bluuebunny/crossref_metadata_2025_split huggingface dataset:
FC 106: Validation of the Optimal Torque Teno Virus Range for Risk Stratification of Graft Rejection and Infection in Kidney Transplant Recipients by TTV R-GENE®
Authors: Görzer Irene , Gelas Fanny , Haupenthal Frederik , Kulifaj Dorian , Puchhammer-Stöckl Elisabeth , Bond Gregor 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The nonpathogenic and ubiquitous Torque Teno virus (TTV) plasma load is associated with immunosuppression in solid organ transplant recipients. An optimal TTV range has been defined for risk stratification of graft rejection and infection in the first year post kidney transplant applying an in-house PCR. Recently, a commercial PCR—the TTV R-GENE® kit—has been CE certified for clinical use. The present study was designed to validate and refine the optimal TTV range applying the TTV R-GENE® kit.

METHOD
Patients and events were selected from the prospective TTV-POET trial, including all 628 consecutive adult recipients of a kidney allograft transplanted at the Medical University of Vienna, between January 2016 and July 2020. Patients were followed for 12 months post-transplant or until drop-out. TTV was quantified longitudinally by the TTV R-GENE® kit. The primary outcome was biopsy proven graft rejection and the secondary end-point was infection.

RESULTS
A total of 78 patients with 85 graft biopsies (rejection, n = 18) and 274 patients with 80 infectious events following TTV quantification after reaching steady state in month 3 post-transplantation were selected. TTV was quantified at a median of 17 days before rejection was diagnosed and 63 days before onset of infection. The risk for rejection decreased by 25% with every log level increase in TTV load [RR 0.75, 95% confidence interval (95% CI) 0.67–0.85; &lt; 0.001]. For TTV loads &lt; 5log10 c/mL a high specificity of 90% for rejection was calculated. The risk for an infection increased by 6% with every log level increase of TTV load (RR 1.06, IQR 1.00–0.12; = 0.047). For TTV loads &gt; 7log10 c/mL a high specificity of 91% for infection was calculated. Multivariate modelling revealed an independent associated between TTV and rejection and infection, respectively.

CONCLUSION
These data support the value of TTV quantified by TTV R-GENE® for risk stratification of graft rejection and infection in the first year post kidney transplantation. The optimal TTV range defined within this study will be applied in an interventional randomized controlled trial to assess the safety of TTV-guided immunosuppression: the TTVguideIT trial.
FC 107: Development and Validation of a Machine Learning-Based Virtual Biopsy System in Kidney Transplant Patients
Authors: Yoo Daniel , Divard Gillian , Raynaud Marc , Naesens Maarten , Kamar Nassim , Bouquegneau Antoine , Oppenheimer Federico , De Sousa Erika , Kuypers Dirk , Durrbach Antoine , Seron Micas Daniel , Rabant Marion , Duong Van Huyen Jean-Paul , Bestard Oriol , Basic-Jukic Nikolina , Jurić Ivana , Legendre Christophe , Lefaucheur Carmen , Aubert Olivier , Loupy Alexandre 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Graphical Abstract
In kidney transplantation, day-zero biopsies are used to assess organ quality and discriminate lesions inherited from the donor or acquired after transplantation. However, many centres worldwide do not perform those biopsies which remain invasive, costly and may delay the transplant procedure. We aimed to develop and validate a noninvasive virtual biopsy system.

METHOD
A total of 17 centres were included from Europe, North America and Australia from 2000 to 2019. Candidate predictors were assessed following a prespecified protocol. Outcome measures were the day-zero biopsy lesions (Banff classification) including CV, AH, IFTA scores and % of sclerotic glomeruli. Six machine learning models were developed and their performances were assessed.

RESULTS
A total of 12 992 day-zero biopsies were included. Eleven parameters were used to build the classifiers, including donor age, kidney function, hypertension, BMI, proteinuria, diabetes, sex, donor type, cause of death and Hep-C status. The ensemble models (random forests, neural networks, gradient boosting, extreme gradient boosting tree, linear discriminant analysis, and naive Bayes) showed multi-AUC of 0.738, 0.817 and 0.788 for prediction of CV, AH and IFTA scores, and a good performance for predicting glomerulosclerosis (mean absolute error, MAE = 4.766). We confirmed the robustness and generalizability in multiple clinical scenarios and subpopulations and built an online interface for clinicians: https://transplant-pred/Virtual_Biopsy.

