1
|
Lasorsa F, Rutigliano M, Milella M, d’Amati A, Crocetto F, Pandolfo SD, Barone B, Ferro M, Spilotros M, Battaglia M, Ditonno P, Lucarelli G. Ischemia-Reperfusion Injury in Kidney Transplantation: Mechanisms and Potential Therapeutic Targets. Int J Mol Sci 2024; 25:4332. [PMID: 38673917 PMCID: PMC11050495 DOI: 10.3390/ijms25084332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
Kidney transplantation offers a longer life expectancy and a better quality of life than dialysis to patients with end-stage kidney disease. Ischemia-reperfusion injury (IRI) is thought to be a cornerstone in delayed or reduced graft function and increases the risk of rejection by triggering the immunogenicity of the organ. IRI is an unavoidable event that happens when the blood supply is temporarily reduced and then restored to an organ. IRI is the result of several biological pathways, such as transcriptional reprogramming, apoptosis and necrosis, innate and adaptive immune responses, and endothelial dysfunction. Tubular cells mostly depend on fatty acid (FA) β-oxidation for energy production since more ATP molecules are yielded per substrate molecule than glucose oxidation. Upon ischemia-reperfusion damage, the innate and adaptive immune system activates to achieve tissue clearance and repair. Several cells, cytokines, enzymes, receptors, and ligands are known to take part in these events. The complement cascade might start even before organ procurement in deceased donors. However, additional experimental and clinical data are required to better understand the pathogenic events that take place during this complex process.
Collapse
Affiliation(s)
- Francesco Lasorsa
- Department of Precision and Regenerative Medicine and Ionian Area-Urology, Andrology and Kidney Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Monica Rutigliano
- Department of Precision and Regenerative Medicine and Ionian Area-Urology, Andrology and Kidney Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Martina Milella
- Department of Precision and Regenerative Medicine and Ionian Area-Urology, Andrology and Kidney Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Antonio d’Amati
- Department of Precision and Regenerative Medicine and Ionian Area-Pathology Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Felice Crocetto
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy
| | - Savio Domenico Pandolfo
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy
- Department of Urology, University of L’Aquila, 67010 L’Aquila, Italy
| | - Biagio Barone
- Division of Urology, Department of Surgical Sciences, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology, IRCCS, 71013 Milan, Italy
| | - Marco Spilotros
- Department of Precision and Regenerative Medicine and Ionian Area-Urology, Andrology and Kidney Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Michele Battaglia
- Department of Precision and Regenerative Medicine and Ionian Area-Urology, Andrology and Kidney Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Pasquale Ditonno
- Department of Precision and Regenerative Medicine and Ionian Area-Urology, Andrology and Kidney Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Giuseppe Lucarelli
- Department of Precision and Regenerative Medicine and Ionian Area-Urology, Andrology and Kidney Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy
| |
Collapse
|
2
|
McDonald M. Allograft nephrectomy vs. no nephrectomy for failed renal transplants. FRONTIERS IN NEPHROLOGY 2023; 3:1169181. [PMID: 37675360 PMCID: PMC10479781 DOI: 10.3389/fneph.2023.1169181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 06/13/2023] [Indexed: 09/08/2023]
Abstract
The role of allograft nephrectomy (AN) in failed renal transplants is a topic of debate, owing to controversial results reported in the literature and the fact that most of the studies are limited by a retrospective design and small numbers of participants. Allograft nephrectomy is most likely of benefit in the patient with recurrent allograft intolerance syndrome (AIS) following pulse steroids. Immunosuppression weaning in the presence of clinical signs related to a chronic inflammatory state is also reasonable grounds to pursue AN. Studies are mainly inconclusive but suggest that AN has no overall benefit for allograft survival after retransplant. This topic is still of interest in the transplant field and is particularly relevant for patients who are likely to require retransplantation within their lifetime. Further assessment is needed in the form of randomized controlled trials that control for various AN indications and immunosuppression regimens, and have clearly defined survival outcomes.
Collapse
Affiliation(s)
- Michelle McDonald
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| |
Collapse
|
3
|
Graft Failure after Uterus Transplantation in 16 Recipients: A Review. J Clin Med 2023; 12:jcm12052032. [PMID: 36902818 PMCID: PMC10003853 DOI: 10.3390/jcm12052032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Uterus transplantation (UTx) is now an alternative to surrogacy and adoption for women with uterine factor infertility to have children; however, there are still unresolved clinical and technical issues. One of these is that the graft failure rate after transplantation is somewhat higher than that of other life-saving organ transplants, which is a critical concern. Herein, we summarize the details of 16 graft failures after UTx with living or deceased donors using the published literature in order to learn from these negative outcomes. To date, the main causes of graft failure are vascular factors (arterial and/or venous thrombosis, atherosclerosis, and poor perfusion). Many recipients with thrombosis develop graft failure within one month of surgery. Therefore, it is necessary to devise a safe and stable surgical technique with higher success rates for further development in the UTx field.
