bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO963GRAFT- AND PATIENT-SURVIVAL AFTER FIRST KIDNEY TRANSPLANT BIOPSY
Authors: Nasic Salmir , Mölne Johan , Stegmayr Bernd , Felldin Marie , Peters Björn 
Published: May 2021

Abstract

Background and Aims
Kidney transplantation is frequently used as a treatment in uremic patients. However, long term function is not easily predicted. The aim of this study was to investigate to what extent histological diagnosis in the first registered transplant kidney biopsy is related to clinical outcome.

Method
Included were data of 1463 patients (36.6 % women, 63.4 % men) that were merged from a kidney transplantation register and a biopsy register. These patients obtained their first registered transplant biopsy during the period January 1, 2007 until July 30, 2017. Fisher’s exact test and χ-2 analyses were used for cross-tabulation of data. Graft- and patient-survival analysis was performed by Kaplan-Meier analysis with log-rank tests comparing different groups and in next step age and gender adjusted analysis were performed by multivariate Cox-regression-analysis. Data are presented as Hazard Ratio (HR) and 95% Confidence Intervals (CI). A two-sided p-value of &lt;0.05 was considered as statistically significant.

Results
The graft-survival was shorter for patients with biopsy-proven glomerular diseases (HR 8.1, CI 3.1-20.7) and rejections (HR 4.3, CI 1.7 -10.5) compared to normal biopsy findings. Further, there was a shorter graft-survival for those with chronic damages (HR 3.2, CI 1.3-8.0), acute tubular injuries (HR 3.0, CI 1.2-7.8), and borderline changes (HR 2.9, CI 1.1-7.6). The patient-survival was reduced for patients with biopsy-proven hematological diseases (HR 9.6, CI 2.1-44.0). Sub analysis of all types of rejections showed shorter graft-survival for chronic T-cell-mediated rejection (TCMR) (HR 4.8, CI 2.1-11.7), active antibody-mediated rejection (ABMR) (HR 4.4, CI 2.1-9.3), chronic ABMR (HR 3.8, CI 2.2-6.7), combined chronic ABMR and TCMR (HR 4.0, CI 2.4-6.9) and other rejections (HR 3.3, CI 1.1-9.6) compared to acute TCMR. Patients with TCMR Banff grade II rejection had a better graft-survival (HR 0.35, CI 0.20-0.63) compared to other rejections as well as patients with TCMR Banff grade I (HR 0.52, CI 0.29-0.93). 265 patients had graft-loss and 42 of those patients died afterwards (15.8%). Of the 42 who died after graft-loss 9 patients died within 30 days after transplant failure (21.4%).

Conclusion
A shorter graft-survival was found in kidneys with glomerular diseases, rejections, acute tubular injuries, borderline changes and chronic damages. A shorter patient-survival was noted for patients with transplant kidney biopsies with hematological diseases. Patients with Banff grade II rejection had a better graft-survival compared to all other diagnosis and other rejections. Further, awareness should be given to patients the first month after graft-loss.
MO968ROUTINE BIOMARKERS FOR THE SEVERITY OF COVID-19 PNEUMONIA MAY PRESENT DIFFERENTLY IN KIDNEY TRANSPLANT RECIPIENTS
Authors: Burgos García Elena , Molina Gomez Maria , Cacho Judit , Juega Mariã‘o Francisco Javier , Cañas Sole Laura , Taco Omar , Pérez-Mir Mónica , Urrutia Marina , Graterol Fredzzia , Lauzurica Ricardo 
Published: May 2021

Abstract

Background and Aims
The treatment of coronavirus disease (COVID-19) is based on the patient’s clinical status and levels of inflammatory biomarkers. The comparative activity of these biomarkers in KT patients with COVID-19 pneumonia from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and non-SARS-CoV-2 aetiologies is unknown. The aim of this study was to compare the clinical presentation and inflammatory parameters at admission of KT patients with COVID-19 pneumonia and those with non-COVID-19 pneumonia over the same period.

Method
Biomarkers were measured and compared between KT patients with COVID-19 pneumonia (n=42) and non-COVID-19 pneumonia (n=18) from March to November 2020.

Results
Both groups showed comparable demographics. The COVID-19 KT patients had fewer neutrophils (4,650 [2,925-9,498] vs. 9,100 [7,170-11,150],p=0.01) than the non-COVID group, although there was no significant difference in the lymphocyte count. Non-COVID-19 pneumonia was associated with a higher d-dimer (962 [427-1,448] vs. 1,704 [868-2,481],p=0.09) and IL-6 (37 [23-10] vs 254 [53-602],p=0.006) levels. The ferritin level was higher in the COVID-19 group (908 [496-1,377] vs. 340 [264-785],p=0.008).

