bluuebunny/crossref_metadata_2025 huggingface dataset:
P1637UK KIDNEY ALLOCATION SCHEME: APPROPRIATE MATCHING BUT RESOURCE IMPLICATIONS
Authors: Murray Eleanor , Pearson Robert , Thomson Peter , Clancy Marc , Asher John
Published: June 2020

Background and Aims

UK NHSBT kidney matching scheme changed in September 2019, aiming to better match graft and patient survival through stratification of donors and recipients into risk quartiles. We present data on two years of transplants aiming to highlight discrepancies between our unit and the model on which the scheme is based, and the potential implications on service provision of its’ introduction.

Method

We reviewed all deceased donor transplants in our centre in 2015 and 2016. Recipients and donors were re-classified into the risk index quartiles and endpoint data included inpatient days in first year, 1 year eGFR, survival, imaging, and infection episodes. Comparisons were made with NHSBT literature.

Results

196 deceased donor transplants were performed. Distribution of D1-4 kidneys to R1-4 recipients in our cohort did not reflect those presented in the allocation scheme models, with our population skewed toward higher risk R4 category (73.4%), including 55 D4R4 (83% of D4 kidneys), see Figure 1. 2.0% had an age difference between donor and recipient of >25years, and 12.8% 15-25 years, compared with the NHSBT proposed targets of 8% and 20% respectively.

Within the R4 group, recipients receiving a D4 graft were associated with a higher rate of DGF (41.7%, vs 23.2% D1-D3 grafts, p=0.009), longer index admission (median 11 days vs 8 days, p=0.038) and more readmissions within the first post-operative year (median 18 vs 11 days, p = 0.005) – Figure 2.

D4 grafts demonstrated lower mean eGFR at one year (35.7, vs. 54.8 ml/min, p<0.001), Figure 3. R4 recipients experienced graft loss more frequently (HR 3.4 vs R1-3 (95%CI 0.8-13.9, p=0.12). One-year survival in R4 cohort was 97.8% (four deaths), and 93.8% at 4 years; R1-3 cohort had 100% survival to 4 years; there was no significant impact on R4 patient survival with D4 kidneys vs. D1-D3.

Day ward attendances, bacteraemia, and CT imaging events did not differ by R or D category; D4 was associated with higher rates of transplant ultrasound (5.6 vs R1-3 4.25, p=0.009), and R4 with higher rates of urinary tract infection (3.6 vs R1-3 1.5, p=0.03).

Conclusion

Firstly, our transplant population is weighted to higher risk R4 recipients; secondly, intended principals of the allocation scheme are already largely being observed. Thirdly, our data does suggest that increasing R4D4 transplants will have a significant impact on transplant centres, with resource burden primarily within the first year. But despite poorer graft function, patient survival appears to be equivalent and improved matching may in the longer term reduce need for re-implantation as the scheme intends.
P1641DONOR ACUTE KIDNEY INJURY HAS A DELETERIOUS IMPACT ON KIDNEY GRAFT SURVIVAL: THE DON-AKI STUDY
Authors: Lenain Rémi , Prouteau Camille , Chatauret Nicolas , Deshayes Aurélie , Foucher Yohann , Giral Magali , Hamroun Aghilès , Maanaoui Mehdi , Hazzan Marc
Published: June 2020

Background and Aims

Acute kidney injury (AKI) during organ procurement represents an important cause of discarded kidneys. In the context of organ shortage, the evaluation of such grafts is needed in order to enlarge the donor pool. Although many studies showed an increased risk of delayed graft function when donors present with AKI, long-term impact on graft survival remains controversial. A recent large US registry study concluded that AKI during organ procurement had no deleterious effect on graft survival. However the definition of AKI in this latter study is questionable. Indeed the donor baseline serum creatinine (SCr), according to KDIGO recommendations, is often not available. In this situation, the KDIGO guidelines suggest to estimate the baseline SCr using the MDRD equation, assuming a baseline glomerular filtration rate at 75 mL/min/1.73m?

This method was applied in the present study to assess the impact of donor kidney failure on long term kidney allograft survival.

Method

We analyzed the French national allocation system CRISTAL (Agence de la Biomédecine) data of all the recipients who received a deceased donor kidney graft from 2006 to 2017. 26786 transplant patients from 14899 deceased kidney donors were included. The donors were categorized into four groups. Ongoing AKI at the time of kidney procurement: n=1880 (3373 transplantations, AKI group), AKI with total recovery (normal SCr) at the time of kidney procurement: n=1332 donors (2392 transplantations, recovery group), elevated SCr all along the procedure: n=952 donors (1745 transplantations, unclassified AKI/CKD group) and normal SCr all along the procedure: n=10735 donors (19276 transplantations, no-AKI group). The main outcome was death censored graft survival.

Results

4458 graft losses occurred during the study period (648 in the AKI group, 411 in the recovery group, 297 in the unclassified AKI/CKD group and 3102 in the no-AKI group) after a median follow-up time of 5.7 years (3 - 8.9). Multivariate analysis showed a significant increase risk of graft loss for each group when compared to the no-AKI group: HR 1.18 (1.04-1.34), HR 1.15 (1.04-1.28) and HR 1.22 (1.12-1.34) for the unclassified AKI/CKD, recovery and AKI groups, respectively. Regarding the AKI group, the risk of graft loss increased according to the AKI stage (KDIGO 2012): HR 1.20 (1.08-1.32) for stage I AKI and HR 1.31 (1.13-1.53) for stage II-III AKI.

