Thinking Outside the Box: Novel Kidney Protective Strategies in Kidney Transplantation

Ibrahim, Hassan N.; Murad, Dina N.; Knoll, Greg

doi:10.2215/cjn.15070920

Cited by 9 publications

(8 citation statements)

References 70 publications

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“…There are no contemporary data in ESRD to determine whether revascularization is helpful or harmful overall; however, the risks of revascularization in ESRD are higher than for the general population. Given these uncertainties, there is a recommendation for screening candidates at high risk for IHD at time of evaluation, in order to guide medical management and inform risk [29,30].…”

Section: Discussionmentioning

confidence: 99%

Long-Term Results of Kidney Transplantation in the Elderly: Comparison between Different Donor Settings

Yemini

Rahamimov

Ghinea

et al. 2021

JCM

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With scarce organ supply, a selection of suitable elderly candidates for transplant is needed, as well as auditing the long-term outcomes after transplant. We conducted an observational cohort study among our patient cohort >60 years old with a long follow up. (1). Patients and Methods: We used our database to study the results after transplant for 593 patients >60 years old who underwent a transplant between 2000–2017. The outcome was compared between live donor (LD; n = 257) recipients, an old-to-old (OTO, n = 215) group using an extended criteria donor (ECD) kidney, and a young-to-old (YTO, n = 123) group using a standard-criteria donor. The Kaplan−Meir method was used to calculate the patient and graft survival and Cox regression analysis in order to find risk factors associated with death. (2). Results: The 5- and 10-year patient survival was significantly better in the LD group (92.7% and 66.9%) compared with the OTO group (73.3% and 42.8%) and YTO group (70.9% and 40.6%) (p < 0.0001). The 5- and 10-year graft survival rates were 90.3% and 68.5% (LD), 61.7% and 30.9% (OTO), and 64.1% and 39.9%, respectively (YTO group; p < 0.0001 between the LD and the two DD groups). There was no difference in outcome between patients in their 60’s and their 70’s. Factors associated with mortality included: age (HR-1.060), DM (HR-1.773), IHD (HR-1.510), and LD/DD (HR-2.865). (3). Conclusions: Our 17-years of experience seems to justify the rational of an old-to-old allocation policy in the elderly population. Live-donor transplant should be encouraged whenever possible. Each individual decision of elderly candidates for transplant should be based on the patient’s comorbidity and predicted life expectancy.

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Section: Discussionmentioning

confidence: 99%

Long-Term Results of Kidney Transplantation in the Elderly: Comparison between Different Donor Settings

Yemini

Rahamimov

Ghinea

et al. 2021

JCM

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“…Despite the excellent short-term outcomes following solid organ transplantation, the long-term survival of kidney transplants has only negligibly improved in recent years. 1 As a consequence, one out of five patients on the waitlist for kidney transplantation are candidates whose previous grafts failed. 2 Maximizing the long-term outcomes of transplantation and preventing re-transplantation is, thus, paramount—not only for improving transplant recipients’ outcomes, but also for reducing waitlist pressures.…”

Section: Introductionmentioning

confidence: 99%

A non-muscle myosin heavy chain 9 genetic variant is associated with graft failure following kidney transplantation

