Juan P. Rocca

Increased access to transplantation of highly sensitized patients under the new kidney allocation system. A single center experience

We aimed to investigate the impact of the new kidney allocation system (KAS) on the rate of transplantation of sensitized patients at our center. Pre-KAS and post-KAS intervals were Jan 1st to Dec 3rd 2014 and Jan 1st 2015 to Dec 3rd 2015, respectively. The number of deceased-donor crossmatches performed by flow cytometry increased from 715 pre-KAS to 1188 post-KAS. The percent of crossmatches performed for sensitized patients with calculated panel reactive antibody (cPRA)>0% increased from 19% pre-KAS to 26% post-KAS (p<0.0001). The number of deceased-donor kidney transplants performed at our center increased from 115 pre-KAS to 125 post-KAS (9% increase). There was a significant increase in the percentage of deceased-donor kidney transplants received by sensitized candidates (from 14% to 26% pre- and post-KAS, respectively; p<0.0001). The highest increase was seen in the patients with cPRA>98%, from 0% to 9%, followed by the group with cPRA 50-79%, from 5% to 8%. This increase was balanced by a decrease of 12% in the percentage of non-sensitized recipients, and a modest decrease of 1% in the group with cPRA 1-49%. In conclusion, transplant rate has increased in sensitized patients after KAS. The highest increase was observed among highly sensitized patients (cPRA>98%).

Insights from Comparison of the Renal and Skin Single Cell Transcriptomes in Lupus Nephritis

Lupus nephritis (LN) occurs in up to 50% of patients with systemic lupus erythematosus (SLE), and is a major contributor to mortality and morbidity. LN presents as a highly heterogeneous disease both in histopathology and response to therapy. The molecular and cellular processes leading to renal damage and to the heterogeneity of the disease are not well understood. To elucidate the processes underpinning the heterogeneity of LN, we applied singlecell RNA-sequencing (scRNA-seq) to renal biopsies from LN patients. Skin biopsies were evaluated as a source of biomarkers for monitoring kidney disease. Type-I interferon (IFN) response signatures were identified in tubular cells and keratinocytes, differentiating LN patients from healthy controls. Non-responders associated with higher IFN signatures in both tissue compartments. Moreover, non-response was also associated with a fibrotic signature in the tubular cells. Receptor-ligand interaction analysis indicated that the fibrotic process is likely mediated by FGF receptors with the initiating signal originating from infiltrating leukocytes. Differential expression analysis of tubular cells between proliferative and membranous LN pointed to several fibrosis-relevant pathways, which may offer insight into their histological differences. In summary, scRNA-seq was applied to LN to deconstruct its heterogeneity and provide novel targets for personalized approaches to therapy.

Utilization of LCP-Tacrolimus (Envarsus XR) in Simultaneous Pancreas and Kidney Transplant Recipients

A higher incidence of rejection is seen in pancreas transplant recipients compared to those who receive kidney transplant alone.[1][1] Niederhaus and colleagues found that 21% of pancreas transplant recipients either had acute cellular or antibody-mediated rejection.[2][2] Notably, a marked graft

Renal Allograft Torsion Following Simultaneous Pancreas Kidney Transplant Should Be Suspected With Sustained Kidney Injury With Normal Pancreas Function

Simultaneous pancreas kidney transplant is usually offered to patients with end-stage renal disease and type 1 diabetes mellitus. Classically, a midline celiotomy is made to facilitate intraperitoneal placement of both organs. A disadvantage of this technique is that it can lead to renal allograft torsion. In contrast to retroperitoneal positioning of the kidney, an intraperitoneal approach allows for the possibility of greater mobility.

Improving pancreas graft utilization through importation

We analyze our outcomes utilizing imported allografts as a strategy to shorten wait list time for pancreas transplantation.

Pancreas Transplantation Is Feasible in Donors With Shprintzen-Goldberg Syndrome

Shprintzen-Goldberg syndrome (SGS) is an autosomal dominant connective tissue disorder. To date, this report is the first account of a successful pancreas transplantation from an SGS donor. The similarity of the outcomes from previous year-on-year pancreas transplantations at the same center demonstrates promising results. Increasing awareness of the utilization of donors with SGS may promote expansion of center-specific criteria for organ acceptance. Therefore, every consideration should be given for use of organs from donors with this genetic abnormality because there is no evidence to suggest poorer allograft viability.

Letter to the Editor: Mobile Technology Can Improve Adherence and Lessen Tacrolimus Variability in Patients Receiving Kidney Transplants.

Medication adherence is of paramount importance in transplant recipients. Studies have demonstrated that variability in tacrolimus blood concentrations is associated with de novo formation of donor-specific antibodies and an increased incidence of rejection following renal transplantation.[1][1]-[3

Beware of right renal vein valves in transplanted kidneys: Renal vein valvuloplasty in a donor kidney

# Beware of Right Renal Vein Valves in Transplanted Kidneys: Renal Vein Valvuloplasty in a Donor Kidney {#article-title-2} Here we present an unusual case of renal vein thrombectomy after renal allograft reperfusion secondary to venous outflow obstruction (VOO). While VOO is an unfortunate