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1.
Sci Rep ; 14(1): 20319, 2024 09 02.
Artículo en Inglés | MEDLINE | ID: mdl-39223169

RESUMEN

Severity of deceased donor kidney fibrosis impacts graft survival in deceased-donor kidney transplantation. Our aim was to identify potential miRNA biomarkers in urinary exosomes that mirror interstitial fibrosis and tubular atrophy (IFTA) severity. Among 109 urine samples from deceased donors, 34 displayed no IFTA in the zero-day biopsy (No IFTA group), while the remaining 75 deceased donor kidneys exhibited an IFTA score ≥ 1 (IFTA group). After analyzing previous reports and electronic databases, six miRNAs (miR-19, miR-21, miR-29c, miR-150, miR-200b, and miR-205) were selected as potential IFTA biomarker candidates. MiR-21, miR-29c, miR-150, and miR-205 levels were significantly higher, while miR-19 expression was significantly lower in the IFTA group. MiR-21 (AUC = 0.762; P < 0.001) and miR-29c (AUC = 0.795; P < 0.001) showed good predictive accuracy for IFTA. In the No IFTA group, the eGFR level at 1 week after transplantation was significantly higher compared to the IFTA group (41.34 mL/min/1.73m2 vs. 28.65 mL/min/1.73m2, P = 0.012). These findings signify the potential of urinary exosomal miRNAs as valuable biomarker candidates for evaluating the severity of IFTA in deceased donor kidneys before they undergo recovery.


Asunto(s)
Aloinjertos , Biomarcadores , Exosomas , Fibrosis , Trasplante de Riñón , MicroARNs , Humanos , Biomarcadores/orina , Masculino , Exosomas/metabolismo , Femenino , Trasplante de Riñón/efectos adversos , Persona de Mediana Edad , Estudios Prospectivos , MicroARNs/orina , MicroARNs/genética , Adulto , Riñón/patología , Tasa de Filtración Glomerular
2.
Int J Surg ; 2024 Aug 08.
Artículo en Inglés | MEDLINE | ID: mdl-39116448

RESUMEN

BACKGROUND: Accurate forecasting of clinical outcomes after kidney transplantation is essential for improving patient care and increasing the success rates of transplants. Our study employs advanced machine learning (ML) algorithms to identify crucial prognostic indicators for kidney transplantation. By analyzing complex datasets with ML models, we aim to enhance prediction accuracy and provide valuable insights to support clinical decision-making. MATERIALS AND METHODS: Analyzing data from 4077 KT patients (June 1990 - May 2015) at a single center, this research included 27 features encompassing recipient/donor traits and peri-transplant data. The dataset was divided into training (80%) and testing (20%) sets. Four ML models-eXtreme Gradient Boosting (XGBoost), Feedforward Neural Network, Logistic Regression, and Support Vector Machine-were trained on carefully selected features to predict the success of graft survival. Performance was assessed by precision, sensitivity, F1 score, Area Under the Receiver Operating Characteristic (AUROC), and Area Under the Precision-Recall Curve. RESULTS: XGBoost emerged as the best model, with an AUROC of 0.828, identifying key survival predictors like T-cell flow crossmatch positivity, creatinine levels two years post-transplant and human leukocyte antigen mismatch. The study also examined the prognostic importance of histological features identified by the Banff criteria for renal biopsy, emphasizing the significance of intimal arteritis, interstitial inflammation, and chronic glomerulopathy. CONCLUSION: The study developed ML models that pinpoint clinical factors crucial for KT graft survival, aiding clinicians in making informed post-transplant care decisions. Incorporating these findings with the Banff classification could improve renal pathology diagnosis and treatment, offering a data-driven approach to prioritizing pathology scores.

