bluuebunny/crossref_metadata_2025 huggingface dataset:
MO957LONG TERM OUTCOME OF POST-TRANSPLANT INFECTIONS IN ADULT RENAL TRANSPLANT RECIPIENTS
Authors: Prasad Narayan , Gala Ruju , Kaul Anupama , Bhadauria Dharmendra , Patel Manas Ranjan
Published: May 2021

Background and Aims

Infections are a significant cause of morbidity in the form of graft loss and mortality in RTR. Several factors in the pre and peri transplant period increase the susceptibility to PTI, affecting the overall graft and patient survival.

Method

An observational study of 644 adult RTR (=>18yrs) between Jan 2010 and Dec 2015, followed till Jun 2019. The primary objective was to study the epidemiology of risk factors of PTI. The secondary objective was to evaluate transplant outcomes.

Results

PTI were seen in 83.1%, of which majority (64%) occurred in the first year. Of all infections, 55.5% were bacterial, 18.5% viral, 10.8% parasitic, 8% fungal, and remaining 7.1% mycobacterial. UTI (37.4%) was most common infection with E. Coli (18.9%) being the commonest cause.

Relative risk with PTI for graft dysfunction was 3 times higher (95% CI 1.70-3.57, p=0.00), 3 times higher for graft failure (95% CI 1.35-4.93, p=0.002) compared to non-PTI group and death was 3 times higher (95%CI 1.3-7.2, p=0.01) as compared to non-PTI. Overall, graft loss was 19.4% and the mortality rate was 12.1% of the study population.

The relative risk of fungal infections to cause graft loss was 2 times higher as compared to other infections (95% CI 1.23-2.18, p<0.003). The relative risk of fungal infections to cause death was 2 times higher than other infections (95% CI 1.20-2.56, p <0.008)

On multivariate analysis, the predictors of PTI were ATG induction (P<0.01), pre transplant Tuberculosis (P=0.02) and dialysis vintage (P=0.02).

On KM survival analysis, graft and patient survival was inferior in PTI at 1,5and 9years; (graft: 94.6%; 81.8%;70.1% vs non PTI 97.2%; 92.2%; 88.1%, p = 0.006, patient: PTI 97.1 %; 88.2%; and 81.9%vs non PTI 99.1% , 95.8%; 92.9% , p=0.012)

Conclusion

PTI have a significant impact on graft survival (70% vs 88%) and patient survival (82% vs 93%) in RTR, with fungal infections having worse outcomes.
MO925VALVULAR HEART DISEASE EVOLUTION IN KIDNEY TRANSPLANT RECIPIENTS AND RELATED RISK FACTORS
Authors: Galceran Isabel , Redondo Pachón M Dolores , Pérez Sáez María José , Arias Cabrales Carlos , Burballa Tarrega Carla , Buxeda Anna , Crespo Barrio Marta , Pascual Santos Julio
Published: May 2021

Background and Aims

Cardiovascular diseases remains the leading cause of death in recipients of kidney transplantation (KT). Valvular heart disease (VHD) is not an exclusion criteria for KT, however it’s repercussion on KT follow-up has been less studied. Our objective was to analyse the impact of VHD in KT recipients and related risk factors of VHD progression (VHDp).

Method

Observational retrospective cohort study of all patients who underwent KT at Hospital del Mar (Barcelona, Spain) between January 1980 and December 2018. VHD was defined as presence of aortic stenosis (AS), aortic regurgitation, mitral stenosis, mitral regurgitation, tricuspid stenosis, tricuspid regurgitation or double valve injury of any degree diagnosed by echocardiography. We analysed the VHDp, defined as worsening of the initial valvular degree on heart ultrasound after KT, risk factors related with VHDp, recipients and graft survival.

Results

During the study period, 1422 patient underwent KT and 48 of them (3.4%) had VHD diagnosed prior to KT. In the median time of follow-up of 56.3 months (IQR25-75 17.7-119 month), 17 patients (35.4%) presented VHDp and 31 patients did not (64.6%). Figure 1 shows the primary outcome in the different types of VHD, AS was the valve with more VHDp after KT.

Statistical evaluation revealed that recipients with VHDp had a higher body mass index (BMI) (27.4 ± 6.3 vs 24.3 ± 3.8 kg/m2, p=0.04) and worse PTH control (427.0 ± 309.3 vs 186.2 ± 140.6 pg/ml, p=0.02) at the moment of the KT. Also, patients with VHDp reached a worse nadir glomerular filtration rate (GFR) (44.1 ± 17.5 vs 56.0 ± 13.9 ml/min/1.73m2, p=0.01) during the follow-up, needed more time to reach their nadir GFR (4 [2-13] vs 1.2 [1.0-4.7] months, p<0.001) and required more furosemide dose at that time (72.7 ± 21.7 vs 15.8 ± 5.6 mg/day, p=0.02).

At the end of follow-up, 213 KT recipients had died, 16 with preKT-VHD (33.3% of all patients with VHD) and 197 without preKT-VHD (14.3% of all cases without VHD). There was a statistical significant association between preKT-VHD status and all-cause mortality after KT (log rank < 0.001). However, there wasn’t statistical association between preKT-VHD status and death-censored graft survival (log rank = 0.2).

Conclusion

VHD has a significant impact on increased pos-KT mortality but it is not associated with graft survival. More than one third of recipients with preKT-VHD presented deterioration after KT. We found that increased preKT BMI and PTH, nadir GFR after KT, time to reach this nadir GFR and diuretic dose at that time are related with VHD progression.
MO963GRAFT- AND PATIENT-SURVIVAL AFTER FIRST KIDNEY TRANSPLANT BIOPSY
Authors: Nasic Salmir , Mölne Johan , Stegmayr Bernd , Felldin Marie , Peters Björn
Published: May 2021

Background and Aims

Kidney transplantation is frequently used as a treatment in uremic patients. However, long term function is not easily predicted. The aim of this study was to investigate to what extent histological diagnosis in the first registered transplant kidney biopsy is related to clinical outcome.

