bluuebunny/crossref_metadata_2025_split huggingface dataset:
#2362 Clinical utility Anti-human T-lymphocyte Immunoglobulin (ATLG) as an induction agent in a living donor kidney transplantation: 5-year follow-up data
Authors: Sinha Vijay Kumar 
Published: May 2024

Abstract

Background and Aims
The usage of induction agents for living donor kidney transplants in India is varied. Polyclonal antibodies currently in use are anti-thymocyte globulin (ATG) and anti-T-lymphocyte globulin (ATLG). The role and dose of ATLG need to be defined. This study is focused on ATLG usage and the outcome with long-term follow-up.

Method
This is an analysis of 206 patients who received ATLG as an induction agent from 2017 to 2023. Patients received triple immunosuppression therapy: Tacrolimus, Mycophenolate Mofetil (MMF), and prednisolone for maintenance immunosuppression.

Results
A total of 206 patients received ATLG as an induction agent for living donor kidney transplants. The mean age of the patients was 39.13 ± 12.56 years. There were 87.3% (n = 180) males and 12.6% (n = 26) females. The majority of transplants in our study were ABO-compatible (94.6%, n = 195) and ABO-incompatible (5.2%, n = 11). The mean age of donors was 41 ± 13.7 years. Males were 38.3% (n = 79), and females were 61.6% (n = 127). Overall survival observed in the current study was 98% (n = 202), Post-transplant, 4 patients died (n = 2 died due to COVID-19, 1 due to Heart failure and 1 was infectious mortality.) The mean cumulative dose of ATLG in the current study was 305.1 ± 61.8 mg, and the mean dose was 5.4 ± 1.4 mg/kg. The baseline etiologies of patients who underwent transplant were chronic glomerulonephritis (47.5% n = 98), diabetic nephropathy (16.9% n = 35), hypertension (29.1% n = 60), CIN, and other GMB diseases. In the current study, the figure shows overall 11.6% (n = 24) rejections and 5-year follow-up data of Serum creatinine within a normal range. Post-transplant BK Virus Nephropathy was observed in 3.39% (n = 7) cases, CMV infection in two cases, TB was observed in three cases and fungal pneumonia in one case.

Conclusion
Long-term 5 year follow-up of Living donor kidney transplant shows that ATLG is an effective and safe induction agent. Good compliance with Oral immunosuppressant can improve graft survival as per the current study.
#1038 Progressive multifocal leukoencephalopathy in kidney transplant recipients: a retrospective multicenter nationwide cohort study
Authors: Sanson Adelaide , Lombardi Yannis , Francois Helene 
Published: May 2024

Abstract

Background and Aims
Progressive multifocal leukoencephalopathy (PML) is a serious opportunistic infectious disease affecting the central nervous system caused by JC virus. While extensively studied in patients with HIV infection, haematological malignancies, or undergoing immunotherapies, there is a lack of data concerning kidney transplant recipients (KTRs).

Method
We performed a retrospective, multicentric, nationwide study. We contacted all kidney transplantation centres in France to gather all cases of PML. We obtained the count of patients with a functional kidney allograft using the registry of the French regulatory agency.

Results
We collected 24 cases of PML. Between 2012 and 2021, the estimated minimal nationwide incidence of PML was 4.7/100 000 patient-years. The median duration from kidney transplantation to PML was 88 months (interquartile range: 9 to 355). Eight patients (33%) had been exposed to belatacept (median exposure: 18.5 months). Almost all patients underwent reduction or withdrawal of immunosuppressive drug doses and 13 (54%) received a specific treatment. Fifteen patients (65%) died within one year after diagnosis.

Conclusion
In this nationwide study, PML incidence rate in KTRs was at least 4.7/100 000 patient-years resulting in an alarming 65% mortality rate within a year despite immunosuppressants doses decrease or withdrawal. Further investigations are warranted to demonstrate the efficacy of specific treatments and confirm a potential association between belatacept exposure and PML occurrence, as suggested by our study.
#1718 Infectious complications among early versus late pulse steroid therapy among renal transplant recipients
Authors: Kaul Anupma , Prasad Narayan , Roy Shuvam 
Published: May 2024

Abstract

Background and Aims
Renal transplant recipients are at risk for infectious complications, with opportunistic infections predominating early after transplant and community acquired infections occurring in late transplant period. Pulse steroid is a form of heightened immunosuppression given to a transplant recipient, usually for treatment of rejection. This study aimed to investigate the effects of early and late pulse steroid therapy on the development of infectious complications in renal transplant recipients.

