Safety and efficacy of direct- acting oral anticoagulants versus warfarin in kidney transplant recipients: a retrospective single- center cohort study

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155941/1/tri13599.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155941/2/tri13599_am.pd

Oropharyngeal candidiasis outcomes in renal transplant recipients receiving nystatin versus no antifungal prophylaxis

ObjectiveTo compare the incidence of oropharyngeal candidiasis (OC), or thrush, in renal transplant recipients receiving nystatin versus no antifungal prophylaxis.MethodsThis was a single‐center, retrospective, non‐inferiority study of adult renal transplant recipients (RTRs) who received nystatin for 30 days for OC prophylaxis (nystatin group) or no antifungal prophylaxis therapy (No PPX group). The primary outcome was the incidence of OC within 3 months post‐transplant. Secondary outcomes included time to OC occurrence and severity of OC. The pre‐specified non‐inferiority margin was 10%.ResultsThe incidence of OC within 3 months post‐transplant among 257 RTRs was 7.8% (10/128) in the No PPX group and 4.7% (6/129) RTRs in the nystatin group, a risk difference of 3.2% (95% CI, −2.7% to 9.1%, non‐inferiority P = .04). The median time to OC was 7.5 days (IQR 6.3‐34.3 days) in the nystatin group and 9.5 days (IQR 5.3‐30.5 days) in the No PPX group (P = .64). Esophageal candidiasis was observed in 10% (1/10) of RTRs with OC in the No PPX group compared to 16.7% (1/6) RTRs in the nystatin group (P = 1.00). All RTRs with OC achieved symptom resolution with fluconazole and/or nystatin. Two patients in the No PPX group required readmission for decreased oral intake, and OC was diagnosed and treated during their hospital day.ConclusionsIn this retrospective study of adult RTRs, the absence of antifungal prophylaxis demonstrated non‐inferiority to 30‐day nystatin prophylaxis at reducing the incidence of OC within 3 months of transplant. OC prophylaxis may not be warranted after renal transplant.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/168352/1/tid13559_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/168352/2/tid13559.pd

Oropharyngeal candidiasis outcomes in renal transplant recipients receiving nystatin versus no antifungal prophylaxis

ObjectiveTo compare the incidence of oropharyngeal candidiasis (OC), or thrush, in renal transplant recipients receiving nystatin versus no antifungal prophylaxis.MethodsThis was a single‐center, retrospective, non‐inferiority study of adult renal transplant recipients (RTRs) who received nystatin for 30 days for OC prophylaxis (nystatin group) or no antifungal prophylaxis therapy (No PPX group). The primary outcome was the incidence of OC within 3 months post‐transplant. Secondary outcomes included time to OC occurrence and severity of OC. The pre‐specified non‐inferiority margin was 10%.ResultsThe incidence of OC within 3 months post‐transplant among 257 RTRs was 7.8% (10/128) in the No PPX group and 4.7% (6/129) RTRs in the nystatin group, a risk difference of 3.2% (95% CI, −2.7% to 9.1%, non‐inferiority P = .04). The median time to OC was 7.5 days (IQR 6.3‐34.3 days) in the nystatin group and 9.5 days (IQR 5.3‐30.5 days) in the No PPX group (P = .64). Esophageal candidiasis was observed in 10% (1/10) of RTRs with OC in the No PPX group compared to 16.7% (1/6) RTRs in the nystatin group (P = 1.00). All RTRs with OC achieved symptom resolution with fluconazole and/or nystatin. Two patients in the No PPX group required readmission for decreased oral intake, and OC was diagnosed and treated during their hospital day.ConclusionsIn this retrospective study of adult RTRs, the absence of antifungal prophylaxis demonstrated non‐inferiority to 30‐day nystatin prophylaxis at reducing the incidence of OC within 3 months of transplant. OC prophylaxis may not be warranted after renal transplant.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/168352/1/tid13559_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/168352/2/tid13559.pd

Increasing net immunosuppression after BK polyoma virus infection

BackgroundReducing immunosuppression can effectively treat BK viremia (BKV) and BK nephropathy, but has been associated with increased risks for acute rejection and development of donor- specific antibodies (DSA). To date there have been no systematic evaluations of re- escalating immunosuppression in transplant patients with resolving BKV. Importantly, the safety of this approach and impact on graft survival is unclear.MethodsWe performed a single- center retrospective review of kidney transplant recipients between July 2011 and June 2013 who had immunosuppression reduction after developing BKV (plasma PCR - ¥Â 1000 copies/ml). Changes in immunosuppression and patient outcomes were tracked until occurrence of a complication event: biopsy- proven acute rejection (BPAR), detection of de novo DSA, or recurrent BKV. Patients were grouped according to whether or not net immunosuppression was eventually increased.ResultsOut of 88 patients with BKV, 44 (50%) had net immunosuppression increased while the other 44 did not. Duration of viremia, peak viremia, induction, and sensitization status were similar between the two groups. In a Kaplan- Meier analysis, increasing immunosuppression was associated with less BPAR (P = .001) and a trend toward less de novo DSA development (P = .06). Death- censored graft survival (P = .27) was not different between the two groups. In the net immunosuppression increase group, recurrent BKV occurred in 22.7% without any BKV- related graft losses.ConclusionThese findings support potential benefits of increasing immunosuppression in patients with low- level or resolved BKV, but prospective trials are needed to better understand such an approach.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/167446/1/tid13472_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167446/2/tid13472.pd

Risk Factors for CMV and BK Infections in an Elderly Veteran Population Following Kidney Transplantation: Implications for Immunosuppression Induction and Management

Cytomegalovirus (CMV) and BK Polyomavirus (BKPyV) are the most common opportunistic pathogens following kidney transplantation. We evaluated 102 patients with a median age of 63 at Edward Hines VA Hospital from November 2020 to December 2022. Our primary interest was the incidence of CMV and BKPyV infections, as well as CMV and BKPyV coinfection. Secondary interests included time to infection, rejection, and graft and patient survival. There were no statistically significant differences in patient age, donor age, race, transplant type, incidence of delayed graft function, or induction in both cohorts (any infection (N = 46) vs. those without (N = 56)). There was a 36% (37/102) incidence of CMV, a 17.6% (18/102) of BKPyV and an 8.8% (9/102) incidence of coinfection. There was a decreased incidence of CMV infection in Basiliximab induction versus antithymocyte globulin (21% and 43%). CMV risk status had no effect on the incidence of CMV infection following transplant. African American recipients had a lower incidence of BKPyV infection (12% vs. 39%), yet a higher incidence was observed in those with high cPRA (50% vs. 14%). Most CMV and/or BKPyV infections occurred within the first six months post-transplant (54%). Immunosuppression management of the elderly should continually be evaluated to reduce opportunistic infections post-transplant