Publications by authors named "Giselle Guerra"

52 Publications

Perioperative risk factors associated with delayed graft function following deceased donor kidney transplantation: A retrospective, single center study.

World J Transplant 2021 Apr;11(4):114-128

Department of Anesthesiology, University of Miami/Jackson Memorial Hospital, Miami, FL 33136, United States.

Background: There is an abundant need to increase the availability of deceased donor kidney transplantation (DDKT) to address the high incidence of kidney failure. Challenges exist in the utilization of higher risk donor organs into what appears to be increasingly complex recipients; thus the identification of modifiable risk factors associated with poor outcomes is paramount.

Aim: To identify risk factors associated with delayed graft function (DGF).

Methods: Consecutive adults undergoing DDKT between January 2016 and July 2017 were identified with a study population of 294 patients. The primary outcome was the occurrence of DGF.

Results: The incidence of DGF was 27%. Under logistic regression, eight independent risk factors for DGF were identified including recipient body mass index ≥ 30 kg/m, baseline mean arterial pressure < 110 mmHg, intraoperative phenylephrine administration, cold storage time ≥ 16 h, donation after cardiac death, donor history of coronary artery disease, donor terminal creatinine ≥ 1.9 mg/dL, and a hypothermic machine perfusion (HMP) pump resistance ≥ 0.23 mmHg/mL/min.

Conclusion: We delineate the association between DGF and recipient characteristics of pre-induction mean arterial pressure below 110 mmHg, metabolic syndrome, donor-specific risk factors, HMP pump parameters, and intraoperative use of phenylephrine.
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http://dx.doi.org/10.5500/wjt.v11.i4.114DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8058644PMC
April 2021

Efficacy and Safety of Once-Daily LCP-Tacrolimus Versus Twice-Daily Immediate-Release Tacrolimus in Adult Hispanic Stable Kidney Transplant Recipients: Sub-Group Analysis from a Phase 3 Trial.

Ann Transplant 2021 Apr 16;26:e929535. Epub 2021 Apr 16.

Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.

BACKGROUND The pharmacokinetics and metabolism of tacrolimus, an immunosuppressant commonly used to prevent transplant rejection, can differ in specific subpopulations. This analysis examined treatment outcomes and safety of immediate-release tacrolimus (IR-Tac) and LCP-tacrolimus (LCPT) in stable Hispanic kidney transplant recipients. MATERIAL AND METHODS This was a post hoc analysis of clinical trial data from Hispanic adult stable kidney transplant recipients randomized to remain on IR-Tac or convert from IR-Tac to a reduced dose of LCPT (NCT00817206). Composite treatment failure was evaluated at 12 months. Estimated glomerular filtration rate and tacrolimus trough concentrations were evaluated over 12 months. RESULTS Fifty-five stable (LCPT n=26, IR-Tac n=29) kidney transplant recipients who self-identified as Hispanic or Latino were included in this analysis. Composite treatment failure occurred in 1 patient (4%) who converted to LCPT and 1 (3%) who remained on IR-Tac. The estimated glomerular filtration rate was stable over time and similar in the 2 treatment groups (P=0.08). Tacrolimus trough levels for both groups were similar over time in the 2 treatment groups (P=0.98). Treatment-emergent adverse events were similar in patients who converted to LCPT and in those who remained on IR-Tac. CONCLUSIONS Efficacy and safety were similar in Hispanic kidney transplant recipients who converted from IR-Tac to LCPT and in those remaining on IR-Tac.
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http://dx.doi.org/10.12659/AOT.929535DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8056872PMC
April 2021

Complex Surgical Reconstruction of Upper Pole Artery in Living-Donor Kidney Transplantation.

Ann Transplant 2021 Jan 15;26:e926850. Epub 2021 Jan 15.

Department of Surgery, Miami Transplant Institute, Miami, FL, USA.

BACKGROUND The use of allografts with multiple renal arteries has increased in the era of laparoscopic donor nephrectomy. Although several studies recommend reconstructing lower pole arteries (LPAs) to reduce risk of urologic complications, it is common opinion to ligate upper pole arteries (UPAs) with a diameter less than 2 mm because of increased risk of thrombosis related to their reconstruction. This retrospective study evaluates the feasibility and safety of reconstructing thin UPAs during living-donor kidney transplantation, with the goal of maintaining the integrity of the graft and assuring its maximal function. MATERIAL AND METHODS Data from 922 living-donor kidney transplants performed between 2009 and 2019 were reviewed. Six cases with UPAs were identified (0.65%). The study endpoints were incidence of allograft vascular and urologic complications, slow graft function, delayed graft function, graft failure, and graft and patient survival. RESULTS The UPAs had a mean diameter of 1.8±0.28 mm. Methods of reconstruction included: interposition graft (n=2), end-to-side anastomosis inside the renal hilum to a branch of the main renal artery (n=3), and side-to-side anastomosis with the main renal artery (n=1). Additional reconstruction of LPAs (n=2) and main renal arteries (n=2) was performed. During a median (range) follow-up of 14.5 (9-49) months no complications were observed. CONCLUSIONS Ex vivo reconstruction of UPAs with a diameter less than 2 mm is worth attempting, particularly in the setting of living-donor kidney transplantation.
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http://dx.doi.org/10.12659/AOT.926850DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7814512PMC
January 2021

COVID-19 in solid organ transplant recipients: A systematic review and meta-analysis of current literature.

Transplant Rev (Orlando) 2021 01 14;35(1):100588. Epub 2020 Nov 14.

