bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1771NOCARDIOSIS IN RENAL TRANSPLANT RECIPIENTS- TEN YEARS OF SINGLE CENTER EXPERIENCE
Authors: Singh Ravi Kumar , Bhalla A K , Gupta Anurag , Bhargava Vinant , Gupta Ashwani , Rana Devinder Singh 
Published: June 2020

Abstract

Background and Aims
Nocardiosis is a localized or disseminated bacterial infection caused by aerobic Actinomyces that commonly affects immunocompromised hosts. This study aimed to retrospectively review the clinical course and outcome of nocardiosis in renal transplant recipients at our center

Method
Data was obtained from hospital records retrospectively. Sixteen cases of nocardiosis were identified in a series of more than 1800 consecutive renal transplants performed at Sir Ganga Ram Hospital in the last decade from the year 2010 to 2019.

Results
Thirteen out of Sixteen patients(81.25%) had developed nocardiosis within a 1-year post-renal transplant. The diabetic population constituted 31.3%. CMV disease was present in 25% of patients six months prior to the diagnosis of Nocardiosis.56.3% of patients were on Trimethoprim-sulfamethoxazole prophylaxis while they were diagnosed with nocardiosis. Pleuropulmonary nocardiosis was the most common form of infection(68.75%). Primary cutaneous nocardiosis was identified in one patient(6.25%). cerebral nocardiosis and disseminated nocardiosis was diagnosed in two patients each(12.5%).In the last 3 years with the introduction of MALDI-TOF led to the identification of the subspecies of Nocardia which was not possible earlier. In the last 3 years, 6 patients were diagnosed with nocardiosis, in which 4 were infected with Nocardia farcinica, one patient with Nocardia Asiatica and one with Nocardia cyrigeorgica. Nocardia farcinica was resistant to cotrimoxazole, which used to be first-line therapy against Nocardiosis before subspecies identification and sensitivity testing. With the help of proper identification of subspecies by MALDI-TOF and antibiotic susceptibility by E-testing, 5 out of 6 patients could be treated while earlier 6 out of 10 patients could be treated.

Conclusion
Nocardiosis is a rare, difficult-to-diagnose-and-treat infection following kidney transplantation. Trimethoprim-sulfamethoxazole prophylaxis was not effective in the prevention of disease. The Subspecies identification and modification of the plan of management according to antibiotic sensitivity results in improved outcomes.
P1772CONVERSION TO BELATACEPT IMPROVES RENAL GRAFT FUNCTION OF PATIENTS WITH SEVERE HISTOLOGICAL AND FUNCTIONAL INVOLVEMENT. LONG-TERM UNICENTRIC EXPERIENCE
Authors: Lopez-Oliva Maria Ovidia , Alvarez Garcia Laura , Perez Robles Tamara , Vaca Gallardo Marco Antonio , Juan Santacruz , Gonzalez Garcia Elena , Selgas Rafael , Jimenez Carlos 
Published: June 2020

Abstract

Background and Aims
Belatacept selectively blocks the costimulation signal of T cells. Its use, both de novo and in conversion, is associated with a better renal graft function compared to the regimens that include a calcineurin inhibitor (CNI). We expose our experience with belatacept as a rescue therapy in patients who present moderate-severe dysfunction after renal transplantation and compare the evolution with those patients who received the contralateral kidney graft without change to belatacept.

Method
Adult kidney transplanted patients, with graft dysfunction and renal biopsy with CNI toxicity or chronic vascular lesions who are changed from CNI to belatacept were included. Efficacy (creatinine, proteinuria, TFGe, acute rejection tested by biopsy, anti HLA) and safety (adverse events, tumors or infections) variables were recorded before and after the change.

Results
11 patients were included. The change to belatacept was made at a median of 13 months from the transplant (range 1-62 months) and the duration of the treatment ranged between 6 and 74 months. Renal function improved from a mean creatinine of 3.04±1.34 mg/dl before the change to 1.9±0.3 mg/dl at 6 and 12 months after conversion (p = 0.016), being the last average creatinine (December 2019) of 1.7±0.3 mg/dl.
Belatacept was withdrawn in one case, at one year, due to the development of specific donor antibodies without evidence of acute rejection. There were no cases of post-transplant lymphoproliferative syndrome. Two patients developed VBK replication controlled with immunosuppression modification and three patients developed CMV infection controlled with valganciclovir. There was no episode of acute rejection after conversion.
In 5 cases the contralateral kidney graft was not implanted, while in 6 cases it was implanted in another recipient who was not given belatacept and was taken on CNI therapy. The last average creatinine (December 2019) of patients without belatacept was 3.3±1.6 mg/dl vs. 1.6±0.2 mg/dl in patients with belatacept (p = 0.03).

