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Arabi Z, Tawhari M, Alghamdi AA, Alnasrullah A. Lipid Management in Kidney Transplant Recipients Per KDIGO and American Heart Association Guidelines: A Single-Center Experience. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2024; 12:47-53. [PMID: 38362088 PMCID: PMC10866382 DOI: 10.4103/sjmms.sjmms_95_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/20/2023] [Accepted: 08/16/2023] [Indexed: 02/17/2024]
Abstract
Background The 2013 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommends statin treatment for all adult kidney transplant recipients (KTRs), except those aged <30 years of age and without prior cardiovascular risk factors (CVRF), but does not specify on-treatment low-density lipoprotein cholesterol (LDL) target levels. The 2018 American Heart Association (AHA) guidelines addressed the management of hyperlipidemia in the general population based on an individualized approach of the CVRF with a specific on-treatment LDL target. Objective To analyze dyslipidemia management according to the recommendations of the KDIGO and AHA guidelines. Methods This retrospective study included all KTRs who underwent transplantation between January 2017 and May 2020 at King Abdulaziz Medical Center, Riyadh, Saudi Arabia. The rate of statins prescription in general, rate of statins prescription among KTRs per their CVRF, and rate of achieving the proposed LDL goals, as defined by the AHA, were analyzed. Results A total of 287 KTRs were included. Of the 214 (74.6%) patients aged ≥30 years, 80% received a statin. Statins were prescribed in 93% and 96% of KTRs with diabetes or coronary artery disease, respectively. In patients aged ≥30 years, LDL targets, per AHA guidelines, were achieved in 62% with a target of 2.6 mmol/l, and in 19% with a target of 1.8 mmol/l. Statin therapy resulted in non-significant changes in the mean LDL values from baseline to 12 months after transplantation (P = 0.607), even when only patients prescribed statin after transplantation were included (P = 0.34). Conclusion By applying the KDIGO guidelines, a high rate of statin prescriptions was achieved among KTRs with multiple CVRF and KTRs in general. However, a significant proportion of these KTRs did not achieve the LDL targets proposed by the AHA guidelines, suggesting that higher-intensity statins would be required to achieve these targets.
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Affiliation(s)
- Ziad Arabi
- Division of Nephrology, Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard – Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohammed Tawhari
- Division of Nephrology, Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard – Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abdullah Ashour Alghamdi
- Division of Nephrology, Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard – Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ahmad Alnasrullah
- Division of Nephrology, Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard – Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Clinical outcomes of posttransplantation diabetes mellitus in kidney transplantation recipients: a nationwide population-based cohort study in Korea. Sci Rep 2022; 12:21632. [PMID: 36517524 PMCID: PMC9751267 DOI: 10.1038/s41598-022-25070-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
Posttransplantation diabetes mellitus (PTDM) is an important metabolic complication after KT that causes graft failure and cardiovascular complications in kidney transplantation (KT) recipients. Using the national claim data of South Korea, 7612 KT recipients between 2009 and 2017 were analyzed. PTDM was defined as a consecutive 30-day prescription history of antidiabetic medication after KT. Among these patients, 24.7% were diagnosed with PTDM, and 51.9% were diagnosed within 6 months after KT. Compared to patients without PTDM, those with PTDM were older, more likely to be men, more likely to be diagnosed with hypertension and cardio-cerebrovascular disease, and experienced more rejection episodes requiring high-dose steroid treatment after KT. During the follow-up, 607 DCGFs, 230 DWGFs, 244 MACEs, and 260 all-cause mortality events occurred. Patients with PTDM showed a higher risk of DCGF (adjusted hazard ratio [aHR] 1.49; 95% confidence interval [CI] 1.22-1.82; P < 0.001) and MACEs (aHR 1.76; 95% CI 1.33-2.31; P < 0.001) than patients without PTDM. The risks for all clinical outcomes were higher in the insulin group than in the non-use insulin group. PTDM in KT recipients resulted in both worse allograft and patient outcomes represented by DCGF and MACE, especially in patients needing insulin treatment.
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Abstract
CONTEXT Though posttransplant diabetes mellitus (PTDM, occurring > 45 days after transplantation) and its complications are well described, early post-renal transplant hyperglycemia (EPTH) (< 45 days) similarly puts kidney transplant recipients at risk of infections, rehospitalizations, and graft failure and is not emphasized much in the literature. Proactive screening and management of EPTH is required given these consequences. OBJECTIVE The aim of this article is to promote recognition of early post-renal transplant hyperglycemia, and to summarize available information on its pathophysiology, adverse effects, and management. METHODS A PubMed search was conducted for "early post-renal transplant hyperglycemia," "immediate posttransplant hyperglycemia," "post-renal transplant diabetes," "renal transplant," "diabetes," and combinations of these terms. EPTH is associated with significant complications including acute graft failure, rehospitalizations, cardiovascular events, PTDM, and infections. CONCLUSION Patients with diabetes experience better glycemic control in end-stage renal disease (ESRD), with resurgence of hyperglycemia after kidney transplant. Patients with and without known diabetes are at risk of EPTH. Risk factors include elevated pretransplant fasting glucose, diabetes, glucocorticoids, chronic infections, and posttransplant infections. We find that EPTH increases risk of re-hospitalizations from infections (cytomegalovirus, possibly COVID-19), acute graft rejections, cardiovascular events, and PTDM. It is essential, therefore, to provide diabetes education to patients before discharge. Insulin remains the standard of care while inpatient. Close follow-up after discharge is recommended for insulin adjustment. Some agents like dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists have shown promise. The tenuous kidney function in the early posttransplant period and lack of data limit the use of sodium-glucose cotransporter 2 inhibitors. There is a need for studies assessing noninsulin agents for EPTH to decrease risk of hypoglycemia associated with insulin and long-term complications of EPTH.
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Affiliation(s)
- Anira Iqbal
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Keren Zhou
- Department of Endocrinology, Diabetes & Metabolism, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Sangeeta R Kashyap
- Department of Endocrinology, Diabetes & Metabolism, Cleveland Clinic Foundation, Cleveland, Ohio
| | - M Cecilia Lansang
- Department of Endocrinology, Diabetes & Metabolism, Cleveland Clinic Foundation, Cleveland, Ohio
- Corresponding author: M. Cecilia Lansang, MD, MPH, Department of Endocrinology, Diabetes & Metabolism, Cleveland Clinic Foundation, 9500 Euclid Avenue, F-20, Cleveland, Ohio 44195 Phone: 216-445-5246 x 4, Fax: (216) 445-1656,
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Naik M, Bhat T, Idrees M, Wani M, Wani I, Wani A, Wani M, Bhat M, Hamid A. A study comparing office blood pressure with ambulatory blood pressure in successful adult kidney-transplant recipients at a tertiary care center in North India. INDIAN JOURNAL OF TRANSPLANTATION 2022. [DOI: 10.4103/ijot.ijot_46_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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De Lima JJG, Gowdak LHW, David-Neto E, Bortolotto LA. Early cardiovascular events and cardiovascular death after renal transplantation: role of pretransplant risk factors. Clin Exp Nephrol 2021; 25:545-553. [PMID: 33506358 DOI: 10.1007/s10157-021-02019-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The purpose of this study was to verify the risk factors present in patients on the kidney transplant waiting list that may interfere with the incidence of cardiovascular (CV) events and death during the first 12 months after transplantation. METHODS Based on the data collected prospectively during pretransplant workups, a retrospective study was conducted including 665 patients followed up until death or completing 12 months posttransplantation. Endpoints were the composite incidence of CV events and death. RESULTS The prevalence of diabetes, LV hypertrophy, and CV disease at baseline was high; 14% of patients had angina, 26% an abnormal myocardial scan, and 47% coronary artery disease. CV events occurred in 53 patients (8.4%) and in 29 (55%) caused death. The independent predictors of events were age ≥ 50 years (HR 2.292; CI% 1.093-4.806), angina (HR 1.969; CI% 1.039-3.732), and altered myocardial scan (HR 1.905, CI% 1.059-3.428). Altered myocardial scan (HR 2.822, 95% CI 1.095-6.660) was also one of the independent predictor of CV death. CONCLUSION The incidence of CV events and death were predicted by variables associated with myocardial ischemia, a potentially modifiable risk factor. Patients with pretransplantation myocardial ischemia should be considered at a higher risk of developing early CV complications and managed accordingly before, during, and after kidney transplantation.
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Affiliation(s)
- Jose Jayme G De Lima
- Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, Rua Eneas Carvalho Aguiar 44, São Paulo, SP, 05403-000, Brazil.
| | - Luis Henrique W Gowdak
- Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, Rua Eneas Carvalho Aguiar 44, São Paulo, SP, 05403-000, Brazil
| | - Elias David-Neto
- Renal Transplant Unit, Urology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Luiz A Bortolotto
- Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, Rua Eneas Carvalho Aguiar 44, São Paulo, SP, 05403-000, Brazil
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Jha AK, Lata S. Kidney transplantation in valvular heart disease and pulmonary hypertension: Consensus in waiting. Clin Transplant 2020; 35:e14116. [PMID: 33048408 DOI: 10.1111/ctr.14116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 09/24/2020] [Accepted: 10/01/2020] [Indexed: 11/29/2022]
Abstract
Kidney transplantation induces a lesser anesthetic, surgical, and physiological alterations than other solid organ transplantation. Concomitant valvular pathologies expose these patients to poor postoperative outcome. There is a critical gap in knowledge and lack of coherence in the guidelines related to the management in patients with end-stage renal disease with valvular heart disease. The individualized diagnostic and management plan should be based on the assessment of perioperative outcomes. Similarly, pulmonary hypertension in end-stage renal disease poses a unique challenge, it can manifest in isolation or may be associated with other cardiac lesions, namely left-sided valvular heart disease and left ventricular systolic and diastolic dysfunction. Quantification and stratification according to etiology are needed in pulmonary hypertension to ensure an adequate management plan to minimize the adverse perioperative outcomes. Lack of randomized controlled trials has imposed hindrance in proposing a unified approach to clinical decision-making in these scenarios. In this review, we have described the magnitude of the problems, pathophysiologic interactions, impact on clinical outcomes and have also proposed a management algorithm for both the scenarios.
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Affiliation(s)
- Ajay Kumar Jha
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Suman Lata
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Huang X, Jia Y, Zhu X, Zhang Y, Jiang L, Wei X, Zhao D, Zhao X, Du Y. Effects of Statins on Lipid Profile of Kidney Transplant Recipients: A Meta-Analysis of Randomized Controlled Trials. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9094543. [PMID: 32462035 PMCID: PMC7212277 DOI: 10.1155/2020/9094543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 03/21/2020] [Accepted: 04/07/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the benefits of statins on lipid profile in kidney transplant recipients via a meta-analysis. METHODS We systematically identified peer-reviewed clinical trials, review articles, and treatment guidelines from PubMed, Embase, the Cochrane Library, Wanfang, Chinese National Knowledge Infrastructure (CNKI), SinoMed (CBM), and Chongqing VIP databases from inception to April 2019. In the analysis, only randomized controlled clinical trials performed in human were included. RESULTS Eight articles were included in the analysis, involving 335 kidney transplant recipients who received statins and 350 kidney transplant patients as the control group. Results revealed that statins improved the lipid profile of kidney transplant recipients. Specifically, statin therapy significantly reduced total cholesterol and low-density lipoprotein cholesterol. However, it had no effects on high-density lipoprotein cholesterol and triglyceride levels. CONCLUSIONS The present study provides valuable knowledge on the potential benefits of statins in kidney transplant recipients. This meta-analysis shows that statin therapy modifies the lipid profile in this patient population.
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Affiliation(s)
- Xiu Huang
- Department of Nephrology, The First Hospital of Jilin University, Changchun 130000, China
| | - Yong Jia
- School of Nursing, Jilin University, Changchun 130000, China
| | - Xiaoyu Zhu
- Department of Nephrology, The First Hospital of Jilin University, Changchun 130000, China
| | - Yangyang Zhang
- Department of Nephrology, The First Hospital of Jilin University, Changchun 130000, China
| | - Lili Jiang
- Department of Nephrology, The First Hospital of Jilin University, Changchun 130000, China
| | - Xuejiao Wei
- Department of Nephrology, The First Hospital of Jilin University, Changchun 130000, China
| | - Dan Zhao
- Department of Nephrology, The First Hospital of Jilin University, Changchun 130000, China
| | - Xiaoxia Zhao
- Department of Nephrology, The First Hospital of Jilin University, Changchun 130000, China
| | - Yujun Du
- Department of Nephrology, The First Hospital of Jilin University, Changchun 130000, China
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Sasal J, Naimark D, Klassen J, Shea J, Bargman JM. Late Renal Transplant Failure: An Adverse Prognostic Factor at Initiation of Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080102100413] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Early renal transplant failure necessitating a return to dialysis has been shown to be a poor prognostic factor for survival. Little is known about the outcome of patients with late transplant failure returning to dialysis. It was our clinical impression that late transplant failure (>2 months) carries an increased morbidity and mortality risk in patients returning to dialysis. Objective To determine whether patients with a failed renal transplant have an outcome different to those on dialysis who have never received a kidney transplant. Setting Peritoneal dialysis (PD) unit in a teaching hospital. Patients and Design All failed renal transplant patients (fTx) in the Toronto Hospital Peritoneal Dialysis program between 1989 and 1996 were identified. This cohort of 42 fTx patients was compared with a cohort of randomly selected never-transplanted PD patients (non-Tx). The PD program was selected because of the availability of well-documented patient archival material. The non-Tx group was matched for age and presence of diabetes. Data were collected until retransplantation, change of dialysis modality or center, death, or until June 1998. Results There was no difference at initiation of PD between groups in serum albumin, residual renal function, or mean serum parathyroid hormone level. The mean low-density lipoprotein level was significantly higher in the fTx cohort. The duration of dialysis before Tx in fTx patients accounted for the increased total length of dialysis in fTx (mean 15 months). However, post-Tx the duration of PD was similar for both groups (30.7 months for fTx vs 31.6 months for non-Tx). The fTx group had a considerably worse outcome than the non-Tx group. The time to first peritonitis, subsequent episodes of peritonitis, catheter change, or transfer to hemodialysis occurred at a much faster rate in fTx patients. The most dramatic difference was in survival. There were 3 deaths in the non-Tx group and 12 in the fTx group ( p < 0.01). The mean age at time of death in the fTx group was 47.5 years. Deaths were due mainly to gram-negative peritonitis and cardiovascular disease. Conclusions W e conclude that late failed renal transplant patients starting dialysis are at increased risk of complications and have strikingly higher mortality rates than non-Tx patients. A previously failed kidney transplant can be considered an adverse prognostic factor for patients commencing PD; these patients need to be closely monitored. Although this study was limited to PD patients, the same principles likely apply to fTx patients returning to any form of renal replacement therapy.
