Antiphospholipase A2 Receptor Antibody Levels Predict the Risk of Posttransplantation Recurrence of Membranous Nephropathy

Transplantation - Current Issue Antiphospholipase A2 Receptor Antibody Levels Predict the Risk of Posttransplantation Recurrence of Membranous Nephropathy

Background: Secretory phospholipase A2 receptor (PLA2R) is the target antigen of the auto-antibodies produced in most (∼70%) patients with primary membranous nephropathy (pMN). The applicability of anti-PLA2R1 antibody monitoring for the prediction of MN recurrence in kidney transplant recipients still is a matter of debate. Methods: We sought to characterize the presence and concentration of anti-PLA2R antibodies by enzyme-linked immunosorbent assay (ELISA) in a cohort of 21 patients with pMN before and after transplantation to evaluate whether anti-PLA2R concentrations could predict pMN recurrence. Results: The presence of pMN recurrence was significantly correlated with the existence of a positive ELISA assay at graft biopsy or with high level of anti-PLA2R1 activity before transplantation (P = 0.03). In the receiver operating characteristic analysis, anti-PLA2R levels (cut-off of 45 U/mL) during the pretransplantation period accurately predicted pMN recurrence, with a sensitivity of 85.3%, specificity of 85.1%, negative predictive value of 92%, and an area under the curve of 90.8%. This finding supports the hypothesis that anti-PLA2R cause pMN recurrence in humans and indicates the need to prove in an experimental model. Furthermore, 6 of 7 patients with recurrence were carriers of HLA DQA1* 05:01/05 and DQB1* 02:01, confirming these DQ alleles as those associated with higher anti-PLA2R levels. Conclusions: This study is the first to demonstrate pretransplantation circulating anti-PLA2R antibodies in a cohort of renal transplant recipients who prospectively developed recurrent disease. Currently, anti-PLA2R levels measured by ELISA may be a rational tool to establish the risk of MN recurrence in renal allograft recipients.


http://journals.lww.com/transplantjournal/Fulltext/2015/08000/Antiphospholipase_A2_Receptor_Antibody_Levels.30.aspx

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Alberto Reino Buelvas

Changing Kidney Allograft Histology Early Posttransplant: Prognostic Implications of 1-Year Protocol Biopsies

AJT - Early Changing Kidney Allograft Histology Early Posttransplant: Prognostic Implications of 1-Year Protocol Biopsies

Allograft histology 1 year posttransplant is an independent correlate to long-term death-censored graft survival. We assessed prognostic implications of changes in histology first 2 years posttransplant in 938 first kidney recipients, transplanted 1999–2010, followed for 93.4 ± 37.7 months. Compared to implantation biopsies, histology changed posttransplant showing at 1 year that 72.6% of grafts had minor abnormalities (favorable histology), 20.2% unfavorable histology, and 7.2% glomerulonephritis. Compared to favorable, graft survival was reduced in recipients with unfavorable histology (hazards ratio [HR] = 4.79 [3.27–7.00], p < 0.0001) or glomerulonephritis (HR = 5.91 [3.17–11.0], p < 0.0001). Compared to unfavorable, in grafts with favorable histology, failure was most commonly due to death (42% vs. 70%, p < 0.0001) and less commonly due to alloimmune causes (27% vs. 10%, p < 0.0001). In 80% of cases, favorable histology persisted at 2 years. However, de novo 2-year unfavorable histology (15.3%) or glomerulonephritis (4.7%) related to reduced survival. The proportion of favorable grafts increased during this period (odds ratio = 0.920 [0.871–0.972], p = 0.003, per year) related to fewer DGF, rejections, polyoma-associated nephropathy (PVAN), and better function. Graft survival also improved (HR = 0.718 [0.550–0.937], p = 0.015) related to better histology and function. Evolution of graft histologic early posttransplant relate to long-term survival. Avoiding risk factors associated with unfavorable histology relates to improved histology and graft survival.

http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fajt.13423

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Alberto Reino Buelvas

Coronary Events in Obese Hemodialysis Patients Before and After Renal Transplantation [feedly]

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Coronary Events in Obese Hemodialysis Patients Before and After Renal Transplantation
// Clinical Transplantation

Abstract

We examined the impact of obesity (BMI ≥ 30 kg/m², n=357) on prognosis in 1696 hemodialysis (HD) patients before and after renal transplantation (TX). End-points were coronary events, composite CV events, and death.