Method

Included were data of 1463 patients (36.6 % women, 63.4 % men) that were merged from a kidney transplantation register and a biopsy register. These patients obtained their first registered transplant biopsy during the period January 1, 2007 until July 30, 2017. Fisher’s exact test and χ-2 analyses were used for cross-tabulation of data. Graft- and patient-survival analysis was performed by Kaplan-Meier analysis with log-rank tests comparing different groups and in next step age and gender adjusted analysis were performed by multivariate Cox-regression-analysis. Data are presented as Hazard Ratio (HR) and 95% Confidence Intervals (CI). A two-sided p-value of <0.05 was considered as statistically significant.

Results

The graft-survival was shorter for patients with biopsy-proven glomerular diseases (HR 8.1, CI 3.1-20.7) and rejections (HR 4.3, CI 1.7 -10.5) compared to normal biopsy findings. Further, there was a shorter graft-survival for those with chronic damages (HR 3.2, CI 1.3-8.0), acute tubular injuries (HR 3.0, CI 1.2-7.8), and borderline changes (HR 2.9, CI 1.1-7.6). The patient-survival was reduced for patients with biopsy-proven hematological diseases (HR 9.6, CI 2.1-44.0). Sub analysis of all types of rejections showed shorter graft-survival for chronic T-cell-mediated rejection (TCMR) (HR 4.8, CI 2.1-11.7), active antibody-mediated rejection (ABMR) (HR 4.4, CI 2.1-9.3), chronic ABMR (HR 3.8, CI 2.2-6.7), combined chronic ABMR and TCMR (HR 4.0, CI 2.4-6.9) and other rejections (HR 3.3, CI 1.1-9.6) compared to acute TCMR. Patients with TCMR Banff grade II rejection had a better graft-survival (HR 0.35, CI 0.20-0.63) compared to other rejections as well as patients with TCMR Banff grade I (HR 0.52, CI 0.29-0.93). 265 patients had graft-loss and 42 of those patients died afterwards (15.8%). Of the 42 who died after graft-loss 9 patients died within 30 days after transplant failure (21.4%).

Conclusion

A shorter graft-survival was found in kidneys with glomerular diseases, rejections, acute tubular injuries, borderline changes and chronic damages. A shorter patient-survival was noted for patients with transplant kidney biopsies with hematological diseases. Patients with Banff grade II rejection had a better graft-survival compared to all other diagnosis and other rejections. Further, awareness should be given to patients the first month after graft-loss.
MO968ROUTINE BIOMARKERS FOR THE SEVERITY OF COVID-19 PNEUMONIA MAY PRESENT DIFFERENTLY IN KIDNEY TRANSPLANT RECIPIENTS
Authors: Burgos García Elena , Molina Gomez Maria , Cacho Judit , Juega Mariã‘o Francisco Javier , Cañas Sole Laura , Taco Omar , Pérez-Mir Mónica , Urrutia Marina , Graterol Fredzzia , Lauzurica Ricardo
Published: May 2021

Background and Aims

The treatment of coronavirus disease (COVID-19) is based on the patient’s clinical status and levels of inflammatory biomarkers. The comparative activity of these biomarkers in KT patients with COVID-19 pneumonia from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and non-SARS-CoV-2 aetiologies is unknown. The aim of this study was to compare the clinical presentation and inflammatory parameters at admission of KT patients with COVID-19 pneumonia and those with non-COVID-19 pneumonia over the same period.

Method

Biomarkers were measured and compared between KT patients with COVID-19 pneumonia (n=42) and non-COVID-19 pneumonia (n=18) from March to November 2020.

Results

Both groups showed comparable demographics. The COVID-19 KT patients had fewer neutrophils (4,650 [2,925-9,498] vs. 9,100 [7,170-11,150],p=0.01) than the non-COVID group, although there was no significant difference in the lymphocyte count. Non-COVID-19 pneumonia was associated with a higher d-dimer (962 [427-1,448] vs. 1,704 [868-2,481],p=0.09) and IL-6 (37 [23-10] vs 254 [53-602],p=0.006) levels. The ferritin level was higher in the COVID-19 group (908 [496-1,377] vs. 340 [264-785],p=0.008).

Conclusion

COVID-19 pneumonia in KT recipients shows a different presentation of inflammatory biomarkers than other non-COVID pneumonias. It could be usefully to identify KT patients with COVID-19.More detailed studies are necessary to understand the presentation of biomarkers in KT with COVID-19.
MO972THROMBOPHILIC SCREENING IN LIVING KIDNEY DONOR EVALUATION
Authors: Diotallevi Laura , Mori Giacomo , Di Sandro Stefano , Di Benedetto Fabrizio , Cappelli Gianni
Published: May 2021

Background and Aims

Living Kidney Donor Transplantation (LKDT) is the first therapeutic choice in end stage renal disease (ESRD). Donor safety has to be ensured, throughout an extensive pre operative screening. Venous thromboembolism (VTE) and deep vein thrombosis(DVT) are the most frequent complications after abdominal surgery. Living kidney donation is considered a safe procedure, with a major morbidity rate around 5%, and a not clearly defined incidence of VTE and DVT. We thus proceeded to evaluate the thrombophilic risk among potential kidney donors to define an adequate prophylactic strategy.

Method

Our Transplant Center introduced thrombophilic screening in all potential donors from 2019. We checked clinical history for previous thrombotic events, active or treated malignacies. Our thombophilic risk panel comprehended: Lupus Anticoagulant (LAC), Factor V -II-VIII, in Protein C and S activity. In case of LAC undetermined results on two consecutive samples, we tested anti-cardiolipin and anti-beta2-glycoprotein 1 antibodies. Nephrectomy was performed by mini-invasive robotic technique; anticoagulation was provided by Enoxaparin 4000U 7-14 days.

Results

We studied 32 potential donors. No previous thrombotic events were reported. Malignancies were observed in 4 patients (12.5%), 1 before starting the study and 3 were discovered during the evaluation (MGUS, non small cell lung carcinoma). Thrombophilic screening showed uncertain LAC in 3 (9%) patients, an heterozygote mutation in Factor V associated with APC positivity in 1 patient(3%), heterozygote mutation in Factor II in 3(9%) disorder in Protein C S and Factor VIII activity respectively in 4 (12.5%) 3(9%)and 4(12.5%) patients. Among the 9 patients deemed fit for donation: uncertain LAC in 1(11%) patient, heterozygote mutation in Factor II in 1 (9%) patient. No thrombotic event was reported after donation.

