Tuesday, December 2, 2014

I'm sharing "Randomized Trial of Valganciclovir Versus Valacyclovir Prophylaxis for Prevention of Cytomegalovirus in Renal Transplantation."

I thought you would be interested in this article.

Clinical Journal of the American Society of Nephrology : CJASN 2014 Nov 25;

Randomized Trial of Valganciclovir Versus Valacyclovir Prophylaxis for Prevention of Cytomegalovirus in Renal Transplantation.
Tomas Reischig, Martin Kacer, Pavel Jindra, Ondrej Hes, Daniel Lysak, Mirko Bouda

PMID: 25424991

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Alberto Reino Buelvas

The Need for a Standardized Informed Consent Procedure in Live Donor Nephrectomy: A Systematic Review

Transplantation - Current Issue The Need for a Standardized Informed Consent Procedure in Live Donor Nephrectomy: A Systematic Review

imageBackgroundInformed consent in live donor nephrectomy is a topic of great interest. Safety and transparency are key items increasingly getting more attention from media and healthcare inspection. Because live donors are not patients, but healthy individuals undergoing elective interventions, they justly insist on optimal conditions and guaranteed safety. Although transplant professionals agree that consent should be voluntary, free of coercion, and fully informed, there is no consensus on which information should be provided, and how the donors' comprehension should be ascertained. MethodsComprehensive searches were conducted in Embase, Medline OvidSP, Web-of-Science, PubMed, CENTRAL (The Cochrane Library 2014, issue 1) and Google Scholar, evaluating the informed consent procedure for live kidney donation. The methodology was in accordance with the Cochrane Handbook for Interventional Systematic Reviews and written based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. ResultsThe initial search yielded 1,009 hits from which 21 articles fell within the scope of this study. Procedures vary greatly between centers, and transplant professionals vary in the information they disclose. Although research has demonstrated that donors often make their decision based on moral reasoning rather than balancing risks and benefits, providing them with accurate, uniform information remains crucial because donors report feeling misinformed about or unprepared for donation. Although a standardized procedure may not provide the ultimate solution, it is vital to minimize differences in live donor education between transplant centers. ConclusionThere is a definite need for a guideline on how to provide information and obtain informed consent from live kidney donors to assist the transplant community in optimally preparing potential donors.


http://journals.lww.com/transplantjournal/Fulltext/2014/12150/The_Need_for_a_Standardized_Informed_Consent.3.aspx

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Alberto Reino Buelvas

Summary of the British Transplantation Society Guidelines for Management of the Failing Kidney Transplant

Transplantation - Current Issue Summary of the British Transplantation Society Guidelines for Management of the Failing Kidney Transplant

imageThe British Transplantation Society "Guideline for Transplantation Management of the Failing Kidney Transplant" was published in May 2014. This is the first national guideline in this field. In line with previous guidelines published by the British Transplantation Society, the guideline has used the GRADE system to rate the strength of evidence and recommendations.This article summarizes the Statements of Recommendation contained in the guideline, which provide a framework for the management of the failing kidney graft in the United Kingdom and may be of wide international interest. It is recommended that the full guideline document is consulted for details of the relevant references and evidence base. This may be accessed at: http://www.bts.org.uk/MBR/Clinical/Guidelines/Current/Member/Clinical/Current_Guidelines.aspx


http://journals.lww.com/transplantjournal/Fulltext/2014/12150/Summary_of_the_British_Transplantation_Society.2.aspx

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Alberto Reino Buelvas

Wednesday, November 26, 2014

I'm sharing "Belatacept for kidney transplant recipients."

I thought you would be interested in this article.

Cochrane Database of Systematic Reviews 2014 Nov 24; 11 : CD010699.

Belatacept for kidney transplant recipients.
Philip Masson, Lorna Henderson, Jeremy R Chapman, Jonathan C Craig, Angela C Webster

PMID: 25416857

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Alberto Reino Buelvas

Tuesday, November 18, 2014

I'm sharing "Multitarget Therapy for Induction Treatment of Lupus Nephritis: A Randomized, Controlled Trial."

I thought you would be interested in this article.

Annals of Internal Medicine 2014 Nov 11;

Multitarget Therapy for Induction Treatment of Lupus Nephritis: A Randomized, Controlled Trial.
Zhihong Liu, Haitao Zhang, Zhangsuo Liu, Changying Xing, Ping Fu, Zhaohui Ni, Jianghua Chen, Hongli Lin, Fuyou Liu, Yongcheng He, Yani He, Lining Miao, Nan Chen, Ying Li, Yong Gu, Wei Shi, Weixin Hu, Zhengzhao Liu, Hao Bao, Caihong Zeng, Minlin Zhou

PMID: 25383558

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Alberto Reino Buelvas

Monday, November 17, 2014

Evaluating the Safety and Rationale for Cinacalcet Posttransplant Hyperparathyroidism and Hypercalcemia.

unboundmedicine.com Evaluating the Safety and Rationale for Cinacalcet Posttransplant Hyperparathyroidism and Hypercalcemia.




http://www.unboundmedicine.com/medline/citation/25223316/Evaluating_the_Safety_and_Rationale_for_Cinacalcet_Posttransplant_Hyperparathyroidism_and_Hypercalcemia_

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Alberto Reino Buelvas

A Randomized Study Evaluating Cinacalcet to Treat Hypercalcemia in Renal Transplant Recipients With Persistent Hyperparathyroidism.

unboundmedicine.com A Randomized Study Evaluating Cinacalcet to Treat Hypercalcemia in Renal Transplant Recipients With Persistent Hyperparathyroidism.

Abstract

Persistent hyperparathyroidism (HPT) after kidney transplantation (KTx) is associated with hypercalcemia, hypophosphatemia and abnormally high levels of parathyroid hormone (PTH). In this randomized trial, cinacalcet was compared to placebo for the treatment of hypercalcemia in adult patients with persistent HPT after KTx. Subjects were randomized 1:1 to cinacalcet or placebo with randomization stratified by baseline corrected total serum calcium levels (≤11.2 mg/dL [2.80 mmol/L] or >11.2 mg/dL [2.80 mmol/L]). The primary end point was achievement of a mean corrected total serum calcium value <10.2 mg/dL (2.55 mmol/L) during the efficacy period. The two key secondary end points were percent change in bone mineral density (BMD) at the femoral neck and absolute change in phosphorus; 78.9% cinacalcet- versus 3.5% placebo-treated subjects achieved the primary end point with a difference of 75.4% (95% confidence interval [CI]: 63.8, 87.1), p < 0.001. There was no statistical difference in the percent change in BMD at the femoral neck between cinacalcet and placebo groups, p = 0.266. The difference in the change in phosphorus between the two arms was 0.45 mg/dL (95% CI: 0.26, 0.64), p < 0.001 (nominal). No new safety signals were detected. In conclusion, hypercalcemia and hypophosphatemia were effectively corrected after treatment with cinacalcet in patients with persistent HPT after KTx.

