Canadian Society of Transplantation and Canadian Society of Nephrology Commentary on the 2009 KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients

Knoll, Greg; Blydt-Hansen, Tom; Campbell, Patricia; Cantarovich, Marcelo; Cole, Edward; Fairhead, Todd; Gill, John S.; Gourishankar, Sita; Hébert, Diane; Hodsman, Anthony B.; House, Andrew A.; Humar, Atul; Karpinski, Martin; Kim, S. Joseph; Mainra, Rahul; Prasad, G. V. Ramesh

doi:10.1053/j.ajkd.2010.05.004

Cited by 46 publications

(34 citation statements)

References 66 publications

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“…Additional factors to consider in this patient group are immunosuppression therapy and the implication for other organs from the index donor. Screening is not recommended for renal cell carcinoma [12] *Endorsed by the Canadian Society of Transplantation [13] and European Renal Best Practice [14] Guidelines from both the European Association of Urologists and the American Urological Association recommend radiological work-up of any renal mass with cross-sectional, multiphasic contrast-enhanced imaging with CT or MRI [22,23]. Depending on the time interval between transplantation and detection of the renal mass, thoracic imaging should be considered to assess for evidence of metastatic spread, while bone and brain imaging reserved for cases with clinical suspicion of disease at these sites.…”

Section: Identification Post-transplantmentioning

confidence: 99%

Management of Renal Cell Carcinoma and Other Renal Masses in the Kidney Graft

Warren

Olsburgh

2020

Curr Urol Rep

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Purpose of Review Renal masses in the kidney graft pose an important clinical dilemma, balancing graft function against the need for cancer control. Recent Findings Donor origin cancers in the renal graft can be classified as 'donor transmitted' or 'donor derived'. The landmark TracerX Renal changed our understanding of renal cell carcinoma oncogenesis, demonstrating that key mutations in childhood lead to clinically apparent tumours in later life. Identified pre-operatively, contemporary evidence suggests that masses excised prior to transplantation result in acceptable oncologic safety and graft function. Identified post-operatively management mirrors that for a mass in a solitary kidney in the non-transplant population, with focus on a nephron-sparing approach. Summary With growing number of kidney transplants each year, ageing donors, and increasing graft survival, masses in the renal graft are likely to become a more prevalent clinical conundrum.

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Section: Identification Post-transplantmentioning

confidence: 99%

Management of Renal Cell Carcinoma and Other Renal Masses in the Kidney Graft

Warren

Olsburgh

2020

Curr Urol Rep

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“…Meanwhile, for patients with PJP, KDIGO recommends reducing the amount of immunosuppressive medications. 12,13 Nevertheless, optimal timing and quantity of dosage reduction are unknown and deserve investigation.…”

Section: Introductionmentioning

confidence: 99%

Aggressive Immunosuppressant Reduction and Long-Term Rejection Risk in Renal Transplant Recipients with Pneumocystis jiroveci Pneumonia

Yang¹,

Shih²,

Wu³

et al. 2012

Exp Clin Transplant

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Objectives: Pneumocystis jiroveci pneumonia is a rare but lethal complication in renal transplant recipients. Dose reduction of immunosuppressive agents in such situations is recommended, but its quantity and safety are unclear. Materials and Methods: From January 2001 to January 2011, twenty of one thousand forty-six renal transplant recipients in a single center developed Pneumocystis jiroveci pneumonia, which was diagnosed by the Giemsa and Gomori methenamine silver stains from a specimen of bronchoalveolar lavage. Results: We found that timing of the first immunosuppressant reduction of the Pneumocystis jiroveci pneumonia survivor (mean, 1.4 days after admission) was significantly earlier than that of the deceased patient (mean, 5.1 days after admission). Logistic regression analysis indicated that for those whose immunosuppressants were reduced more aggressively (either 1 of the immunosuppressants was reduced by more than 50% within 2 days of hospitalization) were significantly more likely to survive (mortality risk, OR, 0.074 [95% CI, 0.01-0.84]; P = .035). In addition, none of the survivors developed acute rejection or allograft necrosis during a mean follow-up of 2 years. Conclusions: Dosage reduction of immunosuppressive agents in renal transplant recipients with Pneumocystis jiroveci pneumonia should be prompt and sufficient. Aggressive immunosuppressant dosage reduction is safe in such circumstance and is associated with minimal risk of in-hospital and long-term acute allograft rejection.

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“…According to the Kidney Disease Improving Global Outcomes (KDIGO) 2008, steroids may be withdrawn the first week after transplantation, which helps to minimize adverse effects without affecting graft survival. Candidate patients for this procedure are those of low immunological risk and need to have received an induction therapy [38]. Grenda recently performed a metaanalysis of available studies of steroid minimizing or steroid withdrawal in pediatric transplantation immunosuppressive protocols.…”

Section: Treatment Of Growth Failure In Ckdmentioning

confidence: 99%

Growth Retardation in Children with Kidney Disease

Salas¹,

Pinto²,

Rodríguez

et al. 2013

International Journal of Endocrinology

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Growth failure is almost inextricably linked with chronic kidney disease (CKD) and end-stage renal disease (ESRD). Growth failure in CKD has been associated with both increased morbidity and mortality. Growth failure in the setting of kidney disease is multifactorial and is related to poor nutritional status as well as comorbidities, such as anemia, bone and mineral disorders, and alterations in hormonal responses, as well as to aspects of treatment such as steroid exposure. This review covers updated management of growth failure in these children including adequate nutrition, treatment of metabolic alterations, and early administration of recombinant human growth hormone (GH).

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Canadian Society of Transplantation and Canadian Society of Nephrology Commentary on the 2009 KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients

Cited by 46 publications

References 66 publications

Management of Renal Cell Carcinoma and Other Renal Masses in the Kidney Graft

Management of Renal Cell Carcinoma and Other Renal Masses in the Kidney Graft

Aggressive Immunosuppressant Reduction and Long-Term Rejection Risk in Renal Transplant Recipients with Pneumocystis jiroveci Pneumonia

Growth Retardation in Children with Kidney Disease

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