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Leng Y, Yu X, Yang Y, Xia Y. Efficacy and safety of medications for osteoporosis in kidney transplant recipients or patients with chronic kidney disease: A meta-analysis. J Investig Med 2023; 71:760-772. [PMID: 37387531 DOI: 10.1177/10815589231184215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
This study conducted a meta-analysis to analyze the efficacy and safety of osteoporosis medications in kidney transplant recipients and patients with chronic kidney disease (CKD). PubMed, Embase, the Cochrane Central Register of Controlled Trials were searched from the date of their inception through October 21, 2022. We performed a meta-analysis of the efficacy and safety of osteoporosis medications in adult patients with stage 3-5 CKD or kidney transplant recipients enrolled in randomized clinical trials (RCTs). We calculated the standard mean deviations with 95% confidence intervals (CI) for bone mineral density (BMD) and T scores after 6 and 12 months treatment, pooled odds ratio and 95% CI for fracture risk, and summarized adverse events. The inclusion criteria were met by 27 studies. Out of this, 19 studies were included for the meta-analysis. In stage 3-4 CKD patients, alendronate increased lumbar spine BMD. In patients at stage 5 CKD and undergoing hemodialysis, alendronate and raloxifene increased lumbar spine BMD. After 6 months, the BMD of kidney transplant recipients was seen to be significantly increased; however, there was no difference after 12 months, and the risk of fracture did not reduce. Thus, there is no evidence that these medications reduce the risk of fracture, and their effect on BMD and fracture remains unproven. These medications may increase the incidence of adverse events and their safety needs to be further evaluated. Therefore, we cannot draw a definitive conclusion about the efficacy and safety of osteoporosis medications in the above group of patients.
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Affiliation(s)
- Yunji Leng
- Phase I Clinical Trial Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xian Yu
- Phase I Clinical Trial Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yi Yang
- Phase I Clinical Trial Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yifan Xia
- Department of Joint Surgery, Chongqing General Hospital, Chongqing, China
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2
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Yang D, Zhuang B, Zheng Y, Xu M, Lin J, Zhang X, Wang C, Xie X, Huang G, Xie X, Wang Y. Shear wave elastography using high-frequency linear probe for transplant kidney monitoring: A methodological study. Clin Hemorheol Microcirc 2023:CH221668. [PMID: 37125543 DOI: 10.3233/ch-221668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVES To investigate the influencing factors of the image quality of shear wave elastography (SWE) performed using a high-frequency probe and its reproducibility for renal allografts. METHODS A total of 211 patients with transplanted kidneys who underwent SWE examination performed using high-frequency or low-frequency probes were recruited for the study. The reproducibility of inter- and intraobserver agreements were analysed by using the intraclass correlation coefficient (ICC). According to the colour filling of the area of interest and imaging noise when conducting SWE, the image quality was classified as three grades: "good", "common", and "poor". A logistic regression was used to analyse the independent factors for SWE quality. RESULTS In the comparative analysis, high frequency, transection measurement and middle pole were selected as the appropriate measurement methods. Regarding reproducibility, the ICCs) of the intra- and interobserver agreements were 0.85 and 0.77, respectively. Multivariate analysis indicated that only the skin allograft distance and kidney width were independent variables for SWE quality. In the subgroup analysis of the skin-allograft distance, the "good" and "common" rates of images decreased as the distance increased, but the CV (coefficients of variation) showed the opposite trend. The SWE quality of kidney width <5.4 cm was significantly better than that of kidney width ≥5.4 cm. CONCLUSIONS High-frequency SWE can be used in the evaluation of transplanted kidneys due to its good repeatability and high successful measurement rate, but we should pay attention to the influence of the skin-allograft distance and kidney width on SWE quality.
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Affiliation(s)
- Daopeng Yang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Bowen Zhuang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yanling Zheng
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ming Xu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jinhua Lin
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaoer Zhang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Changxi Wang
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Gang Huang
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaohua Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yan Wang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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3
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Neves CL, Marques IDB, Custódio MR. Mineral and bone disorder after kidney transplantation (KTx). J Bras Nefrol 2021; 43:674-679. [PMID: 34910805 PMCID: PMC8823922 DOI: 10.1590/2175-8239-jbn-2021-s113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/03/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Carolina Lara Neves
- Universidade Federal da Bahia, Hospital das Clínicas, Salvador, BA, Brazil.,Hospital Ana Nery, Salvador, BA, Brazil
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4
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Song SH, Choi HY, Kim HY, Nam CM, Jeong HJ, Kim MS, Kim SII, Kim YS, Huh KH, Kim BS. Effects of bisphosphonates on long-term kidney transplantation outcomes. Nephrol Dial Transplant 2021; 36:722-729. [PMID: 33367861 DOI: 10.1093/ndt/gfaa371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Bisphosphonates are administered to post-transplantation patients with mineral and bone disorders; however, the association between bisphosphonate therapy and long-term renal graft survival remains unclear. METHODS This nested case-control study investigated the effects of bisphosphonates on long-term graft outcomes after kidney transplantation. We enrolled 3836 kidney transplant recipients treated from April 1979 to June 2016 and matched patients with graft failure to those without (controls). Annual post-transplant bone mineral density assessments were performed and recipients with osteopenia or osteoporosis received bisphosphonate therapy. The associations between bisphosphonate use and long-term graft outcomes and graft survival were analyzed using conditional logistic regression and landmark analyses, respectively. RESULTS A landmark analysis demonstrated that death-censored graft survival was significantly higher in bisphosphonate users than in non-users in the entire cohort (log-rank test, P < 0.001). In the nested case-control matched cohort, bisphosphonate users had a significantly reduced risk of graft failure than did non-users (odds ratio = 0.38; 95% confidence interval 0.30-0.48). Bisphosphonate use, increased cumulative duration of bisphosphonate use >1 year and increased cumulative bisphosphonate dose above the first quartile were associated with a reduced risk of graft failure, after adjustments. CONCLUSIONS Bisphosphonates may improve long-term graft survival in kidney transplant recipients.
