bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO995DO THE TIMELINE AND SPECTRUM OF INFECTIONS CHANGE AFTER ANTI-REJECTION THERAPY IN KIDNEY TRANSPLANT RECIPIENTS?
Authors: Krishnakumar Arvind , Mani Selvin Sundar Raj , Alam Rizwan , Lalwani Manish , Thomas Athul , Valson Anna , Alexander Suceena , John Elenjickal Elias , Eapen Jeethu Joseph , Yusuf Sabina , Varughese Santosh , David Vinoi George 
Published: May 2021

Abstract

Background and Aims
The infections in kidney transplant recipients has been well defined. The timeline of infections and type of infection among patients who received anti-rejection therapy for acute rejection when compared to the patients who did not develop an acute rejection.

Method
Renal transplant recipients with post-transplant median follow up of four years from July 2009-June 2018 were included in a retrospective cohort study at a tertiary care hospital. Demographic characteristics, biopsy proven rejections, infections and graft and patient outcome were collected from transplant records and the hospital clinical workstation. Early and late acute rejections were defined as less than and more than 3 months respectively. The rates of various infections, type and time to develop an infection in the acute rejection group were compared with the patients who did not develop any rejection.

Results
A total of 794 patients underwent kidney transplant during the study with mean age of 35.5±12 years and 78% being male. Two hundred and eight four patients (35.8 %) had one or more biopsy proven rejections during the median follow up of 48 months (IQR 28,77). 213 patients (75%) developed early acute rejection (less than 3 months) while the remainder developed late acute rejection. The median time to develop the first acute rejection was 12 days (IQR 6,93.3). Majority of the patients (176, 62%) developed biopsy proven acute cellular rejection, 77 patients (27.1%) acute antibody mediated rejection and rest (10.9%) either mixed or borderline rejection who were treated. The proportion of BKV infection and infective diarrhea were more in rejection group when compared to no rejection group which was statistically significant (refer Table 1). At follow up, the patients who developed rejection had more graft loss (p value 0.010) but no increase in mortality. The predictors of infection among the patients who received anti-rejection therapy were identified. The median time to develop any infection in both groups were also compared. The spectrum of infections and outcome following early and late rejections were compared. Subgroup analysis was done to look at the eGFR, proteinuria trend, graft outcomes in patients with no rejection, rejection without any infection at follow up and rejection with any infection at follow up. The effect of type of anti-rejection therapy on spectrum of infections was also studied.

Conclusion
This is one of the few studies which looked at the effect of anti-rejection therapy in kidney transplant recipients. Anti-rejection treatment received post kidney transplant resulted in increased rates of BKV infection and infective diarrhea. Patients with acute rejection had more graft loss during follow up with no significant effect on mortality.
MO997INCIDENTAL SKIN CANCER AFTER KIDNEY TRANSPLANTATION: A REGIONAL POPULATION BASED-COHORT STUDY (2015-2020)
Authors: Villagrasa Tania , Ramos Daniel , Garcia José Luis , Saus Carlos , Cabello Pelegrin Sheila , Allende Natalia , Jimenez Mendoza Sonia Cleofe , Munar Vila Maria Antonia , Tugores Ana , Gomez Marques Gonzalo 
Published: May 2021

Abstract

Background and Aims
Long-term immunosuppression in solid organ transplant (SOT) recipients could be associated with high risk of cutaneous malignancies. Any suspicious lesion should be excised and sent for pathologic examination.

Method
We performed a descriptive retrospective single-center study to evaluate the incidence of all skin cancer lesions in 372 kidney transplanted recipients between January 2015 to July 2020 with at least 6 months of follow-up.

Results
We identified 53 recipients who developed skin diseases during post transplant period. Mean age was 63y, predominantly men (62%), caucasian race, with light phototype (I-II 95%).Mean follow-up were 16 months (45% first year, 23% second year, and 32%&gt; 3 years). 70% of the patients were over 60y with an earlier development of the lesions. Actinic keratosis was the most frequent non- excised lesion. 27 patients were biopsied (51%) in whom 66% showed malignant skin lesions (squamous cell carcinoma-SCC: 39%; Basal cell carcinoma-BCC: 50%; melanoma 11%). The most frequent immunosuppressive treatment (IS) associated between these recipients was the combination of tacrolimus (Tac) and mycophenolate (MMF; 62%) versus tacrolimus (Tac) and everolimus scheme (EVE; 38%). Up to 18.5% had multiple and mixed carcinomas. 4 to 5 patients of them were with MMF regimen. This treatment was also more frequent among patients with SCC (33%).

