[Tixagevimab-cilgavimab as pre-exposure prophylactic treatment against SARS-CoV-2 in kidney transplantation patients]. / Tixagevimab-cilgavimab como tratamiento profiláctico preexposición frente a SARS-CoV-2 en pacientes trasplantados renales.

INTRODUCTION: It has been reported that after vaccination with RNAm or viral vectors from SARS-CoV-2 a significant number of solid organ transplant recipients do not develop an effective immune response. In this scenario, the use of tixagevimab-cilgavimab was approved by the European Medicines Agency for COVID-19 prophylaxis in immunocompromised patients in March 2022. We present our experience with a group of kidney transplant recipients who received prophylactic treatment with tixagevimab-cilgavimab. MATERIAL AND METHODS: Prospective study from a cohort of kidney transplant recipients who had been previously vaccinated with 4 doses and did not achieve a satisfactory immune response to vaccination, presenting antibody titers lower than 260 BAU/mL when measured by ELISA. A total of 55 patients who received a single dose of 150mg of tixagevimab and 150mg of cilgavimab between May and September of 2022 were included in this study. RESULTS: No immediate or severe adverse reactions, including worsening of kidney function, were observed after administering the drug or during follow up. All patients who had received the drug 3 months prior presented positive antibody titers (>260 BAU/mL). Seven patients were diagnosed with COVID, and one of those patients had to be admitted to the hospital and died 5 days later from infectious complications and a suspected diagnosis of bacterial coinfection. CONCLUSIONS: In our experience, all kidney transplant recipients reached antibody titers higher than 260 BAU/mL 3 months after receiving prophylactic treatment with tixagevimab-cilgavimab with no severe or irreversible adverse reactions.

[Tixagevimab-cilgavimab as pre-exposure prophylactic treatment against SARS-CoV-2 in kidney transplantation patients]. / Tixagevimab-cilgavimab como tratamiento profiláctico preexposición frente a SARS-CoV-2 en pacientes trasplantados renales.

Introduction: It has been reported that after vaccination with RNAm or viral vectors from SARS-CoV-2 a significant number of solid organ transplant recipients do not develop an effective immune response. In this scenario, the use of tixagevimab-cilgavimab was approved by the European Medicines Agency for COVID-19 prophylaxis in immunocompromised patients in March 2022. We present our experience with a group of kidney transplant recipients who received prophylactic treatment with tixagevimab-cilgavimab. Material and methods: Prospective study from a cohort of kidney transplant recipients who had been previously vaccinated with 4 doses and did not achieve a satisfactory immune response to vaccination, presenting antibody titers lower than 260 BAU/mL when measured by ELISA. A total of 55 patients who received a single dose of 150 mg of tixagevimab and 150 mg of cilgavimab between May and September of 2022 were included in this study. Results: No immediate or severe adverse reactions, including worsening of kidney function, were observed after administering the drug or during follow up. All patients who had received the drug 3 months prior presented positive antibody titers (> 260 BAU/mL). Seven patients were diagnosed with COVID, and one of those patients had to be admitted to the hospital and died 5 days later from infectious complications and a suspected diagnosis of bacterial coinfection. Conclusions: In our experience, all kidney transplant recipients reached antibody titers higher than 260 BAU/mL 3 months after receiving prophylactic treatment with tixagevimab-cilgavimab with no severe or irreversible adverse reactions.

Sodium-glucose cotransporter-2 inhibitor therapy in kidney transplant patients with type 2 or post-transplant diabetes: an observational multicentre study.

Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2is) have cardioprotective and renoprotective effects. However, experience with SGLT2is in diabetic kidney transplant recipients (DKTRs) is limited. Methods: This observational multicentre study was designed to examine the efficacy and safety of SGLT2is in DKTRs. The primary outcome was adverse effects within 6 months of SGLT2i treatment. Results: Among 339 treated DKTRs, adverse effects were recorded in 26%, the most frequent (14%) being urinary tract infection (UTI). In 10%, SGLT2is were suspended mostly because of UTI. Risk factors for developing a UTI were a prior episode of UTI in the 6 months leading up to SGLT2i use {odds ratio [OR] 7.90 [confidence interval (CI) 3.63-17.21]} and female sex [OR 2.46 (CI 1.19-5.03)]. In a post hoc subgroup analysis, the incidence of UTI emerged as similar in DKTRs treated with SGLT2i for 12 months versus non-DKTRs (17.9% versus 16.7%). Between baseline and 6 months, significant reductions were observed in body weight [-2.22 kg (95% CI -2.79 to -1.65)], blood pressure, fasting glycaemia, haemoglobin A1c [-0.36% (95% CI -0.51 to -0.21)], serum uric acid [-0.44 mg/dl (95% CI -0.60 to -0.28)] and urinary protein:creatinine ratio, while serum magnesium [+0.15 mg/dl (95% CI 0.11-0.18)] and haemoglobin levels rose [+0.44 g/dl (95% CI 0.28-0.58]. These outcomes persisted in participants followed over 12 months of treatment. Conclusions: SGLT2is in kidney transplant offer benefits in terms of controlling glycaemia, weight, blood pressure, anaemia, proteinuria and serum uric acid and magnesium. UTI was the most frequent adverse effect. According to our findings, these agents should be prescribed with caution in female DKTRs and those with a history of UTI.

A Current Review of the Etiology, Clinical Features, and Diagnosis of Urinary Tract Infection in Renal Transplant Patients.

