bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO964: High Urgency Renal Transplantation for Patients With Exhaustion Of Vascular Access for Haemodialysis: Experience from A Tertiary Center
Authors: Marques Filipe , Gameiro Joana , Jorge Sofia , Sofia Henriques Pereira Marta , Santana Alice , Oliveira Guerra José , António Lopes José 
Published: May 2022

Abstract

BACKGROUND AND AIMS
When faced with exhaustion of vascular access for haemodialysis (EVAH), allocation for High Urgency Renal Transplantation (HURT) is the appropriate solution. Patients with EVAH usually have multiple comorbidities and an increased risk of cardiovascular and thrombotic events. The aim of this study is to analyze the characteristics and outcomes of patients undergoing HURT due to EVAH.

METHOD
Data from the Renal Transplant Unit since January 2006 were retrospectively analyzed. Eleven patients undergoing HURT were identified.

RESULTS
In the population studied, 45.5% (n = 5) were male, 63.6% (n = 7) were Caucasian and the mean age at the time of transplantation was 41.6 ± 7.8 years. Ninety % (n = 10) were hypertensive, 27.3% (n = 3) were diabetic and 27.3% (n = 3) had previous cardiovascular disease. Patients were on renal replacement therapy for 5.8 ± 2.7 years prior to transplantation. The mean transplant time was 75.5 ± 53.7 months. The mean follow-up period was 90.6 ± 51.9 months. During this period, 63.6% (n = 7) of patients lost their renal graft and mortality was 63.6% (n = 7). Renal graft survival was 81.8% (n = 9) at the first year, 72.7% (n = 8) at the third year and 63.6% (n = 7) at the fifth year of follow-up. At discharge, mean creatinine was 1.8 ± 1.1 mg/dL. At the first year, mean creatinine was 1.9 ± 0.8 mg/dL, at the third year was 2.3 ± 1.9 mg/dL and was 1.6 ± 0.4 mg/dL at the fifth-year post-transplant. The mean time to graft loss was 54.1 ± 49.3 months. Overall survival was 90.9% (n = 10) at the first year, 90.9% (n = 10) at the third year and 81.5% (n = 9) at the fifth-year post-transplantation. Two patients died from a cardiovascular event, one from neoplasia and other from an infectious cause. Two patients died with a functioning kidney allograft.

CONCLUSION
Kidney graft survival in patients undergoing HURT was significantly lower. Portuguese Transplantation Society reporting an overall graft survival of 92.9% at the first year and 85.0% at the fifth year. The mortality of these patients is quite high; however, the fact that they are patients with EVAH, whose life expectancy would be greatly reduced if they were not transplanted, makes HURT continue to be an indicated option in this population of more vulnerable patients.
MO967: Lymphocele After Renal Transplantation: Management, Risk Factors and Impact on Transplant Survival
Authors: Zaghbib Selim , Chakroun Marouene , Saadi Ahmed , Boussaffa Hamza , Bouzouita Abderazzak , Derouiche Amine , Ben Slama Riadh , Bacha Mongi , Abdallah Taieb Ben , Ayed Haroun , Chebil Mohamed 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Lymphocele after renal transplantation remains a common complication, despite all the technical precautions taken, in particular the ligation of lymphatic vessels. Its incidence varies according to the series, depending on the diagnostic methodology, and whether or not it is systematically screened.
This study aims to investigate the risk factors for lymphocele and its impact on transplant survival.

METHOD
We performed a retrospective longitudinal descriptive study including all patients who had a kidney transplant in a Urology department from 1986 to 2017. Clinical presentation and management of lymphocele were studied. Then, the characteristics of patients who presented a lymphocele were compared with those of the rest of the population including characteristics related to the recipient, the donor, the transplant and the procedure to identify risk factors. The impact of lymphocele on patient and transplant survival was then studied.

RESULTS
A total of 720 patients were included with a mean age of 32.7 years. The transplant was from a living donor in 79% and a brain-dead donor in 21%. Lymphocele occurred in 51 patients (7.1%). The lymphocele was asymptomatic in 80%, and clinical manifestations were related to the compression of the transplant or its important size, requiring active treatment, most often percutaneous (13.7%). The lymphocele did not require treatment in 42 cases (82.4%) with disappearance in 90.5%. Revision surgery for a lymphocele was necessary in two cases.
The risk factors for lymphocele were a cadaveric donor (P = 0.003) and an advanced age of the recipient (P &lt; 0.001). No predictive factors related to the transplant (vascular anatomy), or procedure (location and type of anastomoses, ischemia time) were identified.
Transplant survival was 77.9% at 5 years, with a median survival of 15.9 years. The occurrence of a lymphocele did not influence the survival of the transplant (P = 0.25) (Figure 1).

