bluuebunny/crossref_metadata_2025_split huggingface dataset:
#2992 Risk and prognostic factors for post-transplantation lymphoproliferative disease in solid organ transplant recipients—a multicenter analysis
Authors: Mucha Krzysztof , Staros Rafał , Foroncewicz Bartosz , Kamińska Dorota , Raszeja-Wyszomirska Joanna , Dębska-Ślizień Alicja , Nazaruk Paulina , Załuska Wojciech , Ochman Marek , Kosieradzki Maciej , Grąt Michał , Durlik Magdalena 
Published: May 2024

Abstract

Background and Aims
Post-transplantation lymphoproliferative disorder (PTLD), a potentially fatal complication of transplantation, affects solid organ transplant recipients at different rates, depending on organ graft type: the risk greater in lung transplant recipients (LngTRs), lower for liver transplant recipients (LTRs) and lowest for kidney transplant recipients (KTR). In this study we aimed to investigate the factors affecting the development and treatment outcomes of PTLD and compare their effect on KTRs, LTRs and LngTRs.

Method
In this retrospective cohort study we have included all KTRs, LTRs and LngTRs diagnosed with PTLD at six transplantation centers in Poland. The data collected from medical records included: immunosuppression (IS), viral infections, PTLD type, treatment and outcomes. Chi-squared test was used to assess the differences in group composition. To determine the impact of variables upon PTLD time of onset and patient survival, univariate Cox regression was used. p-values below 0.05 were considered statistically significant.

Results
We enrolled 50 KTRs, 36 LTRs and 5 LngTRs from 6 transplantation centers in Poland. Based on the data from the most contributing centers in each group, the prevalence of PTLD was 0.82% of KTRs, 2.03% LTRs and 1.51% of LngTRs. Two thirds of the enrolled patients were male, the median age at first transplantation was 40 years for KTRs, 45 for LTRs and 25 for LngTRs (Table 1). The groups significantly differed in IS treatment: steroid (GCS) and cyclosporin (CsA) use was more frequent in KTRs (p&lt;0.001 and p&lt;0.001 and respectively), tacrolimus (TAC) and anti-CD25 induction in LTRs (p ≤ 0.001 and p&lt;0.001 respectively), sirolimus (RAPA) in LngTRs (p&lt;0.001). KTRs were the latest to develop PTLD (126 months after transplantation, p&lt;0.001). In all groups Monomorphic B-cell PTLD was the most frequent. Initial IS treatment reduction was used in 80-86% of patients, R-CHOP chemotherapy was most common in LTRs (p=0.021), other chemotherapy regimens in KTRs (p=0.031). TAC had the opposite effect on PTLD time of onset in KTRs (HR=2.18, p=0.013) and LTRs (HR=0.18, p=0.036). The overall survival at the end of observation period was 26% for KTRs, 58% for LTRs and 80% for LngTRs. Loss to follow up was most frequent in KTRs at 26%. Patient survival was not affected by PTLD treatment.

Conclusion
KTRs develop PTLD later than LTRs and LngTRs, and time of disease onset is associated with TAC use. Lower survival in KTRs may result from the longer follow-up period compared to other solid organ transplant recipients.
#1692 Prevalence and risk factors for persistent hyperparathyroidism in long-term kidney transplant recipients
Authors: Kittiweerawong Wiphat , Chotmongkol Wijittra , Pongchaiyakul Chatlert , Kritmetapak Kittrawee 
Published: May 2024

Abstract

Background and Aims
Secondary hyperparathyroidism, associated with fractures and cardiovascular mortality in end-stage kidney disease, often resolves after kidney transplantation (KT). However, limited knowledge exists regarding persistent hyperparathyroidism (persist-PTH) after long-term KT. We aimed to define the prevalence and risk factors of persist-PTH in KT recipients at ≥3 years post-KT.

Method
A historical cohort study was conducted in adult KT recipients at Srinagarind Hospital, Khon Kaen University, Thailand, from 2015 to 2020. Persist-PTH is defined as serum parathyroid hormone (PTH) exceeding twice the upper limit of normal (&gt;130 pg/mL) after ≥3 years post-KT.

