Clinical Outcomes of Kidney Transplantation in Patients With Biopsy-Proven Glomerulonephritis

Background

The clinical outcomes after kidney transplantation (KT) according to the types of glomerulonephritis (GN) as the cause of end-stage renal disease (ESRD) are various, but there are not many studies on this.

Clinical Outcomes in Kidney Transplantation Patients From Deceased Donors With Acute Kidney Injury

Background

This single-center study sought to examine the clinical outcomes of kidney transplant recipients from donors displaying acute kidney injury (AKI).

Methods

We analyzed retrospectively the medical records of the donors and recipients of 54 deceased-donor kidney transplantations performed in our center between March 2009 and March 2012.

Results

Among the 54 deceased donors, 36 (66.7%) experienced AKI as determined by the final mean serum creatinine levels measured before graft harvest of 2.66 ± 1.62 mg/dL versus 0.82 ± 0.28 mg/dL among non-AKI donors. The risks of delayed graft function and slow graft function were increased among the AKI versus non-AKI groups in the early post-transplantation period. However, the renal function status of recipients at 3, 6, and 12 months after transplantation was not significantly different between the two groups. Moreover, rejection-free survival rates during the study period were similar. Multivariate analysis revealed an acute rejection episodes (P = .047) and a lower body mass index in the donor relative to the recipient (P = .011) to be independent risk factors predicting poor graft function defined as a 1-year estimated glomerular filtration rate less than 50 mL/min/l.73 m². Donor AKI with either a high level (>4.0 mg/dL), an increasing trend of creatinine, or greater severity by the Risk, Injury, Failure, Loss, and End-stage kidney disease (RIFLE) classification was not a significant risk factor.

Conclusion

Transplantation of kidneys from the AKI donors, namely, patients with severely decreased renal function, displayed excellent short-term outcomes. Accordingly, kidney transplantations from deceased donors with AKI should be considered more actively to expand the donor pool in Korea.     

Vitamin D Concentration in Patients After Heart and Kidney Transplantation

Background

One of the main actions of vitamin D is bone mineralization regulation. Vitamin D is linked also to hypertension, diabetes, and cardiovascular disease. Vitamin D deficiency may result in osteomalacia, but its excess may result in bone calcium mobilization. Kidney transplant recipients are also at risk of hypovitaminosis D because of impaired graft function. The aim of the study was to assess vitamin D concentration in patients after heart and kidney transplantation.

Outcomes Associated With COVID-19 Hospitalization in Heart Transplantation Patients

BackgroundHeart transplantation (HT) recipients infected with COVID-19 may be at an increased risk of severe illness due to chronic immunosuppression.Materials and MethodsAdult HT patients hospitalized with COVID-19 at the Cleveland Clinic between March 2020 and March 2021 were included in this retrospective cohort analysis. Twenty-four HT cases were matched to 96 non-HT controls, similarly hospitalized with COVID-19, out of 11,481 patients based on different baseline characteristics. Primary outcome was all-cause mortality; secondary outcomes included mechanical ventilation, intensive care unit admission, vasopressor need, dialysis, pneumonia, and 90-day readmission. Subgroup analysis was performed based on the time from transplantation (within 1 year of transplantation and greater than 1 year since transplantation).ResultsBoth primary and secondary outcomes were not significant. Subgroup analysis did not show a significant difference in mortality (P = .355) or 30-day readmission (P = .841) between patients who were within 1 year of transplantation and remote transplantation beyond 1 year. Univariable analysis of immunosuppressant continuation, dose-reduction, or discontinuation did not significantly affect HT mortality.ConclusionsDespite limited sample size, our results suggest that HT patients do not show worse outcomes after acquiring COVID-19, whether in the first year of transplantation or after a remote transplantation procedure. Future studies with multicenter data that incorporate the subsequent COVID-19 variants (eg, Delta and Omicron), the impact of long COVID-19, and assessing full vs reduced immunosuppression regimens would add insights to this patient population.     

Kidney Transplantation Outcomes in Canadian Aboriginals

Aboriginal populations experience a very high rate of end-stage renal disease (ESRD); however, little is known about the outcomes of transplantation in this population. We performed a retrospective database review to determine the short- and long-term outcomes of kidney transplantation in Aboriginals. Adult Aboriginal (AB) and Caucasian (C) individuals receiving primary kidney transplants between 1969 and 2003 in Manitoba, Canada were examined. A total of 705 recipients were included (126 AB and 579 C). AB recipients were younger, had different etiologies of ESRD, longer cold-ischemic times for deceased donor transplants, and higher peak panel reactive antibody levels. At 1 year post-transplant, there was no difference in serum creatinine, acute rejection or graft survival between AB and C recipients. However, AB recipients experienced greater weight gains early post-transplant and were more likely to develop post-transplant diabetes mellitus. AB recipients exhibited inferior 10-year graft (AB 26% vs. C 47%, p < 0.01) and patient survival (AB 50% vs. 75%, p < 0.01). When graft survival was censored for death with a functioning graft, there was no difference between the two groups. Multivariate analysis revealed AB race to be an independent predictor of premature graft failure and patient death. In conclusion, kidney transplant outcomes have historically been inferior in the Manitoba population of Canadian Aboriginals.     

