Kidney News | 3

April 2017 | Vol. 9, Number 4 Donor-Recipient Weight and Sex Mismatch Inside May Contribute to Kidney Transplant Failure By Tracy Hampton Kidney Transplantation Research has also shown that male re- 2017 cipients of female kidneys are at increased Breaking down barriers and risk of graft loss, presumably due to size building bridges mismatch and nephron number. (Studies indicate that female kidneys have an aver- age of 12% to 17% fewer total nephrons Detective Nephron than male kidneys.) Female recipients of Twists and turns in a case of male kidneys also experience reduced graft metabolic acidosis survival, but to a lesser extent. The mecha- nisms involved are likely immunologic in nature, owing to mismatch between H-Y Fellows Corner minor histocompatibility antigens (on the Referring the preventable before Y chromosome in male donors). it becomes the inevitable To explore the potentially additive ef- fect of size mismatch and sex mismatch, Findings a team led by Amanda Miller, MD, and Switching to Spanish-speaking Karthik Tennankore, MD, of Dalhousie providers improves diabetes University and the Nova Scotia Health control in Latinos ew research indicates that the Several kidney transplantation studies Authority, in Canada, examined wheth- success of a kidney transplant have demonstrated that a smaller donor er receiving a kidney transplant from a may rely in part on how the re- size relative to recipient is associated with smaller donor of the opposite sex would Innovation Summit Ncipient and donor compare in terms of impact a recipient’s transplant outcomes. Co-sponsors ASN, VA gather a higher risk of graft loss, perhaps due to experts to talk about advancing weight and sex. The findings, which are increased strain on the relatively smaller The researchers analyzed information innovation in kidney disease care published in the Clinical Journal of the transplanted kidney. Very few studies on a cohort of US deceased donor trans- American Society of Nephrology, suggest have investigated the outcomes associated plant recipients between 2000 and 2014 that changes may be needed to current with donor-recipient weight mismatch- who were listed in the Scientific Registry Industry Spotlight immunology-based protocols that match ing as determined by body mass in isola- Continued on page 3 Fresenius partners with insurers donors and recipients. tion, however. Variability in Parathyroid Hormone Assays: Better Standardization on the Way? By Eric Seaborg linicians worried about bone dis- techniques makes the interpretation of support of many stakeholders, includ- ease developing in patients with results difficult. ing testing manufacturers, and expects Cchronic kidney disease (CKD) A working group from the Interna- to show progress within the next couple lean on parathyroid hormone (PTH) tional Federation of Clinical Chemis- of years. In the meantime, nephrologists measurements as a marker for skeletal try and Laboratory Medicine (IFCC) is can consult the literature to aid in the and mineral disorders. But the utility working to standardize the assays and interpretation of the assays used by their of PTH assays is controversial—mainly establish protocols for issues such as pre- laboratories. because the variability among analytical analytical variables. The group has the “There can be differences up to four- fold in the results reported with different methods from the same samples,” said the chair of the IFCC group, Catherine M. Sturgeon, PhD, who is consultant clinical scientist at the Royal Infirmary of Edinburgh and director of one of the Continued on page 5 RENAL CANCER CLINICAL TRIALS Now Enrolling Patients: Investigational Immunotherapy Trials for Renal Cell Carcinoma Our clinical trials for locally advanced/metastatic or recurrent renal cell carcinoma (RCC) are studying pembrolizumab, an investigational immunotherapy that targets the PD- 1 pathway. Currently enrolling patients: Keynote 426: 426 Phase III, randomized, open-label trial • Evaluating the safety and effi cacy of pembrolizumab in combination with axitinib as fi rst-line therapy versus sunitinib monotherapy • Patients must*: - Have histologically confi rmed diagnosis of RCC (with clear cell component with or without sarcomatoid features) - Have not received prior systemic therapy for advanced disease Keynote 427: 427 Phase II, single-arm, open-label trial • Evaluating the safety and effi cacy of pembrolizumab (monotherapy) in patients with clear cell and non- clear cell renal carcinoma • Patients must*: - Have histologically confi rmed diagnosis of RCC (clear cell or non- clear cell) - Have