Outcomes of kidney transplant recipients exposed to Chagas disease under Benznidazole prophylaxis. A single center 10-year experience.

BACKGROUND: Chagas disease (ChD) is endemic in many parts of the world and can be transmitted through organ transplantation or reactivated by immunosuppression. Organs from infected donors are occasionally used for transplantation, and the best way of managing the recipients remains a subject of debate. METHODS: We present a single-center cohort study describing a 10-year experience of kidney transplantation in patients at risk of donor-derived ChD and or reactivation. Patients received prophylactic treatment with Benznidazole and were monitored for transmission or reactivation. Monitoring included assessing direct parasitemia, serology, and polymerase chain reaction (PCR). RESULTS: Fifty-seven kidney transplant recipients (KTRs) were enrolled in the study. Forty-four patients (77.2%) were at risk of primary ChD infection, nine patients (15.8%) were at risk of disease reactivation, and four patients (7.0%) were at risk of both. All patients received Benznidazole prophylaxis, starting on the first day after transplantation. Parasitemia was assessed in 51 patients (89.5%), serology also in 51 patients (89.5%), and PCR in 40 patients (70.2%). None of the patients exhibited clinically or laboratory-detectable signs of disease. A single patient experienced a significant side effect, a cutaneous rash with intense pruritus. At 1-year post-transplantation, the patient and graft survival rates were 96.5% and 93%, respectively. CONCLUSION: In this study, no donor-derived or reactivation of Trypanosoma cruzi infection occurred in KTRs receiving Benznidazole prophylaxis.

Antibody responses to SARS-CoV-2 spike protein in a cohort of renal transplant recipients following two-dose primary immunization - A Caribbean country's perspective.

This study compares the humoral immune response of a cohort of renal transplant recipients (RTRs), in Trinidad & Tobago following two-dose primary immunization with non-mRNA vaccines amidst the COVID-19 pandemic. RTRs along with healthy, age-and gender-matched controls received either the adenoviral vector vaccine, AstraZeneca-Vaxzevria (AZ) or the inactivated vaccine, Beijing CNBG-BBIBP- CorV/Sinopharm (SP). Samples were taken after completion of a two-dose primary immunization during the period November 2021 to December 2021, at a mean interval of 138 days following immunization. 38/72 RTRs (53 %) failed to generate any protective antibody responses, compared with 7/73 participants, approximately 10 % in the healthy, age and gender-matched control group. In the RTRs, there was no significant correlation of their antibody concentration with either the timing of sample collection or the interval since transplantation. The study provides necessary information about the humoral response after two- doses of non-mRNA vaccines in a group of transplant recipients.

Torque Teno Virus (TTV) in Renal Transplant Recipients: Species Diversity and Variability.

Torque Teno Virus (TTV) is a nonpathogenic and ubiquitous ssDNA virus, a member of the Anelloviridae family. TTV has been postulated as a biomarker in transplant patients. This study aimed to determine the TTV species diversity and variability in renal transplant recipients and to associate species diversity with the corresponding TTV viral load. From 27 recipients, 30 plasma samples were selected. Viral load was determined using two real-time PCR assays, followed by RCA-NGS and ORF1 phylogenetic analysis. The TTV diversity was determined in all samples. Variability was determined in three patients with two sequential samples (pre- and post-transplantation). Most of the samples presented multiple TTV species, up to 15 different species were detected. In the pre-transplant samples (n = 12), the most prevalent species were TTV3 (75%) and TTV13 (75%), and the median number of species per sample was 5 (IQR: 4-7.5). TTV3 was also the most prevalent (56%) in the post-transplant samples (n = 18), and the median number of species was 2 (IQR: 1.8-5.5). No significant correlation between the number of species and viral load was found. The number and type of TTV species showed total variability over time. We report high TTV species diversity in Argentinian recipients, especially in pre-transplant period, with total intra-host variability. However, we found no significant correlation between this high diversity and TTV viral load.

Comparison of palonosetron and ondansetron in preventing postoperative nausea and vomiting in renal transplantation recipients: a randomized clinical trial

