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Nowak PJ, Sokołowski Ł, Meissner P, Pawłowicz-Szlarska E, Sarniak A, Włodarczyk A, Wlazeł RN, Prymont-Przymińska A, Nowak D, Nowicki M. Kidney Transplant Recipients Show Limited Lung Diffusion Capacity but Similar Hydrogen Peroxide Exhalation as Healthy Matched Volunteers: A Pilot Study. J Clin Med 2023; 12:6964. [PMID: 38002579 PMCID: PMC10672367 DOI: 10.3390/jcm12226964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/31/2023] [Accepted: 11/04/2023] [Indexed: 11/26/2023] Open
Abstract
Patients with end-stage chronic kidney disease show higher systemic oxidative stress and exhale more hydrogen peroxide (H2O2) than healthy controls. Kidney transplantation reduces oxidative stress and H2O2 production by blood polymorphonuclear leukocytes (PMNs). Kidney transplant recipients (KTRs) may be predisposed to an impairment of lung diffusing capacity due to chronic inflammation. Lung function and H2O2 concentration in the exhaled breath condensate (EBC) were compared in 20 KTRs with stable allograft function to 20 healthy matched controls. Serum interleukin eight (IL-8) and C-reactive protein (CRP), blood cell counts, and spirometry parameters did not differ between groups. However, KTRs showed lower total lung diffusing capacity for carbon monoxide, corrected for hemoglobin concentration (TLCOc), in comparison to healthy controls (92.1 ± 11.5% vs. 102.3 ± 11.9% of predicted, p = 0.009), but similar EBC H2O2 concentration (1.63 ± 0.52 vs. 1.77 ± 0.50 µmol/L, p = 0.30). The modality of pre-transplant renal replacement therapy had no effect on TLCOc and EBC H2O2. TLCOc did not correlate with time after transplantation. In this study, TLCOc was less reduced in KTRs in comparison to previous reports. We suggest this fact and the non-elevated H2O2 exhalation exhibited by KTRs, may result perhaps from the evolution of the immunosuppressive therapy.
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Affiliation(s)
- Piotr Jan Nowak
- Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Lodz, Pomorska 251, 92-213 Lodz, Poland; (E.P.-S.); (M.N.)
| | - Łukasz Sokołowski
- Department of Obstetrics and Gynecology, Polish Mother’s Memorial Hospital Research Institute, Rzgowska 281/289, 93-338 Lodz, Poland;
| | - Paweł Meissner
- University Laboratory of Blood Pressure Regulation and Function of the Autonomic Nervous System, Medical University of Lodz, Pomorska 251, 92-213 Lodz, Poland
| | - Ewa Pawłowicz-Szlarska
- Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Lodz, Pomorska 251, 92-213 Lodz, Poland; (E.P.-S.); (M.N.)
| | - Agata Sarniak
- Department of Clinical Physiology, Medical University of Lodz, Mazowiecka 6/8, 92-215 Lodz, Poland; (A.S.); (A.P.-P.); (D.N.)
| | - Anna Włodarczyk
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Mazowiecka 6/8, 92-215 Lodz, Poland;
| | - Rafał Nikodem Wlazeł
- Department of Laboratory Diagnostics and Clinical Biochemistry, Medical University of Lodz, Pomorska 251, 92-213 Lodz, Poland;
| | - Anna Prymont-Przymińska
- Department of Clinical Physiology, Medical University of Lodz, Mazowiecka 6/8, 92-215 Lodz, Poland; (A.S.); (A.P.-P.); (D.N.)
| | - Dariusz Nowak
- Department of Clinical Physiology, Medical University of Lodz, Mazowiecka 6/8, 92-215 Lodz, Poland; (A.S.); (A.P.-P.); (D.N.)
| | - Michał Nowicki
- Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Lodz, Pomorska 251, 92-213 Lodz, Poland; (E.P.-S.); (M.N.)
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Lung Transplantation. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Snell G, Kotsimbos T, Williams TJ. Lung transplantation in Australia: barriers to translating new evidence into clinical practice. Med J Aust 2006; 184:428-9. [PMID: 16646739 DOI: 10.5694/j.1326-5377.2006.tb00311.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2006] [Accepted: 03/26/2006] [Indexed: 11/17/2022]
Abstract
Evidence "beyond reasonable doubt" may never be achievable for low-volume drugs.
