bluuebunny/crossref_metadata_2025 huggingface dataset:
MO874: Incidence of Severe Infections in Home Haemodialysis and Peritoneal Dialysis Patients
Authors: Bitar Wisam , Helve Jaako , Kanerva Maria , Olavi Honkanen Eero , Rauta Virpi , Haapio Mikko , Finne Patrik
Published: May 2022

BACKGROUND

Dialysis patients have a more than ten-fold risk of dying from infections compared with general population. In earlier studies, the risk of infections was similar in peritoneal dialysis (PD) and haemodialysis (HD), but comparison to home HD has not been performed. Our aim was to study the incidence of severe infections after start of home HD as compared with continuous ambulatory PD (CAPD) and automated PD (APD).

METHODS

We included all 536 adult patients, who were on home dialysis at day 90 from start of kidney replacement therapy (KRT) between 2004 and 2017 in Helsinki healthcare district. Severe infections were identified from patients’ laboratory data as a plasma C-reactive protein over 100 mg/L and confirmed from the patient data system. The cumulative incidence of the first severe infection was estimated considering death as a competing risk event. Hazard ratios of first severe infection were assessed using Cox regression with propensity score adjustment. Incidence rate (IR) and ratios (IRR) of all severe infection episodes were calculated.

RESULTS

The probability of getting a severe infection during the first year of dialysis was 35% for CAPD, 25% for APD and 11% for home HD patients. During a 5-year follow-up, the hazard ratio of severe infection was 2.8 [95% confidence interval (95% CI) 1.6–4.8] for CAPD and 2.2 (95% CI 1.4–3.5) for APD in comparison to home HD with adjustment for propensity scores. IR of infections/100 patient-years was 54 for CAPD, 37 for APD and 20 for home HD patients. The IR of peritonitis was 37 for CAPD and 25 for APD patients. When infection episodes caused by peritonitis were excluded, the IR of severe infections was not higher among PD than home HD patients.

CONCLUSION

The risk of severe infection was considerably lower among home HD than PD patients. This difference was mainly explained by the peritonitis episodes among the PD patients.
MO876: B Lymphocyte Subpopulations in End-Stage Renal Disease Patients Undergoing Renal Replacement Therapy: Does the Method Affect the Phenotype?
Authors: Vasileia Daikidou Dimitra , Sampani Erasmia , Fylaktou Asimina , Nikolaidou Vasiliki , Dimitriadis Chrysostomos , Lioulios Georgios , Papagianni Aikaterini , Stangou Maria
Published: May 2022

BACKGROUND AND AIMS

End-stage renal disease (ESRD) patients are considered as immunocompromised, and infections contribute greatly to their morbidity and mortality. This study focuses on the changes of B lymphocyte subpopulations in pre- and post- renal replacement therapy ESRD patients and the potential differences between haemodialysis and peritoneal dialysis.

METHOD

Using flow cytometry, B cells (CD19+) and their subsets B1a (CD19 + CD5+), naive (CD19 + CD27−), memory (CD19 + CD27+), (CD19 + BAFF-R+) and (CD19 + IgM+), were quantified in the peripheral blood of 40 pre-dialysis patients. IgG, IgA and IgM serum levels and apoptotic lymphocytes and b lymphocytes were also measured, and the measurements were repeated 6 months after the initiation of renal replacement therapy. The patients were allocated to haemodialysis (22patients, M/F 10/12, age 64,1 ± 9,8) and peritoneal dialysis (18 patients, M/F 11/11, age 56,4 ± 15,6). Exclusion criteria were age < 18 or >75 years, active autoimmune or chronic inflammatory disease, medical history of malignancy, corticosteroids or immunosuppresive treatment for the last 12 months.

RESULTS

There were no statistically significant difference between the two groups concerning the aforementioned variants pre dialysis. Collectively, ESRD patients showed no statistically significant alterations after the initiation of dialysis concerning the B cells phenotype, lymphocyte apoptosis and Immunoglobin serum levels, with the notable exception of B1a cells, which presented a decrease (3.6 ± 4.9 μ/L versus 1.6 ± 2.5 μ/L, P = 0.022). There seem to be no particular differences between the two methods either, with the exception of WBC count (6574 ± 1519 μ/L versus 8325 ± 2541 μ/L, P = 0.014) and apoptotic B lymphocytes (2 ± 2.4 μ/L versus 4.5 ± 3.9 μ/L, P = 0.02), which were lower in the peritoneal dialysis patients. Lastly there seemed to be no differentiation between the two methods concerning the percentage change of B lymphocytes subpopulations, lymphocyte apoptosis and IgG, IgM and IgA serum levels.

CONCLUSION

The changes that the uremic milieu causes in ESRD patients concerning their humoral Immunity do not reverse with the initiation of renal replacement therapy. Furthermore, with the exception of B cells apoptosis and WBC count, there is no significant difference between haemodialysis and peritoneal dialysis.
MO889: High Flux Dialyzer 2.6 M2 is Promising for Free Light Chains Removal in High Flux Hemodialysis and Hemodiafiltration
Authors: Elsayed Hesham , Anwar Waleed , Zaki Abdelmegied Shaimaa , Emara Ahmed , Sultan Reem , Elsharkawy Magdy
Published: May 2022

BACKGROUND AND AIMS

Immunoglobulin light chains are classified as middle molecule uremic toxins and its removal through effective dialyzer is needed with less albumin loss. This study assessed the free light chains removal using dialyzer surface area (SA) 2.6m2 in high flux dialysis (HD) versus hemodiafiltration (HDF) and its relation to cumulative albumin loss.

