The Experts below are selected from a list of 303 Experts worldwide ranked by ideXlab platform
Bernd Döhler - One of the best experts on this subject based on the ideXlab platform.
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association of Kidney Graft loss with de novo produced donor specific and non donor specific hla antibodies detected by single antigen testing
Transplantation, 2015Co-Authors: Caner Süsal, Bernd Döhler, Daniel Wettstein, Christian Morath, Andrea Ruhenstroth, S Scherer, T H Tran, Petra Gombos, Peter Schemmer, Eric WagnerAbstract:The association of donor-specific HLA antibodies (DSA) with Kidney Graft failure has been addressed previously ; however, the majority of studies were based on small numbers of patients with Graft failure. We investigated 83 patients with failed Kidney transplants for a possible association of de novo development and persistence or loss of pre-existing DSA with Graft failure. Single Antigen Bead assay-detected DSA and non-DSA antibodies were compared between patients with Graft loss and matched controls with functioning Grafts. The incidence of weak de novo DSA or non-DSA at a mean fluorescence intensity of 500 or higher was higher in the Graft loss than in the nonrejector group (76% vs 40%, P < 0.001). Because of the low number of patients developing de novo DSA, the DSA results did not reach statistical significance (only 22% of patients with Graft loss developed de novo DSA). However, at all cutoffs, there was a significantly higher rate of Graft loss in patients with de novo non-DSA. The incidence of strong pretransplant DSA that persist after transplantation was higher in the Graft loss group (10% vs 1%, P = 0.034). When C1q-binding ability in sera of rejectors and nonrejectors with posttransplant de novo or persistent DSA was compared, none of the nonrejectors demonstrated C1q positivity, whereas 43% of patients with Graft loss showed C1q-positive antibodies, although not necessarily donor-specific (P < 0.001). Our data show that the posttransplant presence of persisting or de novo HLA antibodies, especially if C1q binding, is associated with Graft loss, even if the antibodies are not specific for mismatched donor HLA.
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Kidney Graft survival in Europe and the United States: strikingly different long-term outcomes.
Transplantation, 2013Co-Authors: Adam Gondos, Bernd Döhler, Hermann Brenner, Gerhard OpelzAbstract:BACKGROUND: Kidney Graft survival has never been systematically compared between Europe and the United States. METHODS: Applying period analysis to first deceased-donor (DD) and living-donor Kidney Grafts from the United Network for Organ Sharing/Organ Procurement and Transplantation Network for the United States and the Collaborative Transplant Study for Europe, we compared overall and age-specific 1-, 5-, and 10-year Graft survival for Europeans and white, African, and Hispanic Americans for the 2005 to 2008 period. A Cox regression model was used to adjust for differences in patient characteristics. RESULTS: For the 2005 to 2008 period, 1-year survival for DD Grafts was equal (91%) between Europeans and white and Hispanic Americans, whereas it was slightly lower for African Americans (89%). In contrast, overall 5- and 10-year Graft survival rates were considerably higher for Europe (77 and 56%, respectively) than for any of the three U.S. populations (whites, 71 and 46%, Hispanic, 73 and 48%, and African American, 62 and 34%). Differences were largest for recipient ages 0 to 17 and 18 to 29 and generally increased beyond 3 to 4 years after transplantation. Survival patterns for living-donor Grafts were similar as those seen for DD Grafts. Adjusted hazard ratios for Graft failure in United Network for Organ Sharing white Americans ranged between 1.5 and 2.3 (all P
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Kidney Graft survival in europe and the united states strikingly different long term outcomes
Transplantation, 2013Co-Authors: Adam Gondos, Bernd Döhler, Hermann Brenner, Gerhard OpelzAbstract:BACKGROUND: Kidney Graft survival has never been systematically compared between Europe and the United States. METHODS: Applying period analysis to first deceased-donor (DD) and living-donor Kidney Grafts from the United Network for Organ Sharing/Organ Procurement and Transplantation Network for the United States and the Collaborative Transplant Study for Europe, we compared overall and age-specific 1-, 5-, and 10-year Graft survival for Europeans and white, African, and Hispanic Americans for the 2005 to 2008 period. A Cox regression model was used to adjust for differences in patient characteristics. RESULTS: For the 2005 to 2008 period, 1-year survival for DD Grafts was equal (91%) between Europeans and white and Hispanic Americans, whereas it was slightly lower for African Americans (89%). In contrast, overall 5- and 10-year Graft survival rates were considerably higher for Europe (77 and 56%, respectively) than for any of the three U.S. populations (whites, 71 and 46%, Hispanic, 73 and 48%, and African American, 62 and 34%). Differences were largest for recipient ages 0 to 17 and 18 to 29 and generally increased beyond 3 to 4 years after transplantation. Survival patterns for living-donor Grafts were similar as those seen for DD Grafts. Adjusted hazard ratios for Graft failure in United Network for Organ Sharing white Americans ranged between 1.5 and 2.3 (all P<0.001) for 2 to 5 years after transplantation, indicating that lower Graft survival is not explained by differences in baseline patient characteristics. CONCLUSIONS: Long-term Kidney Graft survival rates are markedly lower in the United States compared with Europe. Identifying actionable factors explaining long-term Graft survival differences between Europe and the United States is a high priority for improving long-term Graft survival.
