Le migliori strategie immunosoppressive per il paziente con re-trapianto Prof. Maurizio Salvadori FIRENZE
|
|
|
- Garey Ford
- 6 years ago
- Views:
Transcription
1 Le migliori strategie immunosoppressive per il paziente con re-trapianto Prof. Maurizio Salvadori FIRENZE
2 Best Therapy for Kidney Re- Transplantation? PREVENTION!!!!
3 Registries CTS OPTN UNOS USRDS SRTR Canadian Registry Guidelines UK Guidelines Kdigo Canadian Guidelines Reviews Original papers DATA SOURCES
4 Main biases in affording the issue of best therapy in kidney retransplantation Few if any RCT Cohort studies are affected by several bias: Most are retrospective First transplant may be lost for different causes Re-transplants occur in different era with respect to first transplant Re-transplant patients may be affected by more comorbidities with respect to first transplant
5
6
7
8
9
10 Rao PS, 2006
11 HR=1.66 HR=0.64 HR=0.42 Rao PS, 2006
12 First transplant Re-transplant Sellers MT, 2004
13
14
15
16
17 Maintenance immunosuppression Most retransplant patients are given CNI ( TAC) + MPA TAC + MPA is given in the vast majority of sensitised patients Graft survival rate looks similar
18
19
20
21 Induction therapy Non depletional antibodies are preferred to depletional treatment Survival rate looks similar with respect to no induction Only in sensitised patients (> 30%) induction therapy offers better outcomes
22 Univariate analysis of risk factors for graft survival in retransplant patients Variables p Variables p Recipient age Donor age Recipient sex Donor sex Donor reletionship <0.001 Blood group Primary renal disease HLA-A,B mismatches HLA-DR mismatches Time to first graft loss <0.001 Primary graft nephrectomy Ischaemia time Time to diuresis Primary immunosuppression <0.001 Total steroid dose (at 3 months) Number acute rejections Post-transplant hypertension Chronic allograft nephropathy Mean serum creatinine at 1 year Time to retransplantation El-Agroudy A, 2004
23 Multivariate analysis of risk factors for graft survival in retransplant patients Variable p Consanguinity Primary immunosuppression Time to first graft loss Mean serum creatinine at 1 year <0.001 El-Agroudy A, 2004
24 Characteristics of re-transplants and first transplant patients Re-Transplant First Transplant El-Agroudy A, 2004
25
26 Abouljoud MS, 1995
27 Almond PS, 1991
28
29 Arnol M, 2008
30 Risk factors for re-transplant survival 1 transplant survival < 1 year Time to re-transplant > 1 year Marginal donors PRA Primary Immunosuppression Induction therapy Nephrectomy
31 Messages from guidelines
32 Screening for potential living donor kidney transplant recipients for clinically relevant antibodies is important for ensuring optimal donor selection and graft survival UK Guidelines for kidney living donation, 2005
33 The technique used for the cross-match test should be sensitive and clinically relevant. Cross-match tests should be capable of distinguishing T lymphocyte and B lymphocyte populations and should discriminate between IgG and IgM antibodies. The use of a flow cytometric technique is recommended, particularly for sensitised patients and re-transplantation, as the conventional cytotoxic cross-match is not sufficiently sensitive UK Guidelines for kidney living donation, 2005
34 Patients with a previous transplant Assess patients with a previous graft loss carefully for: Malignancy Cardiovascular disease Increased immunological risk European Association of Urology, 2010
35 Reccomendation Pre-transplant work-up for patients with retransplantation or previous non-renal transplantation should focus on the immunological risk, including a thorough analysis for the presence of anti-hla antibodies European Association of Urology, 2010
36 64: 1 graft; 163: >1 graft 64: 1 graft; 163: >1 graft Noel C. 2009
37 Noel C. 2009
38 Re-transplants: 85% Gurk-Turner C, 2008
39 Gurk-Turner C, 2008
40 Ott U, 2008
41 Ott U, 2008
42 Barocci S, 2009
43 Soran A, 2000
44 Soran A, 2000
45 Opelz G, 1976
46 Opelz G, 1976
47 Human leukocyte antigen matching has been de-emphasized in the allocation of renal allografts and further discounting is planned in the United Network of Organ Sharing kidney allocation model. An unforeseen consequence of poorer matching could be increased sensitization for candidates pursuing retransplantation Transplantation, 2009
48 Meier-Kriesche HU, 2009
49 Meier-Kriesche HU, 2009
50 Dawson KL, 2011
51 Scornik JC, 2011
52 Scornik JC, 2011
53 House AA, 2007
54 House AA, 2007
55 House AA, 2007
56 Donor-directed antibodies detected by solid phase assays (even those that are weak ) present an unacceptable risk factor to the patient
57 TOSCANA I pazienti al 2 Trapianto o successivi potranno utilizzare donatori con mismatch comuni a condizione che i loro sieri, anche storici, non abbiano mai presentato positività della PRA. In questi casi il Centro Trapianti interessato, opportunamente informato dal Laboratorio di Istocompatibilità, potrà decidere se procedere o meno al trapianto. CNT documento finale allocazione reni 19 agosto 2011
58 DDA after early transplantectomy appeared frequently but later than expected. In view of the growing number of marginal donors and the possible necessity of retransplantation, it is considered important to prolong the time of serum sampling and screening to at least 4 months. Immunization might escape attention when serum screening is restarted only from the time the patient is again referred to the waiting list.
