Surveillance renal transplant biopsies and subclinical rejection at three months post‐transplant in pediatric recipients

Hymes, Leonard C.; Greenbaum, Laurence; Amaral, Sandra; Warshaw, Barry L.

doi:10.1111/j.1399-3046.2007.00705.x

Cited by 34 publications

(30 citation statements)

References 17 publications

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“…The immunosuppressive strategy used in our institution has been described previously (26, 27). In brief, all patients received induction therapy with basiliximab and maintenance immunosuppression with prednisone, MMF, and tacrolimus.…”

Section: Methodsmentioning

confidence: 99%

24 Weeks of Valganciclovir Prophylaxis in Children After Renal Transplantation: A 4-Year Experience

et al. 2011

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Background Cytomegalovirus (CMV) is the most common opportunistic infection after solid-organ transplant. Valganciclovir prophylaxis significantly reduces disease, but limited data are available on its use in children. Recently, an increase in delayed-onset CMV disease has been noted with some arguing that longer prophylaxis may decrease late-onset disease. Methods Single-center, retrospective analysis of pediatric renal transplant patients receiving 24 weeks valganciclovir prophylaxis (15 mg/kg/day, maximum 900 mg/day) from January 2004 to December 2008, aiming to measure the incidence of CMV disease and toxicity of valganciclovir. Results We enrolled 111 patients, 60% males, 46% African Americans, and median age at transplant 14.5 years (range 1.4–20.4 years). Sixty-nine percent of donors and 44% of recipients were seropositive pretransplant. Median duration of valganciclovir use was 5.9 months (range 0.5–24 months). CMV viremia and disease occurred in 27% and 4.5%, respectively. All patients with disease presented after prophylaxis ended and all were D+/R−. Thymoglobulin use (P=0.04) and positive donor CMV status (P=0.02) were associated with a higher risk of CMV viremia. Twenty-four percent had hematologic toxicity directly associated with valganciclovir. Conclusions Valganciclovir use in children was effective as prophylaxis against CMV disease; no children at our institution developed disease while on therapy. Our regimen of 24 weeks of prophylaxis was associated with a lower rate of late-onset disease than previous reports with 12-week regimens. Further controlled studies should be considered to compare longer versus shorter periods of prophylaxis and dose reductions and their impact on prevention of late-onset disease, resistance, cost, and toxicity.

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Section: Methodsmentioning

confidence: 99%

24 Weeks of Valganciclovir Prophylaxis in Children After Renal Transplantation: A 4-Year Experience

et al. 2011

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“…Given the insensitivity of serum creatinine, subclinical rejection is detected more frequently in children than in adults when surveillance biopsies are performed (4, 5). Indeed, this indolent inflammation is consequential, as subclinical rejection in children is associated with subsequent allograft fibrosis (6, 7), and early treatment with corticosteroids reduces the number of subsequentclinical acute rejection (AR) episodes (8).…”

Section: Introductionmentioning

confidence: 99%

Urinary Chemokines CXCL9 and CXCL10 Are Noninvasive Markers of Renal Allograft Rejection and BK Viral Infection

Jackson

Kim

Begley

et al. 2011

American Journal of Transplantation

172

153

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Renal transplant recipients require periodic surveillance forimmune-based complications such as rejection and infection. Noninvasive monitoring methods are preferred, particularly for children, for whom invasive testing is problematic. We performed a cross-sectional analysis of adult and pediatric transplant recipients to determine whether a urine-based chemokine assay could non-invasively identify patients with rejection amongst other common clinical diagnoses. Urine was collected from 110 adults and 46 children with defined clinical conditions: healthy volunteers, stable renal transplant recipients, and recipients with clinical or subclinical acute rejection (AR) or BK infection (BKI), calcineurin inhibitor (CNI) toxicity, orinterstitial fibrosis (IFTA). Urine was analyzed using a solid-phase bead-array assay for the interferon gamma-induced chemokines CXCL9 and CXCL10. We found that urine CXCL9 and CXCL10 were markedly elevated in adults and children experiencing either AR or BKI (p=0.0002), but not in stable allograft recipients, or recipients with CNI toxicity or IFTA. The sensitivity and specificity of these chemokine assays exceeded that of serum creatinine. Neither chemokine distinguished between AR and BKI. These data show that urine chemokine monitoring identifies patients with renal allograft inflammation. This assay may be usefulfor non-invasively distinguishing those allograft recipients requiring more intensivesurveillance from those with benign clinical courses.

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“…A cute T cell-mediated rejection (TCMR) remains a major determinant of pediatric renal allograft outcome. 1 Fourteen percent of children experience at least one episode of clinical rejection in the first year after transplant, 1 and 29% to 44% will have subclinical TCMR by 3 months after transplantation 2,3 Clinical TCMR is associated with the later development of de novo donor-specific antibodies (dnDSA), 4 chronic allograft damage in the form of interstitial fibrosis and tubular atrophy (IFTA), 5,6 and premature allograft failure. 1 Subclinical TCMR, which is defined by histologic evidence for rejection in the absence of a clinically significant increase in serum creatinine, is similarly deleterious to allograft outcome.…”

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confidence: 99%

Elevated Urinary CXCL10-to-Creatinine Ratio Is Associated With Subclinical and Clinical Rejection in Pediatric Renal Transplantation

et al. 2015

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Surveillance renal transplant biopsies and subclinical rejection at three months post‐transplant in pediatric recipients

Cited by 34 publications

References 17 publications

24 Weeks of Valganciclovir Prophylaxis in Children After Renal Transplantation: A 4-Year Experience

24 Weeks of Valganciclovir Prophylaxis in Children After Renal Transplantation: A 4-Year Experience

Urinary Chemokines CXCL9 and CXCL10 Are Noninvasive Markers of Renal Allograft Rejection and BK Viral Infection

Elevated Urinary CXCL10-to-Creatinine Ratio Is Associated With Subclinical and Clinical Rejection in Pediatric Renal Transplantation

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