bluuebunny/crossref_metadata_2025 huggingface dataset:
P1695OUTCOMES OF KIDNEY TRANSPLANTATION IN RECIPIENTS WITH MENTAL RETARDATION
Authors: ORS SENDOGAN DAMLA , ERDOGMUS SIYAR , Kumru Şahin Gizem , EYUPOGLU SAHIN , Eren Sadioğlu Rezzan , TUZUNER ACAR , Keven Kenan , SENGUL SULE
Published: June 2020

Background and Aims

Mental retardation in patients with chronic kidney disease is a relative contraindication for kidney transplantation. Currently, in the literature there are limited outcome data in renal transplant recipients with mental retardation and approaches to decision of transplantation changes in different centers. The aim of this study is to evaluate the results of kidney transplantation recipients with mental retardation in our center.

Method

In this study, we examined retrospectively 8 kidney transplant recipients with mental retardation in Renal Transplantation Unit of Ankara University School of Medicine between 2006-2018 years.

Results

The cause of mental retardation in these patients were; genetic syndromes in three patients, meningoencephalitis in one patient, prematurity in one patient, and chromosomal abnormality in one patient. In two patients, the cause of mental retardation is unknown. All patients had good social support for drug compliance and follow-up.

The causes of end-stage renal failure were; cystic kidney disease in three patients, hypertensive nephropathy in one patient and vesicoureteral reflux in one patient. In three patients, the etiology of kidney disease is unknown. At the time of pretransplantation period evaluation, six candidates were receiving hemodialysis and two candidates were receiving peritoneal dialysis respectively. Mean dialysis duration before transplantation was 50.7±22.8 months (min 4-max 180). Cadaveric kidney transplantation was performed in three of eight patients (deceased donor kidney allocated to patient with medical urgency in the event of potential imminent loss of dialysis access in one patient and in normal conditions in two patients) and living kidney transplantation was performed in five patients. The mean follow-up period after transplantation was 54.1±48.0 months. Three patients had early posttransplant complications; including urinary tract infection in three patients, deep vein trombosis in one patient and cardiopulmoner arrest with septic shock secondary to femoral graft infection and parailiac abscess in one patient (Table). No patients underwent graft biopsy and no patients experienced acute rejection episode. At the end of the follow-up time, graft and patient survival were 100%.

Conclusion

Mental retardation is not a contraindication for kidney transplantation in candidates without the history of noncompliance with proper social support.
P1699EFFECT OF UREMIA IN THE POSTOPERATIVE OF PREEMPTIVE LIVING-DONOR KIDNEY TRANSPLANT PATIENTS
Authors: Molina Andãºjar Alã­cia , Cuadrado Elena , Cucchiari David , De Sousa Erika , Oppenheimer Federico , Diekmann Fritz , Revuelta Ignacio
Published: June 2020

Background and Aims

Getting a preemptive kidney transplant has many benefits but no studies have assessed the potential deleterious effect of uremia on peritransplant complications. Uremic toxins interact negatively with biologic functions and may contribute to infections and bleeding or thormbosis.

Method

we evaluated 255 living-donor kidney transplant recipients (117 preemptive and 138 non-preemptive) from January 2006 to December 2015. Patients iniciated immunosuppression treatment 3 days prior to transplant. Exclusion criteria included: history of solid organ transplant, chronic immunosuppression treatment at the time of transplant (including prednisone), peritransplant rituximab/eculizumab treatment and HIV infection. An analysis of baseline characteristics and the incidence of symptomatic infection, bleeding or thrombosis during first week was performed in both groups. To analyze bleeding, the need of transfusion, drop of hematocrit in 72h and need of bladder washout was assessed.

Results

baseline characteristics are descrived in table 1. Non preemptive patients were older (50 vs 46 years) and had a higher prevalence of Diabetes Mellitus and dialypemia (22 vs 11% and 43 vs 30% respectively), without differences in the immunosupression scheme. The median eGFR in preemptive group at transplant was 12 ml/min. A more anemic profile was detected in the preemptive group with median hemoglobin of 116 vs 127 g/L in the non-preemptive group with no-differences in albumin levels. There were a total of 38 symptomatic infections (22 in the preemptive and 16 in the non-preemptive group), without statistical differences in the incidence between the groups (OR 1,75 CI 0,879-3,5, P =0,107). Hematocrit drop was greater in the non-preemptive group (8 vs 6 points in the first 72h p = 0.004) but thrombosis was more common in the preemptive group (5 vs 1, OR 6,116 CI 0,704-53,1, p = 0.062).

Conclusion

Uremia in preemptive living kidney transplant recipients does not seem to have influence on the incidence of infections in the first week after transplantation. The bleeding profile in the non-preemptive group in contrast to the prothrombotic profile in preemptive recipients needs further investigation in future studies that assess parameters of platelet and coagulation function as well as endothelial activation.
P1701ANTIBODY MEDIATED REJECTION: CLINICAL PHENOTYPE MATTERS
Authors: Burballa Tarrega Carla , Llinás Laura , Buxeda Anna , Arias Cabrales Carlos , Pérez Sáez María José , Redondo Pachón M Dolores , Mir Fontana Marisa , Faura Anna , Crespo Barrio Marta , Pascual Santos Julio
Published: June 2020

Background and Aims

Protocol biopsies following kidney transplantation (KT) allow the histological diagnosis of antibody-mediated rejection (ABMR) with stable renal function (RF). Controversy arises when considering isolated proteinuria as a clinical biomarker. Currently, there is no effective treatment for ABMR and transplant units may decide on treatment independently of the clinical expression.