Links

  • Publisher Full Text
  • Authors

    Evenepoel P, Cooper K, Holdaas H, Messa P, Mourad G, Olgaard K, Rutkowski B, Schaefer H, Deng H, Torregrosa JV, Wuthrich RP, Yue S

    Source

    American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons : 2014 Sep 15 pg

    Pub Type(s)

    JOURNAL ARTICLE

    Language

    ENG

    PubMed ID

    25225081




    http://www.unboundmedicine.com/medline/citation/25225081/A_Randomized_Study_Evaluating_Cinacalcet_to_Treat_Hypercalcemia_in_Renal_Transplant_Recipients_With_Persistent_Hyperparathyroidism_

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    Alberto Reino Buelvas

    Friday, November 14, 2014

    Prevalence and Risk Factors of Noncontrolled and Resistant Arterial Hypertension in Renal Transplant Recipients.

    Transplantation - Published Ahead-of-Print Prevalence and Risk Factors of Noncontrolled and Resistant Arterial Hypertension in Renal Transplant Recipients.

    Background: Arterial hypertension (HT) is common in renal transplant recipients (RTRs). Control of HT is not optimal in this high-risk population despite recommendations for target blood pressure levels under 130/80 mm Hg. Methods: We performed a cross-sectional analysis of the prevalence of uncontrolled HT, and using a Cox regression model, we identified the risk factors associated with resistant HT. Results: Eight hundred eleven RTRs (>1 year after transplantation) were included. A total of 10.5% were normotensive (<130/80 mm Hg without treatment), 41% had controlled HT, 32.5% uncontrolled HT, and 16% resistant HT. In univariate analysis, compared to controlled HT, the RH group had significantly higher body mass index and older donors, delayed graft function, prevalence of metabolic syndrome (69.2 vs. 51.9%), fast glycemia and glycated hemoglobin, albuminuria, triglycerides and uric acid levels, and worse measured glomerular filtration rate (mGFR). In multivariate analysis, recipient age (P<0,001), mGFR (P=0.037), albuminuria (P<0.001), and metabolic syndrome (P=0.007) were significantly associated with RH. Association of metabolic syndrome with RH was much stronger than each of its components. Conclusion: Our data show that despite the recommendations issued by scientific societies, blood pressure control in RTRs is far from the recommended targets. At least a third of our patients (uncontrolled HT) did not receive optimal treatment and suffered therapeutic inertia. Decreased mGFR, metabolic syndrome, and urinary albumin excretion emerged as strong predictors of poor HT control. Whether prevention and management of the metabolic syndrome and reduction of albuminuria could help to more consistently reach the blood pressure recommended targets deserves further investigation. (C) 2014 by Lippincott Williams & Wilkins


    http://pdfs.journals.lww.com/transplantjournal/9000/00000/Prevalence_and_Risk_Factors_of_Noncontrolled_and.97957.pdf

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    Friday, October 24, 2014

    Diarrhea After Kidney Transplantation: A New Look at a Frequ... : Transplantation

    journals.lww.com Diarrhea After Kidney Transplantation: A New Look at a Frequ... : Transplantation

    Diarrhea After Kidney Transplantation: A New Look at a Frequent Symptom

    Aulagnon, Florence1,2; Scemla, Anne1,2; DeWolf, Susan3; Legendre, Christophe1,2,4,5,6; Zuber, Julien1,2,3,4,6,7

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    Abstract

    Diarrhea is a frequent but overlooked complication of kidney transplantation. Diarrhea is repeatedly neglected, often considered by patients and clinicians an unavoidable side effect of immunosuppressive regimens. It is, however, associated with a significant impairment in life quality. Severe and chronic posttransplant diarrhea may lead to dehydration, malabsorption, rehospitalization, immunosuppression, noncompliance, and a greater risk of graft loss and death. There is thus a need to optimize and standardize the management of posttransplant diarrhea with consistent diagnostic and therapeutic strategies. A recent study has suggested that the increased sensitivity of molecular tools might help in early pathogen identification and guidance of antimicrobial treatment. Most bacterial and protozoan infections are readily curable with appropriate antimicrobial agents; cryptosporidiosis and C. difficile infections may however be complicated by relapsing courses. In addition, identification of enteric viral genomes in stool has further reduced posttransplant diarrhea of unknown origin. Chronic norovirus-related posttransplant diarrhea, arising from the interplay of the virus and immunosuppressive drugs, has emerged as a new challenge in the field. Prospective and controlled studies are necessary to evaluate the efficacy and safety of innovative anti-norovirus therapeutics, as well as optimal immunosuppressive regimens, to enable viral clearance while preventing rejection and donor-specific antibody formation. This review seeks to provide a basis for the design of future clinical prospective studies.

    Copyright © 2014 by Lippincott Williams & Wilkins




    http://journals.lww.com/transplantjournal/Abstract/2014/10270/Diarrhea_After_Kidney_Transplantation__A_New_Look.3.aspx

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    Thursday, October 23, 2014

    A Paired Survival Analysis Comparing Hemodialysis and Kidney Transplantation From Deceased Elderly Donors Older Than 65 Years.

    Transplantation - Published Ahead-of-Print A Paired Survival Analysis Comparing Hemodialysis and Kidney Transplantation From Deceased Elderly Donors Older Than 65 Years.

    Background: Kidney transplantation from deceased donors aged 65 years or older is associated with suboptimal patient and graft survival. In large registries, survival is longer after kidney transplantation than when remaining on dialysis. However, whether recipients of these old grafts survive longer than their dialysis counterparts is unknown. Methods: We retrospectively assessed the outcomes of 5,230 recipients of first deceased donor grafts transplanted during the period of 1990 to 2010 in Catalonia, 915 of whom received grafts from donors 65 years or older. In a match-pair analysis, we aimed to pair each of 915 eligible cases with one control (1:1 ratio). Each pair had the same characteristics at the time of entering dialysis program: age, sex, primary renal disease, period of dialysis onset, and cardiovascular comorbidities. We found 823 pairs. Results: Patient survival of 823 recipients of elderly donors was significantly higher than that of their 823 matched dialysis waitlisted nontransplanted partners (91.6%, 74.5%, and 55.5% vs. 88.8%, 44.2%, and 18.1%, respectively at 1, 5, and 10 years; P<0.001). The probability of death after the first year was similar (8.1% transplant vs 10.3% dialysis; P=0.137); however, analyzing the whole period, the adjusted proportional risk of death was 2.66 (95% confidence interval, 2.21-3.20) times higher for patients remaining on dialysis than for transplanted patients (P<0.001). Conclusion: Our study demonstrates that despite the fact that kidney transplantation from elderly deceased donors is associated with reduced graft and patient survival, their paired counterpart patients remaining on dialysis have a risk of death 2.66 times higher. (C) 2014 by Lippincott Williams & Wilkins


    http://pdfs.journals.lww.com/transplantjournal/9000/00000/A_Paired_Survival_Analysis_Comparing_Hemodialysis.97979.pdf

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    Tuesday, October 14, 2014

    Adenosine Triphosphate-Competitive mTOR Inhibitors: A New Class of Immunosuppressive Agents That Inhibit Allograft Rejection.

    AJT Adenosine Triphosphate-Competitive mTOR Inhibitors: A New Class of Immunosuppressive Agents That Inhibit Allograft Rejection.

