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Kidney transplantation is the gold standard for the treatment of end-stage renal diseases (ESRDs). However, the scarcity of donor kidneys has caused more and more ESRD patients to be stuck on the waiting list for transplant surgery. Improving the survival rate for renal grafts is an alternative solution to the shortage of donor kidneys. Therefore, real-time monitoring of the surgical process is crucial to the success of kidney transplantation, but efficient methods and techniques are lacking. Herein, a fluorescence technology based on bright, photostable and long-circulating aggregation-induced emission (AIE) active NIR-II nano-contrast agent DIPT-ICF nanoparticles for the whole-process monitoring and evaluation of renal transplantation has been reported. In the aggregated state, DIPT-ICF exhibits superior photophysical properties compared with the commercial dyes IR-26 and IR-1061. Besides, the long-circulating characteristic of the AIE nano-contrast agent helps to achieve renal angiography in kidney retrieval surgery, donor kidney quality evaluation, diagnosing vascular and ureteral complications, and assessment of renal graft reperfusion beyond renovascular reconstruction, which considerably outperforms the clinically approved indocyanine green (ICG). An AIE nano contrast agent with the longest absorption wavelength and highest absorbance in the AIE fluorophore family is designed and fabricated for monitoring kidney transplantation.

Infections remain a common complication of solid-organ transplantation and are a major factor of morbidity and mortality in renal transplant recipients. The incidence of infection in renal transplant patients is directly related to the net immunosuppressive effect achieved and the duration of the administration of immunosuppressive therapy. The major types of infections can be categorized according to the time post-transplant during which they occur: in the first month after transplantation post-surgical bacterial infections and in the period from one to four months post-transplant opportunistic infections, overall cytomegalovirus; late infections, beyond 6-12 months, are community-acquired infections. Opportunistic infections (like Pneumocystis carini, Listeria monocytogenes, and Aspergillus fumigatus) most frequently occur in the first 12 months post-transplant and can be modulated by prior exposures and the use of prophylaxis., Infections remain a common complication of solid-organ transplantation and are a major factor of morbidity and mortality in renal transplant recipients. The incidence of infection in renal transplant patients is directly related to the net immunosuppressive effect achieved and the duration of the administration of immunosuppressive therapy. The major types of infections can be categorized according to the time post-transplant during which they occur: in the first month after transplantation post-surgical bacterial infections and in the period from one to four months post-transplant opportunistic infections, overall cytomegalovirus; late infections, beyond 6-12 months, are community-acquired infections. Opportunistic infections (like Pneumocystis carini, Listeria monocytogenes, and Aspergillus fumigatus) most frequently occur in the first 12 months post-transplant and can be modulated by prior exposures and the use of prophylaxis.

PURPOSE OF REVIEW: Kidney dysfunction is challenging in liver transplant candidates to determine whether it is reversible or not. This review focuses on the pertinent data on how to best approach liver transplant candidates with kidney dysfunction in the current era after implementing the simultaneous liver kidney (SLK) allocation policy and safety net. RECENT FINDINGS: The implementation of the SLK policy inverted the steady rise in SLK transplants and improved the utilization of high-quality kidneys. Access to kidney transplantation following liver transplant alone (LTA) increased with favorable outcomes. Estimating GFR in liver transplant candidates remains challenging, and innovative methods are needed. SLK provided superior patient and graft survival compared to LTA only for patients with advanced CKD and dialysis at least 3 months. SLK can provide immunological protection against kidney rejection in highly sensitized candidates. Post-SLK transplant care is complex, with an increased risk of complications and hospitalization. SUMMARY: The SLK policy improved kidney access and utilization. Transplant centers are encouraged, under the safety net, to reserve SLK for liver transplant candidates with advanced CKD or dialysis at least 3 months while allowing lower thresholds for highly sensitized patients. Herein, we propose a practical approach to liver transplant candidates with kidney dysfunction.

The International Society of Nephrology Global Kidney Health Atlas charts the availability and capacity of kidney care globally. In the North America and the Caribbean region, the Atlas can identify opportunities for kidney care improvement, particularly in Caribbean countries where structures for systematic data collection are lacking. In this third iteration, respondents from 12 of 18 countries from the region reported a 2-fold higher than global median prevalence of dialysis and transplantation, and a 3-fold higher than global median prevalence of dialysis centers. The peritoneal dialysis prevalence was lower than the global median, and transplantation data were missing from 6 of the 10 Caribbean countries. Government-funded payments predominated for dialysis modalities, with greater heterogeneity in transplantation payor mix. Services for chronic kidney disease, such as monitoring of anemia and blood pressure, and diagnostic capability relying on serum creatinine and urinalyses were universally available. Notable exceptions in Caribbean countries included non-calcium-based phosphate binders and kidney biopsy services. Personnel shortages were reported across the region. Kidney failure was identified as a governmental priority more commonly than was chronic kidney disease or acute kidney injury. In this generally affluent region, patients have better access to kidney replacement therapy and chronic kidney disease-related services than in much of the world. Yet clear heterogeneity exists, especially among the Caribbean countries struggling with dialysis and personnel capacity. Important steps to improve kidney care in the region include increased emphasis on preventive care, a focus on home-based modalities and transplantation, and solutions to train and retain specialized allied health professionals.

BACKGROUND: Kidney transplant (KT) candidates with HIV face higher mortality on the waitlist compared with candidates without HIV. Because the HIV Organ Policy Equity (HOPE) Act has expanded the donor pool to allow donors with HIV (D + ), it is crucial to understand whether this has impacted transplant rates for this population. METHODS: Using a linkage between the HOPE in Action trial (NCT03500315) and Scientific Registry of Transplant Recipients, we identified 324 candidates listed for D + kidneys (HOPE) compared with 46 025 candidates not listed for D + kidneys (non-HOPE) at the same centers between April 26, 2018, and May 24, 2022. We characterized KT rate, KT type (D + , false-positive [FP; donor with false-positive HIV testing], D - [donor without HIV], living donor [LD]) and quantified the association between HOPE enrollment and KT rate using multivariable Cox regression with center-level clustering; HOPE was a time-varying exposure. RESULTS: HOPE candidates were more likely male individuals (79% versus 62%), Black (73% versus 35%), and publicly insured (71% versus 52%; P < 0.001). Within 4.5 y, 70% of HOPE candidates received a KT (41% D + , 34% D - , 20% FP, 4% LD) versus 43% of non-HOPE candidates (74% D - , 26% LD). Conversely, 22% of HOPE candidates versus 39% of non-HOPE candidates died or were removed from the waitlist. Median KT wait time was 10.3 mo for HOPE versus 60.8 mo for non-HOPE candidates ( P < 0.001). After adjustment, HOPE candidates had a 3.30-fold higher KT rate (adjusted hazard ratio = 3.30, 95% confidence interval, 2.14-5.10; P < 0.001). CONCLUSIONS: Listing for D + kidneys within HOPE trials was associated with a higher KT rate and shorter wait time, supporting the expansion of this practice for candidates with HIV.

During an epidemiological survey, a potential novel species within the basidiomycetous yeast genus Trichosporon was observed. The clinical strain was obtained from a urine sample taken from a Brazilian kidney transplant recipient. The strain was molecularly identified using the intergenic spacer (IGS1) ribosomal DNA locus and a subsequent phylogenetic analysis showed that multiple strains that were previously reported by other studies shared an identical IGS1-genotype most closely related to that of Trichosporon inkin. However, none of these studies provided an in-depth characterization of the involved strains to describe it as a new taxon. Here, we present the novel clinically relevant yeast for which we propose the name Trichosporon austroamericanum sp. nov. (holotype CBS H-24937). T. austroamericanum can be distinguished from other siblings in the genus Trichosporon using morphological, physiological, and phylogenetic characters.

Introduction: Comorbidities and immunosuppressive therapies are associated with reduced immune responses to primary COVID-19 mRNA vaccination in kidney transplant recipients (KTRs). In healthy individuals, prior SARS-COV-2 infection is associated with increased vaccine responses, a phenotype called hybrid immunity. In this study, we explored the potential influence of immune suppression on hybrid immunity in KTRs. Methods: Eighty-two KTRs, including 59 SARS-CoV-2-naïve (naïve KTRs [N-KTRs]) and 23 SARS-CoV-2-experienced (experienced KTRs [E-KTRs]) patients, were prospectively studied and compared to 106 healthy controls (HCs), including 40 SARS-CoV-2-naïve (N-HCs) and 66 SARS-CoV-2-experienced (E-HCs) subjects. Polyfunctional antibody and T cell responses were measured following 2 doses of BNT162b2 mRNA vaccine. Associations between vaccine responses and clinical characteristics were studied by univariate and multivariate analyses. Results: In naïve KTRs, vaccine responses were markedly lower than in HCs and were correlated with older age, more recent transplantation, kidney retransplantation after graft failure, arterial hypertension, and treatment with mycophenolate mofetil (MMF). In contrast, vaccine responses of E-KTRs were similar to those of HCs and were associated with time between transplantation and vaccination, but not with the other risk factors associated with low vaccine responses in naïve KTRs. Conclusion: In conclusion, hybrid immunity overcomes immune suppression and provides potent humoral and cellular immunity to SARS-CoV-2 in KTRs., SCOPUS: ar.j, info:eu-repo/semantics/published

Kidney transplantation is the most successful kidney replacement therapy available, resulting in improved recipient survival and societal cost savings. Yet, nearly 70 years after the first successful kidney transplant, there are still numerous barriers and untapped opportunities that constrain the access to transplant. The literature describing these barriers is extensive, but the practices and processes to solve them are less clear. Solutions must be multidisciplinary and be the product of strong partnerships among patients, their networks, health care providers, and transplant programs. Transparency in the referral, evaluation, and listing process as well as organ selection are paramount to build such partnerships. Providing early culturally congruent and patient-centered education as well as maximizing the use of local resources to facilitate the transplant work up should be prioritized. Every opportunity to facilitate pre-emptive kidney transplantation and living donation must be taken. Promoting the use of telemedicine and kidney paired donation as standards of care can positively impact the work up completion and maximize the chances of a living donor kidney transplant.

