Pre-transplant immune factors may be associated with BK polyomavirus reactivation in kidney transplant recipients

BK polyomavirus (BKPyV) reactivation in kidney transplant recipients can lead to allograft damage and loss. The elements of the adaptive immune system that are permissive of reactivation and responsible for viral control remain incompletely described. We performed a prospective study evaluating BKPyV-specific T-cell response, humoral response and overall T-cell phenotype beginning pre-transplant through one year post-transplant in 28 patients at two centers. We performed an exploratory analysis of risk factors for the development of viremia and viruria as well as compared the immune response to BKPyV in these groups and those who remained BK negative. 6 patients developed viruria and 3 developed viremia. BKPyV-specific CD8+ T-cells increased post-transplant in viremic and viruric but not BK negative patients. BKPyV-specific CD4+ T-cells increased in viremic, but not viruric or BK negative patients. Anti-BKPyV IgG antibodies increased in viruric and viremic patients but remained unchanged in BK negative patients. Viremic patients had a greater proportion of CD8+ effector cells pre-transplant and at 12 months post-transplant. Viremic patients had fewer CD4+ effector memory cells at 3 months post-transplant. Exploratory analysis demonstrated lower CD4 and higher total CD8 proportions, higher anti-BKPyV antibody titers and the cause of renal failure were associated BKPyV reactivation. In conclusion, low CD4, high CD8 and increased effector CD8 cells were found pre-transplant in patients who became viremic, a phenotype associated with immune senescence. This pre-transplant T-cell senescence phenotype could potentially be used to identify patients at increased risk of BKPyV reactivation

Trajectories of perceived benefits in living kidney donors: association with donor characteristics and recipient outcomes.

BACKGROUND: While improved health of the recipient may serve as a primary motivating factor, living kidney donors (LDs) also may expect to accrue some personal benefit following donation. This study sought to identify trajectories of perceived benefit over the first 2 years after donation. METHODS: Prospective questionnaire data were collected from 133 LDs from three kidney transplant programs in the United States. Before surgery, LDs completed the Living Donation Expectancies Questionnaire to assess their expectations of personal growth, interpersonal benefits, and spiritual benefits from the donation experience. This report then assessed the degree to which these expectations were met at 1, 6, 12, and 24 months post-donation. RESULTS: Analyses revealed four (Interpersonal Benefit) and five (Personal Growth, Spiritual Benefit) distinct trajectories over time. For some LDs, pre-donation expectancies about benefit were met or exceeded over the 2 years, while for others the anticipated benefits were either short-lived or not met at all. Trajectory group assignment was associated with some donor characteristics (e.g., age, gender, and relationship to recipient). Also, LDs whose recipients had functioning grafts and who reported improved health status following transplantation were more likely to have their pre-donation personal growth and interpersonal benefit expectations consistently met or exceeded. CONCLUSIONS: Longitudinal trajectory analysis can help to identify different outcomes patterns for LDs and factors associated with them. The relevance of these findings is discussed in the context of LD education, follow-up care, and future research on donation benefits

Readiness of wait-listed black patients to pursue live donor kidney transplant.

ContextFor adults with end-stage kidney disease, live donor kidney transplant (LDKT) has better outcomes than long-term dialysis and deceased donor kidney transplant. However, black patients receive LDKT at a much lower rate than adults of any other race or ethnicity.ObjectiveTo examine the LDKT readiness stage of black patients on the transplant waiting list and its association with LDKT knowledge, concerns, and willingness.DesignCross-sectional analysis of baseline data from a randomized controlled trial to improve knowledge and reduce concerns about LDKT.Patients and Setting-One hundred fifty-two black patients on the kidney transplant waiting list at a single transplant center in the northeastern United States.Main outcome measuresLDKT readiness stage, knowledge, concerns, and willingness to talk to others about living donation.ResultsSixty percent of patients were not considering or not yet ready to pursue LDKT, and only 11% had taken action to talk to family members or friends about the possibility of living kidney donation. Patients in later stages of LDKT readiness (ie, who had talked to others about donation or were preparing to do so) had significantly more knowledge (P<.001), fewer concerns (P=.002), and more willingness (P=.001) to talk to others about living donation than those in earlier readiness stages.ConclusionsThe large percentage of black patients who are in the earlier stages of LDKT readiness may account for the low rate of LDKT in this patient population at our transplant center. Innovative and tailored LDKT educational strategies for black patients are needed to help reduce racial disparities in LDKT

Readiness of Wait-Listed Black Patients to Pursue Live Donor Kidney Transplant

ContextFor adults with end-stage kidney disease, live donor kidney transplant (LDKT) has better outcomes than long-term dialysis and deceased donor kidney transplant. However, black patients receive LDKT at a much lower rate than adults of any other race or ethnicity.ObjectiveTo examine the LDKT readiness stage of black patients on the transplant waiting list and its association with LDKT knowledge, concerns, and willingness.DesignCross-sectional analysis of baseline data from a randomized controlled trial to improve knowledge and reduce concerns about LDKT.Patients and Setting-One hundred fifty-two black patients on the kidney transplant waiting list at a single transplant center in the northeastern United States.Main outcome measuresLDKT readiness stage, knowledge, concerns, and willingness to talk to others about living donation.ResultsSixty percent of patients were not considering or not yet ready to pursue LDKT, and only 11% had taken action to talk to family members or friends about the possibility of living kidney donation. Patients in later stages of LDKT readiness (ie, who had talked to others about donation or were preparing to do so) had significantly more knowledge (P<.001), fewer concerns (P=.002), and more willingness (P=.001) to talk to others about living donation than those in earlier readiness stages.ConclusionsThe large percentage of black patients who are in the earlier stages of LDKT readiness may account for the low rate of LDKT in this patient population at our transplant center. Innovative and tailored LDKT educational strategies for black patients are needed to help reduce racial disparities in LDKT