Underwent Kidney Transplantation Research Articles

Parvovirus B19 infection after kidney transplantation: A single centre experience

BackgroundParvovirus B19 is an uncommon cause of anaemia in kidney transplant recipients (KTRs). The study aims to determine the incidence, clinical presentation, laboratory findings and outcome of parvovirus B19-related anaemia in KTR. MethodWe conducted a 12-year retrospective, single-centre study describing the clinical profile of KTRs with parvovirus B19-related anaemia. ResultAmongst the 714 patients who underwent kidney transplantation between January 2011 and January 2023, (cumulative follow-up: 1287 patient-years), six females and one male, developed parvovirus B19-related anaemia. The incidence proportion (risk) is 0.98% with an incidence rate of 5.43 cases per 1000 patient-year. The median duration from transplant to development of anaemia was 6 weeks (range: 4–40 weeks). The mean fall in haemoglobin was 2.88 ± 1.55 gm/dl; concomitant leukopenia and thrombocytopenia were observed in 57.1 and 28.6% of patients. Three patients responded to a reduction in immunosuppression, the four non-responders required the administration of low-dose intravenous immunoglobulin. The mean duration from initiation of therapy to a sustained rise in haemoglobin was 7.71 ± 2.62 weeks. None of the patients had a relapse of the infection. ConclusionsParvovirus B19 infection is an uncommon cause of post-transplant refractory anaemia. The key to successfully managing such patients includes a high index of suspicion, early diagnosis and reduction of immunosuppression with or without administration of intravenous immunoglobulin.

The Impact of Urinary Tract Infections in Kidney Transplant Recipients: A Six-Year Single-Center Experience.

Background Urinary tract infections (UTIs) are the most common infections following kidney transplantation. Risk factors for UTIs in kidney transplant recipients include female gender, age, pre-transplant urinary tract abnormalities, diabetes, and recurrent UTIs. Infections of the bladder or urethra are termed lower UTIs, while those involving the kidneys or ureters are called upper UTIs. Methods We retrospectively screened our hospital information system to identify all patients who underwent kidney transplantation in the surgery department at King Abdulaziz Medical Center in Riyadh. A total of 553 records were ultimately included in the final analysis. Results A total of 553 patients were ultimately included in the analysis. More than half of the patients were males (62.4%), and 31.1% were aged between 45 and 60 years. Of these, 230 patients had a UTI, representing 41.59% of the sample. The most commonly reported causes were hypertensive nephrosclerosis (43.4%) and diabetic nephropathy (28.8%). The most frequently isolated causative agents were Escherichiacoli (51.0%) and Klebsiella pneumoniae (21.8%). UTIs were significantly more prevalent among females, accounting for 73.6% of cases. Antibiotics were used in 86.5% of patients, with trimethoprim/sulfamethoxazole (65.8%) and ciprofloxacin (54.8%) being the most commonly prescribed. Conclusion About half of the patients in this study suffered from UTIs. E. coli and K. pneumoniae were the most commonly isolated organisms. Trimethoprim/sulfamethoxazole and ciprofloxacin were the most frequently prescribed antibiotics. A significant association was found between acquiring a UTI and being female (p < 0.001), as well as having pre-existing bladder dysfunction (p = 0.024).

89 Frailty in Renal Transplantation: Retrospective Cohort Study to Examine the Impact of the New 2019 Kidney Offering Scheme on Older Transplant Recipients

Abstract Background 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 impact of the scheme on older patients undergoing kidney transplantation (KT) is unknown. Aim This study aims to compare outcomes of elderly KT recipients before and after the introduction of the 2019 kidney offering scheme. Method A retrospective cohort study of two groups of elderly patients who underwent KT was undertaken. Group 1 included patients transplanted between 01/09/2017 and 31/08/2019 as part of the “2006 allocation scheme”. Group 2 included patients transplanted between 01/09/2019 and 31/08/2021 as part of the “2019 offering scheme”. An elderly patient was defined as any person over 60 years of age at the time of KT. Univariate binary logistic regression analysis was performed to determine odds ratios (OR) and 95% confidence intervals. Results There were 107 elderly deceased donor KT recipients; 62 from Group 1 and 45 from Group 2. The median age at transplantation was 68 years (62-71) and 67 years (64-73), respectively. Univariate analysis showed that level four HLA mismatch (OR 4.667 95%CI 1.640-13.275, p = 0.004) and a requirement for re-intervention (OR 6.496 95%CI 1.306-32.216, p = 0.022) were significantly more likely in the 2019 offering scheme. One year graft survival worsened on introduction of the 2019 offering scheme (85% vs 80%). Conclusions The introduction of the 2019 offering scheme has led to less favourable HLA matches, increased need for reintervention, and a lower one-year graft survival in elderly KT recipients.

