Chronic kidney diseases are a major worldwide societal burden. In the United States, where the prevalence of chronic kidney disease is approximately 14%,
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close to 1 million persons have end-stage ...renal disease (ESRD). Of those affected, 700,000 (70.8%) are treated with dialysis, and the remaining 300,000 (29.2%) with kidney transplantation (i.e., 56 cases per 1 million population).
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Currently, just over 100,000 U.S. patients with ESRD are on the waiting list for a kidney transplant, but every year, only 15 to 16% will receive a kidney transplant, and of those kidneys, 32 to 34% are from live donors.
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Annual U.S. expenditures . . .
This study evaluated 7-year efficacy and safety outcomes in transplant recipients assigned to a more-intensive or less-intensive belatacept regimen or cyclosporine for immunosuppression. Both ...belatacept regimens were associated with significantly superior patient and graft survival.
The use of prolonged maintenance immunosuppressive therapy after kidney transplantation has improved the short-term outcomes,
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but the effect on long-term allograft survival is not known.
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Prospective, phase 3, randomized studies examining the outcomes of immunosuppressive regimens beyond 5 years or showing a survival advantage of newer immunosuppressive regimens over that afforded by regimens containing the calcineurin inhibitor cyclosporine are lacking.
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Belatacept is a selective costimulation blocker that has been developed to improve long-term outcomes in kidney-transplant recipients by providing effective immunosuppression without the toxic effects of calcineurin inhibitors.
Current standard-of-care immunosuppressive regimens combine calcineurin inhibitors with antiproliferative drugs, with . . .
Hepatitis E virus may cause chronic infection in certain patients, such as those who are immunocompromised. In this report from France involving 59 solid-organ transplant recipients with persistent ...HEV viremia, ribavirin was associated with HEV clearance in 78% of patients.
Hepatitis E virus (HEV) genotype 3 causes self-limiting infection in nonimmunocompromised patients.
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However, it can lead to chronic hepatitis and cirrhosis in patients who have received solid-organ transplants,
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patients with human immunodeficiency virus infection,
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and patients with hematologic cancers who are receiving chemotherapy.
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In a large cohort of solid-organ transplant recipients, HEV infection evolved to chronic infection in approximately 66% of the patients and to cirrhosis in 10%.
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Furthermore, several HEV-induced extrahepatic manifestations (e.g., neurologic symptoms and kidney injuries) have been reported in transplant recipients who are infected with HEV.
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To date, there is no established therapy for . . .
Antibody mediated rejection (ABMR) is the leading cause of immune-related allograft failure following kidney transplantation. Chronic active ABMR (CABMR) typically occurs after one-year ...post-transplant and is the most common cause of late allograft failure. This study was designed to assess common practices in Europe for post-transplant surveillance 1 year after kidney transplant, as well as the diagnosis and management of CABMR. A 15-minute online survey with 58 multiple choice or open-ended questions was completed by EU transplant nephrologists, transplant surgeons and nephrologists. Survey topics included patient caseloads, post-transplant routine screening and treatment of CABMR. The results indicated that observing clinical measures of graft function form the cornerstone of post-transplant surveillance. This may be suboptimal, leading to late diagnoses and untreatable disease. Indeed, less than half of patients who develop CABMR receive treatment beyond optimization of immune suppression. This is attributable to not only late diagnoses, but also a lack of proven efficacious therapies. Intravenous Immunoglobulin (IVIG), steroid pulse and apheresis are prescribed by the majority to treat CABMR. While biologics can feature as part of treatment, there is no single agent that is being used by more than half of physicians.
Lionel Rostaing and Paolo Malvezzi discuss the clinical implications of Laurence Fardet and colleagues' accompanying research study on infectious complications in patients receiving steroid treatment.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Interest in hepatitis E virus (HEV) infection has increased over the last few years since chronic HEV infection was first reported in transplant patients. Chronic genotype-3 HEV infections have been ...now reported in patients with a solid-organ transplant, hematology disease, and in those who are human immunodeficiency virus-positive. Cases of HEV-related cirrhosis have been also reported. Furthermore, HEV associated extrahepatic manifestations, including neurologic symptoms, kidney injuries, and hematological disorders, have been reported. Antiviral therapies, such as pegylated-interferon and ribavirin, have been found to be efficient in treating HEV infection. The aim of this review is to summarize the incidence, natural history, risk factors, and treatment of HEV infections in immunosuppressed patients. HEV-induced extrahepatic manifestations are described.