Abstract Background: End-stage renal diseases patients have a high risk of postoperative nausea and vomiting (PONV), which is multifactorial and need acute attention after renal transplantation for a successful outcome in term of an uneventful postoperative period. The study was done to compare the efficacy of palonosetron and ondansetron in preventing early and late-onset PONV in live donor renal transplantation recipients (LDRT). Methods: The prospective randomized double-blinded study was done on 112 consecutive patients planned for live donor renal transplantation. Patients of both sexes in the age group of 18-60 years were randomly divided into two groups: Group O (Ondansetron) and Group P (Palonosetron) with 56 patients in each group by computer-generated randomization. The study drug was administered intravenously (IV) slowly over 30 seconds, one hour before extubation. Postoperatively, the patients were accessed for PONV at 6, 24, and 72 hours using the Visual Analogue Scale (VAS) nausea score and PONV intensity scale. Results: The incidence of PONV in the study was found to be 30.35%. There was significant difference in incidence of PONV between Group P and Group O at 6 hours (12.5% vs. 32.1%, p = 0.013) and 72 hours (1.8% vs. 33.9%, p < 0.001), but insignificant difference at 24 hours (1.8% vs. 10.7%, p = 0.113). VAS-nausea score was significantly lower in Group P as compared to Group O at a time point of 24 hours (45.54 ± 12.64 vs. 51.96 ± 14.70, p = 0.015) and 72 hours (39.11 ± 10.32 vs. 45.7 ± 15.12, p = 0.015). Conclusion: Palonosetron is clinically superior to ondansetron in preventing early and delayed onset postoperative nausea and vomiting in live-related renal transplant recipients.

Percepción de la calidad de vida en pacientes con trasplante renal / Perception of quality of life in renal transplant patients / Percepção da qualidade de vida em pacientes transplantados renais

La enfermedad renal crónica (ERC) es un problema sanitario mundial que afecta al 10% de la población. Su prevalencia ha ido en aumento debido a factores relacionados con el estilo de vida y el envejecimiento de la población. Objetivo. Analizar la percepción de los pacientes receptores de trasplantes renales sobre su calidad de vida, y evaluar los factores que influyen en la calidad de vida post-trasplante renal. Metodología. Para ello, se llevó cabo un estudio bibliográfico considerando fuentes de bases de datos académicas como PubMed, Scopus, Web of Science, entre otras. Donde se usaron como descriptores de búsqueda "trasplante renal", "calidad de vida", "percepción del paciente", "resultados post-trasplante". Además, la búsqueda se amplió en revistas especializadas, tesis, libros y conferencias relacionadas con el tema. como criterios de inclusión fueron considerados estudios originales, revisiones sistemáticas, metaanálisis, publicaciones en los últimos 10 años, etc. Y como exclusión fueron considerados estudios no relacionados, artículos de opinión, publicaciones en idiomas no accesibles. En cuanto al proceso extracción de la información, se usó la matriz de registro y las técnicas de observación y análisis documental, la matriz quedo constituida por Autor(es), año de publicación, país de origen, objetivos del estudio, metodología utilizada, variables analizadas, resultados principales, y conclusiones relevantes. Conclusión. Es esencial reconocer que la calidad de vida post-trasplante renal es una experiencia subjetiva que varía significativamente entre los pacientes y que está influenciada por una amplia gama de factores, que van desde la gestión de síntomas físicos hasta el manejo de desafíos psicológicos y sociales.

Chronic kidney disease (CKD) is a worldwide health problem affecting 10% of the population. Its prevalence has been increasing due to factors related to lifestyle and population aging. Objective. To analyze the perception of renal transplant recipients on their quality of life, and to evaluate the factors that influence post renal transplant quality of life. Methodology. For this purpose, a bibliographic study was carried out considering sources of academic databases such as PubMed, Scopus, Web of Science, among others. The search descriptors used were "renal transplant", "quality of life", "patient perception", "post-transplant results". In addition, the search was extended to specialized journals, theses, books and conferences related to the subject. Inclusion criteria included original studies, systematic reviews, meta-analysis, publications in the last 10 years, etc. Unrelated studies, opinion articles, publications in non-accessible languages were considered as exclusion criteria. As for the information extraction process, the registration matrix and the techniques of observation and documentary analysis were used, the matrix was made up of author(s), year of publication, country of origin, objectives of the study, methodology used, variables analyzed, main results, and relevant conclusions. Conclusion. It is essential to recognize that post-renal transplant quality of life is a subjective experience that varies significantly among patients and is influenced by a wide range of factors, ranging from the management of physical symptoms to the management of psychological and social challenges.

A doença renal crônica (DRC) é um problema de saúde global que afeta 10% da população. Sua prevalência tem aumentado devido a fatores de estilo de vida e ao envelhecimento da população. Objetivo. Analisar a percepção dos receptores de transplante renal sobre sua qualidade de vida e avaliar os fatores que influenciam a qualidade de vida pós-transplante renal. Metodologia. Para isso, foi realizado um estudo bibliográfico considerando fontes de bancos de dados acadêmicos como PubMed, Scopus, Web of Science, entre outros. Os descritores de busca utilizados foram "transplante renal", "qualidade de vida", "percepção do paciente", "resultados pós-transplante" Além disso, a busca foi estendida a periódicos especializados, teses, livros e congressos relacionados ao tema. Os critérios de inclusão incluíram estudos originais, revisões sistemáticas, meta-análises, publicações nos últimos 10 anos, etc. Estudos não relacionados, artigos de opinião e publicações em idiomas não acessíveis foram considerados como critérios de exclusão. Quanto ao processo de extração de informações, foram utilizadas a matriz de registro e as técnicas de observação e análise documental. A matriz foi composta por autor(es), ano de publicação, país de origem, objetivos do estudo, metodologia utilizada, variáveis analisadas, principais resultados e conclusões relevantes. Conclusões. É essencial reconhecer que a qualidade de vida pós-transplante renal é uma experiência subjetiva que varia significativamente entre os pacientes e é influenciada por uma ampla gama de fatores, que vão desde o controle dos sintomas físicos até o enfrentamento de desafios psicológicos e sociais.

