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We aimed to investigate the immune responses to homologous and heterologous COVID-19 booster vaccinations in renal transplant recipients (RTRs) and to identify factors affecting these responses. In this prospective multicenter observational study, we measured the antibody kinetics of 90 RTRs using the chemiluminescent microparticle immunoassay method. The mean age of participants was 45.2 ± 11.4 years, with 35.6% being female. On the 42nd day after the first vaccine dose, the median antibody level was 16.7 (IQR 2.5-249.5) AU/mL, and the seropositivity rate was 60% (n = 36). Mycophenolic acid (MFA) (OR: 0.087, 95% CI: 0.024-0.311) and ACE inhibitor use (OR: 0.203, 95% CI: 0.052-0.794) were identified as independent factors affecting seropositivity. Patients who received the Pfizer/BioNTech booster had significantly higher antibody levels compared to those who received the CoronaVac/Sinovac booster (p = 0.021). Additionally, a significantly higher rate of COVID-19 positivity was observed among patients who received the CoronaVac/Sinovac booster (p = 0.031). Heterologous COVID-19 booster vaccination is significantly more effective than homologous inactivated booster vaccination in enhancing immune responses and preventing new infections in RTRs. MFA and ACE inhibitor usage were independent factors affecting seropositivity. Additional COVID-19 vaccine doses are needed in this patient group., (Journal of Medical Virology© 2024 The Author(s). Journal of Medical Virology published by Wiley Periodicals LLC.)

Background: It is thought that the Fracture Risk Assessment Tool (FRAX) score of the World Health Organization (WHO) determines a 10-year fracture risk. This study aimed to investigate the major osteoporotic fracture (MOF) and hip fracture (HF) values determined with the FRAX score and practicality of the FRAX score in kidney transplant recipients (KTRs)., Methods: This study was conducted with 44 female and 59 male KTRs and 100 subjects in the healthy control group. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry. FRAX scores were calculated from baseline information (age, height, weight, BMD of the femur and neck T score, fracture history, glucocorticoid use, smoking status, alcohol consumption, and presence of rheumatoid arthritis)., Results: In KTRs, FRAX score MOF, and FRAX score HF were found to be significantly elevated, whereas the BMD femur T score was determined to be significantly low. No significant relationship was found among the FRAX score MOF and HF and kidney function tests and bone parameters. In the receiver operating characteristic (ROC) analysis, which was performed based on the determination of the FRAX score, the cutoff point was determined as ≥ 3.4 for MOF and ≥ 0.4 for HF., Conclusion: In KTRs, increased FRAX score MOF and HF compared with healthy individuals were determined. FRAX score MOF ≥ 3.4 and HF ≥ 0.4 values indicate high-risk patients for increased fracture risk. The high accuracy rates determined suggest that the use of the FRAX score in KTRs is a valuable method for determining fracture risk., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Beyza Algul Durak reports financial support was provided by Ankara City Hospital Pediatric Nephrology Department. Beyza Algul Durak reports a relationship with Ankara City Hospital Pediatric Nephrology Department that includes: non-financial support. Beyza Algul Durak has a patent pending to Determination of Bone Fracture Risk in Kidney Transplant Recipients with FRAX Score. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Accelerated development of atherosclerosis has been observed in renal transplant recipients (RTRs). Angiopoietin-2 (Ang-2) and vascular endothelial growth factor (VEGF) are vascular enzymes that play important roles in vascular development and angiogenesis., Objective: This study aimed to investigate the relationship between Ang-2 and VEGF and atherosclerosis in RTRs., Design and Setting: This study was conducted at Ankara City Hospital, Turkey., Methods: This cross-sectional study included 36 (37.5%) female and 60 (62.5%) male RTRs. All findings were compared with those of 70 healthy controls. Ultrasonographic measurements of the carotid artery intima-media thickness (CA-IMT) and renal resistive index (RRI) were used as indicators of atherosclerosis., Results: Log10 Ang-2, log10 VEGF, CA-IMT, and RRI levels were significantly higher in patients than in healthy controls. No significant differences were detected in CA-IMT and RRI between those with log10 Ang-2 ≥ 3.53 pg/mL and those with < 3.53 pg/mL. No significant differences were detected in CA-IMT and RRI between those with log10 VEGF ≥ 1.98 pg/mL and those with < 1.98 pg/mL. No correlation was detected between log10 Ang-2 and log10 VEGF, CA-IMT, or RRI., Conclusions: Increased serum angiogenic growth factor levels and increased atherosclerosis development were detected in RTRs compared to healthy individuals. No relationship was observed between angiogenic growth factors and atherosclerosis. This may be due to the decreased synthesis and effect of angiogenic growth factor receptors synthesized from atherosclerotic plaques due to atherosclerosis, which improves after renal transplantation.

