bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1602MICROVASCULAR INFLAMMATION WITHOUT DSA OR C4D: AN ORPHAN CATEGORY IN BANFF CLASSIFICATION WITH INTENSE CAPILLARITIS AND CYTOTOXIC T-CELL INFILTRATION
Authors: Buxeda Anna , Llinàs Laura , Gimeno Javier , Arias Cabrales Carlos , Burballa Tarrega Carla , Redondo Pachon Dolores , Raïch Regué Dàlia , Pérez-Sáez Maria José , Pascual Julio , Crespo Marta 
Published: June 2020

Abstract

Background and Aims
Antibody-mediated rejection (ABMR) associated with donor-specific HLA antibodies (DSA) is the leading cause of late allograft failure after kidney transplantation. Microvascular inflammation (MVI) without detectable circulating DSA or C4d + cannot be classified as ABMR according to Banff-2017. The involvement of intragraft lymphocyte subsets in the development of humoral damage in kidney transplantation (KT) is relevant. We aimed to analyze lymphocyte subset distribution in kidney transplant biopsies (KTBx) with ABMR compared with MVI and with normal KTBx.

Method
KTBx with ABMR, MVI (g+ptc≥2, without DSA) or normal findings were included. DSA were identified with Luminex single antigen assays. Intragraft lymphocyte subsets’ characterization was performed by immunohistochemistry: T-lymphocytes (CD3, CD4, CD8, Foxp3), B-lymphocytes / plasmatic cells (CD20, CD138), NK cells (CD56), macrophages / monocytes (CD68), cytotoxic cells (TIA1) and activated cells (PD1) were evaluated.

Results
We analyzed 34 KTBx: 21 ABMR, 5 MVI and 8 KTBx with normal findings. KT with ABMR and MVI had more proteinuria at the time of the biopsy compared with the normal group (575 mg/24h and 964 mg/24h vs 147 mg/24h, p=0.002 and p=0.005 respectively). DSA were more frequently detected in patients with ABMR (95.2% vs 0% and 37.5%, p&lt;0.001 and p=0.003 respectively). KTBx with ABMR and MVI had increased cytotoxic T-cell infiltration apparently corresponding to NK cells in peritubular capillaries (ptc) compared to normal group. Moreover, both groups showed a greater number of macrophages and monocytes in glomeruli. KT with MVI but not with ABMR had a significantly increased activated cell infiltration (PD1+) in ptc compared to the normal group, and showed an increased cytotoxic T-cell infiltration in glomeruli compared to ABMR and normal groups.

Conclusion
ABMR and MVI have an increased infiltration of NK cells with cytotoxic activity in ptc that differs from the normal group. However, KT with MVI show greater infiltration of activated cells in ptc and cytotoxic T-cell in glomeruli compared to ABMR suggesting the possibility of different activation pathways.
P1603INVOLVEMENT OF SUCCINATE DEHYDROGENASE (SDH) IN DECEASED RENAL TRANSPLANT DONORS' INFAMMATION AND FIBROSIS
Authors: Guillén-Gómez Elena , Silva Irene , Galano Carla , Arce Yolanda , Caballero Francisco , Guirado Lluis , Diaz Encarnacion Montserrat Mercedes 
Published: June 2020

Abstract

Background and Aims
Succinate is a Krebs cycle intermediate that is converted to fumarate by succinate dehydrogenase (SDH). SDH is part of the electron-transport chain of inner mitochondrial membrane (complex II) and its activity depends indirectly on the oxygen availability. Low oxygen states, such as ischemia, can increase circulating succinate levels due to low SDH activity. In renal transplantation, ischemia and hypoxia can increase renal succinate formation and induce the infiltration of immune cells producing TNF-α, increasing inflammation, renal epithelial apoptosis, as well as leukocyte recruitment, binding and migration, which can lead to renal graft damage.

Method
Samples of pre-implantation renal tissue, 17 from living donors and 40 from deceased donors were analyzed by Real-time PCR.

