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JOURNAL ARTICLE
Mohan Shenoy, Rachel Lennon, Nick Plant, Dean Wallace, Amrit Kaur
BACKGROUND: Children with non-genetic steroid-resistant nephrotic syndrome (SRNS) are at high risk of disease recurrence (DR) and graft loss following renal transplant (RT). Although pre-emptive plasma exchange (PE) and rituximab have been suggested to prevent DR, there is insufficient published data to support this practice. The aim is to study the role of pre-emptive PE and rituximab in the prevention of DR in children with non-genetic SRNS undergoing living donor (LD) RT. METHODS: Prospective single-centre study of four consecutive children (age 6-17 years) with non-genetic SRNS (including two with previous graft loss due to DR) who underwent LD RT between July 2014 and September 2016...
June 2020: Pediatric Nephrology
#2
JOURNAL ARTICLE
Aureliusz Kolonko, Natalia Słabiak-Błaż, Henryk Karkoszka, Andrzej Więcek, Grzegorz Piecha
Proteasome inhibitor bortezomib has been used in the treatment of refractory cases of acute and chronic antibody-mediated rejection (AMR) in kidney transplant recipients. However, its efficacy and safety as a primary treatment for early AMR has been scarcely investigated. We herein present our preliminary experience with bortezomib- and plasmapheresis-based primary treatment for early AMR. Thirteen patients transplanted between October 2015 and September 2019 were treated (starting at median 19th post-transplant day) with bortezomib/plasmapheresis protocol for early biopsy-proven AMR...
February 15, 2020: Journal of Clinical Medicine
#3
REVIEW
Tsukasa Nakamura, Takayuki Shirouzu, Katsuya Nakata, Norio Yoshimura, Hidetaka Ushigome
Organ transplantation has progressed with the comprehension of the major histocompatibility complex (MHC). It is true that the outcome of organ transplantation largely relies on how well rejection is managed. It is no exaggeration to say that to be well acquainted with MHC is a shortcut to control rejection. In human beings, MHC is generally recognized as human leukocyte antigens (HLA). Under the current circumstances, the number of alleles is still increasing, but the function is not completely understood...
September 13, 2019: International Journal of Molecular Sciences
#4
Giovanni Gambaro, Alessandro Naticchia, Pietro Manuel Ferraro, Gionata Spagnoletti, Jacopo Romagnoli, Maria Paola Salerno, Franco Citterio
INTRODUCTION: Dent's disease is a rare X-linked recessive disorder that manifests in childhood or early adulthood and can lead to end-stage renal disease (ESRD). It occurs in males, who are hemizygous. In patients who develop ESRD, a deceased donor kidney transplant cures the disease. Females are obligate carriers of the mutated gene, and some show a mild Dent's disease phenotype. There may be reason for concern when considering a female obligate carrier (i.e., the mother) for kidney donation because of the risk of kidney function deterioration...
2019: Kidney & Blood Pressure Research
#5
JOURNAL ARTICLE
D Argiolas, E Carta, G Mascia, M B Michittu, G B Piredda
BACKGROUND: Recurrence of focal segmental glomerulosclerosis (FSGS) in renal allograft recipients after first transplant occurs in the second graft in virtually all patients. There is little evidence regarding optimal treatment. CASE PRESENTATION: A 55-year-old man with primary FSGS and disease recurrence in both the first and the second kidney grafts is presented. In 1999, the patient developed FSGS 3 years after transplant, which was treated with plasmapheresis and cyclophosphamide...
2019: Transplantation Proceedings
#6
JOURNAL ARTICLE
M Lee Sanders, Melissa Swee, Mony Fraer, Sarat Kuppachi, Patrick Ten Eyck, Prerna Rastogi
AIMS: BK polyomavirus nephropathy (BKPyVN) is an important cause of allograft failure after renal transplantation. Despite early screening for the virus, allograft loss from BKPyVN is still experienced in up to 14% of all renal transplant recipients. The aim of this study was to investigate the association between BKPyVN histopathologic disease severity and allograft outcome at our center. METHODS: Kidney transplant recipients who had undergone transplantation between 2002 and 2014 with biopsy proven BKPyVN were eligible for this retrospective study...
