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Saha A, Kapadia SF, Vala KB, Trivedi VB, Patel HV, Shah PR, Kute VB. De novo Donor-specific Anti-human Leukocyte Antigen Antibody and Its Outcome in Pediatric Renal Transplant Recipients: A Single-center Experience in India. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2023; 34:87-95. [PMID: 38092720 DOI: 10.4103/1319-2442.391006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Development of de novo donor-specific anti-HLA antibody (dnDSA) is associated with poor graft survival in adults. However, there is a paucity of data about its prevalence and outcome in Indian children. We retrospectively assessed the proportion and spectrum of dnDSA and its outcome on antibody-mediated rejection (ABMR) and graft function. Children ≤18 years who were transplanted between November 2016 and October 2019 were included in this study. Pretransplant donor-specific antibody (DSA) was screened by complement-dependent cytotoxicity, flow cytometry crossmatch, and single antigen bead (SAB) class I and II by Luminex platform. Either antithymocyte globulin or basiliximab was used as induction. Tacrolimus, mycophenolate, and prednisolone were used for the maintenance of immunosuppression. SAB screening was done at 1, 3, 6 months, and yearly in seven children and at the time of acute graft dysfunction in eight. Mean fluorescence intensity ≥1000 was considered positive. Protocol biopsies were done at 3, 6, and 12 months and annually thereafter in seven children. Fifteen children, all males with a median age (interquartile range) of 13 years (11; 15.5) were analyzed. Only one child had pretransplant DSA who developed dnDSA posttransplant. Overall, 8 (53%) developed dnDSA over a median follow-up of 18 months. Seven (87%) had Class II, one Class I and 3 (37%) both Class I and II. Six had dQ and two had DR. All children with dnDSA had ABMR, of these two had subclinical rejection. DSAs persisted despite treatment, though graft function improved. Children with DSA and ABMR had lower graft function than those without DSA. The proportion of dnDSA was high in our study, majority against DQ. The detection of dnDSA prompted early diagnosis and treatment of ABMR.
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Affiliation(s)
- Anshuman Saha
- Department of Pediatric Nephrology, Institute of Kidney Diseases and Research Center, Ahmedabad, Gujarat, India
| | - Shahenaz F Kapadia
- Department of Pediatric Nephrology, Institute of Kidney Diseases and Research Center, Ahmedabad, Gujarat, India
| | - Kinnari B Vala
- Department of Pediatric Nephrology, Institute of Kidney Diseases and Research Center, Ahmedabad, Gujarat, India
| | - Varsha B Trivedi
- Department of Transplant Immunology Lab, Institute of Kidney Diseases and Research Center, Ahmedabad, Gujarat, India
| | - Himanshu V Patel
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Ahmedabad, Gujarat, India
| | - Pankaj R Shah
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Ahmedabad, Gujarat, India
| | - Vivek B Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Ahmedabad, Gujarat, India
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Bajaj S, Gershony S, Afshar K, Blydt-Hansen TD. Clinical indicators of slow graft function and outcome after pediatric kidney transplantation. Pediatr Transplant 2022; 26:e14353. [PMID: 35781749 DOI: 10.1111/petr.14353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Lesser degrees of perioperative ischemia-reperfusion injury that does not require dialysis may nonetheless influence allograft outcomes, necessitating evaluation of suitable surrogate indicators of perioperative allograft injury. METHODS This retrospective analysis of pediatric kidney transplants evaluated two indicators representing pace and completeness of recovery, for association with 12-month estimated glomerular filtration rate (eGFR) and first-year rate of eGFR decline: time to creatinine nadir (TTN) and ratio of recipient/donor unadjusted GFR (uGFRR/D ) at 1-month post-transplant. Donor, recipient, and perioperative risk factors were tested further for association with these 2 indicators. RESULTS 179 patients (190 transplants) aged 13 (IQR 7-17) years and 56% male were included. Twelve-month eGFR was strongly associated with unadjusted GFR at 1 month (uGFR1M , p < .001) and uGFRR/D (p = .003), but not with TTN. None of the indicators was associated with the rate of subsequent eGFR decline after 1-month post-transplant. As a potential surrogate indicator, uGFR1M is effectively modeled by TTN and uGFRR/D (adjusted R2 = 0.57) and is associated with 12-month eGFR (β = 0.81 ± 0.08; p < .001). Clinical factors associated with uGFRR/D included donor uGFR (p < .001), BSA (p = .026), age (p = .074), and recipient BSA (p < .001). Factors associated with pace of recovery (TTN) included donor uGFR (p = .018), type (p = .019), and recipient BSA (p = .022). CONCLUSIONS The uGFRR/D ratio, but not TTN, is a useful indicator of perioperative allograft damage that is associated with one-year functional outcome; and uGFR1M is a potential early surrogate outcome. Donor, recipient, and perioperative factors that are associated with slow allograft function are identified.
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Affiliation(s)
- Sargun Bajaj
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sharon Gershony
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kourosh Afshar
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tom David Blydt-Hansen
- Department of Pediatrics (Nephrology), University of British Columbia, Vancouver, British Columbia, Canada
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Personalized Prediction of Kidney Function Decline and Network Analysis of the Risk Factors after Kidney Transplantation Using Nationwide Cohort Data. J Clin Med 2022; 11:jcm11051259. [PMID: 35268350 PMCID: PMC8911006 DOI: 10.3390/jcm11051259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/13/2022] [Accepted: 02/22/2022] [Indexed: 02/04/2023] Open
Abstract
We developed a machine-learning-based model that could predict a decrease in one-year graft function after kidney transplantation, and investigated the risk factors of the decreased function. A total of 4317 cases were included from the Korean Organ Transplant Registry (2014−2019). An XGBoost model was trained to predict the recipient’s one-year estimated glomerular filtration rate (eGFR) below 45 mL/min/1.73 m2 using 112 pre- and peri-transplantation variables. The network of model factors was drawn using inter-factor partial correlations and the statistical significance of each factor. The model with seven features achieved an area under the curve of 0.82, sensitivity of 0.73, and specificity of 0.79. The model prediction was associated with five-year graft and rejection-free survival. Post-transplantation hospitalization >25 days and eGFR ≥ 88.0 were the prominent risk and preventive factors, respectively. Donor age and post-transplantation eGFR < 59.8 were connected to multiple risk factors on the network. Therefore, careful donor−recipient matching in older donors, and avoiding pre-transplantation risk factors, would reduce the risk of graft dysfunction. The model might improve long-term graft outcomes by supporting early detection of graft dysfunction, and proactive risk factor control.
