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Boenink R, Kramer A, Vanholder RC, Mahillo B, Massy ZA, Bušić M, Ortiz A, Stel VS, Jager KJ, Idrizi A, Watschinger B, Neuwirt H, Eller K, Kalachik O, Leschuk S, Petkevich O, Abramowicz D, Hellemans R, Wissing KM, Colenbie L, Trnacevic S, Rebic D, Resic H, Filipov J, Megerov P, Bušić M, Žunec R, Markić D, Soloukides A, Savva I, Toumasi E, Viklicky O, Reischig T, Krejčí K, Sørensen SS, Bistrup C, Skov K, Lilienthal K, Ots-Rosenberg M, Helanterä I, Koivusalo A, Hourmant M, Essig M, Frimat L, Tomadze G, Banas B, Boletis I, Sándor M, Pálsson R, Plant W, Conlon P, Cooney A, Biancone L, Cardillo M, Ziedina I, Jusinskis J, Vaiciuniene R, Dalinkeviciene E, Delicata L, Farrugia E, Radunović D, Prelević V, Tomović F, Hilbrands L, Bemelman FJ, Schaefer B, Resisæter AV, Lien B, Skauby M, Dębska-Ślizień A, Durlik M, Wiecek A, Sampaio S, Romãozinho C, Jorge C, Rambabova-Bushljetikj I, Nikolov IG, Trajceska L, Tacu D, Elec A, Covic A, Zakharova E, Naumovic R, Lausevic M, Baltesová T, Žilinská Z, Dedinská I, Ponikvar JB, Arnol M, Valentín MO, Domínguez-Gil B, Crespo M, Mazuecos A, Wallquist C, Lundgren T, Dickenmann M, Toz H, Aki T, Keven K, Ravanan R, Geddes C. Factors influencing kidney transplantation rates: a study from the ERA Registry. Nephrol Dial Transplant 2023; 38:1540-1551. [PMID: 36626928 DOI: 10.1093/ndt/gfad001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Large international differences exist in kidney transplantation (KT) rates. We aimed to investigate which factors may explain the total, deceased donor, and living donor KT rates over the last decade. METHODS KT experts from 39 European countries completed the Kidney Transplantation Rate Survey on measures and barriers and their potential effect on the KT rate in their country. In the analyses, countries were divided into low, middle, and high KT rate countries based on the KT rate at the start of study period in 2010. RESULTS Experts from low KT rate countries reported more frequently to have taken measures regarding staff, equipment and facilities to increase total KT rate compared with middle and high KT rate countries. For donor type specific KT, the largest international differences in measures taken were reported for deceased donor KT, with middle and high KT rate countries taking more measures, such as the use of expanded criteria donor kidneys, the presence of transplantation coordinators, and (inter)national exchange of donor kidneys. Once a measure was taken, experts' opinion on its success was similar across the low, middle and high KT rate countries. Experts from low KT rate countries more often reported potential barriers, such as patients' lack of knowledge and distrust in the health care system. CONCLUSIONS In particular in low KT rate countries, KT rate might be stimulated by optimizing staff, equipment, and facilities. In addition, all countries may benefit from deceased and living donor specific measures.
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Affiliation(s)
- Rianne Boenink
- ERA Registry, Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Amsterdam, The Netherlands.,Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
| | - Anneke Kramer
- ERA Registry, Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Amsterdam, The Netherlands.,Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
| | - Raymond C Vanholder
- Nephrology Section, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,European Kidney Health Alliance, Brussels, Belgium
| | | | - Ziad A Massy
- Paris-Saclay University, UVSQ, Inserm, CESP, team 5, Clinical Epidemiology, Villejuif 94800, France.,Paris-Saclay University, AP-HP, Ambroise Paré Hospital, Nephrology department Boulogne-Billancourt 92100, France
| | | | - Alberto Ortiz
- Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Vianda S Stel
- ERA Registry, Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Amsterdam, The Netherlands.,Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
| | - Kitty J Jager
- ERA Registry, Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Amsterdam, The Netherlands.,Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
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Bouwmans P, Messchendorp AL, Sanders JS, Hilbrands L, Reinders MEJ, Vart P, Bemelman FJ, Abrahams AC, van den Dorpel MA, Ten Dam MA, de Vries APJ, Rispens T, Steenhuis M, Gansevoort RT, Hemmelder MH, Kho ML, van Baarle D, van der Molen RG, Baan CC, Diavatopoulos DA, Remmerswaal EBM, Imhof C, Malahe RSRK, Frölke SC, Rots N, van der Klis F, ten Hoope E, Konijn WS, de Ronde T, Vervoort JPM, Braks MHJ. Long-term efficacy and safety of SARS-CoV-2 vaccination in patients with chronic kidney disease, on dialysis or after kidney transplantation: a national prospective observational cohort study. BMC Nephrol 2022; 23:55. [PMID: 35123437 PMCID: PMC8817171 DOI: 10.1186/s12882-022-02680-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 01/20/2022] [Indexed: 01/23/2023] Open
Abstract
Background COVID-19 is associated with increased morbidity and mortality in patients with chronic kidney disease (CKD) stages G4-G5, on dialysis or after kidney transplantation (kidney replacement therapy, KRT). SARS-CoV-2 vaccine trials do not elucidate if SARS-CoV-2 vaccination is effective in these patients. Vaccination against other viruses is known to be less effective in kidney patients. Our objective is to assess the efficacy and safety of various types of SARS-CoV-2 vaccinations in patients with CKD stages G4-G5 or on KRT. Methods In this national prospective observational cohort study we will follow patients with CKD stages G4-G5 or on KRT (n = 12,000) after SARS-CoV-2 vaccination according to the Dutch vaccination program. Blood will be drawn for antibody response measurements at day 28 and month 6 after completion of vaccination. Patient characteristics and outcomes will be extracted from registration data and questionnaires during 2 years of follow-up. Results will be compared with a control group of non-vaccinated patients. The level of antibody response to vaccination will be assessed in subgroups to predict protection against COVID-19 breakthrough infection. Results The primary endpoint is efficacy of SARS-CoV-2 vaccination determined as the incidence of COVID-19 after vaccination. Secondary endpoints are the antibody based immune response at 28 days after vaccination, the durability of this response at 6 months after vaccination, mortality and (serious) adverse events. Conclusion This study will fulfil the lack of knowledge on efficacy and safety of SARS-CoV-2 vaccination in patients with CKD stages G4-G5 or on KRT. Trial registration The study protocol has been registered in clinicaltrials.gov(NCT04841785). Current knowledge about this subjectCOVID-19 has devastating impact on patients with CKD stages G4-G5, on dialysis or after kidney transplantation. Effective SARS-CoV-2 vaccination is very important in these vulnerable patient groups. Recent studies on vaccination in these patient groups are small short-term studies with surrogate endpoints.
Contribution of this studyAssessment of incidence and course of COVID-19 after various types of SARS-CoV-2 vaccination during a two-year follow-up period in not only patients on dialysis or kidney transplant recipients, but also in patients with CKD stages G4-G5. Quantitative analysis of antibody response after SARS-CoV-2 vaccination and its relationship with incidence and course of COVID-19 in patients with CKD stages G4-G5, on dialysis or after kidney transplantation compared with a control group. Monitoring of (serious) adverse events and development of anti-HLA antibodies.
Impact on practice or policyPublication of the study design contributes to harmonization of SARS-CoV-2 vaccine study methodology in kidney patients at high-risk for severe COVID-19.Data on efficacy of SARS-CoV-2 vaccination in patients with CKD will provide guidance for future vaccination policy.
Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02680-3.
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de Boer SE, Sanders JSF, Bemelman FJ, Betjes MGH, Burgerhof JGM, Hilbrands L, Kuypers D, van Munster BC, Nurmohamed SA, de Vries APJ, van Zuilen AD, Hesselink DA, Berger SP. Rationale and design of the OPTIMIZE trial: OPen label multicenter randomized trial comparing standard IMmunosuppression with tacrolimus and mycophenolate mofetil with a low exposure tacrolimus regimen In combination with everolimus in de novo renal transplantation in Elderly patients. BMC Nephrol 2021; 22:208. [PMID: 34078323 PMCID: PMC8172178 DOI: 10.1186/s12882-021-02409-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/18/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In 2019, more than 30 % of all newly transplanted kidney transplant recipients in The Netherlands were above 65 years of age. Elderly patients are less prone to rejection, and death censored graft loss is less frequent compared to younger recipients. Elderly recipients do have increased rates of malignancy and infection-related mortality. Poor kidney transplant function in elderly recipients may be related to both pre-existing (i.e. donor-derived) kidney damage and increased susceptibility to nephrotoxicity of calcineurin inhibitors (CNIs) in kidneys from older donors. Hence, it is pivotal to shift the focus from prevention of rejection to preservation of graft function and prevention of over-immunosuppression in the elderly. The OPTIMIZE study will test the hypothesis that reduced CNI exposure in combination with everolimus will lead to better kidney transplant function, a reduced incidence of complications and improved health-related quality of life for kidney transplant recipients aged 65 years and older, compared to standard immunosuppression. METHODS This open label, randomized, multicenter clinical trial will include 374 elderly kidney transplant recipients (≥ 65 years) and consists of two strata. Stratum A includes elderly recipients of a kidney from an elderly deceased donor and stratum B includes elderly recipients of a kidney from a living donor or from a deceased donor < 65 years. In each stratum, subjects will be randomized to a standard, tacrolimus-based immunosuppressive regimen with mycophenolate mofetil and glucocorticoids or an adapted immunosuppressive regimen with reduced CNI exposure in combination with everolimus and glucocorticoids. The primary endpoint is 'successful transplantation', defined as survival with a functioning graft and an eGFR ≥ 30 ml/min per 1.73 m2 in stratum A and ≥ 45 ml/min per 1.73 m2 in stratum B, after 2 years, respectively. CONCLUSIONS The OPTIMIZE study will help to determine the optimal immunosuppressive regimen after kidney transplantation for elderly patients and the cost-effectiveness of this regimen. It will also provide deeper insight into immunosenescence and both subjective and objective outcomes after kidney transplantation in elderly recipients. TRIAL REGISTRATION ClinicalTrials.gov: NCT03797196 , registered January 9th, 2019. EudraCT: 2018-003194-10, registered March 19th, 2019.
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Affiliation(s)
- S E de Boer
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - J S F Sanders
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - F J Bemelman
- Department of Internal Medicine, Division of Nephrology, Amsterdam Universal Medical Center, Amsterdam, The Netherlands
| | - M G H Betjes
- Department of Internal Medicine, Division of Nephrology & Transplantation, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J G M Burgerhof
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - L Hilbrands
- Department of Internal Medicine, Division of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - D Kuypers
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - B C van Munster
- Department of Internal Medicine, Divison of Geriatrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - S A Nurmohamed
- Department of Internal Medicine, Division of Nephrology, Amsterdam Universal Medical Center, Amsterdam, The Netherlands
| | - A P J de Vries
- Department of Internal Medicine, Division of Nephrology; and Leiden Transplant Center, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
| | - A D van Zuilen
- Department of Internal Medicine, Division of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - D A Hesselink
- Department of Internal Medicine, Division of Nephrology & Transplantation, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - S P Berger
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Kamburova EG, Wisse BW, Joosten I, Allebes WA, van der Meer A, Hilbrands LB, Baas MC, Spierings E, Hack CE, van Reekum FE, van Zuilen AD, Verhaar MC, Bots ML, Drop ACAD, Plaisier L, Seelen MAJ, Sanders JS.F, Hepkema BG, Lambeck AJA, Bungener LB, Roozendaal C, Tilanus MGJ, Voorter CE, Wieten L, van Duijnhoven EM, Gelens M, Christiaans MHL, van Ittersum FJ, Nurmohamed SA, Lardy NM, Swelsen W, van der Pant KA, van der Weerd NC, ten Berge IJM, Bemelman FJ, Hoitsma A, van der Boog PJM, de Fijter JW, Betjes MGH, Heidt S, Roelen DL, Claas FH, Otten HG. Differential effects of donor-specific HLA antibodies in living versus deceased donor transplant. Am J Transplant 2018; 18:2274-2284. [PMID: 29464832 PMCID: PMC6175247 DOI: 10.1111/ajt.14709] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [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: 07/07/2017] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 01/25/2023]
Abstract
The presence of donor-specific anti-HLA antibodies (DSAs) is associated with increased risk of graft failure after kidney transplant. We hypothesized that DSAs against HLA class I, class II, or both classes indicate a different risk for graft loss between deceased and living donor transplant. In this study, we investigated the impact of pretransplant DSAs, by using single antigen bead assays, on long-term graft survival in 3237 deceased and 1487 living donor kidney transplants with a negative complement-dependent crossmatch. In living donor transplants, we found a limited effect on graft survival of DSAs against class I or II antigens after transplant. Class I and II DSAs combined resulted in decreased 10-year graft survival (84% to 75%). In contrast, after deceased donor transplant, patients with class I or class II DSAs had a 10-year graft survival of 59% and 60%, respectively, both significantly lower than the survival for patients without DSAs (76%). The combination of class I and II DSAs resulted in a 10-year survival of 54% in deceased donor transplants. In conclusion, class I and II DSAs are a clear risk factor for graft loss in deceased donor transplants, while in living donor transplants, class I and II DSAs seem to be associated with an increased risk for graft failure, but this could not be assessed due to their low prevalence.