Method

KT recipients (1987-2017) with post-KT biopsies (2008-2018) showing ABMR graft lesions (category 2-Banff’2015) >1year post-KT were included. Cases were grouped into phenotypes of ABMR according to the clinical picture at biopsy : 1) acute RF impairment (↑creatinine >15% three weeks before biopsy) with/without proteinuria and with/without DSA detection. 2) sub-acute RF impairment (↑creatinine >15% six months before biopsy) with/without proteinuria and with/without DSA detection, 3) performed for DSA detection with stable RF and no proteinuria or 4) protocol biopsy, with stable RF, no proteinuria or DSA detection. We considered an additional category: 5) isolated proteinuria (↑>500 mg or x2 six months before biopsy). Categories 1), 2) and 5) were considered clinical ABMR. Categories 3) and 4) were considered subclinical ABMR. We aimed to evaluate graft outcomes in the different ABMR phenotypes.

Results

In a cohort of 105 KT recipients with histologic lesions of ABMR, biopsies corresponded to phenotypes 1) in 35 (33%), 2) 10 (9,5%), 3) 21 (20,3%), 4) 14 (13,4%) and y 5) in 25 23,8%). No differences between clinical and subclinical ABMR were found in baseline characteristics except for donors ‘age, who were older within the clinical group (51.8±18.8 vs. 43.88 ±16.1; p=0.04). At time of biopsy, subclinical had better RF than clinical ABMR (creatinine 1.3±0.4 mg/dl vs. 2.2±1.1 mg/dl; p=0.02) and less proteinuria (161 mg/g [IQR 93-269] vs 939 mg/g [IQR 412-2000]; p=0.001)

Graft survival was worse in those patients with acute and sub-acute RF impairment, followed by those with isolated proteinuria (Figure 1). In comparison to subclinical ABMR, those with RF impairment and isolated proteinuria had an increased risk of graft lost; HR 9.4 (95% IC 2.2-40.7, p=0.002) and 4.8 (95% IC 1.01-23.2, P=0.05) respectively. DSA detection in these groups did not impact graft survival. Specific treatment was not different among groups, except for steroid pulses, which were more frequently applied in cases of ABMR with clinical manifestation.

Conclusion

The clinical phenotypes of ABMR influence long-term graft survival independently from treatment. Understanding graft evolution according to clinical phenotype at the time of histologic diagnosis should guide the therapeutic strategy, to balance risk-benefit ratio.
P1711RENAL RESISTIVE INDEX (RRI) OF KIDNEY ALLOGRAFT. OMEN OF THE OUTCOME OF TRANSPLANTION?
Authors: Smyrli Maria , Tsouka Glykeria , Oikonomaki Theodora , Vougas Vasileios , Apostolou Theofanis , Christodoulidou Christallenia
Published: June 2020

Background and Aims

Renal resistive index (RRI) of ultrasonography is a useful and potent tool for assessment and evaluation of renal hyperfiltration status of the transplanted patients. The aim of this study was to evaluate the association of RRI with renal function one year after transplant.

Method

We evaluated retrospectively 98 kidney allograft recipients. Data were collected from transplantations performed in our medical center between 01/2014 and 09/2018. Patients with acute loss of the renal function and renal survival less than a year were excluded from the study. We compared longitudinally the RRI at the first week after transplant and the third month, with glomerular filtration rate (eGFR, by CKD-EPI) at the end of the first year of transplantation. RRI was measured on the interlobular artery level, in each of the aforementioned time periods, and results were classified into 2 groups, RRI <0,8 or>0,8. In addition, age, gender and delayed graft function (DGF) were also determined in all patients.

Results

Sixty seven (67) of the recipients were males and 31 females with a mean age of 48±12years. The corresponding demographics for the donors were 46 males and 52 females with a mean age of 53 ±14. No correlations were found between RRI of the first week with gender and age, of both donors and recipients (p>0.05). Similarly, RRI of the first week was not correlated with DGF and one-year eGFR after transplant (p>0.05). On the contrary, RRI performed at the third month was strongly correlated to DGF and eGFR at the end of the first year. In other words, allograft recipients with a resistive index less than 0.80, had a higher eGFR and reduced frequency of DGF (p=0.01 and 0.03 respectively). Last but not least, higher recipient age and not gender was the main determinant of an increase of resistive index in the third month after transplant (P=0.02).

Conclusion

RRI offers interesting and helpful data on kidney allograft function. RRI of the third month less than 0.8 was related to better renal function at the end of the first year after transplant mainly and a lower incidence of DGF.
P1714INTRA-ABDOMINAL PRESSURE IS ASSOCIATED WITH HIGHER RENAL RESISTIVE INDEX AFTER RENAL TRANSPLANTATION
Authors: Coca Armando , Gonzalez Pablo , Arias-Cabrales Carlos , Perez-Saez Maria Jose , Rollan Maria Jesus , Acosta-Ochoa Isabel , Bustamante-Munguira Elena , Mendiluce Alicia , Pascual Julio , Bustamante-Munguira Juan
Published: June 2020

Background and Aims

The renal arterial resistive index (RRI) reflects renal hemodynamics non-invasively using Doppler arterial waveforms. RRI is defined by factors such as age, sex, weight, height or mean arterial pressure. Intra-abdominal hypertension (IAH) is a common complication among post-surgical patients that can affect renal blood flow. We aimed to determine the relationship between intra-abdominal pressure (IAP) and RRI in a sample of incident kidney transplant patients (KTs).

Method

Single-center prospective cohort of deceased-donor KTs. Anesthesia, surgical technique and immunosuppression induction therapy was 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 72h after surgery or until reoperation. Mean IAP values during the first 24h (24h-IAP) were used in this analysis. Doppler ultrasonography was performed 24h after surgery. RRI was calculated using the following formula: (peak systolic velocity – end-diastolic velocity)/peak systolic velocity. The study was approved by the local ethics committee and written informed consent was obtained in all cases.

