Time Of Renal Transplantation Research Articles

Contraceptive Counselling and Uptake Among Female Kidney Transplant Recipients in Ethiopia

ABSTRACTBackgroundContraceptive counselling and utilization for kidney transplant patients is a vital component of their kidney transplant care. The use of standardized information on contraceptive methods to prevent unplanned post‐transplant pregnancies in Africa in general is less studied. This study aimed to describe contraceptive counselling and uptake among kidney transplant recipients at a kidney transplant centre in Ethiopia.MethodsA descriptive study on contraceptive counselling and uptake among female Ethiopian kidney transplant recipients was conducted at St. Paul's Hospital Millennium Medical College (Ethiopia) from April 15 to July 15, 2023. Data on women's sociodemographic, renal transplantation and contraceptive counselling and use were collected through interviewing the participants using a structured questionnaire. Data were analyzed on SPSS 23 using simple descriptive analysis. Percentages and frequencies were used to present the results.ResultsA total of 60 participants were included in the final analysis. The mean age of the participants was 33.7 ± 8.4 years. The median duration from the time of renal transplant was 19 months. Most (49/60, 81.7%) of the participants reported that they did not receive family planning counselling on contraceptive methods in the early post‐transplant phase. The rate of contraceptive uptake was 8.3% (5/60) with two patients being copper IUD users, and Implanon, tubal ligation and combined oral contraceptives each utilized by a single kidney transplant patient.ConclusionContraceptive counselling and uptake rates among female kidney transplant recipients in this study were very low, which is consistent with findings from previous studies. Increasing female kidney transplant patients’ awareness on safe and effective contraceptive use through adequate contraceptive counselling is essential.

#1245 Standard or personalized policy of peritoneal catheter removal at kidney transplantation?

Abstract Background and Aims The presence of peritoneal dialysis (PD) catheter in an immunosuppressed kidney transplant recipient can increment the risk of infectious complications after transplant. For this reason, it is thought that management of PD catheters at the time of transplant can have an impact on patient and graft outcomes. However, there is no agreement when to remove peritoneal dialysis catheter after transplantation. According to European Guidelines, the catheter can be left in situ for 3-4 months despite a functional graft. Our aim was to review the data from our center regarding infectious PD associated complications after kidney transplant. Method We retrospectively reviewed all 132 patients that were previously on PD and were admitted to our center for renal transplantation between January of 2013 and June of 2023, and had information regarding timing of removal of PD access. Simple descriptive and inferential statistics were used to generate results. Categorical data were described using frequency and percentage. Our main outcome was to assess the PD infectious catheter-associated complications. Our secondary outcomes were the timing of removal of PD catheter after renal transplantation, number of episodes of dialysis post transplantation, and kidney replacement therapy (KRT) used. Our follow up included the time from kidney transplantation (KT) until they removed PD catheter. Those who removed PD catheter at the timing of renal transplantation were excluded when evaluating the infectious complications. Results From the 132 kidney transplant recipients eight patients removed PD catheter at the time of the transplant due to ongoing PD associated infection. Sixty-nine patients were men (52.3%), with a median (IQR) age at transplantation of 48.4 years (41-57). Regarding donors’ characteristics, 88 (33.3%) were deceased, 21 of which were expanded criteria donors, and 44 (66.7%) were living donors. A total of 19 (14.4%) patients had history of PD infectious complications in the three months before transplantation. From the 124 patients that remained with the PD catheter after KT the adverse event infection occurred in 19 (15.3%) patients and two of these had previous access related infection in the 3 months interval before transplantation. The adverse events were: exit-site infection (ESI) 10.4% (n = 19), peritonitis 3% (n = 4) and tunnel infection 1.6% (n = 2). Half required hospitalization mainly due to center logistics for catheter removal. No deaths were registered. The identified microorganisms are present in Table 1. The median (IQR) time of removal of the PD catheter was 4 (3-5) months. Sixteen patients (12.9%) required KRT due to delayed graft function: ten patients used the Tenckhoff catheter and the rest performed haemodialysis (four using central venous catheter and two using arteriovenous fistula). Three patients remained dialysis dependent. When analysing the living donor group the rate of KRT was even lower, with three (6.8%) patients requiring dialysis, and only one used the PD catheter. Conclusion Despite the timing of PD catheter removal was according to the European Guidelines, the risk of PD catheter associated infections is not negligible (15.3%), not to mention the burden for the patient to keep an abdominal device demanding routinely care of the exit site. Peritonitis rate was low and comparable to previous studies. Considering the utility of remaining with the catheter, the risk of needing KRT, namely in living donor KT, was low. We postulate whether PD catheter removal at the time of KT should be considered, especially when the risk of late graft function is low, as in living donors, and/or the risk of PD catheter related infections is high. For this reason, we call for an individualized policy regarding catheter removal in the transition to KT.

