Outcome and Cost Analysis of Induction Immunosuppression With IL2Mab or ATG in DCD Kidney Transplants

Transplantation - Published Ahead-of-Print Outcome and Cost Analysis of Induction Immunosuppression With IL2Mab or ATG in DCD Kidney Transplants

Background: Kidney transplantation from DCD now represents a significant part of the overall transplant activity in the UK. Outcome of different induction immunosuppression regimes and related cost benefit analysis has been reported by very few studies. This is a single centre study on frequency-matched patients who received a DCD kidney transplant between August 2007 and August 2009. Methods: Data on 45 patients divided in 2 groups were collected prospectively and analyzed retrospectively. Group A (24 patients) received IL2Mab and Group B (21 patients) ATG as induction immunosuppression. Patient and graft survival were similar in both groups. Results: In the ATG-induced group, there was a significant lower rate of DGF, BPAR, and infections requiring readmission. A cost analysis was performed including all immunosuppression-related costs, and it has shown remarkable savings in the ATG-induced group. Conclusion: Considering that the number of DCD kidney transplants is destined to rise in the UK, we believe that ATG is a valid option to continue optimizing outcomes of DCD kidney transplant. In our experience, ATG proved to be safe, effective, and contributed to significant cost savings. (C) 2014 by Lippincott Williams & Wilkins


http://pdfs.journals.lww.com/transplantjournal/9000/00000/Outcome_and_Cost_Analysis_of_Induction.98285.pdf

Sent with Reeder

Enviado desde mi iPhone

Survival Trends in ESRD Patients Compared With the General Population in the United States

American Journal of Kidney Diseases Survival Trends in ESRD Patients Compared With the General Population in the United States

Background: Health care resources expended on patients with end-stage renal disease (ESRD) have increased extensively, with uncertain changes in outcomes. In this study, we examined survival trends in the United States in patients with ESRD receiving renal replacement therapy with long-term dialysis or transplantation relative to the general population.Study Design: Secondary analysis of records from the US Renal Data System.Setting & Participants: American adults receiving renal replacement therapy in 1977, 1987, 1997, and 2007.Predictor: Year.Outcome: 1-year survival.Measurements: Abridged period life tables were created for each cross-sectional patient group and were compared with general US population life tables to measure relative survival, calculated as differences in average survival between the general US and the ESRD populations.Results: From 1977 to 2007, ESRD patient groups became significantly older (mean age increased from 47 to 58 years) and sicker (ESRD due to diabetes increased from 9.1% to 38.2%; patients with a high death risk increased from 36.8% to 50.7%). Unadjusted age-specific survival improved (for 50-year-olds, average life expectancy increased 8% from 7.3 years in 1977 to 7.9 years in 2007), but age-specific survival increased more extensively in the general US population (from 27.5 years in 1977 to 30.9 years in 2007; 12% improvement). Accounting for this, age-specific relative survival in patients with ESRD decreased (for 50-year-olds, 20.2 life-years lost in 1977 vs 23.0 life-years lost in 2007).Limitations: Our analysis controlled for neither patient comorbid conditions nor initial glomerular filtration rate at the start of renal replacement therapy.Conclusions: Over the past 4 decades, age-specific survival in patients with ESRD has improved, but has not kept pace with that of the general US population. To be complete, future survival studies in patients with ESRD should focus on both temporal changes in survival within this group and changes relative to the general population.


http://www.ajkd.org/article/S0272-6386(13)01227-4/abstract?rss=yes

Sent with Reeder

Enviado desde mi iPhone

Alendronate as an Effective Treatment for Bone Loss and Vascular Calcification in Kidney Transplant Recipients

Journal of Transplantation - XXX Alendronate as an Effective Treatment for Bone Loss and Vascular Calcification in Kidney Transplant Recipients

Kidney transplant recipients develop secondary osteoporosis induced by immunosuppressive medication, with a high risk of fracture, and abdominal aortic calcification (AC) is a known predictor of cardiovascular mortality. In this study of 12 stable kidney recipients, we estimated the preventive effect of bisphosphonate treatment on bone loss and progression of AC. We randomly divided the subjects into a treatment group with alendronate (group A: 5 subjects) and a control group (group C: 7 subjects). Group A patients received 35 mg/week of alendronate over 24 months, while group C patients were not administered with any bisphosphonates. Two major endpoints were established: (1) the time-dependent change in bone mineral density (BMD) estimated with DEXA and (2) progression of abdominal AC, calculated twice as an index (ACI) using computed tomography data. Over the 2-year study period, group A patients showed significantly increased BMD of 1.86 ± 0.85% ( versus baseline), and almost complete inhibition of ACI progression (38.2 ± 24.2% to 39.6 ± 24.3%), but group C patients showed a decrease in BMD decline with bone loss and progression of ACI (32.8 ± 25.0% to 37.8 ± 29.2%, ). In conclusion, alendronate therapy was an effective treatment in kidney transplant recipients for secondary osteoporosis and vascular calcification as ectopic calcification. This clinical trial is registered with number JMA-IIA00155 of JMACCT CTR.


