Focus on Transplantation

Characteristics of Patients on the Transplant Waitlist

Austin, Texas—The optimal treatment for patients with end-stage renal disease (ESRD) is renal transplantation. The qualification process for transplantation is complex and difficult to navigate for some patients. Deborah Evans, MA, LCSW, and colleagues conducted a data analysis to characterize patients listed as active on the transplant waiting list to improve understanding of the challenges involved in qualifying for a ... Read More »

Evaluation of Tools to Predict Risk of Cardiovascular Event or Death Post-Transplant

Austin, Texas—Due primarily to comorbid conditions, patients who are recipients of renal transplantation are at increased risk for development of cardiovascular disease. Currently, there are no cardiovascular risk stratification tools that are effective and non-invasive for this patient population. Kimberly L. Hoffman, MSN, ACNP-BC, of the University of Cincinnati College of Medicine, assessed the utility of two tools, the Framingham ... Read More »

Preventing FSGS with Preemptive Plasmapheresis

Austin, Texas—Approximately 30% to 50% of recipients of renal transplants experience recurrence of focal segmental glomerulosclerosis (FSGS). This recurrence is associated with poor prognosis, and can lead to loss of graft and subsequent return to dialysis. FSGS recurrence can occur as early as a matter of hours post-transplant or as late as years after transplant. Increased risk for FSGS recurrence ... Read More »

Histologic Findings in Patients Who Switched from Cyclosporine to Everolimus

Decisions regarding immunosuppression following kidney transplantation aim to ensure long-term graft survival. The survival of the graft is associated with a variety of factors that can lead to irreversible nephron loss and progressive dysfunction. Dysfunction commonly occurs relatively late, making graft function a poor marker for the severity of histological changes such as early tubulointerstitial damage from ischemic-reperfusion injury, acute ... Read More »

Longer Pretransplantation Dialysis Exposure Associated with Increased Failure Risk

There are few definitive data on the impact of dialysis exposure prior to nonpreemptive living donor kidney transplantation on allograft outcomes. According to John S. Gill, MD, MS, and colleagues, the mechanisms that underlie the previous findings of the detrimental association of dialysis exposure with transplant failure remain uncertain and may differ between living and deceased donor transplant recipients. In ... Read More »

Obesity and Transplantation Outcomes in Patients with ADPKD

Austin—The rates of renal transplantation among patients with autosomal dominant polycystic kidney disease (ADPKD) are high. Due to the higher incidence of complications post-transplant among patients who are overweight, some patients are required to lose weight prior to being listed for transplant. For patients with local symptoms from organ enlargement, nephrectomy may be performed with transplantation. Data from recent studies ... Read More »

Serum Potassium Levels Pretransplant and Outcomes Posttransplant

Austin—High risks of serum potassium abnormalities are common among patients undergoing hemodialysis; hyperkalemia is particularly common in that patient population. Previous studies have shown that patients with hypo- and hyperkalemia are at increased risk for mortality compared with patients with normokalemia. Potassium regulation can be achieved with kidney transplantation to varying degrees; however, there are few available data on whether ... Read More »

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 »