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Article ; Online: BK Virus Nephropathy.

Sawinski, Deirdre / Trofe-Clark, Jennifer

Clinical journal of the American Society of Nephrology : CJASN

2018 Volume 13, Issue 12, Page(s) 1893–1896

MeSH term(s)	Algorithms ; BK Virus ; Female ; Humans ; Kidney Diseases/therapy ; Kidney Diseases/virology ; Kidney Transplantation ; Polyomavirus Infections/complications ; Polyomavirus Infections/therapy ; Postoperative Complications/therapy ; Postoperative Complications/virology ; Tumor Virus Infections/complications ; Tumor Virus Infections/therapy
Language	English
Publishing date	2018-09-21
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2226665-3
ISSN	1555-905X ; 1555-9041
ISSN (online)	1555-905X
ISSN	1555-9041
DOI	10.2215/CJN.04080318
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Article ; Online: Safety, Effectiveness, and Tolerability of Patiromer in Kidney Transplant Recipients.

Lim, Mary Ann / Sawinski, Deirdre / Trofe-Clark, Jennifer

Transplantation

2019 Volume 103, Issue 9, Page(s) e281–e282

MeSH term(s)	Biomarkers/blood ; Chelating Agents/adverse effects ; Chelating Agents/therapeutic use ; Drug Interactions ; Humans ; Hyperkalemia/blood ; Hyperkalemia/diagnosis ; Hyperkalemia/drug therapy ; Hyperkalemia/etiology ; Immunosuppressive Agents/blood ; Immunosuppressive Agents/therapeutic use ; Kidney Transplantation/adverse effects ; Patient Safety ; Polymers/adverse effects ; Polymers/therapeutic use ; Potassium/blood ; Retrospective Studies ; Risk Assessment ; Tacrolimus/blood ; Tacrolimus/therapeutic use ; Treatment Outcome
Chemical Substances	Biomarkers ; Chelating Agents ; Immunosuppressive Agents ; Polymers ; patiromer (1FQ2RY5YHH) ; Potassium (RWP5GA015D) ; Tacrolimus (WM0HAQ4WNM)
Language	English
Publishing date	2019-07-25
Publishing country	United States
Document type	Letter
ZDB-ID	208424-7
ISSN	1534-6080 ; 0041-1337
ISSN (online)	1534-6080
ISSN	0041-1337
DOI	10.1097/TP.0000000000002829
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Article ; Online: BK and Other Polyomaviruses in Kidney Transplantation.

Trofe-Clark, Jennifer / Sawinski, Deirdre

Seminars in nephrology

2016 Volume 36, Issue 5, Page(s) 372–385

Abstract: For more than 40 years, polyomaviruses (BK virus and JC virus) have been known to cause disease in human beings. Recently, 11 new polyomaviruses were discovered. However, the majority of these viruses are rare in renal transplant recipients and BK and JC ...

Abstract	For more than 40 years, polyomaviruses (BK virus and JC virus) have been known to cause disease in human beings. Recently, 11 new polyomaviruses were discovered. However, the majority of these viruses are rare in renal transplant recipients and BK and JC viruses remain the most important polyomaviruses to impact this population. BK virus presents as BK virus nephropathy and has, in rare instances, been associated with hemorrhagic cystitis or ureteral strictures. JC virus can cause progressive multifocal leukoencephalopathy or nephropathy in this population as well, but is uncommon. Antiviral prophylactic and therapeutic interventions for these diseases are lacking to date, although reduction of immunosuppression has been associated with success in treating both BK virus nephropathy and JC virus-induced disease. Risk factors are not well defined and vary across studies. However, the cumulative degree of immunosuppression is regarded universally as an important contributor to BK virus replication. For these reasons, it is recommended to screen all renal transplant recipients prospectively for BK virus infection. Multicenter trials using standardized BK and JC virus screening methods are necessary to define risk factors better, and to determine the effect of prophylaxis and treatments for these polyomaviruses affecting renal transplant recipients.
Language	English
Publishing date	2016-09
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	604652-6
ISSN	1558-4488 ; 0270-9295
ISSN (online)	1558-4488
ISSN	0270-9295
DOI	10.1016/j.semnephrol.2016.05.014
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Article ; Online: The Second International Consensus Guidelines on the Management of BK Polyomavirus in Kidney Transplantation.

