Highlights from the NASDAT Meetings in Maui, Hawaii


Update on Cytomegalovirus (CMV) in Renal Transplantation
Author: Daniel Brennan, MD
Blogger: Lakshmi Turlapati, MD (East Carolina University – Brody School of Medicine)

Dr. Dan Brennan talked about the importance of CMV infections in renal transplantation and in general population. Asymptomatic CMV increases mortality 4 yrs after transplantation with a RR of 2.6%. CMV is associated with MGUS, colorectal cancer, PTLD post transplant. He also talked in detail about the prophylactic and preemptive management of CMV infection post transplant.



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FGF 23 and its importance in CKD

Author: Myles Wolf, MD
Blogger: Lakshmi Turlapati, MD (East Carolina University – Brody School of Medicine)

Dr. Myles Wolf talked excellently about FGF 23 in detail on both first and second day. His review was outstanding. He explained the phosphate metabolism in CKD and how FGF 23 explains the whole picture. He also mentions that FGF 23 not PTH may be associated with hypophosphatemia post transplant. He also emphasizes on association of FGF 23 and mortality in CKD population and also on FGF 23 and cardiovascular disease in general population.


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Emerging Role of Inhibitors of Mammalian target of Rapamycin-Sirolimus and Everolimus

Author: Barry Kahan, MD
Blogger: Lakshmi Turlapati, MD (East Carolina University – Brody School of Medicine)

Dr. Kahan gave an excellent review on Rapamycin. He covered drug mechanisms, conversion to RAPA and management of proteinuria.



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The Kidney in solid organ transplantation
Author: Wadi N. Suki, MD
Blogger: Lakshmi Turlapati, MD (East Carolina University – Brody School of Medicine)

Dr. Suki talked about organ allocation in solid organ transplantation. He indicated that Liver first and Kidney later might be better approach than combined liver-kidney transplantation.



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Potential therapeutic approaches to Intracellular activation cascades
Author: Barry D. Kahan, MD
Blogger: Lakshmi Turlapati, MD (East Carolina University – Brody School of Medicine)

Dr. Kahan gave an excellent review of various intracellular targets of immunosuppressive agents in transplantation. He covered various drugs, mechanisms, use etc. Interestingly cumin, a spice use in Indian cooking has curcumin with immunosuppressive properties.



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Kidney and Pancreas transplantation
Author: Tariq Shah, MD
Blogger: Lakshmi Turlapati, MD (East Carolina University – Brody School of Medicine)

Dr. Shah talked about combined pancreas-kidney transplantation vs pancreas after kidney transplantation. He concluded that we need more research to ascertain which approach is better.



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Brief review of Immunosuppressive agents in renal transplantation
Author: Tariq Shah, MD
Blogger: Lakshmi Turlapati, MD (East Carolina University – Brody School of Medicine)

Dr. Shah gave a review of history of immunosuppresion. He then talked in detail about mycophenolate and tacrolimus. MPA dose reduction for GI side effects associated with increased risk of rejection and annual increase in graft loss.



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PPAR Gamma Agonists and Kidney scarring
Author: Agnes Fogo, MD
Blogger: Lakshmi Turlapati, MD (East Carolina University – Brody School of Medicine)

Dr. Fogo talked about PPAR gamma being present in injured podocytes in glomerulosclerosis and that pioglitazone protects aging related renal injury in rats.



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Phosphorus control in CKD and ESRD
Author: Wadi Suki, MD
Blogger: Lakshmi Turlapati, MD (East Carolina University – Brody School of Medicine)

Dr. Suki gave an excellent review on importance of phosphorus control in CKD and ESRD population. High phosphorus linked to increased risk of death in CKD, ESRD and CAD population. He indicated that use of non-calcium based binders may improve cardiovascular mortality as high calcium also may increase vascular calcification.



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Genetic diseases in renal transplantation
Author: Tariq Shah, MD
Blogger: Lakshmi Turlapati, MD (East Carolina University – Brody School of Medicine)

Dr. Shah gave a detailed review of Fabry’s disease. Though post renal transplant survival is good, Enzyme replacement therapy may improve quality of life and may improve other symptoms of the disease namely cardiovascular and neurological.



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The Myth of Bioequivalence
Author: Hal Helderman, MD
Blogger: Lakshmi Turlapati, MD (East Carolina University – Brody School of Medicine)

Dr. Helderman talked about that use of generic drugs in renal transplantation. He suggested that bioequivalence doesn’t mean therapeutic equivalence. Switching to generic drugs will need much closer monitoring of patients.


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