bluuebunny/crossref_metadata_2025 huggingface dataset:
MO898: Comparison of Quality of Life and Bio-Psychosocial Burden in Family Caregivers Between Dialysis Patients and Kidney Transplant Recipients
Authors: Vovlianou Stavroula , Koutlas Vasileios , Papoulidou Fani , Tatsis Vasileios , Milionis Haralampos , Skapinakis Petros , Ntounousi Evangelia
Published: May 2022

BACKGROUND AND AIMS

Chronic kidney disease (CKD) is considered as a high-stress disease for patients, because of severe morbidity, chronicity and its life-long treatment often requiring dedicated family care. Caregivers’ burden is considered a multidimensional bio-psychosocial reaction of great importance both for caregivers’ and CKD patients’ Quality of Life (QoL). Kidney transplantation (KT) has been shown to improve patient's QoL, however the effect of KT on family's burden in comparison with dialysis has not been sufficiently studied. Aim of this cross-sectional, multicentre, observational study was to estimate and compare the QoL and burden between family caregivers of dialysis patients versus KT recipients (KTRs).

METHOD

We included 138 caregivers of dialysis patients and 33 of KTRs. We assessed caregivers’ QoL with SF-36 questionnaire and bio-psychosocial burden with Zarit Burden Interview scale (ZBI).

RESULTS

Mean age of caregivers did not differ between the two groups (56y dialysis versus 58y KTRs). The majority of KTRs (57.6%) and dialysis patients’ caregivers (68.1%) were women of whom 73% and 52% were spouses, respectively. Educational level and financial status did not differ between the two groups of caregivers. The results of the SF-36 and ZBI are comparatively presented in the Table 1.

Dialysis patients’ caregivers had worse QoL compared with KTRs caregivers. There was a statistically significant difference in general health, bodily pain and social functioning role among KTRs versus dialysis caregivers. Dialysis caregivers showed a significantly higher burden in 3 sub-dimensions of ZBI (personal strain, role strain, relational deprivation) compared with KTRs caregivers. Moreover, the burden of KTRs caregivers found to be inverse correlated with educational level (P = 0.01), while in dialysis caregivers, older age, female gender and low income were directly associated with burden (P < 0.001, P = 0.019 and P = 0.005, respectively).

CONCLUSION

The caregivers of dialysis patients showed worse QoL and significantly higher burden compared with KTRs caregivers. Further studies of larger size will probably shed light to the potential benefits of ΚΤ in patients’ caregivers and families. Currently, implementation of programs for psychological support in high burdened caregivers of kidney disease patients’ could be of help.
MO913: Exploring Factors Influencing Intradialytic Hypotension Using Deep Learning
Authors: Kawasaki Michihiro , Suzuki Satoshi
Published: May 2022

BACKGROUND AND AIMS

Intradialytic hypotension (IDH) is an independent risk factor affecting the life prognosis in patients undergoing haemodialysis. Various studies using statistical methods have been conducted to identify the factors that cause IDH, but the factors and the interactions among the factors have not yet been clearly elucidated. In this study, we used a neural network model (deep learning) using factors that can be measured in real time as input parameters to identify factors strongly influencing the risk of IDH, with the ultimate goal of predicting IHD using only factors that can be measured in real time.

METHOD

A total of 25 parameters obtained during dialysis treatment in 208 patients were selected as the input parameters for deep learning; the 25 parameters included 18 items selected from the patient background and vital data (including the dialysis time, treatment mode, systolic blood pressure, diastolic blood pressure and mean blood pressure), and seven items calculated from the above data (including the difference between the actual and planned dialysis times and the difference in body weight before and after dialysis). As the evaluation indices, we used F-measure, which is calculated from precision and recall, and attention weight, which indicates the % influence of an input parameter on deep learning. We compared the F-measure and attention.

RESULTS

In the learning using all the input parameters, the correct response rate was 69.6%, the recall rate was 64.2%, the fit rate was 41.7% and the F-measure was 41.7%. The highest value of attention weight among the input parameters was 21.1% for the occurrence of IDH in the most recent treatment. Even in the pattern in which the highest F-measure was found, the attention weight of the occurrence of IDH in the most recent treatment was 21.9%. In all patterns, the top three attention-weighted items were the occurrence of IDH in the most recent treatment, the systolic blood pressure and the body weight before dialysis. The items with high values of the F-measure and high attention weight were considered essential factors for the prediction model.

CONCLUSION

By using deep learning to compare the accuracy of prediction of various input patterns, the occurrence of IDH in the most recent treatment, systolic blood pressure and body weight before dialysis were identified as the factors most strongly influencing the risk of IDH.
MO925: Psychological Wellbeing in Haemodialysis Patients: Comparing Perspectives From Patients, Caregivers and Healthcare Professionals––The Goodrenal Project
Authors: Mesa-Gresa Patricia , Elena Marin Alexandra , Avesani Carla , Clyne Naomi , Garcia-Testal Alicia , Kouidi Evangelia , Van Craenenbroeck Amaryllis , Antonio Lozano-Quilis José , Lindholm Bengt , Yang Kevin , Kougioumtzidou Ourania , Garcia-Maset Rafael , Moscoso Paula , Moura Reboredo Maycon , Lauer Andreas , Segura Eva
Published: May 2022

BACKGROUND AND AIMS

The start of dialysis therapy can contribute to the development of depression, stress and anxiety, which, in turn, has an impact on the patient´s quality of life, the disease process and the associated social and health care costs. This underlines the importance of studies that analyse the psychological profiles of patients on maintenance dialysis to establish relationships between risk factors, prevention steps and intervention strategies aimed at improving their quality of life. Therefore, we explored the perceptions regarding the patient's psychological wellbeing, seen from three different perspectives: patients’ own, their caregivers’ and that of their healthcare professionals (HCPs).