    The mechanistic/mammalian target of rapamycin (mTOR) is inhibited clinically to suppress T cell function and prevent allograft rejection. mTOR is the kinase subunit of two mTOR-containing complexes, mTOR complex (mTORC) 1 and 2. Although mTORC1 is inhibited by the macrolide immunosuppressant rapamycin (RAPA), its efficacy may be limited by its inability to block mTORC1 completely and its limited effect on mTORC2. Adenosine triphosphate (ATP)-competitive mTOR inhibitors are an emerging class of mTOR inhibitors that compete with ATP at the mTOR active site and inhibit any mTOR-containing complex. Since this class of compounds has not been investigated for their immunosuppressive potential, our goal was to determine the influence of a prototypic ATP-competitive mTOR inhibitor on allograft survival. AZD8055 proved to be a potent suppressor of T cell proliferation. Moreover, a short, 10-day course of the agent successfully prolonged murine MHC-mismatched, vascularized heart transplant survival. This therapeutic effect was associated with increased graft-infiltrating regulatory T cells and reduced CD4(+) and CD8(+) T cell interferon-γ production. These studies establish for the first time, that ATP-competitive mTOR inhibition can prolong organ allograft survival and warrant further investigation of this next generation mTOR inhibitors.



    http://www.unboundmedicine.com/medline/citation/25307040/Adenosine_Triphosphate_Competitive_mTOR_Inhibitors:_A_New_Class_of_Immunosuppressive_Agents_That_Inhibit_Allograft_Rejection_

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    Monday, September 15, 2014

    Renal function three years after early conversion from a calcineurin inhibitor to everolimus: Results from a randomized trial in kidney transplantation

    Transplant International Renal function three years after early conversion from a calcineurin inhibitor to everolimus: Results from a randomized trial in kidney transplantation

    Abstract

    In a 36-month, open-label, multicenter trial, 202 kidney transplant recipients were randomized at week 7 post-transplant to convert to everolimus or remain on cyclosporine: 182 were analyzed to month 36 (92 everolimus, 90 controls). Mean (SD) change in measured GFR (mGFR) from randomization to month 36 was 1.3 (14.0)mL/min with everolimus versus -1.7 (15.4)mL/min in controls (p=0.210).. In patients who remained on treatment, mean mGFR improved from randomization to month 36 by 7.9 (11.5)mL/min with everolimus (n=37) but decreased by 1.4 (14.7)mL/min in controls (n=62) (p=0.001). During months 12–36, death-censored graft survival was 100%, patient survival was 98.9% and 96.7% in the everolimus and control groups respectively, and 13.0% and 11.1% of everolimus and control patients, respectively, experienced mild biopsy-proven acute rejection. Protocol biopsies in a limited number of on-treatment patients showed similar interstitial fibrosis progression Donor specific antibodies were present at month 36 in 6.3% (2/32) and 18.0% (9/50) of on-treatment everolimus and control patients with available data (p=0.281). Adverse events were comparable, but discontinuation was more frequent with everolimus (33.7% versus 10.0%). Conversion from cyclosporine to everolimus at seven weeks post-transplant was associated with a significant benefit in renal function at three years when everolimus was continued.

    This article is protected by copyright. All rights reserved.




    http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Ftri.12437

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    Monday, September 8, 2014

    Limitations of Hemoglobin A1c for the Diagnosis of Posttransplant Diabetes Mellitus.

    Transplantation - Published Ahead-of-Print Limitations of Hemoglobin A1c for the Diagnosis of Posttransplant Diabetes Mellitus.

    Background: Posttransplant diabetes mellitus (PTDM) is usually detected 2 to 3 months after transplantation by fasting plasma glucose (fPG) >=7.0 mmol/L (>=126 mg/dL) and/or 2 hr post-challenge plasma glucose >=11.1 mmol/L (>=200 mg/dL) during an oral glucose tolerance test (OGTT). Recently, glycosylated hemoglobin (HbA1c) of 6.5% or higher (>=47.5 mmol/mol) has been proposed as an alternative diagnostic criterion (the HbA1c criterion). We aimed to assess the sensitivity of applying the HbA1c criterion alone or in combination with a single measurement of fPG of 7.0 mmol/L or higher (>=126 mg/dL) at 10 weeks after transplantation as screening tests for the diagnosis of PTDM. Methods: From 1999 to 2011, measurements of fPG, HbA1c, and OGTT were performed in 1,619 nondiabetic renal transplant recipients. Results: The HbA1c criterion detected 38.0% of patients with PTDM diagnosed with the standard diagnostic criteria. The specificity was 86.3%. When the HbA1c threshold value was lowered to 6.2% (44.3 mmol/mol), sensitivity increased to 57.8% with a corresponding reduced specificity of 80.4%. A combination of the HbA1c criterion and fPG of 7.0 mmol/L or higher (126 mg/dL) at 10 weeks after transplantation improved diagnostic precision with a sensitivity of 77.7% and a specificity of 96.1%. Conclusion: The proposed diagnostic HbA1c criterion failed to detect most cases of PTDM, and one of four cases of PTDM was detected by OGTT alone. This indicates that the HbA1c threshold value likely needs to be lowered for renal transplant recipients and supports continued use of OGTT as a diagnostic tool for detection of PTDM. (C) 2014 by Lippincott Williams & Wilkins


    http://pdfs.journals.lww.com/transplantjournal/9000/00000/Limitations_of_Hemoglobin_A1c_for_the_Diagnosis_of.98033.pdf

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    Graft and Patient Survival Outcomes of a Third Kidney Transplant.

    Transplantation - Published Ahead-of-Print Graft and Patient Survival Outcomes of a Third Kidney Transplant.

    Background: The waiting time for deceased donor renal transplantation in the United States continues to grow. Retransplant candidates make up a small but growing percentage of the overall transplant waiting list and raise questions about the stewardship of scarce resources. The utility of renal transplantation among individuals with two prior renal transplants is not described in the literature, and we thus sought to determine the survival benefit associated with a third kidney transplant (3KT). Methods: Multivariable Cox regression models were created to determine characteristics associated with 3KT outcomes and the survival benefit of 3KT among recipients wait listed and transplanted within the United States between 1995 and 2009. Results: A total of 4,334 patients were waitlisted for a 3KT and 2,492 patients received a 3KT. In a multivariate analysis, 3KT demonstrated an overall patient survival benefit compared to the waitlist (hazards ratio, 0.379; 95% confidence interval, 0.302-0.475; P<0.001) for those awaiting their first, second, or third kidney transplants, although an inferior graft outcome compared to first kidney transplants. The time to survival benefit did not accrue until 8 months after transplantation. In addition, we found that the duration of second graft survival was predictive of third graft survival, such that second graft survival beyond 5 years is associated with superior 3KT graft survival. Second graft loss in 30 days or less was not associated with inferior 3KT graft survival. Conclusion: A 3KT achieves a survival benefit over remaining on the waitlist, although is associated with inferior graft outcomes compared to first kidney transplants. Graft survival of the second transplant beyond 5 years is associated with superior 3KT graft survival. (C) 2014 by Lippincott Williams & Wilkins


    http://pdfs.journals.lww.com/transplantjournal/9000/00000/Graft_and_Patient_Survival_Outcomes_of_a_Third.98052.pdf

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    Colchicine Levels in Chronic Kidney Diseases and Kidney Transplant Recipients using Tacrolimus

    Clinical Transplantation Colchicine Levels in Chronic Kidney Diseases and Kidney Transplant Recipients using Tacrolimus

    Abstract

    Background

    Tacrolimus is a CYP3A4 inhibitor and can alter colchicine metabolism. In this study, we aimed to evaluate plasma colchicine levels in different stages of kidney disease as well as in kidney transplant (KTx) recipients using tacrolimus.

