Wednesday, March 23, 2016
Impact of early blood transfusion after kidney transplantation on the incidence of donor-specific anti-HLA antibodies.
- Ferrandiz I, Congy-Jolivet N, Del Bello A, et al.
- Impact of early blood transfusion after kidney transplantation on the incidence of donor-specific anti-HLA antibodies. [JOURNAL ARTICLE]
- Am J Transplant 2016 Mar 21.
http://www.unboundmedicine.com/medline/citation/26998676/Impact_of_early_blood_transfusion_after_kidney_transplantation_on_the_incidence_of_donor_specific_anti_HLA_antibodies_
Sent with Reeder
Enviado desde mi iPhone
Monday, March 21, 2016
Wednesday, March 9, 2016
Medium-Term Renal Function in a Large Cohort of Stable Kidney Transplant Recipients Converted From Twice-Daily to Once-Daily Tacrolimus
Background: There is some evidence pointing toward better renal function in kidney transplant recipients (KTR) treated with once-daily tacrolimus (QD-TAC) vs. twice-daily tacrolimus (BID-TAC). Methods: This is an extension study of a 1-year, single arm prospective study of stable KTR who were converted from BID-TAC to QD-TAC (4.9 ± 4.0 years after transplantation) in Spanish routine clinical practice. Patient and graft survival, renal function, acute rejection episodes, and other analytic parameters were assessed at 24 and 36 months after conversion. Results: A total of 1798 KTR were included in the extension study. Tacrolimus doses at 36 months were significantly lower compared to those at time of conversion (−0.2 mg/day; P = 0.023). Blood levels were lower than baseline during all the study (P < 0.001). Graft and patient survival at 3 years after conversion were 93.9% and 95.1%, respectively. Compared with baseline, the mean estimated glomerular filtration rate (eGFR) remained very stable at all timepoints (56.7 ± 19.8 vs 58.1 ± 24.6 mL/min per 1.73 m2 at month 36; P = 0.623). Even when patients reinitiating dialysis were counted as eGFR = 0, the mean eGFR was very stable. In fact, a small but significant increase was observed at 36 months versus baseline (+0.1 mL/min per 1.73 m2; P = 0.025). An increase in proteinuria was observed at 36 months versus baseline (+0.11 g/24 h; P < 0.001). Acute rejection rates were low during the study. Conclusions: Conversion from BID-TAC to QD-TAC in a large cohort of stable KTR was safe and associated with a very stable renal function after 3 years. Comparative studies are warranted to assess the feasibility of such conversion.http://journals.lww.com/transplantationdirect/Fulltext/2015/08000/Medium_Term_Renal_Function_in_a_Large_Cohort_of.4.aspx
Sent with Reeder
Alberto Reino Buelvas
Native Nephrectomy in Renal Transplant Recipients With Autosomal-Dominant Polycystic Kidney Disease
Background: Native nephrectomy (NNx) is often done in patients with autosomal-dominant polycystic kidney disease. Controversy exists concerning the need and timing of nephrectomy in transplant candidates. We hypothesize that posttransplant NNx does not negatively impact patient and graft survival. Methods: Among 470 autosomal-dominant polycystic kidney disease transplant recipients included in the study, 114 (24.3%) underwent pretransplant (30.7%) or posttransplant (69.3%) NNx. Clinical data were retrieved from electronic records. Follow-up was until death, graft loss or June 2014. Perioperative complications were compared between the surgical techniques (open or laparoscopic) and between the pretransplant and posttransplant nephrectomy groups. The effect of nephrectomy on graft survival was analyzed as a time-dependent covariate when performed posttransplant. Results: Mean age at transplant was 52.4 years, 53.8% were men, 93% white, 70% were from living donors, and 56.8% were preemptive. Nephrectomy was done laparoscopically in 31% and 86% in the pretransplant and posttransplant nephrectomy groups, respectively. Complications were less common in those who underwent nephrectomy posttransplant (26.6% vs 48%, P = 0.03) but were similar regardless of surgical technique (open, 33.3% vs laparoscopic, 33%; P = 0.66). Patient and graft survivals were similar between those who underwent pretransplant nephrectomy and the rest of the recipients. In the posttransplant nephrectomy group, nephrectomy did not affect patient (hazards ratio, 0.77; 95% confidence interval, 0.38-1.54; P = 0.45) or graft survival (hazards ratio, 1.0; 95% confidence interval, 0.57-1.76; P = 0.1). Conclusions: Nephrectomy does not adversely affect patient or graft survival. Posttransplant nephrectomy is feasible when indicated without compromising long-term graft outcome and has fewer complications than pretransplant nephrectomy.http://journals.lww.com/transplantationdirect/Fulltext/2015/11000/Native_Nephrectomy_in_Renal_Transplant_Recipients.4.aspx
Sent with Reeder
Alberto Reino Buelvas
Epstein-Barr Virus–Positive Posttransplant Lymphoproliferative Disease After Solid Organ Transplantation: Pathogenesis, Clinical Manifestations, Diagnosis, and Management
Abstract: Posttransplant lymphoproliferative disease (PTLD) is a potentially fatal complication after (solid organ) transplantation, which is highly associated with Epstein-Barr virus (EBV). The EBV-specific cytotoxic T cell response that is essential in controlling the virus in healthy individuals is suppressed in transplant recipients using immunosuppressive drugs. A primary EBV infection in EBV-seronegative patients receiving an EBV-seropositive donor organ or a reactivation in those who are already latently infected pretransplantation can lead to uninhibited growth of EBV-infected B cells and subsequently to PTLD. Effective preventive strategies, such as vaccines and antiviral agents, are lacking. Because not every transplant recipient with increasing EBV viral load develops PTLD, it is hard to decide how intensively these patients should be monitored and how and when a preemptive intervention should take place. There is a need for other tools to help predict the development of PTLD in patients at risk to make timing and strategy of preemptive intervention easier and more reliable. The cornerstone of the treatment of patients with PTLD is restoring the host's immunity by reduction of immunosuppressive drug therapy. American and British guidelines recommend to add rituximab monotherapy or rituximab in combination with cyclophosphamide, doxorubicin, vincristine, and prednisolone, depending on histology and clinical characteristics. Although response to these therapies is good, toxicity is a problem, and PTLD still has a relatively high mortality rate. An evolving therapy, especially in PTLD occurring in allogeneic stem cell transplantation, is restoring the host's immune response with infusion of EBV-specific cytotoxic T cells. This may also play a role in the future in both prevention and treatment of PTLD in SOT.http://journals.lww.com/transplantationdirect/Fulltext/2016/01000/Epstein_Barr_Virus_Positive_Posttransplant.10.aspx
Sent with Reeder
Alberto Reino Buelvas
Long-term Follow-up of Kidney Transplant Recipients in the Spare-the-Nephron-Trial.