Argumentación ética en la donación de riñón de donante vivo y sano La autodeterminación, voluntad y generosidad superan los riesgos

el gesto altruista del donante vivo y sano de riñón, relacionado genética o sentimentalmente, se basa en autodeterminación, voluntad y generosidad. La argumentación ética alrededor de la donación de riñón de donante vivo y sano se orienta con las éticas principialista y personalista, la dignidad humana, la corporalidad, la divisibilidad del cuerpo, el mal menor y el mal mayor. Hace parte del derecho a la información amplia y suficiente que recibe el donante sobre los riesgos y posibles complicaciones físicas y morales del procedimiento, por medio del comité de bioética y el grupo de trasplantes. Con base en la argumentación ética planteada se procedió a contestar la pregunta de esta investigación: ¿se debe dejar que una persona viva y sana sea sometida a una cirugía que le dejará mononéfrico de por vida, solo por el deseo de ayudar a otro, a pesar de que existen programas activos con donante cadavérico? El objetivo de este artículo es plantear una argumentación ética sobre la donación de riñón de donante vivo y sano que contribuya a una adecuada orientación de su decisión.

the altruistic gesture of the healthy living kidney donor, genetically or sentimentally related, is based on self-determination, willingness, and generosity. The ethical argumentation around living and healthy kidney donation is guided by principled and personalistic ethics, human dignity, corporeality, divisibility of the body, the lesser evil, and the greater evil. It is part of the right to ample and sufficient information that the donor receives about the procedure's risks and possible physical and moral complications through the bioethics committee and the transplant group. Based on the ethical argumentation raised, we proceeded to answer the question of this research: should a living and healthy person be subjected to a surgery that will leave him/her mononephric for life, just because of the desire to help another, even though there are active programs with a cadaveric donor? This article aims to provide an ethical argumentation on living and healthy donor kidney donation that will contribute to an adequate orientation of their decision.

o gesto altruísta do doador de rim vivo e saudável, relacionado genética ou sentimentalmente, está baseado na autodeterminação, vontade e generosidade. A argumentação ética ao redor da doação de rim de doador vivo e saudável é orientada pelas éticas principialista e personalista, pela dignidade humana, pela corporalidade, pela divisibilidade do corpo, pelo mal menor e pelo mal maior. Faz parte do direito à informação ampla e suficiente que o doador recebe sobre os riscos e possíveis complicações físicas e morais do procedimento, por meio do comitê de bioética e do grupo de transplantes. Com base na argumentação ética proposta, procedeu-se a contestar a seguinte pergunta de pesquisa: deve-se deixar que uma pessoa viva e saudável seja submetida a uma cirurgia que a deixará mononéfrico para sempre, somente pelo desejo de ajudar o outro, apesar de existirem programas ativos com doador cadavérico? Nesse contexto, o objetivo deste artigo é apresentar uma argumentação ética sobre a doação de rim de doador vivo e saudável que contribua para uma adequada orientação de sua decisão.

Renal Transplantation in the Elderly: Are They All the Same? A Multicenter, Comorbidity-Based Study.

INTRODUCTION: The age for kidney transplantation (KT) is no longer a limitation and several studies have shown benefits in the survival of elderly patients. The aim of this study was to examine the relationship of the baseline Charlson comorbidity index (CCI) score to morbidity and mortality after transplantation. METHODS: In this multicentric observational retrospective cohort study, we included patients older than 60 years admitted on the waiting list (WL) for deceased donor KT from January 01, 2006, to December 31, 2016. The CCI score was calculated for each patient at inclusion on the WL. RESULTS: Data for analysis were available of 387 patients. The patients were divided in tertiles of CCI: group 1 (CCI: 1-2) n = 117, group 2 (CCI: 3-4) n = 158, and group 3 (CCI: ≥5) n = 112. Patient survival was significantly different between CCI groups at 1, 3, and 5 years, respectively: 90%, 88%, and 84% for group 1, 88%, 80%, and 72% for group 2, and 87%, 75%, and 63% for group 3 (p < 0.0001). Variables associated with mortality were CCI score (p < 0.0001), HLA mismatch (p = 0.014), length of hospital stay (p < 0.0001), surgical complications (p = 0.048). CONCLUSION: Individualized strategies to modify these variables may improve patient's morbidity and mortality after KT.