3.
Sci Rep ; 14(1): 15514, 2024 07 05.
Artículo en Inglés | MEDLINE | ID: mdl-38969704

RESUMEN

This study aimed to create and validate a predictive model for renal function following live kidney donation, using pre-donation factors. Accurately predicting remaining renal function post live kidney donation is currently insufficient, necessitating an effective assessment tool. A multicenter retrospective study of 2318 live kidney donors from two independent centers (May 2007-December 2019) was conducted. The primary endpoint was the reduction in eGFR to below 60 mL/min/m2 6 months post-donation. The primary endpoint was achieved in 14.4% of the training cohort and 25.8% of the validation cohort. Sex, age, BMI, hypertension, preoperative eGFR, and remnant kidney proportion (RKP) measured by computerized tomography (CT) volumetry were found significant in the univariable analysis. These variables informed a scoring system based on multivariable analysis: sex (male: 1, female: 0), age at operation (< 30: 0, 30-39: 1, 40-59: 2, ≥ 60: 3), preoperative eGFR (≥ 100: 0, 90-99: 2, 80-89: 4, < 80: 5), and RKP (≥ 52%: 0, < 52%: 1). The total score ranged from 0 to 10. The model showed good discrimination for the primary endpoint in both cohorts. The prediction model provides a useful tool for estimating post-donation renal dysfunction risk, factoring in the side of the donated kidney. It offers potential enhancement to pre-donation evaluations.


Asunto(s)
Tasa de Filtración Glomerular , Trasplante de Riñón , Riñón , Donadores Vivos , Nefrectomía , Humanos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Trasplante de Riñón/efectos adversos , Estudios Retrospectivos , Riñón/diagnóstico por imagen , Nefrectomía/efectos adversos , Factores de Riesgo , Medición de Riesgo/métodos , Pruebas de Función Renal
4.
Ann Transplant ; 29: e942763, 2024 Feb 06.
Artículo en Inglés | MEDLINE | ID: mdl-38319291

RESUMEN

BACKGROUND Simultaneous liver-kidney transplantation (SLKT) and kidney transplantation (KT) after liver transplantation (LT) provide potential treatment options for patients with end-stage liver and kidney disease. There is increasing attention being given to liver-kidney transplantation (LTKT), particularly regarding the immune-protective effects of the liver graft. This retrospective, single-center, observational study aimed to evaluate the clinical outcomes of KT in LTKT patients - either SLKT or KT after LT (KALT) - compared to KT alone (KTA). MATERIAL AND METHODS We included patients who underwent KT between January 2005 and December 2020, comprising a total of 4312 patients divided into KTA (n=4268) and LTKT (n=44) groups. The LTKT group included 11 SLKT and 33 KALT patients. To balance the difference in sample sizes between the 2 groups, we performed 3: 1 propensity score matching (PSM). RESULTS There was no significant difference in graft survival between the groups. However, the LTKT group exhibited significantly superior rejection-free survival compared to the KTA group (P.


Asunto(s)
Trasplante de Riñón , Humanos , Estudios Retrospectivos , Trasplante Homólogo , Hígado , Aloinjertos
5.
Korean J Transplant ; 37(3): 210-215, 2023 Sep 30.
Artículo en Inglés | MEDLINE | ID: mdl-37751968

RESUMEN

Performing kidney transplantations in patients with morbid obesity presents unique challenges using the conventional retroperitoneal approach. Robot-assisted kidney transplantation (RAKT) offers several advantages, such as better access to hard-to-reach areas. A 56-year-old morbidly obese woman presented with end-stage renal disease due to diabetic nephropathy. The patient had a history of obesity for over 20 years, with a peak body mass index (BMI) of 46.9 kg/m2. Before transplantation, she successfully reduced her BMI to 28.9 kg/m2, but was left with excessive skin folds. The surgery began with the removal of the sac from the incisional hernia and umbilical hernia, which was then used as the site for the GelPOINT port. The da Vinci X robot system was utilized to perform RAKT. After completing RAKT, the plastic surgery team initiated abdominal reconstruction involving panniculectomy, followed by hernial reconstruction and abdominoplasty. The patient's postoperative course was uneventful, and she was discharged on postoperative day 7. Her creatinine level was 0.69 mg/dL, and she did not experience any episodes of rejection during the 16 months following RAKT. This case report describes the successful combination of RAKT with incisional hernia reconstruction and abdominoplasty in a patient with morbid obesity.

