New RBI for Kidney Allografts: Can It Replace Routine Tests? New RBI for Kidney Allografts: Can It Replace Routine Tests?
Dr Desai reviews a study examining the usefulness of a new renal biopsy index (1-RBI). Could it be used in place of invasive routine biopsies in deceased-donor kidney transplant recipients?Medscape Nephrology
Conclusions. Liposomal delivery of prednisolone improved renal bio-availability, increased perfusion and reduced cellular infiltrate in the allograft, when compared with conventional prednisolone. Clinical studies should reveal if treatment with LP results in improved efficacy and reduced side effects in patients with renal allograft rejection.
Background. Kidney transplant outcomes of indigenous Australians are poorer compared with nonindigenous Australians, but it is unknown whether the type of acute rejection differs between these patient groups or whether rejection mediates the effect between ethnicity, death-censored graft failure (DCGF), and death with a functioning graft (DWFG). Methods. Biopsy-proven acute rejection (BPAR) rates and types were compared between indigenous and nonindigenous recipients. The associations between ethnicity, BPAR, DCGF, and DWFG were examined using adjusted competing risk analyses, and mediation analysis was conducted to d...
Conclusions. TCZ reduced total IgG and IgG1-3 and anti–HLA-total IgG and IgG3 levels, suggesting that TCZ suppresses Ig production in B cells nonspecifically, likely through inhibition of interleukin 6–mediated signaling to B cells and plasma cells. This may be a contributing factor for the beneficial effect of TCZ on cAMR observed in this patient population.
This study observes the protection conferred by these agents in isolated muscle bundles as well as on ex-vivo perfused hearts
Hyperphosphatemia is a major risk factor for death, cardiovascular (CV) events and vascular calcification in patients with and without chronic kidney disease. Even subtly higher serum phosphate (s-PHOS) levels within the “normal laboratory range” are associated with a higher risk for CV events and mortality. We therefore investigated the association between s-PHOS levels and heart transplantation (HT) outcomes.
Long term heart allograft survival is negatively impacted by the presence of donor specific antibodies (DSA). HLA-DQ DSA have been associated with reduced graft survival in non-heart allografts, and recent studies have indicated that HLA DR/DQ epitope mismatches may be utilized as a potential prognostic marker for de novo DSA development and subsequent graft loss in the kidney transplant population. Few studies have evaluated the presence of DQ DSA in the heart transplantation population and even fewer have examined the prognostic implications of epitope mismatches.
Candidate selection for multi-organ transplants should consider the chances of good function and benefit of all transplanted organs. Risk factors for early renal graft dysfunction after combined heart-kidney transplant (CHKTx) may include vasoplegia and vasopressor need in spite of good cardiac graft function. We aimed to identify risk factors for vasoplegia after CHKTx and its impact on postoperative and renal allograft outcomes.
Cardiac allograft tolerance in non-human primates (NHPs) has been achieved by our group via hematopoietic mixed chimerism consisting of an allogeneic bone marrow (BM) and kidney co-transplantation from the same donor after non-myeloablative conditioning. In this setting, T cell tolerance is believed to rely on expression of donor MHC molecules in the host's primary and secondary lymphoid organs. Here, we investigated whether donor MHC chimerism could be achieved using donor bone marrow derived extracellular vesicles (exosomes) instead of cells.
Long term tolerance of cardiac allografts has been achieved in non-human primates (NHPs) using a mixed chimerism protocol and by co-transplanting a kidney from the same heart and bone marrow donor. In stark contrast, heart alone recipients rejected in 150-180 days. T cell subset analyses showed a greater expansion of regulatory T cells (Treg) in heart/kidney recipients compared to heart alone controls. To achieve tolerance of isolated heart allografts, we added IL-2 and/or anti-IL6R therapy to enhance host Treg activity.
This study compares allograft injury and chronic allograft dysfunction (CLAD) in AA and W LTx.