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BACKGROUND: Kidney transplant patients are at high risk for coronavirus disease 2019 (COVID-19)-related mortality. However, limited data are available on longer-term clinical, functional, and mental health outcomes in patients who survive COVID-19.METHODS: We analyzed data from adult kidney transplant patients in the European Renal Association COVID-19 Database who presented with COVID-19 between February 1, 2020, and January 31, 2021.RESULTS: We included 912 patients with a mean age of 56.7 (±13.7) y. 26.4% were not hospitalized, 57.5% were hospitalized without need for intensive care unit (ICU) admission, and 16.1% were hospitalized and admitted to the ICU. At 3 mo follow-up survival was 82.3% overall, and 98.8%, 84.2%, and 49.0%, respectively, in each group. At 3 mo follow-up biopsy-proven acute rejection, need for renal replacement therapy, and graft failure occurred in the overall group in 0.8%, 2.6%, and 1.8% respectively, and in 2.1%, 10.6%, and 10.6% of ICU-admitted patients, respectively. Of the surviving patients, 83.3% and 94.4% reached their pre-COVID-19 physician-reported functional and mental health status, respectively, within 3 mo. Of patients who had not yet reached their prior functional and mental health status, their treating physicians expected that 79.6% and 80.0%, respectively, still would do so within the coming year. ICU admission was independently associated with a low likelihood to reach prior functional and mental health status.CONCLUSIONS: In kidney transplant recipients alive at 3-mo follow-up, clinical, physician-reported functional, and mental health recovery was good for both nonhospitalized and hospitalized patients. Recovery was, however, less favorable for patients who had been admitted to the ICU.

Artículo escrito por un elevado número de autores, solo se referencian el que aparece en primer lugar, y los autores pertenecientes a la UAM, Data on renal replacement therapy (RRT) for end-stage renal disease were collected by the European Renal Association (ERA) Registry via national and regional renal registries in Europe and countries bordering the Mediterranean Sea. This article provides a summary of the 2019 ERA Registry Annual Report, including data from 34 countries and additional age comparisons. Methods: Individual patient data for 2019 were provided by 35 registries and aggregated data by 17 registries. Using these data, the incidence and prevalence of RRT, the kidney transplantation activity and the survival probabilities were calculated. In 2019, a general population of 680.8 million people was covered by the ERA Registry. Overall, the incidence of RRT was 132 per million population (p.m.p.). Of these patients, 62% were men, 54% were ≥65 years of age and 21% had diabetes mellitus as primary renal disease (PRD), and 84% had haemodialysis (HD), 11% had peritoneal dialysis (PD) and 5% had pre-emptive kidney transplantation as an initial treatment modality. The overall prevalence of RRT on 31 December 2019 was 893 p.m.p., with 58% of patients on HD, 5% on PD and 37% living with a kidney transplant. The overall kidney transplant rate was 35 p.m.p. and 29% of the kidney grafts were from a living donor. The unadjusted 5-year survival probability was 42.3% for patients commencing dialysis, 86.6% for recipients of deceased donor grafts and 94.4% for recipients of living donor grafts in the period 2010-14. When comparing age categories, there were substantial differences in the distribution of PRD, treatment modality and kidney donor type, and in the survival probabilities, The ERA Registry is funded by the ERA. This article was written by R. Boenink et al. on behalf of the ERA Registry, which is an official body of the ERA. In addition, S.B. reports personal fees from AstraZeneca, outside the submitted work; A.D.-S. reports personal fees from Astellas and Fresenius, outside the submitted work; F.L. reports personal fees from MeditesPharma, outside the submitted work; R.P. reports grants from The Iceland Centre for Research, Landspitali University Hospital Research Fund and University of Iceland Research Fund, outside the submitted work; P.F. reports grants from Finska läkaresällskapet and Liv och Hälsa, outside the submitted work; M.F.S.R. reports personal fees from Baxter and Fresenius, outside the submitted work; A.O. reports grants from Sanofi, and personal fees from Astellas, AstraZeneca, Amicus, Bayes, Fresenius Medical Care and Idorsia, outside the submitted work; and K.J.J. reports grants from ERA, during the conduct of the study

Estimert glomerulær filtrasjonshastighet er etablert som klinisk rutinemål for nyrefunksjon, men estimatet har begrensninger og kan ikke brukes i alle kliniske situasjoner. Estimert glomerulær filtrasjonshastighet har en høy variasjonskoeffisient, og ved avvik i pasientens høyde, vekt eller muskelmasse kan estimatet bli unøyaktig. Hvis det er avgjørende å ha et nøyaktig mål på nyrefunksjonen, kan man måle glomerulær filtrasjonshastighet ved hjelp av en eksogen substans.