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no association of Kidney Graft loss with human leukocyte antigen antibodies detected exclusively by sensitive luminex single antigen testing a collaborative transplant study report
Transplantation, 2011Co-Authors: Caner Süsal, Bernd Döhler, Andrea Ruhenstroth, S Scherer, T H Tran, Jorg Ovens, Khaled Mahmoud, Andreas Heinold, Gerhard OpelzAbstract:BACKGROUND: It is unclear whether Kidney transplant recipients with preformed donor-specific human leukocyte antigen (HLA) antibodies (DSA) detectable only in the highly sensitive Luminex single-antigen (LSA) assay are at an increased risk of Graft failure. METHODS: We studied 3148 patients who received a deceased donor Kidney Graft between 1996 and 2008 and were enrolled in the prospective serum project of the Collaborative Transplant Study. There were 118 patients with Graft loss during the first 3 years after transplantation on whom recipient and donor DNA was available for complete HLA typing. We compared the incidence of LSA-detected DSA in these patients with Graft failure and matched controls with functioning Grafts. All patients were found negative in the less-sensitive complement-dependent lymphocytotoxicity and enzyme-linked immunosorbent assays. RESULTS: When mean fluorescence intensity (MFI) of greater than or equal to 1000 was used as a cutoff for Luminex positivity, 118 patients with Graft loss did not show a higher incidence of DSA against HLA-A, -B, -C, -DRB1/3/4/5, -DQA1, -DQB1, -DPA1, or -DPB1 antigens than 118 matched controls without Graft loss (for all loci P not significant). The incidence of strong DSA (MFI ≥2000 or MFI ≥3000) detected only by LSA was low (for all loci between 0% and 5%) and did not identify unacceptable antigens that were relevant for Graft loss within the first 3 years after transplantation. CONCLUSION: We conclude that, given currently practiced crossmatch procedures and immunosuppressive regimens, exclusion of donor organs carrying "unacceptable" HLA based exclusively on sensitive LSA antibody testing is not justified.
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effect of human leukocyte antigen compatibility on Kidney Graft survival comparative analysis of two decades
Transplantation, 2007Co-Authors: Gerhard Opelz, Bernd DöhlerAbstract:BACKGROUND: Based on an analysis of United Network for Organ Sharing data, it was reported that the influence of human leukocyte antigen (HLA) matching in renal transplantation has diminished in recent years, prompting the suggestion that donor Kidney allocation algorithms should be revised. METHODS: We compared the impact of HLA matching on Kidney Graft survival during the decades 1985-1994 and 1995-2004 using the data of the Collaborative Transplant Study. Results for the last 5 years (2000-2004) were analyzed separately in addition. Multivariate Cox regression analysis was used to account for the influence of confounders. RESULTS: Our results show that, while Graft survival rates have improved overall over time, the relative impact of HLA matching on the Graft survival rate has remained strong and highly significant. Both the need for posttransplant rejection treatment and the Graft survival rates showed statistically highly significant associations with HLA matching regardless of the interval analyzed (P<0.001). CONCLUSIONS: We conclude that HLA mismatches significantly influence the outcome of Kidney transplants and that Kidney exchange programs for the purpose of achieving better HLA matches continue to be meaningful.
Gerhard Opelz - One of the best experts on this subject based on the ideXlab platform.
