bluuebunny/crossref_metadata_2025 huggingface dataset:
MO966COGNITIVE FUNCTIONING AMONG VARIOUS MODALITIES OF RENAL REPLACEMENT THERAPY- ROLE OF RENAL TRANSPLANT
Authors: Kaul Anupma , Behera Manas
Published: May 2021

Background and Aims

Evidences have shown diverse responses on thedescription of cognitive function in patients who have undergone renaltransplantation. The present study examined the changes in cognitive functionamong ESRD patients on maintenance haemodialysis or on CAPD and followingthey post renal transplant. We also looked into the ccognitive status among frailand non frail ESRD patients and their performance in the post transplant period

Method

67 patients who were stable ESRD on thrice a week haemodialysis or onCAPD were investigated 6 months pre and post transplant using a battery ofneurophysiologic testing. Transplant function was assessed on regular interval andfollowing a stable graft function and on stable doses of immunosuppressive medication 6 months post transplant.

Results

CAPD compared to HD had better preservation of cognitive functionsassessed 6 months after initiation of dialysis. There was statistically significantimprovement in general cognitive status performance (P < 0.001), motor speed,spatial reasoning, verbal memory and visual memory post transplant compared tothe pre transplant state. However, non-significant improvements were observed indomains of attention, executive functioning, language and verbal fluency. Theanxiety and depression scores did not show significant improvement despitetransplant. On the basis of fraility, frail individuals experienced less improvement in cognitive function as compared to non frail recipients in our study.

Conclusion

The data demonstrate improvements in cognition following kidneytransplant and emphasize the reversibility of the memory problems evidencedamong patients on dialysis.Focus should be made for interventions in terms ofprevention of cognitive decline among frail patients very early in pre-end stage thus helping in overall outcomes post transplant.
MO967A STUDY OF ACUTE KIDNEY INJURY IN RENAL ALLOGRAFT RECIPIENTS AND ITS IMPACT ON SHORT-TERM OUTCOME OF GRAFT FUNCTION
Authors: Parry Manzoor
Published: May 2021

Background and Aims

Acute kidney injury (AKI) in renal allograft recipients (RAR) is an important factor for short and long-term allograft function and survival. RAR are at high risk of AKI. The etiology, risk factors, and outcomes of AKI in RAR differ from that of AKI in the community setting. This study aimed to evaluate the spectrum and impact of AKI episodes on RAR outcome.

Method

This was a single-centre, prospective observational study on 84 live RAR patients who developed 105 AKI episodes as per Kidney Disease Improving Global Outcome (KDIGO) criteria between January 2018 to December 2019. The severity of AKI was categorized as per KDIGO guidelines. Acute rejection, recurrence of native kidney disease, and de nova glomerulonephritis were diagnosed by graft biopsy. These patients were followed for 3 months after AKI episodes.

Results

The mean age of our study populations was 38.1 ± 13.2 years. Mean serum creatinine at the time of AKI episode was 2.63 ± 0.95 mg/dL. The causes of AKI in our study population were infections (n 48, 45.7% ), dehydration (n 25, 23.8%), biopsy-proven rejection (n 9,8.6%) calcineurin inhibitor toxicity (n 10, 9.5%), biopsy-proven acute tubular necrosis (n 4, 3.8%), recurrence of native kidney disease (n 4, 3.8%), and miscellaneous causes (n 5, 4.8%). Most of the AKI episodes (62.9%) developed in the first year of the transplant, while as 29 (27.6%) cases developed between 1st and 2nd post-transplant year and 10 (9.5%) cases developed AKI beyond 2 years post-transplant. Sixty-four cases (60.9%) of AKI were in KDIGO stage 1, 30 cases (28.6%) were in AKI stage 2 and 11 cases (10.5%) were in AKI stage 3. Previous episodes of AKI (p<0.0001), need for dialysis at the time of AKI (p=0.0016), and higher stage of AKI (p<0.0001) were the factors associated with nonrecovery of graft functions at 3 months follow-up. At 3 months of follow up, AKI had a significant impact on allograft function.

Conclusion

In our study, AKI in RAR had a significant impact on allograft function. Multiple episodes of AKI, need for dialysis, and higher stage of AKI appear to affect the renal recovery at 3 months post-AKI.
MO969IMPACT OF COVID-19 IN KIDNEY REPLACEMENT THERAPY IN AN EPICENTER TERTIARY HOSPITAL IN SOUTHERN BRAZIL
Authors: Teichman Pedro do Valle , Rosa Viccari Alessandra , Fontanive Franco Rodrigo , Budel da Silva Maria Luiza , Da Silva Oliveira Carla Elisabete , Bauer Andrea Carla , Santos Gonçalves Luiz Felipe , Ceratti Manfro Roberto
Published: May 2021

Background and Aims

Patients on renal replacement therapy (RRT) pose multiple risk factors that may increase the risk of death from coronavirus disease 2019 (COVID-19). Currently, evidence of incidence, management, and prognosis of COVID-19 in this population are scarce.

Method

Between May and December 2020, we followed two RRT populations that have the same tertiary hospital in Southern Brazil as its reference hospital for transplantation. Firstly, we monitored eight affiliated dialysis clinics keeping track of COVID-19 incidence and fatality rate in dialysis patients and those on the kidney transplant waiting list. In the same period, we also monitor COVID-19 incidence and mortality among our prevalent population of kidney transplant recipients.

Results

We evaluated 1049 patients in RRT in the dialysis centers. COVID-19 occurred in 89 of such patients (8.5%), and 31 died from such condition (35.8% death rate). Fifteen patients (5.45%), among 275 on the kidney transplant waiting list, contracted the virus, with one death (6.6%).