Paired Analysis of Outcomes After Kidney Transplantation in Peritoneal and Hemodialysis Patients

Background

The impact of dialysis modality before kidney transplantation (hemodialysis or peritoneal dialysis) on outcomes is not clear. In this study we retrospectively analyzed the impact of dialysis modality on posttransplant follow-up.

Outcomes After Kidney Transplantation of Patients Previously Diagnosed With Atrial Fibrillation

Little is known about the prevalence and outcomes of patients with atrial fibrillation/flutter (AF) who receive a kidney transplant. We identified all patients who had >1 year of uninterrupted Medicare A+B coverage before receiving their first kidney transplant (1997–2009). The presence of pretransplant AF was ascertained from diagnosis codes in Medicare physician claims. We studied the posttransplant outcomes of death, all‐cause graft failure, death‐censored graft failure and stroke using multivariable Cox regression. Of 62 706 eligible first kidney transplant recipients studied, 3794 (6.4%) were diagnosed with AF prior to kidney transplant. Over a mean follow up of 4.9 years, 40.6% of AF patients and 24.9% without AF died. All‐cause and death‐censored graft failure were 46.8% and 16.5%, respectively, in the AF group and 36.4% and 19.5%, respectively, in those without AF. Ischemic stroke occurred in 2.8% of patients with and 1.6% of patients without AF. In patients with AF, multivariable‐adjusted hazard ratios (95% confidence intervals) for death, graft failure, death‐censored graft failure and ischemic stroke were 1.46 (1.38–1.54), 1.41 (1.34–1.48), 1.26 (1.15–1.37) and 1.36 (1.10–1.68), respectively. Pre‐existing AF is associated with poor posttransplant outcomes. Special attention should be paid to AF in pretransplant evaluation, counseling and risk stratification of kidney transplant candidates.     

Outcomes of Kidney Transplantation Recipients With Hepatitis in the Antiviral Therapy Era: A Single-Center Experience

Introduction

The use of organs from hepatitis B surface antigen (HBsAg)+ donors could increase the donor pool substantially. However, fulminant hepatic failure requiring urgent liver transplantation or resulting in death has been reported in recipients of HBsAg+ renal transplantation (KT) in pre-nucleos(t)ide analog (NA) era. With effective antiviral therapies such as NAs, it seems feasible to transplant such recipients more safely. To address this issue, we conducted a retrospective, cohort study to evaluate the safety and long-term risks of HBsAg+ KT recipients in the NA era.

Methods

From December 2006 to January 2013, 112 patients undergoing KT were followed at our institute. We analyzed patient and graft outcomes, hepatitis status (HBsAg status, hepatitis B virus [HBV] DNA level, liver function tests, presence of hepatitis C virus [HCV] co-infection), and graft source (domestic or transplant tourism).

Results

Ninety-two KT recipients were still alive. Nine patients were died of nonhepatic factors. Among 112 patients, there were 19 of 92 recipients alive who were HBsAg+, including 6 patients with HBV and HCV dual infections. Two of 19 patients experienced symptomatic hepatitis, one de novo and the other re-activation. Liver functions of these 2 recipients recovered progressively after introduction of NAs. No recipients in our study had experienced graft loss at the time of analysis.

Conclusion

In terms of patient survival and quality of life, KT seems be a safe and feasible therapy of choice for HBsAg+ patients with end-stage renal disease. Infection is easier to prevent than to treat. KT recipients at high risk for HBV reactivation and for complications of HBV, with or without HCV co-infection, may benefit from longer prophylaxis. However, the optimal duration of prophylaxis remains unclear. Furthermore, several issues needed to be solved for clinical concerns, such as frequency and intensity of adverse effects, high costs, increased pill burden, drug–drug interactions, and the emergence of viral resistance variants.     

Predicting Coronary Heart Disease after Kidney Transplantation: Patient Outcomes in Renal Transplantation (PORT) Study

Traditional risk factors do not adequately explain coronary heart disease (CHD) risk after kidney transplantation. We used a large, multicenter database to compare traditional and nontraditional CHD risk factors, and to develop risk‐prediction equations for kidney transplant patients in standard clinical practice. We retrospectively assessed risk factors for CHD (acute myocardial infarction, coronary artery revascularization or sudden death) in 23 575 adult kidney transplant patients from 14 transplant centers worldwide. The CHD cumulative incidence was 3.1%, 5.2% and 7.6%, at 1, 3 and 5 years posttransplant, respectively. In separate Cox proportional hazards analyses of CHD in the first posttransplant year (predicted at time of transplant), and predicted within 3 years after a clinic visit occurring in posttransplant years 1–5, important risk factors included pretransplant diabetes, new onset posttransplant diabetes, prior pre‐ and posttransplant cardiovascular disease events, estimated glomerular filtration rate, delayed graft function, acute rejection, age, sex, race and duration of pretransplant end‐stage kidney disease. The risk‐prediction equations performed well, with the time‐dependent c‐statistic greater than 0.75. Traditional risk factors (e.g. hypertension, dyslipidemia and cigarette smoking) added little additional predictive value. Thus, transplant‐related risk factors, particularly those linked to graft function, explain much of the variation in CHD after kidney transplantation.     