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Kidney Graft survival in europe and the united states strikingly different long term outcomes
Transplantation, 2013Co-Authors: Adam Gondos, Bernd Döhler, Hermann Brenner, Gerhard OpelzAbstract:BACKGROUND: Kidney Graft survival has never been systematically compared between Europe and the United States. METHODS: Applying period analysis to first deceased-donor (DD) and living-donor Kidney Grafts from the United Network for Organ Sharing/Organ Procurement and Transplantation Network for the United States and the Collaborative Transplant Study for Europe, we compared overall and age-specific 1-, 5-, and 10-year Graft survival for Europeans and white, African, and Hispanic Americans for the 2005 to 2008 period. A Cox regression model was used to adjust for differences in patient characteristics. RESULTS: For the 2005 to 2008 period, 1-year survival for DD Grafts was equal (91%) between Europeans and white and Hispanic Americans, whereas it was slightly lower for African Americans (89%). In contrast, overall 5- and 10-year Graft survival rates were considerably higher for Europe (77 and 56%, respectively) than for any of the three U.S. populations (whites, 71 and 46%, Hispanic, 73 and 48%, and African American, 62 and 34%). Differences were largest for recipient ages 0 to 17 and 18 to 29 and generally increased beyond 3 to 4 years after transplantation. Survival patterns for living-donor Grafts were similar as those seen for DD Grafts. Adjusted hazard ratios for Graft failure in United Network for Organ Sharing white Americans ranged between 1.5 and 2.3 (all P<0.001) for 2 to 5 years after transplantation, indicating that lower Graft survival is not explained by differences in baseline patient characteristics. CONCLUSIONS: Long-term Kidney Graft survival rates are markedly lower in the United States compared with Europe. Identifying actionable factors explaining long-term Graft survival differences between Europe and the United States is a high priority for improving long-term Graft survival.
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Kidney Graft survival in Europe and the United States: strikingly different long-term outcomes.
Transplantation, 2013Co-Authors: Adam Gondos, Bernd Döhler, Hermann Brenner, Gerhard OpelzAbstract:BACKGROUND: Kidney Graft survival has never been systematically compared between Europe and the United States. METHODS: Applying period analysis to first deceased-donor (DD) and living-donor Kidney Grafts from the United Network for Organ Sharing/Organ Procurement and Transplantation Network for the United States and the Collaborative Transplant Study for Europe, we compared overall and age-specific 1-, 5-, and 10-year Graft survival for Europeans and white, African, and Hispanic Americans for the 2005 to 2008 period. A Cox regression model was used to adjust for differences in patient characteristics. RESULTS: For the 2005 to 2008 period, 1-year survival for DD Grafts was equal (91%) between Europeans and white and Hispanic Americans, whereas it was slightly lower for African Americans (89%). In contrast, overall 5- and 10-year Graft survival rates were considerably higher for Europe (77 and 56%, respectively) than for any of the three U.S. populations (whites, 71 and 46%, Hispanic, 73 and 48%, and African American, 62 and 34%). Differences were largest for recipient ages 0 to 17 and 18 to 29 and generally increased beyond 3 to 4 years after transplantation. Survival patterns for living-donor Grafts were similar as those seen for DD Grafts. Adjusted hazard ratios for Graft failure in United Network for Organ Sharing white Americans ranged between 1.5 and 2.3 (all P
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no association of Kidney Graft loss with human leukocyte antigen antibodies detected exclusively by sensitive luminex single antigen testing a collaborative transplant study report
Transplantation, 2011Co-Authors: Caner Süsal, Bernd Döhler, Andrea Ruhenstroth, S Scherer, T H Tran, Jorg Ovens, Khaled Mahmoud, Andreas Heinold, Gerhard OpelzAbstract:BACKGROUND: It is unclear whether Kidney transplant recipients with preformed donor-specific human leukocyte antigen (HLA) antibodies (DSA) detectable only in the highly sensitive Luminex single-antigen (LSA) assay are at an increased risk of Graft failure. METHODS: We studied 3148 patients who received a deceased donor Kidney Graft between 1996 and 2008 and were enrolled in the prospective serum project of the Collaborative Transplant Study. There were 118 patients with Graft loss during the first 3 years after transplantation on whom recipient and donor DNA was available for complete HLA typing. We compared the incidence of LSA-detected DSA in these patients with Graft failure and matched controls with functioning Grafts. All patients were found negative in the less-sensitive complement-dependent lymphocytotoxicity and enzyme-linked immunosorbent assays. RESULTS: When mean fluorescence intensity (MFI) of greater than or equal to 1000 was used as a cutoff for Luminex positivity, 118 patients with Graft loss did not show a higher incidence of DSA against HLA-A, -B, -C, -DRB1/3/4/5, -DQA1, -DQB1, -DPA1, or -DPB1 antigens than 118 matched controls without Graft loss (for all loci P not significant). The incidence of strong DSA (MFI ≥2000 or MFI ≥3000) detected only by LSA was low (for all loci between 0% and 5%) and did not identify unacceptable antigens that were relevant for Graft loss within the first 3 years after transplantation. CONCLUSION: We conclude that, given currently practiced crossmatch procedures and immunosuppressive regimens, exclusion of donor organs carrying "unacceptable" HLA based exclusively on sensitive LSA antibody testing is not justified.
