bluuebunny/crossref_metadata_2025 huggingface dataset:
MO1006COMPARISON OF DIFFERENT DEFINITION OF PARTIAL AND COMPLETE REMISSION IN A COHORT OF CHILDREN WITH LUPUS NEPHRITIS*
Authors: de Mutiis Chiara , Tullus Kjell
Published: May 2021

Background and Aims

Lupus Nephritis (LN) occurs in up to 80% of children with SLE and it affects the long term outcome and the overall survival. Achieving and maintaining renal remission is crucial. However definition of remission in children is not clearly defined. We compared the outcomes using different published definitions of complete and partial remission.

Method

248 children with biopsy proven LN class III or higher (ISN/RPS) diagnosed and treated in 23 international centers in the last 10 years were included. Data regarding their renal outcome were collected for twenty-four months after the start of induction therapy. We applied seven definitions of remission to compare the number of children achieving partial and complete remission. Definitions applied have been adapted from the Bristol-Myers Squibb (BMS) trial, the American College of Rheumatology (ACR) recommendations, the Lupus Nephritis Assesment with Rituximab (LUNAR) trial, the Aspreva Lupus Management Study (ALMS) trial, the Abatacept and Cyclophosphamide Combination: Efficacy and Safety Study (ACCESS) trial, the Kidney Disease Improving Global outcomes (KDIGO) guidelines and the Two-Year, Randomized, Controlled Trial of Belimumab in Lupus Nephritis (BLISS-LN).

We also focused on the BMS trial, the ACCESS trial and the KDIGO guidelines definitions to analyse the importance of gender, age, ethnicity and the economic income of the country (as defined by the World Bank) where patients had been treated.

Results

The mean age at diagnosis was 11 years and 4 month. 71.4% were females. They were mainly East-Asian (34.3%), South-Asian (24.6%) and Caucasian (18.6%). 42.7 % were from middle income countries and 57.3% high income countries. The kidney biopsies showed LN class III in 35.5%; class IV in 45.6% and class V in 18.9%.

The different definitions varied significantly in terms of outcomes, with that of the ACCESS trial having the highest percentages of complete remission and the BMS trial the lowest (Figure 1). A relatively small percentage of children achieved partial remission during the follow-up for all the definitions (Figure 2).

Focusing on the BMS, ACCESS and KDIGO definitions, we found no statistically significant differences of gender and age in the rate of children entering complete remission at 6, 12 and 24 months. East Asian children did however achieve remission more often than other ethnic groups (p < 0.05) (Figure 3).

Children treated in high income countries showed a statistically significant higher percentage of complete remission at 12 and 24 months (p < 0.05) (Figure 4).

Conclusion

Rate of complete and partial remission varied considerably when using the different definitions. Ethnicity and income of the country where the patients were treated did influence outcome. The findings of our study can help in deciding how to define remission in urgently needed future treatment studies in children.
MO1007RELATIONSHIP BETWEEN DIALYSIS ADEQUACY, ULTRAFILTRATION RATE AND SURVIVAL IN YOUNG HEMODIALYSIS (HD) PATIENTS HAVING INITIATED CHRONIC HD IN CHILDHOOD*
Authors: Gotta Verena , Marsenic Olivera , Atkinson Andrew , Pfister Marc
Published: May 2021

Background and Aims

Hemodialysis (HD) adequacy is currently assessed based on weight-normalized small solute clearance (spKt/V), with same targets in both adult and pediatric patients on chronic thrice weekly hemodialysis, despite lack of pediatric studies to support this. It has been hypothesised that pediatric patients of small size may require higher spKt/V targets, due to higher ratio of body surface area (BSA) to body weight and/or greater post-dialysis urea rebound. Ultrafiltration rates (UFR) >10-13 mL/kg/h, associated with increased mortality in adults, are furthermore routinely exceeded in pediatric patients with uncertain consequences. We aimed to characterize how different delivered HD adequacy metrics and UFR are associated with survival in a large cohort of patients who started HD in childhood.

Method

Retrospective analysis on a cohort of patients <30y on chronic HD since childhood (<19y), having received thrice-weekly HD 2004-2016 in outpatient DaVita dialysis centers. Mean delivered dialysis dose (spKt/V) and alternative measures of HD adequacy and fluid balance, including eKt/V, body-surface normalized Kt (Kt/BSA) and ultrafiltration rate (UFR), were investigated as predictors of survival in a Weibull regression model.

Results

A total of 1780 patients were included (age at initiation of HD: 0-12y: n=321, >12-18y: n=1459), with median spKtV=1.55, eKt/V=1.31, Kt/BSA=31.2 L/m2 and UFR=10.6 mL/kg/h. Kt/BSA was a better predictor of survival than spKt/V or eKt/V (P<0.001 versus P=0.002, respectively). UFR was associated with survival (P<0.001), with increased mortality <10/>18 mL/kg/h. Associations remained significant after adjusting for age, ethnicity, and etiology of kidney disease.

Conclusion

We found that targeting Kt/BSA>30 L/m2 in children and young adults on maintenance HD is associated with improved long-term outcomes, corresponding to spKt/V>1.4 (>12 years) and >1.6 (<12 years), respectively. Relatively high UFR of 10-18 ml/kg/h appears to be risk-free in this HD population.
MO1008IMPACT OF RAMIPRIL ON ENDOTHELIAL DYSFUNCTION IN CHILDREN ON REGULAR HEMODIALYSIS
Authors: Mohamed Ateya Areej , Kreutz Reinhold , Elhakim Ihab , Shaheen Sara , Maher Radwa , Sabri Nagwa
Published: May 2021

Background and Aims

Endothelial dysfunction is an important risk factor for cardiovascular disease and therefore for increased mortality in end-stage renal disease patients. Asymmetric dimethyl arginine (ADMA), a potent inhibitor of nitric oxide synthase, strongly contributes to endothelial dysfunction. In dialysis patients, ADMA levels are markedly elevated. Previous studies have shown that angiotensin-converting enzyme inhibitors (ACEIs) can significantly reduce ADMA levels in a variety of patients. In contrast, a previous study suggested that short-term treatment with ACEIs may even increase ADMA levels in adult patients on maintenance hemodialysis. However, no study has evaluated the effect of ACEIs in pediatric patients undergoing hemodialysis.