Results

137 patients were enrolled. Table 1 summarizes relevant patient and hemodynamic variables. Stepwise multivariate linear regression analysis was used to examine independent predictors of RRI in this sample, including all variables in Table 1. Age (β=0.005, std.error=0.001, P<0.001), dialysis vintage (β=0.001, std.error<0.001, P=0.02) and 24h-IAP (β=0.005, std.error=0.003, P=0.041) were independent predictors of RRI.

Conclusion

Increased IAP in the first 24h after surgery is common in KTs and is correlated with higher RRI, which is associated with increased risk of graft loss and death.
P1720POSTTRANSPLANT TUBERCULOSIS IN LIVE DONOR RENAL TRANSPLANTATION : A SINGLE-CENTER EXPERIENCE
Authors: Attiya Ahmed Mohamed Naguib , Hamed abbas Mohamed , Abdel-Rahman Ahmed Mansour Hassan , Refaie Ayman
Published: June 2020

Background and Aims

Tuberculosis (TB) is one of the not uncommon serious bacterial infections which affect renal transplant recipients notably in endemic areas. Posttransplant TB occurs peculiarly due to reactivation of latent infection in the recipient or acquiring de novo infection after transplantation or rarely as donor transmitted infection. The aim of this study is to investigate the impact of TB disease and treatment drugs on renal graft and assess the risk factors for graft dysfunction during and after course of treatment.

Method

This retrospective single-center study investigated 3000 patients who underwent live donor renal allograft transplantation in our center between the years 1988-2019. TB diagnosis was confirmed in 44 patients. All proven-TB patients were evaluated regarding pretransplant demographic and immunological data. Posttransplant evaluation included kidney function tests, immunosuppressive therapy regimens, incidence of rejection episodes and anti-rejection therapies before, during and after TB.

Results

Patients were predominantly young (32±9.8 years), male (60%), There was no significant difference regarding other pretransplant demographic and immunological data. Regarding induction therapy, 13 patients received induction therapy; 7 patients received ATG, 6 patients received basiliximab and 31 patients did not receive induction therapy with no significant difference (p=0.07). Concerning maintenance immunosuppressive agents, no significant difference was found regarding different protocols of immunosuppression (p=0.11); however, regarding total dose of the steroid in 1st three months post-transplant, there was significant difference (p=0.017). As regards to rejection episodes, 16 patients were not exposed to rejection episodes before TB, 27 patients developed cellular rejection and only 1 patient developed humoral rejection with no statistical difference (p=0.18). In reference to management of rejection episodes, 25 patients received pulse steroid, 2 patients received pulse steroid and ATG, 1 patient received pulse steroid and plasma exchange (p=0.28) prior to infection with TB with no significant difference. A significant increase was noticed in serum Cr during TB disease and treatment:1.5 mg/dL at baseline (Crbase), 1.8 mg/dL at diagnosis (P=0.43 vs. Crbase), and 2.0 mg/dL during the peak (P=0.03 vs. Crbase).

Conclusion

Posttransplant TB drastically affects kidney function and graft outcome. Cumulative steroid dose in the first 3 months may be considered a risk factor for TB.
P1725USAGE AND OUTCOMES FOR EXPANDED CRITERIA DONOR KIDNEY TRANSPLANTATION IN THE KOREA CHARACTERIZED BY KIDNEY DONOR PROFILE INDEX, SINGLE CENTER STUDY
Authors: Lee Jun Young , Kim Miryung , Kim You Jin , Shin Hanwul , Han Byoung Geun
Published: June 2020

Background and Aims

The demand for Kidney transplantation (KT) is increasing and the number of patients who are waiting for KT is steadily increasing. Therefore, there is an increasing prevalence of KT done by cadaver donor especially, expanded criteria donor. We used Kidney Donor Profile Index (KDPI) to predict the renal prognosis of expanded criteria donor (ECD) KT recipient.

Method

We investigated patients undergo KT by ECD from March 2013 to June 2018 respectively. Through the donor’s last creatinine level, KDPI score, and Kidney Donor Risk Index (KDRI) score the renal survival rate was compared with ROC curve analysis.

Results

The mean age of a total 59 ECD KT recipient is 53.85 ± 9.9 years old. Mean follow up duration after KT was 35.0 ± 18.5 months. 10 patients had KDPI score above 85 (KDPI ≥ 85). Five cases undergo dialysis after KT. Nine cases expired during follow up (four sepsis, three sudden cardiac arrest, one hyperkalemia). Glomerular filtration rate one year after KT was significantly associated with KDPI (r=-0.772, p<0.001). The area under curve (AUC) of KDPI was 0.700 (95% CI 0.494-0.906) and cut off point was 75.5. All renal survival patients had KDPI score below 75.5

Conclusion

Our results show that KDPI could be used as an indicator for predicting the prognosis of the Korean ECD KT.
P1727DECEASED DONOR KIDNEY CHARACTERISTICS AND IMPACT ON 10-YEAR GRAFT SURVIVAL - A LONG-TERM OBSERVATIONAL STUDY
Authors: Ng Chee Yong , Yeon Wenxiang , Kee Terence , Yap Yun Ting , Chionh Chang yin
Published: June 2020

Background and Aims

The long waiting list for deceased donor kidney transplantation has prompted the use of Expanded Criteria Donors (ECD) though it is possibly associated with worse graft function and outcomes than Standard Criteria Donors (SCD). Our centre had also implemented a protocol kidney biopsy at implantation from 2005 to 2009.