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5
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Peters-Sengers H, Houtzager JHE, Heemskerk MBA, Idu MM, Minnee RC, Klaasen RW, Joor SE, Hagenaars JAM, Rebers PM, van der Heide JJH, Roodnat JI, Bemelman FJ. DCD donor hemodynamics as predictor of outcome after kidney transplantation. Am J Transplant 2018; 18:1966-1976. [PMID: 29380523 DOI: 10.1111/ajt.14676] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 12/29/2017] [Accepted: 01/19/2018] [Indexed: 01/25/2023]
Abstract
Insufficient hemodynamics during agonal phase-ie, the period between withdrawal of life-sustaining treatment and circulatory arrest-in Maastricht category III circulatory-death donors (DCD) potentially exacerbate ischemia/reperfusion injury. We included 409 Dutch adult recipients of DCD donor kidneys transplanted between 2006 and 2014. Peripheral oxygen saturation (SpO2-with pulse oximetry at the fingertip) and systolic blood pressure (SBP-with arterial catheter) were measured during agonal phase, and were dichotomized into minutes of SpO2 > 60% or SpO2 < 60%, and minutes of SBP > 80 mmHg or SBP < 80 mmHg. Outcome measures were and primary non-function (PNF), delayed graft function (DGF), and three-year graft survival. Primary non-function (PNF) rate was 6.6%, delayed graft function (DGF) rate was 67%, and graft survival at three years was 76%. Longer periods of agonal phase (median 16 min [IQR 11-23]) contributed significantly to an increased risk of DGF (P = .012), but not to PNF (P = .071) and graft failure (P = .528). Multiple logistic regression analysis showed that an increase from 7 to 20 minutes in period of SBP < 80 mmHg was associated with 2.19 times the odds (95% CI 1.08-4.46, P = .030) for DGF. In conclusion, duration of agonal phase is associated with early transplant outcome. SBP < 80 mmHg during agonal phase shows a better discrimination for transplant outcome than SpO2 < 60% does.
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Affiliation(s)
- H Peters-Sengers
- Department of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Center for Experimental and Molecular Medicine (CEMM), Academic Medical Center, University of Amsterdam, the Netherlands
| | - J H E Houtzager
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | | | - M M Idu
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - R C Minnee
- Department of Surgery, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - R W Klaasen
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - S E Joor
- Department of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - J A M Hagenaars
- Department of Surgery, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - P M Rebers
- Department of Surgery, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - J J Homan van der Heide
- Department of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - J I Roodnat
- Department of Nephrology, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - F J Bemelman
- Department of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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6
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de Fijter JW, Holdaas H, Øyen O, Sanders JS, Sundar S, Bemelman FJ, Sommerer C, Pascual J, Avihingsanon Y, Pongskul C, Oppenheimer F, Toselli L, Russ G, Wang Z, Lopez P, Kochuparampil J, Cruzado JM, van der Giet M. Early Conversion From Calcineurin Inhibitor- to Everolimus-Based Therapy Following Kidney Transplantation: Results of the Randomized ELEVATE Trial. Am J Transplant 2017; 17:1853-1867. [PMID: 28027625 DOI: 10.1111/ajt.14186] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 12/20/2016] [Indexed: 01/25/2023]
Abstract
In a 24-month, multicenter, open-label, randomized trial, 715 de novo kidney transplant recipients were randomized at 10-14 weeks to convert to everolimus (n = 359) or remain on standard calcineurin inhibitor (CNI) therapy (n = 356; 231 tacrolimus; 125 cyclosporine), all with mycophenolic acid and steroids. The primary endpoint, change in estimated glomerular filtration rate (eGFR) from randomization to month 12, was similar for everolimus versus CNI: mean (standard error) 0.3(1.5) mL/min/1.732 versus -1.5(1.5) mL/min/1.732 (p = 0.116). Biopsy-proven acute rejection (BPAR) at month 12 was more frequent under everolimus versus CNI overall (9.7% vs. 4.8%, p = 0.014) and versus tacrolimus-treated patients (2.6%, p < 0.001) but similar to cyclosporine-treated patients (8.8%, p = 0.755). Reporting on de novo donor-specific antibodies (DSA) was limited but suggested more frequent anti-HLA Class I DSA under everolimus. Change in left ventricular mass index was similar. Discontinuation due to adverse events was more frequent with everolimus (23.6%) versus CNI (8.4%). In conclusion, conversion to everolimus at 10-14 weeks posttransplant was associated with renal function similar to that with standard therapy overall. Rates of BPAR were low in all groups, but lower with tacrolimus than everolimus.
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Affiliation(s)
- J W de Fijter
- Department of Nephrology, Leiden University Medical Center, Leiden, the Netherlands
| | - H Holdaas
- Section of Nephrology, Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - O Øyen
- Section of Transplant Surgery, Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - J-S Sanders
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - S Sundar
- Department of Nephrology, Columbia Asia Hospitals, Malleshwaram West, Bangalore, India
| | - F J Bemelman
- Department of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - C Sommerer
- Department of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - J Pascual
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Y Avihingsanon
- Faculty of Medicine, Chulalongkorn University and Excellent Center of Organ Transplantation, King Chulalongkorn Memorial Hospital, Patumwan, Bangkok, Thailand
| | - C Pongskul
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - F Oppenheimer
- Department of Nephrology and Kidney Transplantation, Hospital Clínic de Barcelona, Barcelona, Spain
| | - L Toselli
- Kidney, Liver and Pancreas Transplant Unit, CRAI Norte, Ministry of Health, Buenos Aires, Argentina
| | - G Russ
- University of Adelaide and Central and Northern Adelaide Renal and Transplant Service, Royal Adelaide Hospital, North Terrace, Adelaide, Australia
| | - Z Wang
- Biometrics and Statistical Science, Novartis Pharmaceuticals, East Hanover, NJ
| | - P Lopez
- Research and Development, Novartis Pharma AG, Basel, Switzerland
| | - J Kochuparampil
- Research and Development, Novartis Pharma AG, Basel, Switzerland
| | - J M Cruzado
- Department of Nephrology, University Hospital of Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - M van der Giet
- Department of Nephrology, Charité - Universitätsmedizin, Berlin, Germany
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7
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Bemelman FJ, de Fijter JW, Kers J, Meyer C, Peters-Sengers H, de Maar EF, van der Pant KAMI, de Vries APJ, Sanders JS, Zwinderman A, Idu MM, Berger S, Reinders MEJ, Krikke C, Bajema IM, van Dijk MC, Ten Berge IJM, Ringers J, Lardy J, Roelen D, Moes DJ, Florquin S, Homan van der Heide JJ. Early Conversion to Prednisolone/Everolimus as an Alternative Weaning Regimen Associates With Beneficial Renal Transplant Histology and Function: The Randomized-Controlled MECANO Trial. Am J Transplant 2017; 17:1020-1030. [PMID: 27639190 DOI: 10.1111/ajt.14048] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 08/20/2016] [Accepted: 09/07/2016] [Indexed: 01/25/2023]
Abstract
In renal transplantation, use of calcineurin inhibitors (CNIs) is associated with nephrotoxicity and immunosuppression with malignancies and infections. This trial aimed to minimize CNI exposure and total immunosuppression while maintaining efficacy. We performed a randomized controlled, open-label multicenter trial with early cyclosporine A (CsA) elimination. Patients started with basiliximab, prednisolone (P), mycophenolate sodium (MPS), and CsA. At 6 months, immunosuppression was tapered to P/CsA, P/MPS, or P/everolimus (EVL). Primary outcomes were renal fibrosis and inflammation. Secondary outcomes were estimated glomerular filtration rate (eGFR) and incidence of rejection at 24 months. The P/MPS arm was prematurely halted. The trial continued with P/CsA (N = 89) and P/EVL (N = 96). Interstitial fibrosis and inflammation were significantly decreased and the eGFR was significantly higher in the P/EVL arm. Cumulative rejection rates were 13% (P/EVL) and 19% (P/CsA), (p = 0.08). A post hoc analysis of HLA and donor-specific antibodies at 1 year after transplantation revealed no differences. An individualized immunosuppressive strategy of early CNI elimination to dual therapy with everolimus was associated with decreased allograft fibrosis, preserved allograft function, and good efficacy, but also with more serious adverse events and discontinuation. This can be a valuable alternative regimen in patients suffering from CNI toxicity.
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Affiliation(s)
- F J Bemelman
- Renal Transplant Unit, Amsterdam, the Netherlands
| | - J W de Fijter
- Renal Transplant Unit, Department of Nephrology, Leiden University Medical Centre, Leiden, the Netherlands
| | - J Kers
- Department of Pathology, Academic Medical Centre, Amsterdam, the Netherlands
| | - C Meyer
- University of Amsterdam, Amsterdam, the Netherlands
| | | | - E F de Maar
- Department of Nephrology, Groningen University Hospital, Groningen, the Netherlands
| | | | - A P J de Vries
- Renal Transplant Unit, Department of Nephrology, Leiden University Medical Centre, Leiden, the Netherlands
| | - J-S Sanders
- Department of Nephrology, Groningen University Hospital, Groningen, the Netherlands
| | - A Zwinderman
- Department of Epidemiology and Biostatistics, Academic Medical Centre, Amsterdam, the Netherlands
| | - M M Idu
- Department of Surgery, Academic Medical Centre, Amsterdam, the Netherlands
| | - S Berger
- Department of Nephrology, Groningen University Hospital, Groningen, the Netherlands
| | - M E J Reinders
- Renal Transplant Unit, Department of Nephrology, Leiden University Medical Centre, Leiden, the Netherlands
| | - C Krikke
- Department of Surgery, Groningen University Hospital, Groningen, the Netherlands
| | - I M Bajema
- Department of Pathology, Leiden University Medical Centre, Leiden, the Netherlands
| | - M C van Dijk
- Department of Pathology, Groningen University Hospital, Groningen, the Netherlands
| | | | - J Ringers
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - J Lardy
- Sanquin Diagnostic Services, Amsterdam, the Netherlands
| | - D Roelen
- Department of Immunogenetics and Transplantation Immunology, Leiden University Medical Centre, Leiden, the Netherlands
| | - D-J Moes
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Centre, Leiden, the Netherlands
| | - S Florquin
- Department of Pathology, Academic Medical Centre, Amsterdam, the Netherlands
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8
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Singh R, Geerlings SE, Peters-Sengers H, Idu MM, Hodiamont CJ, Ten Berge IJM, Bemelman FJ. Incidence, risk factors, and the impact of allograft pyelonephritis on renal allograft function. Transpl Infect Dis 2016; 18:647-660. [PMID: 27380002 DOI: 10.1111/tid.12568] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 07/30/2015] [Accepted: 04/03/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND The impact of allograft pyelonephritis (AGPN) on renal allograft function is controversial. In this study, we evaluated the incidence, risk factors, and the impact of AGPN on renal allograft function. METHODS Retrospective cohort study in adult renal allograft recipients with 1-year follow-up after transplantation (Tx). Renal allograft function was evaluated by estimated glomerular filtration rate (eGFR) (by Modification of Diet in Renal Disease formula) and 24-h urine protein excretion. RESULTS A total of 431 renal allograft recipients were analyzed; 57 (13.2%) developed AGPN within 1 year after Tx. Median time between Tx and AGPN was 50 days. Risk factors for AGPN were the presence of a urological catheter (odds ratio [OR] = 18.93, 95% confidence interval [CI] = 8.00-44.81, P < 0.001) and preceding asymptomatic bacteriuria (ASB) (OR = 2.16, 95% CI = 1.20-3.90, P = 0.009). In 72.7%, the causative microorganism of ASB was identical to that of the succeeding AGPN episode. Multivariable linear regression analysis showed that experiencing AGPN did not decrease the eGFR (P = 0.61) nor did increased proteinuria (P = 0.29) 1 year after Tx. For the eGFR, an interaction was found between AGPN/bacteriuria (BU) and acute rejection (AR): the group experiencing BU preceding AR had significantly (P < 0.001) lower eGFR compared with the group that experienced only AR (21 mL/min/1.73 m2 vs. 48 mL/min/1.73 m2 ), as a result of increased prevalence of combined rejections within the BU group. CONCLUSION Indwelling urological catheters and preceding ASB are associated with developing AGPN. An incident of AGPN itself does not impair renal allograft function 1 year after Tx. However, a relevant interaction occurs between BU and AR, in which the sequence of occurrence of these 2 events synergistically impairs the eGFR.