Personality traits and peritoneal dialysis patients’ prognosis

Objective Peritoneal dialysis (PD) requires high patient conscientiousness. Therefore, we aimed to investigate the relationship between conscientiousness score and prognosis in PD patients. Methods The ten-item Big Five Personality Inventory’s Chinese version was used to assess the conscientiousness score. Basic clinical information, prior medical history, hematological examination results, the occurrence of the first peritonitis and catheter-related infection, the start of hemodialysis, and the time of renal transplantation were collected. The patients were split into two groups, high and low conscientiousness groups, based on the mean value of the conscientiousness score. The differences in prognostic indicators were compared between groups, and the association between conscientiousness score and prognostic indicators in PD patients was assessed. Results Enrolled PD patients were divided into low conscientiousness group 103 and high conscientiousness group 98. There were significant differences in serum albumin (p = 0.021) and iPTH (p = 0.045) between the two groups. Multivariate Cox regression analysis identified conscientiousness score as an independent risk factor for the development of first peritonitis (HR = 0.558, 95% CI 0.400–0.779, p = 0.001) and first catheter-related infection (HR = 0.544, 95% CI 0.308–0.962, p = 0.036) in PD patients. Conscientiousness score (HR = 2.377, 95% CI 1.109–5.095, p = 0.026) was independently associated with renal transplantation. Conclusion Conscientiousness personality is closely related to the prognosis of PD patients.

Can a Kidney Failure Patient Survive with One to Two Hemodialysis Sessions per Month for More than 5 Years?

Background: Kidney failure known as renal failure or Stage 5 CKD or End Stage Renal Diseases is a major problem among kidney diseases worldwide, its incidence and prevalence are rising yearly. The management requires renal replacement therapy, hemodialysis, 3 sessions per week or peritoneal dialysis until the time of renal transplantation. The cost is high in low income countries and is not covered by major medical insurances. Few renal patients are able to afford dialysis and renal transplantation. Case Presentation: A 45-year-old man Butcher, living in rural Rwanda presented with renal failure and Hypertension with history of native medication intake. He remained on chronic maintenance hemodialysis since October 2017, at one to two hemodialysis sessions per month. He preserved quality of life and cognitive function. He is reporting to have more than 1000 cc of urine volume per day. Conclusion: This case demonstrates that suboptimal hemodialysis sessions can help the renal patients to survive when they preserve residual renal functions.

Sterile versus clean urinary catheterisation is not associated with post‐transplantation infection

AbstractThe objective of this study is to determine if there was a difference in rate of post‐transplantation urinary tract infection (UTI) in patients who have an indwelling catheter inserted using sterile versus clean technique. UTI is the most common nosocomial infection in the post‐transplantation period. We aim to describe risk factors associated with postoperative UTI in our institution and determine if there was a difference between those who have an indwelling catheter inserted using sterile versus clean technique. Risk factors for UTIs can be divided into recipient, donor, and procedure related factors. While an indwelling urinary catheter increases the risk of infection, it is vital for post‐operative fluid balance monitoring. Given the morbidity of UTIs in transplant recipients, a number of studies have investigated modifiable risk factors; however, investigation of the technique of indwelling catheter insertion at the time of renal transplantation is yet to be examined. A retrospective analysis of a contemporaneously maintained database was performed of renal transplant recipients over a 2‐year period from 2019–2021. Patients were divided into sterile versus clean technique, defined as the use of sterile gloves, gown and fenestrated drape following a surgical scrub, or sterile gloves alone following the use of alcohol‐based hand sanitiser respectively. A p value of <0.05 was considered statistically significant. One hundred sixty‐nine patients were included in analysis, with 31 UTIs (18.3%) within 30 days of renal transplantation. Female gender and autosomal dominant polycystic kidney disease were associated with a higher rate of UTI. One hundred twenty‐three patients had a catheter inserted via sterile technique, and 46 with clean technique, with no significant difference in rate of post‐operative UTI (p = 0.52). Inserting an indwelling catheter either by sterile or clean technique at the time of renal transplantation was not associated with the rate of postoperative UTI within 30 days.