Objectives: Thiols play an important role in defense against reactive oxygen species. We aimed to evaluate the relation between oxidative stress, glucose tolerance, and sleep quality in kidney transplant recipients without diabetes., Materials and Methods: We enrolled 95 kidney transplant recipients without diabetes from living and deceased donors with stable allograft function and 60 healthy controls. We included recipients who received a kidney from a living donor with a first-degree relation. Insulin resistance was determined using the Homeostasis Model Assessment score. Native thiol, total thiol, and disulfide levels were measured, and disulfide versus native thiol/total thiol ratios were calculated from all patients. We used the Pittsburg Sleep Quality Index to assess sleeping patterns. According to standard cutoff value of the index (≤5 indicates good quality sleep; >5 indicates poor sleep quality), we stratified kidney transplant recipients as group 1 (Pittsburg Sleep Quality Index ≤5; n = 41) and group 2 (Pittsburg Sleep Quality Index >5; n = 54)., Results: In correlation analysis, Pittsburg Sleep Quality Index was positively correlated with age, the Homeostasis Model Assessment score, body mass index, serum disulfide levels, disulfide/total thiol ratio, and native/total thiol ratio. The Pittsburgh Sleep Quality Index was negatively correlated with total thiol levels. In subgroup analysis, the Homeostasis Model Assessment score, disulfide levels, and disulfide/total thiol and native/total thiol ratios were significantly lower in group 1; however, total thiol level was significantly higher in this group. In multivariate regression analysis, age, the Homeostasis Model Assessment score, disulfide/total thiol ratio, and renal resistivity index were detected as predictors of sleep quality score., Conclusions: Sleep quality moderates oxidative stress identified by thiol-disulfide homeostasis and insulin resistance in renal transplant recipients without diabetes.

Objectives: We evaluated the effects of body composition on graft function and cardiovascular outcomes in normotensive renal transplant recipients., Materials and Methods: In this cross-sectional study, we analyzed ambulatory blood pressure monitoring data from 136 renal transplant recipients with stable allograft function after living related donor transplant. We enrolled 87 normotensive recipients. We analyzed left ventricular mass index, renal resistive index, and body composition of recipients. We divided recipients into 2 groups according to mean lean body mass, defined by bioimpedance analysis, with 38 in group 1 (lean body mass <47 kg) and 49 in group 2 (lean body mass ≥47 kg)., Results: Mean time posttransplant was 35.0 ± 23.3 months. Mean renal resistive index, left ventricular mass index, lean body mass, body mass index, and fat mass were 0.67 ± 0.1, 195.0 ± 118.5 g/m2, 47.3 ± 9.1 kg, 25.9 ± 5.0 kg, and 44.6±10.5 kg,respectively. Lean body mass was positively correlated to sex (r = 0.36, P = .03), body mass index (r = 0.04, P = .416),renalresistive index (r = 0.495, P = .01), and left ventricular mass index (r = 0.713, P = .02) but negatively correlated to serum albumin levels (r=-0.343, P=0.04). Lean body mass was significantly higher in males than in females (P = .03). Patients in group 2 had significantly higher left ventricular mass index (P = .01) and renal resistive index (P = .03). In multiple regression analysis, lean body mass (P = .01) and left ventricular mass index (P = .01) were predictors of renal resistive index., Conclusions: Lean body mass significantly influences left ventricular mass index and renal resistive index. Hence, body composition analysis could be an early predictor of graft function and cardiovascular outcomes in normotensive renal transplant recipients.

