bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1669PROGNOSTIC IMPORTANCE OF BRAIN-DERIVED NEUROTROPHIC FACTOR (BDNF) IN RENAL TRANSPLANTATION
Authors: Molnar Agnes , Szkibinszkij Edgar , Lenart Lilla , Hosszu Adam , Kovacs Illes , Wagner Laszlo , Rimaszombati Fruzsina , Novozanszki Soma , Szabo Attila , Fekete Andrea 
Published: June 2020

Abstract

Background and Aims
The prevalence of end-stage renal disease (ESRD) has increased ten times higher in the past twenty years, where renal replacement therapy (dialysis or kidney transplantation (KTx)) is the sole life-saving treatment. KTx is the preferred option as it is associated with improved survival and quality of life as well. Delayed graft function (DGF) is one of the main problems affecting long-term kidney survival. Brain-derived neurotrophic factor (BDNF) signalling pathways play pivotal role in mitigating cerebral ischemia/reperfusion injury (IRI), however the relation of BDNF and IRI in KTx is unknown. The aim of our human clinical study was to explore the relationship between serum BDNF concentration, BDNF gene polymorphism and renal graft function after KTx.

Method
Study characteristics: We enrolled 59 ESRD patients with average age of 54.8±12 years who received KTx. Proportion of male patients was 57%. Average cold ischemic time was 927±310 min, warm ischemic time was 54.5±39 min. DGF occurred in 5 cases. Baseline triple immunosuppression therapy consisted of tacrolimus, mycophenolate or everolimus, and prednisolone. Until now, 44 patients completed the 2 years follow-up. For a comparable control group, we collected blood samples from 79 healthy volunteers with average age of 53.9±16 years and with male gender proportion of 52%. Serum BDNF, creatinine, blood urea nitrogen, haemoglobin, blood glucose level and thrombocyte numbers were measured before KTx and 1 week, 1-, 3-, 6 months, and 1-, 2 years after transplantation, as well as in controls. GFR was estimated based on the CKD-EPI formula. BDNF Val66Met polymorphism was determined by PCR-RFLP.

Results
There was no difference in genotype or allele distribution between any of the groups, and no correlation could be observed between serum BDNF and different genotypes either. Serum BDNF level was lower in ESRD patients than healthy controls (p=0.03). There was a weak correlation and marginal significance (p=0.056) between eGFR and serum BDNF level in controls, while in KTx recipients this correlation reached higher significance (p=0.01). Above median BDNF values at 1 month after KTx were predictive for better graft function during the 2 observed years.

Conclusion
Our preliminary human study proposes that BDNF could be a novel biomarker of posttransplant graft function, however further clinical studies with significantly larger population are definitely needed to confirm these results.
P1673ANEMIA AND DECREASED MUSCLE MASS AND MUSCLE STRENGTH IN KIDNEY TRANSPLANT RECIPIENTS
Authors: Vinke Joanna Sophia Jacoline , Wouters Hanneke , Post Adriaan , Stam Suzanne , M. Douwes Rianne , Gomes-Neto António W , Huls Gerwin , Berger Stefan P , Bakker Stephan , De Borst Martin , Eisenga Michele Freerk 
Published: June 2020

Abstract

Background and Aims
Post-transplant anemia is highly prevalent in kidney transplant recipients (KTRs). It is known that anemia impairs health-related quality of life, especially physical functioning. Although surmised, data about the latter are scarce. Hence, we aimed to investigate the association between anemia and muscle mass and muscle strength in KTRs.

Method
We used the TransplantLines Biobank and Cohort study, a prospective cohort study among all types of solid organ transplant recipients. For the current study, we used stable KTRs with a functional graft for more than 1 year post transplantation and with data available on hemoglobin levels and muscle mass (n=824). Muscle mass was assessed using 24-hour urinary creatinine excretion. Muscle strength was determined by means of hand grip strength using a dynamometer. Hand grip strength was tested three times with 30 seconds recovery time between attempts. For current analyses, the mean overall hand grip strength was calculated. Anemia was defined as hemoglobin &lt;12 g/dL for women and &lt;13 g/dL for men, according to WHO definitions. We used multivariable linear regression analyses to assess associations between anemia and muscle mass and strength.