Department of Medicine, Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, FL, USA; Miami Transplant Institute, Jackson Health System, Miami, FL, USA. Electronic address:

Severe acute respiratory virus syndrome 2 (SARS-CoV-2) has led to a worldwide pandemic. Early studies in solid organ transplant (SOT) recipients suggested a wide variety of presentations, however, there remains a paucity of robust data in this population. We conducted a systematic review and meta-analysis of SOT recipients with SARS-CoV-2 infection from January 1 t October 9, 2020. Pooled incidence of symptoms, treatments and outcomes were assessed. Two hundred and fifteen studies were included for systematic review and 60 for meta-analysis. We identified 2,772 unique SOT recipients including 1,500 kidney, 505 liver, 141 heart and 97 lung. Most common presenting symptoms were fever and cough in 70.2% and 63.8% respectively. Majority (81%) required hospital admission. Immunosuppressive medications, especially antimetabolites, were decreased in 76.2%. Hydroxychloroquine and interleukin six antagonists were administered in59.5% and 14.9% respectively, while only few patients received remdesivir and convalescent plasma. Intensive care unit admission was 29% from amongst hospitalized patients. Only few studies reported secondary infections. Overall mortality was 18.6%. Our analysis shows a high incidence of hospital admission in SOT recipients with SARS-CoV-2 infection. As management of SARS-CoV-2 continues to evolve, long-term outcomes among SOT recipients should be assessed in future studies.
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http://dx.doi.org/10.1016/j.trre.2020.100588DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7666542PMC
January 2021

Deceased donor kidney transplant in a 70-year-old Jehovah's Witness patient: to transplant or not to transplant-a case report.

Ann Transl Med 2020 Oct;8(19):1249

Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA.

While Jehovah's Witness (JW) patients refuse transfusions of blood or blood products, they are willing to accept renal allograft transplantation. We describe here a case of what we believe is the oldest (a 70-year-old) JW candidate to undergo a deceased donor kidney transplant reported in the literature. Prior to transplantation, discussions ensued amongst the multidisciplinary transplant team, weighing the potential benefits . risks of performing a kidney transplant on this patient due to her refusal (due to religion) to accept any blood transfusions or blood products combined with her advanced age and having longstanding insulin-dependent, type 2 diabetes mellitus with extensive peripheral vascular disease. Preoperatively, we believed that the odds were in favor of performing the kidney transplant safely without the need for any blood product usage. However, her post-operative course was complicated by severe anemia, which developed by post-transplant day 4. The anemia incapacitated the patient's physical and psychological state, creating medical, social and financial burdens on the patient, family, medical team and hospital. Both family and patient grew concerned about her overall condition. Blood transfusion was offered in order to improve her weakness and shortness of breath that developed due to the severe anemia, but the patient (along with her family) refused such treatment. During the 17 days of hospitalization, it was a continuous struggle between the transplant team, patient, and family for her to continue with the recovery process; at times we had even considered that performing the transplant had been a mistake. While organ transplantation can be performed safely in Jehovah's Witnesses, there are multiple factors seen in this particular case that warrant analyzing: (I) the potential use of stricter transplant exclusionary criteria, given the recipient's advanced age and preexisting co-morbidities, which likely increased her risk of developing severe anemia post-operatively, and (II) the recipient's emotional/psychological post-operative state of high anxiety, which developed while she was experiencing the severe anemia; in hindsight, her anxiety level may have been reduced if we had offered daily post-operative psychological counseling sessions. While the patient's allograft is currently doing well, we probably did not have strict enough criteria for proper selection of a JW candidate for kidney transplantation.
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http://dx.doi.org/10.21037/atm-20-3593DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7607081PMC
October 2020

Randomized trial of 3 maintenance regimens (TAC/SRL vs. TAC/MMF vs. CSA/SRL) with low-dose corticosteroids in primary kidney transplantation: 18-year results.

Clin Transplant 2020 12 11;34(12):e14123. Epub 2020 Nov 11.

Miami Transplant Institute, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA.

A randomized trial of 150 primary kidney transplant recipients, initiated in May 2000, compared tacrolimus (TAC)/sirolimus (SRL) vs. TAC/mycophenolate mofetil (MMF) vs. cyclosporine microemulsion (CSA)/SRL (N = 50/group). All patients received daclizumab induction and maintenance corticosteroids. With current median follow-up of 18 years post-transplant, biopsy-proven acute rejection (BPAR) occurred less often in TAC/MMF (26% (13/50)), vs. the TAC/SRL (36% (18/50)) and CSA/SRL (34% (17/50)) arms combined (p = .23), with statistical significance favoring TAC/MMF (p = .05) after controlling for the multivariable (Cox model) effects of recipient age, recipient race/ethnicity, and donor age. First BPAR rate was clearly more favorable for TAC/MMF after stratifying patients by having 0-1 (N = 72) vs. 2-3 (N = 78) unfavorable baseline characteristics (recipient age <50 years, African American or Hispanic recipient, and donor age ≥50 years) (p = .02). Mean estimated glomerular filtration rate (eGFR), using the CKD-EPI formula, was consistently higher for TAC/MMF, particularly after controlling for the multivariable effect of donor age, throughout the first 96 months post-transplant (p ≤ .008). These differences were translated into an observed more favorable graft failure due to immunologic cause (CAI/TG) rate for TAC/MMF (p = .06), although no significant differences in overall death-uncensored graft loss were observed. Previously reported significantly higher study drug discontinuation and requirement for antilipid therapy rates in the SRL-assigned arms were maintained over time. Overall, these results at 18 years post-transplant more definitively show that TAC/MMF should be the gold standard for achieving optimal, long-term maintenance immunosuppression in kidney transplantation.
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http://dx.doi.org/10.1111/ctr.14123DOI Listing
December 2020

Kidney transplantation during coronavirus 2019 pandemic at a large hospital in Miami.

Transpl Infect Dis 2020 Dec 2;22(6):e13416. Epub 2020 Aug 2.

Division of Infectious Disease, Department of Medicine, University of Miami Miller School of Medicine Miami, Miami, FL, USA.

Background: Coronavirus 2019 (COVID-19) pandemic has resulted in more than 350 000 deaths worldwide. The number of kidney transplants has declined during the pandemic. We describe our deceased donor kidney transplantation (DDKT) experience during the pandemic.

Methods: A retrospective study was conducted to evaluate the safety of DDKT during the COVID-19 pandemic. Multiple preventive measures were implemented. Adult patients that underwent DDKT from 3/1/20 to 4/30/20 were included. COVID-19 clinical manifestations from donors and recipients, and post-transplant outcomes (COVID-19 infections, readmissions, allograft rejection, and mortality) were obtained. The kidney transplant (KT) recipients were followed until 5/31/20.