Conclusion

Donor AKI represents a significant risk factor of graft loss, independently of SCr at the time of procurement. Stage II-III AKI carries a higher risk than stage I AKI suggesting a “dose-effect”. However, considering organ shortage, further studies are required to better allocate these sub-optimal kidneys.
P1646SURVIVAL OF KIDNEY TRANSPLANTS ACCORDING TO PRESENCE OF HLA ANTIBODIES WHEN DONORSPECIFIC ANTIBODIES ARE SCREENED DURING POSTTRANSPLANT FOLLOW-UP
Authors: Derad Inge , Busch Johanna , Nitschke Martin , Ziemann Malte
Published: June 2020

Background and Aims

Posttransplant kidney survival depends on several risk factors. A careful immunogenetic matching and the absence of HLA donor specific antibodies (DSA) seem to determine the longevity of the transplant.

Method

Screening the presence of donor specific HLA antibodies in our posttransplant outpatients was implemented in 2010 (every 6 months in case of DSA free patients for two years, then yearly, and every 3 months in case of DSA + patients for two years, then twice a year). At the same time a treatment protocol was implemented, omitting reduction of immunosuppressive drugs in case of newly detected DSA, and most important with preventing steroid withdrawal in this case.The present single center study reports the long-term survival and kidney function from patients undergoing HLA-screening after transplantation between 2010 and 2016 with a follow-up until 2018. Using a Kaplan-Meier analysis patients without HLA antibodies (no HLA-ab), with HLA antibodies but without DSA (NDSA), and with donor-specific HLA antibodies (DSA) were compared by logrank-testing.

Results

A full dataset was obtained from 318 patients. The mean overall survival (patients and organ function) didn´t differ between the three groups, p=0.318: no HLA-ab 7.2 years (95%confidence interval 6.7;7.6), NDSA 6.6 (5.9;7.2), DSA 6.8 (6.1;7.5), overall 7.0 (6.6;7.3), events are given in Table1. Whereas the mean patient survival didn´t differ between the groups (p=0.715), the mean death-censored graft survival differed significantly, p=0.008, with a reduced transplant survival in the patients with HLA antibodies but without donorspecific antibodies: no HLA-ab 8.0 years (95%confidence interval 7.7;8.3), NDSA 7.0 (6.4;7.6), DSA 7.6 (7.1;8.2), overall 7.7 (7.4;8.0), numbers are given in Table1.

Conclusion

In conclusion, the presence of HLA antibodies was associated with a reduced transplant survival. Patients with HLA antibodies had a worse survival than patients with DSA undergoing HLA screening with a personalised immunosuppressive regimen. Immunosuppressive regimen of the groups, as well as other known risk factors of graft survival have to be further analysed. The results of these multivariate analyses have to be awaited to determine whether the risk for graft loss inferred by HLA antibodies is independent from other factors.
P1670GLOMERULAR C4D IN POST-TRANSPLANT IG-A GLOMERULONEPHRITIS IS ASSOCIATED WITH DECREASED ALLOGRAFT SURVIVAL
Authors: Kikić Željko , Omic Haris , Böhmig Georg A , Kozakowski Nicolas , Eder Michael
Published: June 2020

Background and Aims

Post transplant (pTX) glomerulonephritis (GN) is an important factor contributing to early and late allograft failure. De novo or recurrent IgA GN are the most frequent pTX-GN forms, however little is known about the optimal risk and therapeutic assessment. Recently, immunopathological evidence of glomerular C4d staining has been suggested as a prognostic tool in native glomerular kidney disease, in particular IgA GN. While peritubular capillary C4d is an accepted diagnostic criterion for antibody mediated rejection (ABMR), the role of glomerular C4d in pTX-GN is unkown. The primary hypothesis was that the finding of immunohistochemical glomerular C4d may be associated renal graft survival in post TX IgA GN.

Method

This large retrospective cohort study included all indication biopsies performed for cause in 885 kidney allografts from 1999-2006. Cases were screened for biopsy verified de novo or recurrent pTX-GN. GN cases were re-assessed by a single nephropathologist (NK). Primary endpoint was death-sensored graft survival followed until 01.01.2017.

Results

The prevalence of pTX-GN was 9.6% (n=85/885). De novo or recurrent IgA-GN was the most common pTX GN form with 40%. Of the 34 cases with pTX IgA GN, 27 had adequate material for interpretation of immunohistochemical glomerular C4d in the biopsy specimen. Eighteen of the 27 cases (66%) with pTx-IgA GN showed positive immunohistochemical C4d staining along glomerular capillary walls. There was no difference in renal function at biopsy or after one year comparing glomerular C4d positive vs. C4d negative pTX IgA GN. In univariate KM analysis glomerular C4d positive pTX-IgA GN showed significantly worse renal allograft survival rates (28%) compared to glomerular C4d negative pTX IgA GN (50%) or cases without GN (66%), p<0.001, respectively. In a multivariate Cox-Regression analysis including baseline covariates as well C4d+ABMR, Borderline lesion and TCMR, C4d+pTX IgA-GN remained independently associated with death censored graft-loss (HR 2.92, 95% CI 1.51-5.64, p=0.001).

Conclusion

Glomerular C4d staining in post transplant IgA glomerulonephritis is an independent risk factor for worse allograft survival and may provide a valuable risk assessment tool for prognostic and therapeutic decisions in post transplant glomerulonephritis.
P1672IMPACT OF ISLET TRANSPLANTATION VERSUS INSULIN ALONE AFTER KIDNEY TRANSPLANTATION IN TYPE 1 DIABETES PATIENTS
Authors: Maanaoui Mehdi , Chetboun Mikael , Kerr-Conte Julie , Gmyr Valery , Hubert Thomas , Caiazzo Robert , Jannin Arnaud , Le Mapihan Kristell , Vantyghem Marie-Christine , Hazzan Marc , Pattou François
Published: June 2020

Background and Aims

In patients with type 1 diabetes and end-stage renal disease, kidney transplantation improves both quality of life and survival. When simultaneous kidney-pancreas transplantation appears too invasive, or after failure of the pancreatic graft, an islet after kidney transplantation (IAK) may be considered to restore a stable endocrine function. The aim of our work was to assess the impact of islet transplantation on kidney transplantation outcomes versus insulin alone.

