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Reusing JO, Agena F, Kotton CN, Campana G, Pierrotti LC, David-Neto E. QuantiFERON-CMV as a Predictor of CMV Events During Preemptive Therapy in CMV-seropositive Kidney Transplant Recipients. Transplantation 2024; 108:985-995. [PMID: 37990351 DOI: 10.1097/tp.0000000000004870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
BACKGROUND Prevention of cytomegalovirus (CMV) infection after kidney transplantation is costly and burdensome. METHODS Given its promising utility in risk stratification, we evaluated the use of QuantiFERON-CMV (QFCMV) and additional clinical variables in this prospective cohort study to predict the first clinically significant CMV infection (CS-CMV, ranging from asymptomatic viremia requiring treatment to CMV disease) in the first posttransplant year. A cost-effectiveness analysis for guided prevention was done. RESULTS One hundred adult kidney transplant recipients, CMV IgG + , were given basiliximab induction and maintained on steroid/mycophenolate/tacrolimus with weekly CMV monitoring. Thirty-nine patients developed CS-CMV infection (viral syndrome, n = 1; end-organ disease, n = 9; and asymptomatic viremia, n = 29). A nonreactive or indeterminate QFCMV result using the standard threshold around day 30 (but not before transplant) was associated with CS-CMV rates of 50% and 75%, respectively. A higher QFCMV threshold for reactivity (>1.0 IU interferon-γ/mL) outperformed the manufacturer's standard (>0.2 IU interferon-γ/mL) in predicting protection but still allowed a 16% incidence of CS-CMV. The combination of recipient age and type of donor, along with posttransplant QFCMV resulted in a prediction model that increased the negative predictive value from 84% (QFCMV alone) to 93%. QFCMV-guided preemptive therapy was of lower cost than preemptive therapy alone ( P < 0.001, probabilistic sensitivity analysis) and was cost-effective (incremental net monetary benefit of 210 USD) assuming willingness-to-pay of 2000 USD to avoid 1 CMV disease. CONCLUSIONS Guided CMV prevention by the prediction model with QFCMV is cost-effective and would spare from CMV surveillance in 42% of patients with low risk for CS-CMV.
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Affiliation(s)
- José O Reusing
- Renal Transplant Service, Instituto Central, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Fabiana Agena
- Renal Transplant Service, Instituto Central, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Camille N Kotton
- Immunocompromised Host Infectious Diseases, Infectious Diseases Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Ligia Camera Pierrotti
- Medical Director Department, Dasa, Barueri, Brazil
- Division of Infectious Disease, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil
| | - Elias David-Neto
- Renal Transplant Service, Instituto Central, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Gomes CM, Marchini G, de Bessa J, Carvalhal G, Caldeira MPR, Saldiva PH, Krieger JE, Agena F, Reis S, Paschoal C, Froes M, Srougi M, Nahas WC, Favorito LA. The landscape of biomedical research funding in Brazil: a current overview. Int Braz J Urol 2024; 50:209-222. [PMID: 38386791 PMCID: PMC10953608 DOI: 10.1590/s1677-5538.ibju.2024.9905] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/02/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVE The objective of this narrative review is to discuss the current state of research funding in Brazil. MATERIALS AND METHODS This study is based on the most recent edition of the course Funding for Research and Innovation in the University of Sao Paulo School of Medicine which was a three-day course with 12 hours of instruction. The course brought together leading experts in the field to comprehensively discuss the current state of research funding in Brazil. Each speaker provided a presentation on a specific topic related to research funding. After the workshop, speakers assembled relevant topics in this manuscript. RESULTS collaborative research is critical for securing research funding. It optimizes proposal competitiveness, amplifies societal impact, and manages risks effectively. As such, fostering and supporting these collaborations is paramount for both researchers and funding agencies. To maintain the highest integrity in research, investigators involved in these collaborations must disclose any relationships that could potentially influence the outcomes or interpretation of their projects. CONCLUSIONS In Brazil, the mainstay of research funding stems from public entities, with agencies such as CNPq, CAPES, and state bodies like FAPESP, FAPERJ, FAPEMIG and others at the forefront. Concurrently, industry funding offers viable pathways, especially through industry-sponsored studies, investigator-led projects, and collaborative initiatives. The Brazilian funding landscape is further enriched by innovative platforms, including crowdfunding and the contributions of institutions like the Serrapilheira Institute. Internationally, esteemed organizations such as the National Institutes of Health (NIH) and the Bill & Melinda Gates Foundation stand out as potential funders.
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Affiliation(s)
- Cristiano M. Gomes
- Universidade de São PauloHospital das Clinicas da Faculdade de MedicinaDepartamento de UrologiaSão PauloSPBrasilDepartamento de Urologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil;
| | - Giovanni Marchini
- Universidade de São PauloHospital das Clinicas da Faculdade de MedicinaDepartamento de UrologiaSão PauloSPBrasilDepartamento de Urologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil;
| | - Jose de Bessa
- Universidade Estadual de Feira de SantanaDepartamento de CirurgiaFeira de SantanaBABrasilDepartamento de Cirurgia, Universidade Estadual de Feira de Santana - UEFS, Feira de Santana, BA, Brasil;
| | - Gustavo Carvalhal
- Pontificia Universidade Catolica do Rio Grande do SulPorto AlegreRSBrasilPontificia Universidade Catolica do Rio Grande do Sul – PUC RS, Porto Alegre, RS, Brasil;
| | - Marina P. R. Caldeira
- Universidade de São PauloFaculdade de MedicinaUnidade de Apoio à Pesquisa e InovaçãoSão PauloSPBrasilUnidade de Apoio à Pesquisa e Inovação, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil;
| | - Paulo Hilario Saldiva
- Universidade de São PauloFaculdade de MedicinaDepartamento de PatologiaSão PauloSPBrasilDepartamento de Patologia, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil;
| | - Jose Eduardo Krieger
- Faculdade de Medicina da Universidade de São PauloHospital das ClínicasInstituto do CoraçãoSão PauloSPBrasilInstituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil.