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Affiliation(s)
- R Singh
- Renal Transplant Unit, Division of Nephrology, Department of Internal Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands.
| | - S E Geerlings
- Division of Infectious Diseases, Department of Internal Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
| | - H Peters-Sengers
- Division of Infectious Diseases, Department of Internal Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
| | - M M Idu
- Division of Vascular Surgery, Department of Surgery, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
| | - C J Hodiamont
- Department of Medical Microbiology, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
| | - I J M Ten Berge
- Renal Transplant Unit, Division of Nephrology, Department of Internal Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
| | - F J Bemelman
- Renal Transplant Unit, Division of Nephrology, Department of Internal Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
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9
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Kamburova EG, Wisse BW, Joosten I, Allebes WA, van der Meer A, Hilbrands LB, Baas MC, Spierings E, Hack CE, van Reekum FE, van Zuilen AD, Verhaar M, Bots ML, Drop ACAD, Plaisier L, Seelen MAJ, Sanders JSF, Hepkema BG, Lambeck AJ, Bungener LB, Roozendaal C, Tilanus MGJ, Vanderlocht J, Voorter CE, Wieten L, van Duijnhoven EM, Gelens M, Christiaans MHL, van Ittersum FJ, Nurmohamed A, Lardy NM, Swelsen W, van der Pant KA, van der Weerd NC, Ten Berge IJM, Bemelman FJ, Hoitsma A, van der Boog PJM, de Fijter JW, Betjes MGH, Heidt S, Roelen DL, Claas FH, Otten HG. How can we reduce costs of solid-phase multiplex-bead assays used to determine anti-HLA antibodies? HLA 2016; 88:110-9. [PMID: 27534609 DOI: 10.1111/tan.12860] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 07/24/2016] [Indexed: 11/29/2022]
Abstract
Solid-phase multiplex-bead assays are widely used in transplantation to detect anti-human leukocyte antigen (HLA) antibodies. These assays enable high resolution detection of low levels of HLA antibodies. However, multiplex-bead assays are costly and yield variable measurements that limit the comparison of results between laboratories. In the context of a Dutch national Consortium study we aimed to determine the inter-assay and inter-machine variability of multiplex-bead assays, and we assessed how to reduce the assay reagents costs. Fifteen sera containing a variety of HLA antibodies were used yielding in total 7092 median fluorescence intensities (MFI) values. The inter-assay and inter-machine mean absolute relative differences (MARD) of the screening assay were 12% and 13%, respectively. The single antigen bead (SAB) inter-assay MARD was comparable, but showed a higher lot-to-lot variability. Reduction of screening assay reagents to 50% or 40% of manufacturers' recommendations resulted in MFI values comparable to 100% of the reagents, with an MARD of 12% or 14%, respectively. The MARD of the 50% and 40% SAB assay reagent reductions were 11% and 22%, respectively. From this study, we conclude that the reagents can be reliably reduced at least to 50% of manufacturers' recommendations with virtually no differences in HLA antibody assignments.
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Affiliation(s)
- E G Kamburova
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - B W Wisse
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - I Joosten
- Laboratory Medicine, Lab. Medical Immunology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - W A Allebes
- Laboratory Medicine, Lab. Medical Immunology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A van der Meer
- Laboratory Medicine, Lab. Medical Immunology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - L B Hilbrands
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M C Baas
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - E Spierings
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C E Hack
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F E van Reekum
- Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A D van Zuilen
- Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Verhaar
- Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A C A D Drop
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Plaisier
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M A J Seelen
- Department of Nephrology, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - J S F Sanders
- Department of Nephrology, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - B G Hepkema
- Department of Laboratory Medicine, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - A J Lambeck
- Department of Laboratory Medicine, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - L B Bungener
- Department of Laboratory Medicine, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - C Roozendaal
- Department of Laboratory Medicine, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - M G J Tilanus
- Department of Transplantation Immunology, Tissue Typing Laboratory, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J Vanderlocht
- Department of Transplantation Immunology, Tissue Typing Laboratory, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - C E Voorter
- Department of Transplantation Immunology, Tissue Typing Laboratory, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - L Wieten
- Department of Transplantation Immunology, Tissue Typing Laboratory, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - E M van Duijnhoven
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M Gelens
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M H L Christiaans
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - F J van Ittersum
- Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands
| | - A Nurmohamed
- Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands
| | - N M Lardy
- Department of Immunogenetics, Sanquin, Amsterdam, The Netherlands
| | - W Swelsen
- Department of Immunogenetics, Sanquin, Amsterdam, The Netherlands
| | - K A van der Pant
- Renal Transplant Unit, Department of Internal Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - N C van der Weerd
- Renal Transplant Unit, Department of Internal Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - I J M Ten Berge
- Renal Transplant Unit, Department of Internal Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - F J Bemelman
- Renal Transplant Unit, Department of Internal Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - A Hoitsma
- Dutch Organ Transplant Registry (NOTR), Dutch Transplant Foundation (NTS), Leiden, The Netherlands
| | - P J M van der Boog
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - J W de Fijter
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - M G H Betjes
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands.,Department of Nephrology, Erasmus MC, Rotterdam, The Netherlands
| | - S Heidt
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - D L Roelen
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - F H Claas
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - H G Otten
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
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10
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Heutinck KM, Yong SL, Tonneijck L, van den Heuvel H, van der Weerd NC, van der Pant KAMI, Bemelman FJ, Claas FHJ, Ten Berge IJM. Virus-Specific CD8(+) T Cells Cross-Reactive to Donor-Alloantigen Are Transiently Present in the Circulation of Kidney Transplant Recipients Infected With CMV and/or EBV. Am J Transplant 2016; 16:1480-91. [PMID: 26603974 DOI: 10.1111/ajt.13618] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/05/2015] [Accepted: 10/24/2015] [Indexed: 01/25/2023]
Abstract
T cells play a dual role in transplantation: They mediate transplant rejection and are crucial for virus control. Memory T cells generated in response to pathogens can cross-react to alloantigen, a phenomenon called heterologous immunity. Virus-specific CD8(+) T cells cross-reacting to donor-alloantigen might affect alloimmune responses and hamper tolerance induction following transplantation. Here, we longitudinally studied these cross-reactive cells in peripheral blood of 25 kidney transplant recipients with a cytomegalovirus and/or Epstein-Barr virus infection. Cross-reactive T cells were identified by flow cytometry as virus-specific T cells that proliferate in response to donor cells in a mixed-lymphocyte reaction. In 13 of 25 patients, we found cross-reactivity to donor cells for at least 1 viral epitope before (n = 7) and/or after transplantation (n = 8). Cross-reactive T cells were transiently present in the circulation, and their precursor frequency did not increase following transplantation or viral infection. Cross-reactive T cells expressed interferon-γ and CD107a in response to both alloantigen and viral peptide and resembled virus-specific T cells in phenotype and function. Their presence was not associated with impaired renal function, proteinuria, or rejection. In conclusion, virus-specific T cells that cross-react to donor-alloantigen are transiently detectable in the circulation of kidney transplant recipients.
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Affiliation(s)
- K M Heutinck
- Department of Experimental Immunology, Academic Medical Center, Amsterdam, The Netherlands.,Renal Transplant Unit, Department of Nephrology, Division of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - S L Yong
- Department of Experimental Immunology, Academic Medical Center, Amsterdam, The Netherlands.,Renal Transplant Unit, Department of Nephrology, Division of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - L Tonneijck
- Department of Experimental Immunology, Academic Medical Center, Amsterdam, The Netherlands
| | - H van den Heuvel
- Department of Immunohaematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - N C van der Weerd
- Renal Transplant Unit, Department of Nephrology, Division of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - K A M I van der Pant
- Renal Transplant Unit, Department of Nephrology, Division of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - F J Bemelman
- Renal Transplant Unit, Department of Nephrology, Division of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - F H J Claas
- Department of Immunohaematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - I J M Ten Berge
- Renal Transplant Unit, Department of Nephrology, Division of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
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11
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Singh R, Nieuwdorp M, ten Berge IJM, Bemelman FJ, Geerlings SE. The potential beneficial role of faecal microbiota transplantation in diseases other than Clostridium difficile infection. Clin Microbiol Infect 2014; 20:1119-25. [PMID: 25274035 DOI: 10.1111/1469-0691.12799] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This review gives an outline of the indications for faecal microbiota transplantation (FMT) for diseases other than Clostridium difficile (C. difficile) infection. The remarkable efficacy of FMT against C. difficile infection has already been demonstrated. The use of FMT for other diseases, such as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), and metabolic syndrome, is now being evaluated. The currently available data suggest that FMT might be beneficial for IBD (including ulcerative colitis and, to some extent, Crohn's disease), IBS, and insulin resistance. Several randomized clinical trials are currently being performed, and data are eagerly awaited. A new field of research for the implementation of FMT is the eradication of pathogenic and multiresistant enteric microorganisms. A few animal studies have been performed within this field, but hardly any research data from human studies are available at present.
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Affiliation(s)
- R Singh
- Renal Transplant Unit, Division of Nephrology, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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12
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Otten HG, Joosten I, Allebes WA, van der Meer A, Hilbrands LB, Baas M, Spierings E, Hack CE, van Reekum F, van Zuilen AD, Verhaar MC, Bots ML, Seelen MAJ, Sanders JSF, Hepkema BG, Lambeck AJ, Bungener LB, Roozendaal C, Tilanus MGJ, Vanderlocht J, Voorter CE, Wieten L, van Duijnhoven E, Gelens M, Christiaans M, van Ittersum F, Nurmohamed A, Lardy NM, Swelsen WT, van Donselaar-van der Pant KAMI, van der Weerd NC, Ten Berge IJM, Bemelman FJ, Hoitsma AJ, de Fijter JW, Betjes MGH, Roelen DL, Claas FHJ. The PROCARE consortium: toward an improved allocation strategy for kidney allografts. Transpl Immunol 2014; 31:184-90. [PMID: 25258025 DOI: 10.1016/j.trim.2014.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Kidney transplantation is the best treatment option for patients with end-stage renal failure. At present, approximately 800 Dutch patients are registered on the active waiting list of Eurotransplant. The waiting time in the Netherlands for a kidney from a deceased donor is on average between 3 and 4 years. During this period, patients are fully dependent on dialysis, which replaces only partly the renal function, whereas the quality of life is limited. Mortality among patients on the waiting list is high. In order to increase the number of kidney donors, several initiatives have been undertaken by the Dutch Kidney Foundation including national calls for donor registration and providing information on organ donation and kidney transplantation. The aim of the national PROCARE consortium is to develop improved matching algorithms that will lead to a prolonged survival of transplanted donor kidneys and a reduced HLA immunization. The latter will positively affect the waiting time for a retransplantation. The present algorithm for allocation is among others based on matching for HLA antigens, which were originally defined by antibodies using serological typing techniques. However, several studies suggest that this algorithm needs adaptation and that other immune parameters which are currently not included may assist in improving graft survival rates. We will employ a multicenter-based evaluation on 5429 patients transplanted between 1995 and 2005 in the Netherlands. The association between key clinical endpoints and selected laboratory defined parameters will be examined, including Luminex-defined HLA antibody specificities, T and B cell epitopes recognized on the mismatched HLA antigens, non-HLA antibodies, and also polymorphisms in complement and Fc receptors functionally associated with effector functions of anti-graft antibodies. From these data, key parameters determining the success of kidney transplantation will be identified which will lead to the identification of additional parameters to be included in future matching algorithms aiming to extend survival of transplanted kidneys and to diminish HLA immunization. Computer simulation studies will reveal the number of patients having a direct benefit from improved matching, the effect on shortening of the waiting list, and the decrease in waiting time.