Prevention of incisional hernia after kidney transplantation: study protocol for a randomized controlled trial

BackgroundIncisional hernia is a common complication after kidney transplantation with an incidence of 1.6–18%. Concerning non-transplant patients, a recently published meta-analysis describes a reduction of the incidence of incisional hernia of up to 85% due to prophylactic mesh replacement in elective, midline laparotomy. The aim of our study is to show a reduction of the incidence of incisional hernia after kidney transplantation with minimal risk for complication.Methods/designThis is a blinded, randomized controlled trial comparing time to incisional hernia over a period of 24 months between patients undergoing kidney transplantation and standardized abdominal closure with or without prophylactic placement of ProGrip™ (Medtronic, Fridley, MN, USA) mesh in an onlay position. As we believe that the mesh intervention is superior to the standard procedure in reducing the incidence of hernia, this is a superiority trial.DiscussionThe high risk for developing incisional hernia following kidney transplantation might be reduced by prophylactic mesh placement. ProGrip™ mesh features polylactic acid (PLA) microgrips that provide immediate, strong and uniform fixation. The use of this mesh combines the effectiveness demonstrated by the macropore propylene meshes in the treatment of incisional hernias, a high simplicity of use provided by its capacity for self-fixation that does not increase significantly surgery time, and safety.Trial registrationClinicalTrials.gov NCT04794582. Registered on 08 March 2021. Protocol version 2.0. (02–18-2021).

Kidney Transplant Recipient With Tumefactive Demyelinating Lesions: A Case Report and Literature Review

Tumefactive demyelinating lesions (TDLs) are rare and specific types of inflammatory demyelinating lesions. Its clinical manifestations are nonspecific, and the imaging findings are similar to those of other intracranial space-occupying lesions, which are usually misdiagnosed as tumors or abscesses and require a pathologic examination to confirm the diagnosis. Tumefactive demyelinating lesions after kidney transplantation are even rarer. This article reports a case of TDLs after kidney transplantation. A 60-year-old female patient underwent kidney transplantation 15 years ago and took anti-rejection drugs such as tacrolimus, tacrolimus, and corticosteroids after surgery. The patient was admitted with headache and left limb weakness, and magnetic resonance imaging of the head showed multiple space-occupying lesions with surrounding edema. The patient underwent a stereotactic biopsy of the encephalopathy lesion, and postoperative pathology confirmed TDLs. She was treated with corticosteroids and discharged after the improvement of her symptoms. Here, to our knowledge, we report the first case of TDLs after kidney transplantation. We report this case to provide clinicians with useful information on intracranial demyelinating disease after kidney transplantation.

Evaluating anti-thymocyte globulin induction doses for better allograft and patient survival in Asian kidney transplant recipients

Anti-thymocyte globulin (ATG) is currently the most widely prescribed induction regimen for preventing acute rejection after solid organ transplantation. However, the optimal dose of ATG induction regimen in Asian kidney recipients is unclear. Using the Korean Organ Transplantation Registry, we performed a retrospective cohort study of 4579 adult patients who received renal transplantation in South Korea and divided them into three groups according to the induction regimen: basiliximab group (n = 3655), low-dose ATG group (≤ 4.5 mg/kg; n = 467), and high-dose ATG group (> 4.5 mg/kg; n = 457). We applied the Toolkit for Weighting and Analysis of Nonequivalent Groups (TWANG) package to generate high-quality propensity score weights for intergroup comparisons. During four-year follow-ups, the high-dose ATG group had the highest biopsy-proven acute rejection rate (basiliximab 20.8% vs. low-dose ATG 22.4% vs. high-dose ATG 25.6%; P < 0.001). However, the rates of overall graft failure (4.0% vs. 5.0% vs. 2.6%; P < 0.001) and mortality (1.7% vs. 2.8% vs. 1.0%; P < 0.001) were the lowest in the high-dose ATG group. Our results show that high-dose ATG induction (> 4.5 mg/kg) was superior to basiliximab and low-dose ATG induction in terms of graft and patient survival in Asian patients undergoing kidney transplant.

