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Ahuja HK, Azim S, Maluf D, Mas VR. Immune landscape of the kidney allograft in response to rejection. Clin Sci (Lond) 2023; 137:1823-1838. [PMID: 38126208 DOI: 10.1042/cs20230493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Abstract
Preventing kidney graft dysfunction and rejection is a critical step in addressing the nationwide organ shortage and improving patient outcomes. While kidney transplants (KT) are performed more frequently, the overall number of patients on the waitlist consistently exceeds organ availability. Despite improved short-term outcomes in KT, comparable progress in long-term allograft survival has not been achieved. Major cause of graft loss at 5 years post-KT is chronic allograft dysfunction (CAD) characterized by interstitial fibrosis and tubular atrophy (IFTA). Accordingly, proactive prevention of CAD requires a comprehensive understanding of the immune mechanisms associated with either further dysfunction or impaired repair. Allograft rejection is primed by innate immune cells and carried out by adaptive immune cells. The rejection process is primarily facilitated by antibody-mediated rejection (ABMR) and T cell-mediated rejection (TCMR). It is essential to better elucidate the actions of individual immune cell subclasses (e.g. B memory, Tregs, Macrophage type 1 and 2) throughout the rejection process, rather than limiting our understanding to broad classes of immune cells. Embracing multi-omic approaches may be the solution in acknowledging these intricacies and decoding these enigmatic pathways. A transition alongside advancing technology will better allow organ biology to find its place in this era of precision and personalized medicine.
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Affiliation(s)
- Harsimar Kaur Ahuja
- Surgical Sciences Division, Department of Surgery, School of Medicine, University of Maryland, Baltimore, MD 21201, U.S.A
| | - Shafquat Azim
- Surgical Sciences Division, Department of Surgery, School of Medicine, University of Maryland, Baltimore, MD 21201, U.S.A
| | - Daniel Maluf
- Program of Transplantation, School of Medicine, 29S Greene St, University of Maryland, Baltimore, MD 21201, U.S.A
| | - Valeria R Mas
- Surgical Sciences Division, Department of Surgery, School of Medicine, University of Maryland, Baltimore, MD 21201, U.S.A
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Horwich BH, Shtessel M, Alvarez A, Schiano TD, Grinspan LT. Tough Nut to Crack: Transplant-acquired Food Allergy in an Adult Liver Recipient. Transplant Direct 2023; 9:e1552. [PMID: 37859994 PMCID: PMC10583268 DOI: 10.1097/txd.0000000000001552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 10/21/2023] Open
Affiliation(s)
- Brian H. Horwich
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Maria Shtessel
- Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alanna Alvarez
- Division of Liver Diseases, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Thomas D. Schiano
- Division of Liver Diseases, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lauren T. Grinspan
- Division of Liver Diseases, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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Porret R, Meier RPH, Mikulic J, Pascual M, Aubert V, Harr T, Golshayan D, Muller YD. Atopy as an independent predictor for long-term patient and graft survival after kidney transplantation. Front Immunol 2022; 13:997364. [PMID: 36263051 PMCID: PMC9574189 DOI: 10.3389/fimmu.2022.997364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAtopy is a genetic condition predisposing individuals to develop immunoglobulin E (IgE) against common allergens through T-helper 2 (Th2) polarization mechanisms. The impact of atopy on graft survival in solid organ transplantation is unknown.MethodologyWe analyzed 268 renal allograft recipients from the Swiss Transplant Cohort Study, a prospective multicenter cohort studying patients after solid organ transplantation, with a 9-year median follow-up (IQR 3.0). We used the Phadiatop assay to measure IgE antibodies against a mixture of common inhaled allergens (grass, tree, herbs, spores, animals, and mites) to identify pre-transplantation atopic patients (>0.35 KU/L).ResultsOf 268 kidney transplant recipients, 66 individuals were atopic (24.6%). Atopic patients were significantly younger than non-atopic patients (49.6 vs 58.0 years old, P = 0.002). No significant difference was found for gender, cold/warm ischemia time, preformed donor-specific antibodies (DSA), HLA mismatches, induction and maintenance immunosuppressive therapy, CMV serostatus, or cause of kidney failure. Patient and graft survival at ten years of follow-up were significantly better in the atopic group, 95.2% versus 69.2% patient survival (P < 0.001), and 87.9% versus 60.8% graft survival (P < 0.001), respectively. A multivariate Cox analysis revealed that atopy predicted recipient and graft survival independently of age and living donor donation. Finally, we found similar rates of biopsy-proven acute cellular and antibody-mediated rejections between atopic and non-atopic recipients.ConclusionAtopy was associated with better long-term patient and graft survival, independently of age and living donor donation after kidney transplantation. Yet, atopy should not be used as a predictor for acute rejection.
