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Article ; Online: Practical Considerations for APOL1 Genotyping in the Living Kidney Donor Evaluation.

Mena-Gutierrez, Alejandra M / Reeves-Daniel, Amber M / Jay, Colleen L / Freedman, Barry I

2019 Volume 104, Issue 1, Page(s) 27–32

Abstract: Background: Association between the apolipoprotein L1 gene (APOL1) and nephropathy has altered the epidemiology of chronic kidney disease. In addition, donor APOL1 genotypes play important roles in the time to allograft failure in kidneys transplanted ... ...

Abstract	Background: Association between the apolipoprotein L1 gene (APOL1) and nephropathy has altered the epidemiology of chronic kidney disease. In addition, donor APOL1 genotypes play important roles in the time to allograft failure in kidneys transplanted from deceased donors and the safety of living kidney donation. Methods: This article reviews genetic testing for inherited kidney disease in living kidney donors to improve donor safety. APOL1 genotyping in donors with recent African ancestry is considered. Results: Based on current data, transplant physicians should discuss APOL1 genotyping with potential living kidney donors self-reporting recent African ancestry. Until results from APOL1 Long-term Kidney Transplant Outcomes Network ancillary studies are available, we present practical approaches from our experience for considering APOL1 genotyping in the living donor evaluation. Conclusions: Transplant physicians should inform potential living kidney donors at risk for APOL1-associated nephropathy about the gene and possibility of genetic testing early in the donor evaluation, well before scheduling the donor nephrectomy. Transplant programs must weigh risks of performing a donor nephrectomy in those with 2 APOL1 renal risk variants (high-risk genotypes), particularly younger individuals. Our program counsels kidney donors with APOL1 high-risk genotypes in the same fashion as with risk genotypes in other nephropathy genes. Because most African American kidney donor candidates lacking hypertension, proteinuria and reduced kidney function after workup will not possess APOL1 high-risk genotypes, genetic testing is unlikely to markedly increase donor declines and may reassure donors with regard to their long-term kidney outcomes, potentially increasing the number of African American donors.
MeSH term(s)	African Continental Ancestry Group/genetics ; Apolipoprotein L1/genetics ; Donor Selection/standards ; Genetic Predisposition to Disease ; Genetic Testing/standards ; Humans ; Kidney Transplantation/standards ; Living Donors ; Nephrectomy/adverse effects ; Patient Safety ; Postoperative Complications/prevention & control ; Practice Guidelines as Topic ; Renal Insufficiency, Chronic/congenital ; Renal Insufficiency, Chronic/diagnosis ; Renal Insufficiency, Chronic/epidemiology ; Tissue and Organ Harvesting/adverse effects ; Transplantation, Homologous/standards
Chemical Substances	APOL1 protein, human ; Apolipoprotein L1
Language	English
Publishing date	2019-08-25
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Review
ZDB-ID	208424-7
ISSN	1534-6080 ; 0041-1337
ISSN (online)	1534-6080
ISSN	0041-1337
DOI	10.1097/TP.0000000000002933
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Article ; Online: Creation of a Single Institutional Review Board for Collaborative Research in Nephrology: The APOLLO Experience.

Moore, J Brian / Smith, S Carrie / Russell, Laurie P / Serdoz, Emily S / Dilts, Natalie A / Alexander, Amir A / Reboussin, David M / Bagwell, Benjamin M / Spainhour, Mitzie H / Reeves-Daniel, Amber M / Wesley-Farrington, Deborah J / Ma, Lijun / Freedman, Barry I

Clinical journal of the American Society of Nephrology : CJASN

2023 Volume 18, Issue 10, Page(s) 1362–1365

MeSH term(s)	Humans ; Nephrology ; Ethics Committees, Research
Language	English
Publishing date	2023-05-10
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2226665-3
ISSN	1555-905X ; 1555-9041
ISSN (online)	1555-905X
ISSN	1555-9041
DOI	10.2215/CJN.0000000000000197
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Article ; Online: Employment status at transplant influences ethnic disparities in outcomes after deceased donor kidney transplantation.