Conclusion
The change to belatacept improves the renal function of all patients, even in those with severe histological and functional involvement. The improvement of renal function remains stable in the medium/long term and is significantly better than the renal function of patients with CNI.
P1776HLA TYPING BY NGS ENHANCES MISMATCH DETECTION IN LIVING KIDNEY TRANSPLANTATION
Authors: Pehnke Sarah , Lindner Tom H , Popp Bernt , Doxiadis Ilias , Landgraf Ramona , Lehmann Claudia , Halbritter Jan , Münch Johannes 
Published: June 2020

Abstract

Background and Aims
Antibody mediated rejection (ABMR) due to the development of donor specific HLA antibodies is the most common cause for graft loss in kidney transplant recipients. Therefore, a low count of HLA mismatches is favorable in the course of transplantation. Hitherto, several techniques for HLA typing have been adapted in parallel, e.g. serological or low-resolution PCR. In this single-center study, we aimed to perform “HLA re-typing” by next generation sequencing (NGS) in a living kidney transplant cohort (n=143), in order to identify HLA mismatches in donor/recipient pairs, that were missed by previous HLA typing methods.

Method
We isolated DNA of 102 donor/recipient pairs, that received a living kidney transplantation at the University Hospital Leipzig (Germany) between 1998 and 2018, and performed long range PCR of all known HLA loci. Using these NGS results, we compiled a genomic HLA mismatch formula. We evaluated, if genomic HLA typing identifies more HLA mismatches compared to the results of previous HLA typing methods, that were recorded in the Eurotransplant database for our donor/recipient pairs.

Results
By genomic HLA typing, we were able to identify HLA mismatches in 10.2 % of donor/recipient pairs, that have been missed by previous methods. In our cohort, we recognized most mismatches in the DRB1 locus, that were missed with other HLA typing techniques.

Conclusion
Our results suggest, that genomic HLA typing can be more precise in detecting HLA mismatches in donor recipient/pairs. Especially in the course of living kidney transplantation, a higher accuracy in HLA typing might enhance donor selection. Furthermore, accurate HLA typing can influence graft management in the course of ABMR, as it may improve the detection of donor specific HLA directed antibodies.
P1779NOVEL ONCE-DAILY EXTENDED-RELEASE TACROLIMUS VERSUS TWICE -DAILY TACROLIMUS IN DE NOVO KIDNEY TRANSPLANT RECIPIENTS DURING THE EARLY POSTTRANSPLANT PERIOD
Authors: Polatkan Volkan , Ozdemir Ebru , Erturk Turker , Tatli Emel , Berber Ibrahim , Cakir Ulkem , Yilmaz Gulay 
Published: June 2020

Abstract

Background and Aims
Both under and over-dosing of tacrolimus may compromise clinical outcomes by exposing patients to either the risks of graft rejection or adverse events (AEs) associated with immunosuppressive therapy. This study is designed to compare the clinical follow-up of our kidney transplant recipients receiving once-daily, prolonged-release (PR-T; Advagraf) and twice-daily, immediate-release (IR-T; Prograf) tacrolimus in the early posttransplant period.

Method
This randomized study included 78 de novo, adult kidney transplant recipients to PR-T 0.15 mg/kg/day (Group I=39) and IR-T 0.15 mg/kg/day (Group II=39) for seven days in the posttransplant period. Demographic features and clinical parameters regarding levels of whole blood tacrolimus and serum creatinine were compared between the two groups. Presence of acute rejection and AEs were investigated. Dose adjustments were permitted to target a pre-defined therapeutic range based on measured trough blood concentrations in all patients. SPSS 15 for Windows was used for statistical analysis.

Results
None of the patients suffered from acute rejection and there were no AEs in the early posttransplant period. However, Group II patients were found to have higher whole blood tacrolimus levels on the posttransplant 1st, 4th and 7th days (p=0.02, p=0.009 and p=0.013 respectively). Also serum creatinine levels were significantly increased in Group II patients on the posttransplant 7th day (p=0.02).