59 Lenaers J, 2006
60 Lorenz M, 2004
61 Lefaucheur JASN 2010
62 Lefaucheur JASN 2010
63 Lefaucheur JASN 2010
64 Lefaucheur JASN 2010
65 Lefaucheur JASN 2010
66 Willicombe AJT, 2011
67
68
69
70
71
72
73
74 New Therapies Eculizumab Proteosome Inhibitors
75 Jordan SC, 2006
76 Jordan SC, 2006
77 Jordan SC, 2006
78 Mai, Transplantation, 2009
79 Mai ML, 227
80 54% Retransplants
81 54% Retransplants Vo AA, 2010
82 Vo AA, 2010
83 27/34 retransplants Morath C, 2010
84
85
86 Morath C, 2010
87 First Tx Retransplant Induction* 10 (37%) 20 (74.1%) IL-2R 3 (11.1%) 13 (48.1%) Thymo 0 (0%) 5 (18.5%) OKT3 2 (7.4%) 0 (0%) ATG 5 (18.5%) 0 (0%) Multi 0 (0%) 2 (7.4%) Maintenance CsA 22 (81.5%) 9 (33%) TAC 2 (7.4%) 17 (63%) Other 3 (11.1%) 1 (3.7%) No patient initially induced with a T-cell-depleting antibody underwent induction with a T-cell-depleting antibody at retransplant Johnson SR 2006
88 Ramos E, Transplantation 2004
89 After a mean follow-up of 34.6 months all patients Were found to have good graft function with a mean creatinine of 1.5 mg/dl. It can be concluded that patients with graft loss caused by BKAN can safely undergo retransplantation Ramos E, Transplantation 2004
90 Canadian guidelines, 2005
91
92
93 Predictors of after re-transplant BK virus replication Factors Viremia clearance n (%) Transplant nephrectomy n (%) BKV replication (n=11) No BKV replication (n=20) 6 (55) 20 (100) < (27) 10 (50) 0.3 Pre-emptive n (%) 5 (45) 5 (25) 0.4 Induction use n (%) 9 (81) 17 (85) 0.9 Maintenance immunosuppression (triple) 5 (45) 12 (60) 0.5 p
94 126 Re-Tx ( )
95 Back up slides
96
97 Meier-Kriesche HU, 2009
98 Scemla A, 2010
99 Scemla A, 2010
100
101 Canadian guidelines, 2005
102 El-Agroudy A, 2004
103 Meier-Kriesche HU, 2009
104 Dawson KL, 2011
105 House AA, 2007
106 70 Colonna CsA Only CsA + AZA CsA + AZA + STE CsA + STE AZA + STE CsA Only CsA + AZA CsA + AZA + STE CsA + STE AZA + STE
107
108
109 Lefaucheur JASN 2010
110 Lefaucheur JASN 2010
111 Lefaucheur JASN 2010
112 Lefaucheur JASN 2010
113 Anglicheau D, Am J Transpl, 2007
114 27/34 retransplants Morath C, 2010
115 Morath C, 2010
James E. Cooper, M.D. Assistant Professor, University of Colorado at Denver Division of Renal Disease and Hypertension, Kidney and PancreasTransplant
James E. Cooper, M.D. Assistant Professor, University of Colorado at Denver Division of Renal Disease and Hypertension, Kidney and PancreasTransplant Program Has no real or apparent conflicts of interest
Should red cells be matched for transfusions to patients listed for renal transplantation?
Should red cells be matched for transfusions to patients listed for renal transplantation? Dr M.Willicombe Imperial College Renal and Transplant Centre, Hammersmith Hospital Should red cells be matched
Desensitization in Kidney Transplant. James Cooper, MD Assistant Professor, Kidney and Pancreas Transplant Program, Renal Division, UC Denver
Desensitization in Kidney Transplant James Cooper, MD Assistant Professor, Kidney and Pancreas Transplant Program, Renal Division, UC Denver Organ Shortage Currently there are >90,000 patients on the kidney
Pediatric Kidney Transplantation
Pediatric Kidney Transplantation Vikas Dharnidharka, MD, MPH Associate Professor Division of Pediatric Nephrology Conflict of Interest Disclosure Vikas Dharnidharka, MD, MPH Employer: University of Florida
Back to dialysis after graft failure: Transplantectomy or not? Stop immunosuppression?
