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Symptomatic atherosclerotic vascular disease and graft survival in primary kidney transplant recipients – Observational analysis of the united network of organ sharing database. Transpl Immunol 2022; 75:101734. [DOI: 10.1016/j.trim.2022.101734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
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2
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Clinical Relevance of Corticosteroid Withdrawal on Graft Histological Lesions in Low-Immunological-Risk Kidney Transplant Patients. J Clin Med 2021; 10:jcm10092005. [PMID: 34067039 PMCID: PMC8125434 DOI: 10.3390/jcm10092005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 12/14/2022] Open
Abstract
The impact of corticosteroid withdrawal on medium-term graft histological changes in kidney transplant (KT) recipients under standard immunosuppression is uncertain. As part of an open-label, multicenter, prospective, phase IV, 24-month clinical trial (ClinicalTrials.gov, NCT02284464) in low-immunological-risk KT recipients, 105 patients were randomized, after a protocol-biopsy at 3 months, to corticosteroid continuation (CSC, n = 52) or corticosteroid withdrawal (CSW, n = 53). Both groups received tacrolimus and MMF and had another protocol-biopsy at 24 months. The acute rejection rate, including subclinical inflammation (SCI), was comparable between groups (21.2 vs. 24.5%). No patients developed dnDSA. Inflammatory and chronicity scores increased from 3 to 24 months in patients with, at baseline, no inflammation (NI) or SCI, regardless of treatment. CSW patients with SCI at 3 months had a significantly increased chronicity score at 24 months. HbA1c levels were lower in CSW patients (6.4 ± 1.2 vs. 5.7 ± 0.6%; p = 0.013) at 24 months, as was systolic blood pressure (134.2 ± 14.9 vs. 125.7 ± 15.3 mmHg; p = 0.016). Allograft function was comparable between groups and no patients died or lost their graft. An increase in chronicity scores at 2-years post-transplantation was observed in low-immunological-risk KT recipients with initial NI or SCI, but CSW may accelerate chronicity changes, especially in patients with early SCI. This strategy did, however, improve the cardiovascular profiles of patients.
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3
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Lamarche C, Sharma AK, Goldberg A, Wang L, Blydt-Hansen TD. Biomarker implementation: Evaluation of the decision-making impact of CXCL10 testing in a pediatric cohort. Pediatr Transplant 2021; 25:e13908. [PMID: 33155737 DOI: 10.1111/petr.13908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 09/13/2020] [Accepted: 10/07/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Children are at high risk for subclinical rejection, and kidney biopsy is currently used for surveillance. Our objective was to test how novel rejection biomarkers such as urinary CXCL10 may influence clinical decision-making to indicate need for a biopsy. METHODS A minimum dataset for standard decision-making to indicate a biopsy was established by an expert panel and used to design clinical vignettes for use in a survey. Pediatric nephrologists were recruited to review the vignettes and A) estimate rejection risk and B) decide whether to biopsy; first without and then with urinary CXCL10/Cr level. Accuracy of biopsy decisions was then tested against the biopsy results. IRA was assessed by Fleiss Kappa (κ) for binary choice and ICC for probabilities. RESULTS Eleven pediatric nephrologists reviewed 15 vignettes each. ICC of probability assessment for rejection improved from poor (0.28, P < .01) to fair (0.48, P < .01) with addition of CXCL10/Cr data. It did not, however, improve the IRA for decision to biopsy (K = 0.48 and K = 0.43, for the comparison). Change in clinician estimated probability of rejection with additional CXCL10/Cr data was correlated with CXCL10/Cr level (r2 = 0.7756, P < .0001). Decision accuracy went from 8/15 (53.3%) cases to 11/15 (73.3%) with CXCL10/Cr, although improvement did not achieve statistical significance. Using CXCL10/Cr alone would have been accurate in 12/15 cases (80%). CONCLUSION There is high variability in decision-making on biopsy indication. Urinary CXCL10/Cr improves probability estimates for risk of rejection. Training may be needed to assist nephrologists in better integrate biomarker information into clinical decision-making.