Results
A total of 281 patients were included, with a median age of 41.4 years (interquartile range (IQR), 32.7-49.1), and 117 patients (41.6%) were female. The median post-KT follow-up was 71 months (IQR, 54-89) with a glomerular filtration rate (GFR) of 61.8 mL/min/1.73 m² (IQR, 48.2-76.9). The respective median pre-KT and post-KT PTH were 403 pg/mL (IQR, 196.3-862) and 96.7 pg/mL (IQR, 67.3-166). Post-KT PTH levels correlated with pre-KT PTH levels (r²=0.18; P&lt;0.001). Persist-PTH occurred in 100 patients, with a prevalence of 35.6% (95% confidence interval (CI), 30.2-41.4%). Multivariate analysis revealed significant associations between persist-PTH and a longer dialysis vintage (odds ratio (OR) 1.13 per 6-month increase; 95% CI, 1.06-1.20; P&lt;0.001), lower GFR (OR, 0.76 per 10 mL/min/1.73 m² increase; 95% CI, 0.63-0.92; P=0.004), and higher pre-KT PTH (HR, 1.06 per 50 pg/mL increase; 95% CI, 1.02-1.10; P=0.001). Furthermore, persist-PTH with hypercalcemia (&gt;10.2 mg/dL) occurred in 44 patients (15.7%; 95% CI, 11.8-20.4%), and with hypophosphatemia (&lt;2.5 mg/dL) in 23 patients (8.2%; 95% CI, 5.5-12.0%).

Conclusion
Persist-PTH occurred in over one-third of long-term post-KT recipients, particularly in those with extended dialysis vintage, impaired graft function, and elevated pre-KT PTH levels. This underscores the need for optimal pre-KT PTH control and vigilant graft function monitoring to prevent persist-PTH.
#516 Cancer after kidney transplantation in the single transplant center
Authors: Yankovoy Andrey , Artamonova Aleksandra 
Published: May 2024

Abstract

Background and Aims
A retrospective analysis of peculiarities of development of malignant neoplasms in patients after kidney transplantation receiving long-term immunosuppression.

Method
In this study we evaluated incidence of malignancies observed among 718 renal transplant recipient with at least 6 months of follow-up. A total of 561 men and 257 women, mean age at transplantation 36.3 ± 8.3 years were included.

Results
Thirty-three out of 718 recipients (4.6%) developed malignant neoplasia: 45.5% of these were Kaposi's sarcomas, 12.1%—cancers of the uterine cervix, 12.1% cancer of the stomach, 12.1% - basal cell carcinomas, 6.06% - post transplant lymphoproliferative disorder. There was no significant effect of either cyclosporine A, tacrolimus doses or OKT3/ATG on the incidence of the tumors. The median time from onset of end-stage renal failure (dialysis start) and from the transplantation to the diagnosis of the tumor make up 32 (16-161) and 23 (5-158) mouths, respectively. One renal transplant recipient suffered from multiple myeloma with aggressive course. Three patients diagnosed with renal cell carcinoma of the transplant: clear cell carcinoma, papillary carcinoma, mucinous adenocarcinoma via 264, 24 and 4 months respectively.

Conclusion
The importance of strict adherence to intensive monitoring transplant patients, which can detect tumors at an early stage. Strict adherence to intensive follow-up of transplant patients is important, which makes it possible to identify neoplasms at an early stage, when organ-preserving treatment is feasible and effective. In addition, modification of immunosuppressive therapy in such patients involves reducing the dose or, if possible, completely eliminating calcineurin inhibitors and starting taking mTOR inhibitors (sirolimus or everolimus), taking into account the antitumor effect of this group of immunosuppressants.
#1294 The impact of plant-based diet on renal function and metabolic profile in kidney transplant recipients
Authors: Caletti Chiara , Stefani Lisa , De Tomi Elisa , Tassi Serena , Andreola Stefano , Ferraro Pietro Manuel , Gambaro Giovanni 
Published: May 2024

Abstract

Background and Aims
Controlling and reducing protein intake is the most used approach to preserve renal function in CKD patients. Compared to protein restriction alone, plant-based diets have received particular attention. However, data on the potential risks and benefits of a plant-based diet in kidney transplant patients remains sparse, and evidence in this population is indirect.
The primary purpose of this study was to evaluate if a plant-based diet affects proteinuria and eGFR in renal transplant patients. Establishing whether it influences acid load, glycolipid profile, nutritional status, and performance status were secondary objectives.

