bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1727DECEASED DONOR KIDNEY CHARACTERISTICS AND IMPACT ON 10-YEAR GRAFT SURVIVAL - A LONG-TERM OBSERVATIONAL STUDY
Authors: Ng Chee Yong , Yeon Wenxiang , Kee Terence , Yap Yun Ting , Chionh Chang yin 
Published: June 2020

Abstract

Background and Aims
The long waiting list for deceased donor kidney transplantation has prompted the use of Expanded Criteria Donors (ECD) though it is possibly associated with worse graft function and outcomes than Standard Criteria Donors (SCD). Our centre had also implemented a protocol kidney biopsy at implantation from 2005 to 2009.
The aim of this study was to evaluate the impact of donor factors and donor kidney histology on 10-year graft outcomes.

Method
A retrospective analysis was performed on 108 kidney transplant recipients who underwent a protocol biopsy at implantation from November 2005 to November 2009. The biopsy sample was evaluated for glomerulosclerosis, tubular atrophy, interstitial fibrosis and arteriolar narrowing and scored according to Remuzzi et al., N Engl J Med. 2006;354(4):343 (Remuzzi score). Donor factors evaluated were donor age, hypertension, diabetes mellitus, and terminal serum creatinine. The 10-year graft survival and estimated glomerular filtration rate (eGFR) was the main outcome of interest.

Results
The deceased donors included 58% males, 85% Chinese, with a median age of 49 (IQR 12) years. There were 13% diabetics, 51% hypertensive donors and the median terminal creatinine was 95 umol/L. The recipients were 51% male, 79% Chinese, with a median age of 47 (IQR 11) years at transplant. The time interval to transplant was 9.2 (IQR 3.0) years and the overall 10-year graft survival was 67.6%.
Remuzzi score of ≤3 was associated with better 10-year graft survival compared with Remuzzi score of &gt;3 (76.6% versus 45.2%, P =0.02). 10-year graft survival for SCD and ECD was not statistically different (71.6% versus 58.8%, P=0.187).
A multivariate analysis was performed which included donor status (ECD vs SCD), Remuzzi score (&gt;3 vs ≤3), donor age (≥60 or &lt;60 years), donor hypertension, donor diabetes mellitus and terminal serum creatinine (≥133 umol/L versus &lt;133 umol/L). Only Remuzzi score correlated with a better 10-year graft survival rate (P=0.020). All other factors did not correlate with 10-year graft survival.
Amongst the 73 ten-year graft survivors, the median eGFR at year 10 was 47.5 (IQR 20.3) ml/min if the Remuzzi Score was ≤3 while the eGFR was 39.7 (IQR 33.0) ml/min if Remuzzi score was &gt;3. However, this difference was not statistically significant (P=0.570).
The 10-year eGFR was 45.8 (IQR 22.2) for SCD kidney recipients vs 49.5 (IQR 25.6) for ECD kidney recipients. Paradoxically, the median eGFR was higher with the ECD cohort but this was not statistically significant (P=0.443).

Conclusion
An implantation Remuzzi score of more than 3 is associated with poorer long-term graft survival as compared to other donor factors evaluated on 10-year graft survival or eGFR. Where possible, assessment of the kidney histology should be included as part of the kidney selection and allocation process in order to determine long term outcomes.
P1728FUROSEMIDE STRESS TEST PREDICTS DISCHARGE SERUM CREATININE AFTER KIDNEY TRANSPLANTATION
Authors: Coca Armando , Tabernero Guadalupe , Arias-Cabrales Carlos , Sanchez Gil Jimmy Reinaldo , Menacho Miguel Jose Antonio , Pérez-Sáez Maria José , Mendiluce Alicia , Martin Centellas Jesus , Pascual Julio 
Published: June 2020

Abstract

Background and Aims
Acute tubular necrosis is a common complication after kidney transplantation and is closely related to delayed graft function (DGF) and slower graft function recovery after surgery. The furosemide stress test (FST) uses a standardized dose of furosemide to evaluate the integrity of the renal tubule and determine which patients have developed severe tubular damage. We aimed to apply the FST to a sample of incident deceased-donor kidney transplant recipients and describe its association with DGF and serum creatinine (SCr) at discharge.