Method
Study population was drawn from patients undergoing kidney transplantation in the period between 1st January, 2016 and 31st December, 2020 in the study centre. Early and late pulse steroid therapy was defined based on whether pulse steroid was received within or after 90 days from date of transplant respectively. Patients receiving either early or late (but not both) pulse steroids who were more than or equal to 18 years of age and had at least 90 days of follow up were included in the study. Patients were followed up till 31st December, 2021 or till their death (whichever came earlier).

Results
Total of 516 patients underwent renal transplantation in the study centre in the specified period, out of whom 128 patients (24.8%) fulfilled the inclusion criteria without fulfilling the exclusion criteria. Out of these 128 patients, 83 (64.8%) and 45 (35.2%) patients received early and late pulse steroids respectively. The 2 groups were similar with respect to respect to baseline characteristics and use of other immunosuppressive agents. The mean values (95% confidence interval) for overall infections in early and late pulse steroid categories were 0.46 (0.31-0.61) and 1.16 (0.55-1.78) episodes per year respectively (p = 0.28). Sepsis occurred at higher rate in patients receiving late pulse steroids, with mean values (95% confidence interval) for sepsis in early and late pulse steroid categories being 0.02 (0.00-0.06) and 0.30 (0.04- 0.57) episodes per year respectively (p = 0.01). Viral infections also occurred at higher rate in patients receiving late pulse steroids, with mean values (95% confidence interval) for viral infections in early and late pulse steroid categories being 0.04 (0.02- 0.09) and 0.23 (0.03-0.43) episodes per year respectively (p = 0.01). Rates of other types of infection did not significantly differ between the 2 categories. A greater proportion of patients receiving late pulse steroids died (4.8% and 17.8% in early and late pulse steroid categories respectively, p = 0.02).

Conclusion
Late pulse steroid therapy is associated with more episodes of sepsis and viral infections compared to early pulse steroid therapy, although rate of overall infections do not significantly differ between the two groups. This study highlights the importance of surveillance for infections after pulse steroid therapy in renal allograft recipients.
#2287 Impact of renal reserve before donation in post-transplant renal function of donors and recipients
Authors: González-Rinne Ana , Sorensen Cristian Acosta , Luis-Lima Sergio , Cruz Coriolano , Martin Laura Díaz , Rivero Yaiza , Tirado Marian Rincón , Gallego Eduardo , Tamajon Maria Lourdes Perez , Cabrera Beatriz Escamilla , Hernández Domingo , Porrini Esteban 
Published: May 2024

Abstract

Background and Aims
The influence of Renal Reserve (RR), i.e. its presence or absence, in post-transplant renal function both in living kidney donors and recipients is unknown. The presence of RR in donors may be beneficial in terms of better renal function both for the donor and recipient after transplantation. In the other hand, the absence of RR in donors might indicate a lower renal endowment and so predispose to lower GFR post-transplantation in donors and recipients. However, little evidence is available in this field.

Method
In a previous study (ERA Abstract 2023, #3737) we described in a group of 52 potential living kidney donors, the presence (24-46%), absence (13-25%) or use (15-29%) of RR before donation. The latter was defined as the lack of increase in GFR after stimulation in patients with basal GFR &gt; 100 mL/min. GFR was measured before and after transplantation by the clearance of iohexol with dried blood spots. Presence of RR was defined as an increase &gt;10% of basal GFR after IV amino acid infusion. GFR was unadjusted to body surface area (BSA). In this follow-up study we investigated the impact of the presence, absence or use of RR before donation in GFR 12 months after transplantation, both in donors and recipients.

Results
Of the 52 pairs of donors and recipients, renal transplantation was performed in 21 who also had 12 months of follow-up. Before transplantation 9 donors had RR, 4 did not and 8 had RR in use. Pre-transplant GFR was 95 ± 15 ml/min, 89 ± 6 ml/min and 127 ± 16 ml/min in donors with RR, without RR and with RR in use, respectively. At 12 months after kidney donation, GFR was higher in donors who had RR in use before donation: 79 ± 12 ml/min, compared with those with RR: 65 ± 9 ml/min (p = 0.048) and those without RR 59 ± 10 (p = 0.03). In recipients, GFR was comparable between those who had a donor with RR or RR in use: 72 ± 19 ml/min vs 68 ± 12 ml/min (p = ns), whereas both groups had higher GFR than those recipients whose donors had no RR before donation 53 ± 5 ml/min, although of borderline signification (p = 0.07). Non parametric tests were used. No major complications after transplantations such as rejections or surgical complications, etc, that could alter GFR were observed.