Method
26 renal transplant recipients with eGFR &gt;20 ml/min/1.73 m², urinary protein excretion &gt;0.5 g/day, and transplant age &gt;1 year were considered eligible for the study. Enrolled subjects underwent dietary assessment and biochemical tests at baseline, three and six months after starting the plant-based diet. All subjects underwent performance tests: sit-to-stand and handgrip tests.

Results
Only 18 patients were included in the statistical analysis. After six months, no significant changes in levels of proteinuria, urinary anion gap, triglycerides, and grip strength were detected. However, there was a statistically significant reduction in total cholesterol (p=0.03), LDL (p=0.04), and fasting blood sugar levels (p=0.001). A statistically significant reduction in eGFR (p=0.033) was observed, likely the regression of the previous hyperfiltration caused by the animal protein diet. A significant improvement was found in sit-to-stand test performance (p=0.037). Finally, a direct relationship between azoturia and urinary anion gap was observed.

Conclusions
The work carried out has highlighted how some of the potential benefits of the plant-based diet may also be relevant among kidney transplant patients. The plant-based diet is also associated with improved performance tests.
#2907 Characterization of patients needing red blood cell transfusion after kidney transplant
Authors: de Hilla Nerea Ormaetxe Ruiz , Etxarri Neike Murua , Martín María Fernández , De Juan Oihane Abaunza , Davis Mónica Paola Rodríguez , Noguer Raquel Vila I , Castaño Isabel Benito , Mendia Iñigo Yañez , Montes Amaia Begoña Osorio , Berastegui Begoña Bralo , Álvarez Quintana Eva María , Larrondo Sofia Zarraga 
Published: May 2024

Abstract

Background and Aims
After kidney transplant there is often need of red blood cell (RBC) transfusion because acute bleeding associated with surgery; or because multifactorial progressive anemization the days after. The aim of this work is to describe the characteristics of transfused kidney transplant recipients (KTR) and compare them to nontransfused controls.

Method
Retrospective observational study, reviewing the data from electronic medical records of patients receiving a kidney transplant in our hospital during 2022.

Results
During 2022, 160 kidney transplants were performed in adult people in our hospital and 66 (41.25%) KTR were transfused; some of them receiving the first red blood cell concentration (RBCC) during surgery (19.7%), the rest after surgery hospitalization because acute (10.6%) or progressive (69.7%) anemization. The total number of RBCC received was 1 in the 15% of transfused KTR, 2 in the 48%, 3 in the 8% and ≥ 4CH in the 29%.
Among transfused KTR, the 13.6% kidney grafts came from living donors, 48.5% from Maastricht III, 36.4% from brain death and 1.5% from Maastricht II, whereas the kidney grafts of nontransfunded controls came from living donors (11.7%), Maastricht III (54.26%), encephalic death (32.98%) and Maastricht II (1.06%).
The mean age of the transfused KTR was 62 years, 63.6% were males, 14.1% with ischemic heart disease, 6.3% with heart failure, moderate-severe valvular heart disease. The 12.12% were treated with acenocoumarol and the 25.7% with acetylsalicylic acid before the transplant hospitalization (whereas in nontransfunded controls the percentages were 10.6% and 21.3% respectively).
Haemoglobin (Hb) levels previous to the surgery was lower in transfused KTR, presenting Hb &lt;10 g/dl in the 10.6% of the recipients, whereas in nontransfunded controls was 2.1%. Moreover, ferritin levels were &lt;100 ng/ml in 13.6% and transferrin saturation index was &lt;20% in the 30.3% (whereas in nontransfunded controls it was 25.53% and 38.29% respectively).
The mean of Hb before the transplant surgery in transfused KTR was 11.7 ± 1.4 g/dl, and before RBCC transfusion the median was 7.8 g/dl [7.6-8.1].

Conclusion
Although more studies are needed, it is interesting to know the characteristics of the KTR that need RBC transfusion in order to asses measures (such us for example, Hb, iron … pretransplant adequate thresholds), in order to avoid if it is possible, unnecessary RBC transfusions.
#1274 Post kidney transplant parvovirus disease presenting as refractory anemia—case series of 21 patients
Authors: Mittal Ankur , Hegde Umapati , Gang Sishir , Konnur Abhijit , Patel Hardik 
Published: May 2024

Abstract

Background and Aims
Kidney transplant recipients (KTRs) are susceptible to a wide range of infections, one of which includes Parvovirus B19 (PVB19). It usually presents in the first year after transplant, with anemia and causes increased morbidity and risk of graft dysfunction.

