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Purpose: The evaluation of latent tuberculosis infection (LTBI) is recommended before kidney transplantation. The interferon-γ release assay has been reported to be more specific than the tuberculin skin test (TST) for detecting LTBI. We compared the TST and QuantiFERON-TB Gold In-Tube test (QFT-GIT) for the screening for LTBI and determined the agreement between the two tests in renal transplant recipients before transplantation. Methods: Adult patients who were evaluated for renal transplantation between May 2010 and February 2012 at Severance Hospital in South Korea were prospectively enrolled. We performed TST and QFT-GIT. Results: Of the 126 patients, 23 (19.3 %) had positive TST results and 53 (42.1 %) had positive QFT-GIT results. Agreement between the TST and QFT-GIT was fair (κ = 0.26, P < 0.001). The induration size of TST was significantly correlated with a positive rate of QFT-GIT ( P = 0.015). Age (odds ratio [OR] 1.08, 95 % confidence interval [CI] 1.03-1.13, P = 0.003), male sex (OR 2.73, 95 % CI 1.17-6.38, P = 0.021), and risk for LTBI (OR 4.62, 95 % CI 1.15-18.64, P = 0.031) were significantly associated with positive QFT-GIT results. For positive TST results, only male sex was associated (OR 4.29, 95 % CI 1.40-13.20, P = 0.011). Conclusion: The positivity for QFT-GIT was higher than the positivity for TST, and QFT-GIT more accurately reflected the risk for LTBI. However, a further longitudinal study is needed in order to confirm that the QFT-GIT test can truly predict the development of TB after renal transplantation. [ABSTRACT FROM AUTHOR]

Abstract: Background: Mycophenolate mofetil (MMF) is routinely used at a fixed dose, but several factors interact to alter the blood level of mycophenolic acid (MPA), resulting in toxicity or treatment failure. Methods: From January 2007 to December 2008, 85 kidney transplantation patients were given a fixed dose of 1.5 g/d of MMF in 12-hour intervals. MPA trough levels were measured on postoperative 1 week, 1 month, 3 months, 6 months, and 12 months. Results: Mean age of patients was 41 years. Thirty five cases were deceased donor kidney transplantations and 50 were living donor kidney transplantations. Mean trough levels of MPA were 1.04 μg/mL, 1.09 μg/mL, 1.28 μg/mL, 1.83 μg/mL, and 1.69 μg/mL at postoperative 1 week, 1 month, 3 months, 6 months, and 12 months, respectively. Mean trough levels of the subgroup of patients taking cyclosporine were 0.82 μg/mL, 0.94 μg/mL, 1.01 μg/mL, 1.56 μg/mL, and 1.46 μg/mL (n = 36). Mean trough levels of the subgroup of patients taking tacrolimus were 1.19 μg/mL, 1.21 μg/mL, 1.56 μg/mL, 2.13 μg/mL, and 2.20 μg/mL (n = 49). At 12 months, 31% of all patients experienced one or more opportunistic infections. Eight patients (9.4%) had cytomegalovirus infections, 14 patients (16.5%) had polyomavirus infections, and four patients (4.7%) had parvovirus infections. Ten patients (11.8%) experienced biopsy-proven acute rejection during the follow-up period. Conclusion: Mean MPA trough levels of patients on 1.5 g/d of MMF reached 1.0 μg/mL within 1 week. Thirty one percent of patients experienced opportunistic infections, and 11.8% of patients had biopsy-proven acute rejections. [Copyright &y& Elsevier]

Abstract: Background: Certain donor characteristics are known to be associated with increased graft failure in kidney transplantation. Methods: We analyzed donor and recipient characteristics among deceased donor kidney transplantations performed from 1995 to 2008, excluding multiorgan, pediatric, and retransplantation cases. Results: The 299 cases underwent analysis of donor characteristics including age, sex, cause of brain death, history of hypertension, cardiac arrest, length of intensive care unit (ICU) stay, last serum creatinine before organ donation, and change in creatinine during ICU stay. Cox regression analysis identified two factors that independently predicted a greater risk of graft failure. The factors were cerebrovascular accident (CVA) as the cause of brain death and a history of hypertension. Compared with donors with causes of brain death other than CVA, the adjusted hazard ratios for graft failure (GF) of kidneys from donors with CVA were 2.37 (1.34–4.19, P = .003). The hazard ratio for GF was 2.42 (1.34–4.37, P = .003) for kidneys from those with a history of hypertension. Donors meeting the criteria of CVA as the cause of brain death or history of hypertension comprised 43% of transplantation cases (128/299). Donor age and last serum creatinine level, which were identified in previous studies to show higher risks of graft failure, did not apply in our patients. Conclusion: Donor history of hypertension and CVA as the cause of brain death were significant determinants of reduced graft survival after DDKT in Korea. [Copyright &y& Elsevier]

Abstract: Background: It is generally recognized that living donor kidney transplantation (LDKT) grafts are superior to deceased donor kidney transplantation (DDKT) grafts. We compared survival and functional outcomes of LDKT and DDKT grafts. Methods: Among 1000 kidneys transplanted from 1995 to 2008, we selected grafts surviving >5 years, excluding pediatric, multi-organ transplantation, and retransplantations (n = 454). Results: There were 179 kidneys from deceased donors and 275 from living donors. Recipients showed no difference in age, gender, or cause of renal failure. Donors were younger in the DDKT group (30.6 vs 38.5 years; P < .05). There were more male donors in the DDKT group (73.2% vs 54.5%; P < .05). Deceased donors showed a greater mean number of HLA mismatches (4.2 vs 2.7; P < .05). Death-censored graft survival at 10 years showed no difference (DDKT 88.9% vs LDKT 88.9%; P = .99). Mean serum creatinine at 5 years was 1.41 mg/dL for DDKT and 1.44 mg/dL for LDKT (P = .75). Mean estimated glomerular filtration rate at 5 years was 67.8 mL/min/1.73 m2 for DDKT and 62.1 mL/min/1.73 m2 for LDKT (P = .23). Twenty-three DDKT grafts (12.8%) and 47 LDKT grafts (17.1%) experienced acute rejection episodes (P = .22). DDKT recipients showed more cases of viral and bacterial infections compared with LDKT recipients (viral, 11.7% vs 2.2% [P < .05]; bacterial, 21.8% vs 7.3% [P < .05]). Conclusion: Among kidney grafts surviving >5 years, there was no difference in survival or serum creatinine levels at 5 and 10 years between DDKT and LDKT grafts. [Copyright &y& Elsevier]