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Gallo E, Mingozzi S, Mella A, Fop F, Presta R, Burdese M, Boaglio E, Torazza MC, Giraudi R, Leonardi G, Lavacca A, Gontero P, Sedigh O, Bosio A, Verri A, Dolla C, Biancone L. Clinical outcomes and temporal trends of immunological and non-immunological rare diseases in adult kidney transplant. BMC Nephrol 2021; 22:386. [PMID: 34789191 PMCID: PMC8600810 DOI: 10.1186/s12882-021-02571-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rare diseases (RDs) encompass many difficult-to-treat conditions with different characteristics often associated with end-stage renal disease (ESRD). However, data about transplant outcomes in adult patients are still lacking and limited to case reports/case series without differentiation between immunological/non-immunological RDs. METHODS Retrospective analysis among all adult kidney transplanted patients (KTs) with RDs (RDsKT group) performed in our high-volume transplantation center between 2005 and 2016. RDs were classified according to the Orphanet code system differentiating between immunological and non-immunological diseases, also comparing clinical outcomes and temporal trends to a control population without RDs (nRDsKT). RESULTS Among 1381 KTs, 350 patients (25.3%) were affected by RDs (RDsKTs). During a f/up > 5 years [median 7.9 years (4.8-11.1)], kidney function and graft/patient survival did not differ from nRDsKTs. Considering all post-transplant complications, RDsKTs (including, by definition, patients with primary glomerulopathy except on IgA nephropathy) have more recurrent and de-novo glomerulonephritis (14.6% vs. 9.6% in nRDsKTs; p = 0.05), similar rates of de-novo cancers, post-transplant diabetes, dysmetabolism, hematologic disorders, urologic/vascular problems, and lower infectious episodes than nRDsKTs (63.7% vs 72.7%; p = 0.013). Additional stratification for immunological and non-immunological RDsKTs or transplantation periods (before/after 2010) showed no differences or temporal trends between groups. CONCLUSIONS Kidney transplant centers are deeply involved in RDs management. Despite their high-complex profile, both immunological and non-immunological RDsKTs experienced favorable patients' and graft survival.
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Affiliation(s)
- Ester Gallo
- Renal Transplant Center "A. Vercellone," Nephrology, Dialysis, and Renal Transplant Division, "Città Della Salute e Della Scienza" Hospital, Department of Medical Sciences, University of Turin, Corso Bramante, 88-10126, Turin, Italy
| | - Silvia Mingozzi
- Renal Transplant Center "A. Vercellone," Nephrology, Dialysis, and Renal Transplant Division, "Città Della Salute e Della Scienza" Hospital, Department of Medical Sciences, University of Turin, Corso Bramante, 88-10126, Turin, Italy
| | - Alberto Mella
- Renal Transplant Center "A. Vercellone," Nephrology, Dialysis, and Renal Transplant Division, "Città Della Salute e Della Scienza" Hospital, Department of Medical Sciences, University of Turin, Corso Bramante, 88-10126, Turin, Italy
| | - Fabrizio Fop
- Renal Transplant Center "A. Vercellone," Nephrology, Dialysis, and Renal Transplant Division, "Città Della Salute e Della Scienza" Hospital, Department of Medical Sciences, University of Turin, Corso Bramante, 88-10126, Turin, Italy
| | - Roberto Presta
- Renal Transplant Center "A. Vercellone," Nephrology, Dialysis, and Renal Transplant Division, "Città Della Salute e Della Scienza" Hospital, Department of Medical Sciences, University of Turin, Corso Bramante, 88-10126, Turin, Italy
| | - Manuel Burdese
- Renal Transplant Center "A. Vercellone," Nephrology, Dialysis, and Renal Transplant Division, "Città Della Salute e Della Scienza" Hospital, Department of Medical Sciences, University of Turin, Corso Bramante, 88-10126, Turin, Italy
| | - Elena Boaglio
- Renal Transplant Center "A. Vercellone," Nephrology, Dialysis, and Renal Transplant Division, "Città Della Salute e Della Scienza" Hospital, Department of Medical Sciences, University of Turin, Corso Bramante, 88-10126, Turin, Italy
| | - Maria Cristina Torazza
- Renal Transplant Center "A. Vercellone," Nephrology, Dialysis, and Renal Transplant Division, "Città Della Salute e Della Scienza" Hospital, Department of Medical Sciences, University of Turin, Corso Bramante, 88-10126, Turin, Italy
| | - Roberta Giraudi
- Renal Transplant Center "A. Vercellone," Nephrology, Dialysis, and Renal Transplant Division, "Città Della Salute e Della Scienza" Hospital, Department of Medical Sciences, University of Turin, Corso Bramante, 88-10126, Turin, Italy
| | - Gianluca Leonardi
- Renal Transplant Center "A. Vercellone," Nephrology, Dialysis, and Renal Transplant Division, "Città Della Salute e Della Scienza" Hospital, Department of Medical Sciences, University of Turin, Corso Bramante, 88-10126, Turin, Italy
| | - Antonio Lavacca
- Renal Transplant Center "A. Vercellone," Nephrology, Dialysis, and Renal Transplant Division, "Città Della Salute e Della Scienza" Hospital, Department of Medical Sciences, University of Turin, Corso Bramante, 88-10126, Turin, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, Città Della Salute e Della Scienza Hospital and University of Turin, 10126, Turin, Italy
| | - Omidreza Sedigh
- Division of Urology, Department of Surgical Sciences, Città Della Salute e Della Scienza Hospital and University of Turin, 10126, Turin, Italy
| | - Andrea Bosio
- Division of Urology, Department of Surgical Sciences, Città Della Salute e Della Scienza Hospital and University of Turin, 10126, Turin, Italy
| | - Aldo Verri
- Division of Vascular Surgery, Department of Thoracic-Vascular Surgery, Città Della Salute e Della Scienza Hospital, 10126, Turin, Italy
| | - Caterina Dolla
- Renal Transplant Center "A. Vercellone," Nephrology, Dialysis, and Renal Transplant Division, "Città Della Salute e Della Scienza" Hospital, Department of Medical Sciences, University of Turin, Corso Bramante, 88-10126, Turin, Italy
| | - Luigi Biancone
- Renal Transplant Center "A. Vercellone," Nephrology, Dialysis, and Renal Transplant Division, "Città Della Salute e Della Scienza" Hospital, Department of Medical Sciences, University of Turin, Corso Bramante, 88-10126, Turin, Italy.
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