Tx Patients Research Articles

Quality of life and psychological distress in end-stage renal disease patients undergoing hemodialysis and transplantation.

Among diverse profound impacts on patients' quality of life (QoL), end-stage renal disease (ESRD) frequently results in increased levels of depression, anxiety, and stress. Renal replacement therapies such as hemodialysis (HD) and transplantation (TX) are intended to enhance QoL, although their ability to alleviate psychological distress remains uncertain. This research posits the existence of a significant correlation between negative emotional states and QoL among ESRD patients, with varying effects observed in HD and TX patients. To examine the relationship between QoL and negative emotional states (depression, anxiety, and stress) and predicted QoL in various end-stage renal replacement therapy patients with ESRD. This cross-sectional study included HD or TX patients in the Eastern Region of Saudi Arabia. The 36-item Short Form Survey and Depression Anxiety Stress Scale (DASS) was used for data collection, and correlation and regression analyses were performed. The HD and TX transplantation groups showed statistically significant inverse relationships between QoL and DASS scores. HD patients with high anxiety levels and less education scored low on the physical component summary (PCS). In addition, the results of the mental component summary (MCS) were associated with reduced depression. Compared with older transplant patients, TX patients' PCS scores were lower, and depression, stress, and negative working conditions were highly correlated with MCS scores. The findings of this study revealed notable connections between well-being and mental turmoil experienced by individuals undergoing HD and TX. The PCS of HD patients is affected by heightened levels of anxiety and lower educational attainment, while the MCS of transplant patients is influenced by advancing age and elevated stress levels. These insights will contribute to a more comprehensive understanding of patient support.

The effect of itching on sleep quality and comfort in patients with hemodialysis and renal transplantation: A multi-center cross-sectional study

BackgroundThe aim of this study was to determine the effect of itching on sleep quality and comfort in hemodialysis (HD) and renal transplant (Tx) patients with itching. MethodsThis descriptive, correlational seeking and cross-sectional study was conducted in four hospitals affiliated with a private health group in Istanbul between April and June 2021. The sample of the study consisted of 42 patients receiving HD treatment and 49 patients with renal transplantation. Data were collected using the Patient Information Form, 5-D Itch Scale, Richards-Campbell Sleep Questionnaire and General Comfort Questionnaire. ResultsThere was a significant difference between the HD and renal transplantation groups in the Direction (p = 0.01) and Disability dimension (p = 0.002) of the 5- D Itch scale in favor of the renal transplant group. The mean sleep quality and comfort scores of the groups were similar and moderate. Itching negatively affects sleep quality in patients receiving HD treatment, and 22 % of the change in sleep quality is explained by disability of itching (R2 = 0.22; p = 0.002). Itching negatively affects comfort in both groups. Itching explains 27 % of the change in comfort level in the HD group (R2 = 0.27; p = 0.002) and 25 % of the change in comfort level in the renal transplantation group (R2 = 0.25; p = 0.001). ConclusionsAccording the study results during the hemodialysis treatment process, itching is more intense in terms of distribution and disability and affects the quality of sleep of patients. Itching has a significant impact on patients' perception of comfort. Patients experience itching both during HD treatment and after renal transplantation, which significantly impairs their comfort. Therefore, itching should be carefully monitored during renal replacement therapy and its effects on patients should be evaluated.

Detailed pathological characteristics and survival prognosis of patients with penile cancer from a high-capacity tertiary referral centre over a 20-year period.

120 Background: Penile cancer is a rare cancer that affects 0.1-1 per 100,000 men in developed countries. However, data on this cancer in developing countries, particularly in Asian populations, are lacking. A retrospective study is needed to determine the characteristics of penile cancer patients, tumor-related treatments, and prognosis. The objective of our study was to present statistical results that are applicable to an Asian population under the most recent staging system. Additionally, we aimed to report on the pathological characteristics and prognosis of a large sample of patients with penile cancer who underwent long-term follow-up with the standard extent of radical dissection. Methods: This study retrospectively analyzed clinical and pathological data from 1017 patients who were diagnosed with penile cancer at Sun Yat-sen University Cancer Center between October 2001 and October 2023. The primary study endpoint was overall survival (OS), and the secondary endpoint was progression-free survival (PFS). Survival curves were plotted using the Kaplan‒Meier method, and differences were compared using the log-rank test. Univariate and multivariate Cox proportional risk models were used to analyze the factors associated with tumor survival. Results: The average follow-up time was 50 months (range: 0.6-232.8 months). The 5- and 10-year OS rates were 67.3% and 62.7%, respectively, and the 5- and 10-year PFS rates were 63.9% and 61.1%, respectively. After excluding 127 Tx patients and 23 TIS stage patients, the 10-year OS rates of pTa stage (29 patients), pT1 (305 patients), pT2 stage (217 patients), pT3 stage (271 patients), and pT4 stage (45 patients) patients were 96.3%, 80.1%, 61.7%, 55.4%, and 14.2%, respectively. A total of 690 patients underwent standard lymph node dissection. The 10-year OS rates of pN0 (376 patients), pN1 (111 patients), pN2 (78 patients), and pN3 (125 patients) patients were 92.7%, 62.5%, 48.1% and 31.3%, respectively. The results of the multifactorial analysis revealed that T stage (T4 stage versus Ta-T1 stage: HR=2.38, 95% CI: 1.00~5.66, P=0.05), pathological grade (G3~4 grade versus G1~2 grade: HR=1.63, 95% CI: 1.05~2.53, P=0.027), N stage (pN+ versus pN0: HR=14.11, 95% CI: 7.83~25.43, P<0.001), and white blood cell count (WBC>8.5: HR=1.71, 95% CI: 1.17~2.51, P=0.006) were independent prognostic factors in penile cancer patients. Conclusions: Patients with penile cancer had better long-term OS after standard lymph node dissection. The adverse factors were T stage, pathological grade, extent of lymph node metastasis, and preoperative WBC count. Identifying high-risk patients through preoperative evaluation can improve long-term survival rates. Radical lymph node dissection in the early stage has more curative value, and adjuvant therapy should be provided in patients with advanced-stage disease after surgery.