Conclusion
COVID-19 pneumonia in KT recipients shows a different presentation of inflammatory biomarkers than other non-COVID pneumonias. It could be usefully to identify KT patients with COVID-19.More detailed studies are necessary to understand the presentation of biomarkers in KT with COVID-19.
MO972THROMBOPHILIC SCREENING IN LIVING KIDNEY DONOR EVALUATION
Authors: Diotallevi Laura , Mori Giacomo , Di Sandro Stefano , Di Benedetto Fabrizio , Cappelli Gianni 
Published: May 2021

Abstract

Background and Aims
Living Kidney Donor Transplantation (LKDT) is the first therapeutic choice in end stage renal disease (ESRD). Donor safety has to be ensured, throughout an extensive pre operative screening. Venous thromboembolism (VTE) and deep vein thrombosis(DVT) are the most frequent complications after abdominal surgery. Living kidney donation is considered a safe procedure, with a major morbidity rate around 5%, and a not clearly defined incidence of VTE and DVT. We thus proceeded to evaluate the thrombophilic risk among potential kidney donors to define an adequate prophylactic strategy.

Method
Our Transplant Center introduced thrombophilic screening in all potential donors from 2019. We checked clinical history for previous thrombotic events, active or treated malignacies. Our thombophilic risk panel comprehended: Lupus Anticoagulant (LAC), Factor V -II-VIII, in Protein C and S activity. In case of LAC undetermined results on two consecutive samples, we tested anti-cardiolipin and anti-beta2-glycoprotein 1 antibodies. Nephrectomy was performed by mini-invasive robotic technique; anticoagulation was provided by Enoxaparin 4000U 7-14 days.

Results
We studied 32 potential donors. No previous thrombotic events were reported. Malignancies were observed in 4 patients (12.5%), 1 before starting the study and 3 were discovered during the evaluation (MGUS, non small cell lung carcinoma). Thrombophilic screening showed uncertain LAC in 3 (9%) patients, an heterozygote mutation in Factor V associated with APC positivity in 1 patient(3%), heterozygote mutation in Factor II in 3(9%) disorder in Protein C S and Factor VIII activity respectively in 4 (12.5%) 3(9%)and 4(12.5%) patients. Among the 9 patients deemed fit for donation: uncertain LAC in 1(11%) patient, heterozygote mutation in Factor II in 1 (9%) patient. No thrombotic event was reported after donation.

Conclusion
The frequency of coagulation disorders among kidney living donor is low, but not negligible. Appropriate medical history assessment and thrombophilic screening before donation is recommended, as well as an antithrombotic prophylaxis with Enoxaparin from 7 to 14 days after nephrectomy, tailored on each patient risk factors. This strategy allowed to avoid thrombotic events in patients who underwent nephrectomy. More data are necessary to draw more solid conclusions.
MO973PRE-IMPLANTATION BIOPSY FINDINGS AND IMPACT ON LIVE DONOR KIDNEY TRANSPLANT RECIPIENT OUTCOMES - A SINGLE CENTRE STUDY
Authors: Erandika Naduni , Nanayakkara Nishantha , Wijetunge Sulochana , Rathnathunga Neelakanthi , Harishchandra P K , Fernando Charitha , Weerasinghe Charitha , Wazil A W M , Mahanama Buddhisha , Basnayake Duminda , Abeysundara Hemalika , Abeysekera Rajitha Asanga 
Published: May 2021

Abstract

Background and Aims
Live donor kidney transplantation remains the mainstay of renal replacement therapy in Sri Lanka. The basic universal pre surgical investigations, human leucocyte antigen (HLA) matching and cross matching are routinely performed, however due to high rates chronic kidney disease (CKD) as well as increasing numbers of, chronic kidney disease unknown etiology (CKDu) in Sri Lanka, there is a possibility of subclinical kidney disease being present in donor kidneys which go undiagnosed. A study of pre-implantation biopsy along with follow-up outcomes of kidney transplant recipients is conducted to identify presence of subclinical kidney disease in a Sri Lankan cohort of patients.

Method
We collected thirty three (33) live donor pre-implantation biopsies during 4 consecutive months in 2020 as well as 1 month follow-up data. This is part of an ongoing follow-up study which is conducted at National Hospital, Kandy, Sri Lanka.