CONCLUSION
Our study showed that lymphocele is usually asymptomatic, not requiring a specific treatment in most cases with a high rate of spontaneous disappearance with no impact on transplant survival. Risk factors were a cadaveric donor which may reflect the absence of careful ligation of the transplant's lymphatic vessels in the context of urgent, sometimes multi-organ, cadaveric procurement and advanced recipient age.
MO969: Chronic Hypotension in Dialysis Has A Negative Impact on Kidney Transplant Outcomes
Authors: Auñón Rubio Pilar , Cavero Escribano Teresa , García Santiago Ana , Pascual Julio , Andrés Belmonte Amado 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Persistent chronic hypotension affects 5–10% of dialysis patients, and it is associated with high morbidity and mortality [1]. Although data regarding the influence of this hemodynamic condition on kidney transplantation are scarce, some studies suggest a negative impact on kidney transplant outcomes [2-3]. We decided to analyze the evolution of patients with chronic hypotension in dialysis who undergo kidney transplantation in our center.

METHOD
A retrospective observational study was conducted. We evaluated 2308 consecutive kidney transplants performed at Hospital Doce de Octubre between 2004 and 2020. Sixty-six patients with chronic hypotension (defined as systolic blood pressure ≤ 100 mmHg at the time of transplantation) were identified. A control group of 66 non-hypotensive patients was assigned, matched for the source of organs and age (using as control, whenever possible, the recipient of the other kidney from the same donor). The evolution of both groups was compared in terms of primary graft function, graft thrombosis, delay in graft function, serum creatinine at the end of follow-up and renal graft survival.

RESULTS
Patients with chronic hypotension had higher rates of primary non-function (18.2% versus 6.1%, P = 0.033) mainly due to venous thrombosis of the renal graft (15.2% versus 3%, P = 0.015). Delayed graft function was also more common in patients with chronic hypotension (68.2% versus 50%, P&lt; 0001). Mean graft survival was lower in the group of patients with chronic hypotension (81.1 months) compared to the control group (104.1 months) (P = 0.012). At the end of follow-up, there were 67.7% of functioning grafts within the hypotensive group compared with 86.4% in the control group (P = 0.013). Serum creatinine at the end of follow-up was slightly higher in patients with chronic hypotension (1.76 ± 0,70mg/dL versus 1.50 ± 0.49 mg/dL, P = 0.04). Median follow-up time was 37 months (1–122). In multivariate analysis, chronic hypotension was an independent risk factor for renal graft loss [RR = 2.8 (1.3–6.4), P = 0012].

CONCLUSION
Chronic hypotension in dialysis has a negative impact in short and long-term kidney transplant outcomes. It is associated with higher rates of primary non-function due to venous graft thrombosis, higher rates of delayed graft function, a higher serum creatinine at the end of follow-up and a worse renal graft survival.
It seems crucial to identify this subgroup of patients in order to implement measures aimed to ameliorate transplant results.
MO976: Recurrence of Immune Complex And Complement-Mediated Membranoproliferative Glomerulonephritis in Kidney Transplantation
Authors: Caravaca-Fontán Fernando , Inmaculada Polanco Fernandez Natalia , Andres Amado , Praga Manuel 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Membranoproliferative glomerulonephritis (MPGN) represents a histologic pattern of glomerular injury which may be due to several etiologies. Few studies have comprehensively analyzed the recurrence of MPGN according to the current classification system.

METHOD
We collected a multicenter, retrospective cohort of 220 patients with biopsy-proven native kidney disease due to MPGN between 1981 and 2021 in 11 hospitals. Demographic, clinical and histologic parameters of prognostic interest were collected. The main outcomes were time to kidney failure, time to recurrence of MPGN, and disease remission after recurrence.

RESULTS
The study group included 34 complement-mediated and 186 immune complex-mediated MPGN. Eighty-one patients (37%) reached kidney failure in a median follow-up of 79 months. The main predictors of this event were the development of rejection episodes, and disease recurrence. Fifty-four patients (25%) had a disease recurrence in a median of 16 months after kidney transplantation. The incidence of recurrence was higher in patients with dysproteinemia (67%) and complement-mediated MPGN(62%). In the multivariable model, complement-mediated MPGN emerged as a predictor of recurrence. Thirty-three patients reached kidney failure after recurrence. The main determinants of no remission were: early time to recurrence (&lt;15 months), eGFR &lt;30 mL/min/1.73 m2 and serum albumin &lt;3.5 g/dL at the time of recurrence.

