bluuebunny/crossref_metadata_2025_split huggingface dataset:
#1806 Cycling is safe – effect of intradialytic cycle ergometry on cerebral oxygenation and cognitive function – a pilot study
Authors: Kächele Martin , Hugo Lukas , Mentz Lennart , Kirsten Johannes , Treff Gunnar , Schroeppel Bernd , Schulte-Kemna Lena Sophia , Steinacker Jürgen 
Published: May 2024

Abstract

Background and Aims
Patients on chronic hemodialysis benefit from intradialytic exercise with improvements in endurance, muscle strength and health-related quality of life. It is not known whether the increased oxygen demand during intradialytic exercise negatively affects cerebral oxygenation and cerebral function. The aim of the study was to assess the risk of cerebral undersupply by measuring cerebral oxygenation, perfusion and cognitive function during and after intradialytic ergometer training.

Method
Twelve patience on maintenance hemodialysis (HD) trice weekly were included in the study. In an initial ramp test, using bed cycle ergometer, we first determined the maximum physical strength (Pmax) at the level of exhaustion (HD A). Then, one hour after start of a second HD (HD B), patients performed 40%, 50% and 60% of Pmax for 6 min. Pulmonary function tests, blood volume (BVM), cardiac output (by electrical cardiometry), regional cerebral oxygen saturation (rSO2) (by near-infrared spectroscopy) and cerebral blood flow (CBF, by Doppler sonography) were measured. The relative changes in rSO2, CBF and hematocrit were used to calculate cerebral oxygen supply (DO2). Cognitive tests (Stroop, Trail Making and Mini Addenbrookes Cognitive Examination Test) were performed before and after HD sessions with and, as controls, without ergometry (HD-C).

Results
Median age was 68 (42-85) years, 9/12 were male, complete data set was obtained in 10 patients. During step test exercise (HD B), at the highest exercise level (according to Borg (1-10) 6.75 ± 2.9), rSO2 increased (+6 ± 9%, p=0.034) without a significant change in CBF. In the meantime, relative blood volume decreased during ergometry (-5.8 ± 2.73%; p=0.002), causing a temporary increase of hematocrit. Despite a small decrease in CBF in 3 patients, the mean change of rSO2, CBF and hematocrit always had a positive trend in all patients, as a surrogate of stable cerebral oxygen supply (Table 1). In comparative cognitive tests (B vs. C), we observed no significant changes in cognitive functions.

Conclusion
In this pilot study, intradialytic bed-cycle ergometry during the first hour of HD for &lt;20 min at 40-60% of patients’ individual maximum intensity had no negative effects on cerebral oxygenation and function. Specific studies testing the safety intradialytic exercise with different conditions, such as increasing intensity or duration, are needed.
#2131 Difelikefalin in the management of pruritus associated with chronic kidney disease (Pa-CKD) in hemodialysis: Results from Andalusia
Authors: Mejía Carlos Narváez , Puerto Ana Maria , Ureña Ana Delgado , Rodriguez Francisca Lopez 
Published: May 2024

Abstract

Background and Aims
Pruritus associated with chronic kidney disease (CKD-aP) is a debilitating and common symptom in patients with chronic kidney disease on hemodialysis, with a prevalence of moderate to severe pruritus around 40–45%. The pathogenesis is not yet fully understood. It has been formally attributed mainly to abnormal levels of uremic toxins. The most recent data indicate a significant role for the dysregulation of the kappa opioid receptor (KOR) along with an imbalance in the mu-opioid receptor (MOR). Difelikefalin (DFK) is a KOR agonist approved for the treatment of moderate to severe CKD-aP in patients on hemodialysis in the USA, European Union (EU), Switzerland, Canada, Singapore, and Australia. It has shown rapid and sustained improvement in pruritus and is generally very well tolerated.

Method
We present the real-world experience of DFK in an early access program for patients in a hemodialysis (HD) program three times a week, diagnosed with CKD-aP, receiving the administration of DFK at 0.5 mcg/kg per HD session.
A total of 14 HD patients with severe to very severe CKD-aP (WI-NRS &gt;7) and (moderate-severe SADS) were treated with DFK.
The severity of itching was assessed using the numerical rating scale (WI-NRS). Quality of life was assessed using the Self-Assessed Disease Severity Score (SADS).

Results
The results are shown in Table 1.
78.5% of the patients showed a reduction in WI-NRS of at least 3 points within the first 2 weeks and 92% showed a reduction of ≥ 5 points at 4 weeks, with positive effects on the patients' quality of life, describing a change from SADS C (severe deterioration of quality of life) to SADS A (mild deterioration).

