The Case | Persistent fever in a hemodialysis patient Rodríguez-Espinosa, Diana; Broseta, José Jesús; Garrote, Marta ...
Kidney international,
January 2022, 2022-Jan, 2022-01-00, 20220101, Letnik:
101, Številka:
1
Journal Article
: Background: Simultaneous pancreas‐kidney transplantation (SPK Tx) allows dialysis and insulin therapy to be discontinued and improves the complications of diabetes mellitus type 1 (DM1). This ...study measure quality of life (QoL) in SPK transplant recipients and determine if there are differences in QoL between these patients and those with DM1 in renal replacement therapy (RRT).
Methods: Short Form Health Survey 36‐Item (SF‐36) was administered to 69 SPK transplant recipients and 34 patients with DM1 under RRT. A descriptive analysis, multiple linear regression, ANOVA, and ordinal regression (PLUM) models were constructed.
Results: QoL was higher in SPK transplant recipients than in patients receiving RRT. The best results were in the recently transplanted patients. Respect to Spanish population the men with SPK transplants scored higher on vitality and lower on general health, role limitations‐physical and role limitations‐emotional. Women with SPK transplants scored lower on general health. Among patients under RRT, men scored lower on the general health, physical functioning, vitality, and bodily pain while women scored lower on all dimensions. In both groups, greater age was associated with better mental health.
Conclusion: Positive predictive factors of QoL are SPK Tx and age while negative predictive factors are female sex and RRT.
Abstract
Background and Aims
Getting a preemptive kidney transplant has many benefits but no studies have assessed the potential deleterious effect of uremia on peritransplant complications. Uremic ...toxins interact negatively with biologic functions and may contribute to infections and bleeding or thormbosis.
Method
we evaluated 255 living-donor kidney transplant recipients (117 preemptive and 138 non-preemptive) from January 2006 to December 2015. Patients iniciated immunosuppression treatment 3 days prior to transplant. Exclusion criteria included: history of solid organ transplant, chronic immunosuppression treatment at the time of transplant (including prednisone), peritransplant rituximab/eculizumab treatment and HIV infection. An analysis of baseline characteristics and the incidence of symptomatic infection, bleeding or thrombosis during first week was performed in both groups. To analyze bleeding, the need of transfusion, drop of hematocrit in 72h and need of bladder washout was assessed.
Results
baseline characteristics are descrived in table 1. Non preemptive patients were older (50 vs 46 years) and had a higher prevalence of Diabetes Mellitus and dialypemia (22 vs 11% and 43 vs 30% respectively), without differences in the immunosupression scheme. The median eGFR in preemptive group at transplant was 12 ml/min. A more anemic profile was detected in the preemptive group with median hemoglobin of 116 vs 127 g/L in the non-preemptive group with no-differences in albumin levels. There were a total of 38 symptomatic infections (22 in the preemptive and 16 in the non-preemptive group), without statistical differences in the incidence between the groups (OR 1,75 CI 0,879-3,5, P =0,107). Hematocrit drop was greater in the non-preemptive group (8 vs 6 points in the first 72h p = 0.004) but thrombosis was more common in the preemptive group (5 vs 1, OR 6,116 CI 0,704-53,1, p = 0.062).
Conclusion
Uremia in preemptive living kidney transplant recipients does not seem to have influence on the incidence of infections in the first week after transplantation. The bleeding profile in the non-preemptive group in contrast to the prothrombotic profile in preemptive recipients needs further investigation in future studies that assess parameters of platelet and coagulation function as well as endothelial activation.
Figure
We illustrate the capacity of Artificial Intelligence (AI) and Machine Learning (ML) techniques to preserve consistent categorization abilities whenever the quality of the data decreases, displaying ...mistakes or mismatches across matrix entries, while standard statistical methods exhibit significant modifications in the value of the corresponding coefficients. We design algorithms of different complexity to generate a series of comparable profiles. These profiles are compared within environments that allow for an immediate identification of the generating algorithms and within increasingly complex settings involving almost identical profiles derived from different algorithms. AI and ML techniques outperform standard statistical methods when distinguishing the algorithms generating the profiles. Building on these results, we perform a retrospective analysis where AI and ML techniques are applied to two empirical scenarios defined by different data series of patients transplanted through the period 2006–2019. The first scenario contains the variables describing the evolution of patients inputted correctly. In the second, we modify the content of the vectors of characteristics defining the evolution of patients by exchanging the values of a subset of realizations from two categorical variables. AI and ML techniques are consistently accurate when categorizing patients correctly within both scenarios, a feature particularly relevant when the quality of the information sources composing the medical chain varies. This latter problem is exacerbated among hospitals located in developing countries, where the quality of the data gathered limits their identification and extrapolation capacities.
•Artificial Intelligence (AI) models preserve their accuracy when data quality decreases.•We analyze a data series of 643 kidney patients transplanted during the period 2006–2019.•AI models categorize patients correctly even if misprints are introduced in the data.•Statistical methods exhibit significant modifications in the corresponding coefficients.•This AI property is particularly relevant for hospitals located in developing countries.
