bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1585FACTORS ASSOCIATED WITH PSOAS MUSCLE INDEX IN PATIENTS WITH MAINTENANCE DIALYSIS: FOR EARLY DETECTION OF SARCOPENIA
Authors: Mori Yoshiko , Sawada Tomohiro , Sunohara Keisuke , Owaki Akiko , Nagaya Hiroshi , Inaba Shinichiro 
Published: June 2020

Abstract

Background and Aims
Frailty was known to be associated with higher rates of hospitalization and mortality in dialysis patients, and sarcopenia was documented as the biological substrate of physical frailty. Therefore, early-detecting sarcopenia in dialysis patients is important for improving prognosis. The aim of our study was to investigate the factors associated with low skeletal muscle mass in dialysis patients.

Method
We recruited 134 Japanese patients (male 94, female 40; 117 maintenance hemodialysis, 11 chronic peritoneal dialysis and 6 both HD and PD) who underwent maintenance dialysis at our hospital during April 2019. Computed tomography (CT) imaging at the third lumbar vertebrae level was used to measure the psoas muscle mass index (PMI, psoas muscle area (cm2)/ height (m2) ), and low skeletal muscle mass was defined as under 6.36 cm2/m2 in male and 3.92 cm2/m2 in female.

Results
The prevalence of low skeletal muscle mass was 19.4% in dialysis patients (26/134). The median values of PMI were 5.13 and 7.42 cm2/m2 in low skeletal muscle mass group and normal group, respectively. Univariate analysis identified variables associated with low skeletal muscle mass as follows: gender, age, body mass index, waist circumference, presence of coronary artery disease, total protein, albumin, asparate aminotransferase, γ-glutamyl transpeptidase, phosphorus, visceral fat area and subcutaneous fat area. Multiple logistic regression analysis using above significant factors identified independent variables associated with low skeletal muscle mass as follows: gender (male) (odds ratio [OR], 12.91; 95%confidence interval [CI], 2.50-66.57; p&lt;0.01), age (per 1 year aging) (OR, 1.07; 95%CI, 1.00-1.14; p&lt;0.05), waist circumference (per 1cm decrease) (OR, 1.11; 95%CI, 1.04-1.19; p&lt;0.01), and albumin (per 1g/dL decrease) (OR, 5.55; 95%CI, 1.49-19.9; p&lt;0.05). In sub-analysis targeting only male patients, age (per 1 year aging) (OR, 1.09; 95%CI, 1.01-1.17; p&lt;0.05), waist circumference (per 1cm decrease) (OR, 1.13; 95%CI, 1.05-1.21; p&lt;0.01) and albumin (per 1g/dL decrease) (OR, 5.88; 95%CI, 1.39-25.9; p&lt;0.05) were independent factors associated with low skeletal muscle mass.

Conclusion
In patients who underwent maintenance dialysis, age, waist circumference and albumin could be predictive factors of low skeletal muscle mass. Dialysis patients with such factors are recommended to evaluate nutritional status and physical performance to identify sarcopenia earlier and prevent progressive course of sarcopenia and frailty.
P1607CD 137 SIGNALING IN REGULATORY DENDRITIC CELLS IS REQUIRED FOR SUPPRESSING A SYSTEMIC INFLAMMATION IN THE BM12-INDUCIBLE MODEL OF SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: Lee Jong Soo , Cho Hong Rae , Park Jongha , Yoo Kyung Don , Kwon Byungsuk , Park Hojong , Park Sang Jun , Park Kyungsun 
Published: June 2020

Abstract

Background and Aims
Although CD137 is well known as a costimulatory receptor in T cells, limited information is available for its immunoregulatory function. Here, we report that CD137 signaling maintains CD11b+ regulatory dendritic cells (DCs) that can suppress activation of donor TH1 and TH17 CD4+ T cells in chronic graft-versus-host disease (GVHD).

Method
Chronic GVHD can be induced by mouse BMT models in which donor and recipient strain combination is MHC class I identical but MHC II mismatched. This chronic GVHD model recapitulates human SLE.