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Affiliation(s)
- Joanna Sasal
- Division of Nephrology, The University Health Network, Toronto, Ontario, Canada
| | - David Naimark
- Division of Nephrology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Judy Klassen
- Division of Nephrology, The University Health Network, Toronto, Ontario, Canada
| | - Judy Shea
- Division of Nephrology, The University Health Network, Toronto, Ontario, Canada
| | - Joanne M. Bargman
- Division of Nephrology, The University Health Network, Toronto, Ontario, Canada
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Maekawa YM, Horie K, Iinuma K, Takai M, Ohzawa K, Tsuchiya T, Kato D, Taniguchi T, Ito H, Hishida S, Nakane K, Mizutani K, Koie T, Kato T. Effect of Posttransplant Diabetes Mellitus on Graft Loss After Living-Donor Kidney Transplant at a Single Institution. Transplant Proc 2020; 52:162-168. [PMID: 31901320 DOI: 10.1016/j.transproceed.2019.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 10/06/2019] [Accepted: 10/18/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study aimed to evaluate predictive factors for graft loss in patients who received kidney transplantation (KT) from living kidney donors (LKDs) at a single institute in Japan. METHODS Our study focused on patients with end-stage renal disease who underwent KT from LKDs and were followed up for at least 1 year after surgery. The primary end point was graft survival (GS). GS after KT was analyzed using the Kaplan-Meier method. GS according to subgroup classification was analyzed using the log-rank test. A multivariate analysis was performed using a Cox proportional hazard model. RESULTS The median follow-up period was 105.5 months after KT. The 5- and 10-year GS rates were 97.8% and 96.0% in KT recipients (KTRs) without posttransplant diabetes mellitus (PTDM) and 89.9% and 63.2% in those with PTDM, respectively. The rate of graft loss was significantly higher in KTRs with PTDM than in those without PTDM (P < .001). Of the KTRs whose diabetes mellitus (DM) was cured after KT, those who underwent dialysis because of diabetic nephropathy had no graft loss. In the multivariate analysis, the serum creatinine level at 1 month after KT, PTDM, and human leukocyte antigen mismatches were significantly associated with graft loss after KT. CONCLUSIONS In this study, the rate of graft loss in KTRs with PTDM was significantly higher than that of KTRs without PTDM. However, among KTRs whose DM was cured after KT, those who underwent dialysis because of diabetic nephropathy had no graft loss.
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Affiliation(s)
| | - Kengo Horie
- Department of Urology, Gifu University Graduate School of Medicine, Gifu Japan
| | - Koji Iinuma
- Department of Urology, Gifu University Graduate School of Medicine, Gifu Japan
| | - Manabu Takai
- Department of Urology, Gifu University Graduate School of Medicine, Gifu Japan
| | - Kaori Ohzawa
- Department of Urology, Japanese Red Cross Takayama Hospital, Takayama, Japan
| | - Tomohiro Tsuchiya
- Department of Urology, Gifu University Graduate School of Medicine, Gifu Japan
| | - Daiki Kato
- Department of Urology, Gifu University Graduate School of Medicine, Gifu Japan
| | - Tomoki Taniguchi
- Department of Urology, Gifu University Graduate School of Medicine, Gifu Japan
| | - Hiroki Ito
- Department of Urology, Gifu University Graduate School of Medicine, Gifu Japan
| | - Seiji Hishida
- Department of Urology, Gifu University Graduate School of Medicine, Gifu Japan
| | - Keita Nakane
- Department of Urology, Gifu University Graduate School of Medicine, Gifu Japan
| | - Kosuke Mizutani
- Department of Urology, Gifu University Graduate School of Medicine, Gifu Japan
| | - Takuya Koie
- Department of Urology, Gifu University Graduate School of Medicine, Gifu Japan.
| | - Taku Kato
- Department of Urology, Gifu University Graduate School of Medicine, Gifu Japan
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Effect of Fluvastatin on Cardiovascular Complications in Kidney Transplant Patients: A Systemic Review and Meta-analysis. Transplant Proc 2019; 51:2710-2713. [DOI: 10.1016/j.transproceed.2019.04.087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 03/15/2019] [Accepted: 04/11/2019] [Indexed: 02/02/2023]
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Kim JE, Yu MY, Kim YC, Min SI, Ha J, Lee JP, Kim DK, Oh KH, Joo KW, Ahn C, Kim YS, Lee H. Ratio of triglyceride to high-density lipoprotein cholesterol and risk of major cardiovascular events in kidney transplant recipients. Clin Exp Nephrol 2019; 23:1407-1417. [PMID: 31468232 PMCID: PMC6848440 DOI: 10.1007/s10157-019-01776-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/12/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Dyslipidemia is common in kidney transplant (KT) recipients. We analyzed the ratio of triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) in KT recipients to identify risk factors for major cardiovascular events (MACE). METHODS We retrospectively included KT recipients with a lipid profile performed 1 year after transplantation. We classified patients according to the TG/HDL-C divided into quintiles. Subsequently, we analyzed the association between TG/HDL-C and MACE, defined as heart failure, coronary artery disease, and cerebrovascular disease confirmed by imaging studies. RESULTS A total of 1301 KT recipients were enrolled. The median follow-up duration was 7.4 years (interquartile range 4.4-11.1 years). During the follow-up period, 80 (6.2%) patients developed MACE, which included 38 of unstable anginas, 9 of MIs, 19 of heart failures, 18 of cerebral infarcts, and 4 of cerebral hemorrhages. The fourth and fifth quintiles of TG/HDL-C showed a significantly increased risk of MACE [fourth quintile: adjusted hazard ratio (aHR), 3.38; 95% confidence interval (CI) 1.44-7.95; p = 0.005, fifth quintile: aHR, 2.67; 95% CI 1.13-6.30; p = 0.02]) compared to the second quintile of TG/HDL-C. This association is particularly evident in subgroups of non-DM, HTN, no history of CVD, and statin users. CONCLUSIONS Higher TG/HDL-C levels may be associated with MACE risk in KT recipients.
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Affiliation(s)
- Ji Eun Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea
| | - Mi-Yeon Yu
- Department of Internal Medicine, Hanyang University Guri Hospital, Guri, South Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea
| | - Sang-Il Min
- Department of Surgery, Seoul National University Transplantation Research Laboratory, Seoul National University Hospital, Seoul, South Korea
| | - Jongwon Ha
- Department of Surgery, Seoul National University Transplantation Research Laboratory, Seoul National University Hospital, Seoul, South Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea.,Kidney Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea
| | - Kwon-Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea.,Kidney Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea.,Kidney Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea.,Kidney Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea. .,Kidney Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
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Kgosidialwa O, Blake K, O’Connell O, Egan J, O’Neill J, Hatunic M. Post-transplant diabetes mellitus associated with heart and lung transplant. Ir J Med Sci 2019; 189:185-189. [DOI: 10.1007/s11845-019-02068-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 07/16/2019] [Indexed: 01/12/2023]
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13
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Successful Renal Transplantation between Identical Twins with Very Brief Immunosuppression. Case Rep Transplant 2018; 2018:9842893. [PMID: 30079258 PMCID: PMC6040249 DOI: 10.1155/2018/9842893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 06/03/2018] [Indexed: 11/30/2022] Open
Abstract
Renal transplantation between monozygous identical twins provides an opportunity to utilize minimal immunosuppression to maintain stable allograft function, thereby alleviating the toxicities of immunosuppressive therapy. Despite monozygosity, there is a possibility of discordant protein presentation in identical twins that could trigger alloimmune response and lead to graft injury. Therefore, the optimal immunosuppression regimen in this patient population is unknown, and the safety of immunosuppression withdrawal remains controversial. Herein, we describe two patients who underwent successful renal transplantation from monozygotic identical twin donors. Monozygosity was determined using short tandem repeat (STR) analysis. All immunosuppression was successfully discontinued at 2 days and 3 weeks, respectively, after transplantation. Both patients are alive with functioning renal grafts at 1 year and 5 years after transplant, respectively. These two cases suggest that immunosuppression can be withdrawn safely and rapidly in select monozygous identical twin renal transplant recipients.
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15
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Helanterä I, Räihä J, Finne P, Lempinen M. Early failure of kidney transplants in the current era-a national cohort study. Transpl Int 2018; 31:880-886. [PMID: 29341290 DOI: 10.1111/tri.13115] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 12/11/2017] [Accepted: 01/08/2018] [Indexed: 12/28/2022]
Abstract
Although short-term outcome after kidney transplantation has improved, a small proportion of grafts are lost during the first year. We characterize in detail all early graft losses in the current era in a nationwide cohort of kidney transplant recipients. Altogether 2447 kidney transplantations, performed between June 2004 and October 2016, were included. All graft losses (return to dialysis or patient death) occurring during the first post-transplant year were characterized. During the first post-tranplant year, altogether 109 grafts were lost, 67 grafts failed, and 42 patients died. Fifty-five per cent of the deaths were due to cardiovascular causes, and 29% due to infectious causes. Twenty-one per cent of the failed grafts were primary nonfunction of unknown reason, 34% were lost due to venous thrombosis and 9% due to arterial thrombosis, but only 10 (15%) patients lost a graft due to acute cellular or humoral rejection. Independent risk factors for death included diabetes, and longer duration of pretransplant dialysis treatment, whereas risk factors for graft failure included increased level of panel-reactive antibodies and increased cold ischaemia time. Kidney allografts are rarely lost due to immunological reasons during the first post-transplant year. The most common causes of early death after transplantation are cardiovascular and infectious causes.
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Affiliation(s)
- Ilkka Helanterä
- Transplantation and Liver surgery, Helsinki University Hospital, Helsinki, Finland
| | - Juulia Räihä
- Transplantation and Liver surgery, Helsinki University Hospital, Helsinki, Finland
| | - Patrik Finne
- Department of Nephrology, Helsinki University Hospital, Helsinki, Finland
| | - Marko Lempinen
- Transplantation and Liver surgery, Helsinki University Hospital, Helsinki, Finland
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16
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Ribic CM, Holland D, Howell J, Jevnikar A, Kim SJ, Knoll G, Lee B, Zaltzman J, Gangji AS. Study of Cardiovascular Outcomes in Renal Transplantation: A Prospective, Multicenter Study to Determine the Incidence of Cardiovascular Events in Renal Transplant Recipients in Ontario, Canada. Can J Kidney Health Dis 2017; 4:2054358117713729. [PMID: 28660072 PMCID: PMC5476328 DOI: 10.1177/2054358117713729] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 03/27/2017] [Indexed: 12/14/2022] Open
Abstract
Background: Renal transplant recipients (RTRs) are at significantly higher risk for morbidity and mortality compared with the general population, largely attributed to cardiovascular disease (CVD). Previous estimates of CVD events have come from health care databases and retrospective studies. Objective: The objective of this study was to prospectively determine the prevalence of risk factors and incidence of CVD events in a Canadian cohort of RTRs. Design: Study of Cardiovascular Outcomes in Renal Transplantation (SCORe) was a prospective, longitudinal, multicenter observational study. Setting: Adult RTRs were recruited from 6 participating transplant sites in Ontario, Canada. Patients: Eligible patients were those receiving a living or deceased donor renal transplant. Patients who received simultaneous transplant of any other organ were excluded. Measurements: Primary outcomes included myocardial infarction (MI) defined by American College of Cardiology (ACC-MI) criteria, and major adverse cardiac events (MACE), defined as cardiovascular (CV) death, ACC-MI, coronary revascularization, and nonhemorrhagic stroke. CV events were adjudicated by a single, independent cardiologist. Methods: CV and transplant-specific risk factors that predict MACE and ACC-MI were identified by stepwise regression analysis using the Cox proportional hazards model. Results: A total of 1303 patients enrolled across 6 transplant centers were followed for 4.5 ± 1.6 years (mean ± SD). Incidence of MACE was 7.0%, with significant independent predictors/risk factors including age, diabetes, coronary revascularization, nonhemorrhagic stroke, and renal replacement therapy (RRT). ACC-MI incidence was 4.0%, with significant independent predictors/risk factors including age, coronary revascularization, and duration of RRT in excess of the median value (2.91 years). Limitations: Patients were recruited from a single province, so may not reflect the experience of RTRs in other areas of Canada. Conclusions: Using a prospective design and rigorous methodology, this study found that the incidence of CV events after renal transplantation was elevated relative to the general Canadian population and was comparable with that reported in patient registries, thus helping validate the utility of retrospective analysis in this field. SCORe highlights the importance of monitoring RTRs for traditional cardiac and transplant-specific CV risk factors to help prevent CV morbidity and mortality. Further research is needed to investigate a broader range of potential risk factors and their combined effects on incident CV events.