The aim of this study was to evaluate the impact of donor factors and donor kidney histology on 10-year graft outcomes.

Method

A retrospective analysis was performed on 108 kidney transplant recipients who underwent a protocol biopsy at implantation from November 2005 to November 2009. The biopsy sample was evaluated for glomerulosclerosis, tubular atrophy, interstitial fibrosis and arteriolar narrowing and scored according to Remuzzi et al., N Engl J Med. 2006;354(4):343 (Remuzzi score). Donor factors evaluated were donor age, hypertension, diabetes mellitus, and terminal serum creatinine. The 10-year graft survival and estimated glomerular filtration rate (eGFR) was the main outcome of interest.

Results

The deceased donors included 58% males, 85% Chinese, with a median age of 49 (IQR 12) years. There were 13% diabetics, 51% hypertensive donors and the median terminal creatinine was 95 umol/L. The recipients were 51% male, 79% Chinese, with a median age of 47 (IQR 11) years at transplant. The time interval to transplant was 9.2 (IQR 3.0) years and the overall 10-year graft survival was 67.6%.

Remuzzi score of ≤3 was associated with better 10-year graft survival compared with Remuzzi score of >3 (76.6% versus 45.2%, P =0.02). 10-year graft survival for SCD and ECD was not statistically different (71.6% versus 58.8%, P=0.187).

A multivariate analysis was performed which included donor status (ECD vs SCD), Remuzzi score (>3 vs ≤3), donor age (≥60 or <60 years), donor hypertension, donor diabetes mellitus and terminal serum creatinine (≥133 umol/L versus <133 umol/L). Only Remuzzi score correlated with a better 10-year graft survival rate (P=0.020). All other factors did not correlate with 10-year graft survival.

Amongst the 73 ten-year graft survivors, the median eGFR at year 10 was 47.5 (IQR 20.3) ml/min if the Remuzzi Score was ≤3 while the eGFR was 39.7 (IQR 33.0) ml/min if Remuzzi score was >3. However, this difference was not statistically significant (P=0.570).

The 10-year eGFR was 45.8 (IQR 22.2) for SCD kidney recipients vs 49.5 (IQR 25.6) for ECD kidney recipients. Paradoxically, the median eGFR was higher with the ECD cohort but this was not statistically significant (P=0.443).

Conclusion

An implantation Remuzzi score of more than 3 is associated with poorer long-term graft survival as compared to other donor factors evaluated on 10-year graft survival or eGFR. Where possible, assessment of the kidney histology should be included as part of the kidney selection and allocation process in order to determine long term outcomes.
P1728FUROSEMIDE STRESS TEST PREDICTS DISCHARGE SERUM CREATININE AFTER KIDNEY TRANSPLANTATION
Authors: Coca Armando , Tabernero Guadalupe , Arias-Cabrales Carlos , Sanchez Gil Jimmy Reinaldo , Menacho Miguel Jose Antonio , Pérez-Sáez Maria José , Mendiluce Alicia , Martin Centellas Jesus , Pascual Julio
Published: June 2020

Background and Aims

Acute tubular necrosis is a common complication after kidney transplantation and is closely related to delayed graft function (DGF) and slower graft function recovery after surgery. The furosemide stress test (FST) uses a standardized dose of furosemide to evaluate the integrity of the renal tubule and determine which patients have developed severe tubular damage. We aimed to apply the FST to a sample of incident deceased-donor kidney transplant recipients and describe its association with DGF and serum creatinine (SCr) at discharge.

Method

Single-center prospective observational study of deceased-donor kidney transplant recipients. The FST, a standardized bolus dose of furosemide (1.5 mg/kg) was administered between the 3rd and 5th day after surgery. Patients were excluded if, during that time period, they presented evidence of active bleeding, obstructive uropathy or volume depletion. Urine output (UO) 60 and 120 min after FST was registered. To reduce the risk of hypovolemia, each ml of UO produced for six hours after FST was replaced with 1 ml of normal saline.

Results

25 patients were included in the study. Mean 2h FST UO was 1012±570 ml. Demographic and clinical data are summarized in Table 1. Subjects that suffered DGF had a significantly lower 2h FST UO (534 vs 1164 ml; P=0.015). In adjusted linear regression analysis only a 2h FST UO<1000 ml (β=0.906; 95%CI: 0.04-1.772; P=0.041) and DGF (β=1.592; 95%CI: 0.488-2.696; P=0.008) were independent predictors of SCr at discharge (model adjusted for recipient age, cold ischemia time, number of HLA mismatches, donor SCr and donor hypertension).

Conclusion

Recipients with a 2h FST UO <1000 ml suffered DGF more frequently. FST and DGF were independent predictors of SCr at discharge. A standardized FST could help clinicians distinguish patients with more severe tubular dysfunction and higher risk of DGF.
P1733MINERAL BONE DISEASE (MBD) IS THE POST KIDNEY TRANSPLANTATION POPULATION
Authors: Ryan Louise , Ruane Eva , Watson Alan , Holian John , O'Riordan Aisling
Published: June 2020

Background and Aims

Patients with ESRD have a 4-fold higher risk of fracture compared to the general population. (1) Transplant bone disease is a combination of mineral bone disease sustained pre transplantation and damage incurred post transplantation, risk factors for which include immunosuppression and immobility in the early post transplantation period. Given the high morbidity, mortality and financial burden associated with fractures, the management and prevent of osteoporosis is fundamental. (2) We aimed to compare the management of MBD in our patient cohort to international nephrology and rheumatology guidelines. (1, 3)

Method

A retrospective review of all patients post kidney transplantation attending our department was carried out. Information pertaining to patient demographics, renal history, osteoporosis investigation and management was collected. The results were analysed with Microsoft Excel.