METHOD

A cross-over study included 25 patients who underwent hemodialysis using dialyzer surface area 2.6 m2 in high flux HD followed by online post-dilution hemodiafiltration with washout period 2 weeks using high flux dialyzers (max 2.0 m2 SA). All patients were subjected to single session measurement of dialysate albumin every hour and pre-post dialysis Free light chains (FLC) kappa and Lambda by ELISA.

RESULTS

Dialyzer (SA) 2.6m2 showed significant reduction in post-dialysis kappa and lambda in comparison to pre-dialysis level in high flux hemodialysis and hemodiafiltration (P < 0.001). HDF showed higher kappa and lambda FLC reduction ratio (45.16 ± 6.53 ng/mL), (28.68 ± 4.36 ng/mL), respectively compared with high flux HD (29.52 ± 6.38 ng/mL), (19.48 ± 1.96 ng/mL), respectively (P < 0.001). HDF/HD fold change of kappa and lamda were (1.56 ± 0.23) and (1.48 ± 0.26), respectively. Patients on HDF dialysis had significant total albumin loss in dialysate [median (IQR) 2.47 (1.16) gm/dL] compared with high flux dialysis [median (IQR) 0.65 (0.64) gm/dL] with (P < 0.001). Maximum albumin loss in patients on HDF was in the first hour [median (IQR) 1.22 (0.59)] gm/dL with lower albumin loss in the next hours reaching median {0.17 (0.15) gm/dL} in the fourth hour. Trans-membrane pressure was positively correlated with total albumin loss in high flux hemodialysis and hemodiafiltration (r 0.443, p 0.027, r 0.745, P = 0.001), respectively.

CONCLUSION

High flux dialyzer 2.6 m2 (SA) is effective for free light chains removal especially with online post-dilution hemodiafiltration with acceptable albumin loss.
MO893: The Prognostic Value of Dysvolemia, Cardiac Biomarkers and Echocardiographic Parameters in Chronic Haemodialysis Patients
Authors: Paunic Zoran , Dekleva-Manojlovic Milica , Markovic-Nikolic Natasa , Dimkovic Nada
Published: May 2022

BACKGROUND AND AIMS

Hypervolemia is one of the important risk factors for mortality in haemodialysis (HD) patients. The aim of this study is to determine the prognostic significance of volemia determined by bioimpedance spectroscopy (BIS), as well as cardiac biomarkers and echocardiographic (ECHO) measurements.

METHOD

A prospective single-centre observational study included 73 (42 m) chronic HD patients. The BIS and cardiac biomarkers were measured before the second weekly HD procedure. In addition, to overcome the problem of possible different pre-HD and post-HD fluid volume levels (`overhydration’, OH and post-HD or `dehydration’, DH, respectively) on different HD sessions of the week, the concept of Average Weekly hypervolemia (AVOH) or hypovolemia (AVDH) was implemented—the remaining two OH and DH values were calculated from pre-HD and post-HD weights and normal weight as suggested by BIS measurement. ECHO was performed 1 day after aforementioned measurements (i.e. 1 day after HD).

RESULTS

During observation period 11 subjects died (15%): seven (64%) directly due to cardiovascular (CV), two due to infective and due to malignant causes. Three-year cumulative survival was significantly lower (by Kaplan–Meier analysis) in those who had: 1) AVOH >13% extracellular fluid (ECV) (survival rate 73% versus 92% (P < 0.05); 2) average AVDH> -3% ECV (survival 69% versus 94%; P < 0.01); 3) value of serum N-terminal prohormone of brain natriuretic peptide (NT-proBNP)> 7350 pg/mL (survival 76% versus 93%; P < 0.05); 4) troponin T (TnT) value >0.067 ng/mL, (survival rate 68% versus 94%; P < 0.01). In addition, regarding just CV mortality, left ventricular ejection fraction according to Simpson (LVEF) <40% (survival rate 80% versus 93%; P < 0.05) and global longitudinal strain (GLS) <–8.5 (survival rate 81% versus 95%, P < 0.05) were markers of pure survival.

CONCLUSION

Determination of volemia by BIS, cardiac biomarkers and echocardiography has prognostic significance in HD patients. Further studies will show how much correction of dysvolemia affects their better survival.
MO919: Persistence of Antibodies After SARS-COV-2 Vaccines in Haemodialysis Patients: A 6 Months Follow-Up
Authors: Murt Ahmet , Riza Altiparmak Mehmet , Pekpak Meltem , Ataman Rezzan
Published: May 2022

BACKGROUND AND AIMS

As COVID-19 related mortality is higher in haemodialysis patients than in the general population, proper vaccination strategies against the SARS-CoV-2 virus have utmost importance. It has been previously shown that mRNA vaccines (e.g. BNT162b2) can generate >95% of seropositivity in haemodialysis patients [1]. On the other hand, the seropositivity rate reached by the inactivated vaccine (CoronaVac®) was around 80%. In this study, we aimed to analyse the persistence of SARS-CoV-2 antibodies in haemodialysis patients for 6 months and compare it with the healthy controls.

METHOD

Haemodialysis patients who were vaccinated either by BNT162b2 or CoronaVac® and who continued their regular controls for 6 months were involved in the study. Those who had previous or active SARS-CoV-2 infection, who had malignancies and those who had received immunosuppressive drugs in the previous 12 month were excluded from the study. SARS-CoV-2 IgG levels were measured by a commercial test after the first doses of the vaccines and at the end of the sixth month. Healthy healthcare workers who were vaccinated with similar vaccine schemes were taken as the control group.

