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Article: Cellular Senescence and Frailty in Transplantation.

Lorenz, Elizabeth C / Hickson, LaTonya J / Khairallah, Pascale / Najafi, Bijan / Kennedy, Cassie C

Current transplantation reports

2023 Volume 10, Issue 2, Page(s) 51–59

Abstract: Purpose of review: To summarizes the literature on cellular senescence and frailty in solid-organ transplantation and highlight the emerging role of senotherapeutics as a treatment for cellular senescence.: Recent findings: Solid-organ transplant ... ...

Abstract	Purpose of review: To summarizes the literature on cellular senescence and frailty in solid-organ transplantation and highlight the emerging role of senotherapeutics as a treatment for cellular senescence. Recent findings: Solid-organ transplant patients are aging. Many factors contribute to aging acceleration in this population, including cellular senescence. Senescent cells accumulate in tissues and secrete proinflammatory and profibrotic proteins which result in tissue damage. Cellular senescence contributes to age-related diseases and frailty. Our understanding of the role cellular senescence plays in transplant-specific complications such as allograft immunogenicity and infections is expanding. Promising treatments, including senolytics, senomorphics, cell-based regenerative therapies, and behavioral interventions, may reduce cellular senescence abundance and frailty in patients with solid-organ transplants. Summary: Cellular senescence and frailty contribute to adverse outcomes in solid-organ transplantation. Continued pursuit of understanding the role cellular senescence plays in transplantation may lead to improved senotherapeutic approaches and better graft and patient outcomes.
Language	English
Publishing date	2023-03-21
Publishing country	Switzerland
Document type	Journal Article
ISSN	2196-3029
ISSN	2196-3029
DOI	10.1007/s40472-023-00393-6
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Article: Examining the safety and effectiveness of a 4-week supervised exercise intervention in the treatment of frailty in patients with chronic kidney disease.

Lorenz, Elizabeth C / Hickson, LaTonya J / Hogan, Marie C / Kennedy, Cassie C

Clinical kidney journal

2023 Volume 16, Issue 11, Page(s) 2003–2010

Abstract: Background: The optimal duration of antifrailty interventions and how best to deliver them to patients with chronic kidney disease (CKD) is unknown. The aim of this study was to examine the safety, feasibility and preliminary efficacy of a 4-week ... ...

Abstract	Background: The optimal duration of antifrailty interventions and how best to deliver them to patients with chronic kidney disease (CKD) is unknown. The aim of this study was to examine the safety, feasibility and preliminary efficacy of a 4-week supervised exercise intervention on frailty in patients with CKD. Methods: We conducted a prospective feasibility study involving patients with ≥stage 3 CKD (1 patient with stage 3 CKD, 7 patients with stage 4 CKD and 17 patients with stage 5 CKD) who were either frail or prefrail according to the physical frailty phenotype and/or had a Short Physical Performance Battery (SPPB) score ≤10. The exercise intervention consisted of two supervised outpatient sessions per week for 4 weeks (eight total sessions). Frailty and other study measures were assessed at baseline and after 4 weeks of exercise. Results: Of the 34 participants who completed the baseline assessment and were included in the analyses, 25 (73.5%) completed the 4-week assessment. Overall, 64.0% of patients were on dialysis and 64.0% had diabetes mellitus. After 4 weeks of exercise, frailty prevalence, total SPPB scores and energy/fatigue scores improved. No adverse study-related outcomes were reported. Conclusions: The 4 weeks of supervised exercise was safe, was associated with an excellent completion rate and improved frailty parameters in CKD patients with CKD. This study provides important preliminary data for a future larger prospective randomized study. Clinical trialgov: registration
Language	English
Publishing date	2023-08-09
Publishing country	England
Document type	Journal Article
ZDB-ID	2655800-2
ISSN	2048-8513 ; 2048-8505
ISSN (online)	2048-8513
ISSN	2048-8505
DOI	10.1093/ckj/sfad192
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Article: The Relationship Between Health Literacy and Outcomes Before and After Kidney Transplantation.

