bluuebunny/crossref_metadata_2025 huggingface dataset:
Sense of coherence and social support predict living liver donors’ emotional stress prior to living‐donor liver transplantation
Authors: Erim Yesim , Beckmann Mingo , Kroencke Sylvia , Schulz Karl‐Heinz , Tagay Sefik , Valentin‐Gamazo Camino , Malago Massimo , Frilling Andrea , Broelsch Christoph E. , Senf Wolfgang
Published: August 2010

Abstract:  The protection of the donors from physical or emotional harm has been a fundamental principle in living‐donor liver donation from the beginning. Psychosomatic donor evaluation aims at the selection of eligible donors and the screening and exclusion of psychiatrically vulnerable donors. As clinical interviews may include subjective biases, efforts should be made to establish objective criteria for donor assessment. In recent research, protective factors have been reported to be a significant force behind healthy adjustment to life stresses and can be investigated as possible predictors of donors’ eligibility. Being the central construct of Antonovsky’s theory of salutogenesis, the sense of coherence is one of the most surveyed protective factors and a good predictor of individuals’ stability when experiencing stress. Furthermore, family support has been shown to be a valuable protective resource in coping with stress. This study surveyed whether sense of coherence and social support predict donors’ emotional strain prior to transplantation. Seventy‐one donor candidates were included in the study during the donor evaluation prior to living‐donor liver transplantation. Sense of coherence proved to be a significant predictor for all criterion variables, namely anxiety, depression and mental quality of life. In addition to this, donor candidates who were classified as eligible for donation in the psychosomatic interview had significantly higher values on sense of coherence total scores compared with rejected donors. In a multiple regression analysis, sense of coherence and social support together yielded a prediction of depression with an explained variance of 22% (R2 = 0.22). Sense of coherence and social support can be implemented as self‐rating instruments in the psychosomatic selection of donors and would help to further objectify donors’ eligibility.
Clinical factors associated with graft fibrosis in kidney‐transplant recipients on steroid‐avoidance immunosuppression
Authors: Heilman Raymond L. , Chakkera Harini A , Reddy Kunam S , Colby Thomas V , Moss Adyr A , Williams James W , Mazur Marek J , Petrides Savas , Mulligan David C
Published: August 2010

Abstract:  Background:  Recent studies have documented good patient and graft outcomes and a low risk of acute rejection with steroid‐avoidance immunosuppression in kidney‐transplant recipients, but the risk of progressive graft fibrosis is not well studied.

Methods:  All adult primary kidney transplant or combined kidney and pancreas transplant recipients on steroid avoidance immunosuppression were eligible for study. All recipients received induction with antithymocyte globulin or basiliximab. Corticosteroids were stopped after day 4 post‐transplantation. Patients were maintained with tacrolimus and mycophenolate mofetil. Protocol biopsies were done at reperfusion and at one, four, and 12 months after transplantation.

Results:  Eighty one‐yr protocol biopsies with adequate specimens were obtained from 132 kidney or kidney–pancreas transplant recipients. Fifteen (19%) of the biopsies showed moderate to severe graft interstitial fibrosis (GIF) (Banff ci score ≥2). Recipients with GIF were older, had lower body mass index, greater human lymphocyte antigen (HLA) mismatch, older donors, serum creatinine ≥1.6 mg/dL at one month, a Banff ci score >0 on one‐month biopsy, BK nephropathy, and interstitial cellular infiltrates on the one‐yr biopsy. In the unadjusted logistic regression analysis, BK nephropathy, serum creatinine ≥1.6 mg/dL at one month, recipient age, Banff ci score >0 on one‐month biopsy, and donor age were the only variables associated with a higher risk of GIF on the one‐year biopsy. In the multivariate logistic regression model adjusted for these variables, BK nephropathy, serum creatinine ≥1.6 mg/dL at one month after transplantation, and recipient age were independently associated with the risk of GIF on the one‐year biopsy.

Conclusion:  In this small study of primary kidney or combined kidney–pancreas transplant recipients on steroid‐avoidance immunosuppression, we found that 19% had GIF on a one‐year protocol biopsy. BK nephropathy, serum creatinine ≥1.6 mg/dL one month after transplantation, and recipient age correlated with an increased risk for GIF on the one‐yr biopsy.
Exploring the psychological effects of deceased organ donation on the families of the organ donors
Authors: Merchant Shaila J , Yoshida Eric M , Lee Tim K , Richardson Penny , Karlsbjerg Kari M , Cheung Elsie
Published: August 2010

Abstract:  Background:  Our specific aim was to investigate whether the donation process hindered or ameliorated the bereavement process for organ donor families, specifically with regard to depression, post‐traumatic stress and grief.

Methods:  Using the British Columbia Transplant Society (BCTS) database, we mailed packages to donor families who consented to and successfully proceeded to donate. Each package contained three standardized, validated questionnaires that included scales of depression, post‐traumatic stress, and bereavement. We also included a newly designed questionnaire specific to the BCTS Donation Experience. Seventy‐three completed packages were received and analyzed using multiple regression models. Our overall response rate was 46%.

Results:  The younger the deceased and the shorter the time elapsed since donation, the greater the strength of bereaved feelings reported by the donor families. If donor families felt there were negative aspects about the donation process, the more likely they were bothered by symptoms of post‐traumatic stress. The more comforted donor families felt about donation, the less likely they were bothered by feelings of depression.

