Leptospirosis: A dual threat - predisposing risk for renal transplant and trigger for renal transplant dysfunction.

Leptospirosis (LTPS) is a bacterial infection that affects humans, often with mild or no symptoms. It is estimated that approximately 10 % of patients with LTPS may experience multi-organ dysfunction, including renal abnormalities. In regions where LTPS is widespread, a considerable number of instances involving acute kidney injury (AKI) and chronic kidney disease (CKD) of unknown etiology (CKDu) have been reported. Additionally, studies have shown a correlation between kidney graft dysfunction in patients with stable kidney transplants after LTPS. These findings indicate that exposure to LTPS may increase the likelihood of kidney transplantation due to the onset of both acute and chronic kidney injuries. Simultaneously, it poses a potential risk to the stability of kidney grafts. Unfortunately, there is limited scientific literature addressing this issue, making it difficult to determine the negative impact that LTPS may have, such as its role as a risk factor for the need of kidney transplantation or as a threat to individuals who have undergone kidney transplants. This study aims to shed light on the immune mechanisms triggered during LTPS infection and their importance in both kidney damage and allograft dysfunction.

Frequency of respiratory virus-associated infection among children and adolescents from a tertiary-care hospital in Mexico City.

Acute respiratory infections (ARIs) are a major cause of morbidity and mortality among children. The causative pathogens show geographic and seasonal variations. We retrospectively evaluated the frequency and seasonality of respiratory pathogens in children and adolescents (age: 0-19 years) with ARIs treated between January 1, 2021, and March 31, 2022, at a single center in Mexico. Out of 2400 patients, 1,603 were diagnosed with SARS-CoV-2 infection and 797 were diagnosed with other common respiratory pathogens (CRPs). Of the 797 patients, 632 were infected with one CRP and 165 with > 2 CRPs. Deaths occurred only in SARS-CoV-2-infected patients. Rhinovirus/Enterovirus, respiratory syncytial virus B, and parainfluenza virus 3 were the most prevalent in cases with single and multiple infections. CRP showed a high frequency between autumn and winter of 2021, with higher incidence of hospitalization compared to COVID-19. The main comorbidities were immunosuppression, cardiovascular disease (CD), and asthma. The frequency of CRPs showed a downward trend throughout the first half of 2021. CRPs increased in single- and co-infection cases between the fourth and fifth waves of COVID-19, probably due to decreased nonpharmaceutical interventions and changes in diagnostic tests. Age, cyanosis (symptom), and immunosuppression (comorbidity) were found to differentiate between SARS-CoV-2 infection and CRP infection.

Clinical impact using low-dose mycophenolate mofetil with tacrolimus on infectious, noninfectious complications and acute rejection, in renal transplant: A single hospital experience in Mexico.

Evidence supporting a starting dose of 2 g/day of mycophenolate mofetil (MMF) in combination with tacrolimus (TAC) for renal transplantation (RT) is still limited, but maintaining a dose of <2 g could result in worse clinical outcomes in terms of acute rejection (AR). This study aimed to determine the association between AR and infectious and noninfectious complications after RT with a dose of 1.5 g vs 2 g of MMF. A prospective cohort study was performed with a 12-month follow-up of recipients of RT from living donors with low (1.5 g/day) or standard (2 g/day) doses of MMF. The association between adverse effects and complications and doses of MMF was examined using Cox proportional hazard models, and survival free of AR, infectious diseases, and noninfectious complications was evaluated using the Kaplan-Meier test. At the end of the follow-up, the incidence of infectious diseases was 52% versus 50% (P = .71) and AR was 5% versus 5% (P = .86), respectively. The survival rate free of gastrointestinal (GI) complications requiring medical attention was higher in the low-dose group than in the standard-dose dose (88% vs 45%, respectively; P < .001). The use of 1.5 g/day of MMF confers a reduction in GI complications without an increase in infectious diseases or the risk of AR.

Vitamin D levels in the pre- and post-COVID-19 pandemic periods in pediatric patients with chronic kidney disease.