Kotton, Camille N / Kamar, Nassim / Wojciechowski, David / Eder, Michael / Hopfer, Helmut / Randhawa, Parmjeet / Sester, Martina / Comoli, Patrizia / Tedesco Silva, Helio / Knoll, Greg / Brennan, Daniel C / Trofe-Clark, Jennifer / Pape, Lars / Axelrod, David / Kiberd, Bryce / Wong, Germaine / Hirsch, Hans H

Transplantation

2024

Abstract: BK polyomavirus (BKPyV) remains a significant challenge after kidney transplantation. International experts reviewed current evidence and updated recommendations according to Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). ... ...

Abstract	BK polyomavirus (BKPyV) remains a significant challenge after kidney transplantation. International experts reviewed current evidence and updated recommendations according to Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). Risk factors for BKPyV-DNAemia and biopsy-proven BKPyV-nephropathy include recipient older age, male sex, donor BKPyV-viruria, BKPyV-seropositive donor/-seronegative recipient, tacrolimus, acute rejection, and higher steroid exposure. To facilitate early intervention with limited allograft damage, all kidney transplant recipients should be screened monthly for plasma BKPyV-DNAemia loads until month 9, then every 3 mo until 2 y posttransplant (3 y for children). In resource-limited settings, urine cytology screening at similar time points can exclude BKPyV-nephropathy, and testing for plasma BKPyV-DNAemia when decoy cells are detectable. For patients with BKPyV-DNAemia loads persisting >1000 copies/mL, or exceeding 10 000 copies/mL (or equivalent), or with biopsy-proven BKPyV-nephropathy, immunosuppression should be reduced according to predefined steps targeting antiproliferative drugs, calcineurin inhibitors, or both. In adults without graft dysfunction, kidney allograft biopsy is not required unless the immunological risk is high. For children with persisting BKPyV-DNAemia, allograft biopsy may be considered even without graft dysfunction. Allograft biopsies should be interpreted in the context of all clinical and laboratory findings, including plasma BKPyV-DNAemia. Immunohistochemistry is preferred for diagnosing biopsy-proven BKPyV-nephropathy. Routine screening using the proposed strategies is cost-effective, improves clinical outcomes and quality of life. Kidney retransplantation subsequent to BKPyV-nephropathy is feasible in otherwise eligible recipients if BKPyV-DNAemia is undetectable; routine graft nephrectomy is not recommended. Current studies do not support the usage of leflunomide, cidofovir, quinolones, or IVIGs. Patients considered for experimental treatments (antivirals, vaccines, neutralizing antibodies, and adoptive T cells) should be enrolled in clinical trials.
Language	English
Publishing date	2024-04-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	208424-7
ISSN	1534-6080 ; 0041-1337
ISSN (online)	1534-6080
ISSN	0041-1337
DOI	10.1097/TP.0000000000004976
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Article: BKV Viremia and Development of De Novo DSA in Renal Transplant Recipients.

Sawinski, Deirdre / Trofe-Clark, Jennifer

Clinical transplants

2015 Volume 31, Page(s) 249–256

Abstract: BK virus (BKV) viremia is a common complication of kidney transplantation. In 2008, we enacted a screening protocol to detect BKV infection at our institution. The cumulative incidence of BKV viremia at our center is 24%, with most cases being detected ... ...

Abstract	BK virus (BKV) viremia is a common complication of kidney transplantation. In 2008, we enacted a screening protocol to detect BKV infection at our institution. The cumulative incidence of BKV viremia at our center is 24%, with most cases being detected in the first year post-transplant. We have previously identified the development of de novo donor specific antibody as a consequence of BKV infection treated with immunosuppression reduction; in this report, we confirm our prior findings and extend them to include an association of both Class I and Class II antibodies with BKV viremia. While with a median time of 4 years follow up there was no difference in patient or allograft survival on the basis of BKV viremia. Identification of treatment strategies for BKV that will prevent complications such as donor specific antibodies should be a research priority in this area.
Language	English
Publishing date	2015
Publishing country	United States
Document type	Journal Article
ZDB-ID	607631-2
ISSN	0890-9016
ISSN	0890-9016
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Article ; Online: A survey of solid organ transplant recipient attitudes and concerns regarding contraception and pregnancy.

McIntosh, Tristan / Puerzer, Payton / Li, Miah T / Malat, Gregory / Sammons, Chelsea / Norris, Maxwell / Fallah, Tara / Trofe-Clark, Jennifer / DuBois, James M / Iltis, Ana / Mohan, Sumit / Sawinski, Deirdre

Clinical transplantation

2023 Volume 37, Issue 5, Page(s) e14948

Abstract: Introduction: Many women who are solid organ transplant (SOT) recipients wish to have children after transplantation. Contraception is an important component of post-transplant planning and care, given the increased risk associated with post-transplant ... ...

