bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1702THROMBOTIC MICROANGIOPATHY IN KIDNEY TRANSPLANT RECIPIENTS
Authors: Petr Vojtěch , Hrubá Petra , Šafránek Roman , Dedochova Jarmila , Krejčí Karel , Stepankova Sona , Machová Jana , Slatinska Janka , Kollár Marek , Honsova Eva , Dusilova Sulkova Sylvie , Viklicky Ondrej 
Published: June 2020

Abstract

Background and Aims
Thrombotic microangiopathy (TMA) pathogenesis in kidney transplantation is poorly understood. The aim of this study was to evaluate donor and recipients risk factors for posttransplant TMA.

Method
In this retrospective multicenter national study, we identified both the case and 3M protocol kidney graft biopsies in 5258 recipients with TMA (n=57, 1.1 %) in 1994-2019. To further evaluate the effect of donor kidney on TMA development, the outcomes of the pair kidney grafts from the identical donors (n=43, 6 living donor, 1 pair kidney discarded, 6 insufficient data) as control group was analyzed.

Results
TMA occurred in 57 patients at 8th (median) post-operative day. Interestingly, neither histological nor laboratory signs of TMA were present in controls but in one case where TMA was evident in both recipients and in donor zero-hour biopsy. TMA associated with acute antibody mediated rejection was found in 11 cases (19%). Basic demographics between TMA and control group were similar, however longer cold ischemia time (p &lt; 0,05, Figure 1) and more frequent delayed graft function (p &lt; 0,05) were observed in TMA group. Patients with TMA experienced lower death-censored 5-year graft survival (56 vs. 84 %) in comparison with control group (p &lt; 0,05, HR 2,904 (95% CI 1,411; 6,127), Figure 2).

Conclusion
TMA significantly affects the long-term kidney graft survival. Longer cold ischemia time was identified as the only risk factor and thus recipients genetic background is highly suspected in its pathogenesis.
P1716MULTI-NATIONAL SURVEY AMONG NEPHROLOGISTS & TRANSPLANT SURGEONS ABOUT THE SUITABILITY & ACCEPTANCE OF MARGINAL LIVE KIDNEY DONORS REGARDING AGE DISCREPANCY
Authors: Arabi Ziad , Saleh Kaysi , Hamad Abdullah , Bukhari Mohammad , Mateen Atif , El Hassan El Waleed , Altheaby Abdulrahman 
Published: June 2020

Abstract

Background and Aims
Living donor kidney transplantation is the best option for patients on dialysis. There are no guidelines or generally accepted consensus about the acceptable kidney donor age and what is the acceptable donor-recipient age discrepancy.

Method
This is a cross sectional survey of nephrologists and transplant surgeons about acceptable age of living kidney donors. The survey was sent to participants in different countries and through AST and ERA/EDTA.

Results
122 respondents from 22 countries answered 4 questions related to donor age. Most respondents (N=86, 70%) would allow an 18-years old man to donate to his older sibling. However, this percentage would fall to (N=69, 57%) if the donor was an 18-years old woman (P=0.02), reflecting the impact of childbearing period as a major criterion in considering kidney donation. On the opposite side, up to 20% of respondents will decline a very young donor regardless of the gender of the donor. The acceptance rate of a very young donor drops to only 37% if the recipient is 75-year-old (versus 70% in case of younger recipient, P = 0.004). In case of old donor( &gt; 65 years old) old to an 18 year old recipient with expected prolonged waiting time for deceased donor, ( N= 80, 65%) will advise to find an alternative donor but will allow the donation if no alternative donor is available.