Introduction: Vitamin D (VD) deficiency is common in children with chronic kidney disease (CKD) because of multiple factors. During the coronavirus disease 2019 (COVID-19) pandemic, it increased because of medicine shortage and no enough medical service for patients with non-COVID-19 diseases. Objective: To analyze the effects of the COVID-19 pandemic-related lockdown on the serum levels and status of 25-hydroxyvitamin D3 (25-[OH]D) in children with CKD. Materials and methods: This retrospective study included patients (6-18 years old) who were diagnosed with CKD stage 2-5 and routinely measured for serum VD levels between May 2019 and December 2022. Serum 25-(OH)D levels were measured before, during, and after the pandemic (2019, 2020-2021, and 2022, respectively). The daily dose of cholecalciferol supplementation and the readjustment (if required) were recorded. Results: This study included 171 patients (median age: 12 years). Before the pandemic, the median serum VD level was 25.0 ng/mL (19.3% VD deficiency). Then, VD supplementation was adjusted to 400-1,200 UI daily in 98.8% (n = 169) of patients. During the pandemic, the median VD level decreased to 22.5 ng/mL (43.3% VD deficiency). Hence, the supplementation was readjusted, and after the pandemic, the level was 28.7 ng/mL (18.7% VD deficiency), indicating a statistically significant increase in serum VD levels from the prepandemic period (p = 0.007). Conclusion: Decreased serum VD levels and increased VD deficiency frequency were observed in patients with CKD during the COVID-19 but improved after readjustment of supplementation.

Interdisciplinary evaluation of a robot physically collaborating with workers.

Collaborative Robots-CoBots-are emerging as a promising technological aid for workers. To date, most CoBots merely share their workspace or collaborate without contact, with their human partners. We claim that robots would be much more beneficial if they physically collaborated with the worker, on high payload tasks. To move high payloads, while remaining safe, the robot should use two or more lightweight arms. In this work, we address the following question: to what extent can robots help workers in physical human-robot collaboration tasks? To find an answer, we have gathered an interdisciplinary group, spanning from an industrial end user to cognitive ergonomists, and including biomechanicians and roboticists. We drew inspiration from an industrial process realized repetitively by workers of the SME HANKAMP (Netherlands). Eleven participants replicated the process, without and with the help of a robot. During the task, we monitored the participants' biomechanical activity. After the task, the participants completed a survey with usability and acceptability measures; seven workers of the SME completed the same survey. The results of our research are the following. First, by applying-for the first time in collaborative robotics-Potvin's method, we show that the robot substantially reduces the participants' muscular effort. Second: we design and present an unprecedented method for measuring the robot reliability and reproducibility in collaborative scenarios. Third: by correlating the worker's effort with the power measured by the robot, we show that the two agents act in energetic synergy. Fourth: the participant's increasing level of experience with robots shifts his/her focus from the robot's overall functionality towards finer expectations. Last but not least: workers and participants are willing to work with the robot and think it is useful.

[COVID-19 in transplant recipients: Multicentric report of Mexican experience]. / COVID-19 en receptores de trasplante: reporte multicéntrico de la experiencia mexicana.

Background: Solid Organ Transplant recipients (SOTR) appear to be at particular high risk for critical COVID-19 due to immunosuppressive drugs and comorbidities. We report the first description of clinical course and short-term outcomes of kidney and liver transplant recipients with confirmed COVID-19 in Mexico. The objective of this paper was evaluate the clinical course of transplant patients with COVID-19 infection. Material and methods: We retrospectively evaluated SOTR (kidney and liver) over 18 years of age with confirmed diagnosis of COVID-19 from tertiary care centers in Mexico. Results: Data from 45 kidney transplant recipients were recorded. Median (IQR) age was 43 (IQR 25-70) years. Admission to hospital was required in 37 (75.5 %) patients, of which 8 (16.3%) were hospitalized at Intensive Care Unit (ICU). Acute kidney injury (AKI) stage was documented in 33 (67%) patients. The time of hospitalization was 8 (IQR 6-12) days. Six patients died (12.2%). Additionally, data from 10 liver transplant recipients were included. During their evolution, 5 / 10 required hospital admission and there were no deaths in this group. Conclusions: Transplant recipients show a higher fatality rate and complications from SARS-CoV-2 infection; more studies are needed to identify prognostic factors and effective anti-SARS-CoV-2 therapies.

