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Choong CL, Islahudin F, Wong HS, Yahya R, Mohd Tahir NA, Makmor-Bakry M. The Impact of ABCC2 -24C>T Gene Polymorphism on Graft Survival in Kidney Transplant Recipients. J Pers Med 2024; 14:440. [PMID: 38673067 PMCID: PMC11050844 DOI: 10.3390/jpm14040440] [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: 03/01/2024] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
Personalized medicine in kidney transplantation has the potential to improve outcomes and reduce complications. The aim of this study was to investigate the influence of single nucleotide polymorphisms in genes encoding metabolizing enzymes (CYP3A5) and transporters (ABCC2) on clinical outcomes (acute graft failure and/or acute tubular necrosis (ATN)) in kidney transplant recipients (KTR). This was a multicenter, retrospective cohort study where adult KTR who had undergone kidney transplantation between 2020 and 2021 and received tacrolimus-mycophenolate treatment were enrolled in the study. DNA was extracted from collected blood samples using a commercially available kit. CYP3A5*3, ABCC2 -24C>T and ABCC2 3972C>T SNP were determined by polymerase chain reaction. Of the total 39 patients included, nine (23.1%) KTR had an incidence of acute graft failure and/or ATN. A multiple logistic regression showed wildtype ABCC2 -24C>T C allele had a higher risk of developing acute graft rejection and/or ATN compared to the variant allele carriers (adjusted Odd Ratios [aOR]: 27.675, p = 0.038). Recipients who had delayed graft function (aOR: 49.214, p = 0.012) and a history of CMV infection (aOR: 18.097, p = 0.009) were at 49.2 and 18.1-times increased risk for acute graft failure and/or ATN, respectively. The large aOR was inevitable due to the small sample size and required cautious interpretation. This is the first study to determine the effect of the ABCC2 -24C>T genetic polymorphism on clinical outcomes in Malaysian KTR and forms the basis for further work on ABCC2 -24C>T effects in long-term KTR.
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Affiliation(s)
- Chiau Ling Choong
- Center of Quality Medicine Management, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (C.L.C.); (N.A.M.T.); (M.M.-B.)
| | - Farida Islahudin
- Center of Quality Medicine Management, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (C.L.C.); (N.A.M.T.); (M.M.-B.)
| | - Hin-Seng Wong
- Department of Nephrology, Selayang Hospital, Ministry of Health Malaysia, Batu Caves 68100, Malaysia;
- Sunway Medical Centre, Jalan Lagoon Selatan, Bandar Sunway, Subang Jaya 46150, Malaysia
| | - Rosnawati Yahya
- Department of Nephrology, Kuala Lumpur Hospital, Ministry of Health Malaysia, Kuala Lumpur 50586, Malaysia;
| | - Nor Asyikin Mohd Tahir
- Center of Quality Medicine Management, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (C.L.C.); (N.A.M.T.); (M.M.-B.)
| | - Mohd Makmor-Bakry
- Center of Quality Medicine Management, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (C.L.C.); (N.A.M.T.); (M.M.-B.)
- Faculty of Pharmacy, Universitas Airlangga, Surabaya 60115, Indonesia
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2
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Möckel T, Boegel S, Schwarting A. Transcriptome analysis of renal ischemia/reperfusion (I/R) injury in BAFF and BAFF-R deficient mice. PLoS One 2023; 18:e0291619. [PMID: 37751458 PMCID: PMC10522044 DOI: 10.1371/journal.pone.0291619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 09/02/2023] [Indexed: 09/28/2023] Open
Abstract
Acute kidney injury (AKI) accompanies with high morbidity and mortality. Incomplete renal recovery can lead to chronic and finally end-stage kidney disease, which results in the requirement of lifelong dialysis or kidney transplantation. Consequently, finding predictive biomarker and therefore developing preventive therapeutic approaches is an urgent need. For this purpose, a better understanding of the mechanism underlying AKI is necessary. The cytokine BAFF (B cell activating factor) is related to AKI by supporting B cells, which in turn play an important role in inflammatory processes and the production of antibodies. In our study, we investigated the role of BAFF and its receptor BAFF-R in the early phase of AKI. Therefore, we performed the well-established ischemia/reperfusion (I/R) model in BAFF (B6.129S2-Tnfsf13btm1Msc/J) and BAFF-R (B6(Cg)-Tnfrsf13ctm1Mass/J) deficient mice. Transcriptome of ischemic and contralateral control kidneys was analyzed and compared to wildtype littermates. We detected the upregulation of Lcn2, Lyz2, Cd44, Fn1 and Il1rn in ischemic kidneys as well as the downregulation of Kl. Furthermore, we revealed different expression patterns in BAFF and BAFF-R knockout mice. Compared to wildtype littermates, up- and downregulation of each investigated gene were higher in BAFF-R knockout and lower in BAFF knockout. Our findings indicate a positive impact of BAFF knockout in early phase of AKI, while BAFF-R knockout seems to worsen I/R injury. In addition, our study shows for the first time a remarkable renal upregulation of Lyz2 in a murine I/R model. Therefore, we consider Lyz2 as conceivable predictive or early biomarker in case of I/R and AKI.
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Affiliation(s)
- Tamara Möckel
- Department of Internal Medicine I, Division of Rheumatology and Clinical Immunology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Sebastian Boegel
- Department of Internal Medicine I, Division of Rheumatology and Clinical Immunology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Andreas Schwarting
- Department of Internal Medicine I, Division of Rheumatology and Clinical Immunology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- Center for Rheumatic Disease Rhineland-Palatinate GmbH, Bad Kreuznach, Germany
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3
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Alshaikh EA, Astor BC, Muth B, Jorgenson M, Swanson K, Garg N, Aziz F, Mohamed M, Mandelbrot D, Parajuli S. Delayed Graft Function Among Kidney Transplant Recipients Is Associated With an Increased Risk of Urinary Tract Infection and BK Viremia. Transplant Direct 2023; 9:e1526. [PMID: 37654682 PMCID: PMC10466499 DOI: 10.1097/txd.0000000000001526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/21/2023] [Indexed: 09/02/2023] Open
Abstract
Background Delayed graft function (DGF) among deceased donor kidney transplant recipients (DDKTRs) is a well-known risk factor for allograft rejection, decreased graft survival, and increased cost. Although DGF is associated with an increased risk of rejection, it is unclear whether it also increases the risk of infection. Methods We reviewed all adult DDKTRs at our center between 2010 and 2018. The primary outcomes of interest were BK viremia, cytomegalovirus viremia, pneumonia, and urinary tract infection (UTI) within the first year of transplant. Additional analysis was made with censoring follow-up at the time of allograft rejection. Results A total of 1512 DDKTRs were included, of whom 468 (31%) had DGF. As expected, several recipient, donor, and baseline immunological characteristics differed by DGF status. After adjustment, DGF was significantly associated with an increased risk of BK viremia (hazard ratio: 1.34; 95% confidence interval, 1.0-1.81; P = 0.049) and UTI (hazard ratio: 1.70; 95% confidence interval, 1.31-2.19; P < 0.001) but not cytomegalovirus viremia or pneumonia. Associations were similar in models censored at the time of rejection. Conclusions DGF is associated with an increased risk of early infectious complications, mainly UTI and BK viremia. Close monitoring and appropriate management are warranted for better outcomes in this unique population.
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Affiliation(s)
- Eman A. Alshaikh
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Brad C. Astor
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Brenda Muth
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Margaret Jorgenson
- Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Kurt Swanson
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Neetika Garg
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Fahad Aziz
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Maha Mohamed
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Didier Mandelbrot
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Sandesh Parajuli
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
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4
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The Endothelial Glycocalyx as a Target of Ischemia and Reperfusion Injury in Kidney Transplantation-Where Have We Gone So Far? Int J Mol Sci 2021; 22:ijms22042157. [PMID: 33671524 PMCID: PMC7926299 DOI: 10.3390/ijms22042157] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 02/07/2023] Open
Abstract
The damage of the endothelial glycocalyx as a consequence of ischemia and/or reperfusion injury (IRI) following kidney transplantation has come at the spotlight of research due to potential associations with delayed graft function, acute rejection as well as long-term allograft dysfunction. The disintegration of the endothelial glycocalyx induced by IRI is the crucial event which exposes the denuded endothelial cells to further inflammatory and oxidative damage. The aim of our review is to present the currently available data regarding complex links between shedding of the glycocalyx components, like syndecan-1, hyaluronan, heparan sulphate, and CD44 with the activation of intricate immune system responses, including toll-like receptors, cytokines and pro-inflammatory transcription factors. Evidence on modes of protection of the endothelial glycocalyx and subsequently maintenance of endothelial permeability as well as novel nephroprotective molecules such as sphingosine-1 phosphate (S1P), are also depicted. Although advances in technology are making the visualization and the analysis of the endothelial glycocalyx possible, currently available evidence is mostly experimental. Ongoing progress in understanding the complex impact of IRI on the endothelial glycocalyx, opens up a new era of research in the field of organ transplantation and clinical studies are of utmost importance for the future.
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Tsivilika M, Doumaki E, Stavrou G, Sioga A, Grosomanidis V, Meditskou S, Maranginos A, Tsivilika D, Stafylarakis D, Kotzampassi K, Papamitsou T. The adaptive immune response in cardiac arrest resuscitation induced ischemia reperfusion renal injury. ACTA ACUST UNITED AC 2020; 27:15. [PMID: 33014901 PMCID: PMC7526263 DOI: 10.1186/s40709-020-00125-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/23/2020] [Indexed: 02/07/2023]
Abstract
Background The present study aims to investigate, immunohistochemically, the role of the adaptive immune response in cardiac arrest/resuscitation-induced ischemia–reperfusion renal injury (IRI), namely to assess the presence of lymphocytes in renal tissue samples and the connection between the extent of the damage and the concentration of the lymphocytes by comparing the kidneys of non resuscitated swine with the kidneys of resuscitated swine. Methods Twenty four swine underwent cardiac arrest (CA) via a pacemaker wire. After 7 min, without any intervention, Cardiopulmonary Resuscitation, CPR, was commenced. Five min after CPR was commenced advanced life-support, ALS. Animals were divided into resuscitated animals and non resuscitated animals. Tissue samples obtained from the two groups for immunohistological study aiming to detect T-cells, B-cells and plasma cells using CD3 + , CD20 + , and CD138 + antibodies. Results There seems to be a strong concentration of T lymphocytes in the kidney tissues after ischemia of both non-resuscitated and resuscitated swine. B lymphocytes, also, appear to have infiltrated the ischemic kidneys of both animal groups; nevertheless, the contribution of T lymphocytes to the induction of injury remains greater. There is no strong evidence of correlation between the plasma cells and the damage. Conclusion The adaptive immune response seems to have a strong association with kidney injury and acute tubular necrosis after cardiac arrest/ resuscitation-induced ischemia–reperfusion. However, the extent to which the adaptive immune cells are involved in the induction of renal injury remains uncertain and there are many questions about the mechanism of function of these cells, the answers of which require further studies.
