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3. Live donor kidney transplantation. Situation analysis and roadmap

Author

de la Oliva Valentín, María, Hernández, Domingo, Crespo, Marta, Mahillo, Beatriz, Beneyto, Isabel, Martínez, Itziar, Kanter, Julia, Calderari, Elena, Gil-Vernet, Salvador, Sánchez, Sara, Agüera, Maria Luisa, Bernal, Gabriel, de Santiago, Carlos, Díaz-Corte, Carmen, Díaz, Cándido, Espinosa, Laura, Facundo, Carme, Fernández-Lucas, Milagros, Ferreiro, Tamara, García-Erauzkin, Gorka, García-Alvarez, Teresa, Fraile, Pilar, González-Rinne, Ana, González-Soriano, María José, González, Esther, Gutiérrez-Dalmau, Alex, Jiménez, Carlos, Lauzurica, Ricardo, Lorenzo, Inmaculada, Martín-Moreno, Paloma L., Moreso, Francesc, de Gracia, María Carmen, Pérez-Flores, Isabel, Ramos-Verde, Ana, Revuelta, Ignacio, Rodríguez-Ferrero, María Luisa, Ruiz, Juan Carlos, Sánchez-Sobrino, Beatriz, and Domínguez-Gil, Beatriz

Published
2022
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4. Trasplante renal de donante vivo. Análisis de situación y hoja de ruta

Author

Valentín, María de la Oliva, Hernández, Domingo, Crespo, Marta, Mahillo, Beatriz, Beneyto, Isabel, Martínez, Itziar, Kanter, Julia, Calderari, Elena, Gil-Vernet, Salvador, Sánchez, Sara, Agüera, Maria Luisa, Bernal, Gabriel, de Santiago, Carlos, Díaz-Corte, Carmen, Díaz, Cándido, Espinosa, Laura, Facundo, Carme, Fernández-Lucas, Milagros, Ferreiro, Tamara, García-Erauzkin, Gorka, García-Alvarez, Teresa, Fraile, Pilar, González-Rinne, Ana, González-Soriano, María José, González, Esther, Gutiérrez-Dalmau, Alex, Jiménez, Carlos, Lauzurica, Ricardo, Lorenzo, Inmaculada, Martín-Moreno, Paloma L., Moreso, Francesc, de Gracia, María Carmen, Pérez-Flores, Isabel, Ramos-Verde, Ana, Revuelta, Ignacio, Rodríguez-Ferrero, María Luisa, Ruiz, Juan Carlos, Sánchez-Sobrino, Beatriz, and Domínguez-Gil, Beatriz

Published
2022
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6. Sevelamer Use and Mortality in People with Chronic Kidney Disease Stages 4 and 5 Not on Dialysis

Author

Molina, Pablo, primary, Molina, Mariola D., additional, Carrero, Juan J., additional, Escudero, Verónica, additional, Torralba, Javier, additional, Castro-Alonso, Cristina, additional, Beltrán, Sandra, additional, Vizcaíno, Belén, additional, González-Moya, Mercedes, additional, Kanter, Julia, additional, Sancho-Calabuig, Asunción, additional, Bover, Jordi, additional, and Górriz, José L., additional

Published
2023
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8. Sevelamer Use and Mortality in People with Chronic Kidney Disease Stages 4 and 5 Not on Dialysis

Author

Universidad de Alicante. Departamento de Matemáticas, Molina, Pablo, Molina Vila, Mariola D., Carrero, Juan, Escudero, Verónica, Torralba, Javier, Castro-Alonso, Cristina, Beltrán, Sandra, Vizcaíno, Belén, González-Moya, Mercedes, Kanter, Julia, Sancho-Calabuig, Asunción, Bover, Jordi, Górriz, José L., Universidad de Alicante. Departamento de Matemáticas, Molina, Pablo, Molina Vila, Mariola D., Carrero, Juan, Escudero, Verónica, Torralba, Javier, Castro-Alonso, Cristina, Beltrán, Sandra, Vizcaíno, Belén, González-Moya, Mercedes, Kanter, Julia, Sancho-Calabuig, Asunción, Bover, Jordi, and Górriz, José L.

Abstract

Rationale and objective: Data suggest that non-calcium-based binders, and specifically sevelamer, may lead to lower rates of death when compared with calcium-based binders in end-stage renal disease (ESRD) patients. However, the association between sevelamer use and mortality for those with non-dialysis-dependent chronic kidney disease (NDD-CKD) patients has been uncertain. Study design: Our research is presented in a prospective cohort study. Setting and participants: A total of 966 participants with NDD-CKD stages 4–5 were enrolled in the PECERA study from 12 centers in Spain. Exposure: The participants were treated with sevelamer. Outcome: This study yielded all-cause and cardiovascular mortality outcomes. Analytical approach: We conducted an association analysis between mortality and sevelamer use with time-dependent Cox proportional hazards models. Results: After a median follow-up of 29 months (IQR: 13–36 months), death occurred in 181 participants (19%), with cardiovascular (n = 95, 53%) being the leading cause of death. In a multivariable model, the adjusted hazard ratios (HRs) for patients under sevelamer treatment were 0.44 (95% CI, 0.22 to 0.88) and 0.37 (95% CI, 0.18 to 0.75) for all-cause and cardiovascular mortality, respectively, compared with those of untreated patients. Limitations: Some limitations include potential confusion via indication bias; causal statements about these associations cannot be made due to the observational nature of this study. Conclusions: In this prospective NDD-CKD cohort study, the administration of sevelamer was independently associated with lower all-cause and cardiovascular mortality, suggesting that non-calcium-based phosphate binders might be the first-line therapy for phosphate lowering in this population. Further interventional studies clarifying the risks and benefits of phosphate binders in NDD-CKD are warranted.

Published
2023

9. Live donor kidney transplantation. Situation analysis and roadmap

Author

Valentín, María de la Oliva, Hernández, Domingo, Crespo, Marta, Mahillo, Beatriz, Beneyto, Isabel, Martínez, Itziar, Kanter, Julia, Calderari, Elena, Gil-Vernet, Salvador, Sánchez, Sara, Agüera, Maria Luisa, Bernal, Gabriel, de Santiago, Carlos, Díaz-Corte, Carmen, Díaz, Cándido, Espinosa, Laura, Facundo, Carme, Fernández-Lucas, Milagros, Ferreiro, Tamara, García-Erauzkin, Gorka, García-Alvarez, Teresa, Fraile, Pilar, González-Rinne, Ana, González-Soriano, María José, González, Esther, Gutiérrez-Dalmau, Alex, Jiménez, Carlos, Lauzurica, Ricardo, Lorenzo, Inmaculada, Martín-Moreno, Paloma L, Moreso, Francesc, de Gracia, María Carmen, Pérez-Flores, Isabel, Ramos-Verde, Ana, Revuelta, Ignacio, Rodríguez-Ferrero, María Luisa, Ruiz, Juan Carlos, Sánchez-Sobrino, Beatriz, and Domínguez-Gil, Beatriz

Subjects
Proceso de donación de vivo, Living donation process, Self-assessment of the living donation process, Graft Survival, Trasplante renal de donante vivo, Living donation evolution, Living donor kidney transplantation, Kidney, Autoevaluación del proceso de donación de vivo, Kidney Transplantation, Chronic kidney disease treatment, Benchmarking, Optimización de la donación de vivo, Optimization of living kidney donation, Nephrology, Living Donors, Humans, Kidney Failure, Chronic, Evolución donación de vivo, Tratamiento de la enfermedad renal crónica avanzada
Abstract

Living donor kidney transplantation (LDKT) is the best treatment option for end stage renal disease in terms of both patient and graft survival. However, figures on LDKT in Spain that had been continuously growing from 2005 to 2014, have experienced a continuous decrease in the last five years. One possible explanation for this decrease is that the significant increase in the number of deceased donors in Spain during the last years, both brain death and controlled circulatory death donors, might have generated the false idea that we have coped with the transplant needs. Moreover, a greater number of deceased donor kidney transplants have caused a heavy workload for the transplant teams. Furthermore, the transplant teams could have moved on to a more conservative approach to the information and assessment of patients and families considering the potential long-term risks for donors in recent papers. However, there is a significant variability in the LDKT rate among transplant centers and regions in Spain independent of their deceased donor rates. This fact and the fact that LDKT is usually a preemptive option for patients with advanced chronic renal failure, as time on dialysis is a negative independent factor for transplant outcomes, lead us to conclude that the decrease in LDKT depends on other factors. Thus, in the kidney transplant annual meeting held at ONT site in 2018, a working group was created to identify other causes for the decrease of LDKT in Spain and its relationship with the different steps of the process. The group was formed by transplant teams, a representative of the transplant group of the Spanish Society of Nephrology (SENTRA), a representative of the Spanish Society of Transplants (SET) and representatives of the Spanish National Transplant Organization (ONT). A self-evaluation survey that contains requests about the phases of the LDKT processes (information, donor work out, informed consent, surgeries, follow-up and human resources) were developed and sent to 33 LDKT teams. All the centers answered the questionnaire. The analysis of the answers has resulted in the creation of a national analysis of strengths, weaknesses, opportunities, threats (SWOT) of the LDKT program in Spain and the development of recommendations targeted to improve every step of the donation process. The work performed, the conclusions and recommendations provided, have been reflected in the following report: Spanish living donor kidney transplant program assessment: recommendations for optimization. This document has also been reviewed by a panel of experts, representatives of the scientific societies (Spanish Society of Urology (AEU), Spanish Society of Nephrology Nursery (SEDEN), Spanish Society of Immunology (SEI/GETH)) and the patient association ALCER. Finally, the report has been submitted to public consultation, reaching ample consensus. In addition, the transplant competent authorities of the different regions in Spain have adopted the report at institutional level. The work done and the recommendations to optimize LDKT are summarized in the present manuscript, organized by the different phases of the donation process. (C) 2021 Sociedad Espanola de Nefrologia. Published by Elsevier Espana, S.L.U.