Lorenz, Elizabeth C / Petterson, Tanya M / Schinstock, Carrie A / Johnson, Bradley K / Kukla, Aleksandra / Kremers, Walter K / Sanchez, William / Yost, Kathleen J

Transplantation direct

2022 Volume 8, Issue 10, Page(s) e1377

Abstract: Limited health literacy (HL) is associated with decreased kidney function and death in patients with chronic kidney disease. Less is known about the impact of HL on kidney transplant (KT) outcomes. The aim of this study was to examine the relationship ... ...

Abstract	Limited health literacy (HL) is associated with decreased kidney function and death in patients with chronic kidney disease. Less is known about the impact of HL on kidney transplant (KT) outcomes. The aim of this study was to examine the relationship between HL and KT outcomes, including rates of waitlisting, healthcare utilization, acute rejection, renal allograft function, renal allograft failure, and death. Methods: We performed a retrospective review of HL data previously collected at our center. HL was assessed in a convenience sample of consecutive, English-speaking patients age ≥18 y who were evaluated for KT at Mayo Clinic in Minnesota between June 2015 and March 2017 as part of a practice improvement feasibility project (n = 690). HL was assessed using the 4-item Brief Health Literacy Screening Tool modified for the outpatient KT evaluation process. The 4 items assess confidence completing forms, reading comprehension, and oral literacy. Results: Overall, 30.4% of patients had limited or marginal HL. Patients with limited or marginal HL were less likely than those with adequate HL to be waitlisted for KT (hazard ratio = 0.62 and 0.69, respectively), even after adjusting for age, marital status, body mass index, Charlson comorbidity index, or dialysis dependency. Patient HL was not associated with post-KT healthcare utilization, acute rejection, or renal allograft function. Patients with limited or marginal HL appeared to experience a higher risk of renal allograft failure and post-KT death, but the number of events was small, and the relationship was statistically significant only for marginal HL. Conclusions: Inadequate HL is common in KT candidates and independently associated with decreased waitlisting for KT. We observed no statistically significant relationship between HL and posttransplant outcomes in our cohort. Further efforts to improve communication in patients with inadequate HL may improve access to KT.
Language	English
Publishing date	2022-09-15
Publishing country	United States
Document type	Journal Article
ISSN	2373-8731
ISSN	2373-8731
DOI	10.1097/TXD.0000000000001377
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Article ; Online: Frailty in CKD and Transplantation.

Lorenz, Elizabeth C / Kennedy, Cassie C / Rule, Andrew D / LeBrasseur, Nathan K / Kirkland, James L / Hickson, LaTonya J

Kidney international reports

2021 Volume 6, Issue 9, Page(s) 2270–2280

Abstract: The population is aging. Although older adults have higher rates of comorbidities and adverse health events, they represent a heterogeneous group with different health trajectories. Frailty, a clinical syndrome of decreased physiological reserve and ... ...

Abstract	The population is aging. Although older adults have higher rates of comorbidities and adverse health events, they represent a heterogeneous group with different health trajectories. Frailty, a clinical syndrome of decreased physiological reserve and increased susceptibility to illness and death, has emerged as a potential risk stratification tool in older patients with chronic kidney disease (CKD). Frailty is commonly observed in patients with CKD and associated with numerous adverse outcomes, including falls, decreased quality of life, hospitalizations, and death. Multiple pathologic factors contribute to the development of frailty in patients with CKD, including biological mechanisms of aging and physiological dysregulation. Current interventions to reduce frailty are promising, but additional investigations are needed to determine whether optimizing frailty measures improves renal and overall health outcomes. This review of frailty in CKD examines frailty definitions, the impact of frailty on health outcomes across the CKD spectrum, mechanisms of frailty, and antifrailty interventions (e.g., exercise or senescent cell clearance) tested in CKD patients. In addition, existing knowledge gaps, limitations of current frailty definitions in CKD, and challenges surrounding effective antifrailty strategies in CKD are considered.
Language	English
Publishing date	2021-06-09
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2468-0249
ISSN (online)	2468-0249
DOI	10.1016/j.ekir.2021.05.025
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Article ; Online: Invited response to recurrence of oxalate nephropathy after isolated kidney transplantation for primary hyperoxaluria type 2.