Association between anti-endothelial antigen antibodies and allograft rejection in kidney transplantation.

Endothelial cells are vital in the transplant immune system as semiprofessional antigen-presenting cells. Few studies have investigated the importance of anti-endothelin subtype A receptor (ETAR) antibodies in kidney transplantation. Here, we aimed to analyze the association between anti-angiotensin II type I receptor (AT1R) and anti-ETAR antibodies and the association between the presence of anti-endothelial antibodies and the risk of allograft rejection in kidney transplantation. In total, 252 patients who underwent kidney transplantation were enrolled in this study. Antibodies for human leukocyte antigens (HLAs) and non-HLAs were analyzed immediately before transplantation. Patients were categorized based on the occurrence of antibody-mediated rejection (AMR) or T-cell-mediated rejection (TCMR) by 2017 Banff classification. All p-values were two-tailed, and statistical significance was set at p < 0.05. Patients with anti-AT1R antibodies had a 3.49-fold higher risk of TCMR than those without anti-AT1R antibodies. Patients with anti-ETAR antibodies had a 5.84-fold higher risk of AMR than those without anti-ETAR antibodies. The hazard ratio of AMR in patients with both HLA DSAs and anti-ETAR antibodies, relative to patients without anti-ETAR antibodies and HLA DSAs, was 32.85 (95% CI = 1.82-592.91). Our findings indicated that anti-ETAR antibodies are associated with AMR, and patients with both anti-ETAR antibodies and de novo HLA DSAs were at a high risk of AMR.

Nursing experience of caring a teenager with end-stage renal disease undergoing kidney transplantation

&lt;p&gt;本文描述一位罹患末期腎病變之青少年接受腎臟移植手術的護理經驗。筆者於2019年1月6日至1月30日護理期間，運用身、心、靈、社會整體性評估，確認個案有急性疼痛、焦慮、潛在危險性感染及知識缺失等健康問題。&lt;/p&gt; &lt;p&gt;在疼痛方面，除教導使用固定帶固定傷口和使用別針固定引流管避免拉扯外，並鼓勵採深呼吸放鬆等技巧，以轉移疼痛的注意力；在執行護理活動前均詳細說明步驟與目的，並使用通訊軟體參與病友團體討論，藉由正向經驗分享，來增加對未來生活的信心並降低焦慮感；此外也指導傷口照護、協助認識感染徵兆及瞭解配戴口罩和勤洗手的重要，以降低危險性感染。最後，與個案共同訂定學習目標、提升移植術後自我照顧知識和增進其對藥物的瞭解及記憶，並鼓勵養成良好生活習慣、提醒按時回診追蹤，最終使問題獲得解決。期望藉此經驗分享提供臨床照護參考。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;This article describes a nursing experience of a teenager with end-stage renal disease who successfully underwent kidney transplantation. During the nursing period from January 6 to January 30, 2019, the author confirmed that the patient had health problems of acute pain, anxiety, potential risks for infection, and a lack of knowledge through holistic assessments.&lt;/p&gt; &lt;p&gt;The care processes for reducing his pain perception included the use of tapes or pins to fix the wound and drainage tubes and ways to divert attention from pain. In terms of lowering his anxiety, we explained the purpose and process comprehensively before each nursing care. In addition, we encouraged him to use communication software to participate in group discussions and share positive experiences to increase confidence for future life. We also educated the patient on how to reduce the risk of infection by performing good wound care, recognizing early signs of infection, and understanding the importance of wearing a mask and washing his hands frequently. Finally, we set the same learning goals together, enhanced his knowledge and memory of immunosuppressive drugs, encouraged good living habits, and reminded him to return to the outpatient department on time, eventually solving the problems. We want to share these experiences to provide a reference for clinical care.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Comparing subtotal parathyroidectomy and total parathyroidectomy with autotransplantation in renal transplant recipients.

