bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1651HLA CW12 IN KIDNEY TRANSPLANT RECIPIENTS IS A NOVEL RISK FACTOR FOR THE DEVELOPMENT OF POST-TRANSPLANTATION DIABETES: A SINGLE-CENTRE RETROSPECTIVE STUDY
Authors: Phagura Nuvreen , Culliford Alice , Evison Felicity , Gallier Suzy , Nath Jay , Briggs David , Sharif Adnan 
Published: June 2020

Abstract

Background and Aims
Counselling kidney transplant candidates for their personalised risk of developing post-transplantation diabetes mellitus (PTDM) requires an understanding of risk factors. While some risk factors are well defined (e.g. age, ethnicity, body mass index), others like HLA typing are heterogeneously reported and lack consistency. The aim of this study was to investigate the association between HLA alleles and PTDM risk.

Method
Data was retrospectively extracted from hospital informatics systems for all kidney transplant recipients at a single-centre between 2007 and 2018, with patients excluded if they had pre-existing diabetes. Electronic patient records were then manually searched and records linked to various sources (e.g. NHS Blood and Transplant tissue typing, Hospital Episode Statistics, national death registry) to create a well-phenotyped cohort. Standard immunosuppression for all kidney transplant recipients during this study period was basiliximab induction with maintenance immunosuppression consisting tacrolimus, mycophenolate mofetil and low-dose corticosteroids. PTDM classification was aligned with International Consensus recommendations.

Results
Data was extracted for 1,560 kidney allograft recipients, with median follow up 5.4 years (IQR 2.7-8.7 years) up to October 2018. PTDM developed in 243 kidney transplant recipients (incidence 15.6%). A range of HLA alleles were examined (e.g. HLA-A, HLA-B, HLA-Cw, HLA-Bw, HLA-DR and HLA-DQ) but only the presence of HLA-Cw12 allele was associated with risk for PTDM (27.4% versus 14.3%, p&lt;0.001) along with a selection of predominately recipient- and transplant related variables. In a logistic regression model, adjusted for all variables with a p-value &lt;0.15 on univariate analysis, recipient HLA-Cw12 was found to be an independent risk factor associated with development of PTDM (Odds Ratio 1.793 [95% confidence interval 1.070-3.002], p=0.027) along with recipient female sex, recipient age, recipient BMI and recipient non-white ethnicity.

Conclusion
HLA-Cw12 allele in the kidney transplant recipient is independently associated with development of PTDM, although it is important to acknowledge association does not imply causality. This association has not been previously reported and requires validation and further investigation to understand any possible underlying biological mechanisms.
P1652IMPACT OF HEPATITIS C VIRUS AND DIRECT ACTING ANTIVIRALS ON JAPANESE RENAL ALLOGRAFT RECIPIENTS
Authors: Okino Kazuaki , Yamazaki Keita , Okada Keiichiro , Fujimoto Keiji , ADACHI HIROKI , Kengo Furuichi , Yokoyama Hitoshi 
Published: June 2020

Abstract

Background and Aims
The impact of hepatitis C virus (HCV) infection on patient survival after renal transplantation was worse. Previously, we found that continuous HCV infection was a significant independent risk factor for actuarial survival (especially at ≥20 years after the transplant procedure) among Japanese renal allograft recipients. This study evaluates the impact of HCV and of the new direct acting antivirals (DAAs) on patient outcomes in renal allograft recipients.

Method
We studied 46 cases (28 males, 18 females; 37 living-donor cases, 9 deceased-donor cases; mean follow-up period 305 months ranging from 2 to 420 months) out of the 315 renal transplanted patients who underwent the first renal transplantation in Kanazawa Medical University since 1974. They had antibodies against HCV: 11 were positive for HCV RNA and received DAAs (Group A, all of them genotype 1b); 27 were HCV RNA positive and did not receive any treatment (Group B); 8 were negative for HCV RNA (Group C) (Fig.1).

