Anders Hartmann - Profile on Academia.edu (original) (raw)
Papers by Anders Hartmann
Clinical Microbiology and Infection, Jul 1, 2005
Human cytomegalovirus (HCMV) infection is the single most frequent infectious complication in the... more Human cytomegalovirus (HCMV) infection is the single most frequent infectious complication in the early period after kidney transplantation. The HCMV load in blood, measured by HCMV PCR or the HCMV pp65 antigen test, is a predictor of HCMV disease in seropositive recipients. However, plasma virus load measurements are of only modest value in predicting the risk of HCMV disease in seronegative recipients of kidneys from seropositive donors. HCMV infection is an independent riskfactor for acute kidney graft rejection. There is also evidence that HCMV is associated with an increased long-term mortality and post-transplant diabetes mellitus. Whether pre-emptive or prophylactic therapy should be the preferred strategy is not yet decided. Some studies indicate that HCMV prophylaxis may reduce the risk of acute rejection, and thereby increase long-term graft survival in seronegative recipients of kidneys from seropositive donors.
Cytomegalovirus High-risk Kidney Transplant Recipients Show No Difference in Long-term Outcomes Following Preemptive Versus Prophylactic Management
Transplantation, May 26, 2023
Background. Following kidney transplantation (KT), cytomegalovirus (CMV) infection remains an imp... more Background. Following kidney transplantation (KT), cytomegalovirus (CMV) infection remains an important challenge. Both prophylactic and preemptive antiviral protocols are used for CMV high-risk kidney recipients (donor seropositive/recipient seronegative; D+/R–). We performed a nationwide comparison of the 2 strategies in de novo D+/R– KT recipients accessing long-term outcomes. Methods. A nationwide retrospective study was conducted from 2007 to 2018, with follow-up until February 1, 2022. All adult D+/R– and R+ KT recipients were included. During the first 4 y, D+/R– recipients were managed preemptively, changing to 6 mo of valganciclovir prophylaxis from 2011. To adjust for the 2 time eras, de novo intermediate-risk (R+) recipients, who received preemptive CMV therapy throughout the study period, served as longitudinal controls for possible confounders. Results. A total of 2198 KT recipients (D+/R–, n = 428; R+, n = 1770) were included with a median follow-up of 9.4 (range, 3.1–15.1) y. As expected, a greater proportion experienced a CMV infection in the preemptive era compared with the prophylactic era and with a shorter time from KT to CMV infection (P < 0.001). However, there were no differences in long-term outcomes such as patient death (47/146 [32%] versus 57/282 [20%]; P = 0.3), graft loss (64/146 [44%] versus 71/282 [25%]; P = 0.5), or death censored graft loss (26/146 [18%] versus 26/282 [9%]; P = 0.9) in the preemptive versus prophylactic era. Long-term outcomes in R+ recipients showed no signs of sequential era–related bias. Conclusions. There were no significant differences in relevant long-term outcomes between preemptive and prophylactic CMV-preventive strategies in D+/R– kidney transplant recipients.
American Journal of Transplantation, 2017
Kidney transplanted patients still have significantly higher mortality compared with the general ... more Kidney transplanted patients still have significantly higher mortality compared with the general population. The innate immune system may play an important role during periods, with suppression of the adaptive immune system. In the present study, two soluble pattern recognition molecules of the innate immune system were investigated, collectin liver 1 (CL-L1) and collectin kidney 1 (CL-K1). Potential associations of their pretransplant levels and long-term graft and recipient survival were examined. The levels of CL-L1 and CL-K1 were measured at the time of transplantation in 382 patients (≥17 years) transplanted in 2000-2001. The cohort was subsequently followed until December 31, 2014. Data on patient and graft survival were obtained from the Norwegian Renal Registry. Both high CL-L1 (≥376 ng/mL) and high CL-K1 (≥304 ng/mL) levels were significantly associated with overall mortality in multivariate Cox analyses with hazard ration (HR) 1.50, 95% confidence interval (CI) 1.09-2.07, p = 0.013 and HR 1.43, 95% CI 1.02-1.99, p = 0.038, respectively. Moreover, high CL-K1 levels were significantly associated with cardiovascular mortality. No association between measured biomarkers and death-censored graft loss was found. Finally, there was a significant correlation between these two collectins, r = 0.83 (95% CI 0.80-0.86). In conclusion, CL-L1 and CL-K1 were significantly associated with mortality in kidney transplant recipients.
