Focus on Transplantation

Patient Networks Promote Living Donor Transplantation Conversations

New Orleans—Ideas, attitudes, and behaviors are known to spread within social networks; however, there are few available data on the structure and influence of social networks within the framework of hemodialysis clinics. Avrum Gillespie, MD, and colleagues utilized a survey and observational data to examine the role of patient hemodialysis social networks and discussions of living donor kidney transplantation. Results ... Read More »

Nocturnal Hypertension in Pediatric Transplant Recipients

New Orleans—Pediatric kidney transplant recipients commonly exhibit nocturnal hypertension and non-dipper status during ambulatory blood pressure monitoring, both of which are associated with cardiovascular risk in adults. Christine B. Sethna, MD, and colleagues conducted an open label, blinded end point clinical trial to examine the chronotherapeutic alteration of anti-hypertensive medication on nocturnal hypertension and non-dipper status in a cohort of ... Read More »

Changes in Hospitalization in Transplant Recipients with CMV Infection

New Orleans—With increasing use of more aggressive immunosuppressive therapies, cytomegalovirus (CMV) infection has become a frequent complication of kidney transplantation. It is unclear how the burden of inpatient hospitalization related to CMV has changed over time in the United States. Neetika Garg, MD, and colleagues utilized the National Inpatient Sample 2004-2014 to identify hospitalizations with primary or secondary diagnosis of ... Read More »

BMI and the Risk of Graft and Patient Failure in Kidney Transplantation

New Orleans—Previous studies in kidney transplant recipients with high body mass index (BMI) have yielded conflicting results; some studies reported inferior outcomes compared with patients with lower BMI and others reported superior outcomes in patients with high BMI compared with lower BMI. Whether BMI is a significant independent risk factor for graft failure and patient death in the modern immunosuppressive ... Read More »

Study Protocol: The ACT (Active Care after Transplantation) Trial

Individuals who have undergone renal transplantation often experience low physical activity, reduced physical fitness, and reduced physical functioning. In the early stages of chronic kidney disease, patients have declines in levels of physical activity; at progression to end-stage renal disease (ESRD), physical activity levels have further declined in the majority of patients. Patients with ESRD exhibit deconditioning and reductions in ... Read More »

Everolimus Exposure Combined with Low Dose Tacrolimus for Efficacy and Safety

Immunosuppressive agents are key in ensuring long-term graft survival in renal transplant recipients. Clinicians seek to achieve a balance between a low rate of acute rejections and avoidance of toxicities related to immunosuppression. The mammalian target of rapamycin (mTOR) inhibitors bind to the immunophilin FKBP12, blocking the activity of mTOR, a serine threonine protein kinase involved in the proliferation and ... Read More »

Risk of Melanoma in Kidney Transplant Recipients Associated with Older Age, Sex, and Donor Type

Patients who undergo kidney transplantation for long-term curative treatment of end-stage renal disease are required to maintain lifelong immunosuppressive treatment to ensure adequate graft function. The immunosuppression therapy is associated with an increase in the risk of certain kinds of cancers, particularly cancer of the skin, leading to increased morbidity and mortality in transplant recipients. The risk of skin cancer, ... Read More »

Differentiating between Allograft Active Rejection and Allograft Injury

Long-term survival of a renal transplant depends on accurate and timely detection of allograft rejection and effective treatment. The standard for diagnosis of rejection is histology obtained via needle biopsy; however, the technique is rarely utilized for surveillance due to high cost, complicated logistics, and potential complications, as well as patient discomfort and inconvenience. A possible noninvasive marker for diagnosis ... Read More »

Treating Hypertension in Transplant Recipients: Chlorthalidone versus Amlodipine

In kidney transplantation recipients, hypertension following the transplant has been shown to be an independent risk factor for transplant failure. Hypertension after transplantation is also associated with increased risk for cardiovascular disease and mortality. Contributors involved in development of hypertension after transplant include donor, recipient, and transplantation factors. Patients treated with calcineurin inhibitors (CNIs) have been shown to have increased ... Read More »

Cognitive Impairment Among Kidney Transplant Recipients

As many as 50% to 87% of patients on maintenance dialysis experience cognitive impairment, influencing quality of life, employment rates, adherence to treatment, hospital admissions, health care costs, morbidity, and mortality. Kidney transplantation offers advantages in quality of life and survival over dialysis, but kidney transplant recipients have several risk factors for cognitive impairment, including comorbid illness, depression, and lower ... Read More »