Background: Chronic active antibody-mediated rejection (caAMR) in kidney transplants is associated with irreversible tissue damage and a leading cause of graft loss in the long-term. However, the treatment for caAMR remains a challenge to date. Recently, tocilizumab, a recombinant humanized monoclonal antibody directed against the human interleukin-6 (IL-6) receptor, has shown promise in the treatment of caAMR. However, it has not been systematically investigated so far underscoring the need for randomized controlled studies in this area. Methods: The INTERCEPT study is an investigator-driven randomized controlled open-label multi-center trial in kidney transplant recipients to assess the efficacy of tocilizumab in the treatment of biopsy-proven caAMR. A total of 50 recipients with biopsy-proven caAMR at least 12 months after transplantation will be randomized to receive either tocilizumab (n = 25) added to our standard of care (SOC) maintenance treatment or SOC alone (n = 25) for a period of 24 months. Patients will be followed for an additional 12 months after cessation of study medication. After the inclusion biopsies at baseline, protocol kidney graft biopsies will be performed at 12 and 24 months. The sample size calculation assumed a difference of 5 ml/year in slope of estimated glomerular filtration rate (eGFR) between the two groups for 80% power at an alpha of 0.05. The primary endpoint is the slope of eGFR at 24 months after start of treatment. The secondary endpoints include assessment of the following at 12, 24, and 36 months: composite risk score iBox, safety, evolution and characteristics of donor-specific antibodies (DSA), graft histology, proteinuria, kidney function assessed by measured GFR (mGFR), patient- and death-censored graft survival, and patient-reported outcomes that include transplant-specific well-being, adherence to immunosuppressive medications and perceived threat of the risk of graft rejection. Discussion: No effective treatment exist

Cancer is a common complication after kidney transplantation. Kidney transplant recipients (KTR) have a 2- to 4-fold higher risk of developing cancer compared to the general population and post-transplant malignancy is the third most common cause of death in KTR. Moreover, it is well known that certain cancer types are overrepresented after transplantation, especially non-melanoma skin cancer. Immune checkpoint inhibitors (ICI) have revolutionized the treatment of cancer, with remarkable survival benefit in a subgroup of patients. ICI are monoclonal antibodies that block the binding of specific co-inhibitory signaling molecules. Cytotoxic T lymphocyte-associated antigen-4 (CTLA-4), programmed cell death protein 1 (PD-1), and its ligand programmed cell death ligand 1 (PD-L1) are the main targets of ICI. Solid organ transplant recipients (SOTR) have been excluded from clinical trials owing to concerns about tumor response, allo-immunity, and risk of transplant rejection. Indeed, graft rejection has been estimated as high as 48% and represents an emerging problem. The underlying mechanisms of organ rejection in the context of treatment with ICI are poorly understood. The search for restricted antitumoral responses without graft rejection is of paramount importance. This review summarizes the current knowledge of the use of ICI in KTR, the potential mechanisms involved in kidney graft rejection during ICI treatment, potential biomarkers of rejection, and how to deal with rejection in clinical practice., SCOPUS: re.j, info:eu-repo/semantics/published

Background: BK polyomavirus (BKPyV) infection after kidney transplantation can lead to serious complications such as BKPyV-associated nephropathy (BKPyVAN) and graft loss. The aim of this study was to investigate the incidence of BKPyVAN after implementing a BKPyV screening program, to map the distribution of BKPyV genotypes and subtypes in the Uppsala-orebro region and to identify host and viral risk factors for clinically significant events. Methods This single-center prospective cohort study included kidney transplant patients aged >= 18 years at the Uppsala University Hospital in Sweden between 2016 and 2018. BKPyV DNA was analyzed in plasma and urine every 3 months until 18 months after transplantation. Also genotype and subtype were determined. A logistic regression model was used to analyze selected risk factors including recipient sex and age, AB0 incompatibility and rejection treatment prior to BKPyVAN or high-level BKPyV DNAemia. Results: In total, 205 patients were included. Of these, 151 (73.7%) followed the screening protocol with 6 plasma samples, while184 (89.8%) were sampled at least 5 times. Ten (4.9%) patients developed biopsy confirmed BKPyVAN and 33 (16.1%) patients met criteria for high-level BKPyV DNAemia. Male sex (OR 2.85, p = 0.025) and age (OR 1.03 per year, p = 0.020) were identified as significant risk factors for developing BKPyVAN or high-level BKPyV DNAemia. BKPyVAN was associated with increased viral load at 3 months post transplantation (82,000 vs. < 400 copies/mL; p = 0.0029) and with transient, high-level DNAemia (n = 7 (27%); p < 0.0001). The most common genotypes were subtype Ib2 (n = 50 (65.8%)) and IVc2 (n = 20 (26.3%)). Conclusions: Male sex and increasing age are related to an increased risk of BKPyVAN or high-level BKPyV DNAemia. BKPyVAN is associated with transient, high-level DNAemia but no differences related to viral genotype were detected., De två sista författarna delar sistaförfattarskapet.

Background and hypothesis There seems to be a lack of consensus on the necessity and the modality of psychological and specifically cognitive assessment of candidates for kidney transplantation. Both points are often delegated to individual hospitals/centres, whereas international guidelines are inconsistent. We think it is essential to investigate professionals' opinions to advance towards a consistent clinical practice. Methods This paper presents the results of an international survey among clinical professionals, mainly nephrologists from the CONNECT (Cognitive decline in Nephro-Neurology: European Cooperative Target) network and beyond (i.e. from personal contacts of CONNECT members). The survey investigated their opinions about the question of whether cognitive decline in patients with chronic kidney disease may affect their eligibility for kidney transplantation. Results Our results show that most clinicians working with patients affected by chronic kidney disease think that cognitive decline may challenge their eligibility for transplantation despite data that suggest that, in some patients, cognitive problems improve after kidney transplantation. Conclusion We conclude that three needs emerge as particularly pressing: defining agreed-on standards for a multifaceted and multifactorial assessment (i.e. including both clinical/medical and psychosocial factors) of candidates with chronic kidney disease to kidney transplantation; further investigating empirically the causal connection between chronic kidney disease and cognition; and further investigating empirically the possible partial reversibility of cognitive decline after kidney transplantation.

Organ transplantation is a life-saving procedure that can significantly improve the quality of life for patients suffering from organ failure. However, the procurement and transplantation of organs involves complex legal and ethical issues. Italy is not an exception, as the country has faced several challenges related to organ transplantation. The article provides an overview of the regulatory framework governing organ transplantation in Italy, focusing on patients’ needs.

RATIONALE & OBJECTIVE: In kidney transplant recipients (KTRs), a belatacept-based immunosuppressive regimen is associated with beneficial effects on cardiovascular (CV) risk factors compared with calcineurin inhibitor (CNI)-based regimens. Our objective was to compare the calculated CV risk between belatacept and CNI (predominantly tacrolimus) treatments using a validated model developed for KTRs. STUDY DESIGN: Prospective, randomized, open-label, parallel-group, investigator-initiated, international multicenter trial. SETTING & PARTICIPANTS: KTRs aged 18-80 years with a stable graft function (estimated glomerular filtration rate > 20 mL/min/1.73 m2), 3-60 months after transplantation, treated with tacrolimus or cyclosporine A, were eligible for inclusion. INTERVENTION: Continuation with a CNI-based regimen or switch to belatacept for 12 months. OUTCOMES: Comparison of the change in the estimated 7-year risk of major adverse CV events and all-cause mortality, changes in traditional markers of CV health, as well as measures of arterial stiffness. RESULTS: Among the 105 KTRs randomized, we found no differences between the treatment groups in the predicted risk for major adverse CV events or mortality. Diastolic blood pressure, measured both centrally by using a SphygmoCor device and peripherally, was lower after the belatacept treatment than after the CNI treatment. The mean changes in traditional cardiovascular (CV) risk factors, including kidney transplant function, were otherwise similar in both the treatment groups. The belatacept group had 4 acute rejection episodes; 2 were severe rejections, of which 1 led to graft loss. LIMITATIONS: The heterogeneous baseline estimated glomerular filtration rate and time from transplantation to trial enrollment in the participants. A limited study duration of 1 year. CONCLUSIONS: We found no effects on the calculated CV risk by switching to the belatacept treatment. Participants in the belatacept group had not only l

RATIONALE & OBJECTIVE: In kidney transplant recipients (KTRs), a belatacept-based immunosuppressive regimen is associated with beneficial effects on cardiovascular (CV) risk factors compared with calcineurin inhibitor (CNI)-based regimens. Our objective was to compare the calculated CV risk between belatacept and CNI (predominantly tacrolimus) treatments using a validated model developed for KTRs. STUDY DESIGN: Prospective, randomized, open-label, parallel-group, investigator-initiated, international multicenter trial. SETTING & PARTICIPANTS: KTRs aged 18-80 years with a stable graft function (estimated glomerular filtration rate > 20 mL/min/1.73 m2), 3-60 months after transplantation, treated with tacrolimus or cyclosporine A, were eligible for inclusion. INTERVENTION: Continuation with a CNI-based regimen or switch to belatacept for 12 months. OUTCOMES: Comparison of the change in the estimated 7-year risk of major adverse CV events and all-cause mortality, changes in traditional markers of CV health, as well as measures of arterial stiffness. RESULTS: Among the 105 KTRs randomized, we found no differences between the treatment groups in the predicted risk for major adverse CV events or mortality. Diastolic blood pressure, measured both centrally by using a SphygmoCor device and peripherally, was lower after the belatacept treatment than after the CNI treatment. The mean changes in traditional cardiovascular (CV) risk factors, including kidney transplant function, were otherwise similar in both the treatment groups. The belatacept group had 4 acute rejection episodes; 2 were severe rejections, of which 1 led to graft loss. LIMITATIONS: The heterogeneous baseline estimated glomerular filtration rate and time from transplantation to trial enrollment in the participants. A limited study duration of 1 year. CONCLUSIONS: We found no effects on the calculated CV risk by switching to the belatacept treatment. Participants in the belatacept group had not only l

