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Mohamed M, Parajuli S, Muth B, Astor BC, Panzer SE, Mandelbrot D, Zhong W, Djamali A. In kidney transplant recipients with BK polyomavirus infection, early BK nephropathy, microvascular inflammation, and serum creatinine are risk factors for graft loss. Transpl Infect Dis 2016; 18:361-71. [PMID: 26998753 DOI: 10.1111/tid.12530] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 12/28/2015] [Accepted: 01/20/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Little information is available on the risk factors for graft loss in kidney transplant recipients with BK polyomavirus (BKPyV) nephropathy (BKVN) in the presence or absence of antibody-mediated rejection (AMR). METHODS We examined the risk factors for graft loss in consecutive kidney allograft recipients with biopsy-confirmed BKVN, with or without concomitant AMR. RESULTS A total of 1904 kidney transplants were performed at our institution during 2005-2011. Of these, 330 (17.33%) were diagnosed with BKPyV viremia, and 69 were diagnosed with BKVN (3.6%). Eleven patients had a concomitant diagnosis of AMR. Patients with AMR were characterized by significantly higher peak panel-reactive antibody, retransplant rates, and desensitization preconditioning at the time of transplantation, as well as microvascular inflammation (MVI = glomerulitis + peritubular capillaritis), C4d score, and donor-specific antibody at the time of diagnosis (P ≤ 0.01). Treatment with plasma exchange, intravenous immunoglobulin, and cidofovir was more prevalent in this group (P ≤ 0.02). Univariate analyses assessing the risk factors for graft loss in all patients with BKVN, identified an independent association of African-American race, deceased-donor transplantation, serum creatinine (Scr), MVI, and early disease (BKVN within 6 months of transplant) with poor outcomes. Multivariate analyses retained only 3 variables: Scr >2 mg/dL (hazard ratio [HR] = 4.3, 95% confidence interval [CI] 1.9-9.7, P = 0.0004), early BKVN (HR = 2.7, 95% CI 1.3-5.3, P = 0.004), and MVI (HR = 1.8, 95% CI 1.2-2.8, P = 0.008). CONCLUSIONS These observations suggest that, in patients with BK infection, early BKVN, Scr >2, and MVI are predictors of poor outcomes. Further studies are needed to determine effective treatment strategies for BKVN, with or without AMR.
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Abramowski A, Aharonian F, Ait Benkhali F, Akhperjanian AG, Angüner EO, Backes M, Balenderan S, Balzer A, Barnacka A, Becherini Y, Becker Tjus J, Berge D, Bernhard S, Bernlöhr K, Birsin E, Biteau J, Böttcher M, Boisson C, Bolmont J, Bordas P, Bregeon J, Brun F, Brun P, Bryan M, Bulik T, Carrigan S, Casanova S, Chadwick PM, Chakraborty N, Chalme-Calvet R, Chaves RCG, Chrétien M, Colafrancesco S, Cologna G, Conrad J, Couturier C, Cui Y, Davids ID, Degrange B, Deil C, deWilt P, Djannati-Ataï A, Domainko W, Donath A, Drury LO, Dubus G, Dutson K, Dyks J, Dyrda M, Edwards T, Egberts K, Eger P, Espigat P, Farnier C, Fegan S, Feinstein F, Fernandes MV, Fernandez D, Fiasson A, Fontaine G, Förster A, Füßling M, Gabici S, Gajdus M, Gallant YA, Garrigoux T, Giavitto G, Giebels B, Glicenstein JF, Gottschall D, Grondin MH, Grudzińska M, Hadasch D, Häffner S, Hahn J, Harris J, Heinzelmann G, Henri G, Hermann G, Hervet O, Hillert A, Hinton JA, Hofmann W, Hofverberg P, Holler M, Horns D, Ivascenko A, Jacholkowska A, Jahn C, Jamrozy M, Janiak M, Jankowsky F, Jung-Richardt I, Kastendieck MA, Katarzyński K, Katz U, Kaufmann S, Khélifi B, Kieffer M, Klepser S, Klochkov D, Kluźniak W, Kolitzus D, Komin N, Kosack K, Krakau S, Krayzel F, Krüger PP, Laffon H, Lamanna G, Lefaucheur J, Lefranc V, Lemière A, Lemoine-Goumard M, Lenain JP, Lohse T, Lopatin A, Lu CC, Marandon V, Marcowith A, Marx R, Maurin G, Maxted N, Mayer M, McComb TJL, Méhault J, Meintjes PJ, Menzler U, Meyer M, Mitchell AMW, Moderski R, Mohamed M, Morå K, Moulin E, Murach T, de Naurois M, Niemiec J, Nolan SJ, Oakes L, Odaka H, Ohm S, Opitz B, Ostrowski M, Oya I, Panter M, Parsons RD, Paz Arribas M, Pekeur NW, Pelletier G, Petrucci PO, Peyaud B, Pita S, Poon H, Pühlhofer G, Punch M, Quirrenbach A, Raab S, Reichardt I, Reimer A, Reimer O, Renaud M, de Los Reyes R, Rieger F, Romoli C, Rosier-Lees S, Rowell G, Rudak B, Rulten CB, Sahakian V, Salek D, Sanchez DA, Santangelo A, Schlickeiser R, Schüssler F, Schulz A, Schwanke U, Schwarzburg S, Schwemmer S, Sol H, Spanier F, Spengler G, Spies F, Stawarz Ł, Steenkamp R, Stegmann C, Stinzing F, Stycz K, Sushch I, Tavernet JP, Tavernier T, Taylor AM, Terrier R, Tluczykont M, Trichard C, Valerius K, van Eldik C, van Soelen B, Vasileiadis G, Veh J, Venter C, Viana A, Vincent P, Vink J, Völk HJ, Volpe F, Vorster M, Vuillaume T, Wagner SJ, Wagner P, Wagner RM, Ward M, Weidinger M, Weitzel Q, White R, Wierzcholska A, Willmann P, Wörnlein A, Wouters D, Yang R, Zabalza V, Zaborov D, Zacharias M, Zdziarski AA, Zech A, Zechlin HS. Constraints on an annihilation signal from a core of constant dark matter density around the milky way center with H.E.S.S. PHYSICAL REVIEW LETTERS 2015; 114:081301. [PMID: 25768750 DOI: 10.1103/physrevlett.114.081301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Indexed: 06/04/2023]
Abstract
An annihilation signal of dark matter is searched for from the central region of the Milky Way. Data acquired in dedicated on-off observations of the Galactic center region with H.E.S.S. are analyzed for this purpose. No significant signal is found in a total of ∼9 h of on-off observations. Upper limits on the velocity averaged cross section, ⟨σv⟩, for the annihilation of dark matter particles with masses in the range of ∼300 GeV to ∼10 TeV are derived. In contrast to previous constraints derived from observations of the Galactic center region, the constraints that are derived here apply also under the assumption of a central core of constant dark matter density around the center of the Galaxy. Values of ⟨σv⟩ that are larger than 3×10^{-24} cm^{3}/s are excluded for dark matter particles with masses between ∼1 and ∼4 TeV at 95% C.L. if the radius of the central dark matter density core does not exceed 500 pc. This is the strongest constraint that is derived on ⟨σv⟩ for annihilating TeV mass dark matter without the assumption of a centrally cusped dark matter density distribution in the search region.
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