#2280 Kidney elastometry, X-flow algorithms to interrogate adult and pediatric number of nephrons

Abstract Background and Aims Standard ultrasound mainly provides information about structural changes in the kidney, whereas parenchymal Doppler ultrasound provides the renal resistance index (RI), which correlates with plasma creatinine levels. Unfortunately, in the case of isolated proteinuria and normal renal function/creatinine levels, these two classical approaches do not show any changes. Recent advances in ultrasound analysis, allowing the measure of kidney stiffness (sharewave elastometry) and the imaging of ultralow-flow vessels up glomeruli (such as X-Flow), might be helpful to identify kidney alterations in case of proteinuria with normal creatinine. We hypothesize that proteinuria with intact glomerular filtration may induce a measurable change in kidney stiffness and the size of low-flow microcircle, with different effects in acute and chronic conditions. We also verify whether the mismatch between creatinine, resistance index, and kidney size may suggest a specific nephrological disease. Method We conducted a transversal study on 301 patients with chronic kidney disease (CKD) and 160 kidney transplant patients (Tx), comparable for age, gender, and eGFR. For all patients, we retrieved the resistance indices of both the kidney and the spleen, clinical variables, shear wave elastrometry, and the X-Flow algorithm (Esaote) to detect the microcircle. We compared Conventional pulsed wave Doppler techniques (resistance index, RI) and ultrasensitive Doppler algorithm (Xflow, Esaote, Genoa, GE, Italy) to study the perfusion pattern and smaller angio-architecture of kidney's cortical vessels. X-Flow is a high-resolution and high-definition Doppler technology, which, with a new algorithm, makes better spatial resolution possible and maximizes Doppler signal penetration capabilities. We also identify a mismatch between creatinine and the renal RI, calculating the renal mismatch index (correlation between renal resistance index and creatinine level). The connection between the resistance index and the kidney size was tested as a significant marker of chronicity. Results The eGFR was best predicted by renal RI in Tx patients (Pearson −0.4, p < 0.01). At variance, the RI is a poor predictor of eGFR in CKD patients: in these subjects, the kidney longitudinal size was a better predictor of eGFR (Pearson's coefficient 0.39, p < 0.01). Using a large dataset from a previous study, we estimated the total number of nephrons using the following approximation: nephron number = (5270*total cortical volume – 61612)*number of kidneys. This formula is only valid for chronic patients and cannot be applied to polycystic patients. We speculated that while eGFR was proportional to the number of active glomeruli in CKD patients (thus correlating with kidney size), in TX patients, the local microcircle better explained the changes in eGFR. The consequence is that the eGFR has different meaning in CKD and Tx patients. Patients deviating from this pattern are identified as having an increased renal dissimilarity index. The multiple regression analysis revealed that RI also depended on age and cholesterol levels. The spleen resistance index correlated with cholesterol levels. The kidney mismatch index defined a subgroup of patients with tubular microcirculation abnormalities. Shearwave stiffness correlated with Resistance index (Pearson −0.3, p = 0.04) and, limited to Tx patients, to the cortical volume (Pearson = −0.446, p < 0.05) and number of nephrons (Pearson −0.44, p < 0.05), but was not associated with creatinine or eGFR. The extent of microcircle measured on X-flow images was altered in chronic forms of proteinuria with normal creatinine levels. Conclusion Kidney elastometry and kidney X-flow indices might show more sources of profitable information that can be collected from ultrasound approaches that allow the identification of a diseased kidney, even in the presence of regular architecture and average resistance index. The X-flow algorithm should be used to study the smaller vascular tree not visualizable with Doppler, such as the afferent arteriole.