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Affiliation(s)
- Caroline Lamarche
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Atul K Sharma
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Aviva Goldberg
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Li Wang
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Tom D Blydt-Hansen
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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4
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Abstract
Interstitial fibrosis with tubule atrophy (IF/TA) is the response to virtually any sustained kidney injury and correlates inversely with kidney function and allograft survival. IF/TA is driven by various pathways that include hypoxia, renin-angiotensin-aldosterone system, transforming growth factor (TGF)-β signaling, cellular rejection, inflammation and others. In this review we will focus on key pathways in the progress of renal fibrosis, diagnosis and therapy of allograft fibrosis. This review discusses the role and origin of myofibroblasts as matrix producing cells and therapeutic targets in renal fibrosis with a particular focus on renal allografts. We summarize current trends to use multi-omic approaches to identify new biomarkers for IF/TA detection and to predict allograft survival. Furthermore, we review current imaging strategies that might help to identify and follow-up IF/TA complementary or as alternative to invasive biopsies. We further discuss current clinical trials and therapeutic strategies to treat kidney fibrosis.Supplemental Visual Abstract; http://links.lww.com/TP/C141.
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5
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Nankivell BJ, Agrawal N, Sharma A, Taverniti A, P'Ng CH, Shingde M, Wong G, Chapman JR. The clinical and pathological significance of borderline T cell-mediated rejection. Am J Transplant 2019; 19:1452-1463. [PMID: 30501008 DOI: 10.1111/ajt.15197] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 10/28/2018] [Accepted: 11/15/2018] [Indexed: 01/25/2023]
Abstract
The pathological diagnosis of borderline rejection (BL-R) denotes possible T cell-mediated rejection (TCMR), but its clinical significance is uncertain. This single-center, cross-sectional cohort study compared the functional and histological outcomes of consecutive BL-R diagnoses (n = 146) against normal controls (n = 826) and acute TCMR (n = 55) from 551 renal transplant recipients. BL-R was associated with the following: contemporaneous renal dysfunction, acute tubular necrosis, and chronic tubular atrophy (P < .001); progressive tubular injury with fibrosis by longitudinal sequential histology (45.3% at 1 year); increased subsequent acute rejection (39.4%), allograft failure (P < .001), and patient mortality (P = .007). BL-R detected by biopsy indicated for impaired function was followed by suboptimal functional recovery (46.3%), persistent inflammation (27.2%), and acute rejection episodes (50.0%) despite antirejection treatment in 83.3%. By 1 year after BL-R, the incidence of new-onset microvascular inflammation (9.3%), C4d staining (22.3%), transplant glomerulopathy (13.3%), and de novo donor-specific antibodies (31.5%) exceeded normal controls (P < .05-.001). BL-R inflammation in protocol biopsy persisted in 28.0% and progressed to acute rejection in 32.6%; however, it resolved in 61.6% of the untreated cases. In summary, BL-R is a heterogeneous diagnostic grouping, ranging from mild inconsequential inflammation to clinically significant TCMR, which is capable of immune-mediated tubular injury resulting in inferior functional, immunological, and histological consequences.
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Affiliation(s)
| | - Nidhi Agrawal
- Department of Renal Medicine, Westmead Hospital, Sydney, Australia
| | - Ankit Sharma
- Department of Renal Medicine, Westmead Hospital, Sydney, Australia.,School of Public Health, University of Sydney, Sydney, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Sydney, Australia
| | - Anne Taverniti
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, Australia
| | - Chow H P'Ng
- Tissue Pathology and Diagnostic Oncology, ICPMR, Sydney, Australia
| | - Meena Shingde
- Tissue Pathology and Diagnostic Oncology, ICPMR, Sydney, Australia
| | - Germaine Wong
- Department of Renal Medicine, Westmead Hospital, Sydney, Australia.,School of Public Health, University of Sydney, Sydney, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Sydney, Australia
| | - Jeremy R Chapman
- Department of Renal Medicine, Westmead Hospital, Sydney, Australia
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6