Conclusion

The frequency of coagulation disorders among kidney living donor is low, but not negligible. Appropriate medical history assessment and thrombophilic screening before donation is recommended, as well as an antithrombotic prophylaxis with Enoxaparin from 7 to 14 days after nephrectomy, tailored on each patient risk factors. This strategy allowed to avoid thrombotic events in patients who underwent nephrectomy. More data are necessary to draw more solid conclusions.
MO973PRE-IMPLANTATION BIOPSY FINDINGS AND IMPACT ON LIVE DONOR KIDNEY TRANSPLANT RECIPIENT OUTCOMES - A SINGLE CENTRE STUDY
Authors: Erandika Naduni , Nanayakkara Nishantha , Wijetunge Sulochana , Rathnathunga Neelakanthi , Harishchandra P K , Fernando Charitha , Weerasinghe Charitha , Wazil A W M , Mahanama Buddhisha , Basnayake Duminda , Abeysundara Hemalika , Abeysekera Rajitha Asanga
Published: May 2021

Background and Aims

Live donor kidney transplantation remains the mainstay of renal replacement therapy in Sri Lanka. The basic universal pre surgical investigations, human leucocyte antigen (HLA) matching and cross matching are routinely performed, however due to high rates chronic kidney disease (CKD) as well as increasing numbers of, chronic kidney disease unknown etiology (CKDu) in Sri Lanka, there is a possibility of subclinical kidney disease being present in donor kidneys which go undiagnosed. A study of pre-implantation biopsy along with follow-up outcomes of kidney transplant recipients is conducted to identify presence of subclinical kidney disease in a Sri Lankan cohort of patients.

Method

We collected thirty three (33) live donor pre-implantation biopsies during 4 consecutive months in 2020 as well as 1 month follow-up data. This is part of an ongoing follow-up study which is conducted at National Hospital, Kandy, Sri Lanka.

Results

Thirty three (33) live donor recipients and their pre-implantation renal biopsy samples were studied. The mean age of the study participants’ was 37.6 (SD 12.5, range 13 - 59) years. A predominant number of male patients were in the sample (n=21, 63.6%). Underlying aetiology of end stage renal disease (ESRD), was predominantly due to chronic hypertension (39.3%; n=13) and diabetic kidney disease (21.2%, n=7) accounting for nearly 60% of the study participants. Among the 33 live donors 1st degree, 2nd degree and non-relative donors were 54.4% (n=18), 18.2% (n=6) and 27.3% (n=9) respectively. Pre-implantation renal biopsy results reported 36.4% (n=12) with abnormal biopsy findings including chronic interstitial nephritis (n=4, 12.1%), interstitial fibrosis (n=6, 18.18%) and acute tubular necrosis (n=2, 6%). Follow-up revealed delayed graft function occurring in 18.2% (n=6) of recipients with 50% (n=3) of them showing abnormalities in the pre-operative donor biopsy sample. At one month follow-up, 48.5% (n=16) reported complications which included graft failure 3% (n=1), all-cause mortality 3% (n=1), acute rejection 39.4% (n=13) and infections 24.2% (n=8). Overall, 37.5% (n=6) of these recipients had abnormal donor biopsy findings, however no significant statistical association was identified.

Conclusion

Our study identified subclinical kidney disease in donor kidneys despite standard pre-transplant screening. Even though, statistically not significant, recipients with abnormal pre-implantation biopsy findings had adverse short term post-transplant complications.
MO976GENDER AND AGE DISPARITY IN INFECTIOUS COMPLICATIONS AFTER KIDNEY TRANSPLANTATION
Authors: Matej Vnucak , Graňák Karol , Skálová Petra , Dedinska Ivana , Laca Ľudovít
Published: May 2021

Background and Aims

Number of older patients with end stage kidney disease has been increasing, therefore there are increased number of older kidney transplant recipients. Potent immunosuppression (IS) used in patients after kidney transplantation (KTx) lowered the incidence of acute kidney rejection but increased the risk of post-transplant infection and sepsis as the most common non-cardiac cause of death. Older adults are at high risk of infections due to functional impairment and multiple comorbidities leading to poor outcome after KTx. Nowadays, no change in IS or prophylactic therapy is recommended based on the age of an adult KTx recipient. Female gender may be risk factor for infection after KTx due immunomodulatory effect of sex hormones such as estradiol.

Methods

The aim of our analysis was to find whether there are sex differences in the incidence of single and repeat infection and whether there is increased incidence of single and recurrent infectious complications in older kidney transplant recipients.

Results

Our analysis consisted of 100 patients after KTx (66 males, 34 females), average age 47,5 ± 12,6 years, treated with anti-thymocyte globulin as an induction IS. Male gender was a protective factor for the incidence of following infections in the 1st month after KTx: infection in general (P = 0.0054), recurrent infection (P = 0.0239), bacterial (P = 0.0125) and mycotic infection (P = 0.0103), recurrent bacterial infection (P = 0.0258). From the 1st to 6th month after KTx, female gender was identified as a risk factor for the incidence of infection in general (P = 0.0218), bacterial (P = 0.0186) and mycotic infection (P = 0.0318), repeat infection (P = 0.0216), recurrent bacterial infection (P = 0.0368). From 6th to 12th month after KTx, female gender was found as a risk factor for the incidence of bacterial infection (P = 0.0144), single infection (P = 0.0355), recurrent infection (P = 0.0007), single bacterial infection (P = 0.0309). Age > 60 years was not found as a risk factor for the incidence of single, repeat infection regarding its etiology. In our analysis we did not found correlation between gender and the incidence of single or recurrent infection of any etiology, we did not find significant differences in the severity of infections reflected by need for hospitalization, intensive care unit or use of vasopressors neither in gender, nor in older patients. In our study we did not confirm gender or age as a risk factor for the acute kidney rejection.