October 2019: Annals of Diagnostic Pathology
#7
JOURNAL ARTICLE
Ping Li, Dongrui Cheng, Jiqiu Wen, Xuefeng Ni, Xue Li, Kenan Xie, Jinsong Chen
Objectives: To investigate the immunohistochemical features of different stages of BK virus allograft nephropathy (BKVN) and further elucidate the underlying immunological mechanism involved in the evolution of BKVN. Methods: Fifty-two renal transplant recipients with biopsy proven BKVN were retrospectively selected. According to the third edition of the American Society of Transplantation Infection guidelines, 10 patients were categorized as having mild BKVN (stage A), 25 were moderate (stage B) and 17 were severe (stage C)...
November 2019: Renal Failure
#8
JOURNAL ARTICLE
Jeong-Hoon Lim, Jang-Hee Cho, Hee-Yeon Jung, Ji-Young Choi, Sun-Hee Park, Yong-Lim Kim, Hyung-Kee Kim, Seung Huh, Eun Sang Yoo, Dong-Il Won, Chan-Duck Kim
INTRODUCTION: HLA-incompatible (HLAi) and ABO-incompatible (ABOi) kidney transplantation (KT) has been on the increase over the last decade. However, there are wide variations in outcomes from these procedures. In this study we evaluated the graft and patient outcomes in incompatible KT and non-sensitized KT. METHODS: Patients who underwent KT between January 2012 and April 2018 were enrolled and reviewed. We divided kidney transplant recipients (KTRs) into five groups as follows: HLAi (n = 50); ABOi (n = 65); HLAi+ABOi (n = 5); control (n = 428); and living-donor control (LD control, n = 218)...
2019: PloS One
#9
REVIEW
Georg A Böhmig, Farsad Eskandary, Konstantin Doberer, Philip F Halloran
Late antibody-mediated rejection (ABMR) is a cardinal cause of kidney allograft failure, manifesting as a continuous and, in contrast with early rejection, often clinically silent alloimmune process. While significant progress has been made towards an improved understanding of its molecular mechanisms and the definition of diagnostic criteria, there is still no approved effective treatment. In recent small randomized controlled trials, therapeutic strategies with promising results in observational studies, such as proteasome inhibitor bortezomib, anti-C5 antibody eculizumab, or high dose intravenous immunoglobulin plus rituximab, had no significant impact in late and/or chronic ABMR...
August 2019: Transplant International
#10
JOURNAL ARTICLE
Audrey Uffing, Luis G Hidalgo, Ciaran McMullan, Jacqueline Perry, Edgar L Milford, Naoka Murakami, Melissa Y Yeung, Indira Guleria, Isabelle G Wood, Enver Akalin, Jamil Azzi, Anil K Chandraker, Leonardo V Riella
Background: Many kidney transplant centers in the United States report both HLA class I and II antibodies detected by sensitive solid-phase assays (SPAs) to United Network for Organ Sharing as unacceptable antigens, significantly reducing the compatible donor organ pool and prolonging waiting time for highly sensitized patients. However, the clinical relevance of all detected donor-specific antibodies (DSAs) by SPA is not unequivocal, because fluorescence intensity does not always accurately reflect antibody pathogenicity...