Conclusion
MO999COMPARISON OF BASILIXIMAB VS NO INDUCTION ON 12-MONTHS RENAL FUNCTION IN KIDNEY TRANSPLANT RECIPIENTS IN THE TACROLIMUS ERA
Authors: Lys Zdenek , Valkovsky Ivo , Havranek Pavel , Dedochova Jarmila , Polaskova Jana , Vaclavik Jan 
Published: May 2021

Abstract

Background and Aims
IL2-RA (Interleukin 2 receptor antagonist) are recommended for the induction immunosuppression of kidney transplant recipients in patients with low/standard immunological risk. Studies showing the effectiveness of these substances have often been performed in patients taking cyclosporine. We aimed to find out whether the same results would be obtained with the more effective tacrolimus in an immunosuppressive regimen.

Method
Induction immunosuppression using IL2-RA basiliximab in all patients undergoing kidney transplantation has been routinely used in our transplant center since April 1, 2018. We retrospectively compared outcomes of kidney transplantation of the last 40 patients before introduction of induction and the first 40 patients after the induction (monitored period of analysis is June 2017 to January 2019). All patients in each group received baseline immunosuppression of tacrolimus, corticosteroid and mycophenolate. We selected patients with low immunological risk (1st transplant, panel reactive antibodies up to 20%, without donor specific antibodies, donation after brain death) in both groups and evaluated their renal outcomes (serum creatinine and estimated glomerular filtration rate/eGFR) at 12 months after transplantation.

Results
Patients in the groups withnout and with basiliximab induction were of comparable age (51.9 years vs. 54.7) and with similar retransplantation rate (20%). The 1-year survival of patients and kidneys was the same (97.4% patient survival and 92.1% renal survival). Renal transplant function at 12 months was analyzed in 21 patients without and 19 patients with basiliximab induction with low baseline immunological risk. The patients who received basiliximab inductive immunosuppression had better graft function 12 months compared to patients without basiliximab administration: median serum creatinine level 112 µmol/L vs. 127 µmol/L (P=0.047) and eGFR 0.85 ml/s vs. 0.77 ml/s (P=0.347). Better renal function was also shown in the subgroup of patients older than 65 years.

Conclusion
At our transplant center, the introduction of basiliximab induction in patients at low immunological risk led to improved graft function in the short term despite the growing subpopulation of geriatric patients.
MO1001THE OUTCOME OF PLASMA CELL-RICH ACUTE REJECTION IN KIDNEY TRANSPLANTATION, IS IT REALLY POOR?
Authors: Mahmoud Tarek S H , Gheith Osama , Yagan Jude , Al-Taleb Ahmad , MA Halim Medhat , Nair Prasad , Alotaibi Torki 
Published: May 2021

Abstract

Background and Aims
The outcome of Plasma cell-rich acute rejection (PCAR) in kidney transplant is reported to be poor. However, PCAR which can be associated with any type of rejection, may not be considered as independent morphological prognostic feature. Different treatment modalities were prescribed with variable responses. We report here four cases of PCAR and describe their presentations, type of rejection, associated conditions and treatment outcome.

Method
Out of 1920 kidney transplant recipients under follow up in our centre from 1996 till 2019, four patients were reported to have PCAR according to 2007 Banff classification. They were re-evaluated based on 2015 Banff classification. The treatment protocol was tailored according to the type of rejection and associated conditions.

Results
The four patients, aged 28, 44, 46 and 54 years, had live unrelated renal transplant done somewhere abroad with no data about donor HLA typing. Two of them were females. One had high PRA and she was positive for HBsAg. One patient received induction immunosuppression with basiliximab. They all received prednisolone, mycophenolate and cyclosporine as the maintenance immunosuppression and had immediate graft function. Rejection happened between 23 to 180 months post-transplant. Two patients had acute T-cell mediated Banff 1A rejections with features consistent with early membranous nephropathy. One had acute T-cell mediated rejection Banff 1B and the fourth had borderline T-cell mediated rejection with morphological changes suggestive of chronic active antibody mediated rejection (AMR). Plasma cells constituted 10 to 30% of the interstitial infiltration. All patients received solumedrol pulse. Both patients with features of membranous nephropathy received rituximab and one of them had additionally IVIG. The patient with AMR received plasma exchange and IVIG. However, she did not receive rituximab as she was positive for HBsAg. All patients responded well to treatment and the mean improvement in eGFR was 12.8%, 24.9%, 40.3% and 39.1% at 1-, 3-, 6- and 12-months post treatment. Repeat kidney biopsy at 3 to 12 weeks post treatment showed resolution of plasma cell infiltration in all patients.