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Affiliation(s)
- H G Otten
- UMC Utrecht, Laboratory for Translational Immunology, The Netherlands
| | - I Joosten
- Radboudumc, Dept. of Laboratory Medicine, The Netherlands
| | - W A Allebes
- Radboudumc, Dept. of Laboratory Medicine, The Netherlands
| | - A van der Meer
- Radboudumc, Dept. of Laboratory Medicine, The Netherlands
| | | | - M Baas
- Radboudumc, Dept. of Nephrology, The Netherlands
| | - E Spierings
- UMC Utrecht, Laboratory for Translational Immunology, The Netherlands
| | - C E Hack
- UMC Utrecht, Laboratory for Translational Immunology, The Netherlands
| | - F van Reekum
- UMC Utrecht, Dept. of Nephrology and Hypertension, The Netherlands
| | - A D van Zuilen
- UMC Utrecht, Dept. of Nephrology and Hypertension, The Netherlands
| | - M C Verhaar
- UMC Utrecht, Dept. of Nephrology and Hypertension, The Netherlands
| | - M L Bots
- UMC Utrecht, Julius Center for Health Sciences and Primary Care, The Netherlands
| | | | | | - B G Hepkema
- UMCG, Dept. of Laboratory Medicine, The Netherlands
| | - A J Lambeck
- UMCG, Dept. of Laboratory Medicine, The Netherlands
| | - L B Bungener
- UMCG, Dept. of Laboratory Medicine, The Netherlands
| | - C Roozendaal
- UMCG, Dept. of Laboratory Medicine, The Netherlands
| | - M G J Tilanus
- Maastricht UMC, Transplantation Immunology, The Netherlands
| | - J Vanderlocht
- Maastricht UMC, Transplantation Immunology, The Netherlands
| | - C E Voorter
- Maastricht UMC, Transplantation Immunology, The Netherlands
| | - L Wieten
- Maastricht UMC, Transplantation Immunology, The Netherlands
| | | | - M Gelens
- Maastricht UMC, Dept. of Nephrology, The Netherlands
| | - M Christiaans
- Maastricht UMC, Dept. of Nephrology, The Netherlands
| | | | | | - N M Lardy
- Sanquin, Dept. of Immunogenetics, The Netherlands
| | - W T Swelsen
- Sanquin, Dept. of Immunogenetics, The Netherlands
| | | | | | - I J M Ten Berge
- AMC Renal Transplant Unit, Dept. of Nephrology, The Netherlands
| | - F J Bemelman
- AMC Renal Transplant Unit, Dept. of Nephrology, The Netherlands
| | | | | | - M G H Betjes
- Erasmus MC, Dept. of Nephrology, The Netherlands
| | - D L Roelen
- LUMC, Immunohematology and Blood Transfusion, The Netherlands
| | - F H J Claas
- LUMC, Immunohematology and Blood Transfusion, The Netherlands
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13
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Singh R, van Nood E, Nieuwdorp M, van Dam B, ten Berge IJM, Geerlings SE, Bemelman FJ. Donor feces infusion for eradication of Extended Spectrum beta-Lactamase producing Escherichia coli in a patient with end stage renal disease. Clin Microbiol Infect 2014; 20:O977-8. [PMID: 24845223 DOI: 10.1111/1469-0691.12683] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- R Singh
- Renal Transplant Unit, Division of Nephrology, Department of Internal Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands
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14
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Dobrowolski LC, Bemelman FJ, van Donselaar-van der Pant KAMI, Hoitsma AJ, ten Berge IJM, Krediet CTP. Treatment efficacy of hypertension in kidney transplant recipients in the Netherlands. Neth J Med 2014; 72:258-263. [PMID: 24930459] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Hypertension in kidney transplant recipients jeopardises graft and patient survival. Guidelines suggest blood pressure targets of ≤130/80 mmHg and sodium intake <90 mmol/day. METHODS Since the efficacy of antihypertensive treatment among kidney transplant recipients is unknown, we analysed data on office-based blood pressure and use of antihypertensive drugs from the Netherlands Organ Transplant Registry on 5415 kidney transplant recipients. Additionally, we studied dosages, prevalence of treatment-resistant hypertension and 24-hour sodium excretion in 534 kidney transplant recipients from our centre to explore possibilities for therapy optimisation. RESULTS In patients registered in the Netherlands Organ Transplant Registry, median blood pressure was 134/80 mmHg (interquartile range 122-145/70-85). In 77.2%, the blood pressure was ≥130/80 mmHg; of these patients 10.4% had no registered use, 30.0% used one and 25.9% used ≥3 classes of antihypertensive agents. Parameters from our centre were comparable: 78.7% had a median blood pressure of ≥130/80 mmHg of whom 14.5% had no registered use of antihypertensives and 26.4% used ≥3 classes. Sub-maximal dosages were prescribed in 74.0% of the kidney transplant recipients with a blood pressure of ≥130/80 mmHg while using at least one antihypertensive agent. Treatment-resistant hypertension was present in 7.7%. Median 24-hour sodium excretion was 147 mmol/day (interquartile range 109-195). CONCLUSIONS This study suggests that therapeutic optimisation of antihypertensive treatment in kidney transplant recipients is, in theory, frequently possible by intensifying pharmacological treatment and by providing more advice on dietary sodium restrictions.
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Affiliation(s)
- L C Dobrowolski
- Department of Internal Medicine, Division of Nephrology - Renal Transplant Unit, Academic Medical Centre, Amsterdam, the Netherlands
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Berthelot L, Robert T, Tabary T, Vuiblet V, Drame M, Toupance O, Rieu P, Monteiro RC, Toure F, Ferrario S, Cantaluppi V, De Lena M, Dellepiane S, Beltramo S, Rossetti M, Manzione AM, Messina M, Gai M, Dolla C, Biancone L, Camussi G, Pontrelli P, Oranger AR, Accetturo M, Rascio F, Gigante M, Castellano G, Schena A, Fiorentino M, Zito A, Zaza G, Stallone G, Gesualdo L, Grandaliano G, Pattonieri EF, Gregorini M, Corradetti V, Rocca C, Milanesi S, Peloso A, Ferrario J, Cannone M, Bosio F, Maggi N, Avanzini MA, Minutillo P, Paulli M, Maestri M, Rampino T, Dal Canton A, Wu KST, Coxall O, Luque Y, Candon S, Rabant M, Noel LH, Thervet E, Chatenoud L, Snanoudj R, Anglicheau D, Legendre C, Zuber J, Hruba P, Brabcova I, Krepsova E, Slatinska J, Sekerkova A, Striz I, Zachoval R, Viklicky O, Scholbach TM, Wang HK, Loong CC, Yang AH, Wu TH, Hruba P, Brabcova I, Krepsova E, Slatinska J, Sekerkova A, Striz I, Zachoval R, Viklicky O, Guberina H, Rebmann V, Dziallas P, Dolff S, Wohlschlaeger J, Heinemann FM, Witzke O, Zoet YM, Claas FHJ, Horn PA, Kribben A, Doxiadis IIN, Prasad N, Yadav B, Agarwal V, Jaiswal A, Rai M, Hope CM, Coates PT, Heeger PS, Carroll R, Zaza G, Masola V, Secchi MF, Onisto M, Gambaro G, Lupo A, Matsuyama M, Kobayashi T, Yoneda Y, Chargui J, Touraine JL, Yoshimura R, Vizza D, Perri A, Lupinacci S, Toteda G, Lofaro D, Leone F, Gigliotti P, La Russa A, Papalia T, Bonofilgio R, Sentis Fuster A, Kers J, Yapici U, Claessen N, Bemelman FJ, Ten Berge IJM, Florquin S, Glotz D, Rostaing L, Squifflet JP, Merville P, Belmokhtar C, Le Ny G, Lebranchu Y, Papazova DA, Friederich-Persson M, Koeners MP, Joles JA, Verhaar MC, Trivedi HL, Vanikar AV, Dave SD, Suarez Alvarez B, Garcia Melendreras S, Carvajal Palao R, Diaz Corte C, Ruiz Ortega M, Lopez-Larrea C, Yadav AK, Bansal D, Kumar V, Kumar V, Minz M, Jha V, Kaminska D, Koscielska-Kasprzak K, Chudoba P, Mazanowska O, Banasik M, Zabinska M, Boratynska M, Lepiesza A, Korta K, Klinger M, Csohany R, Prokai A, Pap D, Balicza-Himer N, Vannay A, Fekete A, Kis-Petik K, Peti-Peterdi J, Szabo A, Masajtis-Zagajewska A, Muras K, Niewodniczy M, Nowicki M, Pascual J, Srinivas TR, Chadban S, Citterio F, Henry M, Legendre C, Oppenheimer F, Lee PC, Tedesco-Silva H, Zeier M, Watarai Y, Dong G, Hexham M, Bernhardt P, Vincenti F, Rocchetti MT, Pontrelli P, Rascio F, Fiorentino M, Zito A, Stallone G, Gesualdo L, Grandaliano G, Su owicz J, Wojas-Pelc A, Ignacak E, Janda K, Krzanowski M, Su owicz W, Dellepiane S, Cantaluppi V, Mitsuhashi M, Murakami T, Benso A, Biancone L, Camussi G, Scholbach TM, Wang HK, Loong CC, Wu TH, Leuning D, Reinders M, Lievers E, Duijs J, Van Zonneveld AJ, Van Kooten C, Engelse M, Rabelink T, Assounga A, Omarjee S, Ngema Z, Ersoy A, Gultepe A, Isiktas Sayilar E, Akalin H, Coskun F, Oner Torlak M, Ayar Y, Riegersperger M, Plischke M, Steinhauser C, Jallitsch-Halper A, Sengoelge G, Winkelmayer WC, Sunder-Plassmann G, Foedinger M, Kaziuk M, Kuz'Niewski M, Ignacak E, B Tkowska- Prokop A, Pa Ka K, Dumnicka P, Kolber W, Su Owicz W. TRANSPLANTATION BASIC SCIENCE, ALLOGENIC AND XENOGENIC TOLERANCE. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Van Londen M, Humalda JK, Aarts BM, Sanders JS, Bakker SJL, Navis GJ, De Borst MH, Pazik J, O Dak M, Lewandowski Z, Podgorska M, Sadowska A, Sitarek E, Malejczyk J, Durlik M, Drechsler C, Philstrom H, Meinitzer A, Pilz S, Tomaschitz A, Abedini S, Fellstrom B, Jardine A, Wanner C, Maerz W, Holdaas H, Halleck F, Staeck O, Neumayer HH, Budde K, Khadzhynov D, Rostaing L, Allal A, Congy N, Aarninck A, Del Bello A, Maggioni S, Debiols B, Sallusto F, Kamar N, Stolyarevich E, Artyukhina L, Kim I, Tomilina N, Zaidenov V, Kurenkova L, Keyzer CA, De Borst MH, Van Den Berg E, Jahnen-Dechent W, Navis G, Bakker SJL, Van Goor H, Pasch A, Aulagnon F, Avettand-Fenoel V, Scemla A, Lanternier F, Lortholary O, Anglicheau D, Legendre C, Zuber J, Furic-Cunko V, Basic-Jukic N, Coric M, Kastelan Z, Hudolin T, Kes P, Mikolasevic I, Racki S, Lukenda V, Orlic L, Dobrowolski LC, Verberne HJ, Ten Berge IJM, Bemelman FJ, Krediet CTP, Ferreira AC, Silva C, Remedio F, Pena A, Nolasco F, Heldal K, Lonning K, Leivestad T, Reisaeter AV, Hartmann A, Foss AE, Midtvedt K, Vlachopanos G, Kassimatis T, Zerva A, Kokkona A, Stavroulaki E, Agrafiotis A, Sanchez Sobrino B, Lafuente Covarrubias O, Karsten Alvarez S, Zalamea Jarrin F, Rubio Gonzalez E, Huerta Arroyo A, Portoles Perez J, Basic-Jukic N, Kes P, Baek CH, Kim M, Kim JS, Yang WS, Han DJ, Park SK, Zulkarnaev A, Vatazin A, Cabiddu G, Maxia S, Castellino S, Loi V, Guzzo G, Piccoli GB, Pani A, Bucsa C, Tacu D, Harza M, Sinescu I, Mircescu G, Stefan G, Alfieri CM, Laura F, Danilovic B, Cresseri D, Meneghini M, Riccardo F, Regalia A, Messa P, Panuccio V, Tripepi R, Parlongo G, Quattrone S, Leonardis D, Tripepi G, Zoccali C, Mallamaci F, Amer H, Geerdes PA, Fettes TT, Prieto M, Walker RC, Edwards BS, Cosio FG, Khrabrova M, Nabokov A, Groene HJ, Weithofer P, Kliem V, Smirnov A, Dobronravov V, Sezer S, Gurlek Demirci B, Tutal E, Guliyev O, Say N CB, Ozdemir Acar FN, Haberal M, Albugami MM, Hussein M, Alsaeed S, Almubarak A, Bel'eed-Akkari K, Go biewska JE, Tarasewicz A, D bska- lizie A, Rutkowski B, Albugami MM, Hussein M, Almubarak A, Alsaeed S, Bel'eed-Akkari K, Ailioaie O, Arzouk N, Tourret J, Mercadal L, Szumilak D, Ourahma S, Parra J, Billault C, Barrou B, Alfieri CM, Floreani R, Ulivieri FM, Meneghini M, Regalia A, Zanoni F, Croci D, Rastaldi MP, Messa PG, Keyzer CA, Riphagen IJ, Joosten MM, Navis G, Muller Kobold AC, Kema IP, Bakker SJL, De Borst MH, Santos Lascasas J, Malheiro J, Fonseca I, Martins L, Almeida M, Pedroso S, Dias L, Henriques A, Cabrita A, Vincenti F, Weir M, Von Visger J, Kopyt N, Mannon R, Deng H, Yue S, Wolf M, Halleck F, Khadzhynov, D, Schmidt D, Petereit F, Slowinski T, Neumayer HH, Budde K, Staeck O, Hernandez Vargas H, Artamendi Larranaga M, Gil Catalinas F, Ramalle Gomara E, Bello Ovalle A, Pimentel Guzman G, Coloma Lopez A, Dall Anesse C, Gil Paraiso A, Beired Val I, Sierra Carpio M, Huarte Loza E, Slubowska K, Szmidt J, Chmura A, Durlik M, Staeck O, Khadzhynov D, Schmidt D, Niemann M, Petereit F, Lachmann N, Neumayer HH, Budde K, Halleck F, Alotaibi T, Nampoory N, Gheith O, Halim M, Aboatteya H, Mansour H, Abdulkawey H, Said T, Nair P, WazNa-Jab O Ska E, Durlik M, Elias M, Caillard S, Morelon E, Rivalan J, Moal V, Frimat L, Mourad G, Rerolle JP, Legendre C, Mousson C, Delahousse M, Pouteil-Noble C, Dantal J, Cassuto E, Subra JF, Lang P, Thervet E, Roosweil D, Molnar