The interactive association between Immune system and Kidney function

The Immune System (IS) and Kidney function are closely and interactively connected. IS dysfunction happening in autoimmune diseases, infections, malignancies, etc. is implicated in the pathogenesis of kidney involvement, leading to a great spectrum of glomerular and interstitial injury through several immunological pathways, such as immune complex deposition, activation of complement and signaling pathways. Complications of chronic kidney disease (CKD), including accumulation of uremic toxins, O2 free radicals, advanced glycation end products, increased expression of Toll Like Receptors on monocytes, cytokine overproduction, result in a situation characterized by chronic inflammation combined with premature ageing, and usually designated as “inflamm-aging”, followed by detrimental clinical consequences in CKD patients, such as increased cardiovascular risk, susceptibility to infections and malignancies. Kidney transplant can potentially restore the immune profile of patients, albeit immunosuppression treatment may be followed by further complications. The presence of certain T cell subsets at time of renal transplantation may affect response to immunosuppression and acute or chronic rejection, suggesting that patients’ immune profile at time of transplantation may have substantial impact in short and long term graft function.

Renal Transplant in Pediatric Patients With Congenital Abnormalities of the Lower Urinary Tract

Congenital abnormalities of the lower urinary tract can result in end-stage renal disease and are responsible for a significant number of renal transplants. Management of these patients is not always consensual, and more evidence is required about the frequency of associated complications. Our aim was to report the experience of a Pediatric Renal Transplant Unit with renal transplant in pediatric patients with congenital abnormalities of the lower urinary tract. Data on renal transplants performed in pediatric patients with congenital abnormalities of the lower urinary tract between January 1, 2009, and December 31, 2019, in this center were retrospectively reviewed. Fifty-three pediatric renal transplants were performed in the institution during the considered time period. Of these, 26 transplants were performed in 24 patients with congenital abnormalities of the lower urinary tract, and 14 were male. The median age at the time of renal transplant was 10.5 years (interquartile range, 5.25-15 years), and the most frequent diagnoses were neurogenic bladder (n = 7; 29%) and posterior urethral valve (n = 7; 29%). Three patients (13%) underwent preemptive renal transplant, 15 were on peritoneal dialysis (63%), and 6 were on hemodialysis (25%). A total of 81 pyelonephritides were diagnosed in the 24 patients, mostly attributed to Escherichia coli, followed by Klebsiella pneumonia. The median follow-up was 92.5 months (interquartile range, 52.3-114 months). For patients with congenital abnormalities of the lower urinary tract, graft survival was 92.3% at 1, 5, and 10 years, with no deaths reported. Renal transplant is the treatment of choice for pediatric patients with end-stage renal disease. The procedure does not seem to be associated with worse patient outcomes. Additionally, despite the significant number of pyelonephritides cases, it does not seem to result in decreased graft or patient survival.

Outcomes of removal of peritoneal dialysis catheter at the time of renal transplant.

There is no consensus regarding timing of peritoneal dialysis (PD) catheter removal following kidney transplant. We hypothesize that early removal of PD catheter reduces the risk of peritonitis. We conducted a prospective closed-loop audit to review existing practice in our department and determine whether a better strategy could be implemented. Simple descriptive and inferential statistics were used to generate results. Categorical data were described using frequency and percentage. Continuous values were reported as mean ± standard deviation. Between November 2016 and April 2017, forty patients had renal transplant with PD in situ. On average time to removal of PD catheter, posttransplant was 84 days. Four patients (10%) developed exit-site infection. Following departmental consultation, practice was changed to remove all PD catheters at the time of transplant. Between May 2017 and January 2018, twenty patients had renal transplant and 19 had PD catheter removed at the time of transplant. Of these, one required re-insertion. In the patient where PD catheter was left in situ, peritonitis was a complication. We continue to recommend PD catheter removal at the time of transplant.

Comparison of a magnetic retrieval device vs. flexible cystoscopy for removal of ureteral stents in renal transplant patients: A randomized controlled trial.

Placement of a ureteral stent at the time of renal transplantation can reduce complications when compared to non-stented anastomoses. Removal by flexible cystoscopy can be associated with discomfort, risk for infection, and high costs. New magnetic stents offer a means of bypassing cystoscopy by use of a magnetic retrieval device. Our objective was to compare clinical and cost-related outcomes of conventional and magnetic stents in patients undergoing deceased donor renal transplantation. Patients were randomized to receive either a conventional or a Black-Star® magnetic stent. Clinical, procedural, and cost outcomes were assessed, and the Ureteral Stent Symptom Questionnaire (USSQ) was administered with the stent in situ and after stent removal. All variables were compared between groups. Forty-one patients were randomized to conventional (n=19) or Black-Star (n=22) stent. The total time for stent removal under cystoscopy was significantly longer compared to Black-Star removal (6.67±2.47 and 4.80±2.21 minutes, respectively, p=0.019). No differences were found in the USSQ domains between groups. Rates of urinary tract infections and surgical complications between groups were similar. Stent removal was well-tolerated in both groups. Black-Star stent use resulted in a cost savings of $304.02 Canadian dollars (CAD) per case. USSQ scores suggest that stent removal with the Black-Star magnetic stent is as equally well-tolerated as flexible cystoscopy by renal transplant patients. Black-Star stent removal was significantly faster than conventional stents. No differences in discomfort, infection rate, or complication rate were found. Use of the Black-Star stent resulted in an estimated annual savings of $27 360 CAD at our centre.