Conclusions:  Our data suggest that donation has a beneficial effect on the bereavement process.
Clinical course of kidney transplant patients with acute rejection and BK virus replication following Campath therapy
Authors: Kayler Liise K. , Mohanka Ravi , Morgan Claire , Basu Amit , Shapiro Ron , Randhawa Parmjeet S.
Published: August 2010

Abstract:  Background:  Kidney transplant recipients with active BK virus (BKV) replication are generally treated with reduction in immunosuppression to allow a successful immune response against the virus.

Methods:  We inadvertently administered Campath to two patients with BKV viruria, and one patient with BKV nephropathy, since allograft biopsies showed severe tubulitis or intimal arteritis, and results of PCR and in situ hybridization were not available at the time of therapeutic intervention.

Results:  Increased viral replication was observed, but not uniformly in all cases, and follow‐up biopsies showed nephropathy in one additional case. Extra‐renal dissemination did not occur. With subsequent reduction of immunosuppression or antiviral therapy, it was still possible to obtain clearance of viremia in all cases. Serum creatinine fell transiently after Campath in one patient; however, at one yr post‐treatment all had increased levels over baseline. One graft was lost to persistent acute rejection that led to interstitial fibrosis and tubular atrophy.

Conclusion:  These cases suggest that Campath treatment does not (i) irreversibly deplete cells believed to be important in mounting an immune response against BKV, or (ii) preclude subsequent eradication of viral DNA from the blood.
Spotting the owl: surreptitious cytomegalovirus disease in a renal transplant recipient
Authors: Tarkan Joshua L , Woo Sook‐Bin , Pavlakis Martha , Johnson Scott R , Chirieac Lucian R , Chimienti Sonia N , Mandelbrot Didier A
Published: August 2010

Abstract:  Cytomegalovirus (CMV) is a known cause of ulcerative oral lesions among HIV‐infected patients, but such ulcers have not been previously reported in recipients of solid organ transplants. We describe a case of a renal transplant recipient who developed severe CMV‐associated oral lesions despite prophylaxis with valganciclovir, and in the absence of detectable CMV viremia. The diagnosis was made only after multiple biopsies of the lesions. The patient recovered upon reducing immunosuppression. Potential pitfalls in making a prompt diagnosis are reviewed. The differential diagnosis of a large oral ulceration in a transplant recipient is broad, but should include CMV infection.
Three‐year follow‐up of malignancies in tacrolimus‐treated renal recipients – an analysis of European multicentre studies
Authors: Cowlrick I. , Delventhal H. , Kaipainen K. , Krcmar C. , Petan J. , Schleibner S.
Published: August 2010

Abstract:  Five prospective, multicentre adult renal studies of three yr duration conducted in Europe for which tacrolimus was used as the primary immunosuppressant in at least one treatment arm was identified. This was confirmed by literature review as the only source fulfilling these criteria. Our goal was to identify absolute (reported) incidences of malignancies in patients exposed to tacrolimus and relative rates as a proportion of the total malignancies recorded for three yr after transplant. The five studies provided 2435 patients in nine different treatment regimens. All regimens combined tacrolimus with azathioprine or mycophenolate mofetil and corticosteroids except for one regimen which also employed daclizumab without corticosteroids. There were 83 patients with malignancies or 3.4% of the total population. No patient experienced more than I malignancy type. Malignancy incidences relative to those patients experiencing a malignancy were: total skin 37.3%, lymphoma 15.7%, and non‐skin‐non‐lymphoma 47.0%. Annual occurrence of all malignancies reflected a progressive increase with time. While the larger proportion of lymphoma and non‐skin‐non‐lymphoma malignancies occurred during the first year after transplant, malignancies affecting the skin increased more linearly with time. These findings are consistent with reports in the literature, reflect the current established experience with tacrolimus to date, and should provide a robust basis for future comparisons with tacrolimus‐based immunosuppression.
Design of a regulated system of compensation for living kidney donors
Authors: Matas Arthur J.
Published: August 2010

Abstract:  The pros and cons of a regulated system of financial incentives for living donors are being actively debated. To date, a detailed proposal on how such a system could work has not been developed. Herein, the specifics of a potential model, using the infrastructure already in place for deceased donor evaluation and allocation, are outlined.
The impact of employment status on recipient and renal allograft survival
Authors: Petersen Emily , Baird Bradley C. , Barenbaum Lev L. , Leviatov Alexander , Koford James K. , Shihab Fuad , Goldfarb‐Rumyantzev Alexander S.
Published: August 2010

Abstract: Background:  With the improved median survival of kidney transplant recipients, there has been an increased focus on quality of life after transplantation. Employment is a widely recognized component of quality of life. To date, no study has demonstrated a link between post‐transplant employment status and recipient and allograft survival after transplant.

Methods:  The records from the United States Renal Data System (USRDS) and the United Network for Organ Sharing (UNOS) from January 1, 1995, through December 31, 2002, were examined in this retrospective study. Two outcomes, allograft survival time (time between the transplantation and allograft failure or censor) and recipient survival time (time between the transplantation and recipient death or censor), were analyzed using Cox models adjusted for potential confounding factors.

