The Online Transplant Center

Announcement

2011-08-02T07:50:00.000-04:00

From now on, all blog posts will appear on nephronpower.com for this blog. Thanks

T regulatory Cells: A short review

2011-07-21T10:39:00.000-04:00

T regulatory cells have now come out and made a splash in the transplant world but also in the immunology and glomerular disease world. Treg are usually CD4+, CD25+, CTLA4+. A common misconception is that all are Foxp3 positive. There are many types of Tregs. Natural kind that do express Foxp3 and CD25 and they usually are IL-2 dependent Induced Tregs are induced in the periphery and can

Advagraf Study

2011-07-18T10:54:00.000-04:00

There has been talk about using prograf once a day for quite sometime now. When it is used once a day its a tacrolimus prolonged use and its called Advagraf. A recent multicenter, 1:1-randomized, parallel-group, noninferiority study compared the efficacy of twice a day tacrolimus to advagraf.; combined with steroids and low-dose mycophenolate mofetil without antibody induction, in 667 de novo

New Informative Transplant News Website

2011-07-17T09:41:00.000-04:00

please check out www.transplantnow.com. This is similar to Nephrology now and compiles latest articles in Transplantation from major journals and will allow for good compilation.

Many guidelines equal no guildelines for cardiac evaluation before renal tranplantation

2011-07-02T17:15:00.005-04:00

The degree of cardiac testing for potential transplant recipients is highly variable and depends on the practices of the particular transplant center. Multiple guidelines have been proposed by experts in the field however there is a huge variability between each guideline. At the two ends of the spectrum are the KDOQI guidelines which suggest universal testing for CAD at regular intervals

Innate vs Adaptive Immune system

2011-06-24T10:41:00.000-04:00

http://allergycases.org/2005/10/innate-immune-system-short-review.html Check out the above website. Especially the nice break down of innate vs adaptive immune system.

FDA approves Belatacept (NULOJIX) for use in kidney transplantation.

2011-06-17T08:13:00.000-04:00

It’s been a long time since the FDA approved a new drug for transplantation which makes this news very exciting. On June 16th Bristol-Myers Squibb announced that the FDA approved the use of NULOJIX (Belatacept) for use in kidney transplantation as an induction and maintenance agent in combination with mycophenolate mofetil and corticosteroids. The FDA reviewed the

Human Herpes Virus – 6: An uncommon but potentially treatable infectious agent in transplant recipients

2011-06-15T20:45:00.000-04:00

HHV-6 is a DNA virus part of the beta-herpesvirus family and can be divided into HHV-6 A and B. Primary infection is mild and occurs usually in childhood; therefore the majority of healthy adults have serologic evidence of prior infection. HHV-6 can re-activate in the immunocompromised transplant recipient leading to asymptomatic viral replication or less commonly active infection. The

Banff 2011 Updates 2

2011-06-07T07:43:00.000-04:00

BanFF 2011 Presentations By Dr.Kim Solez

2011-06-06T09:47:00.001-04:00

Welcome Address for Paris Banff Allograft Pathology Meeting June 6-10, 2011 View more presentations from Kim Solez

BANFF 2011 Updates

2011-06-06T07:41:00.000-04:00

BANFF 2011

2011-06-05T08:44:00.001-04:00

The agenda for the meeting of Banff in Parishttp://cybernephrology.ualberta.ca/banff/2011/theconference.htm

Alemtuzumab for Induction- the 2011 update

2011-05-20T14:16:00.000-04:00

A recent NEJM May 2011 article has one article that compares use of Alemtuzumab and early steroid removal to Basiliximab and Thymo. Its a nicely done randomized controlled trial that is multi centered. On face value:- appears that rate of biopsy confirmed acute rejection was lower in the alemtuzumab group in the low risk patients when compared to basiliximab and similar to thymo when compared in

Donor Risk Scores?