6.
Sci Rep ; 13(1): 12560, 2023 08 02.
Artículo en Inglés | MEDLINE | ID: mdl-37532735

RESUMEN

Anti-thymocyte globulin (ATG) is currently the most widely prescribed induction regimen for preventing acute rejection after solid organ transplantation. However, the optimal dose of ATG induction regimen in Asian kidney recipients is unclear. Using the Korean Organ Transplantation Registry, we performed a retrospective cohort study of 4579 adult patients who received renal transplantation in South Korea and divided them into three groups according to the induction regimen: basiliximab group (n = 3655), low-dose ATG group (≤ 4.5 mg/kg; n = 467), and high-dose ATG group (> 4.5 mg/kg; n = 457). We applied the Toolkit for Weighting and Analysis of Nonequivalent Groups (TWANG) package to generate high-quality propensity score weights for intergroup comparisons. During four-year follow-ups, the high-dose ATG group had the highest biopsy-proven acute rejection rate (basiliximab 20.8% vs. low-dose ATG 22.4% vs. high-dose ATG 25.6%; P < 0.001). However, the rates of overall graft failure (4.0% vs. 5.0% vs. 2.6%; P < 0.001) and mortality (1.7% vs. 2.8% vs. 1.0%; P < 0.001) were the lowest in the high-dose ATG group. Our results show that high-dose ATG induction (> 4.5 mg/kg) was superior to basiliximab and low-dose ATG induction in terms of graft and patient survival in Asian patients undergoing kidney transplant.


Asunto(s)
Suero Antilinfocítico , Trasplante de Riñón , Adulto , Humanos , Basiliximab , Inmunosupresores/uso terapéutico , Trasplante de Riñón/métodos , Anticuerpos Monoclonales , Estudios Retrospectivos , Rechazo de Injerto/prevención & control , Supervivencia de Injerto , Aloinjertos
7.
Korean J Transplant ; 37(2): 135-140, 2023 Jun 30.
Artículo en Inglés | MEDLINE | ID: mdl-37435144

RESUMEN

Kaposi's sarcoma (KS) is a disease that is not widely known among the general public, but has a high prevalence among organ transplant recipients. Here, we present a rare case of intragraft KS after kidney transplantation. A 53-year-old woman who had been on hemodialysis due to diabetic nephropathy underwent deceased-donor kidney transplantation on December 7, 2021. Approximately 10 weeks after kidney transplantation, her creatinine level increased to 2.99 mg/dL. Upon examination, ureter kinking was confirmed between the ureter orifices and the transplanted kidney. As a result, percutaneous nephrostomy was performed, and a ureteral stent was inserted. During the procedure, bleeding occurred due to a renal artery branch injury, and embolization was performed immediately. Subsequently, kidney necrosis and uncontrolled fever developed, leading to graftectomy. Surgical findings revealed that the kidney parenchyma was necrotic as a whole, and lymphoproliferative lesions had formed diffusely around the iliac artery. These lesions were removed during graftectomy, and a histological examination was performed. The kidney graft and lymphoproliferative lesions were diagnosed as KS based on a histological examination. We report a rare case in which a recipient developed KS in the kidney allograft as well as in adjacent lymph nodes.

8.
PLoS One ; 18(3): e0280924, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36857393

RESUMEN

BACKGROUND: The optimal dose of anti-thymocyte globulin (ATG) as an induction regimen in Asian living-donor kidney recipients is unclear. METHODS: This is a pilot study in which 36 consecutive patients undergoing living-donor kidney transplantation were randomly assigned to receive either 4.5 mg/kg (n = 19) or 6.0 mg/kg (n = 17) of ATG; all patients had corticosteroid withdrawal within 7 days. The primary end point was a composite of biopsy-proven acute rejection, de novo donor-specific antibody formation, and graft failure. RESULTS: At 12 months post-transplant, biopsy-proven acute rejection was more common in the ATG4.5 group (21.1%) than in the ATG6.0 group (0%)(P = .048). Importantly, the rate of the composite end point was significantly higher in the ATG4.5 group (36.8% vs 0%)(P = .006). There were significant differences in neither the renal function nor adverse events between the two groups. One case of death-censored graft failure occurred in the ATG4.5 group and no mortality was observed overall. Compared with pre-transplantation, T cells, natural killer (NK) cells, and natural killer T (NKT) cells were significantly decreased in the first week post-transplantation except for B cells. Although T and NKT cells in both groups and NK cells in the ATG4.5 group had recovered to the pre-transplant levels, NK cells in the ATG6.0 group remained suppressed until six months post-transplant. CONCLUSIONS: Compared with ATG 6.0 mg/kg, ATG 4.5 mg/kg with early corticosteroid withdrawal and low dose maintenance regimen was associated with higher rates of acute rejection in non-sensitized Asian living-donor kidney recipients. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02447822.