Results
Thirty three (33) live donor recipients and their pre-implantation renal biopsy samples were studied. The mean age of the study participants’ was 37.6 (SD 12.5, range 13 - 59) years. A predominant number of male patients were in the sample (n=21, 63.6%). Underlying aetiology of end stage renal disease (ESRD), was predominantly due to chronic hypertension (39.3%; n=13) and diabetic kidney disease (21.2%, n=7) accounting for nearly 60% of the study participants. Among the 33 live donors 1st degree, 2nd degree and non-relative donors were 54.4% (n=18), 18.2% (n=6) and 27.3% (n=9) respectively. Pre-implantation renal biopsy results reported 36.4% (n=12) with abnormal biopsy findings including chronic interstitial nephritis (n=4, 12.1%), interstitial fibrosis (n=6, 18.18%) and acute tubular necrosis (n=2, 6%). Follow-up revealed delayed graft function occurring in 18.2% (n=6) of recipients with 50% (n=3) of them showing abnormalities in the pre-operative donor biopsy sample. At one month follow-up, 48.5% (n=16) reported complications which included graft failure 3% (n=1), all-cause mortality 3% (n=1), acute rejection 39.4% (n=13) and infections 24.2% (n=8). Overall, 37.5% (n=6) of these recipients had abnormal donor biopsy findings, however no significant statistical association was identified.

Conclusion
Our study identified subclinical kidney disease in donor kidneys despite standard pre-transplant screening. Even though, statistically not significant, recipients with abnormal pre-implantation biopsy findings had adverse short term post-transplant complications.
MO976GENDER AND AGE DISPARITY IN INFECTIOUS COMPLICATIONS AFTER KIDNEY TRANSPLANTATION
Authors: Matej Vnucak , Graňák Karol , Skálová Petra , Dedinska Ivana , Laca Ľudovít 
Published: May 2021

Abstract

Background and Aims
Number of older patients with end stage kidney disease has been increasing, therefore there are increased number of older kidney transplant recipients. Potent immunosuppression (IS) used in patients after kidney transplantation (KTx) lowered the incidence of acute kidney rejection but increased the risk of post-transplant infection and sepsis as the most common non-cardiac cause of death. Older adults are at high risk of infections due to functional impairment and multiple comorbidities leading to poor outcome after KTx. Nowadays, no change in IS or prophylactic therapy is recommended based on the age of an adult KTx recipient. Female gender may be risk factor for infection after KTx due immunomodulatory effect of sex hormones such as estradiol.

Methods
The aim of our analysis was to find whether there are sex differences in the incidence of single and repeat infection and whether there is increased incidence of single and recurrent infectious complications in older kidney transplant recipients.

Results
Our analysis consisted of 100 patients after KTx (66 males, 34 females), average age 47,5 ± 12,6 years, treated with anti-thymocyte globulin as an induction IS. Male gender was a protective factor for the incidence of following infections in the 1st month after KTx: infection in general (P = 0.0054), recurrent infection (P = 0.0239), bacterial (P = 0.0125) and mycotic infection (P = 0.0103), recurrent bacterial infection (P = 0.0258). From the 1st to 6th month after KTx, female gender was identified as a risk factor for the incidence of infection in general (P = 0.0218), bacterial (P = 0.0186) and mycotic infection (P = 0.0318), repeat infection (P = 0.0216), recurrent bacterial infection (P = 0.0368). From 6th to 12th month after KTx, female gender was found as a risk factor for the incidence of bacterial infection (P = 0.0144), single infection (P = 0.0355), recurrent infection (P = 0.0007), single bacterial infection (P = 0.0309). Age &gt; 60 years was not found as a risk factor for the incidence of single, repeat infection regarding its etiology. In our analysis we did not found correlation between gender and the incidence of single or recurrent infection of any etiology, we did not find significant differences in the severity of infections reflected by need for hospitalization, intensive care unit or use of vasopressors neither in gender, nor in older patients. In our study we did not confirm gender or age as a risk factor for the acute kidney rejection.

Conclusion
In our analysis, we found significant sex differences in the incidence of bacterial, viral, mycotic, single and repeat infection in different time intervals after kidney transplantation, while we did not confirmed age &gt; 60 years is a risk factor for the infectious complications after KTx.
MO994POST-TRANSPLANT DIABETES MELLITUS PREDICTORS AFTER PANCREAS-KIDNEY TRANSPLANT
Authors: Menezes Maria Do Mar , Bigotte Vieira Miguel , Mendes Filipa , Messias Ana , Moreira Fonseca Nuno , Aires Inês , Nolasco Fernando 
Published: May 2021

Abstract

Background and Aims
Pancreas-kidney transplantation (PKT) is an established treatment for selected patients with type 1 diabetes mellitus (T1DM) with either advanced or end-stage chronic kidney disease. We aimed to evaluate predictors for post-transplant diabetes mellitus (PTDM) at 24 months of follow-up after PKT.