Published
2022
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11. Novel in-home COVID-19 vaccination program for vulnerable populations using public-private collaboration

Author

Zhou, Megan S., primary, Attia, Cyrus, additional, Barnes, Melynda, additional, Chen, Tina, additional, Chlada, Katie, additional, Doukas, Mel, additional, John, Julia, additional, Kanter, Julia, additional, Kim, Dayna, additional, Qualliotine, Kerry, additional, Stein, Jillian, additional, Stern, Kevin, additional, and Broffman, Lauren, additional

Published
2022
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12. Effect of Steroid Withdrawal on the Appearance of De Novo Donor-Specific HLA Antibodies in Kidney Transplant Recipients: A Prospective, Randomized, Controlled, Parallel Group Study. Preliminary Results

Author

Vazquez, Teresa, Alonso-Titos, Juana, Gamez, Juan Pablo, Esteban, Pedro Ruiz, Caballero, Abelardo, Lopez, Veronica, Palma, Eulalia, Leon, Myriam, Cobo, Maria Angeles, Cruzado, Josep Maria, Sellares, Joana, Torres, Armando, Kanter, Julia, and Hernandez, Domingo

Published
2018
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13. Trasplante renal de donante vivo. Análisis de situación y hoja de ruta

Author

Oliva Valentín, María de la, Hernández, Domingo, Crespo, Marta, Mahillo, Beatriz, Beneyto, Isabel, Martínez, Itziar, Kanter, Julia, Calderari, Elena, Gil-Vernet, Salvador, Sánchez, Sara, Agüera, María Luisa, Bernal, Gabriel, De Santiago, Carlos, Díaz-Corte, Carmen, Díaz, Cándido, Espinosa, Laura, Facundo, Carme, Fernández-Lucas, Milagros, Ferreiro, Tamara, Ruiz San Millán, Juan Carlos, and Universidad de Cantabria

Subjects
Benchmarking, Optimización de la donación de vivo, Proceso de donación de vivo, Trasplante renal de donante vivo, Autoevaluación del proceso de donación de vivo, Evolución donación de vivo, Tratamiento de la enfermedad renal crónica avanzada
Abstract

El trasplante renal de donante vivo (TRDV) es la opción terapéutica con las mejores expectativas de supervivencia para el injerto y para el paciente con insuficiencia renal terminal; sin embargo, este tipo de trasplantes ha experimentado un descenso progresivo en los últimos años en España. Entre las posibles explicaciones del descenso de actividad se encuentra la coincidencia en el tiempo con un aumento en el número de donantes renales fallecidos, tanto por muerte encefálica como por asistolia controlada, que podría haber generado una falsa impresión de ausencia de necesidad del TRDV. Además, la disponibilidad de un mayor número de riñones para trasplante habría supuesto un incremento en la carga de trabajo de los profesionales que pudiera enlentecer los procesos de donación en vida. Otro posible argumento radica en un posible cambio de actitud hacia posturas más conservadoras a la hora de informar a pacientes y a familiares acerca de esta opción terapéutica, a raíz de los artículos publicados respecto al riesgo de la donación a largo plazo. Sin embargo, existe una importantísima variabilidad en la actividad entre centros y comunidades autónomas, no explicada por el volumen de trasplante procedente de otros tipos de donante. Este dato, unido a que la indicación de donación renal en vida se realiza de manera mayoritaria en situación de enfermedad renal crónica avanzada (ERCA) y que el tiempo en diálisis es un factor pronóstico negativo respecto a la supervivencia postrasplante, permite concluir que el descenso depende además de otros factores. Por este motivo, en la reunión anual de equipos de trasplante renal, celebrada en la sede de la Organización Nacional de Trasplantes (ONT) en 2018, se constituyó un grupo de trabajo formado por equipos de trasplante renal, el grupo de trasplantes de la Sociedad Española de Nefrología (SEN) (SENTRA), la Sociedad Española de Trasplantes (SET) y la ONT, con el objetivo de identificar otras causas que condicionaron el descenso de la actividad de este tipo de trasplantes en España y su posible relación con la gestión del proceso de donación de vivo. El grupo de trabajo diseñó un cuestionario de autoevaluación, que fue cumplimentado por las 33 unidades de trasplante renal de donante vivo activas en España. El cuestionario contiene preguntas sobre las diferentes fases del proceso de donación de vivo: información inicial, estudio del donante vivo e información de los riesgos, consentimiento, recursos humanos (RRHH), nefrectomía, trasplante y seguimiento posterior. El análisis de las respuestas ha dado como resultado la creación de un análisis de debilidades, amenazas, fortalezas y oportunidades (DAFO) del programa a nivel nacional y ha permitido elaborar recomendaciones específicas dirigidas a mejorar cada una de las fases del proceso de donación en vida. El documento, denominado Análisis de situación del trasplante renal de donante vivo y hoja de ruta ha sido también revisado por un panel de expertos en TRDV, representantes de varias sociedades científicas implicadas (Asociación Española de Urología [AEU], Sociedad Española de Enfermería Nefrológica [SEDEN], Sociedad Española de Inmunología [SEI/GETH]), el Grupo de Trabajo Enfermedad Renal Crónica Avanzada (ACERCA), la Asociación de Pacientes para la Lucha Contra la Enfermedad Renal (ALCER) y sometido posteriormente a consulta pública. Tras incluir las mejoras sugeridas, el documento final ha sido adoptado institucionalmente en el Consejo Interterritorial de Trasplantes (CIT) del Sistema Nacional de Salud. El trabajo realizado y las recomendaciones para optimizar el TRVD se describen a lo largo del presente artículo, organizados por los diferentes apartados del proceso de donación. Living donor kidney transplantation (LDKT) is the best treatment option for end stage renal disease in terms of both patient and graft survival. However, figures on LDKT in Spain that had been continuously growing from 2005 to 2014, have experienced a continuous decrease in the last five years. One possible explanation for this decrease is that the significant increase in the number of deceased donors in Spain during the last years, both brain death and controlled circulatory death donors, might have generated the false idea that we have coped with the transplant needs. Moreover, a greater number of deceased donor kidney transplants have caused a heavy workload for the transplant teams. Furthermore, the transplant teams could have moved on to a more conservative approach to the information and assessment of patients and families considering the potential long-term risks for donors in recent papers. However, there is a significant variability in the LDKT rate among transplant centers and regions in Spain independent of their deceased donor rates. This fact and the fact that LDKT is usually a preemptive option for patients with advanced chronic renal failure, as time on dialysis is a negative independent factor for transplant outcomes, lead us to conclude that the decrease in LDKT depends on other factors. Thus, in the kidney transplant annual meeting held at ONT site in 2018, a working group was created to identify other causes for the decrease of LDKT in Spain and its relationship with the different steps of the process. The group was formed by transplant teams, a representative of the transplant group of the Spanish Society of Nephrology (SENTRA), a representative of the Spanish Society of Transplants (SET) and representatives of the Spanish National Transplant Organization (ONT). A self-evaluation survey that contains requests about the phases of the LDKT processes (information, donor work out, informed consent, surgeries, follow-up and human resources) were developed and sent to 33 LDKT teams. All the centers answered the questionnaire. The analysis of the answers has resulted in the creation of a national analysis of strengths, weaknesses, opportunities, threats (SWOT) of the LDKT program in Spain and the development of recommendations targeted to improve every step of the donation process. The work performed, the conclusions and recommendations provided, have been reflected in the following report: Spanish living donor kidney transplant program assessment: recommendations for optimization. This document has also been reviewed by a panel of experts, representatives of the scientific societies (Spanish Society of Urology (AEU), Spanish Society of Nephrology Nursery (SEDEN), Spanish Society of Immunology (SEI/GETH)) and the patient association ALCER. Finally, the report has been submitted to public consultation, reaching ample consensus. In addition, the transplant competent authorities of the different regions in Spain have adopted the report at institutional level. The work done and the recommendations to optimize LDKT are summarized in the present manuscript, organized by the different phases of the donation process.