| | - Fabiana Agena
- Universidade de São PauloHospital das Clinicas da Faculdade de MedicinaDepartamento de UrologiaSão PauloSPBrasilDepartamento de Urologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil;
| | - Sabrina Reis
- Universidade de São PauloHospital das Clinicas da Faculdade de MedicinaDepartamento de UrologiaSão PauloSPBrasilDepartamento de Urologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil;
| | - Candice Paschoal
- Universidade de São PauloHospital das Clinicas da Faculdade de MedicinaDepartamento de UrologiaSão PauloSPBrasilDepartamento de Urologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil;
| | - Milena Froes
- Universidade de São PauloEscola de EnfermagemSão PauloSPBrasilEscola de Enfermagem da Universidade de São Paulo, São Paulo, SP, Brasil;
| | - Miguel Srougi
- Instituto D'Or de Pesquisa e EnsinoSão PauloSPBrasilInstituto D'Or de Pesquisa e Ensino, São Paulo, SP, Brasil;
| | - William C. Nahas
- Universidade de São PauloHospital das Clinicas da Faculdade de MedicinaDepartamento de UrologiaSão PauloSPBrasilDepartamento de Urologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil;
| | - Luciano A. Favorito
- Universidade Estadual do Rio de JaneiroUnidade de Pesquisa UrogenitalRio de JaneiroRJBrasilUnidade de Pesquisa Urogenital – Universidade Estadual do Rio de Janeiro - UERJ, Rio de Janeiro, RJ, Brasil
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Hullekes F, Uffing A, Verhoeff R, Seeger H, von Moos S, Mansur J, Mastroianni-Kirsztajn G, Silva HT, Buxeda A, Pérez-Sáez MJ, Arias-Cabrales C, Collins AB, Swett C, Morená L, Loucaidou M, Kousios A, Malvezzi P, Bugnazet M, Russo LS, Muhsin SA, Agrawal N, Nissaisorakarn P, Patel H, Al Jurdi A, Akalin E, Neto ED, Agena F, Ventura C, Manfro RC, Bauer AC, Mazzali M, Vinicius de Sousa M, La Manna G, Bini C, Comai G, Reindl-Schwaighofer R, Berger S, Cravedi P, Riella LV. Recurrence of membranous nephropathy after kidney transplantation: A multicenter retrospective cohort study. Am J Transplant 2024:S1600-6135(24)00126-6. [PMID: 38341027 DOI: 10.1016/j.ajt.2024.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024]
Abstract
Membranous nephropathy (MN) is a leading cause of kidney failure worldwide and frequently recurs after transplant. Available data originated from small retrospective cohort studies or registry analyses; therefore, uncertainties remain on risk factors for MN recurrence and response to therapy. Within the Post-Transplant Glomerular Disease Consortium, we conducted a retrospective multicenter cohort study examining the MN recurrence rate, risk factors, and response to treatment. This study screened 22,921 patients across 3 continents and included 194 patients who underwent a kidney transplant due to biopsy-proven MN. The cumulative incidence of MN recurrence was 31% at 10 years posttransplant. Patients with a faster progression toward end-stage kidney disease were at higher risk of developing recurrent MN (hazard ratio [HR], 0.55 per decade; 95% confidence interval [CI], 0.35-0.88). Moreover, elevated pretransplant levels of anti-phospholipase A2 receptor (PLA2R) antibodies were strongly associated with recurrence (HR, 18.58; 95% CI, 5.37-64.27). Patients receiving rituximab for MN recurrence had a higher likelihood of achieving remission than patients receiving renin-angiotensin-aldosterone system inhibition alone. In sum, MN recurs in one-third of patients posttransplant, and measurement of serum anti-PLA2R antibody levels shortly before transplant could aid in risk-stratifying patients for MN recurrence. Moreover, patients receiving rituximab had a higher rate of treatment response.
