Dr. Jeremy R. Chapman, Editor-in-Chief, Transplantation

Late Graft Loss After Kidney Transplantation: Is “Death With Function” Really Death With a Functioning Allograft?

Gaston RS, Fieberg A, Helgeson ES, et al.
Transplantation: July 2020 - Volume 104 - Issue 7 - p 1483-1490

Take 3587 patients and follow them for 5.2 years and find out what happens. This is the DeKAF study from 7 major transplant programs in the USA. The question asked and largely answered in this paper is whether the people who die with graft function are actually dying because of poor graft function or because of concomitant disease. About half of the graft losses in the study were from each of death with a functioning graft (295 patients) and death censored graft failure (350 patients). The key finding is the renal function in those who survived with maintained graft function and those who died with a functioning graft were on similar trajectories. While the study has missing data, it is clear that the group in which the patient survived but the graft was lost, were characterised by being younger and non adherent and suffering rejection. The group who died with functioning grafts were older, diabetic and had been on dialysis for longer. While some of this may seem obvious, the impact on how you follow and look after patients in this COVID impacted world is highly relevant. 

CLICK HERE TO VIEW

CLICK HERE TO VIEW (OPEN ACCESS)

Seroprevalence of Antibodies to SARS-CoV-2 in 10 Sites in the United States, March 23-May 12, 2020

Fiona P. Havers, MD, MHS; Carrie Reed, PhD; Travis Lim, DrPH; Joel M. Montgomery, PhD; John D. Klena, PhD; Aron J. Hall, DVM; Alicia M. Fry, MD; Deborah L. Cannon, BS; Cheng-Feng Chiang, PhD; Aridth Gibbons, BS; Inna Krapiunaya, MS; Maria Morales-Betoulle, PhD; Katherine Roguski, MPH; Mohammad Ata Ur Rasheed, PhD; Brandi Freeman, PhD; Sandra Lester, PhD; Lisa Mills, PhD; Darin S. Carroll, PhD; S. Michele Owen, PhD; Jeffrey A. Johnson, PhD; Vera Semenova, PhD; Carina Blackmore, DVM; Debra Blog, MD; Shua J. Chai, MD; Angela Dunn, MD; Julie Hand, MSPH; Seema Jain, MD; Scott Lindquist, MD; Ruth Lynfield, MD; Scott Pritchard, MPH; Theresa Sokol, MPH; Lynn Sosa, MD; George Turabelidze, MD; Sharon M.Watkins, PhD; John Wiesman, DrPH; RandallW. Williams, MD; Stephanie Yendell, DVM; Jarad Schiffer, MS; Natalie J. Thornburg, PhD

JAMA Intern Med. doi:10.1001/jamainternmed.2020.4130
Published online July 21, 2020

Serum samples were tested from 16 025 persons in 10 sites in the USA; 1205 (7.5%) were 18 years or younger and 5845 (36.2%) were 65 years or older.Most specimens from each site had no evidence of antibodies to SARS-CoV-2. Adjusted estimates of the proportion of persons seroreactive to the SARS-CoV-2 spike protein antibodies ranged from 1.0% in the San Francisco Bay area (collected April 23-27) to 6.9% of persons in New York City (collected March 23-April 1). The estimated number of infections ranged from 6 to 24 times the number of reported cases; for 7 sites (Connecticut, Florida, Louisiana, Missouri, New York City metro area, Utah, and western Washington State), an estimated greater than 10 times more SARS-CoV-2 infections occurred than the number of reported cases. The findings may reflect the number of persons who had mild or no illness or who did not seek medical care or undergo testing but who still may have contributed to ongoing virus transmission in the population.

Presence of Genetic Variants Among Young Men With Severe COVID-19

Caspar I. van der Made, MD; Annet Simons, PhD; Janneke Schuurs-Hoeijmakers, MD, PhD; Guus van den Heuvel, MD; Tuomo Mantere, PhD; Simone Kersten, MSc; Rosanne C. van Deuren, MSc; Marloes Steehouwer, BSc; Simon V. van Reijmersdal, BSc; Martin Jaeger, PhD; TomHofste, BSc; Galuh Astuti, PhD; Jordi Corominas Galbany, PhD; Vyne van der Schoot,MD, PhD; Hans van der Hoeven, MD, PhD; Wanda Hagmolen of ten Have,MD, PhD; Eva Klijn, MD, PhD; Catrien van den Meer, MD; Jeroen Fiddelaers, MD; Quirijn de Mast, MD, PhD; Chantal P. Bleeker-Rovers, MD, PhD; Leo A. B. Joosten, PhD; Helger G. Yntema, PhD; Christian Gilissen, PhD; Marcel Nelen, PhD; JosW. M. van der Meer,MD, PhD; Han G. Brunner,MD, PhD; Mihai G. Netea, MD, PhD; Frank L. van de Veerdonk, MD, PhD; Alexander Hoischen, PhD

JAMA. doi:10.1001/jama.2020.13719
Published online July 24, 2020.

