Outcomes of Older Primary Kidney Transplant Recipients by Induction Agent and High-risk Viral Discordance Status in the United States
These videos have been matched automatically. Contact us if they are not relevant.
These videos have been matched automatically. Contact us if they are not relevant.
View abstract on PubMed
Summary
This summary is machine-generated.For older kidney transplant recipients, alemtuzumab induction increased graft loss risk compared to rabbit antithymocyte globulin. High-risk cytomegalovirus and Epstein-Barr virus discordance negatively impacted survival.
Area Of Science
- Nephrology
- Transplantation Immunology
- Virology
Background
- Older kidney transplant recipients represent a growing population with unique challenges.
- The impact of different induction immunosuppression strategies and viral discordance on outcomes in this demographic remains incompletely understood.
Purpose Of The Study
- To investigate the association between induction immunosuppression type, high-risk viral discordance (Cytomegalovirus and Epstein-Barr virus), and clinical outcomes in kidney transplant recipients over 55 years old.
Main Methods
- Analysis of the Scientific Registry of Transplant Recipients database (2005-2022) for primary kidney transplants in recipients >55 years.
- Categorization of recipients based on induction: rabbit antithymocyte globulin (r-ATG), interleukin-2 receptor antagonist (IL-2RA), or alemtuzumab.
- Utilized Kaplan-Meier curves and multivariable Cox proportional hazard models, adjusting for donor and recipient factors, to assess survival and graft outcomes.
Main Results
- Induction type did not significantly predict recipient survival. However, alemtuzumab was associated with increased graft loss risk compared to r-ATG (HR 1.18; P<0.01).
- High-risk Epstein-Barr virus discordance predicted a 14% increase in mortality (HR 1.14; P<0.01).
- High-risk Cytomegalovirus discordance was linked to a 10% increased risk of graft loss (HR 1.10; P<0.02). Live donor and preemptive transplantation were favorable predictors.
Conclusions
- In older kidney transplant recipients, alemtuzumab induction is associated with a higher risk of graft loss compared to r-ATG.
- High-risk viral discordance for Cytomegalovirus and Epstein-Barr virus significantly portends poorer graft and recipient survival, respectively, highlighting the importance of viral monitoring and management.
These videos have been matched automatically. Contact us if they are not relevant.
These videos have been matched automatically. Contact us if they are not relevant.
Related Concept Videos
A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
Postoperative Nursing Management for Kidney Transplant PatientsPostoperative nursing management care includes monitoring the surgical site, encouraging early movement, and promoting lung health through breathing exercises. Nurses also administer prescribed medications like H2-blockers, such as famotidine, or proton pump inhibitors, like omeprazole, to help prevent gastrointestinal ulcers and bleeding. Fungal infections in the mouth and bladder can result from immunosuppressive and antibiotic...
Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
Acute Kidney Injury (AKI) progresses through distinct clinical phases: the oliguric, diuretic, and recovery phases, each marked by unique manifestations and challenges.Oliguric Phase:The oliguric phase is the initial stage of AKI, typically lasting 10 to 14 days. This phase is marked by a significant reduction in urine output, usually less than 400 mL per day, indicating decreased kidney function. Fluid retention is a prominent feature, leading to symptoms such as edema, hypertension, and...
Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
Tissue transplantation is a significant medical procedure involving the transfer of cells, tissues, or organs from a donor to a recipient, with the primary aim of restoring lost functions. This procedure is crucial in treating a broad spectrum of diseases, including kidney diseases, liver failure, heart disease, and certain types of cancers.
The Biology of Tissue Transplantation
The biology of tissue transplantation hinges on the Major Histocompatibility Complex (MHC) molecules. These molecules...