Both subtotal parathyroidectomy (SPTX) and total parathyroidectomy with autotransplantation (TPTX + AT) are considered acceptable surgical approaches for renal patients. It is common that parathyroid surgery is performed in patients before they undergo kidney transplantation and there is currently no evidence considering the best surgical approach in this subset of patients. Two cohorts were identified of consecutive patients who underwent parathyroidectomy for renal hyperparathyroidism by two surgeons at a single institution over equivalent time periods (SPTX and TPTX + AT). A retrospective chart review was performed to assess these techniques, including outcomes following kidney transplantation. There were 125 patients analysed, with 56 patients who underwent SPTX and 69 who underwent TPTX + AT. Both cohorts effectively reduced PTH post operatively. There were 22 patients in the SPTX cohort and 26 in the TPTX + AT cohort that subsequently received kidney transplants. There were no cases of recurrent hyperparathyroidism and one of hypoparathyroidism (4.5%) in the SPTX patients post-transplant. There was one case of recurrent hyperparathyroidism (3.8%) and four of persistent hypoparathyroidism (15.4%) in the TPTX + AT patients post-transplant. Surgery for renal hyperparathyroidism requires a careful balance of the extent of parathyroid resection to prevent persistent/recurrent disease and avoid permanent hypoparathyroidism. SPTX may be a more appropriate option in kidney transplant candidates in order to minimise the risk of long-term hypoparathyroidism.

Risk Factors for the Occurrence of Early Postoperative Urological and Surgical Complications after Kidney Transplantation from a Living and Cadaveric Donor

This study is based on a retrospective analysis of the medical history of 35 patients who underwent kidney transplantation at the Clinic of Urology of the “Alexandrovska” University Hospital, Sofia for the period from February 2018 to December 2019. Early postoperative complications were detected in 46% of the observed transplant patients. All possible early surgical and urological complications were followed up, including symptomatic and asymptomatic manifestations that did not require active invasive treatment.&#x0D; In our group of patients, possible factors, influencing the occurrence of early complications such as age and BMI of the recipient, age of the donor, preoperative hemodialysis and preoperative recipient residual diuresis, time of cold ischemia, creatinine levels at admission and discharge, hospital stay were studied. Our results show that the incidence of early postoperative urological and surgical complications correspond to the literature data from other transplant centres. We believe that higher preoperative residual diuresis is a good prognostic factor for lower rate of early postoperative complications. Prolonged time of cold ischemia does not affect the frequency of postoperative complications and allows better organization of operative activity. Obesity of the recipient is a risk factor for the occurrence of postoperative complications in transplant patients. In the studied group there is only a hint of the influence of the age of the recipient on the occurrence of complications without it reaching significant values. In our study, there was no relationship between the age of the donor and the occurrence of complications. Our opinion is that the age of the recipient and the donor does not in itself play a significant role, and it is much more important to increase the cardiovascular risk with age and against the background of emerging comorbidities. Serum creatinine levels at admission do not significantly affect the occurrence of early postoperative complications, but only suggest that quality of dialysis treatment plays an important role in the success of kidney transplantation. According to the values of serum creatinine at discharge, postoperative complications have a negative impact on the function of the transplanted kidney and their timely and adequate treatment is necessary to prolong the survival of the graft. The average length of hospital stay in the Clinic of Urology of “Alexandrovska” University Hospital for transplanted patients may be extended due to the specifics of the structure and organization of healthcare in the country.

Psychological Changes in Post Kidney Transplant Recipients: Phenomenology Study

Aims: Kidney transplantation can have a big impact on recipients, so they must be able to adapt to many changes, including psychological changes. Psychological changes are the most complained about by post- kidney transplant recipients. Psychological changes including feelings of anxiety and worry after kidney transplantation, these feelings arise due to post-transplant complications, feelings of guilt and fear of rejection, treatment regimens and uncertainty about the future. Therefore, recipients must be able to deal with psychological changes after kidney transplantation. Objective: To explore the psychological changes of post-kidney transplant recipients. Methods: A qualitative study using a phenomenological approach. This study was conducted on 6 participants who were undergone kidney transplantation. Purosive sampling was performed and data was collected through 35 to 60 min. Data collection in this study was carried out through in-depth interviews, audio recording and field notes. The data analysis technique uses the Collaizi method (1978). Result: This study obtained results including: psychological adaptation transitions and post-transplant anxiety control strategies. Conclusion: Kidney transplant provide better psychological changes if the recipients can implement strategies to control emotions. Therefore, it is important to have family, social and nurses support in controlling the psychological changes of post-kidney transplant recipients.