RESULTS

We recruited 85 haemodialysis patients who had received their first doses of either vaccine. Of them, 4 patients died; 3 patients were hospitalized because of COVID-19 infection during the follow-up; 9 patients missed at least one of their regular controls; and 2 patients were diagnosed with malignancy. A total of 26 patients experienced asymptomatic or mild COVID-19 infection during the follow-up period. SARS-CoV-2 IgG levels were measured at the end of the sixth month for the remaining 41 patients. Sero-positivity significantly decreased at the end of the sixth month for both vaccines, but the BNT162b2 group (n = 22) still had better seropositivity than CoronaVac® (n = 19) group (81% versus 50%; P = .03). In contrast, the seropositivity of healthy controls, even with the inactivated vaccine, was 96%. When one booster dose was applied, 90% of seropositivity could be maintained in the BNT162b2 group at the sixth month.

CONCLUSION

BNT162b2 vaccine generates more persistent antibodies than inactivated vaccines in haemodialysis patients. However, when compared with the healthy controls at the end of the sixth month, antibody titers decrease more profoundly in haemodialysis patients. The booster dose can maintain the antibody levels and should be applied at least every 6 months.
MO920: SARS-COV-2 Neutralizing Antibody Response to Booster Vaccination in Patients on Hemodialysis
Authors: Wang Xiaoling , Han Maggie , Wang Kevin , Thwin Ohnmar , Rivera-Fuentes Lemuel , Haq Zahin , Grobe Nadja , Wang Yuedong , Kotanko Peter
Published: May 2022

BACKGROUND AND AIMS

SARS-CoV-2 antibody titers after two doses of vaccination decrease over time. Hemodialysis patients are especially vulnerable to COVID-19 as they are immunocompromised, putting them at higher risk of infection and poorer response to vaccines. Therefore, administrating the third dose (‘booster’) in these patients is key to reduce COVID-19 infections and prevent severe illness. Dialysis patients were among the first group of patients who received booster vaccinations. To study the humoral response to the third injection in this group, we collected serum from 33 patients on hemodialysis and measured neutralizing antibody titers against SARS-CoV-2 before and after their booster doses.

METHOD

Patients were recruited from a dialysis center in New York City, NY from June to September 2021. Data on COVID-19 vaccination and demographics were collected upon enrollment. Blood samples were taken after enrollment. SARS-CoV-2 neutralization antibodies were assayed using the GenScript SARS-CoV-2 Surrogate Virus Neutralization Test Kit (Cat#L00847-A). Corresponding neutralizing antibody titers are presented as Unit/mL (U/mL).

RESULTS

A total of 33 in-center hemodialysis patients who had received three doses of vaccination were studied. Patients had a mean age of 61 years, 23 (70%) were male. Out of these, 31 (94%) patients received three doses of mRNA-1273 (Moderna), and two patients received the BNT162b2 (Pfizer BioNTech) vaccine. A total of 138 serum samples were analyzed (ranging from 156 days before to 85 days after the booster). Figure 1 shows the antibody titer distribution of all samples in these 33 patients. Each color indicates an individual patient. Each patient has up to 12 data points before and after the booster. The mean neutralizing antibody titers of all 48 data points pre-booster is 29.291 U/mL (range: 228–188.600). Seven days post-booster, the mean neutralizing antibody titer is 73.088 U/mL (range: 12.401–254.504). Mean titer is 169.826 U/mL (range: 17.830–375.046) at 14–28 days post-booster. After the peak time, we observe a decline of the titers. At 72–85 days, the mean titer is 72.179 (range: 33.702–204.382).

We fitted a nonparametric mixed effects model with an adaptive spline and a random intercept for each subject to neutralizing antibody titers on the log10 scale. The estimate of the mean trajectory and its 95% confidence interval are shown in Fig. 2. The estimated peak time is 18.2 days with a 95% confidence interval (0–27.7).

CONCLUSION

Our results suggest that hemodialysis patients have a strong humoral response to booster vaccination. Neutralizing antibody titers peak at 18 days post-booster and wane to an average of 42% of peak value after 10–12 weeks.
MO922: Intradialytic Plantar Electrical Nerve Stimulation During Routine Hemodialysis Process Facilitate Physical Activities of Daily Life in Adults With Diabetes and End-Stage Renal Disease––A Randomized Double-Blinded Controlled Trial
Authors: Hamad Abdullah , Al-Ali Fadwa , Kinker Mishra Ram , Ibrahim Rania , Mathew Mincy , Ateya Heba , Yahya Mohamed , Khan Saifatullah , Talal Talal , Najafi Bijan
Published: May 2022

BACKGROUND AND AIMS

Reduced physical activity in daily life is a persistent problem in patients undergoing hemodialysis (HD). Although exercise could be beneficial, factors such as post-dialysis fatigue, time limitation and severe frailty may result in poor compliance. We are exploring an alternative therapy using intradialytic plantar electrical nerve stimulation (IPENS) provided during the routine hemodialysis process to address this gap.

METHOD

A total of 20 participants undergoing hemodialysis (age = 55 ± 2.7 years, BMI = 30.6 ± 1.3 kg/m2 female = 31%) were randomly assigned to the intervention group (IG), and 18 participants (age = 56 ± 2.2 years, BMI = 32.2 ± 1.2 kg/m2 female = 41%) were assigned to the control group (CG). The IG received 1-h IPENS during the routine hemodialysis process (three sessions/week) for 12 weeks. The CG received an identical but non-functional device for the same period. Participants and therapy-providers were blinded to the group allocation. Daily life physical activity was assessed remotely at baseline and every 12 week using a pendant wearable. To determine the effect of intervention, we estimated Cohen's effect size d. In addition, time effects, group and time × group effects were estimated using a general linear model.

RESULTS

We observed a significant increase in (Cohen's d = 0.97, P < 0.01) number of postural transitions, (d = 0.71, P = 0.04) daily step counts and (d = 0.73, P = 0.03) episodes of walking due to IPENS. All participants in the IG tolerated the IPENS and completed all therapy sessions, indicating the feasibility.