2011-05-11T15:33:00.000-04:00

A recent review in Nature Nephrology discuses this important concept. A large study out of Finland is discussed in this review and how the donor risk score was developed. What they describe is a donor allograft damage index which involves clinical components as well pathology components. What constitutes the clinical components are: age >50, smoking, unstable blood pressure, HTN, need for CPR,

Dual Live Transplants performed

2011-05-06T08:00:00.000-04:00

Check out the latest on dual liver and kidney( live donor) combined transplants done recently. http://www.ldnews.com/news/ci_17976156

Fascinating Wordle in AJT 2011

2011-04-28T10:09:00.000-04:00

Check out this picture that was created on most cited surgical articles in ten surgical journals. Turns out Transplantation topics rule and show the most results. Nice http://onlinelibrary.wiley.com/doi/10.1111/j.1600-6143.2011.03459.x/full

Dichotomous Effects of Rapamycin

2011-04-25T10:01:00.000-04:00

A recent review in AJT 2011 April issue reviews this concept nicely. Rapamycin has many faces and many different effects on different cells. Lets summarize 1. Suppression of CD4 T+ differentiation 2. Increased T reg development 3. Decreased response to skin graft 4. Decreased dendritic cell maturation 5. Increased CD8 + T cell memory differentiation 6. Increased CD8 T cell activation 7.

Arteries and Kidney Transplant

2011-04-18T09:07:00.000-04:00

http://consumer.healthday.com/Article.asp?AID=651907 Check out the news release from JASN

Pancreas Transplantation in the Treatment of Diabetes

2011-04-17T08:51:00.000-04:00

A nice treat from Nephrology on Demand

Transplant Tourism and Malignancy

2011-04-13T16:12:00.002-04:00

Transplant Tourism does still continue and many patients continue to get kidneys from other countries where it could be commercial possible. A recent study showed that when groups were compared( tourism kidneys to home country based kidneys):- the graft and patient survivals were equal but the 10 year cumulative cancer risk was significantly higher in the transplant tourism kidneys; especially

IVIG - how does it work from the Immunology blog?

2011-04-07T08:46:00.000-04:00

http://allergynotes.blogspot.com/2011/04/intravenous-immune-globulin-ivig-in.html

Neutropenia from Tacrolimus

2011-04-02T08:10:00.000-04:00

Post transplant neutropenia has many causes. Etiology is usually medications, infections, cancer. In a retrospective evaluation, 28% neutropenia was noted after first year of transplantation. Most of this was sought to be from MMF-tacrolimus combination. The drugs we usually consider are: MMF, azathioprine, acyclovir, gancyclovir, bactrim, valcyte. A recent review on CJASN 2011, presents

AST Fellows Symposium on Transplantation Medicine

2011-03-31T07:40:00.000-04:00

AST Fellows Symposium on Transplantation Medicine

Who gets kidney first?- the thoughts in 2011

2011-03-28T08:32:00.000-04:00

Organ allocation system always has been going down the list on a first come first basis. A discussion has been ongoing in the transplant circles and organizations on age based distribution of organs. Hence, someone who is young getting a "better" kidney then someone "older". Is that reasonable or is that age based discrimination? Take a look at the reactions of many below. There must be a

Kidney transplant and donation cancer risks

2011-03-23T11:13:00.000-04:00

What are the risks of getting cancer from the donor? Check out this report from UK regarding a recent case. http://www.guardian.co.uk/society/2011/mar/22/kidney-transplants-donated-organs-cancer-risks

Kidney Transplant Recipient Infected With HIV From Live Donor - Procedure Needs Reviewing

2011-03-21T06:26:00.000-04:00

Kidney Transplant Recipient Infected With HIV From Live Donor - Procedure Needs Reviewing

Hematuria Post Kidney Transplantation

2011-03-15T10:48:00.003-04:00

An entity often not talked about and not much out there in the literature. a nice review below by Dr.Krish. Hematuria post transplant View more presentations from Nephrology, NSLIJ

Elimination of anti rejection medicaitons

2011-03-09T14:44:00.000-05:00

ASN news recently reported a study that is ongoing using specially processed stem cells from the same kidney donor being transplanted along with the kidney to that recipient, allowing that to continue in chimerism leading to an early presumed tolerance and hence no anti rejection medications for long term. This concept is not new and has been attempted in the recent past. In 2008, NEJM paper by

Tissue Engineering Renal Tissue

2011-03-08T15:04:00.001-05:00

The Regenerative Division at Wake Forrest University has been doing some ground breaking work. One study done there allowed for some initial work regarding re generation of kidney cells. This system involves the cultivation of expanded primary renal cells in a three-dimensional collagen-based culture system. After one week of growth, individual renal cells began to form renal structures

Bortezomib for desensitization!