Results
In kidneys from deceased donors SDH expression is downregulated before transplantation and it lasts for at least the first year. Low SDH gene expression at 4 months after kidney transplant is positively correlated with graft renal function (CKD-EPI) at 12 and 24 months (p=0.046, r= 0.6511 and p= 0.0351, r= 0.4731; respectively). In kidneys from deceased and living donors, SDHD is negatively associated with monocyte recruitment (MCP-1) and activation (IL-1β) and positively with the expression of SOD1. Moreover, only in deceased donors, SDHD gene expression correlates inversely with pro-fibrotic (TGF-β1 and vimentin) and inflammatory (TNF-α) molecules, as well as with M1 (CD80, CD86) and M2 (CD163) macrophage markers, all of which are found to be higher expressed in deceased donor kidneys than in living donor ones.

Conclusion
Our results indicate that low gene expression of SDH in kidneys from deceased donors could result in reduced activity of SDH that would reduce the ability to transform succinate to fumarate resulting in succinate accumulation, increasing inflammation and reparation through fibrosis worsening transplant outcome.
P1643TORQUE TENO VIRUS FOR RISK STRATIFICATION OF SUBCLINICAL GRAFT REJECTION AFTER KIDNEY TRANSPLANTATION- A PROSPECTIVE STUDY
Authors: Doberer Konstantin , Böhmig Georg A , Puchhammer-Stöckl Elisabeth , Bond Gregor 
Published: June 2020

Abstract

Background and Aims
Non-invasive monitoring strategies are insufficient to detect patients at risk for subclinical graft rejection after kidney transplantation. The highly prevalent and non-pathogenic Torque Teno virus (TTV) reflects the immunocompetence of its host: high level viraemia indicates strong and low level viraemia weak immunosuppression, respectively. Thus TTV replication might serve as a candidate for immunologic monitoring.

Method
To analyze the association between TTV and subclinical kidney graft rejection, an interim analysis of the prospective “TTV POET” cohort study (DRKS00012335) was performed including data available until 31/01/2019. All consecutive kidney graft recipients transplanted at the Medical University Vienna since 01/12/2016 (n=308) with a protocol biopsy 12 months after transplantation (n=47; median 12.4 months) and stable graft function were included. Biopsy results according to current BANFF classification were analyzed in the context of peripheral blood TTV levels quantified by PCR.

Results
Graft function was excellent (median eGFR MDRD: 57 ml/min/1.73m2, urinary PKR: 92 mg/g). Twenty recipients (43%) had subclinical rejection (borderline TCMR, n=16; ABMR, n=3; TCMR type I, n=1). TTV level quantified at the date of biopsy was lower in recipients with rejection compared to recipients without rejection. The risk for rejection increased by 11% with each log level decrease in TTV copies/ml (RR 0.89, 95% CI 0.85-0.93; p&lt;0.001). Differences in TTV levels were evident not only at the date of biopsy, but already 6 weeks earlier. Patients with biopsies showing chronic leasons, suggesting ongoing allo-reactivity, had a longer period of time with TTV levels &lt;1x106 copies/ml.

Conclusion
Our data suggests an association between TTV level and subclinical graft rejection at 12 months after kidney transplantation. Future clinical trials are necessary to test the potential of TTV guided immunosuppression to reduce subclinical rejection.
P1645VITAMIN K DEPENDENT PROTEINS AFTER KIDNEY TRANSPLANTATION: RESULTS FROM PROSPECTIVE STUDY
Authors: Fusaro Maria , Khairallah Pascale , Aghi Andrea , Plebani Mario , Zaninotto Martina , Cosma Chiara , Aponte Farias Maria A , Cortez Natalia E , Tripepi Giovanni Luigi , Nickolas Thomas 
Published: June 2020

Abstract

Background and Aims
Two Vitamin K-dependent proteins (VDKPs) link bone and vasculature in CKD-MBD: Bone Gla Protein (BGP) and Matrix Gla Protein (MGP). In ESKD, Vitamin K deficiency is highly prevalent and leads to increased levels of inactive VKDPs (undercaboxylated (ucBGP and dephosphorylated (dp)-uMGP), which are linked to greater risk of fractures and severity of vascular calcification. We hypothesized that kidney transplantation (KT) would improve Vitamin K status and lower levels of inactive VKDPs.