Poppelaars

Eskandari

Damman

et al. 2022

Preprint

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BackgroundDespite current matching efforts to identify optimal donor-recipient pairs in kidney transplantation, alloimmunity remains a major proponent of late transplant failure. While kidney allocation based on human leukocyte antigen (HLA) matching has markedly prolonged short-term graft survival, new data suggests that additional genetic parameters in donor-recipient matching could help improve the long-term outcomes. Here, we studied the impact of a recently discovered non-muscle myosin heavy chain 9 gene (MYH9) polymorphism on kidney allograft failure.MethodsWe conducted a prospective observational cohort study, analyzing the DNA of 1,271 kidney donor-recipient transplant pairs from a single academic hospital for the MYH9 rs11089788 C>A polymorphism. The association of the MYH9 genotype with the risk of graft failure (primary outcome), biopsy-proven acute rejection (BPAR), and delayed graft function (DGF) (secondary outcomes) were determined.ResultsThe MYH9 polymorphism in the donor was not associated with 15-year death-censored kidney graft survival, whereas a trend was seen for the association between the MYH9 polymorphism in the recipient and graft failure (recessive model, P=0.056). Having the AA-genotype of the MYH9 polymorphism in recipients was associated with a higher risk of DGF (P=0.031) and BPAR (P=0.021), although the significance was lost after adjustment for potential confounders (P=0.15 and P=0.10, respectively). The combined presence of the MYH9 polymorphism in donor-recipient pairs was significantly associated with long-term kidney allograft survival (P=0.036), in which recipients with an AA-genotype receiving a graft with an AA-genotype had the worst outcome. After adjustment for covariates, this combined genotype remained significantly associated with 15-year death-censored kidney graft survival (HR 1.68, 95%-CI: 1.05 – 2.70, P=0.031).ConclusionsOur results reveal that recipients with an AA-genotype MYH9 polymorphism receiving a donor kidney with an AA-genotype, have a significantly elevated risk of graft failure after kidney transplantation.Key pointsIn recipients, the MYH9 SNP was associated with delayed graft function and biopsy-proven acute rejection after kidney transplantation, although the significance was lost in multivariable analysis.Presence of the MYH9 variant in both the donor and recipient significantly associated with long-term kidney allograft survival in multivariable analysis.Our present findings suggests that matching donor-recipient transplant pairs based on the MYH9 polymorphism may attenuate the risk of graft loss.

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“…The limited life-span of kidney grafts has encouraged the transplant community to 'think outside the box', e.g., could there be alternative strategies delay graft failure or graft loss [10]?…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of Sodium-Glucose-Transporter-2 inhibitors in kidney transplant patients

Jenssen¹

2021

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of review This review discusses current evidence and future perspectives for use of SLT2 inhibitors in kidney transplant recipients (KTRs). Recent findings Sodium-Glucose-Transporter-2 inhibitors (SGLT2is) lower plasma glucose in patients with type 2 diabetes, and protect against heart failure and progression of chronic kidney disease by a glucose-independent mechanism. Most of the current studies with SGLT2is in kidney transplant patients are however short-term retrospective case studies. These, together with one small randomized clinical trial, show that SGLT2is lower glucose also in KTRs with type 2 diabetes or posttransplant diabetes mellitus. Larger reductions in HbA1c (−0.5 to 1.5% points) are seen only in patients with estimated GFR > 60 ml/min/1.73m2 and HbA1c > 8%. With lower gomerular filtration rate (GFR) or glycated hemoglobin (HbA1c) the glucose-lowering effect is trivial. However, a reduction in body weight, blood pressure and uric acid is also seen, whereas the frequency of side effects (mycotic or urinary tract infections) does not seem to exceed what is seen in nontransplanted patients. Long-term effects on GFR have not been studied in kidney transplanted patients, but SGLT2is induce an early dip in GFR also in these patients. This could signal a beneficial long-term effect on renal hemodynamics. Summary SGLT2is lower glucose safely also in patients with single kidney grafts, but long-term kidney function and patient survival are yet to be explored.

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Thinking Outside the Box: Novel Kidney Protective Strategies in Kidney Transplantation

Cited by 9 publications

References 70 publications

Long-Term Results of Kidney Transplantation in the Elderly: Comparison between Different Donor Settings

Long-Term Results of Kidney Transplantation in the Elderly: Comparison between Different Donor Settings

A non-muscle myosin heavy chain 9 genetic variant is associated with graft failure following kidney transplantation

Efficacy and safety of Sodium-Glucose-Transporter-2 inhibitors in kidney transplant patients

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