Method
Single-center prospective observational study of deceased-donor kidney transplant recipients. The FST, a standardized bolus dose of furosemide (1.5 mg/kg) was administered between the 3rd and 5th day after surgery. Patients were excluded if, during that time period, they presented evidence of active bleeding, obstructive uropathy or volume depletion. Urine output (UO) 60 and 120 min after FST was registered. To reduce the risk of hypovolemia, each ml of UO produced for six hours after FST was replaced with 1 ml of normal saline.

Results
25 patients were included in the study. Mean 2h FST UO was 1012±570 ml. Demographic and clinical data are summarized in Table 1. Subjects that suffered DGF had a significantly lower 2h FST UO (534 vs 1164 ml; P=0.015). In adjusted linear regression analysis only a 2h FST UO&lt;1000 ml (β=0.906; 95%CI: 0.04-1.772; P=0.041) and DGF (β=1.592; 95%CI: 0.488-2.696; P=0.008) were independent predictors of SCr at discharge (model adjusted for recipient age, cold ischemia time, number of HLA mismatches, donor SCr and donor hypertension).

Conclusion
Recipients with a 2h FST UO &lt;1000 ml suffered DGF more frequently. FST and DGF were independent predictors of SCr at discharge. A standardized FST could help clinicians distinguish patients with more severe tubular dysfunction and higher risk of DGF.
P1733MINERAL BONE DISEASE (MBD) IS THE POST KIDNEY TRANSPLANTATION POPULATION
Authors: Ryan Louise , Ruane Eva , Watson Alan , Holian John , O'Riordan Aisling 
Published: June 2020

Abstract

Background and Aims
Patients with ESRD have a 4-fold higher risk of fracture compared to the general population. (1) Transplant bone disease is a combination of mineral bone disease sustained pre transplantation and damage incurred post transplantation, risk factors for which include immunosuppression and immobility in the early post transplantation period. Given the high morbidity, mortality and financial burden associated with fractures, the management and prevent of osteoporosis is fundamental. (2) We aimed to compare the management of MBD in our patient cohort to international nephrology and rheumatology guidelines. (1, 3)

Method
A retrospective review of all patients post kidney transplantation attending our department was carried out. Information pertaining to patient demographics, renal history, osteoporosis investigation and management was collected. The results were analysed with Microsoft Excel.

Results
154 patient records (92 male, 62 female) were reviewed. Mean age was 52 years (range 19-80). Mean eGFR was 54ml/min (range 9-90). 82% of patients were taking corticosteroids, the mean dose was 5mg. 9% were taking corticosteroids pre-transplantation. 11 patients (7%) had a history of parathyroidectomy. 19% of patients had a history of a fracture. 26% of patients had a DEXA scan performed which demonstrated 50% had osteopenia and 29% had osteoporosis. The mean fracture risk assessment tool (FRAX) score (risk of having an osteoporosis-related fracture in the next 10 years) for a major osteoporotic fracture was 10.2% (range 2.1-34%) and for a hip fracture was 3.1% (range 0.2-18). Based on these scores 19% and 26% of patients respectively met the criteria for treatment. Overall, 58% of patients were on treatment for either osteoporosis prevention or management or for mineral bone disease. 74% of patients with osteopenia were on treatment (32% calcium supplementation, 5% alfacalcidol, and 63% cholecalciferol). 82% of patients with osteoporosis were on treatment (45% cinacalcet, 36% cholecalciferol, 18% bisphosphonate and 9% denosumab). 27% of patients with osteoporosis were managed in keeping the guidelines.

