bluuebunny/crossref_metadata_2025 huggingface dataset:
P1656THE IMPACT OF PRE-TRANSPLANT DIALYSIS MODALITY ON EARLY POST-TRANSPLANT PERIOD ADVERSE EVENTS : A PROSPECTIVE COHORT STUDY WITH PROPENSITY SCORE MATCHING
Authors: Boo Hyo Jin , Huh Wooseong , Kim Yon su , Yang Chul-Woo , Kim Yong-Lim , Lee Jong Soo , Kim Joong Kyung , Han Seung Hyeok , Hwang Jung-Won
Published: June 2020

Background and Aims

Among peritoneal dialysis (PD) or hemodialysis (HD) while waiting for a kidney transplant (KT), which is better in terms of KT outcomes has long been of interest. Nowadays it is difficult to agree on which modality is better. The primary objective of this study was to compare the incidence of composite outcomes (delayed graft function, primary non-function, biopsy-proven acute rejection) within 1 year after primary adult KT between recipients taken PD and HD before KT (PD group vs. HD group, respectively).

Method

This study was a prospective, multi-sites cohort study. We used a propensity score matching to control for patients characteristics.

Results

Total 1040 patients were enrolled consecutively. Among them, 1030 patients (248, PD group; 782, HD group) were included in the final analysis. The HD group was older and had higher prevalence of diabetes, higher Charlson comorbidity index score, higher prevalence of positive PRA and more prescription of rituximab than the PD group significantly. After propensity score matching (246, PD group; 476, HD group), there were no differences in baseline characteristics between the two groups. In the whole population, there was no difference in the risk of the composite outcomes between the PD and HD groups (19% vs. 17%, hazard ratio [HR] 1.25, 95% confidence interval [CI] 0.88 ∼ 1.77, p = 0.21). There were also no differences in the risk of each component in the composite outcomes between the two groups. Primary non-function, a component of the composite outcomes did not occur in the both groups. There were no differences in the risks of death, frequency and total duration of re-hospitalization after KT for 1 year, and the changes of eGFR for 1 year between the two groups. The results from the propensity score matched population were consistent with those from the whole population. There was no difference in the risk of the composite outcomes between the PD and HD groups (19% vs. 17%, HR 1.17, 95% CI 0.80 ∼ 1.74, p = 0.43).

Conclusion

The pre-transplant dialysis modality does not affect the incidences of delayed graft function and acute rejection in early period of KT. (NCT01513707)

This study was supported by Baxter Incorporated.
P1658RENAL RECOVERY AFTER LIVER TRANASPLANTATION ALONE IN PATIENTS WITH LIVER CIRRHOSIS AND SEVERE CHRONIC KIDNEY DISEASE WITH NORMAL KIDNEY SIZE
Authors: YANG EUN HYE , Kim Soon Bae , Lee Sung-Gyu
Published: June 2020

Background and Aims

Most guidelines recommend simultaneous liver-kidney transplantation (SLKT) in patients with liver cirrhosis (LC) and severe chronic kidney disease (CKD) over liver transplantation alone (LTA). CKD, however, is not irreversible. This study evaluates the reversibility of kidney disease after LTA based on kidney size.

Method

In this single-center retrospective study, we classified 90 patients with LC and severe CKD into 3 groups: normal kidney-LTA (NK-LTA, n=39), small kidney [both <9cm]-LTA (SK-LTA, n=40), and small kidney-SLKT (SK-SLKT, n=11). Baseline characteristics and renal recovery and survival outcomes were compared among 3 groups.

Results

The NK-LTA group had a lower percentage of hepatocellular carcinoma, a higher pre-LT eGFR, and a shorter duration of eGFR at <60 ml/min and pre-LT dialysis. This group, however, was older, received livers from a higher percentage of deceased donors and had a higher Child-Pugh score. Renal recovery, defined as no hemodialysis (HD) after LT, was found in 79% of those in the NK-LTA group, which was higher than 7.5% of those in the SK-LTA group. Renal survival, defined as patient survival without progression to HD or kidney transplant was found in 56% of patients in the NK-LTA group, which was higher than 2.5% of those of the SK-LTA group.

Conclusion

Patients with LC and severe CKD with normal kidney size may experience reversible kidney disease after LTA. Therefore, kidney after liver transplantation is recommended over SLKT for these patients.
P1661EVOLUTION OF RENAL FUNCTION IN RENAL TRANSPLANTED DONORS PATIENTS IN ASYSTOLE TYPE II. IS THERE A CORRELATION BETWEEN HISTOPATHOLOGY PARAMETERS OF THE DONOR BIOPSY AND THE GRAFT SURVIVAL? EXPERIENCE IN OUR CENTER
Authors: Andrades Gómez Cristina , González Roncero Francisco Manuel , Suárez Benjumea Alejandro , Gascó Martos Blanca , González Corvillo Carmen , De gracia Guindos María del Carmen
Published: June 2020

Background and Aims

With the aim of increasing the number of kidney transplant donors (RT), the use of organs from cadaver donors in asystole (DA) type II of Maastricht has been enhanced in recent years.The important ischemia that this type of donation entails makes it especially complex, resulting in a higher incidence of delayed renal function and non-primary graft function, compared to the TR from donor in brain death.We present our experience with the Mastricht DA type II TR since the beginning of our program in 2013

Method

108 patients with type II performed between January 2010 and June 2019, median follow-up 30 months.