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Affiliation(s)
- Frank Hullekes
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Groningen Transplant Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Audrey Uffing
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Groningen Transplant Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rucháma Verhoeff
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Surgery, Erasmus Medical Center Transplant Institute, Erasmus University, Rotterdam, The Netherlands
| | - Harald Seeger
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Seraina von Moos
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Juliana Mansur
- Division of Nephrology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | | | - Anna Buxeda
- Division of Nephrology, Hospital del Mar, Barcelona, Spain
| | | | | | - A Bernard Collins
- Renal Pathology, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christie Swett
- Renal Pathology, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Leela Morená
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Paolo Malvezzi
- Department of Nephrology, Dialysis, Apheresis and Transplantation, CHU Grenoble Alpes, Grenoble, France
| | - Mathilde Bugnazet
- Department of Nephrology, Dialysis, Apheresis and Transplantation, CHU Grenoble Alpes, Grenoble, France
| | - Luis Sanchez Russo
- Translational Transplant Research Center, Renal Division, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Saif A Muhsin
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nikhil Agrawal
- Division of Nephrology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Pitchaphon Nissaisorakarn
- Division of Nephrology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Het Patel
- Division of Nephrology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ayman Al Jurdi
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Medicine, Nephrology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Enver Akalin
- Einstein/Montefiore Transplant Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Elias David Neto
- Renal Transplant Service, Division of Nephrology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Fabiana Agena
- Renal Transplant Service, Division of Nephrology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Carlucci Ventura
- Renal Transplant Service, Division of Nephrology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Roberto C Manfro
- Division of Nephrology, Hospital de clínicas de Porto Alegre/Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Andrea Carla Bauer
- Division of Nephrology, Hospital de clínicas de Porto Alegre/Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Marilda Mazzali
- Division of Nephrology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | - Gaetano La Manna
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Claudia Bini
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Giorgia Comai
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Stefan Berger
- Groningen Transplant Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Paolo Cravedi
- Translational Transplant Research Center, Renal Division, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Leonardo V Riella
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Medicine, Nephrology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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4
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Quinino RM, Agena F, Modelli de Andrade LG, Furtado M, Chiavegatto Filho ADP, David-Neto E. A Machine Learning Prediction Model for Immediate Graft Function After Deceased Donor Kidney Transplantation. Transplantation 2023; 107:1380-1389. [PMID: 36872507 DOI: 10.1097/tp.0000000000004510] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/07/2023]
Abstract
BACKGROUND After kidney transplantation (KTx), the graft can evolve from excellent immediate graft function (IGF) to total absence of function requiring dialysis. Recipients with IGF do not seem to benefit from using machine perfusion, an expensive procedure, in the long term when compared with cold storage. This study proposes to develop a prediction model for IGF in KTx deceased donor patients using machine learning algorithms. METHODS Unsensitized recipients who received their first KTx deceased donor between January 1, 2010, and December 31, 2019, were classified according to the conduct of renal function after transplantation. Variables related to the donor, recipient, kidney preservation, and immunology were used. The patients were randomly divided into 2 groups: 70% were assigned to the training and 30% to the test group. Popular machine learning algorithms were used: eXtreme Gradient Boosting (XGBoost), Light Gradient Boosting Machine, Gradient Boosting classifier, Logistic Regression, CatBoost classifier, AdaBoost classifier, and Random Forest classifier. Comparative performance analysis on the test dataset was performed using the results of the AUC values, sensitivity, specificity, positive predictive value, negative predictive value, and F1 score. RESULTS Of the 859 patients, 21.7% (n = 186) had IGF. The best predictive performance resulted from the eXtreme Gradient Boosting model (AUC, 0.78; 95% CI, 0.71-0.84; sensitivity, 0.64; specificity, 0.78). Five variables with the highest predictive value were identified. CONCLUSIONS Our results indicated the possibility of creating a model for the prediction of IGF, enhancing the selection of patients who would benefit from an expensive treatment, as in the case of machine perfusion preservation.
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Affiliation(s)
- Raquel M Quinino
- Renal Transplant Service, Hospital das Clinicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Fabiana Agena
- Renal Transplant Service, Hospital das Clinicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - Mariane Furtado
- Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil
| | | | - Elias David-Neto
- Renal Transplant Service, Hospital das Clinicas, University of São Paulo School of Medicine, São Paulo, Brazil
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David-Neto E, Filho MPM, de Sá ÍJAS, Agena F, de Andrade JL, de Paula FJ. The impact of mTOR inhibitors in the regression of left ventricular hypertrophy in elderly kidney transplant recipients. Clin Transplant 2022; 36:e14742. [PMID: 35678134 DOI: 10.1111/ctr.14742] [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: 04/07/2022] [Revised: 05/24/2022] [Accepted: 06/02/2022] [Indexed: 11/27/2022]
Abstract
End-stage kidney disease is frequently associated with left ventricular hypertrophy (LVH), a condition more prevalent in the elderly, that may increase mortality after renal transplantation (RTx). Previous studies suggested that mTOR inhibitors (mTORi) can improve LVH, but this has never been tested in elderly kidney transplant recipients. In this prospective randomized clinical trial, we analyzed the impact of Everolimus (EVL) on the reversal of LVH after RTx in elderly recipients (≥60 years) submitted to different immunosuppressive regimens: EVL/lowTacrolimus (EVL group, n = 53) or mycophenolate sodium/regularTacrolimus (MPS group, n = 47). Patients performed echocardiograms (Echo) up to 3 months after RTx and then annually. At baseline, mean age was 65±3 years in both groups and LVH was observed in 63.6% of patients in EVL group and in 61.8% of MPS group. Last Echo was performed at mean time of 47 and 49 months after RTx in EVL and MPS groups, respectively (P = .34). LVH regression was observed in 23.8% (EVL group) and 19% (MPS group) of patients (P = 1.00). Mean eGFR, blood pressure, and use of RAS blockers were similar between groups throughout follow-up. EVL did not improve LVH in this cohort, and this lack of benefit may be attributed to concomitant use of TAC, senescence, or both.