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Affiliation(s)
- Seung Hwan Song
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Surgery, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Hoon Young Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ha Yan Kim
- Department of Biomedical Systems Informatics, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chung Mo Nam
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyeon Joo Jeong
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Myoung Soo Kim
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Transplantation Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soon I I Kim
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Transplantation Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yu Seun Kim
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Transplantation Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyu Ha Huh
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Transplantation Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Beom Seok Kim
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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5
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Giannini S, Poci C, Fusaro M, Egan CG, Marcocci C, Vignali E, Cetani F, Nannipieri F, Loy M, Gambino A, Adami G, Braga V, Rossini M, Arcidiacono G, Baffa V, Sella S. Effect of neridronate in osteopenic patients after heart, liver or lung transplant: a multicenter, randomized, double-blind, placebo-controlled study. Panminerva Med 2021; 63:214-223. [PMID: 34154321 DOI: 10.23736/s0031-0808.21.04401-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Transplantation (Tx) is an effective therapeutic option in patients with end-stage organ failure and osteoporosis and related fractures are a recognized complication in these patients. Aim of this study was to evaluate the efficacy of neridronate in patients with reduced bone mass after Tx of the heart, liver or lung. METHODS In this multicenter randomized double-blind controlled trial (RCT), 22 patients were treated with neridronate (25 mg i.m./month) and 17 received placebo. All patients received daily oral calcium (500 mg) and vitamin D (400 IU). Dual-energy X-ray absorptiometry (DXA) was evaluated at 0, 6 and 12 months and markers of bone turnover at 0, 3, 6, 9 and 12 months. RESULTS Thirty-nine patients (11 heart Tx, 21 liver Tx, 7 lung Tx), aged 49.3±9.1 years, with a T-score <-2.0 SD at lumbar spine or femoral level were included. In neridronate-treated patients, a significant increase in lumbar bone mineral density (BMD) was observed after 12 months vs. placebo control (0.92±0.13 g/cm2 vs. 0.84±0.08 g/cm2; P=0.005). Femur and hip BMD remained unchanged between groups. Total alkaline phosphatase, bone alkaline phosphatase and beta-cross-laps significantly decreased over the 12 months in neridronate-treated patients vs. placebo, respectively (107.4±74 U/L vs. 157.6±107.1 U/L, P=0.002; 5.7±3.3 µg/L vs. 11.7±4.3 µg/L, P<0.001 and 0.25±0.13 ng/mL vs. 0.73±0.57 ng/mL, P<0.001). No difference was observed between neridronate and placebo groups regarding safety profile. CONCLUSIONS This is the first RCT that demonstrates the efficacy of neridronate in increasing bone density and reducing bone turnover in organ Tx recipients with significant skeletal morbidity.
