Identification of four novel HLA alleles: HLA-B*27:265, -B*35:569, -DRB1*08:117 and -DPB1*1435:01.

Identification of four new HLA alleles (B*27:265, B*35:569, DRB1*08:117, and DPB1*1435:01) in Brazilian bone marrow donors.

Interlocus gene conversion: Identification of HLA-A*23:128 in a Brazilian bone marrow donor.

Identification of novel HLA-A*23:128 allele generated by interlocus gene conversion in Brazilian bone marrow donor.

Impact of pretransplantation malnutrition risk on the clinical outcome and graft survival of kidney transplant patients / Impacto do risco de desnutrição pré-transplante no desfecho clínico e na sobrevida do enxerto de pacientes transplantados renais

ABSTRACT Background: The prevalence of malnourished patients before transplantation and the influence of malnutrition on graft and patient outcomes remain underestimated, despite being associated with higher postoperative morbidity and mortality. This study aimed to develop an easy nutritional screening tool and evaluate the impact of nutritional status on clinical outcome, graft survival (GS) and mortality risk in kidney transplant patients (KTP). Methods: In this retrospective cohort study including 451 KTP, we developed a score by using anthropometric, clinical, and laboratory measures performed in the pretransplant evaluation. The patients were stratified into 3 groups according to the final score: G1 (0 or 1 point)=low risk, G2 (2 to 4 points)=moderate risk, and G3 (>5 points)=high risk of malnutrition. The patients were monitored after transplantation at least 1 to 10 years. Results: Stratifying the 451 patients based on the pretransplant risk score, G1, G2, and G3 were composed of 90, 292, and 69 patients, respectively. Patients from G1 maintained the lowest serum creatinine levels at hospital discharge when compared with others (p = 0.012). The incidence of infection in the patients from G3 was higher than patients from G1 and G2 (p = 0.030). G3 recipients showed worse GS than G1 patients (p = 0.044). G3 patients showed almost threefold higher risk for graft loss (HR 2.94, 95% CI 1.084-7.996). Conclusions: KTP with higher malnutrition risk score were associated with worse outcomes and GS. The nutritional screening tool is easy to be used in clinical practice to evaluate the patient in preparation for kidney transplant.

RESUMO Antecedentes: A prevalência de pacientes desnutridos antes do transplante e a influência da desnutrição nos desfechos do enxerto e do paciente permanecem subestimadas, embora estejam associadas a maior morbimortalidade pós-operatória. Este estudo buscou desenvolver uma ferramenta simples de triagem nutricional e avaliar o impacto do estado nutricional no desfecho clínico, sobrevida do enxerto (SE) e risco de mortalidade em pacientes transplantados renais (PTR). Métodos: Neste estudo de coorte retrospectivo incluindo 451 PTR, desenvolvemos um escore usando medidas antropométricas, clínicas e laboratoriais tomadas na avaliação pré-transplante. Os pacientes foram estratificados em 3 grupos segundo a pontuação final: G1 (0-1 ponto) = baixo risco, G2 (2-4 pontos) = risco moderado e G3 (>5 pontos) = alto risco de desnutrição. Eles foram monitorados por pelo menos 1 a 10 anos após o transplante. Resultados: Os 451 pacientes foram estratificados em G1, G2 e G3, que consistiram em 90, 292 e 69 pacientes, respectivamente. Os pacientes do G1 mantiveram os menores níveis de creatinina sérica na alta hospitalar em relação aos demais (p = 0,012). A incidência de infecção nos pacientes do G3 foi maior que nos pacientes do G1 e G2 (p = 0,030). Os pacientes do G3 apresentaram SE pior do que os pacientes do G1 (p = 0,044) e um risco quase três vezes maior de perda do enxerto (HR 2,94; IC 95% 1,084-7,996). Conclusões: PTR com maior escore de risco de desnutrição foram associados a piores desfechos e menor SE. A ferramenta de triagem nutricional é fácil de usar na prática clínica para avaliar pacientes em preparação para transplante renal.

Impact of HLA eplet mismatch load in immunological outcomes after living donor kidney transplantation.

INTRODUCTION: HLA eplets mismatches (eMM) have been associated with negative kidney outcomes after transplantation, such as the development of de novo donor-specific antibody (dnDSA), antibody-mediated rejection (ABMR), and early graft loss. This study aimed to evaluate the clinical effects of the HLA eMM load on dnDSA development, ABMR, renal function, allograft survival and graft loss. MATERIAL AND METHODS: This retrospective study involved 159 living donor kidney transplant patients categorized into groups based on antigen HLA mismatches assessed traditionally and HLA eMM load. Patients had followed for at least one year. The EpViX online program was used to evaluate the HLA eMM load. Cox models were constructed to assess the risk of graft loss. Kaplan-Meier survival curves were carried out. The analyses had performed using the R program and p < 0.05 was considered significant. RESULTS: From all 159 patients, 28 (17.6%) lost their allografts. Rejection episodes occurred in 37.1% of patients, 13.6% of whom were ABMR. Patients with rejection episodes had higher HLA-AB (p = 0.032) and HLA-DR (p = 0.008) HLA eMM load, HLA-AB (p = 0.006) and HLA-DR (p = 0.009) antigens mismatches, and higher proportions of the following eMM in the HLA-DR locus: 70R eMM (p = 0.015), 70RE (p = 0.015), 74E (p = 0.015) and 48Q (p = 0.047). In multiple models, the presence of HLA-DR 70qq eMM (HR 3.75, 95% CI 1.47; 9.55) add an increase in creatinine levels at 1-year (HR 3.87, 95% CI 2.30, 6.53) were associated with the risk of graft loss. CONCLUSION: The HLA eMM load was related to episodes of rejection and allograft loss. The HLA-DR eMM was most strongly associated with a worse immunologic outcome than eMM mismatches for HLA-AB.