Asunto(s)
Suero Antilinfocítico , Tacrolimus , Humanos , Proyectos Piloto , Donadores Vivos , Estudios Prospectivos , Esteroides
9.
BMC Nephrol ; 24(1): 53, 2023 03 15.
Artículo en Inglés | MEDLINE | ID: mdl-36922759

RESUMEN

BACKGROUND: Recurrent focal segmental glomerulosclerosis (FSGS) after kidney transplantation (KT) is a serious complication and a significant risk factor for graft failure. However, there is no clear evidence of the effectiveness of pre-transplant treatment using plasmapheresis (PP) or rituximab in preventing post-operative FSGS recurrence after KT. METHODS: This single-center retrospective study included 99 adult patients with biopsy-proven primary FSGS who underwent KT between 2007 and 2018. The patients were divided into the pre-treatment group (N = 53, 53.5%) and no pre-treatment group (N = 46, 46.5%). In the pre-transplant group, prophylactic PP was administered before KT in patients undergoing living donor transplantation and the day after KT in those undergoing deceased donor transplantation. RESULTS: The rate of immediate post-operative recurrence was significantly higher in the no pre-treatment group (16 [34.8%]) than in the pre-treatment group (5 [9.4%]; P = 0.002). There were three cases of graft failure due to recurrent FSGS, all of which were in the no pre-treatment group. After adjusting for possible confounding factors, age (per 10-year increase; OR = 0.61, CI, 0.42-0.90; P = 0.012) and pre-transplant treatment (vs. no pre-transplant treatment; OR = 0.17, CI, 0.05-0.54; P = 0.003) were identified as significant factors associated with FSGS recurrence. The rate of death-censored graft survival was significantly superior in the pretransplant treatment group (P = 0.042). CONCLUSION: Pre-transplant treatment with PP was associated with beneficial effects on preventing FSGS recurrence after KT.


Asunto(s)
Glomeruloesclerosis Focal y Segmentaria , Trasplante de Riñón , Adulto , Humanos , Trasplante de Riñón/efectos adversos , Glomeruloesclerosis Focal y Segmentaria/cirugía , Glomeruloesclerosis Focal y Segmentaria/etiología , Estudios Retrospectivos , Rituximab , Donadores Vivos , Plasmaféresis , Recurrencia
10.
Sci Rep ; 13(1): 49, 2023 01 02.
Artículo en Inglés | MEDLINE | ID: mdl-36593273

RESUMEN

Simultaneous deceased donor pancreas and living donor kidney transplant (SPLK) has certain advantages over conventional simultaneous pancreas-kidney transplant (SPK) and may be beneficial for overcoming the paucity of organs needed for diabetic patients requiring transplant. We compared the clinical outcomes of patients who underwent either SPK (n = 149) or SPLK (n = 46) in terms of pre- and post-transplantation variables, development of de novo DSA, occurrence of biopsy-proven acute rejection (BPAR), and graft survival rates. There were no significant differences in the baseline characteristics between the SPK and SPLK groups except for the shorter cold ischemic time of kidney grafts, shorter duration of diabetes, older age of pancreas graft-donors, and younger age of kidney graft-donors in the SPLK group. Our results showed that the death-censored pancreas graft survival rate was lower in the SPLK group. In addition, the incidence of BPAR of the pancreas graft was higher in the SPLK group. There was no significant difference in the presence of de novo DSA and the rates of kidney graft failure, kidney BPAR, and mortality. Our results show that SPLK can be considered an alternative option for SPK although higher incidences of BPAR and graft failure of pancreas after SPLK need to be overcome.


Asunto(s)
Diabetes Mellitus Tipo 1 , Diabetes Mellitus , Trasplante de Riñón , Trasplante de Páncreas , Humanos , Trasplante de Riñón/efectos adversos , Donadores Vivos , Páncreas/cirugía , Trasplante de Páncreas/efectos adversos , Diabetes Mellitus/etiología , Supervivencia de Injerto , Riñón , Diabetes Mellitus Tipo 1/etiología
11.
Biomedicines ; 10(10)2022 Sep 21.
Artículo en Inglés | MEDLINE | ID: mdl-36289608