CONCLUSION
We developed and validated the first virtual biopsy system that enables the prediction of day-zero biopsy, based on routinely collected parameters. This can assist clinicians in assessing allograft quality, discrimination of donor derived versus acquired lesions after transplantation and prevent overdiagnosis of calcineurin inhibitor (CNI) toxicity.
FC 113: Development and Validation of an Integrative DD-CFDNA System to Predict Allograft Rejection: A Population Based Study
Authors: Aubert Olivier , Brousse Romain , Gueguen Juliette , Ursule-Dufait Cindy , Yoo Daniel , Anglicheau Dany , Lefaucheur Carmen , Loupy Alexandre 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Post-transplantation patient care requires development and validation of noninvasive biomarkers to improve allograft monitoring and prevention from unnecessary biopsies. Preliminary reports have suggested the association of donor derived cell-free DNA (dd-cfDNA) with allograft rejection. However, there is no proof of its added value beyond standard of care patient management in large and deep phenotyped cohorts.

METHOD
A total of 1210 concomitant evaluations of allograft histology, anti-HLA DSA and functional parameters between 2013 and 2018 were included corresponding to 637 evaluations in the derivation cohort and 573 in the validation cohort. dd-cfDNA was measured in plasma at the time of the evaluation. Diagnoses were assessed using Banff 2019 criteria. Parameters associated with kidney allograft rejection were assessed using uni- and multivariable logistic regression. We developed a risk model using the variables that were independently associated with rejection.

RESULTS
Higher levels of dd-cfDNA were observed for AMR and TCMR or both compared to other diagnoses (Figure 1A). We found incremental dd-cfDNA levels with increasing Banff lesion scores for g, ptc, i, t, cg and C4d (Figure 1B). There was no association of dd-cfDNA levels with allograft inactive lesions. In multivariable analysis, dd-cfDNA (P &lt; 0.0001) was associated with kidney allograft rejection independently of DSA (P &lt; 0.0001), eGFR (P = 0.018), kidney allograft instability (P = 0.013) and previous rejection (P &lt; 0.0001). Based on these parameters, we built an integrative idd-cfDNA model that showed good discrimination (AUC: 0.83), good calibration and added value beyond a model without dd-cfDNA (AUC of the model without dd-cfDNA: 0.77 versus 0.83 for the integrative model; P &lt; 0.0001). We confirmed our results in the validation cohort with a good discrimination (AUC: 0.82) and a good calibration. This integrative score, including the dd-cfDNA, is being validated in Belgium and in the USA.

CONCLUSION
We demonstrate the independent and added value of dd-cfDNA in addition to conventional features to predict rejection. This first integrative system shows improved performance for patient monitoring and could help physicians in decision-making process.
FC 116: SGLT2 Inhibitors in Kidney Transplantation: A Multicenter Study
Authors: García Carro Clara , Bedia Raba Andrea , Banegas Deras Eduardo J , Alberto Vigara Luis , Valero San Cecilio Rosalía , Cruzado Vega Leónidas , Gavela Eva , Elena González García M , Pérez-Flores Isabel , Sanchez-Bielsa Francisco 
Published: May 2022

Abstract

BACKGROUND AND AIMS
SGLT2 inhibitors (SGLT2i) are the first-line therapy in patients with type 2 diabetes mellitus (DM2) and CKD, together with metformin according to most recent published guidelines. They are related to better renal and cardiovascular outcomes. SGLT2i could be potentially benefitial in terms of renal function preservation and cardiovascular outcomes in kidney transplantion (KT). Despite published data about SGLT2i in KT patients with DM2 or new-onset diabetes after transplantation are limited, their use seems to be common in everyday clinical practice. Our aim is to investigate if SGLT2i are safe and well tolerated in a cohort of KT recipients, as well as to analyze clinical and laboratory data at 6 months after SGLT2i initiation.

METHOD
Multicentre observational study in KT recipients with diabetes under SGLT2i treatment.

RESULTS
A total of 323 patients were included, and 284 completed a 6-month follow-up. Mean age was 61.2 ± 10.3 years old, 74.4% were men and 41% presented DM2. Previous antidiabetic therapies: insulin (48.1%), DPP4 inhibitors (36.1%) and metformin (33.1%). Empagliflozine was started in 55.8%, dapagliflozine in 23.2% and canagliflozin in 20.6%. After SGLT2i initiation, body weight reduction, an improvement in blood pressure and glycaemic control, higher haemoglobin levels and a decrease in cholesterol levels were observed. Also, a mild decrease in eGFR was detected while albuminuria was lower. These differences were statistically significant (Table 1). In 34 patients (10.5%), SGLT2i was stopped: 2.78% presented urinary tract infection (UTI), 1.5% balanitis and 1.2% important eGFR decreasing slope. During the study period, six patients presented a graft loss (one related to SLGT2) and six patients died (deaths not related to SGLT2i).

