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induction of immunosuppression in renal transplantation

Ratna Acharya, Krina Amin, Dhanashree Rajderkar, Matthew Washam, Nailee Pekkucuksen, Sudha Mannemuddhu, Kiran Upadhyay
Nocardia infection after RT is uncommon. The most common modes of exposure are inhalation of dust containing nocardia or contaminated soil/water and surgical instruments. Isolated abdominal nocardiosis following RT has not been reported. We report an 11-year-old female who developed nocardia abscesses of the abdomen post-RT. ESRD was secondary to FSGS and she had received multiple immunosuppressive agents prior to transplant. Induction immunosuppression consisted of thymoglobulin and maintenance was with tacrolimus, mycophenolate, and prednisone...
March 19, 2019: Pediatric Transplantation
Brett Rollins, Samira Farouk, Graciela DeBoccardo, Susan Lerner, Meenakshi Rana, Shirish Huprikar, Leandra Miko, Veronica Delaney, Sander Florman, Ron Shapiro
Rejection rates in HIV-infected kidney transplant (KTx) recipients are higher than HIV-negative recipients. Immunosuppression and highly active antiretroviral therapy (HAART) protocols vary with potentially significant drug-drug interactions, likely influencing outcomes. This is an IRB-approved, single-center, retrospective study of adult HIV infected KTx patients between 5/2009-12/2014 with three-year follow-up, excluding antibody-depleting induction. 42 patients were included; median age was 52 years, 81% male, 50% African American, 29% Hispanic, 17% Caucasian...
March 12, 2019: Clinical Transplantation
Thomas R Spitzer, Nina Tolkoff-Rubin, Benedict Cosimi, Steven McAfee, Bimalangshu R Dey, Yi-Bin Chen, Francis Delmonico, Megan Sykes, David H Sachs, Tatsuo Kawai
BACKGROUND: Specific immune tolerance of transplanted organs in association with either transient or sustained lymphohematopoietic chimerism has been demonstrated in several preclinical animal models and clinically, in patients who are full donor chimeras after hematopoietic stem cell transplantation and subsequently received kidney transplants from the same donor. Most recently, tolerance induction has been extended to patients in whom chimerism was intentionally induced at the time of kidney transplantation...
February 12, 2019: Transplantation
Osama Gheith, Medhat A Halim, Torki Al-Otaibi, Ayman El-Sayed, Prasad Nair, Tarek Mahmoud, Ahmed Fathy, Mohamed Abdul Hameed, Ahmed Samy, Nabil El Serwy, Ayman M Nagib
OBJECTIVES: The number of renal transplants in elderly patients is increasing as age per se does not constitute a contraindication to transplant. We compared renal transplant outcomes in elderly recipients versus a group of middle-aged patients. MATERIALS AND METHODS: Our retrospective casecontrolled study compared elderly transplant recipients (n = 252; > 60 y old) with a matched cohort of younger adult recipients (n = 710; between 40 and 60 years old) who underwent renal transplant at the Hamed Al-Essa Organ Transplant Center of Kuwait between 2000 and 2014...
January 2019: Experimental and Clinical Transplantation
Prasad Nair, Osama Gheith, Torki Al-Otaibi, Mohamed Mostafa, Suzann Rida, Islam Sobhy, Medhat A Halim, Tarek Mahmoud, Mohamed Abdul-Hameed, Ayman Maher, Mohamed Emam
OBJECTIVES: Data on the management of chronic antibody-mediated rejection after kidney transplantation are limited. We aimed to assess the impact of treatment of biopsy-proven chronic active antibodymediated rejection with combined plasma exchange, intravenous immunoglobulin, and rituximab treatment versus intravenous immunoglobulin alone or conservative management on the evolution of renal function in renal transplant recipients. MATERIALS AND METHODS: In this retrospective study, we compared patients diagnosed with chronic active antibody-mediated rejection who were treated with standard of care steroids, intravenous immunoglobulin, plasma exchange, and rituximab (n = 40) at our center versus those who received intravenous immunoglobulin only or just intensified maintenance immunosuppression (n = 28)...
January 2019: Experimental and Clinical Transplantation
Yoshihiro Itabashi, Atsushi Aikawa, Masaki Muramatsu, Youji Hyoudou, Kazunobu Shinoda, Yusuke Takahashi, Kei Sakurabayashi, Toshihide Mizutani, Hideyo Oguchi, Taichi Arai, Takeshi Kawamura, Yuko Hamasaki, Ken Sakai, Seiichiro Shishido
OBJECTIVES: We investigated outcomes in living-donor kidney transplant recipients with preformed donor-specific antibodies (detected with flow cytometry and specified with the LABScreen single antigen test) under desensitization pretransplant and immunosuppression posttransplant. MATERIALS AND METHODS: Of 15 recipients included, 8 had ABO-incompatible kidney transplant. Six patients had sensitization caused by pregnancy, 8 by blood transfusion, 5 by previous transplants, and 1 by unknown cause...