Abstract	Introduction: Many women who are solid organ transplant (SOT) recipients wish to have children after transplantation. Contraception is an important component of post-transplant planning and care, given the increased risk associated with post-transplant pregnancies. We sought to understand patient attitudes and concerns about post-transplant contraception and pregnancy. Methods: Following a comprehensive literature review, our team developed a survey that was administered to female SOT recipients of childbearing age. We used descriptive and inferential statistics to characterize participant views RESULTS: A total of 243 transplant recipients completed the survey (80.7% response rate). The mean age of respondents was 37.5 years (±8.1 years), 66.7% were kidney recipients, and 40.7% were within the first year after transplant. The most common concerns among respondents included fetal and maternal health complications. Participants generally did not agree that transplant recipients should be advised to avoid pregnancy. There was strong support for shared decision-making about pregnancy after transplantation CONCLUSION: Understanding patient perspectives can help transplant providers make better care recommendations and support patient autonomy in reproductive decisions post-transplant. Given that there are some differences in views by transplant type, individualized conversations between patients and providers are needed.
MeSH term(s)	Child ; Pregnancy ; Humans ; Female ; Adult ; Transplant Recipients ; Communication ; Contraception ; Surveys and Questionnaires ; Organ Transplantation/adverse effects
Language	English
Publishing date	2023-03-01
Publishing country	Denmark
Document type	Review ; Journal Article
ZDB-ID	639001-8
ISSN	1399-0012 ; 0902-0063
ISSN (online)	1399-0012
ISSN	0902-0063
DOI	10.1111/ctr.14948
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Article ; Online: Barriers to vaccination in renal transplant recipients.

Maldonado, Angela Q / Johnson, David / Trofe-Clark, Jennifer

Transplant infectious disease : an official journal of the Transplantation Society

2017 Volume 19, Issue 5

Abstract: Vaccine-preventable diseases remain at the forefront of challenges in the long-term care of renal transplant recipients (RTR). Although global vaccination campaigns targeting patients with end-stage renal disease or RTR are standard, rates of vaccination ...

Abstract	Vaccine-preventable diseases remain at the forefront of challenges in the long-term care of renal transplant recipients (RTR). Although global vaccination campaigns targeting patients with end-stage renal disease or RTR are standard, rates of vaccination among renal transplant candidates and RTRs remain suboptimal. We highlight the multifactorial barriers leading to low vaccination rates in this vulnerable population.
Language	English
Publishing date	2017-10
Publishing country	Denmark
Document type	Journal Article
ZDB-ID	1476094-0
ISSN	1399-3062 ; 1398-2273
ISSN (online)	1399-3062
ISSN	1398-2273
DOI	10.1111/tid.12749
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Article ; Online: Tolerability of mycophenolate mofetil in elderly kidney transplant recipients: A retrospective cohort study.

Witek, Stephanie / Malat, Gregory / Sawinski, Deirdre / Sammons, Chelsea / LaFratte, Christopher / Forte, Abigail / Samudralwar, Rahul / Lyle, Sandra / Rashid, Jamal / Trofe-Clark, Jennifer

Clinical transplantation

2022 Volume 36, Issue 7, Page(s) e14671

Abstract: Background: Optimal immunosuppression in elderly kidney transplant recipients (KTRs) is not well defined, with mycophenolate mofetil (MMF) being poorly tolerated. Study aim was to compare MMF dose reduction incidence and reason(s) in elderly vs. ... ...

Abstract	Background: Optimal immunosuppression in elderly kidney transplant recipients (KTRs) is not well defined, with mycophenolate mofetil (MMF) being poorly tolerated. Study aim was to compare MMF dose reduction incidence and reason(s) in elderly vs. nonelderly KTRs in the 1st year after transplant with a protocol dose of 1 g/day. Methods: In this single-center retrospective study, first or repeat KTRs receiving rabbit antithymocyte globulin (rATG), MMF 1 g/day, tacrolimus, and prednisone, were stratified by age [≥60 (elderly) or <60 years (nonelderly)]. Primary outcome was MMF dose reduction incidence in the first year. Secondary outcomes included dose reduction rationale, 1-year patient and graft survival, graft function, rejection, infection, hospital presentation, and time to dose reduction. Of 335 KTRs, dose reduction incidence was significantly greater in the elderly group (66% and 54%, p = 0.04), though this did not remain significant when adjusted for sex, race, and valganciclovir use. Most common rationale was leukopenia in the elderly group and CMV in the nonelderly group. There were no significant differences in secondary outcomes. Conclusions: Mycophenolate mofetil 1 g/day was poorly tolerated in both elderly and nonelderly KTRs receiving lymphocyte-depleting induction with a high incidence of dose reductions; however, no short-term adverse graft outcomes were identified.
MeSH term(s)	Aged ; Graft Rejection/drug therapy ; Graft Rejection/etiology ; Graft Survival ; Humans ; Immunosuppressive Agents/therapeutic use ; Kidney Transplantation ; Mycophenolic Acid/therapeutic use ; Retrospective Studies ; Tacrolimus/adverse effects
Chemical Substances	Immunosuppressive Agents ; Mycophenolic Acid (HU9DX48N0T) ; Tacrolimus (WM0HAQ4WNM)
Language	English
Publishing date	2022-04-24
Publishing country	Denmark
Document type	Journal Article
ZDB-ID	639001-8
ISSN	1399-0012 ; 0902-0063
ISSN (online)	1399-0012
ISSN	0902-0063
DOI	10.1111/ctr.14671
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Article ; Online: Outcomes in kidney transplant recipients treated with immediate-release tacrolimus capsules versus extended-release tacrolimus capsules: A cohort study.

