Maya Campara

Interleukin-2 receptor blockade with humanized monoclonal antibody for solid organ transplantation.

Importance of the field: Induction therapy has reduced the incidence of acute rejection compared with historical standards. The potency of currently available induction immunosuppression is not without risk and should be carefully considered. Induction with daclizumab, an IL-2 receptor antagonist, has been used safely and effectively for over 10 years across different transplant types. As a result of daclizumab use, transplant centers are able to implement steroid-sparing or calcineurin minimization protocols. Unfortunately, the manufacturing costs have resulted in withdrawal of this agent from the market reducing the options for patients undergoing transplantation. Areas covered in this review: This review will update the reader on recently published daclizumab studies in adult solid organ transplant recipients, focusing on comparative studies with other induction agents. What the reader will gain: This paper will provide a summary of comparative studies between daclizumab and other induction therapies focusing on their efficacy and safety. Take home message: Novel applications, such as long-term use in combination with calcineurin-inhibitor dose reduction and its value in the treatment of acute or chronic rejection have yet to be explored. Since daclizumab has been withdrawn from the market, future IL-2 receptor blockade will have to be achieved with basiliximab, which is a chimeric, monoclonal antibody directed against the same epitope.

The use of fosfomycin to treat urinary tract infections in kidney transplant recipients.

Focal segmental glomerulosclerosis after renal transplantation. Clin Transplant 2011: 25: 6. 3. Ruiz JC, Sanchez-Fructuoso A, et al. Management of proteinuria in clinical practice after kidney transplantation. Transplant Rev 2012; 26: 36. 4. Van den Berg JG, van den Bergh Weerman MA, Assmann KJ, et al. Podocyte foot process effacement is not correlated with the level of proteinuria in human glomerulonephritis. Kidney Int 2004; 66: 1901. 5. Henderson LK, Nankivell BJ, Chapman JR. Surveillance protocol kidney transplant biopsies: their evolving role in clinical practice. Am J Transplant 2011; 11: 1570. 6. Mazzucco G, Magnani C, Fortunato M, et al. The reliability of pre-transplant donor renal biopsies (PTDB) in predicting the kidney state. A comparative singlecentre study on 154 untransplanted kidneys. Nephrol Dial Transplant 2010; 25: 3401.

Simultaneous Living Donor Kidney and Parathyroid Allotransplantation: First Case Report and Review of Literature.

Background Congenital hypoparathyroidism can be severely debilitating for patients, leading to renal failure at young age. Parathyroid transplantation may represent a permanent parathyroid replacement therapy. In patients already on immunosuppression for other organ transplant, there is little additional risk involved with parathyroid allotransplantation. Methods Robotic assisted transaxillary single parathyroidectomy is performed on a living donor also donating a kidney to her sibling. Results Recipient total serum PTH levels became detectable after 3 days from the procedure and maintained for 9 months after transplant with minimal calcium supplementation after the procedure. Literature review and previous results are summarized. Conclusions Obtaining a parathyroid gland and a kidney from the same donor reduces the exposure to different HLA antigens. The combined procedure using minimally invasive surgery is safe, with the additional cosmetic advantage and convenience for the willing donor. In the setting of need for immunosuppression, additional transplantation to treat the cause is safe and justified in the recipients.

ABO incompatible renal transplantation in an HIV-seropositive patient.

To date, there have been no reports of successful ABO blood group incompatible renal transplantation in HIV patients. We describe a case of a 47-year-old African American man with end-stage renal disease secondary to HIV-induced nephropathy who underwent a live unrelated (spouse) donor ABO blood group incompatible transplant using an intravenous immunoglobulin/plasmapheresis preconditioning regimen with interleukin-2 receptor antagonist induction along with tacrolimus and mycophenolate mofetil maintenance. The postoperative course was complicated by two acute cellular rejection (Banff Ia) episodes that were successfully managed with corticosteroid boluses and the addition of corticosteroids to maintenance immunosuppression. Antibody-mediated rejection was not observed on biopsy. The patient reached a serum creatinine nadir of 2.0 mg/dL on postoperative day 20, which has now been maintained for 170 days. His current CD4 count was 410 cells/microL.

Eculizumab for Prevention of Antibody-Mediated Rejection in Blood Group-Incompatible Renal Transplantation

Antibody-mediated rejection (AMR) is one of the leading causes of allograft failure especially in patients undergoing ABO-incompatible (ABOi) renal transplantation. We hypothesized that complement inhibition with eculizumab, a C5 inhibitor, would protect against AMR and maintain graft function in ABOi renal transplant recipients. Four patients undergoing living donor kidney transplant from ABOi donors were treated with a 9-week eculizumab course without therapeutic plasma exchange, intravenous immunoglobulin, or splenectomy. All patients had successful transplants and have normal graft function at the time of last follow-up. There were no cases of AMR or acute cellular rejection. Of note, 2 patients were transplanted despite persistent ABO antibody titers of 1:32, conventionally considered a contraindication to proceed in standard protocols. Eculizumab is a promising option to prevent AMR with ABOi renal transplantation without the need for splenectomy, post-transplant therapeutic plasma exchange, and intravenous immunoglobulin. Future multicenter studies are needed to determine long-term efficacy and safety.

Pancreas Transplantation From Pediatric Donors: A United Network for Organ Sharing Registry Analysis

Background Pancreas grafts from pediatric donors are still considered “not ideal.” Perceived concerns are related to low islet mass and potential for graft thrombosis. Methods The study evaluated all pancreas transplants from January 2000 to May 2015 using the Organ Procurement and Transplant Network database. Comparative analysis of recipient and graft survival was performed between pediatric (⩽18 years) and adult donors. In the pediatric group, the outcomes were stratified based on donor age (⩽6, 7-12, and 13-18 years) and weight (<30, 30-95, and >95 kg). Results In the selected era, 18 430 pancreas transplants were performed from 4915 pediatric donors (27%). Short-term graft and patient survivals were comparable between pediatric and adult donors. Ten-year patient and graft survivals were higher in the pediatric donor group: (70% and 54% vs 68% and 51%, P = 0.001). However, very-low-weight pediatric donors (<30 kg) resulted in worse graft survival in the long term (44% at 10 years, P = 0.006). Conclusions Pediatric donor pancreas transplants had comparable patient and graft survival to the adult donor transplants. However, the islet mass of very small donors could influence long-term graft survival if the weights of donors and recipients are not properly matched. Usage of “very small” pediatric donors was not associated with higher incidence of technical complications or early graft loss.

OUTCOMES OF COMBINED LIVER-KIDNEY TRANSPLANT (CLKT) RECIPIENTS ON CALCINEURIN INHIBITOR (CNI) VS. CNI AND MYCOPHENOLATE (MMF) MAINTENANCE IMMUNOSUPPRESSION: 2376

M. Campara1, S. Akkina2, H. Jeon3, J. Oberholzer4, I.G. Tzvetanov3, E. Benedetti3, I.Y. Tang5 1Surgery, Transplant, University of Illinois Medical Center, Chicago/ UNITED STATES OF AMERICA, 2Medicine, Nephrology, University of Illinois at Chicago, Chicago/UNITED STATES OF AMERICA, 3Surgery, Transplant, University of Illinois at Chicago, Chicago/ UNITED STATES OF AMERICA, 4Surgery, University of Illinois, Chicago/IL/UNITED STATES OF AMERICA, 5Medicine, University of Illinois at Chicago, Chicago/IL/UNITED STATES OF AMERICA