Edema Associated With Everolimus de Novo.

BACKGROUND: The appearance of edema limits the use of everolimus de novo together with tacrolimus and steroids in kidney transplantation. We aimed to investigate the frequency and characteristics of patients with edema and compare them according to the type of immunosuppression. METHODS: We studied 150 kidney transplant recipients between 2015 and 2017 based on receiving everolimus de novo (group A) or mycophenolic acid derivatives (group B). RESULTS: We analyzed 50 patients in group A and 100 in group B. Follow-up was 26.2 ± 10 months. Fifty-six patients presented edema (37.3%): 54% in group A and 29% in group B (P = .003). Edema was mild in 74% of patients in group A and 57.1% in group B. The probability of edema was 10.1%, 22.4%, and 41% at 3, 6, and 12 months, respectively, in group A vs 10.1%, 20.3%, and 25.4% in group B (P = .006). Patients were treated mostly with diuretics (14.3% in group A vs 27.6% in group B) and discontinuation of calcium channel blockers (46.4% in group A vs 48.3% in group B). Improvement was 70.4% in group A vs 60.7% in group B; patient worsening was 0% in group A vs 10.7% in group B; and there was no change in 29.6% in group A vs 28.6% in group B. We did not find differences in patient or graft survival in those who presented edema, regardless of the treatment group. CONCLUSION: The use of everolimus and standard doses of tacrolimus caused edema in 54% of patients, with no impact on renal function or survival compared with mycophenolic acid derivatives. The edema was mostly of low intensity and improved in most patients.

Isoagglutinin Titers in ABO-Incompatible Kidney Transplant.

BACKGROUND: A decrease in the isoagglutinin titer <1:8 is usually required for ABO-incompatible (ABOi) transplantation and the presence of high predesensitization titers may condition future transplantation. The aim of the study was to analyze the prognosis of ABOi patients undergoing desensitization and to compare the results according to the baseline isoagglutinin titer. METHODS: ABOi patients transplanted in our center after desensitization with rituximab, apheresis (plasmapheresis, immunoadsorption with Glycosorb, or both) and immunoglobulins were studied. Survival, renal function, and complications were analyzed and the results were compared according to the presence of a baseline isoagglutinin titer higher or lower than 1:128. We analyzed 48 patients (34 male) with a mean age of 50.9 ± 11 years and a mean follow-up of 44.6 ± 30 months. Thirty-eight patients had a basal isoagglutinin titer ≤1:128 and 10 had a titer >1:128. We did not observe differences in patient survival: 96% vs 100% at 5 years (P = .64) and renal survival: 91% vs 100% at 5 years (P = .39), incidence of acute rejection: 13.2% vs 0% (P = .22), infectious complications (cytomegalovirus; 16% vs 30%, P = 0.30; Polyomavirus BK virus: 13% vs 0%, P  =  .22), or surgical (hematoma): 47% vs 60% (P = .47) between the 2 groups. A higher number of apheresis sessions was observed (4.8 ± 1.9 vs 10.9 ± 3.9; P = .001); use of both techniques (0% vs 100%, P < .001) and higher processed volume (1 ± 0.1 vs 1.4 ± 0.5; P = .049) in patients with titer >128 was observed. Creatinine and proteinuria were similar and not significant. CONCLUSIONS: Baseline isoagglutinin titer does not influence the prognosis of ABOi patients after desensitization. The number of sessions required to achieve baseline titer <1:8 is higher but does not influence the number of days of hospital admission.

Angiosarcoma Developing in an Arteriovenous Fistula after Kidney Transplantation.

After transplantation, the main concerns involve immunosuppression, the prevention and treatment of infections and graft rejection, and tumor prevention. Sometimes the complications that may appear in the arteriovenous fistula are neglected following kidney transplantation. This is the reason why we are presenting the case of an angiosarcoma developing in an arteriovenous fistula after kidney transplantation. It is a very rare case and our goal is to create an alarm so that after kidney transplantation clinicians do not lose sight of the patients' previous history.

Analysis of Ultrafiltration Failure Diagnosed at the Initiation of Peritoneal Dialysis with the Help of Peritoneal Equilibration Tests with Complete Drainage at Sixty Minutes. A Longitudinal Study.

UNLABELLED: ♦ BACKGROUND: Ultrafiltration failure (UFF) diagnosed at the initiation of peritoneal dialysis (PD) has been insufficiently characterized. In particular, few longitudinal studies have analyzed the time course of water transport in patients with this complication. ♦ OBJECTIVE: To investigate the time course of peritoneal water transport during the first year on PD in patients presenting UFF since the initiation of this therapy (study group). ♦ METHOD: Prospective, observational, single-center design. We analyzed, at baseline and after 1 year of follow-up, peritoneal water transport in 19 patients incident on PD with UFF. We used incident patients without UFF as a control group. Water transport was characterized with the help of 3.86/4.25% dextrose-based peritoneal equilibration tests (PETs) with complete drainage at 60 minutes. ♦ RESULTS: The study group revealed a disorder of water transport affecting both small-pore ultrafiltration (SPUF) (p = 0.054 vs incident without UFF) and free water transport (FWT) (p = 0.001). After 1 year of follow-up, FWT displayed a general increasing trend in the study group (mean variation 48.9 mL, 95% confidence interval [CI] 15.5, 82.2, p = 0.012), while the behavior of SPUF was less predictable (-4.8 mL, 95% CI -61.4, 71.1, p = 0.85). These changes were not observed in incident patients without UFF. Neither initial clinical characteristics, baseline PET-derived parameters, or suffering peritoneal infections during the first year predicted the time course of the capacity of UF in the study group. Recovery from incident UFF was apparently linked to improvement of SPUF. ♦ CONCLUSIONS: Patients with UFF at the start of PD suffer a disorder of peritoneal water transport affecting both FWT and SPUF. Free water transport increases systematically in these patients after 1 year of follow-up. The evolution of SPUF is less predictable, and improvement of this parameter marks reversibility of this complication.