Fixed- or Controlled-Dose Mycophenolate Mofetil with Standard- or Reduced-Dose Calcineurin Inhibitors: The Opticept Trial

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74911/1/j.1600-6143.2009.02668.x.pd

Underutilization of Timely Kidney Transplants in Those With Living Donors

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134281/1/ajt13592.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134281/2/ajt13592_am.pd

Impact of Everolimus-Based Immunosuppression on Graft Survival Following Kidney Transplantation.

Univ Michigan, Ann Arbor, MI 48109 USAClin Trial & Consulting Serv, Raleigh, NC USANovartis Pharmaceut, E Hanover, NJ USAUniv Fed Sao Paulo, Sao Paulo, BrazilUniv Fed Sao Paulo, Sao Paulo, BrazilWeb of Scienc

The implications of impaired glucose tolerance after kidney transplantation

Background: Post-transplantation diabetes mellitus (PTDM) is highly prevalent after kidney transplantation and associated with significant morbidity. Routine utilization of screening oral glucose tolerance tests (OGTT) after kidney transplant has been scarcely utilized. Given the increased risk of mortality, graft failure, and CV complications associated with PTDM, we sought to describe the prevalence of impaired glucose tolerance (IGT) in a large, single-center cohort of adult nondiabetic kidney transplant patients and to elucidate risk factors and associated long-term outcomes. Methods: A retrospective review of adult living (49.5%) and deceased (50.5%) donor kidney transplant recipients from 2008-2017 was conducted. Individuals with a pretransplant diagnosis of diabetes were excluded. OGTT\u27s were completed within 6 mo post-transplant, at a mean interval of 78 ± 24 days. IGT was defined by 2-hr glucose of 140-199 mg/dL, and PTDM \u3e200 mg/dL. Odds ratio of 95% confidence intervals are reported for risk factors for development of IGT and PTDM. Results: Of 668 recipients, 62% were male, 75% white, 18% black, and 3% Hispanic. 14% underwent prior kidney transplant. Based on screening OGTT, 23.7% of patients developed IGT, with 12% PTDM. Age \u3e50 years was a risk factor for dysglycemia (IGT OR=2.8 (1.9-4.1); PTDM OR=3.1 (1.9-5.1)). BMI \u3e30 kg/m2 at transplant was predictive of IGT (OR=1.7 (1.2-2.5)). Living donation was protective for the development of IGT (OR=0.67 (0.46-0.96)). Race, gender, prior transplant, type of insurance (medicare vs private), cPRA and year of transplant were not predictive for the development of IGT or PTDM. There was no difference in patient or graft survival between recipients with normoglycemia, IGT, or PTDM over a mean follow-up period of 4.2 ± 2.3 years. Conclusions: Over one third of non-diabetic kidney transplant recipients had developed IGT or PTDM within 6 mo post-transplantation. Age \u3e50 and BMI \u3e30 at transplant were associated with increased odds of developing IGT. Recent data from protocol biopsies demonstrates evidence of diabetic nephropathy in prediabetic transplant recipients. Addressing the high incidence of prediabetic states posttransplantation could translate into improved long-term patient and graft outcomes

Urinary Podocin mRNA as Predictor of Renal Allograft Function Decline

Purpose: Traditional biomarkers (such as proteinuria, lyear eGFR) as well as validated risk prediction tools such as the Birmingham Risk Score predict risk of ESRD. However the ideal biomarker is one that is associated with smaller changes in allograft function such that early intervention is likely to be beneficial in retarding progression. In addition, biomarkers that are nephron segment specific will allow to delineate mechanistic processes driving allograft dysfunction. Methods: 125 consenting kidney transplant recipients had urines collected over the first year (2012-2015). Patients were followed till June 2017, graft failure or death whichever was earlier. Demographic and clinical data including EGFR was collected. Urines were analyzed for proteinuria as well as absolute mRNA quantification for podocin, nephrm (podocyte specific markers), Aquaporm2 (distal collecting tubule) and TGFbetal (measure of profibrotic activity). Absolute mRNA data was normalized to urine creatinine. Data on glomerulosclerosis (GS) and Interstitial Fibrosis Tubular Atrophy (TFTA) was obtained from year surveillance biopsies or last biopsy in the first year. Linear regressions were used to determine slope of EGFR decline for individual patient from time of first urine collection to end of follow-up. Progres-sors were defined as those in whom EGFR declined by \u3e3 ml/mm/year. K-fold cross validation techniques were used to split data into derivation and validation cohorts. Results: Overall 10, 327 follow up EGFR observations and 547 urine samples were available for analysis. Twenty grafts were lost in follow up with 10 due to death. Table below highlights comparison of selected urine mRNA markers with traditionally used predictors clinical and histological predictors. Urine mRNA markers outper-formed proteinuria, renal function and histological parameters in predicting risk of progression. Among urine mRNA markers only podocm and TGFbetal predicted risk of progression (LCL of 95%CI was \u3e0. 5). [Figure Presented] Other predators that were tested and not significant: Rejection, CMV and BKV infections. Nephrin was excluded due to collinearity with podocin. Conclusions: The average first year urine podocin mRNA is a good biomarker for predicting allograft function decline (of \u3e3 ml/mm/year over a median 4. 5years) compared to traditionally used biomarkers. Further internal and external validation studies as well as comparison with other mRNA markers are needed to establish clinical utility

Randomized trial of everolimus-facilitated calcineurin inhibitor minimization over 24 months in renal transplantation

10.1097/TP.0b013e3182848e03Transplantation957933-942TRPL