bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO1017: Induction Immunosuppression and Outcome in Early Kidney Transplant Recipients with Covid-19
Authors: Castañeda Amado Zaira , Toapanta Néstor , Jimenez Sara , Molina Gomez Maria , Maruri Kareaga Naroa , Llinás Laura , Villanego Florentino , Canal Cristina , Rodriguez Marisa , Montero Nuria , Vazquez-Sanchez Teresa , Gutierrez Dalmau Alex , Beneyto Isabel , Franco Esteve Antonio , María Vicente Ana , Lourdes Pérez Tamajón M , Leticia Martin-Moreno Paloma , Ramos Ana , Bestard Oriol , Moreso Francesc 
Published: May 2022

Abstract

BACKGROUND AND AIMS
COVID-19 in kidney transplants has a high risk of complications and mortality, especially in older recipients diagnosed during the early period after transplantation. Management of immunosuppression has been challenging during the pandemic. We investigated the impact of induction immunosuppression, either basiliximab or thymoglobulin, on the clinical evolution of kidney transplants developing COVID-19 during the early period after transplantation.

METHOD
Kidney transplant recipients with &lt;6 months with a functioning graft diagnosed of COVID-19 from the initial pandemic outbreak (March 2020) until 31 July 2021 from different Spanish centres participating in a nationwide registry.

RESULTS
A total of 127 patients from 17 Spanish centres developed COVID-19 during the first 6 months after transplantation, 73 (57.5%) received basiliximab and 54 (42.5%) thymoglobulin. Demographics were not different between groups, but patients receiving thymoglobulin were more sensitized (cPRA of 32.7% ± 40.8% versus 5.6% ± 18.5%) and more frequently re-transplanted (30% versus 4%). Recipients older than 65 years treated with thymoglobulin showed the highest rate of acute respiratory distress syndrome [64.7% versus 37.1% for older recipients receiving thymoglobulin and basiliximab (P &lt; .05), and 23.7% and 18.9% for young recipients receiving basiliximab and thymoglobulin (P &gt; .05)] and the poorest survival [mortality rate of 64.7% and 42.9% for older recipients treated with thymoglobulin and basiliximab, respectively (P &lt; .05), and 8.1% and 10.5% for young recipients treated with thymoglobulin and basiliximab (P &gt; .05)]. Older recipients treated with thymoglobulin showed the poorest survival in the Cox's regression model adjusted for comorbidities.

CONCLUSION
Thymoglobulin should be used with caution in older recipients during the present pandemic era.
MO1019: Sigma-1 Receptor Agonists are Protective in a Rat Model of Kidney Transplantation
Authors: Lakat Tamas , Roland Toth Akos , Hodrea Judit , Wagner Laszlo , Szabo Attila , Fekete Andrea , Hosszu Adam 
Published: May 2022

Abstract

BACKGROUND AND AIMS
End-stage renal disease affects nearly 2 million people worldwide. The disease is associated with an irreversible deterioration in renal function and can only be treated by dialysis or kidney transplantation (KTx). KTx is associated with better long-term outcomes and quality of life compared with dialysis, but the shortage of donor organs is a serious and unsolved problem. Graft survival is highly dependent on the extent of cold and warm ischemic injury during Tx. We recently described the renoprotective effects of Sigma-1 receptor (S1R) agonist treatment in IRI. Thus, our aim was to develop a novel preservation solution that, with the addition of S1R agonist compounds, minimizes ischemic damage in order to improve the condition of grafts and so increase the number of organs suitable for Tx.

METHOD
Kidneys of male Wistar rats were perfused and placed in ice cold (i) custodiol preservation solution; custodiol containing S1R agonists, (ii) fluvoxamine or (iii) SA-4503 for 2 h, then autotransplanted and sacrificed 24 h after reperfusion. Sham-operated rats served as controls. In a second experiment, kidneys of wild-type and S1R knockout mice were perfused and placed in an ice-cold preservation solution containing an original, selective S1R agonist compound (VCC) for 24 h of cold ischemia and tissue samples were collected. Renal function parameters were determined. Renal expression of tubular injury markers (Kim-1, Ngal) and inflammatory cytokines (Il-1α, Il-6, Tnf-α, Mcp-1) were measured. Periodic acid-Schiff staining was performed on kidney tissue sections to evaluate structural changes. CD45 immunostaining was performed on kidney sections to determine the extent of leukocyte infiltration. DNA fragmentation resulted by apoptotic events in the kidney was evaluated by TUNEL-assay.