Watchful waiting is an appropriate option for peritoneal dialysis candidates with an asymptomatic ventral hernia.

Expert consensus recommends that all ventral hernias be repaired prior to, or concomitantly with, peritoneal dialysis (PD) catheter insertion. We examined the clinical outcomes of patients undergoing initial PD catheter insertion, with asymptomatic ventral hernias that were not repaired and rather managed using a watchful waiting approach. A single-center, retrospective review of patients undergoing PD catheter insertion from 2005-2019 was performed. Patients who did not undergo repair of a pre-existing ventral hernia at the time of their initial PD catheter insertion were included. The primary endpoint was ventral hernia repair following PD catheter insertion. Forty-one patients were included. Most patients presented with an umbilical hernia (78%). Six patients (15%) underwent ventral hernia repair at a median postoperative interval of 12months [IQR 8-16], due to abdominal discomfort and hernia enlargement (n = 2) and incarceration (n = 2). Two patients remained asymptomatic, yet underwent ventral hernia repair at the time of renal transplantation. The cumulative incidence of ventral hernia repair within 12 and 24 months of PD catheter insertion was 13% and 21%, respectively. Watchful waiting may be an acceptable option for select patients with asymptomatic ventral hernias at the time of initial PD catheter placement. These findings highlight the need to better identify factors associated with asymptomatic ventral hernias that do not warrant concomitant repair to aid surgeons in the decision-making process.

SAT-358 THE INCIDENCE OF MALIGNANCY AND ITS RELATED FACTORS IN PATIENTS UNDERGOING KIDNEY TRANSPLANTATION

Renal transplantation is considered as the treatment of choice for patients with ESRD. The underlying causes of death among renal transplant recipients have changed from early immunologic and nonimmunological failure to cardiovascular disease and malignancy. In this study we evaluated the incidence of malignancy and its related factors in renal transplant patients in Razi Hospital of Rasht over a period of 10 years. In this retrospective study, 549 patients who underwent renal transplantation surgery in Razi Hospital between 2008 and 2019 were studied. Demographic and clinical characteristics of patients and other required information were recorded in a checklist. Required patient information was obtained from the case of pre and post-transplant and outpatient follow-up. In this study, it was found that only the patient's age at the time of renal transplantation in recipients of intervention has a confounding and additive role in incidence of malignancy after transplantation (P=0.0001). It was also found that there was no statistically significant relationship between sex of patients, current smoking status, smoking history, family history of malignancy, number of transplants, post-transplant survival, sun exposure, transplant rejection history, patient follow-up, occupational status, the use of daclizumab (Zenapax ATG) induction and incidence of malignancy after kidney transplantation. Estimates of standardized incidence ratio showed that the incidence of malignancy in kidney transplant recipients was 26.9 higher than the incidence rate in Guilan province and 21.7 higher than the incidence of malignancy in the country. The incidence rate of cancer in kidney transplant patients is 26.9 times higher than Guilan province rate (95% CI: 19.7-35.9) and 21.7 times higher than national rate (95% CI: 15.9-28.9). In this study, the incidence rate of cancer is 792 per 100000-person year. In this study, it was found that only the patient's age at the time of kidney transplantation has a confounding and increasing role in the incidence of post-transplant malignancy. It has also been shown that the most common malignancy in these patients is non-melanoma skin malignancy and Kaposi's sarcoma comes in second.