Results:  Compared to patients working full time at the time of transplantation, those not working by choice have a greater risk to graft [hazard ratio (HR) 1.27, p < 0.001] but not to recipient survival. A similar trend was observed in patients not working at 12 months post‐transplant (HR 1.30, p < 0.001 for graft survival but not for recipient survival). However, at five‐yr post‐transplant not working by choice was protective to the graft (HR 0.47, p < 0.01) as compared to working full time. Results of the analysis in the patient subgroups based on the comorbidities and the overall health status were similar.

Conclusion:  Employment status at the time of transplantation and in post‐transplant period has a strong and independent association with the graft and recipient survival. Full time employment at the time of transplant and at one‐yr post‐transplant is associated with lower risk for graft failure and recipient mortality. However, working beyond the time covered by Medicare might be associated with potential risk for graft survival.
Eubacterium plautii infection in a kidney transplant recipient: a noteworthy case of pleural effusion and fever
Authors: Orlando Giuseppe , Pisani Francesco , Mastrantonio Paola , Bonanni Luigi , Di Cocco Pierpaolo , D’Angelo Maurizio , Tabilio Antonio , Famulari Antonio
Published: August 2010

Abstract:  We report a noteworthy case of Eubacterium plautii infection after kidney transplantation. Our 33‐yr‐old transplant recipient received standard care; his post‐transplant course was uneventful. However, on day 44 he underwent an emergency laparotomy for perforation of the ileum. He was initially treated with ceftazidime, fluconazole and metronidazole, but his fever persisted, so he was switched to meropenem and vancocin. We could not find any cause for his infection. On day 70, his temperature normalized. On day 75, he developed severe leukopenia (280 cell/mL). His cytomegalovirus‐DNA test result was negative, so all immunosuppressants, except for prednisone, were stopped; instead, antibiotic prophylaxis was started, using caspofungin, trimethoprim‐sulfamethoxazole and ciprofloxacin. On day 83, he underwent percutaneous drainage of massive left pleural effusion. We repeatedly cultured the pleural liquid, but it was not till three wk later that we were finally able to identify the causative organism. We hypothesize that the microorganism – which normally resides on the surface of the intestinal lumen – entered the bloodstream via bacterial translocation, eventually colonizing the pleurae. This translocation was favored by our patient poor clinical condition, his immunosuppressive treatment and his heavy antibiotherapy. Our experience highlights the need for wiser use of antibiotics in transplant recipients.
Chronic renal dysfunction following liver transplantation
Authors: Schmitz Volker , Laudi Sven , Moeckel Franziska , Puhl Gero , Stockmann Martin , Tran Zung Vu , Kahl Andreas , Neumann Ulf , Neuhaus Peter
Published: August 2010

Abstract:  With most of the immunosuppressive protocols consisting of calcineurin inhibitors (CI), nephrotoxicity has become a major long‐term complication often compromising outcome. In a single‐center retrospective study, we reviewed 1173 liver transplantations to identify variables indicative for the occurrence of chronic renal dysfunction (CRD) (defined as ≥1 episode of serum creatinine increase ≥1.8 mg/dL ≥2 wk). Chronic renal dysfunction was found in 137 (11.7%) of all transplants [82 (7%) early (after 3–12 months), 55 (4.7%) late‐onset (>12 months)]. Compared to 5‐/10‐yr survival rates in non‐CRD transplants (84/74%) survival was significantly decreased in early (66/46%), but unchanged in late‐onset CRD (98/86%). Rates of alcoholic cirrhosis and prior renal dysfunction were significantly increased in patients with CRD. In a multivariate logistic regression analysis, only cyclosporine A (CyA) as immunosuppression remained an independent risk factor. No correlations to age, gender, rejection/retransplantation or diabetes were found. Surprisingly, renal function (creatinine) showed no difference between patients on CI monotherapy (FK/CyA) compared to those who had mycophenolate mofetil (MMF) added. In liver transplantation, early onset CRD significantly compromises survival. CyA‐based immunosuppression appears to have a stronger impact than FK. The fact that patients with long‐term severe chronic renal dysfunction failed to improve under MMF rescue therapy emphasizes the importance of new diagnostic strategies to earlier identify at‐risk patients.
What happens to the kidney in an SPK transplant when the pancreas fails due to a technical complication?
Authors: Hill Mark , Garcia Raquel , Dunn Ty , Kandaswamy Raja , Sutherland David E.R. , Humar Abhinav
Published: August 2010

Abstract:  We examined a group of SPK recipients that had early (<90 d post‐transplant) pancreas graft failure caused by a technical complication, and looked at outcomes of the kidney graft in these recipients. Of 289 SPK transplants, 36 (12.5%) had early pancreas graft failure because of a technical complication: thrombosis (n = 16), leak (n = 5), infection (n = 14), and pancreatitis (n = 1). Once the pancreas was lost, there was a high incidence of subsequent kidney graft failure. Kidney graft survival in these 36 recipients was 71.4% at one yr and 59.5% at three yr, significantly inferior compared to recipients that did not have early failure of the pancreas (86% at one yr and 82% at three yr, p < 0.001). Of the 36 recipients with early pancreas loss, 18 have gone on to failure of the kidney graft. Causes included thrombosis (n = 3), infection (n = 1), death with function (n = 6), chronic rejection (n = 4), ischemia (n = 1), and other (n = 3). Of the 18 kidney graft failures, nine occurred within three months after loss of the pancreas graft, usually either because of graft thrombosis, or patient death (usually from systemic sepsis). Multivariate analysis showed technical failure of the pancreas to be the most significant risk factor for kidney graft loss (HR = 2.08, p = 0.006).
Determinants of bone mass in end‐stage renal failure patients at the time of kidney transplantation
Authors: Dolgos Szilveszter , Hartmann Anders , Bønsnes Stine , Ueland Thor , Isaksen Gunhild Aker , Godang Kristin , Pfeffer Per , Bollerslev Jens
Published: August 2010

Abstract: Background:  Patients with chronic renal failure (CRF) are at high risk of renal osteodystrophy. Our study aimed to identify predictors of bone mass and cumulative fracture rate at the time of renal transplantation (RTx). This is important since the patients experience further substantial bone loss the first month post‐transplant.