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Affiliation(s)
- Elias David-Neto
- Kidney Transplant Service, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Marcelo Paes Menezes Filho
- Kidney Transplant Service, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - Fabiana Agena
- Kidney Transplant Service, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - José Lázaro de Andrade
- Echochardiographic Service of the Image and Radiology Institute, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Flávio Jota de Paula
- Kidney Transplant Service, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
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Ulisses LRDS, Paixão JO, Agena F, de Souza PS, Paula FJ, Bezerra G, Rodrigues H, Panajotopolous N, David-Neto E, de Castro MCR. Desensitization using IVIG alone for living-donor kidney transplant: impact on donor-specific antibodies. J Bras Nefrol 2022; 44:527-532. [PMID: 35438714 PMCID: PMC9838666 DOI: 10.1590/2175-8239-jbn-2021-0200] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/08/2021] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Sensitization to human leukocyte antigen is a barrier to. Few data have been published on desensitization using polyvalent human intravenous immunoglobulin (IVIG) alone. METHODS We retrospectively reviewed the of 45 patients with a positive complement-dependent cytotoxicity crossmatch (CDCXM) or flow cytometry crossmatch (FCXM) against living donors from January 2003 to December 2014. Of these, 12 were excluded. Patients received monthly IVIG infusions (2 g/kg) only until they had a negative T-cell and B-cell FCXM. RESULTS During the 33 patients, 22 (66.7%) underwent living donor kidney transplantation, 7 (21.2%) received a deceased donor graft, and 4 (12.1%) did not undergo transplantation. The median class I and II panel reactive antibodies for these patients were 80.5% (range 61%-95%) and 83.0% (range 42%-94%), respectively. Patients (81.8%) had a positive T-cell and/or B-cell CDCXM and 4 (18.2%) had a positive T-cell and/or B-cell FCXM. Patients underwent transplantation after a median of 6 (range 3-16). The median donor-specific antibody mean fluorescence intensity sum was 5057 (range 2246-11,691) before and 1389 (range 934-2492) after desensitization (p = 0.0001). Mean patient follow-up time after transplantation was 60.5 (SD, 36.8) months. Nine patients (45.0%). Death-censored graft survival at 1, 3, and 5 years after transplant was 86.4, 86.4, and 79.2%, respectively and patient survival was 95.5, 95.5, and 83.7%, respectively. CONCLUSIONS Desensitization using IVIG alone is an effective strategy, allowing successful transplantation in 87.9% of these highly sensitized patients.
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Affiliation(s)
- Luiz Roberto de Sousa Ulisses
- Universidade de São Paulo, Hospital das Clínicas, Serviço de
Transplante Renal, São Paulo, SP, Brasil.,Correspondence to: Luiz Roberto de Sousa Ulisses. E-mail:
| | - Jenaine Oliveira Paixão
- Universidade de São Paulo, Hospital das Clínicas, Serviço de
Transplante Renal, São Paulo, SP, Brasil
| | - Fabiana Agena
- Universidade de São Paulo, Hospital das Clínicas, Serviço de
Transplante Renal, São Paulo, SP, Brasil
| | - Patrícia Soares de Souza
- Universidade de São Paulo, Hospital das Clínicas, Serviço de
Transplante Renal, São Paulo, SP, Brasil
| | - Flávio J Paula
- Universidade de São Paulo, Hospital das Clínicas, Serviço de
Transplante Renal, São Paulo, SP, Brasil
| | - Gislene Bezerra
- Universidade de São Paulo, Instituto do Coração da São Paulo,
Laboratório de Imunologia, São Paulo, SP, Brasil
| | - Hélcio Rodrigues
- Universidade de São Paulo, Instituto do Coração da São Paulo,
Laboratório de Imunologia, São Paulo, SP, Brasil
| | - Nicolas Panajotopolous
- Universidade de São Paulo, Instituto do Coração da São Paulo,
Laboratório de Imunologia, São Paulo, SP, Brasil
| | - Elias David-Neto
- Universidade de São Paulo, Hospital das Clínicas, Serviço de
Transplante Renal, São Paulo, SP, Brasil
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7
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Odongo FCA, Braga PE, Palacios R, Miraglia JL, Sartori AMC, Ibrahim KY, Lopes MH, Caiaffa-Filho HH, Timenetsky MDCST, Agena F, Fonseca de Azevedo LS, David-Neto E, Precioso AR, Pierrotti LC. An Open-label Randomized Controlled Parallel-group Pilot Study Comparing the Immunogenicity of a Standard-, Double-, and Booster-dose Regimens of the 2014 Seasonal Trivalent Inactivated Influenza Vaccine in Kidney Transplant Recipients. Transplantation 2022; 106:210-220. [PMID: 33988337 DOI: 10.1097/tp.0000000000003702] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 11/26/2022]
Abstract
BACKGROUND Immunogenicity of influenza vaccine in transplant recipients is suboptimal and alternative vaccination regimens are necessary. METHODS We compared the immunogenicity of a standard-dose trivalent inactivated influenza vaccination (SDTIIV), double-dose trivalent inactivated influenza vaccination (DDTIIV), and booster-dose trivalent inactivated influenza vaccination (BDTIIV) of the 2014 seasonal trivalent inactivated influenza vaccine in kidney transplant recipients. We randomized 176 participants to SDTIIV (59), DDTIIV (59), and BDTIIV regimens (58). Antibody titers were determined by hemagglutination inhibition at enrollment and 21 d postvaccination. Seroprotection rates (SPRs), seroconversion rates (SCRs), and geometric mean ratios (GMRs) were analyzed separately for participants with low (<1:40) and high (≥1:40) prevaccination antibody titers. RESULTS Vaccination was confirmed for 172 participants. Immunogenicity analysis was done for 149 participants who provided postvaccination blood samples. In the subgroup with high prevaccination antibody titers, all vaccination regimens induced SPR > 70% to all antigens, but SCR and GMR were below the recommendations. In the subgroup with low prevaccination antibody titers, DDTIIV and BDTIIV regimens induced adequate SCR > 40% and GMR > 2.5 for all antigens, whereas SDTIIV achieved the same outcomes only for influenza B. SPRs were >70% only after DDTIIV (A/H1N1-77.8%) and BDTIIV (A/H3N2-77.8%). BDTIIV regimen independently increased seroprotection to A/H1N1 (PR = 2.58; P = 0.021) and A/H3N2 (PR = 2.21; P = 0.004), whereas DDTIIV independently increased seroprotection to A/H1N1 (PR = 2.59; P = 0.021). CONCLUSIONS Our results suggest that DDTIIV and BDTIIV regimens are more immunogenic than SDTIIV, indicating the need for head-to-head multicenter clinical trials to further evaluate their efficacy.
