bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO974PREDICTORS OF MORTALITY IN KIDNEY TRANSPLANT PATIENTS INFECTED BY SARS-COV-2 IN SOUTH OF SPAIN
Authors: Lopez Veronica , Casas-González Cristina , Vázquez Teresa , Cabello Mercedes , Poveda Inmaculada , Hernández Domingo 
Published: May 2021

Abstract

Background and Aims
Covid-19 pandemic has especially affected kidney transplant (KT) recipients, who are more vulnerable than the general population due to their immunosuppressive status and added comorbidities.
The objetic of this study was to determine risk factors related to infection and mortality from Covid-19 in KT.

Method
We included 53 KT who had PCR-confirmed COVID-19 infection between march 21st and november 24th, from a total of 2030 KT. Outcomes related to patient survival were analyzed.

Results
39 (73%) patients were men, with a mean age of 56±15 years old. Median time after KT where the infection took place was 104 months (IQR: 55-160). One patient was infected 40 days after transplant. 90% were on Tacrolimus therapy and 79% on MMF.
81% of patients were hypertensive, 36% diabetic and 19% had ischemic heart disease. 65% were on ARAII treatment.
Clinical presentation consisted on pneumonia (64%), fever (55%), cough (70%), dyspnoea (45%), lymphopenia (66%) and gastrointestinal symptoms (36%). 21% required intubation and admission in ICU. 8 patients were asymptomatic.
18% received Hydroxychloroquine therapy plus Azithromycin, 11% Tocilizumab, 11% Ritonavir-Lopinavir, 59% steroids, 7.7% Remdesivir and 13.5% convalescent plasma. Immunosuppression was reduced in all symptomatic patients.
10 patients (19%) died. Table 1 compares the characteristics of these patients with those who survived.

Conclusion
We concluded that mortality in KT is very high, more than reported in general population. Risk factors are patient age, time after KT, baseline renal function, the presence of pneumonia, as well as higher CRP levels at the time of diagnosis. More experience is needed to optimize our protocols and therapy for Covid-19 in KT.
MO927IMPACT OF DONOR AGE ON LIVING DONOR KIDNEY TRANSPLANTATION
Authors: Hiramitsu Takahisa , Ohara Kiyomi , Tomosugi Toshihide , Futamura Kenta , Okada Manabu , Norihiko Goto , Ichimori Toshihiro , Narumi Shunji , Watarai Yoshihiko 
Published: May 2021

Abstract

Background and Aims
Although elderly living donors are recognized as a marginal donor for kidney transplantation, the number of elderly living donors are increasing because of insufficiency. We investigated the impact of donor age on living donor kidney transplantation.

Method
A total 858 adult living donor kidney transplantation (LDKT) between January 2008 and December 2018 was included in this study and followed up until September 2020. LDKTs were stratified into 3 groups according to the donor age; 157 LDKTs from donors aged 30 – 49, 592 LDKTs from donors aged 50 – 69, and 109 LDKTs from donors aged 70 – 89. To investigate the impact of donor age on living donors, postoperative estimated glomerular filtration rates (eGFR), mortality rate and incidence of end stage renal disease were compared between 3 donor age groups. To investigate the impact of donor age on recipients, postoperative eGFR was compared between 3 donor age groups and the risk factors of graft loss were analyzed using Cox regression hazard model.

Results
The eGFRs of donors demonstrated a decline with increased donor age and significant differences at all time points among 3 donor age groups. (Figure 1) Mortality rate and incidence of end stage renal disease of donors were similar among 3 donor age groups. (Figure 2) The eGFRs of recipients demonstrated a decline with increased donor age and significant differences at all time points among 3 donor age groups. (Figure 3) Multivariate analysis using Cox regression hazard model demonstrated donor aged 70 – 89 as a significant risk of graft loss (P = 0.024, hazard ratio 3.053, 95% confidence interval 1.160 – 8.040).