Transplantation, Jul 1, 2018
Introduction: Chronic kidney failure is a common long-term complication after non-kidney solid or... more Introduction: Chronic kidney failure is a common long-term complication after non-kidney solid organ transplantation (SOT) such as heart-, lung and liver transplantation. These patients may be offered chronic dialysis and/or kidney transplantation. Data on outcomes of kidney transplantation in these patients have been scarce, and the aim of the present study was to assess outcomes in a nationwide perspective.
Risk factors and incidence of posttransplant diabetes mellitus
Transplantation Proceedings, Aug 1, 2001
Tidsskrift for Den Norske Laegeforening, Jun 10, 2001
Hyperkalsemi kan føre til aku nyresvikt. Vi presenterer to pasienter som belyser problemet alvorl... more Hyperkalsemi kan føre til aku nyresvikt. Vi presenterer to pasienter som belyser problemet alvorlig hyperkalsemi og nyresvikt. Hos den ene pasienten skyldtes hyperkalsemien inntak av høy dose vitamin D (AFI-D₂ forte) ta i terapeutisk hensikt som behandling for hypoparatyreoidisme. Hyperkalsemi hos den andre pasienten skyldtes inntak av uvanlig høye doser kalsiumkarbonat (Titralac) mot magesmerter.
Nephrology Dialysis Transplantation, May 1, 2018
[Therapeutic principles in hyperkalemia]
PubMed, Aug 10, 1991
Nephrology Dialysis Transplantation, May 1, 2015
Response to Letter About Intensity of Immunosuppressive Therapy on Outcome of Treatment for CMV Disease
American Journal of Transplantation, May 1, 2011
We thank Hosseini-Moghaddam et al. (1) for their interest in our posthoc analysis of the influenc... more We thank Hosseini-Moghaddam et al. (1) for their interest in our posthoc analysis of the influence of immunosuppressive intensity on CMV outcomes in the VICTORtrial (2–4). Although predefined end-points were used in this posthoc analysis, these were not end-points in the primary study (VICTOR-trial) and, as mentioned in the paper, the analysis was intended as a pure hypothesis generating work. The type of data collected limited the use of specific statistical methods, for example, that the CNI levels had to be dichotomized and analyzed together in groups without correction for other immunosuppressive drugs.
Tidsskrift for Den Norske Laegeforening, Dec 16, 2004
Forgiftning med metanol er sjeldent i Norge. Høsten 2002 ble smuglersprit med ca. 20 % metanol i ... more Forgiftning med metanol er sjeldent i Norge. Høsten 2002 ble smuglersprit med ca. 20 % metanol i etanol distribuert og innta mange sted presenterer her data for pasienter innlagt i norske sykehus for metanolforgiftning i 2002.
Stadieinndeling og måling av nyrefunksjon ved kronisk nyresykdom
Tidsskrift for Den Norske Laegeforening, Apr 27, 2006
... Svarstad Nyreseksjonen Medisinsk avdeling Haukeland Universitetssjukehus Kristian Selvig Nyre... more ... Svarstad Nyreseksjonen Medisinsk avdeling Haukeland Universitetssjukehus Kristian Selvig Nyreseksjonen Medisinsk avdeling Sykehuset Buskerud Helge Skjønsberg Nyreseksjonen ... er anven-delige i vanlig klinisk praksis og gjør at man kan gradere pasientens nyresykdom i ...
Review Article. Doppler examination of the allografted kidney
Acta Radiologica, 2003
A comprehensive ultrasound examination of the transplanted kidney includes a Doppler examination.... more A comprehensive ultrasound examination of the transplanted kidney includes a Doppler examination. Duplex Doppler, color Doppler and power Doppler can all reveal important information. In addition, calculation of the resistance and pulsatility indices to quantify changes in the spectral Doppler waveform can be of great help, particularly in the first weeks and months following a transplantation. The Doppler part of the examination should evaluate the vessels to and from the transplant, as well as the parenchyma with calculations of indices to detect the presence of increased vascular resistance. The conclusions drawn from the Doppler-derived information combined with the results from gray-scale scanning and clinical information will very often be of clinical significance for the handling of the patient.