Results
We included 824 KTRs (age 56±13 years, 60% males), with a mean hemoglobin of 13.5±1.8 g/dL. Anemia was present in 28% (n=277) of KTRs. Serum hemoglobin was associated with creatinine excretion, independent of age, sex, eGFR, BMI, hs-CRP, smoking status, alcohol use, and the use of RAAS-inhibitors, calcineurin inhibitors, proliferation inhibitors, or prednisolone (β=0.13, P&lt;0.001). Similarly, the presence of anemia was independently associated with a lower creatinine excretion (β=-0.09, P=0.002). In line with creatinine excretion, hemoglobin levels (β=0.15, P&lt;0.001) and the presence of anemia (β=-0.09, P=0.002) were also associated with handgrip strength independent of potential confounders.

Conclusion
Low hemoglobin levels and anemia are both strongly associated with lower muscle mass and muscle strength in KTRs, likely impairing physical functioning. Future research is needed to address whether correction of anemia improves physical performance in KTRs.
P1695OUTCOMES OF KIDNEY TRANSPLANTATION IN RECIPIENTS WITH MENTAL RETARDATION
Authors: ORS SENDOGAN DAMLA , ERDOGMUS SIYAR , Kumru Şahin Gizem , EYUPOGLU SAHIN , Eren Sadioğlu Rezzan , TUZUNER ACAR , Keven Kenan , SENGUL SULE 
Published: June 2020

Abstract

Background and Aims
Mental retardation in patients with chronic kidney disease is a relative contraindication for kidney transplantation. Currently, in the literature there are limited outcome data in renal transplant recipients with mental retardation and approaches to decision of transplantation changes in different centers. The aim of this study is to evaluate the results of kidney transplantation recipients with mental retardation in our center.

Method
In this study, we examined retrospectively 8 kidney transplant recipients with mental retardation in Renal Transplantation Unit of Ankara University School of Medicine between 2006-2018 years.

Results
The cause of mental retardation in these patients were; genetic syndromes in three patients, meningoencephalitis in one patient, prematurity in one patient, and chromosomal abnormality in one patient. In two patients, the cause of mental retardation is unknown. All patients had good social support for drug compliance and follow-up.
The causes of end-stage renal failure were; cystic kidney disease in three patients, hypertensive nephropathy in one patient and vesicoureteral reflux in one patient. In three patients, the etiology of kidney disease is unknown. At the time of pretransplantation period evaluation, six candidates were receiving hemodialysis and two candidates were receiving peritoneal dialysis respectively. Mean dialysis duration before transplantation was 50.7±22.8 months (min 4-max 180). Cadaveric kidney transplantation was performed in three of eight patients (deceased donor kidney allocated to patient with medical urgency in the event of potential imminent loss of dialysis access in one patient and in normal conditions in two patients) and living kidney transplantation was performed in five patients. The mean follow-up period after transplantation was 54.1±48.0 months. Three patients had early posttransplant complications; including urinary tract infection in three patients, deep vein trombosis in one patient and cardiopulmoner arrest with septic shock secondary to femoral graft infection and parailiac abscess in one patient (Table). No patients underwent graft biopsy and no patients experienced acute rejection episode. At the end of the follow-up time, graft and patient survival were 100%.

Conclusion
Mental retardation is not a contraindication for kidney transplantation in candidates without the history of noncompliance with proper social support.
P1699EFFECT OF UREMIA IN THE POSTOPERATIVE OF PREEMPTIVE LIVING-DONOR KIDNEY TRANSPLANT PATIENTS
Authors: Molina Andãºjar Alã­cia , Cuadrado Elena , Cucchiari David , De Sousa Erika , Oppenheimer Federico , Diekmann Fritz , Revuelta Ignacio 
Published: June 2020

Abstract

Background and Aims
Getting a preemptive kidney transplant has many benefits but no studies have assessed the potential deleterious effect of uremia on peritransplant complications. Uremic toxins interact negatively with biologic functions and may contribute to infections and bleeding or thormbosis.

Method
we evaluated 255 living-donor kidney transplant recipients (117 preemptive and 138 non-preemptive) from January 2006 to December 2015. Patients iniciated immunosuppression treatment 3 days prior to transplant. Exclusion criteria included: history of solid organ transplant, chronic immunosuppression treatment at the time of transplant (including prednisone), peritransplant rituximab/eculizumab treatment and HIV infection. An analysis of baseline characteristics and the incidence of symptomatic infection, bleeding or thrombosis during first week was performed in both groups. To analyze bleeding, the need of transfusion, drop of hematocrit in 72h and need of bladder washout was assessed.

