Underwent Kidney Transplantation Research Articles

Onconephrology: The Significance of Renal Function for the Development, Diagnosis, and Treatment of Cancer.

Modern treatment strategies have markedly improved the chances of survival for patients with cancer. As the population ages, cancer is becoming more common, as is chronic kidney disease (CKD). CKD increases the risk of cancer; conversely, cancer treatments can cause CKD. This review is based on publications retrieved by a selective literature search concerning the epidemiology and comorbidities of cancer and kidney diseases, the renal side effects of new anticancer drugs, and the need to consider renal function in cancer treatment. The prevalence of severe CKD in Germany is 2.3%. Persons who have CKD, are on dialysis, or have undergone kidney transplantation are 1.2 to 3.5 times more likely to develop cancer than the general population. For patients who have CKD or are dialysis-dependent, the doses of approximately 67% of anticancer drugs need to be adjusted on the basis of their glomerular filtration rate and the renally excreted fraction of the drug. The optimal efficacy of therapeutic drugs, as well as of those used for diagnostic purposes, and the minimization of side effects, depend critically on adapted dosing and on proper timing of administration before or after dialysis. Modern anticancer drugs can also cause acute kidney damage (incidence with checkpoint inhibitors: 2-16%). Patients who have CKD, are on dialysis, or have undergone kidney transplantation make up a considerable fraction of persons being treated for cancer, and they need interdisciplinary treatment.

Predictors of Post-operative ABG Changes to Pre-operative Levels in Kidney Transplant Patients, a Cross-Sectional Study

Background: Kidney transplant is the treatment of choice for chronic renal failure (CRF), significantly improving patient outcomes. Fluid administration during surgery can lead to the accumulation of acid ions and electrolytes, inducing pH changes from the pre-operative to post-operative period, which may compromise transplant success. The impact of acid-base balance changes on transplant outcomes is crucial, yet research on predictors and arterial blood gas (ABG) changes post-kidney transplant is limited. Understanding ABG changes can enhance perioperative management, early detection of complications, and long-term graft function, thereby optimizing patient care and increasing transplant success rates. Objectives: To assess ABG changes before and after kidney transplant and identify predictors of post-operative acidosis in patients with renal failure through cross-sectional studies. Methods: In a retrospective cohort study, we included 97 patients who had undergone kidney transplant. During surgery, patients received crystalloid fluids, with 49 receiving only normal saline and 48 receiving only Ringer's lactate. Data collection involved the insertion of an arterial line after anesthesia induction, and the first ABG sample was obtained as a pre-operative measure. A post-operative measure was taken at the end of the surgery. Ethical considerations were followed throughout the study. Statistical analysis included paired t-test or Wilcoxon signed-rank test to compare pre- and post-operative ABG measures, with a significance level set at a P-value less than 0.05. Results: Total of 97 patients, which 65 (69.4%) were male and 32 (30.6%) were female and mean age was 38.6 ± 12.2. Variables significantly associated with post-op acidosis were fluid administered (OR: 3.25, 95% CI: 1.45 - 4.58), post-op central venous pressure (CVP) (OR: 2.31, 95% CI: 1.23 - 2.62, p < 0.05), post-op base excess (BE) (OR: 2.16, 95% CI: 1.50 - 2.95, P < 0.05). HCO₃ (P = 0.010), BE (P = 0.002), pH (P = 0.023) were significantly lower in the normal saline group compared to the Ringer's group. Post-op pH and BE was also associated with increased post-op CVP. Post-op acidosis and post-op CVP were significantly associated with post-op BE. Conclusions: Post-operative ABG changes, including decreases in pH and HCO3, are key indicators of transplant outcomes, reflecting graft function and patient stability. These findings highlight the critical need for prompt management of ABG abnormalities to optimize transplant success and minimize complications, making vigilant monitoring a vital part of post-transplant care.

Renal transplantation in older adults: retrospective cohort study to examine the impact of the new 2019 kidney offering scheme on older adult transplant recipients.