Conclusion
The presence or use of RR may determine a better renal function 12 months after donation both for donors and recipients. This is a preliminary study and we acknowledge that the low number of cases is a limitation and so, these results require further studies.
#2573 Effect of pre-transplant dialysis modalities on delayed graft function
Authors: Panuccio Vincenzo Antonio , Cosentino Sonia , Tripepi Rocco , Cambareri Francesco , Parlongo Giovanna , Versace Maria Carmela , Tripepi Giovanni Luigi 
Published: May 2024

Abstract

Background and Aims
Kidney transplantation represents the optimal treatment for end-stage renal disease patients. Benefits and disadvantages of different pre-transplant dialysis modalities and the effects on post-transplant outcomes remain unclear, but many authors identify peritoneal dialysis (PD) such a “bridge” versus renal transplantation.

Method
We analyze a consecutive series of 249 renal transplanted patients (mean age 48 ± 11 years, 67% males) between June 1998 and February 2016 with a low prevalence of comorbidities (diabetes 2%, hypertension 31%, previous cardiovascular events 2%). The median follow-up was 136 months [interquartile range (IR) 91-197 months]. The pre-transplant treatment was hemodialysis (HD) in 215 patients (86%) and peritoneal dialysis (PD) in the remaining 34 patients (14%). The majority of patients received a cadaveric donor organ (219 patients, 88%).

Results
Delayed Graft Function (DGF) was registered in 151 patients (61%). Analyzing pre-transplant dialysis treatment, 15 patients about 34 (44%) on pre-transplant PD had DGF vs 136/215 (63%) on pre-transplant HD treatment (P = 0.03). Remarkable PD patients were older (48 ± 12 years) than HD patients (44 ± 11 years), but this difference did not rise statistical significance (P = 0.09); similarly the prevalence of living donors were higher (13%) in the group of HD patients respect the group of PD patients (9%, P = 0.53).
In a longitudinal analysis the last estimated Glomerular Filtration Rate (eGFR) was lower in patients with DGF (44, IR 19-66 ml/min/1,73 m2) vs patients without DGF (48, IR 35-73 ml/min/1,73 m2, P = 0.04), but no substantial differences was noted at the end of observation in eGFR between the two groups of patients (HD, eGFR 45, IR 25-68 ml/min/1,73 m2 vs PD eGFR 46, IR 24-67 ml/min/1,73 m2).

Conclusion
Results of this study confirm that PD treatment can be considered an optimal “bridge” for renal transplantation probably because peculiar characteristic of this dialysis modality (such us long term preserved diuresis and residual renal function respect HD patients) impacts positively on recovery of renal function. Further study need to clarify these controversial points.
#1207 Post transplant diabetes mellitus in kidney transplanted patients: factors related and impact on long-term outcome
Authors: Alfieri Carlo , Regalia Anna , Campise Maria Rosaria , Verdesca Simona , Delfrate Nicholas Walter , Favi Evaldo , Molinari Paolo , Pisacreta Anna , Castellano Giuseppe 
Published: May 2024

Abstract

Background
Alterations in glucose metabolism are one of the most important complications of renal transplant recipients. The aim of this study was to analyze their prevalence and determinants and assess their influence on the main long-term clinical outcomes in a cohort of kidney transplant recipients.

Methods
we retrospectively analyzed the data of 832 kidney transplant recipients between 2004 and 2020 in our center. Patients were studied at 1 (T1), 6 (T6), and 12 (T12) months after transplantation and followed clinically for a follow-up time of 103 ± 60 months. At T6, an oral glucose tolerance test (OGTT) was performed in 484 patients.

Results
The mean age of the cohort studied was 49 ± 13 years, with a mean dialysis vintage of 54 ± 52 months. Hemodialysis was the therapy before KTx in 70.6% of patients, whereas 20.9% had been treated with peritoneal dialysis. The 8.5% of patients received a pre-emptive KTx. Fifty-seven percent of the patients were male and 83.5% had a KTx from a deceased donor. Both at T1 and T12, immunosuppressive therapy was mainly composed of steroids (average cumulative dose at T12: 2914 ± 962 mg), calcineurin inhibitors and mycophenolate. In our cohort at T12, diabetic patients were 237 (28.6%), of which 51 (6.2%) were already affected by diabetes before KTx. Of note, we diagnosed diabetes by OGTT in 23 KTxps, while in 90 KTxps, OGTT showed prediabetic alterations. Patients with glucose metabolism abnormalities were significantly older, had an altered lipid profile associated with higher BMI values and a significantly higher inflammatory index. Interestingly, our data showed that graft loss was not affected by any type of alteration of glucose metabolism. On the contrary, we found that mortality was significantly higher in patients with pre-transplant diabetes and in those with alterations in glucose metabolism detected with OGTT (both including diabetes and considering only IGT and IFG).