Method
Charts of patients undergoing kidney transplant between May 2013 and March 2022 were reviewed. 21 patients had PVB19. Their clinical presentation, laboratory parameters and outcome was studied. The diagnosis of PVB19 was established by PVB19 polymerase chain reaction (PCR) and by bone marrow examination(BME) in 6 patients.

Results
Prevalence of PVB19 disease was 1.9% (21/1164) with a median time to onset was 39 days post-transplantation. Clinical presentation included fever, generalized weakness, dyspnea, and myalgia in 47%, 76%, 23%, and 33% of patients respectively. Anemia, leukopenia, and thrombocytopenia were present in 100%, 14%, and 9.5% of patients respectively. Graft dysfunction was observed in 61.9% (13/21) patients. 20/21 (95%) patients had a positive PVB19 PCR and one patient had a typical viral inclusion on BME. Immunosuppression especially antiproliferative was reduced in all patients. 8 patients received IVIG, 8 received packed cell blood transfusion and 7 received Erythropoietin therapy. All patients recovered with median time to normalization of hemoglobin was 30 days. One patient had graft loss secondary to non-responsive graft rejection.

Conclusion
PVB19 is a rare but clinically significant cause of refractory anemia during the early post-transplantation. Any kidney transplant patient in first 4 months who has unexplained normocytic normochromic refractory anemia with or without graft dysfunction should be screened for PVB19 by DNA PCR or BME to rule out PVB19 infection. The use of PCR for diagnosis and reduction in immunosuppressants particularly antiproliferative drugs is the mainstay of treatment.
#983 Identification of gut microbiome signatures associated with albuminuria in diabetes mellitus
Authors: Lin Yi-Ting , Sayols-Baixeras Sergi , Dekkers Koen , Baldanzi Gabriel , Larsson Anders , Orho-Melander Marju , Fall Tove , Ärnlöv Johan 
Published: May 2024

Abstract

Background and Aims
Diabetes is a growing global problem with serious complications, including kidney impairment and cardiovascular morbidity and mortality. Monitoring albuminuria, which is associated with these complications, is crucial in optimal diabetes management. Recent research suggests a link between the gut microbiome, plasma metabolites and albuminuria development in diabetes patients, highlighting the need for further investigation using deep metagenomic sequencing.

Method
We investigated the relationship between 1002 gut microbial species, 1308 metabolites and albuminuria in 752 participants with diabetes from the Swedish CArdioPulmonary BioImage Study. To determine the relative abundance of species, we employed deep shotgun metagenomic sequencing of fecal samples. Plasma metabolites were analyzed using mass spectrometry-based methods.

Results
Shannon diversity index was inversely associated with albuminuria after adjusting for confounding factors (Fig. 1). Our multivariable-adjusted models revealed seven metagenomic species that were associated with albuminuria (Fig. 2). Furthermore, employing a global metabolomics approach, we identified phenyl sulfate, among 98 annotated metabolites (Fig. 3), as linked to the species Clostridium sp. AT4 and Eggerthella lenta. Notably, phenyl sulfate is involved in tyrosine metabolism, and we also observed an association between the gut metabolic module of Tyrosine degradation II and albuminuria.

Conclusion
In the present study, we identified seven gut microbial species linked to albuminuria and established a connection between these species and phenyl sulfate, which previously has been associated with podocyte damage and the development of albuminuria. These findings provided additional evidence of the impact of microbial species and contribute to our understanding of the complex relationship between the gut microbiome, plasma metabolites, and albuminuria in patients with diabetes.
#803 Identification and validation of immune and cuproptosis-related genes for diabetic nephropathy by WGCNA and machine learning
Authors: Chen Yubing , Wu Zhan 
Published: May 2024

Abstract

Background and Aims
As the leading cause of chronic kidney disease, diabetic kidney disease (DKD) is an enormous burden for all healthcare systems around the world. However, its early diagnosis has no effective methods.

