1
|
Lin IH, Chen YC, Duong TV, Nien SW, Tseng IH, Wu YM, Wang HH, Chiang YJ, Chiang CY, Chiu CH, Wang MH, Yang NC, Wong TC. Changes in Dietary Nutrient Intake and Estimated Glomerular Filtration Rate over a 5-Year Period in Renal Transplant Recipients. Nutrients 2023; 16:148. [PMID: 38201977 PMCID: PMC10780404 DOI: 10.3390/nu16010148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/18/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
The scarcity of dietary guidance for renal transplant recipients (RTRs) raises concerns regarding obesity and associated comorbidities, including impaired renal function. This two-stage cross-sectional study examined longitudinal changes in dietary nutrient intake in the same individuals over a 5-year interval. This study involved two stages: T1 (September 2016 to June 2018) and T2 (July 2022 to August 2023). The average duration between the two data collection stages was 6.17 ± 0.42 (range 5.20-6.87) years. The study included 227 RTRs with an average age and time since transplant of 49.97 ± 12.39 and 9.22 ± 7.91 years, respectively. Of the 35 patients who participated in both phases, fewer than half met the recommended intakes for energy, dietary fiber, and most vitamins and minerals, as set in the Dietary Reference Intakes (DRIs) or by the Dietitian Association Australia (DAA). Over half exceeded the DRI recommended intake for total protein, and more than 80% of the protein consumed per kilogram of body weight exceeded the DAA's recommendations. In the T2 stage, the RTRs had a significantly higher blood urea nitrogen level, lower albumin level, and estimated glomerular filtration rate. These findings indicate that deteriorating dietary intake in RTRs can adversely affect their nutritional status and transplanted kidney function over a 5-year period.
Collapse
Affiliation(s)
- I-Hsin Lin
- Department of Medical Nutrition Therapy, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (I.-H.L.); (S.-W.N.); (I.-H.T.); (Y.-M.W.)
| | - Yi-Chun Chen
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei 110, Taiwan; (Y.-C.C.); (T.V.D.)
| | - Tuyen Van Duong
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei 110, Taiwan; (Y.-C.C.); (T.V.D.)
| | - Shih-Wei Nien
- Department of Medical Nutrition Therapy, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (I.-H.L.); (S.-W.N.); (I.-H.T.); (Y.-M.W.)
| | - I-Hsin Tseng
- Department of Medical Nutrition Therapy, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (I.-H.L.); (S.-W.N.); (I.-H.T.); (Y.-M.W.)
| | - Yi-Ming Wu
- Department of Medical Nutrition Therapy, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (I.-H.L.); (S.-W.N.); (I.-H.T.); (Y.-M.W.)
| | - Hsu-Han Wang
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (H.-H.W.); (Y.-J.C.)
- Department of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Yang-Jen Chiang
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (H.-H.W.); (Y.-J.C.)
- Department of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chia-Yu Chiang
- Department of Business Administration, College of Management, National Changhua University of Education, Changhua 500, Taiwan;
| | - Chia-Hui Chiu
- Center for General Education, Taipei Medical University, Taipei 110, Taiwan; (C.-H.C.); (M.-H.W.)
| | - Ming-Hsu Wang
- Center for General Education, Taipei Medical University, Taipei 110, Taiwan; (C.-H.C.); (M.-H.W.)
