Focus on Transplantation

Risk of Hip Fracture and PPI Use in Kidney Transplant Recipients

Increased mortality, decreased mobility, and loss of independence are all associated with hip fracture. For patients with end-stage renal disease (ESRD), the risk of hip fracture is considerably elevated compared with that of the general population. The time immediately following kidney transplantation is particularly high-risk for hip fracture due to pre-existing chronic kidney disease and the associated mineral bone disease, ... Read More »

Safety and Efficacy of Belatacept as Immunotherapy in Kidney Transplant Recipients

Cyclosporine and tacrolimus, calcineurin inhibitors (CNIs), are commonly used as immunosuppressive therapy in patients who have undergone kidney transplantation. According to Josep M. Grinyó, MD, PhD, and colleagues in Buenos Aires, Argentina, those agents may be associated with patient comorbidity via nephrotoxicity and cardiovascular risk (hypertension, hypercholesterolemia, and diabetes mellitus), as well as transplant loss via chronic transplant injury. The ... Read More »

Risk Factors for Development of ESRD in Patients with IgA Nephrology

IgA nephropathy (IgAN) accounts for 45.36% of primary glomerular disease in China; it is also a leading cause of end-stage renal disease (ESRD). Approximately 30% of patients with IgAN progressed to ESRD within 10 to 20 years; however, in some patients, disease progression was more rapid, with ESRD occurring within 10 years. Previous studies found associations between various clinical and ... Read More »

Obinutuzumab Safe and Effective for B-Cell Depletion in Transplant Candidates

Chicago—In allosensitized patients with end-stage renal disease (ESRD), the efficacy of rituximab for desensitizing and enabling kidney transplantation is limited; tissue B-cell depletion is incomplete. Robert R. Redfield III, MD, and colleagues recently conducted an open-label phase 1b study to test the hypothesis that obinutuzumab may be more effective for desensitization than rituximab. Obinutuzumab is a glycoengineered type 2 anti-CD20 ... Read More »

Weight Gain and Blood Pressure Control after Transplantation

Orlando—It is well known that blood pressure can be lowered by weight loss; however, there are few data on the relationship between weight loss and reductions in blood pressure in recipients of kidney transplantation. Ekamol Tantisattamo, MD, FACP, FASN, FNKF, of the Multi-Organ Transplant Center at the Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, recently conducted a ... Read More »

Urine Fibrosis Markers and Increased Risk of Allograft Failure

Previous biopsy studies of healthy kidney donors have demonstrated that although tubulointerstitial fibrosis is common and increases with age, the degree of fibrosis is not associated with glomerular filtration rate (GFR) when age is taken into account. There is a strong association between the severity of tubulointerstitial fibrosis on biopsy and progressive loss of estimated GFR (eGFR) across causes of ... Read More »

Patients with ESRD Not Interested in Transplantation

Orlando—Kidney transplantation is the optimal long-term treatment for patients with end-stage renal disease (ESRD) on dialysis. Qualifying for transplantation is a process that requires many steps, starting with the patient’s statement of interest. Deborah Evans, LCSW, and colleagues conducted a study aimed at characterizing interest in transplantation among patients of a large dialysis organization in the United States. The researchers ... Read More »

Interventions Improve Adherence to Tacrolimus after Transplantation

Nonadherence to immunosuppression medications among kidney transplantation recipients can cause rejection and transplant loss. There is a high barrier to adherence during the first year post-transplantation due to the need to take multiple medications with various adverse effects as well as frequent dose changes. Younger age and further time from transplant are associated with lower adherence to the immunosuppression medication ... Read More »

Referral for Transplantation as Quality-of-Care Indicator

Kidney transplantation is associated with better patient outcomes and lower costs than dialysis; however, only <3% of patients with end-stage renal disease (ESRD) receive a kidney transplant before initiation of dialysis therapy and <30% of prevalent patients with ESRD have a functioning transplant. At present, there are no pay-for-performance indicators related to transplantation in the Centers for Medicare & Medicaid ... Read More »

Outcomes in Transplant Recipients Treated with RAS Blockade Agents

In 2013, there were more than 100,000 cases of end-stage renal disease (ESRD) in the United States and the prevalence is increasing by 21,000 each year, making ESRD a major public health problem. The optimal renal replacement therapy is kidney transplantation; however, long-term outcomes are less than optimal, with 10-year transplant rates of 45% for recipients of deceased donor kidneys. ... Read More »