CONCLUSION
One-fourth of patients with native kidney disease due to MPGN developed clinical recurrence in the allograft, especially in cases with complement-mediated disease or in those associated with dysproteinemia. The kidney outcomes of disease recurrence with currently available therapies are heterogeneous and thus, more effective and individualized therapies are needed.
MO978: Survival for Waitlisted Kidney Failure Patients Receiving Transplantation Versus Remaining on the Waiting List: A Systematic Review and Meta-Analysis
Authors: Chaudhry Daoud , Chaudhry Abdullah , Peracha Javeria , Sharif Adnan 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Kidney transplantation is acknowledged as the treatment modality of choice for eligible kidney failure patients versus dialysis. However, evidence for survival benefits in marginal kidney transplant candidates is limited. We aimed to investigate the survival benefit of transplantation versus dialysis for waitlisted kidney failure patients with a priori stratification.

METHOD
Design: Systematic review and meta-analysis.
Data sources: Online databases MEDLINE, Ovid EMBASE, Web of Science, Cochrane Collection and ClinicalTrials.gov were searched between database inception and 1 March, 2021.
Eligibility criteria for selecting studies: All comparative studies that assessed all-cause mortality of transplantation versus dialysis for kidney failure patients waitlisted for transplant surgery were included. Two independent reviewers extracted the data and assessed the risk of bias of included studies. Meta-analysis was performed using the DerSimonian-Laird random effects model, with heterogeneity investigated by sub-group analyses, sensitivity analyses and meta-regression.

RESULTS
Our search identified 48 observational studies with no randomized controlled trials (n = 1 245 850 patients). In total, 92% of studies (n = 44/48) reported a long-term (≥1 year) survival benefit associated with transplantation compared with dialysis. However, 11 of those studies identified stratums in which transplantation offered no statistically significant benefit over remaining on dialysis. In 18 studies suitable for meta-analysis, kidney transplantation showed survival benefit (hazard ratio: 0·45, 95% CI: 0·39–0·54, P &lt; 0·0001), with significant heterogeneity even after sub-group/sensitivity analyses or meta-regression analysis.

CONCLUSION
Kidney transplantation remains the superior treatment modality for most kidney failure patients to reduce all-cause mortality, but some subgroups may lack a survival benefit. Given the continued scarcity of donor organs, further evidence is necessitated to better inform decision making for kidney failure patients.
MO979: Influence of BK Virus Plasma Viral Load in Kidney Transplant Outcomes
Authors: Alonso Marta , Villanego Florentino , Orellana Cristhian , Alberto Vigara Luis , Montiel Natalia , Aguilera Aurora , Manuel Amaro Jose , Garcia Teresa , Mazuecos Auxiliadora 
Published: May 2022

Abstract

BACKGROUND AND AIMS
BK virus infection (BKi) is an important cause of kidney transplant (KT) loss. Besides to reducing immunosuppression, the rest of the therapies have not shown a clear benefit. Our purpose is to analyze the risk factors for BKi and the influence of BK plasma viral load on KT outcomes.

METHOD
Prospective cohort study of KT with BKi, defined by the presence of BK viremia in ≥3 consecutive determinations, from 01 January 2010 to 31 December 2020. BK viremia was determined every 10 days during the first 3 months, at 6th month, 12th month and in case of impaired renal function. In patients with positive viremia, immunosuppressive therapy was changed (reduction/discontinuation of mycophenolate and/or switching to everolimus). Patients with high-level viremia (≥10 000 copies/mL) and low-level viremia (&lt;10 000 copies/mL) were compared. To identify risk factors for BKi, for each KT with BKi, we selected two matched controls and performed a logistic regression analysis. Graft survival was analyzed according to BK viremia (high-level, low-level and negative) using Kaplan–Meier and Cox regression analysis was performed to determine risk factors for graft survival.

RESULTS
849 KT were performed, of which 67 (7.9%) presented BKi. Six KT were excluded due to incomplete data. Finally, 61 KT BKi (n = 27, high-level viremia; n = 34 low-level viremia) and 122 controls were analyzed. The median post-KT time to BKi was 2 months. In the multivariable analysis, male recipient, older age and re-KT were risk factors for BKi.
Proven BK-associated nephropathy was diagnosed in five KT recipients and nine patients had persistent BK viremia, all of them from the high plasma viral loads group. Only one patient lost the graft due to BK-associated nephropathy.
Patients with low-level viremia had worse renal function one month after KT than controls but without differences at the first year. Patients with high-level viremia had worse renal function one year after KT and worse graft survival than recipients with low-level viremia and controls (P = 0.037). In the multivariable analysis, when we analyzed exclusively patients with BKi, high-level viremia was a risk factor for kidney graft survival (HR: 16.31; P = 0.034).

