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doi:10.6002/ect.2016.0030

Cited by 15 publications

(21 citation statements)

References 69 publications

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“…7 Therefore, as disease distribution, population demographics, disease treatments, and transplant protocols change over time, one can reason that infection rates following kidney transplantation will as well. Although a number of studies have recently assessed specific post-transplant infections, 8 - 13 few recent studies have evaluated overall infection rates in kidney transplant patients. 14 , 15 …”

Section: Introductionmentioning

confidence: 99%

Incidence Rate of Post-Kidney Transplant Infection: A Retrospective Cohort Study Examining Infection Rates at a Large Canadian Multicenter Tertiary-Care Facility

Cowan

Bennett

Fergusson

et al. 2018

Can J Kidney Health Dis

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Background:Reducing post-operative infections among kidney transplant patients is critical to improve long-term outcomes. With shifting disease demographics and implementation of new transplantation protocols, frequent evaluation of infection rate and type is necessary.Objective:Our objectives were to assess the incidence and types of post-operative infections in kidney transplant recipients at a large tertiary-care facility and determine sample sizes needed for future intervention trials.Design:Retrospective cohort study.Setting:The Ottawa Hospital, Ottawa, Ontario.Patients:Adult kidney transplant patients, N = 142.Measurements:Demographic data, transplant protocol, infections up to 2 years following transplantation.Methods:Infections within 2 years following transplantation in all kidney transplant recipients between January 2011 and December 2012 were reviewed. Sample sizes were determined using all-cause infection rates and infection-free survival data.Results:Of 142 patients, 44 (31.0%) had at least one infection. The incidence of infection was 36.2 per 100 patient-years by 2 years post-transplant. A total of 32 (22.5%) patients had 56 infection-related hospitalizations with 73.2% occurring in the first year. In the first 2 years, urinary tract infections had the highest incidence (18.1 per 100 patient-years) followed by skin (3.9 per 100 patient-years), cytomegalovirus (3.9 per 100 patient-years), and bacteremia (3.9 per 100 patient-years). Results indicate that 206 patients per study arm would be needed to show a 30% reduction in the 2-year incidence of infection post-transplantation.Limitations:Infection rates may be slightly underestimated due to the relatively short 2-year follow-up; however, the highest infection-risk period was captured within this time frame.Conclusions:Infections post-kidney transplant are still common, particularly urinary tract infections. They are associated with significant morbidity and hospitalization. Given the feasible sample sizes calculated in this study, intervention trials are indicated to further reduce infection rates within the first 2 years post-kidney transplantation.

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Section: Introductionmentioning

confidence: 99%

Incidence Rate of Post-Kidney Transplant Infection: A Retrospective Cohort Study Examining Infection Rates at a Large Canadian Multicenter Tertiary-Care Facility

Cowan

Bennett

Fergusson

et al. 2018

Can J Kidney Health Dis

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“…Risk factors for BKV infection include increased age of both the recipient and donor, male recipient, receiving a kidney from a female donor, placement of ureteral stents, human leukocyte antigen mismatch, and a history of rejection. 14 - 16 There was a significant difference in the mean age of the recipients in this study, and being an elderly recipient was a risk factor for BKV infection. Although no significant difference was found between the 2 groups in terms of male recipient as a risk factor for BKV infection, more than half of the subjects in each group were male recipients; thus, male recipient as a potential risk factor for BKV infection should be kept in mind.…”

Section: Discussionmentioning

confidence: 61%

Prediction of Early BK Virus Infection in Kidney Transplant Recipients by the Number of Cells With Intranuclear Inclusion Bodies (Decoy Cells)