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Affiliation(s)
- Raphaël Porret
- Division of Immunology and Allergy, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Raphaël P. H. Meier
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Josip Mikulic
- Transplantation Center, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Manuel Pascual
- Transplantation Center, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Vincent Aubert
- Division of Immunology and Allergy, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Thomas Harr
- Division of Immunology and Allergy, University Hospitals of Geneva, Geneva, Switzerland
| | - Déla Golshayan
- Transplantation Center, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Yannick D. Muller
- Division of Immunology and Allergy, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
- *Correspondence: Yannick D. Muller,
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Stojanovic S, Chatelier J, Bosco J, O'Hehir RE, Snell G. Transient acquired donor peanut allergy presenting as life-threatening anaphylaxis following lung transplantation. Ann Allergy Asthma Immunol 2022; 129:517-519. [PMID: 35830945 DOI: 10.1016/j.anai.2022.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/07/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Stephanie Stojanovic
- Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Victoria, Australia.
| | - Josh Chatelier
- Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Victoria, Australia
| | - Julian Bosco
- Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Victoria, Australia; Allergy, Immunology and Respiratory Medicine, Central Clinical School, Monash University, Victoria, Australia
| | - Robyn E O'Hehir
- Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Victoria, Australia; Allergy, Immunology and Respiratory Medicine, Central Clinical School, Monash University, Victoria, Australia
| | - Greg Snell
- Lung Transplant Service, The Alfred Hospital, Victoria, Australia
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Abstract
ABSTRACT Allergic and atopic conditions, including food allergy, asthma, eczema and eosinophilic disease of the gastrointestinal tract after liver transplant in previously non-allergic children have been increasingly described. After a liver transplant, children can present mild to severe reactions to food allergens (ie, from urticaria-angioedema to life-threatening anaphylactic reactions). De novo post-transplant food allergy may become clinically evident in children who undergo liver transplant between a few months and a few years of transplant. The present narrative review aims to describe the spectrum of de novo post-transplant food allergy development, the current theories of pathogenesis, risk factors and to suggest possible clinical management strategies.
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Affiliation(s)
- Francesca Mori
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital
| | - Mattia Giovannini
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital
- Department of Health Sciences, University of Florence
| | - Simona Barni
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital
| | | | - Giuseppe Indolfi
- Department NEUROFARBA, University of Florence and Meyer Children's University Hospital, Florence, Italy
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Mungan D, Gürman G, Mısırlıgil Z, Toprak SK, Dalva K, Topçuoğlu P, Akdiş M, Akdiş C. Transferability and curability of allergic disease by allogeneic hematopoietic stem cell transplantation. Allergy 2020; 75:2392-2394. [PMID: 32356571 DOI: 10.1111/all.14349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Dilşad Mungan
- Division of Immunology and Allergy Department of Chest Diseases Faculty of Medicine Ankara University Ankara Turkey
| | - Günhan Gürman
- Department of Hematology Faculty of Medicine Ankara University Ankara Turkey
| | - Zeynep Mısırlıgil
- Division of Immunology and Allergy Department of Chest Diseases Faculty of Medicine Ankara University Ankara Turkey
| | - Selami Koçak Toprak
- Department of Hematology Faculty of Medicine Ankara University Ankara Turkey
| | - Klara Dalva
- Department of Hematology Faculty of Medicine Ankara University Ankara Turkey
| | - Pervin Topçuoğlu
- Department of Hematology Faculty of Medicine Ankara University Ankara Turkey
| | - Mübeccel Akdiş