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Lee YH, Sato Y, Saito M, Fukuma S, Saito M, Yamamoto S, Komatsuda A, Fujiyama N, Satoh S, Lee SH, Boor P, Habuchi T, Floege J, Yanagita M. Advanced Tertiary Lymphoid Tissues in Protocol Biopsies are Associated with Progressive Graft Dysfunction in Kidney Transplant Recipients. J Am Soc Nephrol 2022; 33:186-200. [PMID: 34725107 PMCID: PMC8763171 DOI: 10.1681/asn.2021050715] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 09/13/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Tertiary lymphoid tissues (TLTs) are ectopic lymphoid tissues found in chronically inflamed organs. Although studies have documented TLT formation in transplanted kidneys, the clinical relevance of these TLTs remains controversial. We examined the effects of TLTs on future graft function using our histologic TLT maturity stages and the association between TLTs and Banff pathologic scores. We also analyzed the risk factors for the development of TLTs. METHODS Serial protocol biopsy samples (0 hour, 1, 6, and 12 months) without rejection were retrospectively analyzed from 214 patients who underwent living donor kidney transplantation. TLTs were defined as lymphocyte aggregates with signs of proliferation and their stages were determined by the absence (stage I) or presence (stage II) of follicular dendritic cells. RESULTS Only 4% of patients exhibited TLTs at the 0-hour biopsy. Prevalence increased to almost 50% at the 1-month biopsy, and then slightly further for 12 months. The proportion of advanced stage II TLTs increased gradually, reaching 19% at the 12-month biopsy. Presence of stage II TLTs was associated with higher risk of renal function decline after transplantation compared with patients with no TLT or stage I TLTs. Stage II TLTs were associated with more severe tubulitis and interstitial fibrosis/tubular atrophy at 12 months and predicted poorer graft function independently from the degree of interstitial inflammation. Pretransplantation rituximab treatment dramatically attenuated the development of stage II TLTs. CONCLUSIONS TLTs are commonly found in clinically stable transplanted kidneys. Advanced stage II TLTs are associated with progressive graft dysfunction, independent of interstitial inflammation.
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Affiliation(s)
- Yu Ho Lee
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan,Division of Nephrology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Yuki Sato
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan,Medical Innovation Center TMK Project, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mitsuru Saito
- Department of Urology, Graduate School of Medicine, Akita University, Akita, Japan
| | - Shingo Fukuma
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masaya Saito
- Department of Hematology, Nephrology, and Rheumatology, Graduate School of Medicine, Akita University, Akita, Japan
| | - Shigenori Yamamoto
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan,Medical Innovation Center TMK Project, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Atsushi Komatsuda
- Department of Hematology, Nephrology, and Rheumatology, Graduate School of Medicine, Akita University, Akita, Japan
| | - Nobuhiro Fujiyama
- Center for Kidney Disease and Transplantation, Akita University Hospital, Akita, Japan
| | - Shigeru Satoh
- Center for Kidney Disease and Transplantation, Akita University Hospital, Akita, Japan
| | - Sang-Ho Lee
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Peter Boor
- Institute of Pathology, RWTH University of Aachen, Germany, Aachen, Germany,Division of Nephrology, RWTH University of Aachen, Germany, Aachen, Germany,Electron Microscopy Facility, RWTH University of Aachen, Aachen, Germany
| | - Tomonori Habuchi
- Department of Urology, Graduate School of Medicine, Akita University, Akita, Japan
| | - Jürgen Floege
- Division of Nephrology, RWTH University of Aachen, Germany, Aachen, Germany
| | - Motoko Yanagita
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan,Institute for the Advanced Study of Human Biology (ASHBi), Kyoto University, Kyoto, Japan
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Aubert O, Divard G, Pascual J, Oppenheimer F, Sommerer C, Citterio F, Tedesco H, Chadban S, Henry M, Vincenti F, Srinivas T, Watarai Y, Legendre C, Bernhardt P, Loupy A. Application of the iBox prognostication system as a surrogate endpoint in the TRANSFORM randomised controlled trial: proof-of-concept study. BMJ Open 2021; 11:e052138. [PMID: 34620664 PMCID: PMC8499283 DOI: 10.1136/bmjopen-2021-052138] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Development of pharmaceutical agents in transplantation is currently limited by long waits for hard endpoints. We applied a validated integrative risk-prognostication system integrative Box (iBox) as a surrogate endpoint to the TRANSFORM Study, a large randomised controlled trial, to project individual patient long-term kidney allograft survival from 1 year to 11 years after randomisation. DESIGN Post-hoc analysis of a randomised open-label controlled trial. SETTING Multicentre study including 186 centres in 42 countries worldwide. PARTICIPANTS 2037 de novo kidney transplant recipients. INTERVENTION Participants were randomised (1:1) to receive everolimus with reduced-exposure calcineurin inhibitor (EVR+rCNI) or mycophenolic acid with standard-exposure CNI (MPA+sCNI). PRIMARY OUTCOME MEASURE The iBox scores were computed for each participant at 1 year after randomisation using functional, immunological and histological parameters. Individual long-term death-censored allograft survival over 4, 6 and 11 years after randomisation was projected with the iBox risk-prognostication system. RESULTS Overall, 940 patients receiving EVR+rCNI and 932 receiving MPA+sCNI completed the 1-year visit. iBox scores generated at 1 year yielded graft survival prediction rates of 90.9% vs 92.1%, 87.9% vs 89.5%, and 80.0% vs 82.4% in the EVR+rCNI versus MPA+sCNI arms at 4, 6, and 11 years post-randomisation, respectively (all differences below the 10% non-inferiority margin defined by study protocol). Inclusion of immunological and histological Banff diagnoses parameters in iBox scores resulted in comparable and non-inferior predicted graft survival for both treatments. CONCLUSIONS This proof-of-concept study provides the first application of a validated prognostication system as a surrogate endpoint in the field of transplantation. The iBox system, by projecting kidney allograft survival up to 11 years post-randomisation, confirms the non-inferiority of EVR+rCNI versus MPA+sCNI regimen. Given the current process engaged for surrogate endpoints qualification, this study illustrates the potential to fast track development of pharmaceutical agents. TRIAL REGISTRATION NUMBER TRANSFORM trial: NCT01950819.iBox prognostication system: NCT03474003.
