bluuebunny/crossref_metadata_2025_split huggingface dataset:
#1992 Triglyceride-glucose index and risk of cardiovascular events, graft loss and new onset diabetes after transplantation in renal transplant recipients
Authors: Lee Hyo Jin , Lee Yu Ho , Kim Jin Sug , Jeong Kyunghwan , Lee Jeong-Yeun , Kim Hyun Kyu , Yoon Hye Eun , Na Ki Ryang , Lee Dong Ryeol , Yang Jaeseok , Kim Myoung Soo , Hwang Hyeon Seok 
Published: May 2024

Abstract

Background and Aims
Insulin resistance is prevalent disorder, but its clinical significance remains undetermined in renal transplant recipients. We explored the clinical implication of triglyceride-glucose (TyG) index in renal transplant recipients, recognizing it as a valuable marker for insulin resistance.

Method
A total of 6354 renal transplant recipients were enrolled from a nationwide, prospective cohort between May 2014 and December 2022. The TyG index was assessed between 6- and 12-months post-transplantation. We evaluated the association between TyG index and the risk of composite of cardiovascular events and death, renal allograft loss, and new onset diabetes after transplantation (NODAT).

Results
During the mean follow-up period of 39.2 ± 26.1 months, a total of 106 composite events of cardiovascular events and death, 174 events of renal allograft loss, and 438 events of NODAT were observed. The cumulative rate for composite events, graft loss, and NODAT was greater in patients with higher TyG quartile (all P &lt; 0.001). In multivariate analysis, higher quartile of TyG was associated with an increased risk of composite events (HR 1.81, 95% CI 1.14–2.86), renal allograft loss (HR 2.13, 95% CI 1.28–3.55), and NODAT (HR 2.52, 95% CI 1.90–3.34). Higher quartile of TyG was associated with future graft dysfunction (adjusted mean eGFR differences of −4.72, 95% CI −7.39 – −2.04). There was a linear escalation in the risk of composite events and graft loss with the incremental rise in the TyG index, concomitant with an exponential augmentation in the risk of NODAT.

Conclusion
Renal transplant recipients with higher TyG index are associated with higher risk of composite of cardiovascular event and death, renal allograft loss, and NODAT.
#2990 Prevalence and risk factors of altered control of BP during the night in a large hemodialysis population investigated by 48 hours ABPM
Authors: Torino Claudia , Mallamaci Francesca , Sarafidis Pantelis , Ekart Robert , Balafa Olga , Del Giudice Antonio , Aucella Filippo , Morosetti Massimo , Tripepi Rocco , Marino Carmela , Tripepi Giovanni Luigi , Zoccali Carmine 
Published: May 2024

Abstract

Background and Aims
Altered BP control during the night (non-dipping, reverse dipping and nocturnal hypertension) is recognized as a powerful risk factor for death and CV events in the hemodialysis (HD) population. However, these alterations have been described in relatively small studies and the epidemiology and risk factors for subtypes non-dipping and nocturnal hypertension are still poorly characterized in the current literature. We investigated the problem in a large Registry (The EURECAm Registry) that is the sole that adopted state of the art 48 h ABPM recording in the HD population.

Method
We included in this analysis 534 HD patients, enrolled in 7 centers, led by members of the EURECA-m working group, in 3 European countries. 48 h ABPM was measured by using well validated instruments (AAMI/ESH/ISO). As recommended by the European Society of Hypertension guidelines, recordings were made at 15-minute intervals during the day and 30 minutes during the night. Hypertension was defined as 48 h blood pressure (BP) &gt;130/80, nocturnal hypertension as a nighttime BP &gt;120/70 mmHg, non-dipping as a night/day systolic BP fall &lt;10% and reverse dipping as a night/day ratio &gt;1.

Results
Among 534 HD patients, 317 were hypertensive and. 217 normotensive. As many as 274 patients were non-dippers (51%), 32% were reverse dippers, and 381 (71%) had nocturnal hypertension. Of note, forty-one per cent of non-dippers, 37% of reverse dippers and 19% of patients with nocturnal hypertension were normotensives. As expected, the majority of reverse dippers (87%) had frank nocturnal hypertension. In a combined analysis of non-dippers and reverse dippers, as compared to dippers, these patients more frequently exhibited atrial fibrillation and had lower Heart Rate both pre-dialysis (72± 11 vs 77±13 bpm, P = 0.004) and post-dialysis (74± 13 vs 78±14 bpm, P = 0.03) and lower serum albumin (3.9±0.4 vs 4.0±0.3 g/dL, P = 0.02) but did not differ for age and gender.