Conclusion
The prognosis of living donors after donation were not affected by the donor age except for the lower eGFR with increased donor age. The eGFRs of recipients and graft loss rates were the worst in the recipients transplanted from donors aged 70 – 89.
MO928EXHALED HYDROGEN AS A MARKER OF INTESTINAL FERMENTATION IS ASSOCIATED 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: May 2021

Abstract

Background and Aims
Diarrhea is a common gastrointestinal (GI) complaint among kidney transplant recipients (KTR). Exhaled hydrogen (H2) is a surrogate marker of small intestinal bacterial overgrowth, which has been proposed to drive GI symptoms such as diarrhea. In a large cohort of KTR, we assessed the amount of exhaled H2 to evaluate its association with diarrhea and potential clinical and dietary determinants.

Method
Clinical, laboratory and dietary data from the TransplantLines Biobank and Cohort Study (NCT03272841), comprising 424 KTR were analyzed. Exhaled H2 concentration was measured using a model DP Quintron Gas Chromatograph. Diarrhea was classified according to the Bristol Stool Form Scale (BSFS) and stool water content was measured using a freeze-drying method. Dietary intake was assessed using a validated self-administered food frequency questionnaire (FFQ). Possible determinants of exhaled H2, such as sex, age, eGFR, mycophenolate mofetil and tacrolimus use, and several other clinical, biochemical and nutritional factors, were studied using univariable linear regression. All variables with a p&lt;0.05 were included in a multivariable linear regression model run backward to identify the determinants of exhaled H2 production.

Results
KTR (55.4±13.2 years, 60.8% male, mean eGFR 49.8±19.1 mL/min/1,73 m2) were divided into three groups according to median exhaled H2 concentration (G1, 1.0-6.9 ppm, n=151; G2, 7.0-19.9 ppm, n=139; G3, ≥20.0 ppm, n=134). Hence, signs of small intestinal bacterial overgrowth (exhaled H2 ≥20 ppm) were identified in 31.6% of KTR. Seventy-six patients (33.0%) had diarrhea according to BSFS. Exhaled H2 correlated with stool water content (r=0.24, p=0.04) and increased risk of diarrhea (OR = 6.03, 95% CI 1.6-22.1, p&lt;0.01). In multivariable linear regression analyses, polysaccharide intake was independently associated with exhaled H2 (std. β=0.24, p=0.01), whereas the other factors were not significant.

Conclusion
These findings suggest that higher fasting exhaled H2 is associated with increased risk of diarrhea in KTR with polysaccharide intake as an independent determinant of exhaled H2. The present results suggest that diarrhea in KTR may reflect an altered small bowel gut microbial composition, at least partly under dietary influence.
MO929KIDNEY TRANSPLANTATION IN MONOCLONAL IMMUNOGLOBULIN DEPOSITION DISEASE: A REPORT OF 6 CASES
Authors: Cuadrado Payán Elena , Molina-Andujar Alicia , Tovar Natalia , Castrejón de Anta Natalia , Revuelta Ignacio , Cucchiari David , Cofan Pujol Federico , Esforzado Nuria , Cibeira M Teresa , Rosiñol Laura , Bladé Joan , Diekmann Fritz , Fernández de Larrea Carlos , Quintana Luis F 
Published: May 2021

Abstract

Background and Aims
Monoclonal immunoglobulin deposition disease (MIDD) is a systemic rare condition that usually leads to end stage renal disease. Treatment of patients with a bortezomib-based regimen followed by autologous stem cell transplantation (ASCT) has been increasingly used, with improvements in the response rates and the renal graft outcomes in kidney transplant recipients

Method
Retrospective study of 6 patients diagnosed of MIDD with complete response but not renal response after hematologic treatment that underwent kidney transplant in our institution between 2010 and 2019.

Results
A total of 6 patients (5 women) were analyzed, with mean age at diagnosis of 47 years (range 40-53). At presentation their mean eGFR was 18 mL/minute (range 9-25) and mean proteinuria of 5.5 g (range 0.290-12.5). The deposit was kappa type except in 1 case (heavy and light lambda type chains). In all of them there was an absence of monoclonal component in blood and urine but positive immunofixation in 5 cases (2 only in urine). 3 started chronic hemodialysis during admission and the others at 3, 5 and 44 months after diagnosis. As hematological treatment, all received bortezomib followed by ASCT, being under complete hematological response at the time of kidney transplant. It was performed at 28 months on average from ASCT (range 11-42), with mean kappa/lambda ratio of 2.6 (range 1.33-3.75). 3 patients received induction with thymoglobulin and 3 with basiliximab, followed by triple therapy with tacrolimus + prednisone + mTOR inhibitor (4 patients) or mycophenolate (2 patients). During a median follow-up of 20,5 months from kidney transplant and 54 months from ASCT, 1 patient experienced hematologic relapse and 2 had hematologic progression (one of them with MIDD relapse in the allograft) requiring treatment. The patient with organ relapse received Daratumumab monotherapy achieving complete hematologic response but graft failure. The other 5 patients had functional graft with median serum creatinine 1.68 mg/dl.