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Affiliation(s)
- Olivier Aubert
- University of Paris, INSERM, PARCC, Paris Translational Research Centre for Organ Transplantation, Paris, France
- Kidney Transplant Department, Necker Hospital, APHP, Paris, France
| | - Gillian Divard
- University of Paris, INSERM, PARCC, Paris Translational Research Centre for Organ Transplantation, Paris, France
- Kidney Transplant Department, Necker Hospital, APHP, Paris, France
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Federico Oppenheimer
- Department of Nephrology and Renal Transplantation, Renal Transplant Unit, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Claudia Sommerer
- Department of Nephrology, University Hospital Heidelberg, Heidelberg, Germany
| | - Franco Citterio
- Agostino Gemelli University Polyclinic Foundation, Catholic University of the Sacred Heart, Milan, Italy
| | - Helio Tedesco
- Nephrology Division, Hospital do Rim, UNIFESP, Sao Paulo, Brazil
| | - Steve Chadban
- Department of Renal Medicine and Transplantation, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Mitchell Henry
- Department of Surgery, The Comprehensive Transplant Center, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Flavio Vincenti
- Department of Surgery, Kidney Transplant Service, University of California San Francisco, San Francisco, California, USA
| | - Titte Srinivas
- Division of Nephrology and Hypertension, University Hospitals of Cleveland, Cleveland, Ohio, USA
| | - Yoshihiko Watarai
- Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Christophe Legendre
- University of Paris, INSERM, PARCC, Paris Translational Research Centre for Organ Transplantation, Paris, France
- Kidney Transplant Department, Necker Hospital, APHP, Paris, France
| | - Peter Bernhardt
- Department of Research and Development, Novartis, Basel, Switzerland
| | - Alexandre Loupy
- University of Paris, INSERM, PARCC, Paris Translational Research Centre for Organ Transplantation, Paris, France
- Kidney Transplant Department, Necker Hospital, APHP, Paris, France
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6
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Codina S, Manonelles A, Tormo M, Sola A, Cruzado JM. Chronic Kidney Allograft Disease: New Concepts and Opportunities. Front Med (Lausanne) 2021; 8:660334. [PMID: 34336878 PMCID: PMC8316649 DOI: 10.3389/fmed.2021.660334] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/10/2021] [Indexed: 12/12/2022] Open
Abstract
Chronic kidney disease (CKD) is increasing in most countries and kidney transplantation is the best option for those patients requiring renal replacement therapy. Therefore, there is a significant number of patients living with a functioning kidney allograft. However, progressive kidney allograft functional deterioration remains unchanged despite of major advances in the field. After the first post-transplant year, it has been estimated that this chronic allograft damage may cause a 5% graft loss per year. Most studies focused on mechanisms of kidney graft damage, especially on ischemia-reperfusion injury, alloimmunity, nephrotoxicity, infection and disease recurrence. Thus, therapeutic interventions focus on those modifiable factors associated with chronic kidney allograft disease (CKaD). There are strategies to reduce ischemia-reperfusion injury, to improve the immunologic risk stratification and monitoring, to reduce calcineurin-inhibitor exposure and to identify recurrence of primary renal disease early. On the other hand, control of risk factors for chronic disease progression are particularly relevant as kidney transplantation is inherently associated with renal mass reduction. However, despite progress in pathophysiology and interventions, clinical advances in terms of long-term kidney allograft survival have been subtle. New approaches are needed and probably a holistic view can help. Chronic kidney allograft deterioration is probably the consequence of damage from various etiologies but can be attenuated by kidney repair mechanisms. Thus, besides immunological and other mechanisms of damage, the intrinsic repair kidney graft capacity should be considered to generate new hypothesis and potential therapeutic targets. In this review, the critical risk factors that define CKaD will be discussed but also how the renal mechanisms of regeneration could contribute to a change chronic kidney allograft disease paradigm.
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Affiliation(s)
- Sergi Codina
- Department of Nephrology, Hospital Universitari Bellvitge, Barcelona, Spain
- Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
| | - Anna Manonelles
- Department of Nephrology, Hospital Universitari Bellvitge, Barcelona, Spain
| | - Maria Tormo
- Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
| | - Anna Sola
- Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
| | - Josep M. Cruzado
- Department of Nephrology, Hospital Universitari Bellvitge, Barcelona, Spain
- Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
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7
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Fan M, Xing Z, Du Y, Pan L, Sun Y, He X. Quantitative assessment of renal allograft pathologic changes: comparisons of mono-exponential and bi-exponential models using diffusion-weighted imaging. Quant Imaging Med Surg 2020; 10:1286-1297. [PMID: 32550137 DOI: 10.21037/qims-19-985a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Diffusion-weighted imaging (DWI) can noninvasively assess renal allograft pathologic changes that provide useful information for clinical management and prognostication. However, it is still unknown whether the bi-exponential model analysis of DWI signals is superior to that of the mono-exponential model. Methods Pathologic and DWI data from a total of 47 allografts were prospectively collected and analyzed. Kidney transplant interstitial fibrosis was quantified digitally. The severity of acute and chronic pathologic changes was semi-quantified by calculating the acute composite scores (ACS) and chronic composite score (CCS). Mono-exponential total apparent diffusion coefficient (ADCT), and the bi-exponential parameters of true diffusion (D) and perfusion fraction (fp) were acquired. The diagnostic performances of both mono-exponential and bi-exponential parameters were assessed and compared by calculating the area under the curve (AUC) from receiver-operating characteristic (ROC) curve analysis. Results ADCT, D, and fp were all significantly correlated with interstitial fibrosis, ACS, and CCS. Cortical fp discriminated mild from moderate and severe ACS with the largest AUC of 0.89 [95% confidence interval (CI), 0.77-0.96]. Noticeably, only cortical fp could differentiate severe ACS from mild-to-moderate ACS (P<0.001) with an AUC of 0.80 (95% CI, 0.65-0.90) and a sensitivity of 100% (95% CI, 66.4-100%). Strikingly, the joint use of D and fp in either the cortex or the medulla could achieve a sensitivity of 100% for identifying either mild or severe interstitial fibrosis. Meanwhile, the serial use of cortical D and cortical fp showed the largest specificity for identifying both mild [88.9% (95% CI, 70.8-97.6%)] and severe [84.4% (95% CI, 67.2-94.7%)] interstitial fibrosis. For identifying mild CCS, the AUC of medullary ADCT (0.90, 95% CI, 0.78-0.97) was similar to that of cortical D (0.81, 95% CI, 0.67-0.91) and fp (0.86, 95% CI, 0.73-0.94), but statistically larger than that of medullary D (P=0.005) and fp (P=0.01). Furthermore, the parallel use of cortical D and cortical fp could increase the sensitivity to 95.0% (95% CI, 75.1-99.9%), whereas serial use of medullary D and medullary fp could increase the specificity to 100% (95% CI, 87.2-100%). The AUCs for differentiating severe from mild and moderate CCS were statistically insignificant among all parameters in the cortex and medulla (P≥0.15). Conclusions Cortical fp was superior to the ADCT for identifying both mild and severe acute pathologic changes. Nevertheless, ADCT was equal to or better than single D or fp for evaluating chronic pathologic changes. Thus, both monoexponential and bi-exponential analysis of DWI images are complementary for evaluating kidney allograft pathologic changes, and the combined use of D and fp can increase the sensitivity and specificity for discriminating allograft pathologic changes severity.