In 2019, a new kidney offering scheme was launched in the United Kingdom, aiming to better match estimated patient survival and graft life expectancy. The scheme's impact on older patients undergoing kidney transplantation (KT) is unknown. This study aims to compare the outcomes of older adult KT recipients before and after introduction of the 2019 scheme. A retrospective observational cohort study of older adults who underwent KT was undertaken. Group 1 were transplanted between 1 September 2017 and 31 August 2019 (2006 allocation scheme) and group 2 between 1 September 2019 and 31 August 2021 (2019 offering scheme). An older adult was any person ≥60 years old at the time of KT. Univariable binary logistic regression analysis was performed to determine odds ratios (OR) and 95% confidence intervals (CI). There were 107 older adult deceased donor KT recipients, 62 from group 1 and 45 from group 2. Median age at transplantation was 68 (interquartile range [IQR] 62-71) and 67 (IQR 64-73) years, respectively. Univariable analysis showed that re-intervention (OR 6.486, 95% CI 1.306-32.216, p = 0.022) and critical care admission (OR 5.619, 95% CI 1.448-21.812, p = 0.013) were significantly more likely in group 2. Group 2 recipients were significantly more likely to have a level 4 human leucocyte antigen (HLA) mismatch (OR 4.667, 95% CI 1.640-13.275, p = 0.004) and to have undergone previous KT (OR 4.691, 95% CI 1.385-15.893, p = 0.013). The introduction of the 2019 offering scheme was associated with re-intervention and critical care admission for older KT recipients. We also observed less-favourable HLA matches but more KT in difficult-to-match groups.

Robotic Repair of Ureteral Strictures After Kidney Transplantation

Background. Approximately 5% to 10% of patients who undergo kidney transplantation develop ureteral stricture, which can be treated endoscopically or by open surgery, which is more effective but complications are common and potentially severe. Robotic surgery has begun to emerge as an alternative in reconstructive procedures. However, few studies have evaluated the role of robotic surgery in this clinical setting. The aim of this study was to assess the efficacy and safety of robotic surgery in treating ureteral stricture after kidney transplantation. Methods. Single-center study of patients (n = 27), who developed ureteral stricture following kidney transplantation. All patients were treated from 2018 to 2023. We describe the patients’ baseline characteristics and clinical and surgical features. We determined the success rate as a measure of efficacy and complications to measure safety. Results. We perform 15 pyeloureterostomies to the native ureter and 12 ureteroneocystostomies. At a median follow-up of 15 mo, the success rate was 92.6%. Fourteen patients (52%) developed treatment-related complications, mainly grade II (Clavien-Dindo classification), except for one grade IVb complication. The median length of hospital stay was 3 d [interquartile range (2–6)]. Conclusions. These data show that robotic surgery is a safe and effective procedure for the treatment of ureteral strictures after kidney transplantation. The success rate was high with a low complication rate. To our knowledge, this is the largest series to date to evaluate robotic surgery in this clinical setting.