Conclusion
Our cohort have significant risk factors for osteoporosis including maintenance corticosteroid treatment and previous fractures. There is a high prevalence of osteoporosis in our cohort compared to that reported internationally (4) and they had a high predicted rate of future fractures. Increased screening with targeted treatment is required to reduce the risk of fractures in our post renal transplant patients.
P1748PARATHYROIDECTOMY REMAINS EFFECTIVE FOR TREATING TERTIARY HYPERPARATHYROIDISM: LONG-TERM RESULTS OF A RANDOMIZED STUDY
Authors: Coloma Lopez Ana , Moreno Pablo , Torregrosa Jose-Vicente , Montero Nuria , Manonelles Anna , Melilli Edoardo , Cruzado Josep 
Published: June 2020

Abstract

Background and Aims
Tertiary hyperparathyroidism is a common cause of hypercalcemia after kidney transplant (KT) and has been associated with renal dysfunction, loss bone mineral density and increased risk of fracture, vascular calcification, and increased risk of cardiovascular events. Long clinical management remains controversial. The aim of this study is to evaluate the long-term effectiveness and safety of parathyroidectomy versus cinacalcet in patients with persistent hyperparathyroidism.

Method
A 12-month prospective, multicenter, randomized study demonstrated than subtotal parathyroidectomy is more effective than cinacalcet for controlling hypercalcemia. Now, we evaluate in the same cohort of patients if this effect is maintained after 5 years of follow-up. Laboratory assessment included serum calcium, serum phosphate, intact parathyroid hormone (iPTH), calcidiol levels, estimated glomerular filtration rate and proteinuria at 2, 3, 4 and 5 year follow-up. Therapeutic details about the use of vitamin D, calcium supplementation and phosphate binders were compiled. Fragility fractures were also collected.

Results
In total, 24 patients had data available at 5 years, 13 in the cinacalcet group and 11 in the parathyroidectomy group. At 5 years, six of 13 patients in the cinacalcet group and ten of 11 patients in the parathyroidectomy group (p=0.015) showed normocalcemia (Figure 1). Subtotal parathyroidectomy retained a greater reduction of iPTH compared with cinacalcet group (Figure 2). No differences were observed in kidney function and incidence of fragility fractures between both groups. In relation of treatment, 8 of 13 patients in cinacalcet group maintained treatment with cinacalcet after 5 years follow-up.

Conclusion
Subtotal parathyroidectomy is more effective in long term to maintain normal serum calcium and iPTH compared with cinacalcet in kidney transplant patients with tertiary hyperparathyroidism.
P1750IMMUNE-ADSORPTION COLUMNS IN ABOI INCOMPATIBLE RENAL TRANSPLANTATION: EXPERIENCE FROM DEVELOPING WORLD
Authors: Sharma Sourabh , Mukherjee Debabrata 
Published: June 2020

Abstract

Background and Aims
We present our experience of ABO-incompatible renal transplant using immunoadsorption (IA) columns. We have compared efficacy of two commercially available columns

Method
This single-center prospective study was conducted at Army Hospital Research and Referral, Delhi. All consecutive ABO-incompatible renal transplants from January 2014 to February 2018 were analyzed. Of 30 patients who underwent transplantations, 28 underwent antibody depletion with immunoadsorption columns. Of them, 14 cases were in the “Glycosorb group,” while 14 in the “Adsopak group.”

Results
The donors in the Adsopak group were older than those in the Glycosorb group (p &lt; 0.05). Both groups had spousal donors in majority. The cutoff for the antibody titer was 1:8. Themedian titer in the Adsopak group was 128 (range, 1:4 to 1:2048), while that in the Glycosorb group was 24 (range, 1:8 to 1:128). All patients in the Glycosorb group had baseline titers 1:128, while 13 patients in the Adsopak group had baseline titers 1:512. Nil titer was achievable with Glycosorb®(50%,7/14) but notwith Adsopak®(P&lt; 0.001). The Glycosorb group was advantageous in terms of graft failure because no rejection was noticed in these patients in their follow-up period. Three patients in the Adsopak group developed rejection (two had mixed rejection, and one had antibody-mediated rejection). Four patients died of sepsis (three in the Glycosorb and one in the Adsopak group). Lower baseline serum creatinine level was achieved in the Glycosorb group.