Results

: mean age of the donor 42 years, 65% blood group A, mean Cr at the first month of 3 mg/dl, at the 3rd month of 1.9 mg/dl and currently 1.6 mg/dl. Mean ange of the receptor 46 years, time on dialysis 30 months, 1st transplant all, except 1. PRAc pre TR was < 25%, initial immunosuppression with thymoglobulin, steroids, mycophenolate, and delayed introduction of tacrolimus. 10% never function; 73.5% delayed renal function. 7.2% acute rejection. Survivors of the 1st, 3rd and 5th year recipients are 98%, 98% and 86% respectively. In a innovative way, it has been registered the correlation between histopathology parameters of the donor biopsy and the graft survival.

Conclusion

RT with type II DA has more incidence of delayd renal function and non-primarygraft function, however results in survival and kidney function in our center are very acceptable, comparable to donors in brain death.
P1679HYPOMAGNESAEMIA AND HYPERGLYCAEMIA AFTER KIDNEY TRANSPLANTATION
Authors: Carlsen Rasmus , Svensson My , Birkeland Kåre , Bressendorff Iain , Gulseth Hanne , Åsberg Anders , Midtvedt Karsten , Jenssen Trond Geir
Published: June 2020

Background and Aims

Hypomagnesaemia has been associated with increased insulin resistance and decreased insulin secretion. Recent data suggest that early post-engraftment hypomagnesaemia may play a role in development of post-transplant diabetes mellitus (PTDM). This single-centre study investigated the association between hypomagnesaemia 8 weeks post-engraftment and glucose metabolism changes 1 year after kidney transplantation.

Method

The study included 425 renal transplantation recipients, transplanted at Oslo University Hospital between March 2015 and May 2018. All included patients had functioning grafts with valid blood sampling and oral glucose tolerance tests 8 weeks and 1 year after transplantation. Patients with known pretransplant diabetes and those developing PTDM the first 8 weeks after transplantation were excluded. The association between plasma magnesium 8 weeks after transplantation and HbA1c, fasting plasma glucose and 2-hr glucose after 1 year was tested using both unadjusted and multiple linear regression, adjusted for: gender, age, body mass index (BMI), systolic blood pressure (SBP), tacrolimus (trough), measured glomerular filtration rate (mGFR; iohexol clearance) and plasma triglycerides.

Results

Patients had a median age of 54 (range 18-83) years, 65% were men and mean mGFR 1 year after transplantation was 56 (SD±14) ml/min/1.73m2. Median plasma magnesium was 0.72 (0.46-0.94) mmol/L 8 weeks after Tx and patients with hypomagnesaemia (Mg< 0.7 mmol/L) (n=169) were not different compared to patients with normal plasma magnesium (n=256) regarding age, gender, BMI, tacrolimus, mGFR, SBP or plasma triglycerides after 1 year.

In unadjusted linear regression 1 mmol/L higher plasma magnesium at 8 weeks was associated with the following glycaemic endpoints 1 year after transplantation (β-coefficient, CI 95%, p-value); fasting glucose: HbA1c: +9 mmol/mol (1;16, P=0.02); +0.5 mmol/L (-0.7;1.7, P=0.39); 2-hour glucose: +0.74 mmol/L (-2.5;3.9, P=0.65). In multiple linear regression the following numbers were: Fasting glucose: HbA1c: +8 mmol/mol (0.3;16, P=0.042); +0.7 mmol/L (-0.5;2.0, P=0.26); 2-hour glucose: +2.8 mmol/L (-0.6;6.2, P=0.11).

Conclusion

In both unadjusted and multiple linear regression there was a positive correlation between 8-week plasma magnesium and HbA1c 1 year after transplantation. A similar trend was found for fasting and 2-hour glucose, although this was not statistically significant.
P1683INFLUENCE OF BIOPSY PROGNOSIS ON GRAFT SURVIVAL
Authors: Andrades Gómez Cristina , Pérez valdivia Miguel Ángel , Calvillo Arbizu Jorge , Cabrera López Rocío , Suñer Poblet Marta , González Corvillo Carmen
Published: June 2020

Background and Aims

Renal transplantation is the best alternative renal replacement option for patients with advanced chronic kidney disease. However, the supply of young donors is limited, and does not cover the demand of patients on the renal transplant waiting list, for this reason are being used older donors and exists a high discard rate of those organs base on pathological results (score) of the preimplant renal biopsy.

There are several methods to evaluate the quality of the kidneys and the Kidney Donor Profile Index (KDPI) has acquired special relevance to decide the perform of preimplant renal biopsy. Based on the score, a preimplant renal biopsy is performed, which is decisive in certain cases.

However, there is poor evidence to support this decision, which can be described as “conservative,” since there is not enough certainty that there is influence of the preimplant biopsy score score on graft survival.

Method

389 biopsies of kidney transplant donors of cadaver donors in brain death and asystole type III were included. Donors in asystole type II, combined and live, were excluded. Samples examined by the same pathologist and in paraffin (no case by freezing). A graft survival analysis was performed based on the results of the renal biopsy (score). Likewise, a multivariate analysis of graft survival was carried out including, in addition to the results of the renal biopsy, results such as the age of the donor and recipient and the KDPI.

Results

graft survival was compared between two transplant subpopulations in our hospital based on whether a preimplant biopsy was performed. According to the data used there are no significant differences in graft survival between transplants in which biopsy has been performed and those that have not.

Conclusion

our work shows, as is currently the case in the literature, the absence of influence on the score of the preimplant biopsy score on graft survival.
P1690EXPERIENCE WITH EXPANDED CRITERIA DONORS: 10-YEAR SINGLE CENTER ANALYSIS
Authors: Graňák Karol , Matej Vnuäã¡k , Skálová Petra , Miklušica Juraj , Laca Ľudovít , Dedinska Ivana
Published: June 2020

Background and Aims

Kidneys from expanded criteria donors with diagnosis of brain death have become a part of the organ transplant program, which have thus increased the number of transplants.