Results: Seventy-six patients received kidneys from 57 donors. Fever, dyspnea, and cough were reported in 1, 2, and 1 donor, respectively. Thirty-eight (66.6%) donors were tested for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) prior to donation (mainly by nasopharyngeal or bronchoalveolar lavage polymerase chain reaction [PCR]) and 36 (47.3%) KT recipients were tested at the time of DDKT by nasopharyngeal PCR; all of these were negative. Our recipients were followed for a median of 63 (range: 33-91) days. A total of 42 (55.3%) recipients were tested post-transplant for SARS-CoV2 by nasopharyngeal PCR including 12 patients that became symptomatic; all tests were negative except for one that was inconclusive, but it was repeated and came back negative. Forty (52.6%) KT recipients were readmitted, and 7 (9.2%) had biopsy-proven rejection during the follow-up. None of the KT recipients transplanted during this period died.

Conclusions: Our cohort demonstrated that DDKT can be safely performed during the COVID-19 pandemic when preventive measures are implemented.
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http://dx.doi.org/10.1111/tid.13416DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7404591PMC
December 2020

Management of crash and burn patients with SARS-CoV-2 associated ARDS.

J Card Surg 2020 Sep 14;35(9):2129-2130. Epub 2020 Jul 14.

Heart and Lung Transplant and Mechanical Circulatory Support, Miller School of Medicine, University of Miami, Miami, Florida.

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http://dx.doi.org/10.1111/jocs.14699DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7405179PMC
September 2020

Antimicrobial resistance and recurrent bacterial urinary tract infections in hospitalized patients following kidney transplantation: A single-center experience.

Transpl Infect Dis 2020 Aug 9;22(4):e13337. Epub 2020 Jun 9.

Division of Infectious Diseases and Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL, USA.

Purpose: The burden of urinary tract infections (UTIs) and risk factors for developing infections with multidrug resistant organisms (MDROs) post-kidney transplantation (KT) are poorly understood.

Methods: Single-center retrospective cohort study (January 2015-December 2017) evaluating first and recurrent episodes of bacteriuria and subsequent analysis of episodes caused by MDROs up to 6 months post-KT. Donor and recipient variables were reviewed.

Results: A total of 743 adults underwent single KT during the study period, and 106 patients were hospitalized with bacteriuria. 45% were asymptomatic in their first episode. 73.6% had a single episode, and 26.4% had 2 or more episodes. A total of 28 patients had recurrent episodes; 64.3% had an MDRO on the first episode and 78.6% on the second episode. Escherichia coli was the most common organism isolated, 88.5% were resistant to trimethoprim-sulfamethoxazole (TMP-SMX), 9.3% were extended-spectrum beta-lactamase (ESBL) producers, and 38.1% were MDROs. Body mass index ≥30 was significantly associated with the presence of MDROs in both univariate and multivariate analyses (RR 1.37, 95% CI 1.01-1.88; OR 3.26, CI 1.29-8.25). A total of 12 donors had bacteremia or bacteriuria and 6 (50%) with E coli. A total of 10 KT recipients received antibiotic prophylaxis to prevent donor-derived infections.

Conclusions: Our results suggest that a significant proportion of patients develop recurrent bacteriuria post-transplantation; of those, more than half caused by MDROs. There is a possible association between obesity and MDROs in KT recipients that merits further investigation. With the global crisis in antimicrobial resistance, innovative strategies are needed to prevent and treat UTIs in KT patients.
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http://dx.doi.org/10.1111/tid.13337DOI Listing
August 2020

Long-term Kidney Transplantation Outcomes Network (APOLLO): Design and Rationale.

Kidney Int Rep 2020 Mar 13;5(3):278-288. Epub 2019 Dec 13.

Division of Nephrology, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York, USA.

Introduction: Much of the higher risk for end-stage kidney disease (ESKD) in African American individuals relates to ancestry-specific variation in the apolipoprotein L1 gene (). Relative to kidneys from European American deceased-donors, kidneys from African American deceased-donors have shorter allograft survival and African American living-kidney donors more often develop ESKD. The National Institutes of Health (NIH)-sponsored Long-term Kidney Transplantation Outcomes Network (APOLLO) is prospectively assessing kidney allograft survival from donors with recent African ancestry based on donor and recipient genotypes.

Methods: APOLLO will evaluate outcomes from 2614 deceased kidney donor-recipient pairs, as well as additional living-kidney donor-recipient pairs and unpaired deceased-donor kidneys.

Results: The United Network for Organ Sharing (UNOS), Association of Organ Procurement Organizations, American Society of Transplantation, American Society for Histocompatibility and Immunogenetics, and nearly all U.S. kidney transplant programs, organ procurement organizations (OPOs), and histocompatibility laboratories are participating in this observational study. APOLLO employs a central institutional review board (cIRB) and maintains voluntary partnerships with OPOs and histocompatibility laboratories. A Community Advisory Council composed of African American individuals with a personal or family history of kidney disease has advised the NIH Project Office and Steering Committee since inception. UNOS is providing data for outcome analyses.

Conclusion: This article describes unique aspects of the protocol, design, and performance of APOLLO. Results will guide use of genotypic data to improve the assessment of quality in deceased-donor kidneys and could increase numbers of transplanted kidneys, reduce rates of discard, and improve the safety of living-kidney donation.
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http://dx.doi.org/10.1016/j.ekir.2019.11.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7056919PMC
March 2020

Treatment of latent tuberculosis infection with short-course regimens in potential living kidney donors.

Transpl Infect Dis 2020 Apr 21;22(2):e13244. Epub 2020 Jan 21.

Division of Nephrology, Department of Medicine, University of Miami School of Medicine, Miami, Florida.

Background: Treatment data for latent tuberculosis infection (LTBI) among potential living kidney donors are scarce.

Methods: This retrospective study was performed to evaluate the prevalence of positive QuantiFERON-TB Gold In-Tube (QFT-GIT) among potential living kidney donors that were screened from 2009 to 2017. We investigated if there was any difference in the time to donation between QFT-GIT-positive and QFT-GIT-negative donors. We assessed the regimens used to treat LTBI and whether the recipients of QFT-GIT-positive donors developed active tuberculosis (TB).