Divers, Jasmin / Mohan, Sumit / Brown, W Mark / Pastan, Stephen O / Israni, Ajay K / Gaston, Robert S / Bray, Robert / Islam, Shahidul / Sakhovskaya, Natalia V / Mena-Gutierrez, Alejandra M / Reeves-Daniel, Amber M / Julian, Bruce A / Freedman, Barry I

BMC nephrology

2022 Volume 23, Issue 1, Page(s) 6

Abstract: Background: African American (AA) recipients of deceased-donor (DD) kidney transplants (KT) have shorter allograft survival than recipients of other ethnic groups. Reasons for this disparity encompass complex interactions between donors and recipients ... ...

Abstract	Background: African American (AA) recipients of deceased-donor (DD) kidney transplants (KT) have shorter allograft survival than recipients of other ethnic groups. Reasons for this disparity encompass complex interactions between donors and recipients characteristics. Methods: Outcomes from 3872 AA and 19,719 European American (EA) DDs who had one kidney transplanted in an AA recipient and one in an EA recipient were analyzed. Four donor/recipient pair groups (DRP) were studied, AA/AA, AA/EA, EA/AA, and EA/EA. Survival random forests and Cox proportional hazard models were fitted to rank and evaluate modifying effects of DRP on variables associated with allograft survival. These analyses sought to identify factors contributing to the observed disparities in transplant outcomes among AA and EA DDKT recipients. Results: Transplant era, discharge serum creatinine, delayed graft function, and DRP were among the top predictors of allograft survival and mortality among DDKT recipients. Interaction effects between DRP with the kidney donor risk index and transplant era showed significant improvement in allograft survival over time in EA recipients. However, AA recipients appeared to have similar or poorer outcomes for DDKT performed after 2010 versus before 2001; allograft survival hazard ratios (95% CI) were 1.15 (0.74, 1.76) and 1.07 (0.8, 1.45) for AA/AA and EA/AA, compared to 0.62 (0.54, 0.71) and 0.5 (0.41, 0.62) for EA/EA and AA/EA DRP, respectively. Recipient mortality improved over time among all DRP, except unemployed AA/AAs. Relative to DDKT performed pre-2001, employed AA/AAs had HR = 0.37 (0.2, 0.69) versus 0.59 (0.31, 1.11) for unemployed AA/AA after 2010. Conclusion: Relative to DDKT performed before 2001, similar or worse overall DCAS was observed among AA/AAs, while EA/EAs experienced considerable improvement regardless of employment status, KDRI, and EPTS. AA recipients of an AA DDKT, especially if unemployed, had worse allograft survival and mortality and did not appear to benefit from advances in care over the past 20 years.
MeSH term(s)	Adult ; African Americans/psychology ; Employment ; Female ; Graft Survival ; Humans ; Kidney Failure, Chronic/ethnology ; Kidney Failure, Chronic/mortality ; Kidney Failure, Chronic/surgery ; Kidney Transplantation ; Male ; Middle Aged ; Proportional Hazards Models ; Race Factors ; Tissue Donors ; Transplantation, Homologous ; United States/epidemiology
Language	English
Publishing date	2022-01-03
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2041348-8
ISSN	1471-2369 ; 1471-2369
ISSN (online)	1471-2369
ISSN	1471-2369
DOI	10.1186/s12882-021-02631-4
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Article ; Online: Apolipoprotein L1 Gene Effects on Kidney Transplantation.

Freedman, Barry I / Locke, Jayme E / Reeves-Daniel, Amber M / Julian, Bruce A

Seminars in nephrology

2017 Volume 37, Issue 6, Page(s) 530–537

Abstract: The pathogenesis of many common etiologies of nephropathy has been informed by recent molecular genetic breakthroughs. It now is apparent that the ethnic disparity in the risk for nondiabetic chronic kidney disease between African Americans and European ... ...