METHOD

This study is part of the GoodRENAL Project, which is funded by the European Community Erasmus + and involves four countries: Belgium, Greece, Spain and Sweden. Exploratory questionnaires regarding patients’ psychological wellbeing were developed by the team, and responses were obtained from three groups of stakeholders: 38 patients, who were randomly allocated to this study from the first dialysis shift of the week (mean age 58 ± 0.51 years; 50% women); 34 caregivers (mean age 54 ± 13 years; 80% women); and 39 healthcare professionals (HCPs mean age 42 ± 10 years; 79% women).

The exploratory questionnaires comprised different parts, exploring the psychological state of patients through closed questions, open questions and questions about barriers, needs and facilitators regarding psychological wellbeing. The patients’ and caregivers’ questionnaires had 10 items scored from 1 (‘never’) to 5 (‘almost all the time’). The HCPs questionnaire included 10 items rated as 1 (‘totally disagree’) to 5 (‘totally agree’).

RESULTS

To analyse the descriptive data, the response frequency was grouped into items based on the level of agreement or the frequency of the occurrence (almost all the time and all the time). The table below shows answers received from patients, caregivers and HCPs.

CONCLUSION

Patients consistently reported a much more positive subjective perception of their psychological state, compared with that assumed by HCPs, while the perceived perception of patients’ states reported by their caregivers was in general closer to that reported by the patients. The extent by which patients’ positive responses are related to adaptations such as social desirability, distorted subjective perception, minimization or normalization of symptomatology should be explored in further studies.
MO929: Oxidative Stress in Hemodialysis Patients
Authors: Chiodan Milena , Bob Flaviu , Sircuta Alexandru , Maralescu Felix-Mihai , Petrica Ligia , Schiller Adalbert , Schiller Oana-Marina
Published: May 2022

BACKGROUND AND AIMS

It is known that chronic kidney disease (CKD) is associated with complications such as anaemia, mineral bone disorders (CKD-MBD) or diselectrolytemia.Therefore, the diet of renal patients is restricted in different nutrients such as potassium or phosphorus, a fact that could potentially increase oxidative stress [1]. We investigated the relationship between an oxidative damage marker (malondialdehyde-MDA) on the one hand, and plasma antioxidant status (glutathione peroxidase-GPx) activity on the other hand with the nutritional status and with complications associated with CKD (anaemia, CKD-MBD).

METHOD

We conducted a single-centre cross-sectional study that included 58 CKD G5D patients (mean age of 60.39 ± 11.73 years; 33 males, 25 females; mean haemodialysis vintage of 6.43 ± 4.89 years). All patients have been assessed regarding dialysis status (medical history). We performed analysis before the dialysis session using standard methods blood biochemistry, complete blood count and using spectrophotometry (HPLC)-malondialdehyde and glutathione peroxidase.

RESULTS

The studied patients’ mean malondialdehyde was 1.41 ± 0.42 mcmol/L, while mean glutathione peroxidase was 58.65 ± 12.15 U/g Hg. The oxidative stress markers did not show any statistically significant correlation with age, gender, dialysis vintage or with predialysis urea and bicarbonate. Patients with a BMI > 30 kg/sqm (21 versus 37 patients) showed a significantly higher level of MDA 1.57 ± 0.51 mcmol/L versus 1.31 ± 0.33 mcmol/L, P = 0.02. We have also found a negative statistically significant correlation between MDA level and serum K (r = –0.29, P = 0.02) and serum phosphorus (r = –0.29, P = 0.03). Patients with predialysis K of higher then 5.5 mEq/L had a statistically significant lower MDA (1.29 ± 0.4 mcmol/L versus 1.54 ± 0.4 mcmol/L, P = 0.025) and a non-significant higher GPx (59.0 ± 12.58 U/g Hg versus 58.2 ± 11.87 U/g Hg, P = 0.8). We found a negative statistically significant correlation of the MDA level with haemoglobin (r = –0.39, P = 0.002) and with haematocrit (r = –0.35, P = 0.006). No statistically significant correlation of the plasma antioxidant GPx with the studied parameters of anaemia and CKD-MBD has been found.

CONCLUSION

In our study, we found that increased oxidative stress (expressed through the malondialdehyde level) is associated with obesity and more severe anaemia. The indirect relationship found with serum K and phosphorus could indicate the risk of oxidative stress, and therefore it could be useful to take into account the dietary antioxidants when recommending low potassium and low phosphorus diet.
MO934: Correlation Between Sarcopenia and Oral Health in Patients on Chronic Haemodialysis
Authors: Kovačević Petra , Altabas Karmela , Klarić Iva , Altabas Velimir , Kovačević Karla
Published: May 2022

BACKGROUND AND AIMS

Patients on haemodialysis have signs of chronic systemic inflammation and a higher incidence of sarcopenia. Poor oral health can also trigger systemic inflammation and thus affect sarcopenia. The aim of the study was to examine oral health and the presence of sarcopenia in patients on chronic haemodialysis and to determine whether there is a correlation between them.

METHOD

This study included 100 patients on chronic haemodialysis at the Clinical University Hospital `Sestre Milosrdnice’ in Zagreb, who underwent oral status, routine laboratory measurements, bioimpedance analysis of body composition and measurement of hand grip strength.