Conclusion
Currently, 11 out of the 14 patients continue with Difelikefalin and maintain a sustained response in both itch intensity and quality of life.
The availability of this new treatment, along with a new understanding of the impact of pruritus on our patients, has the potential to significantly improve the lives of patients living with CKD-aP. Sharing the clinical experience of DFK in series like this is important to raise awareness, not only of DFK but also of CKD-aP, particularly in the absence of specific treatments.
#2402 Reproducibility of memory B-cell and HLA antibody detection in patients on kidney transplant waiting list
Authors: Sanz-Ureña Sara , Alari-Pahissa Elisenda , Pérez-Saéz María José , Barbosa Francesc , Collado-Nieto Silvia , Huacon Betty Odette Chamoun , Federico-Vega Judith , Medina-Jaramillo Andrea , Redondo-Pachón Dolores , Crespo Marta 
Published: May 2024

Abstract

Background and Aims
Detection of HLA antibodies (HLA-Abs) impacts on the access and outcomes of kidney transplantation (KT). Currently, evaluation of HLA-Abs in serum is performed using single antigen bead assays (SAB). The analysis of circulating HLA-specific memory B cells (mBc), capable of differentiating to HLA-Abs secreting cells, was conceived with the aim of complementing the study of the HLA-Abs found in serum, but there is debate regarding the representativeness and reproducibility of the test. Thus, we studied HLA-Abs generated by mBc from patients on the waiting list (WL) at two different time points without sensitizing events in between and compared them with HLA-Abs detected in serum.

Method
We selected 7 patients on the WL for a first KT with a cPRA of 3%-100%: 4 had pregnancies and 2 had blood transfusions as known sensitizing events. We collected blood and serum samples at 2 time points separated by an average of 3.5 months (T1, T2). We cultured polyclonally activated PBMCs and isolated and concentrated IgG from the supernatant (SN) to study HLA-Abs. We tested SN and sera with SAB assays. Beads with MFI &gt;750 were considered positive.

Results
SAB serum study (Fig. 1a). Eighty-two percent of the specificities found at T1 were also detected at T2, and 97% of those identified at T2 were also observed at T1. Thus, there was good concordance between T1 and T2 samples (κ = 0.869, Cohen) and the MFI the specificities correlated (p &lt; 0.0001, Spearman).
SAB SN study (Fig. 1b). Forty-one percent of the positive specificities detected at T1 were also identified at T2, and 59% of the positive specificities found at T2 had been seen at T1. Thus, there was a moderate concordance between T1 and T2 samples (κ = 0.454, Cohen) and the MFI of the specificities still correlated (p &lt; 0.0001, Spearman). Only 42% and 35% of the positivities found in serum were also detected in the SN at T1 and T2, respectively. However, we found 9 positivities unique to the SN T1 (100% HLA-ABC) in 2 patients with cPRA&gt;80% and we also identified a total of 20 positivities unique to the SN at T2 (45% HLA-ABC, 55% HLA-DPDQDR) in 3 patients with cPRA&gt;80%.

Conclusion
The study of the degree of sensitization with SAB serum analysis remains stable between samples along time, while the mBc analysis shows less reproducibility. We identified a higher number of HLA-Ab in the study of serum compared with the study of the SN of mBc; however, we found some HLA-Abs unique to the SN. We suggest that, probably due to the small number of circulating mBC, increasing the number of samples tested for mBc improves the representativeness of the test.
#621 The effect of intra-operative mean arterial pressure on early graft function in deceased donor kidney transplantation
Authors: Oh Chang-Kwon , Bang Jun Bae 
Published: May 2024

Abstract

Background and Aims
The adequate perfusion pressure to the graft is essential for proper graft function in kidney transplantation, especially in deceased donor kidney transplantation. In particular, Mean arterial pressure (MAP) during operation can affect early graft function because MAP is associated with renal blood flow and glomerular filtration rate. Therefore, the analysis of intra-operative parameters are necessary to evaluate adequate graft perfusion. The aim of this study is to investigate the relationship between intra-operative parameters including MAP and early graft function in deceased donor kidney transplantation.

Method
We retrospectively analyzed 363 recipients who underwent deceased donor kidney transplantation from March 2010 to December 2020. Anesthetic monitoring data during intraoperative period was analyzed and basic clinical parameters were evaluated.