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effect of human leukocyte antigen compatibility on Kidney Graft survival comparative analysis of two decades
Transplantation, 2007Co-Authors: Gerhard Opelz, Bernd DöhlerAbstract:BACKGROUND: Based on an analysis of United Network for Organ Sharing data, it was reported that the influence of human leukocyte antigen (HLA) matching in renal transplantation has diminished in recent years, prompting the suggestion that donor Kidney allocation algorithms should be revised. METHODS: We compared the impact of HLA matching on Kidney Graft survival during the decades 1985-1994 and 1995-2004 using the data of the Collaborative Transplant Study. Results for the last 5 years (2000-2004) were analyzed separately in addition. Multivariate Cox regression analysis was used to account for the influence of confounders. RESULTS: Our results show that, while Graft survival rates have improved overall over time, the relative impact of HLA matching on the Graft survival rate has remained strong and highly significant. Both the need for posttransplant rejection treatment and the Graft survival rates showed statistically highly significant associations with HLA matching regardless of the interval analyzed (P<0.001). CONCLUSIONS: We conclude that HLA mismatches significantly influence the outcome of Kidney transplants and that Kidney exchange programs for the purpose of achieving better HLA matches continue to be meaningful.
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effect of human leukocyte antigen compatibility on Kidney Graft survival comparative analysis of two decades
Transplantation, 2007Co-Authors: Gerhard Opelz, Bernd DöhlerAbstract:Background. Based on an analysis of United Network for Organ Sharing data, it was reported that the influence of human leukocyte antigen (HLA) matching in renal transplantation has diminished in recent years, prompting the suggestion that donor Kidney allocation algorithms should be revised. Methods. We compared the impact of HLA matching on Kidney Graft survival during the decades 1985-1994 and 1995-2004 using the data of the Collaborative Transplant Study. Results for the last 5 years (2000-2004) were analyzed separately in addition. Multivariate Cox regression analysis was used to account for the influence of confounders. Results. Our results show that, while Graft survival rates have improved overall over time, the relative impact of HLA matching on the Graft survival rate has remained strong and highly significant. Both the need for posttransplant rejection treatment and the Graft survival rates showed statistically highly significant associations with HLA matching regardless of the interval analyzed (P<0.001). Conclusions. We conclude that HLA mismatches significantly influence the outcome of Kidney transplants and that Kidney exchange programs for the purpose of achieving better HLA matches continue to be meaningful.
Caner Süsal - One of the best experts on this subject based on the ideXlab platform.
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association of Kidney Graft loss with de novo produced donor specific and non donor specific hla antibodies detected by single antigen testing
Transplantation, 2015Co-Authors: Caner Süsal, Bernd Döhler, Daniel Wettstein, Christian Morath, Andrea Ruhenstroth, S Scherer, T H Tran, Petra Gombos, Peter Schemmer, Eric WagnerAbstract:The association of donor-specific HLA antibodies (DSA) with Kidney Graft failure has been addressed previously ; however, the majority of studies were based on small numbers of patients with Graft failure. We investigated 83 patients with failed Kidney transplants for a possible association of de novo development and persistence or loss of pre-existing DSA with Graft failure. Single Antigen Bead assay-detected DSA and non-DSA antibodies were compared between patients with Graft loss and matched controls with functioning Grafts. The incidence of weak de novo DSA or non-DSA at a mean fluorescence intensity of 500 or higher was higher in the Graft loss than in the nonrejector group (76% vs 40%, P < 0.001). Because of the low number of patients developing de novo DSA, the DSA results did not reach statistical significance (only 22% of patients with Graft loss developed de novo DSA). However, at all cutoffs, there was a significantly higher rate of Graft loss in patients with de novo non-DSA. The incidence of strong pretransplant DSA that persist after transplantation was higher in the Graft loss group (10% vs 1%, P = 0.034). When C1q-binding ability in sera of rejectors and nonrejectors with posttransplant de novo or persistent DSA was compared, none of the nonrejectors demonstrated C1q positivity, whereas 43% of patients with Graft loss showed C1q-positive antibodies, although not necessarily donor-specific (P < 0.001). Our data show that the posttransplant presence of persisting or de novo HLA antibodies, especially if C1q binding, is associated with Graft loss, even if the antibodies are not specific for mismatched donor HLA.