Transplant International, Mar 18, 2022
Background: Elevated levels of oxalate are common in renal failure patients and nonhyperoxaluria ... more Background: Elevated levels of oxalate are common in renal failure patients and nonhyperoxaluria disease, and may cause damage after transplantation. We examined outcomes after 15 years for 167 kidney transplant recipients who had plasma oxalate measured early after transplantation. Analyses included plasma oxalate, recipient age, donor age, live donor, HLA-DR mismatch, mGFR, and smoking. Results: Median age was 52 years (range 18-81), 63% were male and 38% had live donors. Median plasma oxalate concentration 10 weeks after transplantation was 9.0 μmol/L (range 2.7-53.0), one third above the upper reference limit (11.0 μmol/L). Multivariable analysis revealed upper quartile plasma oxalate (>13.0 μmol/L, p = 0.008), recipient age (p < 0.001), deceased donor (p = 0.003), and current smoking (p < 0.001) as significant factors associated with patient survival. Upper quartile plasma oxalate (p = 0.021), recipient age (p = 0.001), deceased donor kidney (p = 0.001), HLA-DR mismatch (p = 0.015), and current smoking (p = 0.014) were also associated with graft loss. Factors associated with death censored graft losses were donor age (p = 0.012), deceased donor (p = 0.032), and HLA-DR mis-matched kidneys (p = 0.005) but plasma oxalate was not (p = 0.188). Conclusions: Plasma oxalate in the upper quartile early after transplantation was significantly associated with impaired long-term patient survival and graft losses, but not when censored for death.
Kidney International Reports, Feb 1, 2020
Introduction: There is an increasing demand for accurately measured glomerular filtration rate (G... more Introduction: There is an increasing demand for accurately measured glomerular filtration rate (GFR). Iohexol serum clearance has become a new gold standard, but it is challenging when GFR is low and 24hour sampling is required for accurate results. The primary aim of this study was to develop an iohexol pharmacokinetic population model for accurate determination of individual GFR using limited sampling for up to 5 hours also when renal function is <40 ml/min. Methods: A nonparametric iohexol population pharmacokinetic model was developed with rich data from 176 patients. In a validation cohort of 43 patients, a model-determined GFR (iohexol clearance) using different limited sampling strategies for up to 5 hours was compared with the strategy currently used in routine care, a log-linear 2-point method. In all, 1526 iohexol concentrations were used, from patients ranging in age from 1 to 82 years and GFR from 14 to 149 ml/min. Results: The clinical 2-point method showed insufficient agreement compared with reference values; 15% of GFR values had an error of greater than AE10% even when sampling for 24 hours when estimating GFR <40 ml/min per 1.73 m 2 (standard procedure). Restricted sampling the first 5 hours with the population model required 4 samples to determine GFR accurately. This strategy showed excellent agreement with the reference; <3% of GFR values had an error greater than AE10 %. Conclusion: Using an iohexol population pharmacokinetic model allows for accurate determination of GFR within 5 hours when applying 4 optimally timed samples, even in patients with GFR <40 ml/min.
Nephrology Dialysis Transplantation, Dec 1, 1997
Nephrology Dialysis Transplantation, Sep 1, 2003
Background. About one-quarter of renal transplant patients will suffer from symptomatic cytomegal... more Background. About one-quarter of renal transplant patients will suffer from symptomatic cytomegalovirus (CMV) disease if no preventive therapeutic measures are taken. In this prospective, randomized single-centre study pre-emptive therapy with oral ganciclovir is compared with conventional deferred treatment. Methods. Renal transplant recipients (n ¼ 455) over 18 years of age were screened weekly for CMV pp65 antigenaemia during the first 12 weeks post-transplantation. If CMV pp65 antigen in leukocytes appeared within 8 weeks post-transplantation patients were randomized and included in the study. Five patients developed CMV disease before positive CMV pp65, and 14 patients with a positive antigen test developed CMV disease before randomization could take place, all these representing a limitation of the applicability of the results in the overall renal transplant population. Altogether 179 patients were not randomized for various reasons. Eighty patients completed the study, 42 were randomized to receive pre-emptive oral ganciclovir therapy and 38 to conventional deferred treatment (control group). Results. Time from transplantation to start of ganciclovir capsules was 36 (12-60) days and duration of oral ganciclovir therapy was 49 (27-70) days, median (range). No patient in the pre-emptive treatment group, but nine of 38 patients (23.7%) in the control group, developed CMV disease during the first 12 weeks posttransplantation (P ¼ 0.0009). In the period from 3 months to 1 year post-transplantation, two patients in each group developed CMV disease. There were no significant differences in acute rejection or renal function between treatment groups during the first post-transplant year. Conclusions. Pre-emptive oral ganciclovir therapy in renal transplant recipients during the first 12 weeks post-transplantation effectively prevents CMV disease during this time period. The incidence of late CMV disease (3 months to 1 year after transplantation) was similar in the two groups, indicating that pre-emptive therapy does not result in late onset of CMV disease.