9391 Clinical Accuracy Of Continuous Glucose Monitoring In Post-kidney Transplant Patients With Type 2 Diabetes

Abstract Disclosure: Q. Aziz: None. K. Batra: None. S. Fatima: None. J. Splinter: None. A.L. Champion: None. A.M. Kumar: None. K.E. Izuora: Research Investigator; Self; Novo Nordisk. Background: Continuous glucose monitoring (CGM) devices provide real time blood glucose data to guide therapy in patients with diabetes mellitus. Diabetic nephropathy is a major complication of diabetes which can eventually lead to End Stage Renal Disease (ESRD). Kidney transplant is a treatment option for ESRD and patients who undergo kidney transplant are exposed to anti-rejection therapy, including high-dose steroids, resulting in significant fluctuations in blood glucose. Having a reliable system for monitoring blood glucose continuously, such as a CGM, can provide valuable information to guide optimal diabetes management. Objective This study aims to compare the clinical accuracy of the CGM data with the Point of Care Testing (POCT) glucose values as a reference among post kidney transplant patients with Type 2 diabetes mellitus (T2DM). Methodology This study was conducted at an academic medical center from September 2023 to January 2024, enrolling subjects ≥ 18 years, diagnosed with T2DM , admitted for kidney transplant. Following informed consent, a blinded CGM (Freestyle Libre Pro®) was applied. We collected all POCT and serum glucose values and downloaded corresponding CGM glucose data. Using matched pairs between CGM and POCT glucose values, bias and absolute relative differences (ARD) were calculated. Based on the ARD, the Clarke error grid (CEG) analysis was conducted to quantify the clinical accuracy of CGM and POCT by assigning glucose data points into 5 zones A, B, C, D, and E. Summary statistics for numeric variables included mean and standard deviation, whereas categorical variables were described as counts and proportions. All analyses were performed using SAS, 9.4 version. Results: A total of 22 subjects were analyzed after excluding one patient due to CGM malfunction. Subjects were 58±9.69 years old, and 82% were males. The mean body mass index was 30±6.41 kg/m2 and mean HbA1c was 6.7 ± 1.07%, at baseline. The mean duration of diabetes and ESRD were 19±10.6 years and 3±2.27 years respectively. Average CGM wear time was 76±24.5 hours. The CEG comparing CGM values with POCT values showed 83.79% values in zone A, 15.29% in zone B (combined =99.08%) with the Mean Absolute Relative Difference (MARD) of 13.24%. The CEG comparing CGM values with serum glucose showed 83.1% values in zone A, 16.9% in zone B (combined =100%) with the MARD of 13.10%. Conclusion: Our results indicate that CGM values are comparable to the POCT and serum glucose values in post kidney transplant patients with T2DM receiving high dose steroids. Therefore, use of CGMs should be considered as a useful tool, providing timely information to guide prompt interventions and improve outcomes in this patient population. Presentation: 6/3/2024

The Influence of Initial Immunosuppression on the Kinetics of Humoral Response after SARS-CoV-2 Vaccination in Patients Undergoing Kidney Transplantation.

Background: The effect of initial immunosuppressive therapy on the kinetics of the SARS-CoV-2 vaccine-induced humoral response is unknown. Here, we compared the kinetics of SARS-CoV-2 vaccine-induced humoral response in chronic kidney disease patients undergoing kidney transplantation (KTRs) and compared to patients remaining on dialysis during the Omicron circulation. Methods: This prospective, non-randomized, real-world study included 113 KTRs and 108 patients on dialysis. Those with previous COVID-19 or negative IgG at screening were excluded. Blood samples were collected to assess SARS-CoV-2 IgG titers and neutralizing antibodies at months (M) 1, 3, 6, and 12. Results: Seroreversion occurred in one KTR and in three patients on dialysis. KTRs had lower IgG titers over time (M1: 10,809.3 ± 12,621.7 vs. 15,267.8 ± 16,096.2 AU/mL; M3: 12,215.5 ± 12,885.8 vs. 15,016.2 ± 15,346.1 AU/mL; M6: 12,540.4 ± 13,010.7 vs. 18,503.5 ± 14,581.0 AU/mL; p = 0.005), but neutralizing antibodies were similar (M1: 94.0 vs. 90.3%; M3: 92.9 vs. 90.5%; M6: 99.0 vs. 95.5%; M12: 98.9 vs. 97.5%; p = 0.812). During follow-up, KTRs received more vaccines (141 vs. 73; p < 0.001) and contracted more COVID-19 (32.7% vs. 14.8%; p = 0.002). Conclusions: Compared to patients on dialysis, KTRs had lower SARS-CoV-2 IgG titers and similar rates of seroreversion and neutralizing antibodies over time. Although KTRs received more boosters, they had a higher incidence of COVID-19.

Pediatric Kidney Transplantation in an Under-resourced Country: A Single-Center Experience.

Kidney transplant is the optimal method for managing children with end-stage kidney disease. This study aimed to present the experience and results of the pediatric kidney transplant program at our center. A single-center observational study was conducted at Children's University Hospital in Damascus, Syria. We reviewed the medical records of all kidney transplants performed between April 2018 and December 2022. All patients were under 14 years old when they underwent kidney transplant. All donors were living, as an effective deceased donor program is currently not an option in Syria. From April 2018 to December 2022, 33 pediatric kidney transplants were performed at our center. Most recipients were boys (n = 24; 72.7%), and 9 were girls (27.3%). Median age was 10 years (range, 4.5-14 y). The most frequent underlying diseases for kidney failure were renal dysplasia-hypoplasia (42.5%), reflux nephropathy (18.2%), and neurogenic bladder with posterior urethral valves (12%). In 10 patients, kidney transplant was performed preemptively (30.3%). Initial graft function was observed in all grafts (100%). During observation time (5 years), 28 patients (85%) retained adequate graft function. The 1-year graft and patient survival rates were 91%. Syria is still suffering from the consequences of the war, affecting organ transplantation in many ways. The good 1-year graft and patient survival in our center was encouraging. However, we admit that the number of patients was small and the follow-up duration was also not long enough; future research is needed to improve long-term outcomes.