Published
2022

14. Randomized Controlled Trial Assessing the Impact of Tacrolimus Versus Cyclosporine on the Incidence of Posttransplant Diabetes Mellitus

Author

Torres, Armando, Hernández, Domingo, Moreso, Francesc, Serón, Daniel, Burgos, María Dolores, Pallardó, Luis M., Kanter, Julia, Díaz Corte, Carmen, Rodríguez, Minerva, Díaz Gómez, Joan Manuel, Silva, Irene, Valdes, Francisco, Fernández-Rivera, Constantino, Osuna, Antonio, Gracia Guindo, María C., Gómez Alamillo, Carlos, Ruiz, Juan C., Marrero Miranda, Domingo, Pérez-Tamajón, Lourdes, Rodríguez, Aurelio, González-Rinne, Ana, Alvarez, Alejandra, Perez-Carreño, Estefanía, de la Vega Prieto, María José, Henriquez, Fernando, Gallego Samper, Roberto, Salido, Eduardo, Porrini, Esteban, and Universitat Autònoma de Barcelona

Subjects
Cyclosporin A, Steroid withdrawal, Renal transplantation, Posttransplant hyperglycemia, Posttransplant diabetes, Tacrolimus
Abstract

Despite the high incidence of posttransplant diabetes mellitus (PTDM) among high-risk recipients, no studies have investigated its prevention by immunosuppression optimization. We conducted an open-label, multicenter, randomized trial testing whether a tacrolimus-based immunosuppression and rapid steroid withdrawal (SW) within 1 week (Tac-SW) or cyclosporine A (CsA) with steroid minimization (SM) (CsA-SM), decreased the incidence of PTDM compared with tacrolimus with SM (Tac-SM). All arms received basiliximab and mycophenolate mofetil. High risk was defined by age >60 or >45 years plus metabolic criteria based on body mass index, triglycerides, and high-density lipoprotein-cholesterol levels. The primary endpoint was the incidence of PTDM after 12 months. The study comprised 128 de novo renal transplant recipients without pretransplant diabetes (Tac-SW: 44, Tac-SM: 42, CsA-SM: 42). The 1-year incidence of PTDM in each arm was 37.8% for Tac-SW, 25.7% for Tac-SM, and 9.7% for CsA-SM (relative risk [RR] Tac-SW vs. CsA-SM 3.9 [1.2-12.4; P = 0.01]; RR Tac-SM vs. CsA-SM 2.7 [0.8-8.9; P = 0.1]). Antidiabetic therapy was required less commonly in the CsA-SM arm (P = 0.06); however, acute rejection rate was higher in CsA-SM arm (Tac-SW 11.4%, Tac-SM 4.8%, and CsA-SM 21.4% of patients; cumulative incidence P = 0.04). Graft and patient survival, and graft function were similar among arms. In high-risk patients, tacrolimus-based immunosuppression with SM provides the best balance between PTDM and acute rejection incidence.

Published
2021

15. Clinical Relevance of Corticosteroid Withdrawal on Graft Histological Lesions in Low-Immunological-Risk Kidney Transplant Patients

Author

Hernández, Domingo, Alonso-Titos, Juana, Vázquez, Teresa, León, Myriam, Caballero, Abelardo, Cobo, María Angeles, Sola, Eugenia, López Jiménez, Verónica, Ruiz-Esteban, Pedro, Cruzado, Josep María, Sellarés, Joana, Moreso, Francesc, Manonelles, Anna, Torío, Alberto, Cabello, Mercedes, Delgado-Burgos, Juan, Casas, Cristina, Gutiérrez, Elena, Jironda, Cristina, Kanter, Julia, Seron, Daniel, Torres, Armando, Universitat Autònoma de Barcelona, [Hernández,D, Alonso-Titos,J, Vázquez,T, Sola,E, López,V, Ruiz-Esteban,P, Cabello,M, Delgado-Burgos,J, Casas,C, Gutiérrez,E, Jironda,C] Nephrology Department, Hospital Regional Universitario de Málaga, University of Málaga, IBIMA, REDinREN (RD16/0009/0006), Málaga, Spain. [León,M] Pathology Department, Hospital Regional Universitario de Malaga, IBIMA, REDinREN (RD16/0009/0006), Málaga, Spain. [Caballero,A, Torío,A] Immunology Department, Hospital Regional Universitario de Málaga, University of Málaga, IBIMA, REDinREN (RD16/0009/0006), Málaga, Spain. [Cobo,MA, Torres,A] Nephrology Department, Hospital Universitario de Canarias, Instituto de Tecnologías Biomédicas-Universidad La Laguna, REDinREN (RD16/0009/0031), Tenerife, Spain. [Cruzado,JM, Manonelles,A] Nephrology Department, Hospital Universitari de Bellvitge, University of Barcelona, IDIBELL, REDinREN (RD16/0009/0003), Barcelona, Spain. [Sellarés,J, Moreso,F, Serón,D] Nephrology Department, Hospital Universitari Valld’Hebron, Universitat Autonoma, Barcelona, REDinREN (RD16/0009/0030), Barcelona, Spain. [Kanter,J] Nephrology Department, Hospital Universitario Dr. Peset, Valencia, Spain., This study was funded by grants from the Instituto de Salud Carlos III, Madrid, Spain (ICI14/0016, PI17/02043, CM19-00210, and REDinREN Network, RD16/0009/0006, RD16/0009/0003, RD16/0009/0030 and RD16/0009/0031), FONDOS FEDER and the Spanish Society of Transplanta tion. We also appreciate support from Astellas Pharma Inc. with a grant via the Andalusian Society of Solid Organ Transplantation (SATOT).

Subjects
Protocol biopsy, corticosteroids withdrawal, medicine.medical_treatment, Biopsy, 030232 urology & nephrology, Trasplantament renal, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Renal Replacement Therapy::Kidney Transplantation [Medical Subject Headings], 030230 surgery, Gastroenterology, Kidney transplant, Anatomy::Body Regions::Transplants::Allografts [Medical Subject Headings], Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings], Kidney transplantation, Low immunological risk, 0302 clinical medicine, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Biopsy [Medical Subject Headings], subclinical inflammation, Trasplante de riñón, chronic graft histological changes, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Evaluation Studies as Topic::Clinical Trials as Topic::Controlled Clinical Trials as Topic::Randomized Controlled Trials as Topic [Medical Subject Headings], Adrenocortical hormones, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Evaluation Studies as Topic::Clinical Trials as Topic::Clinical Trials, Phase IV as Topic [Medical Subject Headings], Immunosuppression, General Medicine, Presión sanguínea, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Biological Therapy::Immunomodulation::Immunotherapy::Immunosuppression [Medical Subject Headings], Chronic graft histological changes, Corticosteroids withdrawal, Blood pressure, Corticosteroid, Medicine, medicine.symptom, rejection, Biòpsia, kidney transplant, medicine.medical_specialty, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies::Prospective Studies [Medical Subject Headings], medicine.drug_class, Inflammation, Rejection, Article, 03 medical and health sciences, Internal medicine, Phenomena and Processes::Circulatory and Respiratory Physiological Phenomena::Cardiovascular Physiological Phenomena::Hemodynamics::Blood Pressure [Medical Subject Headings], medicine, protocol biopsy, Clinical significance, Borderline lesions, Corticoesteroides, Subclinical inflammation, Inflamación, business.industry, Chemicals and Drugs::Hormones, Hormone Substitutes, and Hormone Antagonists::Hormones::Adrenal Cortex Hormones [Medical Subject Headings], Corticosteroides, Tacrolimus, Terapia de inmunosupresión, Clinical trial, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Evaluation Studies as Topic::Clinical Trials as Topic::Multicenter Studies as Topic [Medical Subject Headings], low immunological risk, Rechazo, business, Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Inflammation [Medical Subject Headings], Chemicals and Drugs::Organic Chemicals::Lactones::Macrolides::Tacrolimus [Medical Subject Headings], borderline lesions
Abstract

The impact of corticosteroid withdrawal on medium-term graft histological changes in kidney transplant (KT) recipients under standard immunosuppression is uncertain. As part of an open-label, multicenter, prospective, phase IV, 24-month clinical trial (ClinicalTrials.gov, NCT02284464) in low-immunological-risk KT recipients, 105 patients were randomized, after a protocol-biopsy at 3 months, to corticosteroid continuation (CSC, n = 52) or corticosteroid withdrawal (CSW, n = 53). Both groups received tacrolimus and MMF and had another protocol-biopsy at 24 months. The acute rejection rate, including subclinical inflammation (SCI), was comparable between groups (21.2 vs. 24.5%). No patients developed dnDSA. Inflammatory and chronicity scores increased from 3 to 24 months in patients with, at baseline, no inflammation (NI) or SCI, regardless of treatment. CSW patients with SCI at 3 months had a significantly increased chronicity score at 24 months. HbA1c levels were lower in CSW patients (6.4 ± 1.2 vs. 5.7 ± 0.6%, p = 0.013) at 24 months, as was systolic blood pressure (134.2 ± 14.9 vs. 125.7 ± 15.3 mmHg, p = 0.016). Allograft function was comparable between groups and no patients died or lost their graft. An increase in chronicity scores at 2-years post-transplantation was observed in low-immunological-risk KT recipients with initial NI or SCI, but CSW may accelerate chronicity changes, especially in patients with early SCI. This strategy did, however, improve the cardiovascular profiles of patients.

Published
2021

16. Impact of HLA Mismatching on Early Subclinical Inflammation in Low-Immunological-Risk Kidney Transplant Recipients

Author

Hernández, Domingo, Vázquez, Teresa, Alonso-Titos, Juana, León, Myriam, Caballero, Abelardo, Cobo, María Angeles, Sola, Eugenia, López Jiménez, Verónica, Ruiz-Esteban, Pedro, Cruzado, Josep María, Sellarés, Joana, Moreso, Francesc, Manonelles, Anna, Torio, Alberto, Cabello, Mercedes, Delgado-Burgos, Juan, Casas, Cristina, Gutiérrez, Elena, Jironda, Cristina, Kanter, Julia, Seron, Daniel, Torres, Armando, Universidad Autònoma de Barcelona, [Hernández,D, Vázquez,T, Alonso-Titos,J, Sola,E, López,V, Ruiz-Esteban,P, Cabello,M, Delgado-Burgos,J, Casas,C, Gutiérrez,E, Jironda,C] Nephrology Department, Hospital Regional Universitario de Málaga, University of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), REDinREN (RD16/0009/0006), Málaga, Spain. [León,M] Pathology Department, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga (IBIMA), REDinREN (RD16/0009/0006), Málaga, Spain. [Caballero,A, Torio,A] Immunology Department, Hospital Regional Universitario de Málaga, University of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), REDinREN (RD16/0009/0006), Málaga, Spain. [Cobo,MA, Torres,A] Nephrology Department, Instituto de Tecnologías Biomédicas-Universidad La Laguna, Hospital Universitario de Canarias, REDinREN (RD16/0009/0031), Tenerife, Spain. [Cruzado,JM, Manonelles,A, ] Nephrology Department, Hospital Universitari de Bellvitge, University of Barcelona, IDIBELL, REDinREN (RD16/0009/0003), Barcelona, Spain. [Sellarés,J, Moreso,F, Serón,D] Nephrology Department, Hospital Universitari Valld’Hebron, Universitat Autonoma, Barcelona, REDinREN (RD16/0009/0030), Barcelona, Spain. [Kanter,J] Nephrology Department, Hospital Universitario Dr. Peset, Valencia, Spain., This study was funded by grants from the Instituto de Salud Carlos III, Madrid, Spain (ICI14/0016, PI17/02043, CM19-00210, and REDinREN Network, RD16/0009/0006, RD16/0009/0003, RD16/0009/0030 and RD16/0009/0031), FONDOS FEDER and Spanish Society of Transplantation. We also appreciate support from Astellas Pharma Inc. with a grant via the Andalusian Society of Solid Organ Transplantation (SATOT).