Results
baseline characteristics are descrived in table 1. Non preemptive patients were older (50 vs 46 years) and had a higher prevalence of Diabetes Mellitus and dialypemia (22 vs 11% and 43 vs 30% respectively), without differences in the immunosupression scheme. The median eGFR in preemptive group at transplant was 12 ml/min. A more anemic profile was detected in the preemptive group with median hemoglobin of 116 vs 127 g/L in the non-preemptive group with no-differences in albumin levels. There were a total of 38 symptomatic infections (22 in the preemptive and 16 in the non-preemptive group), without statistical differences in the incidence between the groups (OR 1,75 CI 0,879-3,5, P =0,107). Hematocrit drop was greater in the non-preemptive group (8 vs 6 points in the first 72h p = 0.004) but thrombosis was more common in the preemptive group (5 vs 1, OR 6,116 CI 0,704-53,1, p = 0.062).

Conclusion
Uremia in preemptive living kidney transplant recipients does not seem to have influence on the incidence of infections in the first week after transplantation. The bleeding profile in the non-preemptive group in contrast to the prothrombotic profile in preemptive recipients needs further investigation in future studies that assess parameters of platelet and coagulation function as well as endothelial activation.
P1701ANTIBODY MEDIATED REJECTION: CLINICAL PHENOTYPE MATTERS
Authors: Burballa Tarrega Carla , Llinás Laura , Buxeda Anna , Arias Cabrales Carlos , Pérez Sáez María José , Redondo Pachón M Dolores , Mir Fontana Marisa , Faura Anna , Crespo Barrio Marta , Pascual Santos Julio 
Published: June 2020

Abstract

Background and Aims
Protocol biopsies following kidney transplantation (KT) allow the histological diagnosis of antibody-mediated rejection (ABMR) with stable renal function (RF). Controversy arises when considering isolated proteinuria as a clinical biomarker. Currently, there is no effective treatment for ABMR and transplant units may decide on treatment independently of the clinical expression.

Method
KT recipients (1987-2017) with post-KT biopsies (2008-2018) showing ABMR graft lesions (category 2-Banff’2015) &gt;1year post-KT were included. Cases were grouped into phenotypes of ABMR according to the clinical picture at biopsy : 1) acute RF impairment (↑creatinine &gt;15% three weeks before biopsy) with/without proteinuria and with/without DSA detection. 2) sub-acute RF impairment (↑creatinine &gt;15% six months before biopsy) with/without proteinuria and with/without DSA detection, 3) performed for DSA detection with stable RF and no proteinuria or 4) protocol biopsy, with stable RF, no proteinuria or DSA detection. We considered an additional category: 5) isolated proteinuria (↑&gt;500 mg or x2 six months before biopsy). Categories 1), 2) and 5) were considered clinical ABMR. Categories 3) and 4) were considered subclinical ABMR. We aimed to evaluate graft outcomes in the different ABMR phenotypes.

Results
In a cohort of 105 KT recipients with histologic lesions of ABMR, biopsies corresponded to phenotypes 1) in 35 (33%), 2) 10 (9,5%), 3) 21 (20,3%), 4) 14 (13,4%) and y 5) in 25 23,8%). No differences between clinical and subclinical ABMR were found in baseline characteristics except for donors ‘age, who were older within the clinical group (51.8±18.8 vs. 43.88 ±16.1; p=0.04). At time of biopsy, subclinical had better RF than clinical ABMR (creatinine 1.3±0.4 mg/dl vs. 2.2±1.1 mg/dl; p=0.02) and less proteinuria (161 mg/g [IQR 93-269] vs 939 mg/g [IQR 412-2000]; p=0.001)
Graft survival was worse in those patients with acute and sub-acute RF impairment, followed by those with isolated proteinuria (Figure 1). In comparison to subclinical ABMR, those with RF impairment and isolated proteinuria had an increased risk of graft lost; HR 9.4 (95% IC 2.2-40.7, p=0.002) and 4.8 (95% IC 1.01-23.2, P=0.05) respectively. DSA detection in these groups did not impact graft survival. Specific treatment was not different among groups, except for steroid pulses, which were more frequently applied in cases of ABMR with clinical manifestation.