May 2019: Transplantation Direct
#11
JOURNAL ARTICLE
Laura A Michielsen, Bram W Wisse, Elena G Kamburova, Marianne C Verhaar, Irma Joosten, Wil A Allebes, Arnold van der Meer, Luuk B Hilbrands, Marije C Baas, Eric Spierings, Cornelis E Hack, Franka E van Reekum, Michiel L Bots, Adriaan C A D Drop, Loes Plaisier, Marc A J Seelen, Jan-Stephan F Sanders, Bouke G Hepkema, Annechien J Lambeck, Laura B Bungener, Caroline Roozendaal, Marcel G J Tilanus, Christien E Voorter, Lotte Wieten, Elizabeth M van Duijnhoven, Mariëlle Gelens, Maarten H L Christiaans, Frans J van Ittersum, Shaikh A Nurmohamed, Neubury M Lardy, Wendy Swelsen, Karlijn A van der Pant, Neelke C van der Weerd, Ineke J M Ten Berge, Frederike J Bemelman, Andries Hoitsma, Paul J M van der Boog, Johan W de Fijter, Michiel G H Betjes, Sebastiaan Heidt, Dave L Roelen, Frans H Claas, Henderikus G Otten, Arjan D van Zuilen
BACKGROUND: Pre-transplant donor-specific anti-human leucocyte antigen (HLA) antibodies (DSAs) are associated with impaired kidney graft survival while the clinical relevance of non-donor-specific anti-HLA antibodies (nDSAs) is more controversial. The aim of the present paired kidney graft study was to compare the clinical relevance of DSAs and nDSAs. METHODS: To eliminate donor and era-dependent factors, a post hoc paired kidney graft analysis was performed as part of a Dutch multicentre study evaluating all transplantations between 1995 and 2005 with available pre-transplant serum samples...
June 1, 2019: Nephrology, Dialysis, Transplantation
#12
JOURNAL ARTICLE
Jesmar Buttigieg, Hatem Ali, Ajay Sharma, Ahmed Halawa
The presence of pre-formed donor-specific antibodies (DSAs) in kidney transplantation is associated with worse overall outcomes compared with DSA-negative transplantation. A positive complement-dependant cytotoxic crossmatch presents a high immunological risk, while a negative flow cytometry crossmatch is at the lower end of the risk spectrum. Yet, the presence of low-level DSA detected by Luminex alone, that is, positive Luminex and negative flow (PLNF) cytometry crossmatch lacks robust scientific exploration...
November 1, 2019: Nephrology, Dialysis, Transplantation
#13
JOURNAL ARTICLE
Tina Dalianis, Britt-Marie Eriksson, Marie Felldin, Vanda Friman, Anna-Lena Hammarin, Maria Herthelius, Per Ljungman, Johan Mölne, Lars Wennberg, Lisa Swartling
BK-virus (BKV) associated nephropathy (BKVAN) and BKV associated haemorrhagic cystitis (HC) are complications of BKV infection/reactivation in renal and allogeneic haematopoietic stem cell transplantation (HSCT) patients, respectively. The task of how to manage these diseases was given to the chair by the Swedish Reference Group for Antiviral Therapy (RAV). After individual contributions by members of the working group, consensus discussions were held in a meeting on 23 January 2018 arranged by RAV. Thereafter, the recommendations were published in Swedish on November 2018...
July 2019: Infectious Diseases
#14
JOURNAL ARTICLE
Juhan Lee, Borae G Park, Hyang Sook Jeong, Youn Hee Park, Sinyoung Kim, Beom Seok Kim, Hye Jin Kim, Kyu Ha Huh, Hyeon Joo Jeong, Yu Seun Kim
RATIONALE: Human leukocyte antigen (HLA) is the major immunologic barrier in kidney transplantation (KT). Various desensitization protocols to overcome the HLA barrier have increased the opportunity for transplantation in sensitized patients. In addition, technological advances in solid-phase assays have permitted more comprehensive assessment of donor-specific antibodies. Although various desensitization therapies and immunologic techniques have been developed, the final transplantation decision is still based on the classic complement-dependent cytotoxicity (CDC) crossmatch (XM) technique...
September 2017: Medicine (Baltimore)
#15
REVIEW
Paolo Malvezzi, Thomas Jouve, Johan Noble, Lionel Rostaing
The number of kidney transplant candidates is increasing sharply. Among them, at least 20% are HLA sensitized. For these patients, in the setting of both living- and deceased-donor kidney transplant, we may face donor-specific alloantibodies at pretransplant. In such cases, the microlymphocytotoxicity crossmatch may or may not be positive. Kidney transplant with donor-specific antibodies at pretransplant is known as HLA-incompatible transplant. At present, we can use many methods to ensure that the kidney transplant is successful, provided that the recipient is desensitized before or after transplant...