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no association of Kidney Graft loss with human leukocyte antigen antibodies detected exclusively by sensitive luminex single antigen testing a collaborative transplant study report
Transplantation, 2011Co-Authors: Caner Süsal, Bernd Döhler, Andrea Ruhenstroth, S Scherer, T H Tran, Jorg Ovens, Khaled Mahmoud, Andreas Heinold, Gerhard OpelzAbstract:BACKGROUND: It is unclear whether Kidney transplant recipients with preformed donor-specific human leukocyte antigen (HLA) antibodies (DSA) detectable only in the highly sensitive Luminex single-antigen (LSA) assay are at an increased risk of Graft failure. METHODS: We studied 3148 patients who received a deceased donor Kidney Graft between 1996 and 2008 and were enrolled in the prospective serum project of the Collaborative Transplant Study. There were 118 patients with Graft loss during the first 3 years after transplantation on whom recipient and donor DNA was available for complete HLA typing. We compared the incidence of LSA-detected DSA in these patients with Graft failure and matched controls with functioning Grafts. All patients were found negative in the less-sensitive complement-dependent lymphocytotoxicity and enzyme-linked immunosorbent assays. RESULTS: When mean fluorescence intensity (MFI) of greater than or equal to 1000 was used as a cutoff for Luminex positivity, 118 patients with Graft loss did not show a higher incidence of DSA against HLA-A, -B, -C, -DRB1/3/4/5, -DQA1, -DQB1, -DPA1, or -DPB1 antigens than 118 matched controls without Graft loss (for all loci P not significant). The incidence of strong DSA (MFI ≥2000 or MFI ≥3000) detected only by LSA was low (for all loci between 0% and 5%) and did not identify unacceptable antigens that were relevant for Graft loss within the first 3 years after transplantation. CONCLUSION: We conclude that, given currently practiced crossmatch procedures and immunosuppressive regimens, exclusion of donor organs carrying "unacceptable" HLA based exclusively on sensitive LSA antibody testing is not justified.
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Soluble CD30 as a predictor of Kidney Graft outcome.
Transplantation, 2002Co-Authors: Steffen Pelzl, Gerhard Opelz, Manfred Wiesel, Peter Schnülle, Constanze Schönemann, Bernd Döhler, Caner SüsalAbstract:BACKGROUND: In the present study, we investigated whether the soluble form of CD30 (sCD30), a marker for T helper 2-type cytokine-producing T cells, is increased in sera of potential Kidney Graft recipients. We also investigated whether the pretransplantation serum sCD30 content is related to Kidney Graft survival. METHODS: Pretransplantation sera of 844 cadaver Kidney recipients from three transplant centers in Germany were tested for serum sCD30 content using a commercially available ELISA kit. RESULTS: Kidney Graft recipients showed a significantly higher serum sCD30 content than healthy controls (P
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soluble cd30 as a predictor of Kidney Graft outcome
Transplantation, 2002Co-Authors: Steffen Pelzl, Gerhard Opelz, Manfred Wiesel, Peter Schnülle, Constanze Schönemann, Bernd Döhler, Caner SüsalAbstract:BACKGROUND: In the present study, we investigated whether the soluble form of CD30 (sCD30), a marker for T helper 2-type cytokine-producing T cells, is increased in sera of potential Kidney Graft recipients. We also investigated whether the pretransplantation serum sCD30 content is related to Kidney Graft survival. METHODS: Pretransplantation sera of 844 cadaver Kidney recipients from three transplant centers in Germany were tested for serum sCD30 content using a commercially available ELISA kit. RESULTS: Kidney Graft recipients showed a significantly higher serum sCD30 content than healthy controls (P<0.0001). High sCD30 serum content was associated with Graft rejection. The 2-year Graft survival rate in recipients with a high pretransplantation serum sCD30 was 68+/-6%, significantly lower than the 86+/-1% rate in recipients with a low sCD30 (P<0.0001). Importantly, high sCD30 was indicative of an increased risk of Graft loss even in recipients without lymphocytotoxic alloantibodies. CONCLUSION: These data show that an elevated pretransplantation serum sCD30 reflects an immune state that is detrimental for Kidney Graft survival.