RESUMEN

We aimed to discover and validate urinary exosomal proteins as biomarkers for antibody-mediated rejection (ABMR) after kidney transplantation. Urine and for-cause biopsy samples from kidney transplant recipients were collected and categorized into the discovery cohort (n = 36) and a validation cohort (n = 65). Exosomes were isolated by stepwise ultra-centrifugation for proteomic analysis to discover biomarker candidates for ABMR (n = 12). Of 1820 exosomal proteins in the discovery cohort, four proteins were specifically associated with ABMR: cystatin C (CST3), serum paraoxonase/arylesterase 1, retinol-binding protein 4, and lipopolysaccharide-binding protein (LBP). In the validation cohort, the level of urinary exosomal LBP was significantly higher in the ABMR group (n = 25) compared with the T-cell-mediated rejection (TCMR) group and the no major abnormality (NOMOA) group. Urinary exosomal CST3 level was significantly higher in the ABMR group compared with the control and NOMOA groups. Immunohistochemical staining showed that LBP and CST3 in the glomerulus were more abundant in the ABMR group compared with other groups. The combined prediction probability of urinary exosomal LBP and CST3 was significantly correlated with summed LBP and CST3 intensity scores in the glomerulus and peritubular capillary as well as Banff g + ptc scores. Urinary exosomal CST3 and LBP could be potent biomarkers for ABMR after kidney transplantation.

12.
Ann Surg Treat Res ; 102(1): 55-63, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-35071120

RESUMEN

PURPOSE: There are increased therapeutic usages of rituximab in kidney transplantation (KT). However, few studies have evaluated the effect of rituximab on cancer development following KT. This study aimed to evaluate the effect of rituximab on the cancer occurrence and mortality rate according to each type of cancer. METHODS: Five thousand consecutive recipients who underwent KT at our center were divided into era1 (1990-2007) and era2-rit- (2008-2018), and era2-rit+ (2008-2018) groups. The era2-rit+ group included patients who received single-dose rituximab (200-500 mg) as a desensitization treatment 1-2 weeks before KT. RESULTS: The 5-year incidence rates of malignant tumors after KT were 3.1%, 4.3%, and 3.5% in the era1, era2-rit-, and era2-rit+ group, respectively. The overall incidence rate of cancer after transplantation among the 3 study groups showed no significant difference (P = 0.340). The overall cancer-related mortality rate was 17.1% (53 of 310). Hepatocellular carcinoma (HCC) had the highest mortality rate (61.5%) and relative risk of cancer-related death (hazard ratio, 8.29; 95% confidence interval, 2.40-28.69; P = 0.001). However, we found no significant association between rituximab and the incidence of any malignancy. CONCLUSION: Our results suggest that single-dose rituximab for desensitization may not increase the risk of malignant disease or cancer-related mortality in KT recipients. HCC was associated with the highest risk of cancer-related mortality in an endemic area of HBV infection.

13.
Ann Surg Treat Res ; 101(3): 187-196, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34549042

RESUMEN

PURPOSE: Dipeptidyl peptidase-4 (DPP-4) inhibitors lower blood glucose levels and enhance the function of pancreatic ß cells. Yet, it is unknown whether posttransplant administration of DPP4 inhibitors is beneficial for pancreas transplant recipients. METHODS: We thus retrospectively analyzed the records of 312 patients who underwent pancreas transplantation between 2000 and 2018 at Asan Medical Center (Seoul, Korea) and compared the metabolic and survival outcomes according to DPP-4 inhibitor treatment. RESULTS: The patients were divided into the no DPP-4 inhibitor group (n = 165; no treatment with DPP-4 inhibitors or treated for <1 month) and the DPP-4 inhibitor group (n = 147; treated with DPP-4 inhibitors for ≥1 month). There were no significant differences in levels of glucose, hemoglobin A1c, and insulin between the 2 groups during 36 months of follow-up. However, the level of C-peptide was significantly higher in the DPP-4 inhibitor group at 1, 6, and 24 months posttransplant (all P < 0.05). Moreover, the DPP-4 inhibitor group had significantly higher rates of overall (log-rank test, P = 0.009) and death-censored (log-rank test, P = 0.036) graft survival during a 15-year follow-up. CONCLUSION: Posttransplant DPP-4 inhibitor administration may help improve the clinical outcomes including ß cell function after pancreas transplantation.

