scholarly journals Early Posttransplant Isolated v1 Lesion Does Not Need to Be Treated and Does Not Lead to Increased Fibrosis

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Irfan Moinuddin ◽  
Bijin Thajudeen ◽  
Amy Sussman ◽  
Machaiah Madhrira ◽  
Erika Bracamonte ◽  
...  
Keyword(s):  
Conservative Management ◽  
Graft Loss ◽  
Graft Function ◽  
Close Monitoring ◽  
Kidney Allograft ◽  
Vascular Rejection ◽  
Interstitial Inflammation ◽  
Acute Vascular Rejection ◽  
Allograft Function ◽  
Over Time

Acute vascular rejection (AVR) is characterized by intimal arteritis in addition to tubulitis and interstitial inflammation. It is associated with a poorer prognosis compared to tubulointerstitial rejection (AIR) and AVR is associated with a higher rate of graft loss than AIR. The prognosis and treatment of arteritis without tubulitis and interstitial inflammation (isolated v1 lesion) are still controversial. We report a case of a patient who had a biopsy of the kidney allograft for evaluation of slow graft function. The biopsy revealed an isolated v1 lesion. However, we chose not to augment immunosuppression. The patient’s kidney allograft function improved over time with close monitoring. Repeat biopsy a year later showed no evidence of endothelialitis and relatively unchanged fibrosis and no other abnormalities. Although it is suggested that most cases of isolated v1 lesions will respond to corticosteroids or T cell depleting therapies, some cases will improve with conservative management. Further studies are needed to determine which cases could be managed conservatively.

scholarly journals Exome sequencing and prediction of long-term kidney allograft function

2015 ◽  
Author(s):  
Laurent Mesnard ◽  
Thangamani Muthukumar ◽  
Maren Burbach ◽  
Carol Li ◽  
Huimin Shang ◽  
...  
Keyword(s):  
Amino Acid ◽  
Exome Sequencing ◽  
Amino Acid Level ◽  
Graft Function ◽  
Kidney Graft ◽  
Donor Age ◽  
Post Transplantation ◽  
Kidney Allograft ◽  
Allograft Function

Current strategies to improve graft outcome following kidney transplantation consider information at the HLA loci. Here, we used exome sequencing of DNA from ABO compatible kidney graft recipients and their living donors to determine recipient and donor mismatches at the amino acid level over entire exomes. We estimated the number of amino acid mismatches in transmembrane proteins, more likely to be seen as foreign by the recipient’s immune system, and designated this tally as the allogenomics mismatch score (AMS). The AMS can be measured prior to transplantation with DNA for potential donor and recipient pairs. We examined the degree of relationship between the AMS and post-transplantation kidney allograft function by linear regression. In a discovery cohort, we found a significant inverse correlation between the AMS and kidney graft function at 36 months post-transplantation (n=10 recipient/donor pairs; 20 exomes) (r2>=0.57, P<0.05). The predictive ability of the AMS persists when the score is restricted to regions outside of the HLA loci. This relationship was validated using an independent cohort of 24 recipient donor pairs (n=48 exomes) (r2>=0.39, P<0.005). In an additional cohort of living and mostly intra-familial recipient/donor pairs (n=19, 38 exomes), we validated the association after controlling for donor age at time of transplantation. Finally, a model that controls for donor age, HLA mismatches and time post-transplantation yields a consistent AMS effect across these three independent cohorts (P<0.05). Taken together, these results show that the AMS is a strong predictor of long-term graft function in kidney transplant recipients.

scholarly journals Exome Sequencing and Prediction of Long-Term Kidney Allograft Function

2015 ◽  
Author(s):  
Laurent Mesnard ◽  
Thangamani Muthukumar ◽  
Maren Burbach ◽  
Carol Li ◽  
Huimin Shang ◽  
...  
Keyword(s):  
Amino Acid ◽  
Exome Sequencing ◽  
Amino Acid Level ◽  
Graft Function ◽  
Kidney Graft ◽  
Donor Age ◽  
Post Transplantation ◽  
Kidney Allograft ◽  
Allograft Function

