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Khadzhynov D, Halleck F, Lehner LJ, Duerr M, Kleinsteuber A, Schmidt D, Budde K, Staeck O. SP688FACTORS ASSOCIATED WITH ACUTE REJECTIONS IN KIDNEY TRANSPLANT RECIPIENTS: TIME FOR HLA-DR MATCHING IN ELDERLY RECIPIENTS? Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw178.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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102
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Schrezenmeier E, Halleck F, Staeck O, Khadzhynov D, Budde K, Duerr M. MP727COMPLETE RECOVERY OF KIDNEY ALLOGRAFT FUNCTION AFTER RECURRENCE OF HCV RELATED MPGN: A CASE OF SUCCESSFUL ANTIVIRAL TREATMENT OF HCV IN A KIDNEY ALLOGRAFT RECIPIENT REQUIRING HEMODIALYSIS. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw200.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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103
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Kleinsteuber A, Khadzhynov D, Lehner L, Duerr M, Halleck F, Budde K, Staeck O. SP677HOW DO PRE-EXISTING COMORBIDITIES INFLUENCE LONG-TERM PATIENT AND GRAFT SURVIVAL AND THE IMMUNOLOGIC OUTCOME IN KIDNEY TRANSPLANT RECIPIENTS? - AN EVALUATION OF COMORBID CONDITIONS. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw178.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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104
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Halleck F, Khadzhynov D, Lehner L, Dürr M, Schrezenmeier E, Kleinsteuber A, Budde K, Staeck O. SP676IMPACT OF PRE-EXISTING CHRONIC HEART FAILURE ON PATIENT SURVIVAL, GRAFT FUNCTION AND IMMUNOLOGIC OUTCOME IN KIDNEY TRANSPLANTATION. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw178.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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105
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Staeck O, Khadzhynov D, Kleinsteuber A, Lehner L, Duerr M, Budde K, Halleck F. MO022IMMUNOLOGIC OUTCOME AFTER KIDNEY TRANSPLANTATION DEPENDS ON DONOR FACTORS AND DECEASED DONOR KIDNEY ASSOCIATED RISK ASSESSED BY THE KIDNEY DONOR PROFILE INDEX (KDPI). Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw133.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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106
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Staeck O, Khadzhynov D, Kleinsteuber A, Lehner L, Duerr M, Budde K, Halleck F. SP654PREDICTING PATIENT SURVIVAL AT TIME OF KIDNEY TRANSPLANTATION. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw178.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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107
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Duerr M, Halleck F, Staeck O, Lehner LJ, Schrezenmeier E, Waiser J, Budde K. SP633PROSPECTIVE LONG-TERM ANALYSIS OF B- AND PLASMA CELL SUBSETS IN RENAL TRANSPLANT PATIENTS AFTER TREATMENT WITH RITUXIMAB AND BORTEZOMIB IN ANTIBODY MEDIATED REJECTION. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw177.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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108
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Halleck F, Khadzhynov D, Kleinsteuber A, Schrezenmeier E, Lehner L, Dürr M, Budde K, Staeck O. MP700IMPACT OF PRE-EXISTING DIABETES MELLITUS TYPE 2 AND POST-TRANSPLANT HBA1CIN KIDNEY TRANSPLANTATION. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw200.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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109
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Khadzhynov D, Halleck F, Lehner L, Duerr M, Kleinsteuber A, Budde K, Staeck O. SP667POST-TRANSPLANTAT SURVIVAL OF KIDNEY TRANSPLANT RECIPIENTS IS SIGNIFICANTLY IMPAIRED BY PRE-TRANSPLANT CORONARY ARTERY DISEASE. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw178.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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110
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Lehner LJ, Kleinsteuber A, Khadzhynov D, Halleck F, Schrezenmeier E, Duerr M, Budde K, Staeck O. SO015KDPI DEPENDENT OUTCOMES AND DISCARD RATES - A COMPARISON OF EUROPEAN AND U.S. RESULTS. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw119.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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111
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Staeck A, Khadzhynov D, Lachmann N, Kleinsteuber A, Lehner L, Duerr M, Budde K, Halleck F, Staeck O. SP658INFLUENCEOF PRETRANSPLANT CLASS I AND II NON-DONOR-SPECIFIC ANTI-HLA IMMUNIZATION ONIMMUNOLOGIC OUTCOME AND GRAFT SURVIVAL IN KIDNEY TRANSPLANT RECIPIENTS. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw178.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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112
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Jamieson NJ, Hanson CS, Josephson MA, Gordon EJ, Craig JC, Halleck F, Budde K, Tong A. Motivations, Challenges, and Attitudes to Self-management in Kidney Transplant Recipients: A Systematic Review of Qualitative Studies. Am J Kidney Dis 2016; 67:461-78. [DOI: 10.1053/j.ajkd.2015.07.030] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 07/19/2015] [Indexed: 12/20/2022]
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Pinter J, Hanson CS, Craig JC, Chapman JR, Budde K, Halleck F, Tong A. 'I feel stronger and younger all the time'-perspectives of elderly kidney transplant recipients: thematic synthesis of qualitative research. Nephrol Dial Transplant 2016; 31:1531-40. [PMID: 27333617 DOI: 10.1093/ndt/gfv463] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 12/29/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Kidney transplantation offers improved survival and quality of life to an increasing number of elderly patients with end-stage kidney disease. However, elderly kidney transplant recipients may face unique challenges due to a higher burden of comorbidity, greater cumulative risk of immunosuppression-related complications and increasing frailty. We aimed to describe the perspectives of elderly kidney transplant recipients. METHODS Electronic databases were searched to April 2015. Qualitative studies were eligible if they reported views from elderly kidney transplant recipients (≥60 years). Thematic synthesis was used to analyse the findings. RESULTS Twenty-one studies involving >116 recipients were included. We identified seven themes. 'Regaining strength and vitality' meant valuing the physical and psychosocial improvements in daily functioning and life participation. 'Extending life' was the willingness to accept any organ, including extended criteria kidneys, to prolong survival. 'Debt of gratitude' entailed conscious appreciation toward their donor while knowing they were unable to repay their sacrifice. 'Moral responsibility to maintain health' motivated adherence to medication and lifestyle recommendations out of an ethical duty to protect their gift for graft survival. 'Unabating and worsening forgetfulness' hindered self-management. 'Disillusionment with side effects and complications' reflected disappointment and exasperation with the unintended consequences of medications. 'Finality of treatment option' was an acute awareness that the current transplant may be their last. CONCLUSIONS Kidney transplantation was perceived to slow and even reverse the experience of aging among elderly recipients, especially compared with dialysis. However, some were frustrated over persistent limitations after transplant, struggled with the burden of medication side effects and worried about a possible return to dialysis if the transplant failed. Clarifying patient expectations of transplantation, providing support to alleviate the debilitating impacts of immunosuppression and addressing fears about deteriorating health and graft failure may improve satisfaction and outcomes in elderly kidney transplant recipients.