Method
We analysed a longitudinal cohort of patients with chronic kidney disease and T1DM who underwent PKT at a tertiary referral centre from January 2011 to December 31, 2017. PTDM (post-transplant diabetes mellitus) was defined as the persistent need for pharmacologic treatment of diabetes mellitus after transplant. Continuous variables were recorded as means (±SD) or as medians (25-75% interquartile range), accordingly to data distribution. Categorical variables were recorded as proportions. Comparisons were made using t-tests, Wilcoxon rank-sum tests, or X2 test as appropriate. Unadjusted and adjusted multivariate logistic regression models were fitted to identify risk factors for PTDM at 24 months of follow-up. STATA 14.2 statistical package was used and p &lt;0.05 was considered statistically significant.

Results
From a total of 72 patients who underwent PKT during the study period, 47 patients completed at least 24 months of follow-up. The mean age at transplantation was 37±8 years, 30 (64%) were male, 43 (91%) were white and 4 (9%) were black. At 24-months of follow-up, the prevalence of diabetes mellitus was 28% (13/47).
Number of mismatches, accumulated prednisolone dose, tacrolimus levels, previous rejection episodes, body mass index, cytomegalovirus status, serum creatinine, lipase, amilase at discharge were not associated with PTDM.
Patients with persistent diabetes at 24-months of follow-up had a significantly longer pretransplant diabetes duration (29±10 versus 23±6 years; p-value = 0.026), had higher pretransplant LDL-cholesterol (137±46 versus 100±27 years; p-value = 0.003), and lower C-peptide at post-transplant hospital discharge (3.0 [2.0-3.3] versus 5.8 [4.5-6.5]; p-value = 0.004).
Likewise, in univariate logistic regression models, longer diabetes duration and higher pretransplant LDL-cholesterol were found to be risk factors for PTDM at 24-months (OR 1.11, CI95% 1.00-1.22, p-value = 0.041; OR 1.03, CI95% 1.01-1.06, p-value = 0.014; respectively), while higher C-peptide at post-transplant hospital discharge was found to be protector (OR 1.03, CI95% 1.01-1.06, p-value = 0.014). In a multivariate model including age, pretransplant diabetes duration, pretransplant LDL-cholesterol, and C-peptide at post-transplant hospital discharge, only C-peptide at post-transplant hospital discharge remained significant (OR: 0.41, CI95% 0.18-0.95, p-value = 0.04).

Conclusion
Despite previous results in other studies, and new data researched, in our multivariate model, only lower C-peptide at post-transplant hospital discharge revealed being a predictor of PTDM after PKT.
MO996COVID-19 IN RENAL TRANSPLANT RECIPIENTS; A CASE SERIES FROM IRAQ
Authors: Ali Ala , S. Klaif Mohammed , Altaee Huda 
Published: May 2021

Abstract

Background and Aims
Renal transplant recipients seems at particular risk for Coronavirus disease 2019 (COVID-19). In addition to immune suppression cessation, multiple therapies have been tried with no supportive evidence. Favipiravir and colchicine showed benefit in some reports. Here we describe 19 adult renal transplant recipients with mild to moderate COVID-19 who were treated with the cessation of immunosuppression, favipiravir, and colchicine on an outpatient basis.

Results
This case series includes 19 renal transplant recipients with a mean age of 38.4 + 11.6 years and a mean duration of 55.9 + 36.1 months post-transplant. They were maintained on triple therapy with a calcineurine inhibitor, antiproliferative therapy and steroids. The laboratory data at weeks 1,2, and 3 showed that at weeks 2 all markers of inflammation increased especially serum ferritin (1718 + 315 ng/ml). Serum creatinine increased by &lt; 30% with urine protein creatinine of &lt; 500 mg/g. The mean time to recovery was 13 + 3.1 days. The patient who was on mTOR inhibitor showed the highest inflammatory response and the longest time to recovery, 18 days. All patients showed complete recovery with stable graft function and no patient warranted dialysis, nor ICU care.