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Korth J, Widera M, Dolff S, Guberina H, Bienholz A, Brinkhoff A, Anastasiou OE, Kribben A, Dittmer U, Verheyen J, Wilde B, Witzke O. Impact of low-level BK polyomavirus viremia on intermediate-term renal allograft function. Transpl Infect Dis 2018; 20. [PMID: 29156086 DOI: 10.1111/tid.12817] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/10/2017] [Accepted: 08/13/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND BK polyomavirus (BKPyV)-associated nephropathy (PyVAN) is a significant cause of premature renal transplant failure. High-level BKPyV viremia is predictive for PyVAN; however, low-level BKPyV viremia does not necessarily exclude the presence of PyVAN. As data are limited regarding whether or not low-level BKPyV viremia has an effect on intermediate-term graft outcome, this study analyzes the impact of low-level BKPyV viremia on intermediate-term graft function and outcome compared with high-level viremia and non-viremic patients. METHODS All renal transplant patients received follow-up examinations at the Department of Nephrology, University Hospital Essen. Patients were screened for BKPyV viremia and stratified into three groups according to their maximum BKPyV load in serum (low-level viremia, high-level viremia, and no viremia). RESULTS In 142 of 213 (67%) patients, BKPyV was never detected in serum; 42 of 213 (20%) patients were found positive for low-level viremia (≤104 copies/mL); and 29 of 213 (13%) patients showed high-level viremia (>104 copies/mL). No significant differences regarding transplant function and graft failure were observed between patients without BKPyV viremia (delta estimated glomerular filtration rate [eGFR] +0.1 mL/min [month 1 vs last visit at month 44]) and patients with low-level BKPyV viremia (delta eGFR -1.7 mL/min). In patients with high-level viremia, transplant function was significantly restricted (delta eGFR -6.5 mL/min) compared with low-level viremia until the last visit at 44 ± 9.7 months after transplantation. Although the graft function and graft loss were worse in the high-level viremia group compared with no viremia (eGFR 37 vs 45 mL/min), the difference was not significant. CONCLUSIONS High-level viremia was associated with impaired graft function. In contrast, low-level BKPyV viremia had no significant impact on intermediate-term graft function.
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Affiliation(s)
- Johannes Korth
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,Institute of Virology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Marek Widera
- Institute of Virology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Sebastian Dolff
- Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Hana Guberina
- Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Anja Bienholz
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Alexandra Brinkhoff
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Olympia Evdoxia Anastasiou
- Institute of Virology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,Department of Gastroenterology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Ulf Dittmer
- Institute of Virology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Jens Verheyen
- Institute of Virology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Benjamin Wilde
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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Parajuli S, Arpali E, Astor BC, Djamali A, Aziz F, Redfield RR, Sollinger HW, Kaufman DB, Odorico J, Mandelbrot DA. Concurrent biopsies of both grafts in recipients of simultaneous pancreas and kidney demonstrate high rates of discordance for rejection as well as discordance in type of rejection - a retrospective study. Transpl Int 2017; 31:32-37. [PMID: 28672081 DOI: 10.1111/tri.13007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/11/2017] [Accepted: 06/26/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Sandesh Parajuli
- Division of Nephrology; Department of Medicine; University of Wisconsin School of Medicine and Public Health; Madison WI USA
| | - Emre Arpali
- Division of Transplant Surgery; University of Wisconsin Hospital and Clinics; Madison WI USA
| | - Brad C. Astor
- Division of Nephrology; Department of Medicine; University of Wisconsin School of Medicine and Public Health; Madison WI USA
- Department of Population Health Sciences; University of Wisconsin School of Medicine and Public Health; Madison WI USA
| | - Arjang Djamali
- Division of Nephrology; Department of Medicine; University of Wisconsin School of Medicine and Public Health; Madison WI USA
- Division of Transplant Surgery; University of Wisconsin Hospital and Clinics; Madison WI USA
| | - Fahad Aziz
- Division of Nephrology; Department of Medicine; University of Wisconsin School of Medicine and Public Health; Madison WI USA
| | - Robert R. Redfield
- Division of Transplant Surgery; University of Wisconsin Hospital and Clinics; Madison WI USA
| | - Hans W. Sollinger
- Division of Transplant Surgery; University of Wisconsin Hospital and Clinics; Madison WI USA