January 2019: Experimental and Clinical Transplantation
Quentin Raimbourg, Éric Daugas
Systemic lupus erythematosus is the most characteristic of auto-immune disorders that can lead to tissue damage in many organs, including kidney. Lupus nephritis occurs in 10 to 40% of lupus patients. Its clinical hallmark is the appearance of a proteinuria as soon as a 0.5 g/g or 0.5 g/d threshold, which calls for a renal histological evaluation in order to determine the lupus nephritis severity and the need for specific therapy. More than half of renal biopsies lead to the diagnosis of active lupus nephritis-class III or class IV A according to the ISN/RPS classification-that are the most severe in regards to renal prognosis and mortality...
February 7, 2019: Néphrologie & Thérapeutique
Elias David-Neto, Fabiana Agena, Daisa Silva Ribeiro David, Flavio Jota de Paula, Ligia Camera Pierrotti, Maria Cristina Domingues Fink, Luiz Sergio Fonseca de Azevedo
BACKGROUND: Polyoma viremia is associated with damage to renal tubular and urothelial cells. This may imply that a certain level of viremia, even cleared thereafter, could be associated with long-term renal dysfunction. METHODS: We, retrospectively, analyzed 390 first renal transplants adult recipients (≥18y) who were monitored for BK viremia in the first 12 months and evaluated estimated GFR (MDRD-4 equation) at one month and at the last follow-up (959±392 days)...
February 3, 2019: Transplant Infectious Disease: An Official Journal of the Transplantation Society
Saeideh Jamali, Abdolfatah Sarafnejad, Pedram Ahmadpoor, Mohsen Nafar, Mozhdeh Karimi, Atefeh Eteghadi, Mir Saeed Yekaninejad, Ali Akbar Amirzargar
BACKGROUND: Accumulating evidence suggests that regulatory T cells (Tregs) have a crucial role in immune tolerance and long-term graft survival. However, the influence of immunosuppressive drugs on the level of Tregs has not been fully understood. Therefore we prospectively compare the effect of two different calcineurin inhibitor (CNI)-based immunosuppression protocols on Tregs frequencies and expression of regulatory and effector T cell-related genes in renal transplant recipients. METHODS: The study included 24 renal transplant recipients who received induction therapy (Antithymocyte globulin) and were on triple immunosuppressive therapy so that one group was on Tacrolimus (Tac), mycophenolate moftile (MMF) and prednisolone (P) whereas another group was on Tac, Sirolimus (SRL) and P...
December 28, 2018: Human Immunology
Carole Philipponnet, Julien Aniort, Cyril Garrouste, Jean-Louis Kemeny, Anne-Elisabeth Heng
RATIONALE: Kidney transplantation is considered the best treatment for patients with end stage renal disease. Ischemia- reperfusion injury (IRI) is an evitable event after deceased donor transplantation and influences short term and long term graft outcome. Few data on IRI's histology in the setting of kidney transplantation are available in the literature despite its frequency and its severity. PATIENT CONCERNS: A 64-year-old patient was admitted for his 1st kidney transplantation...
December 2018: Medicine (Baltimore)
Hany M El Hennawy, Ahmed Al Hashemy, Nafaa Al Harbi, Wael T Habhab, Ahmed E Fahmy
Outcome of pediatric kidney transplantation (KT) has improved over the last several decades. We retrospectively reviewed the outcomes pediatric KT in King Faisal Specialist Hospital and Research Center-Jeddah, Saudi Arabia. Between May 2013 and November 2016, we performed renal transplantation in 47 children, 30 (64%) males, and 17 (36%) females. All patients received antibody induction with basiliximab or antithymocyte globulin along with triple immunosuppressive therapy with tacrolimus, mycophenolate mofetil and steroids...
November 2018: Saudi Journal of Kidney Diseases and Transplantation
Y Zhang, S Zhou, J M Hu, H Chen, D Liu, M Li, Y Guo, L P Fan, L Y Li, Y G Liu, M Zhao
Renal transplantation is currently the most effective treatment for end-stage kidney diseases, and acute allograft rejection is well treated with high dose prednisolone and immunosuppressive agents, but long-term use of immunosuppressants will be detrimental to the long-term survival of the transplanted kidney and will have many side effects on the human body. Thus, a local and alloantigen-specific immunological tolerance may be a promising approach to improving kidney transplantation. The aim of this study is to examine the therapeutic potential of transforming bone marrow-derived mesenchymal stem cells (BMSCs) pretreated with erythropoietin (EPO) in inducing immunosuppression in renal grafts after transplantation...
December 2018: Transplantation Proceedings
Atefeh Eteghadi, Fatemeh Pak, Pedram Ahmadpoor, Saeideh Jamali, Mozhdeh Karimi, Mir Saeed Yekaninejad, Parviz Kokhaei, Mohsen Nafar, Ali Akbar Amirzargar
Long-term use of calcineurin inhibitors (CNI) is associated with nephrotoxicity, which is an important cause of renal dysfunction. Therefore, CNI-minimization strategies which decrease the CNI nephrotoxicity under the protection of additional immunosuppressant drugs have been developed. The aim of current cohort study was to compare the effect of two immunosuppressive protocols [tacrolimus (TAC) in combination with mycophenolate mofetil (MMF) and prednisolone (PRED) versus TAC in combination with sirolimus (SRL) and prednisolone] on the frequency of T helper cell subsets (Th1, Th2 and Th17 cells) and their associated cytokine (IFN-γ, IL-4 and IL-17A) levels in renal allograft recipients...