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Affiliation(s)
- Min Fan
- Department of Urology, the Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Zhaoyu Xing
- Department of Urology, the Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Yanan Du
- Department of Radiology, the Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Liang Pan
- Department of Radiology, the Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Yangyang Sun
- Department of Urology, the Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Xiaozhou He
- Department of Urology, the Third Affiliated Hospital of Soochow University, Changzhou 213003, China
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8
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Sim JH, Han SS, Lee DS, Kim YS, Lee H, Kim HR. Analysis of Immune Cell Repopulation After Anti-thymocyte Globulin Administration for Steroid-Resistant T-cell–mediated Rejection. Transplant Proc 2020; 52:759-766. [DOI: 10.1016/j.transproceed.2020.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 01/03/2020] [Accepted: 01/22/2020] [Indexed: 01/05/2023]
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9
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Sexton DJ, O'Kelly P, Williams Y, Plant WD, Keogan M, Khalib K, Doyle B, Dorman A, Süsal C, Unterrainer C, Forde J, Power R, Smith G, Mohan P, Denton M, Magee C, de Freitas DG, Little D, O'Seaghdha CM, Conlon PJ. Progressive improvement in short‐, medium‐ and long‐term graft survival in kidney transplantation patients in Ireland – a retrospective study. Transpl Int 2019; 32:974-984. [DOI: 10.1111/tri.13470] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 11/23/2018] [Accepted: 06/12/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Donal J. Sexton
- National Kidney Transplant Service Department of Nephrology and Kidney Transplantation Beaumont Hospital Dublin Ireland
| | - Patrick O'Kelly
- National Kidney Transplant Service Department of Nephrology and Kidney Transplantation Beaumont Hospital Dublin Ireland
| | - Yvonne Williams
- National Kidney Transplant Service Department of Nephrology and Kidney Transplantation Beaumont Hospital Dublin Ireland
- Department of Transplant Urology Beaumont Hospital Dublin Ireland
| | - William D. Plant
- The National Renal Office Health Service Executive of Ireland Cork University Hospital University College Cork Cork Ireland
| | - Marie Keogan
- Department of Immunology Beaumont Hospital Dublin Ireland
| | - Khairin Khalib
- Department of Immunology Beaumont Hospital Dublin Ireland
| | - Brendan Doyle
- Department of Pathology Beaumont Hospital Dublin Ireland
| | - Anthony Dorman
- Department of Pathology Beaumont Hospital Dublin Ireland
| | - Caner Süsal
- Collaborative Transplant Study Institute of Immunology Heidelberg University Heidelberg Germany
| | - Christian Unterrainer
- Collaborative Transplant Study Institute of Immunology Heidelberg University Heidelberg Germany
| | - James Forde
- Department of Transplant Urology Beaumont Hospital Dublin Ireland
| | - Richard Power
- Department of Transplant Urology Beaumont Hospital Dublin Ireland
| | - Gordon Smith
- Department of Transplant Urology Beaumont Hospital Dublin Ireland
| | - Ponnusamy Mohan
- Department of Transplant Urology Beaumont Hospital Dublin Ireland
| | - Mark Denton
- National Kidney Transplant Service Department of Nephrology and Kidney Transplantation Beaumont Hospital Dublin Ireland
| | - Colm Magee
- National Kidney Transplant Service Department of Nephrology and Kidney Transplantation Beaumont Hospital Dublin Ireland
| | - Declan G. de Freitas
- National Kidney Transplant Service Department of Nephrology and Kidney Transplantation Beaumont Hospital Dublin Ireland
| | - Dilly Little
- Department of Transplant Urology Beaumont Hospital Dublin Ireland
| | - Conall M. O'Seaghdha
- National Kidney Transplant Service Department of Nephrology and Kidney Transplantation Beaumont Hospital Dublin Ireland
| | - Peter J. Conlon
- National Kidney Transplant Service Department of Nephrology and Kidney Transplantation Beaumont Hospital Dublin Ireland
- Royal College of Surgeons in Ireland Dublin Ireland
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10
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DuBay DA, Su Z, Morinelli TA, Baliga P, Rohan V, Bian J, Northrup D, Pilch N, Rao V, Srinivas TR, Mauldin PD, Taber DJ. Development and future deployment of a 5 years allograft survival model for kidney transplantation. Nephrology (Carlton) 2019; 24:855-862. [PMID: 30198104 DOI: 10.1111/nep.13488] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2018] [Indexed: 01/13/2023]
Abstract
AIM Identifying kidney transplant patients at highest risk for graft loss prior to loss may allow for effective interventions to improve 5 years survival. METHODS We performed a 10 years retrospective cohort study of adult kidney transplant recipients (n = 1747). We acquired data from electronic health records, United Network of Organ Sharing, social determinants of health, natural language processing data extraction, and real-time capture of dynamically evolving clinical data obtained within 1 year of transplant; from which we developed a 5 years graft survival model. RESULTS Total of 1439 met eligibility; 265 (18.4%) of them experienced graft loss by 5 years. Graft loss patients were characterized by: older age, being African-American, diabetic, unemployed, smokers, having marginal donor kidneys and cardiovascular comorbidities. Predictive dynamic variables included: low mean blood pressure, higher pulse pressures, higher heart rate, anaemia, lower estimated glomerular filtration rate peak, increased tacrolimus variability, rejection and readmissions. This Big Data analysis generated a 5 years graft loss model with an 82% predictive capacity, versus 66% using baseline United Network of Organ Sharing data alone. CONCLUSION Our analysis yielded a 5 years graft loss model demonstrating superior predictive capacity compared with United Network of Organ Sharing data alone, allowing post-transplant individualized risk-assessed care prior to transitioning back to community care.