Conclusion
Outcome of PCAR management was favourable among our patients irrespective of the type of rejection and associated conditions.
MO1002EFFICACY OF PLASMAPHERESIS IN KIDNEY TRANSPLANT PATIENTS WITH FOCAL SEGMENTAL GLOMERULOSCLEROSIS : A SINGLE CENTER EXPERIENCE
Authors: El Meknassi Imen , Dorsaf Zellema , Awatef Azzabi , Wissal Sahtout , Narjes Ben Aicha , Sanda Mrabet , Asma Fradu , Sabri Ferdaous , Ben Amor Samira , Yosra Guedri , Abdellatif Achour 
Published: May 2021

Abstract

Background and Aims
Plasmapheresis (PP) have been used in kidney transplant (KT) patients for multiple immunological renal diseases. Focal segmental glomerulosclerosis (FSGS) is one of the most prevalent indication for PP. It can be used either for curative or preventive treatment of its recurrence. The aim of our study was to assess the outcomes of PP among KT patients with FSGS.

Method
We performed a retrospective study including all KT patients with FSGS who underwent PP during the period from December 2007 to December 2018. PP was performed using a filtration technique by a Prismaflex machine.

Results
Among 275 KT patients, we have identified 5 patients with FSGS who underwent PP either before or after transplantation. The mean age was 26.4 years. All patients but one received a living-donor kidney with number of mismatches between 3 and 5. All patients were under corticosteroids, mycophenolate mofetil and cyclosporine. Two patients presented recurrent FSGS within 3 days following the transplantation. Mean serum creatinine level and proteinuria before PP were 517 ±191 µmol/l and 17.7 ±7.5 g/day respectively. The PP was used basing on Canaud protocol combined to rituximab. The mean number of PP sessions was 29. Only one patient required hemodialysis. None of the patients had lost his graft. The mean serum creatinine level was 172±55 µmol/l. One patient died of septic shock. PP was used in two other patients before transplantation in order to prevent the recurrence of FSGS. They have preserved a normal kidney function after a period of follow-up (37 months and 7 years). No rejection or recurrence of FSGS was noted during the follow-up period. Another patient aged 20, underwent 5 sessions of PP on alternate days immediately after transplantation to prevent the recurrence of FSGS. His baseline serum creatinine level was at 136 µmol/l. The recurrence of his initial renal disease occurred after 21 months requiring other sessions of PP. Rituximab was tried but stopped in front of allergy reaction. His renal function remained stable. Overall, PP was well tolerated in all patients with no incident.

Conclusion
Recurrence of the FSGS after transplantation is a concern for nephrologists due to the difficulty of treatment. Our study shows the efficacy of plasmapheresis before kidney transplantation to prevent recurrence of FSGS.
MO1003ONSET OF BRAIN TOXOPLASMA GONDII ABSCESSES IN RENAL TRANSPLANT RECIPIENT IN THERAPY WITH BELATACEPT
Authors: Orefice Giuseppe , Vigilante Raffaella , Mennillo Chiara , Giuliana Sofia , Ruosi Carolina , Pollastro Rosa Maria , Calò Federica , Perna Alessandra , Simeoni Mariadelina 
Published: May 2021

Abstract

Background
Belatacept is a new non-nephrotoxic anti-rejection drug that blocks the CD80 / CD86-CD28 complex, that normally activates T lymphocytes.
Although the BENEFIT study proposes its use at the forefront of immunosuppressive therapy to prevent renal transplant rejection, the risk of opportunistic infections should not be underestimated, as demonstrated by the following clinical case.