HLA-DPB1 molecular mismatches are risk factors for acute rejection and low 5-year graft function in first kidney transplants.

The study aimed to investigate the impact of HLA-DPB1 allelic and molecular mismatches on the occurrence of acute rejection (AR) and low 5-year graft function (5Y-GF) in first kidney transplant (KT) recipients. This is a single center retrospective study of 130 deceased donor KT recipients transplanted between 2014 and 2016. HLA-DPB1 allelic MM and the following molecular MM (mMM) were analyzed: expression MM with the high expression G allele in the donor; T cell epitope MM (TCE MM); epitope MM (EMM), considering all six hypervariable regions (EMM-ABCDEF HVR), or only ABEF regions (EMM-ABEF HVR); eplet MM (EpMM); antibody-verified eplet MM (AbVer EpMM); and solvent accessible amino acid MM (SAMM). There was no association of allelic MM with AR or 5Y-GF. The variables independently associated (Cox regression analyses) with AR were high donor final creatinine, nonpermissive TCE MM, ABCDEF EMM load ≥6, EpMM load ≥6; SAMM load ≥5, and AbVer EpMM load ≥3. No association between any HLA-DPB1 mMM and 5Y-GF was observed when all 130 transplant recipients were considered. However, when transplants from expanded criteria donors were excluded, independent associations were detected (logistic regression analyses) with AbVerEpMM load ≥2, SAMM load ≥7, cerebro-vascular death, donor age, and AR. To our knowledge, this is the first study that shows that some HLA-DPB1 mMM are associated with AR and low 5Y-GF in a population of exclusively first kidney transplant recipients.

Hormonal intrauterine device in women with renal transplantation: a prospective observational study

SUMMARY OBJECTIVE: The main objective of this study is to evaluate the rate of continuity and satisfaction with hormonal intrauterine device in renal transplant recipients. METHODS: This was a prospective observational study. The sample consisted of patients treated at a Family Planning Outpatient Clinic, from August 2016 to September 2021. Information on each patient's age, parity, and associated diseases as well as satisfaction with the method were analyzed. Patients were invited to participate through electronic messages, and the questionnaire included questions about acceptance of the contraceptive method. RESULTS: A total of 40 patients were included in the study. The mean age of the renal transplant patients was 32.5 years. The mean duration of hormonal intrauterine device use was 37 months. Acceptance of the method was high, with 97.5% of patients remaining on the method for 1 year and 85% of patients using the hormonal intrauterine device at the time of the study. There were no pregnancies or renal transplant complications in the study. Regarding satisfaction with the method, the majority (77.5%) scored 10. CONCLUSION: Patients were satisfied or very satisfied with the hormonal intrauterine device. Therefore, the continuation rate was high. Furthermore, this contraceptive method proved to be safe and effective in kidney transplant recipients. No complications, graft rejection, or graft failure were observed after intrauterine hormonal device insertion and during follow-up.

Supervivencia de pacientes trasplantados en relación con la compatibilidad inmunológica / Survival of transplant patients in relation to immunological compatibility

Introducción: El trasplante renal es uno de los métodos de sustitución de la función renal y tiene como factor de mayor influencia en su supervivencia, la compatibilidad inmunológica del sistema mayor. Objetivos: Definir la supervivencia del trasplante y su relación con el grado de compatibilidad. Métodos: Se realizó un estudio retrospectivo sobre el tiempo de supervivencia con base hospitalaria de los 512 trasplantes en el período comprendido entre los años 1993 y 2010, ambos incluidos con seguimiento y corte al concluir el año 2019. Se empleó el Kaplan Meier para calcular las supervivencias, se utilizó el paquete estadístico Statiscal Package Social Science (Spss) versión 22.0. Resultados: 397 pacientes recibieron riñones cadavéricos al momento del corte, 11,3 por ciento de los injertos estaban funcionando, mientras que para los 115 que recibieron de vivo, el 45,2 por ciento, p=0,000. La mediana de supervivencia para el cadavérico fue de 3,1 años (SD 2,4-3,8) y dentro de ellos los que compartieron tres o más antígenos lograron el doble de sobrevida, p=0,033. Para el de donante vivo, la mediana fue de 16,0 años (SD 9,1-22,9) y dentro de este grupo 104 pacientes que compartían un haplotipo lograron 44,2 por ciento de función, los hermanos que eran idénticos un 66,0 por ciento. Por parentesco los que recibieron riñones de hermanos tienen mejor supervivencias que de padres a hijos, p=0,001. Conclusiones: Se definió que la compatibilidad inmunológica del sistema mayor entre donante y receptor propicia diferencias en la función de los injertos(AU)