Within our prevalent population of 1348 kidney transplant recipients, 113 were diagnosed with COVID19 (incidence: 8.4%), and 17 of them died (mortality rate: 15%). Finally, the number of kidney transplants decreased by 60.4% compared with the same period in the previous year.

Conclusion

COVID-19 determined a substantial impact on RRT. A high frequency of chronic dialysis patients expired from the disease. The impact on the patients on the transplant waiting list seems to be less pronounced probably due to their better health conditions. The fatality rate in kidney transplant recipients is elevated and probably mostly related to comorbidities. Brazil is currently entering the second wave of the disease and it is crucial to find and provide means to protect such vulnerable populations.
MO970GRAFT OUTCOME AFTER ACUTE REJECTION: A CASE CONTROL STUDY
Authors: Fattoum Safa , Bacha Mohamed Mongi , Mosbahhi Tasnim , Braiek Nesrine , Abderrahim Ezzedine , Ben Hmida Fethi , Ben Abdallah Taieb
Published: May 2021

Background and Aims

Although Acute rejection (AR) is a complication associated with the early period after kidney transplantation (KT), its complications are mostly seen after a long term. The aim of this study was to evaluate graft outcome after AR.

Method

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

Results

AR was responsible of immediate loss of 2 grafts. Chronic graft dyfonction was more frequent in group A (44,1% versus 17,4%, p<0,0001). Creatininemia levels were significantly higher at 3, 6 months, 1 year and 2 years (respectively p =0,0113 ; <0,0001 ; 0,0003 and 0,0172) after KT. The percentage of patients having creatinine levels > 130 µmol/l was higher in group A at 3, 6 months, 1 year, 2 years, 3 years and 5 years (respectively p =0,0186 ; 0,001 ; <0,0001 ; 0,0115 ; 0,0073 and 0,0255).

Graft survival was better in group B (p<0,0001). In group A, AR recurrence was responsible of a worser survival (p<0,0001). Over time, graft survival improved in the 2 groups. Complete functional recovery survival was similar to graft with no rejection but with impared graft function. The worst graft survival was noted if the functional recovery was absent.

Conclusion

Even if graft outcome after AR has improved over time, its deleterious effect is still inevitable. So AR must be prevented in order to enhance graft outcome.
MO971LYMPHOPROLIFERATIVE DISEASE AFTER KIDNEY TRANSPLANTATION: DESCRIBING OUR EXPERIENCE
Authors: Berzal Rico Raquel , Sevillano Angel , Frías González Aida , Yuste Claudia , Aubert Lucia , Sandino Pérez Justo , Rivero Martínez Marta , Cordero García-Galán Lucía , Andrés Belmonte Amado , Praga Manuel
Published: May 2021

Background and Aims

Post-transplant lymphoproliferative disorders (PTLD) are one of the most common malignancies in kidney transplant (KT) recipients. Immunosuppressive therapy and Epstein Barr Virus (EBV) play a main role in their pathogenesis.

Method

In this study we retrospectively analyze the characteristics, clinical evolution and treatments of a group of KT recipients performed between 1986 and 2020 in a single center.

Results

We included 31 patients (64.5% males). Polycystic kidney disease was the most frequent cause of renal failure. Before KT a 6.5% of the patients presented another malignancy, 10% were EBV seronegative and one received immunosuppressive therapy secondary to his primary disease.

Mean age at KT was 43±12 years. 68% of the KT came from brain-dead donors. The most frequent immunosuppressive regime consisted in tacrolimus, mycophenolic acid and prednisone (61.3%). Basiliximab and Timoglobulin were used in the same proportion for the induction therapy (22.6%). Before PTLD appearance the immunosuppressive therapy was reduced in the 54.8% of the recipients. 13% of them presented acute allograft rejection.

The majority of PTLD were diagnosticated between 2016 and 2020. Median time to develop PTLD was 13 years. 54.3% of the patients presented with extranodal involvement. Although all the patients positivized EBV serology, 60% of them had undetectable EBV viral load.

The main therapeutical strategy after PTLD consisted in a reduction of the immunosuppressive therapy. In this way, 28.6% of the recipients was treated with monotherapy with a calcineurin inhibitors and 21.5% with monotherapy with a mTOR inhibitor. In other hand 16.7% received a combination of tacrolimus with a mTOR inhibitor. Rejections were not observed in our group and all the patients presented a preserved kidney function at the end of follow up. Four recipients died because of PTLD. The remaining 27 presented a complete response or stabilization of the disease.

Conclusion

Most of the PTLD were detected between 2016-2020. The time from transplantation to PTLD appearance was long, being EBV viral load negative in the majority of the cases. Graft survival after chemotherapy and reduction of immunosuppressive therapy was excellent, with a low risk of rejection and a good prognosis for hematologic disease. It is possible that a reduction in immunosuppression in selected patients could prevent the development of PTLD.
MO974PREDICTORS OF MORTALITY IN KIDNEY TRANSPLANT PATIENTS INFECTED BY SARS-COV-2 IN SOUTH OF SPAIN
Authors: Lopez Veronica , Casas-González Cristina , Vázquez Teresa , Cabello Mercedes , Poveda Inmaculada , Hernández Domingo
Published: May 2021

Background and Aims

Covid-19 pandemic has especially affected kidney transplant (KT) recipients, who are more vulnerable than the general population due to their immunosuppressive status and added comorbidities.

The objetic of this study was to determine risk factors related to infection and mortality from Covid-19 in KT.

Method

We included 53 KT who had PCR-confirmed COVID-19 infection between march 21st and november 24th, from a total of 2030 KT. Outcomes related to patient survival were analyzed.