#2677 A propensity score-matched analysis of kidney replacement therapy outcomes for older adults stratified by frailty severity

Abstract Background and Aims Older people living with frailty who receive kidney replacement therapy (KRT) experience higher mortality and hospital readmission compared to their non-frail counterparts [1–3]. Shared decision making with older people regarding the optimal KRT modality (haemodialysis [HD], peritoneal dialysis [PD], or kidney transplant [TX]) can present challenges due to the lack of research comparing KRT modalities stratified by frailty severity. The Hospital Frailty Risk Score (HFRS), which uses routinely collected clinical data to categorise frailty severity, has been shown to predict outcomes in advanced chronic kidney disease (CKD) [4]. However, the HFRS has not been used to compare outcomes across KRT modalities. This single-centre project aims to explore outcomes between KRT modalities for older people stratified by HFRS frailty severity. Method Adults aged 60 years or older starting KRT at our institution between December 2012 and January 2022 were included. HFRS was calculated at first estimated glomerular filtration rate (eGFR) result below 15 mL/min/1.73 m2 and at start of KRT. Patients were stratified by KRT modality and their frailty severity (categorized as low, intermediate, or high according to their HFRS score). TX patients were then matched to 1:2 to HD patients and 1:1 to PD patients, based on patient age, HFRS category, and Charlson Comorbidity Index (CCI) at KRT start. Outcomes of interest were hospital readmission and mortality, both overall and within 1 year of KRT initiation. Descriptive statistics compared HD, PD, and TX groups. Results Twenty TX, 20 PD, and 40 HD matched patients were included. Age (HD vs PD vs TX: 68.5 vs 67.6 vs 68.3 years, p = 0.50), proportion of males (57.5% vs 70.0% vs 55.0%, p = 0.66), and CCI (15.0 vs 13.0 vs 13.0, p = 0.95) were similar between cohorts. Frailty, as assessed by the HFRS, worsened or remained the same for most patients in all 3 cohorts between first eGFR < 15 and KRT start (81.0% vs 93.0% vs 83.0%, p = 0.61). All patients were either of low (85.0% vs 80.0% vs 85.0%) or intermediate (15.0% vs 20.0% vs 15.0%) frailty status at time of KRT start and the proportion of patients in each category did not vary with modality (p = 0.92). Re-hospitalization within 1 year of starting KRT was similar between groups (32.5% vs 25.0% vs 10.0%, p = 0.12). Kaplan-Meier survival analyses also demonstrated similar survival among groups at 1 year (75.0% vs 95.0% vs 90.0%, log-rank p = 0.09), but better survival among TX patients overall (0.0% vs 66.1% vs 79.4%, log-rank p = 0.02). Overall and 1 year Kaplan-Meier survival for patients stratified by KRT modality and HFRS are shown in Fig. 1. Conclusion TX may optimize longer term survival for older people with low and intermediate frailty status and kidney failure. Furthermore, the HFRS appears to be a useful prognostic tool that could inform shared decision making with older patients regarding KRT modality choice.

#1866 Gender gap in renal transplantation, myth or truth?

Abstract Background and Aims Multiple works show that women are less likely to receive a kidney transplant (Tx) compared to their male counterparts. We aimed to study the sex differences in access to Tx in our waiting list. We also studied the rate of masculine and feminine donors (Do) and their match to same-sex recipients (Rc). Method We included all adult patients active in our transplant waiting list during a 2-year period (from January 1-2021 to December 31-2022). Our center is a medium volume transplant center, and we only perform Tx from deceased donors, and don't perform combined organ transplantation. We analyzed the rate of women vs male, and Rc's and Do's sex, the degree of sex match and mismatch. We evaluated differences in time in waiting list until Tx, re-transplantation, and hyperimmunized patients, between groups. Results 270 individuals were active in our waiting list, 174 (64%) men, and 96 (36%) women. 142 were transplanted during the study period, 92 (65%) were males, and 50 (35%) females. We found no differences in terms of age, BMI, time to Tx, condition of hyperimmunized or re-Tx in the Rc's group and the rate of Tx (p = 0.34) (see Table A). We had 102 donors, ♀ 41 (40%), ♂ 61 (60%), regarding to their features, differences between age and BMI were statistically non-significant, neither in individually nor delta analysis (see Tables B-C, and Figs A-B). Proportionally more male kidneys were transplanted to female Rc's. Conclusion In our sample, we had a 2:1 rate of males to women in our waiting list, and in access to Tx. Relatively more women received a kidney form a male Do (46 vs 31%). Although other studies find a gender gap in access to kidney Tx, this phenomenon was not found in our sample. However, our results may be conditioned by a small sample size. We need to design well powered and multicentric studies, to dilucidate this controversial issue.

#1219 Extracellular vesicles from patients with AMR-induced reprogramming of human podocytes into senescent cells: role of SGLT2i