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Affiliation(s)
- Jule Pinter
- Sydney School of Public Health, University of Sydney, Sydney, NSW 2006, Australia Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Camilla S Hanson
- Sydney School of Public Health, University of Sydney, Sydney, NSW 2006, Australia Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, University of Sydney, Sydney, NSW 2006, Australia Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Jeremy R Chapman
- Centre for Transplant and Renal Research, Westmead Hospital, Westmead, NSW, Australia
| | - Klemens Budde
- Department of Nephrology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Fabian Halleck
- Department of Nephrology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, NSW 2006, Australia Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
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114
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Bamoulid J, Staeck O, Halleck F, Dürr M, Paliege A, Lachmann N, Brakemeier S, Liefeldt L, Budde K. Advances in pharmacotherapy to treat kidney transplant rejection. Expert Opin Pharmacother 2015; 16:1627-48. [PMID: 26159444 DOI: 10.1517/14656566.2015.1056734] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Current immunosuppressive combination therapy provides excellent prevention of T-cell-mediated rejection following renal transplantation; however, antibody-mediated rejection remains of high concern and accounts for a large number of long-term allograft losses. The recent development of protocol biopsies resulted in the definition of subclinical rejection (SCR), showing histologic evidence for rejection but unremarkable clinical course. AREAS COVERED This review describes the current knowledge and evidence of pharmacotherapy to treat kidney allograft rejections and covers SCR treatment options. Each substance is analyzed with regard to its classical indication and further discussed for the treatment of other forms of rejection. EXPERT OPINION Despite a lack of randomized trials, early acute T-cell-mediated rejection can be treated effectively in most cases without graft loss. The necessity to treat SCR is currently unclear. Due to a lack of effective therapies, new treatment approaches for antibody-mediated rejection are an urgent medical need to improve long-term outcomes. Future research should aim to better define pathophysiology and histology, stratify risk, and develop rational treatment strategies from randomized controlled trials, in order to establish the value of novel therapies in the arsenal of rejection pharmacotherapy. However, the effective prevention of rejection with minimal side effects still remains the goal in immunosuppression.
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Affiliation(s)
- Jamal Bamoulid
- Charité Universitätsmedizin Berlin, Department of Nephrology , Berlin , Germany +49 30 450 514002 ; +49 30 450 514902 ;
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115
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Rissling O, Glander P, Hambach P, Mai M, Brakemeier S, Klonower D, Halleck F, Singer E, Schrezenmeier EV, Dürr M, Neumayer HH, Budde K. No relevant pharmacokinetic interaction between pantoprazole and mycophenolate in renal transplant patients: a randomized crossover study. Br J Clin Pharmacol 2015; 80:1086-96. [PMID: 25913040 DOI: 10.1111/bcp.12664] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/04/2015] [Accepted: 04/20/2015] [Indexed: 02/03/2023] Open
Abstract
AIMS Mycophenolic acid (MPA) suppresses lymphocyte proliferation through inosine monophosphate dehydrogenase (IMPDH) inhibition. Two formulations have been approved: mycophenolate mofetil (MMF) and enteric-coated mycophenolate sodium (EC-MPS). Pantoprazole (PAN) inhibits gastric acid secretion, which may alter MPA exposure. Data from healthy volunteers suggest a significant drug-drug interaction (DDA) between pantoprazole and MPA. In transplant patients, a decreased MPA area under the concentration-time curve (AUC) may lead to higher IMPDH activity, which may lead to higher acute rejection risk. Therefore this DDA was evaluated in renal transplant patients under maintenance immunosuppressive therapy. METHODS In this single-centre, open, randomized, four-sequence, four-treatment crossover study, the influence of PAN 40 mg on MPA pharmacokinetics such as (dose-adjusted) AUC0-12 h (dAUC) was analysed in 20 renal transplant patients (>6 months post-transplantation) receiving MMF (1-2 g day(-1) ) and EC-MPS in combination with ciclosporin. The major metabolite MPA glucuronide (MPAG) and the IMPDH activity were also examined. RESULTS MMF + PAN intake led to a lowest mean dAUC for MPA of 41.46 ng h ml(-1) mg(-1) [95% confidence interval (CI) 32.38, 50.54], while MPA exposure was highest for EC-MPS + PAN [dAUC: 46.30 ng h ml(-1) mg(-1) (95% CI 37.11, 55.49)]. Differences in dAUC and dose-adjusted maximum concentration (dCmax) were not significant. Only for MMF [dAUC: 41.46 ng h ml(-1) mg(-1) (95% CI 32.38, 50.54)] and EC-MPS [dAUC: 43.39 ng h ml(-1) mg(-1) (95% CI 33.44, 53.34)] bioequivalence was established for dAUC [geometric mean ratio: 101.25% (90% CI 84.60, 121.17)]. Simultaneous EC-MPS + PAN intake led to an earlier time to Cmax (tmax) [median: 2.0 h (min-max: 0.5-10.0)] than EC-MPS intake alone [3 h (1.5-12.0); P = 0.037]. Tmax was not affected for MMF [1.0 h (0.5-5.0)] ± pantoprazole [1.0 h (0.5-6.0), P = 0.928). No impact on MPAG pharmacokinetics or IMPDH activity was found. CONCLUSION Pantoprazole influences EC-MPS and MMF pharmacokinetics but as it had no impact on MPA pharmacodynamics, the immunosuppressive effect of the drug was not impaired.