Abstract
BACKGROUND AND AIMS
Seroconversion after a two-dose course of mRNA COVID-19 vaccination in kidney transplant recipients ranges between 30% and 50% in different series. We previously ...demonstrated that a substantial proportion of patients (35%) without a humoral response, develop a cellular response after the second dose assessed by the ELISpot technique. We aim to study the evolution of both humoral and cellular responses in the same cohort before and 1 month after the administration of the third dose of 100 mcg of mRNA-1273 COVID-19 vaccine.
METHOD
Final population included 129 KTRs studied at four time-points: at baseline before the first dose, after the second dose (median 42 days) and before (203 days) and after (232 days) the third dose. At all the time-points, IgG and IgM were assessed as well as N- and S-protein specific ELISpot. The main outcome was seroconversion after the third dose.
RESULTS
After the second dose, 26.7% of naïve cases experienced seroconversion. Before the third dose and in the absence of clinically evident COVID-19, this percentage increased to 61.9%. After the third dose, seroconversion was observed in 80.0% of patients. S-ELISpot positivity after the second dose was significantly associated with final seroconversion OR (95% CI) 3.14 (1.10–8.96); P = .032, while transplantation < 1 year and previous kidney transplant were negatively associated with OR (95% CI) 0.23 (0.07–0.80); P = .021 and OR (95% CI) 0.22 (0.06–0.78); P = .020, respectively). IgG after third dose were significantly higher (P < .001) in patients who maintained S-ELISpot positivity throughout the study (34.3%) and were correlated with S-spots after the second dose (r = 0.344, P < .001).
CONCLUSION
A substantial proportion of KTRs vaccinated with mRNA-1273 develops a late seroconversion after two doses and only a fifth remained seronegative after a third. Cellular immunity seems to play a major role in the development of a final strong humoral response.
Abstract
BACKGROUND AND AIMS
The evidence regarding the benefits of performing preemptive SPK (pSPK) is controversial. The aim of the present study was to evaluate the impact of pSPK on long-term ...patient and grafts outcomes when compared with npSPK and pKTA through a national registry study with recipients reported to the Organ Procurement and Transplantation Network/United Network for Organ Sharing (OPTN/UNOS) registry, and to analyse the potential benefits associated with pSPK not only in patients with T1D but also in patients with T2D.
METHOD
To explore the survival advantage of performing a pSPK, we compared the outcomes in pSPK with nonpreemptive SPK (npSPK) recipients between 2000 and 2017 from the OPTN/UNOS registry. To account for the potential benefit provided solely by the kidney transplant, we further compared to recipients of preemptive Kidney Transplantation Alone (pKTA) with diabetes. A propensity score analysis was applied.
RESULTS
A total of 1522 patients received a pSPK, 7894 an npSPK and 3343 a pKTA. Overall recipient survival was superior for the pSPK group when compared with the pKTA (97.7%, and 80.9% versus 97.7% and 72.9% at 1 and 10 years, respectively, P < 0.001), with pKTA being associated with an increased risk of patient death HR 1.34, 95% confidence interval (95% CI) 1.10–1.63; P = 0.003. Estimated kidney graft survival was similar in both groups. After IPTW adjustment, pKTA was significantly associated with an increased risk of death-censored kidney graft failure (HR 1.31, 95% CI 1.09–1.56; P = 0.002). The npSPK patients presented both worse patient and kidney graft survival when compared with pSPK.
CONCLUSION
In conclusion, the observed survival benefit of performing an SPK preemptively reinforces the need for early referral for transplantation in patients with insulin-dependent diabetes and advanced chronic kidney disease.
Abstract
Background
The criteria for kidney suitability in uncontrolled donors after circulatory death (uDCD) procured after regional normothermic perfusion are based on macroscopic appearance and ...renal haemodynamic values with final renal resistance (FRR). However, these criteria have not been analysed to predict the future graft function. This study presents a model to predict the outcome in uDCD kidneys and define the predictive FRR value.
Methods
All uDCD kidney transplants performed in our hospital from 2004 to 2016 were included. Donors and recipients and pre-transplantation data are described. The endpoint was glomerular filtration rate (GFR) ≥30 mL/min at 6 months after transplantation.
Results
A total of 194 recipients were included. FRR in donors ≥60 years old was (mean ± SD) 0.27 ± 0.11 versus 0.22 ± 0.09 mmHg/mL/min in donors <60 years (P = 0.042). Kidney survival was 88.2% versus 84% at 12 months and 60.7% versus 30.8% at 120 months (P = 0.067). For the group of recipients from donors ≥60 years, the FRR was 0.37 ± 0.08 mmHg/mL/min in the GFR <30 mL/min group versus 0.18 ± 0.06 mmHg/mL/min in the GFR ≥30 mL/min group (P < 0.001). The value FRR ≥0.3 mmHg/mL/min predicts 59–79% of GFR <30 mL/min odds ratio = 2.16, 95% confidence interval (CI) 1.80–6.40; P < 0.001. The predictive accuracy of FRR for GFR by ROC curve was 0.968 (95% CI). The best cut-off for FRR was 0.3 mmHg/mL/min to predict GFR at 6 months with a sensitivity of 67%, specificity of 100%, positive predictive value of 83% and negative predictive value of 92%.
Conclusions
Our results suggest that in uDCD donors the combination of donor age ≥60 years together with FRR ≥0.3 mmHg/mL/min could predict poor outcome at 6 months after transplantation in low immunological risk recipients.
PDF