Conclusion
Prolonged release tacrolimus seems promising in preventing acute transplant rejection with adequate blood levels, as well as making it possible to avoid the interindividual variation in absorption and early calcineurin inhibitor toxicity.
P1780RENAL ALLOGRAFT TUBERCULOSIS - A CASE SERIES
Authors: BALAKRISHNAN SREEJESH , YADUR ANJANEY , NARAYANAN SAJITH , AZIZ FEROZ , N.A. ISMAIL , HAFEEQ BENIL , BHAT RAGHURAMCHANDRA , SASIDHARAN SOORAJ , GAFOOR ABDUL , SHAFEEQ SHYSIL 
Published: June 2020

Abstract

Background and Aims
Renal transplant recipients are at increased risk of tuberculosis (TB) than the general population especially in endemic areas. Post-transplant tuberculosis poses challenges to the physician both for diagnosis and treatment. There are no solid data regarding occurrence of renal allograft tuberculosis in this population. Here we report a case series of renal allograft recipients with occurrence of renal allograft tuberculosis.

Method
We analyzed data of 610 patients who underwent renal transplantation in our center between 2006 to 2019. Clinical details were retrospectively analyzed from Hospital Information System (HIS).

Results
Out of 610 transplant recipients, four (0.65%) were found to have renal allograft TB. One of the donors had a history of pulmonary tuberculosis which was treated. Among the recipients, one had history of disseminated TB 2 years prior to transplantation. Only one patient received induction immunosuppression with lymphocyte depleting agent. All of them received triple immunosuppression with tacrolimus, mycophenolate and prednisolone. None of them received isoniazid/rifampicin prophylaxis. The shortest time interval to the occurrence of allograft tuberculosis was 2 months (donor had history of tuberculosis). The longest was 78 months. All patients presented with fever and allograft dysfunction. Three out of 4 patients had biopsy showing granulomatous interstitial nephritis with urine culture for Mycobacterium tuberculosis positive. One of them had PUJ obstruction due to tuberculosis for which Boari flap vesicocalicostomy was done. One patient had perigraft collection, drainage of which showed Acid Fast Bacilli (AFB) and culture positivity for mycobacterium tuberculosis. The immunosuppression was not reduced for any of them and all were treated with non Rifampicin containing anti-tuberculosis treatment (ATT) regime for 9 months to 1 year. All patients had good response and complete remission. There was no mortality related to allograft tuberculosis. All the patients had their renal function back to baseline at the end of treatment.

Conclusion
Graft tuberculosis may present as fever as allograft dysfunction. The treatment with Anti tuberculosis drugs is effective in achieving complete cure and restoring the graft function.
P1784CARDIOVASCULAR RISK ASSESSMENT PRIOR TO KIDNEY TRANSPLANTATION
Authors: Matej Vnuäã¡k , Graňák Karol , Skálová Petra , Dedinska Ivana 
Published: June 2020

Abstract

Background and Aims
Cardiovascular diseases (CVD) are the most frequent cause of death in dialysed patients. Patients in the risk group of CVD examined prior to kidney transplantation (KTx) are indicated for coronarography (SCG). The aim of our analysis was to identify risk factors (RF) for positive finding of patients undergoing SCG before KTx.

Method
Our analysis consisted of 55 dialysed patients (46 males, 9 females, P&lt;0.0001), undergoing SCG before inclusion on waiting list (WL). We identified patient’s information (age in the time of SCG, gender, ethiology of kidney failure, comorbidities - arterial hypertension, ischemic heart disease /IHD/, diabetes mellitus /DM/), biochemical parameters in the time of SCG (serum level of lipids, haemoglobin, calcium-phosphate metabolism). We divided patients, according to SCG results (negative finding; n=40 v.s positive finding; n=15).

Results
Patients without percutaneous coronary intervention (PCI) (negative finding) we confirmed significantly lower incidence of diabetic nephropathy (P=0.0484) IHD (P=0.0174) and coronary artery disease (P=0.0001). We confirmed, haemodynamically significant coronary stenosis correlate with the occurrence of stroke or transient ischemic attack in patient’s history (P=0.0104). Consequently, we identified predictors for realization PCI (positive result): type 2 DM [OR 2,3492 (P=0.0472)], HDL ≤ 1,03 mmol/l [OR 4.3276 (P=0.0359)], total calcium level ≤ 2mmol/l [OR 2.4935 (P=0.0309)], phosphate level ≥ 1.45 mmol/l [OR 0.2034 (P=0.0351)]. In our analysis, patients non-listed on WL had significantly higher incidence of type 2 DM (P=0.0087), smoking (P=0.0079) and were treated more often with statins (P=0.0025).