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | - Cezmi Akdiş
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
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Muller YD, Vionnet J, Beyeler F, Eigenmann P, Caubet J, Villard J, Berney T, Scherer K, Spertini F, Fricker MP, Lang C, Schmid‐Grendelmeier P, Benden C, Roux Lombard P, Aubert V, Immer F, Pascual M, Harr T. Management of allergy transfer upon solid organ transplantation. Am J Transplant 2020; 20:834-843. [PMID: 31535461 PMCID: PMC7065229 DOI: 10.1111/ajt.15601] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 09/03/2019] [Accepted: 09/07/2019] [Indexed: 01/25/2023]
Abstract
Allergy transfer upon solid organ transplantation has been reported in the literature, although only few data are available as to the frequency, significance, and management of these cases. Based on a review of 577 consecutive deceased donors from the Swisstransplant Donor-Registry, 3 cases (0.5%) of fatal anaphylaxis were identified, 2 because of peanut and 1 of wasp allergy. The sera of all 3 donors and their 10 paired recipients, prospectively collected before and after transplantation for the Swiss Transplant Cohort Study, were retrospectively processed using a commercial protein microarray fluorescent test. As early as 5 days posttransplantation, newly acquired peanut-specific IgE were transiently detected from 1 donor to 3 recipients, of whom 1 liver and lung recipients developed grade III anaphylaxis. Yet, to define how allergy testing should be performed in transplant recipients and to better understand the impact of immunosuppressive therapy on IgE sensitization, we prospectively studied 5 atopic living-donor kidney recipients. All pollen-specific IgE and >90% of skin prick tests remained positive 7 days and 3 months after transplantation, indicating that early diagnosis of donor-derived IgE sensitization is possible. Importantly, we propose recommendations with respect to safety for recipients undergoing solid-organ transplantation from donors with a history of fatal anaphylaxis.
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Affiliation(s)
- Yannick D. Muller
- Division of Immunology and AllergyDepartment of MedicineUniversity Hospitals and University of GenevaGenevaSwitzerland,Transplantation CenterLausanne University Hospital and University of LausanneLausanneSwitzerland,Department of SurgeryUniversity of CaliforniaSan FranciscoCalifornia
| | - Julien Vionnet
- Transplantation CenterLausanne University Hospital and University of LausanneLausanneSwitzerland,Department of Inflammation Biology, School of Immunology and Microbial SciencesKing's College LondonLondonUK
| | | | - Philippe Eigenmann
- Pediatric Allergy UnitDepartment of Women-Children-TeenagersPediatric Allergy UnitUniversity Hospitals of Geneva and University of GenevaGenevaSwitzerland
| | - Jean‐Christoph Caubet
- Pediatric Allergy UnitDepartment of Women-Children-TeenagersPediatric Allergy UnitUniversity Hospitals of Geneva and University of GenevaGenevaSwitzerland
| | - Jean Villard
- Department of Genetic, Laboratory and Pathology MedicineGeneva University HospitalsGenevaSwitzerland
| | - Thierry Berney
- Division of TransplantationDepartment of SurgeryGeneva University HospitalsGenevaSwitzerland
| | - Kathrin Scherer
- Division of Allergy and DermatologyUniversity Hospital BaselBaselSwitzerland
| | - Francois Spertini
- Service of Immunology and AllergyLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Michael P. Fricker
- Division of Rheumatology, Immunology and AllergyInselspitalBernSwitzerland
| | - Claudia Lang
- Allergy UnitDepartment of DermatologyUniversity Hospital of ZürichZürichSwitzerland
| | | | - Christian Benden
- Division of Pulmonary MedicineUniversity Hospital of ZürichZürichSwitzerland
| | - Pascale Roux Lombard
- Division of Immunology and AllergyDepartment of MedicineUniversity Hospitals and University of GenevaGenevaSwitzerland
| | - Vincent Aubert
- Service of Immunology and AllergyLausanne University Hospital and University of LausanneLausanneSwitzerland
| | | | - Manuel Pascual
- Transplantation CenterLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Thomas Harr
- Division of Immunology and AllergyDepartment of MedicineUniversity Hospitals and University of GenevaGenevaSwitzerland
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