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Background and Aims Delayed graft function (DGF) is a common complication after renal transplant. Definitions of DGF are based on analysis of estimated glomerular filtration rate (eGFR) underlying the plasma creatinine fluctuations after renal transplant. We tried to validate an early parameter of DGF in a renal transplant population based on the kinetic estimation of glomerular filtration rate, since this formula adds a quantitative dimension to the assessment of kidney function, and consequently predicting DGF could get a better post-transplant management. Method This is a longitudinal study of 886 renal transplant recipients from our center during the first post-transplant month. As we are searching for functional biochemical markers in renal transplant from decesased donors, we excluded patients with primary gtaft disfunction.The final simple was composed of 574 adult kidney transplant recipients, 348 renal transplant from donors after circulatory death (DCD) and 226 from donors after brain death (DBD). The following are analyzed 5creatinine concentrations, serum Lactate dehydrogenase (LDH) and urinary creatinine excretion rate (CER). Results In DCD there was a significant correlation between DGF duration and all KeGFR and CER determinations during the first post-transplant week. The parameters that achieved the best correlation to predict DGF were KeGFR (r = 0.515; p<0.001) and CER on the fourth day (r = 0.584; p<0.001) (Figure 1). In the DBD, a weak correlation was observed between DGF duration and KeGFR determinations in the first days, being KeGFR at the fourth day the one that presented the highest correlation (r = 0.59 p<0.001). We observed that serum LDH on the first day in the DBD group is associated with worse renal graft function at first, third month and one year after transplantation (p<.045, p<.05 and p<.067 respectively). Conclusion The determination of KeGFR and CER could predict the duration of DGF, especially in DCD recipients. DCD recipients with DGF have significantly better graft survival at one year than DBD recipients with DGF. (p<.001).

Background and Aims BK virus infection continues to be one of the most common clinical issues encountered by transplants providers, which can lead to BK virus nephropathy and, ultimately, graft loss. Despite its importance, there are still many uncertainties surrounding effective prevention and treatment strategies. The aim of this study is to evaluate the BK virus prevalence disease in a cohort of kidney transplant patients, examine consequences of immunosuppression regimens readjustments and assess the progression of viremia and viruria. Method This study analyzed a cohort of patients who received kidney transplants from January 2011 to January 2020 and had a minimum graft survival of three months. In accordance with our established protocol, viremia was measured on a quarterly basis during the first year after transplantation and annually thereafter. BK virus infection (BKVi) was defined as a plasma viral load, determined by real-time PCR, of 10,000 copies/ml or greater, or a viral load of 5,000 copies/ml or greater if accompanied by viruria of greater than 10 million copies/ml. Out of the 490 patients initially selected, 42 were excluded from the study due to inadequate data. Results The maximum levels of viremia during the course of the study were classified as follows: viremia ≥ 10,000 (N = 78; 17.4%), between 5,000-10,000 (N = 11; 2.4%), between 500-1,000 (N = 17; 3.8%) and undetectable (N = 342; 76.3%). The maximum levels of viruria were classified as: viruria ≥ 1 million (N = 98, 21.9%), between 999,999-100,000 (N = 15; 3.3%), between 99,999-10,000 (N = 20, 4.5%) and undetectable (N = 315; 70.3%). In the group diagnosed with BKVi, viremia ≥ 10,000 appeared at a median post-transplant time of 5.8 (2.9-11.7) months. The treatment approach involved replacing tacrolimus or mycophenolate with mTOR inhibitor, based on the patient's immunological risk. In some cases of high immunological risk or intolerance to mTOR inhibitor during the first month, treatment with tacrolimus and mycophenolate was continued. If the previous regimens were not effective, treatment with cyclosporine and mTOR inhibitor was initiated in some cases. The key results are summarized in the Table 1. Conclusion The combination of tacrolimus and mTOR inhibitor appears to be an effective option for BK virus infection, while the combination of mTOR inhibitor and mycophenolate has a high discontinuation rate, which can result in subsequent increase in viremia. In cases where there is no favorable response, the combination of cyclosporine and mTOR inhibitor can be effective. The changes in immunosuppression in patients with BKVi did not result in significant differences in renal function at one year or five years after transplantation, although the sample size is limited and more research is needed to confirm this. Keeping tacrolimus and mycophenolate may lead to a longer time until viremia becomes negative, which could have long-term implications for renal function.

Background and Aims Glucagon-like peptide type 1 agonists (aGLP1) is an important therapy to consider for patients with type 2 diabetes (DM2), especially those with chronic disease with glomerular filtration rates (GFR) up to 15ml/min. They stimulate the production and secretion of insulin from pancreatic β cells, delay gastric emptying, promote weight loss, reduce appetite by acting on the central nervous system, and decrease glucagon secretion from pancreatic α cells. OUTCOMES To assess the serum, urinary and clinical effects of treatment with aGLP1 in kidney transplant (KT) patients. Method This is a retrospective observational study of 32 KT patients from our center who met criteria for treatment with aGLP1. In the sample, serum and urinary data are compared, six months before, after and at the time of intervention. The management of DM was evaluated with glycosylated hemoglobin (HbA1C) and basal glycemia levels, before and after the start of treatment. Changes in cardiovascular risk are studied with the number of heart failure episodes, hospital admissions, and changes in the left ventricular ejection fraction. In addition, other parameters such as: hemoglobin (Hb), iron, ferritin, calcium, phosphorus, magnesium, potassium, uric acid, proteinuria and clinical data such as body weight were assessed. Results The sample presented a mean GFR by CKD EPI of 43.2ml/min. A significant drop in body weight was observed, from 93.3kg to 89.2kg (p = 0.001). Regarding the control of DM, no statistically significant results were obtained, a decrease in glycemia figures from 136 to 133 g/dl and HbA1C was obtained, with a reduction of 2.7%, p = 0.404 and p = 0.105, respectively. Regarding the progression of kidney disease, a decrease in proteinuria from 0.33g/day to 0.25 g/day was obtained, as well as a 9.5% protein/creatinine ratio, p = 0.480 and p = 0.721, respectively. Serum creatinine levels unchanged, with a mean of 1.6 mg/dl. Conclusion The aGLP-1 are a valuable treatment option for initiation in KT patients with DM2, having significant efficacy in weight loss. More studies with large samples are required to assess its safety in this population highly affected by DM2 and with borderline GFR.