| | - Dixon B. Kaufman
- Division of Transplant Surgery; University of Wisconsin Hospital and Clinics; Madison WI USA
| | - Jon Odorico
- Division of Transplant Surgery; University of Wisconsin Hospital and Clinics; Madison WI USA
| | - Didier A. Mandelbrot
- Division of Nephrology; Department of Medicine; University of Wisconsin School of Medicine and Public Health; Madison WI USA
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8
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Gatault P, Kamar N, Büchler M, Colosio C, Bertrand D, Durrbach A, Albano L, Rivalan J, Le Meur Y, Essig M, Bouvier N, Legendre C, Moulin B, Heng AE, Weestel PF, Sayegh J, Charpentier B, Rostaing L, Thervet E, Lebranchu Y. Reduction of Extended-Release Tacrolimus Dose in Low-Immunological-Risk Kidney Transplant Recipients Increases Risk of Rejection and Appearance of Donor-Specific Antibodies: A Randomized Study. Am J Transplant 2017; 17:1370-1379. [PMID: 27862923 DOI: 10.1111/ajt.14109] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/05/2016] [Accepted: 10/30/2016] [Indexed: 01/25/2023]
Abstract
The aim of this study (ClinicalTrials.gov, NCT01744470) was to determine the efficacy and safety of two different doses of extended-release tacrolimus (TacER) in kidney transplant recipients (KTRs) between 4 and 12 mo after transplantation. Stable steroid-free KTRs were randomized (1:1) after 4 mo: Group A had a 50% reduction in TacER dose with a targeted TacER trough level (C0 ) >3 μg/L; group B had no change in TacER dose (TacER C0 7-12 μg/L). The primary outcome was estimated GFR at 1 year. Of 300 patients, the intent-to-treat analysis included 186 patients (group A, n = 87; group B, n = 99). TacER C0 was lower in group A than in group B at 6 mo (4.1 ± 2.7 vs. 6.7 ± 3.9 μg/L, p < 0.0001) and 12 mo (5.6 ± 2.0 vs. 7.4 ± 2.1 μg/L, p < 0.0001). Estimated GFR was similar in both groups at 12 mo (group A, 56.0 ± 17.5 mL/min per 1.73 m²; group B, 56.0 ± 22.1 mL/min per 1.73 m²). More rejection episodes occurred in group A than group B (11 vs. 3; p = 0.016). At 1 year, subclinical inflammation occurred more frequently in group A than group B (inflammation score [i] >0: 21.4% vs. 8.8%, p = 0.047; tubulitis score [t] >0: 19.6% vs. 8.7%, p = 0.076; i + t: 1.14 ± 1.21 vs. 0.72 ± 1.01, p = 0.038). Anti-HLA donor-specific antibodies appeared only in group A (6 vs. 0 patients, p = 0.008). TacER C0 should be maintained >7 μg/L during the first year after transplantation in low-immunological-risk, steroid-free KTRs receiving a moderate dose of mycophenolic acid.
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Affiliation(s)
- P Gatault
- EA4245 Dendritic Cells, Immunomodulation and Grafts, François-Rabelais University, Tours, France.,Department of Nephrology and Clinical Immunology, CHRU Tours, Tours, France
| | - N Kamar
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.,INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France.,Université Paul Sabatier, Toulouse, France
| | - M Büchler
- EA4245 Dendritic Cells, Immunomodulation and Grafts, François-Rabelais University, Tours, France.,Department of Nephrology and Clinical Immunology, CHRU Tours, Tours, France
| | - C Colosio
- Department of Kidney Transplantation, CHU Reims, Reims, France
| | - D Bertrand
- Department of Kidney Transplantation, CHU Rouen, Rouen, France
| | - A Durrbach
- Department of Kidney Transplantation, Kremlin-Bicêtre Hospital, Villejuif, France
| | - L Albano
- Department of Kidney Transplantation, CHU Nice, Nice, France
| | - J Rivalan
- Department of Kidney Transplantation, CHU Rennes, Rennes, France
| | - Y Le Meur
- Department of Kidney Transplantation, CHU Brest, Brest, France
| | - M Essig
- Department of Kidney Transplantation, CHU Limoges, Limoges, France
| | - N Bouvier
- Department of Kidney Transplantation, CHU Caen, Caen, France
| | - C Legendre
- Department of Kidney Transplantation, Necker Hospital, Paris, France.,INSERM Unité 845, Paris, France
| | - B Moulin
- Department of Kidney Transplantation, CHRU Strasbourg, Strasbourg, France
| | - A-E Heng
- Department of Kidney Transplantation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - P-F Weestel
- Department of Kidney Transplantation, CHU Amiens, Amiens, France
| | - J Sayegh
- Department of Kidney Transplantation, CHU Angers, Angers, France
| | - B Charpentier
- Department of Kidney Transplantation, Kremlin-Bicêtre Hospital, Villejuif, France
| | - L Rostaing
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.,INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France.,Université Paul Sabatier, Toulouse, France
| | - E Thervet
- Department of Kidney Transplantation, Georges-Pompidou Hospital, Paris, France
| | - Y Lebranchu
- EA4245 Dendritic Cells, Immunomodulation and Grafts, François-Rabelais University, Tours, France.,Department of Nephrology and Clinical Immunology, CHRU Tours, Tours, France