Method

In this retrospective analysis, we identified the expanded criteria donors in a group of 156 kidney donors at our center. Basic parameters of the donors before kidney recovery were collected. Graft function, graft survival, and patient survival at 1, 3, and 5 years posttransplant were compared in expanded criteria versus standard criteria donors.

Results

Expanded criteria donors were significantly older than standard criteria donors (P < .001), had higher body mass index (P = .006), and had more frequent arterial hypertension (P < .001) and diabetes mellitus (P = .004) in their histories. When we considered the estimated glomerular filtration rate, graft function in the first 6 months after transplant was significantly worse in kidneys from expanded criteria donors (P = .011). In addition, recipients of grafts from expanded criteria donors had significantly worse survival in the first year posttransplant (P = .023); however, no differences in graft survival were observed.

Conclusion

From the long-term aspect, graft function and graft and patient survival in cases of kidneys from expanded criteria donors were comparable to results with kidneys from standard criteria donors. Expanded use of organs available for transplant is important due to the constantly increasing demands versus limited offers of organs.
P1706THE GRAFT SURVIVAL OF KIDNEY TRANSPLANTATION ACCORDING TO ETHNICITY IN KIDNEY TRANSPLANT RECIPIENTS
Authors: Jung Yeonsoon , Kim Jisu , Jeon Haesu , Kim Ye Na , Shin Ho Sik , Rim Hark
Published: June 2020

Background

African American kidney transplant recipients experience disproportionately high rates of graft loss. The aim of this analysis was to use a UNOS data set that contains detailed baseline and longitudinal clinical data to establish and quantify the impact of the current overall graft loss definition on suppressing the true disparity magnitude in US AA kidney transplant outcomes.

Methods

Longitudinal cohort study of kidney transplant recipients using a data set created by United Network for Organ Sharing (UNOS), including 266,128 (African American 70,215, Non-African American 195,913) transplant patient between 1987 and December 2016. Multivariable analysis was conducted using 2-stage joint modeling of random and fixed effects of longitudinal data (linear mixed model) with time to event outcomes (Cox regression).

Results

195,913 non-African American (AA) (73.6%) were compared with 70,215 AA (26.4%) recipients. 10-year-graft survival of AA in all era is lower than that of non-AA (31% in deceased kidney transplants (DKT) AA recipient and 42% in living kidney transplantation (LKT) non-AA recipient). 10-year-patient survival of AA with functioning graft in all era is similar that of non-AA. Multivariate Cox regression of factors associated with patient survival with functioning graft are acute rejection within 6 months, DM, hypertension and etc. Pre-transplant recipient BMI in AA show the trend as a protective factor in patient survival with functioning graft although not significantly in statistics

Conclusions

African American kidney transplant recipients experience a substantial disparity in graft loss, but not patient death with functioning graft.
P1708EFFECT OF PREGNANCY ON KIDNEY TRANSPLANT RECIPIENTS: A PROPENSITY SCORE-MATCHED STUDY
Authors: Abe Toyofumi , Ayumu Taniguchi , Masataka Kawamura , Taigo Kato , Namba-Hamano Tomoko , Ryoichi Imamura , Norio Nonomura
Published: June 2020

Background and Aims

This study aimed to evaluate whether the experience of pregnancy and delivery would be associated with poor maternal outcome among kidney transplant recipients.

Method

A total of 401 female transplant recipients from the Osaka University Transplantation Group Database were included in this study. 73 women who underwent renal transplantation between 1970 and 2017 and became pregnant and delivered at Osaka University Kidney Transplant Group Hospitals. Multivariable logistic regression analysis was used to assess the impact of pregnancy and delivery on renal transplant recipient outcome after one-to-one propensity score (PS) matching for 12 variables including serum creatinine at one year post-transplant between the parous group and the nulliparous group. The outcomes were kidney graft survival and patient survival.

Results

In all patients before PS matching, 75 (18.7%) of the 401 patients died and 137 (34.2%) of the 401 patients lost their kidney grafts during the follow-up period. In the multivariate analysis, pregnancy and delivery was not a significant risk factor for death (adjusted HR 0.662 [95%CI, 0.265-1.656], p-value 0.378) and for death-censored graft survival (adjusted HR 1.224 [95%CI, 0.683-2.196], p-value 0.497). In the PS matched population, 14 (17.5%) of the 80 patients died and 31 (38.8%) of the 80 patients lost their grafts. In the multivariate analysis, pregnancy and delivery was not a significant risk factor for death (adjusted HR 0.611 [95%CI, 0.180-2.072], p-value 0.430) and for death-censored graft survival (adjusted HR 1.308 [95%CI, 0.501-3.416], p-value 0.584).

Conclusion

Pregnancy and delivery after kidney transplantation was not associated with poor kidney transplant outcome in recipients with adequate and stable graft function.
P1709THE ROLE OF CXCL9 AND CXCL13 IN PREDICTION OF POSTTRANSPLANT INFECTION IN KIDNEY TRANSPLANT RECIPIENTS
Authors: Bai Yangjuan , Yan Lin , Li Yi , Li Yamei , Wang Xianding , Wang Lanlan , Shi Yunying
Published: June 2020

Background and Aims

Chemokines are deeply involved in the process of inflammatory and immune responses. Interferon-γ-inducible chemokines C-X-C motif chemokine 9 and 10 (CXCL9 and CXCL10) are significantly associated with Th1 cells and monocytes and rise rapidly during early episode of renal allograft rejection and various infectious diseases. CXCL13 is one of the most potent B cells and T follicular helper (Tfh) cells chemoattractants when acts through its cognate receptor CXCR5. Recent work of CXCL13 indicated a critical immune regulatory role in both multiple infectious diseases and kidney transplantation. Additionally, C-C motif chemokine 2 (CCL2) is shown to be is critical for chronic kidney diseases. The aim of this study was to identify the predictive role of serum CXCL9, CXCL10, CXCL13 or CCL2 on kidney posttransplant infection.