Conclusion
The majority of the nephrologists and transplant surgeons will allow a very young donor to donate to a sibling especially if the donor is a male. However up to 20% will decline this donation regardless of the gender of the donor.
The transplant community is divided about allowing a very young donor to donate to a very old recipient. However, the majority will accept &gt; 65 years old donor to donate to an 18 years old recipient with expected prolonged waiting time for deceased donor.
P1718COMPARISON OF MEASURED GLOMERULAR FILTRATION RATE USING 24-HOUR URINE CREATININE CLEARANCE WITH 51-CHROMIUM EDTA IN A MALAYSIAN COHORT OF LIVING KIDNEY DONOR CANDIDATES
Authors: Thye Chee Keong , Lee Yee Wan , Jalalonmuhali Maisarah , Lim Soo Kun , Ng Kok Peng 
Published: June 2020

Abstract

Background and Aims
All living kidney donors undergo assessment of renal function by evaluation of Glomerular Filtration Rate (GFR). 51Cr-EDTA is one of the most widely used marker for measuring GFR but it is hampered by cost and laboriousness as well as not being widely available in Malaysia. Measuring 24-hour urine for creatinine clearance (Ccr) is a common alternative when exogenous filtration markers are not available. Ccr suffers from over/underestimation of measured GFR (mGFR) due to errors in urine collection and tubular secretion of creatinine. This is a study to compare the correlation of Ccr against 51Cr-EDTA in measuring GFR among the living donors in Malaysian population.

Method
This is a cross-sectional, single-centre study of a cohort of living kidney donor candidates from January 2007 to March 2019. All candidates who had mGFR done with both 51Cr-EDTA and Ccr in University Malaya Medical Centre were enrolled. Special consideration was taken to account for adequate urine sampling for Ccr. Clinical data was analysed for correlation, bias, precision and accuracy between Ccr and 51Cr-EDTA.

Results
A total of 83 living kidney donors with a mean age of 45.60 ± 11.06 years and body mass index (BMI) of 24.36 ± 4.03 were enrolled. Female comprised 74.7% of the donors while Chinese, Malay and Indian accounted for 67.5%, 20.5% and 7.2% of the donors respectively. The study group had a mean serum creatinine of 63.37 ± 16.00 umol/L with a urine volume of 2.03 ± 0.81 L (range 0.70 – 3.82). mGFR from 51Cr-EDTA was 125.56 ± 27.64 ml/min/1.73m2 (range 77.0 – 194.3) whereas calculated Ccr was 136.05 ± 36.15 ml/min/1.73m2 (range 75.32 – 280.06). The correlation coefficient between Ccr and 51Cr-EDTA is moderate (r = 0.43) (p &lt; 0.01). Mean absolute bias between Ccr and 51Cr-EDTA was 10.59 ± 37.99 ml/min/1.73m2 (p &lt; 0.05). The accuracy of Ccr within 30% of 51Cr-EDTA was 77.11%.

Conclusion
Our study showed that Ccr significantly overestimates mGFR compared to 51Cr-EDTA. However, there is a significantly moderate positive correlation between Ccr and 51Cr-EDTA. Thus, in the absence of 51Cr-EDTA, Ccr is a clinically acceptable alternative if utilized with care and understanding its limitations.
P1723CLINICAL AND LABORATORY CHARACTERISTICS OF RENAL TRANSPLANT PATIENTS WITH AA AMYLOIDOSIS IN A TERTIARY CENTER IN TURKEY
Authors: Bilgic Ece , Eren Sadioğlu Rezzan , Eyüpoğlu Şahin , Kocaay Akın fırat , TUZUNER ACAR , Şengül Şule , Keven Kenan 
Published: June 2020

Abstract

Background and Aims
Despite improved therapeutic regimens, AA amyloidosis is still associated with higher risk of mortality after renal transplantation (RT). Moreover the clinical, laboratory characteristics and prognostic factors remain poorly understood. We aimed to identify predictive parameters of prognosis, investigate the etiology, clinical and laboratory features of renal transplant patients with biopsy proven AA amyloidosis.

Method
We conducted a retrospective study using twenty-eight renal transplant patients with AA amyloidosis and twenty-eight renal transplant control patients without amyloidosis matched for age and time after transplantation that were regularly followed in University of Ankara School of Medicine Nephrology Department between October 2018-October 2019. Causes of AA amyloidosis, treatment (colchicine and/ or anti-interleukin (IL) 1 treatment) and number of Familial Mediterranean Fever (FMF) attacks in the last year in case of FMF, biochemical values such as mean CRP, hemoglobin, serum albumin, proteinuria, glomerular filtration rate (GFR), serum creatinine levels were compared between groups.