Results

39 (73%) patients were men, with a mean age of 56±15 years old. Median time after KT where the infection took place was 104 months (IQR: 55-160). One patient was infected 40 days after transplant. 90% were on Tacrolimus therapy and 79% on MMF.

81% of patients were hypertensive, 36% diabetic and 19% had ischemic heart disease. 65% were on ARAII treatment.

Clinical presentation consisted on pneumonia (64%), fever (55%), cough (70%), dyspnoea (45%), lymphopenia (66%) and gastrointestinal symptoms (36%). 21% required intubation and admission in ICU. 8 patients were asymptomatic.

18% received Hydroxychloroquine therapy plus Azithromycin, 11% Tocilizumab, 11% Ritonavir-Lopinavir, 59% steroids, 7.7% Remdesivir and 13.5% convalescent plasma. Immunosuppression was reduced in all symptomatic patients.

10 patients (19%) died. Table 1 compares the characteristics of these patients with those who survived.

Conclusion

We concluded that mortality in KT is very high, more than reported in general population. Risk factors are patient age, time after KT, baseline renal function, the presence of pneumonia, as well as higher CRP levels at the time of diagnosis. More experience is needed to optimize our protocols and therapy for Covid-19 in KT.
MO927IMPACT OF DONOR AGE ON LIVING DONOR KIDNEY TRANSPLANTATION
Authors: Hiramitsu Takahisa , Ohara Kiyomi , Tomosugi Toshihide , Futamura Kenta , Okada Manabu , Norihiko Goto , Ichimori Toshihiro , Narumi Shunji , Watarai Yoshihiko
Published: May 2021

Background and Aims

Although elderly living donors are recognized as a marginal donor for kidney transplantation, the number of elderly living donors are increasing because of insufficiency. We investigated the impact of donor age on living donor kidney transplantation.

Method

A total 858 adult living donor kidney transplantation (LDKT) between January 2008 and December 2018 was included in this study and followed up until September 2020. LDKTs were stratified into 3 groups according to the donor age; 157 LDKTs from donors aged 30 – 49, 592 LDKTs from donors aged 50 – 69, and 109 LDKTs from donors aged 70 – 89. To investigate the impact of donor age on living donors, postoperative estimated glomerular filtration rates (eGFR), mortality rate and incidence of end stage renal disease were compared between 3 donor age groups. To investigate the impact of donor age on recipients, postoperative eGFR was compared between 3 donor age groups and the risk factors of graft loss were analyzed using Cox regression hazard model.

Results

The eGFRs of donors demonstrated a decline with increased donor age and significant differences at all time points among 3 donor age groups. (Figure 1) Mortality rate and incidence of end stage renal disease of donors were similar among 3 donor age groups. (Figure 2) The eGFRs of recipients demonstrated a decline with increased donor age and significant differences at all time points among 3 donor age groups. (Figure 3) Multivariate analysis using Cox regression hazard model demonstrated donor aged 70 – 89 as a significant risk of graft loss (P = 0.024, hazard ratio 3.053, 95% confidence interval 1.160 – 8.040).

Conclusion

The prognosis of living donors after donation were not affected by the donor age except for the lower eGFR with increased donor age. The eGFRs of recipients and graft loss rates were the worst in the recipients transplanted from donors aged 70 – 89.
MO928EXHALED HYDROGEN AS A MARKER OF INTESTINAL FERMENTATION IS ASSOCIATED 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: May 2021

Background and Aims

Diarrhea is a common gastrointestinal (GI) complaint among kidney transplant recipients (KTR). Exhaled hydrogen (H2) is a surrogate marker of small intestinal bacterial overgrowth, which has been proposed to drive GI symptoms such as diarrhea. In a large cohort of KTR, we assessed the amount of exhaled H2 to evaluate its association with diarrhea and potential clinical and dietary determinants.

Method

Clinical, laboratory and dietary data from the TransplantLines Biobank and Cohort Study (NCT03272841), comprising 424 KTR were analyzed. Exhaled H2 concentration was measured using a model DP Quintron Gas Chromatograph. Diarrhea was classified according to the Bristol Stool Form Scale (BSFS) and stool water content was measured using a freeze-drying method. Dietary intake was assessed using a validated self-administered food frequency questionnaire (FFQ). Possible determinants of exhaled H2, such as sex, age, eGFR, mycophenolate mofetil and tacrolimus use, and several other clinical, biochemical and nutritional factors, were studied using univariable linear regression. All variables with a p<0.05 were included in a multivariable linear regression model run backward to identify the determinants of exhaled H2 production.

Results

KTR (55.4±13.2 years, 60.8% male, mean eGFR 49.8±19.1 mL/min/1,73 m2) were divided into three groups according to median exhaled H2 concentration (G1, 1.0-6.9 ppm, n=151; G2, 7.0-19.9 ppm, n=139; G3, ≥20.0 ppm, n=134). Hence, signs of small intestinal bacterial overgrowth (exhaled H2 ≥20 ppm) were identified in 31.6% of KTR. Seventy-six patients (33.0%) had diarrhea according to BSFS. Exhaled H2 correlated with stool water content (r=0.24, p=0.04) and increased risk of diarrhea (OR = 6.03, 95% CI 1.6-22.1, p<0.01). In multivariable linear regression analyses, polysaccharide intake was independently associated with exhaled H2 (std. β=0.24, p=0.01), whereas the other factors were not significant.