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Affiliation(s)
- Derek A DuBay
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Zemin Su
- Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Thomas A Morinelli
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Prabhakar Baliga
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Vinayak Rohan
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - John Bian
- Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David Northrup
- Office of the Chief Information Officer, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nicole Pilch
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Vinaya Rao
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Patrick D Mauldin
- Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David J Taber
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.,Department of Pharmacy, Ralph H Johnson VAMC, Charleston, South Carolina, USA
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11
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Nariman‐Saleh‐Fam Z, Bastami M, Ardalan M, Sharifi S, Hosseinian Khatib SM, Zununi Vahed S. Cell‐free microRNA‐148a is associated with renal allograft dysfunction: Implication for biomarker discovery. J Cell Biochem 2018; 120:5737-5746. [DOI: 10.1002/jcb.27860] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 09/19/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Ziba Nariman‐Saleh‐Fam
- Women’s Reproductive Health Research Center, Tabriz University of Medical Sciences Tabriz Iran
| | - Milad Bastami
- Department of Medical Genetics Faculty of Medicine, Tabriz University of Medical Sciences Tabriz Iran
| | | | - Simin Sharifi
- Dental and Periodontal Research Center, Tabriz University of Medical Sciences Tabriz Iran
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12
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Early Graft Loss after Kidney Transplantation: Endothelial Dysfunction of Renal Microvasculature. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4074209. [PMID: 30148166 PMCID: PMC6083599 DOI: 10.1155/2018/4074209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 07/18/2018] [Indexed: 11/27/2022]
Abstract
Decision process about the acceptance of the deceased donor kidney for transplantation might be challenging. Although histological evaluation of pretransplant donor kidney biopsy provides reliable information regarding cortical necrosis, vascular thrombosis, extensive global glomerulosclerosis, and interstitial fibrosis/tubular atrophy, only electron microscopy enables thorough and reliable insights into microvasculature changes of kidney graft. The aim of the present paper is to briefly present two cases of early kidney graft loss. In one case, the donor was exposed to long-term extracorporeal membrane oxygenation (ECMO); in the other case, the donor experienced Takotsubo cardiomyopathy. In both cases, light microscopy of pretransplant biopsy found no pathology or significant discrepancy in morphology of kidney graft, while electron microscopy revealed severe endothelial dysfunction of renal microvasculature. Our results suggest that severe injury of renal microvasculature with relatively preserved tubular epithelium may be associated with some conditions of deceased kidney donors leading to early kidney graft nonfunction and loss. Further studies are needed to determine prognostic significance of severe ultrastructural microvasculature lesions and to evaluate disease states and conditions that could be associated with severe endothelial dysfunction of kidney graft.
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13
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Zhang H, Gao S, Yan L, Zhu G, Zhu Q, Gu Y, Shao F. EPO Derivative ARA290 Attenuates Early Renal Allograft Injury in Rats by Targeting NF-κB Pathway. Transplant Proc 2018; 50:1575-1582. [DOI: 10.1016/j.transproceed.2018.03.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/01/2018] [Indexed: 02/06/2023]
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14
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Galichon P, Xu-Dubois YC, Buob D, Tinel C, Anglicheau D, Benbouzid S, Dahan K, Ouali N, Hertig A, Brocheriou I, Rondeau E. Urinary transcriptomics reveals patterns associated with subclinical injury of the renal allograft. Biomark Med 2018; 12:427-438. [PMID: 29697267 DOI: 10.2217/bmm-2017-0330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Subclinical pathological features in renal allograft biopsies predict poor outcomes, and noninvasive biomarkers are wanted. RNA quantification in urine predicts overt rejection. We hypothesized that a whole transcriptome analysis would be informative, even for discrete injury. PATIENTS & METHODS We performed an mRNA microarray with an optimized normalization method on 26 urinary cell pellets to study renal partial epithelial to mesenchymal transition (pEMT) in stable kidney allografts. RESULTS & CONCLUSION Unbiased pathway analysis revealed immune response as the main underlying biological process. In a subgroup of pristine biopsies, isolated pEMT was associated with reduced metabolic functions. Thus, pEMT translates into specific urinary mRNA patterns, in other words, increased inflammation and decreased metabolic functions. Deposited in Gene Expression Omnibus (GSE89652).