Method

95 kidney transplant recipients (KTRs) were enrolled in this study. 31 recipients experienced at least once infection episodes within the first posttransplant 12 months and 64 KTRs did not experience any infection episode during the follow-up period. Serum CXCL9, CXCL10, CXCL13 and CCL2 at the time points of pre-transplantation and post-transplant 30 days (POD 30) were analyzed with Bio-Plex® suspension array system.

Results

It was found that serum level of POD 30 CXCL9 and POD 30 CXCL13 was associated with infection within one year after transplantation (P=0.021, P=0.002, respectively, shown in Figure 1). The serum level of CXCL9 and CXCL13 before surgery, the serum level of CCL2 and CXCL10 before and after surgery were not associated with infection within posttransplant one year (P>0.05, shown in Figure 1). The combination of POD 30 CXCL9 plus POD 30 CXCL13 provided the best results with AUC of 0.721 (95%CI, 0.591-0.852), sensitivity of 71.4% and specificity of 68.5% at the optimal cut-off value of 52.72 pg/ml (shown in Figure 2).

Conclusion

Chemokines CXCL9 and CXCL13 as important chemokines could be used to predict the occurrence of infection within posttransplant one year in kidney transplant recipients.
P1710MULTI-NATIONAL SURVEY AMONG NEPHROLOGISTS AND TRANSPLANT SURGEONS ABOUT THE SUITABILITY AND ACCEPTANCE OF MARGINAL LIVE KIDNEY DONORS WITH SICKLE CELL TRAIT
Authors: Arabi Ziad , Mateen Atif , Altheaby Abdulrahman , Hamad Abdullah , Saleh Kaysi , El Hassan El Waleed
Published: June 2020

Background and Aims

Due to organ shortage, many transplant centers may consider “marginal” kidney donors as those with sickle cell trait (SCT) for donation. Acceptance of kidney donors with SCT is in the grey zone, where there are no clear guidelines or consensus toward them. To form a consensus, we conducted a short survey about the suitability and acceptance of living kidney donors with SCT.

Method

This is a cross-sectional survey of nephrologists and transplant surgeons about Suitability and Acceptance of The Marginal Live Kidney Donors. The survey was sent to nephrologists in different countries and it was also distributed through AST& ERA-EDTA.

Results

Of a total of (n=122) respondents from 22 countries: 80.17% (N= 96) were nephrologists and 19.83% (N=23) were transplant surgeons. N= 88 of the respondents (72%) have more than 6 years in practice and they are heavily involved in pre- transplant evaluations of donors and recipients (68.5% of respondents perform donors’ evaluation on weekly or monthly basis and 60 % perform recipient evaluation on weekly basis). The majority (45%) of the respondents were from USA. The completion rate of the survey was 99%. The presence of sickle cell trait was not considered as a contraindication to donor nephrectomy by the majority of respondents (57.38%). Of those (N= 34) 27.87 % of respondents consider them fit for donor nephrectomy after explanation of the risks involved while (N= 36) 29.51 consider them for donor nephrectomy only if there is no other suitable donor available. Out of the total respondents (N= 52) 42.62% considered the presence of sickle cell trait a contraindication to donor nephrectomy.

Conclusion

With lack of consensus and guidelines we found that a significant pool of the transplant physicians and surgeons will consider donors with sickle cell trait for kidney donation especially if there is no other acceptable donor.
P1713A CASE OF DEVASTATING BARIATRIC SURGERY-RELATED ACUTE OXALATE NEPHROPATHY FIRST DIAGNOSED AFTER KIDNEY TRANSPLANTATION
Authors: Santarsia Francesca , Gandolfini Ilaria , Delsante Marco , Palmisano Alessandra , Peyronel Francesco , Sabatino Alice , Regolisti Giuseppe , Fiaccadori Enrico , Maggiore Umberto
Published: June 2020

Background and Aims

Despite the obvious efficacy in achieving weight loss, traditional malabsorptive procedures (intestinal by-pass) used for the treatment of obesity, may be associated with enteric oxaluria. Enteric oxaluria, by causing calcium-oxalate stones and nephrocalcinosis, represents an under-recognized cause of end-stage kidney disease in patients with history of intestinal by-pass. Herein, we describe a patient with a long-standing history of intestinal by-pass who developed a devastating acute oxalate nephropathy first diagnosed after kidney transplantation.

Method

A white female aged 50, who started hemodialysis one year earlier because of tubule-interstitial nephritis on a kidney biopsy, and who had history of recurrent kidney stones (calcium oxalate), underwent urgent deceased-donor kidney transplantation because of exhausted vascular access for hemodialysis (tunneled CVC right giugular vein as the last resort). She had received intestinal by-pass surgery 20 yrs earlier, and had a pacemaker implantation in the left sublavian vein for AV block two years earlier. She was highly sensitized because of blood transfusions at the time of surgery.

Results

After transplantation, graft function had immediate recovery, serum creatinine decreasing to 2.0mg/dL (117 mmol/L) on post-operative day (POD) 3. Shortly after, serum creatinine started rising until it reached 4.0mg/dL (354mmol/L) on POD 5. Three graft biopsies (performed on POD 6, 9 and 15 post-transplant) revealed acute oxalate nephropathy (

Figure1-2

large oxalate crystals on fresh unfixed core of kidney tissue analyzed under bright field microscope using polarized light) with no sign of rejection. Serial monitoring of Luminex SAB did not reveal circulating anti-HLA donor specific antibodies. Fundus examination revealed two tiny mono-lateral retinal oxalate deposits, whereas bone biopsy did not reveal oxalate accumulation. Plasma oxalate levels were 43 mmol/L on POD 10 were urinary oxalate excretion was 29mg /day on POD 14.