Conclusion

These findings suggest that higher fasting exhaled H2 is associated with increased risk of diarrhea in KTR with polysaccharide intake as an independent determinant of exhaled H2. The present results suggest that diarrhea in KTR may reflect an altered small bowel gut microbial composition, at least partly under dietary influence.
MO929KIDNEY TRANSPLANTATION IN MONOCLONAL IMMUNOGLOBULIN DEPOSITION DISEASE: A REPORT OF 6 CASES
Authors: Cuadrado Payán Elena , Molina-Andujar Alicia , Tovar Natalia , Castrejón de Anta Natalia , Revuelta Ignacio , Cucchiari David , Cofan Pujol Federico , Esforzado Nuria , Cibeira M Teresa , Rosiñol Laura , Bladé Joan , Diekmann Fritz , Fernández de Larrea Carlos , Quintana Luis F
Published: May 2021

Background and Aims

Monoclonal immunoglobulin deposition disease (MIDD) is a systemic rare condition that usually leads to end stage renal disease. Treatment of patients with a bortezomib-based regimen followed by autologous stem cell transplantation (ASCT) has been increasingly used, with improvements in the response rates and the renal graft outcomes in kidney transplant recipients

Method

Retrospective study of 6 patients diagnosed of MIDD with complete response but not renal response after hematologic treatment that underwent kidney transplant in our institution between 2010 and 2019.

Results

A total of 6 patients (5 women) were analyzed, with mean age at diagnosis of 47 years (range 40-53). At presentation their mean eGFR was 18 mL/minute (range 9-25) and mean proteinuria of 5.5 g (range 0.290-12.5). The deposit was kappa type except in 1 case (heavy and light lambda type chains). In all of them there was an absence of monoclonal component in blood and urine but positive immunofixation in 5 cases (2 only in urine). 3 started chronic hemodialysis during admission and the others at 3, 5 and 44 months after diagnosis. As hematological treatment, all received bortezomib followed by ASCT, being under complete hematological response at the time of kidney transplant. It was performed at 28 months on average from ASCT (range 11-42), with mean kappa/lambda ratio of 2.6 (range 1.33-3.75). 3 patients received induction with thymoglobulin and 3 with basiliximab, followed by triple therapy with tacrolimus + prednisone + mTOR inhibitor (4 patients) or mycophenolate (2 patients). During a median follow-up of 20,5 months from kidney transplant and 54 months from ASCT, 1 patient experienced hematologic relapse and 2 had hematologic progression (one of them with MIDD relapse in the allograft) requiring treatment. The patient with organ relapse received Daratumumab monotherapy achieving complete hematologic response but graft failure. The other 5 patients had functional graft with median serum creatinine 1.68 mg/dl.

Conclusion

In patients with MIDD and sustained complete hematologic response, a kidney transplant can be considered. The optimal approach to treatment of hematologic relapse or recurrence of MIDD after kidney transplant remains to be determined
MO930BURDEN OF DISEASE IN INCIDENT DIALYSIS PATIENTS WAIT LISTED FOR KIDNEY TRANSPLANTATION 2008 – 2016 IN GERMANY
Authors: Wagner Martin , Arns Wolfgang , Rascher Katherine , Cramer Heyke , Schaller Mathias , Bach Dieter , Von Gersdorff Gero
Published: May 2021

Background and Aims

Only a subset of all patients on dialysis is eligible for kidney transplantation (KTx) due to the large variation of mortality risk. It has been shown that the burden of disease is increasing over the last years in patients at dialysis inception. Moreover, the number of available kidney grafts is decreasing, resulting in a prolonged time on the waiting list. In our study we describe the burden of disease and 3-year mortality in a sample of incident dialysis patients in Germany, stratified by KTx status, including trends over time.

Method

The QiN (Quality in Nephrology) dataset is a registry-based observational study in which >90% of all patients treated in dialysis centers of the non-profit kidney care provider KfH are enrolled. In our analyses we included all adult patients beginning dialysis treatment between 2008 and 2016. Primary outcome was 3-year all-cause death up until Dec 31, 2019. Patients were stratified by last available KTx- status: (a) KTx within 3 years, (b) on dialysis - on waiting list, (c) on dialysis - in evaluation for KTx, (d) on dialysis - KTx never planned, (e) on dialysis - KTx status missing. The burden of disease was assessed by the AROii score (Floege et al. 2015), a predictive model including patient characteristics, laboratory variables and dialysis parameters.

Results

Of a total of n=25987 incident patients analyzed, 3.2% underwent KTx within 3 years, 10.6% were listed for KTx, and 13.4% were in evaluation. In 49.5% KTx was never planned and in 23.3% KTx status was missing. These groups differed significantly in median AROii score, reflecting their burden of disease at dialysis inception: KTx never planned or missing (AROii score 10) as compared to KTx (AROii score 1), listed (AROii score 3) and in evaluation (AROii score 4) (p<0.001).

Similarly, 3-year observed mortality (n=8059 [31%]) differed widely across KTx strata (log rank p<0.001), ranging from 11% in listed patients to 44% (HR 5,982; [5.335; 6.707]) in those with missing KTx status (figure). In the period 2008-2019 the number of KTx within 3 years decreased, but the proportion of patients on the waiting list and the proportion of patients in evaluation increased. In all patients on dialysis the burden of disease at dialysis inception increased over time across KTx strata (p<0.05).

Conclusion

About three quarters of patients started dialysis with a very high mortality risk and at least half of them were considered ineligible for KTx. Patients listed or in evaluation for KTx in Germany have become sicker over the last decade. With decreasing numbers of KTx in Germany the time on the waiting list is prolonged. Longer waiting times and the increasing burden of disease result in advanced risk at the time of transplantation.
MO989STUDY OF PHARMACOGENETICS OF MYCOFENOLATE MOFETIL IN KIDNEY TRANSPLANT RECIPIENTS: EXPERIENCE OF SAHLOUL HOSPITAL
Authors: Hadhri Asma , Sahtout Wissal , Abderrahmen Ameni , Amor Dorra , Azzabi Awatef , Amal Ouni , Mrabet Sanda , Fradi Asma , Ben Aicha Narjes , Zallema Dorsaf , Omezzine Asma , Bousslema Ali , Guedri Yosra , Achour Abdeltif
Published: May 2021

Background and Aims

The pharmacokinetics and pharmacodynamics of the immunosuppressive drug mycophenolate mofetil (MMF) are subject to significant interindividual variability that affects its efficacy and toxicity. The present study focused on the genetic factors potentially involved in the variability of the response to this drug in kidney transplantation, while taking into account the influence of non-genetic factors.