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Affiliation(s)
- Maria Tsivilika
- Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Gianni Chalkidi 45, Charilaou, 54249 Thessaloniki, Greece
| | - Eleni Doumaki
- 1st Department of Internal Medicine, Faculty of Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Stavrou
- Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Colorectal Surgery, Addenbrooke's Hospital, Cambridge, UK
| | - Antonia Sioga
- Laboratory of Histology- Embryology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasilis Grosomanidis
- Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Soultana Meditskou
- Laboratory of Histology- Embryology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Dimitrios Stafylarakis
- 2nd Department of Urology of Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Katerina Kotzampassi
- Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodora Papamitsou
- Laboratory of Histology- Embryology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Rincon Cintra da Cruz P, Cabral Dias Filho A, Santana VBBM, Biela Boaretto RB, Zanettini Riccetto CL. Donor Age Amplifies the Detrimental Effects of Cold Ischemia Time on Long-Term Kidney Allograft Survival Independently of the Occurrence of Delayed Graft Function or Early Acute Rejection. EXP CLIN TRANSPLANT 2020; 18:436-443. [PMID: 32552628 DOI: 10.6002/ect.2020.0066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES We investigated the influence of the interaction between donor age and cold ischemia time on allograft survival in the absence of delayed graft function, early acute rejection, or the combination of both. MATERIALS AND METHODS We conducted a retrospective analysis of a cohort of patients first transplanted with living-related and deceased-donor allografts between 2001 and 2016. Predictors included cold ischemia time, donor and recipient age and sex, body mass index, renal replacement therapy duration, cause of end-stage renal disease, HLA class I and II mismatches, panel of reactive antibodies score, donor creatinine concentration, development of delayed graft function, and biopsy-proven acute rejection. The response variable was time until return to renal replacement therapy. Patients who died with functioning allografts were censored at the time of death. Analyses included multivariate Cox proportional hazards regression. RESULTS The study included 498 patients followed for median of 4.1 years with median cold ischemia time of 17.0 hours. On multivariate analysis, allograft survival was negatively affected by the cold ischemia time-donor age interaction (P = .026), acute rejection (P = .043), delayed graft function (P = .001), and acute rejection combined with delayed graft function (P = .002). Restricted mean allograft survival times in patients who developed neither delayed graft function nor acute rejection decreased from 13.6 to 8.6 years when cold ischemia time increased from 12 to 36 hours and donor age increased from 30 to 60 years. CONCLUSIONS Allograft survival was negatively affected by donor age-cold ischemia time interaction independently of the development of delayed graft function, acute rejection, or their combination.
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Affiliation(s)
- Pedro Rincon Cintra da Cruz
- From the Department of Urology and Kidney Transplantation, Base Hospital of the Federal District, Brasília-DF, Brazil
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7
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Mogulla MR, Bhattacharjya S, Clayton PA. Risk factors for and outcomes of delayed graft function in live donor kidney transplantation – a retrospective study. Transpl Int 2019; 32:1151-1160. [DOI: 10.1111/tri.13472] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/07/2019] [Accepted: 06/11/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Manohar Reddy Mogulla
- Central and Northern Adelaide Renal and Transplantation Services Adelaide SA Australia
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry Adelaide SA Australia
| | | | - Philip A. Clayton
- Central and Northern Adelaide Renal and Transplantation Services Adelaide SA Australia
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry Adelaide SA Australia
- Discipline of Medicine University of Adelaide Adelaide SA Australia
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8
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Noguchi H, Kakuta Y, Okumi M, Omoto K, Okabe Y, Ishida H, Nakamura M, Tanabe K. Pure versus hand-assisted retroperitoneoscopic live donor nephrectomy: a retrospective cohort study of 1508 transplants from two centers. Surg Endosc 2019; 33:4038-4047. [PMID: 30888499 DOI: 10.1007/s00464-019-06697-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 02/06/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Although minimally invasive procedures have been established as the standard for a donor nephrectomy, there are many different surgical techniques described in the literature. The aim of this study is to compare the outcomes of kidney transplant procedures using the pure retroperitoneoscopic donor nephrectomy (PRDN) and hand-assisted retroperitoneoscopic donor nephrectomy (HARDN) techniques. METHODS A retrospective study involving 1508 transplant procedures was conducted; 874 were PRDN procedures; and 634 were HARDN. We reviewed the outcomes of the PRDN and HARDN groups, which were performed at two different centers over an identical time period. RESULTS Donors in the PRDN group had a longer operation time (P < 0.0001), reduced estimated blood loss (P < 0.0001), less open conversion (P = 0.0002), lower postoperative serum C-reactive protein levels (P < 0.0001), and a shorter postoperative hospital stay (P < 0.0001) than the HARDN group. Recipients in the PRDN group had lower serum creatinine levels at postoperative day 1-6 and the decreased incidence of slow graft function (P = 0.0017) than the HARDN group. The HARDN procedure was an independent risk factor for the incidence of acute rejection (P = 0.0211) and graft loss (P = 0.0193). CONCLUSIONS Our study suggests that the PRDN procedure is less invasive for donors as it results in reduced blood loss, lower postoperative serum CRP levels, and a shorter postoperative stay than the HARDN procedure. Additionally, PRDN provides a better outcome for recipients as it lowers the incidence of acute rejection and improves graft survival compared to HARDN.
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Affiliation(s)
- Hiroshi Noguchi
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan.,Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoichi Kakuta
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Masayoshi Okumi
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Kazuya Omoto
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Yasuhiro Okabe
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hideki Ishida
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan.
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9
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Comparative Assessment of uNGAL, uNAG and Cystatin C As Early Biomarkers in Renal Post-Transplant Patients. ACTA MEDICA BULGARICA 2018. [DOI: 10.2478/amb-2018-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Urinary neutrophil gelatinase-associated lipocalin (uNGAL), urinary N-acetyl-bd-glucosaminidase (NAG), urinary α1-microglobulin/creatinine ratio and cystatin C have been suggested as potential early markers of delayed graft function (DGF) following kidney transplantation. We conducted a prospective study in 50 consecutive kidney transplant recipients to evaluate serial changes of these biomarkers within the first week after transplantation and assess their performance in predicting DGF (dialysis requirement during initial post-transplant week) and graft function throughout the first year. Urine samples were collected on post-transplantation days 0, 1, 2, 4, and 7. Statistical analysis: Linear mixed and multivariable regression models, receiver-operating characteristic (ROC), and areas under ROC curves were used. At all-time points, mean urinary NGAL levels were significantly higher in patients developing DGF. Shortly after transplantation (3-6 h), uNGAL and uNAG values were higher in DGF recipients (on average +242 ng/mL; NAG – 6.8 U/mmol creatinine, considering mean dialysis time of 4.1 years) and rose further in the following days, contrasting with prompt function recipients. On Day-1 uNGAL levels accurately predicted DGF (AUC-ROC = 0.93), with a performance higher than serum creatinine (AUC-ROC = 0.76), and similar to cystatin C (AUC-ROC = 0.95). Multivariable analyses revealed that uNGAL levels at days 4 and 7 were strongly associated with one-year serum creatinine level. Urinary NGAL, serum cystatin C is an early marker of graft injury and is independently associated with dialysis requirement within one week after transplantation and one-year graft function.
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10
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Yu MY, Yu BC, Kim YC, Min SI, Ha J, Yang J, Song EY, Kim DK, Joo KW, Ahn C, Kim YS, Lee H. Trend, not severity, of acute kidney injury affects graft outcome in deceased donor kidney transplantation. Clin Transplant 2018; 32:e13431. [DOI: 10.1111/ctr.13431] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/03/2018] [Accepted: 10/14/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Mi-yeon Yu
- Department of Internal Medicine; Hanyang University Guri Hospital; Guri Korea
| | - Byung Chul Yu
- Department of Internal Medicine; Soon Chun Hyang University Bucheon Hospital; Bucheon Korea
| | - Yong Chul Kim
- Department of Internal Medicine; Hanyang University Guri Hospital; Guri Korea
| | - Sang Il Min
- Department of Surgery; Seoul National University Hospital; Seoul Korea
| | - Jongwon Ha
- Department of Surgery; Seoul National University Hospital; Seoul Korea
- Transplantation center; Seoul National University Hospital; Seoul Korea
| | - Jaeseok Yang
- Department of Surgery; Seoul National University Hospital; Seoul Korea
- Transplantation center; Seoul National University Hospital; Seoul Korea
| | - Eun Young Song
- Department of Laboratory Medicine; Seoul National University Hospital; Seoul Korea
| | - Dong Ki Kim
- Department of Internal Medicine; Hanyang University Guri Hospital; Guri Korea
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Korea
| | - Kwon Wook Joo
- Department of Internal Medicine; Hanyang University Guri Hospital; Guri Korea
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Korea
| | - Curie Ahn
- Department of Internal Medicine; Hanyang University Guri Hospital; Guri Korea
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Korea
| | - Yon Su Kim
- Department of Internal Medicine; Hanyang University Guri Hospital; Guri Korea
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Korea
- Kidney Research Institute, Seoul National University College of Medicine; Seoul Korea
| | - Hajeong Lee
- Department of Internal Medicine; Hanyang University Guri Hospital; Guri Korea
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Korea
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11
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Wang CJ, Tuffaha A, Phadnis MA, Mahnken JD, Wetmore JB. Association of Slow Graft Function with Long-Term Outcomes in Kidney Transplant Recipients. Ann Transplant 2018. [PMID: 29610451 PMCID: PMC6248282 DOI: 10.12659/aot.907397] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Whether slow graft function (SGF) represents an intermediate phenotype between immediate graft function (IGF) and delayed graft function (DGF) in kidney transplant recipients is unknown. Material/Methods In a retrospective cohort analysis of 1,222 kidney transplant recipients, we classified patients as having IGF, SGF, and DGF using two different schemas. SGF was defined as serum creatinine (Cr) ≥3.0 mg/dL by postoperative day 5 in Schema 1, and in Schema 2, SGF was defined as Cr >1.5 mg/dL plus a creatinine reduction ratio <20% between postoperative days 1 and 3. A complementary log-log model was used to examine the association of graft function with graft survival and patient survival. Results Mean age of study patients was 51.5±13.3 years, 59.9% were male, and 66.7% were white. In Schema 1, SGF and DGF were associated with comparable increases in risk of graft failure compared to IGF (hazard ratio (HR) 1.46, 95% confidence intervals (CI) 1.02–2.10 for SGF and HR 1.56, CI 1.11–2.22 for IGF); estimates were similar for Schema 2 (HR 1.52, CI 1.05–2.20 for SGF and HR 1.54, CI 1.10–2.17 for IGF). However, for mortality, outcomes for SGF were similarly to IGF, both SGF and IGF were associated with lower risk relative to DGF (HR 0.54, CI 0.36–0.80 for SGF in Schema 1; HR 0.58, CI 0.39–0.85 for SGF in Schema 2). Conclusions These findings suggest that SGF may be a marker for graft failure but not for mortality, and SGF may therefore represent a phenotype separate from IGF and DGF.