SUN-329 RETURN TO DIALYSIS AFTER KIDNEY TRANSPLANTATION : ABOUT 13 CASES

The return to dialysis after transplant loss is an emerging problem in dialysis centers. The objective of this study is to determine the conditions ofinitial treatment in dialysis of patients who have lost graft function. This study involved 13 renal transplant patients who started or restarted a chronic dialysis program in the renal nephrology and renal transplant department at Sahloul Hospital. We collected biological and epidemiological clinical data from all patients during the transplantation period and during dialysis. Thirteen (13) patients were enrolled: 8 men (61%) and 5 women (39%); all these patients were dialyzed before renal transplantation for an average duration of 39.5 months, 10 of whom were on hemodialysis (HD) and 3 peritoneal dialysis (DP). At the time of renal transplantation, patients were, on average 43 years old. The 13 recipients had a living donation, with a functional kidney transplant lasting 6 to 66 months, with an average of 28.5 months. Kidney transplant recipients, on average of 28 years old when they returned to dialysis. 9 patients were hypertensive, one patient had diabetes, one patient had kaposi sarcoma and 2 patients had heart disease. 10 patients started dialysis with HD. 9 patients started emergency dialysis with positioning of a central catheter. Dialysis in 7 patients and preexisting arterio-venous fistula in 2 patients. Mean serum creatinine pre-dialysis was 889 μmol /L. The average urea was 37 mmol /L. The mean hemoglobin, albumin levels were 7.4 g / dl and 32 g /L respectively. Serum calcium was 1.88 mmol/L and there was mild hyperkalemia and hyperphosphatemia. Four patients received between 3 and 4 treatments for hypertension, while 5 received 2 but did not allow normalization of blood pressure in the vast majority of cases. These data may provoke critical reflection among practitioners in charge of kidney transplant patients, as regards the management of the transition period from renal transplantation to dialysis.

SUN-327 SUCCESSFUL PREGNANCY AFTER KIDNEY TRANSPLANTATION: EXPERIENCE OF SAHLOUL HOSPITAL DE SOUSSE

A successful transplant allows the restoration of pituitary ovarian function and fertility. The objective of our study was to report successful pregnancies in our renal transplant patients, and analyze them through a review of the literature Our study is retrospective, descriptive, including all successful pregnancies occurring in patients who had a kidney transplant between 2007 and 2018. Four pregnancies were identified in 3 patients. The average age of patients at the time of renal transplantation was 26 years. The average age of patients at the time of pregnancy was 30 years. When pregnancies were planned, MycophenolateMofetiland blockers of the renin angiotensin aldosterone systemwerestopped before pregnancy. The average time between transplant and first conception after transplant was 39 months. All pregnancies were completed, and the mean term of delivery was 38 weeks of amenorrhea. The delivery route was caesarean section in all cases. No maternal complications occurred during pregnancy except one case of toxemia of pregnancy without eclampsia. No cases of acute graft rejection during pregnancy were observed Mean serum creatinine levels during pregnancy were stable at 87.5μmol /L. Mean birth weight was 3160 g with 1 child with hypotrophy (<2500 g). Six months postpartum, mean serum creatinine was 92.33 μmol /L and blood pressure was normal. The good evolution of pregnancies in renal transplant patients requires multidisciplinary management for the well-being of the mother and the baby. These are at-risk pregnancies that need to be planned. A minimum delay of 12 months between transplantation and conception with a creatinemia lower than 150 μmol /L should be respected.