Method

276 kidney transplant patients treated with MMF were involved, recruited from the Nephrology and transplantion Department of Sahloul Hospital. Data on transplantation, exposure to MMF and clinical outcomes of the patients were collected. A PCR-RFLP genetic study of 9 polymorphisms of UGT, SLCO and IMPDH was performed. Were studied the relationship between the genetic polymorphisms and the exposure to MMF, the risk of acute and chronic rejection of the kidney graft, as well as the adverse effects of MMF.

Results

This study showed that the variant alleles of polymorphisms UGT1A9 -2152C>T and IMPDH II 3757T>C would increase the risk of acute and chronic rejection. The variant allele of SLCO1B1 388A>G would protect against acute rejection.

The variant allele of the UGT1A9 98T>C polymorphism would increase the risk of diarrhea, unlike the variant allele of the UGT1A9 -275T>A polymorphism, which appears to be a protective factor against diarrhea. The variant allele of the UGT1A8 518C>G polymorphism would increase the risk of infections. However, relationship between genetic polymorphisms and exposure to MMF was not demonstrated.

Conclusion

These results highlight the need to take genetic variability into account in predicting the therapeutic response to MMF before initiating the treatment.

Acute rejection and genetic polymorphisms

SNP Genotype Acute rejection
MO990THE RELATIONSHIP BETWEEN T-CELL INFILTRATION IN BIOPSY PROVEN ACUTE T-CELL MEDIATED REJECTION WITH ALLOGRAFT FUNCTION
Authors: Ahmadpoor Pedram , Dalili Nooshin
Published: May 2021

Background and Aims

Todays increasing effort are made to detect non-invasive and reliable methods for prediction of organ rejection. In the current study, we evaluated the degree of CD3, CD20, Th17 and Tregs infiltration in kidney biopsy of the patients with acute cellular rejection and the possible relation with graft outcome.

Method

From 70 biopsy proven ATCMR according to Banff criteria in whom kidney biopsy were done based on acute creatinine rise, 50 patients were selected. 20 patients excluded because of insufficient specimen or clinical data. All of recruited patients experienced their first episode of ATCMR. 21 patients had deceased donors and 29 had living ones. Paraffin sections were deparaffinized then dehydrated using alcohols. The tissues were incubated with Antibodies in two stages. First, they were incubated with antihuman IL-17 monoclonal antibody and polyclonal antibody against FOXP3. The results analyzed with SPSS version 20. P value less than 0.05 was considered as significant.

Results

FOXP3 mean cell count in stable graft function group was 7.88 but in impaired graft group was 8.02, which was not statistically significant (P-value :0. 96). Th17 mean cell count in stable group was 5.0 but in impaired group was 10.1, which was not significant too (P-value: 0.24). FOXP3/Th17 ratio was higher in stable group (1.4 versus 1.12) but without any statistically important value (P-value: 0.22) .CD3 count was higher in impaired group (29.8 versus 27.7) and CD20 count was more in stable group (8.8 versus 7.8) without any significant values (P-value: 0.7 and 0.62) respectively. FOXP3 positive cell count was higher in failure to response group (9.95 vs. 6.63) but with non-significant P-value of 0.1. Th17 count was higher also in this group (11.3 vs. 8.3) but with non-significant value .The FOXP3/Th17 ratio was higher in appropriate response group (1.19 vs. 1.15) with P-value 0.8 .CD3 count was higher in response group and CD20 in failure group vice versa (31.2 vs. 27.3 and 7.96 vs. 8.06) also with nonsignificant values

Conclusion

We observed that allografts with higher Th17 at biopsy had lower levels of GFR in the next 12 months. One conclusion can be that assessing the Th17 infiltration is more effective than FOXP3 Tregs in predicting the prognosis of renal transplant .
MO991KIDNEY TRANSPLANT PATIENTS INFECTED BY SARS-COV-2 PNEUMONIA TREATED WITH REMDESIVIR: CASES REPORTS
Authors: Cacho Judit , Molina Gomez Maria , Burgos García Elena , Villegas Andres , Pérez-Mir Mónica , Cañas Sole Laura , Taco Omar , Juega Mariã‘o Francisco Javier , Lauzurica Ricardo
Published: May 2021

Background and Aims

Remdesivir is the only treatment that has been shown to be useful against SARS-CoV-2 infection. It shorts hospitalization time compared to placebo. Kidney transplant (KT) patients were not included in these studies, therefore, its effects in this population is limited to some published cases.

Method

We performed a retrospective observational study that included all KT patients admitted between August 01, 2020 and November 17, 2020 with SARS-CoV-2 pneumonia who received treatment with remdesivir. Patients received a 200mg loading dose followed by 100 mg/day maintenance dose for 5 days. The objective of this study was to describe the experience of a cohort of KT patients treated with remdesivir.