Abstract	The pathogenesis of many common etiologies of nephropathy has been informed by recent molecular genetic breakthroughs. It now is apparent that the ethnic disparity in the risk for nondiabetic chronic kidney disease between African Americans and European Americans is explained largely by variation in the apolipoprotein L1 gene (APOL1). The presence of two APOL1 renal risk variants markedly increases an individual's risk for kidney disease. In transplantation, kidneys from deceased African Americans with two APOL1 renal risk variants have shorter survival intervals after engraftment, regardless of the ethnicity of the recipient. Precision medicine will transform the clinical practice of nephrology and kidney transplantation, and play an important role in the allocation of kidneys from deceased and living kidney donors with recent African ancestry. This article reviews existing data on APOL1 in deceased-donor and living-donor kidney transplantation. It considers the impact of including APOL1 genotyping in decisions on the allocation and discard of deceased-donor kidneys, as well as the selection of living donors.
MeSH term(s)	Black or African American/genetics ; Apolipoprotein L1/genetics ; Donor Selection ; Genetic Testing ; Genotype ; Genotyping Techniques ; Graft Survival/genetics ; Humans ; Kidney Transplantation ; Living Donors/statistics & numerical data ; Mutation ; Renal Insufficiency, Chronic/epidemiology ; Renal Insufficiency, Chronic/genetics ; Renal Insufficiency, Chronic/surgery ; Resource Allocation
Chemical Substances	APOL1 protein, human ; Apolipoprotein L1
Language	English
Publishing date	2017-11-06
Publishing country	United States
Document type	Journal Article ; Review ; Research Support, N.I.H., Extramural
ZDB-ID	604652-6
ISSN	1558-4488 ; 0270-9295
ISSN (online)	1558-4488
ISSN	0270-9295
DOI	10.1016/j.semnephrol.2017.07.006
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Article ; Online: Dialysis Facility Profit Status and Early Steps in Kidney Transplantation in the Southeastern United States.

McPherson, Laura J / Walker, Elizabeth R / Lee, Yi-Ting Hana / Gander, Jennifer C / Wang, Zhensheng / Reeves-Daniel, Amber M / Browne, Teri / Ellis, Matthew J / Rossi, Ana P / Pastan, Stephen O / Patzer, Rachel E

Clinical journal of the American Society of Nephrology : CJASN

2021 Volume 16, Issue 6, Page(s) 926–936

Abstract: Background and objectives: Dialysis facilities in the United States play a key role in access to kidney transplantation. Previous studies reported that patients treated at for-profit facilities are less likely to be waitlisted and receive a transplant, ... ...

Abstract	Background and objectives: Dialysis facilities in the United States play a key role in access to kidney transplantation. Previous studies reported that patients treated at for-profit facilities are less likely to be waitlisted and receive a transplant, but their effect on early steps in the transplant process is unknown. The study's objective was to determine the association between dialysis facility profit status and critical steps in the transplantation process in Georgia, North Carolina, and South Carolina. Design, setting, participants, & measurements: In this retrospective cohort study, we linked referral and evaluation data from all nine transplant centers in the Southeast with United States Renal Data System surveillance data. The cohort study included 33,651 patients with kidney failure initiating dialysis from January 1, 2012 to August 31, 2016. Patients were censored for event (date of referral, evaluation, or waitlisting), death, or end of study (August 31, 2017 for referral and March 1, 2018 for evaluation and waitlisting). The primary exposure was dialysis facility profit status: for profit versus nonprofit. The primary outcome was referral for evaluation at a transplant center after dialysis initiation. Secondary outcomes were start of evaluation at a transplant center after referral and waitlisting. Results: Of the 33,651 patients with incident kidney failure, most received dialysis treatment at a for-profit facility (85%). For-profit (versus nonprofit) facilities had a lower cumulative incidence difference for referral within 1 year of dialysis (-4.5%; 95% confidence interval, -6.0% to -3.2%). In adjusted analyses, for-profit versus nonprofit facilities had lower referral (hazard ratio, 0.84; 95% confidence interval, 0.80 to 0.88). Start of evaluation within 6 months of referral (-1.0%; 95% confidence interval, -3.1% to 1.3%) and waitlisting within 6 months of evaluation (1.0%; 95% confidence interval, -1.2 to 3.3) did not meaningfully differ between groups. Conclusions: Findings suggest lower access to referral among patients dialyzing in for-profit facilities in the Southeast United States, but no difference in starting the evaluation and waitlisting by facility profit status.
MeSH term(s)	Adolescent ; Adult ; Aged ; Ambulatory Care Facilities/economics ; Cohort Studies ; Female ; Georgia ; Humans ; Kidney Failure, Chronic/surgery ; Kidney Failure, Chronic/therapy ; Kidney Transplantation/statistics & numerical data ; Male ; Middle Aged ; North Carolina ; Referral and Consultation/statistics & numerical data ; Renal Dialysis ; Retrospective Studies ; South Carolina ; Time Factors ; Young Adult
Language	English
Publishing date	2021-05-26
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Research Support, N.I.H., Extramural
ZDB-ID	2226665-3
ISSN	1555-905X ; 1555-9041
ISSN (online)	1555-905X
ISSN	1555-9041
DOI	10.2215/CJN.17691120
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Article ; Online: The impact of APOL1, CAV1, and ABCB1 gene variants on outcomes in kidney transplantation: donor and recipient effects.