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Affiliation(s)
- Christine M Ribic
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - David Holland
- Department of Medicine, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - John Howell
- Astellas Pharma Canada, Inc, Markham, Ontario, Canada
| | - Anthony Jevnikar
- Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada
| | - S Joseph Kim
- Division of Nephrology, Department of Medicine, University of Toronto, Ontario, Canada
| | - Greg Knoll
- Division of Nephrology, Department of Medicine, University of Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Health Research Institute, Ontario, Canada
| | - Brenda Lee
- Astellas Pharma Canada, Inc, Markham, Ontario, Canada
| | - Jeffrey Zaltzman
- Division of Nephrology, Department of Medicine, University of Toronto, Ontario, Canada
| | - Azim S Gangji
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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17
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Nowak M, Tardivel S, Nguyen-Khoa T, Abreu S, Allaoui F, Fournier N, Chaminade P, Paul JL, Lacour B. Mycophenolate Mofetil and Rapamycin Induce Apoptosis in the Human Monocytic U937 Cell Line Through Two Different Pathways. J Cell Biochem 2017; 118:3480-3487. [PMID: 28345768 DOI: 10.1002/jcb.26007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/23/2017] [Indexed: 12/31/2022]
Abstract
Transplant vasculopathy may be considered as an accelerated form of atherosclerosis resulting in chronic rejection of vascularized allografts. After organ transplantation, a diffuse intimal thickening is observed, leading to the development of an atherosclerosis plaque due to a significant monocyte infiltration. This results from a chronic inflammatory process induced by the immune response. In this study, we investigated the impact of two immunosuppressive drugs used in therapy initiated after organ transplantation, mycophenolate mofetil, and rapamycin, on the apoptotic response of monocytes induced or not by oxidized LDL. Here we show the pro-apoptotic effect of these two drugs through two distinct signaling pathways and we highlight a synergistic effect of rapamycin on apoptosis induced by oxidized LDL. In conclusion, since immunosuppressive therapy using mycophenolate mofetil or rapamycin can increase the cell death in a monocyte cell line, this treatment could exert similar effects on human monocytes in transplant patients, and thus, prevent transplant vasculopathy, atherosclerosis development, and chronic allograft rejection. J. Cell. Biochem. 118: 3480-3487, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Maxime Nowak
- Lip(Sys)2-Athérosclérose: homéostasie et trafic du cholestérol des macrophages, Univ. Paris-Sud, Université Paris-Saclay, 92290 Châtenay-Malabry, France
| | - Sylviane Tardivel
- Lip(Sys)2-Athérosclérose: homéostasie et trafic du cholestérol des macrophages, Univ. Paris-Sud, Université Paris-Saclay, 92290 Châtenay-Malabry, France.,Ecole Pratique des Hautes Etudes, Laboratoire nutrition lipidique et apoptose dans le système vasculaire-Faculté de Pharmacie, 92290 Châtenay-Malabry, France
| | - Thao Nguyen-Khoa
- Laboratoire de Biochimie générale-AP-HP (Assistance publique-Hôpitaux de Paris)-Hôpital Necker Enfants Malades, 75015 Paris, France
| | - Sonia Abreu
- Lip(Sys)2-Chimie Analytique Pharmaceutique, Univ. Paris-Sud, Université Paris-Saclay, 92290 Châtenay-Malabry, France
| | - Fatima Allaoui
- Lip(Sys)2-Athérosclérose: homéostasie et trafic du cholestérol des macrophages, Univ. Paris-Sud, Université Paris-Saclay, 92290 Châtenay-Malabry, France
| | - Natalie Fournier
- Lip(Sys)2-Athérosclérose: homéostasie et trafic du cholestérol des macrophages, Univ. Paris-Sud, Université Paris-Saclay, 92290 Châtenay-Malabry, France.,Laboratoire de Biochimie-AP-HP (Assistance publique-Hôpitaux de Paris)-Hôpital Européen Georges Pompidou, 75015 Paris, France
| | - Pierre Chaminade
- Lip(Sys)2-Chimie Analytique Pharmaceutique, Univ. Paris-Sud, Université Paris-Saclay, 92290 Châtenay-Malabry, France
| | - Jean-Louis Paul
- Lip(Sys)2-Athérosclérose: homéostasie et trafic du cholestérol des macrophages, Univ. Paris-Sud, Université Paris-Saclay, 92290 Châtenay-Malabry, France.,Laboratoire de Biochimie-AP-HP (Assistance publique-Hôpitaux de Paris)-Hôpital Européen Georges Pompidou, 75015 Paris, France
| | - Bernard Lacour
- Lip(Sys)2-Athérosclérose: homéostasie et trafic du cholestérol des macrophages, Univ. Paris-Sud, Université Paris-Saclay, 92290 Châtenay-Malabry, France.,Ecole Pratique des Hautes Etudes, Laboratoire nutrition lipidique et apoptose dans le système vasculaire-Faculté de Pharmacie, 92290 Châtenay-Malabry, France.,Laboratoire de Biochimie générale-AP-HP (Assistance publique-Hôpitaux de Paris)-Hôpital Necker Enfants Malades, 75015 Paris, France
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18
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Desai VCA, Ferrand Y, Cavanaugh TM, Kelton CML, Caro JJ, Goebel J, Heaton PC. Comparative Effectiveness of Tacrolimus-Based Steroid Sparing versus Steroid Maintenance Regimens in Kidney Transplantation: Results from Discrete Event Simulation. Med Decis Making 2017; 37:827-843. [DOI: 10.1177/0272989x17700879] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background. Corticosteroids used as immunosuppressants to prevent acute rejection (AR) and graft loss (GL) following kidney transplantation are associated with serious cardiovascular and other adverse events. Evidence from short-term randomized controlled trials suggests that many patients on a tacrolimus-based immunosuppressant regimen can withdraw from steroids without increased AR or GL risk. Objectives. To measure the long-term tradeoff between GL and adverse events for a heterogeneous-risk population and determine the optimal timing of steroid withdrawal. Methods. A discrete event simulation was developed including, as events, AR, GL, myocardial infarction (MI), stroke, cytomegalovirus, and new onset diabetes mellitus (NODM), among others. Data from the United States Renal Data System were used to estimate event-specific parametric regressions, which accounted for steroid-sparing regimen (avoidance, early 7-d withdrawal, 6-mo withdrawal, 12-mo withdrawal, and maintenance) as well as patients’ demographics, immunologic risks, and comorbidities. Regression-equation results were used to derive individual time-to-event Weibull distributions, used, in turn, to simulate the course of patients over 20 y. Results. Patients on steroid avoidance or an early-withdrawal regimen were more likely to experience AR (45.9% to 55.0% v. 33.6%, P < 0.05) and GL (51.5% to 68.8% v. 37.8%, P < 0.05) compared to patients on steroid maintenance. Patients in 6-mo and 12-mo steroid withdrawal groups were less likely to experience MI (11.1% v. 13.3%, P < 0.05), NODM (30.7% to 34.4% v. 37.7%, P < 0.05), and cardiac death (29.9% to 30.5% v. 32.4%, P < 0.05), compared to steroid maintenance. Conclusions. Strategies of 6- and 12-mo steroid withdrawal post-kidney transplantation are expected to reduce the rates of adverse cardiovascular events and other outcomes with no worsening of AR or GL rates compared with steroid maintenance.
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Affiliation(s)
- Vibha C. A. Desai
- Researcher, HealthCore, Andover, MA, USA (VCAD)
- Assistant Professor of Operations Management, College of Business, Clemson University, Clemson, SC, USA (YF)
- Assistant Professor of Pharmacy Practice and Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, USA (TMC)
- Professor of Economics, Carl H. Lindner College of Business, and Adjunct Professor of Clinical Pharmacy, James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, USA (CMLK)
- Chief Scientist, Evidera, and Adjunct Professor of Epidemiology and of Medicine, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada (JJC)
| | - Yann Ferrand
- Researcher, HealthCore, Andover, MA, USA (VCAD)
- Assistant Professor of Operations Management, College of Business, Clemson University, Clemson, SC, USA (YF)
- Assistant Professor of Pharmacy Practice and Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, USA (TMC)
- Professor of Economics, Carl H. Lindner College of Business, and Adjunct Professor of Clinical Pharmacy, James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, USA (CMLK)
- Chief Scientist, Evidera, and Adjunct Professor of Epidemiology and of Medicine, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada (JJC)
| | - Teresa M. Cavanaugh
- Researcher, HealthCore, Andover, MA, USA (VCAD)
- Assistant Professor of Operations Management, College of Business, Clemson University, Clemson, SC, USA (YF)
- Assistant Professor of Pharmacy Practice and Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, USA (TMC)
- Professor of Economics, Carl H. Lindner College of Business, and Adjunct Professor of Clinical Pharmacy, James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, USA (CMLK)
- Chief Scientist, Evidera, and Adjunct Professor of Epidemiology and of Medicine, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada (JJC)
| | - Christina M. L. Kelton
- Researcher, HealthCore, Andover, MA, USA (VCAD)
- Assistant Professor of Operations Management, College of Business, Clemson University, Clemson, SC, USA (YF)
- Assistant Professor of Pharmacy Practice and Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, USA (TMC)
- Professor of Economics, Carl H. Lindner College of Business, and Adjunct Professor of Clinical Pharmacy, James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, USA (CMLK)
- Chief Scientist, Evidera, and Adjunct Professor of Epidemiology and of Medicine, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada (JJC)
| | - J. Jaime Caro
- Researcher, HealthCore, Andover, MA, USA (VCAD)
- Assistant Professor of Operations Management, College of Business, Clemson University, Clemson, SC, USA (YF)
- Assistant Professor of Pharmacy Practice and Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, USA (TMC)
- Professor of Economics, Carl H. Lindner College of Business, and Adjunct Professor of Clinical Pharmacy, James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, USA (CMLK)
- Chief Scientist, Evidera, and Adjunct Professor of Epidemiology and of Medicine, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada (JJC)
| | - Jens Goebel
- Researcher, HealthCore, Andover, MA, USA (VCAD)
- Assistant Professor of Operations Management, College of Business, Clemson University, Clemson, SC, USA (YF)
- Assistant Professor of Pharmacy Practice and Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, USA (TMC)
- Professor of Economics, Carl H. Lindner College of Business, and Adjunct Professor of Clinical Pharmacy, James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, USA (CMLK)
- Chief Scientist, Evidera, and Adjunct Professor of Epidemiology and of Medicine, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada (JJC)
| | - Pamela C. Heaton
- Researcher, HealthCore, Andover, MA, USA (VCAD)
- Assistant Professor of Operations Management, College of Business, Clemson University, Clemson, SC, USA (YF)
- Assistant Professor of Pharmacy Practice and Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, USA (TMC)
- Professor of Economics, Carl H. Lindner College of Business, and Adjunct Professor of Clinical Pharmacy, James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, USA (CMLK)
- Chief Scientist, Evidera, and Adjunct Professor of Epidemiology and of Medicine, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada (JJC)
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Abuzeid W, Iwanochko RM, Wang X, Kim SJ, Husain M, Lee DS. Prognostic impact of SPECT-MPI after renal transplantation. J Nucl Cardiol 2017; 24:295-303. [PMID: 27663251 DOI: 10.1007/s12350-016-0547-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 05/05/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND While renal transplantation is increasingly performed for end-stage renal disease, there is a paucity of data on cardiac screening and prognostication post-transplant. We determined the prognostic value of SPECT-MPI in a cohort who underwent renal transplantation. METHODS Among 4933 renal transplant recipients identified from the Canadian Organ Replacement Register, we examined outcomes of patients who underwent SPECT-MPI in Ontario, Canada. We determined morbidity and mortality using hospitalization and vital statistics registries, according to SPECT-MPI findings. RESULTS We studied 282 renal transplant recipients (median age 46 years [25th, 75th percentile 37, 58]) with detailed SPECT-MPI results available, followed for a median of 5.7 (3.3, 7.7) years. Among those undergoing SPECT-MPI (66% pharmacologic stress), 41% had an abnormal summed stress score (SSS > 0) and 31% demonstrated abnormal summed difference score (SDS > 0). Rates of cardiovascular death were 0.4 per 100 person-years among those with normal stress perfusion (SSS = 0) and 0.4 per 100 person-years with SDS = 0. After adjusting for age, sex, prior myocardial infarction (MI), and cardiac risk factors, an SSS ≥ 4 conferred increased risk of cardiovascular death or cardiovascular hospitalization with adjusted hazard ratios of 2.52 (95% CI 1.41, 4.52, P = .002) for SSS 4-6 and 2.61 (95% CI 1.52, 4.49, P < .001) for SSS ≥ 7. SDS was a significant predictor of cardiovascular death or hospitalization, with adjusted hazard ratios of 2.96 (95% CI 1.72, 5.09, P < .001) for SDS 4-6 and 3.26 (95% CI 1.64, 6.50, P < .001) for SDS ≥ 7. CONCLUSION Among renal transplant recipients, SPECT-MPI predicted risk of cardiovascular death and cardiovascular hospitalization events.