Aims: Tacrolimus is a cornerstone in modern immunosuppressive therapy after kidney transplantation. Tacrolimus dosing is challenged by considerable pharmacokinetic variability, both between patients and over time after transplantation, partly due to variability in cytochrome P450 3A (CYP3A) activity. The aim of this study was to assess the value of the endogenous CYP3A marker 4β‐hydroxycholesterol (4βOHC) for tacrolimus dose individualization early after kidney transplantation. Methods: Data were obtained from 79 adult kidney transplant recipients who contributed a total of 625 4βOHC measurements and 1999 tacrolimus whole blood concentrations during the first 2 months after transplantation. The relationships between 4βOHC levels and individual estimates of tacrolimus apparent plasma clearance (CL/Fplasma) at different time points after transplantation were investigated using scatterplots and population pharmacokinetic modelling. Results: There was no significant correlation between pre‐transplant 4βOHC levels and tacrolimus CL/Fplasma the first week (r = 0.19 [95% CI −0.03‐0.40]) or between 4βOHC and tacrolimus CL/Fplasma 1 week (r = 0.20 [−0.11‐0.47]), 4 weeks (r = 0.21 [−0.07‐0.46]) or 2 months (r = 0.24 [−0.03‐0.48]) after transplantation (P ≥ 0.06). In the population analysis, time‐varying 4βOHC was not a statistically significant covariate on tacrolimus CL/Fplasma, neither in terms of absolute values (P = 0.11) nor in terms of changes from baseline (P = 0.17). 4βOHC values increased between 1 week and 2 months after transplantation (median change +57% [IQR +22–83%], P < 0.001), indicating increasing CYP3A activity. Contradictorily, tacrolimus CL/Fplasma decreased over the same period (median change −13% [IQR −3 to −26%], P < 0.001). Conclusions: 4βOHC does not appear to have a clinical potential to improve individualization of tacrolimus doses early after kidney transplantation. This research has been accepted and published in the British Journal of Clinical Pharmacology. © 2017 Wiley

Det opprinnelige formålet med oppgaven var å validere en ny metode som kunne tas i bruk ved rutinemessig blodbankarbeid på St. Olavs Hospital i Trondheim. Daratumumab (DARA) er et legemiddel som benyttes ved behandling av myelomatosepasienter. Blodtransfusjon til myelomatosepasienter behandlet med anti-CD38 (DARA), er en utfordring fordi anti-CD38 vil kunne gi falske positive svar ved antistoffscreening og utvidet forlik. Dithiothreitol (DTT)-behandling av erytrocytter er en metode som kan redusere DARA-interferens, og dermed sikre trygg utlevering av blodprodukter til denne pasientgruppen. Ettersom den praktiske delen av oppgaven ikke var mulig å gjennomføre, ble oppgaven omgjort til en litteraturgjennomgang av tema. Formålet med oppgaven ble endret fra å validere en ny metode, til å gjennomgå litteratur som kunne svare på om det var hensiktsmessig for St. Olavs å innføre DTT-metoden. For å innhente litteratur ble det benyttet ulike søkemotorer, tilsendt litteratur fra St. Olavs, og kontaktpersoner ved andre sykehus. Søkemotoren PubMed ble primært brukt til innhenting av litteratur, med Google og Google Scholar som supplerende søkemotorer. Tilsendt litteratur fra fagpersoner inneholdt prosedyrer og presentasjoner som ikke lå offentlig tilgjengelig på nett. I tillegg ble det tatt kontakt med Oslo Universitetssykehus, Stavanger Universitetssjukehus og Haukeland sykehus. Den internasjonale valideringsstudien i 2016, utført av amerikanske forskere, konkluderte med at DTT-metoden kunne innføres verden over. Andre studier støttet opp om at DTTmetoden er en robust og enkel metode. En viktig faktor var også at å innføre metoden kunne redusere kostnadene betraktelig. I senere tid er det også blitt undersøkt om DARA-interferens kan elimineres med andre metoder, slik som BMAP eller ved bruk av DARA-Fab. DTTmetoden har allerede vært i bruk i en rekke andre norske sykehus. DTT-metoden gjør det tryggere å gi blodprodukter til myelomatosepasienter behandlet med DARA. DTT-metoden er bedre enn feno- og genotyping på flere områder. På bakgrunn av våre funn kan vi anbefale å innføre DTT-metoden for St. Olavs. En metodevalidering bør gjøres i forkant, slik som allerede planlagt. En alternativ mulighet er å undersøke andre metoder som også bevarer alle andre antigener på erytrocyttene. The initial purpose of this bachelor thesis was to validate a new method to be used at the blood bank at St. Olavs Hospital in Trondheim, Norway. Daratumumab (DARA), is used as treatment for multiple myeloma patients, and interferes with routine blood bank testing, such as antibody screening and crossmatching. Dithiothreitol (DTT)-treatment of erythrocytes is a method that can mitigate the DARA interference, and therefore make transfusion of blood safer for multiple myeloma patients treated with DARA. The aim of this thesis was changed after starting the writing proses. Instead of validating the DTT-method for St. Olavs Hospital, we conducted a literature review of the topic. Based on the review we were able to conclude on whether it is appropriate for St. Olavs Hospital to adopt the DTT-method. We used three different search engines to collect literature. In addition, we received literature from experts on the subject and contacting people from other hospitals. Primary the search engine PubMed was used for collecting literature, with supplementary content from Google and Google Scholar. The literature we received from experts on the subject was mainly procedure manuals and presentations that were not available on the internet. We also got in contact with Oslo Universitetssykehus, Stavanger Universitetssjukehus and Haukeland sykehus. All information was collected through the internet since libraries were closed during this period. In 2016, the international validation study concluded that the DTT-method is a great approach to reduce DARA interference worldwide. This was confirmed by other studies. The studies concluded that DTT would reduce costs while keeping good specificity and sensitivity in blood bank testing. It has also been examined if other methods could eliminate DARA interference. Examples is the use of DARA-Fab fragments or the BMAP-method. Other blood banks in Norway has already taken the DTT-method in use. The DTT-method makes it possible to distribute suitable blood products for multiple myeloma patients treated with DARA. DTT-treatment is safer than pheno- and genotyping. Based on the literature review and interviews, we conclude that the DTT-method is appropriate for St. Olavs Hospital to introduce. A validation of the method should be done as initially planned. However, one could also consider other methods that also preserves other antigens on the erythrocytes.