MZ, Fornadi K, Ronai KZ, Novak M, Mucsi I, Scale TM, Robertson S, Kumwenda M, Jibani M, Griffin S, Williams AJ, Mikhail A, Jeong JC, Koo TY, Jeon HJ, Han M, Oh KH, Ahn C, Yang J, Bancu I, Canas L, Juega J, Malumbres S, Guermah I, Bonet J, Lauzurica R, Basso E, Messina M, Daidola G, Mella A, Lavacca A, Manzione AM, Rossetti M, Ranghino A, Ariaudo C, Segoloni GP, Biancone L, Whang E, Son SH, Kwon H, Kong JJ, Choi WY, Yoon CS, Ferreira AC, Silva C, Aires I, Ferreira A, Remedio F, Nolasco F, Ratkovic M, Basic Jukic N, Gledovic B, Radunovic D, Prelevic V, Stefan G, Garneata L, Bucsa C, Harza M, Sinescu I, Mircescu G, Tacu D, Aniort J, Kaysi S, Mulliez A, Heng AE, Su owicz J, Wojas-Pelc A, Ignacak E, Janda K, Krzanowski M, Miarka P, Su owicz W, Filipov JJ, Zlatkov BK, Dimitrov EP, Svinarov DA, Champion L, Renoux C, Randoux C, Du Halgouet C, Azeroual L, Glotz D, Vrtovsnik F, Daugas E, Musetti C, Battista M, Cena T, Izzo C, Airoldi A, Magnani C, Stratta P, Fiskvik I, Holte H, Bentdal O, Holdaas H, Erkmen Uyar M, Sezer S, Bal Z, Guliyev O, Colak T, Gurlek Demirci B, Ozdemir Acar N, Haberal M, Kara E, Ahbap E, Basturk T, Koc Y, Sakaci T, Sahutoglu T, Akgol C, Sevinc M, Unsal A, Seyahi N, Abdultawab K, Alotaibi T, Gheith O, Mansour H, Halim M, Nair P, Said T, Balaha M, Elsayed A, Awadeen W, Nampoory N, Hwang JC, Jiang MY, Lu YH, Weng SF, Madziarska K, Zmonarski SC, Augustyniak-Bartosik H, Magott-Procelewska M, Krajewska M, Mazanowska O, Banasik M, Penar J, Weyde W, Boraty Ska M, Klinger M, Swarnalatha G, Narendranath L, Shanta Rao G, Sawhney A, Subrahmanyam L, Kumar S, Jeon H, Hakim A, Patel U, Shrivastava S, Banerjee D, Kimura T, Yagisawa T, Nanmoku K, Kurosawa A, Sakuma Y, Miki A, Nukui A, Lee CH, Oh IH, Park JS, Watarai Y, Narumi S, Goto N, Hiramitsu T, Tsujita M, Yamamoto T, Kobayashi T, Muniz Pacios L, Molina M, Cabrera J, Gonzalez E, Garcia Santiago A, Aunon P, Santana S, Polanco N, Gutierrez E, Jimenez C, Andres A, Mohammed M, Hammam M, Housawi A, Goldsmith DJ, Cronin A, Frame S, Smalcelj R, Canoz MB, Yavuz DD, Altunoglu A, Yavuz R, Colak T, Haberal M, Tong A, Hanson CS, Chapman JR, Halleck F, Budde K, Papachristou C, Craig J, Zheng XY, Han S, Wang LM, Zhu YH, Zeng L, Zhou MS, Guliyev O, Erkmen Uyar M, Sezer S, Bal Z, Colak T, Gurlek Demirci B, Ozdemir Acar N, Haberal M, Ranghino A, Diena D, De Rosa FG, Faletti R, Barbui AM, Guarnaccia C, Corcione S, Messina M, Ariaudo C, Segoloni GP, Biancone L, Patel R, Murray PD, Moiseev A, Kalachik A, Harden PN, Norby G, Mjoen G, Holdaas H, Gilboe IM, Shi Y, Luo L, Cai B, Wang T, Tao Y, Wang L, Erkmen Uyar M, Sezer S, Bal Z, Guliyev O, Tutal E, Gurlek Demirci B, Ozdemir Acar N, Haberal M, Di Vico MC, Messina M, Mezza E, Giraudi R, Nappo A, Boaglio E, Ranghino A, Fop F, Segoloni GP, Biancone L, Carta P, Dattolo E, Buti E, Zanazzi M, Villari D, Di Maria L, Santoro G, Li Marzi V, Minetti EE, Nicita G, Carta P, Zanazzi M, Buti E, Antognoli G, Dervishi E, Vignali L, Caroti L, Di Maria L, Minetti EE, Dorje C, Kovacevic G, Hammarstrom C, Strom EH, Holdaas H, Midtvedt K, Reisaeter AV, Alfieri CM, Floreani R, Meneghini M, Regalia A, Zanoni F, Vettoretti S, Croci MD, Rastaldi MP, Messa P, Heldal K, Lonning K, Reisaeter AV, Bernklev T, Midtvedt K, Strakosha A, Pasko N, Nasto F, Cadri V, Dedei A, Thereska N. TRANSPLANTATION CLINICAL 2. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bemelman FJ, ten Berge IJM. Kidney transplantation in atypical haemolytic uraemic syndrome (aHUS): a cheap way out? Neth J Med 2013; 71:339-341. [PMID: 24038558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- F J Bemelman
- Renal Transplant Unit, Department of Nephrology, Division of Internal Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
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Schreinemachers MCJM, Bemelman FJ, Idu MM, van Donselaar-van der Pant KAMI, van de Berg PJEJ, Reitsma JB, Legemate DA, Florquin S, ten Berge IJM, Doorschodt BM, van Gulik TM. First clinical experience with polysol solution: pilot study in living kidney transplantation. Transplant Proc 2013; 45:38-45. [PMID: 23375273 DOI: 10.1016/j.transproceed.2012.10.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 10/09/2012] [Indexed: 01/24/2023]
Abstract
In this study, we assessed the safety of the new organ preservation solution polysol solution in the clinical setting of living kidney transplantation. We conducted a prospective pilot study in nine adult donor-recipient couples using polysol solution for washout and cold storage of kidney grafts. Adverse reactions possibly related to the use of polysol solution as well as renal function at 1, 6, and 12 months after transplantation were monitored. All living kidney transplantation performed in adults in our center within 2002 to 2008 using the University of Winconsin solution served as controls (n = 190). The use of polysol solution was associated with a higher acute rejection rate compared to University of Wisconsin solution at all time points. Also, antibody-mediated rejection occurred more frequently in the polysol group. Renal function at all time points was also comparable between the groups. This pilot study in living kidney transplantation is the first clinical study on the use of polysol solution. Although the study was not powered on the endpoint rejection, we observed a high number of acute rejection and antibody-mediated rejection episodes in recipients of polysol solution preserved grafts as compared to University of Wisconsin solution controls. As a consequence the study was terminated prematurely.
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Affiliation(s)
- M-C J M Schreinemachers
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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van Sandwijk MS, Bemelman FJ, Ten Berge IJM. Immunosuppressive drugs after solid organ transplantation. Neth J Med 2013; 71:281-289. [PMID: 23956308] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In recent years solid organ transplantation has been rapidly developed as a therapeutic intervention that is life-saving and greatly contributes to a better quality of life in organ recipients. The rapid development has been made possible because of a drastic expansion in the immunosuppressive repertoire. Unfortunately, the side effects of these drugs can be severe, which is one of the reasons that life expectancy of transplant patients still significantly falls short of that of the general population. In this review manuscript we will discuss current and future immunosuppressive strategies that are employed in solid organ transplantation. Expanding our understanding of the human immune system will hopefully provide us with newer, smarter drugs that promote immunotolerance without the side effects observed today.
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Affiliation(s)
- M S van Sandwijk
- Department of Nephrology, Academic Medical Center, Amsterdam, the Netherlands.
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Meulen ST, van Donselaar-van der Pant KA, Bemelman FJ, Idu MM. Chylous ascites after laparoscopic hand-assisted donor nephrectomy: Is it specific for the left-side? Urol Ann 2013; 5:45-6. [PMID: 23662011 PMCID: PMC3643324 DOI: 10.4103/0974-7796.106967] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [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: 03/21/2011] [Accepted: 05/17/2011] [Indexed: 12/24/2022] Open
Abstract
We describe a case-report of a chylous ascites after laparoscopic donor nephrectomy, summarize the current literature, and hypothesize on the etiology of this complication.
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Affiliation(s)
- S Ter Meulen
- Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
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Struijk GH, Bouts AHM, Rijkers GT, Kuin EAC, ten Berge IJM, Bemelman FJ. Meningococcal sepsis complicating eculizumab treatment despite prior vaccination. Am J Transplant 2013; 13:819-20. [PMID: 23289494 DOI: 10.1111/ajt.12032] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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van Aalderen MC, Yapici Ü, van der Pol JA, de Reijke TM, van Donselaar-van der Pant KAMI, Florquin S, Bemelman FJ, Ten Berge IJM. Polyomavirus BK in the pathogenesis of bladder cancer. Neth J Med 2013; 71:26-28. [PMID: 23412820] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Polyomaviruses are able to drive malignant transformation in rodent models, and have been implicated in the aetiology of a variety of human malignancies. However, the reports on this association in humans are strongly conflicting. Here we describe a renal transplant (RT) recipient with ureteral stenosis against the background of polyomavirus BK (BKV) activity. Six and a half years after transplantation, this patient developed metastasised bladder cancer. Prior to the diagnosis of cancer, atypical cells were detected in the urine that were denoted as 'decoy cells': virally infected epithelial cells that are frequently seen in the urine of RT recipients with BKV (re)activation, which may morphologically resemble malignant cells. Intriguingly, the primary urothelial carcinoma, as well as the mesenterial and two intestinal metastases, stained positive with antibodies against polyomavirus virus large T antigen protein, whereas the adjacent healthy tissue did not. This case suggests a role for BKV in the pathogenesis of bladder cancer, at least in the context of immunodeficiency.
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Affiliation(s)
- M C van Aalderen
- Renal Transplant Unit, Department of Nephrology, Division of Internal Medicine, Academic Medical Centre, Amsterdam, the Netherlands.
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Brouard S, Pallier A, Renaudin K, Foucher Y, Danger R, Devys A, Cesbron A, Guillot-Guegen C, Ashton-Chess J, Le Roux S, Harb J, Roussey G, Subra JF, Villemain F, Legendre C, Bemelman FJ, Orlando G, Garnier A, Jambon H, Le Monies De Sagazan H, Braun L, Noël C, Pillebout E, Moal MC, Cantarell C, Hoitsma A, Ranbant M, Testa A, Soulillou JP, Giral M. The natural history of clinical operational tolerance after kidney transplantation through twenty-seven cases. Am J Transplant 2012; 12:3296-307. [PMID: 22974211 DOI: 10.1111/j.1600-6143.2012.04249.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We report here on a European cohort of 27 kidney transplant recipients displaying operational tolerance, compared to two cohorts of matched kidney transplant recipients under immunosuppression and patients who stopped immunosuppressive drugs and presented with rejection. We report that a lower proportion of operationally tolerant patients received induction therapy (52% without induction therapy vs. 78.3%[p = 0.0455] and 96.7%[p = 0.0001], respectively), a difference likely due to the higher proportion (18.5%) of HLA matched recipients in the tolerant cohort. These patients were also significantly older at the time of transplantation (p = 0.0211) and immunosuppression withdrawal (p = 0.0002) than recipients who rejected their graft after weaning. Finally, these patients were at lower risk of infectious disease. Among the 27 patients defined as operationally tolerant at the time of inclusion, 19 still display stable graft function (mean 9 ± 4 years after transplantation) whereas 30% presented slow deterioration of graft function. Six of these patients tested positive for pre-graft anti-HLA antibodies. Biopsy histology studies revealed an active immunologically driven mechanism for half of them, associated with DSA in the absence of C4d. This study suggests that operational tolerance can persist as a robust phenomenon, although eventual graft loss does occur in some patients, particularly in the setting of donor-specific alloantibody.