The patient slowly progressed to end-stage kidney disease 2-month post-transplantation despite daily high flux dialysis since POD 7, fat-free and oxalate-free diet, oral potassium and high dose pyridoxine supplements.

Conclusion

Patients on chronic dialysis with a previous history of bariatric surgery via intestinal by-pass may have oxalate nephropathy caused by enteric oxaluria as unknown primary renal disease. The disease may recur shortly after transplantation despite the adoption of prompt aggressive treatment for oxalate removal.
P1715CORRELATION OF DONATED KIDNEY MASS AND GRAFT FUNCTION IN RECIPIENTS OF LIVING DONOR KIDNEY TRANSPLANTATION
Authors: Silva Filipa , Pestana Nicole , Ribeiro Catarina Isabel , Carneiro Diogo , Madanelo Mariana , Tavares Joana , Pedroso Sofia , Almeida Manuela , Malheiro Jorge , Dias Leonídio , Silva Ramos Miguel , Martins La Salete , Henriques António Castro
Published: June 2020

Background and Aims

Kidney volume has been proven to be a surrogate marker of nephron mass and renal function in living donors. Although many studies correlate the kidney mass with renal donors’ function after donation, few studies have compared the donated kidney mass with estimated glomerular filtration rate (eGFR) in the kidneýs recipients.

The purpose of this study is to examine the relationship between donor kidney volume and post-transplantation graft function by using computerized tomography to obtain renal volumes.

Method

Clinical data off all donor and recipient pairs undergoing live donor kidney transplantation (KT) at our institution between January 2008 and December 2017 (n=195) were reviewed. The volume of the kidney selected for transplant was determined using volume calculating software and correlate to transplant recipient eGFR.

Results

All metrics of donor kidney volume (DKV): DKV alone, ADK adjusted for weight, body mass index (BMI) or body surface area (BSA), correlated significantly with eGFR (all with p<0,001) at 1 year after KT, with DKV/BSA having the highest correlation (r=0,431). Hence, recipients were divided into terciles according their DKV/BSA (cm3/m2): tercile 1 (DKV/BSA between 49,7-77,5, n=64), tercile 2 (78-95,2, n=63) and tercile 3 (95,4-176, n=63). eGFR differences between groups at each time point were all significant (P<0.05), except for the comparison between T1 and T2 at month 6 (figure 1)

Significant risk factors for eGFR<60 ml/min at 1-year were: acute rejection (AR) at 1-year (OR=4.116, P=0.018); calculated PRA>0% (OR=2.075, P=0.039); higher donor age (OR per unit=1.033, P=0.047); and peritoneal dialysis modality (in comparison with preemptive KT: OR=3.232, P=0.013). Higher (T3) DKV/BSA tercile (in comparison with T1: OR=0.306, P=0.004) was protective of this outcome.

Patients that experienced AR at 1-year had significantly lower DKV/BSA, particularly those with acute cellular rejection (ACR).

The median follow-up was 4,8 years (IQR: 3.2-7.5). The censored graft survival by DKV/BSA terciles at 10 years were 59,3% for group 1, 91.3% for group 2 and 91.1% for group 3 (figure 3).

Conclusion

Our study demonstrates that transplantation of donor-recipient pairs with lower DKV/BSA ratio were associated with significantly worse graft function and higher incidence of AR. This data suggests that a larger mass of nephrons remaining adjusted to recipient’s weight seems to predict a better long-term eGFR. This method can be useful in order to identify patients at risk for a low eGFR after KT and, in cases of multiple potential donors, optimize donor selection.
P1717OUTCOMES OF INCREASED INTRA-ABDOMINAL PRESSURE AFTER KIDNEY TRANSPLANTATION
Authors: Coca Armando , Arias-Cabrales Carlos , Pérez-Sáez Maria José , Gonzalez Pablo , Acosta-Ochoa Isabel , Bustamante-Munguira Elena , Rollan Maria Jesus , Mendiluce Alicia , Pascual Julio , Bustamante-Munguira Juan
Published: June 2020

Background and Aims

Increased intra-abdominal pressure (IAP) is commonly found among post-surgical patients and can induce organ dysfunction. However, its prevalence and impact after kidney transplantation have not been adequately described. We aimed to study the prevalence of increased IAP after kidney transplantation and its consequences on transplant outcomes.

Method

IAP was prospectively measured in 121 kidney transplant recipients every 8h during the first 72h after surgery using the urinary bladder technique (UnoMeter Abdo-Pressure kit). Mean IAP values during the first 24h (24h-IAP) were used in this analysis. Grading of intra-abdominal hypertension was defined according to WSACS guidelines. Patients were followed for at least 12 months or until graft failure or death. The study was approved by the local ethics committee and informed consent was obtained in all cases.

Results

24h-IAP was 12.6±3.5 mmHg. 84.2% of subjects presented with intra-abdominal hypertension during the first 72h after kidney transplantation. Body mass index (OR: 1.35, 95% CI 1.12-1.63; P=0.002), male sex (OR: 3.34, 95% CI 1.1-10.3; P=0.032) and hemodialysis as renal replacement therapy before transplantation (OR: 4.35, 95% CI 1.32-14.4; P=0.016) were independent determinants of intra-abdominal hypertension. IAP was an independent risk factor for delayed graft function (*model adjusted for recipient age, sex, history of previous kidney transplants, recipient comorbidities, donor terminal serum creatinine and comorbidities, number of HLA mismatches >4, cold ischemia time and donation after cardiac death status), graft failure and death (**model adjusted for all variables included in the previous model plus delayed graft failure) (Figure).

