Focus on Transplantation

HCV Status and Kidney Transplantation Outcomes

In the general population in the United States, the prevalence of hepatitis C virus (HCV) is ~1%; the prevalence among patients on hemodialysis ranges between 3% and 14%. Current US practice guidelines call for screening of all dialysis patients for HCV infection by testing for anti-HCV antibody and, more recently, HCV RNA to confirm chronic infection. For many patients with ... Read More »

Treatment for c-aABMR May Improve Long-Term Allograft Survival

The introduction of calcineurin inhibition (CNI), and induction therapy with T cell depleting agents has significantly improved short-term outcomes of kidney transplantation; however, improvement in long-term renal allograft survival remains a considerable clinical challenge. Recent studies have suggested that chronic-active antibody mediated rejection (c-aABMR) is one of the major barriers for long-term renal allograft survival. Advanced c-aABMR often presents as ... Read More »

Vitamin D Supplementation in Transplant Patients at Risk of Hypercalcemia

Previous studies have demonstrated a high prevalence (94%) of vitamin D insufficiency among kidney transplant recipients. There are several reasons for this trend, including recommendations to limit sun exposure and advising use of sunscreens with a high sun protection factor (due to increased risk of skin cancer among transplant recipients), inadequate nutritional supplementation of vitamin D both during dialysis and ... Read More »

Associations between Trans-fatty Acids and Survival in Renal Transplant Recipients

Trans-fatty acids (TFAs), unsaturated fatty acids, occur naturally in ruminant fats and dairy products; TFAs are produced by biohydrogenation in ruminant gut. However, according to Anupam Chandra, MD, and colleagues most TFAs in modern diets are found in industrial processed food, created by hydrogenating vegetable and fish oils. Margarines, crackers, and deep-fried foods contain partially hydrogenated TFAs due to properties ... Read More »

Metabolic Acidosis and Risk for Cardiovascular Events Following Transplantation

Of the 135,436 kidneys transplanted between 2008 and 2015, an estimated 20% will be lost within 5 years. An additional 35,000 kidney transplants will be lost by 2025, which will result in significant morbidity, mortality, and public health costs. Patient death, primarily due to cardiovascular disease, accounts for nearly half of the failed transplanted kidneys. The other 50% are lost ... Read More »

Racial Disparities in Access to Kidney Transplant after 2014 Kidney Allocation System

Some patients with end-stage renal disease on the kidney transplant waiting list are made inactive due to medical comorbidities, incomplete testing, psychosocial issues, or financial constraints. Those who are made inactive have a higher mortality rate than those who remain on the list. Inactive patients work with their healthcare professionals, social workers, and transplant team to resolve the issues to ... Read More »

Incidence of Nonmelanoma Skin Cancer Varies by Treatment Modality in Transplant Recipients

The most common form of cancer in recipients of solid organ transplants is nonmelanoma skin cancer (NMSC), which is reportedly more common in recipients of renal transplants than in patients receiving maintenance dialysis. Patients on maintenance dialysis are also at increased risk of NMSC, including patients with high comorbidity and those on the active transplant waiting list. There are few ... Read More »

Transplant Outcomes in Patients with C3 Glomerulopathy: A Case Series

C3 glomerulopathy (C3G) is a rare, progressive disease that commonly leads to end-stage renal disease (ESRD). C3G is a form of glomerulonephritis (GN) associated with dysregulation of the alternative complement pathway. C3 dominance with minimal or absent immunoglobulin deposition on immunofluorescence staining is the defining histological finding for C3G. Findings on light microscopy include patterns of membranoproliferative GN (MPGN), mesangioproliferative ... Read More »

Costs of Immunosuppressive Drugs Decreased after Approval of Generic Versions

For patients with end-stage organ failure, solid organ transplantation is life-saving and cost-effective; however, transplant recipients require use of immunosuppressive agents for the rest of their lives to maintain a functioning graft. In 2000, the average cost for immunosuppressive medications was between $10,000 and $14,000 annually. Generic versions of some commonly prescribed agents, including tacrolimus, mycophenolate mofetil, and mycophenolate sodium, ... Read More »

May June 2019: Transplantation Abstract Roundup

Renal Transplantation among Patients with ESRD Due to Lupus Nephritis Annals of Internal Medicine. 2019;170(4):240-247. Rates of premature death are high among patients with end-stage renal disease (ESRD) due to lupus nephritis (ESRD-LN). April Jorge, MD, and colleagues conducted a nationwide cohort study designed to examine the potential effect on survival of renal transplant among patients with ESRD-LN in the ... Read More »