RATIONALE & OBJECTIVE: In kidney transplant recipients (KTRs), a belatacept-based immunosuppressive regimen is associated with beneficial effects on cardiovascular (CV) risk factors compared with calcineurin inhibitor (CNI)-based regimens. Our objective was to compare the calculated CV risk between belatacept and CNI (predominantly tacrolimus) treatments using a validated model developed for KTRs. STUDY DESIGN: Prospective, randomized, open-label, parallel-group, investigator-initiated, international multicenter trial. SETTING & PARTICIPANTS: KTRs aged 18-80 years with a stable graft function (estimated glomerular filtration rate > 20 mL/min/1.73 m2), 3-60 months after transplantation, treated with tacrolimus or cyclosporine A, were eligible for inclusion. INTERVENTION: Continuation with a CNI-based regimen or switch to belatacept for 12 months. OUTCOMES: Comparison of the change in the estimated 7-year risk of major adverse CV events and all-cause mortality, changes in traditional markers of CV health, as well as measures of arterial stiffness. RESULTS: Among the 105 KTRs randomized, we found no differences between the treatment groups in the predicted risk for major adverse CV events or mortality. Diastolic blood pressure, measured both centrally by using a SphygmoCor device and peripherally, was lower after the belatacept treatment than after the CNI treatment. The mean changes in traditional cardiovascular (CV) risk factors, including kidney transplant function, were otherwise similar in both the treatment groups. The belatacept group had 4 acute rejection episodes; 2 were severe rejections, of which 1 led to graft loss. LIMITATIONS: The heterogeneous baseline estimated glomerular filtration rate and time from transplantation to trial enrollment in the participants. A limited study duration of 1 year. CONCLUSIONS: We found no effects on the calculated CV risk by switching to the belatacept treatment. Participants in the belatacept group had not only l

Chronic kidney disease is the non-communicable disease with the highest growth in morbidity and mortality. Renal transplantation (RT) is the first option of renal replacement in end-stage kidney disease (ESKD) and dialysis is an alternative. However, there is no objective quantification of the impact of both options on a patient’s overall survival. The purpose of our study is to assess the potential years of life lost by patients on renal replacement therapy. Methods: Retrospective study cohort conducted from 2008 to 2018 based on autonomic data registry. Results: 11,551 patients included who received renal replacement therapy (RRT) in a range of age from 15 to 94 years. The mean age at the time of onset was 62.7 years, 95% confidence interval (95% CI) (62.4; 63.0). The mortality rate of RRT patients was 42.2%, 95% CI (41.5; 43.3) and the mean age at death was 72.7 years, 95% CI (72.4; 73.1). The number of patients with ESKD treated with RT was 3776, 32.7% of the total, 95% CI (31.8; 33.5). The total amount of years of potential life lost (YPLL) in the entire cohort was 77,831.3 years, 48,010.1 years in men, and 29,821.2 years in women. The mean number of YPLL per patient with RRT was 6.74 years in both sexes, 6.95 years in women, and 6.61 years in men. The mean number of potential years of life lost in dialysis patients was 9.0 years in both sexes, 8.8 years in men, and 9.2 years in women, while among kidney transplant recipients this figure decreased to 2.2 years in both men and women. Conclusions: End-stage chronic kidney disease in renal replacement therapy by dialysis causes an average of 9.0 years of life potentially lost for each patient on dialysis treatment, while having received a kidney transplant reduces this figure by 75.6%.

Renal transplantation represents the best treatment for end-stage kidney disease, leading to improved quality of life and life-expectancy for most of the patients. However, gender disparities are evident both in access and in outcomes of kidney transplantation.nWomen on dialysis are less likely to be on the waiting list for kidney transplantation and receive an organ from a deceased donor or living donor. Several biological and sociocultural aspects could explain this disparity. On the contrary, more women than men are living kidney donors. Italian women are the first organ donors for living transplants in Europe. The gender difference in living donation is certainly affected by different comorbidities, but such a marked trend highlights a greater predisposition to donate of women, especially in the family context. Some differences are also found in kidney outcomes, even not fully understand. Our paper analyzes the main differences in different aspects of kidney transplantation related to gender, including nutritional aspects., Renal transplantation represents the best treatment for end-stage kidney disease, leading to improved quality of life and life-expectancy for most of the patients. However, gender disparities are evident both in access and in outcomes of kidney transplantation. Women on dialysis are less likely to be on the waiting list for kidney transplantation and to receive an organ from a deceased donor or living donor. Several biological and sociocultural aspects could explain this disparity. On the contrary, more women than men are living kidney donors. Italian women are the first organ donors for living transplants in Europe. The gender difference in living donation is certainly affected by different comorbidities, but such a marked trend highlights a greater predisposition to donate of women, especially in the family context. Some differences are also found in kidney outcomes, even not fully understood. Our paper analyzes the main differences in different aspects of kidney transplantation related to gender, including nutritional aspects.

Renal transplantation represents the best treatment for end-stage kidney disease, leading to improved quality of life and life-expectancy for most of the patients. However, gender disparities are evident both in access and in outcomes of kidney transplantation.nWomen on dialysis are less likely to be on the waiting list for kidney transplantation and receive an organ from a deceased donor or living donor. Several biological and sociocultural aspects could explain this disparity. On the contrary, more women than men are living kidney donors. Italian women are the first organ donors for living transplants in Europe. The gender difference in living donation is certainly affected by different comorbidities, but such a marked trend highlights a greater predisposition to donate of women, especially in the family context. Some differences are also found in kidney outcomes, even not fully understand. Our paper analyzes the main differences in different aspects of kidney transplantation related to gender, including nutritional aspects., Renal transplantation represents the best treatment for end-stage kidney disease, leading to improved quality of life and life-expectancy for most of the patients. However, gender disparities are evident both in access and in outcomes of kidney transplantation. Women on dialysis are less likely to be on the waiting list for kidney transplantation and to receive an organ from a deceased donor or living donor. Several biological and sociocultural aspects could explain this disparity. On the contrary, more women than men are living kidney donors. Italian women are the first organ donors for living transplants in Europe. The gender difference in living donation is certainly affected by different comorbidities, but such a marked trend highlights a greater predisposition to donate of women, especially in the family context. Some differences are also found in kidney outcomes, even not fully understood. Our paper analyzes the main differences in different aspects of kidney transplantation related to gender, including nutritional aspects.

BackgroundPrimary FSGS manifests with nephrotic syndrome and may recur following KT. Failure to respond to conventional therapy after recurrence results in poor outcomes. Evaluation of podocyte B7-1 expression and treatment with abatacept (a B7-1 antagonist) has shown promise but remains controversial.MethodsFrom 2012 to 2020, twelve patients developed post-KT FSGS with nephrotic range proteinuria, failed conventional therapy, and were treated with abatacept. Nine/twelve (< 21 years old) experienced recurrent FSGS; three adults developed de novo FSGS, occurring from immediately, up to 8 years after KT. KT biopsies were stained for B7-1.ResultsNine KTRs (75%) responded to abatacept. Seven of nine KTRs were B7-1 positive and responded with improvement/resolution of proteinuria. Two patients with rFSGS without biopsies resolved proteinuria after abatacept. Pre-treatment UPCR was 27.0 ± 20.4 (median 13, range 8-56); follow-up UPCR was 0.8 ± 1.3 (median 0.2, range 0.07-3.9, p < 0.004). Two patients who were B7-1 negative on multiple KT biopsies did not respond to abatacept and lost graft function. One patient developed proteinuria while receiving belatacept, stained B7-1 positive, but did not respond to abatacept.ConclusionsPodocyte B7-1 staining in biopsies of KTRs with post-transplant FSGS identifies a subset of patients who may benefit from abatacept. A higher resolution version of the Graphical abstract is available as Supplementary information.

BackgroundCache Valley virus (CVV) is a mosquito-borne virus that is a rare cause of disease in humans. In the fall of 2020, a patient developed encephalitis 6 weeks following kidney transplantation and receipt of multiple blood transfusions.MethodsAfter ruling out more common etiologies, metagenomic next-generation sequencing (mNGS) of cerebrospinal fluid (CSF) was performed. We reviewed the medical histories of the index kidney recipient, organ donor, and recipients of other organs from the same donor and conducted a blood traceback investigation to evaluate blood transfusion as a possible source of infection in the kidney recipient. We tested patient specimens using reverse-transcription polymerase chain reaction (RT-PCR), the plaque reduction neutralization test, cell culture, and whole-genome sequencing.ResultsCVV was detected in CSF from the index patient by mNGS, and this result was confirmed by RT-PCR, viral culture, and additional whole-genome sequencing. The organ donor and other organ recipients had no evidence of infection with CVV by molecular or serologic testing. Neutralizing antibodies against CVV were detected in serum from a donor of red blood cells received by the index patient immediately prior to transplant. CVV neutralizing antibodies were also detected in serum from a patient who received the co-component plasma from the same blood donation.ConclusionsOur investigation demonstrates probable CVV transmission through blood transfusion. Clinicians should consider arboviral infections in unexplained meningoencephalitis after blood transfusion or organ transplantation. The use of mNGS might facilitate detection of rare, unexpected infections, particularly in immunocompromised patients.

Cardiovascular disease is a leading complication after both liver and kidney transplantation. Factors associated with and rates of cardiovascular events (CVEs) after simultaneous liver-kidney transplant (SLKT) are unknown. This was a retrospective cohort study of adult SLKT recipients between 2002 and 2017 at six centers in six United Network for Organ Sharing regions in the US Multicenter SLKT Consortium. The primary outcome was a CVE defined as hospitalization due to acute coronary syndrome, arrhythmia, congestive heart failure, or other CV causes (stroke or peripheral vascular disease) within 1 year of SLKT. Among 515 SLKT subjects (mean age ± SD, 55.4 ± 10.6 years; 35.5% women; 68.1% White), 8.7% had a CVE within 1 year of SLKT. The prevalence of a CVE increased from 3.3% in 2002-2008 to 8.9% in 2009-2011 to 14.0% in 2012-2017 ( p  = 0.0005). SLKT recipients with a CVE were older (59.9 vs. 54.9 years, p < 0.0001) and more likely to have coronary artery disease (CAD) (37.8% vs. 18.4%, p  = 0.002) and atrial fibrillation (AF) (27.7% vs. 7.9%, p  = 0.003) than those without a CVE. There was a trend toward older age by era of SLKT ( p  = 0.054). In multivariate analysis adjusted for cardiac risk factors at transplant, age (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.02, 1.11), CAD (OR, 3.62; 95% CI, 1.60, 8.18), and AF (OR, 2.36; 95% CI, 1.14, 4.89) were associated with a 1-year CVE after SLKT. Conclusion : Among SLKT recipients, we observed a 4-fold increase in the prevalence of 1-year CVEs over time. Increasing age, CAD, and AF were the main potential explanatory factors for this trend independent of other risk factors. These findings suggest that CV risk protocols may need to be tailored to this high-risk population.