Introduction: Renal transplantation is one of the methods of renal function substitution and the main factor influencing survival is the immunological compatibility of the major system. Objectives: To define transplant survival and the relationship with the degree of compatibility. Methods: A retrospective study was carried out on the hospital-based survival time of 512 transplants from 1993 to 2010, including follow-up and the cut at the end of 2019. The Kaplan-Meier estimator was used to calculate the survivals, the statistical package Statistical Package Social Science (Spss) version 22.0 was used. Results: Three hundred ninety seven (397) patients received cadaveric kidneys at the cut, 11.3percent of the grafts were functioning, 115 received living grafts, 45.2percent p=0.000. The median survival for the cadaveric kidneys was 3.1 years (SD 2.4-3.8) and among them those who shared three or more antigens achieved twice the survival, p=0.033. For the living donor, the median was 16.0 years (SD 9.1-22.9) and within this group, 104 patients, sharing a haplotype, achieved 44.2percent function, siblings, who were identical, achieved 66 .0percent. By kinship, those who received kidneys from siblings have better survival than for those who received it from parents, p=0.001. Conclusions: Immunological compatibility of the major system between donor and recipient was defined to favor differences in the function of the grafts(AU)

Treatment of asymptomatic bacteriuria in the first 2 months after kidney transplant: A controlled clinical trial.

BACKGROUND: The incidence of urinary tract infections (UTIs) in the first 2 months postrenal transplantation (pRT) is very high. We evaluate the efficacy of asymptomatic bacteriuria (AB) screening and treatment on the incidence of UTI in the first 2 months pRT METHODS: We conducted a randomized controlled clinical trial. A urine culture was obtained in all patients on the day of the bladder catheter removal, on week three, and before removal of the ureteral catheter. The intervention group received treatment for AB. The control group did not receive treatment. The primary outcomes were the cumulative incidence of UTI and/or graft pyelonephritis and the time to the first episode of UTI and/or graft pyelonephritis RESULTS: Eighty patients were randomized, 40 in each group, and the median follow-up was 63 days (IQR 54-70). The average age was 29.8 years and 33.7% (n = 27) were women. The incidences of UTI (n = 10, 25 % vs. n = 4, 10%, p = .07) and pyelonephritis (n = 6, 15% vs. n = 1, 2.5%, p = .04) were greater in the intervention group, as also shown in the survival analysis: UTI (HR2.8, 95% CI 0.8-9.1, p = .07) and pyelonephritis (HR 6.5, 95% CI 0.8-54.7, p = .08), respectively. The most commonly isolated bacterium was Escherichia coli (n = 28, 59.5%), and over half were E. coli with extended-spectrum beta-lactamases (n = 15). A major limitation was not obtaining the calculated sample size due to a delay in patient recruitment resulting from the COVID-19 pandemic CONCLUSION: Treatment of AB in the first 2 months pRT does not decrease the incidence of UTI or graft pyelonephritis and may actually increase their frequency. Routine treatment of AB during the first months after renal transplantation should not be a standard procedure.

Sub-classification of borderline changes into diffuse or focal and its impact on long-term renal transplant outcomes.

BACKGROUND: Borderline changes (BL) with stable renal function is a controversial category in renal transplantation, given its contradictory outcomes. The aim of this study was to compare the clinical outcomes of BL in patients with stable renal function classified as focal and diffuse according to the extent of tubulitis. METHODS: Patients with no history of rejection with a surveillance graft biopsy at 3 or 12 months showing BL (n = 40), acute cellular rejection (n = 20) or normal biopsies (n = 20), were included in this study. Biopsies with BL were divided into diffuse BL (BLD) and focal BL (BLF) according to the extent of tubulitis. Because of the low frequency of subclinical ACR (ACRND) (n = 12), biopsies with ACR and graft dysfunction (ACRD) (n = 8) were also included. A composite outcome that included the presence of rejection in subsequent biopsies, graft loss, patient death, decrease in GFR ≥30% or presence of de novo DSA (dnDSA) during the first year of follow-up was evaluated. RESULTS: The primary composite outcome occurred in five patients of each of the Normal, BLF and ACRND, eight patients with BLD and six patients with ACRD (p = 0.105). A trend towards more rejection episodes was observed in the ACRND and ACRD. Also, a shorter time to rejection in the BLD, ACRND and ACRD groups compared to BLF and Normal groups (p = 0.039) was observed. During the first year of follow-up, no patient in the ACRND group developed dnDSA, compared to 15-25% in the other groups. The median time of dnDSA development in the BLF group was 45 months, and in the BLD group was 10 months (p = 0.020). CONCLUSION: Classifying BL biopsies with stable renal function into focal and diffuse categories, is a simple and feasible strategy that helps to differentiate between BLD with a phenotype that shows a trend towards worse outcomes, and BLF that behaves more similar to normal biopsies.