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THE ASSOCIATION OF Kidney Graft OUTCOME WITH PRETRANSPLANT SERUM IgG-ANTI-F(AB')2γ ACTIVITY
Transplantation, 1992Co-Authors: Caner Süsal, J. Groth, H.-h. Oberg, Peter Terness, Gerhard OpelzAbstract:: Pretransplant sera of 474 Kidney Graft recipients were tested for IgG-anti-F(ab')2 gamma activity. The patients had significantly higher IgG-anti-F(ab')2 gamma activity than healthy controls (P = 0.0004). Serum lymphocytotoxic antibodies were correlated with IgG-anti-F(ab')2 gamma (P = 0.004), whereas CMV infection and blood transfusions were not. We found a significant association between pretransplant IgG-anti-F(ab')2 gamma activity and early and 1-year Kidney Graft outcome. This association was pronounced in recipients with no lymphocytotoxic antibodies. Recipients with immediately functioning Grafts and a creatinine < 130 mumol/L at 1 year had strikingly higher pretransplant IgG-anti-F(ab')2 gamma activity than patients with Graft failure (P < 0.0001).
Dixon B. Kaufman - One of the best experts on this subject based on the ideXlab platform.
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delayed Kidney Graft function in simultaneous pancreas Kidney transplant recipients is associated with early pancreas alloGraft failure
American Journal of Transplantation, 2020Co-Authors: Sandesh Parajuli, Robert R. Redfield, Arjang Djamali, Jon S. Odorico, Brenda Muth, Brad C. Astor, Didier A Mandelbrot, Dixon B. KaufmanAbstract:Delayed Graft function (DGF) is a common complication associated with significant untoward effects in Kidney-alone transplantation. The incidence and outcomes following Kidney delayed Graft function (K-DGF) among patients undergoing simultaneous pancreas-Kidney (SPK) transplantation are less certain. We analyzed SPK recipients transplanted at our center between 01/1994 and 12/2017. A total of 632 recipients fulfilled the selection criteria, including 69 (11%) with K-DGF and 563 without. The incidence of K-DGF was significantly higher in recipients of organs from older donors and donation after circulatory death (DCD). The presence of K-DGF was significantly associated with an increased risk of pancreas Graft failure during the first 90 days (n=9, Incidence rate, IR 2.45/100 person-months), but not with late pancreas failure (n=32, IR=0.84/100 person-months), Kidney Graft failure or patient death. Although DCD was associated with K-DGF, DCD was not associated with either pancreas (HR: 0.91, 95% CI 0.58-1.44, p=0.69) or Kidney (HR 1.09, 95% CI 0.66-1.82, p=0.74) Graft failure after adjustment for potential confounders. We found K-DGF to be a significant risk factor for pancreas Graft failure but not Kidney Graft failure, with the major risk period being early (<90 days) post-transplant, and the major donor risk factor as older donor age.
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Pancreas Retransplant After Pancreas Graft Failure in Simultaneous Pancreas-Kidney Transplants Is Associated With Better Kidney Graft Survival.