Results

154 patient records (92 male, 62 female) were reviewed. Mean age was 52 years (range 19-80). Mean eGFR was 54ml/min (range 9-90). 82% of patients were taking corticosteroids, the mean dose was 5mg. 9% were taking corticosteroids pre-transplantation. 11 patients (7%) had a history of parathyroidectomy. 19% of patients had a history of a fracture. 26% of patients had a DEXA scan performed which demonstrated 50% had osteopenia and 29% had osteoporosis. The mean fracture risk assessment tool (FRAX) score (risk of having an osteoporosis-related fracture in the next 10 years) for a major osteoporotic fracture was 10.2% (range 2.1-34%) and for a hip fracture was 3.1% (range 0.2-18). Based on these scores 19% and 26% of patients respectively met the criteria for treatment. Overall, 58% of patients were on treatment for either osteoporosis prevention or management or for mineral bone disease. 74% of patients with osteopenia were on treatment (32% calcium supplementation, 5% alfacalcidol, and 63% cholecalciferol). 82% of patients with osteoporosis were on treatment (45% cinacalcet, 36% cholecalciferol, 18% bisphosphonate and 9% denosumab). 27% of patients with osteoporosis were managed in keeping the guidelines.

Conclusion

Our cohort have significant risk factors for osteoporosis including maintenance corticosteroid treatment and previous fractures. There is a high prevalence of osteoporosis in our cohort compared to that reported internationally (4) and they had a high predicted rate of future fractures. Increased screening with targeted treatment is required to reduce the risk of fractures in our post renal transplant patients.
P1748PARATHYROIDECTOMY REMAINS EFFECTIVE FOR TREATING TERTIARY HYPERPARATHYROIDISM: LONG-TERM RESULTS OF A RANDOMIZED STUDY
Authors: Coloma Lopez Ana , Moreno Pablo , Torregrosa Jose-Vicente , Montero Nuria , Manonelles Anna , Melilli Edoardo , Cruzado Josep
Published: June 2020

Background and Aims

Tertiary hyperparathyroidism is a common cause of hypercalcemia after kidney transplant (KT) and has been associated with renal dysfunction, loss bone mineral density and increased risk of fracture, vascular calcification, and increased risk of cardiovascular events. Long clinical management remains controversial. The aim of this study is to evaluate the long-term effectiveness and safety of parathyroidectomy versus cinacalcet in patients with persistent hyperparathyroidism.

Method

A 12-month prospective, multicenter, randomized study demonstrated than subtotal parathyroidectomy is more effective than cinacalcet for controlling hypercalcemia. Now, we evaluate in the same cohort of patients if this effect is maintained after 5 years of follow-up. Laboratory assessment included serum calcium, serum phosphate, intact parathyroid hormone (iPTH), calcidiol levels, estimated glomerular filtration rate and proteinuria at 2, 3, 4 and 5 year follow-up. Therapeutic details about the use of vitamin D, calcium supplementation and phosphate binders were compiled. Fragility fractures were also collected.

Results

In total, 24 patients had data available at 5 years, 13 in the cinacalcet group and 11 in the parathyroidectomy group. At 5 years, six of 13 patients in the cinacalcet group and ten of 11 patients in the parathyroidectomy group (p=0.015) showed normocalcemia (Figure 1). Subtotal parathyroidectomy retained a greater reduction of iPTH compared with cinacalcet group (Figure 2). No differences were observed in kidney function and incidence of fragility fractures between both groups. In relation of treatment, 8 of 13 patients in cinacalcet group maintained treatment with cinacalcet after 5 years follow-up.

Conclusion

Subtotal parathyroidectomy is more effective in long term to maintain normal serum calcium and iPTH compared with cinacalcet in kidney transplant patients with tertiary hyperparathyroidism.
P1750IMMUNE-ADSORPTION COLUMNS IN ABOI INCOMPATIBLE RENAL TRANSPLANTATION: EXPERIENCE FROM DEVELOPING WORLD
Authors: Sharma Sourabh , Mukherjee Debabrata
Published: June 2020

Background and Aims

We present our experience of ABO-incompatible renal transplant using immunoadsorption (IA) columns. We have compared efficacy of two commercially available columns

Method

This single-center prospective study was conducted at Army Hospital Research and Referral, Delhi. All consecutive ABO-incompatible renal transplants from January 2014 to February 2018 were analyzed. Of 30 patients who underwent transplantations, 28 underwent antibody depletion with immunoadsorption columns. Of them, 14 cases were in the “Glycosorb group,” while 14 in the “Adsopak group.”

Results

The donors in the Adsopak group were older than those in the Glycosorb group (p < 0.05). Both groups had spousal donors in majority. The cutoff for the antibody titer was 1:8. Themedian titer in the Adsopak group was 128 (range, 1:4 to 1:2048), while that in the Glycosorb group was 24 (range, 1:8 to 1:128). All patients in the Glycosorb group had baseline titers 1:128, while 13 patients in the Adsopak group had baseline titers 1:512. Nil titer was achievable with Glycosorb®(50%,7/14) but notwith Adsopak®(P< 0.001). The Glycosorb group was advantageous in terms of graft failure because no rejection was noticed in these patients in their follow-up period. Three patients in the Adsopak group developed rejection (two had mixed rejection, and one had antibody-mediated rejection). Four patients died of sepsis (three in the Glycosorb and one in the Adsopak group). Lower baseline serum creatinine level was achieved in the Glycosorb group.

