Review of the Clinical and Economic Burden of Antibody-Mediated Rejection in Renal Transplant Recipients

Muduma, Gorden; Odeyemi, Isaac; Smith-Palmer, Jayne; Pollock, Richard F

doi:10.1007/s12325-016-0292-y

Cited by 21 publications

(18 citation statements)

References 48 publications

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“…(24) Even considering that free release per se does not justify a greater adherence to immunosuppressant drugs, (23) it is possible to suggest that the influence of a number of health and treatment systems in Brazil helps improve adherence, once therapy is established in legislation by clinical protocols and guidelines, (3) establishing the triple scheme of immunosuppressant drugs as the better therapeutic proposal, assuring the access and free distribution of immunosuppressant to all transplanted individuals, and avoiding the negative financial impact on adherence. (25) The complex therapeutic regimen and with the excessive number of medications ingested daily, directly influence the adherence to the treatment. (26) Unfortunately, nonadherence to immunosuppressants is common among renal recipients.…”

Section: Discussionmentioning

confidence: 99%

Mensuração da adesão aos medicamentos imunossupressores em receptores de transplante renal

et al. 2018

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Objective: To measure adherence of renal transplant recipients to immunosuppressive drugs by using the Basel Assessment of Adherence with immunosuppressive medication Scale (BAASIS®) and to describe sociodemographic characteristics and clinical factors in relation to immunosuppressive drugs and creatinine levels. Methods: This retrospective, cross-sectional study was carried out from 2014 to 2015 in the post-transplantation ambulatory unit of the Kidney Hospital and Universidade Federal de São Paulo (UNIFESP). Results: Of the 181 participants, 53.6% were men; recipients ages ranged from 18 to 74 years. Systemic arterial hypertension was the initial diagnosis of chronic renal failure in 38.7% of recipients. About 95% reported that they never forgot to take several consecutive doses of the medicine, 58.6% of recipients reported total adherence to the immunosuppressive drugs, and 41.4% did not adhere to one or more of the four assessed situations. No signifi cant correlation was found between of creatinine levels and total score and by BAASIS® items. Conclusion: A high rate of patients not adherent to the immunosuppressive treatment was identifi ed (41.4%).There was no signifi cant correlation between creatinine level and receptor age at time of KTP, time after KTP, immunosuppressive separation time and total score and scores of individual BAASIS® items. This study showed that black, male recipients without a family support network, obese and autonomous are more likely not to adhere to immunosuppressive therapy. The evaluation of renal transplant recipient adhesion should be considered during all phases of the nursing process actions that make up the therapeutic plan after renal transplantation. ResumoObjetivo: Mensurar a adesão aos medicamentos imunossupressores em receptores de transplante renal, utilizando a Basel Assessment of Adherence with Immunosuppressive Medication Scale -BAASIS ® e descrever as características sociodemográfi cas, os fatores clínicos em relação aos imunossupressores e os níveis de creatinina. Métodos: Estudo prospectivo, transversal, realizado no período de 2014 a 2015, no Ambulatório Pós-Transplante do Hospital do Rim (complexo hospitalar da Universidade Federal de São Paulo (UNIFESP)). Resultados: Dos 181 participantes, 53,6% eram homens e a idade dos receptores variou de 18 a 74 anos. A Hipertensão Arterial Sistêmica foi o diagnóstico inicial de Insufi ciência Renal Crônica em 38,7% dos receptores. Aproximadamente 95% dos receptores relataram que nunca se esqueceram de tomar o medicamento; 58,6% dos pacientes relataram ter aderido totalmente aos imunossupressores e 41,4% não aderiram a uma ou mais das quatro situações avaliadas pelos itens da BAASIS ® . Não foi encontrada correlação signifi cativa pelos itens da BAASIS ® entre os níveis de creatinina e o escore total. Conclusão: Foi identifi cado um alto índice de pacientes que não aderiram ao tratamento imunossupressor (41,4%). Não houve correlação signifi cativa entre o nível de creatinina e a idade do receptor no momento do TxR, bem c...

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Section: Discussionmentioning

confidence: 99%

Mensuração da adesão aos medicamentos imunossupressores em receptores de transplante renal

et al. 2018

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“…Kidney transplantation is a crucial therapy for patients with end-stage kidney disease (ESKD), as it enhances the quality of patients' life and reduces mortality compared with dialysis [1] . Due to the usage of advanced immunosuppressive medications and the improvement of organ procurement methods, the 5year deceased donor kidney allograft survival rates have increased up to 72.4% [2] .…”

Section: Introductionmentioning

confidence: 99%

Noninvasive Identification of Core Gene Biomarkers in Patients with Acute Kidney Transplant Rejection