Dhondup, Tsering / Lorenz, Elizabeth C / Milliner, Dawn S / Lieske, John C

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons

2017 Volume 18, Issue 2, Page(s) 527

MeSH term(s)	Humans ; Hyperoxaluria ; Hyperoxaluria, Primary ; Kidney Transplantation ; Oxalates
Chemical Substances	Oxalates
Language	English
Publishing date	2017-12-15
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	2060594-8
ISSN	1600-6143 ; 1600-6135
ISSN (online)	1600-6143
ISSN	1600-6135
DOI	10.1111/ajt.14596
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Article ; Online: Development and Validation of a Kidney-Transplant Specific Measure of Treatment Burden.

Lorenz, Elizabeth C / Petterson, Tanya M / Zaniletti, Isabella / Lackore, Kandace A / Johnson, Bradley K / Mai, Martin L / Nair, Sumi S / Bentall, Andrew J / Yost, Kathleen J / Eton, David T

BMC nephrology

2022 Volume 23, Issue 1, Page(s) 301

Abstract: Background: Treatment burden refers to the work involved in managing one's health and its impact on well-being and has been associated with nonadherence in patients with chronic illnesses. No kidney transplant (KT)-specific measure of treatment burden ... ...

Abstract	Background: Treatment burden refers to the work involved in managing one's health and its impact on well-being and has been associated with nonadherence in patients with chronic illnesses. No kidney transplant (KT)-specific measure of treatment burden exists. The aim of this study was to develop a KT-specific supplement to the Patient Experience with Treatment and Self-Management (PETS), a general measure of treatment burden. Methods: After drafting and pretesting KT-specific survey items, we conducted a cross-sectional survey study involving KT recipients from Mayo Clinic in Minnesota, Arizona, and Florida. Exploratory factor analysis (EFA) was used to identify domains for scaling the KT-specific supplement. Construct and known-groups validity were determined. Results: Survey respondents (n = 167) had a mean age of 61 years (range 22-86) and received a KT on average 4.0 years ago. Three KT-specific scales were identified (transplant function, self-management, adverse effects). Higher scores on the KT-specific scales were correlated with higher PETS treatment burden, worse physical and mental health, and lower self-efficacy (p < 0.0001). Patients taking more medications reported higher transplant self-management burden. Conclusions: We developed a KT-specific supplement to the PETS general measure of treatment burden. Scores may help providers identify recipients at risk for nonadherence.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Cross-Sectional Studies ; Humans ; Kidney Transplantation/adverse effects ; Middle Aged ; Self-Management ; Surveys and Questionnaires ; Transplant Recipients ; Young Adult
Language	English
Publishing date	2022-09-03
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2041348-8
ISSN	1471-2369 ; 1471-2369
ISSN (online)	1471-2369
ISSN	1471-2369
DOI	10.1186/s12882-022-02923-3
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Article ; Online: Recovery From Dialysis in Patients With Primary Hyperoxaluria Type 1 Treated With Pyridoxine: A Report of 3 Cases.

Lorenz, Elizabeth C / Lieske, John C / Seide, Barbara M / Olson, Julie B / Mehta, Ramila / Milliner, Dawn S

American journal of kidney diseases : the official journal of the National Kidney Foundation

2020 Volume 77, Issue 5, Page(s) 816–819

Abstract: Primary hyperoxaluria type 1 (PH1) is a genetic disorder characterized by overproduction of oxalate and eventual kidney failure. Kidney failure is usually irreversible in PH1. However, in patients with PH1 homozygous for the G170R mutation (in which the ... ...