Conclusion
The clinical phenotypes of ABMR influence long-term graft survival independently from treatment. Understanding graft evolution according to clinical phenotype at the time of histologic diagnosis should guide the therapeutic strategy, to balance risk-benefit ratio.
P1711RENAL RESISTIVE INDEX (RRI) OF KIDNEY ALLOGRAFT. OMEN OF THE OUTCOME OF TRANSPLANTION?
Authors: Smyrli Maria , Tsouka Glykeria , Oikonomaki Theodora , Vougas Vasileios , Apostolou Theofanis , Christodoulidou Christallenia 
Published: June 2020

Abstract

Background and Aims
Renal resistive index (RRI) of ultrasonography is a useful and potent tool for assessment and evaluation of renal hyperfiltration status of the transplanted patients. The aim of this study was to evaluate the association of RRI with renal function one year after transplant.

Method
We evaluated retrospectively 98 kidney allograft recipients. Data were collected from transplantations performed in our medical center between 01/2014 and 09/2018. Patients with acute loss of the renal function and renal survival less than a year were excluded from the study. We compared longitudinally the RRI at the first week after transplant and the third month, with glomerular filtration rate (eGFR, by CKD-EPI) at the end of the first year of transplantation. RRI was measured on the interlobular artery level, in each of the aforementioned time periods, and results were classified into 2 groups, RRI &lt;0,8 or&gt;0,8. In addition, age, gender and delayed graft function (DGF) were also determined in all patients.

Results
Sixty seven (67) of the recipients were males and 31 females with a mean age of 48±12years. The corresponding demographics for the donors were 46 males and 52 females with a mean age of 53 ±14. No correlations were found between RRI of the first week with gender and age, of both donors and recipients (p&gt;0.05). Similarly, RRI of the first week was not correlated with DGF and one-year eGFR after transplant (p&gt;0.05). On the contrary, RRI performed at the third month was strongly correlated to DGF and eGFR at the end of the first year. In other words, allograft recipients with a resistive index less than 0.80, had a higher eGFR and reduced frequency of DGF (p=0.01 and 0.03 respectively). Last but not least, higher recipient age and not gender was the main determinant of an increase of resistive index in the third month after transplant (P=0.02).

Conclusion
RRI offers interesting and helpful data on kidney allograft function. RRI of the third month less than 0.8 was related to better renal function at the end of the first year after transplant mainly and a lower incidence of DGF.
P1714INTRA-ABDOMINAL PRESSURE IS ASSOCIATED WITH HIGHER RENAL RESISTIVE INDEX AFTER RENAL TRANSPLANTATION
Authors: Coca Armando , Gonzalez Pablo , Arias-Cabrales Carlos , Perez-Saez Maria Jose , Rollan Maria Jesus , Acosta-Ochoa Isabel , Bustamante-Munguira Elena , Mendiluce Alicia , Pascual Julio , Bustamante-Munguira Juan 
Published: June 2020

Abstract

Background and Aims
The renal arterial resistive index (RRI) reflects renal hemodynamics non-invasively using Doppler arterial waveforms. RRI is defined by factors such as age, sex, weight, height or mean arterial pressure. Intra-abdominal hypertension (IAH) is a common complication among post-surgical patients that can affect renal blood flow. We aimed to determine the relationship between intra-abdominal pressure (IAP) and RRI in a sample of incident kidney transplant patients (KTs).

Method
Single-center prospective cohort of deceased-donor KTs. Anesthesia, surgical technique and immunosuppression induction therapy was the same in all cases. IAP monitoring was performed according to WSACS guidelines using the urinary bladder technique (UnoMeter Abdo-Pressure kit). IAP values were registered every 8h during the first 72h after surgery or until reoperation. Mean IAP values during the first 24h (24h-IAP) were used in this analysis. Doppler ultrasonography was performed 24h after surgery. RRI was calculated using the following formula: (peak systolic velocity – end-diastolic velocity)/peak systolic velocity. The study was approved by the local ethics committee and written informed consent was obtained in all cases.

Results
137 patients were enrolled. Table 1 summarizes relevant patient and hemodynamic variables. Stepwise multivariate linear regression analysis was used to examine independent predictors of RRI in this sample, including all variables in Table 1. Age (β=0.005, std.error=0.001, P&lt;0.001), dialysis vintage (β=0.001, std.error&lt;0.001, P=0.02) and 24h-IAP (β=0.005, std.error=0.003, P=0.041) were independent predictors of RRI.