Back to dialysis after graft failure: Transplantectomy or not? Stop immunosuppression? Laurent WEEKERS CHU SartTilman Layout Introduction Epidemiology A note of caution on causality and bias Patient survival
Kidney Transplant Outcomes In Elderly Patients. Simin Goral MD University of Pennsylvania Medical Center Philadelphia, Pennsylvania
Kidney Transplant Outcomes In Elderly Patients Simin Goral MD University of Pennsylvania Medical Center Philadelphia, Pennsylvania Case Discussion 70 year old Asian male, neuropsychiatrist, works full
Predictors of cardiac allograft vasculopathy in pediatric heart transplant recipients
Pediatr Transplantation 2013: 17: 436 440 2013 John Wiley & Sons A/S. Pediatric Transplantation DOI: 10.1111/petr.12095 Predictors of cardiac allograft vasculopathy in pediatric heart transplant recipients
Management of Rejection
Management of Rejection I have no disclosures Disclosures (relevant or otherwise) Deborah B Adey, MD Professor of Medicine University of California, San Francisco Kidney and Pancreas Transplant Center
Literature Review Transplantation
Literature Review 2010- Transplantation Alexander Wiseman, M.D. Associate Professor, Division of Renal Diseases and Hypertension Medical Director, Kidney and Pancreas Transplant Programs University of
BK virus infection in renal transplant recipients: single centre experience. Dr Wong Lok Yan Ivy
BK virus infection in renal transplant recipients: single centre experience Dr Wong Lok Yan Ivy Background BK virus nephropathy (BKVN) has emerged as an important cause of renal graft dysfunction in recent
Management of a Recipient with a Failed Kidney Transplant. Simin Goral MD University of Pennsylvania Medical Center Philadelphia, Pennsylvania
Management of a Recipient with a Failed Kidney Transplant Simin Goral MD University of Pennsylvania Medical Center Philadelphia, Pennsylvania Disclosures Grant support: Bristol-Myers and Squibb Pharmaceuticals,
Renal Transplant Past Present and Future David Landsberg
2012 Renal Transplant Past Present and Future David Landsberg Outline Changing pattern of Donors Types of Donors Allocation Results Challenges in the Elderly LDPE Transplants By Year LD LRD LUD NDAD DD
Progress in Pediatric Kidney Transplantation
Send Orders for Reprints to reprints@benthamscience.net The Open Urology & Nephrology Journal, 214, 7, (Suppl 2: M2) 115-122 115 Progress in Pediatric Kidney Transplantation Jodi M. Smith *,1 and Vikas
Renal Transplantation: Allocation challenges and changes. Renal Transplantation. The Numbers 1/13/2014
Renal Transplantation: Allocation challenges and changes Mark R. Wakefield, M.D., F.A.C.S. Associate Professor of Surgery/Urology Director Renal Transplantation Renal Transplantation Objectives: Understand
Kidney Transplant in the Elderly. Robert Santella, M.D., F.A.C.P.
Kidney Transplant in the Elderly! Robert Santella, M.D., F.A.C.P. Incident Rate of ESRD by Age Age 75+ 65-74 From US Renal Data System, 2012 Should there be an age limit? Various guidelines: Canadian,
Scores in kidney transplantation: How can we use them?
Scores in kidney transplantation: How can we use them? Actualités Néphrologiques 2017 M Hazzan (Lille France ) Contents Scores to estimate the quality of the graft Scores to estimate old candidates to
Transplantation in highly sensitised patients treated with intravenous immunoglobulin and Rituximab
ORIGINAL ARTICLE Advance Access publication 1 February 2010 Transplantation in highly sensitised patients treated with intravenous immunoglobulin and Rituximab Ana Carina Ferreira 1, Sandra Brum 1, Vasco
Should Pediatric Patients Wait for HLA-DR-Matched Renal Transplants?
American Journal of Transplantation 2008; 8: 2056 2061 Wiley Periodicals Inc. C 2008 The Authors Journal compilation C 2008 The American Society of Transplantation and the American Society of Transplant
Steroid Minimization: Great Idea or Silly Move?