Current strategies to improve graft outcome following kidney transplantation consider information at the HLA loci. Here, we used exome sequencing of DNA from ABO compatible kidney graft recipients and their living donors to determine recipient and donor mismatches at the amino acid level over entire exomes. We estimated the number of amino acid mismatches in transmembrane proteins, more likely to be seen as foreign by the recipient's immune system, and designated this tally as the allogenomics mismatch score (AMS). The AMS can be measured prior to transplantation with DNA for potential donor and recipient pairs. We examined the degree of relationship between the AMS and post-transplantation kidney allograft function by linear regression. In a discovery cohort, we found a significant inverse correlation between the AMS and kidney graft function at 36 months post-transplantation (n=10 recipient/donor pairs; 20 exomes) (r2>=0.57, P<0.05). The predictive ability of the AMS persists when the score is restricted to regions outside of the HLA loci. This relationship was validated using an independent cohort of 24 recipient donor pairs (n=48 exomes) (r2>=0.39, P<0.005). In an additional cohort of living and mostly intra-familial recipient/donor pairs (n=19, 38 exomes), we validated the association after controlling for donor age at time of transplantation. Finally, a model that controls for donor age, HLA mismatches and time post-transplantation yields a consistent AMS effect across these three independent cohorts (P<0.05). Taken together, these results show that the AMS is a strong predictor of long-term graft function in kidney transplant recipients.

scholarly journals Polyomavirus Infection and Acute Vascular Rejection in a Kidney Allograft: Coincidence or Mimicry?

2003 ◽  
Vol 3 (4) ◽  
pp. 501-504 ◽  
Author(s):  
Ian D. McGilvray ◽  
Ginette Lajoie ◽  
Atul Humar ◽  
Mark S. Cattral
Keyword(s):  
Kidney Allograft ◽  
Vascular Rejection ◽  
Acute Vascular Rejection

scholarly journals Clinical and Pathological Analyses of Borderline Changes Cases after Kidney Transplantation

Nephron ◽  
2020 ◽  
pp. 1-6
Author(s):  
Tomokazu Shimizu
Keyword(s):  
Renal Allograft ◽  
Interstitial Fibrosis ◽  
Graft Loss ◽  
Graft Function ◽  
Renal Transplant Recipients ◽  
Tubular Atrophy ◽  
Renal Graft ◽  
Interstitial Inflammation ◽  
Biopsy Specimens ◽  
Allograft Biopsy

<b><i>Aim:</i></b> We aimed to perform a clinicopathological analysis of cases presenting with borderline changes (BC) after renal transplantation and discuss whether BC might be clinically or pathologically important. <b><i>Materials and Methods:</i></b> BC was diagnosed in 22 renal allograft biopsy specimens obtained from 20 renal transplant recipients between April 2010 and March 2019 after follow-up at the Department of Transplant Surgery, Kidney Center, Toda Chuo General Hospital. <b><i>Results:</i></b> BC was diagnosed at a median of 500 days following transplantation. Among the 22 renal allograft biopsy specimens showing evidence of BC, tubulitis was observed in all specimens. Interstitial inflammation was present in 18 specimens (82%), peritubular capillaritis in 14 (64%), interstitial fibrosis (ci) and tubular atrophy (ct) in 4 (18%), and C4d deposition in the peritubular capillary was present in 6 specimens (27%). Glomerulitis and intimal arteritis were not observed. There was no renal graft loss during the observation period, but deterioration of renal allograft function after biopsy occurred in 9 patients (45%). <b><i>Conclusions:</i></b> In BC, tubulitis and interstitial inflammation were the main constituents. Because glomerulitis was not observed in our study, we suspect that BC contributes to acute T-cell-mediated rejection. Although BC did not lead to renal graft loss, renal graft function deterioration was seen in nearly half of the patients after the renal graft biopsy. We conclude that BC is important clinically and pathologically and needs to be monitored and treated appropriately.

