Mendez National Institute of Transplantation

Objectives. Culturally relevant education is needed to improve rates of successful kidney transplantation among Hispanic patients with end-stage renal disease (ESRD). This study examined whether patients’ knowledge about kidney disease, postoperative care, and proactive health practices improved after watching a telenovela series about ESRD.Design. 334 ESRD patients and 94 family members/caregivers were assigned to watch a telenovela (‘Fixing Paco,’ a bilingual health education film) or receive standard of care at a transplant center or at a dialysis clinic. Outcomes for pre-transplant patients assigned to standard of care at dialysis centers or at a transplant center were compared to pre-transplant patients in the treatment condition (standard of care + telenovela).Results. Knowledge and behavioral intention scores at baseline across conditions and locations were similar, suggesting that assignment resulted in comparable groups at baseline. Using linear regression, this study found statistically significant improvements in knowledge scores among the telenovela group as compared to the standard of care groups. The telenovela group also had greater improvements in behavioral intention scores compared to the standard of care groups. Family members assigned to the telenovela group had significant improvements in knowledge scores as compared to the standard of care groups.Conclusion. Being well informed about ESRD and adopting proactive health behaviors are important mechanisms in improving transplantation outcomes. These findings suggest that knowledge about kidney disease, postoperative care, and proactive health practices could be improved by viewing a telenovela. Implications, limitations, and directions for future research are discussed.

Background: Cytomegalovirus (CMV) is one of the most common cause of viral infection, causing morbidity and mortality among kidney transplant recipients (RTRs). The dimeric NF-kB transcription factors play critical roles in diverse cellular processes including adaptive and innate immunity, cell differentiation, proliferation and apoptosis. It regulates the expression of numerous genes that play a key role in the inflammatory and immune responses. Inhibitors of NF-kB, known as inhibitor kappa B-alpha (IkB-α), block NF-kB transcriptional activity by forming stable IkB-α:NF-kB complexes. The aim was to investigate the association of gene polymorphisms in the NF-kB and IkB pathway with CMV infection in RTRs. Methods: IkB-α promoter polymorphisms at position -881 (A/G), -826 (C/T), and 297 (C/T) were studied in 247 RTRs (52 RTRs with CMV infection and 195 without CMV infection), using DNA-based polymerase chain reaction with sequence-specific primers and restriction. In the case of NF-kB genotypes, the following single nucleotide polymorphisms (SNPs) were included: NF-kB1 (rs3774959, rs3774932, rs3774937, rs230526, rs230519), NF-kB2 (rs1056890, rs7897947, rs12769316) and NF-kB inducing kinase (NIK) (rs9908330, rs7222094). Results: Median time to CMV infection was 6 months with a mean peak CMV viral load of 7925 copies per ml. Patients with donor-positive/recipient-negative [D+/R-] serostatus were found to be associated with a high risk of CMV infection (p=0.001). A statistically significant correlation was found between IkB-α -297T allele polymorphism and the risk of CMV. Three common haplotypes were found, of which haplotype 2 (GTT) was significantly associated with an increased risk for CMV infected group as compared to non-CMV group (p=0.01). The association was independently significant in multiple logistic regression (p=0.02) along with serologic status D+/R-, acute rejection and thymoglobulin induction. The allelic as well as genotypic frequencies of NF-kB SNPs did not significantly differ between CMV infection and non-CMV group. Conclusion: These results indicated that the NF-kB activation pathway might be associated with the CMV infection.

Post-transplant lymphoproliferative disorder (PTLD) is a serious complication of transplantation. Using the OPTN/UNOS database, primary kidney recipients (2000-2009) were stratified according to transplant type (deceased donor, DD or living donor, LD), donor (D) and recipient (R) Epstein-Barr virus (EBV) serostatus (R+; D+/R- and D-/R-) and recipient age. Incidence and adjusted risk of PTLD and death were compared. Of the 137 939 primary kidney recipients transplanted between 2000 and 2009, 913 subsequently developed PTLD. In 90 208 recipients with known EBV serostatus, we found a trend toward a decrease in PTLD incidence in years 2007-2009 when compared to 2000-2003. This was due to a significant decrease in PTLD incidence in EBV- recipients. Of those, 61 273 had a known donor serostatus and were further examined. In adults, PTLD incidence (in 1000 person-years) in DD and LD was 7.0 and 7.0 in D+/R-; 3.0 and 2.5 in D-/R- and 1.2 and 1.0 in R+, respectively. The hazard ratio (HR) for PTLD (R+ as reference) in D+/R- (6.2 in DD and 7.2 in LD) was double to thrice than for D-/R- transplants (2.4 in both DD and LD). In pediatric recipients, PTLD incidence in DD and LD was 15.9 and 17.3 in D+/R-; 12 and 18 in D-/R- and 1.2 and 2.2 in R+, respectively. The HR for PTLD was 17.4 and 6.9 in D+/R- and 15.9 and 7.6 in D-/R- in DD and LD, respectively. A D+/R-, compared with a D-/R- transplant, may contribute to an increase in PTLD incidence of 35 and 42% in adult DD and LD transplants, respectively.