Conclusion

In our analysis, we found significant sex differences in the incidence of bacterial, viral, mycotic, single and repeat infection in different time intervals after kidney transplantation, while we did not confirmed age > 60 years is a risk factor for the infectious complications after KTx.
MO994POST-TRANSPLANT DIABETES MELLITUS PREDICTORS AFTER PANCREAS-KIDNEY TRANSPLANT
Authors: Menezes Maria Do Mar , Bigotte Vieira Miguel , Mendes Filipa , Messias Ana , Moreira Fonseca Nuno , Aires Inês , Nolasco Fernando
Published: May 2021

Background and Aims

Pancreas-kidney transplantation (PKT) is an established treatment for selected patients with type 1 diabetes mellitus (T1DM) with either advanced or end-stage chronic kidney disease. We aimed to evaluate predictors for post-transplant diabetes mellitus (PTDM) at 24 months of follow-up after PKT.

Method

We analysed a longitudinal cohort of patients with chronic kidney disease and T1DM who underwent PKT at a tertiary referral centre from January 2011 to December 31, 2017. PTDM (post-transplant diabetes mellitus) was defined as the persistent need for pharmacologic treatment of diabetes mellitus after transplant. Continuous variables were recorded as means (±SD) or as medians (25-75% interquartile range), accordingly to data distribution. Categorical variables were recorded as proportions. Comparisons were made using t-tests, Wilcoxon rank-sum tests, or X2 test as appropriate. Unadjusted and adjusted multivariate logistic regression models were fitted to identify risk factors for PTDM at 24 months of follow-up. STATA 14.2 statistical package was used and p <0.05 was considered statistically significant.

Results

From a total of 72 patients who underwent PKT during the study period, 47 patients completed at least 24 months of follow-up. The mean age at transplantation was 37±8 years, 30 (64%) were male, 43 (91%) were white and 4 (9%) were black. At 24-months of follow-up, the prevalence of diabetes mellitus was 28% (13/47).

Number of mismatches, accumulated prednisolone dose, tacrolimus levels, previous rejection episodes, body mass index, cytomegalovirus status, serum creatinine, lipase, amilase at discharge were not associated with PTDM.

Patients with persistent diabetes at 24-months of follow-up had a significantly longer pretransplant diabetes duration (29±10 versus 23±6 years; p-value = 0.026), had higher pretransplant LDL-cholesterol (137±46 versus 100±27 years; p-value = 0.003), and lower C-peptide at post-transplant hospital discharge (3.0 [2.0-3.3] versus 5.8 [4.5-6.5]; p-value = 0.004).

Likewise, in univariate logistic regression models, longer diabetes duration and higher pretransplant LDL-cholesterol were found to be risk factors for PTDM at 24-months (OR 1.11, CI95% 1.00-1.22, p-value = 0.041; OR 1.03, CI95% 1.01-1.06, p-value = 0.014; respectively), while higher C-peptide at post-transplant hospital discharge was found to be protector (OR 1.03, CI95% 1.01-1.06, p-value = 0.014). In a multivariate model including age, pretransplant diabetes duration, pretransplant LDL-cholesterol, and C-peptide at post-transplant hospital discharge, only C-peptide at post-transplant hospital discharge remained significant (OR: 0.41, CI95% 0.18-0.95, p-value = 0.04).

Conclusion

Despite previous results in other studies, and new data researched, in our multivariate model, only lower C-peptide at post-transplant hospital discharge revealed being a predictor of PTDM after PKT.
MO996COVID-19 IN RENAL TRANSPLANT RECIPIENTS; A CASE SERIES FROM IRAQ
Authors: Ali Ala , S. Klaif Mohammed , Altaee Huda
Published: May 2021

Background and Aims

Renal transplant recipients seems at particular risk for Coronavirus disease 2019 (COVID-19). In addition to immune suppression cessation, multiple therapies have been tried with no supportive evidence. Favipiravir and colchicine showed benefit in some reports. Here we describe 19 adult renal transplant recipients with mild to moderate COVID-19 who were treated with the cessation of immunosuppression, favipiravir, and colchicine on an outpatient basis.

Results

This case series includes 19 renal transplant recipients with a mean age of 38.4 + 11.6 years and a mean duration of 55.9 + 36.1 months post-transplant. They were maintained on triple therapy with a calcineurine inhibitor, antiproliferative therapy and steroids. The laboratory data at weeks 1,2, and 3 showed that at weeks 2 all markers of inflammation increased especially serum ferritin (1718 + 315 ng/ml). Serum creatinine increased by < 30% with urine protein creatinine of < 500 mg/g. The mean time to recovery was 13 + 3.1 days. The patient who was on mTOR inhibitor showed the highest inflammatory response and the longest time to recovery, 18 days. All patients showed complete recovery with stable graft function and no patient warranted dialysis, nor ICU care.

Conclusion

In the settings of limited resources, unavailability of costly immunomodulatory therapies and limited hospital capacity, early case definition, judicious management of immune suppression, and affordable antiviral and anti-inflammatory drugs will improve outcome in early cases of COVID-19 in renal transplant recipients.
MO998EARLY VERSUS LATE ACUTE GRAFT PYELONEPHRITIS: A RETROSPECTIVE ANALYSIS OF GRAFT AND PATIENT OUTCOMES
Authors: Kaul Anupma , Mathews Thomas
Published: May 2021

Background and Aims

Acute graft pyelonephritis(AGPN) is thought to affect graft and patient survival among renal transplant recipients. Our objective was to compare these outcomes in those having early AGPN(<6 months from transplant) versus those having late AGPN(>6months from transplant)

Method

This retrospective study analyzed 150 patients who had AGPN over a period of 8 years from 2005 to 2013. They were divided into early AGPN group and late AGPN group. Their baseline characteristics were compared. Predictors of graft loss and mortality were compared using logistic regression analysis. Graft survival and patient survival were analyzed using Kaplan-Meyer survival plots