Palanisamy, Amudha / Reeves-Daniel, Amber M / Freedman, Barry I

Pediatric nephrology (Berlin, Germany)

2013 Volume 29, Issue 9, Page(s) 1485–1492

Abstract: Dramatic improvements have been seen in short-term kidney allograft survival over recent decades with introduction of more potent immunosuppressant medications and regimens. Unfortunately, improvements in long-term graft survival have lagged behind. The ... ...

Abstract	Dramatic improvements have been seen in short-term kidney allograft survival over recent decades with introduction of more potent immunosuppressant medications and regimens. Unfortunately, improvements in long-term graft survival have lagged behind. The genomics revolution is providing new insights regarding the potential impact of kidney donor genotypes on long-term graft survival. Variation in the donor apolipoprotein L1 (APOL1), caveolin 1 (CAV1), and multi-drug resistance 1 encoding P-glycoprotein genes (ABCB1) are all associated with graft survival after kidney transplantation. Although the precise mechanisms whereby these donor gene variants confer risk for graft loss have yet to be determined, these findings provide novel opportunities for modifying interactive environmental factors and optimizing kidney allocation with the ultimate goal of improving long-term graft survival rates.
MeSH term(s)	ATP Binding Cassette Transporter, Subfamily B/genetics ; Apolipoprotein L1 ; Apolipoproteins/genetics ; Caveolin 1/genetics ; Genotype ; Graft Survival/genetics ; Humans ; Kidney Transplantation/mortality ; Lipoproteins, HDL/genetics ; Tissue Donors
Chemical Substances	ABCB1 protein, human ; APOL1 protein, human ; ATP Binding Cassette Transporter, Subfamily B ; Apolipoprotein L1 ; Apolipoproteins ; CAV1 protein, human ; Caveolin 1 ; Lipoproteins, HDL
Language	English
Publishing date	2013-06-09
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	631932-4
ISSN	1432-198X ; 0931-041X
ISSN (online)	1432-198X
ISSN	0931-041X
DOI	10.1007/s00467-013-2531-7
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Article ; Online: Genome-wide association study for time to failure of kidney transplants from African American deceased donors.

Divers, Jasmin / Ma, Lijun / Brown, William Mark / Palmer, Nicholette D / Choi, Young / Israni, Ajay K / Pastan, Stephen O / Julian, Bruce A / Gaston, Robert S / Hicks, Pamela J / Reeves-Daniel, Amber M / Freedman, Barry I

Clinical transplantation

2020 Volume 34, Issue 6, Page(s) e13827

Abstract: Two renal-risk variants in the apolipoprotein L1 gene (APOL1) in African American (AA) deceased donors (DD) are associated with shorter renal allograft survival after transplantation. To identify additional genes contributing to allograft survival, a ... ...

Abstract	Two renal-risk variants in the apolipoprotein L1 gene (APOL1) in African American (AA) deceased donors (DD) are associated with shorter renal allograft survival after transplantation. To identify additional genes contributing to allograft survival, a genome-wide association study was performed in 532 AA DDs. Phenotypic data were obtained from the Scientific Registry of Transplant Recipients. Association and single-nucleotide polymorphism (SNP)-by-APOL1 interaction tests were conducted using death-censored renal allograft survival accounting for relevant covariates. Replication and inverse-variance-weighted meta-analysis were performed using data from 250 AA DD in the Genomics of Transplantation study. Accounting for APOL1, multiple SNPs near the Nudix Hydrolase 7 gene (NUDT7) showed strong independent effects (P = 1.6 × 10
MeSH term(s)	African Americans/genetics ; Apolipoprotein L1/genetics ; Genome-Wide Association Study ; Graft Rejection/genetics ; Humans ; Kidney Transplantation ; Lipoproteins, HDL/genetics
Chemical Substances	APOL1 protein, human ; Apolipoprotein L1 ; Lipoproteins, HDL
Language	English
Publishing date	2020-04-25
Publishing country	Denmark
Document type	Journal Article ; Meta-Analysis ; 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.13827
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Article ; Online: Ranolazine-tacrolimus interaction.

