Alfonso Santos

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Liver transplant, toxoplasmosis and kidney stones: connecting the dots

Case Reports, Feb 1, 2019

The skin-kidney connection: bullous pemphigoid associated with acute allograft rejection and membranous nephropathy

Clinical case reports, Feb 1, 2018

Bullous pemphigoid has been linked to allograft rejection, as well as membranous nephropathy in r... more Bullous pemphigoid has been linked to allograft rejection, as well as membranous nephropathy in renal transplant recipients. Although there is a possibility of multiple distinct autoimmune processes, immune stimulation induced by allograft rejection or antibasement zone antibody interactions are possible mechanisms for the simultaneous skin and renal involvement.

Fever in a transplant recipient: think beyond infection

Clinical case reports, Apr 1, 2018

Immune reconstitution inflammatory syndrome (IRIS) is an exaggerated inflammatory cascade initiat... more Immune reconstitution inflammatory syndrome (IRIS) is an exaggerated inflammatory cascade initiated in response to immune recovery during the resolution of an infection. Reduction in calcineurin inhibitor levels in organ transplant recipients due to enhanced metabolism from interaction with rifampin can predispose these individuals to develop IRIS during the treatment of tuberculosis and mimic sepsis.

Not all inflammation in a renal allograft is rejection

Clinical Case Reports, 2018

Analysis of Risk Factors for Kidney Retransplant Outcomes Associated with Common Induction Regimens: A Study of over Twelve-Thousand Cases in the United States

Journal of Transplantation, 2017

We studied registry data of 12,944 adult kidney retransplant recipients categorized by induction ... more We studied registry data of 12,944 adult kidney retransplant recipients categorized by induction regimen received into antithymocyte globulin (ATG) (N = 9120), alemtuzumab (N = 1687), and basiliximab (N = 2137) cohorts. We analyzed risk factors for 1-year acute rejection (AR) and 5-year death-censored graft loss (DCGL) and patient death. Compared with the reference, basiliximab: (1) one-year AR risk was lower with ATG in retransplant recipients of expanded criteria deceased-donor kidneys (HR = 0.56, 95% CI = 0.35–0.91 and HR = 0.54, 95% CI = 0.27–1.08, resp.), while AR risk was lower with alemtuzumab in retransplant recipients with >3 HLA mismatches before transplant (HR = 0.63, 95% CI = 0.44–0.93 and HR = 0.81, 95% CI = 0.63–1.06, resp.); (2) five-year DCGL risk was lower with alemtuzumab, not ATG, in retransplant recipients of African American race (HR = 0.54, 95% CI = 0.34–0.86 and HR = 0.73, 95% CI = 0.51–1.04, resp.) or with pretransplant glomerulonephritis (HR = 0.65, 95% C...

Association of Baseline Viral Serology and Sirolimus Regimens With Kidney Transplant Outcomes

Transplantation, 2017

This article is made available under the terms and conditions applicable towards Open Access Poli... more

Kidney-pancreas transplant recipient with dysuria and hematuria

Internal and Emergency Medicine, 2016

Comparison of Utilization and Clinical Outcomes for Belatacept- and Tacrolimus- Based Immunosuppression in Renal Transplant Recipients

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, Jan 3, 2016

The performance of belatacept in a real clinical setting has not been reported. A retrospective c... more The performance of belatacept in a real clinical setting has not been reported. A retrospective cohort study was conducted using registry data comparing one-year clinical outcomes between belatacept- and tacrolimus-treated adult kidney transplant recipients (KTR) from 6.1.2011 through 12.1.2014. Of 50 244 total patients, 417 received belatacept+tacrolimus, 458 received belatacept alone, and 49 369 received tacrolimus alone at discharge. In the overall study cohort, belatacept alone was associated with a higher risk for one-year acute rejection, with highest rates associated with non-lymphocyte depleting (LD) induction (aHR: 2.65; 95%CI: 1.90-3.70, P<.0001). There was no significant difference in rejection rates between belatacept+tacrolimus and tacrolimus alone. In KTR meeting inclusion criteria for the BENEFIT-EXT trial, one-year kidney function was higher with belatacept+tacrolimus and belatacept alone versus tacrolimus alone groups (mean eGFR: 65.6 vs 60.4 vs 54.3 ml/min/1.73M...