CONCLUSION

These are early results related to IPENS therapy's feasibility and effectiveness to improve mobility among individuals undergoing routine hemodialysis. We can recommend routine IPENS therapy as a practical alternative for those who may not engage in routine exercise programs if the results will be held in the larger sample.
MO932: Same But Different? Covid-19 Metabolome in Hemodialysis
Authors: Schuller Max , Oberhuber Monika , Prietl Barbara , Zügner Elmar , Prugger Eva-Maria , Magnes Christoph , Eller Kathrin
Published: May 2022

BACKGROUND AND AIMS

The ongoing coronavirus disease 2019 (COVID-19) pandemic presents a major health and economical challenge. Chronic kidney disease (CKD) patients on haemodialysis (HDp) are at a particularly high risk of severe and fatal courses [1]. The COVID-19 metabolome is distinct [2] and may harbour potential prognostic markers and therapeutic targets. However, the metabolome in SARS-CoV-2 infected HDp remains unstudied.

METHOD

Untargeted and targeted metabolomics via high-performance liquid chromatography and tandem mass spectrometry of EDTA-plasma were performed in 39 individuals without CKD (non-HDp) and 41 HDp. Individuals were further grouped according to COVID-19 disease status and severity: negative, asymptomatic/mild (no or mild symptoms) and moderate/severe (requiring hospitalization).

RESULTS

Principal component analysis shows a clear separation of non-HDp and HDp alongside PC2, independent of COVID-19. Non-HDp with moderate/severe courses are shifted to the right of PC1. The influence of COVID-19 is less pronounced in HDp (Figure 1). Free fatty acids are main contributors to PC1, whereas PC2 reflects the complex metabolic disarray as seen in uraemia (Table 1).

CONCLUSION

Our data underlines the fundamental metabolic differences between non-HDp and HDp [3]. Furthermore, moderate/severe COVID-19 leads to a distinct metabolite signature in non-HDp. This effect is less pronounced in HDp, which could be indicative of a decreased capability to adapt to infectious challenges. In summary, these findings warrant caution when extrapolating COVID-19 metabolomics from otherwise healthy individuals, as the validity of prognostic markers and/or effectiveness of therapeutic approaches based on the metabolome may be limited in HDp.
MO939: Role of The General Practitioner in Promoting Organ Donation
Authors: Afifi Rania , Rostoum Soukaina , Berrada Omar , Mtioui Naoufal , Elkhayat Selma , Zamd Mohamed , Medkouri Ghislaine , Ramdani Benyouns , Benghanem Mohamed , Jandou Issam , Alafifi Mahmoud , Moataz Amine , Dakir Mohammed , Debbagh Adil , Aboutaieb Rachid
Published: May 2022

BACKGROUND AND AIMS

Organ transplants now play a significant role in the treatment of diseases that are nonetheless fatal. Organ and tissue transplantation in Morocco is severely delayed, and the number of transplants conducted in our country does not reach 10 per million inhabitants per year. Due to a scarcity of organs and tissues, the number of transplants and tissue grafts, which are primarily a Ministry of Health effort, is limited.

The main link in the medical chain is the general practitioner. In addition to his solitary practice of medicine, he is already responsible for a number of public health missions, primarily in the fields of disease prevention and detection, as well as organ and tissue donation promotion.

We conducted a quantitative cross-sectional study through a survey to measure the level of involvement and dedication of general practitioners in the promotion of organ donation.

METHOD

A quantitative descriptive cross-sectional study, based on a questionnaire with 20 closed questions, self-administered, emailed, completed anonymously and voluntarily intended to the general practitioner of the region of Casablanca. Questionnaire data were collected, encoded and analyzed using SPSS-PC (Version 21.0).

RESULTS

Our study targeted 200 general practitioners in total, of which 165 responded to the questionnaire, giving an overall response rate of 82.5%.

The average age of participants was 34.22. The duration of exercise varied between 1 and 40 years, with an estimated average of 11 years, 65% of the doctors practiced in the urban environment and ∼59.5% worked in the liberal sector.

A total of 87% of the doctors questioned were in favor of organ donation, and 13% were against organ donation, for which the religious cause represented 78% and 16% refused for medical reasons, 54.5% of them had never discussed the subject with their relatives, and 80.5% of practitioners declared having a patient waiting or who had received an organ transplant. Only 38% of doctors had already discussed this subject with their patients, of whom >64% were following the sole initiative of the patient himself, and in none of the cases was awareness raising through posters in the waiting room.

Only 1.5% of participants had brochures on organ donation in their waiting rooms, and >87% thought that TV shows in waiting rooms were a good means of information and awareness.

CONCLUSION

The involvement of general practitioners begins at the awareness stage, with the goal of disseminating information about organ donation.
MO942: Regulatory T and B Cell Responses are Equally Compromised During Antibody-Mediated Rejection of Kidney Allografts
Authors: Louis Kevin , Fadakar Paul , Macedo Camila , Yamada Masaki , Zeevi Adriana , Randhawa Parmjeet , Lefaucheur Carmen , Metes Diana
Published: May 2022

BACKGROUND AND AIMS

Although considerable advances have been made in understanding the cellular effector mechanisms responsible for donor-specific antibody (DSA) generation leading to antibody-mediated rejection (ABMR), the identification of cellular regulators of such immune responses is lacking.

METHOD

In a cohort of 96 kidney transplant recipients, we used high-dimensional flow cytometry to concomitantly profile and track the two major subsets of regulatory lymphocytes in the blood: T regulatory (TREG) and transitional B (TrB) cells. Additionally, we established co-culture assays to address their respective capacities to suppress antibody responses in vitro.