Results: Forty out of 427 (9%) potential living kidney donors had a positive QFT-GIT. QFT-GIT-positive donors were as likely as negative donors to undergo donation (30 [75%] vs 315 [81%], P = .33). The time from QFT-GIT testing to donation was longer among QFT-GIT-positive donors (median 221 days [range: 4-1139] vs 86 days [range: 3-1887], P = .001). Twelve-week rifapentine (RPT)/Isoniazid (INH) was the most common treatment used and was not associated with significant adverse reactions. There was a trend toward longer time to donation among QFT-GIT-positive donors who were treated for LTBI compared with QFT-GIT-positive donors who were not (252 days [range: 88-1139] vs 95 days [range: 4-802], P = .05). Twenty-nine recipients of QFT-GIT-positive living kidney donors were evaluated. Eleven of these recipients received kidneys from donors that were not treated for LTBI. Two of these recipients were treated with INH post-transplantation.

Conclusions: The time from QFT-GIT testing to donation was longer among QFT-GIT-positive donors. The short-course regimens appear to be excellent options for LTBI treatment among living kidney donors and avoid delaying organ donation further.
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http://dx.doi.org/10.1111/tid.13244DOI Listing
April 2020

Pretransplant Levels of C-Reactive Protein, Soluble TNF Receptor-1, and CD38+HLADR+ CD8 T Cells Predict Risk of Allograft Rejection in HIV+ Kidney Transplant Recipients.

Kidney Int Rep 2019 Dec 19;4(12):1705-1716. Epub 2019 Aug 19.

Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, Florida, USA.

Introduction: HIV-positive (HIV+) kidney transplant recipients exhibit a 2- to 3-fold increased risk of allograft rejection. Dysregulated immune activation in HIV infection persists despite successful antiretroviral therapy and is associated with non-AIDS morbidity, including renal disease. We hypothesized that the pathological levels of inflammation and immune activation associated with chronic HIV infection could have clinical utility in the prediction of rejection in HIV+ kidney recipients.

Methods: Prospective cohort study of 22 HIV-negative (HIV-; donor) to HIV+ (recipient) kidney transplant recipients who underwent biomarker assessment pretransplant and were subsequently followed for development of acute rejection. Plasma levels of markers of inflammation (soluble tumor necrosis factor receptor 1 [sTNF-R1] and C-reactive protein [CRP]) and microbial translocation (soluble CD14 and lipopolysaccharide) were measured by enzyme-linked immunosorbent assay or chromogenic endpoint assay. Levels of activated (CD38+HLADR+) CD4+ and CD8+ T cells, and T regulatory cells (CD4+CD25highFoxP3+) were measured by flow cytometry.

Results: Among the biomarkers evaluated, only the pretransplant levels of sTNF-R1, CRP, and frequencies of CD38+HLADR+ CD8 T cells, were found to be at significantly higher levels among patients who experienced biopsy-proven acute rejection. Confirming our hypothesis, patients with high pretransplant levels of sTNF-R1 or activated CD8+ T cells had a significantly increased 200-day cumulative incidence of biopsy-proven acute rejection (0 vs. 38% for both;  = 0.01). Similarly, pretransplant CRP levels higher than 5 μg/ml were associated with increased risk of acute rejection within the first 6 months post-transplant (0 vs. 43%;  = 0.01).

Conclusion: Biomarker-based identification of HIV+ recipients at increased risk for rejection might facilitate individualized induction immunosuppression regimens in this vulnerable patient population.
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http://dx.doi.org/10.1016/j.ekir.2019.08.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6895601PMC
December 2019

Hand-assisted laparoscopic nephrectomy in a high risk overweight donor with left-sided IVC, and previous abdominal surgery.

Int J Surg Case Rep 2019 28;64:20-23. Epub 2019 Sep 28.

Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA; Department of Urology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA; Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA. Electronic address:

Introduction: The extension of donor eligibility criteria represents one of the possible ways to increase the organ shortage, thus decreasing the waiting time for kidney transplantation. Expectedly, this strategy is associated with a growing number of more technically demanding living donor nephrectomy procedures requiring careful assessment, and sound surgical experience in order to avoid intraoperative complications.

Case Presentation: After a thorough evaluation through preoperative imaging, we performed a hand-assisted left laparoscopic living donor nephrectomy in a 56 year-old overweight patient with history of prior abdominal surgery, harboring a left-sided inferior vena cava (IVC).

Discussion/conclusion: This case describes our comprehensive approach in this complex surgical scenario to preserve donor safety and provide an optimal kidney graft.
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http://dx.doi.org/10.1016/j.ijscr.2019.09.039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6796603PMC
September 2019

Vascular Reconstructions in Living Unrelated Kidney Transplant Using Donor Ovarian Vein and Recipient Inferior Epigastric Artery with Simultaneous Enucleation of a Complex Cyst.

Case Rep Transplant 2019 13;2019:3272080. Epub 2019 Mar 13.

Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA.

Increasing the organ donor pool and solving the recipient demands continue to be one of the challenges in transplantation. We report our experience in transplanting a living donor kidney requiring complex vascular reconstructions and an enucleation of complex cyst. A 57-year-old male patient underwent a living unrelated kidney transplant. The living donor kidney was procured through a laparoscopic hand-assisted right donor nephrectomy. After vascular stapling, the kidney had a short upper pole arterial branch, a short renal vein (3 mm), and a complex upper pole cyst. The renal vein was elongated using the donor ovarian vein and the short upper pole artery was extended using the recipient inferior epigastric artery and anastomosed to the main renal artery. The renal allograft vessels were anastomosed end-to-side to the external iliac vessels. The complex cyst was removed performing an enucleation with a rim of normal tissue and reconstruction of the calyceal system. This case represents three different surgical reconstructions in order to make the organ available for transplantation. In some circumstances, complex vascular reconstruction of living donor kidney with removal of complex cyst represents a strategy to expand the donor pool.
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http://dx.doi.org/10.1155/2019/3272080DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6436338PMC
March 2019

Clinical outcomes in HIV+/HCV+ coinfected kidney transplant recipients in the pre- and post-direct-acting antiviral therapy eras: 10-Year single center experience.