Conclusion

Results of ABO-incompatible renal transplantation were satisfactory, and the use of immunoadsorption columns could effectively deplete antibody titers. Glycosorb columns were more efficient than Adsopak columns. Graft survival was better with Glycosorb. Post-transplant infections were a major cause of mortality.
P1751THE GUANYLATE CYCLASE C AGONIST LINACLOTIDE LIMITS PROGRESSION TO RENAL FIBROSIS AND IMPROVE RENAL FUNCTION IN MOUSE MODEL OF CHRONIC KIDNEY DISEASE AFTER ISCHEMIA-REPERFUSION INJURY
Authors: Nakayama Yuki , Isoyama Naohito , Nakamura Kimihiko , Hiroyoshi Toshiya , Fujikawa Kouki , Matsuyama Hideyasu
Published: June 2020

Background and Aims

Renal ischemia-reperfusion injury (IRI) is a clinically significant condition that leads to acute kidney injury (AKI). AKI is followed by tissue repair characterized by collagen deposition and fibrosis which ultimately results in progression to chronic kidney disease (CKD). Especially in renal transplantation, the degree of IRI has directly led to poor long-term graft survival. Trimethylamine-N-oxide (TMAO), a hepatic metabolic product of trimethylamine generated from dietary phosphatidylcholine, has been linked with progression of CKD. Linaclotide, a guanylate cyclase C agonist, has been reported decrease the plasma levels of TMAO. We investigated whether the reduction of TMAO by linaclotide protect renal function after IRI using an experimental mouse model.

Method

Linaclotide (100μg/kg) was administered for 2weeks before IRI and continued for 2weeks after IRI. After 2weeks since IRI, the renal function was evaluated by serum creatinine level and removed kidneys sections were performed Azan stain to evaluate the level of fibrosis.

Results

The administration of linaclotide before IRI significantly improved renal function. (Fig.1) Histological examination of kidneys showed linaclotide limits to expand fibrosis area after I/R injury. (Fig.2)

Conclusion

The reduction of TMAO by linaclotide before renal IRI could prevent renal fibrosis and improve renal function. Linaclotide may be useful for the patient expected to suffer renal IRI for example renal transplantation and partial nephrectomy.

Fig2
P1754ASSOCIATION OF GUT MICROBIAL FERMENTATION WITH DIARRHEA IN KIDNEY TRANSPLANT RECIPIENTS
Authors: Guedes Rodrigues Fernanda , Casper Swarte Johann , M. Douwes Rianne , J. Knobbe Tim , Pfeferman Heilberg Ita , Bakker Stephan , De Borst Martin
Published: June 2020

Background and Aims

Diarrhea is a common complaint by kidney transplantation recipients (KTR). Metabolic abnormalities and immunosuppressive drugs may cause alterations in the gut microbiome possibly leading to diarrhea. A hydrogen (H2) breath test, reflecting nutrient fermentation, can detect changes in the composition of gut microbiota. In the present study, we studied the association of exhaled H2 with diarrhea in KTR, and investigated its determinants.

Method

All data were collected from the TransplantLines Biobank Cohort Study (NCT03272841). Living kidney donors were used as healthy controls. Breath H2 concentrations were analysed using solid state-sensor gas-chromatography. The stool water content was measured by faecal dry matter analysis and diarrhea was classified as >80% of water content in stools. Age, sex, body mass index (BMI), diabetes mellitus, eGFR and immunosuppressive medication were tested as potential determinants for H2 using linear multivariable regression.

Results

We included 424 KTR (mean age 55.4 ± 13.2 years, 39,1% female, transplant vintage 5.5 ± 9.5 years) and 164 healthy controls in this study. Immunosuppressive drugs included tacrolimus (78.5%), mycophenolate mofetil (MMF, 73.3%), cyclosporine (9.0%), and everolimus (2.4%) in various combinations. The median concentration of H2 in exhaled breath was significantly higher among KTR versus healthy controls (11.0 ppm [5.0 - 25.0] vs 9.0 ppm [4.0-22.5] p=0.005). The exhaled H2 was correlated with stool water content (r=0.24, p=0.04), as shown in figure 1. Serum tacrolimus trough levels were associated with exhaled H2 (standardized β=0.14, p=0.01), independent of age, sex, BMI, diabetes mellitus, eGFR and other immunosuppressive medication. In contrast, MMF trough levels were not independently associated with H2 (standardized β=0.07, p=0.21).

Conclusion

Exhaled H2, a marker of gut fermentation, is higher in KTR compared to healthy controls, and is associated with stool water content. Present results suggest that altered gut microbial fermentation contributes to the occurrence of diarrhea in KTR. Tacrolimus trough level was an independent determinant of H2. These data encourage further studies to validate the association of immunosuppressive drugs, gut microbiota and post-transplant diarrhea.
P1763TUBERCULOSIS IN RENAL TRANSPLANT RECEPIENTS - DO RITUXIMAB AND OTHER IMMUNOSUPRESSION HAVE A ROLE?
Authors: Kaul Anupma , Bhaduria Dharmendra , Prasad Narayan , Gupta Amit
Published: June 2020

Background and Aims

Rituximab is an anti CD 20 agent used widely in renal transplant recipients. Its use is associated with various infections;however, its association with Tuberculosis (TB) is not well established and has not been studied in post renal transplantation patients.

Method

This is a single centre, retrospective analysis of 56 renal transplant recipients who received rituximab for various reasons and 287 post renal transplant patients who did not receive rituximab during the study period from January 2013 to June 2017. The association between use of rituximab and incidence of TB was studied. Other factors associated with tuberculosis were also investigated.

