. SSI was caused by S. aureus in 2 (10%) patients and Pseudomonas in 1 (5%) patient. UTI was significantly more in older patients and the patients with a longer duration of catheterization. Older patients and overweight patients had significantly higher rates of SSI. In total, 33% of the recipient during the early hospital stay developed UTIs, all of which were complicated types. SSI developed in 15%, where 2/3rd was superficial and 1/3rd was deep. Older age with a longer duration of catheterization and DJ stent was found to be associated with the occurrence of UTI, while older age and high BMI were related to the event of SSI. BSMMU J 2022; 15(2): 127-131

Surgical treatment of pelvic lipomatosis: a systematic review of 231 cases.

Pelvic lipomatosis (PL) is a rare condition that is characterized by excessive growth of fat in the pelvic cavity. Studies have yet to systematically review surgical treatments for PL. To provide a reference for selecting reasonable surgical treatments for PL patients according to previous literature on the surgical treatment of PL. We conducted this systematic review in accordance with the Preferred Reporting Items for a Systematic Review and Meta-Analysis (PRISMA) of Individual Participant Data guidelines. Literature on PL published from 1968 to 2022 was retrieved from the PubMed and EMBASE databases. Data were collected and analyzed independently by two independent investigators. A total of 42 studies, involving 231 patients with PL, were included in the analysis. The surgical treatments included transurethral resection (TUR) (48.5%), ureteral stent placement (11.7%), percutaneous nephrostomy (1.3%), ureterocutaneostomy (1.3%), ureteral reimplantation (10.4%), ileal conduit (13%), and allograft kidney transplantation (0.4%). After excluding patients with unclear prognoses, 42.9% of patients showed improvement in lower urinary tract symptoms (LUTS) after TUR. Ureteral stent placement provided relief of hydronephrosis in 62.5% of PL patients. Percutaneous nephrostomy resulted in stable renal function in 33.3% of PL patients, while ureterocutaneostomy led to remission of postoperative hydronephrosis in 33.3% of PL patients. After ureteral reimplantation, 70.8% of patients experienced relief of hydronephrosis or had stable renal function. Ileal conduit led to remission of hydronephrosis, alleviation of symptoms, or maintenance of stable renal function in 83.3% of PL patients. One patient with PL had stable renal function after allograft renal transplantation. The surgical treatments for PL include TUR, ureteral stent placement, urinary diversion, and allograft renal transplantation. However, the choice of surgical method should be determined after comprehensive consideration of the patient's condition.

Renal transplant outcomes in allografts with multiple versus single renal arteries

Context: Anatomical variations of the grafts are one of the challenging problems in renal transplantation. Among these anatomical variations, multiple renal arteries (MRAs) are considered the most common. Aims: The aim of the study was to find out the outcome of recipient’s receiving multiple artery renal allografts. Settings and Method: This was a single-institutional, prospective, observational study of 212 patients who underwent open live renal allografting after exclusion criteria. All patients were followed up for a minimum of 12 months, and serum creatinine was done at 1 month, 3 months, 6 months, and at 12 months of follow-up. Statistical Analysis Used: Quantitative data have been presented in terms of means and standard deviation. Categorical data have been presented in terms of proportions and percentages. Student’s t-test has been used for the comparison of individual quantitative parameters. Value of P < 0.05 was considered statistically significant. Results: Serum creatinine on the postoperative day-1 was found to be higher in the MRAs group compared to single renal artery (SRA) group (2.25 mg/dl vs. 2.02 mg/dl, P = 0.178). During follow-up of the recipients, there was no statistically significant difference in serum creatinine between the two groups when measured at 1, 3, and 6 months and at 1 year. Conclusions: Outcomes in recipients receiving multiple artery renal allografts were similar compared to the cohort of allografts with SRA. Hence, transplantation of renal allograft with MRAs is safe, and the recipient in need should not be denied of a graft with multiple vessels.