Results
In amyloidosis and non-amyloiodosis group, the mean age was 44±13 and 44±12 years; 57% and 54% were males, mean time after transplantation was 95±64 and 93±12 month, respectively. FMF was found as the most common cause of AA amyloidosis (86%). All FMF patients received colchicine and eight (33%) FMF patients with AA amyloidosis with insufficient response to colchicine were treated with anti-IL-1 agents. The mean colchicine dose was 0,92±0,34 mg/day. The mean GFR were 63±24 ml/dk/1,73 m2 in amyloidosis and 71±19 ml/dk/1,73 m2 in non amyloidosis group, (p=0.195). The most important finding of present study was significantly higher CRP levels in patients with AA amyloidosis compared to non-amyloidosis group (15,12±15,16 mg/L vs 6,59±8,20 mg/L, p=0,011, respectively).

Conclusion
In this study, we found higher CRP levels in renal transplant patients with AA amyloidosis which indicates persistent ongoing chronic inflammation among these patients.

Figure
Clinical and Laboratory Characteristics of Patient Groups
P1724RISK FACTORS FOR BK VIRUS INFECTION AFTER KIDNEY TRANSPLANTATION IN THE CONTEMPORARY ERA: A SINGLE-CENTRE OBSERVATIONAL STUDY
Authors: Phagura Nuvreen , Thandi Karanjeet , Evison Felicity , Gallier Suzy , Sharif Adnan 
Published: June 2020

Abstract

Background and Aims
BK infection remains a risk factor for kidney transplant dysfunction and allograft loss. While many risk factors are reported in the literature, many are from historical cohorts and have never been validated in the contemporary era. The aim of this study was to explore risk factors for BK virus infection in the contemporary era of kidney transplantation and immunosuppression using a well-phenotyped clinical cohort.

Method
In this single-centre observational study, data was extracted from hospital informatics systems for all kidney allograft recipients transplanted between January 1st 2007 and June 30th 2018. BK virus was checked in the context of any transplant dysfunction (indication-based) aligned with UK guidance. Positive BK virus results were defined as &gt;200 copies/ml. Clinical outcomes extracted from electronic hospital records were linked with national datasets. Univariate analysis was undertaken to investigate the association between donor-, recipient- and transplant-related variables and risk for BK virus reactivation. Any variable with a p-value &lt;0.15 in univariate

Results
Data was analysed for 1,770 kidney transplant recipients with median follow up 5.3 years (IQR 2.7 to 8.7 years). BK virus was associated with (versus without); male sex (8.3% versus 5.3% respectively, p=0.010), ABO-incompatible transplantation (12.7% versus 5.9% respectively, p=0.021) and delayed graft function (9.0% versus 6.3% respectively, p=0.032). In a multivariate analysis, including all variables in univariate analysis with p-value &lt;0.15, the only independent variables associated with BK infection were recipient male sex (OR 2.051 [95% CI 1.196-3.519], p=0.009 and ABO-incompatible transplantation (OR 4.087 {95% CI 1.847-9.042], p=0.001). From an outcome perspective, recipients with BK viraemia had worse graft function at 1-, 3- and 5-year post kidney transplantation but no increased risk for death-censored graft loss.

Conclusion
In the contemporary era, only recipient male sex and ABO-incompatible kidney transplantation are independently associated with risk for BK infection. Study limitations include lack of data regarding novel risk factors (e.g. BK virus serostatus). Association does not imply causality and we suggest further work is warranted to validate contemporary risk factors for BK infection in different kidney transplant population cohorts.
P1741TACROLIMUS FAST METABOLIZERS SHOW A HIGHER PROGRESSION OF INTERTITIAL FIBROSIS AND TUBULAR ATROPHY DURING THE FIRST YEAR AFTER RENAL TRASPLANTATION
Authors: Chamoun Huacon Betty , Torres Irina , Gabaldon Alejandra , Toapanta Néstor , Sellares Joana , Perello Manel , Moreso Francesc , Seron Micas Daniel 
Published: June 2020

Abstract

Background and Aims
Fast tacrolimus metabolizers (expressed as the blood concentration/ dose ratio; C / D; ng / mL * mg) showed poorer renal function at 2 years, a higher incidence of nephrotoxicity and BK polyomavirus infection. Greater variability of tacrolimus trough levels (CV) from six to twelve months is associated with the appearance of HLA antibodies, interstitial fibrosis / tubular atrophy (IFTA) progression and allograft loss. We evaluate the relationship between C / D, CV and IFTA progression.