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Affiliation(s)
- Sandro Giannini
- Department of Medicine (DIMED), Clinica Medica Uno, University of Padua, Padua, Italy -
| | - Carlo Poci
- Department of Medicine (DIMED), Clinica Medica Uno, University of Padua, Padua, Italy
| | - Maria Fusaro
- National Research Council (CNR), Institute of Clinical Physiology (IFC), Pisa, Italy.,Department of Medicine, University of Padua, Padua, Italy
| | | | - Claudio Marcocci
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Edda Vignali
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Filomena Cetani
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Monica Loy
- Unit of Thoracic Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Antonio Gambino
- Unit of Cardiac Surgery, Department of Cardio-Thoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giovanni Adami
- Unit of Rheumatology, Department of Medicine, University of Verona, Verona, Italy
| | - Vania Braga
- Unit of Rheumatology, Department of Medicine, University of Verona, Verona, Italy
| | - Maurizio Rossini
- Unit of Rheumatology, Department of Medicine, University of Verona, Verona, Italy
| | - Gaetano Arcidiacono
- Department of Medicine (DIMED), Clinica Medica Uno, University of Padua, Padua, Italy
| | - Valeria Baffa
- Department of Medicine (DIMED), Clinica Medica Uno, University of Padua, Padua, Italy
| | - Stefania Sella
- Department of Medicine (DIMED), Clinica Medica Uno, University of Padua, Padua, Italy
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6
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Zhang H, Wang Z, Zhang J, Zhang X, Gui Z, Sun L, Yang H, Tan R, Gu M. The synergism of B and T lymphocyte attenuator (BTLA) and cytotoxic T lymphocyte associated antigen-4 (CTLA-4) attenuated acute T-cell mediated rejection and prolonged renal graft survival. Transl Androl Urol 2020; 9:1990-1999. [PMID: 33209663 PMCID: PMC7658142 DOI: 10.21037/tau-20-728] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Acute T-cell mediated rejection (TCMR) continues to be a major problem in the area of kidney transplantation. The B and T lymphocyte attenuator (BTLA) and cytotoxic T lymphocyte associated antigen-4 (CTLA-4) were recently found costimulatory molecules. The research aims to explore the inhibitory synergism of BTLA and CTLA-4 in TCMR. Methods We investigated the suppressive role of overexpressed BTLA and CTLA-4 in vitro. The rat kidney transplantation model was established to explore the effect of combined overexpressed BTLA and CTLA-4 in recipients of kidney transplantation. The grafts and peripheral blood were harvested for renal function, histology, immunohistochemical and flow cytometry analysis. Results Combination therapy decreased the secretion of interleukin-2 (IL-2) and proliferation of T cells compared to the single therapy and the control group. Decrease of interstitium monocyte infiltration and especially intimal arteritis in the graft was observed with the combination therapy, with remarkable reduction of numbers and proliferation response of T cells in peripheral blood and grafts. Combined overexpressed BTLA and CTLA-4 attenuated the acute TCMR after kidney transplantation and improved the graft function and prolonged the graft survival. The inhibiting role against TCMR in the combination therapy group was more effective than single therapy. Conclusions The synergism of BTLA and CTLA-4 attenuated acute TCMR after kidney transplantation by suppressing T cell activation and proliferation.
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Affiliation(s)
- Hengcheng Zhang
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zijie Wang
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiayi Zhang
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiang Zhang
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zeping Gui
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Li Sun
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Haiwei Yang
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ruoyun Tan
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Min Gu
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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7
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Rajan RK, Chandran S, Sreelatha HV, John A, Parameswaran R. Pamidronate-Encapsulated Electrospun Polycaprolactone-Based Composite Scaffolds for Osteoporotic Bone Defect Repair. ACS APPLIED BIO MATERIALS 2020; 3:1924-1933. [PMID: 35025315 DOI: 10.1021/acsabm.9b01077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Bone fractures associated with osteoporosis are a major concern all over the world especially among the elderly population and postmenopausal women. Bisphosphonates (BPs) are widely used clinically for both treatment and prevention of osteoporosis despite their poor oral bioavailability and undesired side effects. Local delivery of BPs from polymeric scaffolds can improve the efficacy and overcome the undesirable side effects associated with oral bisphosphonate therapy. The aim of the present study is to explore the effectiveness of pamidronate (PDS) encapsulated electrospun polycaprolactone/polycaprolactone-polyethyleneglycol-polycaprolactone/nanohydroxyapatite (PCH) scaffolds in healing critical-size calvarial defects in an osteoporotic rat animal model. Prior to implantation studies, the effect of PDS on the fiber architecture, mechanical properties, and in vitro degradation behavior was evaluated. The in vitro release of PDS from PCH scaffolds in phosphate buffer saline (PBS) at 37 °C was monitored for a period of 21 days. An osteoporotic animal model was successfully developed in Wistar rats by bilateral ovariectomy. Results of micro CT (computed tomography) and blood serum analysis confirmed the osteoporotic model induction in rats. Critical-size calvarial defects of 8 mm size were created in osteoporotic rats, and the in vivo osteogenic efficacy of PCH-PDS scaffolds was evaluated by micro CT, histology, and histomorphometry. Micro CT analysis showed improved osseous tissue integration with the use of PDS-loaded PCH scaffolds after 12 week post implantation. Histology, density measurement using micro CT, and histomorphometry further substantiate that PCH-PDS scaffolds have the potential to be used for the repair of osteoporotic bone defects. Our findings revealed that incorporation of PDS onto PCH scaffolds provides a promising biomaterial that could be used for regenerating osteoporosis-related fractures.