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Affiliation(s)
- Olesja Rissling
- Department of Nephrology, Charité University Hospital Berlin, Berlin, Germany.,Institute of Pharmacy, Department of Biology, Chemistry, Pharmacy, Freie Universitaet Berlin, Berlin, Germany
| | - Petra Glander
- Department of Nephrology, Charité University Hospital Berlin, Berlin, Germany
| | - Pia Hambach
- Department of Nephrology, Charité University Hospital Berlin, Berlin, Germany
| | - Marco Mai
- Department of Nephrology, Charité University Hospital Berlin, Berlin, Germany
| | - Susanne Brakemeier
- Department of Nephrology, Charité University Hospital Berlin, Berlin, Germany
| | - Daniela Klonower
- Department of Nephrology, Charité University Hospital Berlin, Berlin, Germany
| | - Fabian Halleck
- Department of Nephrology, Charité University Hospital Berlin, Berlin, Germany
| | - Eugenia Singer
- Department of Nephrology, Charité University Hospital Berlin, Berlin, Germany
| | | | - Michael Dürr
- Department of Nephrology, Charité University Hospital Berlin, Berlin, Germany
| | | | - Klemens Budde
- Department of Nephrology, Charité University Hospital Berlin, Berlin, Germany
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116
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Huber L, Lachmann N, Niemann M, Naik M, Liefeldt L, Glander P, Schmidt D, Halleck F, Waiser J, Brakemeier S, Neumayer HH, Schönemann C, Budde K. Pretransplant virtual PRA and long-term outcomes of kidney transplant recipients. Transpl Int 2015; 28:710-9. [DOI: 10.1111/tri.12533] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 09/22/2014] [Accepted: 01/26/2015] [Indexed: 02/04/2023]
Affiliation(s)
- Lu Huber
- Section of Nephrology; Department of Medicine; Georgia Regents University Medical Centre; Augusta GA USA
| | - Nils Lachmann
- Center for Transfusion Medicine and Cell Therapy; Regional Tissue Typing Laboratory; Campus Virchow Klinikum; Charité Universitätsmedizin Berlin; Berlin Germany
| | - Matthias Niemann
- Center for Transfusion Medicine and Cell Therapy; Regional Tissue Typing Laboratory; Campus Virchow Klinikum; Charité Universitätsmedizin Berlin; Berlin Germany
| | - Marcel Naik
- Department of Nephrology; Charité Campus Mitte; Charité Universitätsmedizin Berlin; Berlin Germany
| | - Lutz Liefeldt
- Department of Nephrology; Charité Campus Mitte; Charité Universitätsmedizin Berlin; Berlin Germany
| | - Petra Glander
- Department of Nephrology; Charité Campus Mitte; Charité Universitätsmedizin Berlin; Berlin Germany
| | - Danilo Schmidt
- Department of Nephrology; Charité Campus Mitte; Charité Universitätsmedizin Berlin; Berlin Germany
| | - Fabian Halleck
- Department of Nephrology; Charité Campus Mitte; Charité Universitätsmedizin Berlin; Berlin Germany
| | - Johannes Waiser
- Department of Nephrology; Charité Campus Mitte; Charité Universitätsmedizin Berlin; Berlin Germany
| | - Susanne Brakemeier
- Department of Nephrology; Charité Campus Mitte; Charité Universitätsmedizin Berlin; Berlin Germany
| | - Hans H. Neumayer
- Department of Nephrology; Charité Campus Mitte; Charité Universitätsmedizin Berlin; Berlin Germany
| | - Constanze Schönemann
- Center for Transfusion Medicine and Cell Therapy; Regional Tissue Typing Laboratory; Campus Virchow Klinikum; Charité Universitätsmedizin Berlin; Berlin Germany
| | - Klemens Budde
- Department of Nephrology; Charité Campus Mitte; Charité Universitätsmedizin Berlin; Berlin Germany
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117
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Khadzhynov D, Halleck F, Schmidt D, Kreimer S, Budde K, Staeck O. FP816IMMUNOLOGIC LONG-TERM OUTCOME OF LIVING KIDNEY TRANSPLANTATION DEPENDING ON THE DONOR-RECIPIENT RELATIONSHIP. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv185.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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118
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Halleck F, Khadzhynov D, Liefeldt L, Glander P, Bamoulid J, Kreimer S, Lehner L, Budde K, Staeck O. FP870HLA-DR MATCHING IMPROVES IMMUNOLOGIC OUTCOMES IN ELDERLY KIDNEY TRANSPLANT RECIPIENTS. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv185.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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119
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Staeck O, Khadzhynov D, Mahn M, Schmidt D, Kreimer S, Bamoulid J, Budde K, Fuller F, Halleck F. FP837BODY MASS INDEX (BMI) MISMATCH IN DECEASED KIDNEY DONATION IS AN INDEPENDENT RISK FACTOR FOR GRAFT FAILURE. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv185.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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120
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Staeck O, Khadzhynov D, Kreimer S, Rajakangas E, Schönemann C, Lachmann N, Schmidt D, Bamoulid J, Budde K, Halleck F. FP834IMPACT OF PREGNANCIES ON IMMUNIZATION AND OUTCOME IN KIDNEY TRANSPLANTATION. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv185.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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121
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Tong A, Hanson CS, Chapman JR, Halleck F, Budde K, Josephson MA, Craig JC. 'Suspended in a paradox'-patient attitudes to wait-listing for kidney transplantation: systematic review and thematic synthesis of qualitative studies. Transpl Int 2015; 28:771-87. [PMID: 25847569 DOI: 10.1111/tri.12575] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 02/23/2015] [Accepted: 03/31/2015] [Indexed: 12/21/2022]
Abstract
Patients on waiting lists for kidney transplantation have higher mortality rates and have specific anxieties about their eligibility, process, and outcomes of wait-listing. We aimed to describe patient experiences and attitudes to wait-listing for kidney transplantation. Electronic databases were searched to September 2014. Thematic synthesis was used to analyze the findings. From 22 studies (n = 795 patients), we identified six themes: accepting the only option (chance to regain normality, avoiding guilt, impulsive decision-making); maintaining hope (determined optimism, appreciating a fortuitous gift, enduring for optimal outcomes, trust in clinical judgment); burden of testing (strenuous commitment, losing the battle, medical mistrust); permeating vulnerability (eligibility enigma, being threatened, angst of timing uncertainty, desperate urgency, living in limbo, spiraling doubt and disappointment, residual ambivalence); deprived of opportunity (unfairly dismissed, unexpected disqualification, self-resignation and acceptance, jealousy, suspicious of inequity); and moral guilt (awaiting someone's death, questioning deservingness). The waiting list offered hope of restored normality. However, the demands of workup, uncertainty about eligibility, and waiting times that exceeded expectations impelled patients to disillusionment, despair, and suspicion of inequity. Managing patient expectations and ensuring transparency of wait-listing and allocation decisions may allay patient disappointment and skepticism, to improve patient satisfaction and treatment outcomes.