    Method

    This study included 6 FMF patients with normal glomerular filtration rate (GFR) as controls, 3 patients with low GFR, 6 FMF patients on hemodialysis (HD), and 6 FMF patients who were KTx recipients using tacrolimus. After a three-day washout period, plasma colchicine levels were measured at 0 (pre-dose), 1,2,4,8, and 24 hours post-dose of 1 mg oral colchicine. Area under the curve 0-24 hours (AUC0-24) and maximum concentration (Cmax) were evaluated and compared between the groups.

    Results

    Colchicine AUC0-24 was 6-fold higher in HD (p<0.001) and 3-fold higher in KTx recipients (p<0.001) when compared to the control. The low GFR group had mildly higher AUC0-24 than the control group. Cmax levels were also higher in HD (p=0.011) and KTx recipient (p=0.06) groups and mildly elevated in low GFR patients in comparison to controls.

    Conclusion

    Colchicine AUC0-24 and Cmax were significantly increased in HD patients and KTx recipients using tacrolimus. Therefore, dose adjustments are needed to avoid toxicity in both circumstances.

    This article is protected by copyright. All rights reserved.




    http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fctr.12448

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    Saturday, September 6, 2014

    I'm sharing "Risk of ESRD and Death in Patients with CKD Not Referred to a Nephrologist: A 7-Year Prospective Study."

    I thought you would be interested in this article.

    Clinical Journal of the American Society of Nephrology : CJASN 2014 Jul 29;

    Risk of ESRD and Death in Patients with CKD Not Referred to a Nephrologist: A 7-Year Prospective Study.
    Roberto Minutolo, Francesco Lapi, Paolo Chiodini, Monica Simonetti, Elisa Bianchini, Serena Pecchioli, Iacopo Cricelli, Claudio Cricelli, Gaetano Piccinocchi, Giuseppe Conte, Luca De Nicola

    PMID: 25074838

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    A Randomized Multicenter Trial of Paricalcitol versus Calcitriol for Secondary Hyperparathyroidism in Stages 3-4 CKD

    Clinical Journal of the American Society of Nephrology current issue A Randomized Multicenter Trial of Paricalcitol versus Calcitriol for Secondary Hyperparathyroidism in Stages 3-4 CKD


    Abstract

    Background and objectives Calcitriol is used to treat secondary hyperparathyroidism in patients with CKD. Paricalcitol is less calcemic and phosphatemic in preclinical studies and in some trials in dialysis patients, but head-to-head comparisons in nondialysis patients are lacking. A large meta-analysis of trials concluded that these agents did not consistently reduce parathyroid hormone (PTH) and increased the risk of hypercalcemia and hyperphosphatemia. Therefore, the objective of this multicenter trial was to compare the rate of hypercalcemia between calcitriol and paricalcitol, while suppressing PTH 40%–60%.

    Design, setting, participants, & measurements Patients with stages 3–4 CKD (n=110) with a PTH level >120 pg/ml were recruited and randomized to 0.25 μg/d of calcitriol or 1 μg/d of paricalcitol between April 2009 and July 2011. Subsequent dose adjustments were by protocol to achieve 40%–60% PTH suppression below baseline. The primary endpoint was the rate of confirmed hypercalcemia of >10.5 mg/dl between groups.

    Results Forty-five patients in each group completed the 24 weeks of treatment. Both agents suppressed PTH effectively (−52% with paricalcitol and −46% with calcitriol; P=0.17), although the paricalcitol group reached a 40% reduction in PTH sooner at a median 8 weeks (interquartile range [IQR], 4, 12) versus 12 weeks (IQR, 8, 18; P=0.02) and had a lower pill burden of 240 (IQR, 180, 298) versus 292 (IQR, 231, 405;P=0.01). Confirmed hypercalcemia was very low in both groups (three with paricalcitol and one with calcitriol) and was not significantly different (P=0.36). Both groups had small increases in calcium and phosphorus levels (0.3–0.4 mg/dl in each electrolyte) and significant decreases in alkaline phosphatase, a marker of high bone turnover, with no significant differences between groups.

    Conclusions These results show that both calcitriol and paricalcitol achieved sustained PTH and alkaline phosphatase suppression in stages 3–4 CKD, with small effects on serum calcium and phosphorus and a low incidence of hypercalcemia.


    http://cjasn.asnjournals.org/cgi/content/short/9/9/1620?rss=1

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    Thursday, September 4, 2014

    Hypervolemia and Blood Pressure in Prevalent Kidney Transplant Recipients

    Transplantation - Most Popular Articles Hypervolemia and Blood Pressure in Prevalent Kidney Transplant Recipients

    imageBackgroundThe prevalence and consequences of hypervolemia in kidney transplant recipients (KTRs) have not been investigated. Specifically, its impact on blood pressure (BP) and relationship with N-terminal fragment of prohormone B-type natriuretic peptide (NT-proBNP) are unknown. The objectives of this study were to establish the prevalence of hypervolemia among clinically stable KTRs, investigate the predictors of posttransplant hypervolemia, assess its impact on blood pressure, and determine its relationship with NT-proBNP. MethodsThis single-center cross-sectional study enrolled 123 clinically stable KTRs. Extracellular volume status was determined by multifrequency bioimpedance analysis. Mild and severe hypervolemia were defined as percentage volume expansion of greater than 7% and greater than 15%, respectively. Systolic BP (SBP) and diastolic BP (DBP) were measured, with mean arterial pressure (MAP) calculated. Serum NT-proBNP was quantified using a noncompetitive immunoluminometric assay. Potential demographic, nutritional, and clinical predictors of extracellular volume status, BP, and NT-proBNP levels were assessed. ResultsHypervolemia was present in 30% of KTRs, with 5% classified as severe hypervolemia. Significant predictors of volume expansion were increased sodium intake, advancing age, and reduced fat mass (P<0.01 for all associations). Hypervolemia was the only independent predictor of elevated MAP, SBP, and DBP (P<0.001 for all associations). Raised NT-proBNP levels were independently associated with both hypervolemia (P=0.01) and allograft dysfunction (P=0.03). ConclusionsHypervolemia is unexpectedly common among clinically stable KTRs. It is closely associated with elevated BP. The relationship with increased sodium intake signals potential therapeutic focus. Further study is warranted to prospectively investigate objective measures of extracellular volume status among KTRs.


    http://journals.lww.com/transplantjournal/Fulltext/2014/08150/Hypervolemia_and_Blood_Pressure_in_Prevalent.16.aspx

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    Tuesday, September 2, 2014

    Risk of Metabolic Complications in Kidney Transplantation After Conversion to mTOR Inhibitor: A Systematic Review and Meta-Analysis.