RESULTS

Of the total number of participants (N = 100), 28.0% had sarcopenia. The majority of participants were male (61.0%). Poor oral hygiene was recorded in as many as 39.0% of participants, while 46.0% had their last visit to the dentist several years ago. It is interesting to note that 64.3% of patients with confirmed sarcopenia were last examined by a dentist several years ago, while in those without sarcopenia the proportion was 38.9%. The median total number of erupted teeth in all patients was 12.0 (7.0–23.0). A positive correlation of the total number of erupted teeth and erupted premolars with sarcopenia was confirmed.

CRP was significantly elevated in patients with sarcopenia (P = 0.035), in contrast to those without sarcopenia (3.45 versus 2.70). A total of 51% of patients had increased calculus formation, 49% had oral candidiasis and 38% periodontitis, with as many as 24% of petechiae on the mucosa and 22% of dental caries. A total of 8% of patients had an ammonia breath and 4% had a metallic taste in their mouth. Of all the examined signs and symptoms of oral health, significant differences were observed only in the incidence of dental caries, which was significantly more common in the group that did not have sarcopenia (P = 0.031). However, it should be noted that in patients with sarcopenia, total edentulousness was present in 17.9% as opposed to 9.7% in patients who did not have sarcopenia, i.e. 12% of the total number of participants had total edentulousness. Moreover, in 21% of patients with sarcopenia, a complete denture was present in combination with a partial denture, while that was the case in only 9.7% of patients without sarcopenia.

CONCLUSION

This study confirmed poorer oral health in haemodialysis patients who had sarcopenia. Therefore, intervention studies are needed to improve oral health of patients on HD, which could possibly influence the incidence and severity of sarcopenia.
MO936: Oral Nutritional Supplementation Support in HAEmodialysis Patients: Impact on Nutritional Rehabilitation
Authors: Sá Martins Vitor , Adragao Teresa , Pinto Iola , Aguiar Leila , Dias Catarina , Figueiredo Rita , Lourenço Pedro , Pascoal Tania , Pereira Juliana , Pinheiro Tatiana , Ramião Inês , Velez Brígida , Luisa Papoila Ana , Borges Nuno , Calhau Conceição , Garrido Jesus , Macário Fernando
Published: May 2022

BACKGROUND AND AIMS

Nutritional status management and rehabilitation are significant concern treating maintenance haemodialysis (HD) patients. Oral nutritional supplements are essential to complement insufficient dietary intake, namely of energy and protein, and to rehabilitate a patient's nutritional status. Therefore, the objective of this preliminary study was to assess the impact of oral nutritional supplementation (ONS) prescription patterns on patients’ nutritional status.

METHOD

We did a cross-sectional analysis of HD patients’ first oral nutritional supplementation with commercial formulas between October 2018 and March 2020 in 25 outpatient HD clinics. The registered nutritionist dietitian decided to initiate, choosing the type of supplement and dose as part of a routine protocol of a comprehensive nutritional intervention and assessment. We assessed albumin, normalized protein catabolic rate, potassium and phosphate at the beginning (t = 0) and end (t = 1) of the supplementation period to understand the nutritional impact. We also estimated the daily proportion of energy, and protein contribution of each oral nutritional supplementation implemented, categorizing in cut-offs of 100 kcal and 5 g of protein.

RESULTS

We analyzed 398 patients, 217 (54.5%) males, 165 (41.5%) diabetic, with a median age of 79 years. Concerning feeding support status, 24.6% were autonomous, 54.8% had family care and 20.6% were institutionalized.

  Globally, the ONS impact was significant in the increment of albumin (P < 0.001) and nPCR (P = 0.002), although nPCR was not significant in the categorized group providing <5 g of protein/day (Table 2). The increment of K was also significant (P < 0.001) but not clinically relevant in increasing the risk of hyperkalaemia. There was no significant difference in P (P = 0.086).

CONCLUSION

ONS significantly impacted nutritional rehabilitation, with an albumin and nPCR increase (except for the categorized group of < 5 g protein/day). Although the increment of potassium was statistically significant, it was not clinically relevant in increasing the risk of hyperkalaemia. Further analyses are needed to understand the best targets for the energy and protein contribution of ONS.
MO952: Risk Factors of Post Transplantation Diabetes Mellitus After Kidney Transplantation
Authors: Carlsen Rasmus , Åsberg Anders , Birkeland Kåre , Svensson My , Bressendorff Iain , Gulseth Hanne , Midtvedt Karsten , G. Jenssen Trond
Published: May 2022

BACKGROUND AND AIMS

Between 10 and 30% of kidney transplant recipients develop post-transplant diabetes mellitus (PTDM). PTDM is a major risk factor for cardiovascular events and death in kidney transplant recipients. At our center prednisolone doses are tapered to a low maintenance dose eight weeks after transplantation. In a retrospective single-center cohort study, we investigated risk factors for development of de novo PTDM from 8 weeks after kidney transplantation.

METHOD

Inclusion criteria were kidney transplantation, age > 18 years, no known diabetes prior to, or at the 8-week control after transplantation and with at least one year of follow up. At the 8-week control an oral glucose tolerance test (OGTT) was performed for PTDM diagnosis. De novo PTDM was defined as fasting glucose ≥7 mmol/L, 2-h glucose ≥11.1 mmol/L at OGTT performed routinely at the one-year visit, or at least two registered dispensations of glucose lowering medication in the Norwegian Prescription Database (NorPD).

RESULTS

In total 632 patients (median age 53 years, 62% males) with a median follow-up of 2.7 years [1–4] were included of which 54 (8.5%) developed de novo PTDM (31 diagnosed by the OGTT at 1 year and 23 identified by glucose lowering dispensation). De novo PTDM patients were older than non-PTDM patients at transplantation (median age 63 versus 52 years), were more often males (81% versus 61%), and had higher fasting blood glucose (mean 5.8 versus 5.3 mmol/L), 2-h glucose (mean 8.3 versus 6.6 mmol/L) and HbA1c (median 38 versus 32 mmol/mol) at the 8-week post-transplantation control.