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Affiliation(s)
- Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Camilla S Hanson
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Jeremy R Chapman
- Centre for Transplant and Renal Research, Westmead Hospital, Westmead, NSW, Australia
| | - Fabian Halleck
- Department of Nephrology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Klemens Budde
- Department of Nephrology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Jonathan C Craig
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
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Bamoulid J, Staeck O, Halleck F, Khadzhynov D, Brakemeier S, Dürr M, Budde K. The need for minimization strategies: current problems of immunosuppression. Transpl Int 2015; 28:891-900. [PMID: 25752992 DOI: 10.1111/tri.12553] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 12/30/2014] [Accepted: 02/27/2015] [Indexed: 12/31/2022]
Abstract
New immunosuppressants and the better use of immunosuppressant combination therapy have led to significant improvements in renal allograft outcomes over the last decades. Yet, despite dramatic reduction in rejection rates and improvement in 1-year graft survival, long-term graft attrition rates remained rather constant. Current immunosuppressant combinations are frequently leading to overimmunosuppression and are increasing cardiovascular risk. Importantly, calcineurin inhibitors are nephrotoxic, contribute to cardiovascular risk and chronic allograft dysfunction. Furthermore, immunosuppressant-associated toxicities aggravate immune-mediated nephron injury and side effects lead to nonadherence, an identified important reason for late acute and chronic antibody-mediated rejections. The frequent development of a chronic humoral response indicates rather insufficient immunosuppression of current combinations than simple under-immunosuppression. While there is no evidence that increasing immunosuppressive doses will improve outcomes or reduce de novo HLA-antibody formation, there is clear evidence that adequate minimization strategies will reduce side effect burden. Because of low rejection risk, but frequent side effects, drug minimization is particularly relevant for the many maintenance patients. In summary, new therapeutic strategies need to be developed from adequately powered clinical trials for reduction of the many side effects of immunosuppressants. Such evidence-based and time-dependent immunosuppressive minimization strategies are needed to achieve better long-term outcomes in the future.
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Affiliation(s)
- Jamal Bamoulid
- Department of Nephrology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Oliver Staeck
- Department of Nephrology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Fabian Halleck
- Department of Nephrology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Dmytri Khadzhynov
- Department of Nephrology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Susanne Brakemeier
- Department of Nephrology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Dürr
- Department of Nephrology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Klemens Budde
- Department of Nephrology, Charité Universitätsmedizin Berlin, Berlin, Germany
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Ejaz NS, Alloway RR, Halleck F, Dürr M, Budde K, Woodle ES. Review of bortezomib treatment of antibody-mediated rejection in renal transplantation. Antioxid Redox Signal 2014; 21:2401-18. [PMID: 24635140 DOI: 10.1089/ars.2014.5892] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
SIGNIFICANCE Development of donor-specific antibodies (DSA) after kidney transplantation is associated with reduced allograft survival. A few strategies have been tested in controlled clinical trials for the treatment of antibody-mediated rejection (AMR), and no therapies are approved by regulatory authorities. Thus development of antihumoral therapies that provide prompt elimination of DSA and improve allograft survival is an important goal. RECENT ADVANCES Proteasome inhibitor (PI)-based regimens provide a promising new approach for treating AMR. To date, experiences have been limited to off-label bortezomib use in AMR. Key findings with PI-based therapy are that they provide effective primary and rescue therapy for AMR by prompt reduction in immunodominant DSA and improvements in histologic and renal function. Early and late AMR differ immunologically and in response to PI therapy. Bortezomib-related toxicities in renal transplant recipients are similar to those observed in the multiple myeloma population. CRITICAL ISSUES Although preliminary evidence with PI therapy for AMR is encouraging, the evidence is limited. Larger, prospective, randomized controlled trials with long-term follow up are needed. Advancement in endpoints of clinical trial designs and rigorous clinical trials with more standardized adjunct therapies are also required to explore the risks and benefits of AMR treatment modalities. FUTURE DIRECTIONS In the next few years, new PIs are likely to be introduced and new approaches would be developed for achieving synergy with PIs. The ultimate goal will be to develop a regimen that delivers reliable, rapid, complete, and durable elimination of DSA with an acceptable safety profile.