Results

A total of 36 KT patients developed SARS-CoV-2 infection, 6 of them received treatment with remdesivir. The rest of the patients did not receive the drug due to either CKD-EPI less than 30 mL/min or they did not present clinical criteria. In addition to remdesivir, all pacients received dexamethasone and anticoagulation therapy. Immunosuppression was suspended in all patients, maintaining only dexamethasone. 50% were men, the median age was 58.5 (52.75–68) years. 67% had unknown underlying kidney disease, 83% were hypertensive and 33% had diabetes. All patients received KT from deceased brain donor and 50% received thymoglobulin as induction treatment. Median time from transplantation was 49 (20.5–135.5) months, with median glomerular filtration at admission of 47.5 (42.25–63.25) mL/min. The most frequent clinical manifestation was dry cough and dyspnea (83%), followed by tachypnea and fever (67%). Chest X-rays of all patients showed pulmonary infiltrates and required low oxygen flow therapy upon admission, requiring high flow nasal therapy in 33% of cases during admission. Only 17% of the cases presented deterioration of the graft function, not requiring hemodialysis in any case, and all recovered renal function at hospital discharge. No patient died or required admission to the critical care unit. Median days of admission was 12 (10–18) days.

Conclusion

KT patients with SARS-CoV-2 pneumonia under treatment with remdesivir have a good clinical course, with few cases of renal function deterioration and a low mortality rate. Additional studies are necessary with a larger number of patients to improve the knowledge of remdesivir in KT with SARS-CoV-2 infection.
MO993IMMUNOSUPPRESSION MINIMIZATION IN KIDNEY TRANSPLANT RECIPIENTS HOSPITALIZED FOR COVID-19
Authors: Anton Pampols Paula , Trujillo Hernando , Melilli Edoardo , Urban Blanca , Sandino Pérez Justo , Favà Alexandre , Gutierrez Eduardo , Bestard Oriol , Mancebo Esther , Sevillano Angel , Cruzado Josep , Morales Enrique
Published: May 2021

Background and Aims

Immunosuppressed patients such as kidney transplant recipients (KTs) have increased mortality risk in the setting of coronavirus disease 2019 (COVID-19). The role and management of chronic immunosuppressive therapies during COVID-19 must be characterized.

Method

Herein, we report the follow-up of a cohort of 47 KTs admitted at two Spanish Kidney Transplant Units who survived COVID-19. The impact of the management of immunosuppression during COVID-19 on graft function and immunologic events was evaluated.

Results

At least one immunosuppressive agent was withdrawn in 83% of patients, with antimetabolites being the most frequent. Steroids were generally not stopped and the dose was even increased in 15% of patients as part of the treatment of COVID-19. Although immunosuppressive drugs were suspended during a median time of 17 days, no rejection episodes neither de novo donor specific antibodies were observed up to 3 months after discharge, and no significant changes occurred in calculated panel reactive antibodies. Acute graft dysfunction was common (55%) and the severity was related to tacrolimus trough levels, which were higher in patients receiving antivirals. At the end of follow-up, all patients recovered baseline kidney function.

Conclusion

Our observational study suggests that immunosuppression in KTs hospitalized due to COVID-19 could be safely minimized.
MO995DO THE TIMELINE AND SPECTRUM OF INFECTIONS CHANGE AFTER ANTI-REJECTION THERAPY IN KIDNEY TRANSPLANT RECIPIENTS?
Authors: Krishnakumar Arvind , Mani Selvin Sundar Raj , Alam Rizwan , Lalwani Manish , Thomas Athul , Valson Anna , Alexander Suceena , John Elenjickal Elias , Eapen Jeethu Joseph , Yusuf Sabina , Varughese Santosh , David Vinoi George
Published: May 2021

Background and Aims

The infections in kidney transplant recipients has been well defined. The timeline of infections and type of infection among patients who received anti-rejection therapy for acute rejection when compared to the patients who did not develop an acute rejection.

Method

Renal transplant recipients with post-transplant median follow up of four years from July 2009-June 2018 were included in a retrospective cohort study at a tertiary care hospital. Demographic characteristics, biopsy proven rejections, infections and graft and patient outcome were collected from transplant records and the hospital clinical workstation. Early and late acute rejections were defined as less than and more than 3 months respectively. The rates of various infections, type and time to develop an infection in the acute rejection group were compared with the patients who did not develop any rejection.

Results

A total of 794 patients underwent kidney transplant during the study with mean age of 35.5±12 years and 78% being male. Two hundred and eight four patients (35.8 %) had one or more biopsy proven rejections during the median follow up of 48 months (IQR 28,77). 213 patients (75%) developed early acute rejection (less than 3 months) while the remainder developed late acute rejection. The median time to develop the first acute rejection was 12 days (IQR 6,93.3). Majority of the patients (176, 62%) developed biopsy proven acute cellular rejection, 77 patients (27.1%) acute antibody mediated rejection and rest (10.9%) either mixed or borderline rejection who were treated. The proportion of BKV infection and infective diarrhea were more in rejection group when compared to no rejection group which was statistically significant (refer Table 1). At follow up, the patients who developed rejection had more graft loss (p value 0.010) but no increase in mortality. The predictors of infection among the patients who received anti-rejection therapy were identified. The median time to develop any infection in both groups were also compared. The spectrum of infections and outcome following early and late rejections were compared. Subgroup analysis was done to look at the eGFR, proteinuria trend, graft outcomes in patients with no rejection, rejection without any infection at follow up and rejection with any infection at follow up. The effect of type of anti-rejection therapy on spectrum of infections was also studied.