Results
: The deletion of CD137 in recipient mice shifted the disease phenotype toward acute GVHD, which was caused by the activation of donor T cells. CD137-/- recipients had had characteristic changes associated with acute GVHD: 1) there were defects in differentiation of T follicular helper (TFH) cells, germinal-center B cells, and plasma cells, and production of anti-DNA IgG1 autoantibody; 2) their splenic DCs showed dysregulated expression of DC-specific transcription factors and pro-inflammatory genes, and 3) there were strong activation of donor T cells but decreased Treg cells in the CD137-/- recipient spleen. CD11b+ splenic DCs stimulated with agnostic anti-CD137 antibody and CpG markedly increased expression of immunomodulatory genes, and such regulatory DCs inhibited acute GVHD in CD137-/- recipients. Their suppressive action was mediated through IL-10 that is indispensable for the induction and expansion of peripheral Treg cells.

Conclusion
Our study identifies CD137 signaling in DCs as an important braking point to prevent systemic inflammation, and this control system may be considered as a therapeutic strategy for a variety of inflammatory and autoimmune diseases.
P1639DEVELOPMENT OF SELF-LIMITED LOW-LEVEL BK VIREMIA/VIRURIA SUGGESTS IDEAL IMMUNOSUPPRESSION TO SUPPRESS T-CELL AND ANTIBODY-MEDIATED REJECTION AND PRESERVE KIDNEY ALLOGRAFT FUNCTION
Authors: Näf Bettina , Müller Thomas , Wuthrich Rudolf Peter , Schachtner Thomas 
Published: June 2020

Abstract

Background and Aims
Polyomavirus BK (BKV) viremia has been suggested as a surrogate marker of overimmunosuppression. Due to recent advances in monitoring strategies and pre-emptive therapy, progression to BKV-associated nephropathy (BKVN) has been reduced. Reduction of maintenance immunosuppression during BKVN, however, has been associated with both T-cell mediated rejection (TCMR), antibody-mediated rejection (ABMR), and inferior kidney allograft outcomes. Although the administration of intravenous immunoglobulins (IVIG) failed to treat BKVN, IVIG may have properties to reduce allosensitization.

Method
We studied 860 kidney transplant recipients (KTRs) predominantly under tacrolimus-based triple-drug maintenance immunosuppression from 2009 to 2018. We identified 130 KTRs (15.1%) with high-level BK viremia &gt;10,000 copies/mL (presumptive BKVN), 180 KTRs (20.9%) with low-level BK viremia &lt;10,000 copies/mL, 85 KTRs (9.9%) with isolated BK viruria, and 465 KTRs (54.1%) with no BK viruria/viremia. Kidney allograft outcomes with respect to TCMR, ABMR, development of de novo donor-specific antibodies (DSA), kidney allograft survival, and estimated glomerular filtration rate (eGFR) slope were analysed. Due to the increased incidence of TCMR and ABMR among KTRs with presumptive BKVN, 48 of 130 KTRs (36.9%) with high-level BK viremia starting from 2015 received IVIG (0.5 g/kg of body weight) on a biweekly basis during BKV replication.

Results
Very interestingly, KTRs with low-level BK viremia/viruria showed a significantly lower incidence of TCMR compared to KTRs with no BK viremia/viruria and KTRs with high-level BK viremia (p&lt;0.05). In addition, KTRs with low-level BK viremia/viruria showed a significantly lower incidence of ABMR compared to KTRs with high-level BK viremia (p&lt;0.05). No differences were observed with respect to the development of de novo DSA (MFI&gt;5000) between KTRs with low-level BK viremia/viruria, KTRs with no BK viremia/viruria, and KTRs with high-level BK viremia (p&gt;0.05). KTRs with low-level BK viremia/viruria showed superior kidney allograft survival and lower eGFR slope compared to KTRs with no BK viremia/viruria and KTRs with high-level BK viremia (p&lt;0.05). The administration of IVIG during high-level BK viremia didn’t impact the development of TCMR, ABMR, development of de novo DSA, eGFR slope, and kidney allograft survival (p&lt;0.05).

Conclusion
Our results show that low-level BK viremia/viruria is associated with suppression of TCMR and ABMR in the early period posttransplantation, and preservation of kidney allograft function in the long-term. The administration of IVIG didn’t prove beneficial to reduce allosensitization among KTRs with high-level BK viremia.
P1648CLINICAL OUTCOMES OF LIVING DONOR KIDNEY TRANSPLANTATION FROM MARGINAL DONORS
Authors: Kinoshita Yoshitaka , Yagisawa Takashi , Sugihara Toru , Takeshima Saki , Kubo Taro , Shinzato Takahiro , Shimizu Toshihiro , Kamei Jun , Akira Fujisaki , Ando Satoshi , Suzuki Motofumi , Kume Haruki , Fujimura Tetsuya 
Published: June 2020

Abstract

Background and Aims
Evidence demonstrating the outcomes of living donor kidney transplantation (LDKT) from marginal donors (MDs) is limited. We retrospectively investigated the clinical outcomes of LDKT from MDs in both recipients and donors.