| | - Nien-Chieh Yang
- Department of Nutrition and Health Sciences, Chinese Culture University, Taipei 111, Taiwan;
| | - Te-Chih Wong
- Department of Nutrition and Health Sciences, Chinese Culture University, Taipei 111, Taiwan;
| |
Collapse
|
2
|
Kang ZY, Liu C, Liu W, Li D. Association between blood transfusion after kidney transplantation and risk for the development of de novo HLA donor-specific antibodies and poor clinical outcomes: A single-center retrospective study. Transpl Immunol 2023; 81:101930. [PMID: 37730183 DOI: 10.1016/j.trim.2023.101930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/14/2023] [Accepted: 09/16/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Blood transfusion after kidney transplantation may increase the risk of sensitization and development of de novo human leukocyte antigen (HLA) donor-specific antibodies (DSAs). This study aimed to evaluate whether blood transfusion during the first year after kidney transplantation influences the development of de novo DSAs and clinical outcomes of kidney transplantation recipients. METHODS This retrospective cohort study included nonsensitized first-time kidney transplantation recipients at Tianjin First Central Hospital from 2010 to 2022. The incidence of de novo DSA development and clinical outcomes between the groups were compared. Luminex single antigen beads were used to monitor DSAs. RESULTS Of the 538 non-HLA-sensitized kidney transplantation recipients included in the study, 164 patients who received at least one unit of leukoreduced red blood cell transfusion within the first year (the transfused group), whereas the remaining 374 patients received no blood transfusion (the non-transfused group). Our analysis showed that there was a significant difference in the development of de novo DSAs and de novo anti-class I HLA-Ab between the two groups. Indeed, the transfused recipients had a higher serum creatinine and lower estimated glomerular filtration rate (eGFR) at 1-, 6-, and 12-month (all p > 0.05) after transplantation. Futhermore, a higher incidence of CMV infection, antibody-mediated rejection (AMR), hyper acute rejection (HAR), and delayed graft function (DGF) was identified in the transfused group (all p < 0.05). The graft survival was lower in the transfused group compared with patients in the non-transfused group (P = 0.002). Blood transfusion post-transplantation was a risk factor for de novo DSAs development but not an independent predictive factor for AMR and graft loss (odds ratio = 2.064 [1.243-3.429], p = 0.005). CONCLUSIONS Our study showed that blood transfusion after transplantation is associated with the occurrence of de novo DSAs increasing an immunological risk for poor clinical outcomes for kidney transplantation recipients.
Collapse
Affiliation(s)
- Zhong-Yu Kang
- Department of Blood Transfusion, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, Nankai, China
| | - Chun Liu
- Department of Blood Transfusion, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, Nankai, China
| | - Wei Liu
- Department of Blood Transfusion, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, Nankai, China
| | - Daihong Li
- Department of Blood Transfusion, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, Nankai, China.
| |
Collapse
|
3
|
Malyszko J, Basak G, Batko K, Capasso G, Capasso A, Drozd-Sokolowska J, Krzanowska K, Kulicki P, Matuszkiewicz-Rowinska J, Soler MJ, Sprangers B, Malyszko J. Haematological disorders following kidney transplantation. Nephrol Dial Transplant 2020; 37:409-420. [PMID: 33150431 DOI: 10.1093/ndt/gfaa219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Indexed: 01/19/2023] Open
Abstract
Transplantation offers cure for some haematological cancers, end-stage organ failure, but at the cost of long-term complications. Renal transplantation is the best-known kidney replacement therapy and it can prolong end-stage renal disease patient lives for decades. However, patients after renal transplantation are at a higher risk of developing different complications connected not only with surgical procedure but also with immunosuppressive treatment, chronic kidney disease progression and rejection processes. Various blood disorders can develop in post-transplant patients ranging from relatively benign anaemia through cytopenias to therapy-related myelodysplasia and acute myeloid leukaemia (AML) and post-transplant lymphoproliferative disorders followed by a rare and fatal condition of thrombotic microangiopathy and haemophagocytic syndrome. So far literature mainly focused on the post-transplant lymphoproliferative disease. In this review, a variety of haematological problems after transplantation ranging from rare disorders such as myelodysplasia and AML to relatively common conditions such as anaemia and iron deficiency are presented with up-to-date diagnosis and management.
Collapse
Affiliation(s)
| | - Grzegorz Basak
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Batko
- Department of Nephrology, Collegium Medicum, Jagiellonian University, Cracow, Poland
| | - Giavambatista Capasso
- Department of Translational Medical Sciences, University Luigi Vanvitelli, Naples, Italy
| | - Anna Capasso
- Department of Oncology, Livestrong Cancer Institutes, Dell Medical School, The University of Texas, Austin, TX, USA
| | - Joanna Drozd-Sokolowska
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Krzanowska
- Department of Nephrology, Collegium Medicum, Jagiellonian University, Cracow, Poland
| | - Pawel Kulicki
- Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | - Maria Jose Soler
- Department of Nephrology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ben Sprangers
- Department of Microbiology, Immunology, and Transplantation, Laboratory of Molecular Immunology, Rega Institute, Katholieke Universiteit Leuven, Belgium.,Division of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Jacek Malyszko
- 1st Department of Nephrology and Transplantology, Medical University of Bialystok, Bialystok, Poland
| |
Collapse
|
4
|
Gafter-Gvili A, Gafter U. Posttransplantation Anemia in Kidney Transplant Recipients. Acta Haematol 2019; 142:37-43. [PMID: 30970356 DOI: 10.1159/000496140] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 12/11/2018] [Indexed: 11/19/2022]
Abstract
Posttransplantation anemia (PTA) is common among kidney transplant patients. Early PTA is usually defined as anemia which develops up to 6 months after transplantation, and late PTA is defined as anemia which develops after 6 months. There are multiple causes, with iron deficiency being the major contributor. The occurrence of late PTA has been associated with impaired graft function. Early PTA has been shown to be a predictor of late PTA. PTA is associated with reduced mortality, reduced graft survival, and a decline in GFR. The association with mortality is related to the severity of the anemia and to specific causes of anemia. Treatment of PTA should probably begin as soon as possible after kidney transplantation. The optimal target hemoglobin level in kidney transplant recipients with anemia is higher than recommended in chronic kidney disease and should probably be up to 12.5-13 g/dL. In order to achieve this target, appropriate treatment with erythropoiesis-stimulating agents (ESA) and iron is indicated.