RESULTS

TREG and TrB were potent suppressors of T follicular helper-mediated B cell differentiation into plasmablast and antibody generation. While TREG and TrB were both durably expanded in patients who did not develop DSA post-transplant, patients who manifested DSA and progressed to ABMR displayed a marked and persistent numerical reduction in TREG and TrB cells. Strikingly, specific cell clusters expressing the transcription factor T-bet were selectively depleted in both TREG and TrB compartments in patients with ABMR. Importantly, the coordinated loss of these T-bet + CXCR5+ TREG and T-bet+CD21–TrB cell clusters was correlated with increased and inflammatory DSA responses, more extensive microvascular inflammation and a higher rate of kidney allograft loss.

CONCLUSION

Our study identified coordinated and persistent defects in the regulatory T and B cell responses in patients undergoing ABMR, which may contribute to their loss of humoral immune regulation and thus warranting timely therapeutic interventions to replenish and sustain TREG and TrB cells in these patients.
MO943: Levels of Forkhead Box P3 (FOXP3) Transcripts in Kidney Transplant Recipients is Associated With Post-Transplant Cytomegalovirus Viremia
Authors: Saleh Qais , Rasmussen Marianne , Nagarajah Subagini , Tepel Martin
Published: May 2022

BACKGROUND AND AIMS

The forkhead box P3 (FOXP3) transcription factor is essential for the differentiation of T regulatory cells, which are major regulators of immune tolerance and immunologic activity. Quantification of the FOXP3 mRNA in peripheral blood might be clinically useful. Considering possible post-transcriptional regulation of FOXP3 mRNA, we tested the hypothesis that a low level of FOXP3 is associated with a higher risk of cytomegalovirus (CMV) viremia, in kidney transplant recipients (KTRs).

METHOD

Blood samples were collected the first day after transplantation from incident adult kidney transplant recipients. Ribonucleic acid was extracted from peripheral blood mononuclear cells and used in quantitative reverse transcription polymerase chain reaction. Levels of FOXP3 were measured using two primers differentiating mRNA FOXP3 and pre-mRNA FOXP3 (pre-FOXP3), both primers were normalized to the reference gene β-actin. We defined viremia with CMV as the finding of more than 1000 copies per mL of CMV DNA in plasma, at least once, within 3 months after transplantation. A ratio of FOXP3 to pre-FOXP3 was calculated and compared, using Mann–Whitney U-test according to CMV viremia status. Finally using receiver operating characteristics, we calculated are under the curve.

RESULTS

Of 340 patients enrolled, 24 experienced post-transplant CMV viremia. The median ratio of FOXP3 to pre-FOXP3 was lower in those diagnosed with post-transplant CMV viremia, compared to those who were not 6.8 [1.2–11.3] versus 12.2 [3.5–28.9] P < 0.01, respectively. Receiver operating characteristics yielded an area under the curve of 66.7% P < 0.01.

CONCLUSION

Our data shows an association between low levels of FOXP3 and risk for post-transplant CMV infection in kidney transplant recipients.
MO944: Persistent Microscopic Hematuria At Kidney Donor Screening and Long-Term Post-Donation Kidney Outcomes
Authors: Van Der Weijden Jessica , Van Londen Marco , Pol Robert , Sanders Jan-Stephan , Navis Gerjan , Nolte Ilja , De Borst Martin , Berger Stefan P
Published: May 2022

BACKGROUND AND AIMS

According to current guidelines, a kidney biopsy is indicated in prospective living kidney donors with persistent microscopic hematuria and negative urological work-up. We investigated whether persistent microscopic hematuria at donor screening is associated with changes in post-donation eGFR, proteinuria, or blood pressure.

METHOD

We included 701 living kidney donors who underwent two urinalyses before donation and had annual evaluation of estimated glomerular filtration rate (eGFR), protein:creatinine ratio (PCR) and systolic blood pressure (SBP). The association between pre-donation persistent microscopic hematuria (≥ 1 red blood cell per high power field or ≥3 red blood cell per µL) and outcomes was assessed using generalized linear mixed models.

RESULTS

Mean age was 52 ± 11 years, median [interquartile range] follow-up time was 5 [2–8] years. Pre-donation persistent microscopic hematuria was present in 88 donors (80% female, versus 45% in non-hematuria group, P < 0.001). There were no significant associations between persistent microscopic hematuria at screening and course of eGFR [0.44 mL/min/1.73 m2 increase/year for hematuria donors versus 0.34 mL/min/1.73 m2 increase/year for non-hematuria donors (P = 0.65)], PCR (0.02 versus 0.04 mg/mmol increase/year, P = 0.38), or SBP (1.42 versus 0.92 mmHg increase/year, P = 0.17) post-donation, even after adjusting for pre-donation age, sex, body mass index, eGFR, PCR, SBP and ACE inhibitor/angiotensin receptor blocker use. Sensitivity analyses in subgroups with risk-factor(s) of kidney disease and subgroups with poorer post-donation courses of the outcomes yielded similar results.

CONCLUSION

Donors with persistent microscopic hematuria at donor screening had no increased risk of progressive eGFR decline, proteinuria, or hypertension. Despite the limitation of potential selection bias, it seems safe to allow donors with persistent microscopic hematuria without other risk factors to donate without prior kidney biopsy. However, these results warrant validation on the longer term after donation.
MO948: Impact of DE Novo Immunosuppression in The Covid-19 Serological Status at Kidney Transplantation
Authors: Llinàs-Mallol Laura , Odette Chamoun Huacon Betty , Redondo Pachon Dolores , Padilla Eduardo , Arias-Cabrales Carlos , Burballa Carla , Iriarte-Abril Miren , Farrera-Núñez Júlia , Solà Eulàlia , José Pérez-Saéz María , Crespo Marta
Published: May 2022

BACKGROUND AND AIMS

COVID-19 infection has heavily impacted our national health system since March-2020. Although the kidney transplant (KT) activity was strongly reduced initially, nowadays it is partially recovered by using ‘COVID-clean’ pathways and vaccination of KT candidates since February-2021. However, scarce information is available regarding how de novo KT immunosuppression influences the serological status of vaccinated recipients.