CONCLUSION
BKi is not an uncommon complication after KT. Only high BK viral load was associated with BK-associated nephropathy, persistent viremia, and poorer graft survival. BK viremia &lt;10 000 copies/mL did not affect KT outcomes. Therefore, monitoring BK plasma viral loads and changes in immunosuppression to reduce viremia are effective strategies to minimize the impact of BK virus on graft survival.
MO1007: Intestinal Permeability in Patients After Kidney Transplantation Treated with Two Different Formulations of Extended-Release Tacrolimus
Authors: Kolonko Aureliusz , Słabiak-Błaż Natalia , Pokora Patrycja , Piecha Grzegorz , Jan Wiecek Andrzej 
Published: May 2022

Abstract

BACKGROUND AND AIMS
A prompt achieving of adequate tacrolimus blood exposure is crucial in early period after kidney transplantation. A gut epithelial barrier integrity may play a role in tacrolimus absorption. The aim of this study was to investigate the intestinal fatty acid binding protein (I-FABP) concentrations as a marker of intestinal permeability in recent kidney transplant recipients (KTRs) treated with two different tacrolimus extended-release formulations.

METHOD
48 pairs of consecutive KTRs were analyzed. Within each pair, an early conversion was performed from twice-daily (Prograf) to a once-daily tacrolimus formulation: Advagraf or Envarsus. On the day of discharge from the hospital, I-FABP plasma levels were measured and the tacrolimus concentration-to-dose (C/D) ratio was calculated. Tacrolimus exposure was assessed with an area under the curve (AUC) based on blood trough level and 3-h post-dose measurement.

RESULTS
There were no differences in recipient age, dialysis vintage, BMI and residual diuresis between the Advagraf and Envarsus groups. The median I-FABP plasma levels [Advagraf: 1450 (750–2100) versus Envarsus 1200 (600–1790) pg/mL; P = .18] and mean tacrolimus AUC [154 (143–164) versus 145 (132–158) ng.h/mL, respectively; P = .30] were similar. As expected, C/D ratio was significantly greater in the Envarsus group [2.06 (1.32–3.09) versus 1.16 (0.72–1.52) in the Advagraf group; P &lt; .001]. Interestingly, log I-FABP correlated inversely with tacrolimus AUC only in the Envarsus group (r = –0.431; P &lt; .01) but not in the Advagraf group (r = 0.05; P = .72).

CONCLUSION
Our findings suggest that destabilization of the enterocyte membrane integrity may influence the intestinal tacrolimus absorption, which may cause lower tacrolimus exposure in KTRs treated with Envarsus. However, explanation of this phenomenon needs further investigation.
MO1014: The Effects of a 6-Month Exercise Training Programme on Glycemic Control, Lipid Profile and Functional Capacity of Diabetic Kidney Transplant Recipients
Authors: Michou Vasiliki , Nikodimopoulou Maria , Kouidi Evangelia , Deligiannis Asterios 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The effects of exercise training in kidney transplant (KT) recipients with diabetes mellitus remain unclear [1]. This randomized controlled trial aimed to investigate the effects of a 6-month home-based exercise training programme on functional capacity, glucose levels and lipid profile of diabetic KT patients.

METHOD
A total of 21 type II diabetic KT recipients were randomly assigned into two groups: exercise (n = 11, aged 52.9 + 10.1 years) and control (n = 10, aged 53.01 + 9.5 years). All participants at baseline and at the end of the study underwent biochemical tests for fasting plasma glucose (FPG) levels, glycated haemoglobin (HbA1c) and lipid profile and cardiopulmonary exercise testing for maximum oxygen uptake (VO2peak) estimation. The exercise group followed a 6-month supervised home-based aerobic and progressive resistance exercise programme of moderate intensity, 3 times/week, while the control group continued to receive usual care.

RESULTS
At the end of the 6-month study, the exercise group had significantly lower values in FBG by 13.4% (P = .01), HbA1c by 1.5% (P = .01) and triglycerides by 8.5% (P &lt; .05) and higher values in high-density lipoprotein by 10.2% (P &lt; .05) and VO2peak by 4.7% (P = .02) than the control group. Moreover, there were statistically significant differences between the two groups at the end of the study for FBG, triglycerides and VO2peak. Finally, after training there was a moderate, positive linear relationship between VO2peak and HbA1c in the exercise group (r = 0.408, P = .03).