The association of immunosuppressive regimens (ISRs) with posttransplant lymphoproliferative disorder (PTLD) may be related with the Epstein-Barr virus (EBV) recipient serostatus. We selected primary kidney transplant recipients from Organ Procurement Transplant Network/United Network for Organ Sharing database (2000-2009) who were discharged with a functioning graft and were receiving an ISR including an antiproliferative drug and a calcineurin inhibitor as follows: mycophenolate mofetil (MMF)/mycophenolate sodium+tacrolimus (TAC), MMF+cyclosporine A (CsA); mammalian target of rapamycin inhibitor (mTORi)+TAC; and mTORi+CsA. Adjusted risks of PTLD, rejection, death, and graft failure were examined in all recipients and compared between EBV+ and EBV- recipients. Of 114,025 recipients, 754 developed PTLD (5-year incidence of 0.84%). Adjusted hazard ratio for PTLD was 4.39 (95% CI: 3.60-5.37) for EBV- versus EBV+ recipients; and 1.40 (95% CI: 1.03-1.90) for mTORi+TAC, 0.80 (95% CI: 0.65-0.99) for MMF+CsA, and 0.90 (95% CI: 0.57-1.42) for mTORi+CsA, versus MMF+TAC users. In EBV- recipients, hazard ratio for PTLD was 1.98 (95% CI: 1.28-3.07) for mTORi+TAC, 0.45 (95% CI: 0.28-0.72) for MMF+CsA, and 0.84 (95% CI: 0.39-1.80) for mTORi+CsA users versus MMF+TAC. No difference was seen in EBV+ recipient groups. Rejection rates were higher among MMF+CsA recipients in both EBV groups. Death and graft failure risk were increased in all EBV+ISR groups, while in EBV- these risks were only increased in mTORi+TAC group versus MMF+TAC. In EBV- recipients, immunosuppression with mTORi+TAC was associated with increased risk of PTLD, death, and graft failure, while MMF+CsA use was associated with a trend to increased risk of rejection, lower PTLD risk, and similar risk for graft failure when compared with MMF+TAC.

THURSDAY AFTERNOON - MINI ORAL ABSTRACTS: Interventions and Outcomes in Liver Transplantation II: PDF Only

Cochran, A.1; Nowicki, M. J.1; Bryant, D.2; Chinchilla-Reyes, C.1; Stadtler, M.2; Mone, T.2 Author Information

Transplantation: July 27, 2008 - Volume 86 - Issue 2S - p 305 doi: 10.1097/01.tp.0000331907.00765.4f

Human T-cell lymphotrophic virus (HTLV) type I has been linked to adult T-cell leukemia/lymphoma (ATL) and HTLV-I associated myelopathy (HAM). Transmission of HTLV by blood and organ transplantation has been documented, with some infections leading to clinical disease. Organ donors are tested for anti-HTLV antibodies and donor suitability is determined primarily by results from enzyme immunoassays (EIA). Confirmatory testing is not routinely performed, and the number of false positive organ donors is unknown. In order to investigate the contemporary seroprevalence of anti-HTLV I/II antibodies among solid organ donors and determine the number of false positive samples, we tested 1,408 specimens from prospective organ donors in 2002 and 2003. All specimens were tested for anti-HTLV antibodies by a commercial EIA. Repeatedly reactive specimens underwent confirmatory testing using a commercial Western blot. There were 22 repeatedly EIA reactive donor specimens (1.56%). Five specimens did not undergo further testing because of case shutdown or insufficient sample quantity. HTLV I/II western blot confirmed six positives, whereas five were negative and six were indeterminate. The majority of confirmed specimens were positive for antibodies to HTLV-II. Our data shows that 29% of initially reactive specimens were false positives. With the increasing demand for organs, the unnecessary rejection of organs that are falsely positive for HTLV antibodies becomes of tremendous importance and stresses the need for timely confirmatory testing for HTLV.