Method

In this retrospective parallel-arm cohort study in Lille, we included all type 1 diabetes patients who received a kidney graft from 2000 to 2017, followed by an islet transplantation after kidney (IAK) or not (kidney alone, KA). The primary study endpoint was the change of renal function (estimated glomerular filtration rate, eGFR). Secondary endpoints were glycemic control-related markers, such as HBA1c.

Results

During the period of study, 14 patients were included in the KA group versus 15 in the IAK group (including 5 after failure of a simultaneous pancreatic graft) were enrolled. At baseline, kidney donor sex, BMI, cause of death, cold ischemia time and recipient sex, waiting time on dialysis, type of dialysis, and number of previous kidney transplantation, were similar between the two groups. Yet, there were significant differences between KA and IAK, considering donor age (resp. 56.0±15.0 vs 35.2±13.7 years, p<0.001), use of perfusion machine (resp. 7 vs 0, p= 0.002), recipient age (resp. 55.7±5.7 vs 42.1±6.1, p<0.001), and recipient BMI (24.7± 1.8 vs 21.9±2.5 k/m? p=0.004). In IAK, the median (IQR) time between islet and kidney transplantation was 21.8 months (19.0 – 29.4). eGFR was not significantly different at baseline (IAK: 57.8±17.7 vs KA: 48.9±21.4 ml/min, p=0.22) but the decrease was significantly lower up to 5 years in the IAK group (IAK: 0.05±1.99 ml/min/year vs KA: -2.42±3.43 ml/min/year, p=0.03). HBA1c was similar at baseline in both groups (IAK: 7.8±1.6% versus KA: 7.9±1.1%, p=0.31), but significantly lower in the IAK group up to 5 years (IAK: 6.6±0.97% versus KA: 7.8±1.12%, p<0.001).

Conclusion

In patients with type 1 diabetes and a functioning kidney graft, IAK was associated with a better glucose control and a slower decrease of eGFR than standard insulin therapy. Our results suggest that IAK should be proposed to type 1 diabetes patients with a functional kidney graft.
P1686MULTI-NATIONAL SURVEY AMONG NEPHROLOGISTS AND TRANSPLANT SURGEONS ABOUT THE SUITABILITY AND ACCEPTANCE OF MARGINAL LIVE KIDNEY DONORS WITH MICROSCOPIC HEMATURIA
Authors: Arabi Ziad , Saleh Kaysi , Hamad Abdullah , Bukhari Mohammad
Published: June 2020

Background and Aims

Potential kidney donors with isolated hematuria are often excluded from donating although there is a wide controversy about the definition and threshold of investigations or exclusion form donation. Many centers use the cut off of > 3 RBC in men and > 5 RBC in women. Some centers consider positive dipstick on urinalysis as the definition of microscopic hematuria. Kidney biopsy in these donors can be borderline and inconclusive. We conducted a short survey about the suitability of these marginal living kidney donors with microscopic hematuria.

Method

This is a cross-sectional survey of nephrologists and transplant surgeons (TS) about suitability and acceptance of marginal live kidney donors with isolated microscopic hematuria. The question was about a 35-yr. old man non-smoker with isolated microscopic hematuria (4 RBC on repeated UA and trace hematuria on dipstick) and negative imaging. The survey was mainly distributed through American Society of Transplantation, American Society of Transplant Surgeons and European Renal Association-European Dialysis and Transplant Association. In-training nephrologists or transplant surgeons were excluded.

Results

A total of (n= 122 from 22 countries, 80% nephrologists and 20% TS) responded to the survey. Most respondents were experienced in donor evaluation (72% of physicians have over 6 years’ experience and 68.5% of them perform donors’ evaluation on weekly or monthly bases). Interestingly, at this low level of microscopic hematuria (4 RBC on repeated UA and trace hematuria on dipstick) only very limited number of respondents (7.5%) would allow donation without further work up. Instead, most respondents (n= 75, 63%) would ask for kidney biopsy prior to taking further steps. Many physicians (n=35, 29%) choose to ask for an alternative donor to avoid the hassle of kidney biopsy which may not change the management. There was no difference in acceptance rate for donors between TS and nephrologists (7.2% versus 8.3% respectively, p=NS), requesting kidney biopsy (63.9% vs. 62.5%) or in declining these donors (28.8% versus 29.1%, p=NS).

Conclusion

Young kidney donors with persistent isolated microscopic hematuria (even at mild degree) require further evaluation with kidney biopsy before donation. However up to one third of the nephrologist and transplant surgeon will ask for an alternative donor to avoid the hassle of kidney biopsy which can be borderline or inconclusive.
P1689COMPARISON OF NON-STEROIDAL ANTI-INFLAMMATORY DRUGS(NSAIDS) AND/OR PAINKILLERS USE BY KIDNEY (KTRS) AND HEART TRANSPLANT RECIPIENTS (HTRS)
Authors: Jędrzejczak Anna , Szczurek Wioletta , Zakliczyńśki Michał , Foroncewicz Bartosz , Staros Rafał , Pączek Leszek , Mucha Krzysztof
Published: June 2020

Background and Aims

Solid organ transplantation (SOT) has become the therapy of choice for the treatment of end-stage organ failure. The non-steroidal anti-inflammatory drugs (NSAIDs) and over-the- counter (OTC) painkillers are ofenly used. In a group of SOT recipients, co-morbidities and immunosuppression interactions significantly increase the risk of side effects. The aim of the study was to analyze the frequency and reasons of the NSAIDs and/or painkillers use by renal (RTRs) and heart transplant recipients (HTRs).