Pierce, Dwayne A / Reeves-Daniel, Amber M

The Annals of pharmacotherapy

2010 Volume 44, Issue 11, Page(s) 1844–1849

Abstract: Objective: To report the case of a kidney allograft recipient on a stable regimen of tacrolimus who exhibited increased tacrolimus concentrations within 24 hours of initiating ranolazine.: Case summary: A 64-year-old kidney allograft recipient on a ... ...

Abstract	Objective: To report the case of a kidney allograft recipient on a stable regimen of tacrolimus who exhibited increased tacrolimus concentrations within 24 hours of initiating ranolazine. Case summary: A 64-year-old kidney allograft recipient on a stable dose of tacrolimus (10 mg twice daily) was admitted for recent worsening of her chronic anginal pain. The patient was initiated on ranolazine 500 mg twice daily on hospital day 2. Tacrolimus concentrations rose from 7.0-10.1 ng/mL preadmission to 17.8 ng/mL within 24 hours of ranolazine initiation. Ranolazine therapy was continued due to the patient's beneficial response; therefore, the tacrolimus dose was eventually decreased by 70% to 3 mg twice daily to maintain steady-state trough concentrations between 6.6 and 7.9 ng/mL with ranolazine therapy. Ranolazine dechallenge on a subsequent admission produced subtherapeutic tacrolimus concentrations requiring dosage increases. Discussion: Ranolazine, an antianginal agent, is both a substrate and a weak inhibitor of CYP3A as well as a substrate and moderate inhibitor of the P-glycoprotein (P-GP) efflux transport system. Tacrolimus, an immunosuppressant, is also a substrate of CYP3A and P-GP. Through possible inhibition of both P-GP- and CYP3A-mediated first-pass metabolism and CYP3A systemic metabolism, ranolazine may have significantly increased serum concentrations of tacrolimus necessitating an eventual 70% decrease in the tacrolimus dose. Based on the Horn Drug Interaction Probability Scale, this interaction is possible. Conclusions: We suggest that the eventual 70% decrease in tacrolimus dose after ranolazine initiation may indicate that ranolazine decreases the metabolism and clearance of tacrolimus, causing an elevation in tacrolimus concentrations and the potential for tacrolimus toxicity. Clinicians should be aware of this possible interaction when initiating ranolazine in patients on tacrolimus.
MeSH term(s)	ATP-Binding Cassette, Sub-Family B, Member 1/antagonists & inhibitors ; Acetanilides/pharmacology ; Cytochrome P-450 CYP3A Inhibitors ; Dose-Response Relationship, Drug ; Drug Interactions ; Enzyme Inhibitors/pharmacology ; Female ; Humans ; Immunosuppressive Agents/administration & dosage ; Immunosuppressive Agents/pharmacokinetics ; Immunosuppressive Agents/therapeutic use ; Kidney Transplantation/methods ; Middle Aged ; Piperazines/pharmacology ; Ranolazine ; Tacrolimus/administration & dosage ; Tacrolimus/pharmacokinetics ; Tacrolimus/therapeutic use
Chemical Substances	ATP-Binding Cassette, Sub-Family B, Member 1 ; Acetanilides ; Cytochrome P-450 CYP3A Inhibitors ; Enzyme Inhibitors ; Immunosuppressive Agents ; Piperazines ; Ranolazine (A6IEZ5M406) ; Tacrolimus (WM0HAQ4WNM)
Language	English
Publishing date	2010-11
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	1101370-9
ISSN	1542-6270 ; 1060-0280
ISSN (online)	1542-6270
ISSN	1060-0280
DOI	10.1345/aph.1P297
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Article ; Online: Association of APOL1 variants with mild kidney disease in the first-degree relatives of African American patients with non-diabetic end-stage renal disease.

Freedman, Barry I / Langefeld, Carl D / Turner, Jolyn / Núñez, Marina / High, Kevin P / Spainhour, Mitzie / Hicks, Pamela J / Bowden, Donald W / Reeves-Daniel, Amber M / Murea, Mariana / Rocco, Michael V / Divers, Jasmin

Kidney international

2012 Volume 82, Issue 7, Page(s) 805–811

Abstract: Familial aggregation of non-diabetic end-stage renal disease (ESRD) is found in African Americans and variants in the apolipoprotein L1 gene (APOL1) contribute to this risk. To detect genetic associations with milder forms of nephropathy in the high-risk ...