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Affiliation(s)
- S Brouard
- Institut National de la Sante Et de la Recherche Medicale INSERM U643, and Institut de Transplantation Urologie Néphrologie du Centre Hospitalier Universitaire Hôtel Dieu, Nantes, France
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Klarenbeek PL, Remmerswaal EBM, ten Berge IJM, Doorenspleet ME, van Schaik BDC, Esveldt REE, Koch SD, ten Brinke A, van Kampen AHC, Bemelman FJ, Tak PP, Baas F, de Vries N, van Lier RAW. Deep sequencing of antiviral T-cell responses to HCMV and EBV in humans reveals a stable repertoire that is maintained for many years. PLoS Pathog 2012; 8:e1002889. [PMID: 23028307 PMCID: PMC3460621 DOI: 10.1371/journal.ppat.1002889] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 07/11/2012] [Indexed: 01/17/2023] Open
Abstract
CD8+ T-cell responses against latent viruses can cover considerable portions of the CD8+ T-cell compartment for many decades, yet their initiation and maintenance remains poorly characterized in humans. A key question is whether the clonal repertoire that is raised during the initial antiviral response can be maintained over these long periods. To investigate this we combined next-generation sequencing of the T-cell receptor repertoire with tetramer-sorting to identify, quantify and longitudinally follow virus-specific clones within the CD8+ T-cell compartment. Using this approach we studied primary infections of human cytomegalovirus (hCMV) and Epstein Barr virus (EBV) in renal transplant recipients. For both viruses we found that nearly all virus-specific CD8+ T-cell clones that appeared during the early phase of infection were maintained at high frequencies during the 5-year follow-up and hardly any new anti-viral clones appeared. Both in transplant recipients and in healthy carriers the clones specific for these latent viruses were highly dominant within the CD8+ T-cell receptor Vβ repertoire. These findings suggest that the initial antiviral response in humans is maintained in a stable fashion without signs of contraction or changes of the clonal repertoire. Several viruses have found ways to evade the human immune system and cause latent infections. Examples include HIV and herpes-viruses. Most humans carry these herpes-viruses. The human immune system mounts continuous responses against these viruses to prevent them from causing disease. If this balance is disturbed, these viruses can cause extensive pathology. We do not know how the immune response against these viruses evolves over time. Understanding this response might help to understand why the immune system does not clear these viruses and might help in preventive and therapeutic strategies. Here we used a new technology that allowed us to track virus specific immune cells (CD8+ T cells) over time in a quantitative manner. When we used this technology to study the evolution of latent responses against herpes-viruses (from infection until 5 years later) we found that immune responses were very rigid and did not evolve over time. Collectively our data shows that – for these herpes-viruses – the initial immune response is maintained despite the fact that this does not result in clearance of the virus. Therefore, if a virus survives the initial response, it will not be cleared in the future. This is an important consideration in understanding latent infection and for vaccination-design.
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Affiliation(s)
- P. L. Klarenbeek
- Department of Clinical Immunology & Rheumatology, Academic Medical Center, Amsterdam, the Netherlands
- Department of Genome Analysis, Academic Medical Center, Amsterdam, the Netherlands
- Department of Experimental Immunology, Academic Medical Center, Amsterdam, the Netherlands
| | - E. B. M. Remmerswaal
- Department of Experimental Immunology, Academic Medical Center, Amsterdam, the Netherlands
- Renal Transplant Unit, Academic Medical Center, Amsterdam, the Netherlands
| | - I. J. M. ten Berge
- Department of Experimental Immunology, Academic Medical Center, Amsterdam, the Netherlands
- Renal Transplant Unit, Academic Medical Center, Amsterdam, the Netherlands
| | - M. E. Doorenspleet
- Department of Clinical Immunology & Rheumatology, Academic Medical Center, Amsterdam, the Netherlands
- Department of Genome Analysis, Academic Medical Center, Amsterdam, the Netherlands
- Department of Experimental Immunology, Academic Medical Center, Amsterdam, the Netherlands
| | - B. D. C. van Schaik
- Bioinformatics Laboratory, Academic Medical Center, Amsterdam, the Netherlands
| | - R. E. E. Esveldt
- Department of Clinical Immunology & Rheumatology, Academic Medical Center, Amsterdam, the Netherlands
- Department of Genome Analysis, Academic Medical Center, Amsterdam, the Netherlands
- Department of Experimental Immunology, Academic Medical Center, Amsterdam, the Netherlands
| | - S. D. Koch
- Department of Experimental Immunology, Academic Medical Center, Amsterdam, the Netherlands
| | - A. ten Brinke
- Sanquin Research at CLB and Landsteiner Laboratory, Amsterdam, the Netherlands
| | - A. H. C. van Kampen
- Bioinformatics Laboratory, Academic Medical Center, Amsterdam, the Netherlands
| | - F. J. Bemelman
- Renal Transplant Unit, Academic Medical Center, Amsterdam, the Netherlands
| | - P. P. Tak
- Department of Clinical Immunology & Rheumatology, Academic Medical Center, Amsterdam, the Netherlands
| | - F. Baas
- Department of Genome Analysis, Academic Medical Center, Amsterdam, the Netherlands
| | - N. de Vries
- Department of Clinical Immunology & Rheumatology, Academic Medical Center, Amsterdam, the Netherlands
| | - R. A. W. van Lier
- Department of Experimental Immunology, Academic Medical Center, Amsterdam, the Netherlands
- Sanquin Research at CLB and Landsteiner Laboratory, Amsterdam, the Netherlands
- * E-mail:
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25
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Havenith SHC, Remmerswaal EBM, Bemelman FJ, Yong SL, van Donselaar-van der Pant KAMI, van Lier RAW, Ten Berge IJM. Rapid T cell repopulation after rabbit anti-thymocyte globulin (rATG) treatment is driven mainly by cytomegalovirus. Clin Exp Immunol 2012; 169:292-301. [PMID: 22861369 PMCID: PMC3445006 DOI: 10.1111/j.1365-2249.2012.04622.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Rabbit anti-thymocyte globulin (rATG) induces a long-lasting lymphocytopenia. CD4(+) T cells remain depleted for up to 2 years, whereas the CD8(+) T cell compartment is refilled rapidly by highly differentiated CD27(-) CD45RA(+) CD57(+) effector-type cells. Because the presence of these highly differentiated CD8(+) T cells has been associated with cytomegalovirus (CMV) infection, we questioned to what extent restoration of CMV T cell immunity contributes to the re-emergence of T cells following rATG treatment. We compared T cell repopulation in six CMV-seropositive patients with CMV reactivation (reactivating CMV(+) ) to that in three CMV(+) patients without reactivation (non-reactivating CMV(+) ), and to that in three CMV-seronegative recipients receiving a kidney from a CMV-seronegative donor (CMV(-/-) ). All patients received rATG because of acute allograft rejection. Total CD4 and CD8 counts, frequency and phenotype of virus-specific CD8(+) T cells were determined. In reactivating CMV(+) patients, total CD8(+) T cells reappeared rapidly, whereas in non-reactivating CMV(+) patients they lagged behind. In CMV(-/-) patients, CD8(+) T cell counts had not yet reached pretransplant levels after 2 years. CMV reactivation was indeed followed by a progressive accumulation of CMV-specific CD8(+) T cells. During lymphocytopenia following rATG treatment, serum interleukin (IL)-7 levels were elevated. Although this was most prominent in the CMV-seronegative patients, it did not result in an advantage in T cell repopulation in these patients. Repopulated CD8(+) T cells showed increased skewing in their Vβ repertoire in both CMV(-/-) and reactivating CMV-seropositive patients. We conclude that rapid T cell repopulation following rATG treatment is driven mainly by CMV.
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Affiliation(s)
- S H C Havenith
- Renal Transplant Unit, Department of Internal Medicine Department of Experimental Immunology, Academic Medical Center Landsteiner Laboratory, Sanquin Research, Department of Experimental Immunology, Amsterdam, the Netherlands.
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26
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van de Berg PJEJ, Yong SL, Koch SD, Lardy N, van Donselaar-van der Pant KAMI, Florquin S, Bemelman FJ, van Lier RAW, ten Berge IJM. Characteristics of alloreactive T cells measured before renal transplantation. Clin Exp Immunol 2012; 168:241-50. [PMID: 22471286 DOI: 10.1111/j.1365-2249.2011.04551.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Several assays to measure pre-existing allospecific T cell immunity in renal transplant candidates have been developed in the past years. In 46 patients, we used flow cytometry-based mixed lymphocyte culture to measure the precursor frequency and phenotype of alloreactive T cells before renal transplantation, using donor-specific or third-party cells for allostimulation. Allostimulation induced up-regulation of co-stimulatory molecules, chemokine receptors relevant for migration of T cells into the graft and effector proteins. Recipients prone for acute rejection had a higher precursor frequency of alloreactive CD8(+) T cells and a lower percentage of interleukin (IL)-7Rα expressing alloreactive CD8(+) T cells than non-rejectors. These data point to quantitative and qualitative differences between T cells of patients who will experience acute cellular rejection episodes from those who will not.
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Affiliation(s)
- P J E J van de Berg
- Renal Transplant Unit, Department of Experimental Immunology, Academic Medical Center, Amsterdam, the Netherlands.
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27
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Minnee RC, Bemelman WA, Donselaar-van der Pant KAMI, Booij J, ter Meulen S, ten Berge IJM, Legemate DA, Bemelman FJ, Idu MM. Risk factors for delayed graft function after hand-assisted laparoscopic donor nephrectomy. Transplant Proc 2011; 42:2422-6. [PMID: 20832519 DOI: 10.1016/j.transproceed.2010.05.163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Accepted: 05/12/2010] [Indexed: 02/01/2023]
Abstract
BACKGROUND Delayed graft function (DGF) has a negative effect on the results of living-donor kidney transplantation. OBJECTIVE To investigate potential risk factors for DGF. METHODS This prospective study included 200 consecutive living donors and their recipients between January 2002 and July 2007. Delayed graft function was defined as need for dialysis within the first postoperative week. RESULTS Delayed graft function was diagnosed in 12 patients (6%). Intraoperative complications occurred in 10 donors (5%), and postoperative complications in 24 donors (13.5%). One-year kidney graft survival with vs without DGF was 52% and 98%, respectively (P < .002). In donors, 2 univariate risk factors for DGF identified were lower counts per second at peak activity during scintigraphy, and multiple renal veins. In recipients, only 2 or more kidney transplantations and occurrence of an acute rejection episode were important factors. At multivariate analysis, increased risk of DGF was associated with the presence of multiple renal veins (odds ratio, 151.57; 95% confidence interval, 2.53-9093.86) and an acute rejection episode (odds ratio, 78.87; 95% confidence interval, 3.17-1959.62). CONCLUSION Hand-assisted laparoscopic donor nephrectomy is a safe procedure. The presence of multiple renal veins and occurrence of an acute rejection episode are independent risk factors for DGF.
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Affiliation(s)
- R C Minnee
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
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28
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van den Heuvel MEN, van der Lee JH, Cornelissen EAM, Bemelman FJ, Hoitsma A, Geskus RB, Bouts AHM, Groothoff JW. Transition to the adult nephrologist does not induce acute renal transplant rejection. Nephrol Dial Transplant 2009; 25:1662-7. [DOI: 10.1093/ndt/gfp684] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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29
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Baas MC, van Donselaar-van der Pant KAMI, Bemelman FJ. Emphysematous pyelonephritis in a renal transplant patient. Neth J Med 2009; 67:403-404. [PMID: 20009119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- M C Baas
- Renal Transplant Unit, Department of Nephrology, Academic Medical Centre, Amsterdam, the Netherlands.
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30
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Baas MC, van Donselaar KAMI, Florquin S, van Binnendijk RS, ten Berge IJM, Bemelman FJ. Mumps: not an innocent bystander in solid organ transplantation. Am J Transplant 2009; 9:2186-9. [PMID: 19563333 DOI: 10.1111/j.1600-6143.2009.02732.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Recently two major outbreaks of mumps have occurred: in the UK more than 56,000 cases were notified between 2004 and 2005, and in the United States, 6,584 cases were reported in 2006. Most patients were young healthy adults, in whom mumps normally has a benign course. Little is known about mumps in the immunocompromised patient. Here, we report a case of a 56-year renal transplant recipient who developed acute irreversible transplant failure due to interstitial nephritis caused by mumps. RNA of the mumps virus was detected in the urine as well as in a renal biopsy. In view of the ongoing presence of the mumps virus in the population, one should be aware of the possible occurrence of this infection in immunocompromised patients.
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Affiliation(s)
- M C Baas
- Renal Transplant Unit, Department of Nephrology, Division of Internal Medicine, Academic Medical Center, Amsterdam
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31
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Weenink JJ, Weenink AG, Geerlings SE, van Gool T, Bemelman FJ. Severe cerebral toxoplasma infection cannot be excluded by a normal CT scan. Neth J Med 2009; 67:150-152. [PMID: 19591247] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A fatal case is reported concerning a severely immunocompromised 50-year-old female renal transplant recipient who developed fever and confusion. Cerebral imaging with contrast-enhanced computed tomography (CT) scans showed no abnormalities while subsequently performed magnetic resonance imaging (MRI ) showed clear abnormalities in the basal ganglia. By that time serology and polymerase chain reaction had confirmed the diagnosis of cerebral toxoplasmosis. Because of the suboptimal sensitivity of these tests negative results should be handled with care. Once cerebral toxoplasmosis is suspected in at-risk patients, treatment should be started empirically pending the confirmation of the diagnosis. A normal cerebral CT scan does not preclude cerebral toxoplasmosis.In these situations MRI can give important additional information.