Method

This cross-sectional study was perfomed in randomly selected 388 RTRs and 286 HTRs aged from 18 to 82 years. The original annonymus questionnaire consisting of 32 questions related to health status and NSAIDs and/or analgesics use was applied. Questionnaire was distributed in paper-form and completed with the participation of medical worker either in transplant cardiosurgical or renal transplantation center. “R” v. 3.6.1. was used for statistical analysis and p-value <0.05 was considered significant.

Results

674 patients were surveyed. All patients: 34,3% (n=231) women and 65,7% (n=443) men in the mean age of 62.27 years completed the questionnaire. 70% (n=451) of respondents declared using NSAIDs and/or analgesics. Furthermore, 87% of participants declared using OTC painkillers. The most frequent causes for using analgesics are listed in Table 1.

68,5% of our SOT recipients declared that they were informed by their doctor about consequences of other drugs used with immunosuppression. 69,9% of HTRs comparing to 54,3% of RTRs ask their doctor before taking analgesics. Nevertheless, the survey also showed that every third patient (31,5%) was not sufficiently informed. Acetaminophen was the first-choice drug taken by 67,6% of patients (Fig. 1). Only 20% of patients declared not using NSAIDs and/or analgesics at all.

Conclusion

The result of our study indicates high frequency of NSAID and painkillers usage by RTRs and HTRs. Considering potentially harmful influence on transplanted organs, the costs of transplantation and post-trasplant care, the awareness of drug- related side effects or interactions and patients compliance need to be highlighted.
P1693LONG-TERM OUTCOME OF KIDNEY TRANSPLANTATION IN PLASMA CELLS DYSCRASIAS
Authors: Zappulo Fulvia , Donati Gabriele , Comai Giorgia , Bini Claudia , Angeletti Andrea , Scrivo Anna , Zamagni Elena , Cavo Michele , La Manna Gaetano
Published: June 2020

Background and Aims

Survival of patients with Multiple Myeloma (MM), Light Chain Amyloidosis (LCA) and Monoclonal Gammopathies of renal significance (MGRS) on chronic renal replacement therapy (RRT) is poor. The gold standand treatment of plasma cell dyscrasias (PCD) is high-dose chemotherapy followed by Autologous Stem Cell Transplantation (ASCT) which can induce complete remission and longer survival than chemotherapy alone. Kidney transplantation (KT) after ASCT could represent an option for patients with PCD and End Stage Renal Disease (ESRD). There is no evidence about the time of follow up required from MM remission and KT.

Method

We present a case series of 5 patients who underwent KT after ASCT and remission of MM among 2,500 transplant recipients followed at the Nephrology Dialysis and Renal Transplantation Unit of S.Orsola University Hospital from 1967 untill now. As in case of recovery from solid cancers, the feasibility of KT after MM was considered when no signs of relapse were assessed. In our cohort 3 patients were affected by Light Chain Deposition Disease (LCDD), 1 patient presented Myeloma Cast Nephropathy (MCN) and one patient Light Chain Amyloidosis (LCA). They all required RRT and underwent KT after ASCT.

Results

Time between ASCT and KT ranged from 3 and 11 years and clinical outcome was very different. The mean follow up period ranged from 2 to 4 years. In the first case (LCDD) KT was performed 11 years after ASCT, the graft failure occurred 6 years later because of chronic allograft nephropathy requiring RRT. In the second case (LCDD) patient received KT 3 years after ASCT. He developed Bence-Jones proteinuria requiring specific therapy with Dexametasone and Bortezomib determining progressive graft failure. In the third case (LCDD) KT was performed 4 years after ASCT and the 4 year follow up is negative for relapse of MM or ESRD. The fourth patient presented MCN and received KT 8 years after ASCT. MCN relapsed 6 years later; it caused ESRD requiring RRT. In the last patient (LCA) KT was performed 4 years after ASCT. No recurrence occurred in a 2-year follow up.

Conclusion

MM is the most frequent malignancy in dialytic population; the need for KT in MM remains high. ASCT improves the quality of life and offers higher survival in patients with myeloma/MGRS/amyloidosis-related ESRD. Therefore the combination of chemotherapy/ASCT and KT is pivotal to pursue renal restoring. Since high risk of recurrence larger study are required to clarify the better follow up period after MM remission and KT.
P1694PROGNOSTIC VALUE OF BODY COMPOSITION ON GRAFT FUNCTIONING IN KIDNEY TRANSPLANT PATIENTS
Authors: Dimitrijevic Zorica , Mitic Branka , Paunovic Goran , Paunovic Karolina , Tasic Danijela , Vrecic Tamara , Cvetkovic Mina , Jovanovic Andriana , Jancic Nina
Published: June 2020

Background and Aims

Post-transplant weight gain and particularly visceral fat gain has been linked to the development of metabolic disorders and cardiovascular disease. Moreover, the effect of obesity on graft function after kidney transplantation has recently become a subject of interest. The aim of our study was to investigate the association of body mass index (BMI), body fat percentage (BF%) and waist-to-hip ratio (WHR) with the kidney function in kidney transplant patients.