Diabetes Care, Mar 12, 2019
Sodium-glucose cotransporter 2 (SGLT2) inhibitors have lately become the recommended treatment in... more Sodium-glucose cotransporter 2 (SGLT2) inhibitors have lately become the recommended treatment in patients with type 2 diabetes and high cardiovascular risk. Patients with posttransplant diabetes mellitus (PTDM) also have high cardiovascular risk. The aim of this study was to investigate the safety and efficacy of empagliflozin in renal transplant recipients with PTDM. RESEARCH DESIGN AND METHODS Forty-nine renal transplant recipients were included in an investigator-initiated, single-center, prospective, double-blind study and randomized to receive either 10 mg empagliflozin or placebo once daily for 24 weeks. Patients transplanted >1 year ago, diagnosed with PTDM, with stable renal function (estimated glomerular filtration rate [eGFR] >30 mL/min/1.73 m 2), and with stable immunosuppressive therapy were studied. RESULTS Forty-four renal transplant recipients (22 empagliflozin/22 placebo, 34 males) completed the study. Median (interquartile range) change in glycated hemoglobin (HbA 1c) was significantly reduced with empagliflozin compared with placebo: 20.2% (20.6, 20.1) (22.0 mmol/mol [26.5, 21.0]) vs. 0.1% (20.1, 0.4) (1.0 mmol/mol [20.75, 3.8]) (P = 0.025). The magnitude of glucose reduction was dependent on GFR and baseline HbA 1c. The treatment also resulted in a significant reduction in body weight of 22.5 kg (24.0, 20.05) compared with an increase of 1.0 kg (0.0, 2.0) in the placebo group (P = 0.014). There were no significant differences between the groups in adverse events, immunosuppressive drug levels, or eGFR. CONCLUSIONS Empagliflozin appeared safe and improved glycemic control in renal transplant recipients with PTDM compared with placebo. A concomitant reduction in body weight was seen. Posttransplant diabetes mellitus (PTDM) is a serious condition that may follow renal transplantation. In the early posttransplant period, hyperglycemia is common in renal transplant recipients mainly due to high doses of immunosuppressive therapy (1,2). However, 10-20% of renal transplant recipients without a prior history of diabetes develop persisting hyperglycemia after renal transplantation, defined as PTDM (3-6).
Renal reserve is present several years following donor nephrectomy
Journal of The American Society of Nephrology, Dec 7, 1994
Tidsskrift for Den Norske Laegeforening, Apr 20, 2001
Nyreseksjonen Rikshospitalet 0027 Oslo Medisinsk avdeling Det finnes overraskende få epidemiologi... more Nyreseksjonen Rikshospitalet 0027 Oslo Medisinsk avdeling Det finnes overraskende få epidemiologiske studier om aku nyresvikt og så vidt oss bekjent er ingen tidligere publisert i Norge. Formålet med denne studien var å kartlegge omfang, etiologi, behandling og resultater av aku dialysetrengende nyresvikt, basert på data fra Rikshospitalet fra 1998. Denne studien er hovedsakelig basert på data fra skjemaer fylt ut for alle pasienter (n = 44) med dialysetrengende aku nyresvikt ved Rikshospitalet i 1998. Skjemaene ble utarbeidet ved Haukeland Sykehus med stø e fra andre miljøer og Norsk nyremedisinsk forening og blir brukt ved flere andre sykehus.