2011-03-06T10:04:00.001-05:00

Donor specific alloantibody producing plasma cells might be a good target for proteosomic inhibition by bortezomib. Bortezomib has some data in case series and reports of treating antibody mediated rejection. A recent study published in Transplantation 2011 discussed case series of 4 patients with extremely high DSA and couldn't just get apheresis alone. They received 4 doses of bortezomib alone

Skin cancer and Transplants

2011-02-24T07:55:00.000-05:00

Talking to your patients and just educating them regarding regular skin cancer screening might be just enough to raise awareness and prevent skin cancer. Regular yearly dermatology visits for skin check ups are essential for prevention. Check out this latest healhday article. http://consumer.healthday.com/Article.asp?AID=650075

Risk factors for post transplant Hypertension

2011-02-15T19:59:00.000-05:00

Here are a list of factors that contribute to post kidney transplant development of Hypertension. 1. Pre existing HTN 2. Body Mass Index 3. Native Kidney disease 4. Donor age 5. Donor sex 6. Donor Hypertension 7. Longer Cold Ischemia time 8. Delayed graft function 9. Steroids 10. CNI( cyclosporine>tacrolimus) 11. Acute rejection 12. Anti body mediated rejection 13. Chronic Allograft Nephropathy

JOURNAL CLUB: BELATACEPT and Transplantation

2011-02-08T20:52:00.000-05:00

Co Stimulation Blockade and The AllograftView more presentations from Nephrology, NSLIJ.

Male Fertility and Transplantation

2011-02-07T09:47:00.000-05:00

Male fertility has not been studied in detail in transplantation. Does immunosuppresive therapy have impact on sperm production or motility? Most reports suggest that male transplant recipients have successfully fathered healthy kids. The one drug that might have led to problems is sirolimus: On observational study showed that sperm count was decreased in the sirolimus arm of the study and that

Nephsap review: Transplantation

2011-02-04T09:38:00.000-05:00

A question encountered on our recent Nephsap review on transplantation: What regimen would be the safest in pregnancy? If one had to choose between CNI + prednisone or CNI+ azathioprine. The groups were divided. What is the data? As you go down the list in immunosuppresive medications: most are C and below and no medication is a Risk category A or B. Cyclosporine has the most data with

The Transplant Web

2011-01-25T09:26:00.000-05:00

The most recent issue of AJT, under AJT report discusses the Transplant web and what is on the web for transplantation. It discusses many issues that pertain social media and transplantation. It brings home key points that patients are using the internet for their information and physicians are to be aware of that. Social media can be a very good and powerful tool to discuss and teach physicians

Fibrosis with Inflammation at One Year Predicts Transplant Functional Decline

2011-01-21T23:14:00.000-05:00

At the ASN 2010, there was an abstract regarding the role of fibrosis and inflammation at one year to predict transplant survival. Kidney transplants with both interstitial fibrosis and subclinical inflammation but not fibrosis alone after 1 year have reduced survival. This study tested whether fibrosis with inflammation at 1 year associates with decline of renal function in a low-risk cohort and

NSLIJ - Innate B Cell in Humans that Protects Against Infections

2011-01-21T20:23:00.000-05:00

NSLIJ - Innate B Cell in Humans that Protects Against Infections

Informing the Debate: Rates of Kidney Transplantation in Nations With Presumed Consent

2011-01-17T23:09:00.000-05:00

Informing the Debate: Rates of Kidney Transplantation in Nations With Presumed Consent

Quiz 9 Answers

2011-01-11T13:42:00.000-05:00

Which of these statements is TRUE regarding living donor related transplantation in Fabry's Disease? Renal Transplantation from a heterozygote female relative into a patient with Fabry is risky as globotriaosylceramide accumulation might be present in this donor, without clinical symptoms ( is a true statement)The measurement of Alpha galactosidase A activity in a potential female living related

Can Alcohol Consumption be protective post transplant?