RESULTS
S1R agonists mitigated renal functional impairment and tubular dilatation following Tx. Expression of early and sensitive tubular injury markers was markedly less elevated in S1R agonist-treated kidneys. S1R agonists alleviated renal apoptosis as shown on TUNEL-stained kidney sections. Decreased numbers of CD45 + leukocytes and decreased inflammatory cytokine expressions confirmed the anti-inflammatory effect of S1R agonists. The S1R agonist VCC compound mitigated cold ischemic structural kidney damage in wild-type but not in S1R KO mice, which confirms the protective role of the receptor.

CONCLUSION
The addition of S1R agonists to the preservation solution during Tx improves graft function and alleviates structural damage, thus improving long-term outcomes. S1R agonists reduce graft injury during cold storage, therefore the number of transplantable donor organs can be increased.

FUNDING
OTKA PD-131 637; FK-124 491; 2020–4.1.1.-TKP2020-6 183 069 269; 2020–4.1.1.-TKP2020-6 183 169 273; KDP-2020/1 019 145.
MO1021: Long-Term Outcomes After Conversion to a Belatacept-Based Immunosuppression in Kidney Transplant: A Matched Cohort Study
Authors: Divard Gillian , Debiais-Deschamps Charlotte , Legendre Christophe , Lefaucheur Carmen , Aubert Olivier , Loupy Alexandre 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Conversion to a belatacept regimen after transplant seems to be safe. However, no studies have reported the long-term efficacy and safety outcomes after conversion to a belatacept regimen and compared it with patients treated with a CNI-based regimen in kidney transplantation. This study aims to investigate the long-term outcomes of patients converted to a belatacept regimen compared with matched patients under a CNI regimen.

METHOD
Kidney transplant recipients transplanted between 1998 and 2019 from two French academic transplant canters were recruited. We used a propensity score to match with a 1:1 ratio of patients at the time of the biopsy, which indicates the conversion to a belatacept regimen to control patients under a CNI regimen with a biopsy after transplant. We used 11 parameters associated with graft survival for the matching, 4 baseline transplant characteristics (recipient age, prior transplant status, donor type and dgf) and 7 at time of the biopsy (time after transplant, eGFR, proteinuria, DSA and Banff scores cv, ah, IFTA). Transplant outcomes defined by graft and patient survival, as well as safety outcomes, were compared between the matched patients.

RESULTS
From 3215 kidney transplant recipients transplanted during the study period with the inclusion criteria (311 patients under belatacept and 2904 patients under CNI). A total of 243 patients under belatacept were matched with 243 controls under CNI. All prognostic parameters were well-balanced before conversion between the two groups, with a mean age of 54.7 ± 15.1 years (P = .4543), a mean time of 2.2 ± 3.2 years after transplant (P = .586), a mean eGFR of 33.0 ± 13.3 mL/min/1.73 m2 (P = .976), a median proteinuria of 0.23 (0.12–0.50) g/g (P = .278) and 30.9% of positive anti-HLA DSA (P = 1.0) in the belatacept group. After a mean follow-up time after conversion of 4.4 ± 2.5 years, 36 (14.8%) patients lost their grafts and 39 (16.0%) patients died in the belatacept cohort. After conversion to a belatacept regimen, the graft survival was significantly improved when we compared with the matched patients’ under CNI P &lt; .0001 (Fig. 1). Patients converted to Belatacept showed a lower death rate of 16.0% compared with 30.0% for the CNI treated patients (P &lt; .001). The safety outcomes showed a similar rate of biopsy proven rejection (P = .08), major adverse cardiovascular events and cancer between the two groups, while a significant higher rate of CMV disease was observed among the belatacept treated patients P &lt; .01).