Introduction: There is no published study regarding the effects of preventive measures on coronavirus disease 2019 (COVID-19) frequency in renal transplantation recipients. The aim of this study is to reveal the preventive measures taken by renal transplant recipients during the COVID-19 pandemic and whether these measures influence the prevalence of the disease., Materials and Methods: After detecting the first COVID-19 case in Turkey, we briefed all of our renal transplant recipients on preventive measures regarding COVID-19. Two months afterward, a questionnaire was prepared regarding the preventive measures practiced by renal transplant recipients, and patients were asked whether they had any COVID-19 symptoms or had received a COVID-19 diagnosis., Results: Among 132 patients, 68 were surveyed through telephone calls. During this time, 95.5% of patients were in isolation at home except for when seeing to their essential needs. Two (2.9%) patients were hospitalized due to increases in creatinine level and urinary tract infection. All patients have worn masks when going out and stated that they washed their hands more frequently. There was a decrease in the frequency of hospital controls in 79.4% of patients. Although 2 (2.9%) patients had complaints of dysuria and fever, they did not apply to the hospital because they thought hospitals carried risk during the pandemic. One patient had a cough with fever and was admitted to the hospital with suspicion of COVID-19 but tested negative., Discussion: It was determined that renal transplant recipients in our study population meticulously complied with preventive measures and increased the use of masks and hand hygiene practices. As a result, none were infected with severe acute respiratory syndrome coronavirus 2., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Purpose The aim of this study was to evaluate the relationship between Fibroblast Growth Factor-23 (FGF23) serum levels and cardiovascular disease and early graft failure in renal transplant recipients.  Methods This cross-sectional study was conducted on renal transplant recipients followed by our adult kidney transplant clinic. The patients were divided into two groups according to the mean FGF23 levels (mean FGF23 level=71.2 ± 34.6pg/mL). The patients included in the study were classified as Group 1 (FGF23 <71 pg/mL, n= 42) and Group 2 (FGF23 ≥ 71pg/mL, n= 46) and the data was analyzed as a statistical significance between the two groups. The presence of atherosclerosis was determined by a Doppler ultrasound for evaluate the carotid artery intima-media thickness (CA-IMT). Intrarenal Doppler spectra were obtained with same Doppler ultrasound to determine the renal resistivity index (RRI) for evaluate graft renal failure. Results A total of 88 kidney transplantation recipients were included in the study. In the multivariate analysis adjusted for age and gender, the eGFR (β =-0.217, p=0.048), CA-IMT (β =0.318, p=0.009) and RRI (β =0.246, p=0.019) parameters were statistically significant, while the remaining parameters were not statistically significant. In the group analysis, Ca (9.6 ± 0.3 vs. 8.8 ± 0,2, p< 0.05), CA-IMT (0.9 ± 0.2, vs. 0.6 ± 0.3, p< 0.05) and RRI (0.69 ± 0.04 vs. 0.60 ± 0.01, p< 0.05) were significantly higher in the patients in group 2 than the patients in group 1.  Conclusion According to our results, FGF23 can be considered as a descriptive biomarker for cardiovascular prognosis and graft function for patients with kidney transplantation., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Algul Durak et al.)

Introduction: Chronic kidney disease (CKD) is a major health issue worldwide, which leads to end-stage renal failure and cardiovascular events. Neutrophil to lymphocyte ratio (NLR) is a surrogate marker of inflammation and has been widely studied in malignancies, hypertension, heart diseases, and vascular diseases. In this study, we aimed to investigate if NLR represents renal reserve and function after partial or radical nephrectomy., Methods: We conducted a retrospective study consists of patients who had undergone radical/partial nephrectomy in our hospital and/or who admitted to urology and nephrology clinics as an outpatient. Patients were divided into four groups: Group 1 (n =  46): Healthy controls; Group 2 (n =  50): Patients who had undergone unilateral partial nephrectomy; Group 3 (n =  46): Patients who had gone unilateral nephrectomy; Group 4 (n =  82): Patients who had CKD., Results: The mean NLR of each group was as follows: Group 1: 2.14 ± 0.73; Group 2: 3.52 ± 3.74; Group 3: 3.64 ± 3.52, and Group 4: 3.53 ± 2.30. NLR was lower in Group 1 compared to other groups but statistically significant difference was observed only between Group 1 (control) and Group 4 (CKD), 2.14 ± 0.73 versus 3.53 ± 2.30 (p = .005). In non-parametric correlation analysis NLR was found negatively correlated with GFR and positively correlated CKD stage (p = .028 for both correlations)., Conclusions: The NLR may constitute a practical predictor of CKD besides Cr in patients who had undergone partial or radical nephrectomy.