Results

A total of 150 patients with AGPN were analyzed. Of these 55.3% (n=83) had early AGPN and 44.7% (n=67) had late AGPN. These two groups were comparable regarding baseline characteristics and immunosuppression. In early AGPN group, 13.3% (n=11) patients had CMV disease during follow up compared to 3% (n=2) in late AGPN group(p<0.05). In the early AGPN group, 26.5% (n=22) had prolonged Foley’s catheterization (>5days) following transplant surgery compared to 7.5% (n=5) in late AGPN group (p<0.05). In the early AGPN group, 38.6% (n=32) had prolonged DJ stent in-situ (>2weeks) following transplant surgery compared to 19.4% (n=13) in the late AGPN group (p<0.05). Recurrent GPN was more common in the late AGPN group than the early AGPN group - 35.8% (n=24) versus 18.1% (n=15). Predictors for graft loss were assessed in patients with AGPN and the presence of renal abscess was predictive of graft loss in univariate analysis (HR-6.129, 95% CI 1.776–21.154, p-0.004). There were no significant predictors of mortality in univariate analysis. Kaplan Meier survival analysis showed decreased death censored graft survival in the early AGPN group (p-0.035). There was no

Conclusion

Occurrence of early AGPN had a significant impact on long term graft survival in renal transplant recipients with no significant effect on patient survival. This study underlines the paramount importance of the prevention of UTIs in renal transplant recipients.
MO1000MAINTENANCE IMMUNOSUPPRESSIVE THERAPY IN PREVENTION OF ACUTE REJECTION AFTER KIDNEY TRANSPLANTATION
Authors: Fattoum Safa , Bacha Mohamed Mongi , Mosbehi Tasnim , Braiek Nesrine , Abderrzhim Ezzedine , Ben Hmida Fethi , Ben Abdallah Taieb
Published: May 2021

Background and Aims

Acute rejection (AR) is a redoubtable immunological complication after kidney transplantation (KT). Maintenance immunosuppressive treatment (IS) is a corner stone in prevention of AR. The aim of this study was to define the role of different maintenance IS in preventing AR.

Method

It was a longitudinal, retrospective, analytical study including kidney transplant patients followed up in our department between 1986 and 2019. Our population was divided in 2 groups: group A (129 KT complicated by at least one episode of AR) and group B (491 KT not complicated by AR).

Results

All patients received low dose of corticosteroids (CS) in their IS.

Calcineurin inhibitors (CI) were not prescribed in first intention in 33,3% of groups A patients versus 13,2% in group B. Cyclosporin A (CsA) was prescribed in first intention in 57,4% of group A patients versus 45,7% in group B. Tacrolimus was prescribed in first intention in 9,3% of group A patients versus 41,1% in group B (p<0,0001).

All patients received Atimetabolite (AM) in their IS. In first intention, Azathioprin was prescribed in 73,6 % of group A patients and Mycophenolate Mofetil (MMF) was prescribed in 78,6% of group B patients (<0,0001).

In first intention, maintenance IS consisted in low dose corticosteroids (CS) associated with AM in 13,5% of our patients. CI was associated to CS and AM in 86,5% of patients. Tritherapy was significantly more used than biotherapy in group A (p<0,0001). Different associations used were CS+Aza, CS+MMF, CS+AZA+CsA, CS+MMF+CsA or CS+MMF+ Tac. From group A, 74,8% of patients received CS+AZA or Cs+AZA+CsA. And from group B, 75,8% of patients received CS+MMF+CsA or CS+MMF+Tac.

Conclusion

Maintenance IS therapy must be well chosen according to immunological risk in order to prevent AR.
MO979THERAPEUTIC OPTIONS FOR RECURRENCE OF PRIMARY FOCAL SEGMENTAL GLOMERULONEPHRITIS (FSGS) IN THE RENAL ALLOGRAFT: SINGLE-CENTER EXPERIENCE
Authors: Vallianou Kalliopi , Marinaki Smaragdi , Skalioti Chrysanthi , Lionaki Sophia , Darema Maria , Melexopoulou Christina , Boletis Ioannis
Published: May 2021

Background and Aims

Focal Segmental Glomerulosclerosis (FSGS) recurrence after kidney transplantation (KTx) is relatively frequent and is associated with poor graft survival. The aim of this study was to investigate which management strategies were associated with better outcomes in our cohort of KTx recipients with primary FSGS.

Method

We retrospectively collected data on patients with primary FSGS who received a KTx between 1993 and 2019. A history of biopsy proven FSGS in native kidneys and new onset of significant proteinuria early post-KTx led to the diagnosis of recurrence, which was confirmed by graft biopsy.

Results

From 1993 to 2019 we performed 46 KTxs in patients with primary FSGS. We identified 26 episodes of recurrence in 25 patients, 67% of them occurring in males. They were younger at the time of KTx (33.8 vs 41.1 years old, p=0.067) and had progressed to end stage renal disease (ESRD) faster after FSGS diagnosis (61.4 vs 111.2 months, p=0.038), while they were less likely to have received prophylactic plasmapheresis (61.5% vs 90%, p=0.029). 76.7% of recurrences were found early, after a median of 0.5 months (IQR 0.1-1) with a median proteinuria was 8.5 (IQR 4.9-11.9) g/day. All patients with recurrence were treated with plasmapheresis, while 8 (30.7%) additionally received rituximab, 1 (3.8%) abatacept and 4 (15.4%) ACTH. 7 (27%) patients experienced complete and 11 (42.3%) partial remission after a mean time of 3 (±1.79) and 4.4 (±2.25) months respectively. Prognosis was worse for patients who experienced a recurrence. 11 (42.3%) patients lost their graft from FSGS in a median time of 33 (IQR 17.5-43.3) months.

Conclusion

In this series of patients, primary FSGS recurred frequently after KTx. Prophylacic plasmapheresis was shown efficacious in avoiding FSGS recurrence, while timely diagnosis and plasmapheresis-based regimens induced remission in more than half of the patients.
MO985EFFICACY AND SAFETY OF FERRIC CARBOXYMALTOSE IN THE MANAGEMENT OF EARLY POST-RENAL TRANSPLANT ANEMIA
Authors: Núñez Delgado Sara , Solà-Porta Eulàlia , Arias-Cabrales Carlos , Redondo-Pachón Dolores , Buxeda Anna , Burballa Carla , Mir Marisa , Pascual Julio , Crespo Marta , Pérez-Sáez María José
Published: May 2021

Background and Aims

The efficacy and safety of intravenous ferric carboxymaltose (FeCarb) has been demonstrated both in patients with chronic kidney disease and dialysis, but its effects have not been evaluated in kidney transplant (KT) recipients.