Material and methods:  Altogether 133 renal transplant patients were examined for bone mineral density (BMD) using dual‐energy X‐ray absorptiometry shortly after RTx.

Results:  The patients’Z‐scores were significantly lower at the time of RTx compared to the reference population (p < 0.05), 32% were osteopenic and 11% had osteoporosis. Independent predictors of low bone mass were age (p < 0.001), female sex (p < 0.001), intact parathyroid hormone (iPTH) level (p < 0.001), former transplantation (p = 0.001) and time on hemodialysis (HD) (p = 0.005). Body mass index (BMI) (p < 0.001) and physical activity (p = 0.027) were associated with high BMD. Cumulative fracture rate (29%) was associated with physical inactivity (p = 0.003), BMI (p = 0.036) and osteopenia (p < 0.001) at the time of RTx.

Conclusion:  In a representative CRF population, BMD was reduced. Independent predictors of BMD were as for the general population, and uremia associated predictors were time on HD, previous transplantation and serum iPTH level. Fracture rate was high, and physical inactivity had the strongest association with fractures.
Attitude to nephrolithiasis in the potential living kidney donor: a survey of the German kidney transplant centers and review of the literature
Authors: Giessing Markus , Fuller Florian , Tuellmann Max , Liefeld Lutz , Slowinski Torsten , Budde Klemens , Loening Stefan A.
Published: August 2010

Abstract:  Living donor kidney transplantation (LD‐KTX) is increasing worldwide. With the prevalence of urolithiasis ranging between 4% and 15%, the number of donors with current nephrolithiasis or a history of the disease will increase as well. A questionnaire was sent to all German centers with LD‐KTX programs (urologists and general surgeons). Answers were compared for differences between urological and surgical kidney transplant centers. Response rate was 74%. Nephrolithiasis at the time of KTX is an exclusion criterion at 36% of the German centers (58% urological/19% surgical, χ2 = 4.65, p = 0.03, Fishers exact p = 0.05), 96% of the centers accept kidney donors with a history of nephrolithiasis. The length of the stone‐free episode is regarded as relevant by 42% of all centers (58% urological vs. 32% surgical centers, p = ns). Stone composition is a criterion for 54% of centers (66% vs. 44%, p = ns). More than half of the centers accept a history of cystine stones, almost all centers of struvite and urate stones. Donors with current nephrolithiasis were less commonly accepted by urologists than by general surgeons. For almost all centers history of nephrolithiasis does not preclude living kidney donation. Stone composition proved to be of little relevance for decision making.
Liver transplantation for sinusoidal obstructive syndrome (veno‐occlusive disease): case report with review of the literature and the UNOS database
Authors: Membreno Fernando E. , Ortiz Jorge , Foster Preston F. , Wright Francis , Ostrower Victor S. , Metter John D. , Palma‐Vargas Juan , LeMaistre Charles F.
Published: August 2010

Abstract: Background:  Severe sinusoidal obstructive syndrome (SOS) is a life‐threatening complication of stem cell transplantation. We report the case of a young man transplanted for SOS.

Method:  A single chart review with query of the United Network of Organ Sharing database and review of the medical literature.

Case:  A 23‐yr‐old male diagnosed with chronic myeloid leukemia underwent a matched unrelated stem cell transplant. The conditioning regimen included high‐dose cyclophosphamide and busulfan. Within one month, he developed painful hepatomegaly, jaundice, ascites, and weight gain, and was diagnosed with biopsy‐proven SOS. Despite therapy with defibrotide, he continued to deteriorate with the development of progressive renal failure and encephalopathy. The patient underwent orthotopic liver transplantation. After surgery, he developed cytomegalovirus infection and six wk later presented with a bile leak, hepatic artery thrombosis, and a liver abscess. A repeat bone marrow biopsy showed no evidence of recurrent disease. Although the patient was listed for re‐transplantation, he succumbed prior to an organ becoming available.

Conclusion:  Severe SOS in the setting of bone marrow transplantation portends a poor prognosis. Careful patient selection, timing, and perhaps less immunosuppression should be considered when performing a liver transplantation in the setting of severe SOS.
CD25, CD28 and CD38 expression in peripheral blood lymphocytes as a tool to predict acute rejection after liver transplantation
Authors: Boleslawski Emmanuel , BenOthman Samia , Grabar Sophie , Correia Leonor , Podevin Philippe , Chouzenoux Sandrine , Soubrane Olivier , Calmus Yvon , Conti Filomena
Published: August 2010

Abstract:  Background/Aim:  The aim of this study was to determine whether the expression of CD25, CD28 and CD38 (which reflects the degree of T‐cell activation) by peripheral blood mononuclear cells constitutes a useful means of measuring the immune status of liver transplant recipients.