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Affiliation(s)
- Remya K Rajan
- Division of Polymeric Medical Devices, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology-Trivandrum, Thiruvananthapuram, Kerala 695012, India
| | - Sunitha Chandran
- Department of Microbiology and Immunology, Louisiana State University Shreveport, Shreveport, Louisiana 71115-2301, United States
| | - Harikrishnan V Sreelatha
- Division of Laboratory Animal Science, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology-Trivandrum, Thiruvananthapuram, Kerala 695012, India
| | - Annie John
- Department of Biochemistry, University of Kerala, Trivandrum, Kerala 695034, India
| | - Ramesh Parameswaran
- Division of Polymeric Medical Devices, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology-Trivandrum, Thiruvananthapuram, Kerala 695012, India
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8
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Remya KR, Chandran S, John A, Ramesh P. Pamidronate-encapsulated electrospun polycaprolactone as a potential bone regenerative scaffold. J BIOACT COMPAT POL 2019. [DOI: 10.1177/0883911519835142] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study explores the potential of electrospun polycaprolactone scaffolds for the controlled delivery of pamidronate disodium pentahydrate, an amino-bisphosphonate drug used for the treatment of osteoporosis. Major drawbacks associated with oral bisphosphonate therapy are its poor bioavailability and gastrointestinal side-effects. Herein, we used polycaprolactone, a well-known Food and Drug Administration–approved biomaterial, as the delivering vehicle for pamidronate disodium pentahydrate. Scaffolds based on polycaprolactone with three different formulations (1, 3, and 5 wt%) of pamidronate disodium pentahydrate were fabricated by electrospinning, and a comparative study was carried out to evaluate the effect of pamidronate disodium pentahydrate on physico-mechanical and biological properties of polycaprolactone. The observations from Fourier-transform infrared spectra and thermogravimetric analysis confirmed the successful incorporation of pamidronate disodium pentahydrate into polycaprolactone scaffolds. The study also revealed that pamidronate disodium pentahydrate–loaded scaffolds exhibited improved hydrophilicity as well as superior mechanical properties as depicted by the contact angle measurements and mechanical property evaluation. In vitro drug release studies of pamidronate disodium pentahydrate–loaded scaffolds in phosphate buffer saline at 37°C showed that all the scaffolds exhibited controlled release of pamidronate disodium pentahydrate. In vitro degradation studies further revealed that pamidronate disodium pentahydrate incorporated polycaprolactone scaffolds degraded faster as depicted by the fiber rupture and drop in mechanical properties. In vitro cell culture studies using human osteosarcoma cell lines demonstrated that pamidronate disodium pentahydrate–loaded polycaprolactone scaffolds were cytocompatible. The human osteosarcoma cells had favorable interaction with the scaffolds, and the viability of adhered cells was depicted by the fluorescein diacetate/propidium iodide staining. MTT assay further revealed enhanced cell viability on PCL/PDS3 scaffolds. Our findings bespeak that the pamidronate disodium pentahydrate–encapsulated electrospun polycaprolactone scaffolds have the potential to serve as a promising drug delivery vehicle for osteoporotic bone defect repair.
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Affiliation(s)
- KR Remya
- Division of Polymeric Medical Devices, Department of Medical Devices Engineering, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology–Trivandrum, Trivandrum, India
| | - Sunitha Chandran
- Department of Microbiology and Immunology, Louisiana State University Shreveport, Shreveport, LA, USA
| | - Annie John
- Department of Biochemistry, University of Kerala, Trivandrum, India
| | - P Ramesh
- Division of Polymeric Medical Devices, Department of Medical Devices Engineering, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology–Trivandrum, Trivandrum, India
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9
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Wang Z, Yang H, Liu X, Zhang J, Han Z, Tao J, Zhao C, Ju X, Tan R, Gu M. Role of B and T Lymphocyte Attenuator in Renal Transplant Recipients with Biopsy-Proven Acute Rejection. Med Sci Monit 2018; 24:387-396. [PMID: 29352109 PMCID: PMC5786872 DOI: 10.12659/msm.905752] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Acute rejection is a common predisposing cause of allograft dysfunction in kidney transplantation. Recently, the B and T lymphocyte attenuator (BTLA)/herpes virus entry mediator (HVEM)/lymphotoxin (LIGHT)/CD160 pathway was found to be potentially involved in the regulation of T cell activation. This could mean that this pathway is involved in graft rejection in kidney transplantation; the present study aimed to explore this possibility. Material/Methods The expression of BTLA, HVEM, LIGHT and CD160 on peripheral CD4+, CD8+ and CD19+ lymphocytes were analyzed by flow cytometry in recipients with biopsy-proven acute rejection (BPAR) or stable allograft function, as well as in healthy volunteers. Moreover, we performed HE staining and immunohistochemical staining to assess the expression of BTLA and HVEM in kidney samples from recipients with BPAR and patients who underwent the surgery of radical nephrectomy. Results We observed the significantly lower expression of BTLA on CD4+ T cells in recipients from the BPAR group than in recipients from the stable group. The expression of BTLA on CD8+ T cells among recipients both from the BPAR and stable group was statistically increased than that in the healthy volunteers. A significant difference in the expression of CD160 in the stable group was found when compared with the BPAR group or control group. Moreover, there was no significance in the expression of HVEM, LIGHT or CD160 on other subtypes of T cells between the 3 groups or in the expression of BTLA on CD4+ T cells between the BPAR and control group. Conclusions The findings indicate that the BTLA/HVEM pathway does be involved in pathogenesis of acute rejection following kidney transplantation, as well as the induction of transplant tolerance. This pathway may therefore be a useful target for therapy against acute rejection after kidney transplantation.