Method
We evaluated a cohort of 87 low immunological risk renal transplants treated with prolonged-release tacrolimus, mycophenolate mofetil and steroids. We analyzed paired protocol biopsies at 4 and 18 months. Biopsies were evaluated according to the Banff classification and the progression of IFTA was defined as the difference of ci + ct score&gt; 0 between 18 and 4 months. The C / D ratio was calculated as the average of the value recorded at 3, 6 and 12 months of follow-up. The tacrolimus CV between 6 and 12 months was calculated using all the available determinations.

Results
IFTA progression was observed in 36 cases (41%). In the univariate analysis, it was found that the progression of IFTA was associated with the ci + ct score at 4 months (0.92 ± 0.94 for progressors vs. 1.89 ± 1.26 not progressors, p = 0.0003), and with the average of the C / D ratio (1.70 ± 0.73 for progressors vs. 2.28 ± 1.25 not progressors; p = 0.0144, table 1). An independent association between the C/D ratio and the progression of IFTA was observed in the multivariate analysis (OR: 0.42; 95% CI: 0.22-0.82, p = 0.027).

Conclusion
The results of our work suggest that fast tacrolimus metabolizers (lower C / D ratio) are more susceptible to the nephrotoxic effect of tacrolimus.
P1743IMPORTANCE OF KIDNEY ALLOGRAFT REJECTİON IN BK VIRUS NEPHROPATHY
Authors: Demir Erol , Kayaş Kamil , Erel Cansu , Caparali Bilge , Ozler Tuba Elif , Dirim Ahmet Burak , Catikkas Nezahat Muge , Guller Nurana , Safak Seda , Ucar Ali Riza , Oto Ozgur Akin , Yazici Halil , Caliskan Yasar Kerem , Akgul Sebahat Usta , Temurhan Sonay , Ozluk Yasemin , Kilicaslan Isin , Yildiz Alaattin , Turkmen Aydin , Sever Mehmet Sukru 
Published: June 2020

Abstract

Background and Aims
Allograft rejection following BK virus nephropathy (BKVN) is an important cause of allograft loss in kidney transplant recipients. However, the effect of rejection type on allograft survival in patients with BKVN has not been described previously. This study aimed to investigate the relationship between allograft rejection type and graft survival in patients with BKVN.

Method
We retrospectively analyzed the data of 159 kidney transplant recipients diagnosed BKVN and followed-up in our center between January 2009 and December 2019. BKVN was diagnosed by persistent viremia of more than 10000 copies/mL for four weeks or allograft biopsy. Vascular, obstructive or other non-parenchymal etiologies for allograft dysfunction were excluded. All patients were investigated for the presence of anti-HLA antibody at 6 and 12 months after BKVN diagnosis. Luminex solid-phase assay was used to investigate Class I and Class II PRA and MFI values greater than 1000 were accepted as positive. Allograft biopsy was performed in patients with progressive graft dysfunction or the presence of donor-specific antibodies (DSA) and analyzed according to the Banff Classification. The primary outcomes were defined as allograft loss or the allograft dysfunction which defined as was doubling serum creatinine levels.

Results
Patients were followed-up median 70 (IQR 13-198) months after kidney transplantation. Demographic data and clinical characteristics are provided in the table. 28 kidney transplant recipients suffered from allograft rejection after BKVN. Median rejection time to rejection after BKVN was 9 (IQR 5-164) months. 3 patients (18,8%) in the AMR group and 1 patient (8,3%) in the TCMR group experienced graft loss during follow-up. The mean serum creatinine levels at the last clinical visit were significantly higher in the AMR group compared to the TCMR group (1,9±0,8 vs 1,3±1,2 mg/dl; p=0,002). In multivariate analysis, AMR was an independent risk factor for allograft dysfunction (HR, 1,735; 95% CI 1,060 to 2,839; p=0,028).