Features of Kidney Transplant in Pediatric Recipients: Experience of a Single Center.

Congenital abnormalities of the kidneys and the urinary tract are common reasons for endstage renal disease in children. We studied the features of postoperative management and possible complications after pediatric kidney transplant. We retrospectively analyzed 29 children aged from 9 to 18 years who underwent kidney transplants from April 2018 to December 2013 (17 boys and 12 girls). All recipients were on hemodialysis for 3 to 18 months (mean of 10.17 ± 4.52 mo). Etiology of end-stage kidney disease included chronic glomerulonephritis (n = 12 [41.4%]), urolithiasis (n = 3 [10.3%]), and congenital abnormalities of the kidneys and the urinary tract (n =14 [48.3%]), including urinary reflux (n = 5 [17.2%]). Donors were parents in 16 cases, siblings in 5, uncles in 5, and aunts in 3 cases. HLA mismatching ranged from 2 to 5 (mean of 2.93 ± 1.39). Three patients had intraoperative nephrectomy, and 2 patients had hydronephrosis and urethroplasty with megaureter to prevent urinary tract infection. Six patients (20.6%) had early postoperative complications: 2 with delayed graft function, 1 with venous anastomosis thrombosis, 2 with hematoma around the graft, and 1 with lymphocele. Venous anastomosis thrombosis was eliminated by open thrombectomy, with graft function restored on postoperative day 17. The lymphocele was eliminated by puncture and drainage. Hematomas did not require surgical correction and blood transfusion. Ten patients (34.4%) had late postoperative complications: 1 with stricture of vesicoureteral anastomosis, 3 with vesicoureteral reflux, and 5 with urinary tract infection (3 with bacterial culture). Stricture of vesicoureteral anastomosis was successfully resolved by open surgery. Vesicoureteral reflux was eliminated with hydrogel. One patient developed chronic kidney rejection within 6 months because of noncompliance with posttransplant regimen and required transplantectomy. A major factor in reducing frequency of infections after surgery is the recipient's nephrectomy.

Advanced Prediction of Glomerular Filtration Rate After Kidney Transplantation Using Gradient Boosting Techniques.

Clinicians often face uncertainty when interpreting whether a decline in estimated glomerular filtration rate is within the patient's expected range of fluctuation or if the decline signals a substantial deviation. Thus, accurate predictions of glomerular filtration rate can be an early warning system, prompting timely interventions, such as biopsies to preclude early graft rejection and adjustments in immunosuppression. Traditional models, encompassing linear and conventional methods, typically struggle with variabilities and complexities in posttransplant data. We evaluated the efficacy of a gradient boosting model in predicting posttransplant glomerular filtration rate, to potentially enhance accuracy over traditional prediction approaches. Our patient dataset included 68 pediatric patients aged 1 to 18 years who underwent kidney transplant between 2017 and 2023 at Baskent University Hospital (Ankara, Turkey). The dataset comprised 2285 glomerular filtration rate measurements, along with patient demographics and transplant-related data. For our model, we included "days to transplant" (glomerular filtration rate values pretransplant), "days from transplant" (glomerular filtration rate values up to 7 days posttransplant), patient age, sex, and donor types. We divided the dataset into a training set (70%) and a test set (30%). To evaluate model performance, we used mean absolute error and root mean squared error, with a focus on the accuracy of glomerular filtration rate predictions at various posttransplant stages. In the training set, the gradient boosting model demonstrated a significant improvement in prediction accuracy, achieving an mean absolute error of ~5.64 mL/min/1.73 m². Our model underscored the promise of advanced machine learning techniques in refining prediction of glomerular filtration rate after kidney transplant. With its augmented precision, the model can support clinicians in making informed decisions regarding early biopsies and interventions, thus highlighting the vital role of sophisticated analytical methods in medical prognosis and the monitoring of pediatric patient care.