Results
All Group A patients had HCV RNA negativity after 2-12 weeks of treatment started, and 11 (100%) achieved a sustained virological response (SVR) at 24 weeks. All of them had no adverse effects by the use of DAAs. In this cohort, no patients in Group A died. On the other hand, 15 (55.5％) of 27 in Group B and 3 (37.5%) of 8 in Group C died. Causes of death among Group B were liver cirrhosis (5 cases), hepatocellular carcinoma (2 case), infections complicated with chronic hepatitis (6 cases) in chronic phase, fibrosing cholestatic hepatitis due to HCV (1 case) after surgery, and cardiovascular disease (1 case). The patient survival rate was significantly higher in Group A patients who received DAAs by Kaplan- Meier life table method (Log Rank test, Kay-square 11.7, p=0.004) (Fig.2).

Conclusion
Our results support the notion that continuous HCV infection was a harmful and that new DAAs were efficient and safe to treat HCV infection after renal transplantation.
P1662COMMERCIAL KIDNEY TRANSPLANTATION: PARTICIPANTS' ATTITUDES AND PERCEPTIONS
Authors: AlRahbi Fatma , Alsalmi Issa 
Published: June 2020

Abstract

Background and Aims
Kidney transplantation is the gold standard for patients with end-stage kidney disease. In view of shortages of available organs, long wait times for possible transplantation, and strict regulation, many patients opt for commercial transplantation. The national diseased program must be a priority with full financial and administrative support. All government agencies including religious affairs must work together to support the program and to provide the citizens with a good transplantation service and ameliorate the impact of commercial transplantation.
This study elicits the reasons and motivations for patients with end-stage kidney disease to elect for commercial transplant.

Method
A questionnaire-based evaluation was conducted during the period from July 2015 until late December 2015. It consisted of 28 multiple choice questions and was distributed to all patients who underwent commercial kidney transplantation.

Results
One hundred and fifty patients were approached to participate and 106 agreed. Of the participants, 60% were male with an average age of 41.5 (SD 14.8) years and ranged from 18 to 83 years. The majority (82%) of our participants were educated ranging from primary to college level. The major reason (71%) for these participants to obtain commercial transplants was stated as the unavailability of a live related donor. Thirteen percent stated that they objected to getting a kidney donated from a family member, and 9% stated that they were worried about taking a kidney from a family member. Finally, 3% of participants stated that they needed prompt transplant and could not wait for a long time for transplant investigations and the workup associated with this program.

Conclusion
Even considering the ongoing ethical debates, number of patients undergoing commercial transplantation is on the rise. The study showed that the most common underlying cause for seeking commercial transplantation is the unavailability of a national transplant program, particularly transplantation from cadaveric sources.
P1666ASSOCIATION OF TACROLIMUS TROUGH LEVEL AND DAILY DOSE RATIO WITH OUTCOMES IN A PROSPECTIVE PREVALENT COHORT OF KIDNEY TRANSPLANT RECIPIENTS
Authors: Cseprekal Orsolya , Marton Adrienn , Török Szilárd , Mucsi Istvan , Wagner Laszlo , Remport Adam , Molnar Miklos Zsolt 
Published: June 2020

Abstract

Background and Aims
Tacrolimus is an integral part of the immunosuppressive regimen after solid organ transplantation. Due to its narrow therapeutic window, it requires frequent serum trough level (C0) monitoring and dose adjustment. Both over-and under treatment may have harmful effects regarding overall mortality and graft survival due to increased risk of cardiovascular diseases, malignancies, new onset diabetes and rejection. C0 and total daily dose ratio (CD) has recently been suggested as a potential predictor of worse graft outcome in the early period after transplantation, however, long term prospective studies are lacking. We hypothesized the association between lower CD ratio and increased risk of death with functioning graft (DWFG), graft loss (GL) and overall death (D) in our prospective cohort study.