Method
Between 2014-2017, we conducted a study in 34 patients to assess changes in VKDPs during the 1st year of KT. In a specialized lab we determined VKDPs pre- and 1-year post-KT: total BGP, uc BGP, total MGP, and dp-uc MGP. We determined the prevalence of Vitamin K deficiency based on levels of uc BGP and dp-uc MGP.

Results
Our cohort had a mean +/- SD age of 48+/-14 years, 32% were female and 97% were Caucasian. 1 year post-KT, there was a decrease in the levels of all VKDPs and the prevalence of Vitamin K deficiency (Table 1 and Figure 1). Patients with greatest severity of Vitamin K deficiency pre-KT had the largest decreases of inactive VDKPs post-KT.

Conclusion
KT was associated with improvement in Vitamin K status as manifested by decreased levels of inactive VKDPs. These are the first prospective data on VKDPs in CKD patients pre- and post-KT. Studies are needed to assess the impact of improvement in VKDP status after KT on CKD-MBD outcomes.
P1653METABOLIC SYNDROME-RELATED DIETARY PATTERN AND RISK FOR MORTALITY IN RENAL TRANSPLANT RECIPIENTS
Authors: Cai Qingqing , C.J. Osté Maryse , Dekker Louise H , Gomes-Neto António W , Bakker Stephan , De Borst Martin , Navis Gerjan 
Published: June 2020

Abstract

Background and Aims
The metabolic syndrome (MetS) is an important risk factor for premature mortality in renal transplant recipients (RTR). Diet plays an important role in MetS development. Although an unhealthy diet may affect the long term outcome in RTR, no specific dietary patterns have been established that are linked with MetS in RTR. Reduced rank regression (RRR) has emerged as a method that identifies linear functions of predictor variables (food groups) that explain maximized variation in the response variables (biomarkers). We aim to identify a MetS-related dietary pattern (MetS-DP) in RTR, and to test its association with all-cause mortality.

Method
We included 432 adult RTR who had a functioning graft ≥1 year and were free of diabetes at baseline. The MetS-DP was constructed at baseline using dietary information derived from a 177-item food frequency questionnaire by reduced rank regression (RRR). In the RRR model, six components of MetS were used as response variable (age- and sex- adjusted waist circumference, systolic blood pressure, diastolic blood pressure, serum triglycerides, HbA1c, and HDL cholesterol), and 48 food groups were made as predictor variables. Using Cox proportional regression, we evaluated the association between the Met-DP score and all-cause mortality in RTR.

Results
The MetS-DP was characterized by a high intake of fat processed meat and desserts, and a low intake of vegetables, tea, rice, fruits, milk and vegetarian products. During a mean follow-up of 5.2 ±1.2 year, 64 RTRs (14.8%) died. Multivariate analysis showed that RTR in the highest tertile of MetS-DP score had a higher risk of all-cause mortality (hazard ratio [HR]=2.38; 95% confidence interval [CI],1.16-4.91, P=0.018) compared to the lowest tertile, independent of potential confounders.

Conclusion
The results suggest that the MetS-DP is significantly associated with all-cause mortality in RTR. Dietary measures may be useful to prevent MetS and reduce mortality in RTR.
P1654INCIDENCE AND RISK FACTORS OF THROMBOTIC MICROANGIOPATHY AFTER KIDNEY TRANSPLANTATION
Authors: Futamura Kenta , Norihiko Goto , Fukuhara Hiroki , Nawano Takaaki , Kanda Akiko , Tomosugi Toshihide , OKADA Manabu , Tsujita Makoto , HIRAMITSU Takahisa , Narumi Shunji , Watarai Yoshihiko 
Published: June 2020

