Focus on Transplantation

Everolimus Exposure Combined with Low Dose Tacrolimus for Efficacy and Safety

Immunosuppressive agents are key in ensuring long-term graft survival in renal transplant recipients. Clinicians seek to achieve a balance between a low rate of acute rejections and avoidance of toxicities related to immunosuppression. The mammalian target of rapamycin (mTOR) inhibitors bind to the immunophilin FKBP12, blocking the activity of mTOR, a serine threonine protein kinase involved in the proliferation and ... Read More »

Risk of Melanoma in Kidney Transplant Recipients Associated with Older Age, Sex, and Donor Type

Patients who undergo kidney transplantation for long-term curative treatment of end-stage renal disease are required to maintain lifelong immunosuppressive treatment to ensure adequate graft function. The immunosuppression therapy is associated with an increase in the risk of certain kinds of cancers, particularly cancer of the skin, leading to increased morbidity and mortality in transplant recipients. The risk of skin cancer, ... Read More »

Differentiating between Allograft Active Rejection and Allograft Injury

Long-term survival of a renal transplant depends on accurate and timely detection of allograft rejection and effective treatment. The standard for diagnosis of rejection is histology obtained via needle biopsy; however, the technique is rarely utilized for surveillance due to high cost, complicated logistics, and potential complications, as well as patient discomfort and inconvenience. A possible noninvasive marker for diagnosis ... Read More »

Treating Hypertension in Transplant Recipients: Chlorthalidone versus Amlodipine

In kidney transplantation recipients, hypertension following the transplant has been shown to be an independent risk factor for transplant failure. Hypertension after transplantation is also associated with increased risk for cardiovascular disease and mortality. Contributors involved in development of hypertension after transplant include donor, recipient, and transplantation factors. Patients treated with calcineurin inhibitors (CNIs) have been shown to have increased ... Read More »

Cognitive Impairment Among Kidney Transplant Recipients

As many as 50% to 87% of patients on maintenance dialysis experience cognitive impairment, influencing quality of life, employment rates, adherence to treatment, hospital admissions, health care costs, morbidity, and mortality. Kidney transplantation offers advantages in quality of life and survival over dialysis, but kidney transplant recipients have several risk factors for cognitive impairment, including comorbid illness, depression, and lower ... Read More »

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 »