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Affiliation(s)
- Fatuma Catherine Atieno Odongo
- Departamento de Moléstias Infecciosas, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Ricardo Palacios
- Instituto Butantan, Divisão de Ensaios Clínicos, São Paulo, Brazil
| | | | - Ana Marli Christovam Sartori
- Departamento de Moléstias Infecciosas, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Karim Yaqub Ibrahim
- Departamento de Moléstias Infecciosas, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marta Heloisa Lopes
- Departamento de Moléstias Infecciosas, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Helio Hehl Caiaffa-Filho
- Serviço de Biologia Molecular da Divisão de Laboratório Central, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Fabiana Agena
- Serviço de Transplante Renal, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Luiz Sergio Fonseca de Azevedo
- Serviço de Transplante Renal, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Elias David-Neto
- Serviço de Transplante Renal, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Lígia Camera Pierrotti
- Departamento de Moléstias Infecciosas, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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8
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Quinino RME, Agena F, Paula FJD, Nahas WC, David-Neto E. Comparative analysis of kidney transplant costs related to recovery of renal function after the procedure. ACTA ACUST UNITED AC 2021; 43:375-382. [PMID: 33899907 PMCID: PMC8428635 DOI: 10.1590/2175-8239-jbn-2020-0172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 01/20/2021] [Indexed: 12/26/2022]
Abstract
Introduction: The number of kidney transplants (KTx) is increasing in Brazil and,
consequently, the costs of this procedure increase the country's health
budget. We retrospectively evaluated the data of kidney transplant
procedures until hospital discharge, according to kidney function recovery
after the procedure. Methods: Retrospective analysis of the non-sensitized, 1st KTx from deceased donors
performed between Jan/2010 to Dec/2017. Results: Out of the 1300 KTx from deceased donors performed in this period, 730
patients were studied and divided into 3 groups: Immediate Renal Function
(IRF) - decrease in serum creatinine ≥ 10% on two consecutive days; Delayed
Graft Function (DGF) - decrease in serum creatinine <10% on two
consecutive days, without the need for dialysis, and Dialysis (D) - need for
dialysis during the first week. Patients in group D stayed longer in the
hospital compared to DGF and IRF (21, 11 and 8 days respectively, p <
0.001). More D patients (21%) were admitted to the ICU and performed a
greater number of laboratory tests (p < 0.001) and renal biopsies (p <
0.001), in addition to receiving a higher amount of immunosuppressants.
Total hospital costs were higher in group D and DGF compared to IRF (U$
7.021,48; U$ 3.603,42 and U$ 2.642,37 respectively, p < 0.001). Conclusion: The costs of the transplant procedure is impacted by the recovery of kidney
function after the transplant. The reimbursement for each of these different
kidney function outcomes should be individualized in order to cover their
real costs.