Treatment of post-transplant recurrent FSGS in children using plasmapheresis and augmentation of immunosuppression.

BACKGROUND: Up to 60% of pediatric renal transplant recipients with end-stage renal disease due to primary focal and segmental glomerulosclerosis (FSGS) may develop recurrent disease. Such recurrence is associated with poor prognosis if no remission is achieved. We report a single center experience with a protocol based on plasmapheresis and increased immunosuppression that resulted in a high long-lived remission rate. METHODS: This retrospective cohort study included consecutive pediatric renal transplant patients with recurrent FSGS treated with a standardized protocol using plasmapheresis and cyclophosphamide to supplement usual post-transplant immunosuppression with calcineurin inhibitors and steroids. Relapse was defined as urinary protein/creatinine ratio > 1.0 g/g and remission as < 0.5 g/g. RESULTS: Seventeen patients with FSGS recurrence post-transplant were treated. All had therapy resistant FSGS in native kidneys and had been on dialysis from 4 to 10 years. Of the 17, one died perioperatively from a pulmonary thromboembolism. Fifteen others achieved a complete remission within 3 months of treatment for FSGS recurrence. After a median follow-up period of 4 years, there were no recurrences of significant proteinuria. One patient achieved remission with rituximab. CONCLUSION: The addition of plasmapheresis and cyclophosphamide to a calcineurin- and steroid-based immunosuppression regime was highly successful in inducing high remission rates with recurrent FSGS. Prospective trials are needed to evaluate further the efficacy of increased immunosuppression along with plasmapheresis in this setting.

Delayed Graft Function Under the Microscope: Surveillance Biopsies in Kidney Transplantation.

Delayed graft function (DGF) is a common complication of kidney transplantation and frequently leads to the necessity of surveillance biopsies. The purpose of this study is to describe the histological findings in surveillance biopsies of deceased donor kidney transplant recipients and evaluate the risk factors for graft outcomes. This is a monocentric, retrospective study including kidney transplant recipients that underwent a graft biopsy during the DGF period between January 2006 and July 2019. 356 biopsies were performed in 335 deceased donor transplant recipients. Biopsies were analyzed according to the Banff classification. The main histological findings were: acute tubular necrosis in 150 biopsies (42.1%), acute rejection in 96 biopsies (26.9%), and borderline findings in 91 biopsies (25.5%). In the multivariate analysis, recipient age (p = 0.028) and DGF duration (p = 0.005) were associated with rejection, antibody-induction with anti-thymocyte globulin (ATG) was protective (p = 0.001). The occurrence of rejection was associated with lower death-censored graft survival (log-rank; p = 0.009). Surveillance biopsies of kidney grafts experiencing DGF remain an essential tool for the care of kidney transplant recipients. The recipient's age and duration of DGF are independent risk factors for acute rejection, while antibody-induction therapy with ATG is associated with protection from its occurrence.

Temporal Reduction in COVID-19-Associated Fatality Among Kidney Transplant Recipients: The Brazilian COVID-19 Registry Cohort Study.

Data from the general population suggest that fatality rates declined during the course of the pandemic. This analysis, using data extracted from the Brazilian Kidney Transplant COVID-19 Registry, seeks to determine fatality rates over time since the index case on March 3rd, 2020. Data from hospitalized patients with RT-PCR positive SARS-CoV-2 infection from March to August 2020 (35 sites, 878 patients) were compared using trend tests according to quartiles (Q1: <72 days; Q2: 72-104 days; Q3: 105-140 days; Q4: >140 days after the index case). The 28-day fatality decreased from 29.5% (Q1) to 18.8% (Q4) (pfor-trend = 0.004). In multivariable analysis, patients diagnosed in Q4 showed a 35% reduced risk of death. The trend of reducing fatality was associated with a lower number of comorbidities (20.7-10.6%, p for-trend = 0.002), younger age (55-53 years, pfor-trend = 0.062), and better baseline renal function (43.6-47.7 ml/min/1.73 m2, pfor-trend = 0.060), and were confirmed by multivariable analysis. The proportion of patients presenting dyspnea (pfor-trend = 0.001) and hypoxemia (pfor-trend < 0.001) at diagnosis, and requiring intensive care was also found reduced (pfor-trend = 0.038). Despite possible confounding variables and time-dependent sampling differences, we conclude that COVID-19-associated fatality decreased over time. Differences in demographics, clinical presentation, and treatment options might be involved.

Invasive coronary artery disease assessment and myocardial infarction in patients on renal replacement therapy.