CONCLUSION
This study confirms that conversion to belatacept post-transplant is associated with improved long-term graft outcome and acceptable safety. Conversion to belatacept after transplant should be considered as a valuable therapeutic option for kidney recipients.
MO1023: Effects of Bortezomib on Complement Fixation and IGM Reactivity in Late Abmr — Results of A Randomized Controlled Trial (The Borteject Trial)
Authors: Doberer Konstantin , Eskandary Farsad , Wahrmann Markus , Haindl Susanne , A. Böhmig Georg , Bond Gregor 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Late antibody-mediated rejection (ABMR) is a cardinal cause of kidney allograft failure. Currently, there is no proven effective treatment for this type of rejection. In a recent randomized controlled trial, we have reported no meaningful effect of plasma cell-directed treatment using the proteasome inhibitor bortezomib on the clinical course of late ABMR (BORTEJECT trial; ClinicalTrials.gov, NCT01873157; Eskandary et al. J Am Soc Nephrol, 2018; 29: 591). Treatment had also no significant effect on IgG type donor-specific antibody (DSA) patterns, possibly due to rapid reconstitution of the allospecific plasma cell repertoire. To further dissect the impact of bortezomib on donor-specific B cell alloimmunity, we here sought to investigate whether and to what extent bortezomib impacts the dynamics of specific alloreactivity patterns, in particular, the course of IgM type DSA and complement-activating capability of detected DSA.

METHOD
The BORTEJECT trial was a randomized, placebo-controlled parallel group trial designed to investigate whether two cycles of bortezomib (each cycle: 1.3 mg/m2 intravenously on days 1, 4, 8 and 11) were able to halt the progression of IgG-DSA-positive late ABMR. A total of 44 recipients were randomly assigned to receive bortezomib (n = 21) or placebo (n = 23). In the present re-analysis of biobanked serum samples obtained in the context of the trial, we applied modified single antigen bead assays to assess IgM-DSA and, in addition, complement (C1q) binding. To estimate antibody/complement binding, levels of mean fluorescence intensity (MFI) were recorded. IgM DSA was defined in relation to donor/recipient HLA typing, independently of IgG reactivity patterns.

RESULTS
At baseline, the complement-fixing capability of the immunodominant IgG DSA did not differ between groups. Thirty of 44 patients had detectable IgM DSA at baseline, and we observed a considerable overlap of IgG and IgM DSA specificities (22/30) without group differences. IgM DSA levels were also similar between groups.
Bortezomib treatment did not affect the complement-fixing capability of IgG DSA over time. Similarly, there was no effect on the course of IgM-DSA. There were also no significant differences between groups when analysing percentage changes.

CONCLUSION
A limited course of bortezomib as a sole treatment strategy may not be sufficient to impact on DSA levels, including the evolution of IgM type DSA and the complement-binding capability of detected alloreactivity patterns. Our study results, which may mirror the lack of clinical efficacy, reinforce the need for the development of innovative new strategies to effectively target plasma cells and halt the progression of ABMR.
MO1028: Vascular Access Type in Haemodialysis Paediatrics Patients—From Central Venous Catheter to Arteriovenous Fistula
Authors: Cohombo Josefa , Vilaça Joana , Costa Teresa , Do Sameiro Faria Maria , Conceição Mota Maria 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Haemodialysis (HD) in children has become progressively more used, the efficiency of the treatment, as well as the technical improvements, are evident. Permanent access in the form of a fistula is the preferred type of vascular access (VA) for most paediatric patients on maintenance HD. However, age-related anatomical limitations, shorter waiting times for transplantation, or lack of paediatric/surgical expertise limit its use. Central venous catheter (CVC) remains the most used access in children. Here we present the results of the last 14 years of experience in paediatric HD vascular access from a reference centre in northern Portugal.

METHOD
A retrospective descriptive study of patients admitted to our paediatric HD Unit between January 2007 and December 2021. Clinical data were collected from medical records.