2011-01-05T10:24:00.001-05:00

One study presented at the recent ASN 2010 at Denver found that alcohol consumption in moderation was indicative of lesser incidence of post transplant diabetes (NODAT). The investigators argue that the belief of interactions with medications might be false and without evidence. Not only did they show that it was a decreased NODAT risk but also decreased risk of death post transplant. So kind of

Chronic renal allograft dysfunction

2010-12-25T08:29:00.000-05:00

This month's Kidney International has a special extra edition on Chronic renal allograft dysfunction. This supplement has >10 articles that highlights latest development in transplantation on pathogenetic mechanisms of T and B cells in Chronic rejection, IF/TA and then few chapters on fibrosis and genomic studies. Risk factors, infections and immune monitoring are also discussed. Few of them

CMV in solid Organ transplantation!

2010-12-21T08:28:00.000-05:00

CMV infections are fairly common in solid organ transplantations. A nice review in Nature Review Nephrology this month highlights prophylaxis treatment, active treatment and serology testing. What I found very useful wa a table on dosage recommendations for ganciclovir and valganciclovir in varied renal function states. A nice section on anti viral resistance also reveals some important data on

Genetic Nephropathies and Kidney Transplantation

2010-12-18T08:11:00.000-05:00

A recent article in Nature Review Nephrology reviews the diseases we always get worried if a living donor can be used. This review outlines the does and don't of hereditary nephropathies and donor evaluation of kidney transplantation. A table in the articles nicely summarizes the disease entity and if the living related donation would be appropriate. In Finnish type Congenital Nephrotic syndrome,

Quiz 9 Answers

2010-12-10T09:00:00.001-05:00

Which drug is paired incorrectly with the target molecule? Rituximab -- CD20 Alemtuzumab -- CD52 Belatacept -- CD198 Belimumab --- TNFSF13B Atacicept ---TACI-IgThe correct answer is Belatacept CD198, that is incorrect pairing. Most of you got it right. We all are familiar with Rituximab which is a B cell antagonist and since all B cells besides plasma cells are CD20 Positive, its an anti CD20.

Sirolimus- the Positive aspects

2010-12-03T13:41:00.000-05:00

The same issue of KI shares another view- the positive aspects of sirolimus As we mentioned earlier that this agent was discovered as a cancer drug and has antiproliferative properties Recent animal data and human data have shown it to be beneficial in preventing cancer post transplant So the benefits of this agents are: 1. Prevention of cancer, as mTOR is responsible for transcription and

Sirolimus - The negative aspects

2010-11-30T09:00:00.000-05:00

A recent article in Kidney International discusses the negative and positive aspects of this interesting drug- sirolimus, mTOr inhibitor. Initially designed to fight renal cancer, fast caught on to treat rejection and be used as an immunosuppression. 1. Six trials so far have randomized sirolimus vs a calcineurin inhibitor that were mentioned in this article. They all had more acute rejection

The Kidney Transplant in HIV patients- the NEJM study

2010-11-18T11:10:00.001-05:00

Kidney Transplantation was rare in HIV+ cases few years ago and now many centers have developed protocols that have allowed this to happen with relatively good outcomes. No prospective studies were ever done in this matter for rejection rates, outcome measures and so forth, This month in NEJM 2010, a nice multi center study takes a look at this particular question. The investigators evaluated 150

Quiz 8 answers

2010-11-03T08:59:00.001-04:00

Immunology Quiz: There are two types of Tregs:- the natural kind and the induced kind. Which of these statements is FALSE?1.The natural T regs are thymus derived 0 (0%)2.The induced T regs are generated in the periphery 0 (0%)3.The natural T regs are derived from T effector cells 5 (50%)4.The natural T regs suppress autoimmunity 2 (20%)5. The induced T regs induction requires CD28