Conclusions
Our data showed that age at transplantation, lipid profile, and the inflammatory state were the variables that most influenced the development of PTDM. Interestingly, mortality was significantly associated with pre-transplant diabetes and alteration in glucose metabolism. This allowed us to highlight the impact of prediabetes status and the importance of OGTT as a screening test in post-transplant and potentially pre-transplant. Future randomized controlled trials will be able to resume the topic, including the analysis of the effects of new antidiabetic drugs.
#2219 Glycemic control and adverse outcomes in patients with diabetes and CKD stage 4-5: a nationwide cohort study
Authors: Faucon Anne-Laure , Caldinelli Aurora , Regland Minnie , Carrero Juan-Jesus , Evans Marie 
Published: May 2024

Abstract

Background and Aims
Although poor glycemic control is strongly associated with adverse clinical outcomes, few studies have evaluated their risk across the full glycemic spectrum in patients with moderate to advanced chronic kidney disease (CKD). Guidelines for HbA1c targets are mainly derived from extrapolation of trials conducted in people with normal or mildly reduced kidney function. In non-dialysis CKD individualized targets are recommended, often aiming for less strict glycemic control, due to lack of evidence for the efficacy of lower HbA1c, and potentially greater harm. In this study, we analyzed long-term outcomes across the full spectrum of HbA1c in CKD stage 4-5.

Method
Using data from the Swedish Renal Registry, we included patients with diabetes and CKD stages 4-5. Adjusted cause-specific Cox models were used to analyze associations between the one-year baseline mean HbA1c level (&lt;43, 43-52 [reference], 53-64, 65-74, 75-89, ≥90 mmol/mol) and the occurrence of major adverse cardiovascular events (MACE, a composite of cardiovascular death, hospitalization for myocardial infarction or stroke), kidney replacement therapy (KRT), all-cause mortality, and hospitalization/death due to hypoglycemia.

Results
We included 2571 patients (71 years, 64% men, eGFR 20 mL/min per 1.73m², HbA1c 59.7 mmol/mol [7.6%], 75% insulin users). At baseline, patients with a higher HbA1c level were younger, had a higher prevalence of cardiovascular disease and were more likely prescribed insulin. Kidney function and malnutrition-inflammation markers were, however, not different between groups.
Over a median follow-up of 4.9 [4.6;5.2] years, 939 (37%) KRT, 1078 (42%) MACE, and 1523 (59%) deaths occurred. Increasing HbA1c was gradually associated with the risk of MACE (adjusted HR from 0.76 [95% CI: 0.60-0.96] for HbA1c &lt;43 mmol/mol to 1.39 [1.01-1.92] for HbA1c ≥ 90 mmol/mol) (Fig.). In contrast, a J-shaped relationship was observed for the risk of all-cause mortality. Compared to the reference group (43-52 mmol/mol; 5-year absolute risk 52% [48-56]), a HbA1c &lt;43 mmol/mol was not associated with a higher mortality (adjusted HR 1.03 [0.86-1.23], 5-year absolute risk 57% [51-63]), while any HbA1c above 75 mmol/mol was associated with a higher risk of death. The risks of KRT and severe hypoglycemia were not different across HbA1c levels.

Conclusion
In CKD stage 4-5, HbA1c above the general recommendation for non-CKD patients (43-52 mmol/mol) is associated with a higher risk of MACE and all-cause mortality, but not KRT, without increased risk of severe hypoglycemia. This suggests that targeting a lower HbA1c, together with other cardio-reno-metabolic prevention strategies, might contribute to improve health outcomes in this very high-risk population.
#1405 Salt sensitivity and hypertensive nephropathy: a link to be discovered
Authors: Tunesi Francesca , Simonini Marco , D'urbano Luca , Citterio Lorena , Zagato Laura , Manunta Paolo , Lanzani Chiara Livia 
Published: May 2024

Abstract

Background and Aims
Sodium sensitivity (SS) is a change in blood pressure (BP) depending on Na+ intake, 30% of population has it. Either a salt load test or a sodium dietary protocol can be used to stratify the population into 3 groups based on BP variation: sodium sensitive (SS), sodium resistant (SR), inverse sodium sensitivity (ISS), based on an increase, a non-significant variation or a decrease in BP following the administration of Na+. SNPs located in genes related with Na+ metabolism, aldosterone synthesis and kidney tubular Na+ reabsorption are related to this phenotype.