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Affiliation(s)
- Zijie Wang
- Department of Urology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Haiwei Yang
- Department of Urology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Xuzhong Liu
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, China (mainland)
| | - Jingying Zhang
- Department of Oncology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Zhijian Han
- Department of Urology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Jun Tao
- Department of Urology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Chunchun Zhao
- Department of Urology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Xiaobin Ju
- Department of Urology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Ruoyun Tan
- Department of Urology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Min Gu
- Department of Urology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
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10
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Wang Z, Fei S, Suo C, Han Z, Tao J, Xu Z, Zhao C, Tan R, Gu M. Antifibrotic Effects of Hepatocyte Growth Factor on Endothelial-to-Mesenchymal Transition via Transforming Growth Factor-Beta1 (TGF-β1)/Smad and Akt/mTOR/P70S6K Signaling Pathways. Ann Transplant 2018; 23:1-10. [PMID: 29292365 PMCID: PMC6248046 DOI: 10.12659/aot.906700] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background The related mechanisms involved in allograft interstitial fibrosis and chronic allograft dysfunction (CAD), following renal transplant, remain largely unknown. Here, we explored the role of hepatocyte growth factor (HGF) treatment on the endothelial-to-mesenchymal transition (EndMT) as a new way to target and prevent kidney fibrosis and improve outcomes for renal transplant recipients. Method/Material We extracted proteins and mRNAs from human umbilical vein endothelial cells (HUVECs) and human renal glomerular endothelial cells (HRGECs) treated with transforming growth factor-beta1 (TGF-β1) and/or varying doses of HGF, and assessed the effect of HGF on the EndMT using western blotting, qRT-PCR, and ELISA assays. We utilized cell motility and migration assays to evaluate cell movement, and applied western blotting to assess the mechanism by which TGF-β1 induced the EndMT. Results HGF significantly attenuated the development of TGF-β1-induced EndMT in a concentration-dependent way, and weakened the abilities of motility and migration of both HUVECs and HRGECs. Moreover, our results reveal that the antifibrotic effect of HGF on the EndMT was associated with the TGF-β/Smad and Akt/mTOR/p70S6K signaling pathways. Conclusions Our study suggests that HGF treatment significantly attenuates the development of EndMT induced by TGF-β1 via the TGFβ/Smad and Akt/mTOR/P70S6K signaling, which provides novel insights into the prevention and treatment of interstitial fibrosis and CAD following renal transplant.
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Affiliation(s)
- Zijie Wang
- Department of Urology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Shuang Fei
- Department of Urology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Chuanjian Suo
- Department of Urology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Zhijian Han
- Department of Urology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Jun Tao
- Department of Urology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Zhen Xu
- Department of Urology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Chunchun Zhao
- Department of Urology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Ruoyun Tan
- Department of Urology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Min Gu
- Department of Urology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
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Wang Z, Yang H, Guo M, Han Z, Tao J, Chen H, Ge Y, Wang K, Tan R, Wei JF, Gu M. Impact of complement component 3/4/5 single nucleotide polymorphisms on renal transplant recipients with antibody-mediated rejection. Oncotarget 2017; 8:94539-94553. [PMID: 29212248 PMCID: PMC5706894 DOI: 10.18632/oncotarget.21788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 09/24/2017] [Indexed: 01/29/2023] Open
Abstract
Antibody-mediated rejection (ABMR) is an important risk of allograft dysfunction in kidney transplantation. The complement system is considered to be associated with the generation of alloreative antibodies and donor-specific antibodies. However, the association of complement single nucleotide polymorphisms (SNPs) with ABMR still remained unclear. Blood samples of 199 renal transplant recipients containing 68 with ABMR and 131 with stable graft function were collected, and analyzed by next-generation sequencing with an established gene panel. High quality readout was obtained in 18 C3 SNPs, 9 C4 SNPs and 22 C5 SNPs. Concerning C3 gene polymorphisms, after being adjusted with age, sex and immunosuppressive protocols, rs10411506 and rs2230205 were found to be statistically associated with ABMR in dominant model (rs10411506: OR=2.73, 95% CIs: 1.16, 6.68, P=0.028; rs2230205: OR=2.52, 95% CIs: 1.07, 5.92, P=0.034); rs10411506, rs2230205 and rs2230201 were found different in HET model (rs10411506: OR=3.05, 95% CIs: 1.22, 7.64, P=0.017; rs2230205: OR=2.90, 95% CIs: 1.20, 7.00, P=0.018; rs2230201: OR=2.41, 95% CIs: 1.03, 5.64, P=0.042). The linkage analysis showed relatively high linkage disequilibrium among these SNPs. In addition, no significant correlation was found between C4 SNPs, or C5 SNPs, and the development of ABMR. Our study firstly identified the two SNPs (rs10411506 and rs2230205) in C3 gene were statistically correlated with ABMR in kidney transplantation. These findings may have implications for the diagnosis and prevention of ABMR.