Clinical Microbiology and Infection, Jul 1, 2005
Human cytomegalovirus (HCMV) infection is the single most frequent infectious complication in the... more Human cytomegalovirus (HCMV) infection is the single most frequent infectious complication in the early period after kidney transplantation. The HCMV load in blood, measured by HCMV PCR or the HCMV pp65 antigen test, is a predictor of HCMV disease in seropositive recipients. However, plasma virus load measurements are of only modest value in predicting the risk of HCMV disease in seronegative recipients of kidneys from seropositive donors. HCMV infection is an independent riskfactor for acute kidney graft rejection. There is also evidence that HCMV is associated with an increased long-term mortality and post-transplant diabetes mellitus. Whether pre-emptive or prophylactic therapy should be the preferred strategy is not yet decided. Some studies indicate that HCMV prophylaxis may reduce the risk of acute rejection, and thereby increase long-term graft survival in seronegative recipients of kidneys from seropositive donors.
Cytomegalovirus High-risk Kidney Transplant Recipients Show No Difference in Long-term Outcomes Following Preemptive Versus Prophylactic Management
Transplantation, May 26, 2023
Background. Following kidney transplantation (KT), cytomegalovirus (CMV) infection remains an imp... more Background. Following kidney transplantation (KT), cytomegalovirus (CMV) infection remains an important challenge. Both prophylactic and preemptive antiviral protocols are used for CMV high-risk kidney recipients (donor seropositive/recipient seronegative; D+/R–). We performed a nationwide comparison of the 2 strategies in de novo D+/R– KT recipients accessing long-term outcomes. Methods. A nationwide retrospective study was conducted from 2007 to 2018, with follow-up until February 1, 2022. All adult D+/R– and R+ KT recipients were included. During the first 4 y, D+/R– recipients were managed preemptively, changing to 6 mo of valganciclovir prophylaxis from 2011. To adjust for the 2 time eras, de novo intermediate-risk (R+) recipients, who received preemptive CMV therapy throughout the study period, served as longitudinal controls for possible confounders. Results. A total of 2198 KT recipients (D+/R–, n = 428; R+, n = 1770) were included with a median follow-up of 9.4 (range, 3.1–15.1) y. As expected, a greater proportion experienced a CMV infection in the preemptive era compared with the prophylactic era and with a shorter time from KT to CMV infection (P < 0.001). However, there were no differences in long-term outcomes such as patient death (47/146 [32%] versus 57/282 [20%]; P = 0.3), graft loss (64/146 [44%] versus 71/282 [25%]; P = 0.5), or death censored graft loss (26/146 [18%] versus 26/282 [9%]; P = 0.9) in the preemptive versus prophylactic era. Long-term outcomes in R+ recipients showed no signs of sequential era–related bias. Conclusions. There were no significant differences in relevant long-term outcomes between preemptive and prophylactic CMV-preventive strategies in D+/R– kidney transplant recipients.
American Journal of Transplantation, 2017
Kidney transplanted patients still have significantly higher mortality compared with the general ... more Kidney transplanted patients still have significantly higher mortality compared with the general population. The innate immune system may play an important role during periods, with suppression of the adaptive immune system. In the present study, two soluble pattern recognition molecules of the innate immune system were investigated, collectin liver 1 (CL-L1) and collectin kidney 1 (CL-K1). Potential associations of their pretransplant levels and long-term graft and recipient survival were examined. The levels of CL-L1 and CL-K1 were measured at the time of transplantation in 382 patients (≥17 years) transplanted in 2000-2001. The cohort was subsequently followed until December 31, 2014. Data on patient and graft survival were obtained from the Norwegian Renal Registry. Both high CL-L1 (≥376 ng/mL) and high CL-K1 (≥304 ng/mL) levels were significantly associated with overall mortality in multivariate Cox analyses with hazard ration (HR) 1.50, 95% confidence interval (CI) 1.09-2.07, p = 0.013 and HR 1.43, 95% CI 1.02-1.99, p = 0.038, respectively. Moreover, high CL-K1 levels were significantly associated with cardiovascular mortality. No association between measured biomarkers and death-censored graft loss was found. Finally, there was a significant correlation between these two collectins, r = 0.83 (95% CI 0.80-0.86). In conclusion, CL-L1 and CL-K1 were significantly associated with mortality in kidney transplant recipients.