CONCLUSION
SGLT2i have a safe security profile in KT, and are related to a better glycaemic and blood pressure control, as well as to a decrease in albuminuria, and to an improvement in cardiovascular risk factors. Thus, SGLT2i should be prescribed in KT recipients with DM2 or NODAT with adequate eGFR. UTI surveillance is essential in these patients.
FC 129: Stopping versus Continuing Renin–Angiotensin System Inhibitors After Acute Kidney Injury and Adverse Clinical Outcomes: An Observational Study From Routine Care Data
Authors: Janse Roemer , Fu Edouard , Clase Catherine M , Tomlinson Laurie , Lindholm Bengt , Van Diepen Merel , Dekker Friedo W , Jesus Carrero Juan 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The risk–benefit ratio of continuing with renin–angiotensin system inhibitors (RASi) after an episode of acute kidney injury (AKI) is unclear. While stopping RASi may prevent recurrent AKI or hyperkalaemia, it may deprive patients of the cardiovascular benefits of using RASi.

METHOD
We analysed outcomes of long-term RASi users experiencing AKI (stage 2 or 3, or clinically coded) during hospitalization in Stockholm, Sweden, during 2007–2018. We compared stopping RASi within 3 months after discharge with continuing. The primary study outcome was the composite of all-cause mortality, myocardial infarction and stroke. Recurrent AKI was our secondary outcome, and we considered hyperkalaemia as a positive control outcome. Propensity score overlap weighted Cox models were used to estimate hazard ratios, balancing 75 confounders. Weighted absolute risk differences (ARD) were also determined.

RESULTS
We included 10 165 individuals, of whom 4429 stopped and 5736 continued RASi, with a median follow-up of 2.3 years. Median age was 78 years, 45% were women, and median kidney function before the index episode of AKI was 55 mL/min/1.73 m2. After weighting, those who stopped had an increased risk [HR, 95% confidence interval (95% CI)] of the composite of death, myocardial infarction and stroke (1.13, 1.07–1.19; ARD 3.7, 95% CI 2.6–4.8) compared with those who continued, a similar risk of recurrent AKI (0.94, 0.84–1.05), and a decreased risk of hyperkalaemia (0.79, 0.71–0.88).

CONCLUSION
Stopping RASi use among survivors of moderate-to-severe AKI was associated with a similar risk of recurrent AKI, but higher risk of the composite of death, myocardial infarction and stroke.
MO087: Ambulatory Blood Pressure Trajectories and Blood Pressure Variability in Kidney Transplant Recipients: A Comparative Study Against Hemodialysis Patients
Authors: Korogiannou Maria , Sarafidis Pantelis , Eleni Alexandrou Maria , Theodorakopoulou Marieta , Pella Eva , Efstathios Xagas , Argyris Antonis , Protogerou Athanase , Papagianni Aikaterini , Boletis Ioannis , Marinaki Smaragdi 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Hypertension is the most prevalent cardiovascular risk factor in kidney transplant recipients (KTRs). Preliminary data suggest similar ambulatory blood pressure (ΒP) levels in KTRs and hemodialysis (HD) patients. This is the first study evaluating in comparison the full ambulatory BP profile and short-term BP variability (BPV) in KTRs versus HD patients.

METHOD
Two hundred four KTRs were matched (2:1 ratio) with 102 HD patients for age and gender. BP levels, BP trajectories and BPV indices over a 24-h ambulatory BP monitoring (ABPM) in KTRs were compared against both the first and second 24-h period of a standard 48-h ABPM in HD. To evaluate the effect of renal replacement treatment and time on ambulatory BP levels, two-way-ANOVA for repeated-measurements was performed.

RESULTS
KTRs had significantly lower SBP and pulse-pressure (PP) levels compared with HD during all periods studied (24-h SBP: KTR: 126.5 ± 12.1 mmHg; HD first 24-h: 132.0 ± 18.1 mmHg, P = 0.006; second 24-h: 134.3 ± 17.7 mmHg, P &lt; 0.001); no significant differences were noted for DBP levels with the exception of second nighttime. Repeated-measurements-ANOVA showed a significant effect of RRT modality and time on ambulatory SBP levels during all periods studied, and a significant interaction between-them; the greatest between-group difference in BP (KTRs—HD in mmHg) was observed at the end of the second 24-h (−13.9 mmHg, 95%CI: −21.5 to −6.2, P &lt; 0.001). Ambulatory systolic and diastolic BPV indices were significantly lower in KTRs than in HD during all periods studied (24-h SBP-ARV: KTRs: 9.6 ± 2.3 mmHg; HD first 24-h: 10.3 ± 3.0 mmHg, P = 0.032; second 24-h: 11.5 ± 3.0 mmHg, P &lt; 0.001). No differences were noted in dipping pattern between the two groups.