CONCLUSION
The results of this study demonstrated that a 6-month home-based mixed-type exercise training programme can improve the functional capacity, levels of glucose and lipid profile of diabetic KT recipients.
MO1025: Periostin as a Potential Biomarker of Renal and Arterial Damage in Children with Tuberous Sclerosis Complex
Authors: Skrzypczyk Piotr , Maria Wabik Anna , Szyszka Michał , Szmigielska Agnieszka , Krzemien Grazyna , Jozwiak Sergiusz , Brzewski Michal , Stelmaszczyk-Emmel Anna , Panczyk-Tomaszewska Malgorzata 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Experimental data suggest that periostin is involved in the formation of renal cysts. Tuberous sclerosis complex (TSC) is a multisystem genetic disease characterized by the formation of lesions in virtually all organs, including the kidney—most commonly angiomyolipomas (AML) and cysts. There are no reliable markers of progression of renal lesions in patients with TSC. The study aimed to evaluate serum periostin levels in children with TSC and to assess the usefulness of periostin as a marker of renal lesion severity and arterial damage in this group of patients.

METHOD
In a group of 35 children with TSC (mean age 8.46 ± 5.64 years, 17 boys, 18 girls), serum periostin levels (ng/mL), anthropometric parameters, renal changes (by ultrasound and magnetic resonance imaging), blood pressure and biochemical parameters were evaluated. The control group consisted of 25 healthy children (mean age 8.72 ± 4.73 years, 14 boys, 11 girls). In addition, central pressure and parameters of arterial structure and function (cIMT, PWV, AIx75HR) were assessed in 20 children with TSC and 17 healthy children (age ≥ 4 years).

RESULTS
Arterial hypertension was found in two (5.7%) patients; AML was present in 20 (57.1%) children, including 9 (27.3%) atypical AML and 22 (62.8%) had cysts in the kidneys. Children with TSC did not differ in periostin levels compared with healthy children [67.46 ± 35.61 versus 68.14 ± 24.07 (ng/mL), P = .499]. In children with TSC, periostin concentration was negatively correlated with age (r = −0.614, P &lt; .001), height (r = −0.634, P &lt; .001), body weight (r = −0.658, P &lt; .001), maximum cyst size (r = −0.481, P = .004) and office and ABPM systolic and diastolic blood pressure (r = −0.396 to −0.621, P &lt; .050). There was no relationship between periostin levels and AML size or arterial damage parameters. In multivariate analysis, the only determinant of serum periostin levels in children with TSC was age [beta = −0.547, 95% confidence interval (95% CI) (−0.831 to −0.262)].

CONCLUSION
The usefulness of serum periostin determination as a marker of renal cystic lesions in children with tuberous sclerosis requires further study.
MO1027: Kidney Tubular Damage Associated with Early Sepsis and Longer Hospital Stay in Newborns with Neonatal Infection
Authors: Da Silva Barbosa Joycilene , Cavalcante Meneses Gdayllon , Rebouças Castelo Luan , Bezerra Da Silva Junior Geraldo , Maria Costa Martins Alice , De Francesco Daher Elizabeth , Lima Sampaio Tiago , Coelho Lopes Nicole , de Oliveira Gomes Amanda , Beatriz Timbó de Oliveira Ana , Daniel Alves Albuquerque Francisco , Pinheiro Gonçalves Lemes Romélia 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The aim of the study was to evaluate the early association of urinary cystatin-C (uCysC) (proximal tubular injury biomarkers) with sepsis and longer hospital stay in premature newborns (NBs) with neonatal infection.

METHOD
This is a prospective study with NBs from Neonatal Intensive Care Unit (nUTI), between August 2019 and September 2020. Three groups were constructed: healthy NBs, NBs with neonatal infection without sepsis and NBs with sepsis. Premature newborns with kidney disease, renal malformation, insufficient data in the medical record, or samples with scarce volume were excluded. Urine samples were collected for biomarkers measurements. Urinary cystatin-C was quantified in the urine and expressed with or without ratio by urinary creatinine to investigate the urinary concentration bias.

RESULTS
In total, 62 NBs were included: 27 healthy, 24 with neonatal infection without sepsis and 11 with sepsis. No acute kidney injury (AKI) was found in NBs and 22 (63%) had longer hospital stay (˃ 30 days). Higher levels of urinary cystatin-C, both adjusted for urinary creatinine, were elevated in NBs's sepsis group. Moreover, in NBs with a longer hospital stay, there was an elevated level of urinary cystatin-C, which was capable to predict the need for ˃ 30 days of hospital stay (AUC-ROC = 0.783, P = .01).

CONCLUSION
Our study demonstrated that kidney tubular damage biomarker, such as uCysC, was associated with early sepsis in premature NBs and was useful to prognosis evaluation.