Conclusion
Results of ABO-incompatible renal transplantation were satisfactory, and the use of immunoadsorption columns could effectively deplete antibody titers. Glycosorb columns were more efficient than Adsopak columns. Graft survival was better with Glycosorb. Post-transplant infections were a major cause of mortality.
P1751THE GUANYLATE CYCLASE C AGONIST LINACLOTIDE LIMITS PROGRESSION TO RENAL FIBROSIS AND IMPROVE RENAL FUNCTION IN MOUSE MODEL OF CHRONIC KIDNEY DISEASE AFTER ISCHEMIA-REPERFUSION INJURY
Authors: Nakayama Yuki , Isoyama Naohito , Nakamura Kimihiko , Hiroyoshi Toshiya , Fujikawa Kouki , Matsuyama Hideyasu 
Published: June 2020

Abstract

Background and Aims
Renal ischemia-reperfusion injury (IRI) is a clinically significant condition that leads to acute kidney injury (AKI). AKI is followed by tissue repair characterized by collagen deposition and fibrosis which ultimately results in progression to chronic kidney disease (CKD). Especially in renal transplantation, the degree of IRI has directly led to poor long-term graft survival. Trimethylamine-N-oxide (TMAO), a hepatic metabolic product of trimethylamine generated from dietary phosphatidylcholine, has been linked with progression of CKD. Linaclotide, a guanylate cyclase C agonist, has been reported decrease the plasma levels of TMAO. We investigated whether the reduction of TMAO by linaclotide protect renal function after IRI using an experimental mouse model.

Method
Linaclotide (100μg/kg) was administered for 2weeks before IRI and continued for 2weeks after IRI. After 2weeks since IRI, the renal function was evaluated by serum creatinine level and removed kidneys sections were performed Azan stain to evaluate the level of fibrosis.

Results
The administration of linaclotide before IRI significantly improved renal function. (Fig.1) Histological examination of kidneys showed linaclotide limits to expand fibrosis area after I/R injury. (Fig.2)

Conclusion
The reduction of TMAO by linaclotide before renal IRI could prevent renal fibrosis and improve renal function. Linaclotide may be useful for the patient expected to suffer renal IRI for example renal transplantation and partial nephrectomy.
Fig2
P1754ASSOCIATION OF GUT MICROBIAL FERMENTATION WITH DIARRHEA IN KIDNEY TRANSPLANT RECIPIENTS
Authors: Guedes Rodrigues Fernanda , Casper Swarte Johann , M. Douwes Rianne , J. Knobbe Tim , Pfeferman Heilberg Ita , Bakker Stephan , De Borst Martin 
Published: June 2020

Abstract

Background and Aims
Diarrhea is a common complaint by kidney transplantation recipients (KTR). Metabolic abnormalities and immunosuppressive drugs may cause alterations in the gut microbiome possibly leading to diarrhea. A hydrogen (H2) breath test, reflecting nutrient fermentation, can detect changes in the composition of gut microbiota. In the present study, we studied the association of exhaled H2 with diarrhea in KTR, and investigated its determinants.

Method
All data were collected from the TransplantLines Biobank Cohort Study (NCT03272841). Living kidney donors were used as healthy controls. Breath H2 concentrations were analysed using solid state-sensor gas-chromatography. The stool water content was measured by faecal dry matter analysis and diarrhea was classified as &gt;80% of water content in stools. Age, sex, body mass index (BMI), diabetes mellitus, eGFR and immunosuppressive medication were tested as potential determinants for H2 using linear multivariable regression.