Conclusion
In a large cohort of HD patients investigated by the state-of-the-art technique, 48 h ABPM alterations in the nocturnal BP profile were almost universal, and nocturnal hypertension was the more prevalent alteration, followed by non-dipping and reverse dipping. These alterations were independent of age and gender. Long-term, granular follow-up analyses are warranted to identify the prognostic value of these alterations.
#1844 Pregnancy outcome among kidney transplant recipients
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). Gesatational 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.
#2251 Long-term systolic blood pressure variability as an independent risk factor for cardiovascular events in kidney transplant recipients
Authors: Viazzi Francesca , Bussalino Elisabetta , Picciotto Daniela , Macciò Lucia , Gandolfo Maria Teresa , Parodi Angelica 
Published: May 2024

Abstract

Background and Aims
Cardiovascular (CV) events represent the main cause of death in patients undergoing renal transplantation. Several studies have described the role of blood pressure variability (BPV) in predicting all-cause mortality and fatal and non-fatal CV events in the general population and in diabetic patients. Systolic blood pressure variability (SBPV) has recently been proposed as a predictor of clinical outcomes in patients with chronic kidney disease.
However, evidence is still scarce about the prognostic role of BPV in the setting of renal transplantation.
The aim of the study was to evaluate the role of long-term SBPV in the development of fatal and non-fatal CV events (myocardial infarction, unstable angina or revascularization, stroke and hospitalization for heart failure) in subjects undergoing kidney transplantation.

Method
We performed a single-center retrospective observational analysis in a cohort of 272 kidney transplant patients (mean age 64 ± 13 years, 66% men), with a transplant duration ≥12 months and with at least 6 blood pressure measurements at defined intervals (3 months ±15 days) over an assessment period of 18 months.
BPV was expressed as standard deviation of ambulatory systolic blood pressure (SBP) and patients were accordingly classified in tertiles (low &lt;9.3 mmHg, medium 9.3-13 mmHg, high &gt;13 mmHg).
The role of SBPV was analyzed by Kaplan-Meier (logrank) and its independent effect by Cox Regression.

Results
Over a mean follow-up of 58.7 ± 17.2 months, 27 subjects (9.9%) developed CV events. For each increase of 2.7 mmHg in SBP standard deviation, the risk for fatal or non-fatal CV events increased almost 3-folds (P = 0.02) and patients in the highest tertile of SBP standard deviation showed a 4-fold increased risk (P = 0.01) (Fig. 1). This relationship was maintained even after incremental adjustment for time-averaged pulse pressure, age, diabetes, prior CV event, and dialysis vintage (HR 3.2, 95% CI 1.1–10.0, p 0.04) (Table 1).

Conclusion
Long-term BPV represents an independent risk factor for CV events in kidney transplant patients. It is therefore essential to seek for stable long-term blood pressure levels in this population in order to minimize the residual CV risk.
#2581 Cryptococcosis in kidney transplant recipients: a nationwide multicenter retrospective cohort study—CRITERE study
Authors: Tardieu Laurene , Divard Gillian , Scemla Anne , Kaminski Hannah , Kamar Nassim , Levi Charlène , Moal Valérie , Tourret-Arnaud Jérôme , Quintrec Moglie Le , Rafat Cédric 
Published: May 2024

Abstract

Background and Aims
Cryptococcosis stands as the third most common invasive fungal infection in solid organ transplant recipients. Clinical management and prognosis of the disease remains largely unexplored in the context of kidney transplant recipients. Our main objective was to describe the natural history of cryptococcosis after kidney transplantation from the graft patterns of kidney injury to the long term outcomes.

Method
We established a nationwide cohort of adult kidney transplant recipients diagnosed with cryptococcosis between 2002 and 2019 in France. All data were gathered starting from the transplantation date and encompassed up to the latest follow-up consultation. All putative causes of AKI as claimed by the attending clinicians were recorded. Cases were matched (ratio 1:6) with kidney transplant recipients from the French prospective multicenter cohort DIVAT with parameters at time of transplant including immunosuppression and known risk factors of cryptococcosis such as age, history of smoke, history of cancer and HIV status. Transplant outcomes (graft failure and patient death) were then compared between matched patients.