Conclusion
In patients with MIDD and sustained complete hematologic response, a kidney transplant can be considered. The optimal approach to treatment of hematologic relapse or recurrence of MIDD after kidney transplant remains to be determined
MO930BURDEN OF DISEASE IN INCIDENT DIALYSIS PATIENTS WAIT LISTED FOR KIDNEY TRANSPLANTATION 2008 – 2016 IN GERMANY
Authors: Wagner Martin , Arns Wolfgang , Rascher Katherine , Cramer Heyke , Schaller Mathias , Bach Dieter , Von Gersdorff Gero 
Published: May 2021

Abstract

Background and Aims
Only a subset of all patients on dialysis is eligible for kidney transplantation (KTx) due to the large variation of mortality risk. It has been shown that the burden of disease is increasing over the last years in patients at dialysis inception. Moreover, the number of available kidney grafts is decreasing, resulting in a prolonged time on the waiting list. In our study we describe the burden of disease and 3-year mortality in a sample of incident dialysis patients in Germany, stratified by KTx status, including trends over time.

Method
The QiN (Quality in Nephrology) dataset is a registry-based observational study in which &gt;90% of all patients treated in dialysis centers of the non-profit kidney care provider KfH are enrolled. In our analyses we included all adult patients beginning dialysis treatment between 2008 and 2016. Primary outcome was 3-year all-cause death up until Dec 31, 2019. Patients were stratified by last available KTx- status: (a) KTx within 3 years, (b) on dialysis - on waiting list, (c) on dialysis - in evaluation for KTx, (d) on dialysis - KTx never planned, (e) on dialysis - KTx status missing. The burden of disease was assessed by the AROii score (Floege et al. 2015), a predictive model including patient characteristics, laboratory variables and dialysis parameters.

Results
Of a total of n=25987 incident patients analyzed, 3.2% underwent KTx within 3 years, 10.6% were listed for KTx, and 13.4% were in evaluation. In 49.5% KTx was never planned and in 23.3% KTx status was missing. These groups differed significantly in median AROii score, reflecting their burden of disease at dialysis inception: KTx never planned or missing (AROii score 10) as compared to KTx (AROii score 1), listed (AROii score 3) and in evaluation (AROii score 4) (p&lt;0.001).
Similarly, 3-year observed mortality (n=8059 [31%]) differed widely across KTx strata (log rank p&lt;0.001), ranging from 11% in listed patients to 44% (HR 5,982; [5.335; 6.707]) in those with missing KTx status (figure). In the period 2008-2019 the number of KTx within 3 years decreased, but the proportion of patients on the waiting list and the proportion of patients in evaluation increased. In all patients on dialysis the burden of disease at dialysis inception increased over time across KTx strata (p&lt;0.05).

Conclusion
About three quarters of patients started dialysis with a very high mortality risk and at least half of them were considered ineligible for KTx. Patients listed or in evaluation for KTx in Germany have become sicker over the last decade. With decreasing numbers of KTx in Germany the time on the waiting list is prolonged. Longer waiting times and the increasing burden of disease result in advanced risk at the time of transplantation.
MO989STUDY OF PHARMACOGENETICS OF MYCOFENOLATE MOFETIL IN KIDNEY TRANSPLANT RECIPIENTS: EXPERIENCE OF SAHLOUL HOSPITAL
Authors: Hadhri Asma , Sahtout Wissal , Abderrahmen Ameni , Amor Dorra , Azzabi Awatef , Amal Ouni , Mrabet Sanda , Fradi Asma , Ben Aicha Narjes , Zallema Dorsaf , Omezzine Asma , Bousslema Ali , Guedri Yosra , Achour Abdeltif 
Published: May 2021

Abstract

Background and Aims
The pharmacokinetics and pharmacodynamics of the immunosuppressive drug mycophenolate mofetil (MMF) are subject to significant interindividual variability that affects its efficacy and toxicity. The present study focused on the genetic factors potentially involved in the variability of the response to this drug in kidney transplantation, while taking into account the influence of non-genetic factors.