In a multiple logistic regression analysis, significant associated factors of PTDM were age (years), OR 1.04 (CI 95%: 1.01;1.06), triglycerides (mmol/L), OR 1.42 (CI 95%: 1.10;1.81) and tacrolimus (µg/L) OR 1.23 (CI 95%: 1.03;1.46) concentrations measured at the one-year control visits, and CMV serostatus (positive donor to negative recipient), OR 2.12 (CI 95%: 1.04;4.28). Plasma magnesium, gender, BMI and plasma creatinine were not associated with development of PTDM.

CONCLUSION

Development of de novo PTDM from 8 weeks after kidney transplantation was associated with increased age, higher triglycerides, higher tacrolimus concentrations and D+/R- CMV-serostatus.
MO963: Vitamin D Status and Sars-Cov-2 Infection in A Cohort of Renal Transplanted Patients
Authors: Regalia Anna , Maria Alfieri Carlo , Rosaria Campise Maria , Cresseri Donata , Teresa Gandolfo Maria , Castellano Giuseppe , Messa Piergiorgio
Published: May 2022

BACKGROUND AND AIMS

Immunomodulatory and anti-inflammatory properties have been hypothesized for native vitamin D (nVD). Very little is reported about nVD and risk of Sars-CoV-2 infection (COV) in renal transplant (RTx). In a cohort of renal transplanted patients (RTxp) we retrospectively evaluated: (i) nVD status in patients with (COV+) and without (COV-) COV infection; (ii) the impact of nVD status on severity of COV.

METHOD

The study includes 61 COV + in whom nVD status was available in the year before the infection, and 122 COV- matched 1:2 for age (53[45–64]years), gender (M = 60.7%), RTx vintage (7[2–15] years), presence of diabetes (18%), arterial hypertension (85%) and cardiac symptomatic disease (3%). Renal function, 24-h proteinuria and mineral metabolism (MM) parameters were evaluated at 1, 6 and 12 months before COV whereas nVD status was considered as the mean 25-OH-VD levels at the same timepoints. Severity of COV was based on the need for hospitalization (HOSP+: 27/61, 44.3%) and death (D+: 6/61, 9.8%).

RESULTS

(i) nVD levels were significantly lower in COV + than in COV- (19[12–26] ng/mL and 23[16–30] ng/mL, respectively, P = 0.01). No differences in the other biochemical parameters were found. The COV discriminative power of nVD status was evaluated by ROC curve (AUC 0.61, 95% CI: 0.54–0.68, P = 0.01), with a value of 25-OHVD 23.9 ng/mL showing the best discriminative power (sensibility 72%, specificity 47%). (ii) nVD levels showed a trend towards lower values in HOSP + COV + than HOSP-COV+ (17[8–25] ng/mL versus 20[14–26] ng/mL) and in D + COV + than D-COV+ (13[6–23] ng/mL versus 20[13–26] ng/mL), although these differences did not reach the statistical significance (P = 0.1 and P = 0.2, respectively).

CONCLUSION

With the limitations of the retrospective nature of the study and the small sample size, our data report that:

No association was found between nVD levels in the year preceding the infection and COV severity.
MO980: Metabolomics Approach and Acute Rejection in Kidney Transplant Recipients
Authors: Dedinska Ivana , Baranovičová Eva , Graňák Karol , Vnučák Matej , Beliančinová Monika , Mokáň Marián
Published: May 2022

BACKGROUND AND AIMS

Non-invasive diagnosis of graft rejection after kidney transplantation is still an unresolved issue. Changes in serum metabolite concentrations reflect the various processes involved in the graft, and thus graft rejection. Metabolomics approach might help with non-invasive diagnosis of graft rejection based on identification of T-cell activation.

METHOD

In a group of 55 patients after primary kidney transplantation (average follow-up 68.4 months, median 59 months) we identified patients with cellular rejection (ACR), antibody mediated rejection (AMR) and control group (CG)—patients without history of graft rejection. We used NMR metabolomic approach to determine the relative levels of metabolites in blood plasma.

RESULTS

From 23 evaluated metabolites: lactate was significantly increased in CG and in ACR against AMR (P  < 0.05), whilst plasma glutamine decreased in CG against ACR (P  < 0.05) and AMR (P  < 0.05) groups. Further, tyrosine was significantly increased in CG against AMR (P  < 0.05). All three branched chain α-keto acids (BCKAs) behaved similarly. However, little over significance cut off were CG >AMR. When discriminating CG and AMR, Random Forest discriminatory algorithm performed with AUC = 0.849 when included also evaluated plasma creatinine and with AUC = 0.83 when creatinine was excluded (other metabolites with the highest discriminatory power were glutamine, lactate, tyrosine and BCKAs).

CONCLUSION

Metabolomic approach to blood plasma in patients after kidney transplantation seems to be very promising when looking for non-invasive techniques assessing graft viability/survival. The observed metabolomic changes were able to very well discriminate between patients with AMR and control group. However, discrimination of ACR against CG and AMR was rather poor.
MO988: Malignancy After Kidney Transplantation: A Two-Center Experience
Authors: Demir Erol , Tamer Dincer Mevlut , Karaca Cebrail , Erel Cansu , Karahan Latif , Pekmezci Aslihan , Trabulus Sinan , Seyahi Nurhan , Turkmen Aydin
Published: May 2022

BACKGROUND AND AIMS

Kidney transplantation (KT) is the preferred treatment option for patients with end-stage renal disease (ESRD) as it provides better patient survival and quality of life. While longer graft survival is maintained with potent immunosuppressive drugs used to prevent allograft rejection, de novo malignancy development after transplantation has become a substantial issue. In this study, we aimed to investigate the incidence and risk factors of post-transplant malignancy in kidney transplant recipients, including its demographic, clinical and laboratory features.