Abstract Background and Aims Extracellular vesicles (EVs) are organelles released by different cells that deliver biological information into the extracellular space and contribute to several diseases. However, their role in patients with antibody-mediated allograft rejection (AMR) remains uncertain. Our aim was to test the influence of plasma-derived EVs on human conditional immortalized podocytes (PODO) by investigating the possible role of dapagliflozin (Dapa) as a pharmacological agent. Methods Twenty-eight Rtx patients were included in the study, 14 with AMR, and 14 control TX patients (RTX). (CTRL). Plasma-derived Evs were used to stimulate PODO for 24 h, followed by exposure to 100 nM Dapa for 24 h. Differential ultracentrifugation at 110,000 g was applied, followed by counting with Nanosight and characterization by high-resolution flow cytometry according to the MISEV2018 criteria. PKH26 dye was used for the EVs-PODO incorporation study using Z-stack microscopy image acquisition. Total RNA and protein were extracted for gene expression and protein analysis, and the cells were fixed for immunostaining evaluation. Results We first found that upon activation with EV, PODO incorporated Es and shared them between cells; moreover, AMR-EVs led to an increased expression of tetraspanin marker of cell activation CD9 (p = 0.028) compared with CTRL. Importantly, the incubation of PODO with RTX-EVs induced a senescence-associated secretory phenotype (TNF alpha p = 0.0006, MCP1 p = 0.014); with cytoskeletal dysregulation and increase in gene expression and proteins involved in the epithelial to mesenchymal transition such as VIM (p = 0.026), senescence P21 (p = 0.04), inflammation CD44 (p = 0.034) with downregulation of Klotho (p = 0.002). Interestingly, incubation with Dapagliflozin significantly counteract PODO activation with reduction in P21 expression (p = 0.039) and an increase in Klotho (p = 0.047) abrogating inflammaging. Conclusions Our findings demonstrate that plasma EVs of AMR induced cellular senescence in PODO, reprogramming cellular processes such as cytoskeleton shape and composition, secretion of inflammatory cytokines, and decrease of the nephroprotective protein Klotho. This pathogenic process can be efficiently counteracted by SGLT2i.

Abstract PO1-13-02: Circulating tumor DNA mutation landscape in HR+/HER2− patients with mBC treated with cyclin-dependent kinase 4/6 inhibitors in the SCRUM-Japan MONSTAR-SCREEN study

Abstract Introduction: Combination of cyclin-dependent kinase 4 and 6 inhibitors (CDK 4/6i) + endocrine therapy (ET) is recommended as first- or second-line treatment (1L or 2L Tx) for hormone receptor-positive, human epidermal growth factor receptor-2-negative metastatic breast cancer (HR+/HER2− mBC). In this study, we assessed cancer-specific genetic alterations in circulating tumor DNA (ctDNA) and tissues in abemaciclib-treated patients with HR+/HER2− mBC in Japan. Methods: MONSTAR-SCREEN is a multicenter study and part of a nation-wide cancer genome screening project for patients with advanced solid tumors (SCRUM Japan). Regardless of the Tx line, the current analysis included abemaciclib-treated patients with HR+/HER2− mBC (N=97). Data were collected between Jan 2020 and Dec 2021. Blood samples collected at ≤21 days before abemaciclib initiation (baseline; n=77) and at disease progression or Tx discontinuation (paired post-Tx; n=33) were tested with the FoundationOne® Liquid Companion Diagnostic panel. Additionally, archival or fresh tissue biopsy samples (n=79) were tested with the FoundationOne® Companion Diagnostic panel. Patient characteristics, baseline genetic alterations, neoplastic burden (measured by shedding rate and maximum variant allele frequency [VAF]), and alterations at clinical progression were reported. Results: The total population (N=97) included patients with next generation sequencing ctDNA and/or tissue data. All were female with median age of 57 years (interquartile range 50, 67). Bone, either alone or with other sites, was the most common metastatic site (61%). 78% of patients received abemaciclib in the first or second line of Tx (LoT). Fulvestrant with or without gonadotropin-releasing hormone (55%), letrozole (24%), and anastrozole (11%) were the most common concomitant drugs. Among patients with baseline ctDNA data (n=77), 30% and 21% had received prior ET and prior chemotherapy, respectively. In baseline ctDNA samples, PIK3CA (37%) and TP53 (28%) alterations were detected most frequently across all LoT; while ESR1 (16%), GATA3 (11%), and FGF3/4/19 (9%) were more frequently detected in samples from later LoT. The frequency of ESR1 alterations (p< 0.01), shedding rate, and maximum VAF (both p< 0.05) were significantly higher in prior ET recipients than those who did not receive prior ET. Frequency of post-Tx ESR1 alterations numerically decreased from baseline in patients on fulvestrant (23% to 18%) and numerically increased in patients on aromatase inhibitors (27% to 45%). Other genes showed either a numeric increase or similar alteration frequency between the baseline and post-tx. Newly acquired post-Tx alterations were detected in FGF3/4/19 (18%); PIK3CA, TP53, and RB1 (all 15%) and ESR1 (12%). The table shows PIK3CA and ESR1 alterations detected at baseline and post-Tx. In the tissue samples (n=79), TP53 (32% vs 20%) and ESR1 (14% vs 7%) alterations were numerically more frequent in metastatic versus primary lesions. Other gene alteration frequencies were similar. Conclusion: PIK3CA alterations were the most frequently detected genetic alterations in both pre- and post- abemaciclib Tx patients with HR+/HER2− mBC. Patients with prior ET had more frequent ESR1 alterations and higher neoplastic burden. Evidence from this study provides insight into the ctDNA dynamics and potential resistance mechanisms in patients with HR+/HER2− mBC. PIK3CA and ESR1 alterations detected in circulating tumor DNA at baseline and post abemaciclib treatment Citation Format: Masaya Hattori, Victoria Serelli-Lee, Yoichi Naito, Takashi Yamanaka, Hiroyuki Yasojima, Rikiya Nakamura, Takao Fujisawa, Mitsuho Imai, Yoshiaki Nakamura, Hideaki Bando, Tsutomu Kawaguchi, Takayuki Yoshino, Hiroji Iwata. Circulating tumor DNA mutation landscape in HR+/HER2− patients with mBC treated with cyclin-dependent kinase 4/6 inhibitors in the SCRUM-Japan MONSTAR-SCREEN study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-13-02.

