Focus on Transplantation

Nutritional Status of Children with ESRD Varies with Renal Replacement Therapy Modality

Among pediatric patients with end-stage kidney disease (ESRD), the frequency of protein-energy malnutrition ranges from 20% to 80%, resulting in loss of lean mass, depletion of fat mass, and deceleration of growth, affecting height. Multiple factors are involved in these alterations, including hormonal imbalance, low nutrient intake, decreased residual renal function, use of renal replacement therapies (RRT), i.e., hemodialysis and ... Read More »

INTENT Trial Examines Intervention to Prevent Excessive Weight Gain Post-Transplant

Recipients of kidney transplant have markedly improved outcomes compared with patients on dialysis; however, survival among kidney transplant recipients is significantly reduced compared with age-matched general population. The reduction in survival is due, in large part, to an increase in the risk of cardiovascular disease. Weight gain, obesity, and diabetes are risk factors for cardiovascular disease, and there is an ... Read More »

Incidence of Post-Transplant De Novo Heart Failure Deceased from 1998 to 2010

Compared with other modes of renal replacement therapy, kidney transplantation offers improved survival and quality of life. However, life expectancy among kidney transplant recipients is lower than that in the general population. Cardiovascular disease is one factor that contributes to the increased rates of mortality in the transplant population; heart failure, myocardial infarction, and stroke occur frequently in the first ... Read More »

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 »

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 »

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 »

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 »