Top Transplant Programs "by volume" in 2009, check out the list

2010-11-01T11:00:00.001-04:00

http://nephronline.com/news.asp?N_ID=4188

Outcomes of kidney transplantation from HCV positive donors

2010-10-26T20:20:00.006-04:00

Given the global organ shortage for transplantation, use of expanded criteria donors and donors with potentially transmissible diseases has been established as a way to mitigate this problem somewhat. While there is universal consensus on rejecting kidneys from HCV antibody positive donors for transplantation in HCV antibody negative recipients, there is controversy regarding the use of these

Salivary Prograf levels

2010-10-26T09:00:00.000-04:00

Check out this interesting post from Pediatric Nephrology on salivary tacrolimus levels https://www.pediatric-nephrology.com/daily-updates/2010/10/26/329-salivatac.html

U 002 Nierentransplantation / kidney transplant

2010-10-26T07:03:00.001-04:00

A nice you tube video ( cartoon) of a transplant surgery

FGF-23 and PTH and Bone Disease post transplant

2010-10-24T15:32:00.000-04:00

Patients with ESRD have bone disease of various types. The three that are commonly seen are adynamic bone disease, increased bone turnover related or a combination of both. BMD loss is common complication following kidney transplantation. Few points to take home from a recent paper published in CJASN 2010, October edition. 1. The bone loss is accelerated in the post transplant period- why?

Aspergilloma in the transplant kidney

2010-10-23T12:03:00.000-04:00

A recent issue of AJKD talks about a case of aspergilloma in the transplanted kidney. The fact that it affected the kidney is the novelty of the case and the also they used a novel way of treating this patient. Please see the link below. http://www.ajkd.org/article/S0272-6386(10)01257-6/fulltext

Renal Fellow Network: Pancreas transplant pearls

2010-10-21T10:48:00.000-04:00

Renal Fellow Network: Pancreas transplant pearls: "Pancreas transplantation is considered the treatment of choice for patients with refractory Type I Diabetes Mellitus. The first pancreas tr..."

Wait list and desensitization?

2010-10-19T08:47:00.000-04:00

Two landmark papers have discussed using potential agents for potential patients who are on wait list for a kidney but have a very high PRA or now one might use a cPRA. The first paper is from 2004 titled was using IVIG. A rare treat to find a randomized double blind placebo controlled trial in transplant literature, this is one of them. 101 patients ESRD with PRA>50% randomized to getting

Sirolimus and Male Fertility

2010-10-17T15:43:00.004-04:00

I just came across an interesting paper published couple of years ago. Zuber et al (Am J Transplantion,July 2008) carried out an observational study in male patients aged 20-40 years who received a kidney transplant during 1995-2005 in France. Patients on sirolimus based immunosuppression had a significantly reduced total sperm count and a decreased proportion of motile spermatozoa compared to

Quiz 7 Answers

2010-10-14T11:26:00.000-04:00

What is the most common glomerular disease following Liver Transplantation? Ig A Nephropathy 7 (46%) Minimal Change Disease 0 (0%) Membranous GN 4 (26%) MPGN Type 1 4 (26%) When 105 renal biopsies were studied in patients with non renal transplants for causes of glomerular disease, the most common transplant where glomerular disease was seen was liver transplantation. If you exclude,

New Transplant Information website

2010-10-12T22:33:00.000-04:00

Check out this excellent website on information on transplantation http://www.kidneylink.org/ It has medical news, patient stories, webinars and useful links to all transplant readership

REJECTION and TOLERANCE

2010-10-08T13:37:00.000-04:00

This week is a transplant week in the journals. The NEJM has a nice review on Rejection of the Kidney Allograft. Have a look. its very well written and combines the latest information on all concepts of rejection(with excellent visual portrayals) Antibody Mediated and Cellular Mediated are discussed. It even goes into details of T cell activation and co stimulation and is a simple read for all.