Urogenital tumors following kidney transplantation-monocentric analysis of incidences and overview of urological preventive measures

Urogenital tumors are among the most common solid malignancies after kidney transplantation (TX). We analyzed the incidence and mortality of urogenital tumors after kidney TX in our own patient population as well as answered the question of recommended follow-up necessity and frequency in this cohort. Retrospective monocentric data collection of tumor diseases and the most common urogenital tumors after kidney TX at the Transplant Center Dresden between 2010 and 2020 was done. From this, we derived recommendations for auseful follow-up concept. Atotal of 13% (93/710) of kidney TX patients developed aneoplasm. Older patients (60.1 ± 10.6 vs. 53.8 ± 12.5; p < 0.001), with higher Charlson scores (≥ 4: 68% vs. 46%; p < 0.001) and aprevious tumor history (18% vs. 8%; p < 0.001) were more likely to develop aneoplasm after transplantation. In the multivariate analysis, previous tumor history was found to be an independent predictor of tumor development after renal transplantation (OR 2.2; 95%-KI [1.2-4.1]; p = 0.01). Urogenital tumors accounted for 30% (28/93) of all malignancies. Renal cell carcinoma of the native kidney was the most common (n = 12) neoplasm, followed by prostate cancer (n = 9). Most solid malignancies after kidney TX arise from the urinary tract. Due to their frequency, there is an urgent need for specialized urological therapy and long-term follow-up care. Even before listing for TX, risk factors can be recognized and individual concepts for follow-up care can be developed.

O158 Telephone post-operative follow-ups can be safely used for thyroidectomy and parathyroidectomy patients

Abstract Introduction The aim of this study was to implement and evaluate the efficiency of telephone post-operative follow-ups (TFUs) in an Endocrine Surgical Unit. Methods Patients operated [thyroidectomy (Tx) or parathyroidectomy (PTx)] in the Department of Endocrine Surgery between 6/2019 and 1/2021 were included in this study. Patients with a cancer diagnosis on histology were automatically converted to a clinic appointment. Results 155 patients were included. There were 75 and 80 patients with a Tx or a PTx operation respectively. The mean age for Tx and PTx patients was 50 (SD:17) and 56 (SD:15) respectively. The male/female ratio for Tx and PTx patients was 1:5. and 1:4 respectively. The main indication for an operation was Thy3a/f tumour and PHPT. The mean hospital stay for Tx and PTx patients was 1.3 (SD:1.5) and 1.2 (SD:0.9) days respectively. The % of patients discharged back to the GP after the 1st TFU was 50% and 46% for Tx and PTx patients respectively. 15% and 8% of Tx and PTx patients respectively required a 3rd FU. 8%, and 5% of Tx and PTx patients respectively required a conversion a subsequent clinic appointment. The mean (SD) distance of the patient's residence from hospital was 16 km (SD:25) and 23 km (SD: 20) for Tx and PTx patients respectively. There were no complaints from the patients in this study. Conclusion Post-operative TFUs are suitable for patients undergoing a Tx and/or PTx. A small percentage of patients will require conversion to a face-to-face clinic follow-up.

Burden, depression and anxiety effects on family caregivers of patients with chronic kidney disease in Greece: a comparative study between dialysis modalities and kidney transplantation.

Burden of caregivers is a status that was identified as a consequence of daily care. Anxiety and depression are probably related to complex tasks interwined with the care of a family member suffering from chronic kidney disease (CKD). To examine the experienced burden, anxiety and depression of Greek caregivers of patients with End-Stage CKD on dialysis as well as kidney transplant recipients (TX) in relation to their demographic profile and to compare among the groups. A total of 396 participants (198 couples of patients and caregivers) were recruited. Structured interviews and self-completed questionnaires were obtained from patients undergoing dialysis modalities as well as TX (28 peritoneal dialysis patients, 137 hemodialysis patients, 33 TX) and their caregivers. Zarit Burden Interview, Beck Depression Inventory and the Generalized Anxiety Disorder-2 scales were used as screening tools. The majority of caregivers were females (67.2%), with a median age of 58years. Total burden was indicated as mild to moderate (Mdn = 36 (24-51)). Caregivers of haemodialysis (HD) patients showed the highest burden (Mdn = 40 (26-53)) followed by peritoneal dialysis(PD) (Mdn = 29 (25-51)) and TX group (Mdn = 28 (21-43)) (p = 0.022). Caregivers' depression and anxiety were related to the type of patients' treatment, as well. Caregivers of HD and PD patients reported significantly higher depression (Mdn = 11 (5-18)) and anxiety scores (Mdn = 3 (2-5)) in comparison to TX caregivers (Mdn = 6 (2-13) and Mdn = 2 (2-4)) (p = 0.045 and p = 0.04, respectively). Caregivers of TX patients appeared to have less burden, depression and anxiety levels compared with caregivers of patients on dialysis modalities. Caregivers' burden is significantly associated with anxiety, depressive symptoms, gender, duration of caregiving, educational level, financial status and caregivers' age.

