All Rights Reserved. No part of the contents of this document may be reproduced or transmitted in any form or by any means without the written permission of the publisher. 4 Standard Guidance A. General Provisions A.1 Basis and Scope A.1.1 This document sets forth the conditions that a laboratory must satisfy in order to be accredited by the American Society for Histocompatibility and Immunogenetics (ASHI) to perform testing on human specimens. These Standards have been established by the ASHI Quality Assurance and Standards Committee following review, and response to, public comments. These Standards have been approved by the ASHI Board of Directors. These Standards have been established to help ensure accurate and dependable immunogenetics, histocompatibility, and transplantation testing consistent with the current state of wellestablished laboratory procedures. A.1.2 All laboratories requesting ASHI accreditation must meet the same requirements, regardless of their location in the U.S. or a foreign country and regardless of whether or not they are using ASHI accreditation for compliance with CLIA regulations. Re: A.1.2-Certain rare cases in which Standards are indicated to apply only to UNOS laboratories or only to U.S. Laboratories (e.g., the requirement to include the FDA disclaimer on reports) are exceptions to Standard A.1.2 A.2 Abbreviations ARB Accreditation Review Board ASHI The American Society for Histocompatibility and Immunogenetics. CDC Centers for Disease Control and Prevention CFR US Code of Federal Regulations CLIA Clinical Laboratory Improvement Amendments of 1988. CLIA regulations are defined in 42 CFR 493. CMS US Centers for Medicare and Medicaid Services CPRA Calculated Panel Reactive Antibody CREG Cross Reactive Group DNA Deoxyribonucleic acid EFI European Federation for Immunogenetics ELISA Enzyme-linked immunosorbent assay
These trends suggest improvements in CVS risk management and outcomes in the kidney transplant population in Australia and New Zealand.
Hepatitis C virus (HCV) infection is present in 2-50% of renal transplant recipients and patients receiving hemodialysis. Renal transplantation confers an overall survival benefit in HCV positive (HCV+) hemodialysis patients, with similar 5-year patient and graft survival to those without HCV infection. However, longer-term studies have reported increased liver-related mortality in HCV-infected recipients. Unfortunately, attempts to eradicate HCV infection before transplant have been disappointing. Interferon is poorly tolerated in-patients with end-stage renal disease and ribavirin is contraindicated because reduced renal clearance results in severe hemolysis. Antiviral therapy following renal transplantation is also poorly tolerated, because of interferon-induced rejection and graft loss. Although the prevalence of hepatitis B virus (HBV) infection has declined in hemodialysis patients and renal transplant recipients since the introduction of routine vaccination and other infection control measures, it remains high within countries with endemic HBV infection (especially Asia-Pacific and Africa). Renal transplantation is associated with reduced survival in HBsAg+ hemodialysis patients. Unlike interferon, lamivudine is a safe and effective antiviral HBV treatment both before and after renal transplantation. Lamivudine therapy commenced at transplantation should prevent early posttransplant reactivation and subsequent progression to cirrhosis and late liver failure. This preemptive therapy should also eradicate early liver failure from fibrosing cholestatic hepatitis. Because cessation of treatment may lead to severe lamivudine-withdrawal hepatitis, most patients require long-term therapy. The development of lamivudine-resistance will be accelerated by immunosuppression and may result in severe hepatitis flares with decompensation. Regular monitoring with liver function tests and HBV DNA measurements should enable early detection and rescue with adefovir. Chronic HCV and HBV infections are important causes of morbidity and mortality in renal transplant recipients. The best predictor for liver mortality is advanced liver disease at the time of transplant, and liver biopsy should be considered in all potential HBsAg+ or HCV+ renal transplant candidates without clinical or radiologic evidence of cirrhosis. Established cirrhosis with active viral infection should be considered a relative contraindication to isolated renal transplantation.
PPI are now the most commonly identified cause of AIN in the Auckland area. Recovery occurs after withdrawal of the drug but is often incomplete. Early diagnosis may be facilitated by clinician awareness of the insidious onset of renal failure, and an elevated erythrocyte sedimentation rate and C-reactive protein.
The conference agenda, discussion questions, and plenary session presentations are available on the KDIGO website: https://kdigo.org/ conferences/controversies-conference-on-coronary-artery-valvulardisease/. 18 THM and MJS are primary co-authors.
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