Karsten Midtvedt

INTRODUCTION AND AIMS: Tacrolimus (Tac) is the cornerstone of solid organ transplant immunosuppression & is also used as second or third line therapy of various immunological diseases. Fatty acids (FAs) may influence Tac absorption & metabolism. To date, no study has investigated effects of marine n-3 FA intake on Tac pharmacokinetics.

INTRODUCTION AND AIMS: Successful kidney transplantation (KTx) is the optimal treatment for patients with end stage renal disease (ESRD). Many older patients experience good health-related quality of life (HRQoL) in modern dialysis while immunosuppressive drugs are known to have side effects with negative impact on HRQoL. There is a lack of knowledge regarding HRQoL after KTx in elderly recipients. The aim of this study was to measure HRQoL longitudinally in patients ≥65 years of age, from time of enlisting for KTx and until 3 year post transplant.

INTRODUCTION AND AIMS: Fracture risk is increased after kidney transplantation, but how to identify those that may benefit from intervention remains unclear. New guidelines published in 2017 advocate bone mineral density (BMD) testing to assess fracture risk, but the evidence is sparse. The purpose of this study was to investigate the predictability of BMD on fracture after kidney transplantation.

In recipients with type 1 diabetes, we aimed to determine whether long-term normoglycemia achieved by successful simultaneous pancreas and kidney (SPK) transplantation could beneficially affect progression of coronary artery disease (CAD) when compared with transplantation of a kidney-alone from a living donor (LDK). In 42 kidney transplant recipients with functioning grafts who had received either SPK (n = 25) or LDK (n = 17), we studied angiographic progression of CAD between baseline (pretransplant) and follow-up at 7 years or older. In addition, computed tomography scans for measures of coronary artery calcification and echocardiographic assessment of left ventricular systolic function were addressed at follow-up. During a median follow-up time of 10.1 years (interquartile range [IQR], 9.1-11.5) progression of CAD occurred at similar rates (10 of 21 cases in the SPK and 5 of 14 cases in the LDK group; P = 0.49). Median coronary artery calcification scores were high in both groups (1767 [IQR, 321-4035] for SPK and 1045 [IQR, 807-2643] for LDK patients; P = 0.59). Left ventricular systolic function did not differ between the 2 groups. The SPK and LDK recipients were similar in age (41.2 ± 6.9 years vs 40.5 ± 10.3 years; P = 0.80) and diabetes duration at engraftment but with significant different mean HbA1c levels of 5.5 ± 0.4% for SPK and 8.3 ± 1.5% for LDK patients (P Conclusions In patients with both type 1 diabetes and end-stage renal disease, SPK recipients had similar progression of CAD long-term compared with LDK recipients. Calcification of coronary arteries is a prominent feature in both groups long-term posttransplant.

Introduction and Aims: Estimated renal allograft half-life is between 10 and 20 years. Many renal transplant recipients will therefore be in need of a repeated transplantation, some after having reached an advanced age. Advanced age and many years of immunosuppression often leads to increased co-morbidity. This may affect patient survival and graft outcome. This study was designed to evaluate the outcome of recipients older than 65 years receiving allograft nr.1 vs allograft nr.2.

Introduction and Aims: The overall life-expectancy is increasing. With increasing age comes an increasing risk of developing end stage renal disease (ESRD).We have previously shown that patients older than 70 years with ESRD have a survival benefit if transplanted compared to continued dialysis. Is this true for patients reaching their eighties?

Background: Acute rejection (AR) episodes in renal transplant recipients are suspected when plasma creatinine is elevated and other potential causes out ruled. Graft biopsies are however needed for definite diagnosis. Non-invasive AR-biomarkers is an unmet clinical need. The urinary proteome is an interesting source in the search for such a biomarker in this population.Methods: In this proof of principle study, serial urine samples in the early post transplant phase from 6 patients with biopsy verified acute rejections and 6 age-matched controls without clinical signs of rejection were analyzed by shotgun proteomics.Results: Eleven proteins fulfilled predefined criteria for regulation in association with AR. They presented detectable regulation already several days before clinical suspicion of AR (increased plasma creatinine). The regulated proteins could be grouped by their biological function; proteins related to growth and proteins related to immune response. Growth-related proteins (IGFBP7, Vasorin, EGF and Galectin-3-binding protein) were significantly up-regulated in association with AR (P = 0.03) while proteins related to immune response (MASP2, C3, CD59, Ceruloplasmin, PiGR and CD74) tended to be up-regulated (P = 0.13).Conclusion: The use of shotgun proteomics provides a robust and sensitive method for identification of potentially predictive urinary biomarkers of AR. Further validation of the current findings is needed to establish their potential clinical role with regards to clinical AR diagnosis.Trial registration: ClinicalTrials.gov number NCT00139009

There is limited knowledge about the incidence, clinical implication and spontaneous course of transplant renal artery stenosis detected early after renal transplantation. We performed Doppler ultrasound examination of the transplant artery(s) 2 months after transplantation in 98 consecutive patients and peak systolic velocity (PSV) was measured. All patients with an elevated PSV ≥1.8 m/s were reexamined 20 months later and clinical data were followed for 3 years. At the initial examination 2 months after transplantation 15 recipients had a PSV ≥1.8 m/s, mean value for PSV 2.5 (1.8-3.6) m/s, whereas 83 recipients had a normal PSV of 1.3 (0.7-1.7) m/s (P<0.01). At baseline there were no statistical significant differences in clinical parameters between the high PSV versus normal PSV recipients. Twenty (15-28) months after transplantation 14 patients with initial elevated PSV were re-examined. There was an overall mean reduction in PSV of 0.5 (-0.7 to 1.2) m/s from 2.4 (1.8-3.4) m/s to 1.9 (1.2-3.1) m/s (P=0.02). Detection of a high PSV early after transplantation did not affect graft function or blood pressure 3 years after engraftment. We conclude that a high PSV, at 2 months after engraftment, seems to be more of an 'incidental finding' that should be re-challenged and carefully interpreted.

The overall number of transplants per million of population has increased to 60.8, which is the highest in Europe. However, the increase in kidney transplants in the new millennium has mainly been due to an increased deceased donation rate. The short waiting list for deceased donor kidney transplantation, less than 50 per million inhabitants, reflects the high transplant rate. In our opinion, renal transplantation is a safe and satisfactory treatment for patients with terminal kidney failure, including patients over the age of 70. The patient must fulfill the medical criteria for acceptance for transplantation. Ideally, the patient should receive a transplant before the commencement of dialysis, or as soon as possible after starting dialysis. Organs from old and suboptimal donors can be transplanted as single grafts with very good outcomes. Furthermore, functional capacity prior to organ retrieval is far more important than evaluation of kidney biopsies at the time of engraftment.