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Affiliation(s)
- J J Weenink
- Department of Internal Medicine, Renal Transplant Unit, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Centre, Amsterdam, the Netherlands.
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32
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Bemelman FJ, ten Berge RJM. [Late complications following renal transplantation]. Ned Tijdschr Geneeskd 2008; 152:1317-1321. [PMID: 18661857] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The number of renal transplant recipients is increasing steadily. Physicians from all specialties are ever more likely to encounter this vulnerable group of patients. They constitute a susceptible group because of increased mortality and morbidity. Half of the renal transplants are lost due to chronic transplant failure. The primary cause of chronic transplant failure is chronic allograft nephropathy. Other causes of transplant failure are calcineurin inhibitor toxicity, recurrence of the original renal disease such as glomerulonephritis and diabetes mellitus, stenosis of the renal artery in the transplant, and urological complications. The other half of the renal transplants are lost due to the death of the recipient. The primary cause of death is cardiovascular disease due to former chronic renal, hypertension and dyslipidemia following the use of immunosuppressants. In addition malignancies, infections and bone abnormalities do occur more frequently as compared to the normal populations. Alertness is warranted following kidney transplantation by both the patients themselves as well as all the treating specialists. Careful periodical monitoring for life is required because of the risk of the abovementioned complications.
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Affiliation(s)
- F J Bemelman
- Academisch Medisch Centrum/Universiteit van Amsterdam, afd. Inwendige Geneeskunde, onderafd. Nierziekten, Amsterdam.
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33
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Nikolaeva N, Bemelman FJ, Yong SL, Verschuur A, van Lier RAW, ten Berge IJM. The pyrimidin analogue cyclopentenyl cytosine induces alloantigen-specific non-responsiveness of human T lymphocytes. Clin Exp Immunol 2008; 151:348-58. [PMID: 18062797 PMCID: PMC2276945 DOI: 10.1111/j.1365-2249.2007.03557.x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2007] [Indexed: 11/29/2022] Open
Abstract
Cyclopentenyl cytosine (CPEC) has been shown to induce apoptosis in human T lymphoblastic cell lines and T cells from leukaemia patients. In this study we have addressed the question of whether CPEC is able to decrease proliferation and effector functions of human alloresponsive T lymphocytes and induce T cell anergy. The proliferative capacity of human peripheral blood mononuclear cells in response to allogeneic stimulation was measured by 5,6-carboxy-succinimidyl-diacetate-fluorescein-ester staining. Flow cytometric analysis was performed using surface CD4, CD8, CD25, CD103 and intracellular perforin, granzyme A, granzyme B, caspase-3 and forkhead box P3 (FoxP3) markers. The in vivo immunosuppressive capacity was tested in a murine skin graft model. Addition of CPEC at a concentration of 20 nM strongly decreased the expansion and cytotoxicity of alloreactive T cells. Specific restimulation in the absence of CPEC showed that the cells became anergic. The drug induced caspase-dependent apoptosis of alloreactive T lymphocytes. Finally, CPEC increased the percentage of CD25(high) FoxP3+ CD4+ and CD103+ CD8+ T cells, and potentiated the effect of rapamycin in increasing the numbers of alloreactive regulatory T cells. Treatment with CPEC of CBA/CA mice transplanted with B10/Br skin grafts significantly prolonged graft survival. We conclude that CPEC inhibits proliferation and cytotoxicity of human alloreactive T cells and induces alloantigen non-responsiveness in vitro.
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Affiliation(s)
- N Nikolaeva
- Department of Experimental Immunology, Division of Nephrology, Academic Medical Centre, Amsterdam, The Netherlands
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34
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Vedder AC, Linthorst GE, van Breemen MJ, Groener JEM, Bemelman FJ, Strijland A, Mannens MMAM, Aerts JMFG, Hollak CEM. The Dutch Fabry cohort: diversity of clinical manifestations and Gb3 levels. J Inherit Metab Dis 2007; 30:68-78. [PMID: 17206462 DOI: 10.1007/s10545-006-0484-8] [Citation(s) in RCA: 132] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Revised: 11/27/2006] [Accepted: 12/08/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Fabry disease (OMIM 301500) is an X-linked lysosomal storage disorder with characteristic vascular, renal, cardiac and cerebral complications. Globotriaosylceramide (Gb(3)) accumulates in Fabry patients as a result of alpha-galactosidase A deficiency. The phenotypic variability is high, but the relationship between clinical symptoms in individual Fabry patients has not been uniformly documented. Also, the relation between the most prominent biochemical abnormalities, elevated Gb(3) levels in plasma and urine, and clinical symptoms is not firmly established. METHODS Clinical and biochemical characteristics of 96 (25 deceased) Dutch Fabry patients were collected retrospectively and before the initiation of enzyme therapy. RESULTS Clinical assessment revealed that median life expectancy was 57 years for male and 72 years for female patients. Cerebral complications, acroparaesthesias and gastrointestinal complications, but not cardiac and auditory complications, were all seen more frequently in male than female patients. Glomerular filtration rate (GFR) was highly variable in male patients, including 2 patients with GFR < 30 ml/min, but median GFR did not differ between males and females (103 and 101 ml/min, respectively). Hyperfiltration was more frequently observed in the female patient group. Microalbuminuria was present in 60% of males and 45% of females. No specific pattern of combined symptoms existed except for a relationship between left ventricular hypertrophy (LVH) and cerebral complications (males 36%, females 32%), or proteinuria (males 35%, females 31%). Gb(3) was found to be more elevated in plasma samples from male (n = 26; median 6.27 micromol/L (1.39-9.74)) than female Fabry patients (n = 37; median 2.16 (0.77-4.18)). This was also observed for urinary Gb(3): males (n = 22) median 1851 nmol/24 h (40-3724); females (n = 29) median 672 (86-2052). Plasma and urinary Gb(3) levels correlated with each other in both males (r = 0.4, p = 0.05) and females (r = 0.4, p = 0.03), but no correlation between elevated Gb(3) levels and clinical symptoms could be detected. CONCLUSION Analysis of the characteristics of the Dutch Fabry cohort has revealed that a limited relationship between various disease manifestations exists and that individual symptoms do not correlate with elevated urinary or plasma Gb(3) levels, limiting their value as surrogate disease markers.
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Affiliation(s)
- A C Vedder
- Department of Internal Medicine/Endocrinology and Metabolism, Academic Medical Center, Amsterdam, The Netherlands
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35
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Polle SW, Idu MM, Bemelman FJ, Maartense S, ter Meulen S, Bemelman WA. [The first 100 hand-assisted laparoscopic donor nephrectomies at the Academic Medical Center in Amsterdam]. Ned Tijdschr Geneeskd 2006; 150:851-7. [PMID: 16676516] [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] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To evaluate the results of the first 100 hand-assisted donor nephrectomies in our hospital. DESIGN Prospective, descriptive. METHOD In the period January 2000-July 2004, 100 consecutive donors underwent laparoscopic nephrectomy as part of a living-related kidney transplantation at the Academic Medical Center in Amsterdam, the Netherlands. The operation was performed laparoscopically using a hand port (hand-assisted nephrectomy). The incision made for the hand port was also used for the removal of the kidney. RESULTS Mean operating time was 168 min (range: 88-285). Median warm ischaemia time was 3 min (1.0-4.5) and median blood loss was 50 ml (20-1500). None of the operations required conversion to an open procedure and there were no deaths among donors or recipients. Postoperatively, 12 complications occurred in 10 donors. Median hospital stay for the donors was 5 days. In 3 recipients, the transplanted kidney had to be removed within 14 days. 1n 3 other recipients, surgical re-intervention was necessary due to urological complications. One-year graft survival was 94%. CONCLUSION Hand-assisted laparoscopic donor nephrectomy was a safe and minimally invasive procedure for renal transplantation in this patient series.
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Affiliation(s)
- S W Polle
- Academisch Medisch Centrum/Universiteit van Amsterdam
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36
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Abstract
Abstract
Background
Hand-assisted laparoscopic donor nephrectomy (HLDN) may have advantages over laparoscopic donor nephrectomy, such as shorter learning curve, operation and warm ischaemia times. The aim of this study was to evaluate the feasibility and safety of HLDN.
Methods
Between January 2000 and October 2002, 50 consecutive HLDN procedures were performed through a low transverse abdominal incision, 23 right sided and 27 left sided.
Results
The median age of the donors was 44 years. No HLDN required conversion to an open procedure. The median operating time for HLDN was 153 min. The median warm ischaemia time was 3 (range 1·0–4·5) min and the median blood loss was 50 (range 20–500) ml in both left- and right-sided procedures. Eight patients suffered ten minor complications during their admission. The duration of hospital stay was 5 days for donors. Three recipients developed graft failure owing to acute rejection, renal vein thrombosis and ischaemic necrosis.
Conclusion
Both left- and right-sided HLDN procedures were feasible and safe through a low transverse abdominal incision.
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Affiliation(s)
- S Maartense
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
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37
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Abstract
The main reason for conversion in laparoscopic donor nephrectomy (LDN) is peroperative bleeding. One of the advantages of hand-assisted laparoscopic donor nephrectomy (HDLN) is facilitated control in case of bleeding. This report describes two methods to avert conversion in HLDN in the case of abrupt major arterial bleeding. In the first case, during left HLDN the clips placed on the renal artery dislodged, and the surgeon managed to control the bleeding by compressing the focus of the bleeding with his finger. A balloon occlusion catheter was inserted through a groin incision in the aorta and advanced to the origo of the renal artery. Due to control of the hemorrhage, it was possible to close the renal artery stump by laparoscopic suturing, and a conversion was averted. The patient was discharged after 5 days, without signs of damage to the remaining kidney. In the second case, during right HLDN, the clips on the renal artery dislodged during stapling of the renal vein. The bleeding was controlled by finger compression and new clips were placed. The cuff of the artery was long enough to be clipped again. The patient was discharged after 5 days. Graft function was excellent in both cases. Major arterial bleeding can be controlled and managed in hand-assisted laparoscopic surgery. The use of a balloon occlusion catheter is an elegant way to avert conversion.
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Affiliation(s)
- S Maartense
- Department of Surgery, Academic Medical Center, Meibergdreef 9, 1100DD Amsterdam, The Netherlands
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Meijer RT, Surachno S, Yong SL, Bemelman FJ, Florquin S, Ten Berge IJM, Schellekens PTA. Treatment of acute kidney allograft rejection with a non-mitogenic CD3 antibody. Clin Exp Immunol 2003; 133:485-92. [PMID: 12930378 PMCID: PMC1808785 DOI: 10.1046/j.1365-2249.2003.02200.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
T3/4.A is a non-mitogenic murine IgA mAb to human CD3 that was selected for clinical studies to provide an alternative for the mitogenic, T cell-activating, therapeutic mAb OKT3. Previously, we reported that T3/4.A is better tolerated in humans than the IgG2a-CD3 mAb T3/4.2a. Here we report the results of a phase II clinical trial to assess the immunosuppressive potential of T3/4.A. Eighteen first kidney transplant recipients with a first rejection episode were included. Baseline immunosuppression consisted of cyclosporin and prednisolone. Rejection treatment consisted of 5 mg mAb per day during 10 days. Fourteen patients responded, of whom four experienced a second rejection within 2 weeks, one experienced chronic rejection after 2.5 years, whereas the others remained rejection-free after treatment (median duration of follow-up 42 months). Four patients did not respond and eventually lost their graft. These results are similar to treatment results with OKT3, as reported in the literature. Following the first dose of T3/4.A, side effects were limited, and reduced compared to OKT3-treated controls. On the second day, 15 patients developed transient vomiting and/or diarrhoea, which coincided with elevated serum levels of proinflammatory cytokines. Minimal or even no side effects occurred during the remaining days, which is in sharp contrast to that seen generally during OKT3 treatment. Both T cell numbers and TCR expression were reduced during the therapy. We conclude that T3/4.A is a good alternative for OKT3 to treat rejection episodes in renal transplant recipients.
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Affiliation(s)
- R T Meijer
- Academic Medical Center, University of Amsterdam, Division of Clinical Immunology and Rheumatology, Amsterdam, The Netherlands.
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39
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Bemelman FJ, Yong S, Parlevliet KJ, Surachno S, Schellekens PTA, ten Berge RJM. No long-term benefit of low-dose OKT3 induction therapy in non to moderately immunized renal allograft recipients. Transplant Proc 2002; 34:3165-7. [PMID: 12493407 DOI: 10.1016/s0041-1345(02)03585-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- F J Bemelman
- Department of Nephrology, Academic Medical Centre, Amsterdam, The Netherlands
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40
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Bemelman FJ, Surachno S, ten Berge RJ. [Immunology in medical practice. XXX. Organ transplantation: indications and results]. Ned Tijdschr Geneeskd 2000; 144:1432-6. [PMID: 10932695] [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] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
During the past 30 years, solid organ transplantation has developed into a routine medical procedure. Currently, one-year transplant survival rates for kidney, heart, liver and pancreas are between 80 and 90%; for most organs, the long-term results are fair with 5-year survival rates of 60%. Inclusion criteria for potential recipients have become less stringent. These days, potential recipients are rarely excluded on the basis of their calendar age alone. The development of more and stronger immunosuppressive drugs has facilitated transplantation across wider immunological differences between donor and recipient with good results. While the number of patients on the waiting lists for organ transplantation increased, the number of organs offered for donation decreased. This has resulted in waiting times of several years for most organ transplantations. While the short-term outcome has improved significantly over the past decades, the long-term outcome has not. Most renal transplants, for example, are lost due to chronic rejection. The challenge for the future will be to improve the long-term outcome of organ transplantation and to decrease the morbidity associated with chronic immunosuppressive therapy.