Method
First, gene expression data in GEO database were extracted, and the differential genes of diabetic tubulopathy were obtained. Immune-related gene sets were generated by WGCNA and immune cell infiltration analyses. Then, differentially expressed immune-related cuproptosis genes (DEICGs) were derived by the intersection of differential genes and genes related to cuproptosis and immune. To investigate the functions of DEICGs, volcano plots and GO term enrichment analysis was performed. Machine learning and protein-protein interaction (PPI) network analysis helped to finally screen out hub genes. The diagnostic efficacy of them was evaluated by GSEA analysis, receiver operating characteristic (ROC) curve, single-cell RNA sequencing and the Nephroseq website. The expression of hub genes at the animal level by STZ -induced and db/db DKD mouse models was further verified.

Results
Finally, three hub genes, including FSTL1, CX3CR1 and AGR2 that were up-regulated in both the test set GSE30122 and the validation set GSE30529, were screened. The areas under the curve (AUCs) of ROC curves of hub genes were 0.911, 0.935 and 0.922, respectively, and 0.946 when taking as a whole. Correlation analysis showed that the expression level of three hub genes demonstrated their negative relationship with GFR, while those of FSTL1 displayed a positive correlation with the level of serum creatinine. GSEA was enriched in inflammatory and immune-related pathways. Single-nucleus RNA sequencing indicated the main distribution of FSTL1 in podocyte and mesangial cells, the high expression of CX3CR1 in leukocytes and the main localization of AGR2 in the loop of Henle. In mouse models, all three hub genes were increased in both STZ-induced and db/db DKD models.

Conclusion
Machine learning was combined with WGCNA, immune cell infiltration and PPI analyses to identify three hub genes associated with cuproptosis, immunity and diabetic nephropathy, which all have great potential as diagnostic markers for DKD and even predict disease progression.
#707 Effectiveness of a personalized approach to the treatment of patients with chronic coronary syndrome with type 2 diabetes and renal dysfunction
Authors: Alyavi Bakhromxon , Rasulev Yorkin , Abdullayev Akbar 
Published: May 2024

Abstract

Background and Aims
To evaluate the effectiveness of complex personalized treatment of patients with chronic coronary syndrome (CCS) with type 2 diabetes mellitus (T2DM).

Method
We observed patients with chronic stable angina pectoris III (FC) (Group I, 16) and CV IV FC (Group II, 18) with T2DM who underwent planned stenting of the coronary arteries (SCA). At baseline and after 3 and 6 months, we studied cholesterol, LDL cholesterol and HDL cholesterol, triglycerides (TG), ALT and AST, total bilirubin (TB), polymorphism of the CYP2C19 and 9p21 genes (rs 2383206 and rs 10757272), assessed myocardial viability (ECHOCG, MSCT), an ultrasound of the liver was performed. Against the background of basic therapy (antiplatelet agents, statins, beta blockers, ACE inhibitors), patients received a herbal hepatoprotector.

Results
Initial lipid parameters in patients with CCS and T2DM: cholesterol—6.9 mmol/l; LDL cholesterol –3.6; HDL cholesterol –1.1; TG –2.5 mmol/l. Parameters of global and regional systolic function were reduced. At the end of observation, lipid content: cholesterol—5.0; LDL cholesterol—2.3; HDL cholesterol –1.18; TG—1.61 mmol/l. Statins and antiplatelet agents were well tolerated, and there were no cases of withdrawal. Enzyme activity (ALT, AST), OB content were within normal values. The genetic studies carried out helped to select the most effective and safe doses of antiplatelet drugs and statins and significantly reduced the risk of complications and drug resistance. The hepatoprotector had a beneficial effect on the condition and function of the liver and improved the tolerability of medications. A personalized approach to the treatment of CCS was carried out taking into account the results of genetic testing with the selection of optimal doses of drugs. When the genotypes of CYP2C19*17 (rs 12248560) CC, ST and TT were distributed, the dose of antiplatelet agents was increased, and when the genotypes of the CYP2C19 gene (rs 4244285) GG, AG and AA were distributed, they were reduced. Assessment of myocardial viability, selection of doses of statins and antiplatelet agents according to individual characteristics, as well as a hepatoprotector increased the effectiveness and safety of treatment. SCA and basic treatment had an impact on the pathogenetic links of CCS, which is especially important in the treatment of patients with concomitant T2DM.

Conclusion
A personalized approach to the treatment of patients with CCS with T2DM who require SCA, taking into account the functional state and viability of the myocardium, the pharmacogenetic characteristics of the drugs, increases the effectiveness of revascularization, prevents the development of resistance, side effects and complications.