Case report
We report the case of a 71-year-old male kidney transplant recipient that at 7-month follow-up showed a relevant rise of serum creatinine up to 3.8 mg/dl related to graft rejection. The patient started a cycle of treatment with Belatacept in accomplishment to international studies, with improvement in renal function (serum creatinine: 2.8 mg/dl). After 8 months of therapy, due to the appearance of left brachio-crural hypoasthenia, a brain CT and a brain MRI (both without contrast media because of the severe graft dysfunction) were consecutively performed. Imaging revealed multiple nodular formations in the right hemisphere, compatible with brain abscesses or neuro-lymphoma.
Belatacept was promptly suspended, a rachicentesis for liquor analysis performed, and a broad spectrum empiric antibiotic therapy was started on Infectious Disease Specialist advice. After Toxoplasma Gondii positivity was found by PCR on cerebrospinal fluid, neuro-lymphoma was excluded and the patient was switched to a targeted antibiotic therapy with Trimethoprim / Sulfamethoxazole (dose adjusted to renal function) for 6 weeks and subsequently, a maintenance course with Sulfadiazine and Pyrimethamine. During treatment, brain lesions showed progressive reduction, with marked clinical improvement and stabilization of renal function (eGFR 25 ml / min).

Conclusions
As far as is known in the literature, this is the first case of Toxoplasma Gondii brain infection that can be correlated with the use of Belactacept. The appearance of a severe opportunistic infection, in a short period of time after the introduction of Belatacept, could indicate the direct role of Belatacept in the development of these brain abscesses and indicates the importance of carefully evaluating the use of the drug in elderly patients with reduced renal function, in which adequate prophylactic therapy would be particularly indicated.
MO980OUTCOMES OF RABBIT ANTI-THYMOCYTE GLOBULIN VERSUS IL-2 RECEPTOR ANTAGONIST INDUCTION THERAPIES IN 2DR MISMATCH RENAL TRANSPLANT RECIPIENTS
Authors: Ali Hatem Kaies Ibrahim Elsayed , Mohamed Mahmoud , Krishnan Nithya , Malik Shafi 
Published: May 2021

Abstract

Background and Aims
2DR HLA mismatch indicates high immunological risk renal transplant. Induction therapy with rabbit Anti-thymocyte Globulin (r-ATG) and IL-2 Receptor Antagonist (IL-2RA) resulted in marked reduction of acute allograft rejection rate and improved graft survival. However, the outcomes in 2DR (HLA-DR) mismatched renal transplant recipients (RTRs) in the era tacrolimus-mycophenolate mofetil maintenance immunosuppression remains understudied.

Method
This was a retrospective cohort study using data from the United States Organ Procurement and Transplantation Network, all 2 DR mismatched RTRs who were maintained on tacrolimus and mycophenolate mofetil immunotherapy between 2005 and 2015 were included. Follow up data was until September 2020. Patients who received transplants from living donors were included in the study. Collected data included recipient factors (age, sex, ethnicity, diabetes, body mass index), transplant factors (delayed graft function, cold ischemia time, number of previous transplants, panel reactive antibodies, HLA-mismatches, induction therapies, maintenance immunotherapy, and donor factors (donor type, donor age). RTRs were divided into 2 groups: based on induction therapy r-ATG and IL-2RA. Instrumental variable regression models were used to assess effect of induction therapy on acute rejection episodes at 6 months post-transplant and on graft survival. Type of induction therapy was instrumented for the transplant centre to reduce the centre effect on the choice of the induction therapy. Cox proportional hazard regression analysis was performed to assess the effect of induction therapy on graft survival. The regression models were adjusted for collected recipient, donor and transplant factors.

Results
3052 patients received IL2-RA while 5143 patients received R-ATG induction. Using instrumental variables regression models, there were no significant differences between IL2-RA versus R-ATG induction in acute rejection episodes (OR=1.49, 95% CI ranges from 0.73 to 3.05, P=0.27), or graft survival (coefficient=0.95, 95% CI: -0.18 to 2.10, P=0.10). Using Cox proportional hazards regression, there was no significant difference in graft survival between either induction therapies (HR=0.90, 95% CI: 0.74 to 1.09, P=0.29).

Conclusion
This study showed no significant difference in acute rejection episodes or graft survival when using ATG or IL-2RA in 2DR HLA mismatched renal transplant recipients in the current tacrolimus-based maintenance immunosuppression era. Therefore, IL2-RA is a safe induction therapy in this group of patients and non-inferior to R–ATG induction therapy. Moreover, this study also highlights the fact that antigen level 2DR mismatches are not a risk factor for rejection and HLA matching should be based on epitope level rather than antigen level.
MO983EFFICACY AND SAFETY OF SWITCHING TO AZATHIOPRINE FOR MYCOPHENOLATE INDUCED DIARRHEA IN RENAL TRANSPLANT RECIPIENTS
Authors: Sekmek Serhat , Yildirim Tolga , Koc Neriman Sila , Onal Ceren , Jabrayilov Jabrayil , Yilmaz Seref Rahmi , Arici Mustafa , Altun Bulent , Erdem Yunus 
Published: May 2021

Abstract

Background and Aims
Diarrhea is a common side effect of mycophenolate treatment in renal transplant recipients. In patients with mycophenolate induced diarrhea, one of the options is switching mycophenolate to azathioprine. In this study, we aimed to define the safety and efficacy of switching from mycophenolate to azathioprine for mycophenolate related diarrhea in renal transplant recipients.