Cardiac surgery of aortic valve and ascending aorta (Bentall procedure) in a patient with Fabry disease without enzyme replacement therapy: an overview of aortic and aortic valve surgical tips

Introduction: Fabry disease (FD) is a rare disease in which cardiovascular events are one of its manifestations. Aortic and mitral valve involvement are among its manifestations, but due to the concern of suture failure without enzyme replacement therapy (ERT), the desire for its surgery has been very low, and its reported cases have been few. After the introduction of ERT, cardiovascular surgery for such patients has been gradually reported from different places, but due to the high cost of ERT, it is not practically available to patients in the third world and the backward countries. Reports of the experiences of patients with FD who underwent cardiac surgery without ERT can help improve cardiac surgery in these patients. Case Report: A 34-year-old man diagnosed with FD due to chronic renal failure and underwent dialysis 3 times a week for 1.5 years became a candidate for kidney transplant. In pre-transplant examinations, dilatation of aortic root and aortic valve insufficiency were diagnosed, and the patient’s kidney transplant surgery was postponed until after cardiac surgery. The patient underwent cardiac surgery, aortic valve replacement, and ascending aortic replacement, as well as re-implantation of both right and left coronary buttons on the ascending aorta (Bentall procedure). The post-surgery period passed without any special event. The patient’s dialysis continued; after 4 months, he underwent kidney transplant surgery, and the one-year follow-up period also was good. Conclusion: Although there is very little evidence of cardiovascular surgery in patients with FD without ERT, and surgeons have always been worried about suture failure and complications of cardiac surgery, due to the high cost of ERT, this treatment is not available to everyone. The introduced patient underwent cardiac surgery by Bentall procedure without receiving ERT and was discharged without any special complications. By reporting and collecting similar cases, guidance may be provided for patients with FD for whom ERT is not available.

Clinical outcomes for kidney transplantation in 81 adults with IgA nephropathy.

Immunoglobulin A nephropathy (IgAN) is one of the most common types of kidney disease, and kidney transplantation is the most effective treatment for end-stage renal disease. This study aims to analyze the clinical curative effect of renal transplantation for adults with IgAN and to discuss the efficacy and safety of kidney transplantation for IgAN at the perioperative period and medium- and long-term follow-up. This retrospective study included the clinical and follow-up data of 81 adult patients with IgAN who underwent kidney transplantation at the Second Xiangya Hospital, Central South University from January 2018 to January 2022. Of the 81 patients whose age at (34.1±9.9) years old, 47 (58.0%) were male. The body mass index was (20.8±3.2) kg/m2, and the human leukocyte antigen (HLA) mismatch number was 3.5±1.2. The estimated glomerular filtration rate (eGFR) and daily 24-hour urine output for the recipients on the 1st, 5th, and 7th day after kidney transplantation and when they were discharged were analyzed. The recovery of the transplanted kidney and occurrence of complications were comprehensively evaluated. The eGFR, urinary protein, and occult blood were evaluated at the 6th, 12th, 24th, 36th, and 48th month and at the last follow-up. The follow-up time was (25.7±15.8) months. No primary non-function occurred in any patient during the perioperative period time. Fifty-one (63.0%) patients had immediate graft function recovery, and 16 (19.8%) patients had slow graft function recovery. Delayed recovery of graft function was observed in 14 (17.3%) patients. A total of 19 perioperative complications occurred, including 9 patients with acute rejection, 5 patients with urinary fistula, 1 thrombosis in both lower limbs, and 4 lymphatic fistula. The eGFR at 6th, 12th, 24th, 36th, and 48th month of follow-up were (65.3±22.9), (67.6±23.0), (64.3±21.8), (65.9±24.7), and (68.7±31.2) mL/(min·1.73 m2), respectively. The eGFR remained high during the medium- and long-term follow-ups. At the longest follow-up of 56 months, eGFR fluctuation was still mild, and the positive rate of urine protein and occult blood was low. IgAN recurred in 4 transplanted kidneys, accounting for 4.94% of the total patients, without severe renal insufficiency. Three patients had kidney dysfunction due to severe pneumonia, rejection, and stone in the transplanted kidney. The overall survival rate of the transplanted kidney was higher than 95%, and the survival rate of all patients was 100% till Januray 2022. Renal transplantation for adults with IgAN had a remarkable short-term effect. The recipients can be beneficial significantly to favorable midium- and long-term outcomes. IgAN recurrence is infrequent and rarely causes severe renal function damage.