Results
In total 363 recipients, the mean recipient age was 48.9 ± 10.3 and mean donor age was 48.2 ± 15.2. Anesthetic time was mean 285.9 ± 63.8 (min) and operation time was 226.4 ± 48.7 (min). Median value of baseline MAP and MAP at reperfusion were 124 mmHg and 88 mmHg. After initial analysis, the recipients were divided into two groups, high MAP group (n = 185) and low MAP group (n = 178), according to median value of baseline MAP (124 mmHg) and these two groups were analyzed. High MAP group showed higher estimated glomerular filtration rate (eGFR) and urine output compared to low MAP group during immediate postoperative 1 week. At postoperative day 5, eGFRs were 43.4 ± 26.7 and 37.3 ± 24.2 mL/min/1.73 m2 respectively (p = 0.022) and urine outputs were 2942.6 ± 1368.6 and 2474.3 ± 1199.1 mL respectively (p = 0.001). The incidences of delayed graft function showed no significant difference between two groups (2.2% vs 6.2%, p = 0.066). We additionally analyzed the effect of MAP at reperfusion, and the result showed that there was no significant relationship between MAP at reperfusion and early graft function.

Conclusion
In this retrospective study, MAP at reperfusion was not significantly related to early graft function and incidence of delayed graft function. In baseline MAP analysis, high baseline MAP group showed early recovery of eGFR and more urine output than low baseline MAP group. As a result, the recipients with high baseline MAP were related to early recovery of graft function in deceased donor kidney transplantation.
#2932 Our experience in combined and simultaneous liver-kidney transplantation: recipient and kidney graft survival
Authors: Etxarri Neike Murua , de Hilla Nerea Ormaetxe Ruiz , De Juan Oihane Abaunza , Davis Mónica Paola Rodríguez , Noguer Raquel Vila I , Castaño Isabel Benito , Almáraz Sergio Fernández , Quispe Erick David Mamani , Martinez Ander Portugal , Antuñano Patricia Jimenez , Salvador del Valle Ainhoa Inza San , Larrondo Sofia Zarraga 
Published: May 2024

Abstract

Background and Aims
Simultaneous combined liver-kidney transplantation is a definitive treatment in patients with terminal failure of both organs, but sometimes, assessing the indication for said combined transplantation can be difficult. The liver from the same donor as the kidney graft protects the kidney immunologically and this provides long-term follow-up with a lower risk of rejection. No such protection is observed when both organs come from different cadaveric donors. There are no differences in graft survival in simultaneous or isolated transplants (liver or kidney), being prolonged in both cases. However, patient survival is lower, due to the complexity of this procedure and the clinical characteristics of the patients.
The main aim is to analyze the evolution of patients with combined and simultaneous liver-kidney transplantation in our center in terms of graft survival and overall survival of the recipient.

Method
It is a retrospective observational study. The computerized clinical history of 50 patients with combined liver-kidney transplantation was reviewed from August 1998 to November 2023. The data were recorded in an Excell-type database. Descriptive and inferential statistics were performed for the analysis.

Results
50 combined liver-kidney transplants have been performed, of which 28 (56%) died, and 23 of them (82%) with the kidney graft functioning. The main causes of death were neoplasms (11 patients) and infections (7 patients). The survival of the patients at 5 years was approximately 70%.
There were 5 cases of kidney graft loss, excluding death. Chronic rejection was the main cause (70-80%) of kidney graft loss. 60% received a kidney transplant again and died with the graft functioning; 20% died while on hemodialysis; and the remaining 20% are awaiting hemodialysis and are being studied for another kidney transplant.

Conclusion
Simultaneous liver and kidney transplantation is a good therapeutic option for patients with terminal disease of both organs. However, it is a complex procedure in patients with multiple comorbidities, which affects overall survival. In contrast, kidney graft survival is prolonged and many recipients die with functioning grafts. It seems to be related to the immunological protective function of the liver. Consequently, there are few rejections and, the vast majority are chronic rejection.
#2252 Outcome of pregnancy after kidney transplantation
Authors: Gad Donia 
Published: May 2024

Abstract

Background and Aims
Background
The possibility of a term pregnancy is one of the benefits of solid organ transplantation for women. The gonadal dysfunction, caused by the failure of the kidney or another organ, is reverted within a few months after normal graft function. Unplanned pregnancies in transplant recipients, however, may compromise graft function and survival, and may also risk unnecessary fetal exposure to immunosuppressive medications.

Aims
To study the prevalence of pregnancy and pregnancy related complication after kidney transplantation (KT).

