Monday, January 28, 2013

Effect of Peripheral Vascular Disease on Kidney Allograft Outcomes: A Study of U.S. Renal Data System


Effect of Peripheral Vascular Disease on Kidney Allograft Outcomes: A Study of U.S. Renal Data System

Background: The U.S. Renal Data System was used to analyze renal allograft outcomes in patients with peripheral vascular disease (PVD) at the time of transplant listing. Methods: We used an incident cohort of patients who underwent renal transplantation between June 2004 and September 2009. We defined PVD as symptomatic PVD at wait-listing. Comorbid conditions were diabetes mellitus, ischemic heart disease, cerebrovascular disease, hypertension, and smoking. Chi-square test, Student's t test, and Cox regression were used for statistical associations. Results: The mean graft survival was 55.3+/-0.40 months in patients with PVD versus 60.8+/-0.06 months in patients without PVD. There was an increased risk of graft failure with PVD (hazard ratio, 2.01; 95% confidence in-terval, 1.83-2.21; P=0.0001). After adjusting for other variables, PVD remained an independent risk factor for graft failure. Patients with PVD had lower death-censored graft survival versus patients without PVD at 1 year (93.3% vs. 96.6%), 2 years (89.7% vs. 95%), and 3 years (87.2% vs. 93.7%). All-cause mortality was higher in PVD versus without PVD (6.2% vs. 3.0%). In African Americans, the mean allograft survival was 54.8+/-0.98, months with PVD versus 59.7+/-0.135 months without PVD (P=0.0001). In non-African Americans, the mean allograft survival was 55.4+/-0.44 months with PVD versus 61.1+/-0.069 months without PVD (P=0.0001). There were no differences in survival between African Americans with PVD and non-African Americans with PVD. Conclusions: Patients with PVD have inferior allograft and patient survival versus those without PVD. Caution should be exercised when placing patients with symptomatic PVD or amputation on the wait-list. (C) 2013 Lippincott Williams & Wilkins, Inc.

Página original: http://pdfs.journals.lww.com/transplantjournal/9000/00000/Effect_of_Peripheral_Vascular_Disease_on_Kidney.98701.pdf


Sunday, January 20, 2013

Vildagliptin and Pioglitazone in Patients With Impaired Glucose Tolerance After Kidney Transplantation: A Randomized, Placebo-Controlled Clinical Trial


Vildagliptin and Pioglitazone in Patients With Impaired Glucose Tolerance After Kidney Transplantation: A Randomized, Placebo-Controlled Clinical Trial

Background: New-onset diabetes after transplantation (NODAT) is a serious complication after kidney transplantation affecting graft and patient survival. Currently, no guidelines exist for the management of renal transplant patients with impaired glucose tolerance (IGT), a risk factor for the development of NODAT and an independent predictor of death. Methods: In a population of 48 stable renal transplant recipients at least 6 months from time of transplantation with newly diagnosed IGT, we tested the dipeptidylpeptidase-4 inhibitor vildagliptin, the thiazolidinedione pioglitazone, or placebo for 3 months in addition to lifestyle counseling. Outcome measures were difference in change in oral glucose tolerance test between the groups and between baseline and end of study as well as change in HbA1c, serum lipids, and renal and hepatic function. Results: In both treatment groups, 2-hr plasma glucose at 3 months was significantly reduced compared with baseline (vildagliptin: -20+/-24 mg/dL; P=0.002 and pioglitazone: -23+/-29 mg/dL; P=0.004), and pioglitazone also significantly improved fasting plasma glucose (-11+/-14 mg/dL; P=0.003), although the primary outcome (difference in change in 2-hr plasma glucose among the three groups) did not reach statistical significance. Furthermore, HbA1c was decreased in both treatment arms (vildagliptin: -0.1%+/-0.3%; P=0.046 and pioglitazone: -0.2%+/-0.3%; P=0.029). In the placebo group, no significant changes in these parameters were observed. Only mild adverse events occurred and at a similar rate in all three groups. Conclusions: These data demonstrate that both vildagliptin and pioglitazone are of potential benefit in patients with IGT after renal transplantation in addition to lifestyle modification. (C) 2013 Lippincott Williams & Wilkins, Inc.

Página original: http://pdfs.journals.lww.com/transplantjournal/9000/00000/Vildagliptin_and_Pioglitazone_in_Patients_With.98713.pdf