Yamada

Tsuchiya

Inagaki

et al. 2018

Transplantation Direct

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BackgroundBK virus (BKV) is the cause of nephropathy. Because BKV nephropathy can progress to graft loss, early diagnosis of BKV infection is very important. In this study, we aimed to investigate the utility of quantifying cells with intranuclear inclusion bodies (decoy cells) in urinary sediment for the screening and monitoring of BKV infection in renal transplant recipients at our hospital.MethodsThis was a retrospective single-center study. Urine sediment examination was performed at each outpatient visit, and the number of decoy cells was measured in the whole microscopic field. Patients (n = 41) were divided into the BK viremia group (blood positive for BKV DNA by polymerase chain reaction [PCR]) and non-BK viremia group (blood negative for BKV DNA by PCR), and the decoy cell count in urinary sediments was examined.ResultsThe maximum decoy cell count was significantly higher (P = 0.04) in the BK viremia group than in the non-BK viremia group. In the receiver operating characteristic curve for the maximum decoy cells, the cutoff value was 507 cells. The area under the receiver operating characteristic curve was 0.8774 (95% confidence interval, 0.7739-0.9810). The number of decoy cells at the time of appearance in the BK viremia group was not significantly different from that in the non-BK viremia group. However, the BK viremia group showed an increasing trend, whereas the non-BK viremia group showed a decreasing trend, in the number of decoy cells. There was a positive correlation between the number of decoy cells and the data from the urine BKV-DNA PCR quantification (correlation coefficient [r] = 0.74).ConclusionsMeasurement of decoy cells in urinary sediments may predict early BKV infection, and if performed quickly, it may be useful for screening and continuous monitoring of BKV infection in renal transplant recipients.

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“…Persistently high levels of BKV DNA in plasma (i.e., >4 log10 copies/mL for more than 4 weeks) are considered for a presumptive diagnosis of PVAN in kidney transplant patients [ 20 ]; however, the definitive diagnosis is made by histological evaluation of renal allograft biopsy, confirmed by immunohistochemistry or in situ hybridization [ 4 , 13 ]. In the occurrence of high levels of BKV DNA on plasma specimens followed by renal function abnormalities, biopsy is performed for evaluation and staging of PVAN.…”

Section: Methodsmentioning

confidence: 99%

“…Following the results of the biopsies, immunosuppressant agents dosages were modified in order to reduce the effect of PVAN, in particular a common initial approach consisted into the reduction of the calcineurin inhibitor dose by 25% to 50% with target tacrolimus trough levels <6 ng/mL or cyclosporine levels <150 ng/mL. This was followed by a dose reduction of the antiproliferative agent by 50% followed by its discontinuation, depending on the response [20]. All the details of changes in therapy after the first biopsy are reported in Table 4.…”

Section: Patientsmentioning

confidence: 99%

Renal Allograft Biopsies with Polyomavirus BK Nephropathy: Turin Transplant Center, 2015–19

Zanotto¹,

Allesina

Barreca

et al. 2020

Viruses

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Background: In kidney transplant patients, polyomavirus-associated nephropathy (PVAN) represents a serious complication; the key factor for the development of PVAN is immunosuppression level and modulation of anti-rejection treatment represents the first line of intervention. Allograft biopsy and histology remain the criterion standard for diagnosing PVAN. Methods: All consecutive renal biopsies with the diagnosis of PVAN carried out at the University Hospital City of Health and Science of Turin over a five-years period were studied. Renal allograft biopsy was performed due to renal function alterations associated to medium-high polyomavirus BK (BKV)-DNA levels on plasma specimen. Results: A total of 21 patients underwent a first biopsy to diagnose a possible BKV nephropathy, in 18, a second biopsy was made, in eight, a third biopsy, and finally, three underwent the fourth renal biopsy; following the results of each biopsies, immunosuppressant agents dosages were modified in order to reduce the effect of PVAN. Conclusions: In this study, the clinical and histological features of 21 kidney transplant recipients with BKV reactivation and development of PVAN are described. To date, the only treatment for PVAN consists in the reduction of immunosuppressive agents, constantly monitoring viral load.

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Cited by 15 publications

References 69 publications

Incidence Rate of Post-Kidney Transplant Infection: A Retrospective Cohort Study Examining Infection Rates at a Large Canadian Multicenter Tertiary-Care Facility

Incidence Rate of Post-Kidney Transplant Infection: A Retrospective Cohort Study Examining Infection Rates at a Large Canadian Multicenter Tertiary-Care Facility

Prediction of Early BK Virus Infection in Kidney Transplant Recipients by the Number of Cells With Intranuclear Inclusion Bodies (Decoy Cells)

Renal Allograft Biopsies with Polyomavirus BK Nephropathy: Turin Transplant Center, 2015–19

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