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Affiliation(s)
- Pierre Galichon
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S1155, Paris, France.,Institut National de la Santé et de la Recherche Médicale, UMR_S1155, Paris, France.,Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, APHP, Paris, France
| | - Yi-Chun Xu-Dubois
- Institut National de la Santé et de la Recherche Médicale, UMR_S1155, Paris, France.,Service de Santé Publique, Hôpital Tenon, APHP, Paris, France
| | - David Buob
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S1155, Paris, France.,Institut National de la Santé et de la Recherche Médicale, UMR_S1155, Paris, France.,Service d'Anatomie Pathologique, Hôpital Tenon, APHP, Paris, France
| | - Claire Tinel
- Service de Néphrologie et Transplantation Adulte, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Dany Anglicheau
- Service de Néphrologie et Transplantation Adulte, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,RTRS « Centaure », Labex « Transplantex », Paris, France
| | | | - Karine Dahan
- Néphrologie et Dialyses, Hôpital Tenon, APHP, Paris, France
| | - Nacera Ouali
- Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, APHP, Paris, France
| | - Alexandre Hertig
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S1155, Paris, France.,Institut National de la Santé et de la Recherche Médicale, UMR_S1155, Paris, France.,Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, APHP, Paris, France
| | - Isabelle Brocheriou
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S1155, Paris, France.,Institut National de la Santé et de la Recherche Médicale, UMR_S1155, Paris, France.,Service d'Anatomie Pathologique, Hôpital de la Pitié-Salpêtrière, APHP, Paris, France
| | - Eric Rondeau
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S1155, Paris, France.,Institut National de la Santé et de la Recherche Médicale, UMR_S1155, Paris, France.,Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, APHP, Paris, France
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15
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Severova-Andreevska G, Grcevska L, Petrushevska G, Cakalaroski K, Sikole A, Stojceva–Taneva O, Danilovska I, Ivanovski N. The Spectrum of Histopathological Changes in the Renal Allograft - a 12 Months Protocol Biopsy Study. Open Access Maced J Med Sci 2018; 6:606-612. [PMID: 29731924 PMCID: PMC5927487 DOI: 10.3889/oamjms.2018.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 03/16/2017] [Accepted: 03/17/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Renal transplantation became a routine and successful medical treatment for Chronic Kidney Disease in the last 30 years all over the world. Introduction of Luminex based Single Antigen Beads (SAB) and recent BANFF consensus of histopathological phenotypes of different forms of rejection enables more precise diagnosis and changes the therapeutic approach. The graft biopsies, protocol or cause, indicated, remain a golden diagnostic tool for clinical follow up of kidney transplant recipients (KTR). AIM The study aimed to analyse the histopathological changes in renal grafts 12 months after the surgery in KTR with satisfactory kidney function. MATERIAL AND METHODS A 12-month protocol biopsy study was performed in a cohort of 50 Kidney transplant recipients (42 from living and 8 from deceased donors). Usual work-up for suitable donors and recipients, standard surgical procedure, basic principles of peri and postoperative care and follow up were done in all KTR. Sequential quadruple immunosuppression including induction with Anti-thymocyte globulin (ATG) or Interleukin-2R antagonist (IL-2R), and triple drug maintenance therapy with Calcineurin Inhibitors (CNI), Mycophenolate Mofetil (MMF) and Steroids were prescribed to all pts. Different forms of Glomerulonephritis (16), Hypertension (10), End Stage Renal Disease (13), Hereditary Nephropathies (6), Diabetes (3) and Vesicoureteral Reflux (2) were the underlying diseases. All biopsies were performed under ultrasound guidance. The 16 gauge needles with automated "gun" were used to take 2 cores of tissue. The samples were stained with HE, PAS, Trichrome Masson and Silver and reviewed by the same pathologist. A revised and uploaded BANFF 2013 classification in 6 categories (Cat) was used. RESULTS Out of 48 biopsies, 15 (31%) were considered as normal, 4 (8%), Borderline (BL-Cat 3), 5 (10%) as Interstitial Fibrosis/Tubular Atrophy (IF/TA-Cat 5), 5 (10%) were classified as non-immunological (Cat 6), 2 as a pure antibody-mediated rejection (ABMR-Cat 2) and T-cell Mediated Rejection (TCMR-Cat 4). The remaining 17 samples were classified as a "mixed" rejection: 7 (41%) ABMR + IF/TA, 5 (29%) ABMR + BL + IF/TA, 2 (11%) BL + IF/TA, 1 (5%) ABMR + BL, 1 (5%) ABMR + TCMR and 1 (5%) TCMR + IF/TA. The mean serum creatinine at the time of the biopsy was 126.7 ± 23.4 µmol/L, while GFR-MDRD 63.4 ± 20.7 ml/min, which means that the majority of the findings were subclinical. Among the non-immunological histological findings (Cat 6), 3 cases belonged to CNI toxicity, 1 to BK nephropathy and 1 to recurrence of the primary disease. CONCLUSION Our 12-month protocol biopsy study revealed the presence of different forms of mixed subclinical rejection. Use of recent BANFF classification and scoring system enables more precise diagnosis and subsequently different approach to the further treatment of the KTR. More correlative long-term studies including Anti HLA antibodies and Endothelial Cell Activation- Associated Transcripts (ENDAT) are needed.
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Affiliation(s)
- Galina Severova-Andreevska
- University Clinic of Nephrology, Medical Faculty, University St Cyril and Methodius of Skopje, Skopje, Republic of Macedonia
| | - Ladislava Grcevska
- University Clinic of Nephrology, Medical Faculty, University St Cyril and Methodius of Skopje, Skopje, Republic of Macedonia
| | - Gordana Petrushevska
- Institute for Pathology, Medical Faculty, University St Cyril and Methodius of Skopje, Skopje, Republic of Macedonia
| | - Koco Cakalaroski
- Medical Faculty, University St Cyril and Methodius of Skopje, Skopje, Republic of Macedonia
| | - Aleksandar Sikole
- University Clinic of Nephrology, Medical Faculty, University St Cyril and Methodius of Skopje, Skopje, Republic of Macedonia
| | - Olivera Stojceva–Taneva
- University Clinic of Nephrology, Medical Faculty, University St Cyril and Methodius of Skopje, Skopje, Republic of Macedonia
| | - Ilina Danilovska
- University Clinic of Nephrology, Medical Faculty, University St Cyril and Methodius of Skopje, Skopje, Republic of Macedonia
| | - Ninoslav Ivanovski
- Medical Faculty, University St Cyril and Methodius of Skopje, Skopje, Republic of Macedonia
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16
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Fournier MC, Dantan E, Blanche P. An R2-curve for evaluating the accuracy of dynamic predictions. Stat Med 2017; 37:1125-1133. [DOI: 10.1002/sim.7571] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 11/04/2017] [Accepted: 11/06/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Marie-Cécile Fournier
- INSERM UMR 1246-SPHERE; Nantes University, Tours University; Nantes France
- ITUN Institut de Transplantation Urologie Néphrologie INSERM UMR 1064; Nantes France
| | - Etienne Dantan
- INSERM UMR 1246-SPHERE; Nantes University, Tours University; Nantes France
| | - Paul Blanche
- LMBA; Université de Bretagne Sud; Vannes Brittany France
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17
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Abdel-Hady Algharably E, Beige J, Kreutz R, Bolbrinker J. Effect of UMOD genotype on long-term graft survival after kidney transplantation in patients treated with cyclosporine-based therapy. THE PHARMACOGENOMICS JOURNAL 2017; 18:227-231. [PMID: 28418009 DOI: 10.1038/tpj.2017.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 01/31/2017] [Accepted: 02/14/2017] [Indexed: 11/09/2022]
Abstract
The genetic rs12917707-G>T variant in uromodulin (UMOD) has been associated with renal function, chronic kidney disease and hypertension with the minor T-allele showing a protective effect. Hypertension and nephrotoxicity are adverse effects of chronic cyclosporine treatment. We tested whether UMOD rs12917707-T in donor kidneys associates with long-term graft survival in 393 Caucasian patients with stable graft function for more than 10 weeks after kidney transplantation treated with a cyclosporine-based maintenance therapy (mean graft survival 9 years). Presence of the donor T-allele had no effect on blood pressure, serum creatinine 1 year after transplantation, and on number of acute graft rejections during the first year. No significant effect on overall graft survival was observed in Kaplan-Meier analysis (P=0.65). In death-censored adjusted multivariate analysis, presence of donor T-allele associated with a significant lower hazard ratio of 0.67 (95% confidence interval: 0.46-0.97, P=0.05) for graft loss. This protective effect of the donor T-allele on graft loss observed in multivariate adjusted analysis justifies further investigations including patients treated with similar or other immunosuppressive regimens.