Steroid Minimization: Great Idea or Silly Move? Disclosures I have financial relationship(s) within the last 12 months relevant to my presentation with: Astellas Grants ** Bristol Myers Squibb Grants,
SELECTED ABSTRACTS. All (n) % 3-year GS 88% 82% 86% 85% 88% 80% % 3-year DC-GS 95% 87% 94% 89% 96% 80%
SELECTED ABSTRACTS The following are summaries of selected posters presented at the American Transplant Congress on May 5 9, 2007, in San Humar A, Gillingham KJ, Payne WD, et al. Review of >1000 kidney
The New Kidney Allocation System: What You Need to Know. Quality Insights Renal Network 3 Annual Meeting October 2, 2014
The New Kidney Allocation System: What You Need to Know Quality Insights Renal Network 3 Annual Meeting October 2, 2014 Pre Dialysis Era Dialysis Status in USA 500,000 patients on dialysis in 2013 100,000
Alemtuzumab-based induction treatment versus basiliximab based induction treatment in kidney transplantation (the 3C Study): a randomised trial
Alemtuzumab-based induction treatment versus basiliximab based induction treatment in kidney transplantation (the 3C Study): a randomised trial Journal club Feb 2014 Background and Rationale Despite substantial
Tolerance Induction in Transplantation
Tolerance Induction in Transplantation Reza F. Saidi, MD, FACS, FICS Assistant Professor of Surgery Division of Organ Transplantation Department of Surgery University of Massachusetts Medical School Percent
Controversies in Renal Transplantation. The Controversial Questions. Patrick M. Klem, PharmD, BCPS University of Colorado Hospital
Controversies in Renal Transplantation Patrick M. Klem, PharmD, BCPS University of Colorado Hospital The Controversial Questions Are newer immunosuppressants improving patient outcomes? Are corticosteroids
Literature Review: Transplantation July 2010-June 2011
Literature Review: Transplantation July 2010-June 2011 James Cooper, MD Assistant Professor, Kidney and Pancreas Transplant Program, Renal Division, UC Denver Kidney Transplant Top 10 List: July Kidney
BK Viral Infection and Malignancy in Renal Transplantation ~A Case History~
BK Viral Infection and Malignancy in Renal Transplantation ~A Case History~ Mariko Toyoda, MD Department of Nephrology, Japanese Red Cross Kumamoto Hospital Statement of Disclosure The author does not
A clear path forward AVAILABLE NOW THE LATEST INNOVATION IN KIDNEY TRANSPLANT SURVEILLANCE CAN DRIVE BETTER OUTCOMES FOR YOUR PATIENTS
AVAILABLE NOW A clear path forward THE LATEST INNOVATION IN KIDNEY TRANSPLANT SURVEILLANCE CAN DRIVE BETTER OUTCOMES FOR YOUR PATIENTS AlloSure is the first and only non-invasive test that assesses organ
Jadranka Buturović-Ponikvar Department of Nephrology, University Medical Center, Ljubljana, Slovenia
Jadranka Buturović-Ponikvar Department of Nephrology, University Medical Center, Ljubljana, Slovenia Hemodialysis or kidney transplantation what is better? Jadranka Buturović-Ponikvar Department of Nephrology,
Transplantation: Year in Review
Transplantation: Year in Review Alexander Wiseman, MD Medical Director, Kidney and Pancreas Transplant Program Associate Professor, Division of Renal Diseases and Hypertension University of Colorado Outline:
Management of a Recipient with a Failed Kidney Transplant. Simin Goral MD University of Pennsylvania Medical Center Philadelphia, Pennsylvania
Management of a Recipient with a Failed Kidney Transplant Simin Goral MD University of Pennsylvania Medical Center Philadelphia, Pennsylvania Objectives Epidemiology of transplant failure Timing of dialysis
Challenges for Renal Retransplant: An Overview
Challenges for Renal Retransplant: An Overview Mohamed Adel Bakr, Ahmed Abdelfattah Denewar, Mohamed Hamed Abbas Abstract Despite many achievements in renal transplant in the past few years regarding immunosuppression
Long-term outcome of third kidney transplants
Nephrol Dial Transplant (27) 22: 2693 27 doi:1.193/ndt/gfm226 Advance Access publication 23 April 27 Original Article Long-term outcome of third kidney transplants Alexandre Loupy 1, Dany Anglicheau 1,
Considering the early proactive switch from a CNI to an mtor-inhibitor (Case: Male, age 34) Josep M. Campistol
Considering the early proactive switch from a CNI to an mtor-inhibitor (Case: Male, age 34) Josep M. Campistol Patient details Name DOB ESRD Other history Mr. B.I.B. 12 January 1975 (34yo) Membranous GN
Clinical Study Different Impact of Pretransplant Anti-HLA Antibodies Detected by Luminex in Highly Sensitized Renal Transplanted Patients
BioMed Research International Volume 2013, Article ID 738404, 5 pages http://dx.doi.org/10.1155/2013/738404 Clinical Study Different Impact of Pretransplant Anti-HLA Antibodies Detected by Luminex in Highly
Renal Data from the Arab World
Saudi J Kidney Dis Transpl 2011;22(4):818-824 2011 Saudi Center for Organ Transplantation Saudi Journal of Kidney Diseases and Transplantation Renal Data from the Arab World Why does Kidney Allograft Fail?