Collapse
|
4
|
Gunawardena T, Ridgway D. Transplant Nephrectomy: Current Concepts. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2022; 33:716-725. [PMID: 37955463 DOI: 10.4103/1319-2442.389431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023] Open
Abstract
Kidney transplantation is the gold standard treatment option for patients with endstage kidney disease. As the number of waitlisted patients increases, the gap between supply and demand for suitable donor kidneys keeps widening. The adoption of novel strategies that expand the donor pool has attenuated this issue to a certain degree, and this has led to a progressive increase in the number of annual transplants performed. As transplanted kidneys have a finite lifespan, there is a reciprocal rise in the number of patients who return to dialysis once their allograft fails. The clinicians involved in the management of such patients are left with the problem of managing the nonfunctioning allograft. The decision to undertake transplant nephrectomy (TN) in these patients is not straightforward. Allograft nephrectomy is a procedure that is associated with significant morbidity and mortality. It will have implications for the outcomes of the subsequent transplant. In this review, we aimed to compressively discuss the indications, techniques, and outcomes of TN, which is an integral component of the management of a failing allograft.
Collapse
Affiliation(s)
- Thilina Gunawardena
- Department of Renal Transplant, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | | |
Collapse
|
5
|
Novel Insights into the Molecular Mechanisms of Ischemia/Reperfusion Injury in Kidney Transplantation. TRANSPLANTOLOGY 2021. [DOI: 10.3390/transplantology2020018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Ischemia reperfusion injury (IRI) is one of the most important mechanisms involved in delayed or reduced graft function after kidney transplantation. It is a complex pathophysiological process, followed by a pro-inflammatory response that enhances the immunogenicity of the graft and the risk of acute rejection. Many biologic processes are involved in its development, such as transcriptional reprogramming, the activation of apoptosis and cell death, endothelial dysfunction and the activation of the innate and adaptive immune response. Recent evidence has highlighted the importance of complement activation in IRI cascade, which expresses a pleiotropic action on tubular cells, on vascular cells (pericytes and endothelial cells) and on immune system cells. The effects of IRI in the long term lead to interstitial fibrosis and tubular atrophy, which contribute to chronic graft dysfunction and subsequently graft failure. Furthermore, several metabolic alterations occur upon IRI. Metabolomic analyses of IRI detected a “metabolic profile” of this process, in order to identify novel biomarkers that may potentially be useful for both early diagnosis and monitoring the therapeutic response. The aim of this review is to update the most relevant molecular mechanisms underlying IRI, and also to discuss potential therapeutic targets in future clinical practice.
Collapse
|
6
|
Kisu I, Emoto K, Masugi Y, Yamada Y, Matsubara K, Obara H, Matoba Y, Banno K, Kato Y, Saiki Y, Itagaki I, Kawamoto I, Iwatani C, Murase M, Nakagawa T, Tsuchiya H, Ishigaki H, Urano H, Ema M, Ogasawara K, Aoki D, Nakagawa K, Shiina T. Clinical features of irreversible rejection after allogeneic uterus transplantation in cynomolgus macaques. Sci Rep 2020; 10:13910. [PMID: 32807830 PMCID: PMC7431528 DOI: 10.1038/s41598-020-70914-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 07/22/2020] [Indexed: 11/30/2022] Open
Abstract
Uterus transplantation (UTx) is a potential option for women with uterine factor infertility to have a child. The clinical features indicating irreversible rejection of the uterus are unknown. In our experimental series of allogeneic UTx in cynomolgus macaques, six female macaques were retrospectively examined, which were unresponsive to treatment with immunosuppressants (i.e. irreversible rejection). Clinical features including general condition, hematology, uterine size, indocyanine green (ICG) fluorescence imaging by laparotomy, and histopathological findings of the removed uterus were evaluated. In all cases, general condition was good at the time of diagnosis of irreversible rejection and thereafter. Laboratory evaluation showed temporary increases in white blood cells, lactate dehydrogenase and C-reactive protein, then these levels tended to decrease gradually. In transabdominal ultrasonography, the uterus showed time-dependent shrinkage after transient swelling at the time of diagnosis of irreversible rejection. In laparotomy, a whitish transplanted uterus was observed and enhancement of the transplanted uterus was absent in ICG fluorescence imaging. Histopathological findings in each removed uterus showed hyalinized fibrosis, endometrial deficit, lymphocytic infiltration and vasculitis. These findings suggest that uterine transplantation rejection is not fatal, in contrast to rejection of life-supporting organs. Since the transplanted uterus with irreversible rejection atrophies naturally, hysterectomy may be unnecessary.