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Affiliation(s)
- Zijie Wang
- Department of Urology, Nanjing Medical University First Affiliated Hospital, Nanjing 210029, P.R. China
| | - Haiwei Yang
- Department of Urology, Nanjing Medical University First Affiliated Hospital, Nanjing 210029, P.R. China
| | - Miao Guo
- Research Division of Clinical Pharmacology, Nanjing Medical University First Affiliated Hospital, Nanjing 210029, P.R. China
| | - Zhijian Han
- Department of Urology, Nanjing Medical University First Affiliated Hospital, Nanjing 210029, P.R. China
| | - Jun Tao
- Department of Urology, Nanjing Medical University First Affiliated Hospital, Nanjing 210029, P.R. China
| | - Hao Chen
- Department of Urology, Nanjing Medical University First Affiliated Hospital, Nanjing 210029, P.R. China
| | - Yuqiu Ge
- School of Public Health, Nanjing Medical University, Nanjing 211166, P.R. China
| | - Ke Wang
- Department of Urology, Nanjing Medical University First Affiliated Hospital, Nanjing 210029, P.R. China
| | - Ruoyun Tan
- Department of Urology, Nanjing Medical University First Affiliated Hospital, Nanjing 210029, P.R. China
| | - Ji-Fu Wei
- Research Division of Clinical Pharmacology, Nanjing Medical University First Affiliated Hospital, Nanjing 210029, P.R. China
| | - Min Gu
- Department of Urology, Nanjing Medical University First Affiliated Hospital, Nanjing 210029, P.R. China
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12
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Lu P, Song R, Yu Y, Yang J, Qi K, Tao R, Chen K, Zhang W, Gu M. Clinical efficacy of percutaneous nephrolithotomy versus retrograde intrarenal surgery for pediatric kidney urolithiasis: A PRISMA-compliant article. Medicine (Baltimore) 2017; 96:e8346. [PMID: 29069011 PMCID: PMC5671844 DOI: 10.1097/md.0000000000008346] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) are widely used for pediatric upper tract stones; however, comparisons of their clinical efficacies are needed. METHODS Literature searches for relevant articles were performed using PubMed, the Cochrane Central Register of Controlled Trials, Embase and the China CNKI database. Study quality was assessed by Jadad and Newcastle-Ottawa Scales. Standard mean differences (SMDs) or odds ratios (OR), and 95% confidential intervals (95% CIs) were pooled for meta-analysis. In addition, data was evaluated the quality of the body of evidence by means of grading of recommendations assessment, development, and evaluation (GRADE). RESULTS Data from 4 studies (231 PCNL, 212 RIRS cases) were analyzed. There was no significant difference in operation time (SMD: 1.39; 95% CIs: -0.049 to 2.82; P = .058), overall stone-free rate (OR: 3.72; 95% CIs: 0.55-25.22; P = .18), or complication rate (OR: 1.92; 95% CIs: 0.90-4.07; P = .091). PCNL cases had longer hospital stays (SMD: 1.22; 95% CIs: 0.95-1.50; P < .001), but showed a higher stone-free rate for stones greater than 20 mm (OR: 6.38; 95% CIs: 1.83-22.22; P = .004). For stones less than 20 mm, however, no significant difference between PCNL and RIRS was found (OR: 0.92; 95% CIs: 0.33-2.55; P = .87). The quality of evidence based on the GRADE system was low. CONCLUSION Results of our systematic review and meta-analysis suggest that, for the treatment of larger kidney stones (>20 mm) in pediatric patients, PCNL is a better option due to its higher stone-free rate, although RIRS may be associated with shorter hospital stays. A large-scale clinical trial is necessary to validate our findings.