Method
Clinical data on patients who received LDKT in Jichi Medical University Hospital between 2006 and 2019 were extracted from the medical records. Based on the Japanese guideline for preoperative conditions of donors, they were classified as standard donors (SDs) or MDs, the latter including the elderly and patients with obesity, hypertension, diabetes mellitus, and reduced renal function. Multivariate Cox proportional hazard regression analysis for graft survival was performed using explanatory variables of the donor conditions (MD vs SD) and recipient conditions, including age, gender, duration of dialysis, ABO compatibility, and presence of donor specific antibodies. The estimated glomerular filtration rates (eGFRs) of the donors were compared using an unpaired t-test.

Results
Of the 293 donors, 195 were SDs and 98 were MDs.
Demographics and baseline characteristics of recipients and donors
Recipients of kidney transplants from MDs were associated with a higher incidence of death-censored graft loss than recipients of kidney transplants from SDs.
Kaplan-Meier plots for overall and death-censored graft survival.
Multivariate Cox proportional hazard regression analyses for overall and death-censored graft survival
The eGFRs of MDs before transplantation were significantly lower than those of SDs, while no significant differences were observed between the two groups 3- and 5-years after transplantation.
Comparison of estimated glomerular filtration rates of donors

Conclusion
While the renal prognosis of recipients of kidneys from MDs is poorer than that of recipients from SDs, donating a kidney has no adverse effects on the renal health of MDs. The present study is the most comprehensive study that examined that the outcomes of LDKT from MDs according to the Japanese guideline.
P1649IS BK VIRUS CARCINOGENIC?!
Authors: Saleh Ahmed , Halawa Ahmed 
Published: June 2020

Abstract

Background and Aims
The role of polyomaviruses (PyV) in malignancy is controversial, this can be demonstrated in three ways; Firstly, hit and run mechanism where polyomaviruses contribute to the early phases of oncogenic progression. The second way, where PyV act as a passenger as polyomaviruses neither necessary nor contribute to the oncogenic progression. The third way, where PyV acts as (bystander) as PyV is not related to the malignancy, but PyV could be detected in the anatomically connected sites or neighbouring cells. BKV has been classified as a possible carcinogenic to humans (2b) as there is sufficient evidence that it is carcinogenic to animals, however, BKV carcinogenicity evaluation to humans was inadequate. There are inconsistent data regarding the contribution of BKV to tumors that occur in both animals and humans.

Method
Retrospective analyses of 492 consecutive renal transplant recipients in a single-center, 2010-2018. Data Source: prospectively managed electronic patient records. Malignancy data in both control and BKV infected groups were assessed.

Results
A total of 492 cases were studied, were categorized into 2 groups the BKV infected group (n:73) patients and BKV non-infected group (n: 419) patients, then an assessment of different malignancies in both groups. The BKV infected group had 15 cases out of 73 who had malignancy, while the BKV non-infected group had 28 cases out of 419 totally (Table 1). The association between malignancy in BKV was statistically significant (P-value of 0.038). Moreover, the risk factors involved in the development of malignancy in renal transplant recipients were older age, BK virus infection and maintenance immunosuppression agents (Table 2). Lastly, Logistic regression analysis was used to assess predictors of malignancy among renal transplant recipients. For every one-year increase in age among renal transplant recipients, the odds of having a malignancy increase by 4.6% (p=0.003). Meanwhile, there is a 4 times increase in the odds of having malignancy for recipients who are BK virus-positive vs. those who are BK virus negative (p=0.001). Furthermore, there is a 10 times increase in the odds of having malignancy for recipients who are on sirolimus as a maintenance immunosuppressant vs. those who are on TAC/PRED/MMF (p=0.007).