Method

We conducted a prospective, randomized, double-blinded and placebo-controlled trial (NCT04582097) at two nephrology centers in Cairo, Egypt. Patients below the age of 16 years and on regular hemodialysis for 6 months or longer were eligible for inclusion. Exclusion criteria at screening included uncontrolled hypertension, serum potassium level > 5.5 mmol/L, acute infection or treatment with immunosuppressive agents within the previous month, known intolerance of ACEI treatment and inability to discontinue previous ACEI or angiotensin receptor blocker treatment. A total of 135 eligible patients (mean age, 12.6 years; range 7-15 years; 53.3% males) were randomly (1:1) assigned to once oral daily treatment with identical capsules containing either 2.5 mg ramipril (n=68) or placebo (n=67) for four months. Systolic and diastolic blood pressure (BP) and serum ADMA concentrations were measured as primary efficacy and serum potassium levels as primary safety parameter.

Results

At baseline, systolic and diastolic BP and ADMA levels were similar between both treatment groups (Table). After four months, both systolic and diastolic BP were significantly lower in the ramipril compared to the placebo group. Treatment with ramipril resulted in a profound reduction in ADMA levels (-77% compared to baseline) while ADMA levels were unchanged in the placebo group after four months (p <0.001). Serum levels of potassium increase in both groups with no reported symptoms of severe hyperkalemia No serious adverse events were reported in neither group.

Conclusion

Ramipril treatment in pediatric patients on maintenance hemodialysis causes a marked reduction in ADMA levels. This may contribute to improved endothelial vascular function besides its efficacious BP lowering effect.
MO1043EXPLORATION OF REMOTE SCIENTIFIC RESEARCH TRAINING FOR MEDICAL STUDENTS DURING THE COVID-19 PANDEMIC
Authors: Yin Huanhuan , Ji Peili , Shi Xiaoxiao , Zhao Bingbin , Xia Peng , Chen Limeng
Published: May 2021

Background and Aims

We aimed to investigate a new team-based remote teaching model (TRTM) among M.D and Ph.D. candidates major in nephrology to improve their scientific research training and reduce stresses during the COVID-19 pandemic.

Method

From February 1 to April 30 in 2020, we set up TRTM (Fig 1) via online conferencing systems as: (i) Plan-Do-Check-Action cycle every two to three days to promote project progress, (ii) weekly lab meetings for sharing experiences and ideas; and (iii) weekly journal clubs for literature reading and knowledge expansion. We recruited nine students in TRTM training, and another 25 students as control group, who arranged their schedule by themselves during the quarantine.

Results

1. A survey about the remote teaching

25 mentors and 34 students had received a survey and all believed that teamwork, lab meeting, and short-term academic goals were essential in remote training. Non-scheduled discussion (72.0%,18/25) and regular online lab meetings (60.0%,15/25) were the most common traditional methods. About 85.3% of students and 28.0% of the mentors agreed that “poor self-control” was the main cause of remote-teaching difficulty.

2. The effectiveness of TRTM training

Compared to the control group, students in TRTM had more self-reported benefits from “mentors’ feedback”, “team support”, and “team communication” (All P<0.05), despite no significant differences in learning productivity or daily work progress. Meanwhile, the TRTM group presented with lower “anxiety related to the COVID-19 pandemic” and lower “stress-related to scientific research” (Both P<0.05). For TRTM students, the academic ability was also evaluated at the baseline and after three months of practice, by team members (7 teachers and 9 students). They made progress in varied aspects during the pandemic, such as executing planned tasks, self-improvement based on feedback, and teamwork ability (All P<0.001).

Conclusion

Our team-based remote teaching model helped students gain more supports and growth in academics and reduce psychological pressures caused by isolation.
MO1044DESIGN OF THERAPEUTIC EDUCATION WORKSHOPS FOR HOME HEAMODIALYSIS IN A PATIENT-CENTERED CKD RESEARCH: A QUALITATIVE STUDY
Authors: Guerraoui Abdallah , Galland Roula , Belkahla-Delabruyere Flora , Didier Odile , Sauvajon Pierre , Caillette-Beaudoin Agnes
Published: May 2021

Background and Aims

A quarter of the patients did not receive any information on any modality before the start of Renal Remplacement Therapy (RRT). We have therapeutic education workshops for all RRT except for home haemodialysis (HHD). We aimed to identify and describe the needs of patients and caregivers for RRT with HHD. Lastly, to conceive and carry out a Therapeutic Education Workshop.

Method

Two sequential methods of qualitative data collection were undertaken: (1) interviews with a patient who had been on HHD and a doctor specialized in HHD. (2) semi-structured interviews with HHD patients in our center.

Analytic Approach

Thematic analysis. We used thematic analysis and systematically coded and identified themes inductively from data. To ensure that the range and depth of data were reflected in the analysis, transcripts were independently analyzed by 2 research team members experienced in qualitative research.

Transcribed interviews were entered into RQDA 3.6.1 (2019-07-05) software for data organization and coding purposes (Version 3.6.1). Patient interviews were ceased when no new codes were identified (data saturation) after five consecutive interviews.