Obese HD patients were older (55.9 ± 9.2 v 54.2 ± 11), had more diabetes (54% v 40%), dyslipidemia (49% v 30%), altered myocardial scan (38% v 31%), MI (16% v 10%), coronary intervention (11% v 7%), higher total-cholesterol (186 ± 52 v 169 ± 47), and triglycerides (219 ± 167 v 144 ± 91). Obese undergoing TX had more dyslipidemia (46% v 31%), angina (23% v 14%), MI (18% v 5%), increased total-cholesterol (185 ± 56 v 172 ± 48) and triglycerides (237 ± 190 v 149 ± 100). Obesity was independently associated with coronary events (Log-rank=0.008, HR 2.55 %CI 1.27-5.11) and death (Log-rank 0.046, HR 1.52, % CI 1.007 – 2.30) in TX but not in HD.

Obese HD patients had more risk factors and ischemic heart disease but these characteristics did not interfere with prognosis. In TX patients obesity predict coronary events and death.

This article is protected by copyright. All rights reserved.

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Neoplastic and Non-Neoplastic Complications of Solid Organ Transplantation in Patients with Preexisting Monoclonal Gammopathy of Undetermined Significance (MGUS)

Clinical Transplantation Neoplastic and Non-Neoplastic Complications of Solid Organ Transplantation in Patients with Preexisting Monoclonal Gammopathy of Undetermined Significance (MGUS)

Abstract

Monoclonal gammopathy of undetermined significance (MGUS) occurs in 3-7% of the elderly population, with higher prevalence in renal failure patients, and is associated with a 25-fold increased lifetime risk for plasma cell myeloma (PCM), also known as multiple myeloma. Using the California State Inpatient, Emergency Department, and Ambulatory Surgery Databases components of the Healthcare Cost and Utilization Project (HCUP), we sought to determine if patients with MGUS who undergo solid organ allograft (n=22,062) are at increased adjusted relative risk (aRR) for hematological malignancy and other complications. Among solid organ transplant patients, patients with preexisting MGUS had higher aRR of PCM (aRR 19.46; 95%CI 7.05, 53.73; p<0.001), venous thromboembolic events (aRR 1.66; 95%CI 1.15, 2.41; p=0.007), and infection (aRR 1.24; 95%CI 1.06, 1.45; p=0.007). However, when comparing MGUS patients with and without solid organ transplant, there was decreased aRR for PCM with transplant (aRR 0.34; 95%CI 0.13, 0.88; p=0.027), and increased venous thromboembolic events (aRR 2.33; 95%CI 1.58, 3.44; p<0.001) and infectious risks, (aRR 1.44; 95%CI 1.23, 1.70; p<0.001). While MGUS increased the risk of PCM overall following solid organ transplantation, there was lower risk of PCM development compared to MGUS patients who did not receive a transplant. MGUS should not preclude solid organ transplant.

This article is protected by copyright. All rights reserved.

http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fctr.12595

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Alberto Reino Buelvas 

Médico Internista Nefrólogo

You Are What You Eat: Metabolites of Gut Microbiota Provide Novel Insights into Diagnosis and Development of Chronic Kidney Disease

Transplantation - Most Popular Articles You Are What You Eat: Metabolites of Gut Microbiota Provide Novel Insights into Diagnosis and Development of Chronic Kidney Disease

No abstract available


http://journals.lww.com/transplantjournal/Fulltext/2015/07000/You_Are_What_You_Eat___Metabolites_of_Gut.4.aspx

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Alberto Reino Buelvas 

Médico Internista Nefrólogo

Atlas of Renal Pathology: Minimal Change Disease

American Journal of Kidney Diseases Atlas of Renal Pathology: Minimal Change Disease

Minimal change disease (MCD) is characterized by nephrotic syndrome. It is the most common cause of nephrotic syndrome in children aged 1 to 7 years and remains a cause of nephrotic syndrome in adults.


http://www.ajkd.org/article/S0272-6386(15)00634-4/abstract?rss=yes

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Alberto Reino Buelvas 

Médico Internista Nefrólogo