METHOD

We reviewed the course of 38 de novo KT recipients transplanted between March-September 2021 fully vaccinated before KT. SARS-CoV-2 IgG antibodies against Spike (IgG-S) before and after KT (median: 32 days) were quantified with a serological assay (positive ≥13.0 AU/mL).

RESULTS

Of 38 recipients, 35 showed positive IgG-S at KT (92%). We exclude from the analysis, 4 recipients with COVID infection which interfered the analysis and 5 with inappropriate samples. The remaining 26 recipients had received the second dose of the mRNA vaccine a median time of 48 days before the pre-KT IgG determination. All patients maintained IgG-S over the cut-off after KT, but we observed that half de novo recipients (53.8%) showed a 50% reduction in the level of IgG-S at 1 month: 12/20 (60%) of those who received induction with basiliximab and 2/6 (33%) who received thymoglobulin. Regarding the impact of maintenance immunosuppression under induction with basiliximab, the IgG-S levels halved in 50% of those with tacrolimus-mycophenolate and 67% with tacrolimus-everolimus.

The restricted analysis of IgG-S levels excluding five outliers before KT (>800 AU/mL) showed the most intense reduction in three KT recipients who received thymoglobulin-tacrolimus- mycophenolate (263.8 versus 68.8, 74%) compared with seven basiliximab-tacrolimus-mycophenolate cases (494.4 versus 359.8, 27%) and eleven basiliximab-tacrolimus-everolimus (344.0 versus 306.4, 11%) KT recipients.

CONCLUSION

Immunosuppression in de novo KT recipients reduces significantly the seroprotective levels of antibodies anti-Spike induced by COVID m-RNA vaccines in more than half the recipients. In our experience, the combination of thymoglobulin, tacrolimus and mycophenolate produces a more intense reduction than the combination of basiliximab with tacrolimus and mycophenolate or everolimus.
MO949: Metabolic Syndrome and Longitudinal Risk of Renal and Cardiovascular Events in Renal Transplant Recipients: A Single Center Study in Japan
Authors: Naganuma Toshihide , Kabata Daijiro , Iwai Tomoaki , Takemoto Yoshiaki , Uchida Junji
Published: May 2022

BACKGROUND AND AIMS

Metabolic syndrome (MetS) is a condition that promotes arteriosclerosis due to various arteriosclerosis risk factors such as impaired glucose tolerance, impaired lipid metabolism and hypertension, caused by insulin resistance as a result of visceral fat obesity. There have been several epidemiological studies on MetS after renal transplantation conducted in the U.S. and Europe, indicating that MetS is an accumulation of non-immunological risks of renal transplantation, which affects the patient's prognosis as well as that of the kidney. However, the incidence of MetS in Japanese renal transplant recipients is 20 to 30% and lower compared with that of American and European recipients, and its effects on cardiovascular complications and kidney prognosis are not clear. We report on the results of our long-term longitudinal study on MetS in renal transplant recipients.

METHOD

A total of 104 renal transplant outpatients, over 6 months after their transplants and in stable condition, were diagnosed with MetS from January 2006 and June 2007 and followed up until December 2020. The effects of MetS on outcomes including renal and cardiovascular events were studied using four diagnostic criteria [NCEP-ATP III (Japanese, original, Asian) and IDF criteria]. We performed multivariate Cox proportional hazards regression analysis to examine the association between the presence or absence of MetS and combined vascular events in renal transplant recipients. This study protocol was conducted in accordance with the Principles of the Declaration of Helsinki and the Declaration of Istanbul, and was approved by the ethics committee of Osaka City University (No. 2020–197). All analyses were performed using R ver. 4.0.3 (https://www.r-project.org/foundation/) with the ‘rms’ and ‘RcmdrPlugin.EZR’ packages.

RESULTS

The incidence of MetS among our renal transplant recipients in our baseline investigation was 24.0% by the NCEP-ATP III (Japanese) criteria, and our longitudinal study showed that MetS was a significant risk factor even after adjustment of background factors using the propensity score (HR: 2.82; 95% CI: 1.26–6.34, P = 0.012). In addition, the effects of MetS diagnosed using the NCEP (original), NCEP (Asian) and IDF criteria on cardiac composite events were HR: 2.39; 95% CI: 1.07–5.38, P = 0.035, HR: 2.35; 95% CI: 1.00–5.55, P = 0.051, and HR: 1.90; 95% CI: 0.84–4.31, P = 0.12, respectively.

CONCLUSION

Although the incidence of MetS in Japanese renal transplant recipients was lower compared to that of American and European renal transplant recipients, our results indicated that MetS also affected cardiovascular complications and kidney prognosis in Japanese renal transplant recipients. Moreover, depending on the diagnostic criteria for MetS, the HR was shown to be around 2.0–3.0.
MO953: Relevance of Proteinuria and Donor Specific Antibody in Kidney Transplanted Recipients and Allograft Outcomes
Authors: Hashmi Amna , Klenk Nora , Bidiga Laszlo , Kardos Laszlo , Áron Nemes Balázs , Balla Jozsef , P. Szabo Reka
Published: May 2022

BACKGROUND AND AIMS

The onset of proteinuria in renal allograft recipients is a frequent complication that may be associated with an increased risk of graft failure and mortality. Our aim was to research if proteinuria effects is independent from donor specific antibody (DSA) for transplant graft survival and the changes of proteinuria response to therapy in ABMR group.