Method
276 kidney transplant patients treated with MMF were involved, recruited from the Nephrology and transplantion Department of Sahloul Hospital. Data on transplantation, exposure to MMF and clinical outcomes of the patients were collected. A PCR-RFLP genetic study of 9 polymorphisms of UGT, SLCO and IMPDH was performed. Were studied the relationship between the genetic polymorphisms and the exposure to MMF, the risk of acute and chronic rejection of the kidney graft, as well as the adverse effects of MMF.

Results
This study showed that the variant alleles of polymorphisms UGT1A9 -2152C&gt;T and IMPDH II 3757T&gt;C would increase the risk of acute and chronic rejection. The variant allele of SLCO1B1 388A&gt;G would protect against acute rejection.
The variant allele of the UGT1A9 98T&gt;C polymorphism would increase the risk of diarrhea, unlike the variant allele of the UGT1A9 -275T&gt;A polymorphism, which appears to be a protective factor against diarrhea. The variant allele of the UGT1A8 518C&gt;G polymorphism would increase the risk of infections. However, relationship between genetic polymorphisms and exposure to MMF was not demonstrated.

Conclusion
These results highlight the need to take genetic variability into account in predicting the therapeutic response to MMF before initiating the treatment.
Acute rejection and genetic polymorphisms
SNP Genotype Acute rejection
MO990THE RELATIONSHIP BETWEEN T-CELL INFILTRATION IN BIOPSY PROVEN ACUTE T-CELL MEDIATED REJECTION WITH ALLOGRAFT FUNCTION
Authors: Ahmadpoor Pedram , Dalili Nooshin 
Published: May 2021

Abstract

Background and Aims
Todays increasing effort are made to detect non-invasive and reliable methods for prediction of organ rejection. In the current study, we evaluated the degree of CD3, CD20, Th17 and Tregs infiltration in kidney biopsy of the patients with acute cellular rejection and the possible relation with graft outcome.

Method
From 70 biopsy proven ATCMR according to Banff criteria in whom kidney biopsy were done based on acute creatinine rise, 50 patients were selected. 20 patients excluded because of insufficient specimen or clinical data. All of recruited patients experienced their first episode of ATCMR. 21 patients had deceased donors and 29 had living ones. Paraffin sections were deparaffinized then dehydrated using alcohols. The tissues were incubated with Antibodies in two stages. First, they were incubated with antihuman IL-17 monoclonal antibody and polyclonal antibody against FOXP3. The results analyzed with SPSS version 20. P value less than 0.05 was considered as significant.

Results
FOXP3 mean cell count in stable graft function group was 7.88 but in impaired graft group was 8.02, which was not statistically significant (P-value :0. 96). Th17 mean cell count in stable group was 5.0 but in impaired group was 10.1, which was not significant too (P-value: 0.24). FOXP3/Th17 ratio was higher in stable group (1.4 versus 1.12) but without any statistically important value (P-value: 0.22) .CD3 count was higher in impaired group (29.8 versus 27.7) and CD20 count was more in stable group (8.8 versus 7.8) without any significant values (P-value: 0.7 and 0.62) respectively. FOXP3 positive cell count was higher in failure to response group (9.95 vs. 6.63) but with non-significant P-value of 0.1. Th17 count was higher also in this group (11.3 vs. 8.3) but with non-significant value .The FOXP3/Th17 ratio was higher in appropriate response group (1.19 vs. 1.15) with P-value 0.8 .CD3 count was higher in response group and CD20 in failure group vice versa (31.2 vs. 27.3 and 7.96 vs. 8.06) also with nonsignificant values

