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BACKGROUND AND AIMS We evaluated retrospectively in a cohort of kidney-transplanted patients (KTxp), the variations of mineral metabolism (MM) parameters, femoral and vertebral bone density during the first year of kidney transplantation (KTx). METHOD 383 KTxp (M = 232), up to the 650 transplanted in our Department (2004–2017) were studied. At 1st(T1) and 12th(T2) mth of KTx biochemical, femoral and vertebral dual-energy X-ray absorption (DEXA) data were recorded. T-score (Ts) -1 >Ts > -2.5 was considered Osteopenia (F-OPN/V-OPN) and Ts < -2.5 osteoporosis (F-OPS/V-OPS). RESULTS The KTxp age and dialysis vintage (DV) were 48 ± 12 years and 53 ± 25 months; 67% of KTxp had a history of hemodialysis. In 82.5% of cases, a donor deceased KTx (DD) was performed and in 40% of KTxp had a previous history of steroid therapy. During the first year of KTx 91% and 93% of KTxp received respectively calcineurin inhibitors and mycophenolate, and the steroids cumulative dose (SCD) was 2683 ± 926 mg. At T1, cholecalciferol and calcifediol were supplemented in 5% and 8% of KTxp, and AT T12 in 12% and 15% of KTxp. An increase in BMI (23 ± 3 versus 24 ± 3 kg/m2 P Femoral bone mineral density (F-BMD) at T1 and F-Ts-T1 were 0.749 ± 0.17 g/cm2 and -1.55 ± 1.06. F-OPS-T1 was present in 17.5% and F-OPN-T1 in 53% of KTxp. F-BMD-T1 correlated directly with BMI-T1 (P At T1, V-BMD-T1 and V-Ts-T1 were 0.92 ± 0.19 g/cm2 and −1.5 ± 1.58. V-OPS-T1 was present in 30% of KTxp and V-OPN-T1 in 34.5%. V-BMD-T1 correlated directly with BMI-T1 (P At T12, V-BMD-T12 and V-Ts-T12 were 0.90 ± 0.22 g/cm2 and −1.5 ± 1 .33 (both NS versus T1). V-OPS-T12 was present in 27.7% of KTxp and V-OPN-T12 in 37.2%. V-BMD-T12 correlated directly with BMI-T1 and T12 (P CONCLUSION In the first year of KTx several modifications of MM are present. Both femoral and vertebral DEXA seem to be strongly related to the pre-KTx status, in particular, nutritional status and dialysis vintage are related to bone status at T1. Strong importance on T12 evaluation is taken by the SCD.

Background and Aims Urinary tract infections (UTIs) are the most common infectious disease in kidney transplanted patients (KTxps), especially during the first year of kidney transplantation (KTx). This study aims to examine the etiology of UTIs in a large cohort of KTxps, trying to identify their potential predisposing factors both during the first year and in the global follow-up (FU) of KTx. The impact of UTIs on KTx and patient’s survival in the long term will also be analyzed. Method In our study 585 KTxps (M 343; median age 49 years), out of the 616 KTxps transplanted in our Department between 2004 and 2016, were studied and followed up for a median time of 8 years. Clinical and biochemical data about the 1st (T1) and the 12th month (T12) of KTx were collected. Parameters related to UTIs, defined by a positive urine culture associated with urinary sediment suggestive of UTI, regardless of clinical symptoms, were considered in the global FU. A number of UTIs ≥3 was considered significant during the 1st year of KTx and in the overall FU. The reduction of the eGFR/year of FU, the loss of graft and the death of KTxps with a functioning graft were evaluated as outcome. Results The cohort had a slight prevalence of males (59%) and a median age of 49 years. At the time of KTx, JJ ureteral stent (JJ) was placed in 38% of KTxps, with a median stay time of 47 days. During the FU, 1700 UTIs were found in 458 KTxp, 550 UTIs during the first year of KTx. The pathogens most responsible for UTIs in the global FU were Escherichia coli (61%), Enterococcus (12%) and Klebsiella (8%). According to the number of UTIs found during the 1st year of KTx, KTxp were categorized in: UTI1≥3 (N=139) and UTI1 The studied cohort was also categorized according to the number of UTIs during the global FU in UTItot ≥3 (N=168) and UTItot During the FU, the median absolute reduction in eGFR was found to be -0.6[-2.0; +0.9](mL/min)/years. Despite a greater reduction in glomerular filtrate rate in UTI tot≥3 group, the graft loss and the death with functioning graft had no correlation with either UTI1≥3 (7 and 5 patients, respectively) or UTItot≥3 (12 and 8 patients, respectively). Graft loss was observed in 51 KTxps. The number of infections/follow-up time of these KTxps was comparable to that found in those who had a still functioning transplant at the end of observation, and no statistical differences were found in survival analysis according to IVU tot≥3 category. During the global FU, 40 KTxp died with functioning graft. Also with regard to this outcome, no significant correlations were observed with the number of UTIs/follow-up time and in the survival analysis. Conclusion Our data confirm that UTIs are frequent in KTxps. Some factors, such as induction therapy and JJ use, certainly have a favoring effect in UTIs development. Despite the relation observed between UTIs and eGFR reduction, UTIs had no significant impact on graft loss. Beyond prevention through the improvement of lifestyles and various behavioral aspects, the implementation of personalized immunosuppressive protocols associated with a careful management of JJ are desirable interventions in order to prevent the development of UTIs in KTxps.

Background and aims Bone and mineral metabolism (MM) disorders are relevant problems in renal transplanted patients (RTxp). In our observational monocentric study, we evaluated the effects on femoral and lumbar bone mineral density (BMD) and on MM parameters, and the safety of one year-treatment with Denosumab (DB) in a cohort of RTxp. Method We recorded data about 32 RTxp treated with DB in our Center in the last year. RTxp were evaluated for BMD and T-score (Ts) before the start (T0) and after 12 months (T12) of treatment. Osteopenia was defined, at femoral (F-OPN) and lumbar (L-OPN) sites as Ts:-1>Ts>-2.5 whereas osteoporosis, in the same sites (F-OPS and L-OPS) as Ts9.0 mg/dL were the finding at T0 of: 1) F-OPS and/or V-OPS; 2) sVF. During the year of treatment, hypocalcemic (HpCa=Ca Results The cohort was composed mainly by females (n=21). The time of RTx was 144[59-232]mths. Steroid therapy was prescribed in 30 RTxp (93%), 22(68%) and in 2 (6%) RTxp were taking 25OHD and 1-25OH. Three RTxp (9%) were receiving Ca supplements. Bisphosphonate therapy was reported in 15 RTxp (46%) in the year before DB start. At T0, 25(78%) and 7 (22%) RTxp had F-OPS and F-OPN. Twenty-three (71%) and 6 (20%) RTxp had L-OPS and L-OPN. In 3 RTxp normal lumbar T-score was found. sVF were present in 17 RTxp (53%). Ca and P were 9.6±0.6 mg/dL and 3.1±0.6 mg/dL whereas PTH, ALP and 25OHD were 64±32 pg/mL, 80±37 U/L and 28±16 mg/dL. SCr and Prot-U were 1,32±0,4 mg/dL and 0,23±0,16 g/24h. At T12, F-Ts increased significantly (T0: -3.0[-3.5/-2.5] vs T12:-2.8[-3.5/-2.4) as like as V-Ts (T0: -3.0[-3.7/-1.9] vs T12:-2.8[-3.0/-1.6) both p Conclusions The preliminary results presented in our study, limited by the monocentric, not randomized design and by the smallness of the cohort, reported a good bone efficacy of DB in RTxp, especially at lumbar level. The therapy was characterized by a good general safety. Future longer and randomized studies, involving more RTxp might elucidate the possible primary role of DB in the treatment of bone disorders in RTxp.