Antecedentes: Los receptores de trasplante de órgano sólido (RTOS) parecen estar en un riesgo particularmente alto de cuadros severos de infección por coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) debido al uso crónico de medicamentos inmunosupresores y sus comorbilidades. Reportamos la primera descripción del curso clínico y desenlaces a corto plazo de los receptores de trasplante con enfermedad por coronavirus 2019 (COVID-19) confirmada en México. El objetivo de este trabajo es evaluar el curso clínico de estos pacientes. Material y métodos: Evaluamos de manera retrospectiva los RTOS (riñón e hígado) mayores de 18 años de edad, con diagnóstico confirmado de infección por SARS-CoV-2 provenientes de cinco centros de tercer nivel en México. Resultados: Se incluyeron 45 receptores de trasplante renal con una edad de 43 (intervalo intercuartílico [IQR]: 25-70) años. El ingreso hospitalario se requirió en 37 (75.5%) pacientes, de los cuales ocho (16.3%) fueron hospitalizados en la unidad de terapia intensiva. Se documentó lesión renal aguda en 33 (67%) pacientes. El tiempo de hospitalización fue de 8 (IQR: 6-12) días. Seis pacientes fallecieron (12.2%). Adicionalmente, 10 receptores de trasplante hepático fueron incluidos. Durante su evolución, 5 / 10 requirieron ingreso hospitalario; no se presentaron fallecimientos en este grupo de pacientes. Conclusiones: Los receptores de trasplante mostraron una alta tasa de mortalidad y complicaciones por la infección por SARS-CoV-2. Son necesarios más estudios para identificar los factores pronósticos y modalidades de tratamiento eficaces.

Detección de ansiedad y depresión en el binomio receptor-donador durante el protocolo de trasplante renal / Anxiety and depression in the recipient-donor binomial during the kidney transplant protocol

ABSTRACT Introduction: Detection of anxiety and depression in the recipient-donor pair (BinRD) during the kidney transplant protocol (KT) is important to establish psychoeducational interventions that help achieve success during and after KT. Objective: To determine the presence of anxiety and depression symptoms in the BinRD during the RT protocol and to identify characteristics and associated factors. Methods: Cross-sectional study, including 174 binomials being evaluated for TR. The Beck Depression Scale (BDI-II) and the Hospital Anxiety and Depression Scale (HADS) were applied at the beginning of the RT protocol. Results: Anxiety and depression symptoms were more frequent in recipient candidates than in donors ([anxiety 39% vs 21%] [depression 46% vs 15%]) (p<0.0001). The recipients presented a higher risk of depression (OR=4.770, 95% CI 2.854-7.974, p<0.0001) and anxiety (OR=2.383, 95% CI 1.478-3.841, p<0.001). Undertaking hemodialysis in private units (OR 0.264, 95%CI 0.106-0.662, p=0.004) or being on automated peritoneal dialysis (OR 0.386, 95%CI 0.173-0.862, p=0.020 was associated with less anxiety in recipients. Conclusions: a high frequency of anxiety and depression symptoms in the BinRD, so it is important to offer effective psychological interventions focused especially on the recipient during the donation evaluation process.

RESUMEN Introducción: La detección de ansiedad y depresión en el binomio receptor-donador (BinRD) durante el protocolo de trasplante renal (TR) es importante, para establecer intervenciones psicoeducativas que ayuden a lograr el éxito durante y después del TR. Objetivo: Determinar presencia de síntomas de ansiedad y depresión en el BinRD durante el protocolo de TR e identificar características y factores asociados. Métodos: Estudio transversal, incluye 174 binomios en evaluación para TR. Se aplicó la Escala de Depresión de Beck (BDI-II) y la Escala de Ansiedad y Depresión Hospitalaria (HADS) al inicio del protocolo de TR. Resultados: Síntomas de ansiedad y depresión fueron más frecuentes en candidatos a receptores que en donadores ([ansiedad 39% vs 21%] [depresión 46% vs 15%]) (p<0.0001). Los receptores, presentaron mayor riesgo de depresión (OR=4.770, IC 95% 2.854-7.974, p<0.0001) y ansiedad (OR=2.383, IC 95% 1.478-3.841, p<0.001). Realizarse hemodiálisis en unidades privadas (OR 0.264, IC95% 0.106-0.662, p=0.004) o estar en diálisis peritoneal automatizada (OR 0.386, IC95% 0.173-0.862, p=0.020 se asoció a menor ansiedad en receptores. Conclusiones: Se evidenció una alta frecuencia de síntomas de ansiedad y depresión en el BinRD, por lo que es importante ofrecer intervenciones psicológicas eficaces enfocadas especialmente al receptor durante el proceso de evaluación para la donación.

