Daily Blog from the ATC’s Meetings in San Diego, CA

Day 3

Progression of Renal Failure in Transplant Patients with a Cockcroft Clearance Less Than 50 ml/min
Attenuates the Association of Severity of Anemia with Worse Quality of Life
Authors: Francisco Ortega, P. Rebollo, M. A. Gentil, J. M. Campistol, G. Villa, M. Arias
Blogger: Karen Parker, RN BSN

In kidney transplant patients with an eGFR < 50 ml/min/1.73m2, heath related quality of life is worse as severity of anemia increases, but as renal failure progresses the differences according to the level of anemia are attenuated.

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Day 2

When Asking Too Much Leaves Too Little: An Analysis of Obese Living Kidney Donors To Assess Risk of
Hypertension and Adverse Renal Outcomes at a Single Institution

Authors: Matthew Cooper, Rolf Barth, Abdolreza Haririan, Stephen Jacobs, David Klassen, Matthew Weir,
Stephen Bartlett, Joseph Nogueira

Blogger: Karen Parker, RN BSN

Obese living kidney donors experience a modest drop in MDRD-eGFR post-donation and a substantial incidence of hypertension and nearly half have a MDRD-eGFR of less than 60. Further study is needed to assess long-term risks.

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Halted Living Kidney Donors. A Retrospective Analysis of Medical and Social Reasons (Poster)
Authors: Sarat Kuppachi, Sammy Mugambi, Lucia Miles, M. Francesca Egidi (Medical University of South Carolina)
Blogger: Karen Parker, RN BSN

An unexpected number of potential living donors had medical conditions that precluded organ donation. Hypertension: 48% were African-American, BMI > 35: 76 % were AA, Inadequate evaluation of living donors prior to donation might subject donors to an increased risk of renal dysfunction.

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Pregnancy Outcomes after Live Donor vs. Deceased Donor Kidney Transplantation
Presenters: Serban Constantinescu, et al, (Temple University)
Blogger: Karen Parker, RN BSN

There were no significant differences in pregnancy outcomes in living donor or deceased donor kidney transplant recipients. There was a higher creatinine in living donors before and after pregnancy and the high incidences of hypertension, pre-eclampsia, and infection during transplantation underscore the high risk nature of pregnancy in both groups.

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Should the Incarcerated Be Considered for Renal Transplantation? (Poster)
Authors: Harpreet, Bhutani, et al, Buffalo, NY
Blogger: Karen Parker, RN BSN

The average waiting period on the UNOS list for all patients was 35.3 months. Incarcerated patients met the SRTR standards for graft and patient survival. Renal transplant appears to be a viable option in incarcerated patients; it improves their Quality of Life, is cost effective, and should help released prisoners resume a productive role in society.

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Compliance to immunosuppressives in Renal Transplantation – Case of Tacrolimus and Sirolimus (Poster)
Authors: Clara Sequerira, Coimbra, Portugal
Blogger: Karen Parker, RN BSN

Compliance to study drugs, clinical events and self-perceived quality-of-life were comparable in the two study groups; they weren’t related specifically to any of the two immunosuppressive agents.

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Day 1

Desensitization Protocols
Presenter: Lynette Fix, BAN
Blogger: Karen Parker, RN

Many patients have panel reactive antibodies (PRA’s) of 60-80% due to pregnancies, transfusions and previous transplants. 25% of the waiting list in the US has > 30% PRA’s. Some protocols include IVIG or IVIG and Apheresis or Bortezomib (Velcade). Donor specific antibiodies (DSA) present an even greater problem. Some studies show DSA’s of less than 7000 MFI do not indicate rejection therefore we should be monitoring for DSA’s above 7000 to prevent rejection.

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What Role is there for mTOR Inhibitors in Kidney Transplantation
Presenter: Barry Kahan, PhD, MD
Blogger: Karen Parker, RN

Dr Kahan discussed sirolimus and everolimus. He recommended everolimus with a calcineurin inhibitor for high responders and everolimus with mycophenolic acid for low responders.

He reviewed the differences in the two mTOR inhibitors. Sirolimus has a half life of 60 hours and has poor absorption. Everolimus has a half life of 28 hourrs. Everolimus levels should be 3-8 if used with a calcineurin inhibitor or 12-15 without a calcineurin inhibitor.

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Stopping Steroids: Does it Make Any Sense Yet?
Presenter: Robert Steiner, MD
Blogger: Karen Parker, RN

Dr. Steiner reviewed an old (1992) Canadian study and an Astellas study regarding the benefits of steroids in kidney transplantation. He feels we do not appreciate Prednisone and the advantages it offers our patients. He recommends we give it more respect and stop trying to discontinue it. He believes its side effect profile is minimal compared to many of the other immunosuppressive drugs we use.

Other points:

Dose Prednisone per kilogram: the same dose should not be used for a small women and very large man

5mg is not enough for everybody: we should be measuring levels of Prednisone like we do with other transplant medications.

He slammed pharma because he has been unable to get funding to study Prednisone unless he agreed to also study a particular drug along with it.

The take home message: we should pay more attention our steroid doses because it is a cheap drug with many potential benefits and he encouraged us to not dismiss it just because a drug company was not promoting it!

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