Subjects
Biopsy, 030232 urology & nephrology, Trasplantament renal, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Renal Replacement Therapy::Kidney Transplantation [Medical Subject Headings], Persons::Persons::Occupational Groups::Health Personnel::Physicians [Medical Subject Headings], 030230 surgery, Logistic regression, Anatomy::Body Regions::Transplants::Allografts [Medical Subject Headings], Gastroenterology, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Probability::Risk::Risk Factors [Medical Subject Headings], Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings], Kidney transplantation, 0302 clinical medicine, subclinical inflammation, Trasplante de riñón, Medicine, medicine.diagnostic_test, Confounding, General Medicine, Inflamació, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Models, Statistical::Logistic Models [Medical Subject Headings], Funcionamiento retardado del injerto, Chemicals and Drugs::Biological Factors::Antigens::Antigens, Surface::Histocompatibility Antigens::HLA Antigens [Medical Subject Headings], medicine.medical_specialty, low-immunological risk, kidney transplantation, Human leukocyte antigen, Tacrolimus, Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Delayed Graft Function [Medical Subject Headings], Article, 03 medical and health sciences, Internal medicine, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Diagnostic Techniques and Procedures::Clinical Laboratory Techniques::Cytological Techniques::Cytodiagnosis::Biopsy [Medical Subject Headings], Risk factor, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Sensitivity and Specificity::ROC Curve [Medical Subject Headings], Inflammation, Inflamación, business.industry, HLA compatibility, Curva ROC, Delayed graft function, medicine.disease, ROC curve, Clinical trial, Biopsia, Antígenos HLA, business, Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Inflammation [Medical Subject Headings], Banff criteria, Chemicals and Drugs::Organic Chemicals::Lactones::Macrolides::Tacrolimus [Medical Subject Headings]
Abstract

The impact of human leukocyte antigen (HLA)-mismatching on the early appearance of subclinical inflammation (SCI) in low-immunological-risk kidney transplant (KT) recipients is undetermined. We aimed to assess whether HLA-mismatching (A-B-C-DR-DQ) is a risk factor for early SCI. As part of a clinical trial (Clinicaltrials.gov, number NCT02284464), a total of 105 low-immunological-risk KT patients underwent a protocol biopsy on the third month post-KT. As a result, 54 presented SCI, showing a greater number of total HLA-mismatches (p = 0.008) and worse allograft function compared with the no inflammation group (48.5 ± 13.6 vs. 60 ± 23.4 mL/min, p = 0.003). Multiple logistic regression showed that the only risk factor associated with SCI was the total HLA-mismatch score (OR 1.32, 95%CI 1.06–1.64, p = 0.013) or class II HLA mismatching (OR 1.51, 95%CI 1.04–2.19, p = 0.032) after adjusting for confounder variables (recipient age, delayed graft function, transfusion prior KT, and tacrolimus levels). The ROC curve illustrated that the HLA mismatching of six antigens was the optimal value in terms of sensitivity and specificity for predicting the SCI. Finally, a significantly higher proportion of SCI was seen in patients with &gt, 6 vs. ≤6 HLA-mismatches (62.3 vs. 37.7%, p = 0.008). HLA compatibility is an independent risk factor associated with early SCI. Thus, transplant physicians should perhaps be more aware of HLA mismatching to reduce these early harmful lesions.

Published
2021

18. P1082COMPARISON OF THE REMOVAL OF PROTEIN-BOUND TOXINS AND LARGE MIDDLE MOLECULES WITH HIGH-FLUX PMMA AND MEDIUM CUT-OFF DIALYZERS

Author

Molina, Pablo, primary, Peiró, Julio, primary, Martínez-Gómez, María Amparo, primary, Vizcaíno, Belén, primary, Gonzã¡lez Moya, Mercedes, primary, Esteller, Cristina, primary, Beltrán, Sandra, primary, Kanter, Julia, primary, Pérez-Zafra, Erika, primary, Alcover, Silvia, primary, Pantoja, Jonay, primary, Sancho Calabuig, Asunción, primary, Estañ, Nuria, primary, Climente, Mónica, primary, and Pallardó, Luis M, primary

Published
2020
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21. Diagnosis and management of asymptomatic bacteriuria in kidney transplant recipients