The UK Experience of Renal Transplantation in AL Amyloidosis

Systemic AL amyloidosis, caused by monoclonal light chain depositing as amyloid fibril protein, commonly presents with renal involvement. A third of patients with renal involvement have or develop significant renal dysfunction leading to end-stage renal failure (ESRF). In an era of improving life expectancy for patients with AL amyloidosis, renal transplantation, with its marked impact on improving quality of life and reducing the cost burden, is increasingly considered. We report the outcomes of fifty patients who had received a renal allograft between 2004-2019, seen at the UK National Amyloidosis Centre Patient characteristics were: 60% male; median age at diagnosis was 53.5 years (38-69 years); median ECOG performance status 1 (0-3); median presenting creatinine, eGFR and proteinuria were 199μmol/L (69-756 μmol/L), 27ml/min and 8.95g/24h (0.4-19.7g/24h) respectively. Involved light chains were - lambda - 36 (72%) and kappa - 14 (28%). 40 patients were evaluable (5 transplanted for non-amyloid conditions prior to diagnosis, 4 lost to follow up, 1 transplanted for amyloidosis overseas prior to referral). Thirteen (32.5%) had isolated renal involvement whilst 35 (87.5%) patients had other multi-organ involvement including 13/40 (32.5%) with cardiac involvement. Median time from diagnosis to ESRF was 15 months (0-115 months) and from renal replacement therapy to renal allograft was 28 months (3-83 months). Four (10%) received a pre-emptive renal allograft. At time of renal transplantation, patients had a median of 2 prior lines of chemotherapy (range 1-4) whilst 10/40 patients (25%) had a prior autologous stem cell transplant. At transplant, haematological responses (HR) were: complete response (CR) - 22 (55%), very good partial response (VGPR) - 12 (30%), partial response (PR) - 4 (10%) and stable disease - 2 (5%). Median time from HR to renal transplant was 29 months (0-93 months). From renal transplant, haematological PFS was 82.7 months (95% CI 61.2-104.2). Patients achieving a CR achieved a markedly higher PFS of 102.5 months (95% CI 68.8-136.3 months) (p=0.023) as did those with a dFLC &lt;10mg/L at renal transplantation, 121.1 months (95% CI 91.5-150.6 months) (p=0.0001). At a median follow up of 107 months (26-231 months), 14 (35%) patients died, of whom only one had graft failure at the time of death. One patient (with stage 3 cardiac AL) died within 2 days of a renal allograft after a post-operative hypotensive episode. Nine (22.5%) patients had post-transplant chemotherapy for relapse. Median OS from renal transplantation was 106.6 months (95% CI 85.0-128.3 months); significantly better in patients achieving a CR (133.0 months, p=0.005) or dFLC &lt;10mg/L (137.8 months, p=0.0001) prior to transplant. Stage of chronic kidney disease at presentation, plasma cell burden, age at renal transplantation and multi-organ involvement did not impact overall survival. Of the patients experiencing graft failure, 1 graft failed within a week of implantation due to primary non-function after a prolonged cold ischaemia time, 1 functioned poorly from implantation and failed within 4 months and a third failed after 45 months with evidence of amyloid recurrence in the graft. In conclusion, the outcomes of carefully selected patients with AL amyloidosis undergoing renal transplantation is promising and justifies careful consideration. There was only 1 peri-operative death. Patients in a complete response or who have a dFLC &lt;10mg/L prior to renal allograft implantation have significantly better outcomes. At a median follow ~9 years, graft failure is rare (only 7.5%). Disclosures No relevant conflicts of interest to declare.

Is anuria prior to pediatric renal transplantation associated with poor allograft outcomes?

Anuria from end-stage renal disease leads to a defunctionalized bladder and may pose technical challenges at the time of renal transplantation. Anuria's effect on bladder function after renal transplantation is considered to be minimal in adults, although a paucity of evidence is available in children. The purpose of this study was to examine the effects of anuria prior to pediatric renal transplantation for ESRD due to medical renal disease on allograft outcome. We performed a retrospective review of pediatric patients who underwent renal transplantation for medical renal disease at our institution between 2005 and 2016. Demographics and clinical data were assessed. We also compared GFR at 1year post-transplant for medical renal patients with history of anuria and those without. Twenty-one patients fulfilled our inclusion criteria with median duration of anuria was 10months. Preoperative VCUG was available in five patients and their bladder capacity was 29% of expected bladder capacity for age (range 8%-41%). Anticholinergic therapy was prescribed in six patients (28%) for a mean duration of 5months (range 1-16months). Comparison of GFR at 1year post-transplant in anuria group and those without anuria showed no difference (69 vs 75mL/min, P=0.37). No correlation was observed between duration of anuria and post-transplant GFR. The majority of children in our pretransplant anuria cohort did not develop bladder dysfunction after renal transplantation. No difference was observed between GFR at 1year when comparing anuric to non-anuric transplant recipients of medical renal disease etiology.

Is arterial calcification in children and adolescents with end-stage renal disease a rare finding?

To investigate if calcification and intimal media thickness (IMT) of arteries are present in children and adolescents with end-stage renal disease and to describe the risk factors associated with these alterations. In an observational, cross-sectional prospective study, 68 patients were evaluated at the time of renal transplantation. A fragment of the inferior epigastric artery was removed during surgery for histopathological analysis to verify the presence or not of arterial calcification. Two outcomes were considered: the presence of calcium deposition and the measurement of the IMT of the artery. The potential exposure variables were: age, chronic kidney disease aetiology, diagnosis time, systolic blood pressure (SBP), use of oral active vitamin D, homocysteine and C-reactive protein. No arterial calcification was observed in the studied sample. The median value of the IMT of the inferior epigastric artery was 166 μm (interquartile range = 130-208). SBP standard deviation score and age were the only factors associated with this outcome. There was no statistical interaction between SBP and age with the IMT (P = 0.280). Arterial calcification is rare in children and adolescents with end-stage renal disease. The factors associated with IMT were age and SBP.

Peritoneal dialysis catheter removal at the time of renal transplantation: Choosing the optimal candidate.