Results
88 patients were included. Patients were predominantly male (n = 61, 69.3%), with a mean age of 57.0 years [SD ±13.3]. The majority of patients were primary kidney transplants (n = 71, 80.7%) with a median time from ESRD to transplantation of 2.8 years [IQ 1.25-5]. The majority of patients received ATG as induction therapy for their transplant (n = 50, 69.4%)Acute kidney injury (AKI) at diagnosis involved 37.3% of the patients with 13.3% requiring renal replacement therapy. AKI staging was distributed as follows, AKI grade 1 in 12.5% of patients, grade 2 in 13.3% of patients, and grade 3 in 11.5% of patients. During the induction stage, 39% of patients developed amphotericin B-related AKI. AKI resulting from tacrolimus overdose subsequent to tacrolimus/fluconazole interaction occurred in 25.7% of patients during the consolidation stage. Among the patients alive at 3 months following the diagnosis of cryptococcosis, 33.7% of patients exhibited graft dysfunction. Following cryptococcosis, 5 patients displayed T cell rejection and 4 patients developed antibody-mediated rejection. A total of 41 patients with cryptococcosis were matched to 246 controls (ratio 1:6), after a median follow-up of 52.3 [28.1-90.2] months, patients with cryptococcosis exhibited a higher risk of mortality with 35.9% compared with 9.8% (p &lt; 0.001) and graft failure with 33.3% compared with 15.0% (p = 0.0005).

Conclusion
This study has shown that kidney injury manifests itself through a sequential, multi-step process that initially includes pre-renal impairment, ATN and iatrogenic mechanisms. Amphotericin B-related AKI, followed by tacrolimus overdose represent common causes of AKI.
#2323 Sodium-glucose cotransporter 2 inhibitors in kidney transplant recipients—effectiveness and safety
Authors: Freitas Joana , Silvano José , Ribeiro Catarina , Pedroso Sofia , Malheiro Jorge , Almeida Manuela , Fonseca Isabel , Martins La Salete 
Published: May 2024

Abstract

Background and Aims
Given the increasing incidence of posttransplant diabetes and the heightened cardiovascular burden among transplant recipients, the use of SGLT2 inhibitors (SGLT2i) in this population is attractive due to their cardiovascular and renoprotective advantages. However, evidence for diabetic kidney transplant recipients (DKTRs) is limited, primarily due to concerns regarding potential worsening of renal graft dysfunction and adverse effects.

Method
This retrospective study was conducted to evaluate the effectiveness and safety of SGLT2 inhibitors in kidney transplant recipients (KTRs). Individuals with type 1 diabetes (n = 2) and individuals submitted to a double kidney and pancreas transplant (n = 5) were excluded from the study to avoid diabetes type bias . The primary focus was on assessing SGLT2 inhibitors effect on parameters such as hemoglobin A1c levels, body mass index (BMI), lipid panel, hemoglobin levels, renal allograft function (estimated glomerular filtration rate), and urinary protein-to-creatinine ratio. Demographic, clinical, and laboratory data were collected and subjected to analysis using descriptive statistics with SPSS Statistics software. The data were presented as means ± standard error, and comparisons were conducted using the paired sample t-test. A significance level below 0.05 (P &lt; 0.05) was considered statistically relevant.

Results
A total of 104 renal transplant patients were included. The study spanned a median observation period of 14 (2.0–71.0) months. Mean HbA1c decreased from 7.3 to 6.9% (P = 0.001). A significant improvement in BMI (27.6 to 27.0 kg/m2; P = 0.008), total and LDL-Cholesterol(P &lt; 0.001 and P = 0.004, respectively) were also observed. Mean haemoglobin rate at baseline was 13.3 g/dL and also improved at end of follow-up to 13.5 g/dL (P = 0.065). Mean estimated glomerular filtration rate at baseline was 60.1 (26–120) mL/min/1.73 m2 and decreased to 54.8 throughout the follow-up (P = 0.007), while mean serum cystatin increased from 1.7 to 2.0 mg/L (P &lt; 0.001). Regarding urinary protein:creatinine ratio, levels slightly but not significantly rose [+0.33 g/g]. Urinary tract infections occurred in 10% of the recipients. No other side effects were observed during the treatment course or neither the patients needed to discontinue the medication.

Conclusion
This study establishes that the use of SGLT2 inhibitors is both feasible and well-tolerated in kidney transplant recipients (KTRs), with no significant observed side effects. Further studies are required to clarify the impact of SGLT2 inhibitors on long-term patient and allograft survival.
#1455 Pregnancy and related complications after kidney transplantation—a retrospective study
Authors: Elkat Ahmed 
Published: May 2024

Abstract

Background and Aims
Background
Within 2 to 3 weeks of a successful renal transplantation, the fertility of women in childbearing age improves; however, pregnancy after kidney transplantation is challenging and may be associated with serious maternal and fetal complications.