Methods:  Fifty‐two patients enrolled in a prospective randomized study comparing cyclosporine and tacrolimus as the principal immunosuppressive drugs were monitored prospectively. The expression of CD25, CD28 and CD38 was analyzed on CD3‐, CD4‐ and CD8‐positive cells from whole blood using flow cytometry. The prognostic value of baseline and day 14 measurements regarding acute rejection was examined using Kaplan–Meier estimates for univariate analyses and the Cox model for multivariate analyses.

Results:  The mean frequencies of CD28 and CD38‐expressing T cells were significantly higher in patients with acute rejection (p = 0.01 and p = 0.001, respectively), whereas the frequency CD25‐expressing T cells did not differ significantly. Under univariate analysis, baseline CD25 levels, the type of calcineurin inhibitor, as well as the CD28 and CD38 frequencies obtained at day 14 were associated with the subsequent development of acute rejection. Under multivariate analysis, only CD28 and CD38 frequencies obtained at day 14 were independently associated with acute rejection.

Conclusions:  The evaluation of CD28 and CD38 expression in peripheral blood lymphocytes is a simple marker that could be used routinely in clinical practice to assess the level of immunosuppression.
Herpes zoster infection after liver transplantation in patients receiving induction therapy with alemtuzumab
Authors: Alcaide Maria L , Abbo Lilian , Pano Jose R , Gaynor Jeffrey J , Tryphonopoulos Panagiotis , Weppler Debbie , Moon Jang I , Tzakis Andreas G , Morris Michele I
Published: August 2010

Abstract: Background: The incidence of herpes zoster (HZ) infection in liver transplant recipients prior to the use of induction therapy with monoclonal antibodies has been reported as being 1.2–18%. We studied the occurrence of HZ in liver transplant recipients that received induction therapy with alemtuzumab (Campath 1H®).

Material and methods: This was a retrospective review of primary liver transplant recipients who received alemtuzumab as induction therapy at our center. HZ infection was diagnosed clinically as the presence of a characteristic vesicular rash in a dermatomal distribution without any further virological confirmation.

Results: A total of 118 liver transplant recipients were treated with alemtuzumab between August 2002 and August 2005. Twelve patients developed HZ infection, and the cumulative probability of a patient developing HZ infection by 36 months post‐transplant ±1 SE was estimated as 16.5 ± 5.0%. The median time for onset of the infection was 10.2 months (range 4.7–30.7) after the transplant. All patients had only one dermatomal distribution, and none developed systemic infection or complications such as postherpetic neuropathy. All patients except one were treated with systemic intravenous acyclovir. One patient received famciclovir. All of the patients had received ganciclovir during the post‐transplant period but were not receiving any other antiviral medication at the time of the infection.

Conclusion: Herpes zoster infection has previously been reported as a frequent complication of liver transplantation. Our study suggests that it occurs in approximately 16% of patients receiving induction therapy with alemtuzumab. Although alemtuzumab is a powerful immunosuppressive agent and there is still little information regarding its long‐term safety when used in liver transplantation, our data do not suggest any increase in the occurrence and complications of HZ.
Endovascular management of early portal vein thrombosis caused by coronary vein steal after liver transplantation and its outcome
Authors: Koo Bon Yong , Yu Hee Chul , So Min Cheol , Jin Guang Yu , Kwak Hyo Sung , Cho Baik Hwan
Published: August 2010

Abstract:  Early portal vein thrombosis (PVT), after orthotopic liver transplantation (OLT), is relatively uncommon and is a serious complication that can compromise graft and patient survival. The factors predisposing to PVT after OLT include rejection, technical problems during the surgery, use of vein grafts and conduits, preoperative PVT, previous portasystemic shunts and splenectomy, hypercoagulable state, and significant development of gastroesophageal collaterals. Among them, few cases of PVT caused by coronary vein (CV) steal after OLT have been reported. Herein, we present a case with early PVT caused by CV steal after OLT, which is treated by a percutaneous transportal approach, with a review of the relevant literature.
Persistent peritoneal dialysis catheter exit‐site leak in a patient receiving maintenance immunosuppression with sirolimus
Authors: Perl Jeffrey , Jassal Sarbjit Vanita , Bargman Joanne M
Published: August 2010

Abstract:  Patients returning to peritoneal dialysis after renal allograft loss are an increasing segment of the end‐stage renal disease population. Non‐transplant nephrologists will be managing the short‐ and long‐term complications of chronic immunosuppression in these patients. In this case report, the use of sirolimus is described in a patient who developed a significant peritoneal dialysis catheter exit‐site leak delaying the initiation of dialysis. The risk of impaired wound healing at the time of peritoneal dialysis catheter implantation must be considered when bridging patients from transplantation to peritoneal dialysis. Particular caution should be paid to the use of sirolimus during this period.
Antiphospholipid antibodies after renal transplantation and cardiovascular disease
Authors: Fernández‐Fresnedo Gema , López‐Hoyos Marcos , Segundo David San , Crespo Juan , Ruiz Juan Carlos , De Francisco Angel Luis M , Arias Manuel
Published: August 2010

Abstract:  Background:  The aim was to assess the presence of pre‐ or post‐transplant serum antiphospholipid antibodies (APA) and its association with the development of cardiovascular disease (CVD) in renal transplantation.