This article reports a case series of pairs of brothers without medical history and admitted to the intensive care unit (ICU) due to severe COVID-19. The 4 male patients had a mean age of 26 years (range, 21-32), with no history of major chronic disease. They were previously well before developing respiratory insufficiency due to severe COVID-19, requiring mechanical ventilation in the ICU. The mean duration of ventilatory support was 10 days (range, 9-11); the mean duration of ICU stay was 13 days (range, 10-16). One patient died. Rapid clinical whole-exome sequencing of the patients and segregation in available family members identified loss-of-function variants of the X-chromosomal TLR7. In members of family 1, a maternally inherited 4-nucleotide deletion was identified. In primary peripheral blood mononuclear cells from the patients, downstream type I interferon (IFN) signaling was transcriptionally downregulated, as measured by significantly decreased mRNA expression of IRF7, IFNB1, and ISG15 on stimulation with the TLR7 agonist imiquimod as compared with family members and controls. The production of IFN-γ, a type II IFN, was decreased in patients in response to stimulation with imiquimod.

High Prevalence of Asymptomatic COVID-19 Infection in Hemodialysis Patients Detected Using Serologic Screening

Candice Clarke, Maria Prendecki, Amrita Dhutia, Mahrukh A. Ali, Hira Sajjad, Oshini Shivakumar, Liz Lightstone, Peter Kelleher, Matthew C. Pickering, David Thomas, Rawya Charif, Megan Griffith, Stephen P. McAdoo, and Michelle Willicombe

J Am Soc Nephrol, 2020 Jul 30; doi: 10.1681/ASN.2020060827. PMID: 32732391

This article investigated the seroprevalence of SARS-CoV-2 antibodies in a hemodialysis population. Of 356 patients, 121 had been symptomatic when screened before a dialysis session and received an RT-PCR test; 79 (22.2% of the total study population) tested positive for COVID-19. Serologic testing of all 356 patients found 129 (36.2%) who tested positive for SARS-CoV-2 antibodies. Only two patients with PCR-confirmed infection did not seroconvert. Of the 129 patients with SARS-CoV-2 antibodies, 52 (40.3%) had asymptomatic disease or undetected disease by PCR testing alone.

SARS-CoV-2-reactive T cells in healthy donors and patients with COVID-19

Julian Braun, Lucie Loyal, Marco Frentsch, Daniel Wendisch, Philipp Georg, Florian Kurth, Stefan Hippenstiel, Manuela Dingeldey, Beate Kruse, Florent Fauchere, Emre Baysal, Maike Mangold, Larissa Henze, Roland Lauster, Marcus A. Mall, Kirsten Beyer, Jobst Röhmel, Sebastian Voigt, Jürgen Schmitz, Stefan Miltenyi, Ilja Demuth, Marcel A. Müller, Andreas Hocke, Martin Witzenrath, Norbert Suttorp, Florian Kern, Ulf Reimer, Holger Wenschuh, Christian Drosten, Victor M. Corman, Claudia Giesecke-Thiel, Leif Erik Sander & Andreas Thiel

Nature. Published: 29 July 2020. https://doi.org/10.1038/s41586-020-2598-9 (2020)

This article investigated SARS-CoV-2 spike glycoprotein (S)-reactive CD4+ T cells in peripheral blood of patients with COVID-19 and SARS-CoV-2-unexposed healthy donors. The authors detected SARS-CoV-2 S-reactive CD4+ T cells in 83% of patients with COVID-19 but also in 35% of controls. S-reactive CD4+ T cells in HD reacted primarily to C-terminal S epitopes, which show a higher homology to spike glycoproteins of human endemic coronaviruses, compared to N-terminal epitopes. The role of pre-existing SARS-CoV-2 cross-reactive T cells for clinical outcomes remains to be determined in larger cohorts.

July 29 - HIV-positive individuals with end-stage kidney disease may now have a larger pool of kidneys available to them, with recent study results from the National Institutes of Health (NIH) showing that kidneys from HIV-positive deceased donors can be used in addition to those from HIV-negative donors.

READ THE FULL ARTICLE

July 30 - Patients undergoing kidney transplantation are at risk for new-onset diabetes after transplantation (NODAT). NODAT is a common complication after kidney transplantation; however, according to researchers in the Republic of Korea, the mechanism of NODAT is not fully understood. Results of recent studies suggest that in the general population gut bacteria play a key role in diabetes.

READ THE FULL ARTICLE

July 30 - Two coronavirus patients who became so sick that double lung transplants were their only chance for survival are now recovering from their harrowing journeys, their doctors report.

READ THE FULL ARTICLE

July 30 - Using kidneys from older donors for dual transplantation may be a safe and effective way to reduce the organ discard rate, thereby increasing the number of transplants performed, according to a study conducted in the United Kingdom.

READ THE FULL ARTICLE

July 31 - In patients with type 1 diabetes as well as, more recently, type 2 diabetes, pancreas transplantation has proven effective in normalizing glucose control with equivalent patient and graft survival rates. However, according to researchers at Temple University School of Medicine, Philadelphia, Pennsylvania, there are few data available on outcomes of simultaneous kidney-pancreas transplantation in overweight and obese recipients.

READ THE FULL ARTICLE

In accordance with the TTS By-Laws, a Business Meeting will be held shortly after the close of the TTS 2020 Virtual Congress. The meeting will be help on Sunday, September 20, at 8 AM Montreal time and will last approximately one hour. The agenda will include an update on the TTS finances, the announcement of the TTS 2024 Congress location, a presentation for the TTS 2022 Congress in Buenos Aires, the announcement of the 2020-2022 Councilors and Officers and the official change of TTS Presidency. All members are invited to participate.

As this meeting will be virtually, we will send all members a link to join this meeting shortly before the meeting takes place.

Sincerely,

John Fung
Secretary, The Transplantation Society

CLICK HERE TO VISIT THE WEBSITE