Infections remain the most common cause of hospitalization after kidney transplantation, contributing to significant post-transplant morbidity and mortality. There is a growing body of literature that suggests that immunoglobulins may have a significant protective role against post-transplant infections, although the literature remains sparse, inconsistent, and not well publicized among pediatric nephrologists. Of great concern are data indicating a high prevalence of immunoglobulin abnormalities following transplantation and a possible link between these abnormalities and poorer outcomes. Our educational review focuses on the epidemiology and risk factors for the development of immunoglobulin abnormalities after kidney transplantation, the outcomes in patients with low immunoglobulin levels, and studies evaluating possible interventions to correct these immunoglobulin abnormalities.

PurposeAlthough congenital anomalies of the kidney and urinary tract (CAKUT) are among the leading causes of end-stage kidney disease (ESKD) in children and young adults, kidney transplantation access for this population has not been well studied in the US. We compared transplantation access in the US based on whether the etiology of kidney disease was secondary to CAKUT, and additionally by CAKUT subgroups (anatomic vs. inherited causes of CAKUT).MethodsUsing the United States Renal Data System, we conducted a retrospective cohort study of 80,531 children and young adults who started dialysis between 1995 and 2015. We used adjusted Cox models to examine the association between etiology of kidney disease (CAKUT vs. non-CAKUT, anatomic vs. inherited) and receipt of kidney transplantation, and secondarily, receipt of a living vs. deceased donor kidney transplant.ResultsOverall, we found an increased likelihood of kidney transplantation access for participants with CAKUT compared to those without CAKUT (HR 1.23; 95% CI 1.20-1.27). Among the subset of individuals with CAKUT as the attributed cause of ESKD, we found a lower likelihood of kidney transplantation in those with anatomic causes of CAKUT compared to those with inherited causes of CAKUT (adjusted HR 0.85; 0.81-0.90).ConclusionThere are notable disparities in kidney transplantation rates among CAKUT subgroups. Those with anatomic causes of CAKUT started on dialysis have significantly reduced access to kidney transplantations compared to individuals with inherited causes of CAKUT who were initiated on dialysis. Further studies are needed to understand barriers to transplantation access in this population.

BackgroundAdditional "booster" doses of mRNA SARS-CoV-2 vaccines have become standard of care for immunosuppressed patients, including kidney transplant recipients (KTR). While these additional doses have been shown to be efficacious in the adult KTR population, there is paucity of data for pediatric and adolescent KTR.MethodsWe conducted a retrospective single-center observational study to determine the proportion of pediatric and adolescent KTR who seroconverted following two- and three-dose regimens of an mRNA SARS-CoV-2 vaccine series.ResultsForty-three pediatric and adolescent KTR at our center received at least two doses of an mRNA SARS-CoV-2 vaccine. Seroconversion was noted in 56% of those who received a 2-dose series and increased to 85% in those who received a third dose. In the 16 patients who did not seroconvert after a two-dose series, 12 (75%) seroconverted following the third dose. No serious adverse effects of immunization were noted.ConclusionsOur results demonstrate that additional SARS-CoV-2 vaccine doses are not only safe and efficacious in pediatric and adolescent KTR, but may be necessary to optimize antibody response. A higher resolution version of the Graphical abstract is available as Supplementary information.

BackgroundFocal segmental glomerulosclerosis (FSGS) is frequently associated with heavy proteinuria and progressive renal failure requiring dialysis or kidney transplantation. However, primary FSGS also has a ~40% risk of recurrence of disease in the transplanted kidney (rFSGS). Multiple circulating factors have been identified to contribute to the pathogenesis of primary and rFSGS including soluble urokinase-type plasminogen activator receptor (suPAR) and patient-derived CD40 autoantibody (CD40autoAb). However, the downstream effector pathways specific to individual factors require further study. The tumor necrosis factor, TNF pathway activation by one or more circulating factors present in the sera of patients with FSGS has been supported by multiple studies.MethodsA human in vitro model was used to study podocyte injury measured as the loss of actin stress fibers. Anti-CD40 autoantibody was isolated from FSGS patients (recurrent and non-recurrent) and control patients with ESRD due to non-FSGS related causes. Two novel human antibodies-anti-uPAR (2G10) and anti-CD40 antibody (Bristol Meyer Squibb, 986090) were tested for their ability to rescue podocyte injury. Podocytes treated with patient derived antibody were transcriptionally profiled using whole human genome microarray.ResultsHere we show that podocyte injury caused by sera from FSGS patients is mediated by CD40 and suPAR and can be blocked by human anti-uPAR and anti-CD40 antibodies. Transcriptomic studies to compare the molecules and pathways activated in response to CD40 autoantibody from rFSGS patients (rFSGS/CD40autoAb) and suPAR, identified unique inflammatory pathways associated with FSGS injury.ConclusionsWe identified several novel and previously described genes associated with FSGS progression. Targeted blockade of suPAR and CD40 pathways with novel human antibodies showed inhibition of podocyte injury in FSGS.

BackgroundCytomegalovirus (CMV) infection, either de novo or as reactivation after allotransplantation and chronic immunosuppression, is recognized to cause detrimental alloimmune effects, inclusive of higher susceptibility to graft rejection and substantive impact on chronic graft injury and reduced transplant survival. To obtain further insights into the evolution and pathogenesis of CMV infection in an immunocompromised host we evaluated changes in the circulating host proteome serially, before and after transplantation, and during and after CMV DNA replication (DNAemia), as measured by quantitative polymerase chain reaction (QPCR).MethodsLC-MS-based proteomics was conducted on 168 serially banked plasma samples, from 62 propensity score-matched kidney transplant recipients. Patients were stratified by CMV replication status into 31 with CMV DNAemia and 31 without CMV DNAemia. Patients had blood samples drawn at protocol times of 3- and 12-months post-transplant. Additionally, blood samples were also drawn before and 1 week and 1 month after detection of CMV DNAemia. Plasma proteins were analyzed using an LCMS 8060 triple quadrupole mass spectrometer. Further, public transcriptomic data on time matched PBMCs samples from the same patients was utilized to evaluate integrative pathways. Data analysis was conducted using R and Limma.ResultsSamples were segregated based on their proteomic profiles with respect to their CMV Dnaemia status. A subset of 17 plasma proteins was observed to predict the onset of CMV at 3 months post-transplant enriching platelet degranulation (FDR, 4.83E-06), acute inflammatory response (FDR, 0.0018), blood coagulation (FDR, 0.0018) pathways. An increase in many immune complex proteins were observed at CMV infection. Prior to DNAemia the plasma proteome showed changes in the anti-inflammatory adipokine vaspin (SERPINA12), copper binding protein ceruloplasmin (CP), complement activation (FDR = 0.03), and proteins enriched in the humoral (FDR

Kidney transplant is the gold standard for renal replacement therapy in patients with autosomal dominant polycystic kidney disease (ADPKD), which is the fourth leading cause of kidney failure. Despite the medical and economic benefits of preemptive kidney transplant over dialysis before transplant, only 9-21% of qualifying patients receive preemptive transplants. Given the low rates of preemptive transplant, the aim of this study was to determine perceived facilitators and barriers to preemptive transplant among ADPKD patients using a qualitative approach. Data were collected between July 2021 and January 2022 from virtual individual semi-structured interviews of 16 adult participants with ADPKD. Qualitative analysis of the recorded interviews was conducted to generate themes. Our findings revealed two themes specific for facilitators to preemptive transplant (social support and patient agency) and three themes specific to barriers for preemptive transplant (inadequate social support, gaps in knowledge, and institutional and systemic policies). The results also include various subthemes and the application of these themes to the social ecological model. These findings suggest that increasing social support and patient agency, such as through patient navigator programs and encouraging effective communication between health care providers and patients, can facilitate the transplant process. Increasing dissemination of transplant knowledge from institutions and systems to patients through paired kidney exchange education and live donor outreach can also increase timely access to preemptive kidney transplants for patients with ADPKD. Our findings are limited by our single site study in the US, which may not apply to individuals experiencing different social, cultural, and health access conditions.

Introduction: Patients with trisomy 21 have a higher risk for congenital anomalies including congenital anomalies of the kidney and urinary tract. The association between Prune Belly Syndrome and Down Syndrome has been described but the occurrence of both conditions would likely represent a coincidence. There are few published reports on renal transplantation in patients with this syndromes. Clinical Case: We reporte a 5-year-old female patient with antenal diagnosis of down syndrome. Post-natal abdominal ultrasound revealed megabladder and dysplastic kidneys. At five months of age, she was commenced on peritoneal dialysis. The patient underwent renal transplantation at age of 3. Acute thrombosis of transplanted renal artery was diagnosed, resulting in graft loss. Four months after second transplantation, the patient presented bilateral tonsillar enlargement and a post-transplant lymphoproliferative disorder was diagnosed. Conclusion:We describe the existence of these conditions in a single patient who underwent kidney transplantation, it’s clinical manement and follow up. This case has been reported with the hope of contributing to the existing knowledge which pertains to kidney transplantation patients with Down syndrome., Introducción: Los pacientes con trisomía 21 tienen un mayor riesgo de anomalías congénitas, incluidas las anomalías renales y de vías urinarias. La ocurrencia del Síndrome de Prune Belly y el Síndrome de Down ha sido descrita, pero representaría una coincidencia. Existen escasos reportes que describan estos pacientes y que fueran trasplantados. Caso Clínico:Paciente de 5 años con diagnóstico prenatal de trisomía 21. La ecografía postnatal reveló megavejiga y riñones displásicos. Comenzó con diálisis peritoneal a los 5 meses de vida. Se realizó el trasplante renal a los 3 años de edad, complicando con trombosis aguda de la arteria y pérdida del injerto. Cuatro meses después del segundo trasplante, la paciente fue diagnosticada con un trastorno linfoproliferativo post-trasplante.Conclusión: Se describe la evolución y el manejo de un único paciente que presentó múltiples complicaciones, con la esperanza de contribuir al conocimiento existente en relación con los pacientes trasplantados renales con síndrome de Down.