14.
PLoS One ; 16(9): e0256898, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34478461

RESUMEN

The focus of studies on kidney transplantation (KT) has largely shifted from T-cell mediated rejection (TCMR) to antibody-mediated rejection (ABMR). However, there are still cases of pure acute TCMR in histological reports, even after a long time following transplant. We thus evaluated the impact of pure TCMR on graft survival (GS) according to treatment response. We also performed molecular diagnosis using a molecular microscope diagnostic system on a separate group of 23 patients. A total of 63 patients were divided into non-responders (N = 22) and responders (N = 44). Non-response to rejection treatment was significantly associated with the following factors: glomerular filtration rate (GFR) at biopsy, ΔGFR, TCMR within one year, t score, and IF/TA score. We also found that non-responder vs. responder (OR = 3.31; P = 0.036) and lower GFR at biopsy (OR = 0.56; P = 0.026) were independent risk factors of graft failure. The responders had a significantly superior overall GS rate compared with the non-responders (P = 0.004). Molecular assessment showed a good correlation with histologic diagnosis in ABMR, but not in TCMR. Solitary TCMR was a significant risk factor of graft failure in patients who did not respond to rejection treatment.


Asunto(s)
Rechazo de Injerto/inmunología , Trasplante de Riñón , Adulto , Femenino , Humanos , Trasplante de Riñón/efectos adversos , Trasplante de Riñón/métodos , Masculino , Persona de Mediana Edad , Pronóstico , República de Corea , Estudios Retrospectivos , Factores de Riesgo
15.
J Vis Exp ; (173)2021 07 19.
Artículo en Inglés | MEDLINE | ID: mdl-34338681

RESUMEN

This paper describes robot-assisted kidney transplantation (RAKT) from a living donor. The robot is docked between the parted legs of the patient, placed in the supine Trendelenburg position. Kidney allografts are provided by a living donor. Before vascular anastomosis, the kidney allograft is prepared by inserting a double-J stent in the ureter, and the temperature for the anastomosis is lowered by wrapping it in an ice-packed gauze. A 12 mm or 8 mm port for the robotic camera and three 8 mm ports for robotic arms are placed. A peritoneal pouch is created for the kidney allograft by raising the peritoneal flaps on both sides over the psoas muscle before dissecting the iliac vessels and bladder. A 6 cm Pfannenstiel incision is made to insert the kidney into the peritoneal pouch, lateral to the right iliac vessels. After clamping the external iliac vein with Bulldogs clamps, a venotomy is performed, and the graft renal vein is anastomosed to the external iliac vein in an end-to-side continuous manner with a 6/0 polytetrafluoroethylene suture. After clamping the graft renal vein, the iliac vein is declamped. This is followed by clamping of the external iliac artery, arteriotomy, arterial anastomosis with a 6/0 polytetrafluoroethylene suture, clamping of the graft renal artery, and declamping of the external iliac artery. Reperfusion is then carried out, and ureteroneocystostomy is performed using the Lich-Gregoir technique. The peritoneum is closed at a few locations with polymer locking clips, and a closed-suction drain is placed through one of the working ports. After deflating the pneumoperitoneum, all incisions are closed.


Asunto(s)
Trasplante de Riñón , Robótica , Uréter , Anastomosis Quirúrgica , Humanos , Arteria Renal/cirugía , Venas Renales/cirugía , Uréter/cirugía
16.
Pancreas ; 50(4): 587-594, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33939673

RESUMEN

OBJECTIVES: This study aimed to assess posttransplant changes in insulin sensitivity and ß-cell function of pancreas transplant recipients according to the type of diabetes mellitus (DM) and the pretransplant insulin sensitivity measured by the Matsuda Index (MI). METHODS: We analyzed 60 patients who underwent pancreas transplantation and oral glucose tolerance test pretransplant and at 1 month posttransplant. RESULTS: At 1 month posttransplant, insulin sensitivity did not show significant improvement; particularly, the MI was significantly lower after transplant in recipients with type 1 DM (T1DM) and those with pretransplant MI of 5 or greater. ß-cell function was significantly improved after transplant in all recipients regardless of the type of DM and pretransplant MI values. Glucose control was significantly improved in recipients with T1DM and in all recipients regardless of the pretransplant MI values. Additional oral glucose tolerance test at 1 year posttransplant revealed that insulin sensitivity remained unimproved and ß-cell function was higher compared with pretransplant. Glucose control had partially reverted to pretransplant levels in recipients with T1DM and those with pretransplant MI of 5 or greater. CONCLUSIONS: Unlike ß-cell function and glucose control, insulin sensitivity did not significantly improve until posttransplant 1 year after pancreas transplantation regardless of the type of DM or the degree of pretransplant insulin sensitivity.