Method

Retrospective study (2016-2018) of KT recipients who received FeCarb during the first 30 days after kidney transplantation (KT). Early efficacy was analyzed by evaluating the first determination of ferrokinetics and hemoglobin levels after administration and late efficacy with the determination >90 days post-administration. Safety parameters were also analyzed.

Results

Out of 283 KT performed, 77 recipients received one dose of FeCarb (52 received a 500mg dose and 25 a 1000mg dose) after a median of 6 days after the KT (IQR 3.5-9 days). 24 patients required transfusion after administration, 7 of them in the setting of concomitant event and 17 for non-response to FeCarb. Among the non-responders (n=17) there was a higher percentage of women, the initial hemoglobin was lower and they received a higher dose of FeCarb (Table). Responders (n=53) improved early and late ferrokinetic and anemia parameters (Figure). In the multivariate analysis adjusted by gender, controlled infection at the time of FeCarb administration, dose of FeCarb administered, immunosuppression, and previous treatment with erythropoietin, hemoglobin levels below 8 g/dL were associated with increased risk of transfusion after FeCarb administration (HR 11.30 [3.03-42.2]). Tolerability was excellent, with no immediate adverse reactions after FeCarb administration. 17 responders had a controlled infection at the time of FeCarb administration (median days under antibiotic treatment: 3, IQR 1-5). The infection did not worsen the response to FeCarb and no clinical impairment after FeCarb administration was observed.

Conclusion: FeCarb administration in early post-transplant anemia is effective in patients with hemoglobin higher than 8g/dl and is not associated with increased risk of infection deterioration.
MO920TRANSITION FROM GENERIC TO BRAND TACROLIMUS IN TUNISIAN RENAL TRANSPLANT RECIPIENTS
Authors: Amor Dorra , Wissal Sahtout , Ellouz A , Abderrahman Ameni , Azzabi Awatef , HadjBrahim Mayssa , Mrabet Sanda , Fradi Asma , Ben Aicha Narjes , Zallema Dorsaf , Sabri Ferdaous , Omezzine Asma , Guedri Yosra , Achour Abdeltif
Published: May 2021

Background and Aims

Due to unavailability of the generic tacrolimus, commonly used in renal transplant patients in Tunisia, all renal transplant switched to the Brand. No previous studies have assessed the pharmacokinetic differences of this generic tacrolimus compared to the brand. The aim of the present study was to evaluate the effect of this switch on the tacrolimus dose (D) and on the dose-adjusted tacrolimus trough blood concentrations (C0/D) in Tunisian renal transplant recipients.

Method

For the 255 renal transplant monitored in biochemestry department of Sahloul University hospital, 808tacrolimus trough concentration (C0) were collected from october 2018 to February 2020 and were divided to 406 C0 determination before switch and 402 after switch. The dose and the post-transplantation period was recorded for each C0.

Results

The generic tacrolimus doses used were significantly higher compared to the brand: 0,12 mg/kg [0,02-0,6] vs 0,11 mg/kg [0,02-0,22] p<0,001 and this was reported in different post graft periods: 0,17 [0,03-0,22] vs 0,13 [0,06-0,22] p<0,001in the 3 first months after the transplantation and 0,11 [0,02-0,48] vs 0,08 [0,02-0,22] p<0,001 above.The C0/D were significantly lowe runder the the generic tacrolimus compared to the brand 48,34ng/ml per mg/kg/day [11,58-210,00] vs77,35ng/ml per mg/kg/day[19,38-221,67]; p<0,001 and this was reported in different post graft periods: 71,12ng/ml per mg/kg/day [6,80, 451,56] vs80,9750ng/ml per mg/kg/day [17,33-458,80] p=0,017 in the 3 first months after the transplantation and 71,12ng/ml per mg/kg/day [6,80, 451,56] vs80,9750ng/ml per mg/kg/day [17,33-458,80] p=0,017 above. Dose needed to reach target tacrolimus C0 seems to be higher with the generic tacrolimus compared to the brand.

Conclusion

Approval of a generic is dependent on bioequivalence testing in healthy adult volunteers after a single dose, however studies on renal graft recipient populations after chronic use are needed to assed bioequivalence in this special population.
MO1054IMUP: THE ROLE OF TELEMEDICINA ON THE HOMECARE OF CHRONIC KIDNEY DISEASE PATIENTS AFFECTED WITH COVID19
Authors: Yuste Claudia , Caro Espada Paula Jara , Aubert Lucia , Gutiérrez Elena , Frías González Aida , Berzal Raquel , Bergesio Luca , Besada Juan , Bernardos Ana
Published: May 2021

Background and Aims

COVID19 worldwide crisis has shown the fragility of usually overbooked hospital care, encouraging improvements on the homecare and remote monitoring of patients. IMUP (Intelligent Manager for Ubiquitous Personal Mobile Care) is a Mobile App developed by UPM to follow up  chronic kidney disease (CKD) patients affected with COVID19.

Method

CKD patients (or their home caregivers) with access to a mobile phone were asked to introduce daily their symptoms (headache, tiredness, short of breath, cough and diarrhea) in addition to blood pressure and temperature. IMUP also allowed: (1) free asynchronous message exchange between patients and physicians, (2) provided general information and guidelines to reduce household COVID19 transmissions, (3) countdown of isolation days, and (4) notified alarms and alerts.  All patients consented to a mobile phone monitor. Physicians categorized clinical situations reviewing IMUP symptoms into: (1) stable, (2) alert, and (3) presential assistance advised.

Results

A total of 38 patients (9 kidney transplant, 23 haemodialysis, 3 peritoneal dialysis, 3 low clearance)( 58.8% male, age 62.2 ± 15.6 years, 17.6 % diabetics) with confirmed COVID19 infection were followed up with IMUP, 23 after hospitalization (median of 10 [4-16] days) and 15 with complete outpatient follow-up. The mean follow-up with IMUP was 8 [4,17] days. Four houndred and seven daily symptoms were introduced in IMUP, being tiredness the commonest (27%), followed by cough (21.5%) and diarrhea (20.6%).  Reviewing IMUP daily symptoms, 185 clinical situations were categorized in stable and 21 alert. Five patients required presential assistance, 3 of them requiring hospital admission (1 rehospitalization). 81 messages were exchanged, delivering 17 therapeutic recommendations.  IMUP countdown helped to organize isolation on the HD unit (cases and contacts), plus follow up with chest X rays and blood samples.