Prognostic value of dobutamine stress echocardiography for the long-term outcomes in kidney transplant candidates.

Cardiovascular disease is a primary cause of morbidity and mortality in kidney transplant (KT) candidates. Dobutamine stress echocardiography (DSE) is an effective noninvasive modality for evaluating coronary artery disease with high accuracy. However, long-term data in KT candidates are still lacking. This study aims to assess the prognostic value of DSE in predicting long-term outcomes in KT candidates. This study retrospectively included consecutive KT candidates who underwent preoperative DSE between 2007 and 2017 at Siriraj Hospital, Bangkok, Thailand. Normal DSE was characterized by the absence of wall motion abnormalities both at rest and during stress. The primary endpoint was all-cause mortality. Univariable and multivariable analyses were conducted to determine predictors of all-cause mortality, with a P value of <0.05 considered statistically significant. Among 269 patients (mean age 51 years, 58% male), 34 (12.6%) had abnormal DSE results, and 63 (23%) underwent kidney transplantation after DSE. During a median follow-up period of 7.6 (4.5, 10.1) years, 129 (48%) patients died. Patients with abnormal DSE had a significantly higher mortality rate than those with normal DSE (73.5% vs. 44.2%, P=0.003). Univariable analysis demonstrated that male gender [hazard ratio (HR) 1.50, 95% confidence interval (CI): 1.04-2.16, P=0.03], resting systolic blood pressure (HR 1.006, 95% CI: 1.00-1.01, P=0.04), abnormal DSE (HR 1.95, 95% CI: 1.25-3.05, P=0.003), higher delta wall motion score index (HR 2.57, 95% CI: 1.24-5.35, P=0.01), abnormal stress left ventricular end-systolic volume (HR 2.05, 95% CI: 1.11-3.82, P=0.02), and post-KT status (HR 0.48, 95% CI: 0.30-0.79, P=0.004) were associated with mortality. In the multivariable analysis, male gender and abnormal DSE were independent predictors of mortality [adjusted HR (aHR) 1.65, 95% CI: 1.06-2.20, P=0.02 and aHR 1.88, 95% CI: 1.20-2.93, P=0.006, respectively], while post-KT status emerged as an independent predictor of better outcomes (aHR 0.47, 95% CI: 0.29-0.77, P=0.003). In KT candidates, preoperative assessment with DSE provides valuable prognostic information for long-term outcomes, particularly regarding all-cause mortality.

Cardiac Evaluation in Children With Chronic Renal Failure and Effect of Kidney Transplant.

Cardiovascular diseases are an important cause of mortality and morbidity in children with chronic renal failure. Cardiac evaluation and followup are crucial for these patients before and after renal transplant. Echocardiography is a noninvasive imaging modality that allows for the assessment of cardiac structure and function. We retrospectively investigated pretransplant and posttransplant echocardiography findings for 55 pediatric patients who had underwent kidney transplant. We recorded patient characteristics before and after transplant, including age, sex, follow-up period, etiology of renal failure, left ventricular systolic and diastolic diameters and the associated z scores, left ventricular mass indexes and z scores, ejection fraction and fractional shortening, aortic valve and atrioventricular valve insufficiencies, presence of pulmonary hypertension, and pericardial effusion (if any) in echocardiography. All participants underwent echocardiography at baseline and after 6 months following the transplant procedure. Posttransplant echocardiography evaluations showed that the z scores of left ventricular systolic and diastolic diameters decreased significantly, mitral regurgitation decreased, and left ventricular systolic functions and left ventricular mass index increased. Our study revealed that kidney transplant has a beneficial effect on the cardiovascular status of patients with end-stage renal disease, as shown by improvements in both structural and functional echocardiographic features. Cardiac functions must be monitored regularly before and after transplant. Transplantation is the optimal treatment option for preservation and improvement of cardiovascular functions.

Viral Infections in Pediatric Kidney Transplant Recipients: Effects on Graft Function, Risk Factors, and Patient Outcomes.