Clin Transplant 2019 05 4;33(5):e13532. Epub 2019 Apr 4.

Division of Nephrology, Department of Medicine, University of Miami Miller School of Medicine Miami, Florida.

Background: Previous studies have demonstrated inferior patient and graft survival following kidney transplant (KT) in HIV+/HCV+ coinfected patients compared to HIV+/HCV- recipients. However, these studies were conducted prior to the availability of direct-acting antiviral (DAA) agents and data in the modern era are lacking.

Methods: Single center retrospective study of HIV+/HCV+ coinfected KT recipients (2007-2017). Outcomes were assessed for the pre-DAA and post-DAA (ie, after December 2013) eras including 1-year patient survival, death-censored graft survival, and acute rejection; and serious infections (defined as infections requiring admission to the intensive care unit during initial transplant hospitalization or re-admission to the hospital after discharge) within the first 6 months post-transplant.

Results: A total of 13 consecutive HIV+/HCV+ recipients were identified. Median time of post-transplant follow-up was 722 days. Seven patients were transplanted in the DAA era; five of them had anti-HCV Ab+ donors, with two donors being HCV NAT positive; all received DAA therapy, six of them post-transplant (median time from KT to DAA: 83 days; IQR, 54-300). All the patients in the pre-DAA era were on a protease inhibitor-containing ART regimen. One-year patient and death-censored graft survivals were 83% and 67%, respectively, for the patients transplanted in the pre-DAA era, and 100% for both outcomes in the subgroup of patients transplanted in the post-DAA era (P > 0.05). Compared to patients in the post-DAA era, those in the pre-DAA era had higher incidence of serious infections (0 vs 67%; P = 0.02). Acute rejection exclusively occurred in the pre-DAA group (n = 1; 17%).

Conclusions: Outcomes of HIV+/HCV+ KT recipients, including HIV-/HCV+ to HIV+/HCV+ transplants, in the DAA era were excellent in this small cohort. Larger studies are needed.
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http://dx.doi.org/10.1111/ctr.13532DOI Listing
May 2019

Implementation of a Strongyloides screening strategy in solid organ transplant donors and recipients.

Clin Transplant 2019 04 12;33(4):e13497. Epub 2019 Mar 12.

Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida.

Background: Strongyloides stercoralis infects 100 million people worldwide. Mortality rates in hyperinfection syndrome exceed 50%. Donor-derived Strongyloides infection has occurred after heart, kidney, kidney-pancreas and liver transplantation; yet, only 10% of the US organ procurement organizations currently screen donors for strongyloidiasis.

Methods: We report a fatal case of donor-derived disseminated Strongyloides infection in a liver transplant recipient. Following this case, we implemented universal screening and treatment of donors and recipients. We reviewed our local epidemiology and outcomes after protocol implementation.

Results: From a total of 355 deceased donors accepted at our center between January 2016, and March 2018, 14 (3.9%) had positive Strongyloides serology. Except for the index case, all other recipients of Strongyloides antibody-positive donors within that period (including 10 kidneys, 3 livers, one combined liver/kidney, and one kidney/pancreas from eight seropositive donors) received post-transplant prophylaxis with ivermectin, and to date are alive and doing well without signs of infection. Between October 2015, and September 2016, a total of 441 deceased donor solid organ transplants were performed at our center. 220 of these recipients had pretransplant Strongyloides serology available, and 23 of them were seropositive (10.5%). Within the first two years after the implementation of universal screening and treatment of donors and recipients, we had no cases of Strongyloides reactivation in our center.

Conclusions: Implementation of a Strongyloides screening and treatment protocol in our center was an effective strategy to prevent both recipient- and donor-derived strongyloidiasis. Transplant centers should consider implementation of Strongyloides preventive strategies.
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http://dx.doi.org/10.1111/ctr.13497DOI Listing
April 2019

Linezolid- and Vancomycin-resistant Enterococcus faecium in Solid Organ Transplant Recipients: Infection Control and Antimicrobial Stewardship Using Whole Genome Sequencing.

Clin Infect Dis 2019 07;69(2):259-265

Center for Antimicrobial Resistance and Microbial Genomics and Division of Infectious Diseases, McGovern Medical School, University of Texas Health Science Center at Houston, Bogota, Colombia.

Background: Vancomycin-resistant enterococci are an important cause of healthcare-associated infections and are inherently resistant to many commonly used antibiotics. Linezolid is the only drug currently approved by the US Food and Drug Administration to treat vancomycin-resistant enterococci; however, resistance to this antibiotic appears to be increasing. Although outbreaks of linezolid- and vancomycin-resistant Enterococcus faecium (LR-VRE) in solid organ transplant recipients remain uncommon, they represent a major challenge for infection control and hospital epidemiology.

Methods: We describe a cluster of 4 LR-VRE infections among a group of liver and multivisceral transplant recipients in a single intensive care unit. Failure of treatment with linezolid in 2 cases led to a review of standard clinical laboratory methods for susceptibility determination. Testing by alternative methods including whole genome sequencing (WGS) and a comprehensive outbreak investigation including sampling of staff members and surfaces was performed.

Results: Review of laboratory testing methods revealed a limitation in the VITEK 2 system with regard to reporting resistance to linezolid. Linezolid resistance in all cases was confirmed by E-test method. The use of WGS identified a resistant subpopulation with the G2376C mutation in the 23S ribosomal RNA. Sampling of staff members' dominant hands as well as sampling of surfaces in the unit identified no contaminated sources for transmission.

Conclusions: This cluster of LR-VRE in transplant recipients highlights the possible shortcomings of standard microbiology laboratory methods and underscores the importance of WGS to identify resistance mechanisms that can inform patient care, as well as infection control and antibiotic stewardship measures.
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http://dx.doi.org/10.1093/cid/ciy903DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6775576PMC
July 2019

Antibody-mediated rejection implies a poor prognosis in kidney transplantation: Results from a single center.

Clin Transplant 2018 10 23;32(10):e13392. Epub 2018 Sep 23.

The Lillian Jean Kaplan Renal Transplant Center, Miami Transplant Institute, Miami, Florida.