Method
Retrospective cohort study conducted on 236 patients out of 3000 kidney transplant recipient who underwent renal transplantation (RT) at Mansoura Urology and Nephrology Centre between March 1976 and December 2019. divided into group I; 118 kidney transplant female's recipient experienced pregnancy at any time after kidney transplant and group II; 118 kidney transplant female's recipients who didn't experience pregnancy after renal transplantation, they were matched according to age and duration of renal transplantation and comparable in primary immunosuppressant drugs. all kidney recipients were reviewed for preoperative & operative and post-operative details also we record maternal and fetal complication.

Results
Prevalence of pregnancy in our center is 191 pregnancies in 118 women who had underwent kidney transplantation between 1976 and 2019. We have found that the mean age of pregnancy between (26.27 ± 4.37 - 29.89 ± 4.6), the mean gestational age between (33.69 ± 6.4 - 33 ± 7.5) weeks, the live birth rate is 126 (66%). Preterm delivery rate in our study is 85 (44.5%), neonatal death 8 (4.1%), miscarriage 59 (30.9%), intrauterine fetal death 6 (3.1%) and birth defect 4 (2%). The prevalence rates of gestational hypertension is 87 (45.5%), pre-eclampsia 48 (25.1%), gestational diabetes 19 (9.9%), urinary tract infection 36 (18.8%), and graft rejection 8 (4.1%) during pregnancy. caesarean section is the most common method of delivery in our study 133 (69.6%). Kidney transplant recipients who aged more than or equal to 30 years at time of pregnancy are at higher risk for having non live-birth outcome (OR: 3.2, p value: 0.05). Proteinuria more than or equal to 0.5 g/day before pregnancy is a significant risk factor for having non live-birth outcome (OR: 4.7, p value: 0.009). Also, proteinuria ≥0.5 g/day during pregnancy is associated with increases risk for non-live-birth (OR: 10.2, p value: 0.013). Gestational hypertension is associated with increases risk for non-live-birth (OR: 8.3, p value: 0.010).Preeclampsia is associated with increases risk for non-live-birth ( OR: 4.6, p value: 0.005).

Conclusion
Although the outcome of live births is favourable, the risks of maternal and fetal complications are high in kidney transplant recipients including pregnancy-induced hypertension, increased rates of preeclampsia, gestational diabetes, and caesarean section rates. The risk of miscarriage, prematurity, and low birth rate is also high.
#482 Implementation of trans-esophageal echocardiography in pre-transplant recipient's basic preparation
Authors: Fatthy Moataz 
Published: May 2024

Abstract

Background and Aims
Kidney transplantation is the module of choice to reduce mortality in comparison with dialysis [1]. Many patients on transplant waiting list undergoing haemodialysis via central venous catheters [2]. Cardiovascular morbidity control is one of the pillars of successful transplantation outcome [3]. Tans-thoracic echocardiographic abnormalities can be used to identify renal transplant recipients at high risk of cardiovascular disease [4]. Trans-oesophageal echocardiography is superior to trans-thoracic echocardiography in detecting vegetations. Endocarditis complicating central venous catheters often involves right-sided structures, with catheter tips in or near the right atrium, frequently requires Trans-oesophageal echocardiography for diagnosis [5]. Three-dimensional trans-oesophageal echocardiography is considered the missed module for clear vegetations visualization [6].

Method
Evaluation of Transoesophageal echocardiography results in 377 haemodialysis patients with central venous dialysis access planned for kidney transplantation. All patients were examined by transthoracic echocardiography and stated absent vegetations from our registry. Candidates were re-evaluated by real time trans-oesophageal procedure to diagnose possibility of silent vegetations. Informed consent was obtained.

Results
Among 377 patients undergoing haemodialysis via central venous access and recorded in transplantation waiting list. All of them were having absent vegetations stated by transthoracic echocardiography. Our patients were subjected to transoesophageal echocardiography. Results showed 13 patients with variable sized right sided 4-6 mm vegetations (3.4%). Among our positive group of patients six patients were founded with 6 mm vegetation (1.6%), four patients with 5 mm (0.5%) and finally three patients with 4 mm vegetations (0.7%).