The New Kidney Allocation System: What You Need to Know. Anup Patel, MD Clinical Director Renal and Pancreas Transplant Division Barnabas Health
The New Kidney Allocation System: What You Need to Know Anup Patel, MD Clinical Director Renal and Pancreas Transplant Division Barnabas Health ~6% of patients die each year on the deceased donor waiting
Is it safe to transplant against HLA DSA in cardiothoracic patients? development and implementation of national Guidelines
Is it safe to transplant against HLA DSA in cardiothoracic patients? development and implementation of national Guidelines Dr Martin Howell. Laboratory Director. Department of H&I, NHS Blood and Transplant,
Alfonso H. Santos Jr., Michael J. Casey, and Karl L. Womer
Hindawi Journal of Transplantation Volume 217, Article ID 8132672, 1 pages https://doi.org/1.1155/217/8132672 Research Article Analysis of Risk Factors for Kidney Retransplant Outcomes Associated with
Kidney Transplantation in the Elderly. Kristian Heldal, MD, PhD Telemark Hospital Trust, Skien, Norway and University of Oslo
Kidney Transplantation in the Elderly Kristian Heldal, MD, PhD Telemark Hospital Trust, Skien, Norway and University of Oslo Agenda Background: Age and chronic kidney disease End stage kidney disease:
Innovation In Transplantation:
Innovation In Transplantation: Improving outcomes Thomas C. Pearson Department of Surgery Emory Transplant Center CHOA Symposium October 22, 2016 Disclosures Belatacept preclinical and clinical trial were
Kidney transplantation 2016: current status and potential challenges
Kidney transplantation 2016: current status and potential challenges 15/12/2016 BVN-SBN : State-of-the-Art on Kidney Transplantation Patrick Peeters Ghent University Hospital, Belgium Challenges in 2016
The new Banff vision of the role of HLA antibodies in organ transplantation: Improving diagnostic system and design of clinical trials
The new Banff vision of the role of HLA antibodies in organ transplantation: Improving diagnostic system and design of clinical trials Carmen Lefaucheur 1 2 Banff 2015: Integration of HLA-Ab for improving
Debate: HLA matching matters in children
Annual Congress 2018 14 th to 16 th March, the Brighton Centre, Brighton Debate: HLA matching matters in children Presenting the case for - Dr Jon Jin (JJ) Kim, Nottingham Richard & Ronald Herrick 23 Dec
U.S. changes in Kidney Allocation
U.S. changes in Kidney Allocation Match kidneys with longest survival to patients with longest survival No parallel matching for kidneys with lower survival potential Decrease discard of kidneys with lower
HBV, HCV, HIV and Kidney Transplantation. Simin Goral MD University of Pennsylvania Medical Center Philadelphia, Pennsylvania
HBV, HCV, HIV and Kidney Transplantation Simin Goral MD University of Pennsylvania Medical Center Philadelphia, Pennsylvania Objectives Prevalence of hepatitis B (HBV), hepatitis C (HCV) and human immunodeficiency
PREVENTION AND TREATMENT OF BKV NEPHROPATHY Petra Reinke, Berlin, Germany. Chair: Daniel Abramowicz, Brussels, Belgium Rosanna Coppo, Turin, Italy
PREVENTION AND TREATMENT OF BKV NEPHROPATHY Petra Reinke, Berlin, Germany Chair: Daniel Abramowicz, Brussels, Belgium Rosanna Coppo, Turin, Italy Prof Petra Reinke Department of Nephrology University Hospital
What is the Best Induction Immunosuppression Regimen in Kidney Transplantation? Richard Borrows: Queen Elizabeth Hospital Birmingham
What is the Best Induction Immunosuppression Regimen in Kidney Transplantation? Richard Borrows: Queen Elizabeth Hospital Birmingham SYMPHONY Study Ekberg et al. NEJM 2008 Excluded: DCD kidneys; CIT>30hours;
HLA and Non-HLA Antibodies in Transplantation and their Management
HLA and Non-HLA Antibodies in Transplantation and their Management Luca Dello Strologo October 29 th, 2016 Hystory I 1960 donor specific antibodies (DSA): first suggestion for a possible role in deteriorating
A clear path forward COMING SOON THE LATEST INNOVATION IN KIDNEY TRANSPLANT SURVEILLANCE CAN DRIVE BETTER OUTCOMES FOR YOUR PATIENTS
COMING SOON A clear path forward THE LATEST INNOVATION IN KIDNEY TRANSPLANT SURVEILLANCE CAN DRIVE BETTER OUTCOMES FOR YOUR PATIENTS AlloSure is the first and only non-invasive test which assesses organ