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Snell GI, Valentine VG, Vitulo P, Glanville AR, McGiffin DC, Loyd JE, Roman A, Aris R, Sole A, Hmissi A, Pirron U. Everolimus versus azathioprine in maintenance lung transplant recipients: an international, randomized, double-blind clinical trial. Am J Transplant 2006; 6:169-77. [PMID: 16433771 DOI: 10.1111/j.1600-6143.2005.01134.x] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Everolimus is a proliferation signal inhibitor with immunosuppressive activity that may reduce the rate of progression of chronic rejection, bronchiolitis obliterans syndrome (BOS), after lung transplantation. In a randomized, double-blind clinical trial, 213 BOS-free maintenance patients received everolimus (3 mg/day) or azathioprine (AZA, 1-3 mg/kg/day) in combination with cyclosporine and corticosteroids. The prospectively defined primary endpoint was the incidence of efficacy failure (decline in FEV1 >15%[deltaFEV1 >15%], graft loss, death or loss to follow-up) at 12 months. Incidence of efficacy failure at 12 months was significantly lower in the everolimus group than AZA (21.8% vs. 33.9%; p = 0.046); at 24 months, rates of efficacy failure became similar between the groups. At 12 months, the everolimus group had significantly reduced incidences of deltaFEV1 >15%, deltaFEV1 >15% with BOS, and acute rejection. At 24 months, only incidence of acute rejection remained significantly less in the everolimus group. Treatment discontinuations (particularly due to adverse events), serious adverse events and high serum creatinine values were more common with everolimus. For the first time, a drug has demonstrated significant slowing of loss in lung function, suggesting that patients kept on prolonged maintenance treatment with everolimus may benefit from replacing AZA with everolimus 3 months after lung transplantation.
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Affiliation(s)
- G I Snell
- Lung Transplantation Service, Alfred Hospital, Melbourne, Australia.
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Abstract
Post-transplantation bronchiolitis obliterans syndrome (BOS) is a clinicopathological syndrome characterised histologically by obliterative bronchiolitis (OB) and physiologically by airflow limitation. It affects long-term survival with no consistently effective treatment strategy.An updated review of risk factors for OB/BOS, and approaches to prevention and treatment was performed through a systematic review of relevant studies between January 1990 and February 2005. The initial search identified 853 publications, with 56 articles reviewed after exclusions. Early acute rejection is the most significant risk factor, with late rejection (> or =3 months) also significant. Lymphocytic bronchitis/bronchiolitis is relevant, with later onset associated with greater risk. Viral infections are identified as significant risk factors. Human leukocyte antigen matching and OB/BOS development is a weaker association, but is stronger with acute rejection. Recipient and donor characteristics have a minor role. There is limited evidence that altering immunosuppression is effective in reducing the rate of decline in lung function. BOS reflects an allo-immunological injury, possibly triggered by cytomegalovirus and respiratory viral infections, or noninfectious injury. Immunological susceptibility may be reflected by more frequent acute rejection episodes. Preventative and therapeutic modifications in immunosuppression remain important. Identifying markers of immunological susceptibility and, hence, risk stratification requires further research.
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Affiliation(s)
- Andrew I R Scott
- Transplant Unit, Papworth Hospital NHS Trust, Papworth Everard, Cambridge, UK
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Haverich A, Gorler H. Experience with cyclosporine: from revolution to evolution of immunosuppressive protocols in thoracic organ transplantation. Transplant Proc 2004; 36:314S-317S. [PMID: 15041360 DOI: 10.1016/j.transproceed.2004.01.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The introduction of cyclosporine into clinical practice of thoracic organ transplantation had a dramatic and positive effect on both short- and long-term survival. Today, the majority of patients are still treated with this drug, and different immunosuppressive combination therapies have further resulted in improved long-term survival. Such combinations to calcineurin inhibitors include prednisolone, mycophenolate mofetil, azathioprine, and Rapamycin. Based on data from our own institution 1- and 5-year survival rates of 86% and 78% can be obtained after heart transplantation and 76% and 59% after lung transplantation. Causes of death are described. Future immunosuppressive strategies will have to concentrate further on the omission of organ-damaging side effects. Also, not a single compound or combination for immunosuppression after thoracic organ transplantation has proved to be effective in cases with chronic rejection (eg, transplant vasculopathy in heart transplantation and bronchiolitis obliterans in lung transplantation). Moreover, with current survival data in mind, quality of life has to be considered a major focus for future designs of immunosuppressive protocols.
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Affiliation(s)
- A Haverich
- Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany.