METHOD

A retrospective cohort study was conducted at two tertiary care kidney transplant centers in the same province. We recruited adult (>18 years of age) kidney transplant recipients who underwent kidney transplantation between 1986 and 2020. We excluded KT recipients who lost to follow-up in the early post-transplant period and/or with incomplete records. Malignancies that occurred after graft failure were also excluded. Kidney transplant recipients with malignancy were matched to KT recipients without malignancy using a 1:1 ratio.

RESULTS

In this study, 2750 eligible patients were reviewed for the development of malignancy after kidney transplantation. A total of 278 KT recipients (10.1%) had biopsy confirmed malignancies during the follow-up period. The median post-transplant follow-up time was 217 months (IQR: 148–290 months). The most common malignancies were nonmelanoma skin cancer (28.8%), urinary tract cancer (16.5%), Kaposi's sarcoma (9.7%), gastrointestinal tract cancer (6.5%) and post-transplant lymphoproliferative disease (6.5%). The median time from kidney transplantation to the diagnosis of malignancy was 127 months (IQR: 62–198 months).

In comparison to the control group, patients with malignancy were older (P  ≤ 0.001), had a higher family history of malignancy (P  ≤ 0.001), had a greater history of smoking (P = 0.005), and usage of erythropoietin in the pre-transplant period was higher (P  ≤ 0.001). There was no significant difference between the two groups in terms of gender and the type of induction therapy. Overall mortality was higher in patients with malignancy (OR: 2.491 [CI: 1.586–3.912], P < 0.001).

CONCLUSION

The most common malignancy in kidney transplant recipients was found to be non-melanoma skin cancer. Elderly recipients, patients with a family history of malignancy and patients using erythropoietin in the pre-transplant period should be closely monitored for the development of malignancy.
MO991: Covid-19 Infection After Kidney Transplantation in Spain: Comparable Impact Throughout Six Epidemic Waves
Authors: Llinàs-Mallol Laura , Burballa Carla , Redondo Pachon Dolores , Solà Eulàlia , Arias-Cabrales Carlos , Buxeda Anna , Martinez Saez Aida , Bach Anna , Pascual Julio , José Pérez-Saéz María , Crespo Marta
Published: May 2022

BACKGROUND AND AIMS

The successive COVID-19 epidemic waves have significantly influenced kidney transplantation (KT) programs. Contact protection together with vaccination are the principal protective tools for KT recipients. We reviewed the impact of COVID-19 infection in KT recipients throughout the different epidemic waves.

METHOD

Of 900 active KT recipients in our program, 160 (17.8%) have suffered COVID-19 infection during the six epidemic waves: first (March–August 2020), second (September–December2020), third (January–March 2021), fourth (April–May 2021), fifth (June–September 2021) and sixth (October–December 2021, preliminary data). We compared the clinical evolution and the impact of vaccination.

RESULTS

Infected KT recipients were younger in the third and fourth waves (P  < 0.001). We observed a higher percentage of pneumonia and hospital admission in the first and fifth waves (P = 0.045, P = 0.016) (Table 1), without differences in ICU admission, and with the disappearance of asymptomatic cases after the third wave. The highest mortality was observed in KT recipients >65 years old infected within the first 6 months after KT (P = 0.006) and overall mortality was higher in the first wave (P = 0.033). Mortality in hospitalized KT recipients and those admitted in the ICU were similar along the 5 waves, without clear impact of vaccination (P = 0.251). On the 5 January 2022, we have already accumulated an incidence of COVID in KT of 3.1% (sixth wave, 77% with booster vaccination), similar to the first wave (3.8%), with 12.5% mortality, similar to second, third and fifth waves, in patients with outcome (53.3%).

CONCLUSION

The incidence of COVID-19 in KT recipients has been high in all the waves of the pandemic in Spain. Global mortality has diminished after the first wave, and the time until outcome has increased. The highest mortality occurs in the subgroup of old KT recipients early after KT. Vaccination has not significantly reduced the mortality in KT with Covid who require hospital or ICU admission.
MO1001: Tocilizumab in the Treatment of Chronic Antibody-Mediated Rejection Post Kidney Transplantation: Clinical and Histological Monitoring
Authors: Noble Johan , Giovannini Diane , Laamech Reda , Imerzoukene Farida , Janbon Benedicte , Marchesi Laura , Malvezzi Paolo , Jouve Thomas , Rostaing Lionel
Published: May 2022

BACKGROUND AND AIMS

Chronic antibody-mediated rejection (cAMR) has very few effective therapeutic options. Interleukin-6 is an attractive target because it is involved in inflammation and humoral immunity. Therefore, the use of tocilizumab (anti-IL6 receptor, TCZ) is a potential valuable therapeutic option to treat cABMR in kidney-transplant (KT) recipients

METHOD

This single-centre retrospective study included all KT recipients that received monthly TCZ infusions in the setting of cABMR, between August 2018 and July 2021. We assessed 12-month renal function and KT histology during follow-up.