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Affiliation(s)
- Wael Abuzeid
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Robert M Iwanochko
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Robert J. Burns Nuclear Cardiology Laboratory and Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
| | - Xuesong Wang
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - S Joseph Kim
- University of Toronto, Toronto, ON, Canada
- Division of Nephrology, University Health Network, Toronto, ON, Canada
| | - Mansoor Husain
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Robert J. Burns Nuclear Cardiology Laboratory and Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
- Ted Rogers Centre for Heart Research, Toronto, ON, Canada
| | - Douglas S Lee
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.
- University of Toronto, Toronto, ON, Canada.
- Robert J. Burns Nuclear Cardiology Laboratory and Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada.
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
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20
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Sehgal S, Bock MJ, Louks Palac H, Brickman WJ, Gossett JG, Marino BS, Backer CL, Pahl E. New-onset diabetes mellitus after heart transplantation in children - Incidence and risk factors. Pediatr Transplant 2016; 20:963-969. [PMID: 27421915 DOI: 10.1111/petr.12759] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2016] [Indexed: 11/29/2022]
Abstract
Diabetes mellitus is a recognized complication of SOT in adults and is associated with decreased graft and patient survival. Little is known about NOD in pediatric HT recipients. We aimed to characterize the incidence and describe risk factors for development of NOD after HT in children. Children who developed diabetes after HT were identified from the OPTN database. Demographic and clinical data before and after transplant were compared between patients with and without NOD. A total of 2056 children were included, 56% were male, 54% were Caucasian, and 62% had cardiomyopathy prior to HT. NOD developed in 219 children (11%) after HT. The incidence of NOD was 2.4, 9.0, and 10.4% at one, five, and 10 yr after HT, respectively. Obesity (HR: 4.32), dialysis prior to transplant (HR: 2.38), African American race (HR: 1.86), transplant before year 2000 (HR: 1.82), female gender (HR: 1.68), and older age at transplant (HR: 1.28) were independent predictors of NOD. The major modifiable risk factor for NOD is obesity, imparting the maximum hazard. Improved surveillance for diabetes in high-risk patients and specific prevention and intervention strategies are imperative in this population.
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Affiliation(s)
- Swati Sehgal
- Division of Cardiology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Matthew J Bock
- Division of Cardiology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Hannah Louks Palac
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Wendy J Brickman
- Division of Endocrinology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jeffrey G Gossett
- Division of Cardiology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bradley S Marino
- Division of Cardiology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Carl L Backer
- Division of Cardiovascular Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Siragusa Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elfriede Pahl
- Division of Cardiology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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21
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Abstract
BACKGROUND Diabetes mellitus is a chronic illness with great impact on long-term outcome after liver transplantation (LT). Despite this, the current level of glycemic control and quality of screening strategies for diabetes-associated conditions that are being provided to liver transplant recipients with diabetes have not yet been assessed. METHODS We performed a cross-sectional, multicenter study that included 344 liver transplant recipients and examined the level of glycemic control and its associated factors, as well as the quality of screening strategies for diabetes-associated conditions. RESULTS Seventy-five patients (21.8%) suffered from diabetes before transplantation, and 82 (23.8%) developed diabetes mellitus after transplantation. Adequate glycemic control (HbA1c < 7%) was achieved in 66.7% of the patients. Forty-eight percent of patients underwent regular screening for retinopathy, 47.1% for nephropathy, 4.5% for neuropathy, and 5.7% for foot ulcers. Diabetes was associated with higher frequency of cardiovascular disease and dyslipidemia both before and after LT. Multivariate analysis revealed association between poor glycemic control and arterial hypertension, presence of diabetes before transplantation, elevated GGT, and insulin use. CONCLUSIONS Glycemic control was inadequate in 33.3% of LT recipients with diabetes, and screening protocols for diabetes-associated conditions did not meet the standards for medical care set by the American Diabetes Association in any of the participating centers. Consequently, this study reveals a clear deficiency in the quality of diabetes care provided to patients after LT and, hence, we predict that future progress in this area will have a significant impact on medium-term to long-term outcome of these patients.
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Fabbian F, De Giorgi A, Manfredini F, Lamberti N, Forcellini S, Storari A, Todeschini P, Gallerani M, La Manna G, Mikhailidis DP, Manfredini R. Impact of comorbidity on outcome in kidney transplant recipients: a retrospective study in Italy. Intern Emerg Med 2016; 11:825-32. [PMID: 27003820 DOI: 10.1007/s11739-016-1438-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/09/2016] [Indexed: 01/06/2023]
Abstract
The aim of this study was to relate in-hospital mortality (IHM), cardiovascular events (CVEs) and non-immunologic comorbidity evaluated on the basis of International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codification, in Italian kidney transplant recipients (KTRs). We evaluated IHM and admissions due to CVEs between 2000 and 2013 recorded in the database of the region Emilia Romagna. The Elixhauser score was calculated for evaluation of non-immunologic comorbidity. Three main outcomes (i.e. IHM, admission due to major CVEs and combined outcome) were the dependent variables of the multivariate models, while age, gender and Elixhauser score were the independent ones. During the examined period, a total of 9063 admissions in 3648 KTRs were recorded; 1945 patients were males (53.3 %) and 1703 females (46.7 %) and the mean age was 52.9 ± 13.1 years. The non-immunological impaired status of the KTRs, examined by the Elixhauser score, was 3.88 ± 4.29. During the 14-year follow-up period, IHM for any cause was 3.2 % (n = 117), and admissions due to CVEs were 527 (5.8 %). Age and comorbidity were independently associated with CVEs, IHM and the combined outcome. Male gender was independently associated with IHM and combined outcome, but not with CVEs. Evaluation of non-immunological comorbidity is important in KTRs and identification of high-risk patients for major clinical events could improve outcome. Moreover, comorbidity could be even more important in chronic kidney disease patients who are waiting for a kidney transplant.
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Affiliation(s)
- Fabio Fabbian
- Clinica Medica Unit, Department of Medical Sciences, School of Medicine, University of Ferrara, Via L. Ariosto 25, 44121, Ferrara, Italy.
| | - Alfredo De Giorgi
- Clinica Medica Unit, Department of Medical Sciences, School of Medicine, University of Ferrara, Via L. Ariosto 25, 44121, Ferrara, Italy
| | - Fabio Manfredini
- Department of Biomedical Sciences and Surgical Specialties, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Nicola Lamberti
- Department of Biomedical Sciences and Surgical Specialties, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Silvia Forcellini
- Nephrology Unit, Department of Specialistic Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Alda Storari
- Nephrology Unit, Department of Specialistic Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Paola Todeschini
- Department of Specialistic, Diagnostic and Experimental Medicine, School of Medicine, University of Bologna, Bologna, Italy
| | - Massimo Gallerani
- Department of Internal Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Gaetano La Manna
- Department of Specialistic, Diagnostic and Experimental Medicine, School of Medicine, University of Bologna, Bologna, Italy
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinic), University College London (UCL) Medical School, London, UK
| | - Roberto Manfredini
- Clinica Medica Unit, Department of Medical Sciences, School of Medicine, University of Ferrara, Via L. Ariosto 25, 44121, Ferrara, Italy
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Protasiewicz M, Banasik M, Kurcz J, Podgórski M, Zembala M, Zakliczyński M, Mysiak A, Boratyńska M, Klinger M. Renal Artery Denervation in Patient After Heart and Kidney Transplantation With Refractory Hypertension. Transplant Proc 2016; 48:1858-60. [PMID: 27496508 DOI: 10.1016/j.transproceed.2016.01.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 01/21/2016] [Indexed: 11/27/2022]
Abstract
We describe the case of a 54-year-old patient after renal and heart transplantation in whom uncontrolled hypertension was diagnosed. Despite combined antihypertensive therapy, no significant therapeutic effect was achieved. Clinical assessment of ambulatory blood pressure monitoring (ABPM) revealed the ineffectiveness of a bisoprolol, nitrendypin, klonidyn, ramipryl, furosemide, and doxasosine combination used at high doses. High blood pressure levels with their effect on a hypertrophic transplanted heart (left ventricular mass 254 g) and poor renal graft function (39 mL/kg/min) posed an extremely high risk of future cardiovascular complications, and were the reason to perform a native renal arteries denervation. The procedure was carried out through the right femoral artery with the use of a 6F guiding catheter. During a 1-year observation, significant decreases in ABPM systolic and diastolic blood pressures were observed after the procedure (168/88 mm Hg vs 154/77 mm Hg, respectively). Moreover a significant regression of left ventricular mass (215 g/m(2)) and stable renal graft function were noted. The presented case shows that native renal arteries denervation may be successful and safe in kidney and heart transplant recipients. Moreover, during the 1-year follow-up, the reduction in blood pressure was followed by a reduction in transplanted heart hypertrophy, both leading to regression of cardiovascular risk for the patient.
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Affiliation(s)
- M Protasiewicz
- Department of Cardiology, Wroclaw Medical University, Wroclaw, Poland
| | - M Banasik
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.
| | - J Kurcz
- Department of Radiology, Wroclaw Medical University, Wroclaw, Poland
| | - M Podgórski
- Department of Internal Disease and Hypertension, Wroclaw Medical University, Wroclaw, Poland
| | - M Zembala
- Department of Cardiac Surgery and Transplantology, SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Disease, Zabrze, Poland
| | - M Zakliczyński
- Department of Cardiac Surgery and Transplantology, SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Disease, Zabrze, Poland
| | - A Mysiak
- Department of Cardiology, Wroclaw Medical University, Wroclaw, Poland
| | - M Boratyńska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - M Klinger
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
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24
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El-Ghar SMGA, Qureshi M, Shoker A, Prasad K. Oxidative Stress in Renal Transplant Patients Who Develop Cardiovascular Disease. J Cardiovasc Pharmacol Ther 2016; 11:203-10. [PMID: 17056834 DOI: 10.1177/1074248406293254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiovascular disease limits life expectancy of successful renal transplant patients. Reactive oxygen species have been implicated in the development of atherosclerosis, and high levels could be due to increased production or a decrease in antioxidant reserve. Cardiovascular disease in renal transplant recipients could be due to elevated levels of malondialdehyde (an index of levels of reactive oxygen species) and homocysteine and reduced levels of glutathione. Renal transplant recipients with and without cardiovascular disease were studied along with healthy controls. Serum malondialdehyde, plasma homocysteine, and red blood cell glutathione were measured. The results suggest that levels of serum malondialdehyde and plasma homocysteine were higher in patients with or without cardiovascular disease compared with controls; however, the values were similar in both groups of transplant patients. Glutathione levels in red blood cells were similar in all 3 groups. Renal transplant recipients without cardiovascular disease have high levels of oxidative stress and may develop cardiovascular disease with time.
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Affiliation(s)
- Suzan M G A El-Ghar
- Department of Pathology, College of Medicine, University of Saskatchewan, Royal University Hospital, Saskatoon, Saskatchewan, Canada
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25
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Roblin E, Dumortier J, Di Filippo M, Collardeau-Frachon S, Sassolas A, Peretti N, Serusclat A, Rivet C, Boillot O, Lachaux A. Lipid profile and cardiovascular risk factors in pediatric liver transplant recipients. Pediatr Transplant 2016; 20:241-8. [PMID: 26750745 DOI: 10.1111/petr.12664] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2015] [Indexed: 01/14/2023]
Abstract
Cardiovascular diseases induce long-term morbidity and mortality of adult LT recipients. The aim of this retrospective study was to assess CVRF, lipid abnormalities, and atherosclerosis (appraised by c-IMT), more than 10 yr after pediatric LT. Thirty-one children who underwent LT between December 1990 and December 2000 were included. Median age at LT was 14 months (range 4-64), and median follow-up after LT was 11.9 yr (range 9.0-17.3). In our cohort, obesity (9.7%) and treated hypertension (9.7%) were rare. None of the patients was smoker or diabetic. High TC and TG were both observed in 6.5% of the patients. The mean c-IMT for male patients was 1.22 ± 1.55 and 1.58 ± 1.23 mm in female patients. Seven patients (22%) had a mean c-IMT above +2 s.d. Values below the 5th percentile were noted for LDL-cholesterol (58.1%), HDL-cholesterol (25.8%), apolipoprotein B (40%), and apolipoprotein A1 (20%). LDL-cholesterol and apolipoprotein B levels were significantly lower in patients treated by tacrolimus in comparison with CsA (p < 0.05). In conclusion, our results suggest that pediatric LT patients do not present significant CVRF; moreover, instead of hyperlipidemia, hypocholesterolemia (LDL-C) is frequent and immunosuppressive therapy is probably the cause.
