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Hypertension and obesity in living kidney donors

World Journal of Transplantation 2021年第6期11卷 180-186页

作者： Mahmoud M Mohamed Ahmed Daoud Syed Quadri Michael J Casey mariah aurora posadas salas Vinaya Rao Tibor Fülöp Karim M Soliman Department of Medicine Division of NephrologyUniversity of TennesseeMemphisTN 38163United States Department of Medicine Division of NephrologyCairo UniversityCairo 11562Egypt Department of Medicine Division of NephrologyMedical University of South CarolinaCharlestonSC 29425United States Medicine Service Ralph H.Johnson VA Medical CenterCharlestonSC 29401United States

Over the past few decades,the shortage in the kidney donor pool as compared to the increasing number of candidates on the kidney transplant waitlist led to loosening of kidney donors’acceptance *** and obesity represent risk factors for chronic kidney disease,both in native kidneys and those in kidney transplant *** great progress has been made in kidney transplantation from living donors to benefit the recipient survival and quality of life,progress has been slow to fully risk-characterize the *** review critically reassesses the current state of understanding regarding the risk of endstage kidney disease in those donors with obesity,hypertension or *** risk assessment tools need to be developed urgently to fully understand the risk glomerular filtration rate compensation failure in the remaining kidney of the donors.

关键词： Living donor Kidney Obesity Hypertension Living kidney donors

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Development of donor specific antibodies after SARS-CoV-2 vaccination:What do we know so far?

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World Journal of Meta-Analysis 2024年第2期12卷 1-4页

作者： Ahmed Daoud Karim Soliman Maria aurora posadas salas Sakshi Vaishnav Genta Uehara AhmedAbdelkader Tibor Fulop Michael J Casey Department of Medicine Division of NephrologyMedical University of South CarolinaCharlestonSC 29425United States Department of Medicine Cairo University Medical SchoolCairo 11211Egypt Department of Medicine Medical ServicesRalph H.Johnson VA Medical CenterCharlestonSC 29425United States Department of Medicine Division of NephrologyMedical ServicesRalph H.Johnson VA Medical CenterCharlestonSC 29425United States

Vaccination against Coronavirus disease-19(COVID-19)was pivotal to limit spread,morbidity and *** aim is to find out whether vaccines against COVID-19 lead to an immunological response stimulating the production of de novo donor specific antibodies(DSAs)or increase in mean fluorescence intensity(MFI)of pre-existing DSAs in kidney transplant recipients(KTRs).This study involved a detailed literature search through December 2nd,2023 using PubMed as the primary *** search strategy incorporated a combination of relevant Medical Subject Headings terms and keywords:"COVID-19","SARS-CoV-2 Vaccination","Kidney,Renal Transplant",and"Donor specific antibodies".The results from related studies were collated and analyzed.A total of 6 studies were identified,encompassing 460 KTRs vaccinated against *** responses were detected in 8 KTRs of which 5 had increased MFIs,1 had de novo DSA,and 2 were categorized as either having de novo DSA or increased *** were 48 KTRs with pre-existing DSAs prior to vaccination,but one study(Massa et al)did not report whether pre-existing DSAs were associated with post vaccination *** the remaining 5 studies,35 KTRs with pre-existing DSAs were identified of which 7 KTRs(20%)developed de novo DSAs or increased ***,no immunological response was detected in 452(98.3%)*** study affirms prior reports that COVID-19 vaccination is safe for KTRs,especially if there are no pre-existing ***,if KTRs have pre-existing DSAs,then an increased immunological risk may be *** findings need to be taken cautiously as they are based on a limited number of patients so further studies are still needed for confirmation.

关键词： COVID-19 SARS-CoV-2 vaccination Kidney Renal transplant Donor specific antibodies

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BK viral infection: A review of management and treatment

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World Journal of Transplantation 2023年第6期13卷 309-320页

作者： June Hayrelle Gorriceta Amy Lopez Otbo Genta Uehara Maria aurora posadas salas Department of Medicine St Francis Hospital-BartlettBartlettTN 38133United States Department of Medicine St.Luke’s Medical CenterQuezon 1112Philippines Department of Medicine Division of NephrologyMedical University of South CarolinaCharlestonSC 29425United States

BK viral infection remains to be a challenging post-transplant infection,which can result in kidney *** mainstay approach to BK infection is reduction of *** in immunosuppressive regimen with minimization of calcineurin inhibitors,use of mechanistic target of rapamycin inhibitors,and leflunomide have been attempted with variable *** the past few years,investigators have explored potential therapeutic options for BK *** prophylaxis and treatment was found to have no benefit in kidney transplant *** utility of cidofovir is limited by its *** immunoglobulin is becoming a popular option for treatment and prophylaxis for BK infection,as it increases the neutralizing antibody titers against the most common BK virus ***-specific T cell therapy is an emerging treatment option for BK *** this review,we will explore management and therapeutic options for BK infection and recent evidence available in literature.

关键词： BK infection Kidney transplant Treatment Management

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Tacrolimus confers lower acute rejection rates and better renal allograft survival compared to cyclosporine

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World Journal of Transplantation 2016年第4期6卷 697-702页

作者： Mahmoud Kamel Manish Kadian Titte Srinivas David Taber Maria aurora posadas salas Department of Medicine Medical University of South Carolina Department of Surgery Medical University of South Carolina

AIM To compare the impact of tacrolimus(FK) and cyclosporine(CYA) on acute rejection and graft survival and to assess the predominant causes of graft loss between patients receiving these two calcineurin inhibitors(CNIs).METHODS Retrospective review of 1835 patients who received a kidney transplant(KTX) between 1999-2012. Patients were grouped based on initial CNI utilized: 1195 in FK group, 640 in CYA group. Data on baseline characteristics, clinical outcomes, and causes of graft loss in both groups were analyzed. RESULTS Cumulative acute rejection rates were 14% in the FK vs 24% in the CYA group. Despite more marginal donor characteristics in the FK group, these patients had better graft survival rates compared to the CYA group. Three and five year graft survival rates were 88% and 84% respectively in the FK group compared to 79% and 70% respectively in the CYA group(P < 0.001). After multivariate analysis, which controlled for confounders, FK use was a strong predictor for lower acute rejectionrates [odds ratio(OR) 0.60, 95%CI: 0.45-0.79] and better renal allograft survival(OR 0.740, 95%CI: 0.58-0.94). Death with a functioning graft was the most common cause of graft loss in both groups. Common causes of death included cardiovascular disease, infections, and malignancies. Chronic allograft nephropathy was also found to be an important cause of graft loss, being more prevalent in the CYA group. CONCLUSION The use of FK-based maintenance immunosuppression therapy is associated with a significantly lower rate of acute rejection and better graft survival compared to CYA-based regimen. Individualizing immunosuppression through risk-stratified CNI choice may lead to improved outcomes across all spectra of KTX patients.

关键词： Tacrolimus Cyclosporine Renal allograft survival

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