The assistance of BAZAR robot promotes improved upper limb motor coordination in workers performing an actual use-case manual material handling.

This study aims at evaluating upper limb muscle coordination and activation in workers performing an actual use-case manual material handling (MMH). The study relies on the comparison of the workers' muscular activity while they perform the task, with and without the help of a dual-arm cobot (BAZAR). Eleven participants performed the task and the flexors and extensors muscles of the shoulder, elbow, wrist, and trunk joints were recorded using bipolar electromyography. The results showed that, when the particular MMH was carried out with BAZAR, both upper limb and trunk muscular co-activation and activation were decreased. Therefore, technologies that enable human-robot collaboration (HRC), which share a workspace with employees, relieve employees of external loads and enhance the effectiveness and calibre of task completion. Additionally, these technologies improve the worker's coordination, lessen the physical effort required to interact with the robot, and have a favourable impact on his or her physiological motor strategy. Practitioner summary: Upper limb and trunk muscle co-activation and activation is reduced when a specific manual material handling was performed with a cobot than without it. By improving coordination, reducing physical effort, and changing motor strategy, cobots could be proposed as an ergonomic intervention to lower workers' biomechanical risk in industry.

Embodiment modifies attention allotment for the benefit of dual task performance.

Many everyday tasks, like walking down a street, require us to dual task to also avoid collisions of our swinging arms with other pedestrians. The collision avoidance is possible with ease because humans attend to all our (embodied) limbs. But how does the level of embodiment affect attention distribution, and consequently task performance in dual tasks? Here we examined this question with a dual task that required participants to perform a cued button-press (main task) with their right hand, while reacting to possible collisions by a moving object with a left 'robot' hand (secondary task). We observed that participants consistently improve main task performance when they perceived the robot hand to be embodied, compared to when they don't. The secondary task performance could be maintained in both cases. Our results suggest that embodiment of a limb modifies attention allotment for the benefit of dual motor task performance using limbs.

Willingness to change diet and exercise behavior is associated with better lifestyle in dialysis patients close to a kidney transplant.

BACKGROUND & AIMS: Evidence suggests that multiple-behavior interventions (with a specialist) have a greater impact on public health than single-behavior interventions, particularly in a chronic patient. However, there is little understanding of some very basic principles concerning multiple health behavior change, especially in situations such as kidney transplantation, which requires a great willingness to change negative lifestyle behaviors to achieve intermediate and long-term success. We compared healthy lifestyles and nutritional status according to the willingness to change dietary and exercise behavior in dialysis patients from a living donor kidney transplant program. METHODS: 400 dialysis patients had a dietetic, anthropometric, protein-energy wasting [subjective global assessment (SGA)] and biochemical evaluation. Lifestyle was evaluated with an adapted instrument to measure lifestyle in chronic disease. Willingness to change behaviors was evaluated by the trans-theoretical model; 2 groups were formed: willingness to change dietary and exercise behaviors and unwillingness to change. RESULTS: Willingness to change dietary behavior was 50% and exercise 25%. Patients with willingness to change dietary and exercise behaviors had better healthy lifestyle scores, and higher frequency of healthy food consumption. Healthy lifestyle score (R2 = 0.37, p < 0.0001) was predicted by older age, higher educational degree, shorter time on dialysis, and the highest willingness to change dietary and exercise behaviors. CONCLUSIONS: Willingness to change dietary and exercise behaviors was associated with healthy lifestyle, as well as with higher frequency of healthy food consumption and with lower frequency of unhealthy food consumption.

The sum of kidney donor profile index and estimated post-transplant survival scale and their correlation with egfr decline in deceased donor kidney recipients

Background: The impact of donor quality on post-kidney transplant survival may vary by candidate condition. Objective: Analyzing the combined use of the Kidney Donor Profile Index (KDPI) and the estimated post-transplant survival (EPTS) scale and their correlation with the estimated glomerular filtration rate (eGFR) decline in deceased-donor kidney recipients (DDKR). Methods: This was a retrospective, observational cohort study. We included DDKRs between 2015 and 2017 at a national third-level hospital. Results: We analyzed 68 DDKR. The mean age at transplant was 41 ± 14 years, 47 (69%) had sensitization events, 18 (26%) had delayed graft function, and 16 (23%) acute rejection. The graft survival at 12 and 36 months was 98.1% (95% CI 94-100) and 83.7% (95% CI 65-100), respectively. The Pearson correlation coefficient between the percentage reduction in the annual eGFR and the sum of EPTS and KDPI scales was r = 0.61, p < 0.001. The correlation coefficient between the percentage reduction in the annual eGFR and the EPTS and KDPI scales separately was r = 0.55, p < 0.001, and r = 0.53, p < 0.001, respectively. Conclusions: The sum of EPTS and KDPI scales can provide a better donor-recipient relationship and has a moderately positive correlation with the decrease in eGFR in DDKR.