Outcomes of hospitalized renal allograft transplant recipients with coronavirus disease 2019: an Egyptian single-center retrospective study

Background The outcomes of coronavirus disease 2019 in renal-transplant recipients may differ from the general population because of chronic immunosuppression and comorbidities. The aim of this study is to provide information on the clinical characteristics and outcomes of hospitalized renal allograft transplant recipients with coronavirus disease 2019 is restricted in the Arab region. This study aims to narrow this gap. Patients and methods The study was done on 21 renal allograft transplant recipients admitted in the isolation ward of a single Egyptian center for kidney diseases and transplantation during the period from July 2020 to July 2021, all cases were analyzed regarding their clinical presentation, follow-up, workup done, management, and outcomes. Results The main clinical presentations were fever 90.5% and respiratory symptoms 66.7%, not different from the general population. Their clinical course showed remarkable incidence of acute kidney injury (57.1%) than the general population, but mortality was not (14.3%). Remdesivir was tolerable, no noticeable side effects, and did not affect graft function. Conclusion This category of patients need special care, lowering of immunosuppresion during infection, close monitoring of kidney function, and respiratory status. They can receive ventilator support and same treatment as general population, including Remdesivir and Tocilizumab. Both patient and graft survival can be achieved.

81. Impact of Early Post-Transplant Multidrug-Resistant Organism Detection Among Renal Transplant Recipients, 2005–2021

Abstract Background Understanding the impact of multi-drug resistant organism (MDRO) acquisition on renal transplant recipients (RTR) mortality and allograft function is paramount to mitigating deleterious outcomes. Prior studies have been limited by lack of control groups and sample sizes. We aimed to the assess whether the detection of an MDRO or a susceptible organism during the early post-transplant period was associated with increased mortality and allograft failure among RTRs. Methods We performed a retrospective cohort study of RTRs at the Emory University Transplant Center between 2005–2022. Early post-transplant culture positivity was defined as a positive culture within 30 days of renal transplant. The primary outcome was a combined composite of one year- allograft loss and/or mortality following renal transplant. A Kaplan–Meier survival analysis was performed, and differences between survival curves for RTRs with an early post-transplant positive culture (stratified by susceptibility status) and negative control RTRs were assessed using the log-rank test. Multivariable cox proportional hazard and a competing risk analysis were performed. Results Among 3,233 RTRs, 259 (8%) had a susceptible organism detected and 35 (1%) had an MDRO detected (Figure 1). Demographic and microbiology characteristics are summarized in Table 1 &amp; 2. One hundred and forty-nine (5%) RTRs experienced the composite outcome, this was experienced more frequently among RTRs with an MDRO detected (14%, 5/35) compared to RTRs with a susceptible organism defected (8%, 21/259) and negative controls (4%, 123/2,939) (Table 3). Significant difference between time from transplantation to the composite outcome when comparing negative controls, MDRO and susceptible organisms RTRs was observed (log rank p &amp;lt; 0.001) (Figure 2). Early post-transplant culture positivity (aHR 1.98 [1.30, 3.04]) and MDRO detection (aHR: 3.20 [1.30, 7.84]) were significantly associated with the composite outcome (Table 4). Conclusion MDRO as well as susceptible organism acquisition during the early post-transplant period was associated with increased mortality and allograft loss highlighting the need for increased infection prevention efforts within this vulnerable population. Disclosures All Authors: No reported disclosures.

The outcome and risk factor of refractory T-cell–mediated rejection on renal allograft transplantation based on the Korean Organ Transplantation Registry

Eun-Jeong Kwon, Gi-Ae Yun, Seokwoo Park, Sejoong Kim, Ho Jun Chin, Ki Young Na, Dong-Wan Chae, Hyung Sub Park, Taeseung Lee, Jong Cheol Jeong. Korean J Transplant 2022;36:314. https://doi.org/10.4285/ATW2022.F-4537

Mouse Models of Renal Allograft Transplant Rejection: Methods to Investigate Chemokine-GAG Interaction and Therapeutic Blockade.

Chemokine-glycosaminoglycan (GAG) interactions direct immune cell activation and invasion, e.g., directing immune cells to sites of infection or injury, and are central to initiating immune responses. Acute innate and also adaptive or antibody-mediated immune cell responses both drive damage to kidney transplants. These immune responses are central to allograft rejection and transplant failure. While treatment for acute rejection has advanced greatly, ongoing or chronic immune damage from inflammation and antibody-mediated rejection remains a significant problem, leading to transplant loss. There are limited numbers of organs available for transplant, and preventing chronic graft damage will allow for longer graft stability and function, reducing the need for repeat transplantation. Chemokine-GAG interactions are the basis for initial immune responses, forming directional gradients that allow immune cells to traverse the vascular endothelium and enter engrafted organs. Targeting chemokine-GAG interactions thus has the potential to reduce immune damage to transplanted kidneys.Mouse models for renal transplant are available, but are complex and require extensive microsurgery expertise. Here we describe simplified subcapsular and subcutaneous renal allograft transplant models, for rapid assessment of the roles of chemokine-GAG interactions during allograft surgery and rejection. These models are described, together with treatment using a unique chemokine modulating protein (CMP) M-T7 that disrupts chemokine-GAG interactions.

