Archive for the ‘Renal Transplantation’ Category

November 28, 2013

Outcomes of Simultaneous Liver and Kidney Transplantation in Relation to a High Level of Preformed Donor-Specific Antibodies


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Liver transplants rarely experience antibody-mediated rejection, and it has been suggested that a liver transplant can protect the kidney if a simultaneous transplant is performed. In this single-center study, patients who received a simultaneous liver-kidney transplant had a higher risk of acute rejection, but similar renal function and patient and graft survival, whether or not […]

No Comments Posted in Liver Transplantation, Renal Transplantation
November 28, 2013

Cardiovascular Death in Kidney Recipients Treated With Renin-Angiotensin System Blockers


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ACE-I inhibitors and ARBs are first-line treatment for patients with glomerular renal diseases, such as diabetes mellitus. Their role in transplantation is not as clear-cut, since the major renal histologic changes are primarily interstitial and vascular. Randomized controlled trials have not found a benefit in renal graft survival with RAS blockade but two small RCTs […]

No Comments Posted in Renal Transplantation
November 28, 2013

Class II HLA Epitope Matching—A Strategy to Minimize De Novo Donor-Specific Antibody Development and Improve Outcomes


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Although testing for HLA antibodies is long-established practice in transplantation, the immune system actually makes antibodies against specific epitopes, not antigens. This study used the HLA Matchmaker program to assess whether the degree of epitope mismatching predicted the development of post-transplant class II donor-specific antibodies. Thresholds for epitope mismatching at DR and DQ were found. […]

No Comments Posted in Renal Transplantation, Uncategorized
November 28, 2013

Planned Randomized Conversion From Tacrolimus to Sirolimus-Based Immunosuppressive Regimen in De Novo Kidney Transplant Recipients


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While sirolimus has some features that make it an attractive immunosuppressant, it is less effective at preventing acute rejection than calcineurin inhibitors (CnI). An alternate strategy is to use CnI early post-transplant and then switch to sirolimus at some point post-transplant. In this randomized controlled trial, patients with good graft function and no other contraindications […]

No Comments Posted in Renal Transplantation
October 25, 2013

Microarray Diagnosis of Antibody-Mediated Rejection in Kidney Transplant Biopsies: An International Prospective Study (INTERCOM)


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Although considered the gold standard, histologic examination of renal transplant biopsies, expert pathologists frequently disagree on their interpretation of the same sample. The authors of this paper have developed criteria for antibody-mediated rejection based on mRNA expression in biopsy samples detected by microarrays. In this study, they validate their previous findings in a cohort of […]

No Comments Posted in Renal Transplantation
October 25, 2013

Immunosuppression Regimen and the Risk of Acute Rejection in HIV-Infected Kidney Transplant Recipients

Renal transplantation for carefully selected HIV-positive patients has become well-accepted over the last decade. There remain concerns about the risk of overimmunosuppression in this group, due to their pre-existing immunodeficiency due to HIV infection. In this US registry study, HIV-positive patients actually had a higher risk of acute rejection than HIV-negative recipients, but this increased […]

No Comments Posted in Liver Transplantation, Renal Transplantation
October 25, 2013

The European Renal Best Practice (ERBP) Transplantation guideline development group


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These guidelines provide a perspective on appropriate assessment for transplant of both donors and recipients. A detailed, structured plan was followed regarding literature review and grading of the evidence. While the recommendations reflect current knowledge, they also show the areas where expert opinion must be used, and more research is needed.

No Comments Posted in Renal Transplantation
October 11, 2013

Complement-binding anti-HLA antibodies and kidney-allograft survival


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The study by Loupy et. al. shows an important role for complement-fixing (C1Q+) donor-specific HLA antibodies (DSA) in risk prediction of kidney allograft loss. The study examined 1016 kidney transplant recipients transplanted across negative T- and B-cell cytotoxic crossmatches with subsequent testing by Luminex single antigen beads for the detection of complement-fixing as well as […]

No Comments Posted in Renal Transplantation
September 26, 2013

Acute Cellular and Antibody-Mediated Rejection of the Pancreas Allograft: Incidence, Risk Factors and Outcomes

Antibody-mediated pancreas transplant rejection is a relatively recently recognized entity. In this retrospective study, the rate of antibody-mediated rejection post-pancreas transplant was similar to that of acute cellular rejection. Class I DSA were more predictive of antibody-mediated rejection than class II DSA. Antibody-mediated rejection should be considered in all patients with pancreas graft dysfunction post-transplant.

No Comments Posted in Pancreas Transplantation, Renal Transplantation
September 26, 2013

Improving Outcomes of Renal Transplant Recipients With Behavioral Adherence Contracts: A Randomized Controlled Trial


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Non-adherence is a well-recognized cause of poor outcomes post-transplant, but effective interventions to address this problem have been rare. In this randomized controlled trial, patients who were at least one year post-transplant and developed an adherence contract with a pharmacist had better medication adherence, as measured by prescription refills. The rate of hospitalizations was also […]

No Comments Posted in Renal Transplantation, Uncategorized