Conclusion
In the settings of limited resources, unavailability of costly immunomodulatory therapies and limited hospital capacity, early case definition, judicious management of immune suppression, and affordable antiviral and anti-inflammatory drugs will improve outcome in early cases of COVID-19 in renal transplant recipients.
MO998EARLY VERSUS LATE ACUTE GRAFT PYELONEPHRITIS: A RETROSPECTIVE ANALYSIS OF GRAFT AND PATIENT OUTCOMES
Authors: Kaul Anupma , Mathews Thomas 
Published: May 2021

Abstract

Background and Aims
Acute graft pyelonephritis(AGPN) is thought to affect graft and patient survival among renal transplant recipients. Our objective was to compare these outcomes in those having early AGPN(&lt;6 months from transplant) versus those having late AGPN(&gt;6months from transplant)

Method
This retrospective study analyzed 150 patients who had AGPN over a period of 8 years from 2005 to 2013. They were divided into early AGPN group and late AGPN group. Their baseline characteristics were compared. Predictors of graft loss and mortality were compared using logistic regression analysis. Graft survival and patient survival were analyzed using Kaplan-Meyer survival plots

Results
A total of 150 patients with AGPN were analyzed. Of these 55.3% (n=83) had early AGPN and 44.7% (n=67) had late AGPN. These two groups were comparable regarding baseline characteristics and immunosuppression. In early AGPN group, 13.3% (n=11) patients had CMV disease during follow up compared to 3% (n=2) in late AGPN group(p&lt;0.05). In the early AGPN group, 26.5% (n=22) had prolonged Foley’s catheterization (&gt;5days) following transplant surgery compared to 7.5% (n=5) in late AGPN group (p&lt;0.05). In the early AGPN group, 38.6% (n=32) had prolonged DJ stent in-situ (&gt;2weeks) following transplant surgery compared to 19.4% (n=13) in the late AGPN group (p&lt;0.05). Recurrent GPN was more common in the late AGPN group than the early AGPN group - 35.8% (n=24) versus 18.1% (n=15). Predictors for graft loss were assessed in patients with AGPN and the presence of renal abscess was predictive of graft loss in univariate analysis (HR-6.129, 95% CI 1.776–21.154, p-0.004). There were no significant predictors of mortality in univariate analysis. Kaplan Meier survival analysis showed decreased death censored graft survival in the early AGPN group (p-0.035). There was no

Conclusion
Occurrence of early AGPN had a significant impact on long term graft survival in renal transplant recipients with no significant effect on patient survival. This study underlines the paramount importance of the prevention of UTIs in renal transplant recipients.
MO1000MAINTENANCE IMMUNOSUPPRESSIVE THERAPY IN PREVENTION OF ACUTE REJECTION AFTER KIDNEY TRANSPLANTATION
Authors: Fattoum Safa , Bacha Mohamed Mongi , Mosbehi Tasnim , Braiek Nesrine , Abderrzhim Ezzedine , Ben Hmida Fethi , Ben Abdallah Taieb 
Published: May 2021

Abstract

Background and Aims
Acute rejection (AR) is a redoubtable immunological complication after kidney transplantation (KT). Maintenance immunosuppressive treatment (IS) is a corner stone in prevention of AR. The aim of this study was to define the role of different maintenance IS in preventing AR.

Method
It was a longitudinal, retrospective, analytical study including kidney transplant patients followed up in our department between 1986 and 2019. Our population was divided in 2 groups: group A (129 KT complicated by at least one episode of AR) and group B (491 KT not complicated by AR).

Results
All patients received low dose of corticosteroids (CS) in their IS.
Calcineurin inhibitors (CI) were not prescribed in first intention in 33,3% of groups A patients versus 13,2% in group B. Cyclosporin A (CsA) was prescribed in first intention in 57,4% of group A patients versus 45,7% in group B. Tacrolimus was prescribed in first intention in 9,3% of group A patients versus 41,1% in group B (p&lt;0,0001).
All patients received Atimetabolite (AM) in their IS. In first intention, Azathioprin was prescribed in 73,6 % of group A patients and Mycophenolate Mofetil (MMF) was prescribed in 78,6% of group B patients (&lt;0,0001).
In first intention, maintenance IS consisted in low dose corticosteroids (CS) associated with AM in 13,5% of our patients. CI was associated to CS and AM in 86,5% of patients. Tritherapy was significantly more used than biotherapy in group A (p&lt;0,0001). Different associations used were CS+Aza, CS+MMF, CS+AZA+CsA, CS+MMF+CsA or CS+MMF+ Tac. From group A, 74,8% of patients received CS+AZA or Cs+AZA+CsA. And from group B, 75,8% of patients received CS+MMF+CsA or CS+MMF+Tac.

Conclusion
Maintenance IS therapy must be well chosen according to immunological risk in order to prevent AR.