Abstract	Familial aggregation of non-diabetic end-stage renal disease (ESRD) is found in African Americans and variants in the apolipoprotein L1 gene (APOL1) contribute to this risk. To detect genetic associations with milder forms of nephropathy in the high-risk families, analyses were performed using generalized estimating equations to assess relationships between kidney disease phenotypes and APOL1 variants in 786 relatives of 470 families. Adjusting for familial correlations, 23.1, 46.7, and 30.2% of genotyped relatives possessed two, one, or no APOL1 risk variants, respectively. Relatives with two compared with one or no risk variants had statistically indistinguishable median systolic blood pressure, urine albumin to creatinine ratio, estimated glomerular filtration rate (GFR; MDRD equation), and serum cystatin C levels. After adjusting for age, gender, age at ESRD in families, and African ancestry, significant associations were detected between APOL1 with overt proteinuria and estimated GFR (CKD-EPI equation), with a trend toward significance for quantitative albuminuria. Thus, relatives of African Americans with non-diabetic ESRD are enriched for APOL1 risk variants. After adjustment, two APOL1 risk variants weakly predict mild forms of kidney disease. Second hits appear necessary for the initiation of APOL1-associated nephropathy.
MeSH term(s)	Adult ; African Continental Ancestry Group/genetics ; Aged ; Albuminuria/ethnology ; Albuminuria/genetics ; Apolipoprotein L1 ; Apolipoproteins/genetics ; Chi-Square Distribution ; Female ; Gene Frequency ; Genetic Predisposition to Disease ; Genetic Variation ; Glomerular Filtration Rate/genetics ; Heredity ; Humans ; Kidney/physiopathology ; Kidney Diseases/diagnosis ; Kidney Diseases/ethnology ; Kidney Diseases/genetics ; Kidney Diseases/physiopathology ; Kidney Failure, Chronic/diagnosis ; Kidney Failure, Chronic/ethnology ; Kidney Failure, Chronic/genetics ; Kidney Failure, Chronic/physiopathology ; Lipoproteins, HDL/genetics ; Male ; Middle Aged ; Multivariate Analysis ; Pedigree ; Phenotype ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; Young Adult
Chemical Substances	APOL1 protein, human ; Apolipoprotein L1 ; Apolipoproteins ; Lipoproteins, HDL
Language	English
Publishing date	2012-06-13
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	120573-0
ISSN	1523-1755 ; 0085-2538
ISSN (online)	1523-1755
ISSN	0085-2538
DOI	10.1038/ki.2012.217
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Article: Donor-derived myeloid sarcoma in two kidney transplant recipients from a single donor.

Palanisamy, Amudha / Persad, Paul / Koty, Patrick P / Douglas, Laurie L / Stratta, Robert J / Rogers, Jeffrey / Reeves-Daniel, Amber M / Orlando, Giuseppe / Farney, Alan C / Beaty, Michael W / Pettenati, Mark J / Iskandar, Samy S / Grier, David D / Kaczmorski, Scott A / Doares, William H / Gautreaux, Michael D / Freedman, Barry I / Powell, Bayard L

Case reports in nephrology

2015 Volume 2015, Page(s) 821346

Abstract: We report the rare occurrence of donor-derived myeloid sarcoma in two kidney transplant patients who received organs from a single deceased donor. There was no evidence of preexisting hematologic malignancy in the donor at the time of organ recovery. ... ...

Abstract	We report the rare occurrence of donor-derived myeloid sarcoma in two kidney transplant patients who received organs from a single deceased donor. There was no evidence of preexisting hematologic malignancy in the donor at the time of organ recovery. Both recipients developed leukemic involvement that appeared to be limited to the transplanted organ. Fluorescence in situ hybridization (FISH) and molecular genotyping analyses confirmed that the malignant cells were of donor origin in each patient. Allograft nephrectomy and immediate withdrawal of immunosuppression were performed in both cases; systemic chemotherapy was subsequently administered to one patient. Both recipients were in remission at least one year following the diagnosis of donor-derived myeloid sarcoma. These cases suggest that restoration of the immune system after withdrawal of immunosuppressive therapy and allograft nephrectomy may be sufficient to control HLA-mismatched donor-derived myeloid sarcoma without systemic involvement.
Language	English
Publishing date	2015-04-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	2627652-5
ISSN	2090-665X ; 2090-6641
ISSN (online)	2090-665X
ISSN	2090-6641
DOI	10.1155/2015/821346
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