Changes in serum pigment epithelium-derived factor levels after kidney transplantation in patients with end-stage renal disease

Background Pigment epithelium-derived factor (PEDF) is a serin protease inhibitor and a potent inhibitor of angiogenesis. Its serum level has significant associations with metabolic parameters. However, little is known about the association between PEDF levels and lipid parameters in renal transplanted (TX) patients. Therefore, our aim was to investigate the relationship between PEDF level and lipid parameters in TX patients. Methods Seventy TX patients (47 males, 23 females, mean age 51.7 ± 12.4 years) and 34 healthy controls were enrolled. We examined the serum creatinine, C-reactive protein, fasting glucose and lipid parameters right before, then 1 and 6 months after TX. High-density lipoprotein (HDL)-associated paraoxonase-1 (PON1) activities were measured spectrophotometrically. Lipoprotein subfractions were determined by Lipoprint. PEDF and oxidized low-density liporotein (oxLDL) levels were measured by ELISA. Results Before transplantation, patients had had a significantly higher PEDF level compared to control subjects (p < 0.001). One month after transplantation, their PEDF level decreased significantly reaching the healthy controls’ level, and this lower level was maintained during the 6 months follow-up period as well. The initial oxLDL level was significantly higher, while PON1 activities were significantly lower in the patient group compared to the control group. We found a significant positive correlation between PEDF and total cholesterol, low-density lipoprotein (LDL)-cholesterol, triglyceride, oxLDL and small HDL subfraction; while negative correlations were found between PEDF and mean LDL size and large HDL subfraction during the entire follow-up period. Conclusion PEDF may play an important role in the increased oxidative stress and enhanced atherogenesis in renal transplant patients.

Racial and Socioeconomic Disparities in Pediatric Heart Transplant Outcomes in the Era of Anti-Thymocyte Globulin Induction

<h3>Purpose</h3> A recent multicenter pediatric study using antithymocyte globulin (ATG) induction found a reduced risk of first yr rejection in Black heart transplant (tx) recipients. We investigated this finding in the broader field and studied the effects of race and socioeconomic disparity on outcomes in ATG-induced children. <h3>Methods</h3> Using the Pediatric Heart Transplant Society registry, we compared outcomes in Black and White children 1-17 yrs old who underwent heart tx with ATG induction between 2000-2020. The primary outcomes of treated rejection, rejection with hemodynamic compromise (HC), and graft loss (death or re-transplant) were studied over 1- and 10-yr time intervals as well as late outcomes conditional on 1-yr survival<i>.</i> We explored the association of these outcomes with race and socioeconomic disparity, assessed using neighborhood deprivation index [NDI] score at 1-yr post-tx (high NDI score implies more socioeconomic disadvantage). <h3>Results</h3> The study cohort included 1719 ATG-induced pediatric heart tx recipients (23% Black, 77% White). There was no racial difference in incidence of first yr treated rejection (Black 24.5%, White 28.1%, p = 0.2). During the 10 yr follow up, the risk of treated rejection was similar between Black and White recipients; however, Black recipients were at higher risk of HC rejection (p = 0.009) and graft loss (p = 0.02, log rank test). Black recipients had a higher mean NDI score (0.43 vs 0.36, p < 0.001). A higher risk of graft loss was associated with high NDI score in both White and Black recipients (p < 0.001, Fig). In a multivariable Cox model, both high NDI score (HR 2.03, 95% CI 1.38-2.98) and Black race (HR 1.99, 95% CI 1.36-2.93) were associated with graft loss. <h3>Conclusion</h3> Black race and socioeconomic disadvantage remain associated with HC rejection and graft loss after the first post-transplant year in pediatric heart tx patients with ATG induction. These disparities represent important opportunities to improve long term tx outcomes in children.