Two major barriers to achieving long-term graft survival include patient nonadherence in taking the prescribed immunosuppression and antibody-mediated rejection(AMR). We were therefore interested in determining the prognostic impact of developing an AMR component to rejection in a prospective randomized trial of 200 kidney transplant recipients who received dual induction therapy (rATG combined with either daclizumab or alemtuzumab) and planned early corticosteroid withdrawal. With a median follow-up of 96 months post-transplant, 40/200 developed a first BPAR; 9/200 developed a second BPAR. An AMR component to rejection was observed in 70% (28/40) of cases. Percentages having C4d deposition, histopathologic evidence of acute AMR, and presence of DSAs/non-DSAs at the time of first developing the AMR component were 64.3% (18/28), 60.7% (17/28), and 53.6% (15/28), respectively. Development of an AMR component was associated with a significantly higher death-censored graft failure rate following rejection in comparison with the patient state of experiencing BPAR but without developing an AMR component (estimated hazard ratio: 4.52, P = 0.01). The observed percentage developing graft failure following development of an AMR component was 53.6% (15/28) vs only 20.0%(3/15) if it was not observed. Actuarial death-censored graft survival at 60 months following development of an AMR component was 28.3 ± 11.9%. In summary, it appears that more effective AMR prevention/treatment strategies are warranted.
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http://dx.doi.org/10.1111/ctr.13392DOI Listing
October 2018

Roux-en-Y gastric bypass is an effective bridge to kidney transplantation: Results from a single center.

Clin Transplant 2018 05 10;32(5):e13232. Epub 2018 Apr 10.

Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, FL, USA.

Body mass index (BMI) > 35-40 kg/m is often a contraindication, while Roux-en-Y gastric bypass (RYGB) is performed to enable kidney transplantation. This single-center retrospective study evaluated pre- and post-transplant outcomes of 31 morbidly obese patients with end-stage renal disease having RYGB before kidney transplantation between July 2009 and June 2014. Fourteen RYGB patients were subsequently transplanted. Nineteen recipients not having GB with a BMI ≥ 36 kg/m at transplantation were used as historical controls. Mean BMI (±SE) before RYGB was 43.5 ± 0.7 kg/m (range: 35.4-50.5 kg/m ); 87.1% (27/31) achieved a BMI < 35 kg/m . The percentage having improved diabetes/hypertension control was 29.0% (9/31); 25.8% (8/31) had complications (mostly minor) after RYGB. Among transplanted patients, blacks/Hispanics comprised 78.6% (11/14) and 84.2% (16/19) of RYGB and controls; 57.1% (8/14) and 63.2% (12/19) had a (mostly long-standing) pretransplant history of diabetes. While biopsy-proven acute rejection (BPAR) occurred significantly higher among RYGB vs control patients (6/14 vs 3/19, P = .03), patients developing T-cell BPAR were also significantly more likely to have a tacrolimus (TAC) trough level < 4.0 ng/mL within 3 weeks of T-cell BPAR (P = .0007). In Cox's model, the impact of having a TAC level < 4.0 ng/mg remained significant (P = .007) while the effect of RYGB was no longer significant (P = .13). Infections, graft, and patient survival were not significantly different. Despite obvious effectiveness in achieving weight loss, RYGB will need more careful post-transplant monitoring given the observed higher BPAR rate.
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http://dx.doi.org/10.1111/ctr.13232DOI Listing
May 2018

A cluster of donor-derived Cryptococcus neoformans infection affecting lung, liver, and kidney transplant recipients: Case report and review of literature.

Transpl Infect Dis 2018 Apr 12;20(2):e12836. Epub 2018 Feb 12.

Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, USA.

Donor-derived infections (DDIs) are a very rare but potentially devastating complication of solid organ transplantation. Here we present a cluster of proven donor-derived cryptococcal infection in the kidney, liver, and lung recipients from a single donor. Remarkably, the onset of illness in the kidney and liver recipients occurred more than 8-12 weeks after transplantation, which is beyond the incubation period previously reported for donor-derived cryptococcosis. DDI should always be considered in the differential diagnosis of transplant recipients admitted with febrile illness, even when presenting beyond the first month post-transplant. Communication between reference laboratories, transplant centers, and organ procurement organizations is critical to improve outcomes.
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http://dx.doi.org/10.1111/tid.12836DOI Listing
April 2018

A nationwide analysis of re-exploration after liver transplant.

HPB (Oxford) 2018 03 9;20(3):216-221. Epub 2017 Nov 9.

Department of Surgery, Division of Transplant Surgery, Jackson Memorial Hospital/University of Miami, Miami, FL, USA. Electronic address:

Background: A retrospective review to investigate rate and outcomes of re-exploration following liver transplantation in the United States.

Methods: The NIS database was used to examine outcomes of patients who underwent re-exploration following liver transplantation from 2002 to 2012. Multivariate regression analysis was performed to compare outcomes of patients with and without reoperation.

Results: We sampled a total of 12,075 patients who underwent liver transplantation. Of these, 1505 (12.5%) had re-exploration during the same hospitalization. Hemorrhagic (67.9%) and biliary tract anastomosis complication (14.8%) were the most common reasons for reoperation. Patients with reoperation had a significantly higher mortality than those who did not (11.6% vs. 3.8%, AOR: 3.01, P < 0.01). Preoperative coagulopathy (AOR: 1.71, P < 0.01) and renal failure (AOR: 1.57, P < 0.01) were associated with hemorrhagic complications. Peripheral vascular disorders (AOR: 2.15, P < 0.01) and coagulopathy (AOR: 1.32, P < 0.01) were significantly associated with vascular complications. Risk of wound disruption was significantly higher in patients with chronic pulmonary disease (AOR: 1.50, P < 0.01).

Conclusion: Re-exploration after liver transplantation is relatively common (12.5%), with hemorrhagic complication as the most common reason for reoperation. Preoperative coagulation disorders significantly increase hemorrhagic and vascular complications. Further clinical trails should investigate prophylactic strategies in high risk patients to prevent unplanned reoperation.
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http://dx.doi.org/10.1016/j.hpb.2017.08.024DOI Listing
March 2018

Case series: Transplantation of kidneys from donors with renal artery aneurysm.