Concurrent peritoneal dialysis (PD) catheter removal during renal transplantation is controversial, with limited evidence supporting this practice. Our objective was to determine the rate of delayed graft function (DGF) in patients on preoperative PD. Additionally, we sought to identify which patients can safely have their PD catheter removed during transplantation due to a low risk of DGF. We conducted a retrospective observational study between June 2011 and December 2015. The primary outcome was the diagnosis of DGF, defined as the need for dialysis within the first week of transplantation. Clinical and transplant factors, including graft type and donor criteria, were assessed for association with the primary outcome. Catheter-related complication rates were also compared between post-transplant PD and hemodialysis (HD). Of our cohort of 567 patients, 145 patients (25.6%) developed DGF. Obesity (odds ratio [OR] 1.06; 95% confidence interval [CI] 1.00-1.11; p=0.04) and increased perioperative blood loss (OR 1.002; 95% CI 1.000-1.003; p=0.03) were predictors of DGF. Protective factors included living donor (LD) grafts (OR 0.15; 95% CI 0.05-0.49; p=0.002) and intraoperative graft urine production (OR 0.39; 95% CI 0.23-0.65; p<0.001). In our PD cohort, only LD grafts demonstrated lower DGF rates (0 LD vs. 20.8% deceased donor; p=0.003). In terms of post-transplant renal replacement therapy, patients on PD and HD had similar duration of temporary dialysis (one day PD vs. two days HD; p=0.48) and catheter-related complication rates (4.5% PD vs. 2.6% HD; p=0.30). Carefully selected patients, such as those receiving LD grafts, may benefit from concurrent PD catheter removal.

Clinical characteristics of Campylobacter enteritis after pediatric renal transplantation: A retrospective analysis from single center.

There are few reports of patients with Campylobacter enteritis after renal transplantation, and only a few case reports of bacteremia have been published. Although antibiotic therapy for 3-5days has been recommended for immunocompromised patients, the optimal treatment for Campylobacter enteritis after renal transplantation has not been established. This study aimed to clarify the clinical characteristics and treatment outcomes of Campylobacter enteritis after pediatric renal transplantation. This retrospective study included patients who underwent pediatric renal transplantation and were found to have Campylobacter species in stool cultures between January 2014 and May 2017. This study included eight patients who underwent pediatric renal transplantation. The median age at the time of renal transplantation was 14years, and the median period between transplantation and disease occurrence was 4.6years. Clinical symptoms were abdominal pain for eight patients, diarrhea for eight patients, fever for seven patients, vomiting for three patients, and headache for three patients. Campylobacter jejuni was isolated from the stool cultures of all patients. The median administration period of antibiotics as initial therapy was 7days (range, 4-11days). However, clinical relapse was observed in four patients after completing antibiotic therapy. Patients who experienced clinical relapse required a second course of antibiotic therapy for a median duration of 7days (range, 5-10days). Patients with Campylobacter enteritis after pediatric renal transplantation are at high risk for clinical relapse and may require a longer duration of antibiotic therapy than that generally described.

Chronic Kidney Disease, Hypertension and Cardiovascular Sequelae during Long Term Follow up of Adults with Atypical Hemolytic Uremic Syndrome