    AJT Risk of Metabolic Complications in Kidney Transplantation After Conversion to mTOR Inhibitor: A Systematic Review and Meta-Analysis.

    Mammalian target of rapamycin (mTOR) inhibitors have been used in transplantation with the hope of minimizing calcineurin inhibitor (CNI)-induced nephrotoxicity. However, mTOR inhibitors are also associated with a range of side effects, including metabolic complications. We aimed to determine the risks of metabolic complications after the conversion from CNI to mTOR inhibitor postkidney transplant. A systematic search in PubMed up to September 2013 identified nine relevant trials (a total of 2323 patients). The primary end points were the relative risks (RRs) of new-onset diabetes after transplant (NODAT) and hypercholesterolemia. The overall RRs of NODAT and hypercholesterolemia associated with mTOR inhibitors were 1.32 (95% confidence interval [CI] 0.92-1.87) and 2.15 (95% CI 1.35-3.41), respectively, compared with CNI-based regimen. Subgroup analyses revealed no differences in the incidence of NODAT or hypercholesterolemia between sirolimus- versus everolimus-based regimen, or between early versus late conversion. Analyses of secondary outcomes revealed a higher risk of acute rejection, proteinuria and anemia, but no difference in the risk of opportunistic infections after mTOR inhibitor conversion. In conclusion, the conversion from CNI to mTOR inhibitor in low-to-moderate risk kidney transplant recipients was associated with nonsignificant trend toward increased risk of NODAT and significant increase in hypercholesterolemia, acute rejection, proteinuria and anemia.



    http://www.unboundmedicine.com/medline/citation/25146383/Risk_of_Metabolic_Complications_in_Kidney_Transplantation_After_Conversion_to_mTOR_Inhibitor:_A_Systematic_Review_and_Meta_Analysis_

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    A Systematic Review of Conversion From Calcineurin Inhibitor to Mammalian Target of Rapamycin Inhibitors for Maintenance Immunosuppression in Kidney Transplant Recipients.

    AJT A Systematic Review of Conversion From Calcineurin Inhibitor to Mammalian Target of Rapamycin Inhibitors for Maintenance Immunosuppression in Kidney Transplant Recipients.

    This was a systematic review of randomized controlled trials comparing delayed conversion of mammalian target of rapamycin inhibitors (mTORi) for calcineurin inhibitors (CNIs) versus CNI continuation in kidney transplantation. Databases (2000-2012) and conference abstracts (2009-2012) were searched giving a total of 29 trials. Outcomes analyzed included GFR, graft loss, rejection and adverse events and were expressed as weighted mean differences (WMDs) or as risk ratios (RRs). Patients converted to mTORi up to 1 year posttransplant in intention-to-treat analysis had higher GFR compared with those remaining on CNI (WMD 0.28 mL/min/1.73 m(2) , 95% confidence interval [CI] 0.21-0.36; I(2)  = 68%, p < 0.001). Stratifying trials by time posttransplant or type of mTORi did not change the overall heterogeneity. For on-treatment population, mTORi was associated with higher GFR (14.21 mL/min/1.73 m(2) , 10.34-18.08; I(2)  = 0%, p = 0.970) 2-5 years posttransplant. The risk of rejection at 1 year was higher in mTORi trials (RR 1.72, 1.34-2.22; I(2)  = 12%, p = 0.330). Discontinuation secondary to adverse events was more common in patients on mTORi, whereas the incidence of skin cancers and cytomegalovirus infection was lower in patients on mTORi. Conversion from CNI to mTORi is associated with short-term improvements in GFR in a number of studies but longer-term follow-up data of graft and patient survival are required.



    http://www.unboundmedicine.com/medline/citation/25088685/A_Systematic_Review_of_Conversion_From_Calcineurin_Inhibitor_to_Mammalian_Target_of_Rapamycin_Inhibitors_for_Maintenance_Immunosuppression_in_Kidney_Transplant_Recipients_

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    Adenosine Triphosphate-Competitive mTOR Inhibitors: A New Class of Immunosuppressive Agents That Inhibit Allograft Rejection

    AJT - Early Adenosine Triphosphate-Competitive mTOR Inhibitors: A New Class of Immunosuppressive Agents That Inhibit Allograft Rejection

    The mechanistic/mammalian target of rapamycin (mTOR) is inhibited clinically to suppress T cell function and prevent allograft rejection. mTOR is the kinase subunit of two mTOR-containing complexes, mTOR complex (mTORC) 1 and 2. Although mTORC1 is inhibited by the macrolide immunosuppressant rapamycin (RAPA), its efficacy may be limited by its inability to block mTORC1 completely and its limited effect on mTORC2. Adenosine triphosphate (ATP)-competitive mTOR inhibitors are an emerging class of mTOR inhibitors that compete with ATP at the mTOR active site and inhibit any mTOR-containing complex. Since this class of compounds has not been investigated for their immunosuppressive potential, our goal was to determine the influence of a prototypic ATP-competitive mTOR inhibitor on allograft survival. AZD8055 proved to be a potent suppressor of T cell proliferation. Moreover, a short, 10-day course of the agent successfully prolonged murine MHC-mismatched, vascularized heart transplant survival. This therapeutic effect was associated with increased graft-infiltrating regulatory T cells and reduced CD4+ and CD8+ T cell interferon-γ production. These studies establish for the first time, that ATP-competitive mTOR inhibition can prolong organ allograft survival and warrant further investigation of this next generation mTOR inhibitors.




    http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fajt.12799

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    Wednesday, August 20, 2014

    Clinicopathologic features and outcome of mycophenolate-induced colitis in renal transplant recipients

    Clinical Transplantation Clinicopathologic features and outcome of mycophenolate-induced colitis in renal transplant recipients

    Abstract

    Reports on the clinical course of mycophenolic acid (MPA)-related colitis in kidney transplant recipients are scarce. This study aimed at assessing MPA-related colitis incidence, risk factors, and progression after kidney transplantation. All kidney transplant patients taking MPA who had colonic biopsies for persistent chronic diarrhea, between 2000-2012, at the Kidney Transplantation Unit of Botucatu Medical School Hospital, Brazil, were included. CMV immunohistochemistry was performed in all biopsy specimens. Data on presenting symptoms, medications, immunosuppressive drugs, colonoscopic findings, and follow-up were obtained. Of 580 kidney transplant patients on MPA, 34 underwent colonoscopy. Colonoscopic findings were associated with MPA usage in 16 patients. The most frequent histologic patterns were non-specific colitis (31.3%), IBD-like colitis (25%), normal/near normal (18.8%), graft-vs-host disease-like (18.8%), and ischemia-like colitis (12.5%). All patients had persistent acute diarrhea and weight loss. Six of the 16 MPA-related diarrhea patients (37.5%) showed acute dehydration requiring hospitalization. Diarrhea resolved when MPA was switched to sirolimus (50%), discontinued (18.75%), switched to azathioprine (12.5%), or reduced by 50% (18. 75%). No graft loss occurred. Four patients died during the study period. Late onset MPA was more frequent, and no correlation with MPA dose or formulation was found.