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Affiliation(s)
- Pei Lu
- Department of Urology, First Affiliated Hospital with Nanjing Medical University
| | - Rijin Song
- Department of Urology, First Affiliated Hospital with Nanjing Medical University
| | - Yuzhou Yu
- Department of Urology, Nanjing Lishui People's Hospital, Nanjing, China
| | - Jie Yang
- Department of Urology, First Affiliated Hospital with Nanjing Medical University
| | - Kai Qi
- Department of Urology, First Affiliated Hospital with Nanjing Medical University
| | - Rongzhen Tao
- Department of Urology, First Affiliated Hospital with Nanjing Medical University
| | - Keliang Chen
- Department of Urology, First Affiliated Hospital with Nanjing Medical University
| | - Wei Zhang
- Department of Urology, First Affiliated Hospital with Nanjing Medical University
| | - Min Gu
- Department of Urology, First Affiliated Hospital with Nanjing Medical University
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13
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Liu K, Liu X, Gu S, Sun Q, Wang Y, Meng J, Xu Z. Association between TGFB1 genetic polymorphisms and chronic allograft dysfunction: a systematic review and meta-analysis. Oncotarget 2017; 8:62463-62469. [PMID: 28977960 PMCID: PMC5617520 DOI: 10.18632/oncotarget.19516] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 07/13/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Epidemiological studies have investigated the role of transforming growth factor-β1 (TGF-β1) in chronic allograft dysfunction (CAD) following kidney transplantation. TGFB1 gene polymorphisms (SNP rs1800470 and rs1800471) may be associated with the risk of CAD. In this meta-analysis, the relationship between these two variations and the risk of CAD was explored. MATERIALS AND METHODS MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, the Chinese CNKI and WANFANG databases were searched. Data were extracted and pooled results were estimated from odds ratios (ORs) with 95% confidential intervals (95% CIs). Quality assessments were performed, and publication bias of all eligible studies examined. RESULTS Eight studies with 1038 subjects were included in our analysis. According to the effects on TGF-β1 secretion, haplotypes were categorized as "HIGH", "INTERMEDIATE" and "LOW". The combined results showed a statistically significant difference of TGFB1 haplotypes between the CAD recipients and control subjects when "HIGH" with "INTERMEDIATE" and "LOW" ("HIGH" vs. "INTERMEDIATE" + "LOW": OR: 3.56, 95% CIs: 2.20, 5.78, P < 0.001) were compared. No significant association was found between the TGFB1 codon 10 or codon 25 and the CAD risk in all five genetic models. CONCLUSIONS Our meta-analysis has found the haplotype of TGFB1 codon 10/25 T/T G/G and T/C G/G genotypes, associated with increased production of TGF-β1, was linked with CAD risk following kidney transplantation. Moreover, no significant difference was found between TGFB1 codon 10 or codon 25 and the development of CAD.
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Affiliation(s)
- Kun Liu
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, 223300 China
| | - Xuzhong Liu
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, 223300 China
| | - Shuo Gu
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, 223300 China
| | - Qing Sun
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, 223300 China
| | - Yunyan Wang
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, 223300 China
| | - Junsong Meng
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, 223300 China
| | - Zongyuan Xu
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, 223300 China
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14
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Wang Z, Yang H, Suo C, Wei J, Tan R, Gu M. Application of Ultrasound Elastography for Chronic Allograft Dysfunction in Kidney Transplantation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1759-1769. [PMID: 28503746 DOI: 10.1002/jum.14221] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 11/28/2016] [Indexed: 05/21/2023]
Abstract
Interstitial fibrosis is the main characteristic of chronic allograft dysfunction, which remains the key factor affecting long-term allograft survival after kidney transplantation. Ultrasound elastography (UE), including real-time elastography, transient elastography, and acoustic radiation force impulse, has been applied widely in breast, thyroid, and liver diseases, especially in the assessment of liver fibrosis. Recently, numerous studies have reported the efficacy of UE methods in evaluating renal allograft fibrosis. This review aims to investigate the clinical applications, limitations, and future roles of UE in current clinical practice in light of changing management paradigms. In current clinical practice, UE methods, especially transient elastographic measurement, appear to be useful for ruling out fibrosis but do not have sufficient accuracy to distinguish between various stages of allograft fibrosis. Moreover, there remain considerable issues to be solved for the application of UE in kidney transplantation. Thus, UE methods cannot replace the crucial role of renal allograft biopsy in the diagnosis and evaluation of allograft fibrosis in kidney transplantation. Perhaps UE methods could be of more importance in the long-term observation and evaluation of allograft fibrosis during follow-up.
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Affiliation(s)
- Zijie Wang
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Haiwei Yang
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chuanjian Suo
- Department of Pharmacy, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jifu Wei
- Department of Pharmacy, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ruoyun Tan
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Min Gu
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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15
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Recent Changes in Chronic Kidney Disease–Mineral and Bone Disorders and Associated Fractures After Kidney Transplantation. Transplantation 2017; 101:1897-1905. [DOI: 10.1097/tp.0000000000001449] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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16
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Wang Z, Han Z, Tao J, Wang J, Liu X, Zhou W, Xu Z, Zhao C, Wang Z, Tan R, Gu M. Role of endothelial-to-mesenchymal transition induced by TGF-β1 in transplant kidney interstitial fibrosis. J Cell Mol Med 2017; 21:2359-2369. [PMID: 28374926 PMCID: PMC5618680 DOI: 10.1111/jcmm.13157] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 02/12/2017] [Indexed: 01/18/2023] Open
Abstract
Chronic allograft dysfunction (CAD) induced by kidney interstitial fibrosis is the main cause of allograft failure in kidney transplantation. Endothelial‐to‐mesenchymal transition (EndMT) may play an important role in kidney fibrosis. We, therefore, undertook this study to characterize the functions and potential mechanism of EndMT in transplant kidney interstitial fibrosis. Proteins and mRNAs associated with EndMT were examined in human umbilical vein endothelial cells (HUVECs) treated with transforming growth factor‐beta1 (TGF‐β1) at different doses or at different intervals with western blotting, qRT‐PCR and ELISA assays. Cell motility and migration were evaluated with motility and migration assays. The mechanism of EndMT induced by TGF‐β1 was determined by western blotting analysis of factors involved in various canonical and non‐canonical pathways. In addition, human kidney tissues from control and CAD group were also examined for these proteins by HE, Masson's trichrome, immunohistochemical, indirect immunofluorescence double staining and western blotting assays. TGF‐β1 significantly promoted the development of EndMT in a time‐dependent and dose‐dependent manner and promoted the motility and migration ability of HUVECs. The TGF‐β/Smad and Akt/mTOR/p70S6K signalling pathways were found to be associated with the pathogenesis of EndMT induced by TGF‐β1, which was also proven in vivo by the analysis of specimens from the control and CAD groups. EndMT may promote transplant kidney interstitial fibrosis by targetting the TGF‐β/Smad and Akt/mTOR/p70S6K signalling pathways, and hence, result in the development of CAD in kidney transplant recipients.