Current strategies to kidney allocation
Current strategies to kidney allocation Dr Marie Alice Macher Dr Christian Jacquelinet Emilie Savoye Dr Corinne Antoine Direction Prélèvement Greffe organes - tissus From organ sharing to organ allocation
Clinical Study Over Ten-Year Kidney Graft Survival Determinants
International Nephrology Volume 2012, Article ID 302974, 5 pages doi:10.1155/2012/302974 Clinical Study Over Ten-Year Kidney Graft Survival Determinants Anabela Malho Guedes, 1, 2 Jorge Malheiro, 1 Isabel
Why Do We Need New Immunosuppressive Agents
Why Do We Need New Immunosuppressive Agents 1 Reducing acute rejection rates has not transplanted into better long-term graft survival Incidence of early acute rejection episodes by era Relative risk for
Donor-derived Cell-free DNA Improves DSA-informed Diagnosis of ABMR in Kidney Transplant Patients
Donor-derived Cell-free DNA Improves DSA-informed Diagnosis of ABMR in Kidney Transplant Patients Stanley C. Jordan, MD Director, Division of Nephrology Medical Director, Kidney Transplant Program Medical
Transplant Options for Patients: Choices and Consequences. Olwyn Johnston Medical Director Kidney Transplantation Vancouver General Hospital
Transplant Options for Patients: Choices and Consequences Olwyn Johnston Medical Director Kidney Transplantation Vancouver General Hospital BC Kidney Days October 6 th 2017 Non contributory Conflict of
Calcineurin inhibitors in HLA-identical living related donor kidney transplantation
Nephrol Dial Transplant (2014) 29: 209 218 doi: 10.1093/ndt/gft447 Calcineurin inhibitors in HLA-identical living related donor kidney transplantation ABSTRACT Priya S. Verghese 1, Ty B. Dunn 2, Srinath
Strategies for Desensitization
Strategies for Desensitization Olwyn Johnston MB, MRCPI, MD, MHSc BC Nephrology Day October 8 th 2010 Pre-transplant crossmatch (CMX) with donor lymphocytes has been standard of practice Positive CDC CXM
Pancreas After Islet Transplantation: A First Report of the International Pancreas Transplant Registry
American Journal of Transplantation 2016; 16: 688 693 Wiley Periodicals Inc. Brief Communication Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons doi:
Long-term prognosis of BK virus-associated nephropathy in kidney transplant recipients
Original Article Kidney Res Clin Pract 37:167-173, 2018(2) pissn: 2211-9132 eissn: 2211-9140 https://doi.org/10.23876/j.krcp.2018.37.2.167 KIDNEY RESEARCH AND CLINICAL PRACTICE Long-term prognosis of BK
Long-term complications after kidney transplantation. Adnan Sharif
Long-term complications after kidney transplantation Adnan Sharif RA guidelines (2011) KDIGO guidelines (2009) Long-term complications after kidney transplantation ATC 2013 abstracts Outline Patient/Graft
DSA Positive and then To biopsy or not?
DSA Positive and then To biopsy or not? Banff SCT 2017 29 March 2017 Peter Nickerson, MD, FRCPC, FCAHS Flynn Family Chair in Renal Transplantation Professor of Internal Medicine and Immunology Relevant
Cases: CMV, HCV, BKV and Kidney Transplantation. Simin Goral, MD University of Pennsylvania Medical Center
Cases: CMV, HCV, BKV and Kidney Transplantation Simin Goral, MD University of Pennsylvania Medical Center Disclosures Grant support: Otsuka Pharmaceuticals, Astellas Pharma, Angion, AstraZeneca, and Kadmon
PRETRANSPLANT IMMUNOLOGIC RISK ASSESMENT FOR IMMUNOSUPPRESSIVE MANAGEMENT
PRETRANSPLANT IMMUNOLOGIC RISK ASSESMENT FOR IMMUNOSUPPRESSIVE MANAGEMENT OF KIDNEY TRANSPLANT RECIPIENTS Enver Akalin, M.D. Professor of Clinical Medicine and Surgery Albert Einstein College of Medicine
Clinical Questions of Combined Liver Kidney Transplantation
Clinical Questions of Combined Liver Kidney Transplantation Miklos Z Molnar, MD, PhD, FEBTM, FERA, FASN Associate Professor of Medicine Methodist University Hospital, Transplant Institute Division of Transplantation,
Immunomodulator y effects of CMV disease
Immunomodulator y effects of CMV disease Oriol Manuel MD Service of Infectious Diseases and Transplantation Center University Hospital of Lausanne Switzerland Outline The transplant troll The indirect
Nephrology Grand Rounds