Can Urol Assoc J 2017 Jul 11;11(7):E307-E310. Epub 2017 Jul 11.

Department of Transplant Surgery, University of Miami Miller School of Medicine, Miami, FL, United States.

Introduction: With the present disparity between organ availability and recipient demands, we reported our experience in transplanting kidneys with renal artery aneurysm after back-table reconstruction.

Methods: Four patients were identified. The repair consisted of excision of the aneurysm with ostial closure, and for one of the cases, an ovarian vein patch was used. We reviewed the safety and outcomes of this procedure. All donors were asymptomatic before surgery and were diagnosed incidentally during living donor evaluation. The nephrectomies performed were hand-assisted laparoscopic approaches. All recipients had followup renal function and ultrasound duplex of renal artery at six and 12 months and then annually.

Results: The mean age of the recipients was 28.7 years (range 3-45). The mean size of the aneurysm was 7.4 ± 2.7 mm. All patients had immediate graft function with median serum creatinine of 1.9 ± 1.5 mg/dL at discharge. The average length of hospital stay was 6.25 ± 2.6 days. They also maintained good renal function with an average estimated glomerular filtration rate (eGFR) of 102.8 mL/min/1.73m (range 53.4-199 mL/min/1.73m) and patent vessels at one year. One patient suffered from acute antibody-mediated rejection and lost his graft (medication non-compliance). One patient had two simultaneous benign renal cysts that were resected. Three of the kidneys were right-sided and one left. Mean cold ischemia time was 86 ± 18 minutes. No deaths have been recorded.

Conclusions: Transplanting kidneys with a renal artery aneurysm after ex-vivo repair is safe and the outcomes are encouraging. Also, it may play an important role in expanding the donor pool in the face of current organ shortage.
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http://dx.doi.org/10.5489/cuaj.4244DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5519391PMC
July 2017

Phaeohyphomycosis due to Exophiala infections in solid organ transplant recipients: Case report and literature review.

Transpl Infect Dis 2017 Aug 26;19(4). Epub 2017 Jun 26.

Department of Medicine, Division of Infectious Diseases, Jackson Health System/University of Miami Miller School of Medicine, Miami, FL, USA.

This case report and literature review underscores the cutaneous presentations of phaeohyphomycosis in the solid organ transplant population. Increased cognizance with prompt identification is critical. The therapy and clinical outcomes of phaeohyphomycosis, caused by the Exophiala genus, in the solid organ transplant population, is analyzed to examine optimal care. This review highlights the inherent difficulties in providing the appropriate duration of antifungal therapy to avoid relapsing infections in immunosuppressed patients.
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http://dx.doi.org/10.1111/tid.12723DOI Listing
August 2017

Transplantation of kidneys from hepatitis C-positive donors into hepatitis C virus-infected recipients followed by early initiation of direct acting antiviral therapy: a single-center retrospective study.

Transpl Int 2017 Sep 2;30(9):865-873. Epub 2017 May 2.

Department of Medicine, University of Miami Miller School of Medicine and the Miami Veterans Administration Hospital, Miami, FL, USA.

The availability of direct acting antiviral agents (DAA) has transformed the treatment of hepatitis C virus (HCV) infection. The current study is a case series that reports the outcomes from a cohort of twenty-five HCV-infected ESRD patients who received a kidney from an anti-HCV-positive deceased organ donor followed by treatment with DAAs in the early post-transplant period. Time to transplantation and the efficacy of DAA therapy as measured by sustained viral response at 12 weeks were assessed. The median waiting time from original date of activation on the United Network Organ Sharing (UNOS) waiting list until transplantation was 427 days; however, the median time from entering the patient into UNet for a HCV-positive offer until transplantation was only 58 days. The 25 patients were started on antiviral treatment early post-transplant (median 125 days) and 24 of 25 (96%) achieved a sustained virologic response at 12 weeks. Tacrolimus dose adjustments were required during antiviral treatment in 13 patients to maintain therapeutic levels. Accepting a kidney from an anti-HCV-positive deceased donor shortened the waiting time for HCV-infected kidney transplant candidates. We recommend that kidneys from anti-HCV-positive donors should be considered for transplant into HCV-infected recipients followed by early post-transplant treatment with DAA agents.
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http://dx.doi.org/10.1111/tri.12954DOI Listing
September 2017

Impact of antiretroviral therapy on clinical outcomes in HIV kidney transplant recipients: Review of 58 cases.

F1000Res 2016 21;5:2893. Epub 2016 Dec 21.

Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, USA.

Antiretroviral therapy (ART) poses challenging drug-drug interactions with immunosuppressant agents in transplant recipients.  We aimed to determine the impact of specific antiretroviral regimens in clinical outcomes of HIV kidney transplant recipients.  A single-center, retrospective cohort study was conducted at a large academic center. Subjects included 58 HIV to HIV adult, first-time kidney transplant patients. The main intervention was ART regimen used after transplantation.  The main outcomes assessed at one- and three-years were: patient survival, death-censored graft survival, and biopsy-proven acute rejection; we also assessed serious infections within the first six months post-transplant.  Patient and graft survival at three years were both 90% for the entire cohort. Patients receiving protease inhibitor (PI)-containing regimens had lower patient survival at one and three years than patients receiving PI-sparing regimens: 85% vs. 100% ( =0.06) and 82% vs. 100% ( =0.03), respectively. Patients who received PI-containing regimens had twelve times higher odds of death at 3 years compared to patients who were not exposed to PIs (odds ratio, 12.05; 95% confidence interval, 1.31-1602; =0.02).  Three-year death-censored graft survival was lower in patients receiving PI vs. patients on PI-sparing regimens (82 vs 100%, =0.03). Patients receiving integrase strand transfer inhibitors-containing regimens had higher 3-year graft survival. There were no differences in the incidence of acute rejection by ART regimen. Individuals receiving PIs had a higher incidence of serious infections compared to those on PI-sparing regimens (39 vs. 8%, =0.01).  PI-containing ART regimens are associated with adverse outcomes in HIV kidney transplant recipients.
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http://dx.doi.org/10.12688/f1000research.10414.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5310378PMC
December 2016

Randomized trial of rATg/Daclizumab vs. rATg/Alemtuzumab as dual induction therapy in renal transplantation: Results at 8years of follow-up.