Method
Our study included 386 prevalent kidney transplant recipients (205(53%) males, median and IQR age of 47.5 (13.2) years, eGFR 53.5 (22.5) ml/min/1.73m2, time since last transplant 51 (26-79) months) out of a total of 993 enrolled between 2006-2007. Sociodemographic, past medical history, clinical and laboratory data were collected and CD was recorded at baseline and 1 year after the enrollment. The associations between CD and CD2 ratios and above mentioned outcomes were examined using survival models..

Results
The median and IQR of CD was 2.1(1.4-3.2) at baseline and 2.0 (1.3-3.0) 1 year later (CD2). There was 46 (11.9%) DWFG, 79 (20.5%) GL and 68 (17.6%) D, respectively. After adjustment for important confounders (age, gender, eGFR, Charlson score, dialysis duration, donor age, rejection), neither CD (DWGL: HR 0.56(0.30-1.03) p=0.06; GL: HR 0.82(0.50-1.36) p=0.46; D: HR 0.79(0.48-1.32) p=0.38) nor CD2 (DWGL: HR 1.12(0.54-2.31) p=0.74; GL: HR 0.76(0.61-1.97) p=0.78; D: HR 1.19(0.64-2.20) p=0.59) found to be predictors of the outcomes.

Conclusion
CD ratio was not associated with increased risk of death with functioning graft, graft loss or overall death in our prevalent kidney transplant recipients.
P1674KIDNEY TRANSPLANTATION FROM HBSAG+ LIVING DONORS TO HBSAG- RECIPIENTS: CLINICAL OUTCOMES AT A HIGH-VOLUME CENTER
Authors: Wang Xianding , Liu Jinpeng , Lin Tao 
Published: June 2020

Abstract

Background and Aims
Data on kidney transplantation (KTx) from hepatitis B surface antigen (HBsAg)+ donors to HBsAg- recipients [D(HBsAg+)/R(HBsAg-)] are limited. We aimed to report the outcomes of D(HBsAg+)/R(HBsAg-) KTx in recipients with or without hepatitis B surface antibody (HBsAb).

Method
Eighty-three D(HBsAg+)/R(HBsAg-) living KTx cases were retrospectively identified. The 384 cases of KTx from hepatitis B core antibody (HBcAb)+ living donors to HBcAb- recipients [D(HBcAb+)/R(HBcAb-)] were used as the control group. Primary endpoint was post-transplant HBsAg -→+.

Results
Before KTx, 24 donors (28.9%) in the D(HBsAg+)/R(HBsAg-) group were hepatitis B virus (HBV) DNA+, and 20 recipients were HBsAb-. All eighty-three D(HBsAg+)/R(HBsAg-) recipients received HBV prophylaxis, while no D(HBcAb+)/R(HBcAb-) recipients received prophylaxis. After a median follow-up of 36 months (range 6-106) and 36 months (range 4-107) for the D(HBsAg+)/R(HBsAg-) and D(HBcAb+)/R(HBcAb-) groups, respectively, 2/83 (2.41%) D(HBsAg+)/R(HBsAg-) recipients and 1/384 (0.26%) D(HBcAb+)/R(HBcAb-) became HBsAg+, accompanied with HBV DNA+ (P=0.083). The three recipients with HBsAg-→+ were exclusively HBsAb-/HBcAb- before KTx. Recipient deaths were more frequent in the D(HBsAg+)/R(HBsAg-) group (6.02% vs. 1.04%, P=0.011), while liver and graft function, rejection, infection, and graft loss were not significantly different. In univariate analyses, pre-transplant HBsAb-/HBcAb- combination in the D(HBsAg+)/R(HBsAg-) recipients carried a significantly higher risk of HBsAg-→+, HBV DNA-→+, and death.