BACKGROUND: The incidence of myocardial infarction (MI) is elevated in patients receiving renal replacement therapy (RRT). We hypothesized that an invasive strategy of assessment of coronary artery disease (CAD) will identify patients more prone to developing MI. METHODS: This was a single-center observational cohort study that included 1678 patients receiving RRT (hemodialysis and renal transplantation) assessed for CAD prospectively and analyzed retrospectively. Endpoints were the incidence of MI and death. RESULTS: The median follow-up was 43 months, and 180 patients experienced an MI with a mortality rate of 74%. Multivariate analysis showed that diabetes (HR 1.633; 95% CI 1.165-2.289), prior MI (HR 1.724; 95% CI 1.153-2.579), and CAD (HR 2.073; 95% CI 1.400-3.071) were predictors of MI. Altered myocardial scan did not correlate with MI. At the discretion of the attending physicians, 20/180 patients (11%) underwent coronary intervention that was associated with a higher cumulative survival (Log-rank 0.007). CONCLUSION: Patients with CAD suffered an MI more frequently, independently of symptoms and risk factors for MI, including noninvasive testing. Because of the elevated rate of the lethality of MI, invasive coronary studies may be indicated in select patients on RRT. Once an MI occurs, our data suggest that an invasive therapeutic approach is warranted.

Amyloidosis and the Kidney: An Update.

Various types of systemic amyloidosis can wreak havoc on the architecture and functioning of the kidneys. Amyloidosis should be suspected in patients with worsening kidney function, proteinuria, and multisystem involvement, but isolated kidney involvement also is possible. Confirming the amyloidosis type and specific organ dysfunction is of paramount importance to select the appropriately tailored treatment and aim for better survival while avoiding treatment-associated toxicities. Amyloid renal staging in light chain amyloidosis amyloidosis helps inform prognosis and risk for end-stage kidney disease. Biomarker-based staging systems and response assessment guide the therapeutic strategy and allow the timely identification of refractory or relapsing disease so that patients can be switched to salvage therapy. Kidney transplantation is a viable option for selected patients with amyloidosis. Because of the complex nature of the pathophysiology and treatment of amyloidosis, a multidisciplinary team-based approach should be used in the care of these patients.

Changes in blood glucose level after renal transplantation in pediatrics: A study of risk factors of new-onset diabetes after transplantation.

BACKGROUND: New-onset diabetes after transplantation refers to the development of diabetes after solid organ transplantation without a history of diabetes and is related to poor graft function and lower survival rate. In the kidney transplant population, NODAT occurs in 24% of adults and 9% of children. The real incidence and risk factors in the pediatric population is unknown, which we aimed to determine in this study. METHODS: A retrospective study was conducted in patients who underwent kidney transplantation in the Pediatric Nephrology Service of the "Federico Gómez" Children's Hospital of Mexico. RESULTS: The study included 127 children divided into groups 1 and 2 (without [n = 110 patients, 86.5%] and with NODAT [n = 17 patients, 13.4%], respectively), with median ages of 14 years (interquartile range [IQR], 9-16 years) and 15 years (IQR, 13-16 years; p = .3), respectively. Cox proportional hazards analysis revealed an association between changes from baseline to 24-h postoperative blood glucose level as a risk factor of the development of NODAT. This implies that each unit increase in blood glucose level in the first hours after transplantation also increases the risk of developing diabetes (95% confidence interval, 1.011-1.021; p = <.001). CONCLUSIONS: Post-kidney transplant patients require immediate follow-up, and attention should be paid to changes in blood glucose level in the first 24 h after transplantation, as any alteration may be an early sign of development of NODAT, especially in patients with a family history of diabetes mellitus.

Non-dipper effect in hypertense patients after renal transplantation by 24-hour ambulatory blood pressure monitoring.

OBJECTIVE: Determinate instant and after 1-month non-dipper effect in hypertense patients after renal transplant by 24-hour ambulatory blood pressure monitoring in Hospital General de Zona No. 50, San Luis Potosí, Mexico. METHOD: Descriptive, longitudinal and prospective cohort study of a non-probability convenience sampling in post-transplant patients with hypertension. We collected data from MAPA and includes age, sex, cardiovascular risk factors in variables. Use of central tendency and dispersion measures for descriptive analysis and t Student for inferential analysis. RESULTS: 19 patients were included, 11 male (57.9%) and 8 females (42.1%), with age range 20 to 49 years (median of 30.2 years ± 7.7). Where the non-dipper effect in the first take was 89.5% and in the second take 84.2%. CONCLUSIONS: There is a high frequency of the non-dipper pattern in patients at one month of kidney transplant, the persistence of this hypertension may be, among others, by the use of immunosuppressants. A new category for non-dipper classification is described.