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Affiliation(s)
- Nicole S Ejaz
- 1 Division of Transplantation, Department of Surgery, University of Cincinnati College of Medicine , Cincinnati, Ohio
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Schachtner T, Reinke P, Dorje C, Mjoen G, Midtvedt K, Strom EH, Oyen O, Jenssen T, Reisaeter AV, Smedbraaten YV, Sagedal S, Mjoen G, Fagerland MW, Hartmann A, Thiel S, Zulkarnaev A, Vatazin A, Vincenti F, Harel E, Kantor A, Thurison T, Hoyer-Hansen G, Craik C, Kute VB, Shah PS, Vanikar AV, Modi PR, Shah PR, Gumber MR, Patel HV, Engineer DP, Shah VR, Rizvi J, Trivedi HL, Malheiro J, Dias L, Martins LS, Fonseca I, Pedroso S, Almeida M, Castro-Henriques A, Cabrita A, Costa C, Ritta M, Sinesi F, Sidoti F, Mantovani S, Di Nauta A, Messina M, Cavallo R, Verflova A, Svobodova E, Slatinska J, Slavcev A, Pokorna E, Viklicky O, Yagan J, Chandraker A, Messina M, Diena D, Tognarelli G, Ranghino A, Bussolino S, Fop F, Segoloni GP, Biancone L, Leone F, Mauro MV, Gigliotti P, Lofaro D, Greco F, Perugini D, Papalia T, Perri A, Vizza D, Giraldi C, Bonofilgio R, Luis-Lima S, Marrero D, Gonzalez-Rinne A, Torres A, Salido E, Jimenez-Sosa A, Aldea-Perona A, Gonzalez-Posada JM, Perez-Tamajon L, Rodriguez-Hernandez A, Negrin-Mena N, Porrini E, Mjoen G, Pihlstrom H, Dahle DO, Holdaas H, Von Der Lippe N, Waldum B, Brekke F, Amro A, Reisaeter AV, Os I, Klin P, Sanabria H, Bridoux P, De Francesco J, Fortunato RM, Raffaele P, Kong J, Son SH, Kwon HY, Whang EJ, Choi WY, Yoon CS, Thanaraj V, Theakstone A, Stopper K, Ferraro A, Bhattacharjya S, Devonald M, Williams A, Mella A, Messina M, Gallo E, Fop F, Di Vico MC, Diena D, Pagani F, Gai M, Ranghino A, Segoloni GP, Biancone L, Cho HJ, Nho KW, Park SK, Kim SB, Yoshida K, Ishii D, Ohyama T, Kohguchi D, Takeuchi Y, Varga A, Sandor B, Kalmar-Nagy K, Toth A, Toth K, Szakaly P, Zulkarnaev A, Vatazin A, Kildushevsky A, Fedulkina V, Kantaria R, Staeck O, Halleck F, Rissling O, Naik M, Neumayer HH, Budde K, Khadzhynov D, Bhadauria D, Kaul A, Prasad N, Sharma RK, Sezer S, Bal Z, Erkmen Uyar M, Guliyev O, Erdemir B, Colak T, Ozdemir N, Haberal M, Caliskan Y, Yazici H, Artan AS, Oto OA, Aysuna N, Bozfakioglu S, Turkmen A, Yildiz A, Sever MS, Yagisawa T, Nukui A, Kimura T, Nannmoku K, Kurosawa A, Sakuma Y, Miki A, Damiano F, Ligabue G, De Biasi S, Granito M, Cossarizza A, Cappelli G, Martins LS, Fonseca I, Malheiro J, Henriques AC, Pedroso S, Almeida M, Dias L, Davide J, Cabrita A, Von During ME, Jenssen TG, Bollerslev J, Godang K, Asberg A, Hartmann A, Bachelet T, Martinez C, Bello A, Kejji S, Couzi L, Guidicelli G, Lepreux S, Visentin J, Congy-Jolivet N, Rostaing L, Taupin JL, Kamar N, Merville P, Sezer S, Bal Z, Erkmen Uyar M, Ozdemir H, Guliyev O, Yildirim S, Tutal E, Ozdemir N, Haberal M, Sezer S, Erkmen Uyar M, Bal Z, Guliyev O, Sayin B, Colak T, Ozdemir Acar N, Haberal M, Banasik M, Boratynska M, Koscielska-Kasprzak K, Kaminska D, Bartoszek D, Mazanowska O, Krajewska M, Zmonarski S, Chudoba P, Dawiskiba T, Protasiewicz M, Halon A, Sas A, Kaminska M, Klinger M, Stefanovic N, Cvetkovic T, Velickovic - Radovanovic R, Jevtovic - Stoimenov T, Vlahovic P, Rungta R, Das P, Ray DS, Gupta S, Kolonko A, Szotowska M, Kuczera P, Chudek J, Wiecek A, Sikora-Grabka E, Adamczak M, Szotowska M, Kuczera P, Madej P, Wiecek A, Amanova A, Kendi Celebi Z, Bakar F, Caglayan MG, Keven K, Massimetti C, Imperato G, Zampi G, De Vincenzi A, Fabbri GDD, Brescia F, Feriozzi S, Filipov JJ, Zlatkov BK, Dimitrov EP, Svinarov DA, Poesen R, De Vusser K, Evenepoel P, Kuypers D, Naesens M, Meijers B, Kocak H, Yilmaz VT, Yilmaz F, Uslu HB, Aliosmanoglu I, Ermis H, Dinckan A, Cetinkaya R, Ersoy FF, Suleymanlar G, Fonseca I, Oliveira JC, Santos J, Martins LS, Almeida M, Dias L, Pedroso S, Lobato L, Castro-Henriques A, Mendonca D, Watarai Y, Yamamoto T, Tsujita M, Hiramitsu T, Goto N, Narumi S, Kobayashi T, Dahle DO, Holdaas H, Reisaeter AV, Dorje C, Mjoen G, Line PD, Hartmann A, Housawi A, House A, Ng C, Denesyk K, Rehman F, Moist L, Musetti C, Battista M, Izzo C, Guglielmetti G, Airoldi A, Stratta P, Musetti C, Cena T, Quaglia M, Fenoglio R, Cagna D, Airoldi A, Amoroso A, Stratta P, Palmisano A, Degli Antoni AM, Vaglio A, Piotti G, Cremaschi E, Buzio C, Maggiore U, Lee MC, Hsu BG, Zalamea Jarrin F, Sanchez Sobrino B, Lafuente Covarrubias O, Karsten Alvarez S, Dominguez Apinaniz P, Llopez Carratala R, Portoles Perez J, Yildirim T, Yilmaz R, Turkmen E, Altindal M, Arici M, Altun B, Erdem Y, Dounousi E, Mitsis M, Naka K, Pappas H, Lakkas L, Harisis H, Pappas K, Koutlas V, Tzalavra I, Spanos G, Michalis L, Siamopoulos K, Iwabuchi T, Yagisawa T, Kimura T, Nanmoku K, Kurosawa A, Yasunaru S, Lee MC, Hsu BG, Yoshikawa M, Kitamura K, Fuji H, Fujisawa M, Nishi S, Carta P, Zanazzi M, Buti E, Larti A, Caroti L, Di Maria L, Minetti EE, Shi Y, Luo L, Cai B, Wang T, Zou Y, Wang L, Kim Y, Kim HS, Choi BS, Park CW, Yang CW, Kim YS, Chung BH, Baek CH, Kim M, Kim JS, Yang WS, Han DJ, Park SK, Mikolasevic I, Racki S, Lukenda V, Persic MP, Colic M, Devcic B, Orlic L, Sezer S, Gurlek Demirci B, Guliyev O, Colak