RESULTS

Forty patients were included. At 12-months, eGFR was not significantly different, 41.6 ± 17 versus 43 ± 17 mL/min/1.73 m2 (P = .102) in patients with functional graft. Six patients (15%) lost their grafts: Their condition was clinically more severe at the time of the first TCZ infusion. Histological follow-up showed no statistical difference in the scores of glomerulitis, peritubular capillaritis, and interstitial fibrosis/tubular atrophy (IFTA). However, the chronic glomerulopathy score, increased significantly over time, and conversely, arteritis and inflammation in IFTA ares improved in follow-up biopsies.

CONCLUSION

In our study, the addition of TCZ prevented clinical and histological worsening of cABMR in KT recipients, except for more severely ill patients. Randomized studies are needed to clarify the risk/benefit of TCZ in cABMR.
MO1002: Two-Step Desensitization Protocol Consisting of High-Dose Intravenous Immunoglobulin, Plasmapheresis and Rituximab in Highly Sensitized Kidney Transplantation
Authors: Okada Manabu , Hiramitsu Takahisa , Futamura Kenta , Norihiko Goto , Narumi Shunji , Watarai Yoshihiko , Ichimori Toshihiro
Published: May 2022

BACKGROUND AND AIMS

High-dose intravenous immunoglobulin (IVIG) therapy has not only immediate effects but also gradual effects via Fc receptors. To optimize IVIG therapy, we adopted a two-step desensitization protocol in kidney transplantation (KTx) with positive flow cytometry crossmatch (FCXM).

METHOD

In the first step, rituximab 200 mg and IVIG 2 g/kg were administered 2 months before KTx. In the second step, patients received additional rituximab 200 mg and IVIG 2g/kg for 2 weeks prior to transplantation in combination with plasmapheresis.

RESULTS

Of the six KTx with positive FCXM, there was no rejection except one (16.7%) subclinical antibody-mediated rejection within 1 month after transplantation. Average graft function was acceptable (serum creatinine level of 1.17 mg/dL).

CONCLUSION

The two-step desensitization protocol is an effective option for achieving successful transplant outcomes in KTx with positive FCXM, which can spare more aggressive and expensive treatments, such as C5 inhibitors, proteasome inhibitors and imlifidase.
MO1003: Role of Tacrolimus Trough Levels on Intra-Abdominal Pressure After Kidney Transplantation
Authors: Martínez Manrique María , Ardura Paula , Lorenzo Arturo , Acosta-Ochoa Isabel , Lucía Valencia Ana , Sanz-Ballesteros Sandra , Mendiluce Alicia , Reinaldo Sanchez Gil Jimmy , Fidalgo Veronica , Coca Armando
Published: May 2022

BACKGROUND AND AIMS

Increased intra-abdominal pressure (IAP) is common after kidney transplantation (KT). However, the role of potential transplant-specific predictors of this complication, such as tacrolimus-associated endothelial dysfunction, remains unclear. We aimed to describe the relationship between tacrolimus trough levels and IAP in a sample of incident KT patients.

METHOD

Single-centre prospective cohort of deceased-donor KTs. Anesthesia, surgical technique and immunosuppression induction therapy were the same in all cases. IAP monitoring was performed according to WSACS guidelines using the urinary bladder technique (UnoMeter Abdo-Pressure kit). IAP values were registered every 8h during the first 72 h after surgery or until reoperation. Mean IAP values during the first 7 2h (72 h-IAP) were used in this analysis. The first measured tacrolimus trough levels after transplantation were included as a potential predictor of IAP. Patients without recorded tacrolimus trough levels during the first 7 days after surgery were excluded. The study was approved by the local ethics committee.

RESULTS

A total of 192 patients were enrolled in the study. Table 1A summarizes relevant patient and haemodynamic variables. Subjects with more severe intra-abdominal hypertension were more commonly males, with longer dialysis vintage, higher BMI and suffered diabetes more frequently. Multivariate linear regression analysis was used to examine potential predictors of 72 h-IAP, including male sex, months on dialysis, body mass index (BMI) (Table 1B), 72 h-fluid balance and tacrolimus trough levels. Recipient age, months on dialysis, BMI and tacrolimus trough levels were independent predictors of 72 h-IAP.

CONCLUSION

Tacrolimus-associated endothelial dysfunction may play a role in the increase of IAP after transplantation. In contrast, accumulated fluid balance, one of the strongest predictors of IAP in the ICU setting, failed to predict IAP values in our sample. These results offer new insight both into the pathophysiology of increased IAP and into the complex mechanisms of tacrolimus-associated nephrotoxicity in the early post-transplant period.
MO1008: The Role of IL-27/IL-27R in BKPYV Reactivation and Graft Rejection in Kidney Transplant Recipients
Authors: Afshari Afsoon , Roozbeh Jamshid , Yaghobi Ramin
Published: May 2022

BACKGROUND AND AIMS

Kidney transplantation is the only cure for patients with end-stage renal disorders. Therefore, protecting these patients from transplant rejection is a critical lifesaving project after transplantation. Graft rejection and BK polyoma virus (BKPyV) associated nephropathy (BKVAN) is one of the common causes of graft loss among kidney transplant recipients (KTRs) through activating innate and adaptive immunity. In between, the role of cytokines is very perilous in handling the immune responses against rejection, such as IL-27, and in this study, it is tried to investigate the role of IL-27 and its receptor (IL-27R; WSX-1) in KTRs.

METHOD

EDTA-treated blood samples were collected from 90 KTRs that were divided into three equal groups of BKV-inactive/non-reject (G1), BKV-active/non-reject (G2) and BKV-inactive/reject (G3), after being monitored by real-time PCR (Taq-Man) in plasma. A total of 30 normal individuals were considered as healthy control group (G0). A real-time PCR (SYBR Green) technique is used to determine the expression level of studied genes.