RESULTS
In total 46 patients were enrolled, mainly boys (n = 26, 56.5%), mean age at admission 10.8 + 5.3 years (1–17), 39.1% weighing ˂ 30 kg (n = 18) and 17.4% ˂15 kg (n = 8). More than half were incident patients starting on HD (n = 25, 54.3%), 45.7% (n = 21) were transferred from peritoneal dialysis (PD) and one patient had a previous kidney transplant (KT). Regarding CKD etiology, 52.2% (n = 24) were mainly due to congenital anomalies of the kidney and urinary tract; chronic glomerulonephritis was responsible for 19.6% of cases (n = 9). Most patients started HD with a CVC (n = 38, 82.6%), including two patients with an arteriovenous fistula (AVF) who required a temporary CVC until fistula maturation. At the end of follow-up, about 43.5% (n = 20) of the patients ended up with an AVF (compared with 17.4% at the beginning) and, not surprisingly, 90% (n = 18) of them weighed ˃ 30 kg and only one child ˂ 15 kg. The mean duration of dialysis was 1.1 + 0.5 years (1 month–8 years); 28 patients were submitted to KT (60.9%), 7 transferred to PD (15.2%) and 4 (8.7%) remain on HD. Average waiting times for KT are quite longer in patients with AVF (1.56 years), in comparison to CVC (0.584 years).

CONCLUSION
In children, choosing the best vascular access remains a challenge. CVCs continue to be the most used type of vascular access. This option can be justified by the limitations of smaller patients, the expectation of a short waiting time for KT and the need to cannulate every other day (with the pain and fear associated with it). CVCs were associated with less effective dialysis and higher complication rates. On the other hand, AVFs have shown excellent long-term patency in paediatric HD patients. In our group, no significant complications were reported and no thrombosis occurred.
MO1029: Is there a Relationship Between Fibroblast Growth Factor 23 and Blood Pressure in Children with Chronic Kidney Disease?
Authors: Balmukhanova Altynay , Kabulbayev Kairat , Alpay Harika , Balmukhanova Aigul , Kanatbayeva Assiya 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Chronic kidney disease (CKD) is a complex medical and social problem worldwide due to high prevalence and mortality rates. According to the ESPN/ERA-EDTA, the prevalence of CKD stages 3–5 in children is about 55–60 pmarp [1]. Moreover, CKD usually causes different severe complications, including pathologic changes in the cardiovascular system, which significantly affect long-term survival. Unlike many complications of CKD, hypertension can be present in the earliest stages of the disease [2]. Nowadays, there has been a scientific and practical interest in Fibroblast growth factor 23 (FGF-23) which is mostly considered as a phosphate-regulating biomarker [3]. There are some speculations that FGF-23 affects blood pressure (BP) in adults due to the impact on the renin-angiotensin-aldosterone system (RAAS) by decreasing calcitriol [4] and the direct effect of FGF-23 on sodium reabsorption, which has been demonstrated in experimental models [5].
Therefore, the aim of our study was to investigate the link between FGF-23 and BP in children with CKD.

METHOD
There were 73 children with CKD stages 1–5, mean age was 9.79 ± 0.58 years. BP was determined by 3 times measurement and calculating the mean value. Received results were compared with percentile norms according to age and gender in order to divide patients into two groups: normotensive and hypertensive. FGF-23 was determined in serum by multimatrix ELISA kit (Biomedica Medizinprodukte GmbH, Austria). Statistical analysis was performed using SPSS version 26 (IBM, USA).

RESULTS
In the group with normal BP the median of FGF-23 in serum was 1.8 [0.7–3.4] pmol/L. In comparison, in the group with a hypertensive level of BP median indicator of FGF-23 was 7.6 (1.98–18.5) pmol/L (P &lt; .001). The prevalence of elevated FGF-23 in children with high BP predominates 1.6 times [95% confidence interval (95% CI): 1.2–2.1]. It is also noticed that pulse BP positively correlated with FGF-23 level in serum (r = 0.402, P &lt; .001).

CONCLUSION
Our findings confirm that FGF-23 is linked to BP in children with CKD what makes us conclude that more careful attention to children with a high level of FGF-23 is needed in relation to hypertension and as a consequence cardiovascular complications. However, more investigations should be done in order to establish a causal relationship.
MO1046: The Selection of Renal Replacement Therapy for End-Stage Kidney Disease Patients by the Shared Decision-Making Method
Authors: Sakai Kentaro , Oota Osamu , Hisanaga Tetsuya , Yada Tomotaka , Matsui Rei , Higashi Harumichi 
Published: May 2022

Abstract

BACKGROUND AND AIMS
In Japan, &gt; 97% of patients with end-stage kidney disease (ESKD) select hemodialysis as a renal replacement therapy (RRT). Hemodialysis (HD) and peritoneal dialysis (PD) have been provided at our hospital for many years, and kidney transplantation (KT) has been available here since 2015. In January 2018, we introduced the option of RRT for outpatients based on the shared decision-making (SDM) method, which was recently shown to be useful for patients.