Abstract	Primary hyperoxaluria type 1 (PH1) is a genetic disorder characterized by overproduction of oxalate and eventual kidney failure. Kidney failure is usually irreversible in PH1. However, in patients with PH1 homozygous for the G170R mutation (in which the glycine at amino acid 170 is replaced by an arginine), pyridoxine is an enzyme cofactor and decreases urinary oxalate excretion by reducing hepatic oxalate production. We report recovery from dialysis in 3 patients with PH1 homozygous for the G170R mutation in response to pharmacologic-dose pyridoxine treatment. Median age at initiation or resumption of pyridoxine treatment was 37 (range, 20-53) years, and median daily pyridoxine dose was 8.8 (range, 6.8-14.0) mg per kilogram of body weight. Duration of hemodialysis before recovery of kidney function was 10 (range, 5-19) months. Plasma oxalate concentration improved after recovery of kidney function. At a median of 3 (range, 2-46) months following discontinuation of hemodialysis, estimated glomerular filtration rate was 34 (range, 23-52) mL/min/1.73m
MeSH term(s)	Adult ; Female ; Homozygote ; Humans ; Hyperoxaluria, Primary/blood ; Hyperoxaluria, Primary/complications ; Hyperoxaluria, Primary/drug therapy ; Kidney Failure, Chronic/etiology ; Kidney Failure, Chronic/metabolism ; Kidney Failure, Chronic/therapy ; Middle Aged ; Oxalates/blood ; Pyridoxine/therapeutic use ; Recovery of Function ; Renal Dialysis ; Renal Insufficiency, Chronic/etiology ; Renal Insufficiency, Chronic/metabolism ; Renal Insufficiency, Chronic/therapy ; Transaminases/genetics ; Transaminases/metabolism ; Vitamin B Complex/therapeutic use ; Young Adult
Chemical Substances	Oxalates ; Vitamin B Complex (12001-76-2) ; Transaminases (EC 2.6.1.-) ; Alanine-glyoxylate transaminase (EC 2.6.1.44) ; Pyridoxine (KV2JZ1BI6Z)
Language	English
Publishing date	2020-09-04
Publishing country	United States
Document type	Case Reports ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	604539-x
ISSN	1523-6838 ; 0272-6386
ISSN (online)	1523-6838
ISSN	0272-6386
DOI	10.1053/j.ajkd.2020.07.017
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Zs.A 1669: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: The impact of urinary tract infections in renal transplant recipients.

Lorenz, Elizabeth C / Cosio, Fernando G

Kidney international

2010 Volume 78, Issue 8, Page(s) 719–721

Abstract: Urinary tract infections (UTIs), including cystitis and pyelonephritis, are the most common infections after kidney transplantation. On examining the role of surveillance and treatment of asymptomatic bacteriuria posttransplant, Fiorante and colleagues ... ...

Abstract	Urinary tract infections (UTIs), including cystitis and pyelonephritis, are the most common infections after kidney transplantation. On examining the role of surveillance and treatment of asymptomatic bacteriuria posttransplant, Fiorante and colleagues found that up to 50% of recipients had bacteriuria. Despite routine treatment, recurrent UTIs remained common. Many risk factors contribute to the high incidence of UTIs, which can undermine graft function and survival. Given that many UTIs are asymptomatic, screening protocols may be beneficial.
MeSH term(s)	Humans ; Incidence ; Kidney Transplantation/adverse effects ; Opportunistic Infections/etiology ; Risk Factors ; Urinary Tract Infections/etiology
Language	English
Publishing date	2010-10
Publishing country	United States
Document type	Comment ; Journal Article
ZDB-ID	120573-0
ISSN	1523-1755 ; 0085-2538
ISSN (online)	1523-1755
ISSN	0085-2538
DOI	10.1038/ki.2010.219
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Zs.A 797: Show issues

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Article ; Online: Kidney Transplant Outcomes of Patients With Multiple Myeloma.