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Affiliation(s)
- Raquel Martins E Quinino
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Serviço de Transplante Renal, São Paulo, SP, Brasil
| | - Fabiana Agena
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Serviço de Transplante Renal, São Paulo, SP, Brasil
| | - Flávio Jota de Paula
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Serviço de Transplante Renal, São Paulo, SP, Brasil
| | - William Carlos Nahas
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Serviço de Transplante Renal, São Paulo, SP, Brasil
| | - Elias David-Neto
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Serviço de Transplante Renal, São Paulo, SP, Brasil
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9
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Uffing A, Pérez-Saéz MJ, Jouve T, Bugnazet M, Malvezzi P, Muhsin SA, Lafargue MC, Reindl-Schwaighofer R, Morlock A, Oberbauer R, Buxeda A, Burballa C, Pascual J, von Moos S, Seeger H, La Manna G, Comai G, Bini C, Russo LS, Farouk S, Nissaisorakarn P, Patel H, Agrawal N, Mastroianni-Kirsztajn G, Mansur J, Tedesco-Silva H, Ventura CG, Agena F, David-Neto E, Akalin E, Alani O, Mazzali M, Manfro RC, Bauer AC, Wang AX, Cheng XS, Schold JD, Berger SP, Cravedi P, Riella LV. Recurrence of IgA Nephropathy after Kidney Transplantation in Adults. Clin J Am Soc Nephrol 2021; 16:1247-1255. [PMID: 34362788 PMCID: PMC8455056 DOI: 10.2215/cjn.00910121] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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: 01/19/2021] [Accepted: 06/21/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES In patients with kidney failure due to IgA nephropathy, IgA deposits can recur in a subsequent kidney transplant. The incidence, effect, and risk factors of IgA nephropathy recurrence is unclear, because most studies have been single center and sample sizes are relatively small. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We performed a multicenter, international, retrospective study to determine the incidence, risk factors, and treatment response of recurrent IgA nephropathy after kidney transplantation. Data were collected from all consecutive patients with biopsy-proven IgA nephropathy transplanted between 2005 and 2015, across 16 "The Post-Transplant Glomerular Disease" study centers in Europe, North America, and South America. RESULTS Out of 504 transplant recipients with IgA nephropathy, recurrent IgA deposits were identified by kidney biopsy in 82 patients; cumulative incidence of recurrence was 23% at 15 years (95% confidence interval, 14 to 34). Multivariable Cox regression revealed a higher risk for recurrence of IgA deposits in patients with a pre-emptive kidney transplant (hazard ratio, 3.45; 95% confidence interval, 1.31 to 9.17) and in patients with preformed donor-specific antibodies (hazard ratio, 2.59; 95% confidence interval, 1.09 to 6.19). After kidney transplantation, development of de novo donor-specific antibodies was associated with subsequent higher risk of recurrence of IgA nephropathy (hazard ratio, 6.65; 95% confidence interval, 3.33 to 13.27). Immunosuppressive regimen was not associated with recurrent IgA nephropathy in multivariable analysis, including steroid use. Graft loss was higher in patients with recurrence of IgA nephropathy compared with patients without (hazard ratio, 3.69; 95% confidence interval, 2.04 to 6.66), resulting in 32% (95% confidence interval, 50 to 82) graft loss at 8 years after diagnosis of recurrence. CONCLUSIONS In our international cohort, cumulative risk of IgA nephropathy recurrence increased after transplant and was associated with a 3.7-fold greater risk of graft loss.
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Affiliation(s)
- Audrey Uffing
- Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts,Division of Nephrology, University of Groningen, Groningen, the Netherlands
| | | | - Thomas Jouve
- Department of Nephrology, Dialysis, Apheresis and Transplantation, CHU Grenoble Alpes, Grenoble, France
| | - Mathilde Bugnazet
- Department of Nephrology, Dialysis, Apheresis and Transplantation, CHU Grenoble Alpes, Grenoble, France
| | - Paolo Malvezzi
- Department of Nephrology, Dialysis, Apheresis and Transplantation, CHU Grenoble Alpes, Grenoble, France
| | - Saif A. Muhsin
- Renal Division, Harvard Medical School, Boston, Massachusetts
| | | | | | - Alina Morlock
- Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - Rainer Oberbauer
- Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - Anna Buxeda
- Division of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Carla Burballa
- Division of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Julio Pascual
- Division of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Seraina von Moos
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Harald Seeger
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Gaetano La Manna
- Department of Experimental Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Giorgia Comai
- Department of Experimental Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Claudia Bini
- Department of Experimental Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Luis Sanchez Russo
- Renal Division, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samira Farouk
- Division of Nephrology, Beth Israel Medical Center, Boston, Massachusetts
| | | | - Het Patel
- Division of Nephrology, Beth Israel Medical Center, Boston, Massachusetts
| | - Nikhil Agrawal
- Division of Nephrology, Beth Israel Medical Center, Boston, Massachusetts
| | | | - Juliana Mansur
- Division of Nephrology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - Carlucci Gualberto Ventura
- Renal Transplant Service, Division of Nephrology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Fabiana Agena
- Renal Transplant Service, Division of Nephrology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Elias David-Neto
- Renal Transplant Service, Division of Nephrology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Enver Akalin
- Einstein/Montefiore Transplant Center, Albert Einstein College of Medicine, Bronx, New York
| | - Omar Alani
- Einstein/Montefiore Transplant Center, Albert Einstein College of Medicine, Bronx, New York
| | - Marilda Mazzali
- Division of Nephrology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Roberto Ceratti Manfro
- Division of Nephrology, Hospital de clínicas de Porto Alegre/Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Andrea Carla Bauer
- Division of Nephrology, Hospital de clínicas de Porto Alegre/Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Aileen X. Wang