Comparative Analyses of Donor-Recipient Racial and Ethnic Disparities in Cardiothoracic Transplantation: A Study of the UNOS/OPTN Database

<h3>Purpose</h3> Racial disparities are well-described in organ transplantation (Tx). However, previous analyses have not compared the demographics of the donor pool relative to the recipient pool. <h3>Methods</h3> The annual composition of donor organ pool, recipient waitlist pool, and Tx patient pool, were characterized with respect to racial/ethnic background using UNOS/OPTN STAR database for both heart (HTx) and lung (LTx) transplantation, 1989-2017. Annual recipient/donor "ratios" (RDR) were calculated for the waitlist and Tx list. Annual RDR was defined as the percentage (%) of a racial/ethnic group present within either the waitlist or Tx list for a given year, divided by that year's % of corresponding racial/ethnic group. An RDR >1.0 indicates relative overrepresentation, whereas RDR <1.0 indicates relative underrepresentation. <h3>Results</h3> For HTx, whites accounted for a majority of recipients as well as donors for the entire study period. [RDR, relatively constant, ∼1.0]. Blacks accounted for a steadily increasing % of recipients and to a lesser extent donors, over time [RDR, increased over time, ∼1.0-1.4]. Hispanics accounted for a modest increase in % of recipients and to a greater extent donors, over time [RDR, relatively constant, <0.8]. For LTx, whites accounted for a majority of recipients as well as donors for the entire study period [RDR, consistently >1.0, ranging ∼1.1-1.4]. Blacks accounted for a modest increase in % of recipients and to a greater extent donors, over time [RDR, relatively constant, consistently <0.6]. Hispanics accounted for a modest increase in % of recipients and to greater extent donors, over time [RDR, relatively constant, consistently <0.7]. <h3>Conclusion</h3> Relative to the representation within the donor population, Hispanic patients comprise a much lower than expected % of HTx recipients. Both Blacks and Hispanics are substantially underrepresented with respect to receiving LTx. These disparities may have an impact on organ allocation policies.

Quality of Life, Depression, and Anxiety in Patients Undergoing Renal Replacement Therapies in Saudi Arabia

Despite improvements in renal replacement therapy (RRT) for end-stage renal disease (ESRD), it continues to have serious negative impacts on quality of life (QOL) and emotional status. This study determines the association between demographic characteristics and the negative emotional states of depression, anxiety, and stress in Saudi Arabia. A comparative cross-sectional study was conducted in the Eastern Region of Saudi Arabia. Convenience sampling was used to recruit participants comprising hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (Tx) patients. They completed the Short Form-36 Survey and the Depression, Anxiety, Stress Scale (DASS). The physical component summary (PCS) score was similar for HD (41.7) and PD (41.5), but higher among Tx (45.2). The mental component summary (MCS) score was similar between HD (48.0) and Tx (48.8), but lower in PD (42.3). The majority of patients in all groups had normal levels of depression, anxiety, and stress. Overall, the study found that PCS was higher among Tx patients compared to HD and PD, while MCS was higher among HD and Tx patients than PD patients. Most patients' levels of depression, anxiety, and stress were within the normal range. Those findings will provide policymakers and health managers with the significant factors which can affect the QOL of dialysis and Tx patients.

Towards Personalized Musculoskeletal Interventional Oncology: Enhanced Image-Guided Biopsies and Interventions

Studies comparing endocrine-specific outcomes following parathyroidectomy (PTx) versus concurrent parathyroidectomy and thyroidectomy (PTx + Tx) are few.10,019 patients were selected from the Collaborative Endocrine Surgery Quality Improvement Program (2014–2019). Baseline characteristics and short-term (≤30 days) outcomes for PTx + Tx vs PTx patients were compared using bivariate and multivariable methods.PTx + Tx patients were more likely to experience clinical hypoparathyroidism (6.7% vs 0.5%, p < 0.001), recurrent laryngeal nerve transection, (0.4% vs 0.1%, p = 0.002) and hematoma requiring evacuation (1.0% vs 0.2%, p < 0.001). Readmissions and ED visits for hypocalcemia were more frequent after PTx + Tx vs PTx. Concurrent surgery was associated with an 8-fold increase in risk of short-term complications (Odds Ratio (OR): 8.0, 95% Confidence Interval (CI): 5.7–11.1, p < 0.001).Patients undergoing PTx + Tx have increased rates of postoperative complications, ED visits, and readmissions compared to patients undergoing parathyroidectomy alone. These findings could help guide surgeon-patient discussions on the risks of concurrent surgery.

Outcomes of concurrent parathyroidectomy and thyroidectomy among CESQIP surgeons

BackgroundStudies comparing endocrine-specific outcomes following parathyroidectomy (PTx) versus concurrent parathyroidectomy and thyroidectomy (PTx + Tx) are few. Methods10,019 patients were selected from the Collaborative Endocrine Surgery Quality Improvement Program (2014–2019). Baseline characteristics and short-term (≤30 days) outcomes for PTx + Tx vs PTx patients were compared using bivariate and multivariable methods. ResultsPTx + Tx patients were more likely to experience clinical hypoparathyroidism (6.7% vs 0.5%, p < 0.001), recurrent laryngeal nerve transection, (0.4% vs 0.1%, p = 0.002) and hematoma requiring evacuation (1.0% vs 0.2%, p < 0.001). Readmissions and ED visits for hypocalcemia were more frequent after PTx + Tx vs PTx. Concurrent surgery was associated with an 8-fold increase in risk of short-term complications (Odds Ratio (OR): 8.0, 95% Confidence Interval (CI): 5.7–11.1, p < 0.001). ConclusionsPatients undergoing PTx + Tx have increased rates of postoperative complications, ED visits, and readmissions compared to patients undergoing parathyroidectomy alone. These findings could help guide surgeon-patient discussions on the risks of concurrent surgery.