    This article is protected by copyright. All rights reserved.




    http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fctr.12452

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    Friday, August 8, 2014

    Cardiovascular morbidity and mortality after kidney transplantation

    Transplant International Cardiovascular morbidity and mortality after kidney transplantation

    Abstract

    Kidney transplantation is the optimal treatment for patients with end stage renal disease (ESRD) who would otherwise require dialysis. Patients with ESRD are at dramatically increased cardiovascular (CV) risk compared to the general population. As well as improving quality of life, successful transplantation accords major benefits by reducing cardiovascular risk in these patients. Worldwide, cardiovascular disease remains the leading cause of death with a functioning graft and therefore is a leading cause of graft failure. This review focuses on the mechanisms underpinning excess cardiovascular morbidity and mortality and current evidence for improving cardiovascular risk in kidney transplant recipients. Conventional cardiovascular risk factors such as hypertension, diabetes mellitus, dyslipidaemia, and pre-existing ischaemic heart disease are all highly prevalent in this group. In addition, kidney transplant recipients exhibit a number of risk factors associated with pre-existing renal disease. Furthermore, complications specific to transplantation may ensue including reduced graft function, side effects of immunosuppression and post transplantation diabetes mellitus. Strategies to improve cardiovascular outcomes post transplantation may include pharmacological intervention including lipid lowering or antihypertensive therapy, optimisation of graft function, lifestyle intervention and personalising immunosuppression to the individual patients risk profile.

    This article is protected by copyright. All rights reserved.




    http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Ftri.12413

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    Benefits of Rituximab Combined With Intravenous Immunoglobulin for Desensitization in Kidney Transplant Recipients

    Transplantation - Current Issue Benefits of Rituximab Combined With Intravenous Immunoglobulin for Desensitization in Kidney Transplant Recipients

    imageBackgroundHighly HLA-sensitized (HS) patients have difficulty accessing compatible donors, especially deceased donor (DD) transplants. Desensitization protocols (DES) have evolved, but rigorous evaluation is lacking. Here, we examined the efficacy of rituximab as a DES agent in a placebo-controlled trial. MethodsCandidates were randomized to IVIG+placebo versus IVIG+rituximab. End points included rates of transplantation, antibody-mediated rejection (ABMR), and renal function. Protocol biopsies were performed at 1 year and analysis of patient and graft survival and donor-specific HLA antibodies (DSA) were performed. ResultsInitially, 15 HS DDs were randomized with 13 receiving transplants. However, we discontinued study entry after five serious adverse events were observed. The study was un-blinded and attribution of patients was noted (IVIG+placebo N=7, IVIG+rituximab N=6). No significant differences were seen in DSA levels at transplant. All ABMR episodes occurred in the IVIG+placebo arm and required intense therapy (P=0.06). The two graft losses were in the placebo group. DSA rebound associated with severe ABMR was seen in three patients in the IVIG+placebo group. No rebound was seen in the IVIG+rituximab group. Renal function at 6 and 12 months showed a significant benefit for IVIG+rituximab (P=0.04). ConclusionsBased on limited assessment with acknowledged limitations, both protocols appear effective in achieving levels of DSA allowable for transplantation. However, IVIG+rituximab appeared more effective in preventing DSA rebound and, more importantly, preventing ABMR and development of transplant glomerulopathy.


    http://journals.lww.com/transplantjournal/Fulltext/2014/08150/Benefits_of_Rituximab_Combined_With_Intravenous.15.aspx

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    Diarrhea After Kidney Transplantation: A New Look at a Frequent Symptom.

    Transplantation - Published Ahead-of-Print Diarrhea After Kidney Transplantation: A New Look at a Frequent Symptom.

    Diarrhea is a frequent but overlooked complication of kidney transplantation. Diarrhea is repeatedly neglected, often considered by patients and clinicians an unavoidable side effect of immunosuppressive regimens. It is, however, associated with a significant impairment in life quality. Severe and chronic posttransplant diarrhea may lead to dehydration, malabsorption, rehospitalization, immunosuppression, noncompliance, and a greater risk of graft loss and death. There is thus a need to optimize and standardize the management of posttransplant diarrhea with consistent diagnostic and therapeutic strategies. A recent study has suggested that the increased sensitivity of molecular tools might help in early pathogen identification and guidance of antimicrobial treatment. Most bacterial and protozoan infections are readily curable with appropriate antimicrobial agents; cryptosporidiosis and C. difficile infections may however be complicated by relapsing courses. In addition, identification of enteric viral genomes in stool has further reduced posttransplant diarrhea of unknown origin. Chronic norovirus-related posttransplant diarrhea, arising from the interplay of the virus and immunosuppressive drugs, has emerged as a new challenge in the field. Prospective and controlled studies are necessary to evaluate the efficacy and safety of innovative anti-norovirus therapeutics, as well as optimal immunosuppressive regimens, to enable viral clearance while preventing rejection and donor-specific antibody formation. This review seeks to provide a basis for the design of future clinical prospective studies. (C) 2014 by Lippincott Williams & Wilkins


    http://pdfs.journals.lww.com/transplantjournal/9000/00000/Diarrhea_After_Kidney_Transplantation___A_New_Look.98094.pdf

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    I'm sharing "Controlled-dose versus fixed-dose mycophenolate mofetil for kidney transplant recipients: a systematic review and meta-analysis of randomized controlled trials."

    I thought you would be interested in this article.

    Transplantation 2013 Aug 27; 96 (4) : 361-7.

    Controlled-dose versus fixed-dose mycophenolate mofetil for kidney transplant recipients: a systematic review and meta-analysis of randomized controlled trials.
    Xianding Wang, Xin Qin, Yong Wang, Zhongli Huang, Xiaohong Li, Quantao Zeng, Hao Zeng, Yiping Lu, Li Wang, Tao Lin

    PMID: 23558507

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    Efficacy and safety of conversion from cyclosporine to everolimus in living-donor kidney transplant recipients: an analysis from the ZEUS study

    Transplant International Efficacy and safety of conversion from cyclosporine to everolimus in living-donor kidney transplant recipients: an analysis from the ZEUS study

    Abstract

    Conversion of living-donor kidney transplant patients from calcineurin inhibitor therapy to an mTOR inhibitor is poorly documented. In the prospective, multicenter ZEUS study, 300 kidney transplant recipients without prior rejection (Banff grade >1) and serum creatinine ≤265μmol/L were randomized to continue cyclosporine or convert to everolimus at 4.5 months post-transplant. In a post hoc analysis of 80 living-donor recipients, adjusted estimated GFR (Nankivell) at month 12 (the primary endpoint) was 74.3 (95%CI [70.7, 77.9]) mL/min/1.73m2 with everolimus versus 63.8 (95%CI [60.0, 67.7]) mL/min/1.73m2) with cyclosporine, a difference of 10.5 mL/min/1.73m2 in favor of everolimus (p<0.001). From randomization to month 12, adjusted estimated GFR increased by a mean of 9.8 (95%CI [6.2, 13.4]) mL/min/1.73m2 with everolimus, versus

    -0.7 (95%CI [-4.6, 3.1]) mL/min/1.73m2) (p<0.001) with cyclosporine. There were six biopsy-proven acute rejection episodes in everolimus-treated patients (five Banff grade I) and one episode in cyclosporine-treated patients (Banff grade 1). Overall safety profile was similar between groups. Discontinuation due to adverse events occurred in three everolimus patients (7.1%) and five cyclosporine patients (13.2%) between randomization and month 12. Initiation of everolimus with early elimination of calcineurin therapy is associated with a significant renal benefit at 12 months post-transplant that is observed in both living and deceased-donor recipients.