Method

We conducted a cross-sectional study that enrolled 80 kidney transplant patients aged 23–75 years (mean age 46.7 ± 11.5 years, 60% males). Anthropometric measurements of weight, height, waist, and hip circumferences in addition to skinfold thickness were obtained. BH% was calculated using a 4-site skinfold thickness method calculated through the Jackson-Pollock equation with a Harpenden caliper, utilizing a BF% cutoff of 35% for women and 25% for men to define obesity.

Results

The calculated BMI in our study group was 32.7±8.7 kg/m2, a mean BF% of 29.9±8.5% and a mean WHR of 0.9±0.1 Statistically significant difference in GFR, BMI, WHR and BF% were observed between males and females (r=0.455, p=0.02; r=0.412, p=0.016; r=0.437, p=0.022; r=0.348, p=0.011), respectively. After adjustment for age, gender, donor group, donor age and years of dialysis before transplantation, higher levels of all obesity measures were related to lower eGFR: BMI per 1 SD (β coefficient −3.883, 95% confidence interval [CI] −5,422 to −3,132), WHR (β coefficient −4.443, 95% CI −6.201 to −3.772), and BF% (β coefficient −3.722, 95% CI −4.332 to −3.461). The combination of higher BF% (BF% >33 kg/m2) and central obesity (WHR >0.85 for women, >0.90 for men) was associated with the lowest eGFR compared with that in lean subjects.

Conclusion

The combination of high BF% and WHR may be an important risk factor for lower GFR in a kidney transplant recipient.
P1698MULTI- NATIONAL SURVEY AMONG NEPHROLOGISTS AND TRANSPLANT SURGEONS ABOUT THE SUITABILITY AND ACCEPTANCE OF MARGINAL LIVE KIDNEY DONORS WITH MILD HYPERTENSION
Authors: Arabi Ziad , El Hassan El Waleed , Altheaby Abdulrahman , Hamad Abdullah , Saleh Kaysi
Published: June 2020

Background and Aims

There is variability among transplant centers in the acceptance of living donor candidates with well-controlled hypertension. Increased gestational hypertension and preeclampsia are more common in donors than in the general population especially if the donor is hypertensive at baseline. The purpose of this survey is to form a consensus about the evaluation of marginal live kidney donors (women and men) with hypertension.

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

A total of 122 practitioners from 22 countries responded to the survey. Of those, (N=96, 80.2%) were nephrologists and (n=23 19.83%) were transplant surgeons. The majority (45%) of the respondents were from USA. Most of the respondents (N=85, 69.7%) would allow a multiparous female (MPW) with mild and controlled hypertension (on a single blood pressure medication) who is not planning to have more children to donate. The rest would either advise against donation unless there is no alternative donor (n=23, 18.85%), or decline it altogether (n=14, 11.5%). In contrast, more respondents would reject a primiparous donor woman (PPW) with the same clinical scenario who considers having children (n=51, 42.2%, P=0.00001 ), or accept it only if there is no alternative donor (n=46, 38.0%, P=0.0009). Furthermore, most would not allow donation of a 20 years old male ( M) with an apparent white coat hypertension if his 24-hour ambulatory blood pressure monitoring shows non-dipping nocturnal pattern (n=67, 54.9%), or only accept it if there is no alternative donor (n=36, 29.5%). When comparing the rejection rate among the three donors: 11% for MPW, 41% for PPW and 54% for M. (P = 0.0001 for MPW vs PPW; P=0.00001 for MPW vs M; P=0.04 for PPW vs M).

Conclusion

Most of the nephrologists and transplant surgeons will clear mulptiparous women with mild and controlled hypertension for kidney donation as long as there no further plans for pregnancy. However, the majority of respondents will not clear a hypertensive primiparous due to the increased risk of gestational hypertension and preeclampsia after kidney donation. Most would be also reluctant to accept very young male donors if they show indicators of higher risk of developing hypertension in future.
P1712INFLUENCE OF DONOR AGE ON KIDNEY GRAFT SURVIVAL
Authors: Grande Cabrerizo Carmen , Calvillo Jorge , Pérez valdivia Miguel Ángel , Suñer Poblet Marta , Suarez Benjumea Alejandro , Gasco Martos Blanca
Published: June 2020

Background and Aims

Kidney transplantation is the treatment of choice in patients with end stage kidney disease (ESKD). In recent years, donation activity and kidney transplant in Spain has suffered a significant increase, accompanied by a change in the profile of donors to cope with the waiting list. It has been produced a decrease in mortality due to traffic accidents, the main source of donation, in contrast, strokes are currently the main source. The donor is of older age and with greater morbidity, especially cardiovascular, which makes doubts about its functionality and Whether this is an adequate strategy to expand the donor pool. The objective To analyze if the survival of the graft is worse in donors of very advanced age with respect to other groups of expanded criteria deceased donors.

Method

A retrospective analysis was carried out with data from SICATA regarding kidney transplant from a deceased donor with age ≥55 years made between 1/1/06 -12/31/15 at the Virgen del Rocío University Hospital. The graft failure was defined as return to dialysis. 495 cases were obtained, which were divided by the age of the donor in three groups: between 55-65 (N = 310), between 66 -75 (N = 154) and> 75 (N = 31). These groups were compared in terms of graft survival (censored for death) using analysis of survival Kaplan-Meier log-rank. We also performed a multivariate analysis of risk-adjusted graft survival using the Cox proportional hazard technique with the relevant predictive factors and the age of the donor, as a categorical and continuous variable. Analysis with SPSS 24.0.

Results

The table shows the comparisons between the different population groups and in the Figure is shown the survival functions for each one. Taking into account those results, it cannot be concluded that the age of the donor in these different age groups has significant influence on graft survival with the data we handle.