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Affiliation(s)
- Connie J Wang
- Division of Nephrology, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Ahmad Tuffaha
- Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, KS, USA.,The Kidney Institute, University of Kansas Medical Center, Kansas City, KS, USA
| | - Milind A Phadnis
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jonathan D Mahnken
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | - James B Wetmore
- Division of Nephrology, Hennepin County Medical Center, Minneapolis, MN, USA.,Chronic Disease Research Group, Minneapolis, MN, USA
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12
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Kaabak M, Babenko N, Shapiro R, Zokoyev A, Dymova O, Kim E. A prospective randomized, controlled trial of eculizumab to prevent ischemia-reperfusion injury in pediatric kidney transplantation. Pediatr Transplant 2018; 22. [PMID: 29377474 DOI: 10.1111/petr.13129] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2017] [Indexed: 11/30/2022]
Abstract
Ischemia-reperfusion injury has multiple effects on a transplanted allograft, including delayed or impaired graft function, compromised long-term survival, and an association with an increased incidence of rejection. Eculizumab, a monoclonal antibody blocking terminal complement activation, has been postulated to be an effective agent in the prevention or amelioration of IRI. We performed a single-center prospective, randomized controlled trial involving 57 pediatric kidney transplant recipients between 2012 and 2016. The immunosuppressive protocol included two doses of alemtuzumab; half of the patients were randomized to receive a single dose of eculizumab prior to transplantation. Maintenance immunosuppression was based on a combination of low-dose tacrolimus and mycophenolate, without steroids. Eculizumab-treated patients had a significantly better early graft function, less arteriolar hyalinosis and chronic glomerulopathy on a protocol biopsies taken on day 30, 1 year, and 3 years after transplantation. In the eculizumab group, four non-vaccinated children lost their grafts during the course of a flu-like infection. Eculizumab is associated with better early graft function and improved graft morphology; however, there was an unacceptably high number of early graft losses among the eculizumab-treated children. While a promising strategy, the best approach to complement inhibition remains to be established.
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Affiliation(s)
- Michael Kaabak
- Kidney Transplantation, National Research Center of Surgery, Moscow, Russia
| | - Nadeen Babenko
- Kidney Transplantation, National Research Center of Surgery, Moscow, Russia
| | - Ron Shapiro
- Kidney Transplantation, National Research Center of Surgery, Moscow, Russia
| | - Allan Zokoyev
- Kidney Transplantation, National Research Center of Surgery, Moscow, Russia
| | - Olga Dymova
- Kidney Transplantation, National Research Center of Surgery, Moscow, Russia
| | - Edward Kim
- Kidney Transplantation, National Research Center of Surgery, Moscow, Russia
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Ribeiro GB, Santos EBD, Bona SR, Schaefer PG, Garcez TA, Rabolini EB, Smaniotto GP, Marroni NP, Corso CO. The effects of local ischemic preconditioning and topical hypothermia in renal ischemia/reperfusion injury in rats. Acta Cir Bras 2017; 32:816-826. [PMID: 29160368 DOI: 10.1590/s0102-865020170100000003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 09/29/2017] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Topical hypothermia and local ischemic preconditioning have been shown to reduce renal ischemia-reperfusion (I/R) injury individually. We examined whether combination of both strategies lessens renal I/R injury. METHODS Post right nephrectomy, 40 male Wistar rats were randomly assigned to five experimental protocols performed in the left kidney: topical hypothermia without ischemia (TH), warm ischemia (IR), ischemic preconditioning followed by warm ischemia (IPC+IR), cold ischemia (TH+IR), and ischemic preconditioning followed by cold ischemia (IPC+TH+IR). Eight randomly assigned right kidneys constituted the control group. After 240 min of reperfusion, the left kidney was retrieved to evaluate histological changes, lipid peroxidation and antioxidant enzymes activity. Serum was collected to evaluate urea and creatinine. RESULTS IPC+TH+IR group revealed no difference to any other group subjected to ischemia in relation to histological changes, lipid peroxidation and antioxidant enzymes activity. Creatinine was lower in IPC+TH+IR group compared with IPC+IR, but showed no difference compared to TH+IR group. CONCLUSIONS Combination of local ischemic preconditioning (IPC) and topical hypothermia conferred no protection in renal I/R injury. Moreover, local IPC solely followed by warm ischemia impaired renal function more than warm ischemia alone.
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Affiliation(s)
- Guilherme Behrend Ribeiro
- Fellow Master degree, Postgraduate Program in Medicine: Surgical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre-RS, Brazil. Conception and design of the study; technical procedures; acquisition, interpretation and analysis of data; manuscript writing
| | - Emanuel Burck Dos Santos
- MSc, PhD, Department of Urology, Hospital de Clínicas de Porto Alegre (HCPA), Brazil. Conception and design of the study, critical revision
| | - Silvia Regina Bona
- PhD, Laboratory of Experimental Gastroenterology and Hepatology, HCPA, Brazil. Acquisition and interpretation of data, technical procedures
| | - Pedro Guilherme Schaefer
- MD, Department of Pathology, HCPA, Porto Alegre-RS, Brazil. Histopathological examinations, acquisition of data
| | - Tuane Alves Garcez
- MSc, Animal Experimentation Unit, HCPA, Porto Alegre-RS, Brazil. Technical procedures
| | - Eduardo Brasil Rabolini
- Graduate student, School of Medicine, UFRGS, Porto Alegre-RS, Brazil. Acquisition of data, technical procedures
| | - Guilherme Pereira Smaniotto
- Graduate student, School of Medicine, UFRGS, Porto Alegre-RS, Brazil. Acquisition of data, technical procedures
| | - Norma Possa Marroni
- MSc, Full Professor, Physiologist, Laboratory of Experimental Gastroenterology and Hepatology, UFRGS, Porto Alegre-RS, and Laboratory of Oxidative Stress and Antioxidants, Universidade Luterana do Brasil (ULBRA), Canoas-RS, Brazil. Acquisition and interpretation of data, technical procedures
| | - Carlos Otávio Corso
- MSc, Associate Professor of Surgery, Digestive Surgery Unit, HCPA, and Department of Surgery, UFRGS, Porto Alegre-RS, Brazil. Conception and design of the study, interpretation of data, manuscript writing, critical revision, final approval
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Incidence, Management, and Risk Factors for Lower Gastrointestinal Bleeding in Renal Transplant Recipients. Transplant Proc 2017; 49:501-504. [PMID: 28340821 DOI: 10.1016/j.transproceed.2017.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND There are limited convincing data regarding management and outcomes of lower gastrointestinal bleeding (LGB) in renal transplant recipients (RTR). The aim of this study was to evaluate incidence, management strategies, and risk factors associated with LGB in RTR. METHODS Between January 2004 and December 2013, RTR with LGB were analyzed. LGB was defined as having clinical evidence of hemorrhage after upper gastrointestinal etiology was ruled out. RESULTS There were 1578 RTR with a mean age of 50 ± 14 years at the time of transplantation. Mean follow-up time after transplantation was 57 ± 45 months. Forty-five (2.9%) patients had a documented site of LGB. The most common causes of bleeding were colitis and angiodysplasia (n = 17). Mean time to LGB after transplantation was 43 ± 36 months. Twelve patients with LGB required intervention. Three underwent colectomy, endoscopic treatment was utilized in 8, and 1 patient had angiographic embolization to control bleeding. Recurrent LGB developed in 11 patients of 42 patients who did not have surgery at the time of index bleeding. Surgical (n = 1) or endoscopic intervention (n = 4) was required in 5 of recurrent bleeders. LGB was more commonly seen in RTRs who had development of a nonfunctioning kidney (P < .0001). RTR who had an LGB had an increased overall mortality rate (not directly related to the bleeding episode) compared with those who did not have a LGB (P = .001). We did not observe any increased risk of LGB bleeding among patients who were receiving anticoagulant or anti-aggregant treatment agents (P = .76). CONCLUSIONS Nonfunctioning kidney after transplant is a risk factor for LGB. Overall mortality rates increased after LGB in RTR. Strategies aiming to prolong transplanted kidney function may reduce the incidence of LGB and improve life expectancy in RTR.
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15
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Does Delayed Graft Function Still Herald a Poorer Outcome in Kidney Transplantation? CURRENT TRANSPLANTATION REPORTS 2016. [DOI: 10.1007/s40472-016-0110-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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16
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Dreyer GJ, Hemke AC, Reinders MEJ, de Fijter JW. Transplanting the elderly: Balancing aging with histocompatibility. Transplant Rev (Orlando) 2015; 29:205-11. [PMID: 26411382 DOI: 10.1016/j.trre.2015.08.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 08/30/2015] [Accepted: 08/30/2015] [Indexed: 01/10/2023]
Abstract
Across the world, the proportions of senior citizens (i.e. those ≥65years) increase rapidly and are predicted to constitute over 25% of the general population by 2050. In 2012 already 48% of the population with end stage renal disease (ESRD) was aged 65years or older. Transplantation is considered the preferred treatment option for ESRD offering survival advantage over long-term dialysis in the majority of patients. Indeed, acceptable outcomes have been documented for selected patients over the age of 70years or even cases over 80years. The reality of organ scarcity and prolonged waiting times for a deceased donor kidney transplantation, however, indicate that at best 50% of the selected elderly may have realistic expectations to receive a timely transplant offer. By choice or medical selection, access to transplantation also decreases with increasing age. In order to expedite the chance for elderly to receive a kidney transplant dedicated allocation systems have been developed. These allocation systems, like the Eurotransplant Senior Program (ESP), support preferential local allocation of kidneys from older donors to older patients in order to match recipient and graft life while disregarding histocompatibility for HLA antigens. The consequence has been more acute rejection episodes and an increase in immunosuppressive load. In the elderly, the most common cause of graft loss is death with functioning graft and death from infectious diseases is one of the dominant causes. The Eurotransplant Senior DR-compatible Program (ESDP) was designed to further improve the perspective of successful transplantation in the elderly in terms of life and quality of life by re-introducing matching criteria for HLA-DR in the old-for-old algorithm.
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Affiliation(s)
- G J Dreyer
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - A C Hemke
- Nefrovision/Renine, Dutch Transplant Foundation, Leiden, The Netherlands
| | - M E J Reinders
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - J W de Fijter
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands.
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Delayed graft function and the risk of acute rejection in the modern era of kidney transplantation. Kidney Int 2015; 88:851-8. [PMID: 26108067 DOI: 10.1038/ki.2015.190] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 04/09/2015] [Accepted: 04/23/2015] [Indexed: 01/19/2023]
Abstract
Delayed graft function (DGF) is commonly considered a risk factor for acute rejection, although this finding has not been uniformly observed across all studies. The link between DGF and acute rejection may have changed over time due to advances in immunosuppression and medical management. Here we conducted a cohort study of 645 patients over 12 years to evaluate the association of DGF and biopsy-proven acute rejection (BPAR) in a modern cohort of kidney transplant recipients. DGF was defined as the need for at least one dialysis session in the first week after kidney transplantation. The 1-, 3-, and 5-year cumulative probabilities of BPAR were 16.0, 21.8, and 22.6% in the DGF group, significantly different from the 10.1, 12.4, and 15.7% in the non-DGF group. In multivariable Cox proportional hazards model, the adjusted relative hazard for BPAR in DGF (vs. no DGF) was 1.55 (95% confidence interval (CI): 1.03, 2.32). This association was generally robust to different definitions of DGF. The relative hazard was also similarly elevated for T-cell- or antibody-mediated BPAR (1.52 (0.92, 2.51) and 1.54 (0.85, 2.77), respectively). Finally, the association was consistent across clinically relevant subgroups. Thus DGF remains an important risk factor for BPAR in a contemporary cohort of kidney transplant recipients. Interventions to reduce the risk of DGF and/or its aftereffects remain of paramount importance to improve kidney transplant outcomes.