INTRODUCTION: Atypical hemolytic uremic syndrome (aHUS) is a complement mediated thrombotic microangiopathy that predominantly affects the kidneys although extra-renal manifestations are common. In the pre-eculizumab era, 40-65% of patients either died or had end stage renal disease (ESRD) at 1 year. Long-term renal and cardiovascular outcomes are less well described in the eculizumab era. We conducted this cohort study to describe the renal and cardiovascular outcomes of adult survivors of aHUS, both on and off continued eculizumab therapy.METHODS: Patients with aHUS were identified from the prospective Complement Associated Disease Registry and through the Center for Clinical Data Analysis at Johns Hopkins University. Demographic and clinical data were abstracted, including details of aHUS diagnosis, laboratory studies, treatment, and outcomes including renal function, hypertension and echocardiographic studies. The prevalence of hypertension was compared between patients with and without chronic kidney disease (CKD) using the chi squared test.RESULTS: 45 individuals with aHUS were followed at Johns Hopkins Hospital with a median [interquartile range (IQR)] time since diagnosis of 37.4 [IQR 20.7, 62.6] months. Median age at diagnosis was 32.5 [IQR 23.2, 49.2] years and 71.1% were female. Acute kidney injury was present in 98% (44/45); however, neurologic (64.4%), gastrointestinal (68.8%), and cardiovascular (55.5%) involvement was also common (Table 1). Hypertensive urgency or emergency was present in 40% (18/45), while 13.3% (6/45) had an acute coronary syndrome during the acute episode (2 ST elevation myocardial infarctions and 4 non-ST elevation myocardial infarctions). Complement gene sequencing was completed for 34 patients, of which 8 had variants in CFH, one in CFH and CD46, 5 in other genes (MCP1, CFHR1 homozygous deletion, DGKE, THBD, and THBD with del(CFH-SCR20-CFHR1-int5)]and 20 patients had no pathogenic variants. Thirty-two (71.1%) patients were treated initially with plasma exchange (median 6 [3, 12] exchanges). Thirty-nine (86.7%) received eculizumab (5 started at the time of renal transplant after developing ESRD), and 20 of these (51%) have since discontinued therapy. Median duration of eculizumab therapy was 2.7 [0.9-11.3] months for those who stopped therapy and 29.5 [8.8-55] months for those who continued. One patient died due to a myocardial infarction during the aHUS episode.Of the 44 survivors, 15 (34.1%) had complete renal recovery, 9 (20.5%) had chronic kidney disease (CKD) stage 1-4, and 20 (45.5%) developed CKD stage 5 requiring dialysis at 3 months after the acute episode. Fifteen patients underwent subsequent renal transplantation. At the end of follow up, 23 (52.2%) had CKD [2.2% stage 2, 15.6% stage 3, 4.4% stage 4 and 28.9% stage 5) (Figure 1A). Although not statistically significant, there was a higher rate of CKD (63.1% versus 52.6%, P=0.511) among those not on eculizumab; however, this primarily reflects eculizumab being stopped after ESRD. Hypertension was present in 35 (79.5%) survivors (Figure 1B), of which 14 (40%) had incident hypertension. The prevalence of hypertension was not significantly different between patients with CKD and normal renal function (87% versus 71.4%, P=0.202). Thirty-one (70.4%) were on antihypertensive therapy, and 67% (21 of 31) of these were not controlled to <140/90 mmHg despite the use of multiple agents (Figure 1C). Echocardiograms were performed in 29 (64.4%) individuals (12 within 3 months of diagnosis, and 17 after 3 months). Of these 17, 29.4% were normal studies, 23.5% had reduced left ventricular ejection fraction, 29.4% demonstrated left ventricular hypertrophy or diastolic dysfunction, and 11.7% had pulmonary hypertension.CONCLUSION: Malignant hypertension and cardiac involvement are common during acute aHUS. aHUS survivors also have a high prevalence of hypertension, including a notable incidence of new onset as well as uncontrolled hypertension following aHUS diagnosis. CKD is present in the majority of survivors, and structural cardiopulmonary disease is common. Complement activation has been implicated in the pathogenesis of cardiovascular disease. Further investigation is needed to evaluate the epidemiology of cardiovascular sequelae in aHUS, their associations with specific complement mutations, and optimal management. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Clinical implication of renal allograft volume to recipient body surface area ratio in pediatric renal transplant.

Our study aims to assess the clinical implication of RAV/rBSA ratio in PRT as a predictor for attained renal function at 1year post-transplantation and its association with surgical complications. A retrospective cohort was performed for PRT cases from January 2000 to December 2015 in our institution. Extracted clinical information includes the recipient's demographics, donor type, renal allograft characteristics, arterial, venous and ureteral anastomoses, vascular anastomosis time while kidney off ice, overall operative time, and estimated blood loss. The RAV/rBSA was extrapolated and assessed for its association with renal graft function attained in 1year post-transplantation and surgical complications within 30-day post-transplantation. A total of 324 PRTs cases were analyzed. The cohort consisted of 187 (52.4%) male and 137 (42.3%) female recipients, with 152 (46.9%) living donor and 172 (53.1%) deceased donor renal transplants, and an overall median age of 155.26months (IQR 76.70-186.98) at time of renal transplantation. The receiver operating characteristic identified that a RAV/rBSA ratio of 135 was the optimal cutoff in determining the renal graft function outcome. Univariate and multivariate analyses revealed the relative OR for RAV/rBSA≥135 ratio in predicting an eGFR≥90 attained within 1year post-transplant was highest among younger pediatric recipients (<142.5months) of deceased kidney donors (OR=11.143, 95% CI=3.156-39.34). Conversely, Kaplan-Meier analysis revealed that RAV/rBSA ratio≥135 is associated with lower odds of having eGFR <60 (OR=0.417, 95% CI=0.203-0.856). The RAV/rBSA ratio was not associated nor predictive of transplant-related surgical complications. Our study determined that the RAV/rBSA ratio is predictive of renal graft function at 1-year PRT, but not associated with any increased surgical complications.