Ha, Yoonhee P / Divard, Gillian / Mitra, Nandita / Putt, Mary E / Pallet, Nicolas / Loupy, Alexandre / Anglicheau, Dany / Trofe-Clark, Jennifer / Legendre, Christophe / Bloom, Roy D / Reese, Peter P

Clinical transplantation

2022 Volume 37, Issue 1, Page(s) e14840

Abstract: Introduction: Prior randomized trials and observational studies have generally reported similar outcomes in kidney transplant recipients (KTRs) treated with immediate-release tacrolimus (IR-TAC) versus extended-release tacrolimus (ER-TAC). However, many ...

Abstract	Introduction: Prior randomized trials and observational studies have generally reported similar outcomes in kidney transplant recipients (KTRs) treated with immediate-release tacrolimus (IR-TAC) versus extended-release tacrolimus (ER-TAC). However, many of these previous studies focused on patients with low immunological risks, had small sample sizes and brief follow-up periods, and excluded outcomes associated with graft loss, such as chronic rejection. Methods: To address these limitations, we conducted a cohort study of 848 KTRs at a single transplantation center who had generally high immunological risks and were treated with either IR-TAC capsules (589 patients, 65.9%) or ER-TAC capsules (289 patients, 34.1%). All patients received their designated maintenance immunosuppressive regimen for at least 3 months post-transplantation. Afterwards, tacrolimus formulation was at the discretion of each patient's transplant nephrologist. For the two treatment groups, we compared the hazards of experiencing a composite outcome of acute or chronic antibody-mediated rejection (AMR), acute or chronic T-cell-mediated rejection, de novo DSA, and/or graft loss over a 3-year period starting at 3 months post-transplantation. Results: In a multivariable Cox proportional hazards regression model, KTRs treated with IR-TAC capsules had an increased hazard of experiencing the composite outcome when compared to patients treated with ER-TAC capsules; however, this result was not significant (adj HR 1.24, 95% CI .92-1.68, p = .163). Similar results were obtained with inverse probability of treatment weighting (IPTW) using a propensity score (adj HR 1.25, 95% CI .93-1.68, p = .146). Conclusion: These findings suggest that when compared to IR-TAC capsules, ER-TAC capsules do not reduce the hazard of poor outcomes in KTRs with generally high immunological risks.
MeSH term(s)	Humans ; Tacrolimus/therapeutic use ; Cohort Studies ; Kidney Transplantation/adverse effects ; Kidney Transplantation/methods ; Graft Rejection/drug therapy ; Graft Rejection/etiology ; Immunosuppressive Agents/therapeutic use ; Transplant Recipients
Chemical Substances	Tacrolimus (WM0HAQ4WNM) ; Immunosuppressive Agents
Language	English
Publishing date	2022-11-27
Publishing country	Denmark
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	639001-8
ISSN	1399-0012 ; 0902-0063
ISSN (online)	1399-0012
ISSN	0902-0063
DOI	10.1111/ctr.14840
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Article ; Online: Longer-Term Clinical Outcomes From the THINKER and EXPANDER Trials of Transplantation of HCV-RNA+ Donor Kidneys Into Hepatitis C Virus-Negative Recipients.

Kidney international reports

2023 Volume 8, Issue 7, Page(s) 1460–1463

Language	English
Publishing date	2023-04-29
Publishing country	United States
Document type	Journal Article
ISSN	2468-0249
ISSN (online)	2468-0249
DOI	10.1016/j.ekir.2023.04.018
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