Results suggest that once-daily LCPT in de novo kidney transplantation has comparable efficacy and safety profile to that of IR-Tac. Lower TDD reflects LCPT's improved bioavailability and absorption.

Transplantation substantially increases all types of cataract, and is highly prevalent by slit lamp examination. High-risk patients are older and diabetic, and received hemodialysis and pulse corticosteroid therapy. In contrast to older studies using high-dose corticosteroid and azathioprine, the pattern of cataract in the cyclosporine era is different with broader cataract types, a weaker association with corticosteroids and a progressive course. Regular screening of visual acuity and appropriate surgery for posterior subcapsular or severe cataract are recommended.

BackgroundTofacitinib is an oral Janus kinase inhibitor. This open-label, long-term extension (LTE) study (NCT00658359) evaluated long-term tofacitinib treatment in stable kidney transplant recipients (n = 178) posttransplant.MethodsPatients who completed 12 months of cyclosporine (CsA) or tofacitinib treatment in the phase IIb parent study (NCT00483756) were enrolled into this LTE study, evaluating long-term tofacitinib treatment over months 12 to 72 posttransplant. Patients were analyzed by tofacitinib less-intensive (LI) or more-intensive (MI) regimens received in the parent study. For both groups, tofacitinib dose was reduced from 10 to 5 mg twice daily by 6 months into the LTE. Patients were followed up through month 72 posttransplant, with a focus on month 36 results.ResultsTofacitinib demonstrated similar 36-month patient and graft survival rates to CsA. Biopsy-proven acute rejection rates at month 36 were 11.2% for CsA, versus 10.0% and 7.4% (both P > 0.05) for tofacitinib LI and MI, respectively. Least squares mean estimated glomerular filtration rates were 9 to 15 mL/min per 1.73 m2 higher for tofacitinib versus CsA at month 36. The proportions of patients with grade 2/3 interstitial fibrosis and tubular atrophy in month 36 protocol biopsies were 20.0% for LI and 18.2% for MI (both P > 0.05) versus 33.3% for CsA. Kaplan-Meier cumulative serious infection rates at month 36 were numerically higher for tofacitinib LI (43.9%; P = 0.45) and significantly higher for MI (55.9%; P < 0.05) versus CsA (37.1%).ConclusionsLong-term tofacitinib continued to be effective in preventing renal allograft acute rejection and preserving renal function. However, long-term tofacitinib and mycophenolic acid product combination was associated with persistent serious infection risk.

Local administration of CTLA4-fusion protein with mutated (non-functional) immunoglobulin domains or systemic administration of anti-CD28 monoclonal antibody can prolong corneal allograft survival in the rat.

Cuse 2: A 33-year-old Thai female had a long history of SIB dating back to the age of ten years, manifest by arthritis, skin rash, focal proliferative lupus nephritis, cutaneous vasculitis, recurrent thrombocytopenia, Aust NZ J Med 2000; 30 WALLMAN ET AL.

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Screening for polyoma BK virus (BK) using nucleic testing (NAT) is recommended for kidney and kidney-pancreas transplant recipients, but the performance characteristics of quantitative BK NAT at different thresholds of plasma BK viral loads are unclear. We aim to evaluate the diagnostic accuracy of quantitative BK NAT as an add-on test to qualitative polyoma NAT for the diagnosis of BK virus-associated nephropathy (BKVAN) in kidney and kidney transplant recipients. We calculated the test sensitivity, specificity, and predictive values at the different thresholds of plasma BK viral load for BKVAN. At the recommended threshold of >1 × 10(3) serum BK copies/mL serum for test positivity, the sensitivity for BKVAN was 92.9% (95% confidence intervals [CI]: 66.1-99.8) and specificity 79.1% (95%: CI 67.4-88.1), with corresponding positive and negative predictive values of 42.0% (95% CI: 24.8-57.7%) and 98.6% (95% CI: 98.3-99.9%), respectively. The overall area under curve for the quantitative BK NAT was 0.92 (95% CI: 0.85-0.97). Quantitative BK NAT displays properties of high sensitivity and specificity that are fit for purpose as an add-on test to qualitative polyomavirus NAT for kidney and kidney-pancreas transplant recipients at risk of BKVAN.

ABSTRACT:Positive B cell crossmatch accompanied by high levels of pre-transplant human leukocyte antigen donor-specific antibodies are associated with adverse graft outcomes in kidney transplant recipients. Targeting plasma cells, the main antibody producing cells, with the proteasome inhibitor bortezomib may be a promising desensitization strategy. We report using a combination of bortezomib and plasmapheresis to desensitize a highly sensitized kidney transplant recipient for an ABO-incompatible living donor kidney transplant. The flow cytometric B cell crossmatch was positive on presentation. After treatment, the anti-A titres fell from 1:64 to 1:4, and a negative B flow cytometric crossmatch was achieved prior to transplantation. The combined approach of bortezomib to abrogate antibody production at the plasma cell level, followed by plasmapheresis and low-dose intravenous immunoglobulin to remove in-circulation alloantibodies, has proven to be effective in our case. Bortezomib may play a role in highly sensitized renal transplants.Kidney transplantation is the optimal mode of renal replacement therapy, offering better quality of life and survival advantage compared with chronic dialysis.1,2 There is an increasing disparity between the growing demand for kidney allografts worldwide and available donors. ABO incompatibility and HLA sensitization are the two main barriers to achieving successful transplantation, especially among the highly sensitized population, particularly patients seeking a repeat kidney transplant. 3,4 Various integrated approaches to desensitization are currently available, such as plasmapheresis (PP), intravenous immunoglobulin (IVIg; low and high dose) with or without rituximab, and immunoadsorption (IA)-based regimens [5][6][7] . The optimal desensitization protocol remains unproven, and new agents continue to be explored. The proteasome inhibitor bortezomib presents as one such promising therapy. CASE REPORTA 36 year-old man from regional New South Wales with end-stage kidney disease secondary to reflux nephropathy received a first HLA-identical kidney transplant from his brother in 2007. Despite optimal compliance, suitable matching and good early function, he developed antibodymediated rejection at 1 year post-transplant and subsequent graft failure necessitating return to peritoneal dialysis in 2011. Six months later, he was transitioned to haemodialysis and graft nephrectomy performed.Following this, the prospect of an ABO-incompatible transplant from his wife (A1 to O blood group) was explored. Repeated flow B cytometric crossmatches were found to be positive without the presence of auto-antibodies or HLA donor-specific antibodies. The search for antibodies to non-HLA polymorphic antigens was initiated, and antiangiotensin ii type-1 receptor (AT1R) antibodies and antiendothelin receptor-A antibodies were found at a titre of 23.4 U/mL (<10.0 U/mL) and 30.3 U/mL (<10.0 U/mL), respectively. Desensitization protocol and immunosuppressionThe initial desensitization protocol consisted o...