The multivariate analysis concluded that, for this population group and the data handled, the variables that influence the failure of the graft are: the height of the donor, the sex of the recipient and the time in renal replacement therapy. In no case does the age of the donor influence the survival of the graft.

Conclusion

Kidney transplant improves survival and quality of life in comparison with dialysis long term. Our data did not show significant differences between the different groups of age, which indicates that the use of kidney grafts from elderly donors is acceptable and can greatly expand the donor group. The decision to use or not a kidney elderly donor should be based on the individual characteristics of the donor, as well as in other factors related to the standard clinical criteria for kidney transplant.
P1730KIDNEY PAIRED DONATION IN SLOVAKIA - TOWARDS TO THE NATIONALLY COORDINATED PROGRAMME
Authors: Baltesova Tatiana , Bena Luboslav , Lacková Eva , Dedinska Ivana , Krátka Magdalena , Kuba Daniel , Zilinska Zuzana
Published: June 2020

Background and Aims

AB0 and HLA incompatibility between donor and recipient is one of the possible reasons of the low rate of living kidney donation in Slovakia.

Method

We present a retrospective analysis of living donor kidney transplantations (LDKT) in Slovakia including kidney paired donations.

Results

During the period from 2015 to 2019 there were 823 kidney transplantations, 81 (9,8%) were from living donors. Kidney paired donations are performed since 2005. Altogether 8 two-way paired exchanges were done in 3 transplant centers. The first exchange between two centers was carried out in 2015. A majority of the involved pairs (81%) were married couples, one exchange was initiated by compatible pair. Surgical procedures were simultaneous, cold ischemia times were comparable to other LDKT (median 162 vs 182 minutes). Two recipients had early acute rejection, 3-year graft survival is 100%. There were no serious complications in donors. The participation in EU project ENCKEP (European Network for Collaboration on Kidney Exchange Programmes) has led to the creation of national registry of incompatible pairs in 2018 and the standardization of medical and legal processes of paired exchanges.

Conclusion

Above reported experience is adequate prerequisite for the launch of nationally coordinated programme and international cooperation.
P1732RECURRENCE OF GLOMERULONEPHRITIS POST TRANSPLANT
Authors: Lingaraj Umesh , Mehta Ricken , SM Shivaprasad , A Kishan , V Leelavathi , C Sreedhara , V MYTHRI
Published: June 2020

Background and Aims

Glomerulonephritis (GN) is a major cause of end stage renal disease (ESRD)1.

It represents the primary cause of end stage renal disease (ESRD) for 25% of the dialysis population1 and 45% of the transplant population.

For patients with GN requiring renal replacement therapy, kidney transplantation is associated with superior outcomes compared with dialysis2.

The possibility of recurrence of the original disease after transplantation was described in a seminal paper more than 40 years ago, and it is now clear that all forms of GN may recur after kidney transplantation.3

To study the recurrence of glomerulonephritis post-transplant in a tertiary care centre.

Method

120 renal transplant recipients were analyzed from September 2015 to August 2019 at the Institute of Nephro-Urology, Bangalore.

It was a retrospective analysis of data

Results

120 adult patients underwent kidney transplantation, out of these 70 had GN as primary cause of kidney disease.

85.8% were males, 14.2 % females.

58.9 % were biopsy proven GN, remaining 41.1 % diagnosed based on history and clinical presentation.

All but one patient had their first transplant.

Out of these kidney transplant recipients 08 (11.4%) had recurrence of GN.  From these 4/08 was recurrent IgA N, 2/08 were PGNMID, 1/08 MGN, 1/08 aHUS. Graft loss due to recurrent GN was seen in 1/08 patients (12.5%).

Conclusion

Our study showed that 11.4 % of kidney transplant recipients with GN as their cause of ESRD had recurrent GN post kidney transplantation. IgAN was the most type of GN that recurred most frequently followed by PGNMID. Recurrence of GN was in par with other studies and did not affect graft survival
P1739IMMUNOSUPPRESSION WITH CALCINEURIN INHIBITOR AFTER RENAL TRANSPLANT FAILURE PREVENTS ALLOSENSITIZATION
Authors: López del Moral Cuesta Covadonga , Guiral Sandra , De Cos Gomez Marina , Gómez Pereda David , Rodrigo Emilio , Valero San Cecilio Rosalía , Romón Alonso José Iñigo , San Segundo Arribas David , López-Hoyos Marcos , Ruiz San Millán Juan Carlos
Published: June 2020

Background and Aims

Retransplantation is an important option to consider in patients who return to dialysis after graft failure since it reduces mortality. HLA allosensitization hinders retransplantation, and immunosuppression withdrawal after graft failure seems to favor sensitization. There are no established protocols on the immunosuppressive treatment that should be maintained after transplant failure in order to reduce the development of anti-HLA antibodies. The aim of the study is to evaluate the effect of immunosuppression withdrawal on the development of anti-HLA antibodies after graft loss.

Method

A retrospective analysis including 77 patients who lost their first renal graft between 1/1/2006-12/31/2015 was performed. 22 patients with preemptive second kidney transplant were included. Maintenance immunosuppression was collected in months 1, 3 and 6 after graft failure. Patients were divided into two groups according to the presence or not of calcineurin inhibitor (CNI) as maintenance treatment. Two sera were analyzed per patient, one immediately prior to graft loss and another one after graft failure (Luminex®, Single Antigen). In patients in whom transplantectomy was performed, the selected serum after transplant failure was already after graft nephrectomy. PRA was calculated (cPRA) in each serum and the development of de novo donor-specific antibodies (dnDSA) was evaluated.