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Affiliation(s)
- Zijie Wang
- Department of Urology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Zhijian Han
- Department of Urology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Jun Tao
- Department of Urology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Jun Wang
- Department of Urology, the Affiliated Nanjing Children's Hospital, Nanjing Medical University, Nanjing, China
| | - Xuzhong Liu
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, China
| | - Wanli Zhou
- Department of Urology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Zhen Xu
- Department of Urology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Chunchun Zhao
- Department of Urology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Zengjun Wang
- Department of Urology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Ruoyun Tan
- Department of Urology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Min Gu
- Department of Urology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, China
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17
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Wang J, Yao M, Xu JH, Shu B, Wang YJ, Cui XJ. Bisphosphonates for prevention of osteopenia in kidney-transplant recipients: a systematic review of randomized controlled trials. Osteoporos Int 2016; 27:1683-90. [PMID: 26733377 DOI: 10.1007/s00198-015-3465-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 12/15/2015] [Indexed: 12/19/2022]
Abstract
We conducted a systematic review of randomized controlled trials (RCTs) of bisphosphonates for the prevention of osteopenia in kidney-transplant recipients. Bisphosphonates improved bone mineral density at the lumbar spine and femoral neck after 12 months. However, additional well-designed RCTs are required to determine the optimal treatment strategy. Osteopenic-osteoporotic syndrome is a bone complication of renal transplantation. Bisphosphonates, calcitonin, and vitamin D analogs may be used to prevent or treat osteoporosis or bone loss after renal transplantation. However, there is currently no widely recognized strategy for the prevention of corticosteroid-induced osteoporosis. This study aims to assess the available evidence to guide the targeted use of bisphosphonates for reducing osteoporosis and bone loss in renal-transplant recipients. We searched the Cochrane Central Register of Controlled Trials, PubMed, and EMBASE for randomized controlled trials of bisphosphonates for osteoporosis or bone loss after renal transplantation. A total of 352 abstracts were identified, of which 55 were considered for evaluation and 9 were included in the final analysis. The primary outcome measure was change in the bone mineral density (BMD) of the lumbar spine and femoral neck after 12 months. Data extraction was performed independently by two investigators. BMD at the lumbar spine was improved after treatment with bisphosphonates [9 trials; 418 patients; weighted mean difference (WMD), 0.61; 95 % confidence interval (CI), 0.16-1.06]. Eight trials (406 patients) that reported changes in BMD at the femoral neck also showed improved outcomes after treatment with bisphosphonates (WMD, 0.06; 95 % CI, 0.03-0.09). Bisphosphonates improve BMD at the lumbar spine and femoral neck after 12 months in renal-transplant recipients.
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Affiliation(s)
- J Wang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - M Yao
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
- Institute of Spine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - J-h Xu
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - B Shu
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
- Institute of Spine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Y-j Wang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
- Institute of Spine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - X-j Cui
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
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Current Status of Research on Osteoporosis after Solid Organ Transplantation: Pathogenesis and Management. BIOMED RESEARCH INTERNATIONAL 2015; 2015:413169. [PMID: 26649301 PMCID: PMC4662986 DOI: 10.1155/2015/413169] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 10/29/2015] [Accepted: 10/29/2015] [Indexed: 12/23/2022]
Abstract
Improved survival following organ transplantation has brought to the forefront some long-term complications, among which osteoporosis and associated fractures are the major ones that adversely affect the quality of life in recipients. The pathogenesis of osteoporosis in transplant recipients is complex and multifactorial which may be related to increased bone resorption, decreased bone formation, or both. Studies have shown that the preexisting underlying metabolic bone disorders and the use of immunosuppressive agents are the major risk factors for osteoporosis and fractures after organ transplantation. And rapid bone loss usually occurs in the first 6–12 months with a significant increase in fracture risk. This paper will provide an updated review on the possible pathogenesis of posttransplant osteoporosis and fractures, the natural history, and the current prevention and treatment strategies concerning different types of organ transplantation.
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