METHOD

85 transplanted patients were enrolled in our study and followed up till 31 October 2020 or till death, or date of return to dialysis. We created three groups: ABMR group (n = 19, biopsy proven antibody mediated rejection), ABMRDSApos positive group (n = 14) ABMRDSAneg (n = 5), DSA negative group with stabile kidney function without rejection as a reference (n = 52). Differences in patient, donor and transplant characteristics between DSA positive and negative groups were assessed by Fishers exact test for categorical variables. Death censored graft loss was assessed by Kaplan Meier analysis with log risk statistics.

RESULTS

Proteinuria decrease after treatment in ABMR group (P = 0.0009). Graft failure's frequency increase every 10 mg/mmol elevation of proteinuria means 7% elevation (hazard ratio: 1.07%). Before treatment nephrotic proteinuria was found in group AMBRDSApoz 21%, 14,29% in group ABMR DSAneg 1,92% in reference group. Estimated 3-year graft survival was 87, 5% in ABMR group, 93% in DSA pos group, and 100% in DSA negative group (log-rank probe P = 0.0666).

CONCLUSION

The presence of DSA increases graft loss but it is independent to proteinuria. Therapy refractory proteinuria state represents worse graft survival.
MO958: Hyperleptinemia as A Risk Factor for Post-Transplant Diabetes Mellitus Development After Kidney Transplantation
Authors: Graňák Karol , Vnučák Matej , Beliančinová Monika , Pytliaková Margaréta , Dedinska Ivana
Published: May 2022

BACKGROUND AND AIMS

Adipose tissue, as an endocrine organ, is involved in the synthesis of hormones that are involved in several processes, including the regulation of food intake, the control of insulin sensitivity or as mediators of inflammatory processes. The aim of this study was to determine the importance of leptin, adiponectin, interleukin 6 and interleukin 10 levels for the development of post-transplant diabetes mellitus (PTDM) 1 year after kidney transplantation (KT).

METHOD

In the prospective analysis, the studied sample (n = 104) was divided into three groups: (1) control group, (2) patients who developed a pre-diabetic condition after KT (impaired glucose tolerance, fasting hyperglycemia) and (3) patients who developed de novo PTDM. Pre-transplantation and subsequently at 3, 6 and 12 months after KT, we recorded the basic characteristics of the donor and recipient, including parameters reflecting graft function, metabolic (lipid profile, glucose metabolism parameters) and anthropometric parameters. At the same time, we monitored the levels of adipocytokines (adiponectin, leptin) and interleukins (IL-6, IL-10) during the monitored period (Table 1).

RESULTS

The level of leptin in the post-transplant period had a continuously decreasing tendency in the control group with a significantly lower level 12 months after KT (P = 0.0078). On the other hand, after transient decrease, leptin level remained high in 12 months after KT in the group with prediabetes (P = 0.0343) and PTDM (insignificant). In contrast, adiponectin levels showed a significant decrease after 12 months in the group with prediabetes (P = 0.0009) and PTDM (P <0.0001), while it increased in the control group. IL-6 decreased significantly in the control group (P = 0.0023), with prediabetes (P = 0.0061) and PTDM (P = 0.0499). After adjusting for differences in the baseline donor and recipient characteristics, we found risk factors for PTDM 12 months after KT in a univariate analysis: baseline hyperleptinemia (P = 0.0458) and at 12 months (P = 0.0464), low adiponectin levels at 12 months (P = 0.0108), low IL-6 baseline (P = 0.0180), IL10 at 6 months (P = 0.0271) and 12 months (P = 0.0397). Using multivariate analysis, we identified hyperleptinemia 12 months after KT as an independent risk factor for PTDM development 1 year after KT [OR: 1.0320; 95% Cl: 0.9785–1.0884 (P = 0.0038)] (Table 2).

CONCLUSION

We confirmed that elevated leptin level 12 months after KT is associated with the development of PTDM. Levels of inflammatory process mediators (IL-6 and IL-10) did not correlate with an increased incidence of metabolic complications. Their importance seems to apply in the event of acute rejection, which requires further investigation.
MO962: C-Peptide and Epicardial Adipose Tissue in Chronic Kidney Disease
Authors: D'marco Luis , Bermudez Valmore , Raggi Paolo
Published: May 2022

BACKGROUND AND AIMS

Recent studies suggest that C-peptide (CP) may exhibit characteristics of a hormone and show physiological functions in various tissues. Moreover, it has been proposed that CP could be involved in the regulation of lipolysis, adiponectin release and function of mesenchymal stem cells in adipose tissue. However, there is a certain controversy regarding reported effects of the CP. Its beneficial effects have been demonstrated in long-term complication in type 1 diabetes mellitus (T1DM). Substitution of CP in T1DM improves glomerular hyperfiltration, hypertrophy and proteinuria. In contrast to this, CP in T2DM shows proinflammatory and proatherogenic effects. The aim of this study was to find the association between CP, epicardial adipose tissue (EAT) and vascular calcifications in diabetic subjects under insulin treatment on dialysis.

METHOD

This is a retrospective study of 62 consecutive chronic kidney disease (CKD) stages 5D patients awaiting kidney transplantation referred for risk stratification. Computer tomography (CT) was used to assess quantify coronary artery calcium (CAC) and to measure EAT volume. CAC was considered present if a minimum of three contiguous pixels with an attenuation of ≥130 Hounsfield Units (HU) were detected along the course of a coronary artery. CAC scores were calculated using the method described by Agatston. EAT was identified as a hypodense area surrounding the myocardium and limited by pericardium. The pericardium was traced manually from the mid-left atrium to the left ventricular apex interpolating slices of 10 mm thickness; the application of an attenuation threshold in the range of -250 to -30 HU effectively excluded myocardium, coronary arteries, coronary calcium, aorta and blood pool, leaving in evidence the EAT alone. Demographic and anthropometrics data were collected on all patients through record review.