Transplantation, Jul 1, 2018
Introduction: Chronic kidney failure is a common long-term complication after non-kidney solid or... more Introduction: Chronic kidney failure is a common long-term complication after non-kidney solid organ transplantation (SOT) such as heart-, lung and liver transplantation. These patients may be offered chronic dialysis and/or kidney transplantation. Data on outcomes of kidney transplantation in these patients have been scarce, and the aim of the present study was to assess outcomes in a nationwide perspective.
Risk factors and incidence of posttransplant diabetes mellitus
Transplantation Proceedings, Aug 1, 2001
Tidsskrift for Den Norske Laegeforening, Jun 10, 2001
Hyperkalsemi kan føre til aku nyresvikt. Vi presenterer to pasienter som belyser problemet alvorl... more Hyperkalsemi kan føre til aku nyresvikt. Vi presenterer to pasienter som belyser problemet alvorlig hyperkalsemi og nyresvikt. Hos den ene pasienten skyldtes hyperkalsemien inntak av høy dose vitamin D (AFI-D₂ forte) ta i terapeutisk hensikt som behandling for hypoparatyreoidisme. Hyperkalsemi hos den andre pasienten skyldtes inntak av uvanlig høye doser kalsiumkarbonat (Titralac) mot magesmerter.
Nephrology Dialysis Transplantation, May 1, 2018
[Therapeutic principles in hyperkalemia]
PubMed, Aug 10, 1991
Nephrology Dialysis Transplantation, May 1, 2015
Response to Letter About Intensity of Immunosuppressive Therapy on Outcome of Treatment for CMV Disease
American Journal of Transplantation, May 1, 2011
We thank Hosseini-Moghaddam et al. (1) for their interest in our posthoc analysis of the influenc... more We thank Hosseini-Moghaddam et al. (1) for their interest in our posthoc analysis of the influence of immunosuppressive intensity on CMV outcomes in the VICTORtrial (2–4). Although predefined end-points were used in this posthoc analysis, these were not end-points in the primary study (VICTOR-trial) and, as mentioned in the paper, the analysis was intended as a pure hypothesis generating work. The type of data collected limited the use of specific statistical methods, for example, that the CNI levels had to be dichotomized and analyzed together in groups without correction for other immunosuppressive drugs.
Tidsskrift for Den Norske Laegeforening, Dec 16, 2004
Forgiftning med metanol er sjeldent i Norge. Høsten 2002 ble smuglersprit med ca. 20 % metanol i ... more Forgiftning med metanol er sjeldent i Norge. Høsten 2002 ble smuglersprit med ca. 20 % metanol i etanol distribuert og innta mange sted presenterer her data for pasienter innlagt i norske sykehus for metanolforgiftning i 2002.
Stadieinndeling og måling av nyrefunksjon ved kronisk nyresykdom
Tidsskrift for Den Norske Laegeforening, Apr 27, 2006
... Svarstad Nyreseksjonen Medisinsk avdeling Haukeland Universitetssjukehus Kristian Selvig Nyre... more ... Svarstad Nyreseksjonen Medisinsk avdeling Haukeland Universitetssjukehus Kristian Selvig Nyreseksjonen Medisinsk avdeling Sykehuset Buskerud Helge Skjønsberg Nyreseksjonen ... er anven-delige i vanlig klinisk praksis og gjør at man kan gradere pasientens nyresykdom i ...
Review Article. Doppler examination of the allografted kidney
Acta Radiologica, 2003
A comprehensive ultrasound examination of the transplanted kidney includes a Doppler examination.... more A comprehensive ultrasound examination of the transplanted kidney includes a Doppler examination. Duplex Doppler, color Doppler and power Doppler can all reveal important information. In addition, calculation of the resistance and pulsatility indices to quantify changes in the spectral Doppler waveform can be of great help, particularly in the first weeks and months following a transplantation. The Doppler part of the examination should evaluate the vessels to and from the transplant, as well as the parenchyma with calculations of indices to detect the presence of increased vascular resistance. The conclusions drawn from the Doppler-derived information combined with the results from gray-scale scanning and clinical information will very often be of clinical significance for the handling of the patient.