Methods:  We studied 138 patients transplanted with a cadaver kidney graft between 1990 and 1998 and with a graft functioning for longer than one yr. One pre‐transplant sample and another obtained after transplantation from our serum bank were analyzed. The ELISA used were set up in our laboratory, following established international guidelines, and results were confirmed in three different runs.

Results:  23.9% and 31.2% of patients had pre‐ and post‐transplant positive titers of APA, respectively. 16% developed those antibodies de novo after transplantation. Post‐transplant CVD was observed in 20.3% of patients but they were not associated with the production of APA in the whole population studied. However, multivariate analysis demonstrated an increased risk (RR 2.27; p = 0.02) for CVD when APA were produced after acute rejection.

Conclusions:  The presence of serum APA alone was not an independent risk factor for CVD after kidney transplantation. Nonetheless, in kidney recipients who produced APA de novo after acute rejection, the control of cardiovascular risk factors must be intensified.
Long‐term outcome of transplant renal artery stenosis managed conservatively or by radiological intervention
Authors: Geddes Colin C. , McManus Siobhan K. , Koteeswaran Shiva , Baxter Grant M.
Published: August 2010

Abstract:  The natural history and optimal treatment of transplant renal artery stenosis (TRAS) is poorly defined. Few studies reported long‐term clinical outcomes. A single centre analysis of 43 patients diagnosed with TRAS 1990–2003 was performed. Twenty‐seven had percutaneous intervention (including 10 patients who had >1 intervention) and 16 were managed conservatively at the discretion of the attending clinicians. Transplant function was assessed by slope of estimated glomerular filtration rate (eGFR) over five yr of follow‐up. Patients in the intervention group had lower mean eGFR (36.3 mL/min/1.73 m2 vs. 46.3 mL/min/1.73 m2; p = 0.07) at baseline. Five transplants in the intervention group failed (including two as a direct result of intervention) and one in the conservative group failed. There was no significant difference in the rate of deterioration in renal function (mean slope of eGFR minus 0.8 mL/min/yr and minus 1.0 mL/min/yr in the intervention and conservative groups, respectively; p = 0.79). There was no significant difference in blood pressure or number of anti‐hypertensive agents between the groups at any time point. Baseline Doppler ultrasound indices showed no significant correlation with slope of eGFR in either group. Our data demonstrate that selected patients with TRAS can be managed without intervention and that this approach is associated with good long‐term outcome. Selection of appropriate patients for intervention remains difficult and larger randomized studies are required.
The impact of induction on survival after lung transplantation: an analysis of the International Society for Heart and Lung Transplantation Registry
Authors: Hachem Ramsey R. , Edwards Leah B. , Yusen Roger D. , Chakinala Murali M , Alexander Patterson G. , Trulock Elbert P.
Published: August 2010

Abstract:  Background:  The use of induction immunosuppression after lung transplantation remains controversial. In this study, we examined the impact of induction on survival after lung transplantation.

Methods:  We performed a retrospective cohort study of 3970 adult lung transplant recipients reported to the ISHLT Registry. We divided the cohort into three groups based on the use of induction: none, interleukin‐2 receptor antagonists (IL‐2 RA), and polyclonal antithymocyte globulins (ATG). We estimated graft survival using the Kaplan‐Meier method and constructed a multivariable Cox proportional hazards model to examine the impact of induction on graft survival in the context of other variables.

Results:  During the study period, 2249 patients received no induction, 1124 received IL‐2 RA, and 597 received ATG. Four years after transplantation, recipients treated with IL‐2 RA had better graft survival (64%) than those treated with ATG (60%) and those who did not receive induction (57%; log rank p = 0.0067). This survival advantage persisted in the multivariable model for single and bilateral recipients treated with IL‐2 RA compared to those who did not receive induction (RR = 0.82, p = 0.007). Similarly, bilateral recipients treated with ATG had a survival advantage over bilateral recipients who did not receive induction (RR = 0.78, p = 0.043), but single lung recipients treated with ATG did not have a survival advantage over single lung recipients who did not receive induction (RR = 1.06, p = 0.58).

Conclusions:  Induction with lL‐2 RA for single and bilateral lung recipients and induction with ATG for bilateral recipients are associated with a survival benefit, independent of other variables that might impact survival.
Improved renal function after kidney transplantation is associated with heme oxygenase‐1 polymorphism
Authors: Ozaki K.S. , Marques G.M. , Nogueira E. , Feitoza R.Q. , Cenedeze M.A. , Franco M.F. , Mazzali M. , Soares M.P. , Pacheco‐Silva A. , Câmara N.O.S.
Published: August 2010

Abstract:  Heme oxygenase‐1 (HO‐1) has a microsatellite polymorphism based on the number of guanosine‐thymidine nucleotide repeats (GT) repeats that regulates expression levels and could have an impact on organ survival post‐injury. We correlated HO‐1 polymorphism with renal graft function. The HO‐1 gene was sequenced (N = 181), and the allelic repeats were divided into subclasses: short repeats (S) (<27 repeats) and long repeats (L) (≥27 repeats). A total of 47.5% of the donors carried the S allele. The allograft function was statistically improved six months, two and three yr after transplantation in patients receiving kidneys from donors with an S allele. For the recipients carrying the S allele (50.3%), the allograft function was also better throughout the follow‐up, but reached statistical significance only three yr after transplantation (p = 0.04). Considering only those patients who had chronic allograft nephropathy (CAN; 74 of 181), allograft function was also better in donors and in recipients carrying the S allele, two and three yr after transplantation (p = 0.03). Recipients of kidney transplantation from donors carrying the S allele presented better function even in the presence of CAN.
Optimizing protein recovery for urinary proteomics, a tool to monitor renal transplantation
Authors: Sigdel Tara K. , Lau Ken , Schilling James , Sarwal Minnie
Published: August 2010

Abstract:  Despite attractiveness of urine for biomarker discovery for systemic and renal diseases, the confounding effect of the high abundance plasma proteins in urine, and a lack of optimization of urine protein recovery methods are bottlenecks for urine proteomics.