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Kidneys from Older Living Donors Provide Excellent Short and Intermediate Outcomes--A Single China Center's Experience. Transplantation 2015; 99:e81-8. [PMID: 26308304 DOI: 10.1097/tp.0000000000000580] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Transplantation with kidneys from older living donors is on the rise, yet controversy still exists over whether the outcomes are as satisfactory as with kidneys from younger donors. METHODS We retrospectively analyzed 1009 living donor kidney transplants performed at our center between 2006 and 2013. Graft and patient outcomes were compared between transplants with kidneys from old living donors (OLD, 55-65 years) (n = 264) and from young living donors (YLD, <55 years) (n = 745). RESULTS The age was 32.80 ± 9.71 years and 33.91 ± 5.98 years for recipient in YLD and OLD group, respectively. Death-censored graft survival at 1, 3, and 5 years was 98.8%, 97.1%, and 95.8% in patients receiving YLD kidneys, similar to the corresponding values of 97.6%, 95.5% and 95.5% in patients receiving OLD kidneys (P = 0.356). Patient survival at 1, 3, and 5 years after transplantation was also similar for patients receiving YLD kidneys (98.5%, 97.1%, and 96.7%) and for patients receiving OLD kidneys (99.6%, 99.6%, and 96.8%; P = 0.110). The OLD kidneys were not associated with increased risk of death-censored graft failure (hazard ratio, 2.5; 95% confidence interval, 0.57 to 11.11) and patient death (hazard ratio, 1.67; 95% confidence interval, 0.75 to 3.73). In addition, there is no increased graft loss or patient death for each 10-year increase in donor age. Transplantation with OLD kidneys was not associated with reduced patient or graft outcomes in the short term (≤ 12 months) or medium term (>1 year). CONCLUSIONS Graft and patient outcomes after living-donor kidney transplantation are similar in the short-term and medium-term for donors aged 55 to 65 years and for younger donors. Therefore, the use of OLD kidneys should be encouraged in China.
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10
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Carey BS, Jain R, Adams CL, Wong KY, Shaw S, Tse WY, Kaminski ER. Serum neopterin as an indicator of increased risk of renal allograft rejection. Transpl Immunol 2013; 28:81-5. [PMID: 23481351 DOI: 10.1016/j.trim.2013.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 02/11/2013] [Accepted: 02/12/2013] [Indexed: 12/23/2022]
Abstract
Acute rejection remains associated with poor graft outcome. An early predictor of acute renal transplant rejection is the long sought after goal for transplant immunologists. In this study we measured levels of serum neopterin at day 5 post-transplant in a cohort of 216 consecutive renal allograft recipients, and compared this with serum creatinine and acute rejection episodes during the first year post transplant. We compared serum neopterin in recipients from living donors (LD), donors after brain death (DBD) and donors after cardiac death (DCD). In all cases higher neopterin levels were correlated with acute rejection in the first year post transplant, but this was only significant in recipients of DCD kidneys who suffered acute cellular or vascular rejection (p=0.04, odds ratio 1.08, 95% CI 1.003-1.012). The neopterin/creatinine ratio, which takes into account the effect of kidney function on circulating neopterin levels, was significantly higher for all recipients who suffered biopsy proven cellular or vascular rejection in the first year post transplant, compared to all other patients (p=0.001, for an increase of 0.1, odds ratio=1.64, 95% CI 1.21-2.20). The ability to use non-invasive biomarkers in the transplant recipient has the potential to increase transplant survival for these patients.
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Affiliation(s)
- B Sean Carey
- Department of Immunology, Derriford Combined Laboratory, Derriford Hospital, Plymouth, UK
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11
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12
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Impact of Early Conversion From Tacrolimus to Sirolimus on Chronic Allograft Changes in Kidney Recipients on Rapid Steroid Withdrawal. Transplantation 2012; 93:47-53. [DOI: 10.1097/tp.0b013e3182394cb3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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13
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Iwamoto H, Hama K, Konno O, Yokoyama T, Kihara Y, Jojima Y, Nakamura Y, Takeuchi H, Shimazu M. Early Steroid Withdrawal in Adult Kidney Transplantation at a Single Center. Transplant Proc 2012; 44:179-81. [DOI: 10.1016/j.transproceed.2011.12.068] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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