Viral infections are the leading cause of posttransplant morbidity and mortality. We aimed to determine the effect on graft function, the risk factors, the frequency, and types of viral infections and to evaluate the effect of viral infections on kidney and patient outcomes in pediatric kidney transplant patients. Records of children undergoing kidney transplant in our center during the period February 1, 2010, to December 31, 2023, were retrospectively evaluated. Demographic and laboratory data, kidney failure etiologies, donor types, immunosuppression treatments, acute rejection episodes, accompanying viral infections, glomerular filtration rate, and graft loss rate were analyzed. Seventy-nine pediatric kidney transplant recipients were included in the study. The number of patients who experienced viral infections was 18 (23%). In total, 25 infection episodes were identified, with 6 (24%) attributed to cytomegalovirus infection, 8 (32%) to BK virus infection, 6 (24%) to varicella zoster virus infection (4 cases of shingles, 2 cases of chickenpox), 4 (16%) to parvovirus B19 infection, and 2 (8%) to COVID-19. Of 25 infection episodes, rejection episodes were observed in 11 cases (44%), and infections manifested after rejection in 8 cases (32%). Viral infections occurred an average of 15 months after rejection episodes. For 15 (60%) of the 25 infection episodes, the glomerular filtration rate was observed to be <60 mL/min/1.73 m2 during viral infection. Two patients succumbed to viral infections; 1 was due to COVID-19, and 1 was due to coinfection with parvovirus B19 and cytomegalovirus. Our data emphasized the significant effect of viral infections on pediatric kidney transplant recipients. Early diagnosis and treatment in kidney transplant recipients are important, and clinicians should be alert.

Intracranial Aneurysms Are Detected in 11.2% of Polycystic Patients Undergoing Kidney Transplant Assessment, Particularly in Tall and Hypertensive Patients

Intracranial Aneurysms Are Detected in 11.2% of Polycystic Patients Undergoing Kidney Transplant Assessment, Particularly in Tall and Hypertensive Patients

The Long-Term Effect of Kidney Transplantation on the Serum Fatty Acid Profile

Background: Epidemiologic evidence has demonstrated the prevalence of metabolic disorders and increased cardiovascular risk related to lipid metabolism disorders in kidney transplant recipients. Therefore, it is of great importance to understand lipid alterations and to look for ways to reduce cardiovascular risk in this patient group. Methods: Our study included 25 patients with chronic kidney disease undergoing kidney transplantation (KTx). Three blood samples were taken from each patient: before KTx, 3 months after KTx and 6–12 months after KTx. A series of biochemical blood tests and a detailed analysis of the serum fatty acid profile were performed. Results: In our previous study, the effects of kidney transplantation on serum fatty acid (FA) profile 3 months after the procedure were investigated. The current study shows the longer-term (6–12 months) effects of the procedure on the serum FA profile. We found that although n-3 polyunsaturated FA levels started to decrease 3 months after surgery, they normalized over a longer period of time (6–12 months). Furthermore, we observed a strong decrease in ultra-long-chain FAs and an increase in odd-chain FAs over a longer time after kidney transplantation. All of the above FAs may have an important impact on human health, including inflammation, cardiovascular risk or cancer risk. Conclusions: The changes in serum FA profiles after kidney transplantation are a dynamic process and that more detailed studies could provide an accurate indication for supplementation with some FAs or diet modification.

Pregnancy outcomes in patients with kidney transplant-A retrospective snapshot

Pregnancy in renal transplantation is a sensitive issue since fertility improves shortly after transplantation and the prevalence of pregnancy-related complications in these patients are more in comparison to non-transplanted matched cohorts. Our study aimed at assessing the outcomes of pregnancy in our transplant patients. Methods: This study was designed as a questionnaire based retrospective cross-sectional study wherein the authors contacted all their patients who underwent kidney transplantation under our care and now being followed with us or 4 other hospitals. Results: Total of 20 females conceived unplanned, out of 130 females of child bearing age who underwent kidney transplant. single pregnancy ended up in elective abortion at 4th month after transplant, rest of the pregnancies were successful and uneventful. Conclusion: Fertility related issues should be included in the counselling of kidney transplant females for planned pregnancy. Successful outcome is quite possible. There is a critical need for comprehensive support systems, including counseling, education, and resources, to empower female kidney transplant recipients in their reproductive journeys and to address the gaps in understanding family planning and contraceptive methods in the post-transplant period.