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Affiliation(s)
- Emilie Roblin
- Service d'Hépatologie, Gastroentérologie et Nutrition pédiatriques, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, France
| | - Jérôme Dumortier
- Unité de Transplantation hépatique, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France
| | - Mathilde Di Filippo
- UF Dyslipidémies Cardiobiologie, Département de Biochimie et de Biologie Moléculaire du GHE, Laboratoire de Biologie Médicale Multi Sites, Hospices Civils de Lyon, Lyon, France.,INSERM U1060, INSA de Lyon, INRA U1235, Univ Lyon-1, Université de Lyon, Villeurbanne, Oullins, France
| | - Sophie Collardeau-Frachon
- Université Claude Bernard Lyon 1, Lyon, France.,Service de Pathologie, Groupement hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Agnès Sassolas
- INSERM U1060, INSA de Lyon, INRA U1235, Univ Lyon-1, Université de Lyon, Villeurbanne, Oullins, France.,Service de Pathologie, Groupement hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Noël Peretti
- Service d'Hépatologie, Gastroentérologie et Nutrition pédiatriques, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, France.,Service de Pathologie, Groupement hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - André Serusclat
- Service d'Imagerie, Hôpital Cardiovasculaire et pneumologique Louis Pradel, Hospices Civils de Lyon, Bron, France
| | - Christine Rivet
- Service d'Hépatologie, Gastroentérologie et Nutrition pédiatriques, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, France
| | - Olivier Boillot
- Unité de Transplantation hépatique, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France
| | - Alain Lachaux
- Service d'Hépatologie, Gastroentérologie et Nutrition pédiatriques, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, France.,Université Claude Bernard Lyon 1, Lyon, France
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26
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Rao NN, Dundon BK, Worthley MI, Faull RJ. The Impact of Arteriovenous Fistulae for Hemodialysis on the Cardiovascular System. Semin Dial 2016; 29:214-21. [DOI: 10.1111/sdi.12459] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Nitesh N. Rao
- Department of Renal Medicine; Royal Adelaide Hospital; Adelaide South Australia Australia
- University of Adelaide; Adelaide South Australia Australia
| | - Benjamin K. Dundon
- Monash Cardiovascular Research Centre; Monash HEART; Monash Health; Melbourne Victoria Australia
| | - Matthew I. Worthley
- Cardiovascular Research Centre at the Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Randall J. Faull
- Department of Renal Medicine; Royal Adelaide Hospital; Adelaide South Australia Australia
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Felix R, Saparia T, Hirose R, Almers L, Chau Q, Jonelis T, Zheng S, Zaroff J. Cardiac Events After Kidney Transplantation According to Pretransplantation Coronary Artery Disease and Coronary Revascularization Status. Transplant Proc 2016; 48:65-73. [DOI: 10.1016/j.transproceed.2015.12.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 12/30/2015] [Indexed: 12/11/2022]
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28
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Neale J, Smith AC. Cardiovascular risk factors following renal transplant. World J Transplant 2015; 5:183-95. [PMID: 26722646 PMCID: PMC4689929 DOI: 10.5500/wjt.v5.i4.183] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 08/19/2015] [Accepted: 09/25/2015] [Indexed: 02/05/2023] Open
Abstract
Kidney transplantation is the gold-standard treatment for many patients with end-stage renal disease. Renal transplant recipients (RTRs) remain at an increased risk of fatal and non-fatal cardiovascular (CV) events compared to the general population, although rates are lower than those patients on maintenance haemodialysis. Death with a functioning graft is most commonly due to cardiovascular disease (CVD) and therefore this remains an important therapeutic target to prevent graft failure. Conventional CV risk factors such as diabetes, hypertension and renal dysfunction remain a major influence on CVD in RTRs. However it is now recognised that the morbidity and mortality from CVD are not entirely accounted for by these traditional risk-factors. Immunosuppression medications exert a deleterious effect on many of these well-recognised contributors to CVD and are known to exacerbate the probability of developing diabetes, graft dysfunction and hypertension which can all lead on to CVD. Non-traditional CV risk factors such as inflammation and anaemia have been strongly linked to increased CV events in RTRs and should be considered alongside those which are classified as conventional. This review summarises what is known about risk-factors for CVD in RTRs and how, through identification of those which are modifiable, outcomes can be improved. The overall CV risk in RTRs is likely to be multifactorial and a complex interaction between the multiple traditional and non-traditional factors; further studies are required to determine how these may be modified to enhance survival and quality of life in this unique population.
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29
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Wong N, Tee PS, Kee TYS, Tan JWC. Current practices in coronary artery disease evaluation of renal transplant candidates prior to renal transplantation. PROCEEDINGS OF SINGAPORE HEALTHCARE 2015. [DOI: 10.1177/2010105815611803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Cardiovascular disease is the leading cause of morbidity and mortality in renal transplant recipients and candidates awaiting transplant. Pre-transplant coronary artery disease evaluation can aid in determining transplant candidacy, identifying patients who may benefit from pre-operative cardiac intervention, and implementing measures to reduce perioperative and post-transplant cardiovascular events. However, the choice of investigations and approach in evaluation has yet to be well defined. This article aims to review the evidence for the use of non-invasive investigations and coronary angiography in prognostication, as well as the evidence for revascularization in reducing future cardiac events. The article will also summarize international recommendations and describe the local practice in coronary artery disease evaluation prior to transplant.
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Affiliation(s)
- Ningyan Wong
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Ping Sing Tee
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Terence Yi-Shern Kee
- Department of Renal Medicine, Singapore General Hospital, Singapore
- Duke-NUS Graduate Medical School, Singapore
| | - Jack Wei Chieh Tan
- Department of Cardiology, National Heart Centre Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore
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30
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Zhou J, Qin L, Yi T, Ali R, Li Q, Jiao Y, Li G, Tobiasova Z, Huang Y, Zhang J, Yun JJ, Sadeghi MM, Giordano FJ, Pober JS, Tellides G. Interferon-γ-mediated allograft rejection exacerbates cardiovascular disease of hyperlipidemic murine transplant recipients. Circ Res 2015; 117:943-55. [PMID: 26399469 DOI: 10.1161/circresaha.115.306932] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 09/23/2015] [Indexed: 01/05/2023]
Abstract
RATIONALE Transplantation, the most effective therapy for end-stage organ failure, is markedly limited by early-onset cardiovascular disease (CVD) and premature death of the host. The mechanistic basis of this increased CVD is not fully explained by known risk factors. OBJECTIVE To investigate the role of alloimmune responses in promoting CVD of organ transplant recipients. METHODS AND RESULTS We established an animal model of graft-exacerbated host CVD by combining murine models of atherosclerosis (apolipoprotein E-deficient recipients on standard diet) and of intra-abdominal graft rejection (heterotopic cardiac transplantation without immunosuppression). CVD was absent in normolipidemic hosts receiving allogeneic grafts and varied in severity among hyperlipidemic grafted hosts according to recipient-donor genetic disparities, most strikingly across an isolated major histocompatibility complex class II antigen barrier. Host disease manifested as increased atherosclerosis of the aorta that also involved the native coronary arteries and new findings of decreased cardiac contractility, ventricular dilatation, and diminished aortic compliance. Exacerbated CVD was accompanied by greater levels of circulating cytokines, especially interferon-γ and other Th1-type cytokines, and showed both systemic and intralesional activation of leukocytes, particularly T-helper cells. Serological neutralization of interferon-γ after allotransplantation prevented graft-related atherosclerosis, cardiomyopathy, and aortic stiffening in the host. CONCLUSIONS Our study reveals that sustained activation of the immune system because of chronic allorecognition exacerbates the atherogenic diathesis of hyperlipidemia and results in de novo cardiovascular dysfunction in organ transplant recipients.
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Affiliation(s)
- Jing Zhou
- From the Departments of Surgery (J.Z., L.Q., R.A., Q.L., Y.J., G.L., J.J.Y., G.T.) and Immunobiology (T.Y., Z.T., J.S.P.) and Medicine (Y.H., J.Z., M.M.S., F.J.G.) and the Interdepartmental Program in Vascular Biology and Therapeutics (J.J.Y., M.M.S., F.J.G., J.S.P., G.T.), Yale University School of Medicine, New Haven, CT; Veterans Affairs Connecticut Healthcare System, West Haven (J.J.Y., M.M.S., F.J.G., G.T.); Research Institute, Nationwide Children's Hospital, Columbus, OH (T.Y.); and Department of Vascular Surgery, Peking University People's Hospital, Beijing, P.R. China (Q.L., Y.J.).
| | - Lingfeng Qin
- From the Departments of Surgery (J.Z., L.Q., R.A., Q.L., Y.J., G.L., J.J.Y., G.T.) and Immunobiology (T.Y., Z.T., J.S.P.) and Medicine (Y.H., J.Z., M.M.S., F.J.G.) and the Interdepartmental Program in Vascular Biology and Therapeutics (J.J.Y., M.M.S., F.J.G., J.S.P., G.T.), Yale University School of Medicine, New Haven, CT; Veterans Affairs Connecticut Healthcare System, West Haven (J.J.Y., M.M.S., F.J.G., G.T.); Research Institute, Nationwide Children's Hospital, Columbus, OH (T.Y.); and Department of Vascular Surgery, Peking University People's Hospital, Beijing, P.R. China (Q.L., Y.J.)
| | - Tai Yi
- From the Departments of Surgery (J.Z., L.Q., R.A., Q.L., Y.J., G.L., J.J.Y., G.T.) and Immunobiology (T.Y., Z.T., J.S.P.) and Medicine (Y.H., J.Z., M.M.S., F.J.G.) and the Interdepartmental Program in Vascular Biology and Therapeutics (J.J.Y., M.M.S., F.J.G., J.S.P., G.T.), Yale University School of Medicine, New Haven, CT; Veterans Affairs Connecticut Healthcare System, West Haven (J.J.Y., M.M.S., F.J.G., G.T.); Research Institute, Nationwide Children's Hospital, Columbus, OH (T.Y.); and Department of Vascular Surgery, Peking University People's Hospital, Beijing, P.R. China (Q.L., Y.J.)
| | - Rahmat Ali
- From the Departments of Surgery (J.Z., L.Q., R.A., Q.L., Y.J., G.L., J.J.Y., G.T.) and Immunobiology (T.Y., Z.T., J.S.P.) and Medicine (Y.H., J.Z., M.M.S., F.J.G.) and the Interdepartmental Program in Vascular Biology and Therapeutics (J.J.Y., M.M.S., F.J.G., J.S.P., G.T.), Yale University School of Medicine, New Haven, CT; Veterans Affairs Connecticut Healthcare System, West Haven (J.J.Y., M.M.S., F.J.G., G.T.); Research Institute, Nationwide Children's Hospital, Columbus, OH (T.Y.); and Department of Vascular Surgery, Peking University People's Hospital, Beijing, P.R. China (Q.L., Y.J.)
| | - Qingle Li
- From the Departments of Surgery (J.Z., L.Q., R.A., Q.L., Y.J., G.L., J.J.Y., G.T.) and Immunobiology (T.Y., Z.T., J.S.P.) and Medicine (Y.H., J.Z., M.M.S., F.J.G.) and the Interdepartmental Program in Vascular Biology and Therapeutics (J.J.Y., M.M.S., F.J.G., J.S.P., G.T.), Yale University School of Medicine, New Haven, CT; Veterans Affairs Connecticut Healthcare System, West Haven (J.J.Y., M.M.S., F.J.G., G.T.); Research Institute, Nationwide Children's Hospital, Columbus, OH (T.Y.); and Department of Vascular Surgery, Peking University People's Hospital, Beijing, P.R. China (Q.L., Y.J.)
| | - Yang Jiao
- From the Departments of Surgery (J.Z., L.Q., R.A., Q.L., Y.J., G.L., J.J.Y., G.T.) and Immunobiology (T.Y., Z.T., J.S.P.) and Medicine (Y.H., J.Z., M.M.S., F.J.G.) and the Interdepartmental Program in Vascular Biology and Therapeutics (J.J.Y., M.M.S., F.J.G., J.S.P., G.T.), Yale University School of Medicine, New Haven, CT; Veterans Affairs Connecticut Healthcare System, West Haven (J.J.Y., M.M.S., F.J.G., G.T.); Research Institute, Nationwide Children's Hospital, Columbus, OH (T.Y.); and Department of Vascular Surgery, Peking University People's Hospital, Beijing, P.R. China (Q.L., Y.J.)
| | - Guangxin Li
- From the Departments of Surgery (J.Z., L.Q., R.A., Q.L., Y.J., G.L., J.J.Y., G.T.) and Immunobiology (T.Y., Z.T., J.S.P.) and Medicine (Y.H., J.Z., M.M.S., F.J.G.) and the Interdepartmental Program in Vascular Biology and Therapeutics (J.J.Y., M.M.S., F.J.G., J.S.P., G.T.), Yale University School of Medicine, New Haven, CT; Veterans Affairs Connecticut Healthcare System, West Haven (J.J.Y., M.M.S., F.J.G., G.T.); Research Institute, Nationwide Children's Hospital, Columbus, OH (T.Y.); and Department of Vascular Surgery, Peking University People's Hospital, Beijing, P.R. China (Q.L., Y.J.)
| | - Zuzana Tobiasova
- From the Departments of Surgery (J.Z., L.Q., R.A., Q.L., Y.J., G.L., J.J.Y., G.T.) and Immunobiology (T.Y., Z.T., J.S.P.) and Medicine (Y.H., J.Z., M.M.S., F.J.G.) and the Interdepartmental Program in Vascular Biology and Therapeutics (J.J.Y., M.M.S., F.J.G., J.S.P., G.T.), Yale University School of Medicine, New Haven, CT; Veterans Affairs Connecticut Healthcare System, West Haven (J.J.Y., M.M.S., F.J.G., G.T.); Research Institute, Nationwide Children's Hospital, Columbus, OH (T.Y.); and Department of Vascular Surgery, Peking University People's Hospital, Beijing, P.R. China (Q.L., Y.J.)
| | - Yan Huang
- From the Departments of Surgery (J.Z., L.Q., R.A., Q.L., Y.J., G.L., J.J.Y., G.T.) and Immunobiology (T.Y., Z.T., J.S.P.) and Medicine (Y.H., J.Z., M.M.S., F.J.G.) and the Interdepartmental Program in Vascular Biology and Therapeutics (J.J.Y., M.M.S., F.J.G., J.S.P., G.T.), Yale University School of Medicine, New Haven, CT; Veterans Affairs Connecticut Healthcare System, West Haven (J.J.Y., M.M.S., F.J.G., G.T.); Research Institute, Nationwide Children's Hospital, Columbus, OH (T.Y.); and Department of Vascular Surgery, Peking University People's Hospital, Beijing, P.R. China (Q.L., Y.J.)