Conclusion
Our study highlights the statistically significant correlation between BK virus infection and the development of malignancy in renal transplant recipients. However, statistical correlation doesn`t mean causation which makes the potential oncogenic role of BKV is unclear. Also, there is increased reporting of malignancy in patients infected with BKV. Increased vigilance is required for early detection of malignancy in patients infected with BKV not only the patients who are heavily immunosuppressed.
P1663CLINICAL AND PATHOLOGICAL FACTORS INFLUENCING RESIDUAL RENAL FUNCTION AFTER LIVING DONOR NEPHRECTOMY
Authors: Okubo Akihiro , Yokoi Hideki , Sakai Kaoru , Matsubara Takeshi , Yanagita Motoko 
Published: June 2020

Abstract

Background and Aims
Renal function decreases with aging. Aging is associated with significant changes in structure and function of the kidney. On the macrostructural level, kidney cortical volume decreases, therefore total kidney volume (TKV) also decreases with aging. On the microstructural level, the number of glomerulosclerosis increases, therefore nephron number decreases with aging. Some reports show that the decline of TKV and nephron number is accompanied by a reduction in renal function.
However, in the field of living kidney transplantation, TKV and glomerulosclerosis are not fully evaluated as factors influencing the donor’s post-transplant renal function.
Living kidney transplantation is an established renal replacement therapy for end-stage renal disease patients. To predict living kidney recipient’s renal function, one-hour protocol biopsy is conducted during the operation. From one-hour protocol biopsy, donor’s pathophysiological findings such as glomerulosclerosis can be evaluated. In this study, we evaluated the correlation of potential influencing factors including TKV and glomerulosclerosis with pre- and post-transplant renal function in living kidney donors.

Method
This is a retrospective study including all 37 living related kidney donors seen at Kyoto University Hospital from January 2013 to April 2019. Estimated glomerular filtration rate (eGFR) was calculated using equation for Japanese population from serum creatinine levels at pre- and post-transplant. TKV was calculated from the 3D volume-rendered images of enhanced CT (=π/6×length×width×thickness), and adjusted to standard body surface area (BSA) by individual BSA. The ratio of number of non-glomerulosclerosis per that of whole glomeruli (non-GS) was evaluated by protocol renal biopsy at one hour after renal reperfusion. This study protocol was approved by the Ethics Committee on human research of the Graduate School of Medicine, Kyoto University.

Results
We evaluated 37 living kidney donors (35.1% male, mean age 58.2 ± 12.0 years). Mean pre-transplant eGFR was 75.7 ± 12.1 ml/min/1.73m2, mean post-transplant eGFR; 44.9 ± 7.75 ml/min/1.73m2, adjusted TKV (aTKV); 349.3 ± 58.4 ml, and non-GS; 0.892 ± 0.086. Pre-transplant eGFR was associated with aTKV and aTKV×nonGS (r=0.525, 0.569 respectively, p&lt;0.01). Post-transplant eGFR was associated with age (≧65 years old, p&lt;0.01), aTKV, non-GS, and aTKV×non-GS (r=0.527, 0.344, 0.626 respectively, p&lt;0.05). The rate of eGFR decline was associated with age (≧65 years old, p=0.044), but not with aTKV and non-GS, aTKV×non-GS.

Conclusion
These results suggest that non-GS and age are correlated with post-transplant renal function but not pre-transplant renal function in living kidney donor, and the decline rate of eGFR are correlated with age.
P1664ASSOCIATED WITH SERUM MYOSTATIN LEVEL WITH GAIT SPEED IN RENAL TRANSPLANT RECIPIENTS
Authors: Tang Chi-Chong , Hou Jia-Sian , Chang Yu-Chi , Lu Chia-Wen , Lee Ming-Che , Hsu Bang-Gee 
Published: June 2020

Abstract

Background and Aims
Walking speed test is a usefulness tool for cardiovascular risk stratification in older adults. The inhibition of myostatin in adult significantly increases muscle mass and confers benefits upon measures of performance and metabolism. The present study evaluated the relationship between walking speed test and serum myostatin levels in renal transplant recipients.

Method
Fasting blood samples were collected from 84 renal transplant recipients. Handgrip strength (HGS) was measured using a Jamar Plus Digital Hand Dynamometer for assessment of muscle strength. Gait speed was measured by walking 6 meters at the usual speed. Gait speed &lt; 1 m/s was defined as low gait speed group according to the European Working Group on Sarcopenia in Older People (EWGSOP) criteria. Serum myostatin levels were measured using a commercial enzyme-linked immunosorbent assay.