Results

Selected sera were extracted 1.0 month before graft failure (interquartile range 0.3-2.0) and 7.6 months after transplant failure (interquartile range 6.0-12.2). By multivariate logistic regression analysis, graft nephrectomy was an independent risk factor for cPRA>75% after transplant failure (OR 4.9, CI 95% 1.0-22.2, p=0.038). Similarly, the absence of CNI at 6 months after graft failure was significantly related to cPRA>75% in the multivariate analysis (OR 4.8, CI 95% 1.5-15.0, p=0.006). It was possible to analyze dnDSA formation in 73 patients. The absence of CNI at 6 months after graft loss was an independent risk factor for dnDSA development (OR 23.2, CI 95% 5.3-100.6, p <0.001). There were no differences in the management of other immunosuppressive drugs.

Conclusion

The absence of maintenance treatment with CNI at the sixth month after graft loss is a risk factor for sensitization. Therefore, immunosuppressive maintenance treatment based on CNI after transplant failure should be considered, since it seems to prevent HLA allosensitization.
P1755EFFICACY AND SAFETY ECULIZUMAB FOR THE TREATMENT OF ANTIBODY MEDIATED REJECTION FOLLOWING RENAL TRANSPLANTATION
Authors: Rim Hark , Kim Jisu , Jeon Haesu , Kim Ye Na , Shin Ho Sik , Jung Yeonsoon
Published: June 2020

Background and Aims

: We evaluated the efficacy and safety of eculizumab in comparison with plasmapheresis (PP) and intravenous immunoglobulin (IVIG) therapy in renal transplant recipients diagnosed with antibody-mediated rejection (AMR).

Methods

This was a multi-center, open-label, prospective, randomized analysis. The patients were randomized as to therapy type (eculizumab infusions or standard of care, SOC: PP/IVIG). The patients (eculizumab arm: 7 patients, SOC arm: 4 patient) were evaluated for the continuing presence of donor-specific antibodies (DSAs) and C4d (staining on biopsy), as well as histological evidence, using repeat renal biopsies after treatment.

Results

The allograft biopsies revealed that eculizumab did not prevent the progression to transplant glomerulopathy. Only 2 patients in the SOC arm experienced rejection reversal, and no graft losses occurred in either group. Following AMR treatment, the DSA titers generally decreased compared to titers taken at the time of AMR diagnosis. There were no serious adverse effects in the eculizumab arm.

Conclusion

Eculizumab alone is not sufficient to treat AMR and does not prevent acute AMR from progressing to chronic AMR or to transplant glomerulopathy. However, it should be considered as a potential alternative therapy because it may be associated with decreased DSA levels.
P1767ERALY VERSUS LATE GRAFT PYELONEPHRITIS- A RETROSPECTIVE ANALYSIS OF GRAFT AND PATIENT OUTCOME
Authors: Kaul Anupma , Mathews Thomas , Bhaduria Dharmendra , Prasad Narayan , Gupta Amit
Published: June 2020

Background and Aims

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

Method

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

Results

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

Conclusion

Occurrence of early AGPN has significant impact on long term graft survival in renal transplant recipients with no significant effect on patient survival.This study underlines the paramount importance of prevention of UTIs in renal transplant recipients.
P1775CMV VIREMIA IN KIDNEY TRANSPLANT RECIPIENTS RECEIVING BASILIXIMAB OR LOW DOSE ANTI THYMOCYTE GLOBULIN INDUCTION WITHOUT VALGANCICLOVIR PROPHYLAXIS- SINGLE CENTRE EXPERIENCE IN INDIA
Authors: Sharma Reetesh , Maksana Mayur , Trehan Naresh
Published: June 2020

Background and Aims

CMV is a major cause of morbidity in transplant recipients and manifests as tissue invasive disease or CMV viral syndrome. Controversy exists regarding best method for CMV prevention. Therefore, we intended to evaluate incidence of CMV viremia and symptomatic CMV infection in adult KTR with basiliximab or antithymocyte globulin (ATG) induction without the use of valganciclovir prophylaxis. This study will help developing a protocol for management of CMV infection/disease in Indian patients since there is no such data amongst Indians.

Method

A prospective, open-label, single centre study. Patients were monitored for CMV DNA-PCR twice a week for month 1 post-transplant, once a week in month2, and then every 2 weeks in month 3, and then once a month from month 4 to 6.

Results

We included 17 patients with low-dose ATG induction (group1) and 20 patients with Basiliximab induction (group2). Mean recipient age was 42.9 and 45.9 yr in group 1 and 2 whereas mean donor age was 50.6 and 51.6 yr respectively. Male recipients were 76.4% (13/17) and 65% (13/20) in group 1 and 2 respectively; male donors were 11.7% (2/17) and 20% (4/20) respectively (not signficant). Average HLA mismatches were 3.4/6 and 3.7/6 (not significant). In group1 average transfusions per patient were 6units (vs 1.7units in group2) and 65% pts in group1 had >3 units transfusion (p<0.05). Mean follow-up was 12.7 and 20.7 months respectively.

Incidence of acute rejection was 5.8% (1/17) and 10% (2/20) in group 1 and 2 respectively. (not significant).

Incidence of CMV viremia requiring valganciclovir therapy was 11.6% (2/17) and 10% (2/20) in group 1 and 2 respectively. (not significant). No patient developed CMV disease.

Mean serum creatinine was 1.1 and 1.09 mg/dL at 1 month and 1.2 and 1.14 mg/dL at 3 months (not significant)

Conclusion

The incidence of CMV viremia is low and not significantly different in patients receiving basiliximab or low dose ATG induction in living donor kidney transplants on tacrolimus based immunosuppression. In our study patients in ATG group had significantly more transfusions vs basiliximab group and hence were more sensitised. Still the incidence of acute rejection remained low in both these groups (5.8% and 10%).