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Azzola A, Havryk A, Chhajed P, Hostettler K, Black J, Johnson P, Roth M, Glanville A, Tamm M. Everolimus and mycophenolate mofetil are potent inhibitors of fibroblast proliferation after lung transplantation1. Transplantation 2004; 77:275-80. [PMID: 14742993 DOI: 10.1097/01.tp.0000101822.50960.ab] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dysregulated fibroblast proliferation is thought to play an important role in the progression of bronchiolitis obliterans (BO) after lung transplantation. Augmented immunosuppression is often used to treat BO. We investigated the effect of methylprednisolone (mPRED), cyclosporine A (CsA), tacrolimus (FK506), azathioprine (AZA), mycophenolate mofetil (MMF), and everolimus (rapamycin derivative [RAD]) on the proliferative capacity of fibroblasts cultured from transbronchial biopsies of lung transplant recipients. METHODS Primary cultures of human lung fibroblasts were obtained from 14 transbronchial biopsies of lung transplant recipients. Subconfluent cells were serum starved for 24 hr followed by growth stimulation in the presence or absence of the respective drug in six concentrations ranging as follows: 0.01 to 100 mg/L for mPRED; 0.01 to 50 mg/L for CsA and AZA; 0.001 to 5 mg/L for FK506 and MMF; and 0.00001 to 1 mg/L for RAD. Proliferation was quantified by [3H]thymidine incorporation and direct cell count. A toxic drug effect was excluded by trypan blue. RESULTS Drug concentrations (mg/L) causing a 50% inhibition of fibroblast proliferation were mPRED 4; CsA 20; FK506 0.3; AZA 7; MMF 0.3; and RAD 0.0006. Drug concentrations (mg/L) causing inhibition of fetal bovine serum-induced proliferation were mPRED 60; CsA 45; FK506 3; AZA 35; MMF 1; and RAD 0.003. CONCLUSIONS RAD and MMF were the most potent antifibroproliferative drugs and were effective at concentrations achieved clinically, supporting their use for the treatment of patients with early BO. Our method holds promise as an in vitro model to assess the likely in vivo responses of human lung fibroblasts to specific immunosuppressive drugs.
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Affiliation(s)
- Andrea Azzola
- The Lung Transplant Unit, St. Vincent's Hospital, Sydney, Australia.
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Lama R, Santos F, Algar FJ, Alvarez A, Baamonde C. Lung transplants with tacrolimus and mycophenolate mofetil: a review. Transplant Proc 2003; 35:1968-73. [PMID: 12962866 DOI: 10.1016/s0041-1345(03)00569-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Traditionally, immunosuppressive maintenance therapy in solid organ transplantation has consisted of cyclosporine (CsA), azathioprine, and prednisone. However, lung transplant recipients are far more frequently affected by acute rejection, especially during the first 6 months after the transplantation, than patients with other transplanted organs. Further, they display a greater risk for chronic transplant dysfunction and ultimate graft loss. Bronchiolitis obliterans syndrome (BOS) is the major cause of morbidity and mortality among long-term survivors after lung transplantation. Acute pulmonary allograft rejection has been identified as the major risk factor for the development of BOS. Based on favourable results in kidney, liver, and heart transplantation, tacrolimus and mycophenolate mofetil have been used as primary prophylaxis and as rescue therapy for recurrent or persistent acute rejection and BOS. A secondary indication is CsA toxicity. This review focuses on reported results of the combination of tacrolimus and mycophenolate mofetil in lung transplantation. These new immunosuppressive drugs have markedly improved the efficacy profiles without additional detrimental toxicities, and appear to be a safe alternative to CsA and azathioprine in patients following lung transplantation. However, at present, BOS is not influenced by these new drugs. The optimal long-term immunosuppressive regimen remains to be established.
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Affiliation(s)
- R Lama
- Divisions of Pulmonary Medicine and Thoracic Surgery, Lung Transplantation Unit, Hospital Universitario Reina Sofia, Córdoba, Spain.
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Chakinala MM, Trulock EP. Acute allograft rejection after lung transplantation: diagnosis and therapy. ACTA ACUST UNITED AC 2003; 13:525-42. [PMID: 13678311 DOI: 10.1016/s1052-3359(03)00056-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Acute rejection remains a significant problem after lung transplantation. While it generally is a treatable condition, significant resources and therapies are directed toward its prevention and resolution. Its larger significance undoubtedly rests in its contribution to the pathogenesis of BOS. Significant questions regarding the origins of AR, the role of LBB, alternative histologic appearances of acute allograft injury, and optimal therapy remain. Controversy regarding the utility of surveillance bronchoscopy and preemptive treatment of occult AR persists because of lack of conclusive evidence. Future investigations might resolve these matters and provide more efficacious and less toxic therapies that will hopefully reduce the impact of chronic rejection and improve long-term outcomes.
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Affiliation(s)
- Murali M Chakinala
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box #8052, St. Louis, MO 63110, USA.
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Estenne M, Hertz MI. Bronchiolitis obliterans after human lung transplantation. Am J Respir Crit Care Med 2002; 166:440-4. [PMID: 12186817 DOI: 10.1164/rccm.200201-003pp] [Citation(s) in RCA: 310] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Marc Estenne
- Chest Service, Erasme University Hospital, 808 Route de Lennik, B-1070 Brussels, Belgium.
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Hummel M, Müller J, Dandel M, Hetzer R. Surveillance biopsies in heart and lung transplantation. Transplant Proc 2002; 34:1860-3. [PMID: 12176605 DOI: 10.1016/s0041-1345(02)03073-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- M Hummel
- German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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