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18
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Zhao H, Ning J, Lemaire A, Koumpa FS, Sun JJ, Fung A, Gu J, Yi B, Lu K, Ma D. Necroptosis and parthanatos are involved in remote lung injury after receiving ischemic renal allografts in rats. Kidney Int 2015; 87:738-48. [PMID: 25517913 DOI: 10.1038/ki.2014.388] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 09/25/2014] [Accepted: 10/02/2014] [Indexed: 12/26/2022]
Abstract
Early renal graft injury could result in remote pulmonary injury due to kidney-lung cross talk. Here we studied the possible role of regulated necrosis in remote lung injury in a rat allogeneic transplantation model. In vitro, human lung epithelial cell A549 was challenged with TNF-α and conditioned medium from human kidney proximal tubular cells (HK-2) after hypothermia-hypoxia insults. In vivo, the Brown-Norway rat renal grafts were extracted and stored in 4 °C Soltran preserving solution for up to 24 h and transplanted into Lewis rat recipients, and the lungs were harvested on day 1 and day 4 after grafting for further analysis. Ischemia-reperfusion injury in the renal allograft caused pulmonary injury following engraftment. PARP-1 (marker for parthanatos) and receptor interacting protein kinase 1 (Rip1) and Rip3 (markers for necroptosis) expression was significantly enhanced in the lung. TUNEL assays showed increased cell death of lung cells. This was significantly reduced after treatment with necrostatin-1 (nec-1) or/and 3-aminobenzamide (3-AB). Acute immune rejection exacerbated the remote lung injury and 3-AB or/and Nec-1 combined with cyclosporine A conferred optimal lung protection. Thus, renal graft injury triggered remote lung injury, likely through regulated necrosis. This study could provide the molecular basis for combination therapy targeting both pathways of regulated necrosis to treat such complications after renal transplantation.
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Affiliation(s)
- Hailin Zhao
- Faculty of Medicine, Department of Surgery and Cancer, Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Jiaolin Ning
- 1] Faculty of Medicine, Department of Surgery and Cancer, Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, Chelsea and Westminster Hospital, London, UK [2] Department of Anesthesiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Alexandre Lemaire
- Faculty of Medicine, Department of Surgery and Cancer, Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Foteini-Stefania Koumpa
- Faculty of Medicine, Department of Surgery and Cancer, Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - James J Sun
- Faculty of Medicine, Department of Surgery and Cancer, Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Anthony Fung
- Faculty of Medicine, Department of Surgery and Cancer, Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Jianteng Gu
- Department of Anesthesiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Bin Yi
- Department of Anesthesiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Kaizhi Lu
- Department of Anesthesiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Daqing Ma
- Faculty of Medicine, Department of Surgery and Cancer, Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, Chelsea and Westminster Hospital, London, UK
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19
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Kaabak M, Babenko N, Kuznetsov O, Matveev A, Minina M, Platova E, Morozova M, Novozhilova T. Eculizumab reverses the potentially fatal effects of kidney graft reperfusion injury. Pediatr Transplant 2014; 18:E44-7. [PMID: 24330127 DOI: 10.1111/petr.12206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2013] [Indexed: 12/23/2022]
Abstract
Half an hour after reperfusion, the kidney, transplanted to the infant from an adult brain dead standard criteria donor, became flabby and acquired blue color. Hyperacute rejection was suspected as a consequence of false negative cross match, and eculizumab was administered with the purpose to treat antibody-mediated injury, with fast and clear effect. The patient's blood was tested for donor-specific antibodies on the next day, and results were negative. We attribute graft damage to reperfusion injury and explain eculizumab's effectiveness to its ability to prevent progression of reperfusion injury.
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Affiliation(s)
- Michael Kaabak
- Department of Kidney Transplantation, National Research Center for Surgery, Moscow, Russian Federation
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20
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Neutrophil gelatinase-associated lipocalin in kidney transplantation is an early marker of graft dysfunction and is associated with one-year renal function. J Transplant 2013; 2013:650123. [PMID: 24288591 PMCID: PMC3833111 DOI: 10.1155/2013/650123] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 09/07/2013] [Accepted: 09/20/2013] [Indexed: 12/13/2022] Open
Abstract
Urinary neutrophil gelatinase-associated lipocalin (uNGAL) has been suggested as potential early marker of delayed graft function (DGF) following kidney transplantation (KTx). We conducted a prospective study in 40 consecutive KTx recipients to evaluate serial changes of uNGAL within the first week after KTx and assess its performance in predicting DGF (dialysis requirement during initial posttransplant week) and graft function throughout first year. Urine samples were collected on post-KTx days 0, 1, 2, 4, and 7. Linear mixed and multivariable regression models, receiver-operating characteristic (ROC), and areas under ROC curves were used. At all-time points, mean uNGAL levels were significantly higher in patients developing DGF (n = 18). Shortly after KTx (3–6 h), uNGAL values were higher in DGF recipients (on average +242 ng/mL, considering mean dialysis time of 4.1 years) and rose further in following days, contrasting with prompt function recipients. Day-1 uNGAL levels accurately predicted DGF (AUC-ROC = 0.93), with a performance higher than serum creatinine (AUC-ROC = 0.76), and similar to cystatin C (AUC-ROC = 0.95). Multivariable analyses revealed that uNGAL levels at days 4 and 7 were strongly associated with one-year serum creatinine. Urinary NGAL is an early marker of graft injury and is independently associated with dialysis requirement within one week after KTx and one-year graft function.
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21
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Zhao H, Watts HR, Chong M, Huang H, Tralau-Stewart C, Maxwell PH, Maze M, George AJT, Ma D. Xenon treatment protects against cold ischemia associated delayed graft function and prolongs graft survival in rats. Am J Transplant 2013; 13:2006-18. [PMID: 23710625 PMCID: PMC3884761 DOI: 10.1111/ajt.12293] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 03/18/2013] [Accepted: 04/04/2013] [Indexed: 01/25/2023]
Abstract
Prolonged hypothermic storage causes ischemia-reperfusion injury (IRI) in the renal graft, which is considered to contribute to the occurrence of the delayed graft function (DGF) and chronic graft failure. Strategies are required to protect the graft and to prolong renal graft survival. We demonstrated that xenon exposure to human proximal tubular cells (HK-2) led to activation of range of protective proteins. Xenon treatment prior to or after hypothermia-hypoxia challenge stabilized the HK-2 cellular structure, diminished cytoplasmic translocation of high-mobility group box (HMGB) 1 and suppressed NF-κB activation. In the syngeneic Lewis-to-Lewis rat model of kidney transplantation, xenon exposure to donors before graft retrieval or to recipients after engraftment decreased caspase-3 expression, localized HMGB-1 within nuclei and prevented TLR-4/NF-κB activation in tubular cells; serum pro-inflammatory cytokines IL-1β, IL-6 and TNF-α were reduced and renal function was preserved. Xenon treatment of graft donors or of recipients prolonged renal graft survival following IRI in both Lewis-to-Lewis isografts and Fischer-to-Lewis allografts. Xenon induced cell survival or graft functional recovery was abolished by HIF-1α siRNA. Our data suggest that xenon treatment attenuates DGF and enhances graft survival. This approach could be translated into clinical practice leading to a considerable improvement in long-term graft survival.
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Affiliation(s)
- H Zhao
- Department of Surgery and Cancer, Section of Anaesthetics, Pain Medicine and Intensive Care, Faculty of Medicine, Imperial College London, Chelsea & Westminster HospitalLondon, UK
| | - H R Watts
- Department of Surgery and Cancer, Section of Anaesthetics, Pain Medicine and Intensive Care, Faculty of Medicine, Imperial College London, Chelsea & Westminster HospitalLondon, UK
| | - M Chong
- Department of Surgery and Cancer, Section of Anaesthetics, Pain Medicine and Intensive Care, Faculty of Medicine, Imperial College London, Chelsea & Westminster HospitalLondon, UK
| | - H Huang
- Department of Surgery and Cancer, Section of Anaesthetics, Pain Medicine and Intensive Care, Faculty of Medicine, Imperial College London, Chelsea & Westminster HospitalLondon, UK
| | - C Tralau-Stewart
- Department of Medicine, Drug Discovery Centre, Imperial College LondonLondon, UK
| | - P H Maxwell
- Division of Medicine, University College LondonLondon, UK
| | - M Maze
- Department of Anesthesia and Perioperative Care, University of CaliforniaSan Francisco, CA
| | - A J T George
- Section of Molecular ImmunologyDepartment of MedicineImperial College London, Hammersmith HospitalLondon, UK
| | - D Ma
- Department of Surgery and Cancer, Section of Anaesthetics, Pain Medicine and Intensive Care, Faculty of Medicine, Imperial College London, Chelsea & Westminster HospitalLondon, UK,Department of Anesthesiology, Hubei University of MedicineHubei, China,*Corresponding author: Daqing Ma,
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22
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Zhao H, Yoshida A, Xiao W, Ologunde R, O'Dea KP, Takata M, Tralau-Stewart C, George AJT, Ma D. Xenon treatment attenuates early renal allograft injury associated with prolonged hypothermic storage in rats. FASEB J 2013; 27:4076-88. [PMID: 23759444 DOI: 10.1096/fj.13-232173] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Prolonged hypothermic storage elicits severe ischemia-reperfusion injury (IRI) to renal grafts, contributing to delayed graft function (DGF) and episodes of acute immune rejection and shortened graft survival. Organoprotective strategies are therefore needed for improving long-term transplant outcome. The aim of this study is to investigate the renoprotective effect of xenon on early allograft injury associated with prolonged hypothermic storage. Xenon exposure enhanced the expression of heat-shock protein 70 (HSP-70) and heme oxygenase 1 (HO-1) and promoted cell survival after hypothermia-hypoxia insult in human proximal tubular (HK-2) cells, which was abolished by HSP-70 or HO-1 siRNA. In the brown Norway to Lewis rat renal transplantation, xenon administered to donor or recipient decreased the renal tubular cell death, inflammation, and MHC II expression, while delayed graft function (DGF) was therefore reduced. Pathological changes associated with acute rejection, including T-cell, macrophage, and fibroblast infiltration, were also decreased with xenon treatment. Donors or recipients treated with xenon in combination with cyclosporin A had prolonged renal allograft survival. Xenon protects allografts against delayed graft function, attenuates acute immune rejection, and enhances graft survival after prolonged hypothermic storage. Furthermore, xenon works additively with cyclosporin A to preserve post-transplant renal function.
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Affiliation(s)
- Hailin Zhao
- 1Department of Surgery and Cancer, Section of Anaesthetics, Pain Medicine and Intensive Care, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK.