Conclusion

Increased IAP was highly common after transplant surgery and was associated with higher rates of delayed graft function, graft failure and death. Routine IAP monitoring should be considered after transplantation to facilitate early identification of complications and initiation of the appropriate treatment to stop its effects.
P1731ABO INCOMPATIBLE DONOR KIDNEY TRANSPLANTATION IN PORTUGAL
Authors: Silva Natalia , Ribeiro Catarina Isabel , Malheiro Jorge , Almeida Manuela , Pedroso Sofia , Martins La Salete , Dias Leonídio , Henriques António Castro , Cabrita António
Published: June 2020

Background and Aims

ABO incompatiblitity was considered a barrier to kidney transplant. However, the shortage of available organs for transplantation and the excellent long term results further establish ABO-incompatible (ABOi) as a safe and effective therapeutic strategy.

The aim of the present study was to evaluate the outcomes of ABOi transplantation in terms of graft survival and function, rejection episodes and infections complications.

Method

The authors present a single center retrospective observational study, that include the analyse of 12 patients who underwent ABOi kidney transplantation between November 2014 and July 2019. All patients received Rituximab (375mg/m2) pre-operation and started Tacrolimus, Mycophenolate Mofetil and Prednisolone one week before surgery. Plasmapheresis was done to remove anti-A or B antibodies until their titles were <1:8 during the first post-operative week and <1:16 at the second.

Results

: A total of 12 patients were included in the study, 75,0% male with 43 years (IQR 31-50) The most common blood group mismatch was A to O (n=4; 33%). In the first year, 2 of patients (17%) developed acute rejection. The follow-up time was 17 months (IQR 7-36). Five patients (42%) developed infectious complications. None patients developed cytomegalovirus or BK polyomavirus infections. At the end graft and patient survival were 100%.

Conclusion

ABOi kidney transplantation has become a routine procedure. By this approach, about 30% of living donors who were refused in the past can now donate their kidneys and thereby significantly expand the living donor pool. Immunosuppressive protocol of this Center can be considered safe.
P1735USING PRONASE PRE-TREATMENT CDC-CROSSMATCH TO STUDY THE RITUXIMAB KINETICS IN KIDNEY TRANSPLANT CANDIDATES AND RECIPIENTS
Authors: Gandolfini Ilaria , Zanelli Paola , Palmisano Alessandra , Benigno Giuseppe Daniele , Fiaccadori Enrico , Maggiore Umberto
Published: June 2020

Background and Aims

Rituximab (RTX) is a monoclonal antibody that targets CD20 on B cells. It is often used in the desensitization before ABO- and HLA-incompatible kidney transplant (KT) and in the treatment of antibody-mediated rejection (ABMR), glomerulonephritis and post-transplant lymphoproliferative disorders (PTLDs) in KT recipients, however in most of these conditions the kinetics of the drug has not been widely investigated. Because of its intrinsic B cytotoxic property, its use can interfere with immunogenetic techniques such as B-cell complement mediated cytotoxic crossmatch (CDCXM). Low dose pronase pretreatment has been proposed to reverse this interference, cleaving the CD20 rituximab target from these cells. We wanted therefore to test the kinetics of rituximab in the serum of kidney transplant candidates or recipients using CDCXM with or without pronase pretreatment.

Method

We conducted a retrospective monocentric study on all KT candidates and recipients that underwent RTX therapy at the Parma Kidney Transplant Nephrology Unit (Parma, Italy) with serial biobanked frozen sera stored at the Immunogenetic Unit of Parma (Parma, Italy). B-cell CDCXM was performed in the presence or absence of low-dose (0.5 mg/mL) B-cells pretreatment. The difference between 2 intervals was analysed by Mann-Whitney test, groups analysis was analysed by Kruskal-Wallis test. The difference in the presence of absence of pronase pretreatment was analyzed by Wilcoxon test for paired data.

Results

We included 31 patients, 58% were male, the average age was 46+/- 13. The majority (74%) of the patients received a living donor KT and the most common indication for RTX was the desensitization for ABO- (58%) or HLA-(13%) incompatible living donor KT. Other indications were the treatment of glomerulonephritis (13%), ABMR (10%) or PTLD (6%). One patient received 2 doses of 1 g, the rest of the patients received 375 mg/m2 once (84%) or twice (16%). In 48% of the patients RTX therapy was followed by isolated plasmapheresis (PEX) or in combination with immunoadsorption (IA)(32%). In most of the patients B-cell CXCXM turned negative at 6 months after RTX treatment (p<0.001)(Figure 1), however this cytotoxicity was more persistent (up to 12 months) in patients who did not underwent PEX+/-IA after RTX (Figure 2). The B-cell pretreatment with pronase was able to turn negative this reaction (p=0.002) in these patients.

Conclusions

The data of our study seem to suggest a persistence of RTX in the sera of KT patients among the 4 months of onlabel treatments, especially in the absence of PEX or IA treatment following RTX.

Moreover the use of B-cell CDCXM in the the presence or absence of pronase could be used to monitor circulating levels of RTX in different diseases.
P1737MICROBIOLOGICAL DIAGNOSIS OF DIARRHEA IN RENAL TRANSPLANT PATIENT BY MULTIPLEX PCR
Authors: Tiwari Vaibhav , Gupta Anurag , Anand Yogeshman , Bhargava Vinant , Malik Manish , Gupta Ashwani , Bhalla A K , Rana Devinder Singh
Published: June 2020

Background and Aims

Acute gastroenteritis is an unwelcome and harmful yet unavoidable complication in the renal transplant patient. Infections, especially atypical organisms like Norovirus, Cryptosporidium, along with typical microorganisms like E. coli and Giardia, form the significant players in the pathogenesis of diarrhea. Standard methods of staining and culture have reduced sensitivity as well as require considerable time for the reports. Stool Polymerase Chain Reaction (PCR)is a quick, sensitive, and hassle-free method that diagnoses more than 20 organisms within 1 hour. This study aims to determine the infective etiology of acute gastroenteritis in the transplant population as well to compare the yield of stool PCR with conservative methods.