Results

Baseline characteristics were similar in both the groups. Mean time for occurrence of TB was 18.4 + 10.6 months after renal transplantation. Rituximab use was not significantly associated with tuberculosis or any other infection. Higher number of rejection episodes (60% vs 32.72%, p=0.029) was the only factor associated with greater incidence of TB. However, no specific type of rejection was associated with tuberculosis. Use of plasmapheresis in post transplant period for treatment of humoral rejections was associated with significantly higher incidence of TB (33.33% vs 13.41%, p=0.031), however when pre- transplant plasmapheresis was also considered, there was no significant difference. The choice of induction agent was not associated with higher incidence of TB.

Conclusion

Use of rituximab is not associated with higher incidence of TB when compared to other immunosuppressive agents. Routine screening and prophylaxis may not be advisable especially in a country like India with high prevalence of TB; as it will further delay transplantation and may adversely affect the outcome of the patients.
P1764EXPRESSION OF TOLL-LIKE RECEPTOR 4, BUT NOT THE TOLL-LIKE RECEPTOR 2, MAY BE USEFUL I ASSESING THE RISK OF RENAL TRANSPLANT DETERIORATION IN RECIPIENTS WHO HAVE RECOVERED FROM CYTOMEGALOVIRUS INFECTION
Authors: Zmonarski Sławomir , Banasik Mirosław , Gołębiowski Tomasz , Krzysztof Letachowicz , Zmonarska Joanna , Myszka Marta , Madziarska Katarzyna , Magdalena Krajewska
Published: June 2020

Background and Aims

Data binding the expression of Toll-like (TLR) 4 receptor (TLR4ex), or TLR2 receptor (TLR2ex) and transplanted kidney (KT) function and symptomatic infections with CMV (CMV+) and are scarcely available.

Objective: To investigate the relationships between TLR4ex and TLR2ex, a relapse of CMV+ and transplant function.

Method

Materials and methods: TLR4ex and TLR2ex were measured in peripheral blood mononuclear cells of KT recipients.

We compared TLR4ex and TLR2ex among 25 CMV+ patients; 81 patients without CMV infection (CMVn). At the beginning (Day-0) TLR4ex, as well as concentrations of cyclosporin A (CyA) and tacrolimus (TAC) were determined.

Both CMV+ and CMVn patients were divided according to the respective median of TLR4ex into groups of low-TLR2/4 expression (L-TLR2/4ex) and high-TLR2/4 expression (H-TLR2/4ex). Glomerular filtration rate (EGFR) was assessed on Day-0 and after the follow-up (F-up). The magnitudes of EGFR change (ΔEGFR) were evaluated. Stable treatment along the F-up period (median 11.9 months) was applied.

Results

Results. In CMV+ TLR2ex of 64,3% and TLR4ex in 67% is below respective median. Past CMV strongly affected TLR2ex and moderately TLR4ex. On Day-0: in CMV+ we found no link of TLR2 ex and TLR4ex with EGFR; In CMV+ TLR2ex and TLR4ex were lower but Day-0 EGFR did not differ from H-TLR2 or H-TLR4ex. In CMVn: GFR-TLR4ex link was present with no similar in case of GFR-TLR2ex. In patients treated with tacrolimus CMV strongly affected TLR4ex, blurring CMV+/CMVn differences.

Post F-up: in CMV+ with L-TLR4ex EGFR declined, there was no change of EGFR in H-TLR4ex; L/H-TLR2ex showed no differences in EGFR. In CMVn with H-TLR4ex EGFR rose, there was no change in L-TLR4ex. In case of TLR2ex we showed no similar differences. Regression analysis points out the impact of CMV+ and TLR4ex on eGFR and ΔEGFR. No similar impact of CMV+ and TLR2ex on eEGFR and ΔEGFR was found.

Conclusion

Conclusion: In the group who had a symptomatic CMV + infection, low TLR4 expression increases the risk of worsening EGFR. In CMVn, high TLR4 expression increases the chance of EGFR improvement. Historic CMV + strongly affects TLR2ex. However, TLR2ex cannot be used as a factor in assessing the risk of EGFR deterioration.
P1769POST TRANSPLANT MALIGNANCY - OUR EXPERIENCE
Authors: Kurian George , Jagadesh Gauri Shankar , Sreedharan Sandeep , Paul Zachariah , Mathew Anil , Raj Rajesh
Published: June 2020

Background and Aims

Cancer is now increasingly recognized as a major cause of death among patients especially after kidney transplantation. Malignancy represent a major burden in transplantation medicine. The Incidence is about 12 fold higher for PTLD and 3.5 fold higher for non-cutaneous malignancy compare to age-matched population. The increased risk is multifactorial and attributed to oncogenic viruses, immunosuppression and altered T cell immunity. In the era of longer graft survival and with the introduction of more potent immunosuppressive medication, malignancy represents a major burden. The incidence of malignancy after renal transplantation is 3 to 5 times higher. Incidence is higher in transplant patients even when compared to patients on hemodialysis.

Aim: We attempted to assess the incidence of post-transplant malignancies in patients who underwent renal transplantation at our centre, along with studying the presentation, type and other factors affecting their development.

Method

We analysed data retrospectively from 626patients who underwent renal transplantation atour centre from January 2003 to September 2018.Pre transplant history, post transplant course including duration on hemodialysis, immunosuppression details and duration till diagnosis of malignancies were collected. Details regarding type of malignancy, histopathology, staging and treatment given and outcome were collected.