Background and Aims: Preservation solutions used as kidney washing solutions intransplantation are necessary for the longer preservation of the kidney. The study aims to compare different kidney-washing solutions used in living renal transplantation. Methods and Results: Forty-nine patients who underwent renal transplantation from live donors were included in the retrospective study. The Ringer’s solution flushed the renal graft in 37 patients (Group 1), and the preservation solution was in 12 patients (Group 2). Group 1, and Group 2 patients were included in the study. There were 22 (59.5%) males in Group 1 and 9 (75%) males in Group 2. Twenty-seven (73%) patients using Ringer’s and 7 (58.3%) patients on preservation solution had comorbidities. There was no significant difference between Group 1 and Group 2 in warm ischemia time, cold ischemia time, and HLA mismatch levels (p> 0.05). The preoperative creatinine value was significantly higher in the preservation solution group (p = 0.003). There was no significant difference between the two groups in values of creatinine levels on the postoperative (p> 0.05). Conclusion: In living renal transplantation, an inexpensive Ringer’s solution, may be used instead of the expensive preservation solution to wash the graft., Antecedentes y Objetivos: Las soluciones de conservación utilizadas como soluciones de lavado de riñón en trasplantes son necesarias para una conservación más prolongada del riñón. El estudio tiene como objetivo comparar diferentes soluciones de lavado de riñón utilizadas en el trasplante renal vivo. Métodos y Resultados: Cuarenta y nueve pacientes sometidos a trasplante renal de donante vivo incluidos en el estudio retrospectivo. La solución de Ringer se utilizó para lavar el injerto renal en 37 pacientes (Grupo1) y la solución de conservación se utilizó en 12 pacientes (Grupo2). Se incluyeron en el estudio pacientes del Grupo 1 y del Grupo 2. Había 22 (59,5%) hombres en el Grupo 1 y 9 (75%) hombres en el Grupo 2. Veintisiete (73%) pacientes que usaban Ringer y 7 (58,3%) pacientes que usaban solución de conservación tenían comorbilidades. No hubo diferencias significativas entre el Grupo 1 y el Grupo 2 con respecto a la isquemia caliente, los tiempos de isquemia fría y los niveles de desajuste (p> 0,05). El valor de creatinina preoperatorio fue significativamente mayor en la solución de conservación (p = 0,003). No hubo diferencia significativa entre los dos grupos en términos de niveles de creatinina en el postoperatorio (p> 0.05).Conclusión: En el trasplante renal vivo, se puede utilizar una solución económica de Ringer en lugar de la costosa solución de conservación para lavar el injerto.

RATIONALE & OBJECTIVE: In kidney transplant recipients (KTRs), a belatacept-based immunosuppressive regimen is associated with beneficial effects on cardiovascular (CV) risk factors compared with calcineurin inhibitor (CNI)-based regimens. Our objective was to compare the calculated CV risk between belatacept and CNI (predominantly tacrolimus) treatments using a validated model developed for KTRs. STUDY DESIGN: Prospective, randomized, open-label, parallel-group, investigator-initiated, international multicenter trial. SETTING & PARTICIPANTS: KTRs aged 18-80 years with a stable graft function (estimated glomerular filtration rate > 20 mL/min/1.73 m2), 3-60 months after transplantation, treated with tacrolimus or cyclosporine A, were eligible for inclusion. INTERVENTION: Continuation with a CNI-based regimen or switch to belatacept for 12 months. OUTCOMES: Comparison of the change in the estimated 7-year risk of major adverse CV events and all-cause mortality, changes in traditional markers of CV health, as well as measures of arterial stiffness. RESULTS: Among the 105 KTRs randomized, we found no differences between the treatment groups in the predicted risk for major adverse CV events or mortality. Diastolic blood pressure, measured both centrally by using a SphygmoCor device and peripherally, was lower after the belatacept treatment than after the CNI treatment. The mean changes in traditional cardiovascular (CV) risk factors, including kidney transplant function, were otherwise similar in both the treatment groups. The belatacept group had 4 acute rejection episodes; 2 were severe rejections, of which 1 led to graft loss. LIMITATIONS: The heterogeneous baseline estimated glomerular filtration rate and time from transplantation to trial enrollment in the participants. A limited study duration of 1 year. CONCLUSIONS: We found no effects on the calculated CV risk by switching to the belatacept treatment. Participants in the belatacept group had not only l

Objectives: Prophylactic acid suppression with proton pump inhibitors or H2 receptor antagonists is often administered after kidney transplantation. The association of proton pump inhibitors or H2 receptor antagonists with acute rejection, hypomagnesemia, and graft loss in kidney transplant recipients is not well established. Materials and Methods: We performed a retrospective cohort study of 302 kidney transplant recipients at one center (57% male; mean age 35.5±11.2 years) with more than six months post-transplant follow-up. Recipients were grouped according to gastric acid prophylaxis: only proton pump inhibitors (n=179), only H2 receptor antagonists (n=42), proton pump inhibitors and H2 receptor antagonists (n=55), and nonusers (n=26). The primary outcome was biopsy-proven acute rejection. Graft loss and hypomagnesemia were defined as secondary outcomes. Results: Nonusers were younger and mostly under steroid-free immunosuppression compared to other study groups (p = 0.030 and p = 0.009, respectively). The primary outcome was similar across study groups (p = 0.266). Kaplan-Meier analyses also demonstrated similar 10-year graft survival rates: 95.5% for proton pump inhibitors, 97.6% for H2 receptor antagonists, 100% for proton pump inhibitors/H2 receptor antagonists, and 96.2% for nonusers (p = 0.275). Conclusions: Using proton pump inhibitors is not associated with acute rejection or graft loss but may cause mild hypomagnesemia in kidney transplant recipients., Objetivos: La supresión profiláctica de la secreción de ácido gástrico con inhibidores de la bomba de protones o antagonistas de los receptores H2 se administra a menudo después del trasplante renal. La asociación de los inhibidores de la bomba de protones o los antagonistas de los receptores H2 con el rechazo agudo, la hipomagnesemia y la pérdida del injerto en los receptores de trasplante renal no está bien establecida. Materiales y Métodos: Realizamos un estudio de cohorte retrospectivo de 302 receptores de trasplante renal en un centro (57% varones; edad media 35,5±11,2 años) con más de seis meses de seguimiento postrasplante. Los receptores se agruparon según la profilaxis del ácido gástrico: solo inhibidores de la bomba de protones (n=179), solo antagonistas de los receptores H2 (n=42), inhibidores de la bomba de protones y antagonistas de los receptores H2 (n=55) y no usuarios (n=26). El resultado primario fue el rechazo agudo comprobado por biopsia. La pérdida del injerto y la hipomagnesemia se definieron como resultados secundarios. Resultados:Los no usuarios eran más jóvenes y en su mayoría bajo inmunosupresión libre de esteroides en comparación con otros grupos de estudio (p = 0,030 y p = 0,009, respectivamente). El resultado primario fue similar entre los grupos de estudio (p = 0,266). Los análisis de Kaplan-Meier también demostraron tasas similares de supervivencia del injerto a 10 años: 95,5 % para los inhibidores de la bomba de protones, 97,6 % para los antagonistas de los receptores H2, 100 % para los inhibidores de la bomba de protones/antagonistas de los receptores H2 y 96,2 % para los no usuarios (p = 0,275). Conclusiones: El uso de inhibidores de la bomba de protones no se asocia con rechazo agudo o pérdida del injerto, pero puede causar hipomagnesemia leve en receptores de trasplante renal.

Objective: To identify the causes for exclusion of living kidney donors at a third-level hospital in northwestern Mexico. Materials and methods: An observational, cross-sectional, descriptive and retrospective study, in which the medical records of candidates for living kidney donation were evaluated from January 1, 2019 to December 31, 2021. Results: Out of the 30 selected records, only 6.6 % (2) were chosen as donors, i.e., the rejection rate of the potential candidates was 93.3 % (28). The average age was 40.7 years; when divided into age groups, it was observed that 7.44 % were ≤ 39 years, 5.31 % were ≥ 50 years and 4.25 % were in the 40–49 age range. The main pathologies that caused the rejection of living donors were chronic diseases such as unknown renal disease, obesity, diabetes mellitus, systemic hypertension and heart diseases, which accounted for 60.7 %. The desire to donate was more frequent among blood relatives than non-blood relatives. In the case of blood relatives, i.e., siblings, parents, children, uncles, aunts, etc., 64.2 % were rejected, while 34.7 % of non-blood relatives, including spouses and friends, were rejected. Conclusions: Based on the body mass index (BMI), the results showed that overweight and obesity were the main causes of exclusion, a situation that is consistent with the Mexican epidemiological profile. The number of living donors at our center has been reduced because most of the population is not healthy and has obesity, which affects the willingness to be a candidate for living kidney donation., Objetivo: Identificar las causas de exclusión de los donantes renales vivos en un centro hospitalario de tercer nivel en el noroeste de México. Materiales y métodos: Estudio de tipo observacional, transversal, descriptivo, retrospectivo. Se realizó la evaluación de los expedientes clínicos de los candidatos vivos para donación renal, que abarcó el periodo comprendido entre el 1 de enero de 2019 y el 31 de diciembre de 2021. Resultados: De los 30 expedientes seleccionados, solo se eligieron 2 (6,6 %) donadores, es decir, existió un índice de rechazo de 28 (93,3 %) de los potenciales candidatos. La edad promedio fue de 40,7 años; al dividirlos en grupos de edad, se observó que el 7,44 % fueron ≤39 años; el 5,31 %, ≥50 años; y el 4,25 %, de 40 a 49 años. Dentro de las principales patologías que originaron el rechazo del donador vivo se encuentran las enfermedades crónicas, como afección renal desconocida, obesidad, diabetes mellitus, hipertensión arterial sistémica y cardiopatías, que representaron el 60,7 %. El deseo de donar es más frecuente entre consanguíneos que en no consanguíneos. En el caso de los consanguíneos, es decir, hermanos, padres, hijos, tíos, etc., el 64,2 % fue rechazado; en los no consanguíneos, el 34,7 %, que incluía a esposos y amigos. Conclusiones: Los resultados obtenidos sobre el índice de masa corporal (IMC) mostraron que el sobrepeso y la obesidad fueron las principales causas de exclusión, circunstancia que es particular en nuestro país respecto a su perfil epidemiológico. La cantidad de donantes vivos en nuestro centro se redujo porque la mayor parte de la población no es sana, padece obesidad y ello repercute al momento de presentarse como candidato a donante.