Conclusion
Living D(HBsAg+)/R(HBsAg-) KTx in HBsAb+ recipients provides excellent graft and patient survivals without HBV transmission. HBV transmission risks should be more balanced with respect to benefits of D(HBsAg+)/R(HBsAg-) KTx in HBsAb-/HBcAb- candidates.
P1678ASSOCIATION OF EPIDERMAL GROWTH FACTOR(EGF) AND EGF RECEPTOR POLYMORPHISMS WITH END STAGE RENAL DISEASE AND ACUTE RENAL ALLOGRAFT REJECTION IN KOREAN POPULATION
Authors: Kang Sunwoo , KIm Byeong Woo 
Published: June 2020

Abstract

Background and Aims
Epidermal growth factor (EGF) has been found to be associated with development and repair mechanisms of several renal diseases. In this study, we hypothesized that single nucleotide polymorphisms (SNPs) of the EGF or its receptor genes might have association with end stage renal disease (ESRD) or acute renal allograft rejection (AR) in Korean patients.

Method
347 recipients of the first renal transplants for ESRD including 63 AR patients among them and 289 healthy adults were included in the study. Five EGF gene SNPs (rs11568835, rs11568943, rs2237051, rs11569017, rs3756261) and four EGFR gene SNPs (rs1140475, rs2293347, rs1050171, rs6965469) were analyzed. The genotypes of these SNPs were analyzed using AxiomTM genome-wide human assay. For statistical analysis we used SNPStats and Haploview version 4.2. Multiple logistic regression models (codominant, dominant, recessive and Log-additive) were produced to obtain odds ratio (OR), 95% confidence interval (CI), and p value.

Results
One SNP (rs11569017) in EGF gene showed significant association with ESRD but not with AR. Another SNP (rs11568835) in EGF gene showed significant association with susceptibility to AR but not with ESRD. One SNP (rs1050171) in EGFR gene showed significant association with susceptibility to AR but not with ESRD.

Conclusion
We suggest that genetic polymorphisms of EGF and EGFR gene may be associated with the risk of development of ESRD and AR in the Korean population.
P1682POST-TRANSPLANT VISIT-TO-VISIT PULSE PRESSURE VARIABILITY AND RISK OF RENAL ALLOGRAFT FUNCTION DECLINE
Authors: Tantisattamo Ekamol , Leelaviwat Natnicha , Lopimpisuth Chawit , Polpichai Natchaya , Vutthikraivit Possawat , Saowapa Sakditad 
Published: June 2020

Abstract

Background and Aims
Pulse pressure (PP) is associated with risk of kidney disease. Association between visit-to-visit PP variability (VVPPV) and renal allograft outcomes is unknown.

Method
VVPPV, variation of PP between each consecutive BP measurement at 4, 12, 24, 36, and 48 weeks after kidney transplantation (KT), was determined by using coefficient of variation (CV = SD/Mean x 100%). VVPPV was then categorized into 12 strata (&lt;5, 5 - &lt;10, 10 - &lt;15, 15 - &lt;20, 20 - &lt;25, 25 - &lt;30, 30 - &lt;35, 35 - &lt;40, 40 - &lt;45, 45 - &lt;50, 50 - &lt;55, and ≥55). Association between the categorized VVPPV and progression of renal allograft function, which was defined by a decrease in estimated glomerular filtration rate (eGFR) after 12-week post-KT, was examined by Cox proportional hazard regression analysis.

Results
Of all 102 renal transplant recipients from a single kidney transplant center, mean age±SD was 54.16±11.73 years and 63 patients (62%) was female. An incidence rate of worsening renal allograft function after 12-week post-KT was 0.017 person-weeks with a median survival time of 36 weeks (Figure 1). Every 5% increase in CV of PP was associated with a 14% increased risk of worsening post-transplant eGFR (hazard ratio (HR) 1.142431, 95% confidence interval (CI) 0.9999617 to 1.305199, and p value 0.050). After adjusted for age, gender, types of induction immunosuppressive medications, pretransplant body mass index category, every increase in 5% CV of PP was significantly associated with a 16% greater risk of worsening post-transplant eGFR (HR 1.160975, 95% CI 1.007967 to 1.337209, and p value 0.038).