Method

We retrospectively analyzed all renal transplant patients admitted between 2015 to 2018 with complaints of diarrhea (>3 stools/day with loose consistency). The sample was tested for conventional microbiological methods, including a stool routine for microscopy and culture. A stool sample was also sent for Multiplex PCR, which was analyzed by Bio Fire FilmArray GI Panel, which identifies 22 enteropathogens. Endoscopic procedures were also undertaken in suspected cases for CMV colitis and pseudomembranous colitis.

Results

110 diarrheal events (admission for diarrhea) were recorded in 82 patients, with 181 organisms isolated in all samples. 16 events did not reveal any organisms in stool PCR. 85% sample yielded a positive result. The conventional method yielded a positive result in only 32.3% as compared to stool PCR. Co-infections were common, as 71.2% of events were associated with 2 or more organisms. Conventional methods failed to diagnose any co-infections. Norovirus G1/G2(20%) was the most common organism isolated from the stool, followed by Giardia (17%) and Enteropathogenic E. coli (16%). Giardia Lamblia with Norovirus G1/G2 was the most common co-infection in 19% of patients.

Conclusion

Stool PCR significantly improves the diagnostic yield in diagnosing enteric pathogens. Stool PCR is especially sensitive in detecting multiple organisms where conventional microbiological methods were completely unsuccessful. Norovirus is the most common enteropathogen, which is not picked by the conventional method. Giardia with Norovirus was the most common co-infection among post-transplant patients.
P1738COULD ADDING BORTEZOMIB HAVE BENEFIT FOR ANTIBODY MEDIATED REJECTION AFTER KIDNEY TRANSPLANTATION?
Authors: Dalili Nooshin , Nafar Mohsen
Published: June 2020

Background and Aims

Antibody Mediated Rejection (ABMR) is a severe complication that frequently occurs after kidney transplantation. The present RCT designed to evaluate the role of adding Bortezomib to standard regimen with plasma exchange, intravenous immunoglobulin and Rituximab in treatment of AMR after kidney transplantation.

Method

26 kidney transplant recipients (KTRs) with a biopsy proven diagnosis of AMR and positive DSA in a randomized clinical trial were compared: Thirteen KTRs treated with plasmapheresis, intravenous immunoglobulin and rituximab (PE-IVIG- RTX ) plus bortezomib versus 13 patients treated with standard of care regimen without bortezomib. We evaluated graft survival and DSA titer with MFI during a year after biopsy proven diagnosis.

Results

Statistical difference in graft survival between the two groups was noted: three out of 13 patients in the PE-IVIG-RTX group (23%) and 1/13 in the bortezomib group (7.5%) experienced loss of allograft function at a median time after diagnosis of 6 month and 12 month, respectively. DSA MFI titers 12 month after AMR diagnosis showed significant reducing slope in Bortezomib group. Regarding pathological changes micro vascular inflammation (glomerulitis + peritubular capillaritis score) reduced after PE-IVIG- RTX plus bortezomib in 7 out of 13 patients whom underwent protocol biopsies after treatment (53%) (Median score 3 in pre- treatment biopsy vs. 1 in post-treatment biopsy; P = 0.036).

Conclusion

Although DSA titer may not differ at 6 months after treatment of AMR between those who received standard regimen and those treated with adding Bortezomib, but at the end of one year patients treated with standard regimen plus Bortezomib reached lower MFI DSA titer. Adding Bortezomib to PE-IVIG- RTX for the treatment of AMR after kidney transplantation may enable clinicians to fight the DSA better and change the future of next generation of highly sensitized kidney transplant candidates.
P1740KINETICS OF B-CELL SUBSETS RECONSTITUTION FOLLOWING RITUXIMAB TREATMENT IN ABO-INCOMPATIBLE KIDNEY TRANSPLANT RECIPIENTS
Authors: Li Yamei , Shi Yunying , Lin Tao , Wang Xianding , Yan Lin , Li Yi , Bai Yangjuan , Yang Cuili , Wan Zhengli , Wang Lanlan
Published: June 2020

Background and Aims

With the application of B-cell-depleting agent rituximab, plasmapheresis and powerful immunosuppression, ABO-incompatible kidney transplant recipients (ABOi-KT) have successfully overcome the ABO antibody barrier. As an important immune cell population, B cells are not only involved in antibody-mediated rejection, but also have been reported to have different immunoregulatory effects due to the existence of distinct B cell subsets. Therefore, comprehensively understanding the reconstitution of B-cell subsets in ABOi-KTRs is crucial to know the immune status that may be related to the subsequent complications.

Method

Fresh whole blood were collected from 22 ABOi-KTRs and 22 ABO-compatible recipients (ABOc-KTRs) at 0, 1week, 2 weeks ,1month, 3months, and 6 months post-transplantation between October 2018 and May 2019. In addition, pre-desensitization samples were also collected from ABOi-KTRs. B cell subsets including total, naïve, memory, plasma, plasma blast and regulatory B cells were determined by flow cytometry.