Aspergillus spp. renal arteritis after kidney transplantation: A reappraisal.

Aspergillus spp. is an uncommon and life-threatening cause of transplantrenal artery pseudoaneurysm after kidney transplantation. We report the case of a 62-year-old woman who underwent kidney transplantation 10 months before and presented a 7-cm asymptomatic transplant renal artery pseudoaneurysm. Transplanted kidney and pseudoaneurysm were surgically removed in emergency. Renal graft, urine, and pseudoaneurysm cultures grew Aspergillus flavus. She recovered after 12 months of antifungal therapy. To date 14 cases of Aspergillus spp. renal arteritis after kidney transplantation have been published, including 50% Aspergillus flavus arteritis. Vast majority were diagnosed within 90 days after transplantation (73%). Despite allograft nephrectomy and antifungal therapy, mortality rate was high (33%).

A prospective validation of a population pharmacokinetic model of tacrolimus in Tunisian kidney transplant patients

BackgroundA prospective validation of pharmacokinetic population (Pk pop) of Tacrolimus (Tac) for dose adjustment in kidney transplant patients was assessed in only one study. The present study was aimed at prospectively evaluating the performance of our previously developed Tac- Pk pop model in predicting trough concentration (C0) in Tunisian kidney transplant patients. Patients and methodIt was a prospective study including patients who had undergone kidney transplantation at Monastir-Nephrology Department. The population study was divided into adherence and control groups. ResultsA total of 198 C0 (30 patients) were analyzed. The proportion of C0 within TR was 63.9% and 38.0% in the adhesion and control group, respectively. The percentage of C0 within TR was significantly higher in the adherence group during both early and late post-transplant period (p = 0.03 and 0.04, respectively). This percentage was found to be significantly higher during the third C0 monitoring and thereafter in the adherence group compared with the control group (65.8% vs 41%, respectively). ConclusionTac dose proposal based on this model could be helpful to improve clinical outcomes in our population by reducing the risk of acute rejection and this immunosuppressant's toxic side effects.

Epimeric vitamin D and cardiovascular structure and function in advanced CKD and after kidney transplantation.

25-hydroxyvitamin D can undergo C-3 epimerization to produce 3-epi-25(OH)D3. 3-epi-25(OH)D3 levels decline in chronic kidney disease (CKD), but its role in regulating the cardiovascular system is unknown. Herein, we examined the relationship between 3-epi-25(OH)D3, and cardiovascular functional and structural endpoints in patients with CKD. We examined n=165 patients with advanced CKD from the Cardiopulmonary Exercise Testing in Renal Failure and After Kidney Transplantation (CAPER) study cohort, including those who underwent kidney transplant (KTR, n=76) and waitlisted patients who did not (NTWC, n=89). All patients underwent cardiopulmonary exercise testing and echocardiography at baseline, 2 months and 12 months. Serum 3-epi-25(OH)D3 was analyzed by liquid chromatography-tandem mass spectrometry. Patients were stratified into quartiles of baseline 3-epi-25(OH)D3 (Q1: <0.4 ng/mL, n=51; Q2: 0.4 ng/mL, n=26; Q3: 0.5-0.7 ng/mL, n=47; Q4: ≥0.8 ng/mL, n=41). Patients in Q1 exhibited lower peak oxygen uptake [VO2Peak=18.4 (16.2-20.8) mL/min/kg] compared with Q4 [20.8 (18.6-23.2) mL/min/kg; P=.009]. Linear mixed regression model showed that 3-epi-25(OH)D3 levels increased in KTR [from 0.47 (0.30) ng/mL to 0.90 (0.45) ng/mL] and declined in NTWC [from 0.61 (0.32) ng/mL to 0.45 (0.29) ng/mL; P<.001]. Serum 3-epi-25(OH)D3 was associated with VO2Peak longitudinally in both groups [KTR: β (standard error) = 2.53 (0.56), P<.001; NTWC: 2.73 (0.70), P<.001], but was not with left ventricular mass or arterial stiffness. Non-epimeric 25(OH)D3, 24,25(OH)2D3 and the 25(OH)D3:24,25(OH)2D3 ratio were not associated with any cardiovascular outcome (all P>.05). Changes in 3-epi-25(OH)D3 levels may regulate cardiovascular functional capacity in patients with advanced CKD.