Systemic lupus erythematosus (SLE) has a clear prevalence in females. Although there are conflicting data, among males affected by SLE to a higher proportion develop lupus nephritis, with a more severe histological and clinical pattern than in females. More frequently males also present an antiphospholipid syndrome. Males are less likely to achieve clinical remission of lupus nephritis. A sex and gender disparity is also present in all the phases preceding the kidney transplant starting from the referral for eligibility and registration on the active waiting list. There is a perception among healthcare staff that women have a greater degree of fragility and are therefore less eligible for kidney transplantation. Women also encounter obstacles in completing the tests necessary for inclusion on the waiting list and in many Health Care contexts they are less likely to have a transplant. In the field of living transplantation, women represent over half of all donors, while males are predominantly recipients. Long-term patient and graft survival appear superior in women compared to men., Systemic lupus erythematosus (SLE) has a clear prevalence in females. Although there are conflicting data, among males affected by SLE a higher proportion develops lupus nephritis, with a more severe histological and clinical pattern than in females. More frequently males also present an antiphospholipid syndrome. Males are less likely to achieve clinical remission of lupus nephritis. A sex and gender disparity is also present in all the phases preceding the kidney transplant from the referral for eligibility to the registration on the active waiting list. There is a perception among healthcare staff that women have a greater degree of fragility and are therefore less eligible for kidney transplantation. Women also encounter obstacles in completing the tests necessary for inclusion in the waiting list and in many Health Care contexts they are less likely to have a transplant. In the field of living transplantation, women represent over half of all donors, while males are predominantly recipients. Long-term patient and graft survival appears superior in women than in men.

Systemic lupus erythematosus (SLE) has a clear prevalence in females. Although there are conflicting data, among males affected by SLE to a higher proportion develop lupus nephritis, with a more severe histological and clinical pattern than in females. More frequently males also present an antiphospholipid syndrome. Males are less likely to achieve clinical remission of lupus nephritis. A sex and gender disparity is also present in all the phases preceding the kidney transplant starting from the referral for eligibility and registration on the active waiting list. There is a perception among healthcare staff that women have a greater degree of fragility and are therefore less eligible for kidney transplantation. Women also encounter obstacles in completing the tests necessary for inclusion on the waiting list and in many Health Care contexts they are less likely to have a transplant. In the field of living transplantation, women represent over half of all donors, while males are predominantly recipients. Long-term patient and graft survival appear superior in women compared to men., Systemic lupus erythematosus (SLE) has a clear prevalence in females. Although there are conflicting data, among males affected by SLE a higher proportion develops lupus nephritis, with a more severe histological and clinical pattern than in females. More frequently males also present an antiphospholipid syndrome. Males are less likely to achieve clinical remission of lupus nephritis. A sex and gender disparity is also present in all the phases preceding the kidney transplant from the referral for eligibility to the registration on the active waiting list. There is a perception among healthcare staff that women have a greater degree of fragility and are therefore less eligible for kidney transplantation. Women also encounter obstacles in completing the tests necessary for inclusion in the waiting list and in many Health Care contexts they are less likely to have a transplant. In the field of living transplantation, women represent over half of all donors, while males are predominantly recipients. Long-term patient and graft survival appears superior in women than in men.

The Banff Digital Pathology Working Group (DPWG) was established with the goal to establish a digital pathology repository; develop, validate, and share models for image analysis; and foster collaborations using regular videoconferencing. During the calls, a variety of artificial intelligence (AI)-based support systems for transplantation pathology were presented. Potential collaborations in a competition/trial on AI applied to kidney transplant specimens, including the DIAGGRAFT challenge (staining of biopsies at multiple institutions, pathologists visual assessment, and development and validation of new and pre-existing Banff scoring algorithms), were also discussed. To determine the next steps, a survey was conducted, primarily focusing on the feasibility of establishing a digital pathology repository and identifying potential hosts. Sixteen of the 35 respondents (46%) had access to a server hosting a digital pathology repository, with 2 respondents that could serve as a potential host at no cost to the DPWG. The 16 digital pathology repositories collected specimens from various organs, with the largest constituent being kidney (n = 12,870 specimens). A DPWG pilot digital pathology repository was established, and there are plans for a competition/trial with the DIAGGRAFT project. Utilizing existing resources and previously established models, the Banff DPWG is establishing new resources for the Banff community.

Background: Kidney transplantation (KT) offers better quality of life and the best chance at survival, at relatively lower costs, compared to other kidney replacement therapies. Though its uptake is gaining momentum, little is still known about what informed the choice of KT as a treatment modality among post-kidney transplant recipients. Objective: To explore the choice of kidney transplantation as a treatment option among post-kidney transplant recipients at Kenyatta National Hospital. Methods: We conducted an exploratory qualitative study involving fifteen post-kidney transplant recipients at Kenyatta National Hospital’s renal unit recruited using purposive sampling method. In-depth interviews using an interview guide were conducted among the study participants. The interviews were audio-recorded and the data transcribed verbatim. The data was analysed using thematic analysis utilizing NVivo v.11 Software. Results: The study participants were male and female post-kidney transplant recipients, most of whom were aged 30 years and above, had tertiary education level and were married. Health practitioners’ influence on the choice of KT as a treatment option among the participants was through offering information to the participants as to the benefits of and requirements for KT. The dominant personal reason that led to the choice of KT as a treatment option among the participants was desire for better QoL. Help from family and friends, in form of kidney organ donation and financial, psychosocial and informational support was also critical in the participants’ choice of KT as a treatment option. Conclusion: The choice of KT as a treatment option among the participants was influenced by receipt of information about KT, desire for greater QoL and help from family and friends. Recommendation: The hospital’s health practitioners are advised to make educating patients about KT an integral component of the care they offer patients with ESKD in the hospital. Families of patie

Several recent randomized controlled trials (RCTs) have demonstrated the broad clinical application of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in improving kidney and cardiovascular outcomes in patients with native kidney disease. In January 2023, Dapagliflozin became the first SGLT2 inhibitor approved by the Italian Medicines Agency Administration (AIFA) for the treatment of chronic kidney disease (CKD) regardless of diabetic status. However, although these agents have received considerable praise for their cardiovascular and nephroprotective effects among patients with native kidney disease, the safety and efficacy of SGLT2i in the kidney transplant setting are not well-known as safety concerns have led to the exclusion of transplant recipients from all large RCTs. This review will discuss the known mechanisms SGLT2i employ to provide their beneficial effects, the potential benefits and risks of these agents in the context of kidney transplantation, and finally, it will examine the current findings of published literature on SGLT2i use in kidney transplant recipients and propose potential directions for future research., Several recent randomized controlled trials (RCTs) have demonstrated the broad clinical application of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in improving kidney and cardiovascular outcomes in patients with native kidney disease. In January 2023, Dapagliflozin became the first SGLT2 inhibitor approved by the Italian Medicines Agency Administration (AIFA) for the treatment of chronic kidney disease (CKD) regardless of diabetic status. However, although these agents have received considerable praise for their cardiovascular and nephroprotective effects among patients with native kidney disease, the safety and efficacy of SGLT2i in the kidney transplant setting are not well-known as safety concerns have led to the exclusion of transplant recipients from all large RCTs. This review will discuss the known mechanisms SGLT2i employ to provide their beneficial effects, the potential benefits and risks of these agents in the context of kidney transplantation, and finally, it will examine the current findings of published literature on SGLT2i use in kidney transplant recipients and propose potential directions for future research.

Several recent randomized controlled trials (RCTs) have demonstrated the broad clinical application of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in improving kidney and cardiovascular outcomes in patients with native kidney disease. In January 2023, Dapagliflozin became the first SGLT2 inhibitor approved by the Italian Medicines Agency Administration (AIFA) for the treatment of chronic kidney disease (CKD) regardless of diabetic status. However, although these agents have received considerable praise for their cardiovascular and nephroprotective effects among patients with native kidney disease, the safety and efficacy of SGLT2i in the kidney transplant setting are not well-known as safety concerns have led to the exclusion of transplant recipients from all large RCTs. This review will discuss the known mechanisms SGLT2i employ to provide their beneficial effects, the potential benefits and risks of these agents in the context of kidney transplantation, and finally, it will examine the current findings of published literature on SGLT2i use in kidney transplant recipients and propose potential directions for future research., Several recent randomized controlled trials (RCTs) have demonstrated the broad clinical application of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in improving kidney and cardiovascular outcomes in patients with native kidney disease. In January 2023, Dapagliflozin became the first SGLT2 inhibitor approved by the Italian Medicines Agency Administration (AIFA) for the treatment of chronic kidney disease (CKD) regardless of diabetic status. However, although these agents have received considerable praise for their cardiovascular and nephroprotective effects among patients with native kidney disease, the safety and efficacy of SGLT2i in the kidney transplant setting are not well-known as safety concerns have led to the exclusion of transplant recipients from all large RCTs. This review will discuss the known mechanisms SGLT2i employ to provide their beneficial effects, the potential benefits and risks of these agents in the context of kidney transplantation, and finally, it will examine the current findings of published literature on SGLT2i use in kidney transplant recipients and propose potential directions for future research.