Abstract

Background and Aims
Thrombotic microangiopathy (TMA) is characterized by mechanical hemolytic anemia, thrombocytopenia, and renal impairment. TMA that occurs in kidney transplant recipients has multiple etiologies and may be de novo or recurrent. Main causes of TMA among recipients are atypical hemolytic uremic syndrome (aHUS), immunosuppressive drugs, ischemia-reperfusion injury (IRI), viral infections, and antibody-mediated rejection (ABMR). Pathological findings of TMA with thrombosis in glomeruli and arterioles are not rare in graft biopsies, but the clinical signs vary widely by etiologies, and incidence and risk factors for each are uncertain. The purpose of this study is to clarify the current status of TMA after kidney transplantation.

Method
The subjects were 1,336 patients (5,425 biopsy specimens) who underwent kidney transplantation (851 ABO-compatible and 485 ABO-incompatible) at Japanese Red Cross Nagoya Daini Hospital and Masuko Memorial Hospital from January 1, 2000 to June 30, 2018. We investigated patient characteristics and graft survival in 69 patients with pathological findings of TMA (12 with symptomatic TMA and 57 with asymptomatic TMA) and 1,207 patients without findings of TMA. Sixty patients were excluded because of incomplete data or biopsy specimens. TMA patients with acute kidney injury (AKI) were defined as symptomatic TMA in this study.

Results
The incidence of post-transplant TMA was 5.2% (symptomatic TMA : 0.9%, asymptomatic TMA : 4.3%) in our cohort. Multivariate analysis revealed significant risk factors for TMA were presence of donor specific antibodies (DSA) and use of cyclosporine (odds ratio [OR] 3.52; 95% confidence interval [CI] 1.58-7.88; p=0.002 and OR 3.70; 95% CI 1.68-8.11; p=0.001, respectively). Causes of symptomatic TMA were ABMR : 66.7% (5 patients with ABO-incompatibility, 3 with preformed DSA), aHUS : 16.7%, cytomegalovirus and adenovirus infection : 8.3%, and causes of asymptomatic TMA were drug-induced: 40.4% (21 patients with calcineurin inhibitor, 2 with everolimus), ABMR: 31.6% (10 with ABO-incompatibility, 8 with de novo DSA), IRI : 14.0 %. Onset of post-transplant TMA was significantly associated with lower graft survival (Figure A), with a stronger correlation in symptomatic TMA than in asymptomatic TMA (Figure B and C).

Conclusion
TMA with AKI that occurred after kidney transplantation had a poor graft prognosis. Therefore, avoiding transplantation, changing donors or using tacrolimus instead of cyclosporine should be considered for patients with DSA or ABO-incompatibility.
P1656THE IMPACT OF PRE-TRANSPLANT DIALYSIS MODALITY ON EARLY POST-TRANSPLANT PERIOD ADVERSE EVENTS : A PROSPECTIVE COHORT STUDY WITH PROPENSITY SCORE MATCHING
Authors: Boo Hyo Jin , Huh Wooseong , Kim Yon su , Yang Chul-Woo , Kim Yong-Lim , Lee Jong Soo , Kim Joong Kyung , Han Seung Hyeok , Hwang Jung-Won 
Published: June 2020

Abstract

Background and Aims
Among peritoneal dialysis (PD) or hemodialysis (HD) while waiting for a kidney transplant (KT), which is better in terms of KT outcomes has long been of interest. Nowadays it is difficult to agree on which modality is better. The primary objective of this study was to compare the incidence of composite outcomes (delayed graft function, primary non-function, biopsy-proven acute rejection) within 1 year after primary adult KT between recipients taken PD and HD before KT (PD group vs. HD group, respectively).

Method
This study was a prospective, multi-sites cohort study. We used a propensity score matching to control for patients characteristics.