Non-Renal Factors Associated with Simultaneous Liver-Kidney Transplant in Patients with End-Stage Liver Disease and Stage 3-5 Chronic Kidney Disease Not Requiring Dialysis

OBM Transplantation

We aimed to identify the non-renal risk factors for simultaneous liver-kidney transplantation (SL... more We aimed to identify the non-renal risk factors for simultaneous liver-kidney transplantation (SLKT) vs. liver transplantation alone (LTA) in end-stage liver disease (ESLD) patients with estimated glomerular filtration rate (eGFR) <60 ml/min, not on dialysis. Using organ procurement and transplantation network data, we studied adult ESLD patients who received deceased-donor SLKT or LTA in July 2002-Mar 2016 with a 4-point modification of renal disease (MDRD) equation-estimated glomerular filtration rate (eGFR) stratified into chronic kidney disease stage 3 (CKD-3): 30-59 ml/min, CKD stage 4 (CKD-4): 15-29 ml/min, and CKD stage 5 (CKD-5): <15 ml/min) and not on maintenance dialysis (NOD). The outcome of the study was identification of non-renal risk factors predicting likelihood of SLKT vs. LTA. We reported the odds ratio (OR) and 95% confidence interval (CI) for SLKT vs. LTA associated with important clinical variables. Strong non-renal (non-creatinine-associated) risk factors...

New-onset diabetes after kidney transplantation: can the risk be modified by choosing immunosuppression regimen based on pretransplant viral serology?

Nephrology Dialysis Transplantation, 2017

Background. This study aimed to analyze adult kidney transplant recipients (KTRs) for the risk of... more Background. This study aimed to analyze adult kidney transplant recipients (KTRs) for the risk of new-onset diabetes after transplantation (NODAT) associated with viral serologies and immunosuppression regimens [tacrolimus (Tac) þ mycophenolate (MPA), cyclosporine (CSA) þ MPA, sirolimus (SRL) þ MPA, SRL þ CSA or SRL þTac]. Methods. Cox regression models were used to examine the risk of NODAT in the first posttransplant year associated with: (i) CSA þ MPA, SRL þ MPA, SRL þ MPA or SRL þ Tac versus reference, Tac þ MPA; (ii) pretransplant viral serology [þ or À; hepatitis B core (HBc), hepatitis C (HCV), cytomegalovirus (CMV) or Epstein Barr Virus (EBV)]; and (iii) interactions between immunosuppression regimens and the viral serology found significant in the main analysis.

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Outcome of kidney transplants for adults with hemolytic uremic syndrome in the U.S.: a ten-year database analysis

Annals of transplantation : quarterly of the Polish Transplantation Society, Jan 21, 2014

There is currently no large study of the U.S. transplant registry comparing the outcome of kidney... more There is currently no large study of the U.S. transplant registry comparing the outcome of kidney transplantation for adults with and without hemolytic uremic syndrome (HUS). To date, information on the outcome of transplants for HUS in the U.S. is derived from single or combined-centers studies, but none has been of a nationwide scope. We retrospectively studied a US registry for the outcome of 323 kidney transplants in adults with HUS and of 121,311 transplants in adults with other renal diseases during the period 1999-2009. We analyzed patient, over-all, and death-censored graft survival in the 5 years following transplantation using Kaplan-Meir curves and Cox hazard models. In the 5 years following kidney transplantation, patient mortality was not significantly different [Hazard Ratio (HR) 1.27, 95% Confidence Interval (CI) 0.78-2.08], but death-censored graft loss was twice as common (HR 2.05, 95% CI 1.53-2.73) for allograft recipients whose native kidney disease was HUS compar...

Gastrointestinal complications in dialysis patients

Replacement of Renal Function by Dialysis, 2004

... Am J Gatroen-fera/80:608, 1985 12. Goldstein H, Murphy D, Sokol A, Rubini ME: Gastric acid se... more

Effect of different tacrolimus levels on early outcomes after kidney transplantation

Annals of transplantation : quarterly of the Polish Transplantation Society, Jan 7, 2014

There is a paucity of modern data on the impact of high tacrolimus levels early after kidney tran... more There is a paucity of modern data on the impact of high tacrolimus levels early after kidney transplantation. This study analyzed the impact of various trough levels of tacrolimus in the first 2 weeks post-transplant on rates of delayed graft function (DGF), length of stay (LoS), hyperkalemia, hyperglycemia, and biopsy-proven acute rejection (BPAR) rates in the first 3 months post-transplant in a retrospective single-center cohort of patients. Patients were divided into 4 groups based on the average of two highest 12-hour trough tacrolimus levels: <10 ng/mL, 10-12 ng/mL, 12-15 ng/mL, >15 ng/mL. The incidence of DGF was noted to be significantly higher in the <10 ng/mL, >15 ng/mL and the 12-15 ng/mL tacrolimus groups as compared to the 10-12 ng/mL group (49%, 25% and 4%, respectively, p≤0.0001). Mean LoS was also noted to be significantly higher in the >15 ng/mL tacrolimus group as compared to the 10-12 ng/mL group (7.4 days and 6.1 days respectively, p=0.0007). There ...

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