KIDNEY TRANSPLANTATION NEWS: July 2014

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

Sent with Reeder

Enviado desde mi iPhone

Tuesday, July 15, 2014

Elevated Urinary CCL2: Cr at 6 Months Is Associated With Renal Allograft Interstitial Fibrosis and Inflammation at 24 Months

Transplantation - Most Popular Articles Elevated Urinary CCL2: Cr at 6 Months Is Associated With Renal Allograft Interstitial Fibrosis and Inflammation at 24 Months

BackgroundWe have demonstrated that 6-month urinary CCL2: Cr is a predictor of interstitial fibrosis and tubular atrophy (IFTA) on 24-month biopsy and death-censored graft loss. However, IFTA is no longer considered prognostically significant, whereas patients with graft loss frequently have interstitial fibrosis and inflammation (IF+i=ci>0+i>0). As early CCL2: Cr predicts late graft loss, the goal of this study was to determine if 6-month urinary CCL2: Cr was a predictor of IF+i at 24 months. MethodsUrinary CCL2 at 6 months was measured with ELISA and correlated with IF+i on 24-month surveillance biopsies from a prospective, multicenter adult renal transplant cohort (n=111). ResultsSix-month urinary CCL2: Cr was significantly higher in IF+i and transplant glomerulopathy patients compared with normal histology at 24 months. By multivariate analysis, 6-month urinary CCL2: Cr was independently correlated with IF+i at 24 months (OR 2.78, 95% CI 1.38–6.12, AUC 0.695, P=0.003). Six-month urinary CCL2: Cr was also an independent correlate of 6-month IF+i (OR 1.99, 95% CI 1.03–4.18, AUC 0.63, P=0.04). Six-month urinary CCL2: Cr distinguished noninflamed renal tissue (normal, fibrosis) from IF+i with a sensitivity/specificity of 0.71/0.62 at a cutoff of 15 ng CCL2/mmol Cr (AUC 0.695, P=0.003, n=91). ConclusionsUrinary CCL2: Cr may be useful for the noninvasive identification of patients with or at risk for IF+i. These patients may benefit from avoidance of drug minimization/withdrawal protocols and more intensive post-transplant surveillance. Furthermore, urinary CCL2: Cr may also identify individuals who may benefit from novel interventional trials targeting IF+i.

http://journals.lww.com/transplantjournal/Fulltext/2014/07150/Elevated_Urinary_CCL2__Cr_at_6_Months_Is.7.aspx

Sent with Reeder

Enviado desde mi iPhone

Wednesday, July 9, 2014

Evolution of donor specific antibodies and incidence of de novo donor specific antibodies in solid organ transplant recipients after switch to everolimus alone or associated with low dose of calcineurin inhibitors

Clinical Transplantation Evolution of donor specific antibodies and incidence of de novo donor specific antibodies in solid organ transplant recipients after switch to everolimus alone or associated with low dose of calcineurin inhibitors

Abstract

Background

Everolimus (EVR) is used in organ transplantation to minimize calcineurin-inhibitors (CNI). Some studies pointed out an increase in rejection and de novo donor specific antibodies (DSA) incidence in kidney transplant patients after switch to EVR and CNI withdrawal. The aims of our study were to determine the evolution of anti-HLA antibodies and the incidence of de novo DSA in transplant recipients after conversion to EVR.

Methods

Heart, lung, kidney and liver transplant recipients were included in a retrospective, monocentric case-control study. Anti-HLA antibodies were identified at transplantation, pre-switch, and at 3, 6 and 12 months post-switch.

Results

Conversion to EVR was performed about 6 years after the transplant and low dose CNI was maintained in 60% of patients. We found no statistical difference for rejection, evolution of preformed anti-HLA antibodies or de novo DSA, after conversion to EVR or not. Incidence of anti-class II DSA tended to increase at month 12 whatever the immunosuppressive regimen.

Conclusions

Late conversion to EVR appears to be safe and to not modify the natural evolution of anti-HLA antibodies in organ transplantation. As 60% of patients received EVR and low doses of CNI, it seems that such combinations could be used with a good outcome.

http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fctr.12418

Sent with Reeder

Enviado desde mi iPad

Saturday, July 5, 2014

More Potent Lipid-Lowering Effect by Rosuvastatin Compared With Fluvastatin in Everolimus-Treated Renal Transplant Recipients

Transplantation - Most Popular Articles More Potent Lipid-Lowering Effect by Rosuvastatin Compared With Fluvastatin in Everolimus-Treated Renal Transplant Recipients