Outcome of Arteriovenous Fistula Following Renal Transplantation

Background: Renal transplantation is the preferred treatment for end-stage renal disease (ESRD), but the management of arteriovenous fistulas (AVFs) post-transplant remains controversial due to complications like thrombosis.Objective: To determine the outcome of AVFs following renal transplantation, focusing on the incidence and timing of AVF thrombosis.Methods: This ambi-directional cohort study included 155 patients with ESRD who underwent kidney transplantation at the Sindh Institute of Urology and Transplantation, Karachi, in 2021. All included patients had a functional AVF at the time of transplantation. Data were collected from electronic health records, including demographic information, AVF characteristics, and incidence of thrombosis. AVF outcomes were monitored through follow-up assessments until September 2024. Statistical analysis was conducted using SPSS version 25, with significance set at p&lt;0.05.Results: Thrombosis occurred in 71 (45.8%) patients, most frequently within one week (14.8%), within four weeks (21.9%), and within one year (34.2%). Surgical ligation was required in 5 patients (3.22%). No significant associations were found between thrombosis and age, comorbidities, or AVF type (p&gt;0.05).Conclusion: AVF thrombosis is a frequent complication post-transplant, not significantly influenced by patient demographics or AVF type, highlighting the need for continued surveillance.

Factors influencing survival in sphingosine phosphate lyase insufficiency syndrome: a retrospective cross-sectional natural history study of 76 patients

BackgroundSphingosine-1-phosphate lyase insufficiency syndrome (SPLIS) is a recently recognized inborn error of metabolism associated with steroid-resistant nephrotic syndrome as well as adrenal insufficiency and immunological, neurological, and skin manifestations. SPLIS is caused by inactivating mutations in SGPL1, encoding the pyridoxal 5’phosphate-dependent enzyme sphingosine-1-phosphate lyase, which catalyzes the final step of sphingolipid metabolism. Some SPLIS patients have undergone kidney transplantation, and others have been treated with vitamin B6 supplementation. In addition, targeted therapies including gene therapy are in preclinical development. In anticipation of clinical trials, it will be essential to characterize the full spectrum and natural history of SPLIS. We performed a retrospective analysis of 76 patients in whom the diagnosis of SPLIS was established in a proband with at least one suggestive finding and biallelic SGPL1 variants identified by molecular genetic testing. The main objective of the study was to identify factors influencing survival in SPLIS subjects.ResultsOverall survival at last report was 50%. Major influences on survival included: (1) age and organ involvement at first presentation; (2) receiving a kidney transplant, and (3) SGPL1 genotype. Among 48 SPLIS patients with nephropathy who had not received a kidney transplant, two clinical subgroups were distinguished. Of children diagnosed with SPLIS nephropathy before age one (n = 30), less than 30% were alive 2 years after diagnosis, and 17% were living at last report. Among those diagnosed at or after age one (n = 18), ~ 70% were alive 2 years after diagnosis, and 72% were living at time of last report. SPLIS patients homozygous for the SPL R222Q variant survived longer compared to patients with other genotypes. Kidney transplantation significantly extended survival outcomes.ConclusionOur results demonstrate that SPLIS is a phenotypically heterogeneous condition. We find that patients diagnosed with SPLIS nephropathy in the first year of life and patients presenting with prenatal findings represent two high-risk subgroups, whereas patients harboring the R222Q SGPL1 variant fare better than the rest. Time to progression from onset of proteinuria to end stage kidney disease varies from less than one month to five years, and kidney transplantation may be lifesaving.