Author

Coussement, Julien, Maggiore, Umberto, Manuel, Oriol, Scemla, Anne, López-Medrano, Francisco, Nagler, Evi, Aguado, José María, Abramowicz, Daniel, Adams, Brigitte, Agnelli, Caroline, Ailioaie, Oana, Akan, Hamdi, Amrouche, Lucile, Andrés, Amado, Anglicheau, Dany, Arnouts, Paul, Baas, Marije, Balgradean, Cristian, Bammens, Bert, Battaglia, Yuri, Baudoux, Thomas, Berto, Bert, Binet, Isabelle, Bistrup, Claus, Bonofiglio, Renzo, Bosmans, Jean-Louis, Bouatou, Yassine, Bouvier, Nicolas, Braconnier, Philippe, Bredewold, Edwin, Broeders, Nilufer, BRUNET, Philippe, Buchler, Matthias, Budde, Klemens, Buron, Fanny, Burtey, Stephane, Buscaroli, Andrea, Büttner, Stefan, Byrne, Catherine, Caldara, Rossana, Cassuto, Elisabeth, Catalano, Concetta, Cavaille, Guilhem, Corbel, Alice, Couzi, Lionel, Crespo, Marta, Daga, Sunil, Debellé, Frederic, Dedinska, Ivana, Devine, Paul, Dickenmann, Michael, Dratwa, Max, Drgona, Lubos, Durlik, Magdalena, Egidi, Maria Francesca, Errasti, Pedro, Etienne, Isabelle, Fariñas, María Carmen, Fehr, Thomas, Fernández-Ruiz, Mario, Founta, Paraskevi, Fourtounas, Konstantinos, Frangou, Eleni, Frimat, Luc, Furian, Luc, Garjau, Maria, Garrigue, Valérie, Gatault, Philippe, Geddes, Colin, Gerlinger, Paul, Gheuens, Eric, Ghisdal, Lidia, Gibbs, Paul, Giral, Magali, Girerd, Sophie, Golshayan, Dela, Gompou, Athina, Grossi, Paolo Antonio, Guglielmetti, Gabriele, Guirado, Luis, Hadaya, Karine, Hazzan, Marc, Helbert, Mark, Hellemans, Rachel, Heller, Katharina, Heemann, Uwe, Henckes, Manu, Hernandez, Domingo, Hertig, Alexandre, Hiesse, Christian, Hilbrands, Luuk, Hilton, Rachel, Hirzel, Cédric, Horcajada, Juan Pablo, Hougardy, Jean-Michel, Huynh-Do, Uyen, Idrizi, Alma, Ismaili, Khalid, Jiménez, Carlos, Jourde-Chiche, Noemie, Kamar, Nassim, Kaminski, Hannah, Kanter, Julia, Karras, Alexandre, Kemlin, Delphine, Kes, Petar, Kianda, Mireille, Klinger, Maria, Knight, Simon, Koneth, Irene, Krrashi, Anita, Kuypers, Dirk, Langlois, Anne, Lang, Philippe, Lauzurica, Ricardo, Le Moine, Alain, Lebeaux, David, Legendre, Christophe, Lemy, Anne, Len, Oscar, Liakopoulos, Vassilios, Lichodziejewska-Niemierko, Monika, Yague, Maria, Lopau, Kai, Madhoun, Philippe, Magott-Procelewska, Maria, Malik, Shafi, Montero, Anna Manonelles, Marchini, Marc, Marega, Alessandra, Mariat, Maria, Mark, Mark, Martin, Pierre-Yves, Martín, Leyre, Martín, Paloma Leticia, Massart, Annick, Matignon, Marie, Maurel, Stéphane, Mazuecos, Auxiliadora, Melexopoulou, Christina, Melilli, Edoardo, Merino, Esperanza, Mesic, Enisa, Messa, Piergiorgio, Michalak, Magdalena, Minetti, Enrico, Miserlis, Grigorios, Montejo, Miguel, Moriconi, Diego, Mottola, Clément, Mourad, Georges, Mueller, Thomas, Muñoz, Patricia, Nabokow, Alexander, Naesens, Maarten, Nikodimopoulou, Maria, Oberbauer, Rainer, Olmedo, María, Olsburgh, Jonathon, Oniscu, Gabriel, Øzbay, Lara Aygen, Palmisano, Alessandra, Papagianni, Aikaterini, Papasotiriou, Mario, Parodi, Angelica, Parry, Rob, Pascual, Julio, Flores, Isabel Pérez, Pérez-Sáez, María, Peruzzi, Licia, Petit-Hoang, Camille, Phelan, Paul, Pillebout, Evangeline, Piotti, Giovanni, Pipeleers, Lissa, Pleros, Christos, Popoola, Joyce, Pretagostini, Renzo, Psimenou, Erasmia, Puig, Josep, Rafat, Cédric, Bloudickova, Silvie Rajnochova, Bushljetikj, Irena Rambabova, Ratkovic, Marina, Redondo, Dolores, Reischig, Tomas, Robert, Thomas, Ferrero, Luis, Rroji, Merita, Rutkowski, Przemyslaw, Rydzewska-Rosolowska, Alicja, Sabé, Núria, Sahali, Dil, Salzberger, Bernd, San-Juan, Rafael, Sobrino, Beatriz Sánchez, Sandrini, Silvio, Santos, Lídia, Sava, Roxana, Schaub, Stefan, Schikowski, Johan, Schvartz, Betoul, Sester, Urban, Silva, Jose Tiago, Snanoudj, Renaud, Somenzi, Danio, Sørensen, Søren, Spanos, Georgios, Steiger, Jürg, Suwelack, Barbara, Theodoropoulou, Eleni, Thervet, Eric, Thorban, Stefan, Tognarelli, Giuliana, Tournay, Yasmina, Tricot, Leïla, Tulissi, Patrizia, Vacher-Coponat, Henri, Valerio, Maricela, Van Der Meijden, W, Van Hamersvelt, Henk, Van Laecke, Steven, Vandivinit, Alain, Vanholder, Raymond, Veroux, Massimiliano, Viklicky, Ondrej, Vigo, Emanuela, Viscoli, Claudio, Watschinger, W, Weekers, W, Welberry Smith, W, Martin, W, Zeneli, Nereida, Zervos, Angelos, Zibar, Lada, Zuber, Julien, Zukunft, Bianca, Nephrology, Department Infections Diseases, Université Libre de Bruxelles [Bruxelles] (ULB), Azienda Ospedaliero-Universitaria di Parma, Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV), Réseau CENTAURE, Service des maladies infectieuses et tropicales [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Service Néphrologie et transplantation rénale Adultes [CHU Necker], CHU Necker - Enfants Malades [AP-HP], Bases moléculaires de la réponse aux xénobiotiques (U775 (IFR95)), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Institut d’Électronique, de Microélectronique et de Nanotechnologie (IEMN) - UMR 8520 (IEMN), Centre National de la Recherche Scientifique (CNRS)-Université de Lille-Université Polytechnique Hauts-de-France (UPHF)-Ecole Centrale de Lille-Université Polytechnique Hauts-de-France (UPHF)-Institut supérieur de l'électronique et du numérique (ISEN), Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Department of Nephrology, Humboldt Universität zu Berlin, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Chirurgie urologique et transplantation rénale [Hôpital de la Conception - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital de la Conception [CHU - APHM] (LA CONCEPTION ), Centre recherche en CardioVasculaire et Nutrition (C2VN), Institut National de la Recherche Agronomique (INRA)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de néphrologie, Hôpital Pasteur [Nice] (CHU), Hôpital de Brabois, CHU de Nancy, Vandoeuvre-lès-Nancy, Service de Néphrologie-transplantation-dialyse [Bordeaux], CHU Bordeaux [Bordeaux], Laboratoire des interactions plantes micro-organismes (LIPM), Centre National de la Recherche Scientifique (CNRS)-Institut National de la Recherche Agronomique (INRA), CHU Rouen, Normandie Université (NU), Unit Infectious Diseases, Hospital 12 de Octubre, Service de Néphrologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de Pédiatrie spécialisée, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie, Centre de Recherche en Transplantation et Immunologie (U1064 Inserm - CRTI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Université de Lille, Department of Pulmonary Medicine, Tampere University Hospital, Urgences néphrologiques et transplantation rénale [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Tenon [APHP], Service de néphrologie (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Swiss Transplantation Cohort Study, University of Basel (Unibas), Department of Nephrology and Hypertension, and Department of Clinical Research, University of Bern, Centro de Investigación en Ciencias del Mar y Limnología (CIMAR), Universidad Nacional de Costa Rica, Service de Néphrologie - Hypertension Artérielle Dialyse - Transplantation, CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Université de Bordeaux (UB), Hôpital Européen Georges Pompidou [APHP] (HEGP), Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania [Philadelphia], Department of Nephrology and Renal Transplantation, University Hospitals Leuven [Leuven]-Catholic University Leuven, Université Grenoble Alpes - UFR Médecine (UGA UFRM), Université Grenoble Alpes (UGA), Imagine - Institut des maladies génétiques (IMAGINE - U1163), Service de néphrologie adultes [CHU Necker], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Necker - Enfants Malades [AP-HP], Centre de Recherches Pétrographiques et Géochimiques (CRPG), Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Division of Nephrology, Maggiore Hospital, IRCCS Foundation, Milano, Université de Lorraine (UL), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Department of Laboratory Medicine, Konventhospital Barmherzige Brueder Linz, Clinical Microbiology and Infectious Diseases Department, Universidad Complutense de Madrid [Madrid] (UCM), University Hospitals Leuven [Leuven], Department of Internal Medicine III, Medizinische Universität Wien = Medical University of Vienna, Service de rhumatologie, Kidney and Pancreas Transplantation, Department d'enginyeria quimica agraria i tecnologia agroalimentaria, Universitat de Girona (UdG), Néphrologie Transplantation, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris (AP-HP), Section of Microbiology [Copenhagen], Department of Biology [Copenhagen], Faculty of Science [Copenhagen], University of Copenhagen = Københavns Universitet (KU)-University of Copenhagen = Københavns Universitet (KU)-Faculty of Science [Copenhagen], University of Copenhagen = Københavns Universitet (KU)-University of Copenhagen = Københavns Universitet (KU), University Hospital Basel [Basel], Service Néphrologie Transplantation Rénale, Hôpital Foch [Suresnes], Centre de néphrologie et transplantation rénale [Hôpital de la Conception - APHM], Hôpital de la Conception [CHU - APHM] (LA CONCEPTION )-Assistance Publique - Hôpitaux de Marseille (APHM), Renal Division, Freiburg University Medical Center, Nephrology Section [Ghent], Ghent University Hospital, Dept. of Nephrology, Institute for Clinical and Experimental Medicine, Division of Infectious Diseases, University of Genoa (UNIGE)-San Martino University Hospital, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Université libre de Bruxelles (ULB), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut d’Électronique, de Microélectronique et de Nanotechnologie - UMR 8520 (IEMN), Centrale Lille-Institut supérieur de l'électronique et du numérique (ISEN)-Université de Valenciennes et du Hainaut-Cambrésis (UVHC)-Université de Lille-Centre National de la Recherche Scientifique (CNRS)-Université Polytechnique Hauts-de-France (UPHF), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Humboldt University Of Berlin, Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Université de Mons (UMons), CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), University of Pennsylvania, Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Universidad Complutense de Madrid = Complutense University of Madrid [Madrid] (UCM), University of Copenhagen = Københavns Universitet (UCPH)-University of Copenhagen = Københavns Universitet (UCPH)-Faculty of Science [Copenhagen], University of Copenhagen = Københavns Universitet (UCPH)-University of Copenhagen = Københavns Universitet (UCPH), Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Universitäts Klinikum Freiburg = University Medical Center Freiburg (Uniklinik), Università degli studi di Genova = University of Genoa (UniGe)-San Martino University Hospital, ERA-EDTA, ESCMID, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Humboldt-Universität zu Berlin, Institut National de la Recherche Agronomique (INRA)-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut national des sciences de l'Univers (INSU - CNRS)-Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Maladies Infectieuses et Tropicales [CHU Pitié-Salpêtrière], Service d'Urgences néphrologiques et transplantation rénale [CHU Tenon], Centre National de la Recherche Scientifique (CNRS)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital de la Conception [CHU - APHM] (LA CONCEPTION ), and San Martino University Hospital-University of Genoa (UNIGE)

Subjects
Nephrology, Male, Cross-sectional study, medicine.medical_treatment, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Practice Patterns, 030230 surgery, Antimicrobial stewardship, urologic and male genital diseases, 0302 clinical medicine, Surveys and Questionnaires, Bacteriuria/diagnosis, Medicine, Practice Patterns, Physicians'/statistics & numerical data, Practice Patterns, Physicians', Asymptomatic Infections, Kidney transplantation, ComputingMilieux_MISCELLANEOUS, Asymptomatic bacteriuria, Questionnaire, Transplantation, Urinary tract infection, Adult, Anti-Bacterial Agents, Bacteriuria, Cross-Sectional Studies, Europe, Female, Humans, Kidney Transplantation, Transplant Recipients, Response rate (survey), Kidney Transplantation/adverse effects, 16. Peace & justice, 3. Good health, medicine.medical_specialty, Asymptomatic Infections/epidemiology, Europe/epidemiology, 03 medical and health sciences, All institutes and research themes of the Radboud University Medical Center, Internal medicine, Dialysis, Physicians', business.industry, medicine.disease, Anti-Bacterial Agents/therapeutic use, Human medicine, Renal disorders Radboud Institute for Health Sciences [Radboudumc 11], business
Abstract

Background Asymptomatic bacteriuria is frequent in kidney transplant recipients (KTRs). However, there is no consensus on diagnosis or management. We conducted a European survey to explore current practice related to the diagnosis and management of asymptomatic bacteriuria in adult KTRs. Methods A panel of experts from the European Renal Association-European Dialysis Transplant Association/Developing Education Science and Care for Renal Transplantation in European States working group and the European Study Group for Infections in Compromised Hosts of the European Society of Clinical Microbiology and Infectious Diseases designed this cross-sectional, questionnaire-based, self-administered survey. Invitations to participate were e-mailed to European physicians involved in the care of KTRs. Results Two hundred and forty-four participants from 138 institutions in 25 countries answered the survey (response rate 30%). Most participants [72% (176/244)] said they always screen for asymptomatic bacteriuria in KTRs. Six per cent (15/240) reported never treating asymptomatic bacteriuria with antibiotics. When antimicrobial treatment was used, 24% of the participants (53/224) said they would start with empirical antibiotics. For an episode of asymptomatic bacteriuria caused by a fully susceptible microorganism and despite no contraindications, a majority of participants (121/223) said they would use a fluoroquinolone (n = 56), amoxicillin/clavulanic acid (n = 38) or oral cephalosporins (n = 27). Conclusions Screening for and treating asymptomatic bacteriuria are common in KTRs despite uncertainties around the benefits and harms. In an era of antimicrobial resistance, further studies are needed to address the diagnosis and management of asymptomatic bacteriuria in these patients.