Conclusion
We observed that allografts with higher Th17 at biopsy had lower levels of GFR in the next 12 months. One conclusion can be that assessing the Th17 infiltration is more effective than FOXP3 Tregs in predicting the prognosis of renal transplant .
MO991KIDNEY TRANSPLANT PATIENTS INFECTED BY SARS-COV-2 PNEUMONIA TREATED WITH REMDESIVIR: CASES REPORTS
Authors: Cacho Judit , Molina Gomez Maria , Burgos García Elena , Villegas Andres , Pérez-Mir Mónica , Cañas Sole Laura , Taco Omar , Juega Mariã‘o Francisco Javier , Lauzurica Ricardo 
Published: May 2021

Abstract

Background and Aims
Remdesivir is the only treatment that has been shown to be useful against SARS-CoV-2 infection. It shorts hospitalization time compared to placebo. Kidney transplant (KT) patients were not included in these studies, therefore, its effects in this population is limited to some published cases.

Method
We performed a retrospective observational study that included all KT patients admitted between August 01, 2020 and November 17, 2020 with SARS-CoV-2 pneumonia who received treatment with remdesivir. Patients received a 200mg loading dose followed by 100 mg/day maintenance dose for 5 days. The objective of this study was to describe the experience of a cohort of KT patients treated with remdesivir.

Results
A total of 36 KT patients developed SARS-CoV-2 infection, 6 of them received treatment with remdesivir. The rest of the patients did not receive the drug due to either CKD-EPI less than 30 mL/min or they did not present clinical criteria. In addition to remdesivir, all pacients received dexamethasone and anticoagulation therapy. Immunosuppression was suspended in all patients, maintaining only dexamethasone. 50% were men, the median age was 58.5 (52.75–68) years. 67% had unknown underlying kidney disease, 83% were hypertensive and 33% had diabetes. All patients received KT from deceased brain donor and 50% received thymoglobulin as induction treatment. Median time from transplantation was 49 (20.5–135.5) months, with median glomerular filtration at admission of 47.5 (42.25–63.25) mL/min. The most frequent clinical manifestation was dry cough and dyspnea (83%), followed by tachypnea and fever (67%). Chest X-rays of all patients showed pulmonary infiltrates and required low oxygen flow therapy upon admission, requiring high flow nasal therapy in 33% of cases during admission. Only 17% of the cases presented deterioration of the graft function, not requiring hemodialysis in any case, and all recovered renal function at hospital discharge. No patient died or required admission to the critical care unit. Median days of admission was 12 (10–18) days.

Conclusion
KT patients with SARS-CoV-2 pneumonia under treatment with remdesivir have a good clinical course, with few cases of renal function deterioration and a low mortality rate. Additional studies are necessary with a larger number of patients to improve the knowledge of remdesivir in KT with SARS-CoV-2 infection.
MO993IMMUNOSUPPRESSION MINIMIZATION IN KIDNEY TRANSPLANT RECIPIENTS HOSPITALIZED FOR COVID-19
Authors: Anton Pampols Paula , Trujillo Hernando , Melilli Edoardo , Urban Blanca , Sandino Pérez Justo , Favà Alexandre , Gutierrez Eduardo , Bestard Oriol , Mancebo Esther , Sevillano Angel , Cruzado Josep , Morales Enrique 
Published: May 2021

Abstract

Background and Aims
Immunosuppressed patients such as kidney transplant recipients (KTs) have increased mortality risk in the setting of coronavirus disease 2019 (COVID-19). The role and management of chronic immunosuppressive therapies during COVID-19 must be characterized.

Method
Herein, we report the follow-up of a cohort of 47 KTs admitted at two Spanish Kidney Transplant Units who survived COVID-19. The impact of the management of immunosuppression during COVID-19 on graft function and immunologic events was evaluated.

Results
At least one immunosuppressive agent was withdrawn in 83% of patients, with antimetabolites being the most frequent. Steroids were generally not stopped and the dose was even increased in 15% of patients as part of the treatment of COVID-19. Although immunosuppressive drugs were suspended during a median time of 17 days, no rejection episodes neither de novo donor specific antibodies were observed up to 3 months after discharge, and no significant changes occurred in calculated panel reactive antibodies. Acute graft dysfunction was common (55%) and the severity was related to tacrolimus trough levels, which were higher in patients receiving antivirals. At the end of follow-up, all patients recovered baseline kidney function.

Conclusion
Our observational study suggests that immunosuppression in KTs hospitalized due to COVID-19 could be safely minimized.