Transplant International, Mar 18, 2022
Background: Elevated levels of oxalate are common in renal failure patients and nonhyperoxaluria ... more Background: Elevated levels of oxalate are common in renal failure patients and nonhyperoxaluria disease, and may cause damage after transplantation. We examined outcomes after 15 years for 167 kidney transplant recipients who had plasma oxalate measured early after transplantation. Analyses included plasma oxalate, recipient age, donor age, live donor, HLA-DR mismatch, mGFR, and smoking. Results: Median age was 52 years (range 18-81), 63% were male and 38% had live donors. Median plasma oxalate concentration 10 weeks after transplantation was 9.0 μmol/L (range 2.7-53.0), one third above the upper reference limit (11.0 μmol/L). Multivariable analysis revealed upper quartile plasma oxalate (>13.0 μmol/L, p = 0.008), recipient age (p < 0.001), deceased donor (p = 0.003), and current smoking (p < 0.001) as significant factors associated with patient survival. Upper quartile plasma oxalate (p = 0.021), recipient age (p = 0.001), deceased donor kidney (p = 0.001), HLA-DR mismatch (p = 0.015), and current smoking (p = 0.014) were also associated with graft loss. Factors associated with death censored graft losses were donor age (p = 0.012), deceased donor (p = 0.032), and HLA-DR mis-matched kidneys (p = 0.005) but plasma oxalate was not (p = 0.188). Conclusions: Plasma oxalate in the upper quartile early after transplantation was significantly associated with impaired long-term patient survival and graft losses, but not when censored for death.
Kidney International Reports, Feb 1, 2020
Introduction: There is an increasing demand for accurately measured glomerular filtration rate (G... more Introduction: There is an increasing demand for accurately measured glomerular filtration rate (GFR). Iohexol serum clearance has become a new gold standard, but it is challenging when GFR is low and 24hour sampling is required for accurate results. The primary aim of this study was to develop an iohexol pharmacokinetic population model for accurate determination of individual GFR using limited sampling for up to 5 hours also when renal function is <40 ml/min. Methods: A nonparametric iohexol population pharmacokinetic model was developed with rich data from 176 patients. In a validation cohort of 43 patients, a model-determined GFR (iohexol clearance) using different limited sampling strategies for up to 5 hours was compared with the strategy currently used in routine care, a log-linear 2-point method. In all, 1526 iohexol concentrations were used, from patients ranging in age from 1 to 82 years and GFR from 14 to 149 ml/min. Results: The clinical 2-point method showed insufficient agreement compared with reference values; 15% of GFR values had an error of greater than AE10% even when sampling for 24 hours when estimating GFR <40 ml/min per 1.73 m 2 (standard procedure). Restricted sampling the first 5 hours with the population model required 4 samples to determine GFR accurately. This strategy showed excellent agreement with the reference; <3% of GFR values had an error greater than AE10 %. Conclusion: Using an iohexol population pharmacokinetic model allows for accurate determination of GFR within 5 hours when applying 4 optimally timed samples, even in patients with GFR <40 ml/min.
Nephrology Dialysis Transplantation, Dec 1, 1997
Nephrology Dialysis Transplantation, Sep 1, 2003
Background. About one-quarter of renal transplant patients will suffer from symptomatic cytomegal... more Background. About one-quarter of renal transplant patients will suffer from symptomatic cytomegalovirus (CMV) disease if no preventive therapeutic measures are taken. In this prospective, randomized single-centre study pre-emptive therapy with oral ganciclovir is compared with conventional deferred treatment. Methods. Renal transplant recipients (n ¼ 455) over 18 years of age were screened weekly for CMV pp65 antigenaemia during the first 12 weeks post-transplantation. If CMV pp65 antigen in leukocytes appeared within 8 weeks post-transplantation patients were randomized and included in the study. Five patients developed CMV disease before positive CMV pp65, and 14 patients with a positive antigen test developed CMV disease before randomization could take place, all these representing a limitation of the applicability of the results in the overall renal transplant population. Altogether 179 patients were not randomized for various reasons. Eighty patients completed the study, 42 were randomized to receive pre-emptive oral ganciclovir therapy and 38 to conventional deferred treatment (control group). Results. Time from transplantation to start of ganciclovir capsules was 36 (12-60) days and duration of oral ganciclovir therapy was 49 (27-70) days, median (range). No patient in the pre-emptive treatment group, but nine of 38 patients (23.7%) in the control group, developed CMV disease during the first 12 weeks posttransplantation (P ¼ 0.0009). In the period from 3 months to 1 year post-transplantation, two patients in each group developed CMV disease. There were no significant differences in acute rejection or renal function between treatment groups during the first post-transplant year. Conclusions. Pre-emptive oral ganciclovir therapy in renal transplant recipients during the first 12 weeks post-transplantation effectively prevents CMV disease during this time period. The incidence of late CMV disease (3 months to 1 year after transplantation) was similar in the two groups, indicating that pre-emptive therapy does not result in late onset of CMV disease.