Published
2018
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22. High-Volume On-Line Hemodiafiltration May Prevent Protein-Energy Wasting in Hemodialysis Patients: A 1-Year Prospective Controlled Study

Author

Molina, Pablo, Vizcaíno, Belén, Molina Vila, Mariola D., Beltrán, Sandra, González-Moya, Mercedes, Mora, Antonio, Castro-Alonso, Cristina, Kanter, Julia, Ávila, Ana I., Górriz, José L., Estañ, Nuria, Pallardó, Luis M., Fouque, Denis, Carrero, Juan, Universidad de Alicante. Departamento de Matemáticas, Bioquímica Aplicada/Applied Biochemistry (AppBiochem), and Laboratorio de Optimización (LOPT)

Subjects
Cachexia, integumentary system, Volume, Hemodialysis, Estadística e Investigación Operativa, Hemodiafiltration
Abstract

INTRODUCTION AND AIMS: Compared to conventional hemodialysis (HD), on-line hemodiafiltration (OL-HDF) achieves a more efficient removal of uremic toxins and reduces inflammation, which could favourably affect nutritional status. We evaluated the effect of OL-HDF on body composition and nutritional status in prevalent high-flux HD (HF-HD) patients.

Published
2018

23. Randomized Controlled Trial Assessing the Impact of Tacrolimus Versus Cyclosporine on the Incidence of Posttransplant Diabetes Mellitus

Author

Torres, Armando, Hernández, Domingo, Moreso, Francesc, Serón, Daniel, Burgos, María Dolores, Pallardó, Luis M., Kanter, Julia, Díaz Corte, Carmen, Rodríguez, Minerva, Díaz Gómez, Juan Manuel, Silva, Irene, Valdes, Francisco, Fernández-Rivera, Constantino, Osuna, Antonio, Gracia Guindo, María C., Gómez Alamillo, Carlos, Ruiz, Juan C., Marrero Miranda, Domingo, Pérez-Tamajón, Lourdes, Rodríguez, Aurelio, González-Rinne, Ana, Alvarez, Alejandra, Perez-Carreño, Estefanía, de la Vega Prieto, María José, Henriquez, Fernando, Gallego Samper, Roberto, Salido, Eduardo, Porrini, Esteban, and Universitat Autònoma de Barcelona

Subjects
Cyclosporin A, Steroid withdrawal, Renal transplantation, Posttransplant hyperglycemia, Posttransplant diabetes, Tacrolimus
Abstract

Despite the high incidence of posttransplant diabetes mellitus (PTDM) among high-risk recipients, no studies have investigated its prevention by immunosuppression optimization. We conducted an open-label, multicenter, randomized trial testing whether a tacrolimus-based immunosuppression and rapid steroid withdrawal (SW) within 1 week (Tac-SW) or cyclosporine A (CsA) with steroid minimization (SM) (CsA-SM), decreased the incidence of PTDM compared with tacrolimus with SM (Tac-SM). All arms received basiliximab and mycophenolate mofetil. High risk was defined by age >60 or >45 years plus metabolic criteria based on body mass index, triglycerides, and high-density lipoprotein-cholesterol levels. The primary endpoint was the incidence of PTDM after 12 months. The study comprised 128 de novo renal transplant recipients without pretransplant diabetes (Tac-SW: 44, Tac-SM: 42, CsA-SM: 42). The 1-year incidence of PTDM in each arm was 37.8% for Tac-SW, 25.7% for Tac-SM, and 9.7% for CsA-SM (relative risk [RR] Tac-SW vs. CsA-SM 3.9 [1.2-12.4; P = 0.01]; RR Tac-SM vs. CsA-SM 2.7 [0.8-8.9; P = 0.1]). Antidiabetic therapy was required less commonly in the CsA-SM arm (P = 0.06); however, acute rejection rate was higher in CsA-SM arm (Tac-SW 11.4%, Tac-SM 4.8%, and CsA-SM 21.4% of patients; cumulative incidence P = 0.04). Graft and patient survival, and graft function were similar among arms. In high-risk patients, tacrolimus-based immunosuppression with SM provides the best balance between PTDM and acute rejection incidence.

Published
2018

24. SP619The effect of etelcalcetide in hemodialysis patients with secondary hyperparathyroidism in daily clinical practice. A prospective multicenter study

Author

Molina, Pablo, primary, Yugueros, Alejandra, additional, Martín, Javier, additional, Pérez-Baylach, Carmen M, additional, Vizcaíno, Belén, additional, González-Moya, Mercedes, additional, Beltrán, Sandra, additional, Kanter, Julia, additional, Bernat, Amparo, additional, and Pallardó, Luis M, additional

Published
2019
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26. The effect of high-volume online haemodiafiltration on nutritional status and body composition: the ProtEin Stores prEservaTion (PESET) study

Author

Universidad de Alicante. Departamento de Matemáticas, Molina, Pablo, Vizcaíno, Belén, Molina Vila, Mariola D., Beltrán, Sandra, González-Moya, Mercedes, Mora, Antonio, Castro-Alonso, Cristina, Kanter, Julia, Ávila, Ana I., Górriz, José L., Estañ, Nuria, Pallardó, Luis M., Fouque, Denis, Carrero, Juan, Universidad de Alicante. Departamento de Matemáticas, Molina, Pablo, Vizcaíno, Belén, Molina Vila, Mariola D., Beltrán, Sandra, González-Moya, Mercedes, Mora, Antonio, Castro-Alonso, Cristina, Kanter, Julia, Ávila, Ana I., Górriz, José L., Estañ, Nuria, Pallardó, Luis M., Fouque, Denis, and Carrero, Juan

Abstract

Background. Compared with conventional haemodialysis (HD), online haemodiafiltration (OL-HDF) achieves a more efficient removal of uraemic toxins and reduces inflammation, which could favourably affect nutritional status. We evaluate the effect of OL-HDF on body composition and nutritional status in prevalent high-flux HD (HF-HD) patients. Methods. In all, 33 adults with chronic kidney disease (CKD) Stage 5 undergoing maintenance HF-HD were assigned to post-dilution OL-HDF (n = 17) or to remain on HF-HD (n = 16, control group) for 12 months. The primary outcome was the change in lean tissue mass (LTM), intracellular water (ICW) and body cell mass (BCM) assessed by multifrequency bioimpedance spectroscopy (BIS) at baseline and 4, 8 and 12 months. The rate of change in these parameters was estimated with linear mixed-effects models. Results. Compared with OL-HDF, patients assigned to HF-HD experienced a gradual reduction in LTM, ICW and BCM. These differences reached statistical significance at Month 12, with a relative difference of 7.31 kg [95% confidence interval (CI) 2.50–12.11; P = 0.003], 2.32 L (95% CI 0.63–4.01; P = 0.008) and 5.20 kg (95% CI 1.74–8.66; P = 0.004) for LTM, ICW and BCM, respectively. The normalized protein appearance increased in the OL-HDF group compared with the HF-HD group [0.26 g/kg/day (95% CI 0.05–0.47); P = 0.002], with a relative reduction in high-sensitive C-reactive protein [−13.31 mg/dL (95% CI −24.63 to −1.98); P = 0.02] at Month 12. Conclusions. OL-HDF for 1 year compared with HF-HD preserved muscle mass, increased protein intake and reduced the inflammatory state related to uraemia and dialysis, supporting the hypothesis that high convection volume can benefit nutritional status and prevent protein-energy wasting in HD patients.

Published
2018

27. High-Volume On-Line Hemodiafiltration May Prevent Protein-Energy Wasting in Hemodialysis Patients: A 1-Year Prospective Controlled Study

Author

Universidad de Alicante. Departamento de Matemáticas, Molina, Pablo, Vizcaíno, Belén, Molina Vila, Mariola D., Beltrán, Sandra, González-Moya, Mercedes, Mora, Antonio, Castro-Alonso, Cristina, Kanter, Julia, Ávila, Ana I., Górriz, José L., Estañ, Nuria, Pallardó, Luis M., Fouque, Denis, Carrero, Juan, Universidad de Alicante. Departamento de Matemáticas, Molina, Pablo, Vizcaíno, Belén, Molina Vila, Mariola D., Beltrán, Sandra, González-Moya, Mercedes, Mora, Antonio, Castro-Alonso, Cristina, Kanter, Julia, Ávila, Ana I., Górriz, José L., Estañ, Nuria, Pallardó, Luis M., Fouque, Denis, and Carrero, Juan

Abstract

INTRODUCTION AND AIMS: Compared to conventional hemodialysis (HD), on-line hemodiafiltration (OL-HDF) achieves a more efficient removal of uremic toxins and reduces inflammation, which could favourably affect nutritional status. We evaluated the effect of OL-HDF on body composition and nutritional status in prevalent high-flux HD (HF-HD) patients.