Conclusion
The occurrence of AMR after BKVN is an important indicator of allograft dysfunction compared to TCMR. DSA screening should be routinely used in this group for early diagnosis and treatment of AMR.
P1745EFFECTS OF DESENSITIZATION THERAPY ON LYMPH NODES AND PERIPHERAL BLOOD TFH AND TFR CELLS IN ABO-INCOMPATIBLE KIDNEY TRANSPLANT RECIPIENTS
Authors: Shi Yunying , Li Yamei , Lin Tao , Wang Xianding , Yan Lin , Li Yi , Bai Yangjuan , Yang Cuili , Wan Zhengli , Wang Lanlan 
Published: June 2020

Abstract

Background and Aims
Desensitization therapy has enabled successful transplantation of renal allografts across the ABO blood group barrier, which significantly expands the living donor pool. Whether the B cell depletion induced by rituximab would affect the proportions of peripheral blood (PB) and lymph nodes (LN) T follicular helper (Tfh) and T follicular regulatory (Tfr) cells, whose survival depends on B cells, in ABO-incompatible kidney transplant recipients (ABOi-KTRs) is unknown.

Method
PB and LN samples were simultaneously collected on the day of transplantation from 14 ABOi-KTRs and 12 ABO-compatible KTRs (ABOc-KTRs) between January to October 2019. Additional PB from ABOi-KTRs was obtained before desensitization treatment (Rituximab+plasmapheresis+ immunosuppression). All recipients were undergone living donor transplantation. The frequency of B, Tfh (CD4+CXCR5+Foxp3-) and Tfr (CD4+CXCR5+Foxp3+) cells and the expression the PD-1, ICOS on Tfh and Tfr cells were quantified by flow cytometry.

Results
After desensitization treatment, significantly lower proportions of PB and LN B cells were observed in ABOi-KTRs (ABOi-a) when compared to ABOc and ABOi-b (ABOi-KTRs before desensitization) groups (Fig. A). Circulating Tfr cells decreased significantly after desensitization therapy, while no difference was found in LN Tfr cells (Fig. F). In addition, ABOi-a group showed higher expression of PD-1 on Tfr cell within PB, but lower within LN when compared to ABOi-b and ABOc groups, respectively (Fig. G). For Tfh proportion and its expression of PD-1 and ICOS within PB and LN, no significant difference was observed among groups (Fig. B-D). Significantly lower ratio of Tfr to Tfh was observed after ABO desensitization (Fig. E).

Conclusion
Our results indicated that ABO desensitization had significant suppression effects on B cells both within the PB and LN of ABOi-KTRs. In addition, the desensitization treatment mainly affected circulating Tfr cells, instead of Tfh cells, which shifted the balance between Tfr and Tfh cells towards Tfr cells in PB. Whereas, this treatment showed no influence on Tfh and Tfr populations within LN in ABOi-KTRs.
P1756ANTI-ABO ANTIBODY- VERSUS ANTI-HLA ANTIBODY-INDUCED ANTIBODY MEDIATED REJECTION IN ABO-INCOMPATIBLE KIDNEY TRANSPLANT PATIENTS: RELATIVE INCIDENCE AND PHENOTYPE DIFFERENCE
Authors: Kong Jinmin , Kwon Hyukyong , Son Sung , Whang EUN 
Published: June 2020

Abstract

Background and Aims
Antibody-mediated rejection(AMR) in ABO incompatible(ABOi) kidney transplant(KT) patients can either be due to donor-specific anti-HLA antibody(DSA) or anti-blood group antibody. The relative frequency and possible phenotype difference of these two types of AMR in ABOi KT patients have not been reported.

Method
Of 111 ABOi KT patients between 2007 and 2019 in our center, 15(13.5%) patients developed acute AMR diagnosed by indication biopsy. Since there is no histologic distinction between DSA- and anti-ABO-induced AMR, we assumed the causative antibody in each case based on anti-ABO level and DSA, measured in serum collected at the time of AMR.