Collapse
Affiliation(s)
- Anat Gafter-Gvili
- Department of Medicine A, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel,
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel,
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,
| | - Uzi Gafter
- Nephrology and Transplantation Immunology Laboratory, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
5
|
Gafter-Gvili A, Ayalon-Dangur I, Cooper L, Shochat T, Rahamimov R, Gafter U, Mor E, Grossman A. Posttransplantation anemia in kidney transplant recipients: A retrospective cohort study. Medicine (Baltimore) 2017; 96:e7735. [PMID: 28796058 PMCID: PMC5556224 DOI: 10.1097/md.0000000000007735] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
We sought to assess the frequency and predictors of early and late posttransplantation anemia (PTA). In addition, we aimed to assess the outcomes of patients with anemia and to assess the impact of anemia on mortality, graft function, and graft failure.Patients who underwent kidney transplantation in a single center during a 4-year period were included. Predictors associated with the development of anemia at 6 months (early PTA) or 2 years (late PTA) were evaluated in a univariate and multivariate analyses. The effects of anemia and other variables on mortality and graft function were assessed.A total of 266 kidney transplant recipients were included. The prevalence of PTA at 6 months (early PTA) was 51.3% and at 2 years (late PTA) was 36.6%. Female sex was significantly associated with early PTA. Patients with early PTA proceeded to late PTA. Patients with both early and late PTA had a higher mortality rate at 4 years compared to patients without anemia. On multivariable analysis, lower Hb at 2 years posttransplantation (hazard ratio [HR] 0.716, 95% confidence intervals [CI] 0.541-0.948, for every increment of 1 g/dL) was significantly associated with mortality. Patients with late PTA suffered a decline in eGFR compared to patients without anemia (P = .026). Furthermore, a lower Hb at 2 years posttransplantation was also associated with graft failure (HR 0.775, 95% CI 0.619-0.969, for every increment of 1 g/dL).Post-transplantation anemia is significantly associated with late mortality, with a decline in graft function and with an increased incidence of graft failure.
Collapse
Affiliation(s)
- Anat Gafter-Gvili
- Department of Medicine A, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Irit Ayalon-Dangur
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Medicine E, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
| | - Lisa Cooper
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Geriatrics, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
| | - Tzippy Shochat
- Bio-Statistical Unit, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
| | - Ruth Rahamimov
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Rabin Medical Center, Petah Tikva, Israel
| | - Uzi Gafter
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Rabin Medical Center, Petah Tikva, Israel
| | - Eytan Mor
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Transplantation, Rabin Medical Center, Beilinson Campus, Israel
| | - Alon Grossman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Medicine E, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
| |
Collapse
|
6
|
Reindl-Schwaighofer R, Oberbauer R. Blood disorders after kidney transplantation. Transplant Rev (Orlando) 2013; 28:63-75. [PMID: 24211181 DOI: 10.1016/j.trre.2013.10.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Revised: 09/21/2013] [Accepted: 10/01/2013] [Indexed: 02/07/2023]
Abstract
Post transplant anemia (PTA) is a common issue in kidney transplant recipients. Most importantly it is associated with an impaired allograft function. Other important factors associated with PTA are immunosuppressive drugs (MPA, AZA and SRL), iron deficiency, infections (Parvo B19), older donor age, rejection episodes, an increased inflammatory state, and erythropoietin hyporesponsiveness. As there are no adequately powered RCTs in the kidney transplant population on anemia treatment with ESA, we have to rely on what we know from the large RCTs in the CKD population. The recently published KDIGO guidelines do not recommend treatment with ESA if Hb is >10 g/dl. Repletion of iron stores is emphasized. Post transplant leukopenia (PTL) and thrombocytopenia (PTT) are frequent complications especially in the first six months after kidney transplantation. Myelosuppression caused by immunosuppressive agents (MPA, AZA, SRL, rATG), antimicrobial drugs (VGCV), and CMV infection is the predominant cause. There are no widely accepted guidelines on treatment strategies, but most often dose reduction or discontinuation of causative medication is done. Most clinicians tend to decrease MPA dose, but this is eventually associated with an increase in acute rejection episodes. VGCV dose reduction (preemptive treatment instead of CMV prophylaxis) may be a successful strategy. In severe cases G-CSF treatment is an important management option and seems to be safe.