not received prior systemic therapy for advanced disease *Additional eligibility criteria apply. For more information and to see if your patients may qualify, visit keynoteclinicaltrials.com Copyright © 2017 Merck & Co., Inc., Kenilworth, NJ, USA April 2017 | ASN Kidney News | 3 Kidney Transplant of transplant failure was further elevated to Miller said. “While more research is re- in obesity among kidney transplant candi- 35% for a male receiving a kidney from a quired before including these variables in dates, donor-recipient weight mismatch Failure female donor and 50% for a female receiv- a recipient matching strategy, this study may factor into clinical decision-making, Continued from page 1 ing a kidney from a male donor. This risk highlights the importance of donor and especially among recipients with increased is similar to that observed when a recipient recipient matching above and beyond metabolic demand.” of Transplants Recipients. The team ex- receives a kidney transplant from a donor current immunology-based protocols.” It In an accompanying editorial, Bethany cluded living donors, patients <18 years who has diabetes, a known risk factor for will be important to determine the extent Foster, MD, MSCE. and Indra Gupta, of age, those receiving multiple organs, kidney failure. It is also comparable to to which any benefit derived from weight MD, of McGill University, stressed that en bloc or sequential transplants, and other risk factors for graft loss that histori- and sex matching would offset the poten- while matching for sex and body size in patients without a documented donor or cally influence organ allocation, including tial risk of longer times on the transplant organ allocation algorithms deserves con- recipient weight. dialysis vintage >4 years and expanded vs. wait list for individual candidates. sideration, this idea must be approached The analysis included 115,124 kid- standard criteria donors. Jane Tan, MD, PhD, a transplant with a great deal of caution. It would re- ney transplant recipients, and 59.4% The study is the first large scale analysis nephrologist at Stanford University Med- quire complex matching, and special care and 61.6% of donors and recipients were to demonstrate that worse kidney trans- ical Center who was not involved with the would have to be taken to avoid disadvan- male, respectively. Over a median follow- plant outcomes associated with donor study, noted that the results lend support taging larger recipients. “Restricting trans- up of 3.8 years, 21,261 of the recipients and recipient weight mismatch—as de- to previous research as well as provide plant options by prioritizing sex matching (18.5%) developed transplant failure. termined by absolute differences in body insights that will be useful when looking may also lead to longer waiting times,” After accounting for other transplant weight, and donor and recipient sex mis- toward the future. they wrote. “Females with a large body size variables, the investigators found that if a match—are additive. “These findings build upon prior stud- would be particularly disadvantaged by an kidney transplant recipient was >30 kg (66 “This study is extremely important be- ies that demonstrate the long-term risks of approach that favoured allocation of sex- pounds) heavier than the donor, there was a cause we have shown that when all else low nephron dose for metabolic demand and body-size matched kidneys.” 28% higher risk of transplant failure com- is considered, something as simple as the in kidney transplantation, as well as the pared with equally weighted donors and combination of a kidney donor’s weight potential impact of non–human leukocyte Article: “Donor-Recipient Absolute recipients. If the kidney was from a smaller and sex is associated with a marked in- antigen immune responses to allograft sur- Weight and Sex Mismatch and the Risk donor of the opposite sex, the relative risk crease in kidney transplant failure,” vival,” she said. “With a continued increase of Graft Loss in Renal Transplantation.” Corporate Supporters ASN gratefully acknowledges the Society’s Diamond and Platinum Corporate Supporters for their contributions in 2016. Diamond Level Platinum Level 4 | ASN Kidney News | April 2017 Ure-Na is lemon-lime flavored urea used to manage hyponatremia. EDITORIAL STAFF Editor-in-Chief: Richard Lafayette, MD Executive Editor: Dawn McCoy Design: Lisa Cain Design For outpatient use, insurance may offer coverage via Communications Assistant: Sara Leeds Prior Authorization. Ure-Na comes in boxes of 8 EDITORIAL BOARD doses. 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