RESULTS

Demographic, clinical and laboratorial characteristics of patients enrolled in the study are resume in the Table 1. Young women and smoking were more prevalent; none of the analytical parameters were correlated with CP. Subjects with higher BMI exhibited higher levels of CP (P 0.03). EAT was strongly correlated with higher levels of CP (P 0.03). EAT was significantly correlated with severity of CAC scores (P 0.01). No correlation was found between CP and CAC.

CONCLUSION

As a marker of insulin reserve, CP can be used to evaluate insulin needs and overdose in dialysis patients and to avoid its lipogenic effects. New and novel hypoglycemic therapies may help in this issue. While EAT was correlated to CP, this was not associated with vascular calcification (CAC); this final observation may be related to the lower levels of vascular damage observed in CKD patients from kidney transplantation waiting list. More studies are needed to explore this association and utility.
MO968: Vascular Complications of Renal Transplantation: Risk Factors and Impact on Graft Survival
Authors: Zaghbib Selim , Chakroun Marouene , Saadi Ahmed , Boussaffa Hamza , Bouzouita Abderazzak , Derouiche Amine , Ben Slama Riadh , Bacha Mongi , Abdallah Taieb Ben , Ayed Haroun , Chebil Mohamed
Published: May 2022

BACKGROUND AND AIMS

Despite the progress made in renal transplantation, vascular complications can occur, jeopardizing the prognosis of the transplant.

This study aims to investigate the risk factors of vascular complications and their impact on transplant survival.

METHOD

We performed a retrospective longitudinal descriptive study including all patients who had a kidney transplant in a Urology department from 1986 to 2017. Transplant Vascular complications included: Arterial thrombosis (AT), Venous thrombosis (VT), hemorrhagic complications (hemorrhage and hematoma) and arterial stenosis (AS). The potential risk factors for vascular complications that were investigated included characteristics related to the recipient, the donor, the transplant and the procedure. The impact of vascular complications on transplant survival was then studied.

RESULTS

A total of 720 patients were included with a mean age of 32.7 years. The transplant was from a living donor in 79% and a brain-dead donor in 21%.

AT occurred in 15 patients (2.1%) and VT occurred in 10 patients (1.4%). Risk factors for vascular thrombosis were recipient age >35 years (P = 0.001; OR = 10.78), recipient smoking (P = 0.005; OR = 1.8), multiple arteries (P  < 0.001; OR = 1.45) and prolonged warm ischemia (P = 0.02). Perirenal hematoma occurred in 11 patients (1.5%) and hemorrhage occurred in six patients (0.8%). The risk factors for bleeding complications were a prolonged pre-transplantation dialysis time (P = 0.03; OR = 1.35), and prolonged warm ischemia (P = 0.02; OR = 1.26). AS was the most frequent vascular complication, occurring in 20 cases (2.8%) and no risk factors were identified.

Transplant survival was 77.9% at 5 years, with a median survival of 15.9 years. Vascular thrombosis led to the loss of the transplant in all cases, and externalized hemorrhage significantly reduced transplant survival (P  < 0.001). Perirenal hematoma (P = 0.42) and transplant artery stenosis (P = 0.25) had no impact on transplant survival (Figure 1).

CONCLUSION

Our study showed that the vascular complications impacted the survival of the transplant and that they were related to factors related to the recipient, the transplant and the procedure insisting on a multidisciplinary and personalized management for each case.
MO972: Impact of Inhibition of Pcsk-9 Among Renal Transplant Recipients with High Cardiovascular Risk
Authors: Alotaibi Torki , Ashry Ahmed Gheith Osama , Maher Nagib Ayman , Hasaneen Ahmed Aboatya Aboatya Hasaneen , MA Halim Medhat , S.H. Mahmoud Tarek , Emam Mohamed , Mostafa Mohamed , Elsayed Zakaria , Nair Prasad
Published: May 2022

BACKGROUND AND AIMS

Monoclonal antibodies inhibiting proprotein convertase subtilisin/Kexin type A(PCSK-9) have emerged as one of the new cholesterol-lowering agents. It is not evaluated among renal transplant recipients despite its favorable safety profile. We aimed to evaluate the safety and efficacy of evolocumab in reducing lipids and cardiovascular events among risky renal transplant recipients. 

METHOD

About 195 kidney transplant recipients—with high cardiovascular risk (>20)—were enrolled in this randomized controlled study during the period between 6.2017 and 6.2018. Patients who received statin and evolocumab (140 mg/2 weeks, group 1, n = 97) while those who were maintained on statin alone comprised group 2 (n = 98). They were followed up for 24 months.

RESULTS

The two groups were comparable regarding their demographics (P  > 0.05). Before enrollment in the study, post-transplant complications were comparable apart from a higher prevalence of NODAT in group 2 (P = 0.033). Smokers were significantly more prevalent in group 1. Basal graft function was significantly higher in group 1 despite equivalent regimen of immunosuppression in both groups (P  > 0.05). Clinically two groups were comparable concerning cardiovascular events and both graft and patient outcomes (P  > 0.05). Basal cholesterol was significantly higher in group 1 (5.5 versus 4.7, P  < 0.001) which dropped significantly after 3 months (versus12 months in group 2) and thereafter (P = 0.031). We observed that triglycerides in the two groups were comparable (P  > 0.05) till the end of the study.

CONCLUSION

Evolocumab is a promising add on lipid-lowering agent. In high risk renal transplant, earlier reduction of cholesterol was observed in the add-on evolocumab group but without significant positive cardiovascular impact.