Basic concepts in Immunology

2010-10-05T07:45:00.000-04:00

Concept 1 Think of Innate immune system as "non antigen presenting mediated". it can get activated without antigen presentation. Cells that are major players: NK cell and Macrophage Adaptive immune system is " antigen presentation mediated". Needs that extra help. Cells that play role here:- B cells, T cells, DC Concept 2 Think of the immune system as : Effector system and Regulatory system

Role Playing exercise in Transplant Education

2010-10-05T07:15:00.000-04:00

We did another session of role playing with the fellows and transplant medicine Each fellow was assigned a "cell" that is an active playing in Immunology. Then they were asked to describe themselves in Homeostasis and then a state of Immunosuppression. A nice discussion and arguments ensued and a live display of the immune reaction was done. The teaching of basic immunology for transplantation

Transplant Glomerulopathy

2010-09-29T16:32:00.000-04:00

Transplant Glomerulopathy(TG) is a common biopsy finding that we see in kidney biopsies for proteinuria workup.The causes of TG are usually of similar to what causes secondary MPGN. Most of the time it turns out to be chronic antibody mediated rejection process. Pathologically, it is defined by glomerular basement membrane duplication with peritubular capillary basement membrane multilayering (

CMV and EBV PCR for 2 years

2010-09-23T08:29:00.001-04:00

Check out this interesting post from Dr.Sethi https://www.pediatric-nephrology.com/home/2010/09/23/300-jasnviremia.html

B cells in Transplantation

2010-09-23T08:27:00.000-04:00

Recently at the ATC 2010, a nice abstract was presented regarding Regulatory B cells. They are coming!!! T cell immunglobulin and mucin -1 or TIM-1 is a costim molecule that controles T effector cells. The listed abstract below showed that Tim-1 is more highly expressed on naive B cells than on T cells. Depleting B cells led to Tim-1 accelerated islet cell rejection in these mice. Re

Infections post transplant

2010-09-23T08:18:00.000-04:00

We had a good discussion about infections post transplant yesterday ranging from rare cases of Parvovirus B19 to common bacterial infections A timeline is important to keep in mind. <1Month into transplant Think of the common post surgical fever causes MRSA, Pneumonias Wound infection C.diff Aspiration BKV can be seen as early as 2 weeks( depending on net immunosuppression state of the patient)

Quiz 6 answers

2010-09-22T16:53:00.001-04:00

Which is true?1.The incidence of Kaposi Sarcoma is most highest in liver transplants of all solid organ transplants 2.Females are more of risk than males get Kaposi Sarcoma in Renal transplant patients 3.It is caused by Human Herpes virus 64.Most cases of Kaposi's Sarcoma occur in individuals of Mediterranean or Arabic origin 5.Most cases of Kaposi Sarcoma are visceral in nature in Transplant

Renal Fellow Network: Doc, I am very sensitized! (part 2)

2010-09-21T14:25:00.000-04:00

Renal Fellow Network: Doc, I am very sensitized! (part 2): "Let’s continue our discussion from our last blog about sensitized kidney recipients. In summary, we have this 60 yo man interested on a seco..."

Renal Fellow Network: Doc, I am very sensitized!

2010-09-21T14:24:00.000-04:00

Renal Fellow Network: Doc, I am very sensitized!: "Another day of transplant clinic… I heard from my attending that a couple is here for a second opinion about a kidney transplant. The husban..."

Concept Map of Treatment of BK Nephritis

2010-09-17T13:42:00.000-04:00

Here is a concept map of BK Nephritis Pathology and Treatment options

Can BK Virus serum PCR be a good marker for Net immunosuppression?

2010-09-12T08:34:00.001-04:00

In the field of transplantation, we are struggling to figure out is the patient on which end of the spectrum, too little immunosuppresion or too much immunosuppression. Markers for rejection have been studied extensively and based on Luminex DSA one can monitor early signs of impending antibody rejection. But many centers are also developing aggressive screening strategies for BK Nephritis.