Asunto(s)
Inhibidores de la Calcineurina/metabolismo , Prueba de Tolerancia a la Glucosa/métodos , Resistencia a la Insulina , Células Secretoras de Insulina/metabolismo , Trasplante de Páncreas/métodos , Adulto , Glucemia/metabolismo , Inhibidores de la Calcineurina/farmacocinética , Inhibidores de la Calcineurina/uso terapéutico , Ciclosporina/metabolismo , Ciclosporina/farmacocinética , Ciclosporina/uso terapéutico , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/metabolismo , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/metabolismo , Femenino , Glucagón/sangre , Glucagón/metabolismo , Humanos , Insulina/sangre , Insulina/metabolismo , Células Secretoras de Insulina/efectos de los fármacos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Tacrolimus/metabolismo , Tacrolimus/farmacocinética , Tacrolimus/uso terapéutico
17.
Clin Transplant ; 35(4): e14224, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33438286

RESUMEN

Laboratory biomarkers that can differentiate non-infectious fever from infectious fever after pancreas transplantation have yet to be discovered. Non-infectious fever was defined as the presence of fever (>38.3°C) in the absence of a documented clinical diagnosis of infection or a positive culture. Among 184 consecutive recipients, a total of 91 recipients developed fever within 1-month post-transplant, of whom 46 had infectious fever and 45 had non-infectious fever at our center between August 2014 and July 2019. The onset of fever was earlier in the non-infectious fever group (14.4 ± 3.7 post-transplant days) compared with the infectious fever group (16.5 ± 5.8 post-transplant days; p = .033). Multivariate analysis showed that serum procalcitonin at the peak of fever could significantly differentiate infectious fever from non-infectious fever (OR 53.378, 95% CI: 6.819-417.802, p < .001). The area under the curve for differentiating between the two groups was 0.853 (95% CI, 0.780-0.926) for procalcitonin and 0.667 (95% CI, 0.549-0.785) for CRP. The best cutoff values of serum procalcitonin and CRP were 0.405 ng/ml (sensitivity, 77.1%; specificity, 80.8%) and 7.355 mg/dl (sensitivity, 66.7%; specificity, 67.3%), respectively. Serum procalcitonin may be useful for differentiating non-infectious fever from infectious fever after pancreas transplantation.


Asunto(s)
Trasplante de Páncreas , Polipéptido alfa Relacionado con Calcitonina , Biomarcadores , Proteína C-Reactiva/análisis , Fiebre/diagnóstico , Fiebre/etiología , Humanos
18.
Korean J Transplant ; 35(4): 253-256, 2021 Dec 31.
Artículo en Inglés | MEDLINE | ID: mdl-35769849

RESUMEN

The impact of the coronavirus disease 2019 (COVID-19) vaccination on humoral and cellular immunity in transplant recipients remains unknown. We report the case of a 78-year-old kidney transplant recipient who experienced acute T cell-mediated rejection after receiving the second dose of the BNT162b2 mRNA COVID-19 vaccine (Pfizer-BioNTech). She had no history of acute rejection throughout the 13 years after deceased donor kidney transplantation. Fifteen days after receiving the second dose of the BNT162b2 vaccine, the recipient visited our center with a mild headache and fever. Her serum creatinine level had increased from 0.61 to 4.95 mg/dL. Kidney allograft biopsy indicated acute T cell-mediated rejection (grade IB) with no pathologic evidence of antibody-mediated rejection. Anti-severe acute respiratory syndrome coronavirus 2 spike-immunoglobulin G and -immunoglobulin M measurements were weak positive and negative, respectively. Careful monitoring of kidney allograft function is vital for transplant recipients undergoing COVID-19 vaccination.