Analysis of Chemokine-to-GAG Interactions in Model of Donor Renal Allograft Transplant.

Binding of chemokines to glycosaminoglycans (GAGs) is classically described as initiating inflammatory cell migration and creating tissue chemokine gradients that direct immune cell responses initiating local leukocyte chemotaxis into damaged or transplanted tissues. The interaction between chemokines and GAGs is an important factor affecting transplant rejection, and blocking the interactions between chemokines and GAGs can significantly reduce acute rejection after transplantation. Here, we investigated the interaction between chemokines and GAGs by establishing a mouse model of acute rejection after kidney transplantation.

Kidney Transplantation and Obesity: Are There Any Differences in Outcomes?

Kidney transplantation (KT) is the gold standard treatment for end-stage renal disease (ESRD) patients. Obesity is a strong risk factor for developing cardiovascular disease, chronic kidney disease, and ESRD. This study aimed to investigate the outcomes of kidney transplantation in obese recipients. We retrospectively reviewed the medical records of recipients from January 2016 to December 2021 in a single center. Outcomes in recipients of a kidney allograft with BMI ≥ 30 were compared with the outcomes in recipients with 30 < BMI. A total of 467 consecutive kidney transplantation recipients' files were studied. 213 (45.6%) allograft recipients had a BMI ≥ 30, and 254 (54.4%) allograft recipients had a BMI < 30. DGF rate was 29.1% in the BMI ≥ 30 and 30.7% in the BMI < 30 group (P = 0.41). On the other hand, 30days readmission rate also did not show a significant difference between the BMI ≥ 30 and BMI < 30 allograft recipients (37 vs. 33.8%, P = 0.46). The mean overall costs of transplantation in the BMI ≥ 30 group was $254,395, and it was $256,029 in the BMI < 30 group (P = 0.84). Our study shows that the outcomes of renal allograft transplant were comparable between recipients with BMI ≥ 30 and BMI < 30 in terms of DGF, LOS, 30days readmission, acute rejection rate, and survival rates, and BMI should not be a single independent criterion for decision making to select an optimal recipient.

Role of Diethylentriamine Penta-Acetic Acid Renograms in Differentiation between Acute Tubular Necrosis and Acute Rejection in Early Post Allograft Renal Transplantation in A Single Tertiary Center

Role of Diethylentriamine Penta-Acetic Acid Renograms in Differentiation between Acute Tubular Necrosis and Acute Rejection in Early Post Allograft Renal Transplantation in A Single Tertiary Center

247.6: Preliminary Results of Ex-vivo Normothermic Machine Perfusion in Deceased Donor Renal Allograft Transplantation – First Clinical Experience From Asia

247.6: Preliminary Results of Ex-vivo Normothermic Machine Perfusion in Deceased Donor Renal Allograft Transplantation – First Clinical Experience From Asia

Characterization of preoperative cardiovascular status and association with outcome following feline renal allograft transplantation: 166 cases.

To retrospectively evaluate preoperative historical, biochemical, and cardiovascular screening data for predictors of survival to discharge and long-term survival in feline renal allograft recipients from 1 institution. 166 cats that underwent renal transplantation at the University of Pennsylvania between 1998 and 2018. Medical records were reviewed for preoperative historical information, biochemical data, and cardiac assessment including auscultation findings, pre- and postoperative systolic blood pressure measurements, thoracic radiographic evaluation, and echocardiographic measurements. The need for hemodialysis, the number of surgical procedures, native kidney biopsy diagnosis and survival time was also recorded. Kaplan-Meier analysis was used to generate survival plots and estimate median survival times with a 95% CI. Univariable and multivariable analysis were performed to determine variables that were independently associated with survival to discharge and long-term survival. The patient population primarily consisted of adult male DSH cats (70%) diagnosed with IRIS stage 4 CKD (66.3%). Abnormalities identified on preoperative cardiac assessment, including hypertension, the presence of a murmur, echocardiographic changes, and radiographic signs of congestive heart failure, were not associated with survival to discharge or long-term survival. Age was the only single significant variable associated with survival, and the risk of death increased by 11% (95% CI, 6% to 17%) for every 1 year in patient age. The presence of cardiac abnormalities identified during the screening process of cats presenting for transplantation should not immediately exclude a potential candidate for the procedure. Owners considering transplantation should be educated on the impact of age on survival following surgery.