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Intermediate Early Graft Function Is Associated With Increased Incidence of Graft Loss and Worse Long-Term Graft Function in Kidney Transplantation. Transplant Proc 2013; 45:1070-2. [DOI: 10.1016/j.transproceed.2013.02.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Acute kidney injury: a conspiracy of Toll-like receptor 4 on endothelia, leukocytes, and tubules. Pediatr Nephrol 2012; 27:1847-54. [PMID: 22033798 PMCID: PMC3523189 DOI: 10.1007/s00467-011-2029-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 08/31/2011] [Accepted: 09/01/2011] [Indexed: 01/08/2023]
Abstract
Ischemic acute kidney injury (AKI) contributes to considerable morbidity and mortality in hospitalized patients and can contribute to rejection during kidney transplantation. Maladaptive immune responses can exacerbate injury, and targeting these responses holds promise as therapy for AKI. In the last decade, a number of molecules and receptors were identified in the innate immune response to ischemia-reperfusion injury. This review primarily focuses on one pathway that leads to maladaptive inflammation: toll-like receptor 4 (TLR4) and one of its ligands, high mobility group box protein 1 (HMGB1). The temporal-spatial roles and potential therapeutics targeting this particular receptor-ligand interaction are also explored.
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25
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O'Neill S, Ross JA, Wigmore SJ, Harrison EM. The role of heat shock protein 90 in modulating ischemia-reperfusion injury in the kidney. Expert Opin Investig Drugs 2012; 21:1535-48. [PMID: 22876854 DOI: 10.1517/13543784.2012.713939] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Kidney transplantation is the gold standard treatment for end-stage renal disease. Ischemia-reperfusion injury (IRI) is an unavoidable consequence of the transplantation procedure and is responsible for delayed graft function and poorer long-term outcomes. AREAS COVERED Pharmacological induction of heat shock protein (Hsp) expression is an emerging pre-conditioning strategy aimed at reducing IRI following renal transplantation. Hsp90 inhibition up-regulates protective Hsps (especially Hsp70) and potentially down-regulates NF-κB by disruption of the IκB kinase (IKK) complex. However, the clinical application of Hsp90 inhibitors is currently limited by their toxicity profile and the exact mechanism of protection conferred is unknown. Toll-like receptor 4 (TLR4) is a further regulator of NF-κB and recent studies suggest TLR4 plays a dominant role in mediating kidney damage following IRI. The full interaction of Hsps with TLRs is yet to be delineated and whether TLR4 signalling can be targeted by Hsp90 inhibition in IRI remains uncertain. EXPERT OPINION Pharmacological pre-conditioning by Hsp90 inhibition involves direct treatment to the kidney donor and/or organ, which aims to reduce injury prior to the onset of ischemia. The major challenges going forward are to establish the exact mechanism of protection offered by these drugs and the investgiation of less toxic analogues that could be safely translated into human studies.
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Affiliation(s)
- Stephen O'Neill
- MRC Centre for Inflammation Research, Tissue Injury and Repair Group, University of Edinburgh, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK
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Koga H, Hagiwara S, Kusaka J, Goto K, Uchino T, Shingu C, Kai S, Noguchi T. New α-Lipoic Acid Derivative, DHL-HisZn, Ameliorates Renal Ischemia-Reperfusion Injury in Rats. J Surg Res 2012; 174:352-8. [DOI: 10.1016/j.jss.2011.01.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 12/05/2010] [Accepted: 01/05/2011] [Indexed: 02/07/2023]
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Abstract
Acute kidney injury occurs with kidney transplantation and too frequently progresses to the clinical diagnosis of delayed graft function (DGF). Poor kidney function in the first week of graft life is detrimental to the longevity of the allograft. Challenges to understand the root cause of DGF include several pathologic contributors derived from the donor (ischemic injury, inflammatory signaling) and recipient (reperfusion injury, the innate immune response and the adaptive immune response). Progressive demand for renal allografts has generated new organ categories that continue to carry high risk for DGF for deceased donor organ transplantation. New therapies seek to subdue the inflammatory response in organs with high likelihood to benefit from intervention. Future success in suppressing the development of DGF will require a concerted effort to anticipate and treat tissue injury throughout the arc of the transplantation process.
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Affiliation(s)
- Andrew Siedlecki
- Nephrology Division, Department of Internal Medicine, Washington University in St. Louis School of Medicine, St Louis, MO
| | - William Irish
- CTI, Clinical Trial and Consulting Services, Raleigh, NC
| | - Daniel C. Brennan
- Nephrology Division, Department of Internal Medicine, Washington University in St. Louis School of Medicine, St Louis, MO
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Koga H, Hagiwara S, Mei H, Hiraoka N, Kusaka J, Goto K, Kashima K, Noguchi T. The vitamin E derivative, ESeroS-GS, attenuates renal ischemia-reperfusion injury in rats. J Surg Res 2011; 176:220-5. [PMID: 22440932 DOI: 10.1016/j.jss.2011.07.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Revised: 07/21/2011] [Accepted: 07/25/2011] [Indexed: 01/03/2023]
Abstract
BACKGROUND Acute kidney injury (AKI), which occurs during renal transplantation and cardiovascular surgery, is a major clinical problem associated with high mortality, and has limited treatment options. Anti-inflammation therapy has been suggested to improve the course and outcome of AKI. In this study, we hypothesized that ESeroS-GS, a vitamin E derivative, inhibits cytokine production and prevents renal ischemia-reperfusion (I/R) injury in rats. METHODS Rats received an intravenous infusion of ESeroS-GS or saline, and underwent experimentally-induced renal I/R injury or sham treatment. Rats were sacrificed after 60 min of ischemia and 24 h of reperfusion. To evaluate the renal protective effects of ESero-GS, renal function was examined, kidneys were histologically assessed, levels of myeloperoxidase (MPO) and serum cytokines were measured, and caspase 3/7 activity was determined. RESULTS ESeroS-GS attenuated I/R-induced histologic alterations, reduced levels of MPO and serum BUN, Cre, TNF-α, and IL-6, and decreased caspase 3/7 activity in kidneys of rats subjected to renal I/R injury. CONCLUSIONS ESeroS-GS attenuated renal injury after I/R by reducing serum cytokine levels. Our findings suggest that ESeroS-GS may have therapeutic potential against various human I/R conditions.
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Affiliation(s)
- Hironori Koga
- Department of Anesthesiology and Intensive Care Medicine, Oita University Faculty of Medicine, Yufu City, Oita, Japan
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Sörensen I, Rong S, Susnik N, Gueler F, Shushakova N, Albrecht M, Dittrich AM, von Vietinghoff S, Becker JU, Melk A, Bohlmann A, Reingruber S, Petzelbauer P, Haller H, Schmitt R. Bβ(15-42) attenuates the effect of ischemia-reperfusion injury in renal transplantation. J Am Soc Nephrol 2011; 22:1887-96. [PMID: 21841063 DOI: 10.1681/asn.2011010031] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Renal ischemia-reperfusion contributes to reduced renal allograft survival. The peptide Bβ(15-42), a breakdown product of fibrin, attenuates inflammation induced by ischemia-reperfusion in the heart by competitively blocking the binding of leukocytes to endothelial VE-cadherin, but whether it could improve outcomes in renal transplantation is unknown. Here, we tested the ability of Bβ(15-42) to ameliorate the effects of renal ischemic injury during allogenic kidney transplantation in mice. In our renal transplantation model (C57BL/6 into BALB/c mice), treatment with Bβ(15-42) at the time of allograft reperfusion resulted in significantly improved survival of recipients during the 28-day follow-up (60% versus 10%). Bβ(15-42) treatment decreased leukocyte infiltration, expression of endothelial adhesion molecules, and proinflammatory cytokines. Treatment significantly attenuated allogenic T cell activation and reduced cellular rejection. Moreover, Bβ(15-42) significantly reduced tubular epithelial damage and apoptosis, which we reproduced in vitro. These data suggest that Bβ(15-42) may have therapeutic potential in transplant surgery by protecting grafts from ischemia-reperfusion injury.
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Affiliation(s)
- Inga Sörensen
- Department of Nephrology and Hypertension, Medical School Hannover, Germany
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Short-time intermittent preexposure of living human donors to hyperoxia improves renal function in early posttransplant period: a double-blind randomized clinical trial. J Transplant 2011; 2011:204843. [PMID: 21559250 PMCID: PMC3087885 DOI: 10.1155/2011/204843] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2010] [Revised: 01/05/2011] [Accepted: 01/26/2011] [Indexed: 11/17/2022] Open
Abstract
The purpose of this human study was to investigate the effect of oxygen pretreatment in living kidney donors on early renal function of transplanted kidney. Sixty living kidney donor individuals were assigned to receive either 8-10 L/min oxygen (Group I) by a non-rebreather mask with reservoir bag intermittently for one hour at four times (20, 16, 12, and 1 hours before transplantation) or air (Group II). After kidney transplantation, urine output, blood urea nitrogen (BUN), serum creatinine, need to additional diuretics (NTADs) in the first 24 hours after transplantation, delayed graft function (DGF), the creatinine clearance (CrCL) on 10th day, and duration of hospital stay from the first posttransplant day till normalization of renal function was recorded and compared in two groups. Mean CrCL in posttransplant day 10, NTAD after 24 hours of transplantation, and urine output during 6 hours after operation were significantly better in Group I compared with Group II (P < .05). Also, DGF during the first week after operation and duration of hospital stay was less in Group I compared with Group II. Intermittent exposure of human living kidney donor to hyperoxic environment may improve renal function following kidney transplantation.
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Imamović G, Zerem E, Osmanović E. Kidney graft outcomes in living-related transplantation have improved with substitution of basiliximab and mycophenolate mofetil for antithymocyte globulin and azathioprine: a single center retrospective cohort study. Eur J Intern Med 2010; 21:524-9. [PMID: 21111938 DOI: 10.1016/j.ejim.2010.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 09/17/2010] [Accepted: 09/21/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND Despite significant reduction in acute rejection rates and improvements in one year kidney allograft outcomes over the past decade, there is an overall lack of improvement in long-term allograft outcomes. We conducted this study to evaluate whether immunosuppressive regimens involving basiliximab and mycophenolate mofetil improved allograft outcomes in living-related kidney transplantation beyond the first year. METHODS In a retrospective cohort study we analyzed kidney graft survival, acute rejection-free survival, kidney function, delayed graft function, and primary non-function in patients receiving an immunosuppressive regimen that included basiliximab and mycophenolate mofetil (group A), and compared to patients receiving antithymocyte globulin and azathioprine (group B). The rest of the treatment protocols remained the same, including cyclosporine A and steroids in both groups. RESULTS Seven-year graft survival rates in groups A and B were 83% and 44%, respectively (p=0.005), 7-year acute rejection-free survival rates were 82% and 53%, respectively (p=0.03), kidney function was better (p=0.004) and its deterioration rate was lower (p=0.006) in patients receiving regimen A. In group A 1 primary non-function event was observed in contrast to 4 composite events of delayed graft function and primary non-function in group B (p>0.05). CONCLUSION Long-term graft outcomes in living-related kidney transplantation have improved with substitution of basiliximab and mycophenolate mofetil for antithymocyte globulin and azathioprine in immunosuppressive protocols.
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Affiliation(s)
- Goran Imamović
- University Clinical Center Tuzla, Department of Nephrology and Dialysis, Tuzla, Bosnia and Herzegovina.
