Archive for the ‘Renal Transplantation’ Category

July 8, 2012

Tolerance and Withdrawal of Immunosuppressive Drugs in Patients Given Kidney and Hematopoietic Cell Transplants

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While tolerance is one of the ultimate goals for transplantation, there have been few studies rigorously attempting tolerogenic protocols. This paper reports the results of an attempt to induce tolerance using a combination of total lymphoid radiation, thymoglobulin and donor bone-marrow cell infusion in recipients of very closely HLA-matched kidneys. Immunosuppression was completely withdrawn in […]

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May 23, 2012

Durability of Antibody Removal Following Proteasome Inhibitor-Based Therapy

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Experience with proteasome inhibitors (PI) for treating antibody-mediated rejection (ABMR) and HLA antibody removal is increasing. However, the durability of the effects PI on HLA antibody removal is unknown. This study examines this question from a unique point of view due to the use of the PI bortezomib as either a combination therapy or a […]

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May 23, 2012

Pretransplant Donor-Specific HLA Class-I and -II Antibodies Are Associated with an Increased Risk for Kidney Graft Failure

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The recent development of Luminex reagents capable of detecting complement fixing HLA antibodies has sparked a lot of interest in the best way to apply this information. This study examined C1Q-fixing HLA antibodies in a retrospective study of pre-transplant samples in patients transplanted across a negative cytotoxic cross-match. Of the 837 sera examined, 210 contained […]

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May 23, 2012

Frequency of HLA-DP-specific antibodies and a possible new cross-reacting group

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Donor specific HLA antibodies to mismatched class II antigens are a common feature of late kidney graft loss. Although antibodies to HLA-DR and -DQ antigens have been recognized for quite some time, antibodies to HLA-DP have an unclear clinical significance. This study examined the incidence of HLA-DP-specific antibodies in 650 patients on the kidney transplant […]

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April 5, 2012

Correction of Postkidney Transplant Anemia Reduces Progression of Allograft Nephropathy

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In this randomized controlled trial, use of erythropoietin in renal transplant recipients to normalize hemoglobin to normal levels (130-150 g/L) resulted in less decline in graft function, less graft failure and fewer deaths compared to maintaining hemoglobin in the range recommended by current renal guidelines (105-115 g/L). This is a surprising result, as there have […]

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April 5, 2012

Understanding the Causes of Kidney Transplant Failure: The Dominant Role of Antibody-Mediated Rejection and Nonadherence

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Understanding the causes of renal allograft failure is key in improving long-term graft survival. In this study, for-cause biopsies were analyzed, and outcomes were related to the biopsy finding. Notably, acute T-cell mediated cellular rejection rarely led to graft loss. In contrast, all patients who experienced graft loss demonstrated some degree of antibody-mediated rejection on […]

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April 5, 2012

A Randomized Trial With Steroids and Antithymocyte Globulins Comparing Cyclosporine/Azathioprine Versus Tacrolimus/Mycophenolate Mofetil (CATM2) in Renal Transplantation

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In the last few years, the tacrolimus and mycophenolic acid has become the most popular therapy used in renal transplant, rather than the older cyclosporine and azathioprine combination. These authors conducted a randomized controlled trial to see whether the use of lymphocyte-depleting induction therapy would give equivalent results between these two drug regimens. In fact, […]

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April 5, 2012

Very early steroid withdrawal or complete avoidance for kidney transplant recipients: a systematic review

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There have been a number of randomized controlled trials over the last few years comparing early corticosteroid withdrawal post-renal transplant to long-term low-dose steroids. This meta-analysis found nine randomized controlled trials using modern immunosuppression protocols to assess the impact of early steroid withdrawal. Patients received tacrolimus or cyclosporine; mycophenolic acid or an mTOR inhibitor; and […]

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February 26, 2012

World Kidney Day 2012: The Global Role of Kidney Transplantation

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This article reflects on the success of kidney transplantation for the therapy of ESRD to commemorate World Kidney Day on March 8, 2012.

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February 26, 2012

Three-Year Outcomes from BENEFIT, a Randomized, Active-Controlled, Parallel-Group Study in Adult Kidney Transplant Recipients

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BENEFIT is a randomized controlled trial comparing two different doses of belatacept, a costimulatory blocker, to standard therapy with cyclosporine in de novo kidney transplant patients. Earlier results from this study showed a higher acute rejection rate with belatacept. Nonetheless, at three years, renal function was significantly better in belatacept-treated patents.

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February 26, 2012

Ureteral Stents Are Associated With Reduced Risk of Ureteral Complications After Kidney Transplantation: A Large Single Center Experience

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Insertion of a double-J stent into the transplant ureter at the time of surgery reduces the risk of ureteric stricture. In this single-centre study, the decision to insert a ureteral stent or not was made by surgeons at the time of transplantation. There was a significant reduction in the risk of stricture, but only in […]

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February 26, 2012

Recurrent Dense Deposit Disease After Renal Transplantation: An Emerging Role for Complementary Therapies

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Membranoproliferative glomerulonephritis type II, or dense deposit disease, is a rare type of renal disease caused by excessive complement deposition in the kidney. It is also associated with a high rate of recurrence post-transplant. In this case report, a patient developed recurrent dense deposit disease shortly after transplant. Despite aggressive treatment, renal function worsened and […]

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January 28, 2012

The PROMISE Study: A Phase 2b Multicenter Study of Voclosporin (ISA247) Versus Tacrolimus in De Novo Kidney Transplantation

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Voclosporin is a new calcineurin inhibitor being assessed for transplantation. In this dose-ranging non-inferiority trial, three therapeutic levels of voclosporin were compared to tacrolimus in new renal transplant recipients. The incidence of acute rejection was similar in all voclosporin groups compared to tacrolimus. The incidence of diabetes increased in the higher-dose voclosporin group. Further studies […]

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