Results

We identified six themes related to the barriers, facilitators, and potential solutions to home dialysis therapy: (1) HHD allows autonomy and freedom with constraints, (2) safety of the care environment, (3) the caregiver and family environment, (4) patient’s experience and experiential knowledge, (5) self-treatment experience - Impact on life, and (6) factors that impact the choice of treatment with HHD.

we designed a model for a therapeutic education workshop in a group of 4 patients and 4 caregivers. Our approach is the person-centered model of care. The workshop is composed of 4 educational sequences

Conclusion

Our study confirmed previous results obtained about the major barriers, facilitators, and potential solutions to HHD. There are three important points regarding HHD: (1) the impact of the HHD on the caregiver, (2) the experience of patients already treated with HHD, and (3) the role of nurses and nephrologists in informing and educating. A program to develop patient-to-patient peer mentorship, allowing patients to discuss their dialysis experience, would be invaluable.
MO1035KIDNEY KNOWLEDGE AMONG USERS OF AN ONLINE SELF MANAGEMENT PLATFORM FOR PEOPLE WITH CKD
Authors: Van den Brand Jan , Quint Karl , Naranjo Karen
Published: May 2021

Background and Aims

Renal Tracker is a blended on- and offline self management platform for people with CKD. One of the goals of the program is to increase user’s knowledge about their kidney disease in order to facilitate communication with their health care providers. In the present study we aim to a baseline data for kidney knowledge to which the program could be compared.

Method

We recruited a cohort of 74 users from the United States of America via social media channels, including Facebook, Pinterest and Google Adwords. The users were offered a 12 week online course program in addition to a 1-on-1 call with a health coach specialized in renal nutrition. Before starting the program users were prompted to complete the Kidney Knowledge Survey (Wright et al AJKD 2011). We compared our results to those in the study by Wright. Pseudonymized data for users was obtained from the RenalTracker analytics server, and analyses were performed using Python 3.8.5 with a JupyterLab 2.2.28 shell.

Results

The mean overall score for our cohort was 18.8 (SD 4.0) for a 67% (SD 14%) correct. By comparison, Wright reported a mean score of 66% (15%). Users found the question about what medication to avoid hardest (26% correct). In addition, users were only able to identify half of the usual symptoms associated with kidney disease. Likewise, they were able to point out about only half of the functions of the kidney. Conversely, 88% knew their target blood pressure, possible long term consequences of CKD.

Conclusion

Our results highlight that even among a subgroup of patients actively researching and looking for information, kidney specific health knowledge needs to be improved. In particular limited knowledge about nephrotoxic drugs is worrying.
MO931PRETRANSPLANT ANGIOTENSIN II TYPE 1 RECEPTOR ANTIBODIES INFLUENCE GRAFT FUNCTION BUT NOT GRAFT SURVIVAL AT 1 YEAR AFTER KIDNEY TRANSPLANTATION IN A LOW IMMUNOLOGICAL RISK COHORT
Authors: Sorohan Bogdan Marian , Berechet Andreea Ioana , Obrisca Bogdan , Constantinescu Ileana , Maruntelu Ionut , Tacu Dorina , Baston Catalin , Sinescu Ioanel , Ismail Gener
Published: May 2021

Background and Aims

Angiotensin II type 1 receptor antibodies (AT1R-Ab) are associated with graft rejection and poor graft outcomes in kidney transplantation (KT). It has been shown that AT1R-Ab have a negative impact on both short-term and long-term graft function, even in the absence of rejection, but this has not been confirmed by other studies. Our aim was to assess the frequency of pretransplant AT1R-Ab and to determine their influence on graft function and survival at 1 year after KT.

Method

We performed a prospective, observational cohort study in 67 adult KT recipients, transplanted between October 2018 and October 2019. Clinical, biological and immunological data of the recipients, age, gender and type of donor, transplant and immunosuppression parameters were collected at the moment of transplantation. A cut-off > 10 U/mL was used for AT1R-Ab detection.

Results

Among the 67 recipients mean age was 41.3 ± 10.3 years, male gender was predominant (59.7%) and the main known cause of end-stage renal disease was glomerular disease. Six patients out of 67 (9%) had a previous kidney transplant. The donor mean age was 50 ± 15.5 years and 65.7% of patients received the kidney graft from a cadaveric donor. Pretransplant AT1R-Ab were detected in 7 out of 67 patients (10.4%) and none of the patients had specific antibodies against human leucocyte antigen. After 1 year of follow-up, median estimated glomerular filtration rate (eGFR) of the recipients was 54 ml/min/1.73 m2 (40.6 – 65.9), 10.4% of patients developed delayed graft function, 7.5% had graft failure and no cases of biopsy proven graft rejection or death was reported. Patients with pretransplant AT1R-Ab had a significant reduced graft function at 1 year after KT compared to those without antibodies [35 (29.8- 55.2) vs 56.1 (41.3 – 66.5) ml/min, p=0.02]. After multivariate linear regression analysis, pretransplant AT1R-Ab were an independent determinant of eGFR at 1 year after KT (β: -14.066; 95% CI: -27.44 - -0.68; p=0.04). Cox regression analysis was used to assess the association of AT1R-Ab along with other clinical, biological and immunological parameters with graft failure. Neither the univariate (HR= 2.07, 95% CI: 0.23-18.52, p=0.51) nor the multivariate (HR= 1.36, 95% CI: 0.10-14.09, p=0.80) Cox regression models showed that pretransplant AT1R-Ab were an independent predictor for graft loss.

Conclusion

We showed that pretransplant AT1R-Ab are an independent determinant of graft function but do not influence the graft survival at 1 year after transplantation in a prospective low immunological risk cohort of kidney transplant recipients.
MO938PATIENT SURVIVAL AFTER LIVING DONOR KIDNEY DONATION
Authors: Naik Marcel , Sakurayama Kayo , Lehner Lukas , Budde Klemens , Halleck Fabian
Published: May 2021

Background and Aims

Living donor kidney transplantation [LDKT] is associated with best patient survival and life quality among kidney replacement therapies in case of chronic kidney disease. Yet, numerous previous studies have reported inconsistent results. The aim of this study was to investigate the influence of recipient and donor characteristics on LDKT recipients in our center.