Nephrology Grand Rounds PTLD in Kidney Transplantation Charles Le University of Colorado 6/15/12 Objectives Background Pathogenesis Epidemiology and Clinical Manifestation Incidence Risk Factors CNS Lymphoma
kidney OPTN/SRTR 2012 Annual Data Report:
kidney wait list 18 deceased donation 22 live donation 24 transplant 26 donor-recipient matching 28 outcomes 3 pediatric transplant 33 Medicare data 4 transplant center maps 43 A. J. Matas1,2, J. M. Smith1,3,
Heart Transplantation ACC Middle East Conference Dubai UAE October 21, 2017
Heart Transplantation ACC Middle East Conference Dubai UAE October 21, 2017 Randall C Starling MD MPH FACC FAHA FESC FHFSA Professor of Medicine Kaufman Center for Heart Failure Department of Cardiovascular
Incidence of Rejection in Renal Transplant Surgery in the LVHN Population Leading to Graft Failure: 6 Year Review
Incidence of Rejection in Renal Transplant Surgery in the LVHN Population Leading to Graft Failure: 6 Year Review Jessica Ludolph 1 Lynsey Biondi, MD 1,2 and Michael Moritz, MD 1,2 1 Department of Surgery,
Update on Kidney Allocation
Update on Kidney Allocation 23rd Annual Conference Association for Multicultural Affairs in Transplantation Silas P. Norman, M.D., M.P.H. Associate Professor Division of Nephrology September 23, 2015 Disclosures
The Kidney Allocation System Changed in a Substantive Way on December 5, Your Patients Have Been, and Will Be, Affected by These Changes
The Kidney Allocation System Changed in a Substantive Way on December 5, 2014 Your Patients Have Been, and Will Be, Affected by These Changes 1 The New Kidney Allocation System Terms of Importance Pediatric
Paired Donation. Andrew Bradley Rachel Johnson Joanne Allen Susan V Fuggle. Cambridge University NHS Hospitals NHS Foundation trust
Paired Donation Andrew Bradley Rachel Johnson Joanne Allen Susan V Fuggle Cambridge University NHS Hospitals NHS Foundation trust Showing a preference 1860 John Calcott Horsley UK Living Donor kidney transplant
How to improve long term outcome after liver transplantation?
How to improve long term outcome after liver transplantation? François Durand Hepatology & Liver Intensive Care University Paris Diderot INSERM U1149 Hôpital Beaujon, Clichy PHC 2018 www.aphc.info Long
Kidney and Pancreas Transplantation in the United States,
American Journal of Transplantation 2006; 6 (Part 2): 1153 1169 Blackwell Munksgaard No claim to original US government works Journal compilation C 2006 The American Society of Transplantation and the
Transplant Update New Kidney Allocation System Transplant Referral Strategies. Antonia Harford, MD University of New Mexico
Transplant Update New Kidney Allocation System Transplant Referral Strategies Antonia Harford, MD University of New Mexico Financial Disclosures Doctor Harford has received financial support for dialysis
Kidney Transplant. Description
Section: Surgery Effective Date: October 15, 2015 Subject: Kidney Transplant Page: 1 of 9 Last Review Status/Date: September 2015 Kidney Transplant Description A kidney transplant involves the surgical
Diagnosis and Management of Acute and Chronic Humoral Rejection. Lars Pape
Diagnosis and Management of Acute and Chronic Humoral Rejection Lars Pape Immunosuppression Acute rejection Chronic rejection Side effects Infections Nephrotoxicity Adult population Nearly all late rejection-related
Answers to Your Questions about a Change in Kidney Allocation Policy What you need to know
Answers to Your Questions about a Change in Kidney Allocation Policy What you need to know Who are UNOS and the OPTN? The United Network for Organ Sharing (UNOS) is a nonprofit organization that operates
J Am Soc Nephrol 14: , 2003
J Am Soc Nephrol 14: 208 213, 2003 Kidney Allograft and Patient Survival in Type I Diabetic Recipients of Cadaveric Kidney Alone Versus Simultaneous Pancreas/Kidney Transplants: A Multivariate Analysis
Diabetes Mellitus GUIDELINES UNGRADED SUGGESTIONS FOR CLINICAL CARE IMPLEMENTATION AND AUDIT BACKGROUND
Diabetes Mellitus Date written: November 2011 Author: Scott Campbell GUIDELINES a. We recommend that diabetes should not on its own preclude a patient from being considered for kidney transplantation (1D).