Robust and Persistent B- and T-Cell Responses after COVID-19 in Immunocompetent and Solid Organ Transplant Recipient Patients.

The development and persistence of SARS-CoV-2-specific immune response in immunocompetent (IC) and immunocompromised patients is crucial for long-term protection. Immune response to SARS-CoV-2 infection was analysed in 57 IC and 15 solid organ transplanted (TX) patients. Antibody responses were determined by ELISA and neutralization assay. T-cell response was determined by stimulation with peptide pools of the Spike, Envelope, Membrane, and Nucleocapsid proteins with a 20-h Activation Induced Marker (AIM) and 7-day lymphoproliferative assays. Antibody response was detected at similar levels in IC and TX patients. Anti-Spike IgG, IgA and neutralizing antibodies persisted for at least one year, while anti-Nucleocapsid IgG declined earlier. Patients with pneumonia developed higher antibody levels than patients with mild symptoms. Similarly, both rapid and proliferative T-cell responses were detected within the first two months after infection at comparable levels in IC and TX patients, and were higher in patients with pneumonia. T-cell response persisted for at least one year in both IC and TX patients. Spike, Membrane, and Nucleocapsid proteins elicited the major CD4+ and CD8+ T-cell responses, whereas the T-cell response to Envelope protein was negligible. After SARS-CoV-2 infection, antibody and T-cell responses develop rapidly and persist over time in both immunocompetent and transplanted patients.

Prevalence, progression and implications of breast artery calcification in patients with chronic kidney disease.

ABSTRACTBreast arterial calcification (BAC) is increasingly recognized as a specific marker of medial calcification. The present retrospective observational cohort study aimed to define the prevalence, progression rate, risk factors and clinical implications of BAC in chronic kidney disease (CKD) patients across stages of disease. The presence and extent of BAC were determined on mammograms in 310 females (58.7 ± 10.8 years, Caucasian) with CKD across various stages of disease [CKD G2–5D n = 132; transplant (Tx) recipients n = 178]. In a subset of 88 patients, repeat mammography was performed, allowing us to calculate the annualized BAC rate. Overall, BAC was observed in 34.7% of the patients. BAC prevalence (P = 0.02) and BAC score (P = 0.05) increased along the progression of CKD. In the overall cohort, patients with BAC were characterized by older age, more cardiovascular disease, more inflammation, higher pulse pressure and borderline higher prevalence of diabetes and were more often treated with a vitamin K antagonist (VKA). The BAC progression rate was significantly lower in Tx patients as compared with CKD G5D. Progressors were characterized by more inflammation, worse kidney function, higher BAC score and higher serum phosphate level (Tx only) at baseline and were more often treated with a VKA. Major adverse cardiovascular event-free survival was significantly worse in Tx patients with BAC. In conclusion, BAC is common among CKD patients, progresses at a slower pace in Tx patients as compared with CKD 5D and associates with dismal cardiovascular outcomes. BAC score, kidney function, serum phosphate at baseline and VKA usage seem to be important determinants of progression.

The Magnitude and Functionality of SARS-CoV-2 Reactive Cellular and Humoral Immunity in Transplant Population Is Similar to the General Population Despite Immunosuppression.

The ability of transplant (Tx) patients to generate a protective antiviral response under immunosuppression is pivotal in COVID-19 infection. However, analysis of immunity against SARS-CoV-2 is currently lacking. Here, we analyzed T cell immunity directed against SARS-CoV-2 spike-, membrane-, and nucleocapsid-protein by flow cytometry and spike-specific neutralizing antibodies in 10 Tx in comparison to 26 nonimmunosuppressed (non-Tx) COVID-19 patients. Tx patients (7 renal, 1 lung, and 2 combined pancreas-kidney Txs) were recruited in this study during the acute phase of COVID-19 with a median time after SARS-CoV-2-positivity of 3 and 4 d for non-Tx and Tx patients, respectively. Despite immunosuppression, we detected antiviral CD4+ T cell-response in 90% of Tx patients. SARS-CoV-2-reactive CD4+ T cells produced multiple proinflammatory cytokines, indicating their potential protective capacity. Neutralizing antibody titers did not differ between groups. SARS-CoV-2-reactive CD8+ T cells targeting membrane- and spike-protein were lower in Tx patients, albeit without statistical significance. However, frequencies of anti-nucleocapsid-protein-reactive, and anti-SARS-CoV-2 polyfunctional CD8+ T cells, were similar between patient cohorts. Tx patients showed features of a prematurely aged adaptive immune system, but equal frequencies of SARS-CoV-2-reactive memory T cells. In conclusion, a polyfunctional T cell immunity directed against SARS-CoV-2 proteins as well as neutralizing antibodies can be generated in Tx patients despite immunosuppression. In comparison to nonimmunosuppressed patients, no differences in humoral and cellular antiviral-immunity were found. Our data presenting the ability to generate SARS-CoV-2-specific immunity in immunosuppressed patients have implications for the handling of SARS-CoV-2-infected Tx patients and raise hopes for effective vaccination in this cohort.