August 2018: Experimental and Clinical Transplantation
#16
JOURNAL ARTICLE
Gastón J Piñeiro, Erika De Sousa-Amorim, Manel Solé, José Ríos, Miguel Lozano, Frederic Cofán, Pedro Ventura-Aguiar, David Cucchiari, Ignacio Revuelta, Joan Cid, Eduard Palou, Josep M Campistol, Federico Oppenheimer, Jordi Rovira, Fritz Diekmann
BACKGROUND: Chronic active antibody-mediated rejection (c-aABMR) is an important cause of allograft failure and graft loss in long-term kidney transplants. METHODS: To determine the efficacy and safety of combined therapy with rituximab, plasma exchange (PE) and intravenous immunoglobulins (IVIG), a cohort of patients with transplant glomerulopathy (TG) that met criteria of active cABMR, according to BANFF'17 classification, was identified. RESULTS: We identified 62 patients with active c-aABMR and TG (cg ≥ 1)...
October 11, 2018: BMC Nephrology
#17
JOURNAL ARTICLE
R A Montgomery, A Loupy, D L Segev
Despite the success of desensitization protocols, antibody-mediated rejection (AMR) remains a significant contributor to renal allograft failure in patients with donor-specific antibodies. Plasmapheresis and high-dose intravenous immunoglobulin have proved to be effective treatments to prevent and treat AMR, but irreversible injury in the form of transplant glomerulopathy can commonly manifest months to years later. There is an unmet need to improve the outcomes for patients at risk for AMR. Updated Banff criteria now take into account the increasing understanding of the complex and heterogeneous nature of AMR phenotypes, including the timing of rejection, subclinical and chronic AMR, C4d-negative AMR, and antibody-mediated vascular rejection...
January 2018: American Journal of Transplantation
#18
JOURNAL ARTICLE
Christos Chatzikyrkou, Jenny Eichler, Annika Karch, Christian Clajus, Florian Gunnar Scurt, Wolf Ramackers, Frank Lehner, Jan Menne, Hermann Haller, Peter R Mertens, Mario Schiffer
BACKGROUND: The efficacy and safety of renin angiotensin aldosterone system blockers (RAASB's) if introduced immediately after renal transplantation have not been extensively investigated. METHODS: The medical charts of 142 kidney transplant recipients who received a RAASB in the early postoperative period and of 114 matched controls were analyzed. The RAASB was given primarily for blood pressure control. RESULTS: 117 patients continued to receive and 50 controls remained continuously free of the RAASB in the first year...
February 2017: Blood Pressure
#19
JOURNAL ARTICLE
Akinori Miyazono, Yasuhiro Okamoto, Hironobu Nagasako, Yuko Hamasaki, Seiichiro Shishido, Takako Yoshioka, Yoshifumi Kawano
Posttransplantation lymphoproliferative disorder (PTLD) is associated with significant mortality in kidney transplant recipients. PTLD cases associated with poor prognostic factors that are refractory to reduction of immunosuppression generally require chemotherapy and immunotherapy. We present a patient with PTLD who achieved complete remission after reduction of immunosuppression alone despite having a poor prognosis. A boy with a mutation in the WT1 gene developed bilateral Wilms tumor at 15 months and received a kidney transplant at the age of 4 years...
September 2016: American Journal of Kidney Diseases
#20
COMPARATIVE STUDY
Rishi Pruthi, Mark McClure, Anna Casula, Paul J Roderick, Damian Fogarty, Mark Harber, Rommel Ravanan
Glomerulonephritis (GN) is the primary diagnosis in 20% to 40% of patients receiving a renal transplant. Here we studied patient survival and graft outcomes in patients with GN transplanted in the UK. UK Renal Registry data were used to analyze patient survival and graft failure in incident transplant patients between 1997 to 2009 who had a diagnosis of primary GN, in comparison to patients transplanted with adult polycystic kidney disease (APKD) or diabetes. Multivariable regression analysis adjusted for age, sex, donor type, ethnicity, donor age, time on dialysis, human leukocyte antigen mismatch, cold ischemic time, and graft failure (for patient survival)...
April 2016: Kidney International
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