    This article is protected by copyright. All rights reserved.




    http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Ftri.12411

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    Wednesday, August 6, 2014

    Effect of HCV, HIV and Coinfection in Kidney Transplant Recipients: Mate Kidney Analyses

    AJT - Early Effect of HCV, HIV and Coinfection in Kidney Transplant Recipients: Mate Kidney Analyses

    Reports of kidney transplantation (KTX) in recipients with hepatitis C virus (HCV+), human immunodeficiency virus (HIV+) or coinfection often do not provide adequate adjustment for donor risk factors. We evaluated paired deceased-donor kidneys (derived from the same donor transplanted to different recipients) in which one kidney was transplanted into a patient with viral infection (HCV+, n = 1700; HIV+, n = 243) and the other transplanted into a recipient without infection (HCV− n = 1700; HIV− n = 243) using Scientific Registry of Transplant Recipients data between 2000 and 2013. On multivariable analysis (adjusted for recipient risk factors), HCV+ conferred increased risks of death-censored graft survival (DCGS) (adjusted hazard ratio [aHR] 1.24, 95% confidence interval [CI] 1.04–1.47) and patient survival (aHR 1.24, 95% CI 1.06–1.45) compared with HCV−. HIV+ conferred similar DCGS (aHR 0.85, 95% CI 0.48–1.51) and patient survival (aHR 0.80, 95% CI 0.39–1.64) compared with HIV−. HCV coinfection was a significant independent risk factor for DCGS (aHR 2.33; 95% CI 1.06, 5.12) and patient survival (aHR 2.88; 95% CI 1.35, 6.12). On multivariable analysis, 1-year acute rejection was not associated with HCV+, HIV+ or coinfection. Whereas KTX in HIV+ recipients were associated with similar outcomes relative to noninfected recipients, HCV monoinfection and, to a greater extent, coinfection were associated with poor patient and graft survival.




    http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fajt.12847

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    Monday, August 4, 2014

    Effects of Obesity on Kidney Transplantation Outcomes: A Systematic Review and Meta-Analysis

    Transplantation - Most Popular Articles Effects of Obesity on Kidney Transplantation Outcomes: A Systematic Review and Meta-Analysis

    imageBackgroundThe effects of obesity on outcomes reported after kidney transplantation have been controversial. The purpose of this systematic review and meta-analysis was to elucidate this issue. MethodsMEDLINE, EMBASE, Cochrane Library, and gray literature were searched up to August 6, 2013. Studies that compared obese and nonobese patients who underwent kidney transplantation and evaluated one of these outcomes—delayed graft function (DGF), acute rejection, graft or patient survival at 1 or 5 years after transplantation, or death by cardiovascular disease (CVD)—were included. Two independent reviewers extracted the data and assessed the quality of the studies. ResultsFrom 1,973 articles retrieved, 21 studies (9,296 patients) were included. Obesity was associated with DGF (relative risk, 1.41; 95% confidence interval, 1.26–1.57; I2=8%; Pheterogeneity=0.36), but not with acute rejection. Graft loss and death were associated with obesity only in the analysis of studies that evaluated patients who received a kidney graft before year 2000. No association of obesity with graft loss and death was found in the analysis of studies that evaluated patients who received a kidney graft after year 2000. Death by CVD was associated with obesity (relative risk, 2.07; 95% confidence interval, 1.17–3.64; I2=0%; Pheterogeneity=0.59); however, most studies included in this analysis evaluated patients who received a kidney graft after year 2000. ConclusionIn conclusion, obese patients have increased risk for DGF. In the past years, obesity was a risk factor for graft loss, death by CVD, and all-cause mortality. However, for the obese transplanted patient today, the graft and patient survival is the same as that of the nonobese patient.


    http://journals.lww.com/transplantjournal/Fulltext/2014/07270/Effects_of_Obesity_on_Kidney_Transplantation.10.aspx

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    Hepatitis C Virus Infection and Kidney Transplantation in 2014: What's New?

    AJT - Early Hepatitis C Virus Infection and Kidney Transplantation in 2014: What's New?

    Chronic hepatitis C virus (HCV) infection remains an important health problem, which is associated with deleterious consequences in kidney transplant recipients. Besides hepatic complications, several extrahepatic complications contribute to reduced patient and allograft survival in HCV-infected kidney recipients. However, HCV infection should not be considered as a contraindication for kidney transplantation because patient survival is better with transplantation than on dialysis. Treatment of HCV infection is currently interferon-alpha (IFN-α) based, which has been associated with higher renal allograft rejection rates. Therefore, antiviral treatment before transplantation is preferable. As in the nontransplant setting, IFN-free treatment regimens, because of their greater efficacy and reduced toxicity, currently represent promising and attractive therapeutic options after kidney transplantation as well. However, clinical trials will be required to closely evaluate these regimens in kidney recipients. There is also a need for prospective controlled studies to determine the optimal immunosuppressive regimens after transplantation in HCV-infected recipients. Combined kidney and liver transplantation is required in patients with advanced liver cirrhosis. However, in patients with cleared HCV infection and early cirrhosis without portal hypertension, kidney transplantation alone may be considered. There is some agreement about the use of HCV-positive donors in HCV-infected recipients, although data regarding posttransplant survival rates are controversial.




    http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fajt.12835

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    Effects of Lowering LDL Cholesterol on Progression of Kidney Disease

    Journal of the American Society of Nephrology current issue Effects of Lowering LDL Cholesterol on Progression of Kidney Disease

    Lowering LDL cholesterol reduces the risk of developing atherosclerotic events in CKD, but the effects of such treatment on progression of kidney disease remain uncertain. Here, 6245 participants with CKD (not on dialysis) were randomly assigned to simvastatin (20 mg) plus ezetimibe (10 mg) daily or matching placebo. The main prespecified renal outcome was ESRD (defined as the initiation of maintenance dialysis or kidney transplantation). During 4.8 years of follow-up, allocation to simvastatin plus ezetimibe resulted in an average LDL cholesterol difference (SEM) of 0.96 (0.02) mmol/L compared with placebo. There was a nonsignificant 3% reduction in the incidence of ESRD (1057 [33.9%] cases with simvastatin plus ezetimibe versus 1084 [34.6%] cases with placebo; rate ratio, 0.97; 95% confidence interval [95% CI], 0.89 to 1.05; P=0.41). Similarly, allocation to simvastatin plus ezetimibe had no significant effect on the prespecified tertiary outcomes of ESRD or death (1477 [47.4%] events with treatment versus 1513 [48.3%] events with placebo; rate ratio, 0.97; 95% CI, 0.90 to 1.04; P=0.34) or ESRD or doubling of baseline creatinine (1189 [38.2%] events with treatment versus 1257 [40.2%] events with placebo; rate ratio, 0.93; 95% CI, 0.86 to 1.01; P=0.09). Exploratory analyses also showed no significant effect on the rate of change in eGFR. Lowering LDL cholesterol by 1 mmol/L did not slow kidney disease progression within 5 years in a wide range of patients with CKD.