Results

The percentages of B cells in ABOi group remained extremely low and significantly lower than ABOc group through the first 6 months after rituximab treatment (Fig. A). Similar trends were observed in total memory and switched memory B cells whose frequencies increased within first 2 weeks, then decreased thereafter. Meanwhile, the significant differences between ABOi and ABOc groups disappeared at 6 months (Fig. B-D). In addition, plasma and plasma blast B cells increased 2 weeks after transplantation and were significantly higher in ABOi group compared to ABOc group (Fig. E, G), while Naïve B cells started to elevate 1 month after transplantation in ABOi-KTRs and significantly higher proportions were found in ABOc group through the entire 6 months (Fig. F). No obvious difference was observed between ABOi and ABOc groups regarding unswitched memory and regulatory B cell percentages (Fig. C, H).

Conclusion

Our preliminary results indicated that B-cell depletion therapy applied in ABOi-KTRs not only significantly reduced the number of B cells, but also changed the composition of B cell subsets in the remaining B cell population. Whether such alteration would be clinical significance requires further follow-up.
P1742POTENTIAL TREATMENT METHOD OF RECURRENT URINARY TRACT INFECTION IN POSTMENOPAUSAL KIDNEY TRANSPLANT RECIPIENTS: THE RESULTS OF PILOT STUDY
Authors: Dolgolikova Anna , Huberskaya Maryna , Efimov Denis , Sadouski Denis , Viarshynin Pavel , Kalachyk Aleh
Published: June 2020

Background and Aims

Infectious complications remain a major cause of morbidity and mortality among transplant recipients. Urinary tract infection (UTI), especially recurrent UTI, is a common problem, with the prevalence up to 75% among kidney transplant (KTx) recipients. Older age, female gender and delayed graft function are among the independent risk factors for recurrent UTIs in renal transplant recipients*. Postmenopausal women with recurrent UTI after KTx especially caused by bacteria with multidrug antibiotic resistance (MDR) form a large and growing up group of patients with almost unachievable remission. The aim of the study was to assess the efficiency of different treatment schemes of recurrent UTI in postmenopausal female transplant recipients.

*prospective study presented at the 50th Interscience Conference on Antimicrobial Agents and Chemotherapy

Method

The randomized prospective pilot study was conducted to assess the efficiency of 3 different therapy schemes, study period: 2017-2019. Recurrent UTIs were defined as ≥2 UTIs in 6 months or ≥3 UTIs in 12 months. A UTI was diagnosed based upon the presence of pyuria defined as >5 WBCs/high-power field and a urine culture of >100,000 colonies/mL. All consecutive female patients with postmenopausal history who presented to the transplant clinic for follow-up over the study period of six months were prospectively randomized into 3 groups. The primary outcome was occurrence of UTI at 6 months.

Results

Escherichia coli was the responsible pathogen for recurrent UTI in 55% of cases. Other causative organisms include Klebsiella pneumoniae (35%) as well as Enterobacter spp (10%). The rate of resistance to all tested antibiotics was the highest in Klebsiella pneumoniae. The first episode of UTI occurred at 16 (8,5;42) week after KTx.

The total number of UTI episodes (per year) after treatment varies from 7 [5;8] in the 1st Group to 0 [0;0] at the 3rd Group (p<0,001), in which 13 out of 15 patients achieved long-term remission during the observation period. Clinical data on the 1st check-up after treatment course and about UTI episodes are given bellow.

Conclusion

Frequent antibiotic usage often causes MDR as well as result in intestinal dysbacteriosis. Immunosuppression state, frequent antibiotic usage, intestinal disbiosis and also vaginal Ph decline form pathogenic vicious circle. Complex usage of fosfomycin that remains active against a considerable proportion of MDR gram-negative bacteria with bacteriophages, estrogen treatment and long-term probiotic supplement may reduce the UTI frequency in postmenopausal women after KTx.
P1744EFFECT OF TREATMENT WITH ALLOPURINOL ON BLOOD PRESSURE, CREATININ CLEARENCE AND PROTEINURIA IN ADULT RENAL ALLOGRAFT RECIPIENTS: A RANDOMIZED CONTROLLED TRIAL
Authors: Cingöz Mukaddes , Özdemir Orhan , Usalan Özlem , Usalan Celalettin
Published: June 2020

Background and Aims

Hyperuricemia has been associated with the development of hypertension, cardiovascular, and renal disease. However, there is no data about the effect of lowering uric acid level on hypertension, renal function, and proteinuria in renal transplant patients. We therefore conducted a prospective study to investigate the benefits of allopurinol treatment in renal transplant patients and to investigate indirectly its effect on graft survival.

Method

A total of 105 Renal transplant recipients(RTRs) were included in this study. Patients were randomized to receive either placebo (n=51) or 300 mg/day allopurinol (n=54). We have examined uric acide, urinary albümin/Cr ratio, eGFR, CRP and blood pressure before and 24 weeks later after treatment in both group.

Results

In the allopurinol group, the mean serum uric acid levels, eGFR, creatinine urinary albümin/Cr ratio significantly improved(P < 0.001). However, blood pressure, CRP not statistically significant (P > 0.05). No correlation was observed between changes in uric acide and changes in CRP, or blood pressure in the allopurinol group. No significant changes were observed in the control group (P > 0.05). Multivariable regression analysis showed that uric acide was positively correlated with UACR (r= 0,473, β = 0.021, P = 0.002) and negatively correlated with eGFR ( r= -0554 β = 0.016, P = 0.001) in RTRs.

Conclusion

We bring indirect evidence that hyperuricemia increases urinary albümin/Cr ratio, and decreases eGFR. Hence, management of hyperuricemia may prevent the progression of renal disease, even in patients with normal renal function, suggesting that early treatment with allopurinol should be an important part of the management of renal transplant recipients. Long-term follow-up studies are warranted to identify the benefits of uric acid management on renal function and proteinuria.