ATHENA: wisdom and warfare in defining the role of de novo mTOR inhibition in kidney transplantation
ATHENA, published in this edition of Kidney International, is the third contemporary, multicenter, randomized, controlled trial to compare de novo use of everolimus, calcineurin inhibitor, and steroids to our current standard of care, mycophenolate, tacrolimus, and steroids, in kidney transplant recipients. This commentary highlights the strengths and significant weaknesses of ATHENA. It then seeks to distill the key messages from the 3 trials, ATHENA, TRANSFORM, and US92, and considers the role of everolimus in kidney transplantation today.
Funding Opportunity RFA-DK-19-007 from the NIH Guide for Grants and Contracts. This FOA invites new applications for the (Re)Building a Kidney (RBK) Consortium. The goal of the RBK is to improve or restore failing kidney function after injury or disease. This FOA invites teams of investigators with complementary expertise to develop and test novel ways to either (1) stimulate productive kidney repair/regeneration in vivo, or (2) generate functional kidney tissue ex vivo for transplantation.
CONCLUSIONS: We conclude that there was no evidence of acute HEV infection in this pretransplant population and that older age seems to be associated with positive anti-HEV IgG. PMID: 31320164 [PubMed]
AbstractMycophenolic acid is commonly prescribed in adult kidney transplant recipients for preventing graft rejection. A therapeutic target for total mycophenolic acid area under the concentration –time curve (30–60 mg h/L) has been established in adult kidney transplant recipients and widely referenced today. However, this specific target range does not adequately characterize mycophenolic acid-associated adverse effects. The primary objective of this qualitative and critical review wa s to characterize the exposure-toxicity relationships of mycophenolic acid in an attempt to determine whether exposu...
Background - Extracorporeal photopheresis (ECP) has shown encouraging results in the prevention of allograft rejection in heart transplantation. However, the role of ECP in kidney transplant (KT) rejection needs to be determined.Methods - This multicentre retrospective study included 33 KT recipients who were treated with ECP for allograft rejection (23 acute antibody-mediated rejections (AMRs), 2 chronic AMRs and 8 acute cellular rejections (ACRs)). The ECP indications were KT rejection in patients who were resistant to standard therapies (n = 18) or in patients for whom standard therapies were contraindica...
ConclusionThe present study suggested that ulinastatin might be clinically useful in reducing preservation injury induced by cold I/R during renal transplantation surgery.
This study elucidates the potential to use mitochondria from different donors (PAMM) to treat UVR stress and possibly other types of damage or metabolic malfunctions in cells, resulting in not only in-vitro but also ex-vivo applications. Gene Therapy in Mice Alters the Balance of Macrophage Phenotypes to Slow Atherosclerosis Progression https://www.fightaging.org/archives/2019/07/gene-therapy-in-mice-alters-the-balance-of-macrophage-phenotypes-to-slow-atherosclerosis-progression/ Atherosclerosis causes a sizable fraction of all deaths in our species. It is the generation of fatty deposits in blood vessel...
We report here a huge ADPKD case of kidney transplantation concomitant with simple nephrectomy through thoracoabdominal approach that allows surgeons to manipulate the renal vessels, the adrenal grand, the trigonal ligament, and the lower pole of the kidney under the wide operative field. Because of the direct recognition of the surgical anatomy, it might be safe and feasible for simple nephrectomy in huge ADPKD patients undergoing concomitant kidney transplantation despite of the wide skin incision required by this approach.
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.
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.
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.