Results
We included 424 KTR (mean age 55.4 ± 13.2 years, 39,1% female, transplant vintage 5.5 ± 9.5 years) and 164 healthy controls in this study. Immunosuppressive drugs included tacrolimus (78.5%), mycophenolate mofetil (MMF, 73.3%), cyclosporine (9.0%), and everolimus (2.4%) in various combinations. The median concentration of H2 in exhaled breath was significantly higher among KTR versus healthy controls (11.0 ppm [5.0 - 25.0] vs 9.0 ppm [4.0-22.5] p=0.005). The exhaled H2 was correlated with stool water content (r=0.24, p=0.04), as shown in figure 1. Serum tacrolimus trough levels were associated with exhaled H2 (standardized β=0.14, p=0.01), independent of age, sex, BMI, diabetes mellitus, eGFR and other immunosuppressive medication. In contrast, MMF trough levels were not independently associated with H2 (standardized β=0.07, p=0.21).

Conclusion
Exhaled H2, a marker of gut fermentation, is higher in KTR compared to healthy controls, and is associated with stool water content. Present results suggest that altered gut microbial fermentation contributes to the occurrence of diarrhea in KTR. Tacrolimus trough level was an independent determinant of H2. These data encourage further studies to validate the association of immunosuppressive drugs, gut microbiota and post-transplant diarrhea.
P1763TUBERCULOSIS IN RENAL TRANSPLANT RECEPIENTS - DO RITUXIMAB AND OTHER IMMUNOSUPRESSION HAVE A ROLE?
Authors: Kaul Anupma , Bhaduria Dharmendra , Prasad Narayan , Gupta Amit 
Published: June 2020

Abstract

Background and Aims
Rituximab is an anti CD 20 agent used widely in renal transplant recipients. Its use is associated with various infections;however, its association with Tuberculosis (TB) is not well established and has not been studied in post renal transplantation patients.

Method
This is a single centre, retrospective analysis of 56 renal transplant recipients who received rituximab for various reasons and 287 post renal transplant patients who did not receive rituximab during the study period from January 2013 to June 2017. The association between use of rituximab and incidence of TB was studied. Other factors associated with tuberculosis were also investigated.

Results
Baseline characteristics were similar in both the groups. Mean time for occurrence of TB was 18.4 + 10.6 months after renal transplantation. Rituximab use was not significantly associated with tuberculosis or any other infection. Higher number of rejection episodes (60% vs 32.72%, p=0.029) was the only factor associated with greater incidence of TB. However, no specific type of rejection was associated with tuberculosis. Use of plasmapheresis in post transplant period for treatment of humoral rejections was associated with significantly higher incidence of TB (33.33% vs 13.41%, p=0.031), however when pre- transplant plasmapheresis was also considered, there was no significant difference. The choice of induction agent was not associated with higher incidence of TB.

Conclusion
Use of rituximab is not associated with higher incidence of TB when compared to other immunosuppressive agents. Routine screening and prophylaxis may not be advisable especially in a country like India with high prevalence of TB; as it will further delay transplantation and may adversely affect the outcome of the patients.
P1764EXPRESSION OF TOLL-LIKE RECEPTOR 4, BUT NOT THE TOLL-LIKE RECEPTOR 2, MAY BE USEFUL I ASSESING THE RISK OF RENAL TRANSPLANT DETERIORATION IN RECIPIENTS WHO HAVE RECOVERED FROM CYTOMEGALOVIRUS INFECTION
Authors: Zmonarski Sławomir , Banasik Mirosław , Gołębiowski Tomasz , Krzysztof Letachowicz , Zmonarska Joanna , Myszka Marta , Madziarska Katarzyna , Magdalena Krajewska 
Published: June 2020

Abstract

Background and Aims
Data binding the expression of Toll-like (TLR) 4 receptor (TLR4ex), or TLR2 receptor (TLR2ex) and transplanted kidney (KT) function and symptomatic infections with CMV (CMV+) and are scarcely available.
Objective: To investigate the relationships between TLR4ex and TLR2ex, a relapse of CMV+ and transplant function.