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 two groups, group I; 118 kidney transplant recipient who experienced pregnancy at any time after kidney transplantation and Group II; 118 kidney transplant recipients who didn`t experience pregnancy after renal transplantation, they were matched according to age, duration of renal transplantation and they are 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%).

Conclusion
The risk of maternal and fetal complications is still high in RT patients and requires multidisciplinary care. All should be considered in patient counseling and clinical decision making. So we recommend educating the transplanted patients to allow for outcome optimization and minimization of complications.
#1862 Post-kidney transplantation de novo monoclonal gammopathy of undetermined significance—impact on patients and graft long-term outcomes
Authors: Domingos Diogo , Querido Sara , Matias Patrícia , Mendes Alexandra , Azevedo Ana Paula , Weigert André 
Published: May 2024

Abstract

Background and Aims
Monoclonal gammopathy of undetermined significance (MGUS) is an asymptomatic premalignant plasma cell condition with a reported prevalence of 3 to 4% in population older than 50 years and progression to multiple myeloma in approximately 1% of the cases. The clinical significance of MGUS in patients diagnosed prior to kidney transplantation (KT) has previously been studied, however, the impact on survival and morbidity of newly diagnosed MGUS on the period after KT, remains unclear.
The aim of this study was to compare the outcomes between patients with MGUS emerging after KT versus non-MGUS patients.

Method
This is a retrospective single-center cohort analysis of a population of 793 kidney transplant recipients between 1985 and 2022. Diagnosis of MGUS after KT was based on positive serum protein electrophoresis and confirmed by serum immunofixation.
We performed a randomized selection of a matched control group, adjusted for age, gender, and KT duration. Both groups were compared for number of infections (bacterial and viral), acute rejections, neoplastic complications, and for overall patient and graft survival.

Results
This study included a total of 112 patients, with a mean age of 60 years (±11), of which 86 (77%) were older than 50 years. Median follow-up duration was 149 [IQR 89-207] months.
We identified 56 patients (7%) with MGUS after KT. Only 1 (1.7%) patient progressed to multiple myeloma. Induction immunosuppression type was not associated with higher development of MGUS.
We found no difference between the MGUS group and the control group in the incidence of infections, acute graft rejections, or solid and hematologic neoplasia (Table 1). There was also no difference between overall patient and graft survival.

Conclusion
MGUS is a premalignant disease frequently present in KT recipients, with a higher prevalence compared to the general population, although its development after KT does not appear to contribute to a worse prognosis or to a higher progression to multiple myeloma.
#1396 Anxiety level in kidney transplant recipients with adverse cardiovascular events
Authors: Smaliakova Maria 
Published: May 2024

Abstract

Background and Aims
Kidney transplantation is the most cardioprotective method of renal replacement therapy and it has a positive effect on the psycho-emotional state of patients. However, kidney transplant recipients have a higher cardiovascular risk and a higher prevalence of anxiety and depression than people in the general population.
The aim of the study was assessment of anxiety levels and the quality of life of kidney transplant recipients preceding adverse cardiovascular events.

Method
The study included 154 kidney transplant recipients. 54 (35.1%) of them had adverse cardiovascular events (acute coronary syndrome, complicated hypertensive crisis or rhythm disturbance) for three years of observation. The comparison group was 100 (64.9%) recipients without cardiovascular complications during the observation period. The study groups were comparable by age, gender, graft function and traditional cardiovascular risk factors.

Results
The average level of situational anxiety of kidney transplant recipients was 39 ± 7, the level of personal anxiety—43 ± 8. The structure was dominated by recipients with moderate personal anxiety—55.2% (n = 85) and moderate situational anxiety—66.9% (n = 103). However, the proportion of persons with high personal anxiety was quite high—40.9% (n = 63). The structure of anxiety levels had no significant differences depending on subsequent cardiovascular complications. Nevertheless, kidney transplantation recipients with adverse cardiovascular events had higher previous level of situational anxiety than recipients without cardiovascular events—41 ± 7 versus 38 ± 7, p &lt; 0.05.
During the study kidney transplant recipients were asked to rate their quality of life on a scale of 1 to 10. Recipients with subsequent adverse cardiovascular events had a lower subjective quality of life than recipients without cardiovascular complications—7 (6-8) versus 8 (7-8), p &lt; 0.01.

Conclusion
Based on the study it was found that recipients with adverse cardiovascular events in the late postoperative period are characterized by a higher level of situational anxiety and a lower quality of life before these complications.