Conclusion
Trans-oesophageal echocardiography may be implemented in renal transplant recipient basic preparation checklist for evaluation of silent vegetations associated with central access of dialysis.
#3070 Machine learning glomerulonephritis diagnosis on single glomeruli
Authors: Pedraza Anibal , Becker Jan , Altini Nicola , Gibier Jean-Baptiste , Quoc Huy , Nguyen Hien , Turkevi-Nagy Sándor , Rosenberg Avi Z , Seshan Surya V , Bueno Gloria 
Published: May 2024

Abstract

Background and Aims
Diagnostic applications of machine learning in nephropathology are only beginning to emerge. We hypothesized that we could develop a machine learning classifier for 12 different classes of glomerulonephritis with CNN and self-attention-based architectures, following the nephropathology paradigm that globally sclerosed glomeruli are not useful for diagnostic purposes.

Method
The dataset contains 11,000 PAS-stained glomerular crops from 350 biopsies (four institutions). Each crop retained the diagnosis label from the 12 classes ABMGN, ANCA, C3-GN, CryoGN, DDD, Fibrillary, infection-associated GN (IAGN), IgAGN, MPGN, Membranous, PGNMID, SLEGN-IV; globally sclerotic glomerular crops were stripped from this diagnostic label and were just labeled as the 13th class Sclerotic. This dataset was divided into 75% of samples for training, 15% for validation and 10% testing, avoiding information leak within biopsies. Moreover, a hold-out validation set of another 50 biopsies with 2,000 new crops that were taken from another three centres.
A classifier was trained in a fully supervised fashion for 13 classes (12 GN classes and Sclerotic), based on an ensemble of multiple transformer-based classification networks, including Swin-Transformer and ConvNext. This allows classification of each glomerular crop by different network instances. Since each network was trained under different conditions, the whole system acquired a more global knowledge understanding rather than a relying on a single method. For the final decision, the system takes the prediction with the largest confidence threshold, which is also predicted along with the class.

Results
The Table and the Figure list the metrics for classification performance calculated as Precision, Sensitivity, Specificity, F1 Score and balanced Accuracy. Balanced accuracy was between 0.4797 for CryoGN and 0.5949 for Membranous, it was 0.6892 for Sclerotic. AUCs for ROCs were between 0.40 for PGNMID and 0.82 for Membranous, with 0.81 for Sclerotic.

Conclusion
This proof-of-concept study establishes a baseline for this challenging classification task, which usually requires immunostains, electron microscopy and even clinical data. Our classification results even on single PAS glomerular crops appear promising. Combined with our automatic glomerular segmentation models, we could rapidly expand the training cohorts sizes and even add more classes of GN.
#681 Bw4/6 mismatch or missing donor Bw6 allele is a risk of early acute rejection in panel reactive antibodies negative kidney transplant recipients
Authors: Elsharkawy Magdy , Emara Ahmed , Abdelsamea Marwa , Abdelmegied Shaimaa Zaki 
Published: May 2024

Abstract

Background and Aims
Epitope and antibody diversity allows Bw4+ or Bw6+ patients to produce antibodies to Bw4 or Bw6 epitopes without breaking self-tolerance. This study assessed the prevalence of mismatched Bw4/6 or missing donor Bw6 allele in kidney transplant (KT) recipients with early acute rejection and its relation to patients and graft outcomes.

Method
A retrospective study included 40 live-related KT recipients divided into 2 equal groups. Group A: 20 KT recipients with early acute rejection in 1st 3 months post-KT and group B: 20 KT recipients with no rejection. Bw4/6 mismatches or missing donor Bw6 were examined in all patients with an assessment of the type of rejection, patients, and graft outcomes.

Results
The prevalence of Bw4/6 mismatch or missing donor Bw6 allele in patients with early acute rejection was 70% (14 patients). Bw4/6 mismatch represented 25% (5 patients) while missing donor Bw6 allele was 45% (9 patients) while the prevalence of Bw4/6 mismatch or missing donor in patients with no rejection was 10% (2 patients) with significant p-value (0.0001). The analysis of demographic data of Bw4/6 mismatch or missing donor Bw6 allele in patients with rejection (N=14) (Fig. 1); mean age was 27.92 years, 71.4% were males (10 patients), panel reactive antibodies (PRA) was positive in 7.1% (1 patient), Donor specific antibodies (DSA) and complement-dependent cytotoxicity (CDC) cross-match were negative in all patients. The most common type of rejection in these patients was acute antibody-mediated rejection (ABMR) 71.4% (10 patients). Patients and graft outcomes; mean serum creatinine after treatment of rejection was 2.16 mg/dl, mortality was 14.3% (2 patients) with graft loss, and survival with functioning graft was 85.7% (12 patients).

Conclusion
Bw4/6 mismatch or missing donor Bw6 allele is a risk of early acute rejection in PRA-negative kidney transplant recipients and is linked to negative patients and graft outcomes.