Zhao

2020

Preprint

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Background: Acute rejection (AR) is one of common and critical complications after kidney transplantation, which gives rise to an increasing of allograft loss and even death. However, the potential mechanisms of AR remain incompletely understood at present. This study aimed to reveal the underlying mechanisms and identify core biomarkers of AR.Methods: The AR gene expression profile GSE1563 involving 6 renal transplant patients undergoing AR and 9 patients with well-functioning transplant with no clinical evidence of rejection was selected to analyze the differentially expressed genes (DEGs) from purified RNA of peripheral blood lymphocytes. DAVID was used to carry out Gene ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses. A protein-protein interaction (PPI) network was built to display the interactions among these DEGs. To get further reliable significant genes and mechanisms, gene set enrichment analysis (GSEA) was applied to evaluate the hub gene analyzing via PPI network.Results: A total of 347 DEGs were captured, including 301 upregulated genes and 46 downregulated genes. Go and KEGG pathway analysis showed the DEGs were particularly enriched in immune response, inflammatory response to antigenic stimulus, RNA transport and protein stabilization. The PPI network indicated 3 modules were also mainly involved in immune response and RNA transport. 18 hub genes were selected in PPI network, among which there were 6 core genes evaluated by DAVID. By the way of GSEA, Oxidative stress was another potential mechanism besides immunity and ncRNA transport. Conclusion: Our analysis uncovered the immune response including humoral and cellular immunity, ncRNA transport as well as oxidative stress was the major mechanisms of AR associated respectively with MAPK8, CCL5, HMGB1, NCBP2, XPO1 and APP, which could be novel noninvasive biomarkers in peripheral blood for early diagnosis and could be helpful to the treatment of AR.

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“…AMR is the leading cause of renal allograft failure, accounting for up to 60% of late renal allograft failure. AMR is associated with a significant burden on the healthcare system . Over the past decade, several factors have influenced the evolution of AMR diagnosis and treatment, including “high‐risk” recipients being considered for renal transplantation and emerging techniques for more sensitive detection of HLA and non‐HLA antibodies.…”

Section: Introductionmentioning

confidence: 99%

“…AMR is associated with a significant burden on the healthcare system. 1,2 Over the past decade, several factors have influenced the evolution of AMR diagnosis and treatment, including "high-risk" recipients being considered for renal transplantation and emerging techniques for more sensitive detection of HLA and non-HLA antibodies. Diagnosis of AMR in renal transplantation can be characterized by (a) histologic evidence of acute renal injury by the presence of glomerulitis, peritubular capillaritis, intimal or transmural arteritis or thrombotic microangiopathy, (b) evidence of current/recent antibody interaction with vascular endothelium, and (c) serologic detection of anti-HLA and/or non-HLA antibodies in the serum.…”

Section: Introductionmentioning

confidence: 99%

Impact of active antibody‐mediated rejection treatment on donor‐specific antibodies in pediatric kidney transplant recipients

Kincaide

Hitchman

Hall

et al. 2019

Pediatric Transplantation

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AMR is a major cause of graft loss after kidney transplantation. We evaluated a retrospective cohort of 13 pediatric kidney transplant patients diagnosed with active AMR. All 13 patients were treated with plasmapheresis (PP), IVIg, and rituximab. Anti‐HLA DSAs were measured at the time of transplantation, AMR diagnosis, 30 days post‐rejection treatment, 90 days post‐rejection treatment, and 24 ± 12 months post‐AMR. A total of 68 DSAs were identified from 13 patients at the time of active AMR diagnosis. The primary objective of this study was to differentiate treatment response rates between class I and class II anti‐HLA DSA post‐AMR treatment. Overall, DSAs were significantly reduced at 30 days, and the reduction was sustained at 90 days post‐treatment, even for class II anti‐HLA and strongly positive DSAs. A significant difference between class I and class II anti‐HLA DSA was observed at 30 days; however, between class significance was lost at 90‐day follow‐up due to continued class II anti‐HLA DSA treatment response. Low DSA strength was predictive of treatment response. eGFR demonstrated significant improvement 90 days after AMR diagnosis compared to the initial value at the time of AMR, and the effect was sustained for 12 months. These results suggest that the AMR treatment is effective in pediatric kidney transplant recipients with an early diagnosis of active AMR across both class I and class II anti‐HLA DSAs.

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Review of the Clinical and Economic Burden of Antibody-Mediated Rejection in Renal Transplant Recipients

Abstract: Astellas Pharma EMEA Limited.

Cited by 21 publications

References 48 publications

Mensuração da adesão aos medicamentos imunossupressores em receptores de transplante renal

Mensuração da adesão aos medicamentos imunossupressores em receptores de transplante renal

Noninvasive Identification of Core Gene Biomarkers in Patients with Acute Kidney Transplant Rejection

Impact of active antibody‐mediated rejection treatment on donor‐specific antibodies in pediatric kidney transplant recipients

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