Method
A total of 177 patients, 59 of whom were switched to azathioprine due to diarrhea and 118 of which were matched control group without diarrhea that continued mycophenolate treatment, participated in this study. We analyzed the effect of switching to azathioprine from mycophenolate on amelioration of diarrhea and graft survival.

Results
We observed that 89.8% of the patients who switched to azathioprine due to diarrhea had improved diarrhea complaints. Patients switched to azathioprine due do diarrhea had lower glomerular filtration rate (59 [15-125] vs. 74 [23-150] mL/min, p&lt;0.001) and higher proteinuria (254 [49 – 15.500] mg/day vs. 184 [5 – 2329] mg/day, p&lt;0.001) compared to control group before the switch. When patients switched to azathioprine were compared to a sub-group of 59 control patients who were matched to patients that switched to azathioprine in terms of baseline renal function and proteinuria in addition to demographic parameters, they had higher ten-years graft loss compared to patients that continued mycophenolate (p=0.03) (Figure 1). Particularly in patients with a glomerular filtration rate of less than 30 mL/min at the time of conversion, the risk of early graft loss was high.

Conclusion
Although switching mycophenolate to azathioprine was an effective approach to improve diarrhea, this approach is associated with increased risk of graft loss.
MO1049PROGRESSION OF CHRONIC KIDNEY DISEASE AND LONG-TERM MORTALITY IN PATIENTS HOSPITALIZED WITH TRICUSPID REGURGITATION
Authors: Elitok Saban , Haase-Fielitz Anja , Ernst Martin , Haase Michael 
Published: May 2021

Abstract

Background and Aims
Uremic toxins negatively affect the cardiovascular system resulting in significant morbidity and mortality. However, independent risk factors for chronic kidney disease (CKD) and that of worsening CKD have not been studied in patients with tricuspid regurgitation (TR), yet. Accordingly, in this study, we aimed to assess independent risk factors for the development of progressive CKD in patients with TR. Also, the impact of progressive CKD on long-term mortality was evaluated.

Method
This retrospective, single-center study comprised 444 consecutive patients with TR who were hospitalized between January 2010 and June 2017. We excluded patients with CKD stage 5. Demographic data, comorbidities, type of admission, medication, echocardiographic and laboratory parameters, and survival status were obtained from patient medical record from index hospital admission through discharge. For at least three years, serum creatinine concentrations and survival status were collected from outpatient medical record. We identified independent risk factors for CKD progression. Also, we assessed the impact of CKD progression and other variables on 3-year mortality using multivariable logistic regression analysis. For analysis of 3-year mortality, we grouped patients according to different combinations of their TR grade and presence or absence of CKD progression.

Results
Stage of CKD at hospital admission (odds ratio 0.34 [95% confidence interval 0.24-0.50], p &lt; 0.001), baseline hemoglobin concentration (OR 0.72 [95% CI 0.57-0.92], p=0.006) and presence of diabetes type 2 (OR 1.81 [95% CI 1.08-3.03], p=0.024) were identified as independent risk factors for CKD progression. Progression of CKD during follow-up (OR 2.16 [95% CI 1.31-3.57], p=0.003), grade of TR and mitral regurgitation during index hospital stay and hemoglobin concentration at baseline were independent risk factors for 3-year mortality. Combination of TR grade and status of CKD progression showed a stepwise pattern for 3-year mortality (Figure 1). Patients with TR 1 and CKD progression had a similar 3-year mortality as patients with TR 2 or 3 but no CKD progression. In patients with TR 1, risk for 3-year mortality doubled if CKD progression occurred (OR 2.49 [95% CI 1.38-4.47], p=0.002).

Conclusion
Although retrospective studies cannot imply causal relationship, based on study findings, kidney follow-up especially in patients with mild TR may be advisable. If CKD progression can be prevented in patients with TR and if such kidney protection may reduce long-term mortality may be objective of future studies.