Results
Of these 15 cases of acute AMR, 5 were attributable to anti-ABO(ABO-AMR) since anti-ABO titer was higher (≥16) and DSA was undetectable at the time of rejection. Five cases were attributable to DSA(DSA-AMR) since DSA was detectable and anti-ABO was lower during rejection. Another 3 cases with lower anti-ABO titer and undetectable DSA were also assumed to be DSA-induced, since this low level of anti-ABO is unlikely to cause rejection and DSA can be undetectable in DSA-induced AMR by adsorption of Ab on graft, as frequently seen in ABO-compatible patients Two cases with both higher anti-ABO titer and detectable DSA was regarded as undetermined. The onset of acute AMR was within 2 weeks in all cases(median 7.0 days) and comparable between DSA- and ABO-AMR. Initial anti-ABO titer was also not statistically different; median(range) 256(64-4096) in ABO-AMR and 64(16-256) in DSA-AMR. All the 5 patients with ABO-AMR had negative PRA before KT, whereas 5 of 8 patients with DSA-AMR had positive PRA before KT, and two DSA-AMR patients had preformed DSA before KT. There was no difference in peak creatinine and response to treatment. All the AMR were recovered by treatment and no graft was lost to rejection. No patient with ABO-AMR developed chronic AMR whereas one of DSA-AMR patients developed chronic AMR.

Conclusion
In summary, among 15 cases of acute AMR, 5 were ABO-AMR, 8 were DSA-AMR and 2 were undetermined. There was no difference in clinical feature between DSA- and ABO-AMR. No patient with ABO-AMR developed chronic AMR.
P1757RITUXIMAB FOR RECURRENCE OF PRIMARY FOCAL SEGMENTAL GLOMERULOSCLEROSIS AFTER KIDNEY TRANSPLANTATION: RESULTS OF A NATIONWIDE STUDY
Authors: Lanaret Camille , Anglicheau Dany , Vincent Audard , Lambert Celine , Couzi Lionel , Buchler Matthias , Ohlmann Sophie , Bertrand Dominique , Jean-Philippe Rérolle , Thierry Antoine , Maillard Nicolas , Schvartz Betoul , Golbin Leonard , Pernin Vincent , Ducloux Didier , Bouvier Nicolas , Poulain Coralie , Heng Anne Elisabeth , Greze Clarisse , Malvezzi Paolo , Martinez Frank , Kamar Nassim , Garrouste Cyril 
Published: June 2020

Abstract

Background and Aims
The indication of rituximab (RTX) in the treatment of primary focal segmental glomerulosclerosis (FSGS) recurrence after kidney transplantation (KT) remains controversial. The objective of our study was to evaluate the benefit and tolerability of adding RTX to the standard of care (SOC) comprising plasmapheresis (PP), corticosteroids, and high-dose anticalcineurins for the treatment of FSGS recurrence after KT.

Method
This retrospective, multicenter study reports on 148 patients, transplanted between 31 December 2004 and 31 December 2018, aged 39.9 + 13.4 years, who developed FSGS recurrence at 7 [3–23] days. In all 109 patients received a SOC (Group 1). RTX was introduced in this group after more than 28 days of SOC for failure or for therapeutic intensification (n = 19, Group 1a), or for early discontinuation of PP (n = 12, Group 1b); 39 patients received RTX associated at the outset with SOC (Group 2).

Results
We observed 46.6% complete remission (CR) and 33.1% partial remission (PR). Ten-year graft survival was 65.6% [51.4–76.6] and 13.4% [3.4–30.0] in responders and non-responders respectively. There was no difference in CR + PR rate between G1 (82.5%) and G2 (71.8%), p = 0.08, confirmed by propensity score +4.3% (95% CI [−9.0%-17.5%], p = 0.53). Following addition of RTX (Group 1a), we observed a CR rate of 26.3% and a PR rate of 31.6%. Patients with and without RTX experienced similar rejection rates (18.6% and 28.2%, p = 0.17) and infection rates (71.4% and 79.5%, p = 0.40). In multivariate analysis, the infections were associted with hypogammaglobulinemia &lt;5g/l (OR = 8.04, 95% CI [1.65,39.25], p = 0.01).

Conclusion
Rituximab could be used in cases of SOC failure or in remission patients for early weaning of plasmapheresis, without increasing infectious risk.