Method
Materials and methods: TLR4ex and TLR2ex were measured in peripheral blood mononuclear cells of KT recipients.
We compared TLR4ex and TLR2ex among 25 CMV+ patients; 81 patients without CMV infection (CMVn). At the beginning (Day-0) TLR4ex, as well as concentrations of cyclosporin A (CyA) and tacrolimus (TAC) were determined.
Both CMV+ and CMVn patients were divided according to the respective median of TLR4ex into groups of low-TLR2/4 expression (L-TLR2/4ex) and high-TLR2/4 expression (H-TLR2/4ex). Glomerular filtration rate (EGFR) was assessed on Day-0 and after the follow-up (F-up). The magnitudes of EGFR change (ΔEGFR) were evaluated. Stable treatment along the F-up period (median 11.9 months) was applied.

Results
Results. In CMV+ TLR2ex of 64,3% and TLR4ex in 67% is below respective median. Past CMV strongly affected TLR2ex and moderately TLR4ex. On Day-0: in CMV+ we found no link of TLR2 ex and TLR4ex with EGFR; In CMV+ TLR2ex and TLR4ex were lower but Day-0 EGFR did not differ from H-TLR2 or H-TLR4ex. In CMVn: GFR-TLR4ex link was present with no similar in case of GFR-TLR2ex. In patients treated with tacrolimus CMV strongly affected TLR4ex, blurring CMV+/CMVn differences.
Post F-up: in CMV+ with L-TLR4ex EGFR declined, there was no change of EGFR in H-TLR4ex; L/H-TLR2ex showed no differences in EGFR. In CMVn with H-TLR4ex EGFR rose, there was no change in L-TLR4ex. In case of TLR2ex we showed no similar differences. Regression analysis points out the impact of CMV+ and TLR4ex on eGFR and ΔEGFR. No similar impact of CMV+ and TLR2ex on eEGFR and ΔEGFR was found.

Conclusion
Conclusion: In the group who had a symptomatic CMV + infection, low TLR4 expression increases the risk of worsening EGFR. In CMVn, high TLR4 expression increases the chance of EGFR improvement. Historic CMV + strongly affects TLR2ex. However, TLR2ex cannot be used as a factor in assessing the risk of EGFR deterioration.
P1769POST TRANSPLANT MALIGNANCY - OUR EXPERIENCE
Authors: Kurian George , Jagadesh Gauri Shankar , Sreedharan Sandeep , Paul Zachariah , Mathew Anil , Raj Rajesh 
Published: June 2020

Abstract

Background and Aims
Cancer is now increasingly recognized as a major cause of death among patients especially after kidney transplantation. Malignancy represent a major burden in transplantation medicine. The Incidence is about 12 fold higher for PTLD and 3.5 fold higher for non-cutaneous malignancy compare to age-matched population. The increased risk is multifactorial and attributed to oncogenic viruses, immunosuppression and altered T cell immunity. In the era of longer graft survival and with the introduction of more potent immunosuppressive medication, malignancy represents a major burden. The incidence of malignancy after renal transplantation is 3 to 5 times higher. Incidence is higher in transplant patients even when compared to patients on hemodialysis.
Aim: We attempted to assess the incidence of post-transplant malignancies in patients who underwent renal transplantation at our centre, along with studying the presentation, type and other factors affecting their development.

Method
We analysed data retrospectively from 626patients who underwent renal transplantation atour centre from January 2003 to September 2018.Pre transplant history, post transplant course including duration on hemodialysis, immunosuppression details and duration till diagnosis of malignancies were collected. Details regarding type of malignancy, histopathology, staging and treatment given and outcome were collected.

Results
Number of transplant recipient-626. The total number of patients with malignancy is 12. Incidence of malignancy posttransplant is 1.9%.Male-7 and female-6.One patient was detected with 2 malignanciesduring her post transplant period. The types of malignancies encountered were

Conclusion
The incidence of malignancy – 1.9%.Probable reason for decreased incidence of malignancy is the decreased immunosuppression needed by South Asian people. The most common malignancy was solid organ tumour; tongue being the most common organ. Most common histological variant is squamous cell carcinoma.Non-Hodgkin is more common than Hodgkin. Incidence of malignancy is low. Decision regarding cancer screening should be made on individual basis.