Frailty and Long-Term Post-Kidney Transplant Outcomes

AbstractPurpose of ReviewTo highlight recent research about frailty and its role as a predictor of adverse, long-term post-kidney transplant (KT) outcomes.Recent FindingsFrailty is easily measured using the physical frailty phenotype (PFP) developed by gerontologist Dr. Linda Fried and colleagues. In recent studies,>  50% of KT recipients were frail (20%) or intermediately frail (32%) at KT admission. Frail recipients were at 1.3-times higher risk of immunosuppression intolerance and 2.2-times higher risk of mortality, even after accounting for recipient, donor, and transplant factors; these findings were cons istent with those on short-term post-KT outcomes. Pilot data suggests that prehabilitation may be an intervention that increases physiologic reserve in frail KT recipients.SummaryPFP is an effective tool to measure frailty in ESRD that improves risk stratification for short-term and long-term post-KT outcomes. Interventions to improve physiologic reserve and prevent adverse KT outcomes, particularly among frail KT recipients, are needed.
Source: Current Transplantation Reports - Category: Transplant Surgery Source Type: research

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We have read the letter by Lenain et  al.,1 which raised concerns about the potential for collinearity given our use of the kidney donor profile index (KDPI) for multivariable adjustment in analyses that showed deceased-donor acute kidney injury (AKI) was not independently associated with allograft failure at a median follow-up of 4 y ears.2 We used KDPI for adjustment because the score is very familiar to the transplant community for describing overall organ quality given that it incorporates 10 donor factors associated with allograft survival.
Source: Kidney International - Category: Urology & Nephrology Authors: Tags: Letter to the Editor Source Type: research
A 55-year-old man with a history of end-stage renal disease due to autosomal dominant polycystic kidney disease and bilateral nephrectomy without adrenalectomy underwent his first kidney transplantation after 6 years of hemodialysis. The patient had no history of donor-specific antibodies. The donor was described as a 69-year-old man with a history of active smoking and  aortic valvulopathy who died of a stroke without cardiac arrest or collapse. Maintenance immunosuppressive therapy consisted of low-dose tacrolimus and everolimus.
Source: Kidney International - Category: Urology & Nephrology Authors: Tags: Make Your Diagnosis Source Type: research
A 30-year-old man who underwent renal transplantation 10 years ago presented with multiple painful swellings in his limbs and joints with limitation of movement (Supplementary Figure  S1), which had developed over 3 weeks. He was on dual immunosuppression with prednisolone and tacrolimus because of multiple infections in the past. He was normotensive and afebrile. Each swollen area was tender and fluctuant. His hemoglobin level was 7.3 g/dl; the total leukocyte count was 21,800 cells/mm3; and the serum creatinine level was 2.9 mg/dl.
Source: Kidney International - Category: Urology & Nephrology Authors: Tags: Nephrology Image Source Type: research
BACKGROUND: Dialysis is the first procedure to partially replace renal function in end-stage renal diseases, despite several adverse side effects, such as infections. The primary aim of this study was to evaluate the levels of immune CMV-specific CD8+ T cells in a representative cohort of pre-transplant patients receiving hemodialysis (HD) or peritoneal dialysis (PD). The secondary aim was to monitor the CMV-specific CD8+ T cells in kidney transplant recipients undergoing different types of dialysis during the first year following their transplant. METHODS: 69 patients were enrolled and examined with respect to the type o...
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
Notice of proposed rule from the Centers for Medicare and Medicaid Services to implement two new mandatory Medicare payment models. The End-Stage Renal Disease (ESRD) Treatment Choices Model (ETC Model) is a mandatory payment model to encourage greater use of home dialysis and kidney transplants. The Radiation Oncology Model (RO Model) promotes quality and financial accountability for providers and suppliers of radiotherapy and tests whether making prospective episode payments to hospital outpatient departments and freestanding radiation therapy centers improves quality of care and reduces Medicare spending. Comments on th...
Source: Federal Register updates via the Rural Assistance Center - Category: Rural Health Source Type: news
Stevie Wonder will receive a kidney transplant in the coming months. Kidney disease is surprisingly common, especially in minority populations. Kidney donation can be performed from a living donor, and can be scheduled as opposed to performed as an emergency surgery.
Source: Forbes.com Healthcare News - Category: Pharmaceuticals Authors: Source Type: news
Conclusion: Our study showed that bendamustine is a potentially toxic agent in the conditioning regimen for autologous SCT, resulting in significant liver, kidney, and gastrointestinal toxicity. Further studies are required to assess its safety and efficacy at reduced doses. PMID: 31309088 [PubMed]
Source: Blood Research - Category: Hematology Tags: Blood Res Source Type: research
ConclusionsProlonged use of cyclosporine may expose to several dose-related adverse events and may contribute to the development of allograft dysfunction but it does not necessarily cause relentless, progressive transplant failure if patients are carefully and consistently monitored during the follow-up.
Source: Clinical and Experimental Nephrology - Category: Urology & Nephrology Source Type: research
The product of the concentrations of urinary tissue inhibitor of metalloproteinases-2 and insulin-like growth factor binding protein-7 (urinary [TIMP-2]  × [IGFBP-7]) has been suggested as biomarker for early d...
Source: BMC Nephrology - Category: Urology & Nephrology Authors: Tags: Research article Source Type: research
Risk of over-immunosuppression or immunization may mitigate the overall and long-term renal outcomes of kidney transplant recipients (KTR) admitted to the ICU in the modern era but remain poorly described. Thu...
Source: BMC Anesthesiology - Category: Anesthesiology Authors: Tags: Research article Source Type: research
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