Focus on Transplantation

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 »

Evaluating Intrarenal Vasculature after Renal Transplantation with Doppler Ultrasound

Chicago—Doppler ultrasound, which facilitates the global evaluation of intrarenal vasculature, is a valuable, noninvasive tool for the diagnosis of complications in renal transplantation. Amir Shabaka, MD, and colleagues recently conducted a retrospective study designed to examine the evolution of renal graft hemodynamics in the immediate postoperative period following transplantation as well as early periods post-transplant. The researchers reported study results ... Read More »

Body Composition and Frailty after Transplant

Chicago—Recent studies have suggested that frailty is a risk factor for poor outcomes following kidney transplantation. Patients with preoperative fraility are at increased risk for early hospital readmission, delayed graft function, and mortality, regardless of their age. One component of frailty after kidney transplantation is weight loss; however, changes in lean and fat mass are not fully accounted for by ... Read More »

Long-Term Survival in Transplant Recipients Undergoing Heart Surgery

Chicago Researchers at a university hospital in Norway evaluated results of open heart surgery in kidney transplant recipients from 1989 to 2015. Bartlomiei J. Witczak, MD, and colleagues reported results of the analysis during a poster session at Kidney Week 2016 in a poster titled Outcomes after Open Heart Surgery in Kidney Transplant Recipients and Matched Controls. During the study ... Read More »

Employed Patients More Likely to Have Transplant List Status

Chicago The optimal long-term treatment option for patients with end-stage renal disease (ESRD) who are on hemodialysis is often kidney transplantation. Qualifications for placement on the active transplant list include patient motivation and engagement with the process. Researchers, led by Deborah S. Evans, recently conducted an analysis to assess transplant status among employed versus unemployed ESRD patients. Results were reported ... Read More »

Statin Use Suboptimal among Post-Transplant Veterans

Chicago Treatment guidelines from Kidney Disease, Improving Global Outcomes (KDIGO) and Kidney Disease Outcomes Quality Initiative (KDOQI) recommend statin medications for kidney transplant recipients. However, data from some empirical studies indicate that statins are underutilized on that patient population. Arouna Senthilkumar, MD, and colleagues recently conducted a retrospective analysis of data from the US Department of Veterans Affairs Healthcare System ... Read More »