Collapse
Affiliation(s)
- Iori Kisu
- Department of Obstetrics and Gynecology, Keio University School of Medicine, 35 Shinanomachi , Shinjuku-ku, Tokyo, 1608582, Japan.
| | - Katsura Emoto
- Department of Pathology, Keio University School of Medicine, Shinjuku, Tokyo, 1608582, Japan
| | - Yohei Masugi
- Department of Pathology, Keio University School of Medicine, Shinjuku, Tokyo, 1608582, Japan
| | - Yohei Yamada
- Department of Pediatric Surgery, Keio University School of Medicine, Shinjuku, Tokyo, 1608582, Japan
| | - Kentaro Matsubara
- Department of Surgery, Keio University School of Medicine, Shinjuku, Tokyo, 1608582, Japan
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine, Shinjuku, Tokyo, 1608582, Japan
| | - Yusuke Matoba
- Department of Obstetrics and Gynecology, Keio University School of Medicine, 35 Shinanomachi , Shinjuku-ku, Tokyo, 1608582, Japan
| | - Kouji Banno
- Department of Obstetrics and Gynecology, Keio University School of Medicine, 35 Shinanomachi , Shinjuku-ku, Tokyo, 1608582, Japan
| | - Yojiro Kato
- Department of Surgery, Division of Gastroenterological and General Surgery, School of Medicine, Showa University, Shinagawa, Tokyo, 1428666, Japan
| | - Yoko Saiki
- Department of Anesthesiology, Saiseikai Kanagawaken Hospital, Yokohama, Kanagawa, 2210821, Japan
| | - Iori Itagaki
- Research Center for Animal Life Science, Shiga University of Medical Science, Ōtsu, Shiga, 5202192, Japan.,The Corporation for Production and Research of Laboratory Primates, Tsukuba, Ibaraki, 3050003, Japan
| | - Ikuo Kawamoto
- Research Center for Animal Life Science, Shiga University of Medical Science, Ōtsu, Shiga, 5202192, Japan
| | - Chizuru Iwatani
- Research Center for Animal Life Science, Shiga University of Medical Science, Ōtsu, Shiga, 5202192, Japan
| | - Mitsuru Murase
- Research Center for Animal Life Science, Shiga University of Medical Science, Ōtsu, Shiga, 5202192, Japan
| | - Takahiro Nakagawa
- Research Center for Animal Life Science, Shiga University of Medical Science, Ōtsu, Shiga, 5202192, Japan
| | - Hideaki Tsuchiya
- Research Center for Animal Life Science, Shiga University of Medical Science, Ōtsu, Shiga, 5202192, Japan
| | - Hirohito Ishigaki
- Department of Pathology, Shiga University of Medical Science, Ōtsu, Shiga, 5202192, Japan
| | - Hiroyuki Urano
- Safety Research Center, Ina Research Inc., Ina, Nagano, 3994501, Japan
| | - Masatsugu Ema
- Research Center for Animal Life Science, Shiga University of Medical Science, Ōtsu, Shiga, 5202192, Japan
| | - Kazumasa Ogasawara
- Research Center for Animal Life Science, Shiga University of Medical Science, Ōtsu, Shiga, 5202192, Japan.,Department of Pathology, Shiga University of Medical Science, Ōtsu, Shiga, 5202192, Japan
| | - Daisuke Aoki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, 35 Shinanomachi , Shinjuku-ku, Tokyo, 1608582, Japan
| | - Kenshi Nakagawa
- Safety Research Center, Ina Research Inc., Ina, Nagano, 3994501, Japan
| | - Takashi Shiina
- Department of Molecular Life Science, Division of Basic Medical Science and Molecular Medicine, Tokai University School of Medicine, Hiratsuka, Kanagawa, 2591193, Japan
| |
Collapse
|
7
|
Ghyselen L, Naesens M. Indications, risks and impact of failed allograft nephrectomy. Transplant Rev (Orlando) 2019; 33:48-54. [DOI: 10.1016/j.trre.2018.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/08/2018] [Accepted: 08/27/2018] [Indexed: 02/07/2023]
|
8
|
Chowaniec Y, Luyckx F, Karam G, Glemain P, Dantal J, Rigaud J, Branchereau J. Transplant nephrectomy after graft failure: is it so risky? Impact on morbidity, mortality and alloimmunization. Int Urol Nephrol 2018; 50:1787-1793. [PMID: 30120679 DOI: 10.1007/s11255-018-1960-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/09/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE To determine the impact of transplant nephrectomy on morbidity and mortality and HLA immunization. METHODS All patients who underwent transplant nephrectomy in our centre between 2000 and 2016 were included in this study. A total of 2822 renal transplantations and 180 transplant nephrectomies were performed during this period. RESULTS The indications for transplant nephrectomy were graft intolerance syndrome: 47.2%, sepsis: 22.2%, vascular thrombosis: 15.5%, tumour: 8.3% and other 6.8%. Transplant nephrectomies were performed via an intracapsular approach in 61.7% of cases. The blood transfusion rate was 50%, the morbidity rate was 38% and the mortality rate was 3%. Transplant nephrectomies more than 12 months after renal transplant failure were associated with more complications (p = 0.006). Transfusions in the context of transplant nephrectomy had no significant impact on alloimmunization. CONCLUSION The risk of bleeding, and therefore of transfusion, constitutes the major challenge of this surgery in patients eligible for retransplantation. Even if transfusions in this context of transplant nephrectomy had no significant impact on alloimmunization, this high-risk surgery, whenever possible, must be performed electively in a well-prepared patient.