Published
2018

28. Randomized Controlled Trial Assessing the Impact of Tacrolimus Versus Cyclosporine on the Incidence of Posttransplant Diabetes Mellitus

Author

Torres, Armando, primary, Hernández, Domingo, additional, Moreso, Francesc, additional, Serón, Daniel, additional, Burgos, María Dolores, additional, Pallardó, Luis M., additional, Kanter, Julia, additional, Díaz Corte, Carmen, additional, Rodríguez, Minerva, additional, Diaz, Juan Manuel, additional, Silva, Irene, additional, Valdes, Francisco, additional, Fernández-Rivera, Constantino, additional, Osuna, Antonio, additional, Gracia Guindo, María C., additional, Gómez Alamillo, Carlos, additional, Ruiz, Juan C., additional, Marrero Miranda, Domingo, additional, Pérez-Tamajón, Lourdes, additional, Rodríguez, Aurelio, additional, González-Rinne, Ana, additional, Alvarez, Alejandra, additional, Perez-Carreño, Estefanía, additional, de la Vega Prieto, María José, additional, Henriquez, Fernando, additional, Gallego, Roberto, additional, Salido, Eduardo, additional, and Porrini, Esteban, additional

Published
2018
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29. SP660HIGH-VOLUME ON-LINE HEMODIAFILTRATION MAY PREVENT PROTEIN-ENERGY WASTING IN HEMODIALYSIS PATIENTS: A 1-YEAR PROSPECTIVE CONTROLLED STUDY

Author

Molina, Pablo, primary, Vizcaíno, Belén, additional, Molina, Mariola, additional, Beltrán, Sandra, additional, González-Moya, Mercedes, additional, Mora, Antonio, additional, Castro-Alonso, Cristina, additional, Kanter, Julia, additional, Avila, Ana, additional, Górriz, José, additional, Estañ, Nuria, additional, Pallardó, Luis, additional, Fouque, Denis, additional, and Carrero, Juan, additional

Published
2018
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30. The effect of high-volume online haemodiafiltration on nutritional status and body composition: the ProtEin Stores prEservaTion (PESET) study

Author

Molina, Pablo, primary, Vizcaíno, Belén, additional, Molina, Mariola D, additional, Beltrán, Sandra, additional, González-Moya, Mercedes, additional, Mora, Antonio, additional, Castro-Alonso, Cristina, additional, Kanter, Julia, additional, Ávila, Ana I, additional, Górriz, José L, additional, Estañ, Nuria, additional, Pallardó, Luis M, additional, Fouque, Denis, additional, and Carrero, Juan J, additional

Published
2018
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33. What is the optimal level of vitamin D in non-dialysis chronic kidney disease population?

Author

Universidad de Alicante. Departamento de Matemáticas, Molina, Pablo, Górriz, José L., Molina Vila, Mariola D., Beltrán, Sandra, Vizcaíno, Belén, Escudero, Verónica, Kanter, Julia, Ávila, Ana I., Bover, Jordi, Fernández, Elvira, Nieto, Javier, Cigarrán, Secundino, Gruss, Enrique, Fernández-Juárez, Gema, Martínez-Castelao, Alberto, Navarro-González, Juan F., Romero, Ramón, Pallardó, Luis M., Universidad de Alicante. Departamento de Matemáticas, Molina, Pablo, Górriz, José L., Molina Vila, Mariola D., Beltrán, Sandra, Vizcaíno, Belén, Escudero, Verónica, Kanter, Julia, Ávila, Ana I., Bover, Jordi, Fernández, Elvira, Nieto, Javier, Cigarrán, Secundino, Gruss, Enrique, Fernández-Juárez, Gema, Martínez-Castelao, Alberto, Navarro-González, Juan F., Romero, Ramón, and Pallardó, Luis M.

Abstract

AIM: To evaluate thresholds for serum 25(OH)D concentrations in relation to death, kidney progression and hospitalization in non-dialysis chronic kidney disease (CKD) population. METHODS: Four hundred and seventy non-dialysis 3-5 stage CKD patients participating in OSERCE-2 study, a prospective, multicenter, cohort study, were prospectively evaluated and categorized into 3 groups according to 25(OH)D levels at enrollment (less than 20 ng/mL, between 20 and 29 ng/mL, and at or above 30 ng/mL), considering 25(OH)D between 20 and 29 ng/mL as reference group. Association between 25(OH)D levels and death (primary outcome), and time to first hospitalization and renal progression (secondary outcomes) over a 3-year follow-up, were assessed by Kaplan-Meier survival curves and Cox-proportional hazard models. To identify 25(OH)D levels at highest risk for outcomes, receiver operating characteristic (ROC) curves were performed. RESULTS: Over 29 ± 12 mo of follow-up, 46 (10%) patients dead, 156 (33%) showed kidney progression, and 126 (27%) were hospitalized. After multivariate adjustment, 25(OH)D < 20 ng/mL was an independent predictor of all-cause mortality (HR = 2.33; 95%CI: 1.10-4.91; P = 0.027) and kidney progression (HR = 2.46; 95%CI: 1.63-3.71; P < 0.001), whereas the group with 25(OH)D at or above 30 ng/mL did not have a different hazard for outcomes from the reference group. Hospitalization outcomes were predicted by 25(OH) levels (HR = 0.98; 95%CI: 0.96-1.00; P = 0.027) in the unadjusted Cox proportional hazards model, but not after multivariate adjusting. ROC curves identified 25(OH)D levels at highest risk for death, kidney progression, and hospitalization, at 17.4 ng/mL [area under the curve (AUC) = 0.60; 95%CI: 0.52-0.69; P = 0.027], 18.6 ng/mL (AUC = 0.65; 95%CI: 0.60-0.71; P < 0.001), and 19.0 ng/mL (AUC = 0.56; 95%CI: 0.50-0.62; P = 0.048), respectively. CONCLUSION: 25(OH)D < 20 ng/mL was an independent predictor of death and progression in patients with stage 3

Published
2016

34. MP352EFFECTS OF A REGIMEN BASED ON RESTRICTED CALCIUM INTAKE FROM PHOSPHATE BINDERS, LOW DOSE VITAMIN D SUPPLEMENTATION , AND PARICALCITOL, ON SURVIVAL, HOSPITALIZATION AND RENAL PROGRESSION. A PROSPECTIVE COHORT STUDY IN NON-DIALYSIS CKD PATIENTS

Author

Molina, Pablo, primary, Gorriz, José L., additional, Juan, Isabel, additional, Bea, Esther, additional, Soldevila, Amparo, additional, Antolin, Andres, additional, Garcia-Hervas, Amelia, additional, Torralba, Javier, additional, Kanter, Julia, additional, and Pallardo, Luis M., additional

Published
2016
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35. What is the optimal level of vitamin D in non-dialysis chronic kidney disease population?

Author

Molina, Pablo, primary, Górriz, José L, additional, Molina, Mariola D, additional, Beltrán, Sandra, additional, Vizcaíno, Belén, additional, Escudero, Verónica, additional, Kanter, Julia, additional, Ávila, Ana I, additional, Bover, Jordi, additional, Fernández, Elvira, additional, Nieto, Javier, additional, Cigarrán, Secundino, additional, Gruss, Enrique, additional, Fernández-Juárez, Gema, additional, Martínez-Castelao, Alberto, additional, Navarro-González, Juan F, additional, Romero, Ramón, additional, and Pallardó, Luis M, additional

Published
2016
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38. The effect of cholecalciferol for lowering albuminuria in chronic kidney disease: a prospective controlled study

Author

Universidad de Alicante. Departamento de Estadística e Investigación Operativa, Molina, Pablo, Górriz, José L., Molina Vila, Mariola D., Peris, Ana, Beltrán, Sandra, Kanter, Julia, Escudero, Verónica, Romero, Ramón, Pallardó, Luis M., Universidad de Alicante. Departamento de Estadística e Investigación Operativa, Molina, Pablo, Górriz, José L., Molina Vila, Mariola D., Peris, Ana, Beltrán, Sandra, Kanter, Julia, Escudero, Verónica, Romero, Ramón, and Pallardó, Luis M.

Abstract

Background. Growing evidence indicates that vitamin D receptor activation may have antiproteinuric effects. We aimed to evaluate whether vitamin D supplementation with daily cholecalciferol could reduce albuminuria in proteinuric chronic kidney disease (CKD) patients. Methods. This 6-month prospective, controlled, intervention study enrolled 101 non-dialysis CKD patients with albuminuria. Patients with low 25(OH) vitamin D [25(OH)D] and high parathyroid hormone (PTH) levels (n = 50; 49%) received oral cholecalciferol (666 IU/day), whereas those without hyperparathyroidism (n = 51; 51%), independent of their vitamin D status, did not receive any cholecalciferol, and were considered as the control group. Results. Cholecalciferol administration led to a rise in mean 25(OH)D levels by 53.0 ± 41.6% (P < 0.001). Urinary albumin-to-creatinine ratio (uACR) decreased from (geometric mean with 95% confidence interval) 284 (189–425) to 167 mg/g (105–266) at 6 months (P < 0.001) in the cholecalciferol group, and there was no change in the control group. Reduction in a uACR was observed in the absence of significant changes in other factors, which could affect proteinuria, like weight, blood pressure (BP) levels or antihypertensive treatment. Six-month changes in 25(OH)D levels were significantly and inversely associated with that in the uACR (Pearson's R = −0.519; P = 0.036), after adjustment by age, sex, body mass index, BP, glomerular filtration rate and antiproteinuric treatment. The mean PTH decreased by −13.8 ± 20.3% (P = 0.039) only in treated patients, with a mild rise in phosphate and calcium–phosphate product [7.0 ± 14.7% (P = 0.002) and 7.2 ± 15.2% (P = 0.003), respectively]. Conclusions. In addition to improving hyperparathyroidism, vitamin D supplementation with daily cholecalciferol had a beneficial effect in decreasing albuminuria with potential effects on delaying the progression of CKD.