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Affiliation(s)
- F J Bemelman
- Academisch Medisch Centrum, Universiteit van Amsterdam
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Buysmann S, Bemelman FJ, Schellekens PT, van Kooyk Y, Figdor CG, ten Berge IJ. Activation and increased expression of adhesion molecules on peripheral blood lymphocytes is a mechanism for the immediate lymphocytopenia after administration of OKT3. Blood 1996; 87:404-11. [PMID: 8547669] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
We investigated the mechanism by which antihuman CD3 monoclonal antibodies of the isotypes IgG2a (eg, OKT3) and IgA (eg, IXA) can induce the rapid disappearance of virtually all circulating T lymphocytes. We hypothesize that upregulation of adhesion molecules on the lymphocyte membrane contributes to this effect. However, this hypothesis is difficult to test, because of the inherent lymphocytopenia and/or shifts in lymphocyte populations between intra and extra-vascular compartments. Therefore, studies in vitro were performed, as well. Analysis of peripheral blood lymphocytes isolated at several times after addition of OKT3 or IXA to whole blood of healthy individuals showed an immediate increase in the proportion of T cells expressing NKI-L16, an activation epitope on CD11a/CD18. Likewise, an increase in CD11b/CD18 expression occurred. In parallel experiments, a transiently increased adhesion of T cells to endothelial cell monolayers was observed. This adhesion could be completely blocked by anti-CD18 or anti-CD11a monoclonal antibodies and only partly by an anti-CD11b antibody. Our data indicate that upregulation of activation epitopes of CD11a/CD18, as well as increased expression of CD11b/CD18 on T lymphocytes, may result in increased adhesion of these cells to intercellular adhesion molecule-1 (ICAM-1) and ICAM-2 on vascular endothelium. This phenomenon may, at least, partly explain the rapidly occurring peripheral lymphocytopenia observed in vivo.
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Affiliation(s)
- S Buysmann
- University of Amsterdam, Department of Internal Medicine, The Netherlands
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42
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Bemelman FJ, Buysmann S, Yong SL, van Diepen FN, Schellekens PT, ten Berge RJ. Biphasic granulocytopenia after administration of the first dose of OKT3. J Lab Clin Med 1995; 126:571-9. [PMID: 7490516] [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] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The effects of the administration of OKT3, a second immunoglobulin G2a (IgG2a) anti-CD3 monoclonal antibody (mAb), and its isotype switch variant IgA on granulocyte kinetics were compared for 5 hours after the first administration of the mAb. In addition, in vivo and in vitro studies were performed on alterations in expression of CD11b and CD62L induced by these mAbs. Within 15 minutes after administration OKT3 and IgG2a anti-CD3 mAbs induced a significant decrease in circulating granulocytes, whereas IgA anti-CD3 mAb did not. Apparently the initial decrease in circulating granulocytes depends on the heavy chain of the administered anti-CD3 mAb, resulting in immunocytoadherence and sequestration in the lungs. Increased adherence to pulmonary endothelium by altered expression of CD11b and CD62L plays a minor role in this first granulocytopenia, because each mAb exerted the same effects on these adhesion molecules in vitro. The second decrease in granulocyte counts occurred 60 minutes after administration of each mAb and correlated with a significant increase in expression of CD11b and CD62L in vivo and with upregulation of CD11b and down-regulation of CD62L in vitro. These alterations could be related to the presence of tumor necrosis factor-alpha both in vivo and in vitro. Thus granulocyte kinetics from 30 minutes after administration of each anti-CD3 mAb resemble neutrophil kinetics induced by TNF-alpha.
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Affiliation(s)
- F J Bemelman
- Department of Internal Medicine, University of Amsterdam, The Netherlands
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Bemelman FJ, Stahl F, Abraham-Inpijn L. [Alcoholism and dentistry]. Ned Tijdschr Tandheelkd 1995; 102:263-5. [PMID: 11837110] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
In this article the physical and psychological consequences of alcohol abuse are considered. In addition the interaction between alcohol abuse and oral health and dentistry is discussed.
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Affiliation(s)
- F J Bemelman
- Vakgroep Algemene Ziekteleer en Inwendige Geneeskunde, Academisch Medisch Centrum, Academisch Centrum Tandheelkunde (ACTA) te Amsterdam, Louwesweg 1, 1066 EA Amsterdam
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44
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Parlevliet KJ, Bemelman FJ, Yong SL, Hack CE, Surachno J, Wilmink JM, ten Berge IJ, Schellekens PT. Toxicity of OKT3 increases with dosage: a controlled study in renal transplant recipients. Transpl Int 1995; 8:141-6. [PMID: 7766296 DOI: 10.1007/bf00344424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
In the present study we prospectively compared side effects occurring in 12 patients after the first administration of low-dose OKT3 (0.5 mg twice daily) induction therapy with those in 10 patients who were treated with a conventional dose of OKT3 (5 mg daily) for acute rejection. We also investigated cytokine release and activation of complement and neutrophils as all of these are held responsible for OKT3-induced side effects. Low-dose OKT3 resulted in a significantly decreased side effects score compared to that after a conventional dose of OKT3 (1.8 vs 5.1, p = 0.0006). Following the first administration of low-dose OKT3, TNF peak levels were significantly lower than after a conventional dose of OKT3. In contrast to our data on conventional dose OKT3 treatment, the first administration of low-dose OKT3 did not induce complement activation as reflected by C3a and C4b/c levels in plasma. Finally, the increase in neutrophil degranulation products lactoferrin and elastase-varies; is directly proportional to 1-antitrypsin was much less following 0.5 mg OKT3 than following 5 mg. We conclude that OKT3-induced toxicity is dose-dependent and is mediated not only by cytokine release but also by activation of complement and neutrophils.
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Affiliation(s)
- K J Parlevliet
- Department of Internal Medicine, University of Amsterdam, The Netherlands
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45
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Bemelman FJ, Donckers AM, Abraham-Inpijn L. [Corticosteroids in dental practice]. Ned Tijdschr Tandheelkd 1995; 102:41-3. [PMID: 11837068] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
In this article some pharmacologic aspects of corticosteroids and their main medical indications are reviewed. In addition, the use of corticosteroids in dentistry and their interference with dental treatment are discussed.
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Affiliation(s)
- F J Bemelman
- Vakgroep Algemene Ziekteleer en Inwendige Geneeskunde, Academisch Centrum Tandheelkunde Amsterdam (ACTA), Louwesweg 1, 1066 EA Amsterdam
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Bemelman FJ, Jansen J, van der Poll T, Hack CE, van Deventer SJ, ten Berge RJ. Increased levels of sTNF receptors following OKT3 treatment. Transplant Proc 1994; 26:3094-5. [PMID: 7998082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- F J Bemelman
- Renal Transplant and Clinical Immunology Unit, Academic Medical Centre, Amsterdam, The Netherlands
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47
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Bemelman FJ, Buysmann S, Wilmink JM, Surachno S, Hack CE, Schellekens PT, ten Berge RJ. Effects of divided doses of steroids on side effects, cytokines, and activation of complement and granulocytes, coagulation and fibrinolysis after OKT3. Transplant Proc 1994; 26:3096-7. [PMID: 7527944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- F J Bemelman
- Renal Transplant Unit, Academic Medical Centre, Amsterdam, The Netherlands
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Bemelman FJ, Buysmann S, Surachno J, Wilmink JM, Schellekens PT, ten Berge IJ. Pretreatment with divided doses of steroids strongly decreases side effects of OKT3. Kidney Int 1994; 46:1674-9. [PMID: 7700026 DOI: 10.1038/ki.1994.467] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The aim of this study was to attenuate side effects of OKT3 by variation of the time interval between administration of corticosteroids and OKT3 in renal allograft recipients. In view of a maximal lymphocytopenia at six hours following MPNS, we postulated a greater preventive action on side effects from administration of methylprednisolone (MPNS) at six hours preceding the first dose of OKT3 compared to administration immediately before. Two groups of renal transplant patients treated for acute rejection with 5 mg OKT3 were studied. Ten patients received 500 mg MPNS six hours and ten patients one hour before administration of OKT3. We measured clinical side effects, body temperature, TNF and IL-6. There were no differences between the two groups regarding clinical side effects and peak body temperatures. However, MPNS administered six hours before administration of OKT3 diminished TNF release; MPNS one hour before decreased IL-6 release. We studied an additional group of six patients receiving 250 mg MPNS six hours before, followed by 250 mg one hour before OKT3. This group experienced significantly less side effects and lower body temperature. In addition, IL-6 levels were significantly decreased. We conclude that two times 250 mg MPNS administered six hours and one hour before the first administration of OKT3 effectively attenuates adverse reactions following administration of OKT3.
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Affiliation(s)
- F J Bemelman
- Academic Medical Center, University of Amsterdam, The Netherlands
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Bemelman FJ, Parlevliet KJ, Schellekens PT, Surachno S, van Royen EA, ten Berge RJ. Sequestration of labelled granulocytes in the lungs following administration of OKT3 is dose-dependent. Transpl Immunol 1994; 2:47-51. [PMID: 8081791 DOI: 10.1016/0966-3274(94)90077-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In the present study the consequences of administration of low-dose (0.5 mg) OKT3 for respiratory side-effects and pulmonary sequestration of labelled granulocytes are compared with the known effects of 5 mg OKT3. Ten renal transplant patients were studied, of whom five were treated with 0.5 mg OKT3 and five with 5 mg OKT3. None of the patients in the 0.5 mg group and two of the patients in the 5 mg group experienced dyspnoea. Sequestration of labelled granulocytes in the lungs was significantly lower in the patients receiving 0.5 mg OKT3 compared with the patients receiving 5 mg OKT3. The simultaneously occurring peripheral blood granulocytopenia was significantly more severe in the 5 mg group than in the 0.5 mg group. We suppose that this sequestration of circulating granulocytes in the lungs is at least partly mediated by complement activation products. In vitro it is demonstrated that fixation of complement activation products on peripheral blood lymphocytes depends on the concentration of OKT3 present in the culture medium. We conclude that respiratory side-effects shortly following infusion of OKT3 are related to complement-induced pulmonary leucostasis, the degree of which is dependent on the administered dose of OKT3.
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Affiliation(s)
- F J Bemelman
- Academic Medical Centre, University of Amsterdam, The Netherlands
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Adriaanse R, Brabant G, Endert E, Bemelman FJ, Wiersinga WM. Pulsatile thyrotropin and prolactin secretion in a patient with a mixed thyrotropin- and prolactin-secreting pituitary adenoma. Eur J Endocrinol 1994; 130:113-20. [PMID: 8130883 DOI: 10.1530/eje.0.1300113] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The circadian and pulsatile thyrotropin (TSH) and prolactin (PRL) release was investigated in a patient with slight hyperthyroidism due to a mixed TSH- and PRL-secreting pituitary adenoma. Blood was withdrawn every 10 min for 24 h (before and after medical treatment); pulse characteristics were analyzed by Desade and Cluster programs (values as mean +/- SD). The inappropriately high mean 24-h TSH concentration of 3.55 +/- 0.31 mU/l was associated with a higher mean 24-h TSH pulse amplitude but unaltered mean 24-h TSH pulse frequency relative to healthy controls. The nocturnal TSH surge (absolute surge 0.5 mU/l, relative surge 16%) was low, related to a loss of the usual nocturnal increase of TSH pulse amplitude and TSH pulse frequency. Chronic treatment with octreotide resulted in a modest clinical and biochemical improvement of the hyperthyroid state; addition of bromocriptine at a later stage had no further beneficial effect. At the end of the follow-up period the mean 24-h TSH paradoxically had increased to 5.33 +/- 0.81 mU/l. The nocturnal TSH surge also increased (absolute surge 1.9 mU/l, relative surge 42%), but circadian changes in TSH pulsatility remained absent. In the untreated period the increased mean 24-h PRL concentration of 234 +/- 24 micrograms/l was associated with an increased mean 24-h PRL amplitude, whereas the 24-h PRL pulse frequency (N = 4) was lower relative to controls. No circadian PRL rhythm was present. After octreotide and bromocriptine treatment the mean 24-h PRL concentration and mean 24-h PRL pulse amplitude were unchanged, but a clear nocturnal increase of PRL now was observed.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- R Adriaanse
- Department of Endocrinology, Academic Medical Center, University of Amsterdam, The Netherlands
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