bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1693LONG-TERM OUTCOME OF KIDNEY TRANSPLANTATION IN PLASMA CELLS DYSCRASIAS
Authors: Zappulo Fulvia , Donati Gabriele , Comai Giorgia , Bini Claudia , Angeletti Andrea , Scrivo Anna , Zamagni Elena , Cavo Michele , La Manna Gaetano 
Published: June 2020

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

Results
The table shows the comparisons between the different population groups and in the Figure is shown the survival functions for each one. Taking into account those results, it cannot be concluded that the age of the donor in these different age groups has significant influence on graft survival with the data we handle.
The multivariate analysis concluded that, for this population group and the data handled, the variables that influence the failure of the graft are: the height of the donor, the sex of the recipient and the time in renal replacement therapy. In no case does the age of the donor influence the survival of the graft.

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

Abstract

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

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

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

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

Abstract

Background and Aims
Glomerulonephritis (GN) is a major cause of end stage renal disease (ESRD)1.
It represents the primary cause of end stage renal disease (ESRD) for 25% of the dialysis population1 and 45% of the transplant population.
For patients with GN requiring renal replacement therapy, kidney transplantation is associated with superior outcomes compared with dialysis2.
The possibility of recurrence of the original disease after transplantation was described in a seminal paper more than 40 years ago, and it is now clear that all forms of GN may recur after kidney transplantation.3
To study the recurrence of glomerulonephritis post-transplant in a tertiary care centre.

Method
120 renal transplant recipients were analyzed from September 2015 to August 2019 at the Institute of Nephro-Urology, Bangalore.
It was a retrospective analysis of data

Results
120 adult patients underwent kidney transplantation, out of these 70 had GN as primary cause of kidney disease.
85.8% were males, 14.2 % females.
58.9 % were biopsy proven GN, remaining 41.1 % diagnosed based on history and clinical presentation.
All but one patient had their first transplant.
Out of these kidney transplant recipients 08 (11.4%) had recurrence of GN.  From these 4/08 was recurrent IgA N, 2/08 were PGNMID, 1/08 MGN, 1/08 aHUS. Graft loss due to recurrent GN was seen in 1/08 patients (12.5%).

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

Results
We included 17 patients with low-dose ATG induction (group1) and 20 patients with Basiliximab induction (group2). Mean recipient age was 42.9 and 45.9 yr in group 1 and 2 whereas mean donor age was 50.6 and 51.6 yr respectively. Male recipients were 76.4% (13/17) and 65% (13/20) in group 1 and 2 respectively; male donors were 11.7% (2/17) and 20% (4/20) respectively (not signficant). Average HLA mismatches were 3.4/6 and 3.7/6 (not significant). In group1 average transfusions per patient were 6units (vs 1.7units in group2) and 65% pts in group1 had &gt;3 units transfusion (p&lt;0.05). Mean follow-up was 12.7 and 20.7 months respectively.
Incidence of acute rejection was 5.8% (1/17) and 10% (2/20) in group 1 and 2 respectively. (not significant).
Incidence of CMV viremia requiring valganciclovir therapy was 11.6% (2/17) and 10% (2/20) in group 1 and 2 respectively. (not significant). No patient developed CMV disease.
Mean serum creatinine was 1.1 and 1.09 mg/dL at 1 month and 1.2 and 1.14 mg/dL at 3 months (not significant)

Conclusion
The incidence of CMV viremia is low and not significantly different in patients receiving basiliximab or low dose ATG induction in living donor kidney transplants on tacrolimus based immunosuppression. In our study patients in ATG group had significantly more transfusions vs basiliximab group and hence were more sensitised. Still the incidence of acute rejection remained low in both these groups (5.8% and 10%).
Hence universal prophylaxis with valganciclovir may not be required in all the patients with basiliximab and low dose ATG induction especially in developing countries where cost of therapy is borne by the patients.