Publications by authors named "Lynn Maestretti"
Article Synopsis
- Antibody-mediated rejection contributes significantly to early kidney transplant failure, but there is a lack of consistent guidelines for measuring antibodies and determining treatment approaches.
- This study evaluated the effectiveness of monitoring donor-specific antibodies (DSA) in children who received kidney transplants at Stanford from 2010 to 2018, including 233 patients with an average follow-up of 45 months.
- The findings revealed that C1q-binding DSA was particularly indicative of graft failure risk; patients with persistent C1q-DSA had a much higher chance of losing their graft, identifying it as a superior biomarker compared to standard DSA.
Background And Objectives: High tacrolimus intrapatient variability has been associated with inferior graft outcomes in patients with kidney transplants. We studied baseline patterns of tacrolimus intrapatient variability in pediatric patients with kidney transplants and examined these patterns in relation to C1q-binding donor-specific antibodies.
Design, Setting, Participants, & Measurements: All tacrolimus levels in participants who underwent kidney-only transplantation at a single pediatric center from 2004 to 2018 (with at least 12-month follow-up, followed until 2019) were analyzed to determine baseline variability.
Background: Currently, there is no consensus among pediatric kidney transplant centers regarding the use and regimen for immunosuppressive induction therapy.
Methods: In this single center, retrospective cohort study, pediatric kidney transplant recipients transplanted between 1 May 2013 and 1 May 2018 with rabbit antithymocyte globulin (rATG) induction were included. We stratified patients based on immunological risk, with high risk defined as those with repeat transplant, preformed donor specific antibody, current panel-reactive antibodies > 20%, 0 antigen match and/or African-American heritage.
Article Synopsis
- The study examines the effects of native nephrectomy (removal of the patient's original kidneys) on posttransplant hypertension in pediatric kidney transplant recipients, as this aspect has not been widely researched.* -
- Data from 136 patients treated between 2007 and 2012 revealed that those who underwent nephrectomy had significantly lower rates of needing antihypertensive medications shortly after and up to five years posttransplant, compared to those who did not.* -
- The findings suggest that native nephrectomy is beneficial in managing hypertension in pediatric transplant patients, highlighting its importance for long-term cardiovascular health and medication adherence.*
Pediatric renal transplant recipient survival continues to improve, but ABMR remains a significant contributor to graft loss. ABMR prognostic factors to guide treatment are lacking. C4d staining on biopsies, diagnostic of ABMR, is associated with graft failure.
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