Risk Factors of Chronic Kidney Diseases: A Retrospective, Record based Study from a Tertiary Care Hospital in India

Abstract Background: There is a alarming rise of chronic kidney diseases (CKDs) prevalence globally, which is associated with significant morbidity and mortality. The burden of Chronic Kidney Diseases is rapidly rising in developing countries. The study aimed to assess the major risk factors of CKD in patients of a tertiary hospital. Materials and Methods: Hospital-based, retrospective study was conducted at a hospital, in Mumbai, among CKD patients. Medical records of 500 CKD patients were analysed. Results: The mean age of participants was 53.87 years. Majority of the patients had risk factors for CKD such as hypertension and diabetes. The mean serum creatinine was 4.04 mg/dL. Majority of the cases were in G4 and G5 stages of CKD and 201 patients had undergone kidney transplant. Association between age and transplant was significant. Furthermore, association between developing New Onset Diabetes Mellitus After Transplantation (NODAT) was statistically significant. Conclusion: Major risk factors for CKD were hypertension, diabetes and advancing age. Most of the cases of CKD were diagnosed late. There should be increased awareness about CKD among the population with special emphasis on cases of hypertension and diabetes.

Long-term outcomes in rapamycin on renal allograft function: a 30-year follow-up from a single-center experience

ObjectivesTo evaluate long-term renal graft prognosis and the role of rapamycin from a single-center in China over a 30-year follow-up.MethodsThis study enrolled a total of 654 patients who underwent kidney transplantation between 1989 and 2020. The basic characteristics of the included patients were collected. Graft survival was described and compared using Kaplan-Meier curves (K-M curves). Both continuous and categorical variables were included in a multivariate Cox proportional-hazards model. Patients were divided into rapamycin-based quadruple immunosuppression regimen group (rapa group, n = 41) and conventional tacrolimus-based triple immunosuppression regimen group (control group, n = 218). The indication biopsy results of the two groups were further reviewed to compare the incidence of rejection, acute rejection, and banff score.ResultsThe overall 5, 10, 15, 20-year graft survival rate of our center is 87.5%, 62.4%, 46.4% and 20.9%, respectively. The median survival time after surgery is 14 years. Multiple Cox regression analysis identified BMI (p = 0.035), dialysis type (p < 0.001), immunosuppressants (p < 0.01), urine albumen (p < 0.001), globulin (p = 0.041), and blood glucose (p = 0.002) as risk factors. The 20-year, 10-year and 5-year AUC is 0.78, 0.75 and 0.75. The combination of FK506 and rapamycin was further suggested by the model to effectively improve the graft prognosis (p < 0.01, HR = 0.763). The K-M curve showed that the long-term survival rate of renal grafts in the rapa group was significantly better than that in the conventional group (p < 0.001). In addition, indication biopsy records revealed a lower possibility of immune rejection in the rapa group than that in the conventional group (p < 0.001). Banff score indicated that rapa group had less vascular inflammation in the transplanted kidney.ConclusionsIn this study, a 30-year follow-up was performed in a single center, and a total graft 20-year survival rate of 20.9% was reported. The prognostic model and subgroup analysis suggested that FK506 combined with rapamycin could effectively improve the prognosis of renal transplantation, which could be explained by reduced acute rejection and less vascular inflammation.

Renal Manifestations of Chronic Hepatitis C: A Review.

Hepatitis C virus (HCV) has emerged as a major global health concern and, if left untreated, can lead to significant liver damage, including cirrhosis, decompensated liver disease, and hepatocellular carcinoma (HCC). Approximately 40% of patients with HCV infection experience extrahepatic manifestations, including renal involvement. HCV-related renal disease is of significant importance among patients with chronic kidney disease (CKD), leading to higher morbidity and mortality. The renal damage due to HCV infection primarily results from cryoglobulinemia and glomerulonephritis, with conditions such as membranoproliferative glomerulonephritis (MPGN) and membranous nephropathy (MN) being most prevalent. Despite advancements in treatment, including the use of directly acting antiviral agents (DAAs), renal complications remain a significant burden in untreated patients. HCV-positive patients on hemodialysis (HD) or those who have undergone kidney transplantation face increased mortality rates compared to their HCV-negative counterparts. Managing HCV infection before kidney transplantation is crucial to mitigate the risk of HCV-related renal complications. Conversely, kidney transplantation from HCV-infected donors is well established, as post-transplant treatment for HCV is safe and effective, potentially reducing mortality and morbidity for patients on transplant waiting lists. This review aims to provide a comprehensive analysis of the renal manifestations of HCV, emphasizing the importance of early diagnosis and treatment to improve patient outcomes.