Low-Dose Antithymocyte Globulin Has No Disadvantages to Standard Higher Dose in Pediatric Kidney Transplant Recipients: Report from the Pediatric Nephrology Research Consortium

Introduction Rabbit antithymocyte globulin (rATG) dosing strategies for induction in pediatric kidney transplantation vary between centers. It is not known whether a lower rATG induction dose provides safe and effective immunosuppression compared with a “standard” higher dose. Methods We performed a retrospective multicenter study of all isolated first-time kidney transplant recipients \u3c 21 years old who received rATG induction between 1 January 2010 and 31 December 2014 at 9 pediatric centers. An a priori cutoff of a 4.5-mg/kg cumulative rATG dose was used to identify low (≤ 4.5 mg/kg) and standard (\u3e 4.5 mg/kg) exposure groups. Outcomes examined included 12 months posttransplant graft function (estimated glomerular filtration rate [eGFR]); the occurrence of acute rejection, donor-specific antibody (DSA), neutropenia, and viral infection (cytomegalovirus [CMV], Epstein-Barr virus [EBV], and BK virus); and 24-month outcomes of posttransplant lymphoproliferative disorder (PTLD) occurrence and patient and graft survival. Results Two hundred thirty-five patients were included. Baseline features of the low and standard rATG dose groups were similar. By 12 months, the rATG dose group had no significant impact on the occurrence of neutropenia, positive DSA, or viral polymerase chain reaction (PCR). Graft function was similar. Acute rejection rates were similar at 17% (low dose) versus 19% (standard dose) (P = 0.13). By 24 months, graft survival (96.4% vs. 94.6%) and patient survival (100% vs. 99.3%) were similar between the low- and standard-dose groups (P = 0.54 and 0.46), whereas the occurrence of PTLD trended higher in the standard-dose group (0% vs. 2.6%, P = 0.07). Conclusion A low rATG induction dose ≤ 4.5 mg/kg provided safe and effective outcomes in this multicenter low immunologic risk pediatric cohort. Prospective studies are warranted to define the optimal rATG induction dose in pediatric kidney transplantation

An eruption of numerous spiny papules in a pediatric transplant patient

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163816/1/ajt16294.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163816/2/ajt16294_am.pd

Omental torsion

Omental torsion is a rare cause of acute abdominal pain, and clinically mimics acute appendicitis. A 11-year-old boy presented with symptoms and signs suggestive of appendicitis. A computed tomography of abdomen revealed findings suggestive of omental torsion. Diagnostic laparoscopy confirmed the diagnosis of torsion of a segment of the greater omentum

Treatment of Hypertension in Children With Catecholamine‐Secreting Tumors: A Systematic Approach

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/113695/1/jch12571.pd

Omental torsion

Omental torsion is a rare cause of acute abdominal pain, and clinically mimics acute appendicitis. A 11-year-old boy presented with symptoms and signs suggestive of appendicitis. A computed tomography of abdomen revealed findings suggestive of omental torsion. Diagnostic laparoscopy confirmed the diagnosis of torsion of a segment of the greater omentum

Treatment of BK virus with a stepwise immunosuppression reduction and intravenous immunoglobulin in pediatric kidney transplant

BackgroundBKV and BKVN are common in pediatric kidney transplant, but there is limited data on treatment approaches. Our objective was to study the prevalence of BKV and BKVN utilizing only plasma qPCR and report treatment outcomes with stepwise IR and IVIG.MethodsA retrospective study of all pediatric kidney transplants from 2013 to 2020. Excluded patients >21 years at transplant and immediate graft failure. Surveillance was conducted using only plasma BK qPCR at 1, 3, 6, 9, 12, 18, and 24 months and annually. BKV defined as ≥250 copies/ml and resolution as 10 000 copies/ml despite IR; and BKVN if confirmed on histology.ResultsFifty-six patients were included in the study; 20 (35.7%) had BKV. BKV was associated with longer duration of stent, 40 vs. 33.5 days (p = .004). Two patients (3.5%) had confirmed, and 2(3.5%) had presumed BKVN. The first-line treatment was IR in 100% of patients. BKVN confirmed and presumed received IVIG every month for six doses. Viral resolution was achieved in 70%, and no difference was noted in estimated glomerular filtration rate between BKV and non-BKV group (p = .438). There were no rejection episodes, and graft survival was 100% over median follow-up of 3 years.ConclusionsPlasma qPCR alone is adequate for screening and monitoring treatment of BKV and BKVN. A stepwise IR and IVIG resulted in BKV resolution in the majority of patients. Larger studies are required to study the role of IVIG in the treatment of BKVN.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/172850/1/petr14241_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/172850/2/petr14241.pd

Practice patterns and influence of allograft nephrectomy in pediatric kidney re- transplantation: A pediatric nephrology research consortium study

IntroductionThere are no guidelines regarding management of failed pediatric renal transplants.Materials & MethodsWe performed a first of its kind multicenter study assessing prevalence of transplant nephrectomy, patient characteristics, and outcomes in pediatric renal transplant recipients with graft failure from January 1, 2006, to December 31, 2016.ResultsFourteen centers contributed data on 186 pediatric recipients with failed transplants. The 76 recipients that underwent transplant nephrectomy were not significantly different from the 110 without nephrectomy in donor or recipient demographics. Fifty- three percent of graft nephrectomies were within a year of transplant. Graft tenderness prompted transplant nephrectomy in 91% (P < .001). Patients that underwent nephrectomy were more likely to have a prior diagnosis of rejection within 3 months (43% vs 29%; P = .04). Nephrectomy of allografts did not affect time to re- listing, donor source at re- transplant but significantly decreased time to (P = .009) and incidence (P = .0002) of complete cessation of immunosuppression post- graft failure. Following transplant nephrectomy, recipients were significantly more likely to have rejection after re- transplant (18% vs 7%; P = .03) and multiple rejections in first year after re- transplant (7% vs 1%; P = .03).ConclusionsPractices pertaining to failed renal allografts are inconsistent- 40% of failed pediatric renal allografts underwent nephrectomy. Graft tenderness frequently prompted transplant nephrectomy. There is no apparent benefit to graft nephrectomy related to sensitization; but timing / frequency of immunosuppression withdrawal is significantly different with slightly increased risk for rejection following re- transplant.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/169276/1/petr13974.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/169276/2/petr13974_am.pd

Facile Synthesis of Semiconducting Ultrathin Layer of Molybdenum Disulfide

In this paper, we have reported a simple and efficient method for the synthesis of uniform, highly conducting single or few layer molybdenum disulfide (MoS2) on large scale. Scanning Electron Microscopy (SEM) and High Resolution Transmission Electron Microscopy (HRTEM) have been used for the confirmation of mono or few layered nature of the as-synthesized MoS2 sheets. X-ray Photoelectron Spectroscopy (XPS), X-Ray Diffraction (XRD) and Raman Spectroscopy have also been used to study the elemental, phase, and molecular composition of the sample. Optical properties of as-synthesized sample have been probed by measuring absorption and photoluminescence spectra which also compliment the formation of mono and few layers MoS2 Current-voltage (I-V) characteristics of as-synthesized sample in the pellet form reveal that MoS2 sheets have an ohmic character and found to be highly conducting. Besides characterizing the as-synthesized sample, we have also proposed the mechanism and factors which play a decisive role in formation of high quality MoS2 sheets