| | - Jiasheng Zhang
- From the Departments of Surgery (J.Z., L.Q., R.A., Q.L., Y.J., G.L., J.J.Y., G.T.) and Immunobiology (T.Y., Z.T., J.S.P.) and Medicine (Y.H., J.Z., M.M.S., F.J.G.) and the Interdepartmental Program in Vascular Biology and Therapeutics (J.J.Y., M.M.S., F.J.G., J.S.P., G.T.), Yale University School of Medicine, New Haven, CT; Veterans Affairs Connecticut Healthcare System, West Haven (J.J.Y., M.M.S., F.J.G., G.T.); Research Institute, Nationwide Children's Hospital, Columbus, OH (T.Y.); and Department of Vascular Surgery, Peking University People's Hospital, Beijing, P.R. China (Q.L., Y.J.)
| | - James J Yun
- From the Departments of Surgery (J.Z., L.Q., R.A., Q.L., Y.J., G.L., J.J.Y., G.T.) and Immunobiology (T.Y., Z.T., J.S.P.) and Medicine (Y.H., J.Z., M.M.S., F.J.G.) and the Interdepartmental Program in Vascular Biology and Therapeutics (J.J.Y., M.M.S., F.J.G., J.S.P., G.T.), Yale University School of Medicine, New Haven, CT; Veterans Affairs Connecticut Healthcare System, West Haven (J.J.Y., M.M.S., F.J.G., G.T.); Research Institute, Nationwide Children's Hospital, Columbus, OH (T.Y.); and Department of Vascular Surgery, Peking University People's Hospital, Beijing, P.R. China (Q.L., Y.J.)
| | - Mehran M Sadeghi
- From the Departments of Surgery (J.Z., L.Q., R.A., Q.L., Y.J., G.L., J.J.Y., G.T.) and Immunobiology (T.Y., Z.T., J.S.P.) and Medicine (Y.H., J.Z., M.M.S., F.J.G.) and the Interdepartmental Program in Vascular Biology and Therapeutics (J.J.Y., M.M.S., F.J.G., J.S.P., G.T.), Yale University School of Medicine, New Haven, CT; Veterans Affairs Connecticut Healthcare System, West Haven (J.J.Y., M.M.S., F.J.G., G.T.); Research Institute, Nationwide Children's Hospital, Columbus, OH (T.Y.); and Department of Vascular Surgery, Peking University People's Hospital, Beijing, P.R. China (Q.L., Y.J.)
| | - Frank J Giordano
- From the Departments of Surgery (J.Z., L.Q., R.A., Q.L., Y.J., G.L., J.J.Y., G.T.) and Immunobiology (T.Y., Z.T., J.S.P.) and Medicine (Y.H., J.Z., M.M.S., F.J.G.) and the Interdepartmental Program in Vascular Biology and Therapeutics (J.J.Y., M.M.S., F.J.G., J.S.P., G.T.), Yale University School of Medicine, New Haven, CT; Veterans Affairs Connecticut Healthcare System, West Haven (J.J.Y., M.M.S., F.J.G., G.T.); Research Institute, Nationwide Children's Hospital, Columbus, OH (T.Y.); and Department of Vascular Surgery, Peking University People's Hospital, Beijing, P.R. China (Q.L., Y.J.)
| | - Jordan S Pober
- From the Departments of Surgery (J.Z., L.Q., R.A., Q.L., Y.J., G.L., J.J.Y., G.T.) and Immunobiology (T.Y., Z.T., J.S.P.) and Medicine (Y.H., J.Z., M.M.S., F.J.G.) and the Interdepartmental Program in Vascular Biology and Therapeutics (J.J.Y., M.M.S., F.J.G., J.S.P., G.T.), Yale University School of Medicine, New Haven, CT; Veterans Affairs Connecticut Healthcare System, West Haven (J.J.Y., M.M.S., F.J.G., G.T.); Research Institute, Nationwide Children's Hospital, Columbus, OH (T.Y.); and Department of Vascular Surgery, Peking University People's Hospital, Beijing, P.R. China (Q.L., Y.J.)
| | - George Tellides
- From the Departments of Surgery (J.Z., L.Q., R.A., Q.L., Y.J., G.L., J.J.Y., G.T.) and Immunobiology (T.Y., Z.T., J.S.P.) and Medicine (Y.H., J.Z., M.M.S., F.J.G.) and the Interdepartmental Program in Vascular Biology and Therapeutics (J.J.Y., M.M.S., F.J.G., J.S.P., G.T.), Yale University School of Medicine, New Haven, CT; Veterans Affairs Connecticut Healthcare System, West Haven (J.J.Y., M.M.S., F.J.G., G.T.); Research Institute, Nationwide Children's Hospital, Columbus, OH (T.Y.); and Department of Vascular Surgery, Peking University People's Hospital, Beijing, P.R. China (Q.L., Y.J.).
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Desai R, Collett D, Watson CJE, Johnson PJ, Moss P, Neuberger J. Impact of Cytomegalovirus on Long-term Mortality and Cancer Risk After Organ Transplantation. Transplantation 2015; 99:1989-94. [PMID: 25706273 DOI: 10.1097/tp.0000000000000641] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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32
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Zhang K, Gao B, Wang Y, Wang G, Wang W, Zhu Y, Yao L, Gu Y, Chen M, Zhou H, Fu Y. Serum Uric Acid and Renal Transplantation Outcomes: At Least 3-Year Post-transplant Retrospective Multivariate Analysis. PLoS One 2015. [PMID: 26208103 PMCID: PMC4514650 DOI: 10.1371/journal.pone.0133834] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Since the association of serum uric acid and kidney transplant graft outcome remains disputable, we sought to evaluate the predictive value of uric acid level for graft survival/function and the factors could affect uric acid as time varies. A consecutive cohort of five hundred and seventy three recipients transplanted during January 2008 to December 2011 were recruited. Data and laboratory values of our interest were collected at 1, 3, 6, 12, 24 and 36 months post-transplant for analysis. Cox proportional hazard model, and multiple regression equation were built to adjust for the possible confounding variables and meet our goals as appropriate. The current cohort study lasts for 41.86 ± 15.49 months. Uric acid level is proven to be negatively associated with eGFR at different time point after adjustment for age, body mass index and male gender (standardized β ranges from -0.15 to -0.30 with all P<0.001).Males with low eGFR but high level of TG were on CSA, diuretics and RAS inhibitors and experienced at least one episode of acute rejection and diabetic issue were associated with a higher mean uric acid level. Hyperuricemia was significantly an independent predictor of pure graft failure (hazard ratio=4.01, 95% CI: 1.25-12.91, P=0.02) after adjustment. But it was no longer an independent risk factor for graft loss after adjustment. Interestingly, higher triglyceride level can make incidence of graft loss (hazard ratio=1.442, for each unit increase millimoles per liter 95% CI: 1.008-2.061, P=0.045) and death (hazard ratio=1.717, 95% CI: 1.105-2.665, P=0.016) more likely. The results of our study suggest that post-transplant elevated serum uric acid level is an independent predictor of long-term graft survival and graft function. Together with the high TG level impact on poor outcomes, further investigations for therapeutic effect are needed.
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Affiliation(s)
- Kun Zhang
- Department of Urology/Transplant Center, First Hospital of Jilin University, Changchun, Jilin, China
| | - Baoshan Gao
- Department of Urology/Transplant Center, First Hospital of Jilin University, Changchun, Jilin, China
| | - Yuantao Wang
- Department of Urology/Transplant Center, First Hospital of Jilin University, Changchun, Jilin, China
| | - Gang Wang
- Department of Urology/Transplant Center, First Hospital of Jilin University, Changchun, Jilin, China
| | - Weigang Wang
- Department of Urology/Transplant Center, First Hospital of Jilin University, Changchun, Jilin, China
| | - Yaxiang Zhu
- Department of Urology/Transplant Center, First Hospital of Jilin University, Changchun, Jilin, China
| | - Liyu Yao
- Department of Urology/Transplant Center, First Hospital of Jilin University, Changchun, Jilin, China
| | - Yiming Gu
- Department of Urology/Transplant Center, First Hospital of Jilin University, Changchun, Jilin, China
| | - Mo Chen
- Department of Urology/Transplant Center, First Hospital of Jilin University, Changchun, Jilin, China
| | - Honglan Zhou
- Department of Urology/Transplant Center, First Hospital of Jilin University, Changchun, Jilin, China
- * E-mail: (YWF); (HLZ)
| | - Yaowen Fu
- Department of Urology/Transplant Center, First Hospital of Jilin University, Changchun, Jilin, China
- * E-mail: (YWF); (HLZ)
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Wallace IR, Waters NH, Pilmore H, Drury PL, Wu F. New onset diabetes after transplantation: Not another acronym! JRSM Open 2015; 6:2054270414567166. [PMID: 25780593 PMCID: PMC4349758 DOI: 10.1177/2054270414567166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
New onset diabetes after transplantation is the onset of diabetes in previously non-diabetic individuals extending beyond the first month post-transplantation.
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Affiliation(s)
- I R Wallace
- Auckland Diabetes Centre, Greenlane Clinical Centre, Auckland 1051, New Zealand
| | - N H Waters
- Auckland Diabetes Centre, Greenlane Clinical Centre, Auckland 1051, New Zealand
| | - H Pilmore
- Department of Transplant Nephrology, Auckland City Hospital, Auckland 1023, New Zealand
| | - P L Drury
- Auckland Diabetes Centre, Greenlane Clinical Centre, Auckland 1051, New Zealand
| | - F Wu
- Auckland Diabetes Centre, Greenlane Clinical Centre, Auckland 1051, New Zealand
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New-onset diabetes after kidney transplant in children. Pediatr Nephrol 2015; 30:405-16. [PMID: 24894384 DOI: 10.1007/s00467-014-2830-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 04/01/2014] [Accepted: 04/11/2014] [Indexed: 02/08/2023]
Abstract
The development of new-onset diabetes after kidney transplantation (NODAT) is associated with reduced graft function, increased cardiovascular morbidity and lower patient survival among adult recipients. In the pediatric population, however, the few studies examining NODAT have yielded inconsistent results. Therefore, the true incidence of NODAT in the pediatric population has been difficult to establish. The identification of children and adolescents at risk for NODAT requires appropriate screening questions and tests pre- and post-kidney transplant. Several risk factors have been implicated in the pathogenesis of NODAT and post-transplant glucose intolerance, including African American race, obesity, family history of diabetes and the type of immunosuppressant regimen. Moreover, uremia per se results in a state of insulin resistance that increases the risk of developing diabetes post-transplant. When an individual becomes glucose intolerant, early lifestyle modification and antihyperglycemic measures with tailoring of the immunosuppressant regimen should be implemented to prevent the development of NODAT. For the child or adolescent with NODAT, antihyperglycemic therapy should be prescribed in order to achieve optimal glycemic control, ultimately reducing complications and improving overall allograft and patient survival. In this article, we review the risk factors, screening methods, diagnosis, management and outcome of children and adolescents with NODAT and post-kidney transplant glucose intolerance.
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More potent lipid-lowering effect by rosuvastatin compared with fluvastatin in everolimus-treated renal transplant recipients. Transplantation 2014; 97:1266-71. [PMID: 24521776 DOI: 10.1097/01.tp.0000443225.66960.7e] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Dyslipidemia is a risk factor for premature cardiovascular morbidity and mortality in renal transplant recipients (RTRs). Pharmacotherapy with mTOR inhibitors aggravates dyslipidemia, thus necessitating lipid-lowering therapy with fluvastatin, pravastatin, or atorvastatin. These agents may not sufficiently lower lipid levels, and therefore, a more potent agent like rosuvastatin maybe needed. METHODS We have aimed to assess the lipid-lowering effect of rosuvastatin as compared with fluvastatin in RTR receiving everolimus. Safety was assessed as the pharmacokinetic (PK) interaction potential of a rosuvastatin/everolimus combination in RTR. A 12-hour everolimus PK investigation was performed in 12 stable RTR receiving everolimus and fluvastatin (80 mg/d). Patients were then switched to rosuvastatin (20 mg/d), and a follow-up 12/24-hour PK investigation of everolimus/rosuvastatin was performed after 1 month. All other drugs were kept unchanged. RESULTS In RTR already receiving fluvastatin, switching to rosuvastatin further decreased LDL cholesterol and total cholesterol by 30.2±12.2% (P<0.01) and 18.2±9.6% (P<0.01), respectively. Everolimus AUC0-12 was not affected by concomitant rosuvastatin treatment, 80.3±21.3 μg*h/L before and 78.5±21.9 μg*h/L after, respectively (P=0.61). Mean rosuvastatin AUC0-24 was 157±61.7 ng*h/mL, approximately threefold higher than reported in the literature for nontransplants. There were no adverse events, and none of the patients had or developed proteinuria. CONCLUSION Rosuvastatin showed a superior lipid-lowering effect compared to fluvastatin in stable RTR receiving everolimus. The combination of everolimus/rosuvastatin seems to be as safe as the everolimus/fluvastatin combination.