Cell-mediated and humoral acute vascular rejection and graft loss: A registry study

Nephrology ◽  
2016 ◽  
Vol 21 (2) ◽  
pp. 147-155 ◽  
Author(s):  
Rachel ZC Teo ◽  
Germaine Wong ◽  
Graeme R Russ ◽  
Wai H Lim
Keyword(s):  
Graft Loss ◽  
Registry Study ◽  
Vascular Rejection ◽  
Acute Vascular Rejection

scholarly journals The Association of Time to Organ Procurement on Short- and Long-Term Outcomes in Kidney Transplantation

2021 ◽  
pp. CJN.11420720 ◽  
Author(s):  
Verner Eerola ◽  
Ilkka Helanterä ◽  
Anna But ◽  
Marko Lempinen ◽  
Heikki Mäkisalo ◽  
...  
Keyword(s):  
United States ◽  
Organ Procurement ◽  
Graft Loss ◽  
Graft Function ◽  
The United States ◽  
Interquartile Range ◽  
Delayed Graft Function ◽  
Kidney Allograft ◽  
Multivariable Models ◽  
Kidney Transplantations

Background and objectivesTransplant centers in Europe aim to minimize the time from brain death to organ procurement (procurement delay), but evidence to justify this is scarce. In the United States, procurement times are significantly longer. Our objective was to analyze how procurement delay associates with kidney allograft outcomes.Design, setting, participants, & measurementsKidney transplantations from brain-dead donors were retrospectively analyzed from the Finnish Kidney Transplant Registry and the Scientific Registry of Transplant Recipients in the United States. Multivariable models were adjusted with donor and recipient characteristics, and the relationship between procurement delay and outcomes was modeled with cubic spline functions.ResultsIn total, 2388 and 101,474 kidney transplantations in Finland and the United States were included, respectively. The median procurement delay was 9.8 hours (interquartile range, 7.8–12.4) in Finland and 34.8 hours (interquartile range, 26.3–46.3) in the United States. A nonlinear association was observed between procurement delay and the risk of delayed graft function, with highest risk seen in short and very long procurement delays. In multivariable models, the lowest risk of delayed graft function was associated with procurement delay between 20 and 50 hours. In multivariable models, longer procurement delay was linearly associated with lower risk of graft loss (hazard ratio, 0.90/1 h longer; 95% confidence interval, 0.88 to 0.92; P<0.001). Acute rejection rates, for which data were only available from Finland, were not associated with procurement delay.ConclusionsLonger procurement delay was associated with noninferior or even better kidney allograft outcomes.

scholarly journals Exome sequencing and prediction of long-term kidney allograft function

2015 ◽  
Author(s):  
Laurent Mesnard ◽  
Thangamani Muthukumar ◽  
Maren Burbach ◽  
Carol Li ◽  
Huimin Shang ◽  
...  
Keyword(s):  
Amino Acid ◽  
Exome Sequencing ◽  
Amino Acid Level ◽  
Graft Function ◽  
Kidney Graft ◽  
Donor Age ◽  
Post Transplantation ◽  
Kidney Allograft ◽  
Allograft Function

Current strategies to improve graft outcome following kidney transplantation consider information at the HLA loci. Here, we used exome sequencing of DNA from ABO compatible kidney graft recipients and their living donors to determine recipient and donor mismatches at the amino acid level over entire exomes. We estimated the number of amino acid mismatches in transmembrane proteins, more likely to be seen as foreign by the recipient’s immune system, and designated this tally as the allogenomics mismatch score (AMS). The AMS can be measured prior to transplantation with DNA for potential donor and recipient pairs. We examined the degree of relationship between the AMS and post-transplantation kidney allograft function by linear regression. In a discovery cohort, we found a significant inverse correlation between the AMS and kidney graft function at 36 months post-transplantation (n=10 recipient/donor pairs; 20 exomes) (r2>=0.57, P<0.05). The predictive ability of the AMS persists when the score is restricted to regions outside of the HLA loci. This relationship was validated using an independent cohort of 24 recipient donor pairs (n=48 exomes) (r2>=0.39, P<0.005). In an additional cohort of living and mostly intra-familial recipient/donor pairs (n=19, 38 exomes), we validated the association after controlling for donor age at time of transplantation. Finally, a model that controls for donor age, HLA mismatches and time post-transplantation yields a consistent AMS effect across these three independent cohorts (P<0.05). Taken together, these results show that the AMS is a strong predictor of long-term graft function in kidney transplant recipients.

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