Method

All LDKT recipients from 01.01.1997 to 18.03.2020 were analyzed retrospectively. Based on the biological relationship between recipient and donor, recipients were grouped into “related” (biologically related) and “unrelated” (not related). Endpoints of this study were patient survival, death-censored graft survival and graft survival including death analyzed by Kaplan-Meier method and log-rank test. Independent risk factors were estimated with Cox-regression.

Results

Among 946 LDKT recipients we identified n=548 related and n=398 unrelated recipients. Over a median observation time of 6.3 years 9.1% (86) of grafts failed and 10.8% (102) of recipients died. Rates of graft failure and deaths were 8.8% and 7.1% in related recipients and 9.5% and 15.8% in unrelated recipients, respectively. Kaplan-Meier-analysis showed 5, 10 and 15 year overall patient survival of 93.8%, 85.6% and 76.0%; death-censored graft survival of 94.7%, and 87.3% and 79.8%; graft survival including death were 89.8%, 76.3% and 62.7%. There was a significant difference between subgroups in patient survival (p<0.001) and graft survival including death (p<0.001) but not in death-censored graft survival (p=0.280). (figure 1, 2, 3) In the multivariate analysis we observed recipient age in years (Hazard Ratio [HR]:1.08; p<0.001) and donor age in years (HR:0.97; p=0.008) to be independent risk factors for patient mortality. The occurrence of a delayed graft function (HR:2.52; p<0.001) as well as recipient age in years (HR:1.04; p<0.001) were risk factors for graft survival including death, while delayed graft function (HR:4.05; p<0.001) was the only independent risk factor for death-censored graft survival.

Conclusion

LDKT recipients without a biological relationship to their donors have an inferior patient survival and graft survival including death. The donor relationship as well as delayed graft function, recipient age and donor age should be taken into account during patient evaluation. Recipients subjected to these characteristics should be informed about their individual risks and carefully monitored long term. Further evaluations are needed particularly including the effects of immunosuppressive medication.
MO939RECURRENCE AND OUTCOME OF ANTI-GLOMERULAR BASEMENT MEMBRANE GLOMERULONEPHRITIS AFTER KIDNEY TRANSPLANTATION: A BELGIAN MULTICENTER STUDY
Authors: Coche Sophie , Sprangers Ben , Van Laecke Steven , Weekers Laurent , De Meyer Vicky , Hellemans Rachel , Castanares Diego , Ameye Heleen , Goffin Eric Jean , Demoulin Nathalie , Gillion Valentine , Mourad Michel , Darius Tom , Antoine Buemi , Arnaud Devresse , Kanaan Nada
Published: May 2021

Background and Aims

Recurrence of anti-glomerular basement membrane (anti-GBM) glomerulonephritis in the kidney graft is a rare event, described in limited case reports and registry analysis. The aim of this study was to evaluate in a large cohort of patients with detailed data collection and long follow-up the risk of recurrence of anti-GBM disease and graft loss caused by recurrence, the risk factors associated with clinical recurrence and the long-term patient and graft survival.

Method

Multicenter retrospective study. Inclusion criteria: patients with anti-GBM glomerulonephritis transplanted with a kidney between 1977 and 2015. Exclusion criteria: systemic vasculitis (except ANCA), lupus erythematosus and cryoglobulinemia. Clinical recurrence was defined as reappearance of signs of glomerulonephritis along with histological signs of proliferative glomerulonephritis and linear IgG staining on kidney biopsy, with or without anti-GBM antibodies.

Results

Fifty-three patients were included. Clinical recurrence in a first kidney transplant occurred in only one patient five years after transplantation -a prevalence rate of 1.9%- in the context of cessation of immunosuppressive drugs. The graft was lost due to recurrence. Histological recurrence with linear IgG staining on kidney biopsy in the absence of histologic signs of proliferative glomerulonephritis was observed in four patients, in the context of cellular rejection. Two patients lost their kidney graft from severe acute rejection; the others fully recovered. Patient survival was 100%, 94% and 89% at 5, 10 and 15 years, respectively. Overall, death-censored first graft survival rates were 88%, 83% and 79% at 5, 10 and 15 years, respectively.

Conclusion

Recurrence rate of anti-GBM glomerulonephritis after transplantation is very low, and associated with graft loss. The long-term patient and graft survival rates are excellent.
MO923PREDICTING POST-TRANSPLANT HRQOL TO OPTIMIZE OUTCOMES IN OLDER KIDNEY TRANSPLANT RECIPIENTS
Authors: Tsarpali Vasiliki , Midtvedt Karsten , Lønning Kjersti , Bernklev Tomm , Von der Lippe Nanna , Reisater Anna Varberg , Heldal Kristian
Published: May 2021

Background and Aims

Kidney transplantation (KT) is the optimal treatment for older patients in need for kidney replacement therapy, with favorable outcomes both on survival, and health-related quality of life (HRQoL). Given the current organ scarcity, allocation of transplants should prioritize patients who are expected to benefit most from KT and identifying reliable predictors of post-transplant HRQoL outcomes is essential to optimize the selection process.

Method

Patients ≥ 65 years, who were enlisted for KT between January 2013 and November 2016 at the Norwegian national transplant center, were asked to participate. Self-reported HRQoL was assessed using the Kidney-Disease Quality of Life Short Form version 1.3 (KDQOL-SF) survey. Pre-transplant comorbidity was assessed by the Liu comorbidity index (LCI). Linear mixed-effect models were used to detect HRQoL changes over time (pre-KT, at -6, -12 and -36 months post-KT), and to identify pre-transplant predictors of post-transplant outcomes.