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Kusaka M, Kuroyanagi Y, Ichino M, Sasaki H, Maruyama T, Hayakawa K, Shiroki R, Sugitani A, Kurahashi H, Hoshinaga K. Serum tissue inhibitor of metalloproteinases 1 (TIMP-1) predicts organ recovery from delayed graft function after kidney transplantation from donors after cardiac death. Cell Transplant 2010; 19:723-9. [PMID: 20525436 DOI: 10.3727/096368910x508825] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Donors after cardiac death (DCD) have recently become an important source of renal transplants to alleviate the shortage of renal grafts in kidney transplantation (KTx), although DCD kidneys often have complications associated with a delayed graft function (DGF). A microarray-based approach using renal biopsy samples obtained at 1 h after KTx from DCD identified the tissue inhibitor of metalloproteinases 1 (TIMP-1) gene as a potential predictive marker for DGF. The current study measured serum TIMP-1 in patients undergoing KTx and analyzed the time course after KTx. The average serum TIMP-1 level before KTx was 240 ± 10 ng/ml (n = 34). In patients undergoing KTx from a living donor (n = 23), the serum TIMP-1 levels showed no increase after KTx (POD1: 226 ± 12, POD2: 211 ± 12, and POD3: 195 ± 10 ng/ml), but in one case, the only patient who required post-KTx HD due to DGF, the level on POD1 was the highest among subjects (361 ng/ml). In contrast, patients undergoing KTx from DCDs (n = 11), the serum TIMP-1 levels increased rapidly after a KTx (POD1: 418 ± 32, POD2: 385 ± 42, and POD3: 278 ± 25 ng/ml). However, two patients who avoided post-KTx HD due to the immediate function of the graft did not show increased levels (<370 ng/ml) on either POD1 or POD2. The peak serum TIMP-1 values appeared to correlate to the post-KTx dialysis period. Furthermore, the increment of serum TIMP-1 on the early POD was found to be predictive of immediate or delayed function of the grafts. These data suggest that monitoring of serum TIMP-1 levels allow the prediction of graft recovery and the need for HD after a KTx from a DCD.
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Affiliation(s)
- Mamoru Kusaka
- Department of Urology, Division of Molecular Genetics, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
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Shingu C, Koga H, Hagiwara S, Matsumoto S, Goto K, Yokoi I, Noguchi T. Hydrogen-rich saline solution attenuates renal ischemia-reperfusion injury. J Anesth 2010; 24:569-74. [PMID: 20480186 DOI: 10.1007/s00540-010-0942-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2009] [Accepted: 03/22/2010] [Indexed: 02/07/2023]
Abstract
PURPOSE Renal ischemia-reperfusion (I/R), an important cause of acute kidney injury, is unavoidable during various types of operations, including renal transplantation, surgical revascularization of the renal artery, partial nephrectomy, and treatment of suprarenal aortic aneurysms. Exacerbation of I/R injury is mediated by reactive oxygen species (ROS). A recent study has shown that hydrogen has antioxidant properties. In this study, we tested the hypothesis that a hydrogen-rich saline solution (HRSS) attenuates renal I/R injury in a rodent model. METHODS Rats were treated with an intravenous injection of HRSS or control saline solution followed by renal I/R. After 24 h of treatment, we performed a histological examination and transmission electron microscopy, and measured serum levels of 8-OHdG. RESULTS Histological analysis revealed a marked reduction of interstitial congestion, edema, inflammation, and hemorrhage in renal tissue harvested 24 h after HRSS treatment compared to saline administration. Renal I/R injury, which led to altered mitochondrial morphology, was also inhibited by HRSS. Furthermore, serum 8-OHdG levels were significantly lower in rats treated with HRSS and subjected to renal I/R. CONCLUSIONS These protective effects were likely due to the antioxidant properties of HRSS. These results suggest that HRSS is a potential therapeutic candidate for treating various I/R diseases.
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Affiliation(s)
- Chihiro Shingu
- Department of Anesthesiology and Intensive Care Medicine, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasamamachi, Yufu, Oita, 879-5593, Japan
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Issa F, Schiopu A, Wood KJ. Role of T cells in graft rejection and transplantation tolerance. Expert Rev Clin Immunol 2010; 6:155-69. [PMID: 20383898 DOI: 10.1586/eci.09.64] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Transplantation is the most effective treatment for end-stage organ failure, but organ survival is limited by immune rejection and the side effects of immunosuppressive regimens. T cells are central to the process of transplant rejection through allorecognition of foreign antigens leading to their activation, and the orchestration of an effector response that results in organ damage. Long-term transplant acceptance in the absence of immunosuppressive therapy remains the ultimate goal in the field of transplantation and many studies are exploring potential therapies. One promising cellular therapy is the use of regulatory T cells to induce a state of donor-specific tolerance to the transplant. This article first discusses the role of T cells in transplant rejection, with a focus on the mechanisms of allorecognition and the alloresponse. This is followed by a detailed review of the current progress in the field of regulatory T-cell therapy in transplantation and the translation of this therapy to the clinical setting.
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Affiliation(s)
- Fadi Issa
- Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
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ETS-GS, a new antioxidant, ameliorates renal ischemia-reperfusion injury in a rodent model. J Surg Res 2010; 171:226-33. [PMID: 20451924 DOI: 10.1016/j.jss.2010.01.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 01/12/2010] [Accepted: 01/25/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ischemia-reperfusion (I/R) contributes to acute kidney injury (AKI). On the other hand, anti-oxidative drugs help to prevent renal injury caused by I/R. The current study examined whether a new antioxidant, ETS-GS, inhibits reactive oxygen species (ROS) generation and thereby prevents renal I/R injury in rodent models. METHODS Rats with experimentally-induced renal I/R injury were treated concurrently with an intravenous injection of either ETS-GS or saline. Anesthesia was induced with sevoflurane. RESULTS Histologic examination revealed marked reduction of interstitial congestion, edema, inflammation, and hemorrhage in kidney tissue harvested 24 h after ETS-GS treatment. Renal I/R-induced secretion of nitric oxide (NO) in serum was inhibited by ETS-GS treatment. Furthermore, malondialdehyde (MDA) levels in the kidney were significantly lower in ETS-GS-treated rats with renal I/R. Moreover, when murine macrophage-like RAW264.7 cells were stimulated with antimycin A in the presence or absence of simultaneous ETS-GS treatment, ETS-GS decreased ROS levels. CONCLUSIONS Thus, ETS-GS lowered ROS levels in cultured cells, reduced serum NO levels, decreased renal MDA levels, and protected rats against I/R-induced kidney injury. Given these in vitro and in vivo findings, ETS-GS is a strong candidate for future exploration of therapeutic potential in various human I/R diseases.
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Zynek-Litwin M, Kuzniar J, Marchewka Z, Kopec W, Kusztal M, Patrzalek D, Biecek P, Klinger M. Plasma and urine leukocyte elastase-alpha1protease inhibitor complex as a marker of early and long-term kidney graft function. Nephrol Dial Transplant 2010; 25:2346-51. [PMID: 20164046 DOI: 10.1093/ndt/gfq041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Neutrophils are mediators of ischaemia/reperfusion (I/R) injury following kidney transplantation (kTx). Leukocyte elastase (LE) complex with alpha(1)protease inhibitor (LE-alpha(1)PI) is a marker of neutrophil degranulation. The aim of this study was to evaluate LE-alpha(1)PI as a marker of I/R kidney damage and to search for correlations between leukocyte activation and post-transplant complications. METHODS Plasma and urine LE-alpha(1)PI were estimated in 55 deceased-donor kidney graft recipients on postoperative days (POD) 1, 3 and 7, as well as in the late post-transplant period. RESULTS The plasma LE-alpha(1)PI level peaked on POD 1 after kTx, and the urine LE-alpha(1)PI peaked on POD 3. On POD 1 and POD 3, the urine LE-alpha(1)PI levels were higher in delayed graft function (DGF) patients than in patients with immediate graft function (IGF: P < 0.001 and P < 0.003, respectively). Urine LE-alpha(1)PI excretion on POD 1 was significantly higher in patients with longer cold ischaemia time (CIT) than in patients with shorter CIT, P < 0.002. Multivariate regression model revealed two factors influencing the occurrence of early acute rejection-urine LE-alpha(1)PI complex on POD 3 and human leukocyte antigen (HLA) mismatches. There was a significant association between the plasma LE-alpha(1)PI on POD 3 and serum creatinine level 6 and 12 months after kTx (r(2) 0.24; P < 0.005 and 0.19; P < 0.005, respectively). CONCLUSIONS This study is the first presentation of a simple, non-invasive measurement of neutrophil activation after kTx. It also demonstrates a strong correlation between the early post-transplant LE-alpha(1)PI complex level and kidney graft function.
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Affiliation(s)
- Malgorzata Zynek-Litwin
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.
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Wang Y, John R, Chen J, Richardson JA, Shelton JM, Bennett M, Zhou XJ, Nagami GT, Zhang Y, Wu QQ, Lu CY. IRF-1 promotes inflammation early after ischemic acute kidney injury. J Am Soc Nephrol 2009; 20:1544-55. [PMID: 19443641 DOI: 10.1681/asn.2008080843] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Acute renal ischemia elicits an inflammatory response that may exacerbate acute kidney injury, but the regulation of the initial signals that recruit leukocytes is not well understood. Here, we found that IFN regulatory factor 1 (IRF-1) was a critical, early proinflammatory signal released during ischemic injury in vitro and in vivo. Within 15 min of reperfusion, proximal tubular cells of the S3 segment produced IRF-1, which is a transcription factor that activates proinflammatory genes. Transgenic knockout of IRF-1 ameliorated the impairment of renal function, morphologic injury, and inflammation after acute ischemia. Bone marrow chimera experiments determined that maximal ischemic injury required IRF-1 expression by both leukocytes and radioresistant renal cells, the latter identified as S3 proximal tubule cells in the outer medulla by in situ hybridization and immunohistochemistry. In vitro, reactive oxygen species, generated during ischemia/reperfusion injury, stimulated expression of IRF-1 in an S3 proximal tubular cell line. Taken together, these data suggest that IRF-1 gene activation by reactive oxygen species is an early signal that promotes inflammation after ischemic renal injury.
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Affiliation(s)
- Yanxia Wang
- Department of Internal Medicine-Nephrology, University of Texas Southwestern Medical School, 5323 Harry Hines Boulevard, Dallas, TX 75390-8856, USA
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Knosalla C, Yazawa K, Behdad A, Bodyak N, Shang H, Bühler L, Houser S, Gollackner B, Griesemer A, Schmitt-Knosalla I, Schuurman HJ, Awwad M, Sachs DH, Cooper DKC, Yamada K, Usheva A, Robson SC. Renal and cardiac endothelial heterogeneity impact acute vascular rejection in pig-to-baboon xenotransplantation. Am J Transplant 2009; 9:1006-16. [PMID: 19422330 PMCID: PMC2824173 DOI: 10.1111/j.1600-6143.2009.02602.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Xenograft outcomes are dictated by xenoantigen expression, for example, Gal alpha1, 3Gal (Gal), but might also depend on differing vascular responses. We investigated whether differential vascular gene expression in kidney and cardiac xenografts correlate with development of thrombotic microangiopathy (TM) and consumptive coagulation (CC). Immunosuppressed baboons underwent miniswine or hDAF pig kidney (n = 6) or heart (n = 7), or Gal-transferase gene-knockout (GalT-KO) (thymo)kidney transplantation (n = 14). Porcine cDNA miniarrays determined donor proinflammatory, apoptosis-related and vascular coagulant/fibrinolytic gene expression at defined time points; validated by mRNA, protein levels and immunopathology. hDAF-transgenic and GalT-KO xenografts, (particularly thymokidneys) exhibited prolonged survival. CC was seen with Gal-expressing porcine kidneys (3 of 6), only 1 of 7 baboons postcardiac xenotransplantation and was infrequent following GalT-KO grafts (1 of 14). Protective-type genes (heme oxygenase-I, superoxide dismutases and CD39) together with von Willebrand factor and P-selectin were upregulated in all renal grafts. Transcriptional responses in Gal-expressing xenografts were comparable to those seen in the infrequent GalT-KO rejection. In cardiac xenografts, fibrin deposition was associated with increased plasminogen activator inhibitor-1 expression establishing that gene expression profiles in renal and cardiac xenografts differ in a quantitative manner. These findings suggest that therapeutic targets may differ for renal and cardiac xenotransplants.