Current status of kidney and pancreas transplantation in the United States,
American Journal of Transplantation 25; 5 (Part 2): 94 915 Blackwell Munksgaard Blackwell Munksgaard 25 Current status of kidney and pancreas transplantation in the United States, 1994 23 Gabriel M. Danovitch
Overview of New Approaches to Immunosuppression in Renal Transplantation
Overview of New Approaches to Immunosuppression in Renal Transplantation Ron Shapiro, M.D. Professor of Surgery Surgical Director, Kidney/Pancreas Transplant Program Recanati/Miller Transplantation Institute
Patient Education Transplant Services. Glossary of Terms. For a kidney/pancreas transplant
Patient Education Glossary of Terms For a kidney/pancreas transplant Glossary of Terms Page 18-2 Antibody A protein substance made by the body s immune system in response to a foreign substance. Antibodies
TRANSPLANT IMMUNOLOGY. Shiv Pillai Ragon Institute of MGH, MIT and Harvard
TRANSPLANT IMMUNOLOGY Shiv Pillai Ragon Institute of MGH, MIT and Harvard Outline MHC / HLA Direct vs indirect allorecognition Alloreactive cells: where do they come from? Rejection and Immunosuppression
Quantification of the Early Risk of Death in Elderly Kidney Transplant Recipients
Wiley Periodicals Inc. C Copyright 2012 The American Society of Transplantation and the American Society of Transplant Surgeons Quantification of the Early Risk of Death in Elderly Kidney Transplant Recipients
The New Kidney Allocation Policy: Implications for Your Patients and Your Practice
The New Kidney Allocation Policy: Implications for Your Patients and Your Practice Clinical Practice Today CME Co-provided by Learning Objectives Upon completion, participants should be able to: Explain
Are two better than one?
Are two better than one? Disclosures Ryutaro Hirose, MD Professor in Clinical Surgery University of California, San Francisco I have no relevant disclosures related to this presentation The PROBLEM There
UEMS & EBS: DIVISION OF TRANSPLANT SURGERY
CURRICULUM AND SYLLABUS TRANSPLANTATION Module 1: Multi-organ retrieval Ability to evaluate donor suitability Ability to retrieve abdominal organs for transplantation Evaluation of donor/ organs suitability
NAPRTCS Annual Transplant Report
North American Pediatric Renal Trials and Collaborative Studies NAPRTCS 2010 Annual Transplant Report This is a privileged communication not for publication. TABLE OF CONTENTS PAGE I INTRODUCTION 1 II
Transplantation in Australia and New Zealand
Transplantation in Australia and New Zealand Matthew D. Jose MBBS (Adel), FRACP, FASN, PhD (Monash), AFRACMA Professor of Medicine, UTAS Renal Physician, Royal Hobart Hospital Overview CKD in Australia
NAPRTCS Annual Transplant Report
North American Pediatric Renal Trials and Collaborative Studies NAPRTCS 2014 Annual Transplant Report This is a privileged communication not for publication. TABLE OF CONTENTS PAGE II TRANSPLANTATION Section
To watch a videotaped interview with this patient, visit clevelandclinic.org/transplant. clevelandclinic.org/transplant
SHARI MOSLEY KIDNEY TRANSPL ANT RECIPIENT Now that I have the transplant, I ve been given back my freedom. Shari Mosley, 23, Woodmere, Ohio. Seven years and one day after starting dialysis three times
A POTENTIAL EXPANSION OF THERAPEUTIC APHERESIS UTILIZATION
THE NEW KIDNEY ALLOCATION SYSTEM: A POTENTIAL EXPANSION OF THERAPEUTIC APHERESIS UTILIZATION Paul Warner, PhD, D(ABHI) Director, HLA/Immunogenetics Laboratory Bloodworks Northwest Seattle, Washington Disclosure
CTS Collaborative Transplant Study
CTS Collaborative Transplant Study Newsletter 3:22 October 1, 22 The CTS website has received a face lift. The new layout is modern and fresh. In addition, when analyzing your own center's results, you
Older Living Kidney Donors and Recipients. Charles Le University of Colorado 6/24/11
Older Living Kidney Donors and Recipients Charles Le University of Colorado 6/24/11 Clinical Scenario HPI: 60 y/o healthy AAM with h/o CKD5 on HD x 2 yrs 2/2 HTN, was evaluated in transplant clinic for
Immunopathology of T cell mediated rejection
Immunopathology of T cell mediated rejection Ibrahim Batal MD Columbia University College of Physicians & Surgeons New York, NY, USA Overview Pathophysiology and grading of TCMR TCMR is still a significant
Intravenous immunoglobulin in BK virus nephropathy
Washington University School of Medicine Digital Commons@Becker Open Access Publications 2014 Intravenous immunoglobulin in BK virus nephropathy Elizabeth I. Anyaegbu Driscoll Children's Hospital Stanley
Chapter 6: Transplantation
Chapter 6: Transplantation Introduction During calendar year 2012, 17,305 kidney transplants, including kidney-alone and kidney plus at least one additional organ, were performed in the United States.
Better than Google- Click on Immunosuppression Renal Transplant. David Landsberg Oct
Better than Google- Click on Immunosuppression Renal Transplant David Landsberg Oct 3 2008 OUTLINE History of Immunosuppression Trends in Immunosupression FK vs CYA Steroid Minimization CNI Avoidance Sirolimus