19.
Ann Transplant ; 25: e925229, 2020 Nov 06.
Artículo en Inglés | MEDLINE | ID: mdl-33154345

RESUMEN

BACKGROUND Given that pregnancy is an immune-sensitizing event, female kidney transplant recipients who receive allografts from their offspring or husbands may have a higher risk of rejection and graft failure due to pre-sensitization acquired during pregnancy or childbirth. We investigated the association between donor relatedness (i.e., offspring, husband, unrelated) and graft survival among female living-donor kidney transplant (LDKT) recipients with pregnancy histories. MATERIAL AND METHODS From January 2009 to January 2018, a total of 2060 LDKTs were performed at Asan Medical Center, Seoul, Korea. After excluding HLA-incompatible transplantation, re-transplantation, and those without a clear history of childbirth, 390 female recipients were included and categorized into group I (offspring-to-mother, n=175), group II (husband-to-wife, n=159), and group III (unrelated, n=56). The primary endpoint was biopsy-proven acute rejection (BPAR) and graft survival. We also evaluated delayed graft function (DGF), death-censored graft failure, and mortality. RESULTS Group I had the lowest number of HLA mismatches (p<0.001), and group II had the highest number of ABO-incompatible transplantations (p=0.005). At 5 years after transplant, graft survival and death-censored graft survival did not significantly differ among the 3 groups (graft survival: 96.0% vs. 95.5% vs. 93.3%, p=0.685; death-censored graft survival: 98.3% vs. 97.5% vs. 100%, p=0.732). Five-year BPAR-free survival showed no significant differences among the 3 groups (88.6 vs. 88.7 vs. 88.6%, p=0.842). Group II had the highest rate of clinical rejection (p=0.103) and DGF (p=0.174), but the difference was not statistically significant. CONCLUSIONS Female LDKT recipients with possible pregnancy-related pre-sensitization who received grafts from offspring or husbands did not show significantly worse clinical outcomes than those who received grafts from unrelated donors.


Asunto(s)
Isoanticuerpos/inmunología , Trasplante de Riñón , Donadores Vivos , Femenino , Rechazo de Injerto/etiología , Supervivencia de Injerto , Antígenos HLA/inmunología , Humanos , Embarazo , República de Corea
20.
Ann Transplant ; 25: e927420, 2020 Oct 06.
Artículo en Inglés | MEDLINE | ID: mdl-33020465

RESUMEN

BACKGROUND Patients receiving ABO-incompatible (ABOi) or human leukocyte antigen (HLA)-incompatible (HLAi) kidney transplantation (KT) require potent immunosuppression and are thus at a higher risk of infectious complications. We evaluated the clinical outcomes of KT stratified by ABO and HLA incompatibilities and identified the factors associated with the clinical outcomes. MATERIAL AND METHODS Recipients who underwent living-related KT between 2012 and 2017 were included and classified into 4 groups: ABO-compatible and HLA-compatible (ABOc/HLAc), HLA-incompatible (ABOc/HLAi), ABO-incompatible (ABOi/HLAc), and ABO-incompatible and HLA-incompatible (ABOi/HLAi). Cox proportional hazards regression analyses were carried out to evaluate the risk factors of acute rejection. Out of the 1732 patients who underwent KT, 1190, 131, 358, and 53 were in the ABOc/HLAc, ABOi/HLAc, ABOc/HLAi, and ABOi/HLAi groups, respectively. RESULTS The ABO/HLAi group showed the lowest 5-year graft survival rate (91.7%). Death-censored graft survival was not significantly different among the groups. The mortality rate from infections was significantly higher in the ABOi/HLAi group (7.5%) than the other groups. Antibody-mediated rejection-free graft survival was the lowest in the ABOi/HLAi group, with significant differences compared with the ABOi/HLAc group (P=0.02) and the ABOc/HLAi group (P=0.03). ABOi/HLAi (hazard ratio [HR], 2.63; 95% confidence interval [CI], 1.04-6.65; P<0.01) and combined infection (HR, 1.91; 95% CI, 1.45-2.51; P<0.01) were significant risk factors for acute rejection. CONCLUSIONS Patients with both ABO and HLA incompatibilities showed inferior rates of overall patient and graft survival due to infectious complications. Infection was a prominent risk factor of acute rejection following KT after adjusting for possible confounders including ABO and HLA incompatibility.


Asunto(s)
Sistema del Grupo Sanguíneo ABO/inmunología , Incompatibilidad de Grupos Sanguíneos/inmunología , Rechazo de Injerto/inmunología , Antígenos HLA/inmunología , Infecciones/etiología , Trasplante de Riñón/efectos adversos , Adulto , Incompatibilidad de Grupos Sanguíneos/mortalidad , Femenino , Rechazo de Injerto/mortalidad , Humanos , Infecciones/inmunología , Infecciones/mortalidad , Trasplante de Riñón/mortalidad , Donadores Vivos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/inmunología , Complicaciones Posoperatorias/mortalidad , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del Tratamiento
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