Collapse
Affiliation(s)
| | - Rainer Oberbauer
- Department of Nephrology, KH Elisabethinen, Linz, Austria; Department of Nephrology, Medical University of Vienna, Vienna, Austria.
| |
Collapse
|
7
|
Bose B, Mudge DW. Interventions for post-transplant anaemia in kidney transplant recipients. Hippokratia 2012. [DOI: 10.1002/14651858.cd010113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Bhadran Bose
- Princess Alexandra Hospital; Department of Nephrology; Ipswich Road Woolloongabba QLD Australia 4102
| | - David W Mudge
- Princess Alexandra Hospital; Department of Nephrology; Ipswich Road Woolloongabba QLD Australia 4102
| |
Collapse
|
8
|
Malyszko J, Oberbauer R, Watschinger B. Anemia and erythrocytosis in patients after kidney transplantation. Transpl Int 2012; 25:1013-23. [PMID: 22716097 DOI: 10.1111/j.1432-2277.2012.01513.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Anemia is a highly prevalent disorder in recipients of renal allografts. Despite its frequent occurrence, there is still uncertainty with regard to treatment targets and treatment options. This includes questions on appropriate iron management, the choice and dosage of erythropoietin stimulating agents, criteria for the timing of treatment initiation and the targeted hemoglobin values. The review summarizes available data on recent therapeutic strategies for post transplant anemia, as well as for post transplant erythrocytosis, another hematological disorder, that has decreased in recent years.
Collapse
Affiliation(s)
- Jolanta Malyszko
- Department of Nephrology and Transplantology, Medical University, Bialystok, Poland.
| | | | | |
Collapse
|
9
|
Rozen-Zvi B, Gafter-Gvili A, Zingerman B, Levy-Drummer RS, Levy L, Mor E, Gafter U, Rahamimov R. Intravenous iron supplementation after kidney transplantation. Clin Transplant 2012; 26:608-14. [DOI: 10.1111/j.1399-0012.2012.01602.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2011] [Indexed: 11/28/2022]
Affiliation(s)
- Benaya Rozen-Zvi
- Department of Neprology and Hypertension; Rabin Medical Center; Petah Tikva; Israel
| | - Anat Gafter-Gvili
- Department of Internal Medicine E; Rabin Medical Center; Petah Tikva; Israel
| | - Boris Zingerman
- Department of Neprology and Hypertension; Rabin Medical Center; Petah Tikva; Israel
| | | | - Liora Levy
- Sackler Medical School; Tel-Aviv University; Tel-Aviv; Israel
| | - Eitan Mor
- Department of Organ Transplantation; Rabin Medical Center; Petah Tikva; Israel
| | - Uzi Gafter
- Department of Neprology and Hypertension; Rabin Medical Center; Petah Tikva; Israel
| | - Ruth Rahamimov
- Department of Neprology and Hypertension; Rabin Medical Center; Petah Tikva; Israel
| |
Collapse
|
10
|
Chadban S, Chan M, Fry K, Patwardhan A, Ryan C, Trevillian P, Westgarth F. The CARI guidelines. Nutritional management of anaemia in adult kidney transplant recipients. Nephrology (Carlton) 2012; 15 Suppl 1:S40-2. [PMID: 20591042 DOI: 10.1111/j.1440-1797.2010.01232.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
11
|
Przybylowski P, Malyszko J, Glowinska I, Malyszko J, Kozlowska S, Mysliwiec M. Prevalence of Iron Deficiency in Heart and Kidney Allograft Recipients. Transplant Proc 2011; 43:3885-7. [DOI: 10.1016/j.transproceed.2011.08.083] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Accepted: 08/31/2011] [Indexed: 11/26/2022]
|
12
|
|