    http://jasn.asnjournals.org/cgi/content/short/25/8/1825?rss=1

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    Wednesday, July 30, 2014

    WTC2014 | Sepsis in Solid Organ Transplantation


    WTC2014 | Sepsis in Solid Organ Transplantation

    WTC2014 | Sepsis in Solid Organ Transplantation

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    WTC2014 | A Phase I/II Trial of Tocilizumab (Anti-IL-6 Receptor) + Intravenous Immunoglobulin (IVIG) for Desensitization (DES) in Difficult to DES Patients


    WTC2014 | A Phase I/II Trial of Tocilizumab (Anti-IL-6 Receptor) + Intravenous Immunoglobulin (IVIG) for Desensitization (DES) in Difficult to DES Patients

    WTC2014 | A Phase I/II Trial of Tocilizumab (Anti-IL-6 Receptor) + Intravenous Immunoglobulin (IVIG) for Desensitization (DES) in Difficult to DES Patients

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    WTC2014 | A Phase I/II Placebo-Controlled Trial of C1 Inhibitor for Prevention of Antibody-Mediated Rejection in HLA Sensitized Patients


    WTC2014 | A Phase I/II Placebo-Controlled Trial of C1 Inhibitor for Prevention of Antibody-Mediated Rejection in HLA Sensitized Patients

    WTC2014 | A Phase I/II Placebo-Controlled Trial of C1 Inhibitor for Prevention of Antibody-Mediated Rejection in HLA Sensitized Patients

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    WTC2014 | Long-Term (More Than 20 Years) Outcome of ABO-Incompatible Living Donor Kidney Transplantation: A Single Center Experience


    WTC2014 | Long-Term (More Than 20 Years) Outcome of ABO-Incompatible Living Donor Kidney Transplantation: A Single Center Experience

    WTC2014 | Long-Term (More Than 20 Years) Outcome of ABO-Incompatible Living Donor Kidney Transplantation: A Single Center Experience

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    WTC2014 | New Onset Diabetes After Kidnet Transplantation Despite the Use of a Steroid-Sparing Regime Is Associated With a Higher Mortality From Cardiac Causes


    WTC2014 | New Onset Diabetes After Kidnet Transplantation Despite the Use of a Steroid-Sparing Regime Is Associated With a Higher Mortality From Cardiac Causes

    WTC2014 | New Onset Diabetes After Kidnet Transplantation Despite the Use of a Steroid-Sparing Regime Is Associated With a Higher Mortality From Cardiac Causes

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    WTC2014 | The Impact of Pretransplant Diabetes Mellitus, New-Onset Diabetes Mellitus After Transplant, and Acute Rejection On Kidney Transplant Outcomes


    WTC2014 | The Impact of Pretransplant Diabetes Mellitus, New-Onset Diabetes Mellitus After Transplant, and Acute Rejection On Kidney Transplant Outcomes

    WTC2014 | The Impact of Pretransplant Diabetes Mellitus, New-Onset Diabetes Mellitus After Transplant, and Acute Rejection On Kidney Transplant Outcomes

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    WTC2014 | Is Hypomagnesemia a Novel Risk Factor for New-Onset Diabetes Mellitus After Kidney Transplantation?


    WTC2014 | Is Hypomagnesemia a Novel Risk Factor for New-Onset Diabetes Mellitus After Kidney Transplantation?

    WTC2014 | Is Hypomagnesemia a Novel Risk Factor for New-Onset Diabetes Mellitus After Kidney Transplantation?

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    WTC2014 | Conversion From Tacrolimus to Cyclosporine A Improves Glucose Metabolism in Patients With New Onset Diabetes After Transplantation: Interim Analysis of a Prospective and Randomized Study


    WTC2014 | Conversion From Tacrolimus to Cyclosporine A Improves Glucose Metabolism in Patients With New Onset Diabetes After Transplantation: Interim Analysis of a Prospective and Randomized Study

    WTC2014 | Conversion From Tacrolimus to Cyclosporine A Improves Glucose Metabolism in Patients With New Onset Diabetes After Transplantation: Interim Analysis of a Prospective and Randomized Study

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    WTC2014 | Vitamin D Deficiency Is a New Independent Risk Factor of NODAT for Kidney Transplant Recipients


    WTC2014 | Vitamin D Deficiency Is a New Independent Risk Factor of NODAT for Kidney Transplant Recipients

    WTC2014 | Vitamin D Deficiency Is a New Independent Risk Factor of NODAT for Kidney Transplant Recipients

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    WTC2014 | A 25 Years Follow-Up of Living Related Kidney Donor in a Dedicated Clinic With Intent to Treat If and When Required


    WTC2014 | A 25 Years Follow-Up of Living Related Kidney Donor in a Dedicated Clinic With Intent to Treat If and When Required

    WTC2014 | A 25 Years Follow-Up of Living Related Kidney Donor in a Dedicated Clinic With Intent to Treat If and When Required

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    WTC2014 | A 25 Years Follow-Up of Living Related Kidney Donor in a Dedicated Clinic With Intent to Treat If and When Required


    WTC2014 | A 25 Years Follow-Up of Living Related Kidney Donor in a Dedicated Clinic With Intent to Treat If and When Required

    WTC2014 | A 25 Years Follow-Up of Living Related Kidney Donor in a Dedicated Clinic With Intent to Treat If and When Required

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    Wednesday, July 16, 2014

    Adenovirus causing fever, upper respiratory infection, and allograft nephritis complicated by persistent asymptomatic viremia

    Transplant Infectious Disease Adenovirus causing fever, upper respiratory infection, and allograft nephritis complicated by persistent asymptomatic viremia

    Abstract

    A 20-year-old woman, with renal transplant complicated by recurrence of focal segmental glomerulosclerosis and post-transplant lymphoproliferative disorder, presented nearly 2 years after transplantation with fever, conjunctivitis, and sinus congestion. She was found to have severe adenovirus (ADV)-induced granulomatous interstitial nephritis, confirmed by immunohistochemical staining for ADV in the renal biopsy, without urinary symptoms, hematuria, or laboratory evidence of a change in allograft function. Fever, upper respiratory tract symptoms, and evidence of adenoviral infection in the allograft resolved with decreased immunosuppression and treatment with cidofovir and intravenous immunoglobulin. Creatinine rose during treatment and remained elevated, possibly related to cidofovir nephrotoxicity. Despite therapy and continued reduction in immunosuppression, asymptomatic low-level viremia persisted for a year. In renal transplant patients with ADV infection, allograft involvement should be highly suspected even without overt urinary symptoms or laboratory evidence of allograft dysfunction. Demonstration of allograft involvement may prompt alternative management that could limit continued allograft infection. No clear recommendations exist for management of asymptomatic ADV viremia in solid organ transplant patients.




    http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Ftid.12248

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