Conclusion

The easy and intuitive use of mobile apps makes them widely accepted by the general population. Remote monitoring by mobile phone apps brings a new opportunity to alleviate our overbooked hospital care. Besides, remote monitoring could help to stratify and organize clinical follow up, allowing a closer communication between physicians and patients.
MO1055JUDICIOUS DIALYSIS DISCONTINUATION IN CHRONIC KIDNEY DISEASE: LENDING MORE TIME TO ECONOMICALLY BURDENED PATIENTS IN DEVELOPING COUNTRY
Authors: Sharma Sourabh , Sharma Neha , Sharma Kailash
Published: May 2021

Background and Aims

Chronic kidney disease (CKD) is important public health problem owing to its high prevalence, morbidity, mortality and socio-economic burden. Patients with end stage kidney disease need to be on kidney replacement therapy which significantly impacts livelihood. Annual average cost of treatment for patients on dialysis is reported to be USD 3151 in developing country like India. It’s quiet high given per capita income of USD 1670

Method

One hundred fifty one CKD Stage 5D patients from Punjab and Rajasthan states, North India were studied in this cross-sectional study. Patients initiated on dialysis within 3 months or protein energy wasting (as per criteria proposed by ISRNM) were excluded. Asymptomatic willing patients, clinically stable for at least 3 months and with pre-dialysis serum Creatinine <6mg/dl, serum potassium <5mg/dl were given a trial for dialysis discontinuation after informed written consent. Biochemical and hemodynamic parameters were measured weekly for 4 weeks and later once monthly. Patients who developed uremic features or rapid rise in serum creatinine were restarted on dialysis.

Results

Fourteen (9.27%) asymptomatic patients with well controlled blood pressure were discontinued from dialysis. Out of them, thirteen patients were on hemodialysis and one on peritoneal dialysis. Twelve (85.71%) out of them were presumed chronic interstitial nephritis while two (14.28%) were autosomal dominant polycystic kidney disease. Mean age of patients was 52.5 years (SD ±18.14 years). Most patients (11/14) were on three or more anti-hypertensive. Mean dialysis vintage was 8.14 months (range 4-16 months). Most patients were non-compliant to dialysis (Mean frequency once in seven days). Two patients were on once in two week dialysis schedule. Mean 24 hour urine output (calculated over 1 week) was 1500ml. Mean baseline serum creatinine was 4.4 mg/dl (SD ±1.06 mg/dl). Mean pre-dialysis serum potassium was 4.5 mg/dl (SD ±0.42 mg/dl). Post-discontinuation serum creatinine levels has been outlined in figure 1. Mean distance of dialysis centre from residence was 83.43 Km (range 1-240 km). One patient need to be restarted on dialysis at fourth week of dialysis discontinuation. Rest patients remained symptom-free and tolerated well.

Conclusion

CKD Stage5D patients should be regularly screened for residual renal function. Recovery of renal function could be seen in some (<10%) cases. Dialysis discontinuation in these cases would decrease their financial and stress burden. However, these cases should be monitored closely and followed-up regularly
FC 043SOLUBLE UROKINASE PLASMINOGEN ACTIVATOR RECEPTOR (SUPAR) DETERMINES OUTCOMES IN CLINICAL AND EXPERIMENTAL SEPTIC ACUTE KIDNEY INJURY
Authors: Nusshag Christian , Wei Changli , Hahm Eunsil , Szudarek Roman , Kälble Florian , Speer Claudius , Uhle Florian , Eugen-Olsen Jesper , Weigand Markus A , Zeier Martin , Morath Christian , Brenner Thorsten , Reiser Jochen
Published: May 2021

Background and Aims

Sepsis is the main contributor to the development of acute kidney injury (AKI) in critically ill patients. Plasma soluble urokinase plasminogen activator receptor (suPAR) is a circulating risk factor for AKI and a new prognostic marker for renal outcome prediction. We analyzed the pathophysiological role and kinetic properties of suPAR in septic AKI in critically ill patients and in a murine model of septic AKI.

Method

200 critically ill patients were enrolled prospectively after meeting Sepsis-3 criteria. Serum suPAR levels were measured at 0, 12, 24, 48, 72, 96, 120 and 168-hour after enrollment (n=1440) and the need for RRT within 7 days (predefined criteria) was assessed as the primary outcome measure. Polybacterial sepsis was induced by cecal slurry injection in three mouse strains, respectively wild type (WT, N=16), uPAR-knockout (KO, N=15), and suPAR transgenic overexpression (OE, N=14).

Results

No or mild AKI occurred in 62 patients (31.0%), moderate or severe AKI without the need for RRT in 102 patients (51.0%), criteria for RRT were met in 36 patients (18.0%) and 7 patients (3.5%) died within the 7-day period. Compared to all other maximum AKI stages and AKI disease courses within 7 days, patients requiring RRT showed significantly higher suPAR levels at all time-points. Patients with suPAR levels ≥ 12.7 ng/mL (highest quartile) had an unadjusted odds ratio (OR) of 9.73 (95% confidence interval [CI], 4.31-21.98) and an adjusted odds ratio of 5.22 (95% CI, 2.16-12.65) for the need for RRT; and 7.47 (95% CI, 3.54-15.74) and 4.44 (95% CI, 1.98-9.97) for RRT or death within 7 days compared to patients with levels < 12.7 ng/mL. Compared to KO mice, WT and OE mice showed a significantly greater impairment of renal function, structure and tubular apoptosis 24 hours after induction of sepsis. The inflammation levels with respect to Interleukin 6 were comparable between different strains. Kaplan-Meier analysis revealed a survival benefit of KO mice over OE mice within 24h (86.7% vs. 50.0%, p=0.033).