Urinary tract infection (UTI) represents the most common infection after kidney transplantation and remains a major cause of morbidity and mortality in kidney transplant (KT) recipients, with a potential impact on graft survival. UTIs after KT are usually caused by Gram-negative microorganisms. Other pathogens which are uncommon in the general population should be considered in KT patients, especially BK virus since an early diagnosis is necessary to improve the prognosis. UTIs following kidney transplantation are classified into acute simple cystitis, acute pyelonephritis/complicated UTI, and recurrent UTI, due to their different clinical presentation, prognosis, and management. Asymptomatic bacteriuria (ASB) represents a frequent finding after kidney transplantation, but ASB is considered to be a separate entity apart from UTI since it is not necessarily a disease state. In fact, current guidelines do not recommend routine screening and treatment of ASB in KT patients, since a beneficial effect has not been shown. Harmful effects such as the development of multidrug-resistant (MDR) bacteria and a higher incidence of Clostridium difficile diarrhea have been associated with the antibiotic treatment of ASB.

Can estimated glomerular filtration rate improve the EuroSCORE?

Several studies have shown that the glomerular filtration rate is a strong predictor of mortality following cardiac surgery. This study was designed to identify the estimated glomerular filtration rate using the MDRD-4 equation as an independent predictive variable of mortality and to determine whether the inclusion of this variable could improve the discriminating power of the EuroSCORE. Data from 2014 consecutive patients who underwent cardiac surgery over a 3-year period were analysed. Mean glomerular filtration rate was 68.4+/-22.7 ml/min per 1.73 m(2); 704 patients (35%) showed a rate

Estenosis de arteria ilíaca tras trasplante renal como causa de hipertensión arterial refractaria y claudicación / Stenosis of the iliac artery after kidney transplantation as a cause of refractory hypertension and intermittent claudication

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Receptores de trasplante renal de donantes en asistolia y muerte cerebral: diferencias en los cuidados enfermeros / Recipients of kidney transplants from donors in asystole and brain death: differences in nursing care

Hoy en día es indiscutible que el trasplante renal es el tratamiento sustitutivo de elección para pacientes con enfermedad renal crónica. En nuestro hospital realizamos fundamentalmente dos tipos de trasplante renal, el clásico donante en muerte cerebral y el donante en asistolia. El objetivo de nuestro estudio fue evaluar si existían diferencias en las cargas de trabajo del personal de enfermería dependiendo de un tipo de trasplante u otro. Se trata de un estudio transversal con 73 pacientes que recibieron un trasplante renal durante el año 2010, 18 procedentes de donante en muerte cerebral y 55 en asistolia. Los trasplante renales de donante en asistolia presentaron mayor incidencia de fallo primario del injerto (15% vs 1,4%) así como mayor retraso de la función renal (18 días vs 0 días). Debido a esto, nuestra labor asistencial se vio incrementada en este tipo de trasplante por precisar un mayor número de biopsias renales que implican unos cuidados de preparación y de vigilancia de sus complicaciones, la necesidad de más sesiones de hemodiálisis y la administración de un mayor número de dosis de timoglobulina. No se objetivaron diferencias significativas en la incidencia de infecciones entre ambos tipo de trasplante, así como en la estancia media hospitalaria, aunque esto último podría estar influido por el tamaño de la muestra. A pesar de las complicaciones mencionadas, la función renal a medio plazo de ambos tipos de trasplante fue similar, lo que alienta la utilización de los donantes en asistolia (AU)

Nowadays it is indisputable that kidney transplant is the preferred replacement therapy for patients with chronic kidney disease. In our hospital we carry out basically two types of kidney transplants, the classic brain dead donor and the asystolic donor. The aim of our study was to evaluate whether there were differences in the workload of nursing staff depending on the type of transplant. This is a transversal study of 73 patients who received a kidney transplant in 2010, 18 of which were from a brain dead donor and 55 from an asystolic donor. The kidney transplants from asystolic donors showed a higher incident of primary graft failure (15% v. 1.4%) and a greater delay in kidney function (18 days v. 0 days). Because of this, our care task was increased in this type of transplant as a greater number of kidney biopsies were required which involve care in preparation and supervision of complications, the need for more haemodialysis session and the administration of a more doses of thymoglobulin. No significant differences were identified in the incidence of infections between the two types of transplant, or in the average hospital stay although the latter could be influenced by the size of the sample. Despite the complications mentioned above, kidney function in the medium term in both types of transplant was similar, which encourages the use of asystolic donors (AU)

Vascular access for dialysis in the elderly.

AIMS: The aim of this study was to analyze early and late outcome of the first vascular accesses performed in the HGUGM of Madrid between 1992 and 1997, comparing the results in patients older and younger than 65 years. METHODS: Retrospective study. All the vascular accesses performed in patients without previous permanent angioaccess between January 1992 and March 1997 were studied. Early failure, complication rate (patient-year of follow-up), and cumulative patency rates were analyzed. RESULTS: The difference between grafts required in young (25%) and old patients (34%) was significant (p < 0.01). Complication rate in autologous fistulas was 0.07 per patient-year in the younger group and 0.12 per patient-year in the older (p < 0.01). Complication rate in grafts was 0.5 per patient-year in the younger group and 0.8 per patient-year in the older group (p < 0.05). There were no significant differences in patency rates for both autologous and graft accesses between patients younger or older than 65 years. Better primary patency (log-rank comparison between curves, p < 0.001), and lower complication rates (0.09 patient-year for autologous and 0.58 for grafts, p < 0.001), were observed in autologous fistulas in both groups. CONCLUSIONS: Autologous access is the best angioaccess for dialysis also in older patients and can be performed in most patients without a previous permanent access. Yet, we observed in our experience that more grafts were needed in patients older than 65 years.