Collapse
Affiliation(s)
- Y Chowaniec
- Institut of Transplantation, Urology and Nephrology (ITUN), CHU Nantes, 30 Bd Jean Monnet, 44035, Nantes, France
| | - F Luyckx
- Service d'Urologie, Hôpital de la Roche sur Yon, La Roche sur Yon, France
| | - G Karam
- Institut of Transplantation, Urology and Nephrology (ITUN), CHU Nantes, 30 Bd Jean Monnet, 44035, Nantes, France
| | - P Glemain
- Institut of Transplantation, Urology and Nephrology (ITUN), CHU Nantes, 30 Bd Jean Monnet, 44035, Nantes, France
| | - J Dantal
- Institut of Transplantation, Urology and Nephrology (ITUN), CHU Nantes, 30 Bd Jean Monnet, 44035, Nantes, France
| | - J Rigaud
- Institut of Transplantation, Urology and Nephrology (ITUN), CHU Nantes, 30 Bd Jean Monnet, 44035, Nantes, France
| | - J Branchereau
- Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France. .,Institut of Transplantation, Urology and Nephrology (ITUN), CHU Nantes, 30 Bd Jean Monnet, 44035, Nantes, France.
| |
Collapse
|
9
|
Li B, Kirshenbaum EJ, Patel P, Gorbonos A. Pushing Boundaries: Robotic Nephrectomy of an Auto-transplanted Kidney for Recurrent Renal Cell Carcinoma. Cureus 2018; 10:e2280. [PMID: 29736363 PMCID: PMC5935431 DOI: 10.7759/cureus.2280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Advances in robotic technology continue to expand the boundaries of minimally invasive approaches in transplant surgery. A single report has previously described the use of the robotic approach in transplant nephrectomy for a failed allograft. Our objective is to describe our technique and experience for the first reported robotic nephrectomy of an auto-transplanted solitary kidney for a recurrence of renal cell carcinoma (RCC). We highlight technical considerations during allograft mobilization and hilum dissection with the additional demands of a previously operated auto-transplant kidney.
Collapse
Affiliation(s)
- Belinda Li
- Urology, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
| | - Eric J Kirshenbaum
- Urology, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
| | - Parth Patel
- Urology, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
| | - Alex Gorbonos
- Urology, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
| |
Collapse
|
10
|
Abstract
Kidney transplantation is recognised as the gold standard treatment of end-stage renal disease in most children, with excellent graft survival rates. When graft failure occurs, renal transplant recipients (RTRs) have the option of removal of the transplant (graft nephrectomy [GN]), or leaving the failed transplant in situ. The aims of this review are to discuss the indications for GN, surgical techniques, outcomes after GN (including risks of allosensitisation and the impact on subsequent transplants), and the possible role of routine GN in the asymptomatic RTR with a failed renal allograft. Literature in both the pediatric and adult renal transplant fields is reviewed. We also discuss how future research in this area could advance our knowledge of which patients to select for GN, and the most appropriate surgical approach.
Collapse
Affiliation(s)
- Benedict L. Phillips
- Department of Nephrology and Transplantation, Guy’s Hospital and the Evelina London Children’s Hospital, London, UK
| | - Chris J. Callaghan
- Department of Nephrology and Transplantation, Guy’s Hospital and the Evelina London Children’s Hospital, London, UK
| |
Collapse
|
11
|
Lucarelli G, Ditonno P. Editorial comment from Dr Lucarelli and Dr Ditonno to Impact of graft nephrectomy on outcomes of second kidney transplantation. Int J Urol 2014; 21:802-3. [PMID: 24796486 DOI: 10.1111/iju.12473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Giuseppe Lucarelli
- Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy.
| | | |
Collapse
|