Results

By November 2020, 220 (76%) out of 289 enrolled participants, were transplanted. The mean age at KT was 71.8 (4.1) years, 154 (70%) were males, 57 (26%) were transplanted pre-emptively and 30 (13.6%) received a transplant from a living donor.

Longer dialysis vintage was independently associated with impaired physical function post-transplantion (Figure 1). Pre-transplant LCI score ≥ 7 consistently predicted poorer HRQoL outcomes at baseline and after 3-years, compared with LCI score < 7 (Figure 2). At 3- years post-transplant, increasing LCI score was lineary associated with decreasing SF-36 scores. Recipients on dialysis for ≥ 1 year with LCI ≥ 7 experienced the worst outcomes, with a marked and sustained post-transplant physical deterioration (Figure 3).

Conclusion

Older wait-listed candidates either on dialysis for >1 year or with elevated pre-transplant LCI are at high risk for impaired HRQoL post-transplant outcomes and should be re-evaluated with respect to transplantability on a regular basis. The identification of criteria to optimize the selection of older transplant candidates should be the scope of future studies
MO943IMPACT OF NON-ACTIVE HEPATITIS B ON PATIENT SURVIVAL AFTER RENAL TRANSPLANTATION
Authors: Paschereit Anissa , Budde Klemens , Dürr Michael , Naik Marcel
Published: May 2021

Background and Aims

Dialysis patients (pts) have an increased risk for hepatitis B (HB) infection and impaired response to HB vaccine compared to the general population. As shown in other studies, patient and graft survival in pts with chronic HB is worse. This study assesses the outcome of HBc-positive patients after kidney transplantation (KTx).

Method

In our retrospective analysis we included all patients >18 years old, who underwent kidney transplantation from 01.01.1990 to 31.08.2019 in our center. Patients were grouped by their serostatus prior to kidney transplantation into “A: naïve” (HB negative), “B: HBc-positive” (non-active HB) and “C: HBsAg-positive” (chronic HB). Primary endpoints included patient and graft survival analyzed with Kaplan-Meier and log-rank test. Regression analysis was applied to determine independent risk factors for the occurrence of primary endpoints.

Results

In 2487 kidney transplant patients, serologic markers were retrievable. We identified n=2198 HB naïve, n=218 non-active HB and n=75 chronic HB pts. Overall 29.1% (A:27.7%, B:37.6%, C:45.3%) pts died and 20.3% (A:19.1%, B:27.5%, C:37.3%) pts suffered from graft failure. The 5-year pts survival (Fig. 1) was A: 87.0%, B: 82.8%, C: 82.2%. The 10-year pts survival was A: 71.7%, B: 61.1%, C: 64.5% and the 20-year pts survival was A: 43.1%, B: 26.1%, C: 40.9% (p=0.01). Kaplan-Meier-analysis showed a 5-year graft survival (Fig. 2) of 87.7% in the naïve, 86.1% in non-active HB and 84.3% in chronic HB group. The 10-year graft survival was A: 77.3%, B: 64.9%, C: 76% and the 20-year graft survival was A: 59.7%, B: 52.2%, C: 33.4% (p<0.001). The overall 5-year pts and graft survival (Fig. 3) was A: 78.7%, B: 74.2%, C: 68.6%. The 10-year pts and graft survival was A: 59.8%, B: 46.4%, C: 51.8%. The 20-year overall rate was A: 30.8%, B: 26.4%, C: 14.9% (p<0.001).

Regression analysis (Table 1) showed that anti-HBs positivity (≥100 IE/l) was a protective factor for graft failure and death (p<0.001).

Conclusion

HB leads to earlier graft loss and inferior patient survival. Beside the already known negative effect of chronic HB infection, also in patients with non-active HB infection overall survival was significant worse to HB naïve patients. Thus, non-active HB status is an important risk factor for overall transplant outcome. Next, influence of antiviral and immunosuppressive regimens and incidence of HB-reactivation are to be analyzed.
MO944BONE DISEASE AFTER KIDNEY TRANSPLANTATION - (SUBTOTAL) PARATHYROIDECTOMY REDUCES FRACTURE RISK
Authors: Jehn Ulrich , Kortenhorn Anja , Schütte-Nütgen Katharina , Strauss Markus , Pavenstädt Hermann Josef , Suwelack Barbara , Reuter Stefan
Published: May 2021

Background and Aims

Kidney transplant recipients can be considered as high-risk collective for pathological fractures, since diverse risk factors leading to mineral bone disorder (MBD) and osteoporosis accumulate in this setting.

(Subtotal) parathyroidectomy (PTX) is indicated for ESRD patients with secondary hyperparathyroidism (sHPT) who do not respond to drug therapy adequately.

This study aims to identify influencable factors that are associated with pathological fractures and bone disease in KTX recipients.

Method

We conducted a retrospective study involving 722 adult patients with a total of 4686 patient-years who were transplanted at our center between January 2007 and June 2015. The clinical patient data was extracted from the patients’ electronic files.

Different laboratory and clinical parameters for mineral bone disorder and osteoporosis including medication were evaluated. As primary endpoint we chose fracture events that were not related to malignancies or adequate trauma.

Results

47 (6,5%) of the patients suffered from pathologic fracture events during the follow-up period. 124 of the patients (17.2%) underwent PTX. In 112 of these patients (90.3%), PTX was performed prior to kidney transplantation (KTx), in 12 patients PTX took place after KTx. Median time for PTX in relation to KTx was 3.7 years prior to KTx (IQR 5.43).

Only 1 (2,2%) of the patients with fracture events has received PTX beforehand compared to 124 (19,2%) of the patients without fractures.

Adjusted for the well-known fracture risk factors for mineral bone disease and osteoporosis which include female sex, age and dialysis vintage, PTX remains a significant protective factor against fractures after KTx in multivariable Cox regression analysis (HR 0.124, p=0.041) and in Kaplan-Meier analysis (Figure 1).