T, Say N CB, Ozdemir Acar FN, Haberal M, Vali S, Ismal K, Sahay M, Civiletti F, Cantaluppi V, Medica D, Mazzeo AT, Assenzio B, Mastromauro I, Deambrosis I, Giaretta F, Fanelli V, Mascia L, Musetti C, Airoldi A, Quaglia M, Guglielmetti G, Battista M, Izzo C, Stratta P, Lakkas L, Naka K, Dounousi E, Koutlas V, Gkirdis I, Bechlioulis A, Evangelou D, Zarzoulas F, Kotsia A, Balafa O, Tzeltzes G, Nakas G, Pappas K, Kalaitzidis R, Katsouras C, Michalis L, Siamopoulos K, Tutal E, Erkmen Uyar M, Uyanik S, Bal Z, Guliyev O, Toprak SK, Ilhan O, Sezer S, Bal Z, Ekmen Uyar M, Guliyev O, Sayin B, Colak T, Sezer S, Haberal M, Hernandez Vargas H, Artamendi Larranaga M, Ramalle Gomara E, Gil Catalinas F, Bello Ovalle A, Pimentel Guzman G, Coloma Lopez A, Sierra Carpio M, Gil Paraiso A, Dall Anesse C, Beired Val I, Huarte Loza E, Choy BY, Kwan L, Mok M, Chan TM, Yamakawa T, Kobayashi A, Yamamoto I, Mafune A, Nakada Y, Tannno Y, Tsuboi N, Yamamoto H, Yokoyama K, Ohkido I, Yokoo T, Luque Y, Anglicheau D, Rabant M, Clement R, Kreis H, Sartorius A, Noel LH, Timsit MO, Legendre C, Rancic N, Vavic N, Dragojevic-Simic V, Katic J, Jacimovic N, Kovacevic A, Mikov M, Veldhuijzen NMH, Rookmaaker MB, Van Zuilen AD, Nquyen TQ, Boer WH, Mjoen G, Pihlstrom H, Dahle DO, Holdaas H, Sahtout W, Ghezaiel H, Azzebi A, Ben Abdelkrim S, Guedri Y, Mrabet S, Nouira S, Ferdaws S, Amor S, Belarbia A, Zellama D, Mokni M, Achour A, Viklicky O, Parikova A, Slatinska J, Hanzal V, Fronek J, Orandi BJ, James NT, Montgomery RA, Desai NM, Segev DL, Fontana F, Ballestri M, Magistroni R, Damiano F, Cappelli G. TRANSPLANTATION CLINICAL 1. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Van Londen M, Humalda JK, Aarts BM, Sanders JS, Bakker SJL, Navis GJ, De Borst MH, Pazik J, O Dak M, Lewandowski Z, Podgorska M, Sadowska A, Sitarek E, Malejczyk J, Durlik M, Drechsler C, Philstrom H, Meinitzer A, Pilz S, Tomaschitz A, Abedini S, Fellstrom B, Jardine A, Wanner C, Maerz W, Holdaas H, Halleck F, Staeck O, Neumayer HH, Budde K, Khadzhynov D, Rostaing L, Allal A, Congy N, Aarninck A, Del Bello A, Maggioni S, Debiols B, Sallusto F, Kamar N, Stolyarevich E, Artyukhina L, Kim I, Tomilina N, Zaidenov V, Kurenkova L, Keyzer CA, De Borst MH, Van Den Berg E, Jahnen-Dechent W, Navis G, Bakker SJL, Van Goor H, Pasch A, Aulagnon F, Avettand-Fenoel V, Scemla A, Lanternier F, Lortholary O, Anglicheau D, Legendre C, Zuber J, Furic-Cunko V, Basic-Jukic N, Coric M, Kastelan Z, Hudolin T, Kes P, Mikolasevic I, Racki S, Lukenda V, Orlic L, Dobrowolski LC, Verberne HJ, Ten Berge IJM, Bemelman FJ, Krediet CTP, Ferreira AC, Silva C, Remedio F, Pena A, Nolasco F, Heldal K, Lonning K, Leivestad T, Reisaeter AV, Hartmann A, Foss AE, Midtvedt K, Vlachopanos G, Kassimatis T, Zerva A, Kokkona A, Stavroulaki E, Agrafiotis A, Sanchez Sobrino B, Lafuente Covarrubias O, Karsten Alvarez S, Zalamea Jarrin F, Rubio Gonzalez E, Huerta Arroyo A, Portoles Perez J, Basic-Jukic N, Kes P, Baek CH, Kim M, Kim JS, Yang WS, Han DJ, Park SK, Zulkarnaev A, Vatazin A, Cabiddu G, Maxia S, Castellino S, Loi V, Guzzo G, Piccoli GB, Pani A, Bucsa C, Tacu D, Harza M, Sinescu I, Mircescu G, Stefan G, Alfieri CM, Laura F, Danilovic B, Cresseri D, Meneghini M, Riccardo F, Regalia A, Messa P, Panuccio V, Tripepi R, Parlongo G, Quattrone S, Leonardis D, Tripepi G, Zoccali C, Mallamaci F, Amer H, Geerdes PA, Fettes TT, Prieto M, Walker RC, Edwards BS, Cosio FG, Khrabrova M, Nabokov A, Groene HJ, Weithofer P, Kliem V, Smirnov A, Dobronravov V, Sezer S, Gurlek Demirci B, Tutal E, Guliyev O, Say N CB, Ozdemir Acar FN, Haberal M, Albugami MM, Hussein M, Alsaeed S, Almubarak A, Bel'eed-Akkari K, Go biewska JE, Tarasewicz A, D bska- lizie A, Rutkowski B, Albugami MM, Hussein M, Almubarak A, Alsaeed S, Bel'eed-Akkari K, Ailioaie O, Arzouk N, Tourret J, Mercadal L, Szumilak D, Ourahma S, Parra J, Billault C, Barrou B, Alfieri CM, Floreani R, Ulivieri FM, Meneghini M, Regalia A, Zanoni F, Croci D, Rastaldi MP, Messa PG, Keyzer CA, Riphagen IJ, Joosten MM, Navis G, Muller Kobold AC, Kema IP, Bakker SJL, De Borst MH, Santos Lascasas J, Malheiro J, Fonseca I, Martins L, Almeida M, Pedroso S, Dias L, Henriques A, Cabrita A, Vincenti F, Weir M, Von Visger J, Kopyt N, Mannon R, Deng H, Yue S, Wolf M, Halleck F, Khadzhynov, D, Schmidt D, Petereit F, Slowinski T, Neumayer HH, Budde K, Staeck O, Hernandez Vargas H, Artamendi Larranaga M, Gil Catalinas F, Ramalle Gomara E, Bello Ovalle A, Pimentel Guzman G, Coloma Lopez A, Dall Anesse C, Gil Paraiso A, Beired Val I, Sierra Carpio M, Huarte Loza E, Slubowska K, Szmidt J, Chmura A, Durlik M, Staeck O, Khadzhynov D, Schmidt D, Niemann M, Petereit F, Lachmann N, Neumayer HH, Budde K, Halleck F, Alotaibi T, Nampoory N, Gheith O, Halim M, Aboatteya H, Mansour H, Abdulkawey H, Said T, Nair P, WazNa-Jab O Ska E, Durlik M, Elias M, Caillard S, Morelon E, Rivalan J, Moal V, Frimat L, Mourad G, Rerolle JP, Legendre C, Mousson C, Delahousse M, Pouteil-Noble C, Dantal J, Cassuto E, Subra JF, Lang P, Thervet E, Roosweil D, Molnar MZ, Fornadi K, Ronai KZ, Novak M, Mucsi I, Scale TM, Robertson S, Kumwenda M, Jibani