Conclusion
Increased IAP in the first 24h after surgery is common in KTs and is correlated with higher RRI, which is associated with increased risk of graft loss and death.
P1720POSTTRANSPLANT TUBERCULOSIS IN LIVE DONOR RENAL TRANSPLANTATION : A SINGLE-CENTER EXPERIENCE
Authors: Attiya Ahmed Mohamed Naguib , Hamed abbas Mohamed , Abdel-Rahman Ahmed Mansour Hassan , Refaie Ayman 
Published: June 2020

Abstract

Background and Aims
Tuberculosis (TB) is one of the not uncommon serious bacterial infections which affect renal transplant recipients notably in endemic areas. Posttransplant TB occurs peculiarly due to reactivation of latent infection in the recipient or acquiring de novo infection after transplantation or rarely as donor transmitted infection. The aim of this study is to investigate the impact of TB disease and treatment drugs on renal graft and assess the risk factors for graft dysfunction during and after course of treatment.

Method
This retrospective single-center study investigated 3000 patients who underwent live donor renal allograft transplantation in our center between the years 1988-2019. TB diagnosis was confirmed in 44 patients. All proven-TB patients were evaluated regarding pretransplant demographic and immunological data. Posttransplant evaluation included kidney function tests, immunosuppressive therapy regimens, incidence of rejection episodes and anti-rejection therapies before, during and after TB.

Results
Patients were predominantly young (32±9.8 years), male (60%), There was no significant difference regarding other pretransplant demographic and immunological data. Regarding induction therapy, 13 patients received induction therapy; 7 patients received ATG, 6 patients received basiliximab and 31 patients did not receive induction therapy with no significant difference (p=0.07). Concerning maintenance immunosuppressive agents, no significant difference was found regarding different protocols of immunosuppression (p=0.11); however, regarding total dose of the steroid in 1st three months post-transplant, there was significant difference (p=0.017). As regards to rejection episodes, 16 patients were not exposed to rejection episodes before TB, 27 patients developed cellular rejection and only 1 patient developed humoral rejection with no statistical difference (p=0.18). In reference to management of rejection episodes, 25 patients received pulse steroid, 2 patients received pulse steroid and ATG, 1 patient received pulse steroid and plasma exchange (p=0.28) prior to infection with TB with no significant difference. A significant increase was noticed in serum Cr during TB disease and treatment:1.5 mg/dL at baseline (Crbase), 1.8 mg/dL at diagnosis (P=0.43 vs. Crbase), and 2.0 mg/dL during the peak (P=0.03 vs. Crbase).

Conclusion
Posttransplant TB drastically affects kidney function and graft outcome. Cumulative steroid dose in the first 3 months may be considered a risk factor for TB.
P1725USAGE AND OUTCOMES FOR EXPANDED CRITERIA DONOR KIDNEY TRANSPLANTATION IN THE KOREA CHARACTERIZED BY KIDNEY DONOR PROFILE INDEX, SINGLE CENTER STUDY
Authors: Lee Jun Young , Kim Miryung , Kim You Jin , Shin Hanwul , Han Byoung Geun 
Published: June 2020

Abstract

Background and Aims
The demand for Kidney transplantation (KT) is increasing and the number of patients who are waiting for KT is steadily increasing. Therefore, there is an increasing prevalence of KT done by cadaver donor especially, expanded criteria donor. We used Kidney Donor Profile Index (KDPI) to predict the renal prognosis of expanded criteria donor (ECD) KT recipient.

Method
We investigated patients undergo KT by ECD from March 2013 to June 2018 respectively. Through the donor’s last creatinine level, KDPI score, and Kidney Donor Risk Index (KDRI) score the renal survival rate was compared with ROC curve analysis.

Results
The mean age of a total 59 ECD KT recipient is 53.85 ± 9.9 years old. Mean follow up duration after KT was 35.0 ± 18.5 months. 10 patients had KDPI score above 85 (KDPI ≥ 85). Five cases undergo dialysis after KT. Nine cases expired during follow up (four sepsis, three sudden cardiac arrest, one hyperkalemia). Glomerular filtration rate one year after KT was significantly associated with KDPI (r=-0.772, p&lt;0.001). The area under curve (AUC) of KDPI was 0.700 (95% CI 0.494-0.906) and cut off point was 75.5. All renal survival patients had KDPI score below 75.5

Conclusion
Our results show that KDPI could be used as an indicator for predicting the prognosis of the Korean ECD KT.