Three methods were performed and compared for percentage protein yield, yield consistency, ease and cost of analysis: (i) organic solvent precipitation, (ii) dialysis/lyophilization, and (iii) centrifugal filtration. Urine samples were subjected to an immunoaffinity column to deplete high abundance proteins. Difference gel electrophoresis was performed to assess use of depletion strategy for detection of low abundance proteins. Urine from healthy volunteers (n = 10) and kidney transplant recipients with proteinuria (n = 11) were used. Centrifugal filtration performed best for analysis ease and yield consistency. Highest percentage yield was obtained from dialysis/lyophilization but was laborious and residual salt interfered with subsequent gel electrophoresis. Organic solvent precipitation was inexpensive, but suffered from varying yield consistency. Increased spot intensity for some low abundance and previously undetected proteins were noted after depletion of high abundance proteins.

In conclusion, we compare the pros and cons of different protein recovery methods and reveal an increase in the dynamic range of protein detection after depletional strategy that could be critical for biomarker discovery, particularly with reference to processing human study samples from clinical trials.
Do graft type or donor source affect acute rejection rates after liver transplant: a multivariate analysis
Authors: Nguyen Thanh H.K. , Melancon Keith , Lake John , Payne William , Humar Abhinav
Published: August 2010

Abstract:  We looked at acute rejection (AR) rates in adult liver transplant recipients to determine if graft type (whole liver vs. partial liver) or donor source (living vs. deceased donor) influenced the risk for AR. Between 1999 and 2005, we performed 292 whole liver transplants from a deceased donor (DD‐WL) and 91 partial transplants, either from a living donor (LDLT, n = 59) or split liver from a deceased donor (DD‐SL, n = 32). Pediatric recipients were not included. The groups were well matched by age and type of liver disease (p = ns), but mean model for end‐stage liver disease (MELD) scores were higher in the DD‐WL vs. LD recipient groups (p < 0.01). Immunosuppression was similar for all. AR rates at 12 months post‐transplant were lower in the LDLT group (10.0%) vs. the DD‐WL group (16.5%, p = 0.10), although this was not statistically significant. AR rates in the DD‐SL transplant group (12.8%) were intermediate compared with the two other groups and not statistically different from either group (p = ns). By multivariate analysis, however, neither graft type (partial vs. whole) nor donor source (LD vs. DD) seemed to have an impact on the risk for AR. The only factor that was associated with an increased risk for AR was not using induction therapy.
Risk factors for acute rejection in renal transplant recipients experiencing delayed graft function
Authors: Moore Jason , Tan Kay , Cockwell Paul , Krishnan Hari , McPake Dawn , Ready Andrew , Mellor Steve , Hamsho Ahmed , Ball Simon , Lipkin Graham , Borrows Richard
Published: August 2010

Abstract: Acute rejection (AR) superimposed upon delayed graft function (DGF) following renal transplantation worsens graft outcomes. However, risk factors for AR in patients displaying DGF remain unclear. In this study, 71 patients displaying DGF ≥ 5 d were investigated. All received cyclosporine, adjunctive azathioprine or mycophenolate mofetil (MMF), and corticosteroids, with 43 receiving anti‐CD25 monoclonal antibody induction. AR episodes were seen in 20 of 71 (28%) patients. Higher C2 levels at days 3 and 5 and the use of MMF were associated with a reduced incidence of AR, with increased HLA‐DR mismatch associated with an increased risk for AR. C2 levels at days 3 and 5 below 885 and 1096 ng/mL, respectively, showed best discriminatory values for AR. C2 levels showed no correlation with DGF duration. This study suggests that optimizing immunosuppression in patients with DGF (by ensuring adequate calcineurin inhibitor exposure and the use of potent adjunctive immunosuppression) may reduce the incidence of AR without prolonging the duration of dialysis requirement.
Selective corticosteroid and calcineurin‐inhibitor withdrawal after pancreas–kidney transplantation utilizing thymoglobulin induction and sirolimus maintenance therapy
Authors: Knight R.J. , Kerman R.H. , McKissick E. , Lawless A. , Podder H. , Katz S. , Van Buren C.T. , Kahan B.D.
Published: August 2010