M, Griffin S, Williams AJ, Mikhail A, Jeong JC, Koo TY, Jeon HJ, Han M, Oh KH, Ahn C, Yang J, Bancu I, Canas L, Juega J, Malumbres S, Guermah I, Bonet J, Lauzurica R, Basso E, Messina M, Daidola G, Mella A, Lavacca A, Manzione AM, Rossetti M, Ranghino A, Ariaudo C, Segoloni GP, Biancone L, Whang E, Son SH, Kwon H, Kong JJ, Choi WY, Yoon CS, Ferreira AC, Silva C, Aires I, Ferreira A, Remedio F, Nolasco F, Ratkovic M, Basic Jukic N, Gledovic B, Radunovic D, Prelevic V, Stefan G, Garneata L, Bucsa C, Harza M, Sinescu I, Mircescu G, Tacu D, Aniort J, Kaysi S, Mulliez A, Heng AE, Su owicz J, Wojas-Pelc A, Ignacak E, Janda K, Krzanowski M, Miarka P, Su owicz W, Filipov JJ, Zlatkov BK, Dimitrov EP, Svinarov DA, Champion L, Renoux C, Randoux C, Du Halgouet C, Azeroual L, Glotz D, Vrtovsnik F, Daugas E, Musetti C, Battista M, Cena T, Izzo C, Airoldi A, Magnani C, Stratta P, Fiskvik I, Holte H, Bentdal O, Holdaas H, Erkmen Uyar M, Sezer S, Bal Z, Guliyev O, Colak T, Gurlek Demirci B, Ozdemir Acar N, Haberal M, Kara E, Ahbap E, Basturk T, Koc Y, Sakaci T, Sahutoglu T, Akgol C, Sevinc M, Unsal A, Seyahi N, Abdultawab K, Alotaibi T, Gheith O, Mansour H, Halim M, Nair P, Said T, Balaha M, Elsayed A, Awadeen W, Nampoory N, Hwang JC, Jiang MY, Lu YH, Weng SF, Madziarska K, Zmonarski SC, Augustyniak-Bartosik H, Magott-Procelewska M, Krajewska M, Mazanowska O, Banasik M, Penar J, Weyde W, Boraty Ska M, Klinger M, Swarnalatha G, Narendranath L, Shanta Rao G, Sawhney A, Subrahmanyam L, Kumar S, Jeon H, Hakim A, Patel U, Shrivastava S, Banerjee D, Kimura T, Yagisawa T, Nanmoku K, Kurosawa A, Sakuma Y, Miki A, Nukui A, Lee CH, Oh IH, Park JS, Watarai Y, Narumi S, Goto N, Hiramitsu T, Tsujita M, Yamamoto T, Kobayashi T, Muniz Pacios L, Molina M, Cabrera J, Gonzalez E, Garcia Santiago A, Aunon P, Santana S, Polanco N, Gutierrez E, Jimenez C, Andres A, Mohammed M, Hammam M, Housawi A, Goldsmith DJ, Cronin A, Frame S, Smalcelj R, Canoz MB, Yavuz DD, Altunoglu A, Yavuz R, Colak T, Haberal M, Tong A, Hanson CS, Chapman JR, Halleck F, Budde K, Papachristou C, Craig J, Zheng XY, Han S, Wang LM, Zhu YH, Zeng L, Zhou MS, Guliyev O, Erkmen Uyar M, Sezer S, Bal Z, Colak T, Gurlek Demirci B, Ozdemir Acar N, Haberal M, Ranghino A, Diena D, De Rosa FG, Faletti R, Barbui AM, Guarnaccia C, Corcione S, Messina M, Ariaudo C, Segoloni GP, Biancone L, Patel R, Murray PD, Moiseev A, Kalachik A, Harden PN, Norby G, Mjoen G, Holdaas H, Gilboe IM, Shi Y, Luo L, Cai B, Wang T, Tao Y, Wang L, Erkmen Uyar M, Sezer S, Bal Z, Guliyev O, Tutal E, Gurlek Demirci B, Ozdemir Acar N, Haberal M, Di Vico MC, Messina M, Mezza E, Giraudi R, Nappo A, Boaglio E, Ranghino A, Fop F, Segoloni GP, Biancone L, Carta P, Dattolo E, Buti E, Zanazzi M, Villari D, Di Maria L, Santoro G, Li Marzi V, Minetti EE, Nicita G, Carta P, Zanazzi M, Buti E, Antognoli G, Dervishi E, Vignali L, Caroti L, Di Maria L, Minetti EE, Dorje C, Kovacevic G, Hammarstrom C, Strom EH, Holdaas H, Midtvedt K, Reisaeter AV, Alfieri CM, Floreani R, Meneghini M, Regalia A, Zanoni F, Vettoretti S, Croci MD, Rastaldi MP, Messa P, Heldal K, Lonning K, Reisaeter AV, Bernklev T, Midtvedt K, Strakosha A, Pasko N, Nasto F, Cadri V, Dedei A, Thereska N. TRANSPLANTATION CLINICAL 2. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Halleck F, Schröder K, Holleck-Weithmann S, Kossmehl P, Kreutz R, Rothermund L. Cardiorenal protection in experimental hypertension with renal failure: comparison between vasopeptidase inhibition and angiotensin receptor blockade. Clin Exp Hypertens 2014; 37:26-32. [PMID: 24678912 DOI: 10.3109/10641963.2014.897718] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of the present study was to compare the preventive impact of treatment with a vasopeptidase inhibitor (VPI) with an angiotensin-receptor blocker (ARB) on left ventricular (LV) function and renal damage in rats with renal failure after 5/6 renal ablation (Nx). METHODS Rats (n = 15-20, each group) underwent either sham-operation (Sham) or 5/6 renal ablation (Nx). Two additional groups of Nx-animals (groups Nx-VPI and Nx-ARB) were treated with the VPI ilepatril (AVE7688, 30 mg kg(-1) d(-1)) or with the ARB olmesartan (10 mg kg(-1 )d(-1)). Animals were followed for 4 weeks. RESULTS Systolic blood pressure (SBP), LV hypertrophy (LVH) and LV end-diastolic pressure (LVEDP) were increased 4 weeks after Nx (p < 0.05). LV pressure rise (+dP/dt/LVPmax), LV pressure fall (-dP/dt/LVPmax), and creatinine clearance decreased, while albuminuria and renal glomerulosclerosis index (GSI) increased with Nx (p < 0.05, respectively). In comparison to Nx, treatment with both VPI and ARB normalized SBP, LVH, LVEDP, +dP/dt/LVPmax, and -dP/dt/LVPmax to Sham control levels. GSI, but not creatinine clearance, was also normalized in response to both treatments. The significant increase in albuminuria observed in Nx (+230-fold versus Sham, p < 0.0001) was partially reduced in Nx-VPI (+47-fold versus Sham, p < 0.0001) and fully abolished in Nx-ARB. CONCLUSIONS Both ilepatril and olmesartan conferred strong cardiorenal protective effects in rats with renal failure. While cardioprotection was clearly comparable with both treatment regimens, the ARB provided a better protection against the increase in albuminuria, although renal function and structural kidney changes were similarly affected by the VIP and ARB.