Results
Total 1040 patients were enrolled consecutively. Among them, 1030 patients (248, PD group; 782, HD group) were included in the final analysis. The HD group was older and had higher prevalence of diabetes, higher Charlson comorbidity index score, higher prevalence of positive PRA and more prescription of rituximab than the PD group significantly. After propensity score matching (246, PD group; 476, HD group), there were no differences in baseline characteristics between the two groups. In the whole population, there was no difference in the risk of the composite outcomes between the PD and HD groups (19% vs. 17%, hazard ratio [HR] 1.25, 95% confidence interval [CI] 0.88 ∼ 1.77, p = 0.21). There were also no differences in the risk of each component in the composite outcomes between the two groups. Primary non-function, a component of the composite outcomes did not occur in the both groups. There were no differences in the risks of death, frequency and total duration of re-hospitalization after KT for 1 year, and the changes of eGFR for 1 year between the two groups. The results from the propensity score matched population were consistent with those from the whole population. There was no difference in the risk of the composite outcomes between the PD and HD groups (19% vs. 17%, HR 1.17, 95% CI 0.80 ∼ 1.74, p = 0.43).

Conclusion
The pre-transplant dialysis modality does not affect the incidences of delayed graft function and acute rejection in early period of KT. (NCT01513707)
This study was supported by Baxter Incorporated.
P1658RENAL RECOVERY AFTER LIVER TRANASPLANTATION ALONE IN PATIENTS WITH LIVER CIRRHOSIS AND SEVERE CHRONIC KIDNEY DISEASE WITH NORMAL KIDNEY SIZE
Authors: YANG EUN HYE , Kim Soon Bae , Lee Sung-Gyu 
Published: June 2020

Abstract

Background and Aims
Most guidelines recommend simultaneous liver-kidney transplantation (SLKT) in patients with liver cirrhosis (LC) and severe chronic kidney disease (CKD) over liver transplantation alone (LTA). CKD, however, is not irreversible. This study evaluates the reversibility of kidney disease after LTA based on kidney size.

Method
In this single-center retrospective study, we classified 90 patients with LC and severe CKD into 3 groups: normal kidney-LTA (NK-LTA, n=39), small kidney [both &lt;9cm]-LTA (SK-LTA, n=40), and small kidney-SLKT (SK-SLKT, n=11). Baseline characteristics and renal recovery and survival outcomes were compared among 3 groups.

Results
The NK-LTA group had a lower percentage of hepatocellular carcinoma, a higher pre-LT eGFR, and a shorter duration of eGFR at &lt;60 ml/min and pre-LT dialysis. This group, however, was older, received livers from a higher percentage of deceased donors and had a higher Child-Pugh score. Renal recovery, defined as no hemodialysis (HD) after LT, was found in 79% of those in the NK-LTA group, which was higher than 7.5% of those in the SK-LTA group. Renal survival, defined as patient survival without progression to HD or kidney transplant was found in 56% of patients in the NK-LTA group, which was higher than 2.5% of those of the SK-LTA group.

Conclusion
Patients with LC and severe CKD with normal kidney size may experience reversible kidney disease after LTA. Therefore, kidney after liver transplantation is recommended over SLKT for these patients.
P1661EVOLUTION OF RENAL FUNCTION IN RENAL TRANSPLANTED DONORS PATIENTS IN ASYSTOLE TYPE II. IS THERE A CORRELATION BETWEEN HISTOPATHOLOGY PARAMETERS OF THE DONOR BIOPSY AND THE GRAFT SURVIVAL? EXPERIENCE IN OUR CENTER
Authors: Andrades Gómez Cristina , González Roncero Francisco Manuel , Suárez Benjumea Alejandro , Gascó Martos Blanca , González Corvillo Carmen , De gracia Guindos María del Carmen 
Published: June 2020

Abstract

Background and Aims
With the aim of increasing the number of kidney transplant donors (RT), the use of organs from cadaver donors in asystole (DA) type II of Maastricht has been enhanced in recent years.The important ischemia that this type of donation entails makes it especially complex, resulting in a higher incidence of delayed renal function and non-primary graft function, compared to the TR from donor in brain death.We present our experience with the Mastricht DA type II TR since the beginning of our program in 2013

Method
108 patients with type II performed between January 2010 and June 2019, median follow-up 30 months.