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | - Xingxing S. Cheng
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | - Jesse D. Schold
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland, Ohio
| | - Stefan P. Berger
- Division of Nephrology, University of Groningen, Groningen, the Netherlands
| | - Paolo Cravedi
- Renal Division, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Leonardo V. Riella
- Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts,Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
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10
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de Sandes-Freitas TV, Mazzali M, Manfro RC, de Andrade LGM, Vicari AR, de Sousa MV, Medina Pestana JO, Garcia VD, de Carvalho DRDBM, de Matos Esmeraldo R, de Oliveira CMC, Simão DR, Deboni LM, David-Neto E, Cavalcanti FCB, Pacheco-Silva Á, Ferreira GF, Madeira RL, Bignelli AT, Meira GSG, Lasmar EP, Keitel E, de Azevedo Matuck T, da Costa SD, Nga HS, Fernandes PFCBC, Narciso HR, Vieira MA, Agena F, Fonseca IB, de Matos ACC, Bastos J, Villaça SS, Hokazono SR, Silva ARB, Lasmar M, Tedesco-Silva H. Exploring the causes of the high incidence of delayed graft function after kidney transplantation in Brazil: a multicenter study. Transpl Int 2021; 34:1093-1104. [PMID: 33742470 DOI: 10.1111/tri.13865] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 08/27/2020] [Revised: 02/17/2021] [Accepted: 03/13/2021] [Indexed: 11/30/2022]
Abstract
This retrospective multicenter (n = 18) cohort study evaluated the incidence, risk factors, and the impact of delayed graft function (DGF) on 1-year kidney transplant (KT) outcomes. Of 3992 deceased donor KT performed in 2014-2015, the incidence of DGF was 54%, ranging from 29.9% to 87.7% among centers. Risk factors (lower-bound-95%CI OR upper-bound-95%CI ) were male gender (1.066 1.2491.463 ), diabetic kidney disease (1.053 1.2961.595 ), time on dialysis (1.005 1.0071.009 ), retransplantation (1.035 1.3971.885 ), preformed anti-HLA antibodies (1.011 1.3831.892 ), HLA mismatches (1.006 1.0661.130 ), donor age (1.011 1.0171.023 ), donor final serum creatinine (sCr) (1.239 1.3171.399 ), cold ischemia time (CIT) (1.031 1.0431.056 ), machine perfusion (0.401 0.5420.733 ), and induction therapy with rabbit antithymocyte globulin (rATG) (0.658 0.8000.973 ). Duration of DGF > 4 days was associated with inferior renal function and DGF > 14 days with the higher incidences of acute rejection, graft loss, and death. In conclusion, the incidence and duration of DGF were high and associated with inferior graft outcomes. While late referral and poor donor maintenance account for the high overall incidence of DGF, variability in donor and recipient selection, organ preservation method, and type of induction agent may account for the wide variation observed among transplant centers.
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Affiliation(s)
- Tainá Veras de Sandes-Freitas
- Departmento de Medicina Clínica, Universidade Federal do Ceará, Fortaleza, CE, Brazil.,Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
| | - Marilda Mazzali
- Hospital de Clínicas da Universidade de Campinas, Campinas, SP, Brazil
| | | | | | | | | | - José Osmar Medina Pestana
- Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, SP, Brazil.,Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | | | | | | | | | | | - Elias David-Neto
- Hospital de Clínicas da Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Álvaro Pacheco-Silva
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.,Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | | | | | | | | | - Elizete Keitel
- Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.,Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Silvana Daher da Costa
- Departmento de Medicina Clínica, Universidade Federal do Ceará, Fortaleza, CE, Brazil.,Hospital Geral de Fortaleza, Fortaleza, CE, Brazil.,Hospital Universitário Walter Cantídio, Fortaleza, CE, Brazil
| | - Hong Si Nga
- Departmento de Medicina Interna, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | | | | | | | - Fabiana Agena
- Hospital de Clínicas da Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Ana Cristina Carvalho de Matos
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.,Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Juliana Bastos
- Santa Casa de Misericórdia de Juiz de Fora, Juiz de Fora, MG, Brazil
| | | | | | | | - Marcus Lasmar
- Hospital Universitário Ciências Médicas, Belo Horizonte, MG, Brazil
| | - Hélio Tedesco-Silva
- Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, SP, Brazil.,Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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11
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Miranda LJC, Agena F, Sartori AMC, David-Neto E, Azevedo LS, Pierrotti LC. Awareness of Inadvertent Use of Yellow Fever Vaccine Among Recipients of Renal Transplant. Transplant Proc 2020; 52:1291-1293. [PMID: 32505502 DOI: 10.1016/j.transproceed.2020.02.182] [Citation(s) in RCA: 1] [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: 02/01/2020] [Accepted: 02/06/2020] [Indexed: 12/01/2022]
Abstract
Yellow fever (YF) is a vaccine-preventable disease, but live attenuated YF vaccine (YFV) is contraindicated in immunosuppressed patients due to the risk of life-threatening YFV-associated side effects. This study aimed to evaluate 1. the knowledge of renal transplant recipients (RTRs) about the contraindication and risks of YFV; 2. the prevalence of inadvertent vaccination of RTRs against YF; and 3. the outcome of these patients. A cross-sectional telephone contact study was conducted with 200 RTRs selected from the outpatient clinic of our transplantation unit. There were 116 successful telephone contacts (58%). A total of 11 vaccinated patients were identified: 5 received YFV in the pretransplant period and 6 in the post-transplant period. All patients received the full dose of the vaccine. Among those vaccinated after transplant, only 1 reported a mild adverse event (nausea) after receiving the vaccine. All vaccinated patients who were post-transplant did not know about vaccine contraindications as a result of their clinical condition. Among the unvaccinated patients, this rate was 12.4%. YFV is the main tool for disease prevention and control as there is no specific antiviral treatment for YF. Our results confirm the evidence that transplant recipients tolerate YFV well. However, data are not strong enough to recommend this vaccine in transplant recipients. Counseling RTRs on the contraindications of YFV is important to prevent inadvertent use of this vaccine in this population.