Serum calcium levels were significantly lower in patients after PTX (p<0.001).

Active Vitamin D was applicated in patients after PTX more frequently (40.0% vs. 22.7%, p<0.001)

Conclusion

Our study reveals PTX as a protective factor regarding pathological fractures after KTx. As these patients show lower serum calcium levels, one explanation for this finding could be a more generous supplementation of these patients with active vitamin D, which is known to increase bone mineral density and to reduce fracture risk. Therefore, considering that hypoprathyroidism following PTX after KTx and low plasma-PTH levels correlate with significant decrease of renal function, patients on conservative sHPT therapy should be treated with active vitamin D preparations more generously and special attention should be paid on bone metabolism.
MO945SERUM AND URINE LEUCINE RICH ALPHA-2-GLYCOPROTEIN-1 IS ASSOCIATED WITH KIDNEY TRANSPLANT INJURY AND FAILURE
Authors: Vasiļvolfa Aiga , Kroiča Juta , Popova Anna , Rācenis Kārlis , Šlisere Baiba , Ziedina Ieva , Folkmane Inese , Lejnieks Aivars , Cernevskis Harijs , Petersons Aivars , Kuzema Viktorija
Published: May 2021

Background and Aims

Kidney transplantation is the treatment of choice for most of the patients with end stage chronic kidney disease. To improve patient and graft survival, early diagnostics and discovery of specific biomarkers is important. Leucine rich alpha-2-glycoprotein-1 (LRG-1) is an innovative, non-invasive biomarker that is elevated in case of angiogenesis, inflammation and kidney injury. Aim was to evaluate biomarker LRG-1 level in serum and urine in kidney transplant recipients in accordance with kidney injury markers and time period after kidney transplantation.

Method

In the study 35 patients were enrolled. Patients had functioning kidney grafts and they were more than one year post transplant. We detected patient serum and urine LRG-1 levels, using ELISA. Correlation between serum LRG-1, urine LRG-1 and kidney graft structural and functional damage markers was performed. Also, we compared serum LRG-1 levels between subgroups (patients >5 years post transplant and ≤ 5 years post transplant).

Results

Serum LRG-1 had positive correlation with serum cystatin-C (r=0,46, p<0,01), serum urea (r=0,53, p<0,01) and negative correlation with eGFR (r= -0,39, p=0,02). Patients with >5 years post transplant had higher serum LRG-1 level compared with patients ≤5 years post transplant (p<0,01). Serum LRG-1 had positive correlation with a longer time period after transplantation (r=0,53, p=0,01). Urine LRG-1 had correlation with proteinuria (r=0,58, p<0,01) and NGAL level in urine (r=0,44, p<0,01). The most common maintenance immunosuppressive regimen was therapy with tacrolimus, mycophenolate and prednisolone (48,6%).

Conclusion

Higher serum LRG-1 level correlates with decreased kidney transplant function and with longer time period after transplantation. Higher LRG-1 level in serum and urine is related to kidney transplant injury and failure. Urine LRG-1 can be a useful biomarker for tubular dysfunction in kidney transplant recipients.
MO947KILLER CELL IMMUNOGLOBULIN LIKE RECEPTOR (KIR) GENE DISTRIBUTION AND ALLOGRAFT KIDNEY FUNCTION
Authors: Erken Ertugrul , Senel Mahmut Egemen , Dinkci Suzan , Goruroglu Ozturk Ozlem , Altunoren Orcun , Gungor Ozkan , Erken Eren
Published: May 2021

Background and Aims

There is increasing evidence about the alloreactivity of natural killer (NK) cells after kidney transplantation. The inhibition and activation cycles of the NK cells are mainly regulated by killer cell immunoglobulin-like receptors (KIRs) which may have extensive allelic polymorphisms within the population. In this study, we examined KIR genes/genotypes in kidney transplant recipients and healthy subjects. We aimed to determine if there are relations between certain KIR genes and graft function in kidney transplant patients.

Method

Renal transplant patients (n=131) and healthy controls (n=183) from the same ethnic background with similar demographics were included. Transplant patients with an obvious cause of graft dysfunction and presensitized patients were excluded. Recruited patients were classified as graft dysfunction (GD) (n=38) or functioning graft (FG) (n=93) on the basis of allograft rejection and dysfunction. Isolated DNA of all participants were typed for 16 KIR genes with specific primers using PCR. Patient groups were compared for KIR genes/genotypes and clinical features.

Results

Significant differences were observed for KIR2DL3 and KIR3DL1 genes that were presented with higher frequencies in healthy controls than in kidney transplant recipients (p=0.001 & p=0.006). Comparison between GD and FG groups revealed a protective association for the inhibitor gene KIR2DL1 (p=0.003, OR=0.148). Distribution of the remaining 15 KIR genes and the rates of KIR genotype patterns were not different among these patient groups.

Conclusion

KIR2DL3 and KIR3DL1 genes were more common in healthy subjects. KIR2DL1 gene was significantly more frequent in patients with FG. We suggest that the presence of KIR2DL1, which is an inhibitor gene for NK cell functions, might be associated with favorable graft function in kidney transplant recipients.
MO949APPRAISAL OF PSYCHO-SOCIAL BURDEN AND QUALITY OF LIFE OF KIDNEY DONORS- IS THERE A DEEP ROOTED APPREHENSION
Authors: Kaul Anupma
Published: May 2021

Background and Aims

Living kidney donation is a very complex psychological experience for donor candidates as well as the recipients improving self-esteem and donor-recipient relationships on one hand while may add on to emotional stresses increasing psychic vulnerability and predisposition to the development of mental disorder. The present study aimed to look into psychosocial outcome among donor characteristics and quantification of the psychological impact of kidney donation.