Conclusion
VVPPV is an independent predictor of worsening renal allograft function.
P1684MULTI-NATIONAL SURVEY AMONG NEPHROLOGISTS AND TRANSPLANT SURGEONS ABOUT THE SUITABILITY AND ACCEPTANCE OF MARGINAL LIVE KIDNEY DONORS WITH HEAVY SMOKING OR INTERMITTENT DRUG ABUSE
Authors: Arabi Ziad , Hamad Abdullah , Saleh Kaysi , Bukhari Mohammad 
Published: June 2020

Abstract

Background and Aims
Potential kidney donors who actively smoke heavily or had intermittent illegal drug use (IIDU) are mostly excluded from donating a kidney. Tobacco use in kidney donor has been linked to worse outcomes for donors and while less evidence exists for IIDU as they mostly excluded from donation. We conducted a short survey about the suitability of these marginal living kidney donors. The purpose of this survey is to form a consensus on live kidney donor with using smoking or illegal drugs.

Method
This is a cross-sectional survey of nephrologists and transplant surgeons about suitability and acceptance of marginal live kidney donors. We asked physicians about accepting kidney donors who are actively smoking or using illegal drugs. The survey was mainly distributed through AST and ERA-EDTA. The role of these organization is limited to facilitate the distribution of the survey as an external study. We excluded in-training nephrologists or transplant surgeons.

Results
One hundred twenty-two physicians from 22 countries (80% nephrologists and 20% transplant surgeons (TS)) participated in the survey. Most physicians were experienced in pre-transplant evaluation (72% over 6 years’ experience and 68.5% of responders perform donors’ evaluation on weekly or monthly bases). Interestingly, most physicians would allow donation in active smoker with advice to quit later (56.2%) (62% of nephrologists versus only 29% of TS (p=0.002). TS would decline active smoker patients than nephrologists (42% versus 25%, p=0.09). Less physicians considered donors with IDU (after psychiatric counselling) than active smoking (30% versus 56.2%, p=0.00003). There was no difference in acceptance rate for donors with IIDU between TS and nephrologists (33.3% versus 29% respectively, p=NS) or in declining these donors (37.5% versus 45.3%, p=0.4). TS would accept more active smokers to donate if no alternative donor available than nephrologists (29.2% vs. 12.3%, p=0.04) but not IDU (29.2% vs. 25.8%, p=ns).

Conclusion
Active heavy smoking and intermittent illegal drug use are not viewed as solo contraindications for kidney donation by most physicians. Nephrologists and TS did not differ in attitude regarding donors with IIDU. Nephrologist seems more confident to accept donors who are actively smoking with advice to quit afterward while TS would accept them more if no alternative donor available or would decline them completely.
P1685POST-TRANSPLANT LYMPHOPROLIFERATIVE DISORDER (PTLD): SINGLE INSTITUTIONAL EXPERIENCE OF TWO DECADES
Authors: Coelho Inês , Cerqueira Sofia , Romãozinho Catarina , Rodrigues Luís , Leal Rita , Guedes Marques Maria , Santos Lidia , Alves Rui , Figueiredo Arnaldo 
Published: June 2020

Abstract

Background and Aims
Post-transplant lymphoproliferative disorders (PTLD) are a group of heterogeneous lymphoid proliferations in chronic immunosuppressed recipients of solid organ and hematopoietic stem cell transplantation. Due to rarity of this disease, retrospective studies from transplant centers have been the main source to provide knowledge and treatment guidelines, which are still in evolution. This study examined the clinical outcomes and identified the predictors of mortality in adult renal transplant recipients who developed PTLD.

Method
We have studied the incidence of PTLD in adult renal transplant recipients who were transplanted in our hospital from 1996 to 2019. Data was collected for demographics, transplant and immunosuppression history, EBV and CMV serostatus, diagnosis, treatment and outcomes of PTLD. We performed univariate and multivariate analysis to identify prognostic factors. PTLD was classified according to 2018 WHO lymphoma classification.