Results

Number of transplant recipient-626. The total number of patients with malignancy is 12. Incidence of malignancy posttransplant is 1.9%.Male-7 and female-6.One patient was detected with 2 malignanciesduring her post transplant period. The types of malignancies encountered were

Conclusion

The incidence of malignancy – 1.9%.Probable reason for decreased incidence of malignancy is the decreased immunosuppression needed by South Asian people. The most common malignancy was solid organ tumour; tongue being the most common organ. Most common histological variant is squamous cell carcinoma.Non-Hodgkin is more common than Hodgkin. Incidence of malignancy is low. Decision regarding cancer screening should be made on individual basis.
P1793MICROBIAL URETERAL STENT COLONIZATION IN KIDNEY TRANSPLANTATION: INCIDENCE AND IMPACT IN URINARY TRACT INFECTION AND RENAL FUNCTION
Authors: Rau Melissa , Carrera Salinas Anna , Marti Sara , Fiol Maria , Etcheverry Begoña , Riera Luis , Ardanuy Tisaire Carmen , Melilli Edoardo
Published: June 2020

Background and Aims

Ureteral stent insertion is nowadays a common practice in kidney transplantation, leading to a dramatic reduction of surgical issues. On the other hands, urinary tract infections are the most common complication in the first months after transplant.

Main scope of our study was to analyze the incidence of stent colonization and its impact on the development of urinary tract infection (UTI) in the first six months after transplantation

Method

Prospective observational study including 23 consecutively recruited patients at one single center. Patients with a previous history of surgical intervention on urinary tract before transplant were excluded. Pigtail stents were removed as for local protocol between 3 and 4 weeks after transplantation in aseptic condition and were cut in a half (proximal and distal) and analyzed separately. Stent colonization were detected by sonication method. Urine culture timing are depicted in Figure 1. In case of clinical symptoms, extra urine cultive were performed as for clinical practice. Patient were followed for 6 months, and results of stent colonization were blinded to clinicians.

Results

Table 1 shows main characteristic of our cohort.

Conclusion
P1794CHANGES IN PHARMACOKINETIC PROFILE OF MYCOPHENOLATE MOFETIL AND TACROLIMUS IN THE TRANSPLANTED PATIENT AFTER BOWEL SURGERY: A PROSPECTIVE COHORT STUDY
Authors: Montero Nuria , Favà Alexandre , Manonelles Anna , González Costello José , Melilli Edoardo , Coloma Lopez Ana , Salvador Gil-Vernet Cebrian , Rigo Raul , Fontova Pere , Torras Joan , Cruzado Josep , Bestard Oriol , Lloberas Núria
Published: June 2020

Background and Aims

Considering the particular pharmacokinetic (PK) profile of mycophenolate (MMF/MPS) with the important contribution of enterohepatic recirculation (EHC) and the potential alteration in tacrolimus (TAC) exposure, a PK study in solid-organ transplant patients who had undergone intestinal resection was carried out.

Method

This is a prospective single-center study of MMF/MPS and TAC exposure changes after bowel resection and after reconstruction. Whole blood samples were collected at the following time points: 0, 0.5, 1, 1.5, 2, 4, 6, 8 and 12 hours post-dose. Areas under the curves (AUCs) were determined in both conditions: with ileostomy and after bowel reconstruction.

Results

Six renal and two cardiac transplant recipients were included. Four subjects completed both pre- and post-reconstruction surgery procedures. Different intestinal anatomic resections were performed (Table 1). Patients with terminal ileostomy showed an under exposure to MMF/MPS. In three patients, initial MPA levels were on target, but they decreased >80% after 4 hours post-drug administration. After bowel reconstruction, the AUC increased maintaining MMF/MPA levels during 12h (Table 2). Before bowel reconstruction, TAC trough levels were within therapeutic target but, after reconstruction, AUCs normalized by dose were much higher than the expected.

Conclusion

Transplant recipients with ileostomy showed infra-exposure to mycophenolate. After 4 hours post-dose, MMF/MPA was undetectable because of the absence of EHC, which was recovered after anatomical correction. TAC exposure was higher after bowel reconstruction suggesting changes in the absorption. The use of mTORi in such clinical situations would be an alternative.
P1802EVALUATION OF THE GENETICAL FEATURES AFFECTING THE RENAL OUTCOMES IN CHILDREN WITH STEROID RESISTANT NEPHROTIC SYNDROME
Authors: Comak Elif , Toylu Aslı , Bilge Ugur , Kaya Aksoy Gülsah , Koyun Mustafa , Akman Sema
Published: June 2020

Background and Aims

Nephrotic syndrome in childhood is characterized by proteinuria, hypoalbuminemia, edema, and hyperlipidemia. Although most children respond to glucocorticoid therapy, approximately 10% of patients turn out to be steroid resistant (steroid-resistant nephrotic syndrome [SRNS]). Although several studies in children with SRNS have shown that mutations in genes encoding proteins in the podocyte skeleton may be responsible for the etiology in only one-third of cases, the genetic features related with renal prognosis and response to immunosuppressive agents are not fully recognized.

The aim of this study was to investigate the genomic alterations associated with renal prognosis and resistance to immunosuppression in children with SRNS.

Method

The children with SRNS were enrolled in this study. Custom gene panel was designed for next-generation sequencing analysis of more than 20 target genes (ABCB1, ABCC2, CTLA4, CYP2C8, CYP2C9, CYP2C19, CYP2D6, CYP3A4, CYP3A5, FOXP3, GSTP1, IMPDH1, IMPDH2, NOS3, NR3C1, SLCO1B1, SLCO1B3, TPMT, UGT1A9, UGT2B7) and 200 single nucleotide variants (SNVs) which were reported as implicated in renal prognosis of nephrotic syndrome. The target gene panel was enriched for drug metabolism regulating transporters and enzymes.

Results

A total of 25 children, 16 boys (64%), median age at last visit 17.5 years (13-18 years), median age at diagnosis 7.5 years (2-15), median follow-up 9.58±4.54 years, were included in the study. All patients were diagnosed focal segmental glomerulosclerosis on renal biopsy.