Nephrology Journal Club

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A twice monthly nephrology journal club that used to meet on Twitter. Hashtag #NephJC

www.nephjc.com

@nephjc.bsky.social

8/10
#NephJC Consensus:
In most cases, DDKT can improve survival compared to continued dialysis.
Not all donor kidneys are created equal (SCD, ECD, DCD, DBD).
Discussion of recipient and donor quality should be undertaken during transplant evaluation, as well of goals of care

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7/10
Question 2
#NephJC #Nephsky
Should older/sicker patients risk transplant?
These are the individualized conversations that are needed. Although older pts receiving poorer kidneys (ECD) didn’t show mortality benefit, QoL is still an important consideration.

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6/10
Question 1
#NephJC #Nephsky
So, should we transplant all ESRD cases?
It depends. SCD kidneys improved mortality in all studied groups. However, SCD kidneys may not be readily available for all waitlisted patients. Worthy of discussion with older, sicker patients.

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5/10 A picture paints 1000 words As the donor & the recipient “quality” ⬇️, so do benefits. Although higher quality kidneys (SCD) did better in worse recipients (those >75, DM+, CVD+), should they have access to SCD kidneys if overall survival is ⬇️ than younger candidates?

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4/10 1 post results 64.1% ♂️, mean age 55 years; median dialysis vintage-238 days. Comorbidities include DM (26%), CVD (25%). For pts > 75 ECD/DCD kidneys did not show a mortality benefit, however, numbers of pts in this category were small.

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3/10 1 post methods -SCD, ECD, donor after brain death (DBD), donor after CV death (DCD) -4 transplant groups: SCD/DBD, SCD/DCD, ECD/DBD, ECD/DCD were compared in 4 patient groups: All, DM+, CVD+, neither DM/CVD The 16 trials generated 1,491,537 person-trials

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2/10 What was the study? 🎯Target trial emulation: using collected data to mimic a randomized trial 🇪🇺 ERA registry: 2000-2019 ✅Included: >20 years of age, waitlisted for receiving a kidney transplant 🧮60 sequential trial emulations

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10/10 START questions the default "longer = better" steroid assumption. A 2-month taper looks to be a reasonable place to START post-remission for many steroid-sensitive patients. However, simplicity and a one-size-fits-all strategy, is not an option.

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8/10 ⚠️ #NephJC Consensus
💡Underpowered (94/114 target, ~75% power), open-label, 2 center trial, wide margin (CI compatible w/ ~14 extra relapses/100 pts short-course), and FSGS trended toward favoring the longer taper underpowered subgroup
💡Hypothesis-generating only

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7/10
Question 2
#NephJC #NephTwitter
Q: Can MCD & FSGS receive similar steroid taper regimens?
A: Probably not! We need a more adequately powered trial to answer this, especially with FSGS which remains more treatment resistant & steroid resistance may be disease defining

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