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Affiliation(s)
- C. Knosalla
- Transplantation Biology Research Center, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - K. Yazawa
- Transplantation Biology Research Center, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - A. Behdad
- Transplantation and Liver Centers, Beth Israel-Deaconess Medical Center/Harvard Medical School, Boston, MA
| | - N. Bodyak
- Division of Endocrinology, Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA
| | - H. Shang
- Transplantation and Liver Centers, Beth Israel-Deaconess Medical Center/Harvard Medical School, Boston, MA
| | - L. Bühler
- Transplantation Biology Research Center, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - S. Houser
- Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - B. Gollackner
- Transplantation Biology Research Center, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - A. Griesemer
- Transplantation Biology Research Center, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - I. Schmitt-Knosalla
- Laboratory of Immunogenetics and Transplantation, Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | | | - M. Awwad
- Previously at Immerge BioTherapeutics, Cambridge, MA
| | - D. H. Sachs
- Transplantation Biology Research Center, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - D. K. C. Cooper
- Transplantation Biology Research Center, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - K. Yamada
- Transplantation Biology Research Center, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - A. Usheva
- Division of Endocrinology, Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA
| | - S. C. Robson
- Transplantation and Liver Centers, Beth Israel-Deaconess Medical Center/Harvard Medical School, Boston, MA
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Kusaka M, Kuroyanagi Y, Mori T, Nagaoka K, Sasaki H, Maruyama T, Hayakawa K, Shiroki R, Kurahashi H, Hoshinaga K. Global Expression Profiles in 1-Hour Biopsy Specimens of Human Kidney Transplantation from Donors after Cardiac Death. Cell Transplant 2009; 18:647-56. [DOI: 10.1177/096368970901805-621] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Because of the worldwide shortage of renal grafts, kidney transplantation (KTx) from donors after cardiac death (DCD) is an alternative way to obtain KTx from brain-dead donors. Although the prognosis of DCD KTx is gradually improving, the graft often undergoes delayed graft function (DGF), rendering the control of DGF essential for post-KTx patient care. In an attempt to characterize etiology of DGF, genome-wide gene expression profiling was performed using renal biopsy samples performed at 1 h after KTx from DCD and the data were compared with those of KTx from living donors (LD). A total of 526 genes were differentially expressed between them. Genes involved in acute inflammation were activated, while metabolic pathways were consistently downregulated in DCD. These findings imply the inferior performance of the DCD grafts relative to LD grafts. Several genes were identified where the expression levels were correlated well with parameters indicating short- and long-term prognosis of the DCD patients. In addition, several genes encoding secretory proteins were identified that might reflect the performance of the graft and be potential noninvasive biomarkers. These data provide a good source for candidates of biomarkers that are potentially useful for the control of DGF.
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Affiliation(s)
- Mamoru Kusaka
- Department of Urology, Division of Molecular Genetics, Institute for Comprehensive Medical Science and 21st Century COE Program, Development Center for Targeted and Minimally Invasive Diagnosis and Treatment, Fujita Health University School of Medicine, Aichi 470-1192, Japan
| | - Yoko Kuroyanagi
- Department of Urology, Division of Molecular Genetics, Institute for Comprehensive Medical Science and 21st Century COE Program, Development Center for Targeted and Minimally Invasive Diagnosis and Treatment, Fujita Health University School of Medicine, Aichi 470-1192, Japan
| | - Terumi Mori
- Department of Urology, Division of Molecular Genetics, Institute for Comprehensive Medical Science and 21st Century COE Program, Development Center for Targeted and Minimally Invasive Diagnosis and Treatment, Fujita Health University School of Medicine, Aichi 470-1192, Japan
| | - Kayuri Nagaoka
- Department of Urology, Division of Molecular Genetics, Institute for Comprehensive Medical Science and 21st Century COE Program, Development Center for Targeted and Minimally Invasive Diagnosis and Treatment, Fujita Health University School of Medicine, Aichi 470-1192, Japan
| | - Hitomi Sasaki
- Department of Urology, Division of Molecular Genetics, Institute for Comprehensive Medical Science and 21st Century COE Program, Development Center for Targeted and Minimally Invasive Diagnosis and Treatment, Fujita Health University School of Medicine, Aichi 470-1192, Japan
| | - Takahiro Maruyama
- Department of Urology, Division of Molecular Genetics, Institute for Comprehensive Medical Science and 21st Century COE Program, Development Center for Targeted and Minimally Invasive Diagnosis and Treatment, Fujita Health University School of Medicine, Aichi 470-1192, Japan
| | - Kunihiro Hayakawa
- Department of Urology, Division of Molecular Genetics, Institute for Comprehensive Medical Science and 21st Century COE Program, Development Center for Targeted and Minimally Invasive Diagnosis and Treatment, Fujita Health University School of Medicine, Aichi 470-1192, Japan
| | - Ryoichi Shiroki
- Department of Urology, Division of Molecular Genetics, Institute for Comprehensive Medical Science and 21st Century COE Program, Development Center for Targeted and Minimally Invasive Diagnosis and Treatment, Fujita Health University School of Medicine, Aichi 470-1192, Japan
| | - Hiroki Kurahashi
- Department of Urology, Division of Molecular Genetics, Institute for Comprehensive Medical Science and 21st Century COE Program, Development Center for Targeted and Minimally Invasive Diagnosis and Treatment, Fujita Health University School of Medicine, Aichi 470-1192, Japan
| | - Kiyotaka Hoshinaga
- Department of Urology, Division of Molecular Genetics, Institute for Comprehensive Medical Science and 21st Century COE Program, Development Center for Targeted and Minimally Invasive Diagnosis and Treatment, Fujita Health University School of Medicine, Aichi 470-1192, Japan
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Propionyl-L-carnitine prevents early graft dysfunction in allogeneic rat kidney transplantation. Kidney Int 2008; 74:1420-8. [DOI: 10.1038/ki.2008.399] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Kusaka M, Kuroyanagi Y, Mori T, Nagaoka K, Sasaki H, Maruyama T, Hayakawa K, Shiroki R, Kurahashi H, Hoshinaga K. Serum neutrophil gelatinase-associated lipocalin as a predictor of organ recovery from delayed graft function after kidney transplantation from donors after cardiac death. Cell Transplant 2008; 17:129-34. [PMID: 18472448 DOI: 10.3727/000000008783907116] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Because of a worldwide shortage of renal grafts, kidneys procured from donors after cardiac death (DCD) have recently become an important source of renal transplants. However, DCD kidneys often have complications with delayed graft function (DGF) and recipients require hemodialysis (HD) in the early period after kidney transplantation (KTx). This study evaluated serum NGAL as a potential specific parameter to predict early functional recovery of transplanted DCD kidneys. The average serum neutrophil gelatinase-associated lipocalin (NGAL) level in normal samples was 53 +/- 30 ng/ml, while that in patients with chronic renal failure requiring HD was markedly raised at 963 +/- 33 ng/ml. In patients undergoing a living-related KTx from a living donor (n=11), serum NGAL level decreased rapidly after KTx, and only in two cases, with serum NGAL levels over 400 ng/ml on postoperative day 1 (POD1), was HD required due to DGF. In contrast, all patients undergoing a KTx from a DCD (n=5) required HD due to DGF. Even in these cases, serum NGAL levels decreased rapidly several days after a KTx prior to the recovery of urine output and preceding the decrease in serum creatinine level. The pattern of decline in serum NGAL was biphasic, the decrease after the second peak indicating a functional recovery within the next several days. These data suggest that monitoring of serum NGAL levels may allow us to predict graft recovery and the need for HD after a KTx from a DCD.
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Affiliation(s)
- Mamoru Kusaka
- Dept. of Urol, Div. of Molecular Genetics, Inst. for Comp. Med. Sci. and 21st Century COE Program, Dev. Center for Targeted and Minimally Invasive Diagnosis and Treatment, Fujita Health University School of Medicine, Japan.
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Ciferska H, Horak P, Konttinen YT, Krejci K, Tichy T, Hermanova Z, Zadrazil J. Expression of nucleic acid binding Toll-like receptors in control, lupus and transplanted kidneys – a preliminary pilot study. Lupus 2008; 17:580-5. [DOI: 10.1177/0961203307088130] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We hypothesized that nucleic acids, free and/or complexed, filtered and/or locally released, might be entrapped in the kidneys because of the specific nucleic acid binding microbial pattern recognizing Toll-like receptors (TLRs). This hypothesis of nucleic acid binding potential was tested using paraffin sections from healthy control, SLE and transplant kidneys, which were labelled using TLR-specific rabbit or goat anti–human antibodies in immunoperoxidase staining. Normal and transplant kidneys contain some double- (TLR-3) and single-stranded RNA binding (TLR-8) receptors, but in particular double-stranded RNA binding receptor TLR-7, mostly in tubuli, whereas no DNA binding TLR-9 was found. SLE kidneys contain more TLR-3 and TLR-8 and express de novo also TLR-9, in particular in glomeruli. On the contrary, TLR-7 was relatively weak in SLE. It is concluded that kidneys have a capacity to bind nucleic acids. TLR stimulation leads to the production of tumour necrosis factor-α and other pro-inflammatory cytokines and to up-regulation of co-stimulatory molecules necessary for the adaptive immune response. This makes renal tissues a potential target for inflammatory and immune responses in autoimmune disease and in the reaction for the foreign tissue.