http://www.hindawi.com/journals/jtrans/2014/269613/

Sent with Reeder

Enviado desde mi iPhone

The effect of magnesium supplements on early post-transplantation glucose metabolism: a randomised controlled trial-R1

Transplant International The effect of magnesium supplements on early post-transplantation glucose metabolism: a randomised controlled trial-R1

Abstract

Posttransplantation hypomagnesemia is common and predicts diabetes. Magnesium improves glycemic control in diabetics and insulin sensitivity in insulin resistant subjects.

We aimed to assess the effectiveness of oral magnesium for improving glycemic control and insulin sensitivity at three months posttransplantation.

We conducted a single-centre, open-label, randomised parallel group study. We included adults with serum magnesium < 1.7 mg/dL within two weeks after kidney transplantation. We randomized participants to 450 mg magnesium oxide up to three times daily or no treatment. The primary endpoint was the mean difference in fasting glycemia. Secondary endpoints were the mean difference in AUC of glucose during an oral glucose tolerance test and insulin resistance measured by HOMA-IR. Analyses were on intention-to-treat basis.

In patients randomised to magnesium oxide (N=27) versus no treatment (N=27), fasting glycemia on average was 11.5 mg/dL lower (95% CI 1.7 to 21.3; p=0.02). There was no difference between the two groups neither for two hour AUC where the mean value was 1164mg/dL/min (95%CI -1884 to 4284; p=0.45) lower in the treatment group nor for HOMA-IR.

Magnesium supplements modestly improved fasting glycemia without effect on insulin resistance. Higher baseline glycemia among patients in the control group may have driven the positive outcome.(ClinicalTrials.gov number: NCT01889576).

This article is protected by copyright. All rights reserved.

http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Ftri.12287

Sent with Reeder

Enviado desde mi iPhone

Cardiovascular Death in Kidney Recipients Treated With Renin–Angiotensin System Blockers

Transplantation - Most Popular Articles Cardiovascular Death in Kidney Recipients Treated With Renin–Angiotensin System Blockers

BackgroundAngiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) are widely prescribed after kidney transplantation, but evidence for an improvement in outcomes is mixed. A recent trial demonstrated a significantly lower incidence of major cardiovascular events in ACEI-treated recipients. MethodsCollaborative Transplant Study data on cardiovascular death during years 2 to 10 after kidney transplantation in patients with a functioning graft were analyzed according to whether ACEI/ARB or other antihypertensive therapy (excluding diuretics) was administered at year 1. ResultsOf 39,251 transplants analyzed, 15,250 (38.9%) received ACEI/ARB and 24,001 (61.1%) received other antihypertensive therapy at year 1 after transplantation. The mean duration of follow-up was 5.8 years. During years 2 to 10 after transplantation, cardiovascular death occurred in 918 patients (cumulative incidence=4.7%) with a functioning graft. The rate of cardiovascular death was similar in patients who received ACEI/ARB therapy or other antihypertensive treatment overall and in subpopulations of patients who were considered by the transplant center to be at an increased cardiovascular risk, had no pretransplant risk factors, were aged 60 years and older, were treated for diabetes at year 1, or had serum creatinine of 130 μmol/L or higher at year 1. Multivariable Cox regression analysis confirmed that treatment with ACEI/ARB did not confer a beneficial effect beyond that conferred by other antihypertensive treatments on the cumulative incidence of cardiovascular death during years 2 to 10 (hazard ratio=1.1, P=0.24). ConclusionsThis large-scale retrospective analysis of prospectively collected data shows that the rate of cardiovascular death in kidney transplant recipients receiving ACEI/ARB or other antihypertensive medications is virtually identical.


http://journals.lww.com/transplantjournal/Fulltext/2014/02150/Cardiovascular_Death_in_Kidney_Recipients_Treated.12.aspx

Sent with Reeder

Enviado desde mi iPhone

Peritoneal dialysis-related peritonitis - PubMed Mobile

http://www.ncbi.nlm.nih.gov/m/pubmed/24336639/


Enviado desde mi iPhone