NN&I - June 2010

Transplant Update Subscribe to our free eNewsletter at www.nephronline.comJune 2010 Nephrology News & Issues 29 Transplant StudiesGene variation among kidney donors associated \037 with graft failureAmong kidney transplant donors, variation of a gene that is an inhibitor of the development of fibrous connective tissue is associated with an increased risk of graft failure, according to a study in the April 7 issue of the Journal of the American Medical Association. Jason Moore, BMBS, of the Renal Institute of Birmingham and University Hospital Birmingham, England, and colleagues looked at CAV1 variants in the development of kidney allograft fibrosis and in kidney trans-plantation outcome. The study included genomic DNA from 785 white kidney transplant donors and their respective recipients. DNA samples were analyzed for common varia-tion in CAV1. Analysis assessing an association between genotype and allograft failure revealed significant differences in graft sur -vival between donor genotypes for the tag single nucleotide polymorphism (SNP) rs4730751, with poorer graft survival in recipients whose donors displayed genotype AA. Overall, graft failure rates were 38.6% for donor genotype AA, 22.3% for donor genotype CC, and 22.2% for donor genotype AC. Data from the Belfast validation group indicated significant differences in graft survival between donor genotypes, and, as in the Birmingham group, poorer graft survival was seen in recipients whose donors displayed genotype AA. Johns Hopkins researchers critical of wasting organs \037Two studies by Johns Hopkins researchers show that marginal organs that are often discarded could be used in patients with Hepatitis C or who are older in age. In a study of national data published online in the American Journal of Transplantation, researchers say that while out-comes are slightly worse when hepatitis C-positive patients receive hepatitis C-positive organs, the advantages of more timely transplants may outweigh the risk of waiting for a hepa-titis C-negative kidney. Patients with hepatitis C-positive make up about 12% of the population with kidney failure. "Nationwide, kidneys from infected donors are inappropri-ately thrown out and denied to patients in need," said study leader Dorry Segev, MD, PhD. In looking at data from more than 93,000 deceased kidney donors between 1995 and 2009, Segev and his colleagues found that hepatitis C-positive kidneys were two and a half times more likely to be discarded than hepatitis C-negative kidneys. In a second review, Segev and colleagues reported that one-third of people older than 65 wait longer than necessary for a kidney because their doctors fail to put them in a queue for organs unsuitable to transplant in younger patients but well-suited to seniors.Researchers reviewed 142,907 first-time, deceased-donor kidney registrants reported to the United Network of Organ Sharing between 2003 and 2008, looking at those who were willing to be listed for expanded criteria donors (ECD) kid- neys and compared survival rates from time of registration for those willing to receive ECD kidneys and those who were not. Those willing to take the older kidneys were more likely to be transplanted.Rapamycin more effective in black patients \037Black kidney transplant patients treated with rapamycin live longer than whites given the same medication, according to research presented at the National Kidney Foundation's Spring Clinical Meetings. "In selected minorities, particularly in African Americans, there may be a group who benefits from rapamycin," said Bhamidipati V. R. Murthy. MD, of the University of Texas Medical School in Houston, the study's lead author. Researchers looked back at 380 patients given the drug who underwent a first kidney transplant at their center between 1993 and 2003, following them up to 2009. Forty-four percent were white, 29% black, and 26% were Hispanic.indications. It has been hypothesized that they may be at additional risk due to their liver disease, which can lead to a life-threatening biliary tract and gallbladder infection. This risk has prompted a recommendation that all children with ARPKD receive indefinite post-transplant antibiotic prophylaxis with trimethoprim-sulfamethoxazole. While most patients with ARPKD require a kidney transplant, some may require a combined liver-kidney trans -plant or a liver transplant alone. Patients with portal venous hypertension and resultant gastrointestinal bleeding that cannot be controlled with medications or surgery may be considered for liver transplantation. If there are signs of poor or deteriorating kidney function, consideration may be given for dual organ liver-kidney transplantation. Overall, the prognosis for children with ARPKD has improved substan -tially during the last few decades. Early initiation of peritoneal dialysis and nephrectomy when indicated has con -tributed to improved patient survival. With careful attention to nutrition, suf -ficient growth can be achieved to allow for successful kidney transplantation. Although ARPKD kidney recipients do as well as children receiving kidneys for other reasons, some of these patients die from infection despite good kidney function. Continued improvements in transplant care will hopefully allow more children to celebrate not only their tenth birthday, but also many more beyond. 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