Method

This was a retrospective random study conducted among 506 renal transplant donors from 2010 till 2018 at Department of nephrology and transplantation at a tertiary care centre in northern part of India.

Results

Majority of donors were females ie mothers (38.1%) and wife (35.5%). A total of 18.6% developed one or more co morbid illness following transplantation. Most of the donors ( 98.9%) were motivated by affection and love for the recipient and out of them (89.1%) felt that there were the first choice among the available donors. A majority of them (94.5%) felt that donation had positively affected their relationship and were respected. These donors showed lesser degree of both depressive and anxiety (HAD score 3.5) and depressive score (BDI II 4.8). Donation had upgraded the stature of the donor in the family and recipient which proved statically significant predictor on donor related outcome. Donors well being was dependant on recepients wellbeing and 20% of the donors felt or were made to feel the guilt of the graft failure or a poor outcome.

Conclusion

The study showed a positive acknowledgement for the donors from the recipients and society thus giving a meaning to life Need of the hours is greater post donation monitoring as well as due recognition among donors which can improve long term donor outcomes.
MO953PREVALENCE AND FACTORS ASSOCIATED WITH HYPERKALAEMIA IN STABLE KIDNEY TRANSPLANT RECIPIENTS WITH PRESERVED RENAL FUNCTION
Authors: Smyrli Maria , Sarafidis Pantelis , Loutradis Charalampos , Korogiannou Maria , Boletis Ioannis , Marinaki Smaragdi
Published: May 2021

Background and Aims

Hyperkalaemia is a frequent and potentially life-threatening condition in patients with CKD. Even after successful kidney transplantation, kidney transplant recipients have mild to severe CKD. Moreover, they share co-morbid conditions and frequently use medications that predispose to hyperkalaemia. This study aimed to examine the prevalence and factors associated with hyperkalaemia in this population.

Method

Over a pre-specified period of 6 months (September 1st 2019 to March 31st 2020), we recorded in a cross-sectional fashion information on serum potassium and relevant demographics, co-morbidities, medications, laboratory and transplant-associated variables in clinically stable kidney transplant recipients attending the Transplant Outpatient Clinic of our Department. Ηyperkalaemia was classified as follows: serum potassium level >5 mEq/L or >5 with concomitant use of sodium polystyrene sulfonate; ≥5.2; and ≥5.5 mEq/L. Univariate and multiple logistic regression analyses were used to identify factors associated with increased serum potassium >5.0 mEq/L.

Results

The study population consisted of 582 stable kidney transplant recipients, 369 (63.4%) males, aged 52.4±13.5 years, with eGFR of 55.8±20.1 ml/min/1.73m2 transplanted for more than one year. The prevalence of hyperkalaemia defined as potassium >5, >5 and use of sodium polystyrene sulfonate, ≥ 5.2 or ≥5.5, was 22.7%, 22.7%, 14.4% and 4.1% (132, 132, 84 and 24 patients), respectively. In multivariate analysis, male gender (OR 2.020, 95% CI 1.264-3.227) and use of renin-angiotensin-aldosterone-system blockers (OR 1.628, 95% CI 1.045-2.536), were independently associated with hyperkalaemia, while higher eGFR (OR 0.967, 95% CI 0.955-0.979) and diuretic use (OR 0.140, 95% CI 0.046-0.430) were associated with lower odds of the disorder.

Conclusion

The prevalence of mild hyperkalaemia in stable kidney transplant recipients is common but that of moderate or severe hyperkalemia is relatively uncommon. Male gender and low eGFR are the most potent factors associated with hyperkalaemia. Among a wide range of factors only male gender, RAAS blockade and low eGFR increased the odds of hyperkalemia.
MO955RENAL TRANSPLANTATION IN PATIENTS WITH LOW URINARY TRACT ABNORMALITIES
Authors: Ladhari Narjes , Awatef Azzabi , Wissal Sahtout , Yosra Guedri , Sanda Mrabet , Narjes Ben Aicha , Dorsaf Zellama , Abdellatif Achour
Published: May 2021

Background and Aims

Kidney transplantation is the only curative treatment for chronic kidney failure that allows to restaure a normal quality of life for patients. In case of abnormalities of the lower urinary tract, there is a risk of recurrence of renal failure due to urodynamic disturbances. The objective of our study is to analyze the profile of transplanted patients with urodynamic abnormalities and to study their impact on the graft.

Method

Our study was conducted within our Nephrology Department, including renal transplant patients during the period from 2007 to 2020 and who underwent a pre-transplant urodynamic evaluation. Patients with vesical or sphincteral abnormalities were selected, their demographic characteristics, graft survival and infectious complications compared to patients without vesico-sphincteral abnormalities were studied.

Results

Of 209 kidney transplant patients during the period 2007-2020, 54 had undergone a pre-transplant urodynamic assay, which resulted in 32 patients having an abnormality: 12 cases of vesical hypertonia or hypotonia, 12 cases of sphincteral hypertonia and 9 patients had vesico-sphincteral dyssynergy. In this group with vesical abnormalities, the average age was 24 years, with extremes of 7 and 49 years, 19 were male versus 13 females. Initial nephropathy was tubulointerstitial in 75% of cases with reflux nephropathy in 17 patients. Comparing this group (G1) to the group of patients with no vesico-sphincteral abnormalities (G2), there was more graft reflux 34.4% in G1 compared to 18.2% in G2 (p= 0.16), more urological complications (p=0.2), more urinary tract infections, 0.55 episodes per patient per year in G1 versus 0.98 in G2 (p=0.21). For the graft function, there was no statistically significant difference between the 5-year creatinine post-transplant averages.