http://pdfs.journals.lww.com/transplantjournal/9000/00000/Long_term_Follow_up_of_Kidney_Transplant.97490.pdf
Sent with Reeder
Alberto Reino Buelvas
Tuesday, March 8, 2016
Fewer cytomegalovirus complications after kidney transplantation by de novo use of mTOR inhibitors in comparison to mycophenolic acid - Radtke - 2016 - Transplant Infectious Disease - Wiley Online Library
1399-3062/asset/TID_centre.gif?v=1&s=987f397a733bdc030e3da046f3a805206b7763e1)
Original Report
Fewer cytomegalovirus complications after kidney transplantation by de novo use of mTOR inhibitors in comparison to mycophenolic acid
- J. Radtke1,†,
- N. Dietze1,†,
- V.N. Spetzler1,
- L. Fischer1,
- E.-G. Achilles1,
- J. Li1,
- S. Scheidat2,
- F. Thaiss2,
- B. Nashan1 and
- M. Koch1,*
Article first published online: 3 FEB 2016
DOI: 10.1111/tid.12494
© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Additional Information
How to Cite
J. Radtke, N. Dietze, V.N. Spetzler, L. Fischer, E.-G. Achilles, J. Li, S. Scheidat, F. Thaiss, B. Nashan, M. Koch. Fewer cytomegalovirus complications after kidney transplantation by de novo use of mTOR inhibitors in comparison to mycophenolic acid. Transpl Infect Dis 2016: 18: 79–88. All rights reserved
Author Information
- 1
Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf UKE, University Transplantation-Center UTC, Hamburg, Germany
- 2
Department of Internal Medicine III, University Medical Center Hamburg-Eppendorf UKE, University Transplantation-Center UTC, Hamburg, Germany
- †
These authors contributed equally to this article.
* Correspondence to:
Prof. Martina Koch, Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
Tel: +(0)-40-7410-56137
Fax: + (0)-40-7410-40051
E-mail: martina.koch@uke.de
Publication History
- Issue published online: 15 FEB 2016
- Article first published online: 3 FEB 2016
- Accepted manuscript online: 27 DEC 2015 10:41PM EST
- Manuscript Accepted: 17 OCT 2015
- Manuscript Revised: 10 OCT 2015
- Manuscript Revised: 11 SEP 2015
- Manuscript Received: 29 JUL 2015
Funded by
- Novartis
- Astellas
- Abstract
- Article
- References
- Cited By
Keywords:
- cytomegalovirus;
- CMV prophylaxis;
- kidney transplantation;
- immunosuppression;
- everolimus;
- mTOR inhibitors
Abstract
Background
Cytomegalovirus (CMV) is a risk factor for patient and graft survival after kidney transplantation.
Methods
We retrospectively analyzed risk factors for CMV infection in 348 patients who received a kidney transplant donated after brain death (n = 232) or by living donation (n = 116) between 2008 and 2013. Of the 348 patients analyzed, 91 received a mammalian target of rapamycin inhibitor (mTORi)-based immunosuppressive regimen. A total of 266 patients were treated with standard immunosuppression (Group 1) consisting of basiliximab induction, calcineurin inhibitor (CNI), and either mycophenolic acid (MPA, n = 219) or everolimus (EVE) (n = 47). We also included 82 patients who received more intense immunosuppression (Group 2) with lymphocyte depletion, CNI, plus either MPA (n = 38) or EVE (n = 44). Only patients in the high-risk constellation received CMV prophylaxis in Group 1, while all patients in Group 2 received prophylaxis for 6 month.
Results
The overall rate of CMV infections was low with 10.1% in all patients. Despite the different prophylaxis strategies applied, no difference was seen in CMV infections between Group 1 (10.9%) and Group 2 (13.6%). A multivariate analysis revealed that patients on EVE had fewer CMV complications compared with patients on MPA (P = 0.013, odds ratio [OR] 4.8, confidence interval [CI] 1.4–16.5). Donor and recipient age >65 years was an independent risk factor (P = 0.002, OR 3.2, CI 1.5–6.7) for CMV infections. Patients with CMV infections had significantly worse graft function after 2 years (P = 0.001).
Conclusion
CMV is a significant risk factor for long-term graft outcome. Patients treated with EVE developed fewer CMV complications compared to patients on MPA. The use of mTORi is useful in patients at high risk of developing CMV infections.
More content like this
http://onlinelibrary.wiley.com/doi/10.1111/tid.12494/abstract?campaign=woletoc
Sent with Reeder
Alberto Reino Buelvas