Conclusion

SuPAR distinguishes between divergent AKI stages/courses and the need for RRT at any time within 7 days after sepsis diagnosis. Our experimental data suggest that suPAR is a pathophysiological driver of septic AKI and may serve as a target for future interventional strategies.
FC 044THE LONG-TERM EFFECTS OF ACUTE KIDNEY INJURY ON INTESTINAL OXALATE-DEGRADING BACTERIA IN RATS
Authors: Stepanova Natalia , Tolstanova Ganna , Nepomnyashchii Valentyn , Akulenko Iryna , Savchenko Svitlana , Kolesnyk Mykola
Published: May 2021

Background and Aims

Gut microbiota is considered an important factor affecting oxalate handling in the intestine. It has been demonstrated that intestinal oxalate secretion provides a complementary route of excretion, and it becomes more evident when kidney function declines. A diversity of gut oxalate-degrading bacteria (ODB) has been hypothesized to play a role in this process. However, there is a general lack of research on the long-term effects of acute kidney injury (AKI) on ODB and their total oxalate-degrading activity (ODA) in fecal microbiota. In this study, we evaluated whether renal dysfunction could affect intestinal ODB and their total ODA in a rat model of glycerol-induced AKI.

Method

The Male Wistar rats (200-300 g, n=20) on oxalate-free diet were randomly divided into 2 groups. After 24-h of water deprivation, Group 1 (n=10) received an intramuscular injection of 50% glycerol (10 ml/kg of body weight), and Group 2 (n=10) served as control. The numbers of ODB (incubated in a highly selective Oxalate Medium and determined using culture method) and total fecal ODA were measured after injection on days 7 and 70. The method of redoximetric titration with a KMnO4 solution was adopted to evaluate total ODA in fecal microbiota; the results were expressed as % of oxalate degradation per 0.01 g of feces.

Renal injury was assessed by histopathological examination, serum creatinine and daily proteinuria levels after removing the animals from the experiment on day 70. Cortical interstitial fibrosis was measured by computerized image analysis on sections stained with picrosirius red. The median (Me) and the interquartile ranges (Q25; Q75) were calculated and compared using the nonparametric Mann-Whitney test. The Spearman correlation coefficient was used to evaluate association between the examined parameters.

Results

The obtained results demonstrated: 1) after glycerol injection on day 7, no differences were found in the numbers of ODB and total fecal ODA between the experimental and control groups: 5.9 (5.4-6.0) vs 6.0 (5.4-6.4) CFU/g, p=0.65 and 2.0 (0.1-5.0) vs 2.5 (2.0-9.0) %/0.01g, p=0.24, respectively; 2) after AKI initiation on day 70, the numbers of ODB and total fecal ODA were significantly lower in Group I compared with control Group II (Fig. 1); 3) the higher percentage of renal interstitial fibrosis was, the higher total fecal ODA occurred in the experimental rats (Fig. 2). In addition, the number of ODB in feces in Group 1 had an inverse association with serum creatinine (r=-0.52, p=0.006) and 24-h proteinuria levels (r=-0.86, p<0.0001).

Conclusion

AKI had the long-term negative effects on the quantitative and qualitative characteristics of ODB in fecal microbiota in rats. Moreover, the results of our study confirmed an increasing trend in total fecal ODA according to the aggravation of renal interstitial fibrosis in rats.
FC 070USE OF POTENTIALLY NEPHROTOXIC MEDICATIONS IN PERSONS WITH CHRONIC KIDNEY DISEASE: PARALLEL COHORT STUDIES IN SWEDISH AND U.S ROUTINE CARE
Authors: Bosi Alessandro , Carrero Juan Jesus , Shin Jung-Im , Xu Yunwen , Grams Morgan , Chang Alexander , Wettermark Bjorn , Barany Franz Peter , Gasparini Alessandro
Published: May 2021

Background and Aims

Many adverse drug events are preventable, such as those potentially resulting from the prescription of nephrotoxic drugs to persons with chronic kidney disease (CKD). We here quantify the extent of contemporary nephrotoxic medication use in patients with CKD.

Method

In two observational cohorts of Swedish (Stockholm CREAtinine Measurements [SCREAM] project, Stockholm, Sweden) and U.S. (Geisinger Health System, Pennsylvania) adults with confirmed CKD stages G3-G5 undergoing routine care during 2016-2018, we explored the prescription (in U.S.) and dispensation (in Sweden) of 115 different ambulatory drugs with proven or purported nephrotoxicity during the 12 months following study inclusion. We evaluated the proportion of participants receiving nephrotoxic drugs, ranked main contributors and identified clinical predictors.

Results

In the Swedish cohort, there were 57880 patients (54.6% women) with median age of 80.00 (inter-quartile range [IQR]: 73.0-86.0) years and eGFR 48.9 ([IQR]: 39.9-55.0) mL/min/1.73 m2. In the U.S. cohort, there were 16255 patients (59% women) with median age of 76 years and eGFR 44 mL/min/1.73 m2. During observation, 20% (Sweden) and 17% (U.S.) of patients received at least one nephrotoxic drug. The top 3 potentially inappropriate nephrotoxic drugs identified were NSAIDs (9% and 11% of participants in U.S. and Sweden received it), antivirals (2.0% and 2.5%) and immunosuppressants (1.5% and 2.7%). Bisphosphonate use was common in Sweden (3.3% of participants), but not in U.S. (0.5%). Conversely, fenofibrates were common in U.S. (3.6%), but not in Sweden (0.13%). In adjusted analyses, patients with young age (<65 years old), women, or with CKD G3 were at higher risk of receiving nephrotoxic medications in both cohorts (P>0.05 for all). Notably, patients aware of their CKD (identified either by issued diagnosis or recent visit to a nephrologist), were at lower risk of nephrotoxic drug use (OR 0.87, 95% CI 0.82-0.92 in Sweden and 0.89, 95% CI 0.81-1.01 in U.S.).

Conclusion

In two geographically distinct health systems, one in five patients with CKD received potentially inappropriate nephrotoxic medications, mainly NSAIDs. Strategies to increase CKD awareness and physician’s knowledge of drug nephrotoxicity may reduce inappropriate ambulatory prescriptions and prevent iatrogenic kidney injury.