Results
Thirty-one renal transplant recipients (36.9%) had low gait speed, and they included a lower percentage of use of mycophenolate mofetil (p = 0.003), higher percentage of use of steroid (p = 0.037), older age (p = 0.0090, higher body weight (p = 0.044), body mass index (p = 0.017), skeletal muscle index (p = 0.027), serum triglyceride (p = 0.029), glucose (p = 0.007), blood urea nitrogen (p = 0.041), cystatin C (p = 0.015), while lower estimated glomerular filtration rate from serum creatinine (eGFRcre, p = 0.047) and estimated glomerular filtration rate from serum cystatin C (eGFRcys, p = 0.006) compared with renal transplant recipients with normal gait speed. After adjusting for cofounders associated with low gait speed in these patients by multivariable logistic regression analysis, serum myostatin levels (Odds ratio (OR): 0.943, 95% confidence interval (CI): 0.898–0.990, p = 0.018), and mycophenolate mofetil used (OR: 0.199, 95% CI: 0.050–0.795, p = 0.022) were independently associated with low gait speed in renal transplant recipients. The area under the receiver-operating characteristic (ROC) curve indicates the diagnostic power of serum myostatin levels at predicting low gait speed of renal transplant recipients was 0.769 (95% CI: 0.664-0.854, p &lt; 0.001). Multivariable forward stepwise linear regression analysis also showed that serum myostatin levels (β = 0.353, adjusted R2 change: 0.245, p = 0.001) was positively associated with gait speed values in renal transplant recipients.

Conclusion
In this study, serum myostatin levels is found to be positively correlated with gait speed values and is identified as serum low myostatin levels is associated with low gait speed in renal transplant patients.
P1667ANALYSIS OF RISK FACTORS FOR CMV DISEASE IN KIDNEY TRANSPLANT PATIENTS - SINGLE CENTER STUDY
Authors: Hanzal Vladimir , Slatinska Janka , Hruba Petra , Viklicky Ondrej 
Published: June 2020

Abstract

Background and Aims
Cytomegalovirus (CMV) disease and infection negatively influence outcome of kidney transplantation. The aim of this retrospective study was to analyze risk factors for CMV disease and its influence on kidney graft function and survival.

Method
1050 patients underwent kidney transplantation from January 2014 to December 2018 and received calcineurin inhibitor, mycophenolate mofetil and steroid-based immunosuppression. Recipients with PRA&gt;20% received rATG while others had received basiliximab as induction. 825 out of 1050 patients (78.6%) received CMV prophylaxis (D+/R-, n=173; R+, n=652). Patients were followed up to 71 months /median 38 months/.

Results
CMV tissue invasive disease occurred in 49 out of 1050 patients (4.7%), while CMV infection in 87 patients (8.3%). CMV disease, but not CMV infection, had significant negative influence on graft survival at 5 years post transplantation (p=0.0029). Patients with CMV disease had significantly worse graft function at 4 years post transplantation (p&lt;0.0001). CMV disease occurred in 31 out of 173 patients (17.9%) in D+/R- group vs. 18 out of 652 patients (2.8%) in R+ group. Incidence of CMV infection was 30/173 patients (17.3%) in D+/R- group vs. 57/652 patients (8.7%) with induction therapy. Shortening of CMV prophylaxis was found in 82 patients (9.9%). Leukopenia (≤ 2.0 x 109/L) was observed in 97 (11.7%) patients from those who received CMV prophylaxis, Its shortening significantly increased risk for both CMV infection (20,7% vs. 7.2%, p&lt;0,0001) and CMV disease (8,5% vs. 4,2%, p=0,04). Among most significant risk factors for CMV disease in univariable analysis were CMV mismatch (OR 11, 95% CI: 5,9-20,4; p&lt;0,0001), delayed graft function (OR 2,8, 95% CI: 1,6-5,1; p&lt;0,0001, cadaveric donor (OR 6, 95% CI: 1,5-25,1; p=0,00013) and shortening of CMV prophylaxis (OR 2.1, 95% CI: 0,91-4,86; p=0,08). Multivariable analysis revealed as independent significant predictors of CMV disease DGF (OR 2,29, 95% CI: 1,2-4,3; p=0,01) and CMV mismatch (OR 10,8, 95% CI: 5,7-20,6; p&lt;0.0001) in a model adjusted for type of donor, prophylaxis shortening and leukopenia.

Conclusion
CMV mismatch is the main independent predictor of CMV disease after kidney transplantation in multivariable analysis.