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Affiliation(s)
- H Ciferska
- III. Department of Internal Medicine, Faculty of Medicine and Faculty Hospital, University of Olomouc, Olomouc, Czech Republic
| | - P Horak
- III. Department of Internal Medicine, Faculty of Medicine and Faculty Hospital, University of Olomouc, Olomouc, Czech Republic
| | - YT Konttinen
- Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland; ORTON Orthopaedic Hospital of the Invalid Foundation, Helsinki, Finland; Coxa Hospital for the Joint Replacement, Tampere, Finland
| | - K Krejci
- III. Department of Internal Medicine, Faculty of Medicine and Faculty Hospital, University of Olomouc, Olomouc, Czech Republic
| | - T Tichy
- Department of Pathology, Faculty of Medicine and Faculty Hospital, University of Olomouc, Olomouc, Czech Republic
| | - Z Hermanova
- Department of Clinical Immunology, Faculty Hospital, Olomouc, Czech Republic
| | - J Zadrazil
- III. Department of Internal Medicine, Faculty of Medicine and Faculty Hospital, University of Olomouc, Olomouc, Czech Republic
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Lewis AG, Köhl G, Ma Q, Devarajan P, Köhl J. Pharmacological targeting of C5a receptors during organ preservation improves kidney graft survival. Clin Exp Immunol 2008; 153:117-26. [PMID: 18505432 DOI: 10.1111/j.1365-2249.2008.03678.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Cadaveric renal transplants suffer frequently from delayed graft function, which is associated with increased risk for long-term graft survival loss. One-third of kidney grafts that are stored in current organ preservation solutions experience delayed graft function, demonstrating the urgent need for improvement. Although ischaemic graft injury is complex in nature, complement activation is considered important to the process. Here we show that pharmacological targeting of the complement 5a receptor (C5aR) during cold ischaemia has a protective effect on early kidney graft survival, inflammation and apoptosis in a mouse model of syngeneic kidney transplantation. Graft survival of kidneys that were stored in University of Wisconsin solution in the presence of a C5aR antagonist increased from 29% to 57%. Increased graft survival was associated with less tubular damage and apoptosis, protection from sustained C5aR expression and decreased production of tumour necrosis factor-alpha and macrophage inflammatory protein-2. In a translational approach, we determined C5aR expression in paediatric living-related and cadaveric allografts. C5aR expression was significantly higher in all compartments of kidneys from cadaveric compared with kidneys from living-related donors. C5aR expression in cadaveric kidneys correlated positively with cold ischaemia time, renal dysfunction and the frequency of apoptotic tubular cells, suggesting a novel role for C5a in delayed graft function pathogenesis. Supplementing organ preservation solutions with C5aR inhibitors may improve early graft function following cadaveric kidney transplantation.
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Affiliation(s)
- A G Lewis
- Division of Molecular Immunology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, College of Medicine, Cincinnati, OH 45229, USA
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Yarlagadda SG, Coca SG, Garg AX, Doshi M, Poggio E, Marcus RJ, Parikh CR. Marked variation in the definition and diagnosis of delayed graft function: a systematic review. Nephrol Dial Transplant 2008; 23:2995-3003. [PMID: 18408075 DOI: 10.1093/ndt/gfn158] [Citation(s) in RCA: 276] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The term delayed graft function (DGF) is commonly used to describe the need for dialysis after receiving a kidney transplant. DGF increases morbidity after transplantation, prolongs hospitalization and may lead to premature graft failure. Various definitions of DGF are used in the literature without a uniformly accepted technique to identify DGF. METHODS We performed a systematic review of the literature to identify all of the different definitions and diagnostic techniques to identify DGF. RESULTS We identified 18 unique definitions for DGF and 10 diagnostic techniques to identify DGF. CONCLUSIONS The utilization of heterogeneous clinical criteria to define DGF has certain limitations. It will lead to delayed and sometimes inaccurate diagnosis of DGF. Hence a diagnostic test that identifies DGF reliably and early is necessary. Heterogeneity, in the definitions used for DGF, hinders the evolution of a diagnostic technique to identify DGF, which requires a gold standard definition. We are in need of a new definition that is uniformly accepted across the kidney transplant community. The new definition will be helpful in promoting better communication among transplant professionals and aids in comparing clinical studies of diagnostic techniques to identify DGF and thus may facilitate clinical trials of interventions for the treatment of DGF.
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Affiliation(s)
- Sri G Yarlagadda
- Section of Nephrology, Yale University and VAMC, 950 Campbell Ave., Mail Code 151B, Bldg 35 A, Room 219, West Haven, CT 06516, USA
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Courtney AE, Maxwell AP. Heme oxygenase 1: does it have a role in renal cytoprotection? Am J Kidney Dis 2008; 51:678-90. [PMID: 18371544 DOI: 10.1053/j.ajkd.2007.11.033] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2007] [Accepted: 11/28/2007] [Indexed: 12/13/2022]
Abstract
Heme oxygenase (HO) was first identified as the rate-limiting enzyme in the degradative pathway of heme, but is now recognized to be involved in diverse biological processes. Different isoforms of HO exist; HO-1 (HMOX1) is ubiquitously present in mammalian tissue with low constitutive expression under physiological conditions, but is upregulated in response to a variety of potentially noxious stimuli. HO-1, an integral component of an important cytoprotective mechanism, mediates its action through removal of heme, the generation of heme breakdown reaction products (biliverdin, free iron, and carbon monoxide), and modulation of key cellular molecules. Data from experimental models in which HO-1 was induced or inhibited, together with observations in genetically modified animals, showed a beneficial effect of HO-1 in several pathways leading to kidney injury. The discovery of a functional guanosine thymine tandem repeat polymorphism in the promoter region of the human HO-1 gene has stimulated clinical investigations in a variety of diseases. However, despite theoretical and experimental support for an important pathophysiological role for HO-1, the relevance of this polymorphism in native kidney or renal transplant function is equivocal. This article reviews the molecular genetics of HO-1, its myriad cytoprotective effects allied to how these are mediated, and relates these findings to experimental and clinical evidence of HO-1 involvement in renal disease.
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Affiliation(s)
- Aisling E Courtney
- Nephrology Research Group, Queen's University of Belfast, Belfast City Hospital, Belfast BT9 7AB, UK.
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Cytokine gene expression in kidney allograft biopsies after donor brain death and ischemia-reperfusion injury using in situ reverse-transcription polymerase chain reaction analysis. Transplantation 2008; 84:1118-24. [PMID: 17998866 DOI: 10.1097/01.tp.0000287190.86654.74] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study focuses on the cytokine genes expression after brain-death, ischemia-reperfusion injury, and during allograft rejection. METHODS A total of 49 needle core biopsies from kidney transplant recipients, performed before and during transplantation procedures were studied. The first biopsy was taken during procurement of the organ, the second after cold ischemia, and the third after approximately 30 min of reperfusion. We also assessed 34 allograft biopsies obtained during acute rejection. Tubular and glomerular expression of interferon (IFN)-gamma, transforming growth factor (TGF)-beta1, platelet-desired growth factor-B (PDGF-B), interleukin (IL)-2, IL-6, IL-10 mRNA was analyzed with reverse-transcription polymerase chain reaction (RT-PCR) in situ technique, which allows to detect a few copies of the target gene without destruction of the tissue architecture. RESULTS Compared with normal kidney tissue from living donor, high gene expression of IFN-gamma, TGF-beta1, PDGF-B, IL-2, IL-6, and IL-10 was detected in all procurement specimens. After reperfusion gene expressions of IL-2, IL-6, and IL-10 were significantly upregulated in renal tubules compared to biopsies taken after cold ischemia. The gene expression of IFN-gamma, TGF-beta1, and PDGF-B remained stable after organ procurement, during cold ischemia, and after reperfusion. Gene expression of IFN-gamma, IL-2, IL-6, IL-10, and PDGF-B in procurement biopsies, as well as in those taken after cold ischemia and reperfusion, were significantly higher than during the period of acute rejection. CONCLUSION The data presented herein strongly point out the importance of the immunological and morphological injury that occurs before and during transplantation. The increase of inflammatory response after brain death is important for further stimulation of the immune response and long-term kidney survival.
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Krogerus L, Soots A, Loginov R, Bruggeman C, Lautenschlager I. CMV increases tubular apoptosis through the TNF-alpha-TNF-R1 pathway in a rat model of chronic renal allograft rejection. Transpl Immunol 2007; 18:232-6. [PMID: 18047930 DOI: 10.1016/j.trim.2007.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2006] [Accepted: 07/24/2007] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Destruction of transplanted kidneys through chronic allograft nephropathy [CAN], also known as chronic rejection, is the greatest obstacle in successful kidney transplantation. Causes behind CAN are many, from pre-transplant causes to infections. Viral infections, especially CMV, are a risk factor for chronic rejection. We have previously developed a rat kidney transplant model, in which CMV enhances the development of chronic rejection under triple drug treatment. In this model we have now further studied the routes of apoptosis in virus induced early CAN vs. the routes of apoptosis in a later developing non-infectious CAN. MATERIALS AND METHODS Renal transplantations were performed in a strain combination of DA/BN under immunosuppression. One group of animals was infected with RCMV and the other was left uninfected. The grafts were harvested on days 3-40 after transplantation. Apoptotic cells were visualised by in situ terminal transferase mediated dUTP nick end labelling [TUNEL] from paraffin embedded, formalin fixed kidney grafts. Cytokines were labelled imunohistochemically from frozen sections, among them tumour necrosis factor alpha [TNF-alpha] and its receptor-protein 1 [TNF-R1] as well as CD 95 [FAS], caspase 3 and CD14. The results were semi-quantitatively scored from 0 to 3+ over various tissues structures separately. RESULTS In the CMV infected grafts, we could demonstrate a more intense TUNEL reaction in tubular epithelium [2.0+/-1.0 vs. 0.8+/-0.5 at day 14, P<0.05] as well as an earlier increase in the expression TNF-alpha in the vascular endothelium [2.0+1.0 vs. 0.0+0.0 at days 3-5, P<0.05] than in the non-infected group. There was also an earlier increase in the tubular TNF-R1 expression [2.2+0.8 vs. 1.0+0.0 at days 5-7, P<0.05]. There was no difference in the expression of CD14, caspase 3 or FAS between the groups. CONCLUSIONS CMV enhanced development of CAN was associated with tubular apoptosis and concomitant increase of TNF-alpha-TNF-R1, rather than the FAS-FAS-ligand activation.
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Affiliation(s)
- Leena Krogerus
- Department of Pathology, Helsinki University Hospital, and University of Helsinki, 00029 HUS, Helsinki, Finland.
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Lu CY, Hartono J, Senitko M, Chen J. The inflammatory response to ischemic acute kidney injury: a result of the 'right stuff' in the 'wrong place'? Curr Opin Nephrol Hypertens 2007; 16:83-9. [PMID: 17293682 DOI: 10.1097/mnh.0b013e3280403c4e] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Ischemic acute kidney injury may be exacerbated by an inflammatory response. How injury elicits inflammation remains a major question in understanding acute kidney injury. The present review examines the hypothesis that molecules released by injured cells elicit inflammation. RECENT FINDINGS After necrotic death, intracellular molecules find their way into the extracellular space. These molecules include heat shock proteins and HMGB1. Receptors for these proteins include TLR4, TLR2, CD91 and RAGE. These proinflammatory mechanisms may be so useful that nature has evolved mechanisms for programming necrotic death via poly(ADP-ribose) polymerase and cyclophilin D. In addition, apoptosis may also elicit inflammation. SUMMARY The concepts discussed in this review are important for clinical medicine. Drugs and genetic manipulation may ameliorate ischemic kidney injury by regulating the inflammatory response to cell injury.
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Affiliation(s)
- Christopher Y Lu
- Department of Internal Medicine, Nephrology Division, UT Southwestern Medical Center, Dallas, Texas 63110, USA.
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50
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Rouabhia M, Gilbert V, Wang H, Subirade M. In vivo
evaluation of whey protein-based biofilms as scaffolds for cutaneous cell cultures and biomedical applications. Biomed Mater 2007; 2:S38-44. [DOI: 10.1088/1748-6041/2/1/s06] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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