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Bozbas H, Altin C, Karacaglar E, Kanyilmaz S, Yildirir A, Muderrisoglu H, Haberal M. The prevalence and types of cardiovascular disease in patients with end-stage renal disease undergoing renal transplantation. Transplant Proc 2014; 45:3478-80. [PMID: 24314936 DOI: 10.1016/j.transproceed.2013.08.102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the most common cause of death in patients with end-stage renal disease (ESRD) as well as in renal transplant recipients (RTR). In this study we sought to evaluate the prevalence and the types of CVD in patients with ESRD undergoing renal transplantation. PATIENTS AND METHODS The data of 500 consecutive patients with ESRD undergoing renal transplantation were evaluated retrospectively. Demographic findings, clinical variables, and laboratory results including invasive and noninvasive cardiologic tests were recorded. RESULTS The mean age of patients was 31.6 ± 10.2 years, of whom 133 (26.6%) were female. The prevalence of major atherosclerotic risk was as follows: hypertension 62.2%, diabetes mellitus 3.4%, smoking 26.4%, dyslipidemia 13.2%, and family history of atherosclerosis 9.8%. Treadmill exercise test was performed on 139 subjects, and myocardial perfusion scintigraphy on 73. Coronary artery disease was identified in 16 of 42 cases (38.1%) who had undergone angiography. Eight patients underwent percutaneous coronary intervention, and coronary bypass surgery was performed on 4 cases prior to renal transplantation. On echocardiographic examination mean ejection fraction was 51.9 ± 7.1%, and wall motion abnormality was detected in 15% of cases. The most prevalent valvular disease was mitral regurgitation (45.8%) followed by tricuspid regurgitation (30.6%). CONCLUSION The findings of this study indicate that CVD and atherosclerotic risk factors are common in patients with ESRD undergoing renal transplantion. With regard to the prognostic significance, pretransplantation identification of these conditions is of paramount importance. As a result, improved detection of occult CV disorders results in the possiblity of improved outcomes following renal transplantation.
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Affiliation(s)
- H Bozbas
- Department of Cardiology, Baskent University, Faculty of Medicine, Ankara, Turkey.
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Protasiewicz M, Początek K, Banasik M, Poręba R, Podgórski M, Kurcz J, Mysiak A, Klinger M, Boratyńska M. Successful renal artery denervation in a renal transplant recipient with refractory hypertension. Am J Hypertens 2014; 27:982-4. [PMID: 24552889 DOI: 10.1093/ajh/hpt291] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Marcin Protasiewicz
- Department of Cardiology; Medical University of Wroclaw, Wroclaw, Poland; Regional Specialist Hospital, Research and Development Center in Wroclaw, Wroclaw, Poland;
| | - Karol Początek
- Department of Cardiology; Medical University of Wroclaw, Wroclaw, Poland
| | - Mirosław Banasik
- Department of Nephrology and Transplantation Medicine, Medical University of Wroclaw, Wroclaw, Poland
| | - Rafał Poręba
- Department of Internal Diseases and Hypertension, Medical University of Wroclaw, Wroclaw, Poland
| | - Maciej Podgórski
- Department of Internal Diseases and Hypertension, Medical University of Wroclaw, Wroclaw, Poland
| | - Jacek Kurcz
- Department of Radiology, Medical University of Wroclaw, Wroclaw, Poland
| | - Andrzej Mysiak
- Department of Cardiology; Medical University of Wroclaw, Wroclaw, Poland; Regional Specialist Hospital, Research and Development Center in Wroclaw, Wroclaw, Poland
| | - Marian Klinger
- Department of Nephrology and Transplantation Medicine, Medical University of Wroclaw, Wroclaw, Poland
| | - Maria Boratyńska
- Department of Nephrology and Transplantation Medicine, Medical University of Wroclaw, Wroclaw, Poland
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Miroševic Skvrce N, Božina N, Zibar L, Barišic I, Pejnovic L, Macolic Šarinic V. CYP2C9 and ABCG2 polymorphisms as risk factors for developing adverse drug reactions in renal transplant patients taking fluvastatin: a case-control study. Pharmacogenomics 2014; 14:1419-31. [PMID: 24024895 DOI: 10.2217/pgs.13.135] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
AIM To investigate whether an association exists between fluvastatin-induced adverse drug reactions (ADRs) and polymorphisms in genes encoding the metabolizing enzyme CYP2C9 and the drug transporter ABCG2 in renal transplant recipients (RTRs). MATERIALS & METHODS Fifty-two RTRs that experienced fluvastatin ADRs and 52 controls matched for age, gender, dose of fluvastatin and immunosuppressive use were enrolled in the study. Genotyping for CYP2C9*2, *3 and ABCG2 421C>A variants was performed by real-time PCR. RESULTS CYP2C9 homozygous and heterozygous mutant allele (*2 or *3) carriers had 2.5-times greater odds of developing adverse effects (χ² = 4.370; degrees of freedom = 1; p = 0.037; φ = 0.21, odds ratio [OR]: 2.44; 95% CI: 1.05-5.71). Patients who were the carriers of at least one mutant CYP2C9 allele (*2 or *3) and who were receiving CYP2C9 inhibitors, had more than six-times greater odds of having adverse effects than those without the inhibitor included in their therapy (p = 0.027; OR: 6.59; 95% CI: 1.24-35.08). Patients with ABCG2 421CA or AA (taken together) had almost four-times greater odds of developing adverse effects than those with ABCG2 421CC genotype (χ² = 6.190; degrees of freedom = 1; p = 0.013; φ = 0.24, OR: 3.81; 95% CI: 1.27-11.45). Patients with A allele had 2.75-times (95% CI: 1.02-7.40) greater odds of developing adverse effects than those with C allele. CONCLUSION Our preliminary data demonstrate an association between fluvastatin-induced ADRs in RTRs and genetic variants in the CYP2C9 and ABCG2 genes.
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Affiliation(s)
- Nikica Miroševic Skvrce
- Pharmacovigilance Unit, Agency for Medicinal Products & Medical Devices, Ksaverska Cesta 4, 10000 Zagreb, Croatia
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Salesi M, Rostami Z, Rahimi Foroushani A, Mehrazmay AR, Mohammadi J, Einollahi B, Asgharian S, Eshraghian MR. Chronic graft loss and death in patients with post-transplant malignancy in living kidney transplantation: a competing risk analysis. Nephrourol Mon 2014; 6:e14302. [PMID: 25032129 PMCID: PMC4090583 DOI: 10.5812/numonthly.14302] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 09/12/2013] [Accepted: 09/22/2013] [Indexed: 12/04/2022] Open
Abstract
Background: Malignancy is a common complication after renal transplantation. Death with functioning graft and chronic graft loss are two competing outcomes in patients with post-transplant malignancies. Objectives: The purpose of our study was to evaluate the risk factors associated with cumulative incidence of these two outcomes. Patients and Methods: Fine-Gray model was used for 266 cases with post-transplant malignancy in Iran. These patients were followed-up from the diagnosis until the date of last visit, chronic graft loss, or death, subsequently. Results: At the end of the study, as competing events, chronic graft loss and death with functioning graft were seen in 27 (10.2%) and 53 cases (19.9%), respectively, while 186 cases (69.9%) were accounted as censored. The incidence rate of death was approximately two-time of the incidence rate of chronic graft loss (8.6 vs. 4.4 per 100 person-years). In multivariate analysis, significant risk factors associated with cumulative incidence of death included age (P < 0.007, subhazard ratio (SHR) = 1.03), type of cancer (P < 0.0001), and response to treatment (P < 0.0001, SHR = 0.027). The significant risk factors associated with cumulative incidence of chronic graft loss were gender (P = 0.05, SHR = 0.37), treatment modality (P < 0.0001), and response to treatment (P = 0.048, SHR = 0.47). Conclusions: Using these factors, nephrologists may predict the occurrence of graft loss or death. If the probability of graft loss was higher, physicians can decrease the immunosuppressive medications dosage to decrease the incidence of graft loss.
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Affiliation(s)
- Mahmoud Salesi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Zohreh Rostami
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Abbas Rahimi Foroushani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Ali Reza Mehrazmay
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Jamile Mohammadi
- Department of Psychology, Faculty of Humanities, Tarbiat Modares University, Tehran, IR Iran
| | - Behzad Einollahi
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Saeed Asgharian
- Salamat Hospital, Ahvaz University of Medical Sciences, Ahvaz, IR Iran
| | - Mohammad Reza Eshraghian
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Mohammad Reza Eshraghian, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, P.O. Box: 14155-6446, Tehran, IR Iran. Tel/Fax: +98-2188989127, E-mail:
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Kohok DD, Shah S, Kumar R, Venuto L, Gudleski G, Venuto R. Interventions to reduce clinical inertia in cardiac risk factor management in renal transplant recipients. J Clin Hypertens (Greenwich) 2014; 16:127-32. [PMID: 24433451 PMCID: PMC8031565 DOI: 10.1111/jch.12249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 11/13/2013] [Accepted: 11/19/2013] [Indexed: 11/29/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death in renal transplant recipients (RTRs). Clinical inertia (CI) is defined as "recognition of the problem, but failure to act." The effect of educational interventions in minimizing CI in CVD risk factor management was assessed. Educational sessions were conducted among 201 RTRs to inform them about their goals for blood pressure (BP), low-density lipoprotein cholesterol (LDL-C) and glycated hemoglobin (HbA1c). Physicians were reminded about treatment goals using checklists. Pre-intervention and post-intervention CI was measured as "no action" or "appropriate action" by the physicians. Post-intervention percentage of RTRs with "no clinical action" for BP, LDL-C, and HbA1c control decreased from 10.8% to 3.8% (P=.02), 28.2% to 11.1% (P=.008), and 10.3% to 4.5% (P=.05), respectively, while those with "appropriate action" increased from 66.2% to 83.3% (P<.001), 68.7% to 79.4% (P=.008), and 85.1% to 93.2% (P=.03), respectively. Educational interventions and patient participation were shown to reduce CI.
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Affiliation(s)
| | - Silvi Shah
- Department of Internal MedicineBuffaloNY
| | | | - Lisa Venuto
- Nephrology DivisionUniversity at BuffaloSchool of Medicine and Biomedical SciencesBuffaloNY
| | | | - Rocco Venuto
- Department of Internal MedicineBuffaloNY
- Nephrology DivisionUniversity at BuffaloSchool of Medicine and Biomedical SciencesBuffaloNY
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Wojtusciszyn A, Mourad G, Bringer J, Renard E. Continuous glucose monitoring after kidney transplantation in non-diabetic patients: early hyperglycaemia is frequent and may herald post-transplantation diabetes mellitus and graft failure. DIABETES & METABOLISM 2013; 39:404-10. [PMID: 23999231 DOI: 10.1016/j.diabet.2012.10.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 10/23/2012] [Accepted: 10/23/2012] [Indexed: 01/28/2023]
Abstract
OBJECTIVES New onset of diabetes after transplantation (NODAT) is a known complication of renal transplantation, but early glycaemic status after transplantation has not been described prospectively. This study aimed to assess blood glucose (BG) levels immediately following kidney transplantation in non-diabetic subjects and to explore their relationship to later graft outcomes and NODAT occurrence. PATIENTS AND METHODS Over a 9-month period, 43 consecutive non-diabetic patients who received a kidney transplant were prospectively investigated. During the first 4 days after transplantation, fasting BG was measured and the 24-h BG profile assessed by continuous glucose monitoring (CGM). Capillary BG was measured on hospital admittance and at least four times a day for CGM calibration thereafter. All adverse events were recorded, and fasting BG and HbA1c were assessed at 3, 6 and 12 months and at the last visit to our centre. RESULTS Immediately following renal transplantation, capillary BG was 12.2 ± 3.8 mmol/L. On day 1 (D1), fasting BG was 9.9 ± 4.3 mmol/L and decreased to 6.0 ± 1.5 mmol/L on D3. The CGM-reported mean 24-h BG (mmol/L) was 10.2±2.4 on D1, 7.7 ± 1.3 on D2 and 7.5 ± 1.1 on D3. From D1 to D4, 43% of patients spent>12h/day with BG levels>7.7 mmol/L. While morbidity during the 3 months following transplantation appeared unrelated to BG, the first post-transplantation capillary BG measurement and fasting BG on D1 tended to be higher in patients who developed diabetes 3 months later. Tacrolimus treatment was associated with a higher incidence of dysglycaemia at 3 and 6 months. After a mean follow-up of 72 months, NODAT was frequently seen (18.6%), and was associated with tacrolimus medication (P<0.01) and a higher rate of renal transplantation failure (RR: 3.6, P<0.02). CONCLUSION Hyperglycaemia appears to be a nearly constant characteristic immediately following transplantation in non-diabetic kidney recipients. Higher BG values could identify patients at risk for later post-transplant diabetes and graft failure.
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Affiliation(s)
- A Wojtusciszyn
- Department of Endocrinology, Diabetes, Nutrition, Lapeyronie Hospital, CHU Montpellier, 391, avenue du Doyen-Giraud, 34295 Montpellier cedex 5, France; Institute of Functional Genomics, UMR CNRS 5203, Inserm U661, University of Montpellier, Montpellier, France; Institute of Research in Biotherapies, Montpellier University Hospital, Montpellier, France.