Published
2014

40. TRASPLANTE RENAL DE DONANTE VIVO. ANÁLISIS DE SITUACIÓN Y HOJA DE RUTA

Author

Valentín, María de la Oliva, Hernández, Domingo, Crespo, Marta, Mahillo, Beatriz, Beneyto, Isabel, Martínez, Itziar, Kanter, Julia, Calderari, Elena, Gil-Vernet, Salvador, Sánchez, Sara, Agüera, Maria Luisa, Bernal, Gabriel, de Santiago, Carlos, Díaz, Carmen, Díaz, Cándido, Espinosa, Laura, Facundo, Carme, Fernández-Lucas, Milagros, Ferreiro, Tamara, García, Gorka, García, Teresa María, Fraile, Pilar, González, Ana, González, María José, González, Esther, Gutiérrez, Alex, Jiménez, Carlos, Lauzurica, Ricardo, Lorenzo, Inmaculada, Martín-Moreno, Paloma L, Moreso, Francesc, Gracia, María Carmen de, Pérez-Flores, Isabel, Ramos, Ana, Revuelta, Ignacio, Rodríguez-Ferrero, María Luisa, Ruiz, Juan Carlos, Sánchez, Beatriz, and Domínguez-Gil, Beatriz

Abstract

El Trasplante Renal de Donante Vivo (TRDV) es la opción terapéutica con las mejores expectativas de supervivencia para el injerto y para el paciente con insuficiencia renal terminal. Sin embargo, este tipo de trasplantes ha experimentado un descenso progresivo en los últimos años en España.

Published
2021
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41. Live donor kidney transplantation. Situation analysis and roadmap.

Author

Valentín MO, Hernández D, Crespo M, Mahillo B, Beneyto I, Martínez I, Kanter J, Calderari E, Gil-Vernet S, Sánchez S, Agüera ML, Bernal G, de Santiago C, Díaz-Corte C, Díaz C, Espinosa L, Facundo C, Fernández-Lucas M, Ferreiro T, García-Erauzkin G, García-Alvarez T, Fraile P, González-Rinne A, González-Soriano MJ, González E, Gutiérrez-Dalmau A, Jiménez C, Lauzurica R, Lorenzo I, Martín-Moreno PL, Moreso F, de Gracia MC, Pérez-Flores I, Ramos-Verde A, Revuelta I, Rodríguez-Ferrero ML, Ruiz JC, Sánchez-Sobrino B, and Domínguez-Gil B

Abstract

Living donor kidney transplantation (LDKT) is the best treatment option for end stage renal disease in terms of both patient and graft survival. However, figures on LDKT in Spain that had been continuously growing from 2005 to 2014, have experienced a continuous decrease in the last five years. One possible explanation for this decrease is that the significant increase in the number of deceased donors in Spain during the last years, both brain death and controlled circulatory death donors, might have generated the false idea that we have coped with the transplant needs. Moreover, a greater number of deceased donor kidney transplants have caused a heavy workload for the transplant teams. Furthermore, the transplant teams could have moved on to a more conservative approach to the information and assessment of patients and families considering the potential long-term risks for donors in recent papers. However, there is a significant variability in the LDKT rate among transplant centers and regions in Spain independent of their deceased donor rates. This fact and the fact that LDKT is usually a preemptive option for patients with advanced chronic renal failure, as time on dialysis is a negative independent factor for transplant outcomes, lead us to conclude that the decrease in LDKT depends on other factors. Thus, in the kidney transplant annual meeting held at ONT site in 2018, a working group was created to identify other causes for the decrease of LDKT in Spain and its relationship with the different steps of the process. The group was formed by transplant teams, a representative of the transplant group of the Spanish Society of Nephrology (SENTRA), a representative of the Spanish Society of Transplants (SET) and representatives of the Spanish National Transplant Organization (ONT). A self-evaluation survey that contains requests about the phases of the LDKT processes (information, donor work out, informed consent, surgeries, follow-up and human resources) were developed and sent to 33 LDKT teams. All the centers answered the questionnaire. The analysis of the answers has resulted in the creation of a national analysis of strengths, weaknesses, opportunities, threats (SWOT) of the LDKT program in Spain and the development of recommendations targeted to improve every step of the donation process. The work performed, the conclusions and recommendations provided, have been reflected in the following report: Spanish living donor kidney transplant program assessment: recommendations for optimization. This document has also been reviewed by a panel of experts, representatives of the scientific societies (Spanish Society of Urology (AEU), Spanish Society of Nephrology Nursery (SEDEN), Spanish Society of Immunology (SEI/GETH)) and the patient association ALCER. Finally, the report has been submitted to public consultation, reaching ample consensus. In addition, the transplant competent authorities of the different regions in Spain have adopted the report at institutional level. The work done and the recommendations to optimize LDKT are summarized in the present manuscript, organized by the different phases of the donation process., (Copyright © 2021 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)

Published
2021
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42. Clinical Relevance of Corticosteroid Withdrawal on Graft Histological Lesions in Low-Immunological-Risk Kidney Transplant Patients.

Author

Hernández D, Alonso-Titos J, Vázquez T, León M, Caballero A, Cobo MA, Sola E, López V, Ruiz-Esteban P, Cruzado JM, Sellarés J, Moreso F, Manonelles A, Torío A, Cabello M, Delgado-Burgos J, Casas C, Gutiérrez E, Jironda C, Kanter J, Serón D, and Torres A

Abstract

The impact of corticosteroid withdrawal on medium-term graft histological changes in kidney transplant (KT) recipients under standard immunosuppression is uncertain. As part of an open-label, multicenter, prospective, phase IV, 24-month clinical trial (ClinicalTrials.gov, NCT02284464) in low-immunological-risk KT recipients, 105 patients were randomized, after a protocol-biopsy at 3 months, to corticosteroid continuation (CSC, n = 52) or corticosteroid withdrawal (CSW, n = 53). Both groups received tacrolimus and MMF and had another protocol-biopsy at 24 months. The acute rejection rate, including subclinical inflammation (SCI), was comparable between groups (21.2 vs. 24.5%). No patients developed dnDSA. Inflammatory and chronicity scores increased from 3 to 24 months in patients with, at baseline, no inflammation (NI) or SCI, regardless of treatment. CSW patients with SCI at 3 months had a significantly increased chronicity score at 24 months. HbA1c levels were lower in CSW patients (6.4 ± 1.2 vs. 5.7 ± 0.6%; p = 0.013) at 24 months, as was systolic blood pressure (134.2 ± 14.9 vs. 125.7 ± 15.3 mmHg; p = 0.016). Allograft function was comparable between groups and no patients died or lost their graft. An increase in chronicity scores at 2-years post-transplantation was observed in low-immunological-risk KT recipients with initial NI or SCI, but CSW may accelerate chronicity changes, especially in patients with early SCI. This strategy did, however, improve the cardiovascular profiles of patients.

Published
2021
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43. Impact of HLA Mismatching on Early Subclinical Inflammation in Low-Immunological-Risk Kidney Transplant Recipients.

Author

Hernández D, Vázquez T, Alonso-Titos J, León M, Caballero A, Cobo MA, Sola E, López V, Ruiz-Esteban P, Cruzado JM, Sellarés J, Moreso F, Manonelles A, Torio A, Cabello M, Delgado-Burgos J, Casas C, Gutiérrez E, Jironda C, Kanter J, Serón D, and Torres A

Abstract

The impact of human leukocyte antigen (HLA)-mismatching on the early appearance of subclinical inflammation (SCI) in low-immunological-risk kidney transplant (KT) recipients is undetermined. We aimed to assess whether HLA-mismatching (A-B-C-DR-DQ) is a risk factor for early SCI. As part of a clinical trial (Clinicaltrials.gov, number NCT02284464), a total of 105 low-immunological-risk KT patients underwent a protocol biopsy on the third month post-KT. As a result, 54 presented SCI, showing a greater number of total HLA-mismatches ( p = 0.008) and worse allograft function compared with the no inflammation group (48.5 ± 13.6 vs. 60 ± 23.4 mL/min; p = 0.003). Multiple logistic regression showed that the only risk factor associated with SCI was the total HLA-mismatch score (OR 1.32, 95%CI 1.06-1.64, p = 0.013) or class II HLA mismatching (OR 1.51; 95%CI 1.04-2.19, p = 0.032) after adjusting for confounder variables (recipient age, delayed graft function, transfusion prior KT, and tacrolimus levels). The ROC curve illustrated that the HLA mismatching of six antigens was the optimal value in terms of sensitivity and specificity for predicting the SCI. Finally, a significantly higher proportion of SCI was seen in patients with >6 vs. ≤6 HLA-mismatches (62.3 vs. 37.7%; p = 0.008). HLA compatibility is an independent risk factor associated with early SCI. Thus, transplant physicians should perhaps be more aware of HLA mismatching to reduce these early harmful lesions.

Published
2021
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