Abstract:  Of 25 simultaneous pancreas–kidney transplant (SPK) recipients treated with thymoglobulin induction, sirolimus and reduced‐dose cyclosporine (CsA), 18 low‐immune responders (non‐African–Americans, PRA < 30%) were withdrawn from prednisone on post‐transplant day 5, whereas seven high‐immune responders continued on prednisone. Most high‐ and low‐immune responder recipients were converted from CsA to mycophenolic acid (MPA) at six months post‐transplantation. At a mean follow‐up of 28 ± 10 months, two pancreas grafts were lost to pancreatitis. There were no patient or kidney graft losses, but one acute rejection episode. At 28 ± 11 months, all 18 low‐responder recipients remain steroid‐free. Twenty recipients (14 low and six high‐immune responders) were converted from CsA to MPA. During conversion, immune response was monitored by Flow‐PRA and T‐cell stimulation (Cylex) assays. Nineteen of 20 recipients displayed a post‐conversion PRA of 0%, whereas one highly sensitized patient expressed a post‐conversion PRA of 67%. Fifty‐eight percent of individual T‐cell stimulation scores were in the hypo‐responsive range. Twelve of 18 low‐immune responders are both steroid and CsA‐free at a mean follow‐up of 17 ± 13 months, whereas five of seven high‐immune responders remain CsA‐free at a mean follow‐up of 11 ± 10 months. These data suggest that thymoglobulin induction with combined sirolimus and CsA maintenance therapy permits immunosuppression minimization in selected SPK recipients.
A case of early graft loss due to hyperacute rejection after ABO‐incompatible renal transplantation
Authors: Horie Katsunori , Kanou Yasuko , Sato Motoyoshi , Tsuyuki Mikito , Ishida Shohei , Shimoji Takeo , Fujita Takashi , Kimura Toru , Kato Masashi , Tsuji Yoshikazu , Kinukawa Tsuneo
Published: August 2010

Abstract:  Graft survival rates of ABO‐incompatible (ABO‐I) living‐related kidney transplantations have greatly improved with the progress of immunosuppressive protocols. However, there are several case reports in which hyperacute rejections (HAR) or delayed hyperacute rejections (DHAR) occurred with immunosuppression, and acute humoral rejection is a risk factor for early graft loss in ABO‐I kidney transplantations. We report a case of early graft loss after ABO‐I kidney transplantation. A 51‐yr‐old male received an ABO‐I kidney transplant from his wife. Graft function deteriorated immediately after surgery and HAR developed. Although plasma exchange and steroid pulse were performed, graft function did not recover. A renal biopsy on postoperative day (POD) 4 indicated compatible findings with HAR. Renal function was deemed irreversible and the renal graft was removed on POD 7. A biopsy performed one h after transplantation revealed a clot in the glomerulus. As this was a case of ABO‐I transplantation without human leukocyte antigen class I and II antibodies in the pre‐ and postoperative flow panel reactive antibody, HAR was most likely caused by the presence of anti‐blood group antibodies. The preoperative anti‐A antibody value of ×64 was rather high in the present case. There is no clear standard for preoperative antibody values and it is difficult to predict prognosis preoperatively with the recent use of strong immunosuppressives. Although the mechanism of onset is unclear in this case, it is believed that the antibody titer should be reduced as much as possible prior to transplantation.
A case of plasma cell‐rich acute rejection 18 months after kidney transplantation successfully treated with steroid pulse therapy
Authors: Shimizu Tomokazu , Ishida Hideki , Shirakawa Hiroki , Omoto Kazuya , Tanabe Kazunari , Yamaguchi Yutaka
Published: August 2010

Abstract:  A 45‐yr‐old Japanese male underwent living‐related kidney transplantation in August 2005, and immunosuppression consisted of tacrolimus, mycophenolate mofetil, methylprednisolone, basiliximab, and rituximab 200 mg. Allograft function was good, and the protocol biopsy post‐transplant day 11 showed no evidence of rejection. The serum creatinine (s‐Cr) level was maintained at the 1.2 mg/dL for 18 months. On February 2007, the patient’s s‐Cr level had increased to 2.03 mg/dL, and an episode biopsy was performed. The biopsy specimen demonstrated moderate to severe tubulitis and moderate interstitial infiltration of plasma cells and lymphocytes. The inflammatory cell infiltrate consisted of >30% plasma cells. The histopathological findings were consistent with plasma cell‐rich acute rejection (PCAR). The PCAR was treated by steroid pulse therapy, and his s‐Cr level decreased to 1.58 mg/dL. A biopsy three months after the steroid pulse therapy showed no evidence of rejection. The patient’s allograft function is currently stable, and s‐Cr level is 1.7 mg/dL. This is a case of PACR, that was successfully treated with steroid pulse therapy alone.
Two cases of kidney transplantation from the same non‐heart beating deceased donor after long cold‐ischemic time more than 24 h
Authors: Nishi Shinichi , Imai Naofumi , Nakagawa Yuki , Saito Kazuhide , Takahashi Kota , Gejyo Fumitake
Published: August 2010

Abstract:  We present here two cases of kidney transplantation from a non‐heart beating deceased donor after long cold‐ischemic time (CIT) more than 24 h. The donor was a young male who died of severe subarachnoid hemorrhage. Grafts were transplanted into two different patients one after another in our hospital. Their total ischemic times were 24 and 43 h because they were the fourth and fifth candidates on the waiting list. Although the anuric phase continued for more than three wk in both cases, finally their grafts functioned well with the nadir serum creatinine of 2.2 and 1.8 mg/dL, respectively. We evaluated protocol biopsies after 50 d from the transplantation. Both biopsy specimens revealed diffuse interstitial fibrosis, particularly more severe in the second recipient. The expression of 8‐OHdG, one of the histochemical markers of oxidative stress, was more strongly expressed in the biopsy specimens of pre‐perfusion and protocol biopsy in the same case. From these results, it was suspected that the interstitial fibrosis was induced by oxidative stress derived from the longer CIT and the following reperfusion.