OBJETIVO: Determinar el efecto non-dipper inmediato y posterior a 1 mes en pacientes adultos hipertensos postrasplante renal con monitoreo continuo de la presión arterial de 24 horas, en el Hospital General de Zona No. 50 de San Luis Potosí, México. MÉTODO: Estudio de tipo cohorte, longitudinal, prospectivo, con muestreo no probabilístico por conveniencia de casos consecutivos en pacientes receptores de trasplante renal con hipertensión arterial. Se recogieron los siguientes datos: edad, sexo, factores de riesgo cardiovascular, uso de antihipertensivos o inmunosupresores, y monitoreo ambulatorio de la presión arterial de 24 horas. Se aplicaron medidas de tendencia central y de dispersión para análisis descriptivo, y prueba t de Student para análisis inferencial. RESULTADOS: Se incluyeron 11 hombres (57.9%) y 8 mujeres (42.1%), con una edad de 20 a 49 años (media 30.2 ± 7.7), en los que el efecto non-dipper inmediato fue del 89.5% y posterior a 1 mes fue del 84.2%. CONCLUSIONES: Existe una alta frecuencia del patrón non-dipper en pacientes a 1 mes del trasplante renal. La persistencia de la hipertensión puede ser, entre otras causas, por el uso de inmunosupresores. Se describe una nueva categoría para la clasificación non-dipper.

Evaluation of renal transplantation recipients those who do not use steroid with panel reactive antibody and donor specific antibody / Evaluación de receptores de trasplante renal que no usan esteroides con panel de anticuerpos reactivos y anticuerpos específicos del donante

ABSTRACT Background: Steroids are the mainstream drugs of immu- nosuppressive regimen in renal transplantation. They are successfully used on induction, maintenance and rejection treatment. Due to complications caused by steroids, treatments are switched to immunosuppressive agents. Graft dysfunction risk caused by reduced total immunosuppression disturbs clinicians very often. We documented the differences among patients by means of clinical presentation and PRA/DSA levels between patients who are using steroids and patients that were prescribed for steroid-free regimen. Methods: 82 individuals who did not use steroid and 52 patients on steroid treatment were included with similar rates of age, sex, primary renal disease, dialysis type, posttransplant follow-up duration and donor type. Pre and posttransplant PRA, DSA levels, posttransplant and current graft function and comorbidities were evaluated. Results: Individuals who do not use steroids were found to have a lower posttransplant creatinine level and glomerular filtration rate (GFR) compared to steroid users. Posttransplant and current spot urinary protein/creatinine rates were also lower in the steroid-free group. However DM, BKVN and induction therapy rates were higher in the steroid-free group. PRA and DSA levels were similar in both groups. On the other hand, posttransplant PRA-I levels were significantly higher in those with less steroid use time. Conclusions: Although steroid free regimens usually worry the clinicians, they can be preferred in patients with low immunological risk for rejection to avoid its side effects such as uncontrolled diabetes, obesity, musculoskeletal problems and cataracts.

RESUMEN Antecedentes: Los esteroides son los principales fármacos del régimen inmunosupresor en el trasplante renal. Se utilizan con éxito en tratamientos de inducción, mantenimiento y rechazo. Debido a las complicaciones causadas por los esteroides, los tratamientos se cambian a agentes inmunosupresores. El riesgo de disfunción del injerto causado por la reducción de la inmunosupresión total perturba a los médicos con mucha frecuencia. Documentamos la diferencia entre los pacientes por medio de la presentación clínica y los niveles de PRA/DSA en aquellos que utilizan esteroides y a los que se les prescribió un regimen sin esteroides. Material y métodos: Se incluyeron 82 individuos que no usaban esteroides y 52 pacientes en tratamiento con esteroides con tasas similares de edad, sexo, enfermedad renal primaria, tipo de diálisis, duración del seguimiento postrasplante y tipo de donante. Se evaluaron la ARP pre y postrasplante, los niveles de DSA, la función y comorbilidades postrasplante y actual del injerto. Resultados: Se encontró que las personas que no usan esteroides tienen un nivel de creatinina postrasplante y una tasa de filtración glomerular (TFG) más bajas en comparación con los usuarios de esteroides. Las tasas de proteína/creatinina urinarias postrasplante y puntuales actuales también fueron más bajas en el grupo sin esteroides. Sin embargo, las tasas de DM, BKVN y terapia de inducción fueron más altas en el grupo sin esteroides. Los niveles de PRA y DSA fueron similares en ambos grupos. Por otro lado, los niveles de PRA-I postrasplante fueron significativamente más altos en aquellos con menos tiempo de uso de esteroides. Conclusiones: Aunque los regimenes libres de esteroides suelen preocupar a los clínicos, pueden ser preferidos en pacientes con bajo riesgo inmunológico de rechazo para evitar sus efectos secundarios, como diabetes no controlada, obesidad, problemas musculoesqueléticos y cataratas.