Conclusion

This is one of the few studies which looked at the effect of anti-rejection therapy in kidney transplant recipients. Anti-rejection treatment received post kidney transplant resulted in increased rates of BKV infection and infective diarrhea. Patients with acute rejection had more graft loss during follow up with no significant effect on mortality.
MO997INCIDENTAL SKIN CANCER AFTER KIDNEY TRANSPLANTATION: A REGIONAL POPULATION BASED-COHORT STUDY (2015-2020)
Authors: Villagrasa Tania , Ramos Daniel , Garcia José Luis , Saus Carlos , Cabello Pelegrin Sheila , Allende Natalia , Jimenez Mendoza Sonia Cleofe , Munar Vila Maria Antonia , Tugores Ana , Gomez Marques Gonzalo
Published: May 2021

Background and Aims

Long-term immunosuppression in solid organ transplant (SOT) recipients could be associated with high risk of cutaneous malignancies. Any suspicious lesion should be excised and sent for pathologic examination.

Method

We performed a descriptive retrospective single-center study to evaluate the incidence of all skin cancer lesions in 372 kidney transplanted recipients between January 2015 to July 2020 with at least 6 months of follow-up.

Results

We identified 53 recipients who developed skin diseases during post transplant period. Mean age was 63y, predominantly men (62%), caucasian race, with light phototype (I-II 95%).Mean follow-up were 16 months (45% first year, 23% second year, and 32%> 3 years). 70% of the patients were over 60y with an earlier development of the lesions. Actinic keratosis was the most frequent non- excised lesion. 27 patients were biopsied (51%) in whom 66% showed malignant skin lesions (squamous cell carcinoma-SCC: 39%; Basal cell carcinoma-BCC: 50%; melanoma 11%). The most frequent immunosuppressive treatment (IS) associated between these recipients was the combination of tacrolimus (Tac) and mycophenolate (MMF; 62%) versus tacrolimus (Tac) and everolimus scheme (EVE; 38%). Up to 18.5% had multiple and mixed carcinomas. 4 to 5 patients of them were with MMF regimen. This treatment was also more frequent among patients with SCC (33%).

Conclusion
MO999COMPARISON OF BASILIXIMAB VS NO INDUCTION ON 12-MONTHS RENAL FUNCTION IN KIDNEY TRANSPLANT RECIPIENTS IN THE TACROLIMUS ERA
Authors: Lys Zdenek , Valkovsky Ivo , Havranek Pavel , Dedochova Jarmila , Polaskova Jana , Vaclavik Jan
Published: May 2021

Background and Aims

IL2-RA (Interleukin 2 receptor antagonist) are recommended for the induction immunosuppression of kidney transplant recipients in patients with low/standard immunological risk. Studies showing the effectiveness of these substances have often been performed in patients taking cyclosporine. We aimed to find out whether the same results would be obtained with the more effective tacrolimus in an immunosuppressive regimen.

Method

Induction immunosuppression using IL2-RA basiliximab in all patients undergoing kidney transplantation has been routinely used in our transplant center since April 1, 2018. We retrospectively compared outcomes of kidney transplantation of the last 40 patients before introduction of induction and the first 40 patients after the induction (monitored period of analysis is June 2017 to January 2019). All patients in each group received baseline immunosuppression of tacrolimus, corticosteroid and mycophenolate. We selected patients with low immunological risk (1st transplant, panel reactive antibodies up to 20%, without donor specific antibodies, donation after brain death) in both groups and evaluated their renal outcomes (serum creatinine and estimated glomerular filtration rate/eGFR) at 12 months after transplantation.

Results

Patients in the groups withnout and with basiliximab induction were of comparable age (51.9 years vs. 54.7) and with similar retransplantation rate (20%). The 1-year survival of patients and kidneys was the same (97.4% patient survival and 92.1% renal survival). Renal transplant function at 12 months was analyzed in 21 patients without and 19 patients with basiliximab induction with low baseline immunological risk. The patients who received basiliximab inductive immunosuppression had better graft function 12 months compared to patients without basiliximab administration: median serum creatinine level 112 µmol/L vs. 127 µmol/L (P=0.047) and eGFR 0.85 ml/s vs. 0.77 ml/s (P=0.347). Better renal function was also shown in the subgroup of patients older than 65 years.

Conclusion

At our transplant center, the introduction of basiliximab induction in patients at low immunological risk led to improved graft function in the short term despite the growing subpopulation of geriatric patients.
MO1001THE OUTCOME OF PLASMA CELL-RICH ACUTE REJECTION IN KIDNEY TRANSPLANTATION, IS IT REALLY POOR?
Authors: Mahmoud Tarek S H , Gheith Osama , Yagan Jude , Al-Taleb Ahmad , MA Halim Medhat , Nair Prasad , Alotaibi Torki
Published: May 2021

Background and Aims

The outcome of Plasma cell-rich acute rejection (PCAR) in kidney transplant is reported to be poor. However, PCAR which can be associated with any type of rejection, may not be considered as independent morphological prognostic feature. Different treatment modalities were prescribed with variable responses. We report here four cases of PCAR and describe their presentations, type of rejection, associated conditions and treatment outcome.

Method

Out of 1920 kidney transplant recipients under follow up in our centre from 1996 till 2019, four patients were reported to have PCAR according to 2007 Banff classification. They were re-evaluated based on 2015 Banff classification. The treatment protocol was tailored according to the type of rejection and associated conditions.

Results

The four patients, aged 28, 44, 46 and 54 years, had live unrelated renal transplant done somewhere abroad with no data about donor HLA typing. Two of them were females. One had high PRA and she was positive for HBsAg. One patient received induction immunosuppression with basiliximab. They all received prednisolone, mycophenolate and cyclosporine as the maintenance immunosuppression and had immediate graft function. Rejection happened between 23 to 180 months post-transplant. Two patients had acute T-cell mediated Banff 1A rejections with features consistent with early membranous nephropathy. One had acute T-cell mediated rejection Banff 1B and the fourth had borderline T-cell mediated rejection with morphological changes suggestive of chronic active antibody mediated rejection (AMR). Plasma cells constituted 10 to 30% of the interstitial infiltration. All patients received solumedrol pulse. Both patients with features of membranous nephropathy received rituximab and one of them had additionally IVIG. The patient with AMR received plasma exchange and IVIG. However, she did not receive rituximab as she was positive for HBsAg. All patients responded well to treatment and the mean improvement in eGFR was 12.8%, 24.9%, 40.3% and 39.1% at 1-, 3-, 6- and 12-months post treatment. Repeat kidney biopsy at 3 to 12 weeks post treatment showed resolution of plasma cell infiltration in all patients.