Introducción: El trasplante renal se establece como primera opción terapéutica para aquellos pacientes con insuficiencia renal terminal. Desde sus inicios, la técnica se ha perfeccionado, y los resultados son cada vez mejores. No obstante, las complicaciones quirúrgicas siguen presentes, constituyendo una importante fuente de morbimortalidad. Destacan entre las mismas las urológicas (las más frecuentes) y las vasculares (que condicionan una mayor mortalidad y pérdida del injerto). Objetivo: A través de la bibliografía disponible, actualizar los datos sobre complicaciones quirúrgicas urológicas más frecuentes del trasplante renal, sus factores de riesgo, su diagnóstico y su tratamiento. Asimismo, se pretende introducir la perspectiva reciente de la cirugía laparoscópica y la robótica. Método: Se ha realizado una revisión bibliográfica mediante una búsqueda en PubMed de artículos relacionados con las complicaciones quirúrgicas urológicas del trasplante renal de cadáver en los últimos cinco años. Resultados: De manera compatible con revisiones previas, las complicaciones urológicas continúan constituyendo las más frecuentes en el trasplante renal, destacando la fuga o fístula urinaria. Las complicaciones precoces (que aparecen en los tres meses que siguen al trasplante) son las que condicionan esencialmente la mortalidad y la supervivencia del injerto. La cirugía robótica y la laparoscópica se establecen (a falta de más estudios y en caso de reducción de los costes) como una alternativa no inferior a la cirugía abierta. Por último, se identifican factores de riesgo en donantes y receptores que presentan asociaciones estadísticamente significativas con algunas de las complicaciones más frecuentes. Conclusiones: Se deben implementar criterios uniformes que definan las complicaciones urológicas y protocolos de diagnóstico de las mismas para homogeneizar los resultados entre estudios de manera que sean comparables. La investigación en mejores cuidados postrasplante y bioma, Introdución: O transplante renal establécese como a primeira opción terapéutica para os pacientes con insuficiencia renal terminal. Desde os seus inicios, a técnica perfeccionouse, e os resultados son cada vez mellores. Porén, as complicacións cirúrxicas continúan presentes, constituíndo unha importante fonte de morbimortalidade. Destacan entre as mesmas as urolóxicas (as máis frecuentes) e as vasculares (que condicionan unha maior mortalidade e perda do enxerto). Obxectivo: A través da bibliografía dispoñible, actualizar os datos sobre as complicacións cirúrxicas urolóxicas máis frecuentes do transplante renal, os seus factores de risco, diagnóstico e tratamento. Ademais, preténdese introducir a perspectiva recente da cirurxía laparoscópica e a robótica. Método: Realizouse unha revisión bibliográfica mediante unha busca en PubMed de artigos relacionados coas complicacións cirúrxicas urolóxicas do transplante renal de cadáver nos últimos cinco anos. Resultados: De xeito compatible con revisións previas, as complicacións urolóxicas continúan sendo as máis frecuentes no transplante renal, destacando a fuga ou fístula urinaria. As complicacións precoces (que aparecen nos tres primeiros meses postransplante) son as que condicionan esencialmente a mortalidade e a supervivencia do enxerto. A cirurxía robótica e a laparoscópica establécense (a falta de máis estudos e en caso de reducións dos costos) como unha alternativa non inferior á cirurxía aberta. Por último, identifícanse factores de risco en doantes e receptores que presentan asociacións estatisticamente significativas con algunhas das complicacións máis frecuentes. Conclusións: É necesario introducir criterios uniformes que definan as complicacións urolóxicas e protocolos de diagnóstico das mesmas para homoxeneizar os resultados entre estudos de xeito que sexan comparables. A investigación en mellores coidados postransplante e biomarcadores que permitan unha detección precoz das complicacións é esencial para contin

Introduction: End-Stage Renal Disease (ESRD) is a complex clinical-humoral syndrome characterized by irreversible deterioration of renal function with multiple etiologies, typically evolving slowly and progressively, leading to terminal uremia and its associated complications. Objective: To understand the potential complications of kidney transplantation, with particular emphasis on incidence, clinical characteristics, and the potential for effective therapy, which will facilitate analysis for future health studies. Development: Using MESH terms or keywords, we conducted an information search, resulting in 101 initial articles, of which 61 were from Pubmed, 18 from Science Direct, 15 from Google Scholar, and 7 from Scielo. At the end of the process, a reading was conducted where 23 were excluded for duplicates, 11 for being partially relevant, 21 for title or abstract screening, 6 for full text review, and finally, after eliminating 11 that did not meet the inclusion criteria, a total of 34 articles were analyzed. Conclusions: Post-transplant complications are divided into pathological ones such as rejection, infection, CVD, and surgical complications that can be vascular, urological, lymphoceles, and hernias., Introducción: La Enfermedad Renal Crónica Terminal (ERCT) constituye un síndrome clínico-humoral complejo como expresión de un deterioro irreversible de la función renal con múltiples etiologías, que evoluciona habitualmente de manera lenta y progresiva, hasta llegar al estado de uremia terminal, con todas sus complicaciones Objetivo: conocer las posibles complicaciones del trasplante renal, con especial énfasis en la incidencia, las características clínicas y el potencial para una terapia eficaz, la misma que facilitará el análisis para futuros estudios de salud. Desarrollo: Mediante los términos MESH o palabras clave desarrollamos la búsqueda de información, en donde tuvimos como resultado 101 artículos iniciales, de los cuales 61 artículos fueron de Pubmed, 18 de Science direct, 15 de Google académico, 7 de Scielo. Al fin del proceso se realizó a una lectura en donde se excluyeron 23 por duplicados, 11 por parcialmente relevantes, 21 por cribado de título o abstract, 6 por revisión del texto completo, y por último después de eliminar 11 que no cumplieron con los criterios de inclusión quedando un total de 34 artículos que se analizaron. Conclusiones: Las complicaciones post trasplante se dividen en patológicas que son el rechazo, la infección, los ECV, y las complicaciones quirúrgicas que pueden ser vasculares, urológicas, linfoceles y hernias

Introduction: High cardiovascular mortality primarily limits survival following kidney transplantation (KTx). The increased risk is intrinsically connected to cardiac structural and functional abnormalities. LV volumetric imaging measurements are used to quantify this, such as left ventricular ejection fraction (LVEF) and left ventricular end-diastolic volume index (LVEDVi). However, there is an increasing interest in the assessment of myocardial strain. It provides direct information about myocardial function by measuring the deformation of myocardial fibres during the cardiac cycle. An impaired LV diastolic strain is associated with adverse outcomes in end-stage kidney disease (ESKD) patients. Cardiac magnetic resonance imaging (MRI) has emerged as the golden standard for evaluating cardiac structure and function. However, studies investigating the prognostic value of myocardial strain are mainly based on echocardiography, and diastolic strain still needs to be examined in KTx recipients. Aim: It was hypothesized that myocardial strain has the potential to detect early diastolic dysfunction more effectively when compared to LV volumetric measurements. The primary objective of this thesis was to determine whether it is possible to predict all-cause mortality of KTx recipients on cardiac MRI two weeks post-KTx by diastolic strain. Methods: Data from patients included in the Amsterdam Leiden GROningen (ALEGRO) trial were used. Medis Suite MR was used to calculate LV volumetric outcomes and identify deformation of the LV during the cardiac cycle. A MATLAB script was developed to obtain diastolic strain rate outcomes from these data. Kaplan-Meier curves were used for survival analysis and Cox regression analysis was performed to identify independent predictors of survival. Results: 67 patients were included with cardiac MRI at baseline, two weeks post-KTx. The mortality was 27\% (n=18) over a median follow-up of 10 years. Significant differences between su, Technical Medicine

Introduction: In kidney transplantation (KT), the role of the intravascular innate immune system (IIIS) in response to ischemia-reperfusion injury (IRI) is not well-understood. Here, we studied parallel changes in the generation of key activation products of the proteolytic cascade systems of the IIIS following living donor (LD) and deceased donor (DD) transplantation and evaluated potential associations with clinical outcomes. Methods: In a cohort study, 63 patients undergoing LD (n = 26) and DD (n = 37) transplantation were prospectively included. Fifteen DD kidneys were preserved with hypothermic machine perfusion (HMP), and the remaining were cold stored. Activation products of the kallikrein-kinin, coagulation, and complement systems were measured in blood samples obtained systemically at baseline and locally from the transplant renal vein at 1, 10, and 30 minutes after reperfusion. Results: DD kidneys exhibited a prompt and interlinked activation of all 3 cascade systems of IIIS post-reperfusion, indicating a robust and local thrombo-inflammatory response to IRI. In this initial response, the complement activation product sC5b-9 exhibited a robust correlation with other IIIS activation markers and displayed a strong association with short-term and mid-term (24-month) graft dysfunction. In contrast, LD kidneys did not exhibit this thrombo-inflammatory response. The use of HMP was associated with reduced thromboinflammation and preserved mid-term kidney function. Conclusion: Kidneys from DD are vulnerable to a prompt thrombo-inflammatory response to IRI, which adversely affects both short-term and long-term allograft function. Strategies aimed at minimizing graft immunogenicity prior to reperfusion are crucial to mitigate the intricate inflammatory response to IRI.

Latar Belakang: Hemolytic Uremic Syndrome (HUS) adalah bentuk trombotik mikroangiopati yang ditandai dengan trombositopenia, anemia hemolitik mikroangiopati dan gagal ginjal akut, serta dapat terjadi baik pada anak anak maupun orang dewasa. Eculizumab adalah antibodi monoklonal chimeric IgG2/4 yang berpasangan dengan protein komplemen C5 dan digunakan untuk mengobati atau mencegah kekambuhan HUS setelah transplantasi ginjal. Tujuan: Artikel ini bertujuan untuk mengetahui penggunaan eculizumab sebagai pilihan terapi pada pasien HUS yang telah menjalani transplantasi ginjal mengenai dampak dan cara pemberianya. Metode: Tinjauan literatur dari dua database yaitu Google Scholar dan PubMed yang terbit dalam rentang waktu 5 tahun yaitu dari tahun 2018-2023. Hasil: Didapatkan 11 literatur yang membuktikan eculizumab dapat dipertimbangkan sebagai pilihan terapi pada pasien HUS dengan transplantasi ginjal. Dampak eculizumab dapat menurunkan risiko kekambuhan atau timbulnya HUS pasca transplantasi ginjal. Walaupun kebanyakan efek samping pemberian eculizumab tidak serius, meningitis hingga kematian tidak dapat dikesampingkan. Maka dibutuhkan pedoman tatacara penggunaan eculizumab berdasarkan data yang lebih besar untuk mengurangi risiko infeksi dan memangkas biaya., Background: Hemolytic Uremic Syndrome (HUS) is a form of thrombotic microangiopathy characterized by thrombocytopenia, microangiopathic hemolytic anemia and acute renal failure, occur in both children and adults. Eculizumab is a chimeric IgG2/4 monoclonal antibody that pairs with complement protein C5 and is used to treat or prevent relapse of HUS after kidney transplantation. Purpose: This article aims to determine the use of eculizumab as a therapeutic option in HUS patients with kidney transplants and explaining both the clinical effect and the method of administration. Method: Literature review from two databases, namely Google Scholar and PubMed, which were published within the last 5 years, from 2018-2023. Results: There were 11 literatures proving that eculizumab can be considered as a therapeutic option in HUS patients with kidney transplantation. Eculizumab can reduce the risk of recurrence or the emergence of HUS after kidney transplantation. Although most of the side effects of eculizumab are not serious, meningitis and death cannot be ruled out. So guidelines for the use of eculizumab are needed based on larger data to reduce the risk of infection and cost lost.

