Adequacy of Initial Everolimus Dose, With and Without Calcineurin Inhibitors, in Kidney Transplant Recipients
This study investigates the adequacy of initial everolimus (EVR) dose, with and without calcineurin inhibitors (CNI), in kidney transplant recipients. Methods: This retrospective cohort analysis involved data from 305 kidney transplant recipients participating in 3 randomized trials receiving reduced dose cyclosporin A (CsA) combined with EVR 0.75 mg BID (CSA/EVR0.75, N = 32) or 1.5 mg BID (CSA/EVR1.5, N = 31), reduced dose tacrolimus (TAC) combined with EVR 1.5 mg BID (TAC0.05/EVR1.5, N = 83), standard dose TAC combined with EVR 1.5 mg BID (TAC0.1/EVR1.5, N = 93), and EVR 1.5 mg BID (EVR1.5, N = 66) with TAC introduction after day 5. The adequacy of the initial EVR dose, based on EVR whole blood trough between 3 and 8 ng/mL, was compared using first EVR blood concentrations obtained at day 3 after transplantation. Results: Recipient age, proportion of patients with diabetes mellitus, and proportion of grafts from living donors were different among the groups. Dose-corrected EVR concentrations were higher in patients receiving CsA than in those receiving TAC or no calcineurin inhibitors (6.7 ± 5.9 versus 5.4 ± 2.2 versus 2.4 ± 0.8 versus 2.5 ± 0.9 versus 2.2 ± 0.7, P = 0.000). No differences were observed comparing dose adjusted EVR concentrations combined with TAC or alone (P = 0.073). The proportion of patients with EVR concentration below
CONCLUSIONS: Patients with advanced age and CYP24A1 rs2296241 A allele had an increased risk of PTDM after kidney transplantation. PMID: 29665413 [PubMed - as supplied by publisher]
Abstract Calciphylaxis is a rare disease characterized by calcification of small- to medium-sized blood vessels in the dermis and subcutaneous fat, resulting in cutaneous necrosis. Although most commonly shown in patients with end-stage kidney disease, it has also been reported in patients with other diseases, including alcoholic cirrhosis and malignancies. Here, we report an unusual case of calciphylaxis in an orthotopic liver transplant recipient with acute kidney injury. The patient, a 43-year-old white female with a history of type 2 diabetes mellitus, alcoholic cirrhosis, and normal kidney function, presented...
The effectiveness of everolimus (EVR) for ABO-incompatible (ABOi) kidney transplantation is unknown. We evaluated outcomes of conversion from steroid to EVR in ABOi kidney transplant recipients.
Conclusion: In this high risk cohort, a significant proportion of patients who were statin eligible including diabetics, were not prescribed statin. Less than half of renal transplant recipients had a lipid panel documented pre and post- transplant. Patterns of use of cardioprotective medications in the renal transplant population, and its relation to renal and cardiac outcomes needs further study.
Background: We compared effects of immunosuppression and co-morbidities on kidney function following renal transplant.Methods: We perfomed retrospective chart review in 211 consecutive renal transplant recipients, treated at a single medical center between 2004 to 2014, who also underwent a post-transplant echocardiogram. Patients were stratified into ESRD/CKD-4 group and CKD1-3 according to standard GFR criteria. The study was approved by IRB.Results: Average age was 52.4 +/- 11.8 years old, 41% were females, 95% with history HTN, 81% with dislipidemia, 20% with CAD, 42% with diabetes mellitus, 26% past smokers, 16% on th...
AbstractPost-transplantation diabetes mellitus (PTDM) may severely impact both short- and long-term outcomes of kidney transplant recipients in terms of graft and patient survival. However, PTDM often goes undiagnosed is underestimated or poorly managed. A diagnosis of PTDM should be delayed until the patient is on stable maintenance doses of immunosuppressive drugs, with stable kidney graft function and in the absence of acute infections. Risk factors for PTDM should be assessed during the pre-transplant evaluation period, in order to reduce the likelihood of developing diabetes. The oral glucose tolerance test is conside...
In this study we present the results of 15 years of SPK in a transplant hospital center in Paran á, Brazil, and evaluated survival, immunosuppression, and transplant-related problems.
End-stage renal disease due to type 1 diabetes mellitus appears to be a regular indication for simultaneous pancreas and kidney transplantation (SPKT). Although the transplant improves patients ’ health condition, it does not mean that all complications will be eliminated.
Simultaneous pancreas-kidney transplantation (SPKT) is the treatment of choice for patients with end-stage renal disease (ESRD) due to type 1 diabetes mellitus (DM1).Since the 1980s, pancreas transplant has become the most effective strategy to restore normoglycemia in patients with DM1.
AbstractThe 2017 American College of Cardiology/American Heart Association hypertension guidelines diagnose hypertension if systolic blood pressure (SBP) is ≥ 130 mmHg or diastolic blood pressure (DBP) is ≥ 80 mmHg. Increased BP is SBP 120–129 mmHg with DBP