BackgroundDyslipidemia is a risk factor for premature cardiovascular morbidity and mortality in renal transplant recipients (RTRs). Pharmacotherapy with mTOR inhibitors aggravates dyslipidemia, thus necessitating lipid-lowering therapy with fluvastatin, pravastatin, or atorvastatin. These agents may not sufficiently lower lipid levels, and therefore, a more potent agent like rosuvastatin maybe needed. MethodsWe have aimed to assess the lipid-lowering effect of rosuvastatin as compared with fluvastatin in RTR receiving everolimus. Safety was assessed as the pharmacokinetic (PK) interaction potential of a rosuvastatin/everolimus combination in RTR. A 12-hour everolimus PK investigation was performed in 12 stable RTR receiving everolimus and fluvastatin (80 mg/d). Patients were then switched to rosuvastatin (20 mg/d), and a follow-up 12/24-hour PK investigation of everolimus/rosuvastatin was performed after 1 month. All other drugs were kept unchanged. ResultsIn RTR already receiving fluvastatin, switching to rosuvastatin further decreased LDL cholesterol and total cholesterol by 30.2±12.2% (P<0.01) and 18.2±9.6% (P<0.01), respectively. Everolimus AUC0–12 was not affected by concomitant rosuvastatin treatment, 80.3±21.3 μg*h/L before and 78.5±21.9 μg*h/L after, respectively (P=0.61). Mean rosuvastatin AUC0-24 was 157±61.7 ng*h/mL, approximately threefold higher than reported in the literature for nontransplants. There were no adverse events, and none of the patients had or developed proteinuria. ConclusionRosuvastatin showed a superior lipid-lowering effect compared to fluvastatin in stable RTR receiving everolimus. The combination of everolimus/rosuvastatin seems to be as safe as the everolimus/fluvastatin combination.

http://journals.lww.com/transplantjournal/Fulltext/2014/06270/More_Potent_Lipid_Lowering_Effect_by_Rosuvastatin.13.aspx

Sent with Reeder

Enviado desde mi iPhone

15-Year Follow-up of a Multicenter, Randomized, Calcineurin Inhibitor Withdrawal Study in Kidney Transplantation

Transplantation - Most Popular Articles 15-Year Follow-up of a Multicenter, Randomized, Calcineurin Inhibitor Withdrawal Study in Kidney Transplantation

BackgroundCalcineurin inhibitors (CNIs) are essential immunosuppressive drugs after renal transplantation. Because of nephrotoxicity, withdrawal has been a challenge since their introduction. MethodsA randomized multicenter trial included 212 kidney patients transplanted between 1997 and 1999. All patients were initially treated with mycophenolate mofetil (MMF), cyclosporine A (CsA), and prednisone (pred). At 6 months after transplantation, 63 patients were randomized for MMF/pred, 76 for MMF/CsA, and 73 for MMF/CsA/pred. Within 18 months after randomization 23 patients experienced a rejection episode: MMF/pred (27.0%), MMF/CsA (6.8%) and MMF/CsA/pred (1.4%) (P<0.001). ResultsDuring 15 years of follow-up, 73 patients died with a functioning graft, and 43 patients lost their graft. Ninety-six were alive with a functioning graft. Intention-to-treat analysis did not show a significant difference in patient and graft survival. In multivariate analysis, death-censored graft survival was significantly associated with serum creatinine at 6 months after transplantation and maximum PRA but not with the randomization group. CNI withdrawal did not result in a reduced incidence of or death by malignancy or cardiovascular disease. Death-censored graft survival was significantly worse in those patients randomized for CNI withdrawal that had to be reverted to CNI. Independent of randomization group, compared with no rejection, death-censored graft survival was significantly worse in 23 patients with acute rejection after randomization. ConclusionFifteen years after conversion to a CNI free regimen, there was no benefit regarding graft and patient survival or regarding prevalence of or death by comorbidities. However, rejection shortly after CNI withdrawal was associated with decreased graft survival.

http://journals.lww.com/transplantjournal/Fulltext/2014/07150/15_Year_Follow_up_of_a_Multicenter,_Randomized,.8.aspx

Sent with Reeder

Enviado desde mi iPhone

Wednesday, July 2, 2014

I'm sharing "Vitamin D supplementation for prevention of cancer in adults."

I thought you would be interested in this article.

Cochrane Database of Systematic Reviews 2014 Jun 23; 6 : CD007469.

Vitamin D supplementation for prevention of cancer in adults.
Goran Bjelakovic, Lise Lotte Gluud, Dimitrinka Nikolova, Kate Whitfield, Goran Krstic, Jørn Wetterslev, Christian Gluud

PMID: 24953955

Sent using journal reader: Read by QxMD

Enviado desde mi iPad

Home

Wednesday, July 30, 2014

WTC2014 | Sepsis in Solid Organ Transplantation

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 Placebo-Controlled Trial of C1 Inhibitor for Prevention of Antibody-Mediated Rejection in HLA Sensitized Patients

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

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

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

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

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

Wednesday, July 16, 2014

Abstract

Tuesday, July 15, 2014

Wednesday, July 9, 2014

Abstract

Background

Methods

Results

Conclusions

Saturday, July 5, 2014

Wednesday, July 2, 2014