Results
: mean age of the donor 42 years, 65% blood group A, mean Cr at the first month of 3 mg/dl, at the 3rd month of 1.9 mg/dl and currently 1.6 mg/dl. Mean ange of the receptor 46 years, time on dialysis 30 months, 1st transplant all, except 1. PRAc pre TR was &lt; 25%, initial immunosuppression with thymoglobulin, steroids, mycophenolate, and delayed introduction of tacrolimus. 10% never function; 73.5% delayed renal function. 7.2% acute rejection. Survivors of the 1st, 3rd and 5th year recipients are 98%, 98% and 86% respectively. In a innovative way, it has been registered the correlation between histopathology parameters of the donor biopsy and the graft survival.

Conclusion
RT with type II DA has more incidence of delayd renal function and non-primarygraft function, however results in survival and kidney function in our center are very acceptable, comparable to donors in brain death.
P1679HYPOMAGNESAEMIA AND HYPERGLYCAEMIA AFTER KIDNEY TRANSPLANTATION
Authors: Carlsen Rasmus , Svensson My , Birkeland Kåre , Bressendorff Iain , Gulseth Hanne , Åsberg Anders , Midtvedt Karsten , Jenssen Trond Geir 
Published: June 2020

Abstract

Background and Aims
Hypomagnesaemia has been associated with increased insulin resistance and decreased insulin secretion. Recent data suggest that early post-engraftment hypomagnesaemia may play a role in development of post-transplant diabetes mellitus (PTDM). This single-centre study investigated the association between hypomagnesaemia 8 weeks post-engraftment and glucose metabolism changes 1 year after kidney transplantation.

Method
The study included 425 renal transplantation recipients, transplanted at Oslo University Hospital between March 2015 and May 2018. All included patients had functioning grafts with valid blood sampling and oral glucose tolerance tests 8 weeks and 1 year after transplantation. Patients with known pretransplant diabetes and those developing PTDM the first 8 weeks after transplantation were excluded. The association between plasma magnesium 8 weeks after transplantation and HbA1c, fasting plasma glucose and 2-hr glucose after 1 year was tested using both unadjusted and multiple linear regression, adjusted for: gender, age, body mass index (BMI), systolic blood pressure (SBP), tacrolimus (trough), measured glomerular filtration rate (mGFR; iohexol clearance) and plasma triglycerides.

Results
Patients had a median age of 54 (range 18-83) years, 65% were men and mean mGFR 1 year after transplantation was 56 (SD±14) ml/min/1.73m2. Median plasma magnesium was 0.72 (0.46-0.94) mmol/L 8 weeks after Tx and patients with hypomagnesaemia (Mg&lt; 0.7 mmol/L) (n=169) were not different compared to patients with normal plasma magnesium (n=256) regarding age, gender, BMI, tacrolimus, mGFR, SBP or plasma triglycerides after 1 year.
In unadjusted linear regression 1 mmol/L higher plasma magnesium at 8 weeks was associated with the following glycaemic endpoints 1 year after transplantation (β-coefficient, CI 95%, p-value); fasting glucose: HbA1c: +9 mmol/mol (1;16, P=0.02); +0.5 mmol/L (-0.7;1.7, P=0.39); 2-hour glucose: +0.74 mmol/L (-2.5;3.9, P=0.65). In multiple linear regression the following numbers were: Fasting glucose: HbA1c: +8 mmol/mol (0.3;16, P=0.042); +0.7 mmol/L (-0.5;2.0, P=0.26); 2-hour glucose: +2.8 mmol/L (-0.6;6.2, P=0.11).

Conclusion
In both unadjusted and multiple linear regression there was a positive correlation between 8-week plasma magnesium and HbA1c 1 year after transplantation. A similar trend was found for fasting and 2-hour glucose, although this was not statistically significant.