Transpl Immunol 2017 02 22;40:42-50. Epub 2016 Nov 22.

The Lillian Jean Kaplan Renal Transplant Center and the Miami Transplant Institute, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA. Electronic address:

Our goal in using dual induction therapy is to bring the kidney transplant recipient closer (through more effectively timed lymphodepletion) to an optimally immunosuppressed state. Here, we report long-term results of a prospective randomized trial comparing (Group I,N=100) rATG/Dac (3 rATG, 2 Dac doses) vs. (Group II,N=100) rATG/Alemtuzumab(C1H) (1 dose each), using reduced tacrolimus dosing, EC-MPS, and early corticosteroid withdrawal. Lower EC-MPS dosing was targeted in Group II to avoid severe leukopenia. Median follow-up was 96mo post-transplant. There were no differences in 1st BPAR (including borderline) rates: 10/100 vs. 9/100 in Groups I and II during the first 12mo(P=0.54), and 20/100 vs. 20/100 throughout the study(P=0.90). Equally favorable renal function was maintained in both treatment arms(N.S.). While not significant, more patients in Group II experienced graft loss, 25/100 vs. 18/100 in Group I(P=0.23). Actuarial patient/graft survival at 96mo was 92%/83% vs. 85%/73% in Groups I and II(N.S.). DWFG-due-to-infection(N.S.), EC-MPS withholding-due-to-leukopenia during the first 2mo(P=0.03), and incidence of viral infections(P=0.09) were higher in Group II, whereas EC-MPS withholding-due-to-GI symptoms was higher in Group I(P=0.009). No other adverse event differences were observed. While long-term anti-rejection and renal function efficacy were demonstrated in both treatment arms, slight over-immunosuppression of Group II patients occurred.
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http://dx.doi.org/10.1016/j.trim.2016.11.004DOI Listing
February 2017

Use of Kidneys with Small Renal Tumors for Transplantation.

Curr Urol Rep 2016 Jan;17(1)

Department of Surgery, Division of Transplantation, Miami Transplant Institute, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Highland Professional Building 1801 N.W. 9th Avenue, Miami, FL, 33136, USA.

Population of patients with end-stage renal disease increases every day. There is a vast difference in the number of patients on the waiting list for a kidney transplant, and the number of donors and the gap increases every year. The use of more marginal organs can increase the donor pool. These organs include the kidneys with small renal cell carcinomas (RCTC). There has been a number of reports in the literature about the use of these grafts for renal transplant after tumor excision and reconstruction. These grafts have been reported to be used with good renal function outcomes without an increased risk for malignancy recurrences. We present the collection of evidence for the use of kidneys with RCC for transplantation, technique used for surgical resection, and reconstruction as well as insights on the recommendations for the use of these grafts.
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http://dx.doi.org/10.1007/s11934-015-0557-zDOI Listing
January 2016

Lower tacrolimus trough levels are associated with subsequently higher acute rejection risk during the first 12 months after kidney transplantation.

Transpl Int 2016 Feb 3;29(2):216-26. Epub 2015 Nov 3.

Miami Transplant Institute, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.

The premise that lower TAC trough levels are associated with subsequently higher first BPAR risk during the first 12 mo post-transplant was recently questioned. Using our prospectively followed cohort of 528 adult, primary kidney transplant recipients (pooled across four randomized trials) who received reduced TAC dosing plus an IMPDH inhibitor, TAC trough levels measured at seven time points, 7, 14 days, 1, 2, 3, 6 and 9 months post-transplant, were utilized along with Cox's model to determine the multivariable significance of TAC level(t) (a continuous time-dependent covariate equaling the most recently measured TAC level prior to time t) on the hazard rate of developing first BPAR during the first 12 months post-transplant. The percentage developing BPAR during the first 12 months post-transplant was 10.2% (54/528). In univariable analysis, lower TAC level(t) was associated with a significantly higher BPAR rate (P = 0.00006), and its significance was maintained even after controlling for 2 significant baseline predictors (African-American/Hispanic Recipient and Developed DGF) in Cox's model (multivariable P = 0.0003). Use of a cutpoint, TAC level(t) <4.0 vs. ≥4.0 ng/ml, yielded an even greater association with BPAR rate (univariable and multivariable P < 0.000001), with an estimated hazard ratio of 6.33. These results suggest that TAC levels <4.0 ng/ml should be avoided during the first 12 months post-transplant when TAC is used in combination with fixed-dose mycophenolate with or without corticosteroids and induction therapy.
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http://dx.doi.org/10.1111/tri.12699DOI Listing
February 2016

Living donor renal transplantation with incidental renal cell carcinoma from donor allograft.

Transpl Int 2015 Sep 7;28(9):1126-30. Epub 2015 May 7.

The Lillian Jean Kaplan Renal Transplant Center of the Division of Transplantation, Miami, FL, USA.

To report our series of cases with living donor kidney transplant by laparoscopic nephrectomy with incidental renal cell carcinomas (RCC) at the time of transplant. We performed a search of cases of renal allografts from living donors with incidental tumors which were confirmed as RCC in final pathology. The graft nephrectomy was performed via hand-assisted laparoscopic procedure. All cases underwent partial nephrectomy of the tumor during the back-table preparation of the graft and sent for pathological analysis. We performed 435 living donor kidney transplants at our Institution and identified four cases consistent with the diagnosis of RCC. Two of them were clear cell type, one papillary and one multilocular RCC. All the tumors presented at stage I of TNM classification. After a median follow-up of 36 months, three patients remain free of dialysis with good allograft function. One noncompliant patient presented with a glomerular filtration rate (GFr) below 15 ml/min after a BK viral infection. At the end of follow-up period, all patients had remained free of tumor. Donors with suspicious renal masses might be accepted for living donation. Partial nephrectomy before transplantation could offer a cure for the disease without risks for the recipient with therapeutic benefit for the donor.
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http://dx.doi.org/10.1111/tri.12594DOI Listing
September 2015