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Bergman AJ, Burke J, Larson P, Johnson-Levonas AO, Reyderman L, Statkevich P, Kosoglou T, Greenberg HE, Kraft WK, Frick G, Murphy G, Gottesdiener K, Paolini JF. Effects of Ezetimibe on Cyclosporine Pharmacokinetics in Healthy Subjects. J Clin Pharmacol 2013; 46:321-7. [PMID: 16490808 DOI: 10.1177/0091270005284851] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This single-center, open-label, 2-period crossover study investigated the effects of multiple-dose ezetimibe (EZE) on a single dose of cyclosporine (CyA). Healthy subjects received 2 treatments in random order with a 14-day washout: (1) CyA 100 mg alone and (2) EZE 20 mg for 7 days with CyA 100 mg coadministered on day 7; EZE 20 mg alone was administered on day 8. AUC(0-last) and Cmax geometric mean ratios (90% confidence interval) for ([CyA + EZE]/CyA alone) were 1.15 (1.07, 1.25) and 1.10 (0.97, 1.26), respectively. Tmax (approximately 1.3 hours) was similar with and without EZE (P >.200). Mean CyA exposure slightly increased (approximately 15%) with multiple-dose EZE 20 mg; however, this value was contained within (0.80, 1.25). The implications for chronic EZE dosing within the usual clinical paradigm of chronic CyA dosing have not been established; caution is recommended when using these agents concomitantly. CyA concentrations should be monitored in patients receiving EZE and CyA.
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Soler MJ, Riera M, Crespo M, Mir M, Márquez E, Pascual MJ, Puig JM, Pascual J. Circulating angiotensin-converting enzyme 2 activity in kidney transplantation: a longitudinal pilot study. Nephron Clin Pract 2012; 121:c144-50. [PMID: 23257682 DOI: 10.1159/000345508] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 10/26/2012] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND/AIMS Angiotensin-converting enzyme 2 (ACE2) is the only known active homologue of ACE, and degrades angiotensin (Ang) II and Ang I to Ang(1-7) and Ang(1-9), respectively. The role of ACE2 in kidney transplant (KT) is unknown. Our objective was to investigate circulating ACE2 activity in KT patients, and the relationship between serum ACE2 activity and age, gender, graft function and cardiovascular risk markers in KT patients. METHODS 113 KT patients with stable graft function were included in this cross-sectional study. Circulating ACE2 activity was assessed using a fluorescent assay. RESULTS Circulating ACE2 activity was detectable in KT patients and was increased in KT with ischemic heart disease as compared to KT without ischemic heart disease (105.9 ± 8.7 vs. 97.1 ± 7.05 relative fluorescence units (RFU)/µl/h, p < 0.05). ACE2 activity was increased in male KT as compared to females (105.2 ± 9.1 vs. 84.7 ± 6.9 RFU/µl/h, p = 0.05). ACE2 activity correlated positively with serum creatinine (r = 0.27), serum urea (r = 0.29), age (r = 0.24), aspartate transaminase (r = 0.39), alanine transaminase (r = 0.48), γ-glutamyl transferase (γ-GT) (r = 0.52), age (r = 0.24), and glycosylated hemoglobin (r = 0.19) (p < 0.05). By multiple regression analysis, age, serum creatinine, and serum γ-GT were independent predictors of serum ACE2 activity (r = 0.66, p < 0.001). CONCLUSIONS Circulating ACE2 activity is measurable in KT patients and directly correlates with age, renal allograft and liver function parameters. These findings suggest that measurement of serum ACE2 may be used as a non-invasive marker to understand the role of the renin-angiotensin system in KT patients.
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Affiliation(s)
- María José Soler
- Department of Nephrology, Hospital del Mar-IMIM, Barcelona, Spain.
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Morales JM, Marcén R, del Castillo D, Andres A, Gonzalez-Molina M, Oppenheimer F, Serón D, Gil-Vernet S, Lampreave I, Gainza FJ, Valdés F, Cabello M, Anaya F, Escuin F, Arias M, Pallardó L, Bustamante J. Risk factors for graft loss and mortality after renal transplantation according to recipient age: a prospective multicentre study. Nephrol Dial Transplant 2012; 27 Suppl 4:iv39-46. [PMID: 23258810 PMCID: PMC3526982 DOI: 10.1093/ndt/gfs544] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 10/18/2012] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND To describe the causes of graft loss, patient death and survival figures in kidney transplant patients in Spain based on the recipient's age. METHODS The results at 5 years of post-transplant cardiovascular disease (CVD) patients, taken from a database on CVD, were prospectively analysed, i.e. a total of 2600 transplanted patients during 2000-2002 in 14 Spanish renal transplant units, most of them receiving their organ from cadaver donors. Patients were grouped according to the recipient's age: Group A: <40 years, Group B: 40-60 years and Group C: >60 years. The most frequent immunosuppressive regimen included tacrolimus, mycophenolate mofetil and steroids. RESULTS Patients were distributed as follows: 25.85% in Group A (>40 years), 50.9% in Group B (40-60 years) and 23.19% in Group C (>60). The 5-year survival for the different age groups was 97.4, 90.8 and 77.7%, respectively. Death-censored graft survival was 88, 84.2 and 79.1%, respectively, and non death-censored graft survival was 82.1, 80.3 and 64.7%, respectively. Across all age groups, CVD and infections were the most frequent cause of death. The main causes of graft loss were chronic allograft dysfunction in patients <40 years old and death with functioning graft in the two remaining groups. In the multivariate analysis for graft survival, only elevated creatinine levels and proteinuria >1 g at 6 months post-transplantation were statistically significant in the three age groups. The patient survival multivariate analysis did not achieve a statistically significant common factor in the three age groups. CONCLUSIONS Five-year results show an excellent recipient survival and graft survival, especially in the youngest age group. Death with functioning graft is the leading cause of graft loss in patients >40 years. Early improvement of renal function and proteinuria together with strict control of cardiovascular risk factors are mandatory.
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Affiliation(s)
| | - Roberto Marcén
- Department of Nephrology, Hospital Ramon y Cajal, Madrid, Spain
| | | | - Amado Andres
- Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain
| | | | | | - Daniel Serón
- Department of Nephrology, Hospital Vall d Hebron, Barcelona, Spain
| | | | | | | | - Francisco Valdés
- Department of Nephrology, Hospital Juan Canalejo, La Coruña, Spain
| | | | - Fernando Anaya
- Department of Nephrology, Hospital Gregorio Marañón, Madrid, Spain
| | | | - Manuel Arias
- Department of Nephrology, Hospital Marqués de Valdecilla, Santander, Spain
| | - Luis Pallardó
- Department of Nephrology, Hospital Dr Peset, Valencia, Spain
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Prakash J, Ghosh B, Singh S, Soni A, Rathore SS. Causes of death in renal transplant recipients with functioning allograft. Indian J Nephrol 2012; 22:264-8. [PMID: 23162269 PMCID: PMC3495347 DOI: 10.4103/0971-4065.101245] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The survival of transplant recipients is significantly lower than age-matched controls in the general population. The aim of this study was to analyze the trends in mortality of renal allograft recipients at our centre. We retrospectively analyzed data from all patients who were transplanted between October 1988 and June 2010 and were followed at our center. Patients were considered to have death with graft function (DWGF) if death was not preceded by return to dialysis or re-transplantation. The study included 98 renal allograft recipients (male : female – 7.99 : 1). The mean recipient and donor ages were 35.06 ± 11.84 (range: 15–69) and 41.17 ± 10.44 (range: 22–60) years, respectively. Basic kidney diseases were CGN (chronic glomerulonephritis) (60.20%), CIN (chronic interstitial nephritis) (15.31%), DN (diabetic nephropathy) (8.16%), ADPKD (autosomal dominant polycystic kidney disease) (2.04%) and others (14.29%). They were followed up for a mean 79.91 ± 60.05 patient-months. Mortality occurred in 25 (25.51%) patients (male : female – 4 : 1). Causes of death were sepsis/infection (36%), coronary artery disease (28%), CVA (8%), failed graft (4%), and rest unknown (24%). DWGF was 88% of total death and contributed to 78.57% of total graft loss. Overall patient survival at 1, 5, 10, and 15 years were 90.8%, 80.2%, 65.6%, and 59.1%, respectively (Kaplan–Meier analysis). Those who died exhibited significant differences in recipient's age (median 40 years vs 31 years, P=0.007), pretransplantation hypertension (HTN) (100% vs 65.75%, P<0.001), post-transplant infection (76% vs 42.47%, P=0.005), coronary artery disease (28% vs 1.37%, P<0.001), and serum creatinine at last follow up (median 2.3mg/dL vs 1.56mg/dL, P=0.003). Cardiovascular disease, in addition to infection, is an important cause of death during the first 15 years following renal transplantation even in nondiabetic recipients. Death with functioning graft is of concern.
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Affiliation(s)
- J Prakash
- Department of Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Bashir S, Wiltshire M, Cardigan R, Thomas S. Lipaemic plasma induces haemolysis in resuspended red cell concentrate. Vox Sang 2012; 104:218-24. [PMID: 23106259 DOI: 10.1111/j.1423-0410.2012.01660.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION We investigated whether haemolysis in red cells suspended in plasma was affected by the lipid content and/or methylene blue (MB) treatment of fresh-frozen plasma (FFP). We also investigated whether haemolysis was affected by the conditions under which lipaemic plasma was stored. METHODS Study 1: Visibly lipaemic (n = 22) or nonlipaemic FFP (n = 24) units were thawed, pooled and split into identical pairs, one of which was MB treated. These units were used to resuspend red cell concentrates (RCC) and tested for haemolysis immediately and after 24 and 48 h of storage at 2-6°C. Study 2: Fresh plasma was aliquoted into 15-ml tubes and stored in one of four ways as follows: room temperature; 2-6°C; frozen and thawed; or twice frozen and thawed. A sample of RCC was resuspended in each of these plasmas and haemolysis measured after 2 h. Study 3: Plasma was divided into 15-ml tubes and stored as in study 2 followed by storage left standing upright in a refrigerator (2-6°C) for 24 h (with the exception of the room temperature sample). Plasma was separated into top, middle and bottom fractions and used to resuspend RCC that were assessed for haemolysis after 2 h. RESULTS The levels of haemolysis in RCC were immediately greater when suspended in lipaemic plasma (0·70 ± 0·53% v 0·05 ± 0·06% for nonlipaemic plasma), which increased further on subsequent storage for 48 h (1·22 ± 0·40% v 0·15 ± 0·14% for nonlipaemic plasma). This was irrespective of whether plasma was MB treated. Lipaemic plasma stored frozen and then thawed resulted in the greatest haemolysis. In lipaemic plasma stored at 2-6°C, the chylomicron-rich top fraction caused the highest level of haemolysis. CONCLUSION Haemolysis in red cells is increased in those suspended in lipaemic plasma and is dependent upon the storage conditions of that plasma prior to suspension. These data are relevant to the choice of plasma used to suspend red cells for neonatal exchange transfusion.
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Affiliation(s)
- S Bashir
- NHS Blood and Transplant, Brentwood, Essex, UK.
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Sessa A, Esposito A, Iavicoli G, Lettieri E, Ragosta G, Rossano R, Capuano M. Cardiovascular Risk Factors in Renal Transplant Patients after Switch From Standard Tacrolimus to Prolonged-Release Tacrolimus. Transplant Proc 2012; 44:1901-6. [DOI: 10.1016/j.transproceed.2012.05.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gokce M, Yuzbasioglu M, Bulbuloglu E, Oksuz H, Yormaz S, Altınoren O, Kutlucan M, Coskuner I, Silay E, Kale I. Cilostazol and Diltiazem Attenuate Cyclosporine-Induced Nephrotoxicity in Rats. Transplant Proc 2012; 44:1738-42. [DOI: 10.1016/j.transproceed.2012.04.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Assessment of Cardiovascular Risk Factors after Renal Transplantation: A Step towards Reducing Graft Failure. Transplant Proc 2012; 44:1270-4. [DOI: 10.1016/j.transproceed.2012.01.111] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 01/21/2012] [Indexed: 11/23/2022]
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50
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Israni AK, Snyder JJ, Skeans MA, Kasiske BL. Clinical diagnosis of metabolic syndrome: predicting new-onset diabetes, coronary heart disease, and allograft failure late after kidney transplant. Transpl Int 2012; 25:748-57. [PMID: 22548293 DOI: 10.1111/j.1432-2277.2012.01488.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Metabolic syndrome is associated with coronary heart disease (CHD) and new-onset diabetes after kidney transplant (NODAT). Using data collected from transplant centers worldwide for the Patient Outcomes in Renal Transplantation study, we examined associations of metabolic syndrome (n = 2253 excluding recipients with diabetes pretransplant), CHD (n = 2253), and NODAT (n = 1840 further excluding recipients with diabetes in the first year post-transplant), with the primary outcome of allograft failure. We assessed risk factors associated with secondary outcomes of metabolic syndrome, NODAT, and CHD after adjusting for type of baseline immunosuppression and transplant center effects. Metabolic syndrome prevalence was 39.8% at 12-24 months post-transplant and 35.4% at 36-48 months. Metabolic syndrome was independently associated with NODAT (hazard ratio 3.46, 95% confidence interval 2.40-4.98, P < 0.0001), CHD (2.03, 1.16-3.52, P = 0.013), and allograft failure (1.36, 1.03-1.79, P = 0.028). Allograft failure occurred in 218 patients (14.6%). After adjustment for metabolic syndrome, NODAT (1.63, 1.18-2.24, P = 0.003) and CHD (5.48, 3.27-9.20, P < 0.0001) remained strongly associated with increased risk of allograft failure. Metabolic syndrome, NODAT, and CHD are risk factors for allograft failure. NODAT and CHD are risk factors for allograft failure, independent of metabolic syndrome.
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Affiliation(s)
- Ajay K Israni
- Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN 55415, USA.
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