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Affiliation(s)
- Fabian Halleck
- Institut für Klinische Pharmakologie und Toxikologie, Charité - Universitätsmedizin Berlin , Campus Mitte, Berlin , Germany and
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Halleck F, Diederichs G, Koehlitz T, Slowinski T, Engelken F, Liefeldt L, Friedersdorff F, Fuller TF, Magheli A, Neumayer HH, Budde K, Waiser J. Volume matters: CT-based renal cortex volume measurement in the evaluation of living kidney donors. Transpl Int 2013; 26:1208-16. [PMID: 24118327 DOI: 10.1111/tri.12195] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 07/21/2013] [Accepted: 09/15/2013] [Indexed: 01/12/2023]
Abstract
Currently, no international standard for the pre-transplant evaluation of living donor renal function exists. Following a standardized questionnaire on current practice in all Eurotransplant (ET) centers, we compared a new CT-based technique to measure renal cortex volume with our standard of DTPA-clearance combined with MAG3-scintigraphy (DTPA × MAG3) and with creatinine-based methods in 167 consecutive living kidney donors. Most ET centers use creatinine-clearance (64%) to measure total renal function and radioistopic methods (82%) to assess split renal function. Before transplantation, CT-measured total cortex volume (r = 0.67; P < 0.001) and estimated GFR using the Cockcroft-Gault formula [eGFR(CG)] (r = 0.55; P < 0.001) showed the strongest correlation with DTPA-clearance. In contrast, the correlation between DTPA-clearance and creatinine clearance was weak (r = 0.21; P = 0.02). A strong correlation was observed between CT-measured split cortex volume and MAG3-measured split renal function (r = 0.93; P < 0.001). A strong correlation was also found between pre-transplant split renal function assessed by eGFR(CG) together with cortex volume measurement and post-transplant eGFR(CG) of both, the donor (r = 0.83; P < 0.001) and the recipient (r = 0.75; P < 0.001). In conclusion CT-based assessment of renal cortex volume bears the potential to substitute existing methods to assess pre-transplant living donor split renal function.
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Affiliation(s)
- Fabian Halleck
- Department of Nephrology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
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Engelken F, Friedersdorff F, Fuller TF, Magheli A, Budde K, Halleck F, Deger S, Liefeldt L, Hamm B, Giessing M, Diederichs G. Pre-operative assessment of living renal transplant donors with state-of-the-art imaging modalities: computed tomography angiography versus magnetic resonance angiography in 118 patients. World J Urol 2013; 31:983-90. [DOI: 10.1007/s00345-012-1022-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 12/27/2012] [Indexed: 11/25/2022] Open
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Halleck F, Duerr M, Waiser J, Huber L, Matz M, Brakemeier S, Liefeldt L, Neumayer HH, Budde K. An evaluation of sirolimus in renal transplantation. Expert Opin Drug Metab Toxicol 2012; 8:1337-56. [PMID: 22928953 DOI: 10.1517/17425255.2012.719874] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Sirolimus is a powerful antiproliferative immunosuppressive drug approved for the prevention of kidney allograft rejection. By its unique mechanism of action, sirolimus provides a multitude of clinical potential and has been used effectively in different drug combinations. Extensive experience has been gained regarding the best timing of its application, side effect profile and potential benefits and limitations compared with other immunosuppressive drugs. AREAS COVERED The authors evaluate the recent experience with sirolimus in kidney transplantation. Pivotal randomized controlled trials were used to provide an overview with special attention to pharmacokinetic and dynamic aspects of sirolimus, its current clinical use as well as perspectives for its future role. EXPERT OPINION Sirolimus enriches the possibilities of immunosuppressive therapies after renal transplantation. Beneficial effects toward kidney function by allowing CNI sparing, lower incidence of malignancies and less viral infections have been suggested. Sirolimus should be used cautiously in de novo patients for reasons of wound healing. An early conversion to a sirolimus-based CNI-free regimen has shown promising results, whereas late conversion is more challenging. Finally, sirolimus-associated side effects are causing tolerability concerns and frequent discontinuations. Future research should aim to better define the therapeutic window and those patients most likely to benefit.
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Affiliation(s)
- Fabian Halleck
- Department of Nephrology, Charité Universitätsmedizin, Berlin, Germany.
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