CONCLUSION
SBP and PP levels and trajectories, and BPV were significantly lower in KTRs compared to age- and gender-matched HD patients during all periods studied. These findings suggest a more favorable ambulatory BP profile in KTRs, in contrast with previous observations.
MO090: Diagnostic Performance of Pre-Dialysis And Ambulatory Blood Pressure Levels in Men and Women Hemodialysis Patients
Authors: Karagiannidis Artemios , Theodorakopoulou Marieta , Eleni Alexandrou Maria , Faitatzidou Danai , Baksiova Afroditi , Giamalis Panagiotis , Papagianni Aikaterini , Sarafidis Pantelis 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Ambulatory blood pressure (BP) control is worse in men than in women with chronic kidney disease or kidney transplantation. So far no study assessed in parallel possible effects of sex differences on the prevalence, control and BP phenotypes according to pre-dialysis and 48-h ABPM in hemodialysis patients. Further, no study has evaluated the diagnostic accuracy of pre-dialysis BP levels in men and women hemodialysis patients.

METHOD
129 male and 91 female hemodialysis patients that underwent 48-h ABPM with Mobil-O-Graph-NG were included in this analysis. Hypertension was defined as follows: (1) pre-dialysis BP ≥ 140/90 mmHg or use of antihypertensive agents, (2) 48-h BP ≥ 130/80 mmHg or use of antihypertensive agents.

RESULTS
The prevalence of hypertension was not different between men and women with the use of pre-dialysis BP (92.2% versus 92.3%, P = 0.987, respectively) or 48-h ABPM (92.2% versus 89%, P = 0.411). With the use of pre-dialysis BP men had significantly lower control rates than women (18.5% versus 32.1%, P = 0.025); a similar pattern of worse control in men was apparent with the use of ABPM, but the difference was not statistically significant (22.7% versus 28.4%, P = 0.360). The rate of patients with concordant lack of control by pre-dialysis and ABPM readings was significantly higher in men than women (65.3% versus 49.4%, P = 0.023); white-coat (14.9% versus 17.6%, P = 0.593) and masked hypertension (10.7% versus 18.8%, P = 0.101) did not differ between groups. However, the misclassifation rate with the use of pre-dialysis BP was lower in men than women. There was moderate or at best fair agreement between pre-dialysis and ambulatory BP with regards to the prevalence (men: κ-statistics = 0.39, P &lt; 0.001 and women: 0.27, P = 0.011) and control rates (κ-statistics = 0.25, P = 0.005 and 0.17, P = 0.124, respectively). Pre-dialysis BP ≥ 140/90 mmHg had sensitivity/specificity of 85.9%/51.4% in men and 72.4%/54.5% in women for the diagnosis of 48-h BP ≥ 130/80 mmHg. Receiver-operating-curve analyses confirmed this poor diagnostic performance.

CONCLUSION
The prevalence of hypertension is similar between men and women hemodialysis patients, but men have worse rates of office BP control. The diagnostic accuracy of pre-dialysis BP levels was equally poor in men and women hemodialysis patients.
MO094: Intensive Blood Pressure Lowering and Myocardial Fibrosis Biomarkers in Individuals With and Without CKD: Results From the Systolic Blood Pressure Intervention Trial (Sprint)
Authors: Aparna Fnu , Pajewski Nicholas , Kitzman Dalane , Upadhya Bharathi , Killeen Anthony , Rajagopalan Sanjay , Wright Jackson , Rahman Mahboob , Dobre Mirela 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Circulating cardiac biomarkers implicated in the pathogenesis of heart disease may provide a non-invasive, more precise assessment of cardiovascular risk. In the Systolic Blood Pressure Intervention Trial (SPRINT), intensive blood pressure lowering was associated with a 25% reduction in cardiovascular events and a 27% reduction in all-cause mortality. We sought to assess whether the beneficial effect of lowering systolic blood pressure on clinical outcomes was accompanied by a reduction in serum biomarkers of myocardial fibrosis.