Impact of transplantation on neutrophil extracellular trap formation in patients with end-stage renal disease: A single-center, prospective cohort study.

ABSTRACT: Increased neutrophil extracellular trap (NET) formation associates with high cardiovascular risk and mortality in patients with end-stage renal disease (ESRD). However, the effect of transplantation on NETs and its associated markers remains unclear. This study aimed to characterize circulating citrullinated Histone H3 (H3cit) and Peptidyl Arginase Deiminase 4 (PAD4) in ESRD patients undergoing transplantation and evaluate the ability of their neutrophils to release NETs.This prospective cohort study included 80 healthy donors and 105 ESRD patients, out of which 95 received a transplant. H3cit and PAD4 circulating concentration was determined by enzyme-linked immunosorbent assay in healthy donors and ESRD patients at the time of enrollment. An additional measurement was carried out within the first 6 months after transplant surgery. In vitro NET formation assays were performed in neutrophils isolated from healthy donors, ESRD patients, and transplant recipients.H3cit and PAD4 levels were significantly higher in ESRD patients (H3cit, 14.38 ng/mL [5.78-27.13]; PAD4, 3.22 ng/mL [1.21-6.82]) than healthy donors (H3cit, 6.45 ng/mL [3.30-11.65], P < .0001; PAD4, 2.0 ng/mL [0.90-3.18], P = .0076). H3cit, but not PAD4, increased after transplantation, with 44.2% of post-transplant patients exhibiting high levels (≥ 27.1 ng/mL). In contrast, NET release triggered by phorbol 12-myristate 13-acetate was higher in neutrophils from ESRD patients (70.0% [52.7-94.6]) than healthy donors (32.2% [24.9-54.9], P < .001) and transplant recipients (19.5% [3.5-65.7], P < .05).The restoration of renal function due to transplantation could not reduce circulating levels of H3cit and PAD4 in ESRD patients. Furthermore, circulating H3cit levels were significantly increased after transplantation. Neutrophils from transplant recipients exhibit a reduced ability to form NETs.

Humoral Acute Rejection in a Kidney Transplant Recipient with Idiopathic Thrombocytopenic Purpura.

A 47-year-old male was diagnosed with chronic kidney disease (CKD) in 2011; idiopathic thrombocytopenic purpura (ITP) was also diagnosed in 2011 refractory to medical treatment and finally treated with splenectomy (2017) without relapses since that date, 5 blood transfusions, and 4 platelet apheresis in 2017. Renal transplant from a living related donor (brother), ABO compatible, crossmatch were negative, sharing 1 haplotype. Donor-specific anti-HLA antibody was negative. Graft function was stable until the 5th day and graft biopsy on the 6th day; thrombotic microangiopathy (TMA), C4D negative and inflammatory infiltration of polymorphonuclear leukocytes inside peritubular capillary, and anti-MICA antibodies were positive. The treatment used were plasmapheresis, intravenous immunoglobulin, and rituximab. Serum creatinine began to decrease since the 14th day, and by day 33, post-RT graft function was restored.

Cytomegalovirus in renal transplant recipients from living donors with and without valganciclovir prophylaxis and with immunosuppression based on anti-thymocyte globulin or basiliximab.