Conclusion
In our analysis, patients with DM and poorly managed chronic kidney disease - mineral bone disease are the most at risk group in the group of patients with CVD with positive SCG finding. Patients with high cardiovascular risk, without DM or other RF can profit from non-invasive imaging methods following faster listing on WL.
P1785KIDNEY TRANSPLANTATION ACROSS VERY HIGH DONOR SPECIFIC ANTIBODIES(DSA) - A SINGLE CENTER EXPERIENCE OF A TERTIARY LEVEL HOSPITAL FROM INDIA
Authors: Hota Jayanta Kumar 
Published: June 2020

Abstract

Background and Aims
Kidney Transplantation across very high donor specific antibodies (DSA) poses a significant challenge even today . With our current understanding and precise desensitization techniques, we are now able to do kidney transplantation across such high DSA . Here we are reporting ten such cases where baseline DSA were more than 10,000 mean fluroscent intensity (MFI) on Single Antigen Bead (SBA) Luminex.

Method:
It is a retrospective analiysis of ten kidney transplant patients from January 2017 to March 2019 . Patients with MFI more than 10,000 to class II HLA antigens at baseline with negative CDC and flow cytometry cross match were included in this study. All patients were treated with 1 dose of Rituximab (375mg/M? before plasma exchanges (PLEX) were started . Each session of PLEX was followed by 10 grams of intravenous human immunoglobulin (IVIg). Solid based SBA Luminex for both class I and II antigens was repeated after the third exchange and fifth exchange and seventh exchange depending on the level of MFI .

Results
Ten patients ( seven males three females ) of age 37± 7 years were included in this study . History of blood transfusion with 5±2 units was present in 7 patients . All females were multiparous ( 3±1children). Mean solid based SBA Luminex for class I HLA antigens was 12000 ± 1500 and for II HLA antigens with MFI 16500 ± 3500 (Chart 1). Mean number of PLEX needed was 5 ± 2 . All patients had solid based SBA MFI was 1500±300 and for class II antigens 2500 ± 1500 before transplantation(Chart 2).There was no incidence of acute antibody mediated rejection . Baseline serum creatinine at discharge was1.35±0.35mg%. There were 3 (30%) biopsy proven cases of acute cellular rejection . There was evidence of BK viremia in 3(30%) patients, CMV infection in 1 (10%) patient, Klebsiella pneumonia in 1(10%) patient and cryptosporium infection in 1 (10%) patient each . There was no mortality and mean serum creatinine at 6 months follow-up was 1.55±1.05mg%. All 3 patients of BK Viremia were treated with modification of immunosupression with substitution of leflunamide for mycophenolate and all are doing well with good graft function with a mean serum creatinine of 1.75±0.55mg% . Other infections were treated accordingly.

Conclusion:
Transplantation across very high donor specific antibodies is possible with excellent immediate and short term graft function with judicious de-sensitization techniques . There was increase in infection rate but none was life threatening and can be managed with proper care.
P1796FACTORS PREDICTING SUBCUTANEOUS INSULIN REQUIREMENT AFTER KIDNEY TRANSPLANT
Authors: Bansal Beena , Bansal Shyam 
Published: June 2020

Abstract

Background and Aims
Diabetes is the most common cause for end stage renal disease leading to kidney transplant. Post transplant glycemic management has significant impact on long term outcomes, but is challenging, especially while transitioning patients from intravenous to subcutaneous insulin dose. This study was therefore planned to assess factors which influence subcutaneous insulin dose after kidney transplant.

Method
Data was prospectively collected from 98 consecutive kidney transplant patients with type 2 diabetes at a tertiary care hospital in India, with regards to age, gender, height, weight, duration of diabetes, pre transplant insulin dose, pre transplant use of oral antidiabetics. First two days after transplant patients are nil by mouth and are on insulin infusion (column based method). On third day, patients are transitioned to multiple subcutaneous insulin. We assessed and recorded the subcutaneous insulin dose requirement by 4th and 5th day.

Results
Mean (SD) for patients’ age was 52.28 (6.32) years, height 167.83 (5.64) cm, weight 70.55 (14.32) kg, body mass index 25.39 (4.72) kg/m2 and duration of diabetes 13.3 (7.02) years. All 98 transplant recipients were male. Mean insulin requirement before transplant was 15.37 (20.24) units/day. Mean post transplant intravenous insulin infusion rate for 4 hours before transitioning to subcutaneous insulin was 2.07 (0.987) units/hour. Mean subcutaneous insulin requirement after transplant was 73.18 (25.45) units/day or 1.12 (0.61) units/kgbw. Mean basal insulin dose was 25.32 (10.91) units. Mean bolus dose before breakfast was 10.75 (4.37) units, before lunch was 20.12 (7.4)) units, before evening snack was 6.65 (3.43) units and before dinner was 10.75 (4.11) units. In terms of proportion of total daily dose (TDD), mean basal insulin was 0.34 (0.08) of TDD, bolus dose before breakfast was 0.15 (0.03) of TDD, before lunch was 0.28 (0.05) of TDD, before evening snack was 0.09 (0.04) of TDD and before dinner was 0.15 (0.04) of TDD.
Subcutaneous insulin dose after transplant correlated with insulin dose of the recipient before transplant (Pearson’s coefficient 0.43; p value 0.003) and weight of the patient (Pearson’s coefficient 0.32; p value 0.001). It did not correlate with age of the recipient, duration of diabetes, intravenous insulin infusion rate or tac level.
On multivariate linear regression analysis to assess the factors predicting subcutaneous insulin dose after transplant, only pre-transplant insulin dose was significant (p value 0.046). Age of the recipient, duration of diabetes, weight of the patient, intravenous insulin infusion rate or preoperative use of oral anti diabetic were not significant