METHOD
SPRINT, a multicenter randomized controlled trial conducted in the United States, enrolled participants aged ≥ 50 years, at increased risk for cardiovascular disease and randomized them to intensive systolic blood pressure lowering (target &lt; 120 mmHg) or standard blood pressure lowering (target &lt; 140 mmHg). In a randomly selected subgroup of SPRINT participants, myocardial fibrosis was assessed by two collagen-derived serum peptides, C-terminal propeptide of procollagen type I (CICP) and N-terminal propeptide of procollagen type 3 (P3NP) and Galectin 3 measured at study baseline and at 24 months follow-up. Chronic kidney disease was defined as eGFR &lt; 60 mL/min/1.73 m2. Analyses were based on linear mixed models including clinic site as a random effect, with adjustments for treatment group and baseline level of each respective biomarker.

RESULTS
A total of 742 SPRINT participants with and without CKD with available measurements of myocardial fibrosis biomarkers at study baseline and 24 months were included in the study. The median (IQR) Galectin 3, CICP and P3NP levels at study baseline and 24 months follow-up in the intensive versus standard group are presented in the Table 1. Intensive blood pressure lowering was not associated with longitudinal changes in CICP or P3NP (Table 1 and Figure 1). Intensive blood pressure lowering was associated with a statistically significant increase in Galectin 3 level [between group mean difference 0.47 (IQR: 0.03–0.92) ng/mL, P = 0.04]. All of the findings were generally consistent across participants with and without CKD (Table 1).

CONCLUSION
In a random sample of SPRINT participants, intensive versus standard blood pressure lowering was not associated with a reduction in circulating myocardial fibrosis biomarkers overtime in hypertensive individuals with and without CKD.
MO349: Occurrence of Postoperative Acute Kidney Injury (AKI) in One Lung Ventilated Patients
Authors: Jovanovsi- Srceva Marija , Nikolov Igor , Nikolova Dushanka , Gavrilovska Aleksandra , Kuzmanovska Biljana , Gjorgjievski Nikola , Dzekova-Vidimliski Pavlina , Severova- Andreevska Galina , Rambabova- Bushljetik Irena , Kuzmanovski Igor , Jakupi Nexhati 
Published: May 2022

Abstract

BACKGROUND AND AIMS
During lung surgery, preoperative fluids are given in restrict manner. This is in correspondence with the fact that lungs produce polyphasic injury during surgery and increased levels of different inflammation, traumatic and stress markers, on one side and a lack of fluids that complicate the transfer of water and kidney function on the other side [1]. One lung ventilation additionally complicate ventilation/perfusion ratio in the lungs, has overall impact on the whole body and to novel knowledge it indirectly leads to kidneys hypoperfusion and injurie [2]. The aim of our study is to evaluate the level of postoperative acute kidney injurie (AKI) occurrence in patients who underwent OLV.

METHOD
In prospective study, 60 patients that underwent lung resection in OLV, BMI&lt;30 m2 without hepatic or renal endocrine diseases, aged 45–65 at the University Clinic for thoracic surgery in Skopje were included. Patients who underwent prior haemotherapy or radiotherapy were exuded. In all patients, we evaluate the demographic, clinical, preoperative state, duration of OLV, operation data and fluid assessment. Primary, we evaluate the occurrence and staging of AKI according to KDGIO criteria [3, 4]. A total of 72 h postoperatively in all patients and post hoc, we corelate its occurrence to several factors.

RESULTS
On average, patients were 59.7 +5.9 SD years old. More males were operated (80%). Overall, AKI stage 1 occurred in total of 13.3% (8 patients), AKI stage 22 in 3.3% (2 patients) and AKI stage 3 in 1.6% (1 patient). OLV longer than 60 min was in 85% of the patients, and all stages AKI were after this time duration. Lobectomy was done in 65% of the patients, while pulmectomy in 18.3% and bilobectomy in 16.7%. In relation to type of surgery done most of the patients that had pneumectomy had AKI 1 (27.2%), and additionally, only in this analysed surgery group, AKI 3 occurred in 9%. In correspondence to the side operated, right side was operated in 57.7% of the patients, and most of the AKI occurred in the right-sided surgery. Most of the patients who developed AKI preoperatively had hypertension and other cardiovascular issues.

CONCLUSION
AKI occurs significantly after OLV, in relation to the type of surgery. Mainly when right-side surgery is done. However, more severe AKI occurs when pulmectomy is done. Fluid regiment, OLV longer than 60 min and some preoperative cardiovascular diseases may contribute to its occurrence.