BACKGROUND: In our population, anti-thymocyte globulin (ATG) of 1 mg/Kg/day for 4 days is used; which permits not using valgancyclovir (VGC) prophylaxis in some renal transplant recipients (RTR) with moderate risk (R+), to reduce costs. This study aimed to determine the incidence and risk of developing cytomegalovirus (CMV), with or without prophylaxis, when exposed to low doses of ATG or basiliximab (BSL). PATIENTS AND METHODS: A retrospective cohort included 265 RTR with follow-up of 12 months. Prophylaxis was used in R-/D+ and some R+. Tacrolimus (TAC), mycophenolate mofetil, and prednisone were used in all patients. Logistic regression analysis was performed to estimate the risk of CMV in RTR with or without VGC. RESULTS: Cytomegalovirus was documented in 46 (17.3%) patients: 20 (43.5%) with CMV infection, and 26 (56.5%) with CMV disease. Anti-thymocyte globulin was used in 39 patients (85%): 32 R+, six D+/R-, and one D-/R-. ATG was used in 90% (27 of 30) of patients with CMV and without prophylaxis. The multivariate analysis showed an association of risk for CMV with the absence of prophylaxis (RR 2.29; 95% CI 1.08-4.86), ATG use (RR 3.7; 95% CI 1.50-9.13), TAC toxicity (RR 3.77; 95% CI 1.41-10.13), and lymphocytes at the sixth post-transplant month (RR 1.77; 95% CI 1.0-3.16). CONCLUSIONS: Low doses of ATG favored the development of CMV and a lower survival free of CMV compared with BSL. In scenarios where resources for employing VGC are limited, BSL could be an acceptable strategy.

Donor-specific antibodies development in renal living-donor receptors: Effect of a single cohort.

Minimization in immunosuppression could contribute to the appearance the donor-specific HLA antibodies (DSA) and graft failure. The objective was to compare the incidence of DSA in renal transplantation (RT) in recipients with immunosuppression with and without steroids. A prospective cohort from March 1st, 2013 to March 1st, 2014 and follow-up (1 year), ended in March 2015, was performed in living donor renal transplant (LDRT) recipients with immunosuppression and early steroid withdrawal (ESW) and compared with a control cohort (CC) of patients with steroid-sustained immunosuppression. All patients were negative cross-matched and for DSA pre-transplant. The regression model was used to associate the development of DSA antibodies and acute rejection (AR) in subjects with immunosuppressive regimens with and without steroids. Seventy-seven patients were included (30 ESW and 47 CC). The positivity of DSA class I (13% vs 2%; P < 0.05) and class II (17% vs 4%, P = 0.06) antibodies were higher in ESW versus CC. The ESW tended to predict DSA class II (RR 5.7; CI (0.93-34.5, P = 0.06). T-cell mediated rejection presented in 80% of patients with DSA class I (P = 0.07), and 86% with DSA II (P = 0.03), and was associated with DSA class II, (RR 7.23; CI (1.2-44), P = 0.03). ESW could favor the positivity of DSA. A most strictly monitoring the DSA is necessary for the early stages of the transplant to clarify the relationship between T-cell mediated rejection and DSA.

The Sum of Kidney Donor Profile Index and Estimated Post-Transplant Survival Scale and Their Correlation with eGFR Decline in Deceased Donor Kidney Recipients.

BACKGROUND: The impact of donor quality on post-kidney transplant survival may vary by candidate condition. OBJECTIVE: Analyzing the combined use of the Kidney Donor Profile Index (KDPI) and the estimated post-transplant survival (EPTS) scale and their correlation with the estimated glomerular filtration rate (eGFR) decline in deceased-donor kidney recipients (DDKR). METHODS: This was a retrospective, observational cohort study. We included DDKRs between 2015 and 2017 at a national third-level hospital. RESULTS: We analyzed 68 DDKR. The mean age at transplant was 41 ± 14 years, 47 (69%) had sensitization events, 18 (26%) had delayed graft function, and 16 (23%) acute rejection. The graft survival at 12 and 36 months was 98.1% (95% CI 94-100) and 83.7% (95% CI 65-100), respectively. The Pearson correlation coefficient between the percentage reduction in the annual eGFR and the sum of EPTS and KDPI scales was r = 0.61, p < 0.001. The correlation coefficient between the percentage reduction in the annual eGFR and the EPTS and KDPI scales separately was r = 0.55, p < 0.001, and r = 0.53, p < 0.001, respectively. CONCLUSIONS: The sum of EPTS and KDPI scales can provide a better donor-recipient relationship and has a moderately positive correlation with the decrease in eGFR in DDKR.

The immunogenetic diversity of the HLA system in Mexico correlates with underlying population genetic structure.