METHOD
Patients receive ∼1-h explanation of the SDM method by a nurse in the outpatient department. If patients desire additional outpatient visits, they receive as many as they want; a decision about RRT is not required after a single visit and patients can change their decision at any time. We conducted a prospective observational study to investigate patients’ selection of RRT and the influence of the SDM method on the selection of RRT. The data were examined by Fisher's exact test and significance was accepted at P &lt; 0.05.

RESULTS
During the period from January 2018 to December 2021, 116 patients visited our outpatient department and 69 patients underwent RRT. Only 53% of the patients initially requested hemodialysis (Figure 1), but &gt; 80% of the patients eventually underwent hemodialysis (Figure 2). From 2018 to 2021, 156 patients started RRT; 58 of them (37%) had visited the outpatient department before starting RRT. The number of patients who visited the outpatient department has increased year by year. The emergency initiation of dialysis decreased significantly after the outpatient use of the SDM method began [odds ratio (OR) 0.44, P = 0.024].

CONCLUSION
There was a tendency for patients’ satisfaction regarding their own selection of RRT via the SDM method in the outpatient department. Patients can obtain the information they need and select a better treatment for themselves via an explanation of the SDM method. The SDM method is thus very effective for both patients and medical staff when considering RRT.
MO1049: An Intradialytic Exercise at Start versus End of HD Session to Improve Strength with Non-Immersive Virtual Reality: A Randomized Controlled Trial
Authors: José Martínez-Olmos Francisco , Garcia-Testal Alicia , Benavent Caballer Vicente , Valtueña-Gimeno Noemi , Toquero Correa Marina , Garcia-Maset Rafael , Rico-Salvador Inmaculada , Royo-Maicas Pilar , Vercher Narbona Verónica , Antonio Gil-Gómez José , Segura-Ortí Eva 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Haemodialysis (HD) induces changes in addition to the kidney in other organs or systems so that patients usually present symptoms such as fatigue, generalized muscle weakness and low tolerance to exercise that result in functional impairment, decreased work capacity and dependence for activities of daily living. Intra-dialysis exercise programmes may help to partly reverse this situation. Exercise during the first 2-h of dialysis has proven to be safe. Our group showed that an acute session of virtual reality exercise during the last 30 min of HD was safe too. The aim of this study was to compare the impact of non-immersive virtual reality intra-dialysis during the first 2-h versus the last 2-h of dialysis on lower-limbs muscle strength.

METHOD
This was a randomized controlled trial. Participants were randomized in two groups: group A performed the exercise during the first and second hour of the HD session and group B performed it during the third and fourth hour. Strength was measured bilaterally with a hand-held Lafayette dynamometer in three movements of the lower limbs (hip flexion, hip abduction and plantar flexion) during the HD session. The intradialytic exercise consisted of a non-immersive virtual reality video game adapted to the dialysis session, in which the patient must catch treasures while avoiding bombs by moving the lower extremities, with a progressive duration of 25–45 min, over a 12-week period.

RESULTS
A total of 33 subjects were included in the analysis, 17 subjects (median age 71.8 years; 10 men) in group A and 16 subjects (median age 73.3 years, 9 men) in group B. At baseline the period analysed, there were no significant differences between the two groups in any of the movements analysed. The force analysed in the different movements showed that there was a significant increase in all the movements analysed in both groups. There was an increase in force in the movements of the lower right limb of 3.31 N in hip flexion, 2.01 N in hip abduction and 1.10 N in plantar flexion, as well as an increase in the outside in the lower left limb of 3.82 N in hip flexion, 2.47 N in hip abduction and 4.63 N in plantar flexion. There were no significant differences in the increase in strength in the movements analysed between both groups in the movements analysed after the 12-week period analysed.

CONCLUSION
There are no differences in the application of an intradialytic exercise at the beginning versus at the end of the HD session to improve strength with non-immersive virtual reality. An intradialytic exercise with non-immersive virtual reality improves limb strength in HD patients.