RESULTS

The results of gene expression comparisons showed that the expression level of IL-27 was significantly higher in G1 compared with the G2 group. Analysis also showed that the difference in the expression level of genes between the G3 and G0 groups was statistically significant. Also, the same comparison between the G1 and G0 groups showed a significant difference.

The area under the ROC curve (AUC) showed that IL-27 is a significant discriminating molecule between all three studied groups of patients. The analyses revealed that the expression level of studied genes has a significant correlation with viral load. Finally, the ROC analysis showed that IL-27 and IL-27R seem to be important molecules for discrimination between G2 and G3 patient groups.

CONCLUSION

It is not easy to determine the IL-27 pro-inflammatory function as an endogenous regulatory mechanism, which might be one of the reasons for the immune system’s inability to inhibit the BKPyV reactivation in KTRs. Therefore, knowing the fact that in vivo loss of IL-27 signalling would not make drastic defects in immune development, turns IL-27 an attractive candidate for therapeutic research. It is important to consider the role of cytokines in different rejection conditions and the role of some cytokines should be more studied, such as IL-27 and IL-27R in course of kidney rejections, which happens especially between 2 weeks and 2 months after transplantation.
MO1010: Seroconversion Rate After Primary Vaccination with Two Doses of BNT162B2 versus MRNA-1273 in Solid Organ Transplant Recipients: A Systematic Review and Meta-Analysis
Authors: Verleye Arno , Wijtvliet Veerle , Abramowicz Daniel , Ledeganck Kristien
Published: May 2022

BACKGROUND AND AIMS

In the general population, the seroconversion rate after primary vaccination with two doses of anti-SARS-CoV-2 mRNA vaccine reaches nearly 100%, with significantly higher antibody titers after mRNA-1273 vaccination compared with BNT162b2 vaccination. Here, we performed a systematic review and meta-analysis to compare the antibody response after two-dose mRNA-1273 versus BNT162b2 vaccination in solid organ transplant (SOT) recipients.

METHOD

A systematic literature research was performed in PubMed, the Web of Science and the Cochrane library, and original research papers were included for a meta-analysis to calculate vaccine-specific seroconversion rates for each of the mRNA vaccines. Next, the pooled relative seroconversion rate was estimated.

RESULTS

Six studies that described the development of antibodies against receptor-binding domain (RBD) and/or S1 subunit of the spike protein were eligible for meta-analysis. Two of them also reported antibody titers. The meta-analysis revealed lower seroconversion rates in SOT recipients vaccinated with two doses of BNT162b2 {45.2%; [95% confidence interval (95% CI) 32.5%–58.3%]} than patients vaccinated with two doses of mRNA-1273 (60.4%; 95% CI 47.4%–72.7%). The relative seroconversion rate amounted 0.79 (95% CI 0.71–0.88).

CONCLUSION

This systematic review and meta-analysis indicates that, in SOT recipients, higher seroconversion rates were observed after vaccination with mRNA-1273 compared with BNT162b2.
MO1017: Induction Immunosuppression and Outcome in Early Kidney Transplant Recipients with Covid-19
Authors: Castañeda Amado Zaira , Toapanta Néstor , Jimenez Sara , Molina Gomez Maria , Maruri Kareaga Naroa , Llinás Laura , Villanego Florentino , Canal Cristina , Rodriguez Marisa , Montero Nuria , Vazquez-Sanchez Teresa , Gutierrez Dalmau Alex , Beneyto Isabel , Franco Esteve Antonio , María Vicente Ana , Lourdes Pérez Tamajón M , Leticia Martin-Moreno Paloma , Ramos Ana , Bestard Oriol , Moreso Francesc
Published: May 2022

BACKGROUND AND AIMS

COVID-19 in kidney transplants has a high risk of complications and mortality, especially in older recipients diagnosed during the early period after transplantation. Management of immunosuppression has been challenging during the pandemic. We investigated the impact of induction immunosuppression, either basiliximab or thymoglobulin, on the clinical evolution of kidney transplants developing COVID-19 during the early period after transplantation.

METHOD

Kidney transplant recipients with <6 months with a functioning graft diagnosed of COVID-19 from the initial pandemic outbreak (March 2020) until 31 July 2021 from different Spanish centres participating in a nationwide registry.

RESULTS

A total of 127 patients from 17 Spanish centres developed COVID-19 during the first 6 months after transplantation, 73 (57.5%) received basiliximab and 54 (42.5%) thymoglobulin. Demographics were not different between groups, but patients receiving thymoglobulin were more sensitized (cPRA of 32.7% ± 40.8% versus 5.6% ± 18.5%) and more frequently re-transplanted (30% versus 4%). Recipients older than 65 years treated with thymoglobulin showed the highest rate of acute respiratory distress syndrome [64.7% versus 37.1% for older recipients receiving thymoglobulin and basiliximab (P < .05), and 23.7% and 18.9% for young recipients receiving basiliximab and thymoglobulin (P > .05)] and the poorest survival [mortality rate of 64.7% and 42.9% for older recipients treated with thymoglobulin and basiliximab, respectively (P < .05), and 8.1% and 10.5% for young recipients treated with thymoglobulin and basiliximab (P > .05)]. Older recipients treated with thymoglobulin showed the poorest survival in the Cox's regression model adjusted for comorbidities.