Hence universal prophylaxis with valganciclovir may not be required in all the patients with basiliximab and low dose ATG induction especially in developing countries where cost of therapy is borne by the patients.
P1777BIOMARKERS OF KIDNEY INJURY AS INDICATOR OF PRECLINICAL TRANSPLANT DYSFUNCTION IN PATIENTS WITH TYPE 1 DIABETES MELLITUS AFTER SIMULTANEOUS PANCREAS-KIDNEY TRANSPLANTATION AND THEIR RELATIONSHIP WITH EARLY REPARATIVE PROCESSES OF NONMYELINATED FIBERS
Authors: Larina Irina , Severina Anastasia , Shamhalova Minara , Shestakova Marina , Nikankina Larisa , Artemova Ekaterina , Dmitriev Ilya , Pinchuk Aleksey , Kaabak Michael , Musaeva Gulya
Published: June 2020

Background and Aims

To evaluate the relationship of early kidney transplant dysfunction markers with complications of end-stage renal disease (ESRD) and corneal nerve structures in patients with type 1 diabetes mellitus (T1DM) аnd long-term history of diabetes, who reached stable euglycemia after simultaneous pancreas-kidney transplantation (SPKT).

Method

The study included 27 patients with T1DM duration for 21 [19; 28] years, diabetic nephropathy (DN) duration 7,0 [5,5; 13,5] years and duration of renal replacement therapy (dialysis) for 2 [1; 4] years after successful SPKT. The posttransplantation period at the time of inclusion was 61 [20; 90] months. Assessment included examination of level of the main kidney transplant dysfunction markers (KIM-1, NGAL, podocin), examination of state of corneal nerve structures according to corneal confocal microscopy (CCM) as indicator of early reparation processes, diabetes complications/ complications of ESRD with dynamic observation for 1 year. All patients received three-component immunosuppressive therapy.

Results

Despite of reached stable euglycemia (HbA1c 5.5 [5.1; 5.9] %, 5.5 [5.3; 5.7] % after 1 year of follow – up), the restoration of graft function to the rate of estimated glomerular filtration rate (eGFR) CKD-EPI stage C2, albuminuria stage A1, 41% of patients still needed antihypertensive therapy, 37% needed treatment with recombinant human erythropoietin and 30% - antiosteoporotic therapy. There were no statistically significant changes in NGAL, KIM-1, and podocin at baseline and after 1 year in assessment of early kidney transplant dysfunction markers. The results of the correlation analysis revealed associations of NGAL and indicators of CCM (CNFD & NGAL (R=0.61, p = 0.01), CNBD & NGAL (R=0.56, p=0.02), CNFL & NGAL (R=0.65, p=0.009) and vitamin D (R=-0.67, p = 0.008), correlation of KIM-1 with albumin-to-creatinine ratio (ACR) (R=0.43, p= 0.04), correlation of podocin with HbA1c (R=-0.46, p=0.03).

Conclusion

SPKT as the way to achieve euglycemia and compensation of uremia does not provide complete regress of DN and complications of ESRD. The revealed correlations of early, most sensitive kidney transplant dysfunction markers with degree of carbohydrate metabolism compensation, ACR and vitamin D level may reflect the persistence of microstructures damage with stable graft function and demonstrate need of multifactorial management in renal function preservation. At the same time, the statistically significant correlations of early kidney transplant dysfunction markers with the state of corneal nerve structures need more detailed investigation.
P1778PROFILE OF NON-BACTERIAL INFECTIONS SPECIFIC TO RENAL TRANSPLANT RECIPIENTS
Authors: Gupta Anurag , Kanjilal Rahul , Rana Devinder Singh , Bhalla A K , Gupta Ashwani , Malik Manish , Bhargava Vinant , Tiwari Vaibhav
Published: June 2020

Background and Aims

Infections in renal transplant recipients are a major cause of morbidity and mortality. It is the one of the major cause of patient death with functioning graft. Hence this project was done to study the profile of non-bacterial infections specific to renal transplant recipients and to determine the risk factors associated with such infections.

Method

Renal-transplant recipients admitted to the department of nephrology with suspected infection were included in the study.

Results

: A total of 342 patients were included in the study. The mean age of the patients was 45.2 ± 13.3 years. 17.5% had ABO incompatible renal transplant. 91% (87% received leukocyte depleting and 4% received non-leukocyte depleting agents) had received induction as majority had three or more HLA mismatch (70%) and the most common donor was wife. 12.8% had history of graft rejection. A total of 147 infectious episodes were encountered in 121 patients. The incidence of non-bacterial infections was 35% (121/342). Viral infections (68/147 = 46%) and invasive fungal infections (44/147 = 30%) were the most common. Cytomegalovirus infection was the most common 35%. Other viral infections encountered were BK virus associated nephropathy (2.3%) and reactivation of Hepatitis B or C virus (2.6%). The most common site of invasive fungal infection were lower respiratory tract, urinary tract, CNS cryptococcosis, soft tissue infection or cellulitis and oesophageal candidiasis in 41%, 32%, 9%, 9% and 9% respectively. Aspergillus (61%) and Rhizopus (33%) was the most common organism causing fungal pneumonia. Four patients were diagnosed with Pneumocystis jirovecii pneumonia. Majority (60%) of the infections were detected after one year post-transplant. Risk factors found to have statistically significance were ABO incompatibility, diabetes mellitus (pre or post-transplant) and history of graft rejection. Nine patients (7%) died of non-bacterial infections specific to renal transplant recipients.

Conclusion

Non-bacterial infections are not uncommon in Indian scenario and the timeline of such infections has changed.