Cidofivir for BK Nephritis

2010-09-12T08:20:00.001-04:00

As we all know that treatment for BK Nephritis is tough. The only thing that really works well is Decreasing immunosuppresion. But as we do that, the risk of mounting an immune response arises and you can start seeing biopsies that look like Acute Cellular Rejection and BK staining Positive. At that time, most people will treat with IV Immunoglobulins and see if there is some response in terms

Paired Chain Donation

2010-09-09T09:19:00.001-04:00

A nice letter to the editor in NEJM this week Sept 2010 reflects on the Kidney Paired Donation program from San Antonio, Texas. KPD, which matches a living donor with a compatible recipient in a tag-team approach among potential donor–recipient pairs, can achieve compatible transplant combinations. Based on this letter, if performed at a national level, it would potentially result in

Histopathology Kidney --Chronic transplant rejection

2010-09-07T22:21:00.001-04:00

Histopathology Kidney--Acute transplant rejection

2010-09-07T22:18:00.001-04:00

Quiz 5 Answers

2010-09-07T21:57:00.000-04:00

Which one of the following is not a risk factor for PTLD EBV status of donor/recipient 2 (16%) Prior malignancy 1 (8%) "Net" immunosuppresion 1 (8%) Prior BK Virus infection 6 (50%) Age 2 (16%) Most of you got this one right away! All except Prior BK infection has been associated to be a risk factor for PTLD In kidney transplant recipients Please review the recent updated PTLD

Immune System - Natural Killer Cell - The Formulation

2010-09-06T22:43:00.001-04:00

The Complement System

2010-09-06T22:42:00.001-04:00

Cell Mediated Immune Response

2010-09-06T22:40:00.001-04:00

Antibody Mediated Immune Response

2010-09-06T22:39:00.001-04:00

Immunology Review

Post Kidney Transplant Renal Injury!

2010-09-06T22:34:00.000-04:00

A Short Reminder! We encounter acute renal failure always in the post transplant period Besides the traditional pre renal, renal and post renal way of looking at the causes of renal injury post transplant, a mnemonic I learned from my mentors was : SCRI or short for serum creatinine. S- STRUCTURAL CAUSES C- Calcineurin Toxicity R- Rejection, any type/ Recurrence of primary disease I- Infection,

CMV infection in Kidney Transplantation

2010-08-27T22:55:00.001-04:00

Here is a brief presentation by Arun Chawla, MD on CMV in Kidney Transplantation. CMV in Organ TransplantationView more presentations from Nephrology, NSLIJ.

Interferon Gamma use in fungal infections in transplant patients

2010-08-26T07:03:00.000-04:00

A recent article in AJT reports the use of Interferon Gamma as a salvage and additional therapy for disseminated fungal infections in kidney transplant recipients. We always get concerned with giving interferons to transplant recipients as it will increase and promote an immune response and pose a risk of rejection. In the above cases, not only did the patients survived but the graft was not

Quiz 4 Answers

2010-08-25T07:57:00.000-04:00

What is the most common cause of Denovo Thrombotic Microangiopathy post renal transplant? Calcineurin inhibitor toxicity 5 (55%) Antibody mediated rejection 3 (33%) MPGN 0 (0%) Malignancy 0 (0%) Infections 1 (11%) Denovo TMA post transplant is defined as happening in the early post transplant period.( 6 months). All of the above can cause de novo TMA in post transplant patients. The

2010-08-21T16:24:00.003-04:00

Post Transplant Lymphoproliferative Disorder (PTLD)View more presentations from Nephrology, NSLIJ.

B cell and long term graft function

2010-08-20T16:21:00.002-04:00

A lot of transplant patients do so well and require very minimal amounts of medications. What is the magic recipe for that? Perhaps it is T regs cells and amount of T regs vs T effector cells. Perhaps it is a subset of B cells. A recent paper in Kidney International addresses this topic. The investigators compared B cells of people with stable graft function and ones with chronic rejection and

Transplantatation of two kidneys in marginal donors

2010-08-16T06:49:00.002-04:00

http://nephrohug.com/2010/08/16/greffe-des-deux-reins/ Check out the above French Blog on this topic from Nephrohug.

The Micro RNA blog

2010-08-13T07:04:00.001-04:00

Take a look at this extensive summaries of blogs just on micro RNAs Very neat blog http://mirnablog.com/

BKV viral protein-1 mRNA in urinary cells

2010-08-11T05:53:00.001-04:00

A noninvasive, accurate biomarker for diagnosis of BKVN is being sought. Recent article in Transplantation reports using the urinary cell mRNA profile at the time of BK Nephropathy diagnosis and compared to risk of graft function.BK Nephropathy was diagnosed with a sensitivity of 100% and specificity of 97% using the urinary mRNA. Levels of granzyme B (GB) mRNA and proteinase inhibitor (PI)-9

Low Donor Kidney Weight ? Does it matter?