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Affiliation(s)
- E Abdel-Hady Algharably
- Institute of Clinical Pharmacology and Toxicology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - J Beige
- Faculty of Medicine, Martin-Luther-University Halle/Wittenberg, Halle, Germany.,Department of Medicine Nephrology, Klinikum St. Georg, Leipzig, Germany
| | - R Kreutz
- Institute of Clinical Pharmacology and Toxicology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - J Bolbrinker
- Institute of Clinical Pharmacology and Toxicology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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18
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Steubl D, Block M, Herbst V, Schlumberger W, Nockher A, Angermann S, Schmaderer C, Heemann U, Renders L, Scherberich J. Serum uromodulin predicts graft failure in renal transplant recipients. Biomarkers 2016; 22:171-177. [PMID: 27790922 DOI: 10.1080/1354750x.2016.1252957] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE AND METHODS Test the ability of serum uromodulin concentrations 1-3 months after renal transplantation to predict all-cause mortality (ACM) and graft loss (GL) in 91 patients. RESULTS uromodulin predicted GL equivalently to the other markers studied: the risk for GL was reduced by 0.21 per one standard deviation (SD) increase (cystatin C: hazard ratio [HR] 4.57, creatinine: HR 4.53, blood-urea-nitrogen [BUN]: HR 2.50, estimated glomerular filtration rate [eGFR]: HR 0.10). In receiver-operating-characteristic (ROC) analysis, uromodulin predicted GL with an area-under-the curve of 0.782 at an optimal cut-off (OCO) of 24.0 ng/ml with a sensitivity of 90.0% and a specificity of 70.2%. CONCLUSION Serum uromodulin predicted GL equivalently compared to conventional biomarkers of glomerular filtration.
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Affiliation(s)
- Dominik Steubl
- a Department of Nephrology, Klinikum rechts der Isar , Technische Universität , München , Germany
| | - Matthias Block
- b Research&Development Department, Euroimmun Medizinische Labordiagnostika AG , Lübeck , Germany
| | - Victor Herbst
- b Research&Development Department, Euroimmun Medizinische Labordiagnostika AG , Lübeck , Germany
| | - Wolfgang Schlumberger
- b Research&Development Department, Euroimmun Medizinische Labordiagnostika AG , Lübeck , Germany
| | - Andreas Nockher
- c Institute of Laboratory Medicine and Pathobiochemistry , Universitätsklinikum Marburg, Philipps-Universität Marburg , Marburg , Germany
| | - Susanne Angermann
- a Department of Nephrology, Klinikum rechts der Isar , Technische Universität , München , Germany
| | - Christoph Schmaderer
- a Department of Nephrology, Klinikum rechts der Isar , Technische Universität , München , Germany
| | - Uwe Heemann
- a Department of Nephrology, Klinikum rechts der Isar , Technische Universität , München , Germany
| | - Lutz Renders
- a Department of Nephrology, Klinikum rechts der Isar , Technische Universität , München , Germany
| | - Jürgen Scherberich
- d Department of Nephrology and Clinical Immunology, Klinikum München-Harlaching , Teaching Hospital of the Ludwig-Maximilian-Universität , München , Germany
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19
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A joint model for longitudinal and time-to-event data to better assess the specific role of donor and recipient factors on long-term kidney transplantation outcomes. Eur J Epidemiol 2016; 31:469-79. [DOI: 10.1007/s10654-016-0121-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 01/16/2016] [Indexed: 12/01/2022]
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20
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Simmonds MJ. Using Genetic Variation to Predict and Extend Long-term Kidney Transplant Function. Transplantation 2016; 99:2038-48. [PMID: 26262502 DOI: 10.1097/tp.0000000000000836] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Renal transplantation has transformed the life of patients with end-stage renal disease and other chronic kidney disorders by returning endogenous kidney function and enabling patients to cease dialysis. Several clinical indicators of graft outcome and long-term function have been established. Although rising creatinine levels and graft biopsy can be used to determine graft loss, identifying early predictors of graft function will not only improve our ability to predict long-term graft outcome but importantly provide a window of opportunity to therapeutically intervene to preserve graft function before graft failure has occurred. Since understanding the importance of matching genetic variation at the HLA region between donors and recipients and translating this into clinical practise to improve transplant outcome, much focus has been placed on trying to identify additional genetic predictors of transplant outcome/function. This review will focus on how candidate gene studies have identified variants within immunosuppression, immune response, fibrotic pathways, and specific ethnic groups, which correlate with graft outcome. We will also discuss the challenges faced by candidate gene studies, such as differences in donor and recipient selection criteria and use of small data sets, which have led to many genes failing to be consistently associated with transplant outcome. This review will also look at how recent advances in our understanding of and ability to screen the genome are starting to provide new insights into the mechanisms behind long-term graft loss and with it the opportunity to target these pathways therapeutically to ultimately increase graft lifespan and the associated benefits to patients.