CONCLUSION

Thymoglobulin should be used with caution in older recipients during the present pandemic era.
MO1019: Sigma-1 Receptor Agonists are Protective in a Rat Model of Kidney Transplantation
Authors: Lakat Tamas , Roland Toth Akos , Hodrea Judit , Wagner Laszlo , Szabo Attila , Fekete Andrea , Hosszu Adam
Published: May 2022

BACKGROUND AND AIMS

End-stage renal disease affects nearly 2 million people worldwide. The disease is associated with an irreversible deterioration in renal function and can only be treated by dialysis or kidney transplantation (KTx). KTx is associated with better long-term outcomes and quality of life compared with dialysis, but the shortage of donor organs is a serious and unsolved problem. Graft survival is highly dependent on the extent of cold and warm ischemic injury during Tx. We recently described the renoprotective effects of Sigma-1 receptor (S1R) agonist treatment in IRI. Thus, our aim was to develop a novel preservation solution that, with the addition of S1R agonist compounds, minimizes ischemic damage in order to improve the condition of grafts and so increase the number of organs suitable for Tx.

METHOD

Kidneys of male Wistar rats were perfused and placed in ice cold (i) custodiol preservation solution; custodiol containing S1R agonists, (ii) fluvoxamine or (iii) SA-4503 for 2 h, then autotransplanted and sacrificed 24 h after reperfusion. Sham-operated rats served as controls. In a second experiment, kidneys of wild-type and S1R knockout mice were perfused and placed in an ice-cold preservation solution containing an original, selective S1R agonist compound (VCC) for 24 h of cold ischemia and tissue samples were collected. Renal function parameters were determined. Renal expression of tubular injury markers (Kim-1, Ngal) and inflammatory cytokines (Il-1α, Il-6, Tnf-α, Mcp-1) were measured. Periodic acid-Schiff staining was performed on kidney tissue sections to evaluate structural changes. CD45 immunostaining was performed on kidney sections to determine the extent of leukocyte infiltration. DNA fragmentation resulted by apoptotic events in the kidney was evaluated by TUNEL-assay.

RESULTS

S1R agonists mitigated renal functional impairment and tubular dilatation following Tx. Expression of early and sensitive tubular injury markers was markedly less elevated in S1R agonist-treated kidneys. S1R agonists alleviated renal apoptosis as shown on TUNEL-stained kidney sections. Decreased numbers of CD45 + leukocytes and decreased inflammatory cytokine expressions confirmed the anti-inflammatory effect of S1R agonists. The S1R agonist VCC compound mitigated cold ischemic structural kidney damage in wild-type but not in S1R KO mice, which confirms the protective role of the receptor.

CONCLUSION

The addition of S1R agonists to the preservation solution during Tx improves graft function and alleviates structural damage, thus improving long-term outcomes. S1R agonists reduce graft injury during cold storage, therefore the number of transplantable donor organs can be increased.

FUNDING

OTKA PD-131 637; FK-124 491; 2020–4.1.1.-TKP2020-6 183 069 269; 2020–4.1.1.-TKP2020-6 183 169 273; KDP-2020/1 019 145.
MO1021: Long-Term Outcomes After Conversion to a Belatacept-Based Immunosuppression in Kidney Transplant: A Matched Cohort Study
Authors: Divard Gillian , Debiais-Deschamps Charlotte , Legendre Christophe , Lefaucheur Carmen , Aubert Olivier , Loupy Alexandre
Published: May 2022

BACKGROUND AND AIMS

Conversion to a belatacept regimen after transplant seems to be safe. However, no studies have reported the long-term efficacy and safety outcomes after conversion to a belatacept regimen and compared it with patients treated with a CNI-based regimen in kidney transplantation. This study aims to investigate the long-term outcomes of patients converted to a belatacept regimen compared with matched patients under a CNI regimen.

METHOD

Kidney transplant recipients transplanted between 1998 and 2019 from two French academic transplant canters were recruited. We used a propensity score to match with a 1:1 ratio of patients at the time of the biopsy, which indicates the conversion to a belatacept regimen to control patients under a CNI regimen with a biopsy after transplant. We used 11 parameters associated with graft survival for the matching, 4 baseline transplant characteristics (recipient age, prior transplant status, donor type and dgf) and 7 at time of the biopsy (time after transplant, eGFR, proteinuria, DSA and Banff scores cv, ah, IFTA). Transplant outcomes defined by graft and patient survival, as well as safety outcomes, were compared between the matched patients.

RESULTS

From 3215 kidney transplant recipients transplanted during the study period with the inclusion criteria (311 patients under belatacept and 2904 patients under CNI). A total of 243 patients under belatacept were matched with 243 controls under CNI. All prognostic parameters were well-balanced before conversion between the two groups, with a mean age of 54.7 ± 15.1 years (P = .4543), a mean time of 2.2 ± 3.2 years after transplant (P = .586), a mean eGFR of 33.0 ± 13.3 mL/min/1.73 m2 (P = .976), a median proteinuria of 0.23 (0.12–0.50) g/g (P = .278) and 30.9% of positive anti-HLA DSA (P = 1.0) in the belatacept group. After a mean follow-up time after conversion of 4.4 ± 2.5 years, 36 (14.8%) patients lost their grafts and 39 (16.0%) patients died in the belatacept cohort. After conversion to a belatacept regimen, the graft survival was significantly improved when we compared with the matched patients’ under CNI P < .0001 (Fig. 1). Patients converted to Belatacept showed a lower death rate of 16.0% compared with 30.0% for the CNI treated patients (P < .001). The safety outcomes showed a similar rate of biopsy proven rejection (P = .08), major adverse cardiovascular events and cancer between the two groups, while a significant higher rate of CMV disease was observed among the belatacept treated patients P < .01).

CONCLUSION

This study confirms that conversion to belatacept post-transplant is associated with improved long-term graft outcome and acceptable safety. Conversion to belatacept after transplant should be considered as a valuable therapeutic option for kidney recipients.