Conclusion
In kidney transplant patients with type 2 diabetes, only pre transplant insulin dose predicted the subcutaneous insulin dose post transplant.
P1797ACUTE RENAL GRAFT FAILURE ASSOCIATED WITH AT1 RECEPTOR ANTIBODIES : 2 CASES IN SKMC
Authors: Bashir Nihal , AlSeiari Mohamed 
Published: June 2020

Abstract

Background and Aims
Some kidney transplantation recipients with negative donor specific antibodies can develop acute rejection episodes which are difficult to treat, associated with non-HLA antibodies like angiotensin 2 type 1 receptor antibodies (AT1R Ab). The mechanism of rejection by AT1R ab involves vascular injury. Our cases are unique as the first patient got mineralocorticoid deficiency like picture unexpectedly. For the second case, hyperacute rejection cause in the first allograft was not identified and but hyperacute rejection episodes involving antibodies against endothelial cells are reported in literature.

Method
2 patients received renal transplantation from life related donors in out institute developed acute rejection episodes. As part of investigations, we did non -HLA antibodies testing which came positive .

Results
Case 1 30 years old male, with end stage renal disease on hemodialysis . The patient had a live related renal transplant with Mismatch 1-1-1 and negative DSA. Induction with Basiliximab was initiated but changed to ATG due to delayed graft function.
Kidney biopsy on day 6 post operatively showed diffuse moderate to severe acute tubular injury (up to necrosis) with glomerular intracapillary fibrin microthrombi, focal minimal peritubular capillaritis and mild glomerulitis and focal weak C4d positivity, highly suspicious for active antibody mediated rejection.
The patient was treated with pulse steroids, ATG total of 7.5mg/kg, 3 sessions of Plasma exchange and IVIG 2 g/kg and 2 doses of Rituximab for his hyperacute rejection. AT1R antibodies titer was 11U/ml. MICA was negative. Losartan was initiated as a maintenance therapy.
P1808INHIBITION OF MIR-155 IMPROVES PROGNOSIS IN AN EXPERIMENTAL FSGS MOUSE MODEL BY REGULATING AUTOPHAGY
Authors: Zhang Yu , Wang Jie , Zhou Jianhua 
Published: June 2020

Abstract

Background and Aims
Focal segmental glomerulosclerosis (FSGS), a podocytopathy, is one of the most common primary glomerular diseases causing end-stage renal disease in children. Its mechanisms remain unclear and the effective treatment lacks. MiR-155 is a typical multifunctional miRNA, which serves a crucial role in the regulation of numerous vessel cells. The present study aimed to investigate the role of miR-155 in the pathogenesis of FSGS.

Method
A FSGS model was establishe by injection of adriamycin in miR-155 knockout mice. Renal pathological changes were observed by Periodic Schiff-Methenamine Silver staining and Masson trichrome staining. Podocyte morphology and autophagosomes were examined with electron microscopy. Podocyte density was estimated by the Weibel-Gomez method. Expression of autophagy markers and apoptosis-associated proteins were analyzed by Western blotting analysis.

Results
Silencing of miR-155 significantly decreased urinary protein excretion and ameliorated glomerulosclerosis in adriamycin-induced FSGS mice. We found that adriamycin treatment led to fusion of podocyte foot processes, swelling of the podocyte body, dilated mitochondria, and podocyte loss. Inhibition of miR-155 improved podocyte depletion and the above cytopathies induced by adriamycin. In addition, the results also demonstrated that in miR-155 KO mice, the expression of LC3 and ATG5 was increased and the expression of P62 was decreased.

Conclusion
These suggest that modulated miR-155 can prevent podocyte damage, by regulating the level of autophagy. The present study provides a novel insight into microRNAs as potential therapeutics for the treatment of podocytopathy.