Conclusion

Outcome of PCAR management was favourable among our patients irrespective of the type of rejection and associated conditions.
MO1002EFFICACY OF PLASMAPHERESIS IN KIDNEY TRANSPLANT PATIENTS WITH FOCAL SEGMENTAL GLOMERULOSCLEROSIS : A SINGLE CENTER EXPERIENCE
Authors: El Meknassi Imen , Dorsaf Zellema , Awatef Azzabi , Wissal Sahtout , Narjes Ben Aicha , Sanda Mrabet , Asma Fradu , Sabri Ferdaous , Ben Amor Samira , Yosra Guedri , Abdellatif Achour
Published: May 2021

Background and Aims

Plasmapheresis (PP) have been used in kidney transplant (KT) patients for multiple immunological renal diseases. Focal segmental glomerulosclerosis (FSGS) is one of the most prevalent indication for PP. It can be used either for curative or preventive treatment of its recurrence. The aim of our study was to assess the outcomes of PP among KT patients with FSGS.

Method

We performed a retrospective study including all KT patients with FSGS who underwent PP during the period from December 2007 to December 2018. PP was performed using a filtration technique by a Prismaflex machine.

Results

Among 275 KT patients, we have identified 5 patients with FSGS who underwent PP either before or after transplantation. The mean age was 26.4 years. All patients but one received a living-donor kidney with number of mismatches between 3 and 5. All patients were under corticosteroids, mycophenolate mofetil and cyclosporine. Two patients presented recurrent FSGS within 3 days following the transplantation. Mean serum creatinine level and proteinuria before PP were 517 ±191 µmol/l and 17.7 ±7.5 g/day respectively. The PP was used basing on Canaud protocol combined to rituximab. The mean number of PP sessions was 29. Only one patient required hemodialysis. None of the patients had lost his graft. The mean serum creatinine level was 172±55 µmol/l. One patient died of septic shock. PP was used in two other patients before transplantation in order to prevent the recurrence of FSGS. They have preserved a normal kidney function after a period of follow-up (37 months and 7 years). No rejection or recurrence of FSGS was noted during the follow-up period. Another patient aged 20, underwent 5 sessions of PP on alternate days immediately after transplantation to prevent the recurrence of FSGS. His baseline serum creatinine level was at 136 µmol/l. The recurrence of his initial renal disease occurred after 21 months requiring other sessions of PP. Rituximab was tried but stopped in front of allergy reaction. His renal function remained stable. Overall, PP was well tolerated in all patients with no incident.

Conclusion

Recurrence of the FSGS after transplantation is a concern for nephrologists due to the difficulty of treatment. Our study shows the efficacy of plasmapheresis before kidney transplantation to prevent recurrence of FSGS.
MO1003ONSET OF BRAIN TOXOPLASMA GONDII ABSCESSES IN RENAL TRANSPLANT RECIPIENT IN THERAPY WITH BELATACEPT
Authors: Orefice Giuseppe , Vigilante Raffaella , Mennillo Chiara , Giuliana Sofia , Ruosi Carolina , Pollastro Rosa Maria , Calò Federica , Perna Alessandra , Simeoni Mariadelina
Published: May 2021

Background

Belatacept is a new non-nephrotoxic anti-rejection drug that blocks the CD80 / CD86-CD28 complex, that normally activates T lymphocytes.

Although the BENEFIT study proposes its use at the forefront of immunosuppressive therapy to prevent renal transplant rejection, the risk of opportunistic infections should not be underestimated, as demonstrated by the following clinical case.

Case report

We report the case of a 71-year-old male kidney transplant recipient that at 7-month follow-up showed a relevant rise of serum creatinine up to 3.8 mg/dl related to graft rejection. The patient started a cycle of treatment with Belatacept in accomplishment to international studies, with improvement in renal function (serum creatinine: 2.8 mg/dl). After 8 months of therapy, due to the appearance of left brachio-crural hypoasthenia, a brain CT and a brain MRI (both without contrast media because of the severe graft dysfunction) were consecutively performed. Imaging revealed multiple nodular formations in the right hemisphere, compatible with brain abscesses or neuro-lymphoma.

Belatacept was promptly suspended, a rachicentesis for liquor analysis performed, and a broad spectrum empiric antibiotic therapy was started on Infectious Disease Specialist advice. After Toxoplasma Gondii positivity was found by PCR on cerebrospinal fluid, neuro-lymphoma was excluded and the patient was switched to a targeted antibiotic therapy with Trimethoprim / Sulfamethoxazole (dose adjusted to renal function) for 6 weeks and subsequently, a maintenance course with Sulfadiazine and Pyrimethamine. During treatment, brain lesions showed progressive reduction, with marked clinical improvement and stabilization of renal function (eGFR 25 ml / min).

Conclusions

As far as is known in the literature, this is the first case of Toxoplasma Gondii brain infection that can be correlated with the use of Belactacept. The appearance of a severe opportunistic infection, in a short period of time after the introduction of Belatacept, could indicate the direct role of Belatacept in the development of these brain abscesses and indicates the importance of carefully evaluating the use of the drug in elderly patients with reduced renal function, in which adequate prophylactic therapy would be particularly indicated.