2010-08-04T16:41:00.001-04:00

We have asked this question many times in conferences and especially when a pediatric kidney gets put in an adult recipient? Does it matter if the donor kidney weight is not compatible to the recipient's weight? There is one study in 2005 that showed that low donor kidney weight to recipient weight ratio did not affect graft survival. That study only had 2.5 year follow up. A recent study in

Post transplant TMA, revisiting Atypical HUS

2010-08-03T14:54:00.002-04:00

Post Transplantation is a real entity. Many causes have been identified. CNI toxicity, Sirolimus, ischemia, antibody mediated rejection or de novo carcinoma, antiphospholipid syndrome, post transplant SLE are a few possible diagnosis. One study showed that among 24 patients with post transplant TMA that was de novo, 7 carried a mutation in CFH or CFI or combined mutation, indicating a genetic

Hematuria and Donation?

2010-07-26T12:17:00.001-04:00

Donating a kidney is a very noble thought. We usually screen for hematuria in the donors. Aysmptomatic hematuria is 13% in general population. Are donors with asymptomatic hematuria safe to donate? This question is a tough one with no specific answers. A recent study in AJT July 2010 tries to answer this question in a retrospective study. 8.3% of kidney donors in 8 years of their evaluation

Nephron Power: TOPIC DISCUSSION: DEXA SCAN in TRANSPLANT PATIENTS?

2010-07-23T11:44:00.001-04:00

Nephron Power: TOPIC DISCUSSION: DEXA SCAN in TRANSPLANT PATIENTS?

Micro RNAs and Transplantation

2010-07-21T14:59:00.001-04:00

A novel concept has been emerging in the last few years regarding micro RNAs. It already has reached some human data in transplant patients. What is micro RNA? These are non coding areas of the RNA that play a critical role in regulation of gene expression. They might alter the structure and lead to either expression or regression of the protein in question. There is mice data that microRNAs

Transplant/Immunology Quiz 3 answers

2010-07-16T15:58:00.001-04:00

Which one of these are risk factors for Post Transplant New Onset Diabetes Mellitus ( NODAT)? HLA Mismatch 20% CMV infection 40% Hep C infection 40% Sirolimus 40% Calcium Channel Blockers 10% Hypomagnesemia 20% Elevated uric acid 30% CNI use 70% Metabolic syndrome 70% Most of you got it right, all above are risk factors except Calcium Channel Blockers. NODAT is a common metabolic complication

Leflunomide and liver failure

2010-07-14T22:01:00.001-04:00

The FDA just expanded the black box warning on leflunomide( ARAVA), a drug that is sometimes used to treat BK Nephritis in Transplant patients. A recent report showed 49 cases of severe liver toxicity from 2002-2009. Usually the reactions were noted in the first 12 months post use of the drug. The greatest risk occurred in patients taking other drugs that may cause liver damage while taking

Lupus Nephritis Post Transplant

2010-07-11T20:10:00.001-04:00

We have asked this questions many times? Every center gives different answers. Some people have different experiences about this topic. When a lupus nephritis associated ESRD patient gets a kidney transplant, what is the risk of recurrence of lupus in the transplanted kidney? Well, the recent issue of JASN highlights this question. From the UNOS database, 6850 patients who had lupus induced

Organ Trading Discussion

2010-07-06T19:12:00.001-04:00

The Economist is holding a live debate on Organ trading on Facebook. Check it out with this link On facebook. Also, the Renal Fellow Network has a recent post on it as well.

Photopheresis therapy for renal allograft rejection?

2010-07-05T19:52:00.002-04:00

The technique involves three stages: 1-leucapheresis, 2- photoactivation with photosensitizer plus UV A irradiation, and 3- re-infusion of the buffy coat. Extra Corporal Photopheresis (ECP) was first introduced for the treatment of Cutaneous T-Cell Lymphoma. Now has been widely used in the treatment of acute allograft rejection; most extensively in cases of cardiac transplant rejection. It has