Heart Transplantation in Patients 70 Years of Age and Older: Initial Experience

Background. Heart transplantation has become a highly successful therapeutic option for patients with end-stage cardiomyopathy. Consequently, the criteria for patient selection, particularly regarding recipients' upper age limits, have been expanded, with an increasing number of people older than 60 years of age now undergoing transplantation.

Methods. A retrospective analysis of 6 patients 70 years of age and older who underwent heart transplantation was done; their clinical courses and outcomes were compared with those of younger patients, with a special emphasis on their posttransplantation quality of life.

Results. All 6 patients are alive and clinically well at a mean follow-up of 12 months. No age-related complications have been observed, and their quality of life is excellent. There has been a very low incidence of rejection, as well as few episodes of rejection.

Conclusions. Heart transplantation in selected people 70 years of age and older can be performed successfully with a morbidity comparable to that seen in younger patients and excellent short-term survival. This initial experience is encouraging, but further studies and long-term follow-up are needed to validate the more routine application of this therapy.     

Alexithymia in Kidney Transplantation Patients

Alexithymia is a marked difficulty in recognizing, exploring, and expressing inner feelings. Studies have proven the presence of a significant proportion of patients with alexithymia in samples from the transplantation population. This study aims to analyze the presence of alexithymia in a sample of 32 kidney transplantation patients from a deceased donor and to compare this construct with the presence of psychological symptoms and the physical and mental state of health perceived by the patients. Alexithymia assessment was analyzed using the Toronto Alexithymia Scale. The psychological symptoms were studied through the Symptom Checklist-90-R. The quality of life was studied through The Complete Form Health Survey. The study showed a high percentage of the presence of alexithymia in the examined transplant recipients. The construct is more present where the perception of their quality of life is low and where there is a greater presence of psychosomatic symptoms.     

Equal 3-Year Outcomes for Kidney Transplantation Alone in HCV-Positive Patients With Cirrhosis

Kidney transplantation alone in clinically compensated patients with cirrhosis is not well documented. Current guidelines list cirrhosis as a contraindication for kidney transplantation alone. This is an Institutional Review Board–approved retrospective study. We report our experience with a retrospective comparison between transplants in hepatitis C virus–positive (HCV⁺) patients without cirrhosis and HCV⁺ patients with cirrhosis. All of the patients were followed for at least a full 3-year period. All of the deaths and graft losses were recorded and analyzed using Kaplan-Meier methodology. One- and three-year cumulative patient survival rates for noncirrhotic patients were 91% and 82%, respectively. For cirrhotic patients, one- and three-year cumulative patient survival rates were 100% and 83%, respectively (P = NS). One- and three-year cumulative graft survival rates censored for death were 94% and 81%, and 95% and 82% for the noncirrhosis and cirrhosis groups, respectively (P = NS). Comparable patient and allograft survival rates were observed when standard kidney allograft recipients were analyzed separately. This study is the longest follow-up document in the literature showing that HCV⁺ clinically ompensated patients with cirrhosis may undergo kidney transplantation alone as a safe and viable practice.Key words: Kidney, Transplantation, Cirrhotic patients, SafetyHepatitis C virus (HCV) affects 200 million people.¹ Approximately 85% of people with HCV will develop chronic infection; of those, 10% to 30% will develop cirrhosis. The prevalence of HCV within the dialysis population is as high as 13%.² HCV is a negative prognostic indicator for survival on dialysis and after kidney transplantation. There is an increased risk of death among long-term hemodialysis patients infected with HCV.³ Importantly, overall survival in these patients is improved after kidney transplantation compared with dialysis.⁴ Liver biopsies are indicated in all HCV-positive candidates considered for kidney transplantation. Up to 12% of asymptomatic patients will have cirrhosis. Those with cirrhosis (while on dialysis) have a 35% higher death rate than their counterparts without cirrhosis.⁵Established cirrhosis is an important predictor of death after renal transplantation and is considered a relative contraindication to isolated renal transplantation. American Association for Study of Liver Disease (AASLD) guidelines recommend end-stage renal disease patients with cirrhosis be evaluated for dual-organ transplantation. The core curriculum in nephrology and the Kidney Disease: Improving Global Outcomes (KDIGO) initiative consider HCV-related cirrhosis a contraindication to kidney transplantation alone (KTA).^6,7 Some authors consider cirrhosis a relative contraindication for KTA because the prospect of survival for graft and patient is dismal.⁸The use of KTA in asymptomatic patients with cirrhosis has not been extensively studied. Reports often exclude patients with cirrhosis,⁹ are limited by small numbers, or combine clinically compensated patients with cirrhosis with those who have only mild fibrosis.¹⁰ The United Network for Organ Sharing (UNOS) database does not track biopsy results, so registry data cannot be mined.We performed 18 KTAs on clinically compensated patients with cirrhosis (CCCs) and compared the results to those from a control group of HCV-positive KTA recipients without cirrhosis. We surmised that the results would be equivalent between groups.