Background. The aim of this study was to identify trends in total, deceased donor (DD) and living donor (LD) kidney transplantation (KT) rates in European countries. Methods. The European Renal Association (ERA) Registry and the Global Observatory on Donation and Transplantation (GODT) databases were used to obtain the number of KTs in individual European countries between 2010 and 2018. General population counts were obtained from Eurostat or the national bureaus of statistics. The KT rate per million population (p.m.p.) and the average annual percentage change (APC) were calculated. Results. The total KT rate in the 40 participating countries increased with 1.9% annually [95% confidence interval (CI) 1.5, 2.2] from 29.6 p.m.p. in 2010 to 34.7 p.m.p. in 2018, reflecting an increase of 3.4 p.m.p. in the DD-KT rate (from 21.6 p.m.p. to 25.0 p.m.p.; APC 1.9%; 95% CI 1.3, 2.4) and of 1.5 p.m.p. in the LD-KT rate (from 8.1 p.m.p. to 9.6 p.m.p.; APC 1.6%; 95% CI 1.0, 2.3). The trends in KT rate varied widely across European countries. An East-West gradient was observed for DD-KT rate, with Western European countries performing more KTs. In addition, most countries performed fewer LD-KTs. In 2018, Spain had the highest DD-KT rate (64.6 p.m.p.) and Turkey the highest LD-KT rate (37.0 p.m.p.). Conclusions. The total KT rate increased due to a rise in the KT rate from DDs and to a lesser extent from LDs, with large differences between individual European countries.

Renal normothermic machine perfusion (NMP) is an organ preservation method based on the circulation of a warm (35–37 °C) perfusion solution through the renal vasculature to deliver oxygen and nutrients. However, its biological effects on marginal kidneys are unclear. We therefore used mass spectrometry to determine the proteomic profile of kidney tissue and urine from eight organs reconditioned for 120 min using a Kidney Assist device. Biopsies were taken during the pre-implantation histological evaluation (T-1), at the start of back table preparation (T0), and after 60 and 120 min of perfusion (T60, T120). Urine samples were collected at T0 (urine produced in the first 15 min after the beginning of normothermic reperfusion), T30, T60 and T120. Multiple algorithms, support vector machine learning and partial least squares discriminant analysis were used to select the most discriminative proteins during NMP. Statistical analysis revealed the upregulation of 169 proteins and the downregulation of 196 during NMP. Machine learning algorithms identified the top 50 most discriminative proteins, five of which were concomitantly upregulated (LXN, ETFB, NUDT3, CYCS and UQCRC1) and six downregulated (CFHR3, C1S, CFI, KNG1, SERPINC1 and F9) in the kidney and urine after NMP. Latexin (LXN), an endogenous carboxypeptidase inhibitor, resulted the most-upregulated protein at T120, and this result was confirmed by ELISA. In addition, functional analysis revealed that the most strongly upregulated proteins were involved in the oxidative phosphorylation system and ATP synthesis, whereas the downregulated proteins represented the complement system and coagulation cascade. Our proteomic analysis demonstrated that even brief periods of NMP induce remarkable metabolic and biochemical changes in marginal organs, which supports the use of this promising technique in the clinic.

Chronic kidney disease is the non-communicable disease with the highest growth in morbidity and mortality. Renal transplantation (RT) is the first option of renal replacement in end-stage kidney disease (ESKD) and dialysis is an alternative. However, there is no objective quantification of the impact of both options on a patient’s overall survival. The purpose of our study is to assess the potential years of life lost by patients on renal replacement therapy. Methods: Retrospective study cohort conducted from 2008 to 2018 based on autonomic data registry. Results: 11,551 patients included who received renal replacement therapy (RRT) in a range of age from 15 to 94 years. The mean age at the time of onset was 62.7 years, 95% confidence interval (95% CI) (62.4; 63.0). The mortality rate of RRT patients was 42.2%, 95% CI (41.5; 43.3) and the mean age at death was 72.7 years, 95% CI (72.4; 73.1). The number of patients with ESKD treated with RT was 3776, 32.7% of the total, 95% CI (31.8; 33.5). The total amount of years of potential life lost (YPLL) in the entire cohort was 77,831.3 years, 48,010.1 years in men, and 29,821.2 years in women. The mean number of YPLL per patient with RRT was 6.74 years in both sexes, 6.95 years in women, and 6.61 years in men. The mean number of potential years of life lost in dialysis patients was 9.0 years in both sexes, 8.8 years in men, and 9.2 years in women, while among kidney transplant recipients this figure decreased to 2.2 years in both men and women. Conclusions: End-stage chronic kidney disease in renal replacement therapy by dialysis causes an average of 9.0 years of life potentially lost for each patient on dialysis treatment, while having received a kidney transplant reduces this figure by 75.6%.

Influenza is a common respiratory tract infection in solid organ transplant (SOT) recipients. We aimed to investigate the incidence, risk factors, and complications of influenza in a large cohort of kidney and liver transplant recipients over 10 consecutive seasons. We conducted a retrospective study, including 378 liver and 683 kidney transplant recipients who were transplanted from January 1, 2010, to October 1, 2019. The data on influenza were retrieved from MiBa, which is a nationwide database that contains all of the microbiology results in Denmark. Clinical data were retrieved from patient records. Incidence rates and cumulative incidences were calculated, and risk factors were investigated using time-updated Cox proportional hazards models. The cumulative incidence of influenza in the first 5 years posttransplantation was 6.3% (95% CI: 4.7 to 7.9%). Of the 84 influenza positive recipients, 63.1% had influenza A, 65.5% were treated with oseltamivir, 65.5% were hospitalized, and 16.7% developed pneumonia. There were no significant differences in outcomes when comparing patients with influenza A and B. We found no significant effect of same-season influenza vaccination, sex, age, or comorbidities on the risk of acquiring influenza. The incidence of influenza in kidney and liver recipients is high, and 65.5% of infected transplant recipients required hospitalization. We were not able to confirm a reduction in influenza incidence or in the risk of complications associated with vaccination.

Background Kidney transplant recipients (KTRs) have increased risk of human papillomavirus (HPV)-related cancers, including cervical and anal cancer. In this cross-sectional clinical study, we investigated the prevalence of cervical high-risk HPV (hrHPV) and low-risk (lrHPV), risk factors for cervical hrHPV infection, and the prevalence of cervical and anal hrHPV co-infection in KTRs and immunocompetent controls. Methods During 2016–2017, we recruited 125 female KTRs and 125 female immunocompetent controls from one dermatology department (KTRs and controls) and five nephrology departments (KTRs) in Denmark. Liquid-based cervical and anal cytology samples were tested for HPV DNA using the INNO-LiPA test and participants answered a questionnaire on lifestyle. Odds ratios (ORs) were estimated using logistic regression, adjusting for age, lifetime sexual partners, smoking, and (in models concerning anal HPV) receptive anal sex. Results KTRs had higher prevalence of cervical hrHPV than controls (35.5% vs. 18.2; ORadjusted = 2.9, 95% CI, 1.5–5.5). In contrast, the prevalence of lrHPV was similar in KTRs and controls (25.6% vs. 23.1; ORadjusted = 1.2, 95% CI, 0.7‒2.3). KTRs were more likely than controls to have cervical and anal hrHPV co-infection (27.3% vs. 6.6%, ORadjusted = 6.3, 95% CI, 2.7–15.0). Conclusions Female KTRs had high prevalence of cervical hrHPV, and co-infection with anal and cervical hrHPV was common. Our results underline that KTRs are an important target group for preventive efforts against HPV-related diseases., Background: Kidney transplant recipients (KTRs) have increased risk of human papillomavirus (HPV)-related cancers, including cervical and anal cancer. In this cross-sectional clinical study, we investigated the prevalence of cervical high-risk HPV (hrHPV) and low-risk (lrHPV), risk factors for cervical hrHPV infection, and the prevalence of cervical and anal hrHPV co-infection in KTRs and immunocompetent controls. Methods: During 2016–2017, we recruited 125 female KTRs and 125 female immunocompetent controls from one dermatology department (KTRs and controls) and five nephrology departments (KTRs) in Denmark. Liquid-based cervical and anal cytology samples were tested for HPV DNA using the INNO-LiPA test and participants answered a questionnaire on lifestyle. Odds ratios (ORs) were estimated using logistic regression, adjusting for age, lifetime sexual partners, smoking, and (in models concerning anal HPV) receptive anal sex. Results: KTRs had higher prevalence of cervical hrHPV than controls (35.5% vs. 18.2; ORadjusted = 2.9, 95% CI, 1.5–5.5). In contrast, the prevalence of lrHPV was similar in KTRs and controls (25.6% vs. 23.1; ORadjusted = 1.2, 95% CI, 0.7‒2.3). KTRs were more likely than controls to have cervical and anal hrHPV co-infection (27.3% vs. 6.6%, ORadjusted = 6.3, 95% CI, 2.7–15.0). Conclusions: Female KTRs had high prevalence of cervical hrHPV, and co-infection with anal and cervical hrHPV was common. Our results underline that KTRs are an important target group for preventive efforts against HPV-related diseases. (Figure presented.).