Aida Asbe-Vollkopf

Transcatheter aortic valve implantation improves outcome compared to open-heart surgery in kidney transplant recipients requiring aortic valve replacement

BACKGROUND Cardiovascular disease is the most frequent cause of mortality for kidney transplant recipients. Open heart surgery has particularly high mortality and morbidity. As an alternative to traditional aortic valve replacement (AVR) for patients with high-grade aortic stenosis, transcatheter aortic valve implantation (TAVI) was developed as an innovative therapy for patients considered at high surgical risk. METHODS We considered all kidney transplant recipients as high-risk patients, which are candidates for TAVI. In 2010 and 2011, eight kidney transplant recipients with severe aortic stenosis underwent TAVI (6 transfemoral; 2 transapical; group I). The outcome of these patients was compared retrospectively to 18 kidney transplant recipients with aortic stenosis, who underwent conventional AVR (group II). RESULTS Both groups had similar baseline characteristics, including estimated perioperative risk (EuroSCORE group I vs. group II: 9.5±5.9 vs. 10.4±10.5; p=0.829). All TAVI procedures were performed successfully with excellent functional results. In the TAVI group (group I), all patients were alive at the 12-month follow-up with one cardiovascular event (stroke). In contrast, the surgical group experienced a 30-day-mortality of 11.1% (n=2) and a 1-year-mortality of 16.7% (n=3). CONCLUSIONS Based on our centers experience, TAVI appears to be an effective and safe alternative to conventional surgery for AVR in patients with prior renal transplantation. Renal transplantation is not currently identified as a risk factor in our traditional scoring system, and may need to be considered independently when weighing alternatives for AVR.

Pretransplant human leukocyte antigen antibodies detected by single-antigen bead assay are a risk factor for long-term kidney graft loss even in the absence of donor-specific antibodies.

Clinical relevance of ELISA‐ and single‐antigen bead assay (SAB)‐detected pretransplant HLA antibodies (SAB‐HLA‐Ab) for kidney graft survival was evaluated retrospectively in 197 patients transplanted between 2002 and 2009 at the University Clinic Frankfurt. Having adjusted for retransplantation and delayed graft function, a significantly increased risk for death‐censored graft loss was found in patients with pretransplant SAB‐HLA‐Ab [HR: 4.46; 95% confidence interval (CI): 1.47–13.48; P = 0.008]. The risk for increased graft loss was also significant in patients with pretransplant SAB‐HLA‐Ab but without SAB‐detected donor‐specific Ab (SAB‐DSA) (HR: 4.91; 95% CI of 1.43–16.991; P = 0.012). ELISA was not sufficient to identify pretransplant immunized patients with an increased risk for graft loss. In immunized patients, graft loss was predominantly present in patients who received transplants with a mismatch on the HLA‐DR locus. In conclusion, even if our study is limited due to small sample size, the results show an increased risk for long‐term graft loss in patients with pretransplant SAB‐HLA, even in the absence of DSA. SAB‐HLA‐Ab‐positive patients, being negative in ELISA or CDC assay, might profit from a well‐HLA‐DR‐matched graft and intensified immunosuppression.

Cholesterol-crystal embolism presenting with delayed graft function and impaired long-term function in renal transplant recipients: two case reports

IntroductionImpaired renal function and/or pre-existing atherosclerosis in the deceased donor increase the risk of delayed graft function and impaired long-term renal function in kidney transplant recipients.Case presentationWe report delayed graft function occurring simultaneously in two kidney transplant recipients, aged 57-years-old and 39-years-old, who received renal allografts from the same deceased donor. The 62-year-old donor died of cardiac arrest during an asthmatic state. Renal-allograft biopsies performed in both kidney recipients because of delayed graft function revealed cholesterol-crystal embolism. An empiric statin therapy in addition to low-dose acetylsalicylic acid was initiated. After 10 and 6 hemodialysis sessions every 48 hours, respectively, both renal allografts started to function. Glomerular filtration rates at discharge were 26 ml/min/1.73m2 and 23.9 ml/min/1.73m2, and remained stable in follow-up examinations. Possible donor and surgical procedure-dependent causes for cholesterol-crystal embolism are discussed.ConclusionCholesterol-crystal embolism should be considered as a cause for delayed graft function and long-term impaired renal allograft function, especially in the older donor population.

Posttransplant Kaposi sarcoma and risk for deep venous thrombosis: a case-control study.

liver (P 0.000). This analysis was unfortunately limited by our inability to consider other singularly important factors such as liver function tests, alcohol consumption history, steatosis, perfusion of the liver, and similar factors. We conclude that age and type of donor (NHB) strongly influence the decision to accept a liver for transplantation. It would seem that discarding a liver graft remains a subjective choice depending on a number of variables that are considered at the time of organ procurement. Not only the donor factors but also the recipient status and the transplanting center play a determinant role in donor selection. It would be interesting to see whether a change has occurred since 2008 with the introduction of new measures recommended by the United Kingdom Transplant Task Force (2).

ANEMIA AND EPOETIN THERAPY IN RECIPIENTS OF RENAL TRANSPLANTS: A SINGLE CENTER SURVEY: 932

Introduction: The prevalence of post-transplant anemia (PTA) in the population of kidney allograft recipients amounts to 20-40%, and is precipitated by pre-existing comorbidities, pharmacological therapy (immunosuppressive, anti-hypertensive, anti-infective, etc.) and the declining excretory/endocrine renal function. In this retrospective survey, the clinical course of 229 kidney transplant recipients suffering from PTA, requiring prolonged epoetin (EPO)-treatment, is analyzed in depth. Methods: Identifying 229 renal allograft recipients from the data base of the Kidney Transplant Outpatient Clinic at the JohannWolfgang-Goethe University Hospital in Frankfurt, who had been treated for anemia with EPO for at least 6 months in the time frame from 1998 – 2010. Demographic, peri-transplant, donor-related, and data on the clinical history up to one year post-transplant are being collected. Detailed information on immunosuppressive therapy, concomitant medication, rejection episodes, hematological parameters, cardiovascular events and GFR are collected from one year pre-EPO-treatment with a follow-up period of 24 months post-EPO-initiation. Results: Currently, 200 patients have been analyzed – 114 were male, with a mean age of 47.6 ± 15.3 yrs at time of dialysis and 5.2 ± 4.5 yrs on dialysis. Reasons for kidney failure included glomerulonephritis (41.8%), idiopathic nephrosclerosis (26.9%), polycystic kidney disease (9.5%) and diabetic nephropathy (6.9%). Cold ischemia time was 799.8 ± 478.7 min, warm ischemia time was 45.2 ± 25.8 min. Serum creatinine was 1.8 ± 0.77 mg/dl at discharge (donor: 0.99 ± 0.48 mg/dl). 19.5% of recipients experienced delayed graft function, following implantation. At the meeting, complete data on all 229 recipients undergoing at least 6 months of EPO-therapy will be presented. Special focus is directed toward the natural course of anemia in this population and the impact of EPOtreatment on hemoglobin levels and renal function. Conclusion: The pathophysiological implication of PTA remains poorly understood, with conflicting data on the association of anemia with cardiovascular events and long term outcome. We will present extensive data on 229 recipients undergoing maintenance EPO therapy with focus on clinical course and renal function. These data will help clarify the role of EPO in the context of declining endocrine kidney allograft function and may form the rationale for a future prospective, randomized trial.