Transplantation direct, 2019Co-Authors: Sandesh Parajuli, Annamalai Arunachalam, Kurtis J. Swanson, Fahad Aziz, Neetika Garg, Natalie M. Bath, Robert R. Redfield, Dixon B. Kaufman, Arjang Djamali, Jon S. OdoricoAbstract:Background: Simultaneous pancreas-Kidney (SPK) transplant is usually the best option for the diabetic end-stage renal disease patient. There is limited information about Kidney Graft outcomes in SPK recipients with isolated pancreas Graft failure who do versus do not undergo pancreas retransplantation. Methods: Patients were divided into 2 groups based on whether they underwent pancreas retransplant (ReTx+) or not (ReTx-). Kidney Graft function and survival were the primary endpoints. Results: One hundred and nine patients satisfied our selection criteria, 25 in ReTx+ and 84 in ReTx-. Mean interval from SPK to pancreas failure was significantly shorter in the ReTx+ compared with the ReTx- group, 19.3 ± 36.7 versus 45.7 ± 47.0 months (P = 0.01), respectively. There was no significant difference in Kidney Graft follow-up post SPK between 2 groups (P = 0.48). At last follow-up, 15 of the 25 (60%) of the repeat pancreas Graft had failed, with a mean Graft survival among these failed pancreas Graft of 2.6 ± 2.7 years, ranging from 0 to 8.1 years. Uncensored Kidney Graft failure was significantly lower in the ReTx+ group compared with the ReTx- group, 44% versus 67% (P = 0.04). Death-censored Kidney Graft failure was also lower in the ReTx+ group, 24% versus 48% (P = 0.04). The difference in patient survival did not reach statistical significance. In adjusted Cox regression analysis, rejection as a cause of pancreas failure was associated with increased risk of death-censored Kidney Graft failure, and pancreas retransplantation was associated with decreased risk of Kidney Graft failure. A similar pattern was seen after 1:1 matching for the interval between SPK and pancreas Graft failure. Conclusions: Even though ReTx+ patients accept the risks associated with repeat pancreas surgery, providers should consider this option in suitable otherwise healthy patients.
Pierre Vereerstraeten - One of the best experts on this subject based on the ideXlab platform.
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hypercholesterolemia is associated with increased Kidney Graft loss caused by chronic rejection in male patients with previous acute rejection
Transplantation, 2000Co-Authors: Karl Martin Wissing, Daniel Abramowicz, Nilufer Broeders, Pierre VereerstraetenAbstract:BACKGROUND: Whereas acute rejection is the main risk factor for the occurrence of chronic rejection, mechanisms in addition to the donor-specific immune response probably contribute to late alloGraft failure. In this study, we investigated the possible role of hypercholesterolemia in the incidence of chronic Kidney Graft loss. METHODS: By using the actuarial method, we retrospectively analyzed the long-term loss of cadaveric Kidney Grafts in patients who had a functioning Graft at 1 year and had received a transplant and undergone cyclosporin A therapy in our center between 1983 and 1997. RESULTS: As observed previously, patients with acute rejection during the 1st posttransplant year (n=198) had significantly higher actuarial Graft loss at 10 years compared with those free of acute rejection (n=244). In patients free of acute rejection at 1 year, hypercholesterolemia (> or =250 mg/dl) had no impact on Graft loss at 10 years. On the contrary, in patients with previous acute rejection, those with hypercholesterolemia (n=59) had a higher immunological (36.0% vs. 19.2%; P<0.01) and overall (50.0% vs. 25.3%; P<0.01) Graft loss at 10 years compared with patients with serum cholesterol <250 mg/dl (n=139). Among patients with 1st year acute rejection, hypercholesterolemia was associated with a significant increase in Graft loss in male but not in female recipients. Multivariate analysis confirmed that hypercholesterolemia was an independent risk factor for chronic Graft loss in male patients (P<0.05). CONCLUSION: Hypercholesterolemia is an independent risk factor for Kidney Graft loss from chronic rejection in male patients with previous acute rejection. Correction of hypercholesterolemia could help to reduce Kidney Graft loss caused by chronic rejection in this category of patients.
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Hypercholesterolemia is associated with increased Kidney Graft loss caused by chronic rejection in male patients with previous acute rejection.
Transplantation, 2000Co-Authors: Karl Martin Wissing, Daniel Abramowicz, Nilufer Broeders, Pierre VereerstraetenAbstract:BACKGROUND: Whereas acute rejection is the main risk factor for the occurrence of chronic rejection, mechanisms in addition to the donor-specific immune response probably contribute to late alloGraft failure. In this study, we investigated the possible role of hypercholesterolemia in the incidence of chronic Kidney Graft loss. METHODS: By using the actuarial method, we retrospectively analyzed the long-term loss of cadaveric Kidney Grafts in patients who had a functioning Graft at 1 year and had received a transplant and undergone cyclosporin A therapy in our center between 1983 and 1997. RESULTS: As observed previously, patients with acute rejection during the 1st posttransplant year (n=198) had significantly higher actuarial Graft loss at 10 years compared with those free of acute rejection (n=244). In patients free of acute rejection at 1 year, hypercholesterolemia (> or =250 mg/dl) had no impact on Graft loss at 10 years. On the contrary, in patients with previous acute rejection, those with hypercholesterolemia (n=59) had a higher immunological (36.0% vs. 19.2%; P