Method
We analyzed data collected from the follow-up (FUP) of 127 subjects with a new diagnosis of hypertension, categorized by their profile through acute salt load test. We analyzed the kidney damage by annual decline of eGFR and development of microalbuminuria. Genetic polymorphism analysis has been executed.

Results
No differences in the decline of eGFR are observed among the groups (−1.3084 ml/min ± 0.16 p-Value 0.372). SR subjects seem to be more prone to develop earlier microalbuminuria (χ 2 10.682, p = 0.005) even with an adequate BP control (P-Anova SBP 0.766; P-Anova DBP 0.856). An inverse correlation exists between pressure-natriuresis ratio and decline in eGFR (R −0.194 p = 0.016). Polymorphism in CYP11B2 (0.72 OR p = 0.045) and NEDD4L (0.74 OR p = 0.027) are protective against eGFR decline. ADD3 polymorphism (3.73 OR p = 0.049) is a risk factor for development of microalbuminuria. KL (0.15 OR p = 0.034), PKD and TRPC6 (p-Value 0.037, p-Value 0.009) polymorphism are protective factor against microalbuminuria.

Conclusion
SR patients are more at risk of developing hypertensive nephropathy earlier than other groups; steeper pressure natriuresis ratio is involved in quicker decline in renal function possibly accelerating development of hypertensive nephropathy. Further studies with larger sample and standardization in salt sensitivity test are needed to translate this knowledges into clinical setting.
#2183 Does thrombotic microangiopathy drive the occurrence and pattern of cerebrovascular disease in malignant hypertension?
Authors: Chen Peter , Delorme Stephen , Alamowitch Sonia , Koumako Cedi , Doreille Alice , Mousseaux Cyril , Paques Michel , Lombardi Yannis , Rafat Cédric 
Published: May 2024

Abstract

Background and Aims
Malignant hypertension (MHT) is characterized by diffuse microvascular damage caused by severe hypertension, often presenting with multiple organ involvement. Cerebrovascular injury, occurring in both acute and chronic forms, stands as a hallmark of the disease, being identified in up to half of patients. Thrombotic microangiopathy (TMA), defined as the association of mechanical hemolytic anemia with thrombocytopenia, also emerges as a frequent complication in MHT patients. However, the potential contribution of TMA to cerebrovascular disease remains unexplored. The secondary objective of this study was to provide a comprehensive description of the patterns of cerebrovascular injury occurring in MHT, with a focus on acute ischemic strokes (AIS).

Method
We retrospectively assessed the brain MRI of patients admitted to the kidney intensive care unit at Tenon hospital for malignant hypertension during the 2017-2023 period. Brain MRIs were performed on a systematic basis regardless of neurological symptoms and were independently reviewed by two trained specialists in a blinded fashion. Patterns of acute cerebrovascular disease, defined as AIS, intracerebral hematoma (ICH) or posterior reversible encephalopathy syndrome (PRES), were systematically assessed. Number of AIS lesions, their size and localization were recorded. Underlying chronic cerebral small vessel disease (CSVD) was defined as presence of lacunes, white matter hyperintensities, cerebral microbleeds or perivascular spaces. Severity of the chronic cerebrovascular disease was measured using a validated CSVD score.

Results
A total of 60 patients were admitted for malignant hypertension, with a mean age of 42.9 years. 40 patients (66.7%) presented with severe acute kidney injury. Cerebrovascular disease, either acute or chronic, was found in 42 patients (70.0%). Underlying chronic CSVD was present in 33 patients (55.0%). Acute patterns of injury occurred in 27 patients (45.0%). AIS was the most frequent (33.3%), followed by PRES (21.7%). Only one patient presented with ICH. Among patients with AIS, 14 (70%) presented with multiple simultaneous lesions. Of note, most patients with AIS exhibited diffuse encephalopathy syndrome (60.0%) rather than focal deficit (40.0%). Systemic TMA was present at admission in 34 patients (56.7%). In an exploratory data analysis, presence of AIS on brain MRI was associated with the presence of underlying CVSD (p = 0.013), but not with the presence of TMA at admission (p = 0.79). No association was found between TMA and PRES (p = 0.22).

Conclusion
Our study confirmed the high incidence of cerebrovascular disease during MHT. Most notably, 1 in 3 patients presented with AIS. TMA did not appear to increase the incidence nor to influence the pattern of brain injury.