Heybeli, Cihan / Bentall, Andrew J / Alexander, Mariam Priya / Amer, Hatem / Buadi, Francis K / Dispenzieri, Angela / Dingli, David / Gertz, Morie A / Issa, Naim / Kapoor, Prashant / Kukla, Aleksandra / Kumar, Shaji / Lorenz, Elizabeth C / Rajkumar, S Vincent / Schinstock, Carrie A / Leung, Nelson

Kidney international reports

2022 Volume 7, Issue 4, Page(s) 752–762

Abstract: Introduction: Data on kidney transplantation (KTx) outcomes of patients with multiple myeloma (MM) are very limited.: Methods: We investigated the outcomes of patients with MM who underwent KTx between 1994 and 2019.: Results: A total of 12 ... ...

Abstract	Introduction: Data on kidney transplantation (KTx) outcomes of patients with multiple myeloma (MM) are very limited. Methods: We investigated the outcomes of patients with MM who underwent KTx between 1994 and 2019. Results: A total of 12 transplants from 11 patients were included. At the time of KTx, 6 were classified as having stringent complete response (CR), 2 as CR, 2 as very good partial response (VGPR), and 2 as partial response (PR). With a median follow-up of 40 (minimum-maximum, 5-92) months after KTx, hematologic progression occurred in 9 transplants (75%). There were 3 grafts (25%) that failed, and 5 patients (45.5%) experienced death with functioning allografts. Graft survival at 1 and 5 years was 82.5% and 66%, respectively. Progression-free survival (PFS) rates of the cohort at 1, 3, and 5 years were 83.3%, 55.6%, and 44.4%, respectively. The estimated median PFS of patients who received bortezomib at any time (pre-KTx and/or post-KTx) was not reached, whereas it was 24 months for those who never received bortezomib ( Conclusion: Kidney transplant outcomes of patients with myeloma who received bortezomib before or after KTx seem to be more favorable. Nevertheless, relapse after KTx in MM is still common. More studies are needed to better determine who benefits from a KTx.
Language	English
Publishing date	2022-01-10
Publishing country	United States
Document type	Journal Article
ISSN	2468-0249
ISSN (online)	2468-0249
DOI	10.1016/j.ekir.2022.01.003
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Article ; Online: Guiding Kidney Transplantation Candidates for Effective Weight Loss: A Clinical Cohort Study.

Kukla, Aleksandra / Diwan, Tayyab / Smith, Byron H / Collazo-Clavell, Maria L / Lorenz, Elizabeth C / Clark, Matthew / Grothe, Karen / Denic, Aleksandar / Park, Walter D / Sahi, Sukhdeep / Schinstock, Carrie A / Amer, Hatem / Issa, Naim / Bentall, Andrew J / Dean, Patrick G / Kudva, Yogish C / Mundi, Manpreet / Stegall, Mark D

Kidney360

2022 Volume 3, Issue 8, Page(s) 1411–1416

Abstract: Background: Obesity is increasingly common in kidney transplant candidates and may limit access to transplantation. Obesity and diabetes are associated with a high risk for post-transplant complications. The best approach to weight loss to facilitate ... ...

Abstract	Background: Obesity is increasingly common in kidney transplant candidates and may limit access to transplantation. Obesity and diabetes are associated with a high risk for post-transplant complications. The best approach to weight loss to facilitate active transplant listing is unknown, but bariatric surgery is rarely considered due to patient- and physician-related apprehension, among other factors. Methods: We aimed to determine the magnitude of weight loss, listing, and transplant rates in 28 candidates with a mean BMI of 44.4±4.6 kg/m Results: In the conservatively managed group (group 1), the mean weight at the time of initial consultation was 126.5±18.5 kg, and the mean BMI was 44.4±4.6 kg/m Conclusions: A conservative weight-loss approach involving multidisciplinary consultation was ineffective in most kidney transplant candidates with diabetes, suggesting that a more proactive approach is needed.
MeSH term(s)	Bariatric Surgery/adverse effects ; Cohort Studies ; Humans ; Kidney Transplantation ; Obesity/surgery ; Weight Loss
Language	English
Publishing date	2022-05-16
Publishing country	United States
Document type	Journal Article
ISSN	2641-7650
ISSN (online)	2641-7650
DOI	10.34067/KID.0001682022
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