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Affiliation(s)
- Matthew J Simmonds
- 1 Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), University of Oxford, Churchill Hospital, Headington, Oxford, United Kingdom
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21
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Lee J, Oh YT, Joo DJ, Ma BG, Lee AL, Lee JG, Song SH, Kim SU, Jung DC, Chung YE, Kim YS. Acoustic Radiation Force Impulse Measurement in Renal Transplantation: A Prospective, Longitudinal Study With Protocol Biopsies. Medicine (Baltimore) 2015; 94:e1590. [PMID: 26426636 PMCID: PMC4616853 DOI: 10.1097/md.0000000000001590] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Interstitial fibrosis and tubular atrophy (IF/TA) is a common cause of kidney allograft loss. Several noninvasive techniques developed to assess tissue fibrosis are widely used to examine the liver. However, relatively few studies have investigated the use of elastographic methods to assess transplanted kidneys. The aim of this study was to explore the clinical implications of the acoustic radiation force impulse (ARFI) technique in renal transplant patients. A total of 91 patients who underwent living donor renal transplantation between September 2010 and January 2013 were included in this prospective study. Shear wave velocity (SWV) was measured by ARFI at baseline and predetermined time points (1 week and 6 and 12 months after transplantation). Protocol biopsies were performed at 12 months. Instead of reflecting IF/TA, SWVs were found to be related to time elapsed after transplantation. Mean SWV increased continuously during the first postoperative year (P < 0.001). In addition, mixed model analysis showed no correlation existed between SWV and serum creatinine (r = -0.2426, P = 0.0771). There was also no evidence of a relationship between IF/TA and serum creatinine (odds ratio [OR] = 1.220, P = 0.7648). Furthermore, SWV temporal patterns were dependent on the kidney weight to body weight ratio (KW/BW). In patients with a KW/BW < 3.5 g/kg, mean SWV continuously increased for 12 months, whereas it decreased after 6 months in those with a KW/BW ≥ 3.5 g/kg.No significant correlation was observed between SWV and IF/TA or renal dysfunction. However, SWV was found to be related to the time after transplantation. Renal hemodynamics influenced by KW/BW might impact SWV values.
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Affiliation(s)
- Juhan Lee
- From the Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System (JL, DJJ, AL, JGL, SHS, YSK); The Research Institute for Transplantation, Yonsei University College of Medicine (DJJ, YSK); Department of Radiology, Severance Hospital, Yonsei University Health System (YTO, DCJ, YEC); Biostatistics Collaboration Unit, Yonsei University College of Medicine (BGM); and Department of Internal Medicine, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea (SUK)
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22
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Increased urinary cystatin C level is associated with interstitial fibrosis and tubular atrophy in kidney allograft recipients. Clin Biochem 2015; 48:546-9. [DOI: 10.1016/j.clinbiochem.2015.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 02/06/2015] [Accepted: 02/13/2015] [Indexed: 11/18/2022]
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23
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Miettinen J, Helin H, Pakarinen M, Jalanko H, Lauronen J. Histopathology and biomarkers in prediction of renal function in children after kidney transplantation. Transpl Immunol 2014; 31:105-11. [PMID: 24801206 DOI: 10.1016/j.trim.2014.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 04/24/2014] [Accepted: 04/25/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Early detection of chronic allograft injury is a major challenge after kidney transplantation (RTx) in adults and children. We correlated the expression of four immunohistochemical biomarkers, P-selectin glycoprotein ligand-1 (PSGL-1), vimentin, α-smooth muscle actin (α-SMA) and collagen IV, to the kidney graft histology and function in pediatric RTx patients. METHODS We analyzed the histopathology and immunohistochemical stainings of 165 biopsies from 56 patients. Histopathology was scored according to Banff '05 classification and biomarker expression semiquantitatively. Glomerular filtration rate (GFR) was measured annually by (51)Cr-EDTA clearance. RESULTS In protocol biopsies, the expression of all four biomarkers correlated with the interstitial fibrosis and tubular atrophy (IF/TA) changes, which increased during the first 36months after RTx. At the time of 18month biopsy, we observed the deterioration of GFR in patients with high (≥2) IF/TA score (50 vs. 68ml/min/1.73m(2), p=0.004) or collagen IV expression (45 vs. 65ml/min/1.73m(2), p=0.016). Intense stainings of IF/TA, collagen IV and vimentin are also associated with poor GFR at 36 and 48months, however, the biomarker scores revealed no additional predictive value for concomitant or late GFR compared to IF/TA score. Patients with high and low biomarker expressions showed no significant differences in annual deterioration of GFR, which declined on average 2.2ml/min/1.73m(2)/year over the 7years follow-up. CONCLUSIONS Overall, the results suggest that traditional histopathology is a sufficient predictor for graft function, and the routine use of these histochemical markers as surrogates for graft function deterioration is questioned.
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Affiliation(s)
- Jenni Miettinen
- Department of Pediatric Nephrology and Transplantation, Children's Hospital, University of Helsinki and Helsinki University Central Hospital, PL 281, 00029 HUS, Helsinki, Finland.
| | - Heikki Helin
- Division of Pathology and Genetics, HUSLAB, Helsinki University Central Hospital, PL 400, 00029 HUS, Helsinki, Finland
| | - Mikko Pakarinen
- Department of Pediatric Surgery, Children's Hospital, University of Helsinki and Helsinki University Central Hospital, PL 281, 00029 HUS, Helsinki, Finland
| | - Hannu Jalanko
- Department of Pediatric Nephrology and Transplantation, Children's Hospital, University of Helsinki and Helsinki University Central Hospital, PL 281, 00029 HUS, Helsinki, Finland
| | - Jouni Lauronen
- Histocompatibility Laboratory, Finnish Red Cross Blood Service, Kivihaantie 7, 00310 Helsinki, Finland
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