Conclusion

Vesico-sphincteral abnormalities are frequently found in young patients with pre-transplant NIC, they are not responsible for more post-transplant complications or significant graft failure
MO956APPRAISAL OF PSYCHO-SOCIAL BURDEN AND QUALITY OF LIFE OF KIDNEY DONORS- IS THERE A DEEP ROOTEDAPPREHENSION ?
Authors: Kaul Anupma , Behera Manas
Published: May 2021

Background and Aims

Living kidney donation is a very complex psychological experience for donor candidates as well as the recipients improving self-esteem and donor-recipient relationships on one hand while may add on to emotional stresses increasing psychic vulnerability and predisposition to the development of mental disorder. The present study aimed to look into psychosocial outcome among donor characteristics and quantification of the psychological impact of kidney donation.

Method

This was a retrospective random study conducted among 506 renal transplant donors from 2010 till 2018 at Department of nephrology and transplantation at a tertiary care centre in northern part of India.

Results

Majority of donors were females ie mothers (38.1%) and wife (35.5%). A total of 18.6% developed one or more co morbid illness following transplantation. Most of the donors (98.9%) were motivated by affection and love for the recipient and out of them (89.1%) felt that there were the first choice among the available donors. A majority of them (94.5%) felt that donation had positively affected their relationship and were respected. These donors showed lesser degree of both depressive and anxiety (HAD score 3.5) and depressive score (BDI II 4.8). Donation had upgraded the stature of the donor in the family and recipient which proved statically significant predictor on donor related outcome. Donors well being was dependant on recepients wellbeing and 20% of the donors felt or were made to feel the guilt of the graft failure or a poor outcome.

Conclusion

The study showed a positive acknowledgement for the donors from the recipients and society thus giving a meaning to life Need of the hours is greater post donation monitoring as well as due recognition among donors which can improve long term donor outcomes.
MO961KIDNEY TRANSPLANTATION AS A TREATMENT OF CHOICE FOR AA AMYLOIDOSIS DUE TO PERIODIC FEVER SYNDROME
Authors: Dedinska Ivana , Graňák Karol , Vnučák Matej
Published: May 2021

Background and Aims

Renal AA amyloidosis is the most serious complication of periodic fever syndrome, which, inadequate suppression, due to persistent inflammation, leads to nephrotic syndrome and renal failure over several years. In most cases, periodic fever syndromes begin to manifest clinically in early childhood. Occurrence in adulthood is considered rare and is associated with a poorer clinical course. Kidney transplantation is an effective and safe treatment for end-stage chronic kidney disease (CKD) based on AA amyloidosis.

Method

We present cases of two patients after deceased donor kidney transplantation, who have been diagnosed with adult periodic fever syndrome.

Conclusion

Periodic fever syndromes are diseases beginning to manifest clinically in early childhood in 60–90% of cases, most often in the case of familial Mediterranean fever around 4 years of age, in the case of CAPS usually only a few months after birth. Occurrence in adulthood is considered rare and is associated with a poorer clinical course. Kidney transplantation is an effective and safe treatment of end-stage CKD based on AA amyloidosis associated with periodic fever syndrome. Adequate targeted treatment against IL-1 or TNF is important and appears to be safe during the post-transplant period, with regular monitoring of renal function, acute phase inflammatory reactants, and histological findings by protocol graft biopsies. It will be important and necessary to assess the development of diseases in the post-transplant period in the long term.
MO964DEATH WITH GRAFT FUNCTION AMONG EGYPTIAN KIDNEY TRANSPLANT RECIPIENTS: A SINGLE CENTER EXPERIENCE
Authors: Gamal Mostafa , Salah Ahmed Mohamed , Hendy Yasser , Refaie Ayman
Published: May 2021

Background and Aims

Kidney transplantation is the optimal treatment of end stage renal disease (ESRD). Despite improvements in patient selection and management, every transplant carries risk of graft loss. Death with graft function (DWGF) is an important cause of long-term loss of grafts and patients. In this study, we investigated clinical characteristics and causes of DWGF among a cohort of 2953 Egyptian kidney transplant recipients.

Method

A total of 291 recipients who died with graft function (DWGF) were evaluated regarding causes and timing of death. Causes of death were investigated in different eras of immunosuppression; era 1 (1976-1995): steroid and azathioprine, era 2 (1996-2005): cyclosporine-based and era 3 (2006-2018): tacrolimus-based. Demographic data, original kidney disease, pre- and post-transplant co-morbidities, immunosuppression regimens, biopsy proven acute rejection episodes and graft function at last follow up were analyzed.

Results

Proportion of DWGF in total graft loss had changed over time. In our retrospective study, it decreases from 29.5% in era 1 to 13.7% in the most recent era of kidney transplantation. Most patients in DWGF group had diabetes mellitus, hypertension, frequently experienced more infections and more rejection episodes. cyclosporine-based immunosuppression was more prevalent. A total of 291 patients (9.9%) died with graft function. DWGF was responsible for 58.3% of a total of 499 deaths (figure 1). For this group of patients, median serum creatinine at last follow up was 1.7 mg/dl (range: 0.2 - 7 mg/dl). Out of 291 recipients who died with functioning graft, 53 patients (18.2%) died within the first year, 55 (18.9%) died within 1-5 years, 75 (25.8%) died within 5-10 years while 108 patients (37.1%) died after 10 years post transplantation. The majority of DWGF was secondary to cardio-vascular diseases (CVD) (30.9%) and serious infections (29.2%) (figure 2). Death due to malignancy was lowest within the ﬁrst year (1.9%), increased thereafter but unexpectedly malignancy (22.2%) was the third main cause of death in the late period after transplantation (figure 3).

Conclusion

DWGF accounts for 24.5% of total graft loss. The most common cause is cardiovascular disease followed by serious infections. Pre-transplant diabetes mellitus, steroid dose and infections had most significant association with DWGF. Understanding different causes of death according to the time after transplantation is mandatory in order to improve the long-term outcomes.