Diabetes Care, Mar 12, 2019
Sodium-glucose cotransporter 2 (SGLT2) inhibitors have lately become the recommended treatment in... more Sodium-glucose cotransporter 2 (SGLT2) inhibitors have lately become the recommended treatment in patients with type 2 diabetes and high cardiovascular risk. Patients with posttransplant diabetes mellitus (PTDM) also have high cardiovascular risk. The aim of this study was to investigate the safety and efficacy of empagliflozin in renal transplant recipients with PTDM. RESEARCH DESIGN AND METHODS Forty-nine renal transplant recipients were included in an investigator-initiated, single-center, prospective, double-blind study and randomized to receive either 10 mg empagliflozin or placebo once daily for 24 weeks. Patients transplanted >1 year ago, diagnosed with PTDM, with stable renal function (estimated glomerular filtration rate [eGFR] >30 mL/min/1.73 m 2), and with stable immunosuppressive therapy were studied. RESULTS Forty-four renal transplant recipients (22 empagliflozin/22 placebo, 34 males) completed the study. Median (interquartile range) change in glycated hemoglobin (HbA 1c) was significantly reduced with empagliflozin compared with placebo: 20.2% (20.6, 20.1) (22.0 mmol/mol [26.5, 21.0]) vs. 0.1% (20.1, 0.4) (1.0 mmol/mol [20.75, 3.8]) (P = 0.025). The magnitude of glucose reduction was dependent on GFR and baseline HbA 1c. The treatment also resulted in a significant reduction in body weight of 22.5 kg (24.0, 20.05) compared with an increase of 1.0 kg (0.0, 2.0) in the placebo group (P = 0.014). There were no significant differences between the groups in adverse events, immunosuppressive drug levels, or eGFR. CONCLUSIONS Empagliflozin appeared safe and improved glycemic control in renal transplant recipients with PTDM compared with placebo. A concomitant reduction in body weight was seen. Posttransplant diabetes mellitus (PTDM) is a serious condition that may follow renal transplantation. In the early posttransplant period, hyperglycemia is common in renal transplant recipients mainly due to high doses of immunosuppressive therapy (1,2). However, 10-20% of renal transplant recipients without a prior history of diabetes develop persisting hyperglycemia after renal transplantation, defined as PTDM (3-6).
Renal reserve is present several years following donor nephrectomy
Journal of The American Society of Nephrology, Dec 7, 1994
Tidsskrift for Den Norske Laegeforening, Apr 20, 2001
Nyreseksjonen Rikshospitalet 0027 Oslo Medisinsk avdeling Det finnes overraskende få epidemiologi... more Nyreseksjonen Rikshospitalet 0027 Oslo Medisinsk avdeling Det finnes overraskende få epidemiologiske studier om aku nyresvikt og så vidt oss bekjent er ingen tidligere publisert i Norge. Formålet med denne studien var å kartlegge omfang, etiologi, behandling og resultater av aku dialysetrengende nyresvikt, basert på data fra Rikshospitalet fra 1998. Denne studien er hovedsakelig basert på data fra skjemaer fylt ut for alle pasienter (n = 44) med dialysetrengende aku nyresvikt ved Rikshospitalet i 1998. Skjemaene ble utarbeidet ved Haukeland Sykehus med stø e fra andre miljøer og Norsk nyremedisinsk forening og blir brukt ved flere andre sykehus.