December 17, 2018: International Immunopharmacology
Mary Helen Foster, Jeffrey Robinson Ord
Autoimmunity is a leading cause of chronic kidney disease and loss of native and transplanted kidneys. Conventional immunosuppressive therapies can be effective but are non-specific, noncurative, and risk serious side effects such as life-threatening infection and cancer. Novel therapies and targeted interventions are urgently needed. In this brief review we explore diverse strategies currently in development and under consideration to interrupt underlying disease mechanisms in immune-mediated renal injury...
December 14, 2018: Human Vaccines & Immunotherapeutics
Alexandra Kreps, Karen Paltoo, Isabel McFarlane
Background: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease with a wide range of clinical features and variable clinical course. SLE tends to affect women during childbearing years and is characterized by multi-organ involvement. Cardiac complications in SLE, which have been described to occur in about 50% of the cases, contributes to significant morbidity and mortality in this population. We describe a patient with SLE and established lupus nephritis who subsequently developed cardiac manifestations including valvular abnormalities, arrythmia and end stage heart failure...
2018: American journal of medical case reports
Marilena Gregorini, Vincenzo Sepe, Francesca Eleonora Pattonieri, Anna Allesina, Teresa Rampino
BACKGROUND: Post-transplant diabetes mellitus (PTDM) is an emerging problem in kidney transplantation, representing an important risk factor for kidney function loss. Diabetic nephropathy (DN) occurrence in transplanted kidneys is poorly investigated. Current knowledge describes DN recurrence in graft 5.9 years from kidney transplantation however there is little data about PTDM and DN. Here, we report a clinical case peculiar for an early appearance of advanced glomerular diabetic lesions, after kidney transplantation...
December 7, 2018: BMC Nephrology
Nashila AbdulRahim, Lee Anderson, Suman Kotla, Hao Liu, Venkatesh K Ariyamuthu, Mythili Ghanta, Malcolm MacConmara, Shannan R Tujios, Arjmand Mufti, Sumit Mohan, Jorge A Marrero, Parsia A Vagefi, Bekir Tanriover
The number of simultaneous liver kidney transplant (SLKT) and the concomitant use of induction therapy have increased over the last decade. However, there is little data comparing outcomes amongst induction agents in the context of maintenance immunosuppression regimen consisting of tacrolimus and mycophenolic acid (TAC/MPA). We queried the OPTN registry for SLKT recipients maintained on TAC/MPA at discharge in the U.S. between 2002 and 2016. The cohort was divided into three groups based on induction type: r-ATG (N=831), IL2RA (N=1,558), and no-induction (N=2,333)...
December 2, 2018: Liver Transplantation
Evaldo Favi, Carmelo Puliatti, Samuele Iesari, Andrea Monaco, Mariano Ferraresso, Roberto Cacciola
Background: Standard-criteria donation after circulatory death (DCD) kidney transplants (KTx) have higher primary nonfunction, delayed graft function (DGF), and rejection rates than age-matched donation after brain death (DBD) but similar graft survival. Data on expanded-criteria DCD are conflicting and many centers remain concerned regarding their use. Methods: In this single-center observational study with 5-year follow-up, we analyzed data from 112 primary DCD Maastricht category-III single KTx receiving similar organ preservation and maintenance immunosuppression...
October 2018: Transplantation Direct
C I Tsao, M Ting, N K Chou, N-H Chi, Y-S Chen, S-C Huang, C-Y Tsan, C-H Wang, H-Y Yu, C T Shun, S-S Wang
Renal function after heart transplantation (HTx) typically follows a biphasic pattern and an initial decay within 1 to 2 years. Trajectory of renal function after HTx is less reported, especially in Asia. The aims of this cohort study were to describe the changes in HTx recipients' serum creatinine and estimated glomerular filtration rate (eGFR) levels 5 years following HTx in Taiwan. METHODS: We retrospectively reviewed 5 years of 440 consecutive adult patients (≥ 18 years) who underwent first HTx from June 1987 to December 2014 at the National Taiwan University Hospital...
November 2018: Transplantation Proceedings
O Konno, T Yokoyama, Y Kihara, Y Nakamura, T Ueno, H Takeuchi, H Iwamoto
BACKGROUND: Extended-release tacrolimus (TacER), administered once daily, offers improved adherence with reduced side effects while still maintaining an immunosuppressive potency equivalent to that of conventional tacrolimus preparations. METHODS: The study included 83 patients who received consecutive living-donor kidney transplants at our facility from June 2013 to December 2016. Comparisons were made between 48 cases of induction with TacER and 35 cases of induction with cyclosporine (CyA)...
October 2018: Transplantation Proceedings
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