Results
Twenty-four patients (12 males and 12 females) were eligible for the analysis. Mean age at time of the transplant was 43.1 ± 16.9 years, with a time between grafting and PTLD of 66 months (IQR 36-98 months). Mean follow-up time was 87 months (IQR 61-117 months). 25% of patients received a living donor renal transplant. 12,5% of patients received induction therapy with thymoglobulin. Mean age at time of PTLD diagnosis was 48,8 ± 17,9 years. Five cases were from Epstein-Barr virus (EBV) mismatched (D+/R-) transplants and there was seroconversion at time of PTLD diagnosis. 25% of patients had central nervous system involvement. 19 patients have monomorphic PTLD and the most common histological diagnosis was diffuse large B cell lymphoma. We identified that age &gt;30 years at time of the transplant was predictor of mortality (HR 33.01; 95% CI: 3.24-336.14; p=0.003). Surprisingly, presence of B symptoms at time of PTLD diagnosis confer a better prognosis (HR 0,143; 95% CI: 0,035-0,579; p=0.006). All cases were managed with reduction in immunosuppression and converted to everolimus. 8 patients were treated with rituximab and there was no significant difference in the survival of these patients. By the end of follow-up, 7 patients went into remission, 1 returned to chronic dialysis, and 16 patients died (15 of them due to the disease). Mean time between PTLD and death was 3 months (IQR 1-6 months).

Conclusion
PTLD is an infrequent disease with a poor prognosis in renal transplant patients. Some cases have a close relationship with EBV, but it can also develop in the absence of the classical risk factors. The factor affecting mortality in our population was age &gt;30 years at time of the transplant. Presence of B symptoms at time of PTLD diagnosis seems to confer a better prognosis probably due to early investigation and diagnosis of the disease.
P1687ASSOCIATION OF URINARY MICRORNA-21-5P WITH INTERSTITIAL FIBROSIS AND TUBULAR ATROPHY (IFTA) IN RENAL TRANSPLANT RECIPIENTS
Authors: Gniewkiewicz Michal , Paszkowska Izabela , Gozdowska Jolanta , Czerwinska Katarzyna , Sadowska-Jakubowicz Anna , Deborska-Materkowska Dominika , Perkowska-Ptasinska Agnieszka , Kosieradzki Maciej , Durlik Magdalena 
Published: June 2020

Abstract

Background and Aims
One of the most limiting factors of long-term graft survival is chronic renal allograft dysfunction (CAD). The major hallmarks of CAD are interstitial fibrosis and tubular atrophy (IFTA).
MicroRNAs (miRNAs) are 19-25 nucleotides, small, noncoding molecules involved in the regulation of gene expression. MiRNAs have a role in various immunological processes, including inflammation and fibrosis. Particularly, microRNA-21-5p (miR-21) is reported to be strongly associated with pathogenesis regarding tubulointerstitium.
The aim of this study was to analyse expression levels of urinary miR-21 in the renal transplant recipients and evaluate their application in the assessment of IFTA and kidney allograft function.

Method
The expression levels of urinary miR-21 were measured in 31 renal transplant recipients with biopsy-evaluated IFTA (IFTA 0+I: n=17; IFTA II+III: n=14) by quantitative PCR. Protocolar biopsies were performed 1 or 2 years after renal transplantation. Urine samples were collected at the time of biopsy procedure. MicroRNA-191-5p was used as reference gene. Correlations between the clinicopathological parameters and the level of expression of miR-21 were assessed.

Results
Relative expression level of miR-21 was significantly increased in IFTA II+III group compared to IFTA 0+I group. MiR-21 correlated positively with serum concentration of creatinine and negatively with eGFR. ROC analysis showed diagnostic value of miR-21 with an area under curve (AUC) of 0.80, high sensitivity and specificity.

Conclusion
MiR-21 is associated with IFTA and dysfunction of kidney allograft. It may be considered as potential non-invasive biomarker of renal allograft function.