We studied HLA class I (HLA-A, -B) and class II (HLA-DRB1, -DQB1) allele groups and alleles by PCR-SSP based typing in a total of 15,318 mixed ancestry Mexicans from all the states of the country divided into 78 sample sets, providing information regarding allelic and haplotypic frequencies and their linkage disequilibrium, as well as admixture estimates and genetic substructure. We identified the presence of 4268 unique HLA extended haplotypes across Mexico and find that the ten most frequent (HF > 1%) HLA haplotypes with significant linkage disequilibrium (Δ'≥0.1) in Mexico (accounting for 20% of the haplotypic diversity of the country) are of primarily Native American ancestry (A*02~B*39~DRB1*04~DQB1*03:02, A*02~B*35~DRB1*08~DQB1*04, A*68~B*39~DRB1*04~DQB1*03:02, A*02~B*35~DRB1*04~DQB1*03:02, A*24~B*39~DRB1*14~DQB1*03:01, A*24~B*35~DRB1*04~DQB1*03:02, A*24~B*39~DRB1*04~DQB1*03:02, A*02~B*40:02~DRB1*04~DQB1*03:02, A*68~B*35~DRB1*04~DQB1*03:02, A*02~B*15:01~DRB1*04~DQB1*03:02). Admixture estimates obtained by a maximum likelihood method using HLA-A/-B/-DRB1 as genetic estimators revealed that the main genetic components in Mexico as a whole are Native American (ranging from 37.8% in the northern part of the country to 81.5% in the southeastern region) and European (ranging from 11.5% in the southeast to 62.6% in northern Mexico). African admixture ranged from 0.0 to 12.7% not following any specific pattern. We were able to detect three major immunogenetic clusters correlating with genetic diversity and differential admixture within Mexico: North, Central and Southeast, which is in accordance with previous reports using genome-wide data. Our findings provide insights into the population immunogenetic substructure of the whole country and add to the knowledge of mixed ancestry Latin American population genetics, important for disease association studies, detection of demographic signatures on population variation and improved allocation of public health resources.

Genetic diversity of HLA system in two populations from Nayarit, Mexico: Tepic and rural Nayarit.

We studied HLA class I (HLA-A, -B) and class II (HLA-DRB1, -DQB1) alleles by PCR-SSP based typing in 161 Mexicans from the state of Nayarit living in Tepic (N = 97) and rural communities (N = 64), to obtain information regarding allelic and haplotypic frequencies. We find that the ten most frequent haplotypes found in the state of Nayarit include eight Native American and two European haplotypes. Admixture estimates revealed that the main genetic components in the state of Nayarit are Native American (50.79 ±â€¯5.03% by ML; 42.24% of Native American haplotypes) and European (37.04 ±â€¯6.21% by ML; 35.72% of European haplotypes), while African genetic component is less apparent but relatively high (12.17 ±â€¯2.50% by ML; 13.36% of African haplotypes).

Genetic diversity of HLA system in four populations from Baja California, Mexico: Mexicali, La Paz, Tijuana and rural Baja California.

We studied HLA class I (HLA-A, -B) and class II (HLA-DRB1, -DQB1) alleles by PCR-SSP based typing in 250 Mexicans from the states of Baja California Norte and Baja California Sur living in Mexicali (N = 100), La Paz (N = 75), Tijuana (N = 25) and rural communities (N = 50) to obtain information regarding allelic and haplotypic frequencies. The most frequent haplotypes for the Baja California region include nine Native American and five European haplotypes. Admixture estimates revealed that the main genetic components are European (50.45 ±â€¯1.84% by ML; 42.03% of European haplotypes) and Native American (43.72 ±â€¯2.36% by ML; 40.24% of Native American haplotypes), while the African genetic component was less apparent (5.83 ±â€¯0.98% by ML; 9.36% of African haplotypes).

Genetic diversity of HLA system in two populations from Sinaloa, Mexico: Culiacán and rural Sinaloa.

We studied HLA class I (HLA-A, -B) and class II (HLA-DRB1, -DQB1) alleles by PCR-SSP based typing in 286 Mexicans from the state of Sinaloa living in Culiacán (N = 103) and rural communities (N = 183) to obtain information regarding allelic and haplotypic frequencies. We find that the most frequent haplotypes for the state of Sinaloa include ten Native American most probable ancestry and five European most probable ancestry haplotypes. The admixture estimates revealed that the main genetic components in the state of Sinaloa are European (62.39 ±â€¯3.47%) and Native American (37.61 ±â€¯2.85%), while the African genetic component was estimated as virtually absent (0.00 ±â€¯1.86%).