Impact of pretransplantation malnutrition risk on the clinical outcome and graft survival of kidney transplant patients.

BACKGROUND: The prevalence of malnourished patients before transplantation and the influence of malnutrition on graft and patient outcomes remain underestimated, despite being associated with higher postoperative morbidity and mortality. This study aimed to develop an easy nutritional screening tool and evaluate the impact of nutritional status on clinical outcome, graft survival (GS) and mortality risk in kidney transplant patients (KTP). METHODS: In this retrospective cohort study including 451 KTP, we developed a score by using anthropometric, clinical, and laboratory measures performed in the pretransplant evaluation. The patients were stratified into 3 groups according to the final score: G1 (0 or 1 point)=low risk, G2 (2 to 4 points)=moderate risk, and G3 (>5 points)=high risk of malnutrition. The patients were monitored after transplantation at least 1 to 10 years. RESULTS: Stratifying the 451 patients based on the pretransplant risk score, G1, G2, and G3 were composed of 90, 292, and 69 patients, respectively. Patients from G1 maintained the lowest serum creatinine levels at hospital discharge when compared with others (p = 0.012). The incidence of infection in the patients from G3 was higher than patients from G1 and G2 (p = 0.030). G3 recipients showed worse GS than G1 patients (p = 0.044). G3 patients showed almost threefold higher risk for graft loss (HR 2.94, 95% CI 1.084-7.996). CONCLUSIONS: KTP with higher malnutrition risk score were associated with worse outcomes and GS. The nutritional screening tool is easy to be used in clinical practice to evaluate the patient in preparation for kidney transplant.

Effect of Delayed Graft Function on the Outcome and Allograft Survival of Kidney Transplanted Patients from a Deceased Donor.

BACKGROUND: In kidney transplantation (KT), delayed graft function (DGF) is a significant early complication observed in the first week. The study aimed to investigate the impact of DGF on the outcome, allograft, and patient survival after KT with organs from deceased donors. METHODS: This retrospective study was conducted using 304 KT patients who received an organ from deceased donors from 2008 to 2018. The patients were divided into 2 groups, DGF positive (DGF+) and DGF negative (DGF-). The database containing the clinical, laboratory, and immunologic information of donors and recipients was statistically analyzed using the SSPS program. RESULTS: In this study, 189 (62.17%) were DGF+ and 115 (37.83%) were DGF-. Until 6 months after KT, the estimate glomerular filtration rate was better in group DGF-, but it was similar between the groups during 10-year follow-up. Graft losses were higher in DGF+ group than in the DGF- (P = .046). The serum creatinine level was persistently higher in DGF+ group until the sixth month (P ≤ .05). Allograft survival rates were better in patients who were DGF- (P = .033). Those who had DGF for more than 15 days had a worse graft survival (P = .003), but in 10 year follow-up, patient survival rates were similar (P = .705). CONCLUSION: DGF+ patients were associated with dialysis time before KT, ischemia time, and the donors' clinical status, such as age, organ quality, and serum creatinine. All these factors had a great impact on graft survival but not on patient survival.

Estudo prospectivo para avaliar clínica e imunologicamente receptores em baixo, médio, alto e muito alto risco de rejeição humoral com rins de doadores falecidos / Prospective study to clinical and immunological evaluation of recipients in low, medium, high and strong risk of humoral rejection with kidney of deceased donors

Introdução: Os anticorpos específicos contra o doador (DSA) representam uma das principais barreiras para o sucesso do transplante renal. Material e métodos: Os cem receptores, classificados em baixo risco (BR), médio risco (MR), alto risco (AR) e muito alto risco (MAR) de terem rejeição mediada por anticorpos (RMA) foram transplantados com rins de doadores falecidos (DF). A sobrevida dos enxertos foi avaliada após um ano. Resultados: Dos 100 receptores que receberam rins de DF, 54 (54,0%) foram classificados como BR. Destes, oito rejeitaram (14,8%), três perderam os enxertos, sendo duas perdas por RMA (DSA MFI 1223 a 2341) e uma por causa não imunológica (CNI). Entre os 30 (30,0%) classificados em MR, 10 (33,3%) rejeitaram, desses quatro perderam os enxertos, sendo duas perdas por RMA (DSA MFI 530 e 870), uma por rejeição celular (RC) e uma por CNI. Entre os 10 (10,0%) classificados em AR, três rejeitaram, sendo observadas três perdas por RMA (DSA MFI de 3493 a 6068). Entre os 6 (6,0%) classificados como MAR, cinco tiveram episódios de rejeições, quatro perderam os enxertos, sendo três perdas por RMA (DSA MFI 7226 a 12591) e uma por RC. A sobrevida dos enxertos no primeiro ano para os pacientes em BR, MR, AR+MAR foi de 91,22%, 78,75% e 80,28%, respectivamente. Conclusão: Esse protocolo demonstrou ser eficiente e permitiu uma avaliação imunológica precisa de receptores classificados de acordo com o risco de RMA. Do total de pacientes, 26 (26%) tiveram episódios de rejeições, 12 (46%) pacientes perderam os enxertos devido a causas imunológicas, sendo duas perdas por RC e 10 por RMA, o que evidencia a gravidade das rejeições. Além disso, tivemos duas perdas por CNI. Após um ano, 87 (87%) dos pacientes mantiveram boa função renal, com creatinina variando de 0,9 a 1,6 mg/dL...