Choice Of treatment method for symptomatic Bladder outlet obstruction in patients with benign prostatic hyperplasia after kidney transplantation

St. Petersburg, Russian Federation The paper presents a comparative assessment of different methods of treating symptomatic bladder outlet obstruction (BOO) in patients with benign prostatic hyperplasia (BPH) who underwent kidney transplantation (KT).

Uncontrolled hypertension is associated with increased risk of graft failure in kidney transplant recipients: a nationwide population-based study.

Hypertension is highly prevalent in patients with kidney transplantation caused by transplantation-related immunologic or non-immunologic risk factors. However, whether a strict definition of hypertension (≥130/80 mmHg) and subdivided blood pressure (BP) groups are associated with an increased risk of graft failure after kidney transplantation using a nationwide large cohort study are still unknown. Using Korean National Health Insurance Service data, we included 14,249 patients who underwent kidney transplantation from 2002 to 2016. Patients were categorized into five BP groups according to the 2021 Kidney Disease: Improving Global Outcomes practice guidelines for BP management: normal BP (<120/80 mmHg), elevated BP (120-129/ < 80 mmHg), incident hypertension (≥130/80 mmHg), and controlled or uncontrolled hypertension with anti-hypertensive medications. The primary outcome was graft failure, which occurred in 1934 (13.6%) participants during the 6-year follow-up. After adjusting for covariates, hypertension was associated with a higher risk of graft failure [Adjusted hazard ratio (AHR), 1.70; 95% confidence interval (CI), 1.48-1.96)] than no-hypertension. The AHR for graft failure was the highest in patients with uncontrolled hypertension (AHR, 2.13; 95% CI, 1.80-2.52). The risk of graft failure had a linear relationship with systolic and diastolic BP, and pulse pressure. In this nationwide population-based study, hypertension ≥130/80 mmHg based on the 2021 KDIGO BP guidelines in kidney transplantion recipients, and elevated systolic and diastolic BP, and pulse pressure were associated with the risk of developing graft failure in kidney transplant recipients.

Pediatric Kidney Transplantation—Living or Deceased Donor?

Kidney transplantation is ideal for children and adolescents with chronic end-stage renal disease because it offers better growth, development, and quality of life. Donor choice is vitally important in this age group, given the long life expectancy of these patients. A retrospective analysis of pediatric patients (<18 years) who underwent kidney transplantation from January 1999 to December/2018 was performed. Short- and long-term outcomes were compared between living and deceased donor transplants. We included 59 pediatric kidney transplant recipients, 12 from a living donor and 47 from a deceased donor. Thirty-six (61.0%) patients were boys, and 5 (8.5%) had a retransplant. There were no differences between groups on sex, race, and weight of the recipient and donor, as well as the age and the etiology of the recipient's primary disease. Most recipients received induction immunosuppression with basiliximab and maintenance with triple therapy, with no differences between groups. Living donor transplants were mostly pre-emptive (58.3% vs 4.3%, P < .001) and had fewer HLA mismatches (≤3: 90.9% vs 13.0%, P < .001), older donors (38.4 vs 24.3 years, P < .001) and shorter hospital stays (8.8 vs 14.1 days, P=.004). There were no statistically significant differences regarding medical-surgical complications and graft or patient survival. However, we found that at 13 years post-transplant 91.7% of the living donor grafts were functioning vs 72.3% of the deceased donor grafts. Our experience points out that a living donor graft in pediatric patients is associated with a higher probability of pre-emptive transplant, shorter hospital stay, greater HLA compatibility, and increased graft survival.

Multiple Brownish Macules on both Palms in a Patient Who Underwent Kidney Transplantation.

Multiple Brownish Macules on both Palms in a Patient Who Underwent Kidney Transplantation.