Focus on Transplantation

Immediate-Release versus Extended-Release Tacrolimus in African Americans

One-third of deceased donor kidney transplant recipients in the United States are of African ancestry, despite African Americans constituting 13% of the US population. Results of immunosuppression trials are often not generalizable to African American kidney transplant recipients because that patient population is often under-represented in those studies. Compared with kidney transplant recipients of European ancestry, rates of rejection and ... Read More »

Case Study of Patients with Predominant Mesangial C1q Deposits

In 1985, researchers described C1q nephropathy (C1qN). The condition is characterized by (1) the presence of predominant or co-dominant mesangial C1q deposits detected by immunofluorescence microscopy; (2) corresponding mesangial or paramesangial electron-dense deposit (EDD); and (3) absence of clinical and serological evidence of systemic lupus erythematosus (SLE). Patients present with proteinuria in the nephrotic range and are resistant to steroid ... Read More »

Program Streamlining Donor Assessment Process Improves Rate of Living Donor Transplantations

The best outcomes related to patient survival and quality of life for patients with end-stage renal disease (ESRD) are associated with renal transplantation. Greater transplant and patient survival seen in living versus deceased donor transplants; however, efforts to increase rates of living donation need to be balanced with ensuring patient safety via a comprehensive screening process. Prior to 2010 the ... Read More »

Evaluation of RADIANT Community Study Process

Studies of quality improvement interventions at dialysis facilities have shown improvements in end-stage renal disease (ESRD) outcomes and in quality of life of patients with ESRD. However, according to Reem E. Hamoda, MD, and colleagues, those studies focused on effect size in evaluating the success of the intervention, with few data on why the intervention worked or whether the intervention ... Read More »

Impact of Pre-Transplant Vascular Disease on Long-Term Outcomes after Transplantation

Vascular disease is associated with an increased risk of death among dialysis patients on the transplant waiting list. Among candidates for transplantation on the deceased donor waiting list, the annual rate of vascular-related deaths is >8%; the rate increases with cumulative time on dialysis therapy. Even with the modest survival benefit of transplantation for patients with vascular disease, vascular-disease–related death ... Read More »

Donor and Recipient Views on Anonymity Policies in Kidney Donation

In Spain and in the Netherlands, anonymity is maintained for kidney donation from live donors in nondirected (unspecified) and paired exchange (specified indirect) donation. The anonymity is required both prior to and following kidney donation for nondirected and paired exchange proceedings.  In other countries, including the United Kingdom and the United States, there is no requirement of anonymity for those ... Read More »

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 »