COVID-19 infection remains a threat to the health systems of many countries. Potential success in the fight against the COVID-19 pandemic is the vaccination of high-risk groups, including patients with end-stage kidney disease (ESKD) and after solid organ transplantation (SOT). Immunosuppression in kidney transplant recipients can also reduce the immunogenicity of SARS-CoV-2 vaccines (varied by vaccine platform), available data suggest that they are efficacious in approximately 50–70%, compared to non-transplant situations. In this paper, we present a newly developed acute humoral and cellular rejection with acute allograft failure and need of hemodialysis 14 days after administration of the adenovirus vectored SARS-CoV-2 vaccine (AstraZeneca; CHADOx1, AZD1222). This occurred in a patient who previously had an asymptomatic COVID-19 infection. Case reports of acute allograft rejection after vaccination against SARS-CoV-2 can help stratify risk groups of patients who develop hyperimmune reactions. However, it is also possible that those with a previous mild primary COVID-19 infection may also develop acute allograft rejections upon COVID-19 re-infection.

Background and Objectives: It has been confirmed that adiponectin/leptin (A/L) ratio correlates better with cardiometabolic risk factors than hormone levels alone. The aim of our study was to determine the risk of developing post-transplant diabetes mellitus (PTDM) and other metabolic conditions depending on A/L ratio after kidney transplantation (KT). Material and Methods: In a prospective analysis, the studied samples were divided into three groups: control group, prediabetes and PTDM group. Pre-transplantation, at 3, 6 and 12 months after KT, we recorded basic characteristics of donor and recipient. We also monitored levels of adipocytokines and calculated A/L ratio. Results: During observed period, we recorded significant increase in A/L ratio in control group (p = 0.0013), on the contrary, a significant decrease in PTDM group (p = 0.0003). Using Cox regression Hazard model, we identified age at time of KT (HR 2.8226, p = 0.0225), triglycerides at 1 year (HR 3.5735, p = 0.0174) and A/L ratio < 0.5 as independent risk factors for prediabetes and PTDM 1-year post-transplant (HR 3.1724, p = 0.0114). Conclusions: This is the first study to evaluate the relationship between A/L and risk of PTDM and associated metabolic states after KT. We found out that A/L ratio <0.5 is independent risk factor for prediabetes and PTDM 1 year post-transplant.

Background and Aims Infections are the most common non-cardiac cause of death after kidney transplantation (KT). The main goal of immunosuppressive therapy is to find a balance between the low incidence of acute rejection and infectious complications. Method We conducted a retrospective, monocentric analysis of transplant patients at the Transplant Center University Hospital Martin from 2011 to 2020 with various induction immunosuppressive therapies. We monitored the incidence of infections in terms of etiology, localization and severity at different intervals after KT. Results Our study included 39 patients on induction therapy with basiliximab to whom we paired 39 patients with induction therapy with thymoglobulin based on gender and age, in total our population consisted of 78 patients (56 men, 22 women), the mean age was 45 years. In the group of patients with induction therapy with thymoglobulin, we noted a higher proportion of fungal (P=0.0409), urogenital infections (P=0.0384), sepsis (P=0.0497) and leukopenia (0.0384) from 1st to 6th month after KTx, higher incidence of skin infections (P= 0.0218) and serious infections requiring hospitalization (P = 0.0269) from 6th-12th months to TO. On the other hand, in the basiliximab patient group, we identified a higher incidence of acute humoral and cellular rejection (P=0.0218) after 6 months of TO. From the perspective of recurrent infections, in the Thymoglobulin induction group, we noted a higher incidence of infections by localization, etiology and severity. Risk factors for recurrent bacterial infections from 1st to 6th month after KT are: history of respiratory diseases (P = 0.0108), thrombocytopenia (P = 0.0104) and infections caused by multi-resistant bacteria (P = 0.0003). Conclusion Patients on inductive immunosuppressive therapy with thymoglobulin are at a higher risk of recurrent, multidrug-resistant and severe infections after KT compared to induction with basiliximab with identical maintenance immunosuppressive therapy. On the other hand, patients on induction therapy with basiliximab have a higher risk of developing acute rejection. Therefore, it is essential to identify risk groups of patients benefiting from milder or more intensive inductive immunosuppressive therapy without a concomitant increased risk of infectious complications or acute graft rejection

Background and Aims Chronic kidney disease represents a world-wide health problem, affecting approximately 195 million women around the world. Risk of development of chronic kidney disease is greater in women in comparison to men. Method We retrospectively analysed cohort of 1457 patients after kidney transplantation from all transplant centres in Slovakia over period of ten years from 2010 – 2020. Parameters taken into account were cause of end-stage renal disease (ESRD), outcome of transplantation in a context of differences between the genders. Results Out of 1,457 patients, 557 (517 primary transplantation) were women, 900 (831) men. Primary causes leading to end-stage renal disease (ESRD) in female recipients where we observed a statistically significant difference between genders were tubulointerstitial nephritis (32.1% in females vs. 22.3% in males, p&lt;0.0001), autosomal dominant polycystic kidney disease (17.6% vs. 11.6%, p = 0.0013), and systemic lupus erythematosus (2.3% vs. 0.2%, P = .0001). In male recipients native kidneys were more frequently affected by glomerulonephritis (38% vs. 25.7%, p&lt;0.0001), nephropathy as a complication of type 2 diabetes mellitus (7.8% vs. 4.1%, p&lt;0.0001), and IgA nephropathy (2.9% vs. 1.1%, P = .0232). There were no statistically significant gender differences in other causes of ESRD. However, there was no significant difference in time spent on dialysis between female and male recipients (39.4 ± 39 months vs. 35.8 ± 33.2 months, p&gt;0.05), female recipients waited for a kidney transplant significantly longer (32.9 ± 27.4 months vs. 39.4 ± 31.5 months, p&lt;0.0001). Overall death-censored graft survival rates in our cohort in female and male recipients were after 12 months 91.2% vs. 93.1%, p=NS, 5 years 80.7% vs. 82.6%, p=NS, and 10 years 60% vs. 66.7%, p=NS (Fig. 1). After 12 months, 5 and 10 years, the overall patient survival rates among female vs. male recipients were 96.8% vs. 97.1%, p=NS; 89.9% vs. 88.9%, p=NS; and 72.9% vs. 76%, p=NS (Fig. 2), respectively. Conclusion Despite comparable patient and graft survival rates in male and female recipients in our study, there are other studies showing that gender, as well as gender mismatch significantly influence outcomes of transplantation.