Although cold ischemia time has been widely studied in renal transplantation area, there is no consensus on its precise relationship with the transplantation outcomes. To study this, we sampled data ...from 3839 adult recipients of a first heart-beating deceased donor kidney transplanted between 2000 and 2011 within the French observational multicentric prospective DIVAT cohort. A Cox model was used to assess the relationship between cold ischemia time and death-censored graft survival or patient survival by using piecewise log-linear function. There was a significant proportional increase in the risk of graft failure for each additional hour of cold ischemia time (hazard ratio, 1.013). As an example, a patient who received a kidney with a cold ischemia time of 30h presented a risk of graft failure near 40% higher than a patient with a cold ischemia time of 6h. Moreover, we found that the risk of death also proportionally increased for each additional hour of cold ischemia time (hazard ratio, 1.018). Thus, every additional hour of cold ischemia time must be taken into account in order to increase graft and patient survival. These findings are of practical clinical interest, as cold ischemia time is among one of the main modifiable pre-transplantation risk factors that can be minimized by improved management of the peri-transplantation period.
Atypical hemolytic uremic syndrome (aHUS) is a rare complement-mediated kidney disease that was first recognized in children but also affects adults. This study assessed the disease presentation and ...outcome in a nationwide cohort of patients with aHUS according to the age at onset and the underlying complement abnormalities.
A total of 214 patients with aHUS were enrolled between 2000 and 2008 and screened for mutations in the six susceptibility factors for aHUS and for anti-factor H antibodies.
Onset of aHUS occurred as frequently during adulthood (58.4%) as during childhood (41.6%). The percentages of patients who developed the disease were 23%, 40%, 70%, and 98% by age 2, 18, 40, and 60 years, respectively. Mortality was higher in children than in adults (6.7% versus 0.8% at 1 year) (P=0.02), but progression to ESRD after the first aHUS episode was more frequent in adults (46% versus 16%; P<0.001). Sixty-one percent of patients had mutations in their complement genes. The renal outcome was not significantly different in adults regardless of genetic background. Only membrane cofactor protein (MCP) and undetermined aHUS were less severe in children than adults. The frequency of relapse after 1 year was 92% in children with MCP-associated HUS and approximately 30% in all other subgroups.
Mortality rate was higher in children than adults with aHUS, but renal prognosis was worse in adults than children. In children, the prognosis strongly depends on the genetic background.
This study demonstrates that switching from calcineurin inhibitors to sirolimus had an antitumoral effect in kidney-transplant recipients with cutaneous squamous-cell carcinomas and may have ...implications concerning immunosuppressive treatment of such patients.
Skin cancers affect more than half of organ-transplant recipients during their long-term course.
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Several studies have shown that after a first cutaneous squamous-cell carcinoma, multiple subsequent skin cancers develop in 60 to 80% of kidney-transplant recipients within 3 years.
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Transplant recipients share common risk factors with the nonimmunosuppressed population,
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but the specific tumor burden of such patients is linked to the immunosuppressive medications used.
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A decrease in cutaneous carcinogenesis after the reduction of immunosuppression has been reported.
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Consequently, changes in immunosuppression are frequently made in patients with skin cancer, although there is currently no consensus on the level . . .
In this prospective study, we assessed biomarkers of inflammation (IL-6 and SAA) from the serum of 120 COVID-19 patients, of whom 70 had chronic kidney disease. All the samples were taken at ...emergency-department (ED) admission. Our goal was to relate the biomarkers to the results of death and acute kidney injury. All the patients underwent chest computer tomography to estimate the severity score (0-5), which was performed at hospital admission. Finally, biomarkers were also evaluated in a healthy control group and in non-COVID-19-CKD patients. IL-6 and SAA were statistically different between the subgroups, i.e., they were significantly increased in patients with COVID-19. Both of the biomarkers (IL-6 and SAA) were independently associated with mortality, AKI and a higher grade of pathological changes in the lung's parenchyma. Both high baseline levels of IL-6 and SAA on hospital admission were highly correlated with a later ventilatory requirement and mortality, independent of hospital stay. Mortality was found to be significantly higher when the chest CT severity score was 3-4, compared with a severity score of 0-2 (
< 0.0001). Conclusions: at the admission stage, IL-6 and SAA are useful markers for COVID-19 patients with CKD.
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