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Affiliation(s)
| | - Fabiana Agena
- Renal Transplantation Service, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Ana Marli Christovam Sartori
- Division of Infectious Diseases, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Elias David-Neto
- Renal Transplantation Service, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Luiz Sergio Azevedo
- Renal Transplantation Service, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Lígia Camera Pierrotti
- Division of Infectious Diseases, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
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12
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Uffing A, Pérez-Sáez MJ, Mazzali M, Manfro RC, Bauer AC, de Sottomaior Drumond F, O'Shaughnessy MM, Cheng XS, Chin KK, Ventura CG, Agena F, David-Neto E, Mansur JB, Kirsztajn GM, Tedesco-Silva H, Neto GMV, Arias-Cabrales C, Buxeda A, Bugnazet M, Jouve T, Malvezzi P, Akalin E, Alani O, Agrawal N, La Manna G, Comai G, Bini C, Muhsin SA, Riella MC, Hokazono SR, Farouk SS, Haverly M, Mothi SS, Berger SP, Cravedi P, Riella LV. Recurrence of FSGS after Kidney Transplantation in Adults. Clin J Am Soc Nephrol 2020; 15:247-256. [PMID: 31974287 PMCID: PMC7015092 DOI: 10.2215/cjn.08970719] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [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: 07/31/2019] [Accepted: 11/29/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVES FSGS recurrence after kidney transplantation is a major risk factor for graft loss. However, the natural history, clinical predictors, and response to treatment remain unclear because of small sample sizes and poor generalizability of single-center studies, and disease misclassification in registry-based studies. We therefore aimed to determine the incidence, predictors, and treatment response of recurrent FSGS in a large cohort of kidney transplant recipients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The Post-Transplant Glomerular Disease (TANGO) project is an observational, multicenter, international cohort study that aims to investigate glomerular disease recurrence post-transplantation. Transplant recipients were screened for the diagnosis of idiopathic FSGS between 2005 and 2015 and details were recorded about the transplant, clinical outcomes, treatments, and other risk factors. RESULTS Among 11,742 kidney transplant recipients screened for FSGS, 176 had a diagnosis of idiopathic FSGS and were included. FSGS recurred in 57 patients (32%; 95% confidence interval [95% CI], 25% to 39%) and 39% of them lost their graft over a median of 5 (interquartile range, 3.0-8.1) years. Multivariable Cox regression revealed a higher risk for recurrence with older age at native kidney disease onset (hazard ratio [HR], 1.37 per decade; 95% CI, 1.09 to 1.56). Other predictors were white race (HR, 2.14; 95% CI, 1.08 to 4.22), body mass index at transplant (HR, 0.89 per kg/m2; 95% CI, 0.83 to 0.95), and native kidney nephrectomies (HR, 2.76; 95% CI, 1.16 to 6.57). Plasmapheresis and rituximab were the most frequent treatments (81%). Partial or complete remission occurred in 57% of patients and was associated with better graft survival. CONCLUSIONS Idiopathic FSGS recurs post-transplant in one third of cases and is associated with a five-fold higher risk of graft loss. Response to treatment is associated with significantly better outcomes but is achieved in only half of the cases.
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Affiliation(s)
- Audrey Uffing
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maria José Pérez-Sáez
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Servicio de Nefrología, Hospital del Mar, Barcelona, Spain
| | - Marilda Mazzali
- Division of Nephrology, School of Medical Sciences, University of Campinas (UNICAMP), Sao Paulo, Brazil
| | - Roberto C Manfro
- Division of Nephrology, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Andrea Carla Bauer
- Division of Nephrology, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Michelle M O'Shaughnessy
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Xingxing S Cheng
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Kuo-Kai Chin
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Carlucci G Ventura
- Kidney Transplant Service, Hospital das Clinicas-University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Fabiana Agena
- Kidney Transplant Service, Hospital das Clinicas-University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Elias David-Neto
- Kidney Transplant Service, Hospital das Clinicas-University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Juliana B Mansur
- Division of Nephrology, Hospital do Rim, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Helio Tedesco-Silva
- Division of Nephrology, Hospital do Rim, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Gilberto M V Neto
- Division of Nephrology, Hospital do Rim, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Anna Buxeda
- Servicio de Nefrología, Hospital del Mar, Barcelona, Spain
| | - Mathilde Bugnazet
- Service de Néphrologie Dialyse, Aphérèses et Transplantation, Grenoble University Hospital, Grenoble, France
| | - Thomas Jouve
- Service de Néphrologie Dialyse, Aphérèses et Transplantation, Grenoble University Hospital, Grenoble, France
| | - Paolo Malvezzi
- Service de Néphrologie Dialyse, Aphérèses et Transplantation, Grenoble University Hospital, Grenoble, France
| | - Enver Akalin
- Montefiore Einstein Center for Transplantation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Omar Alani
- Montefiore Einstein Center for Transplantation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Nikhil Agrawal
- Division of Nephrology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Gaetano La Manna
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Giorgia Comai
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Claudia Bini
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Saif A Muhsin
- Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Samira S Farouk
- Renal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Meredith Haverly
- Renal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Suraj Sarvode Mothi
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stefan P Berger
- Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Paolo Cravedi
- Renal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Leonardo V Riella
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts;
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13
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Ventura CG, Whisenant T, Gelbart T, David DS, Agena F, Salomon DR, David-Neto E, Kurian SM. Discovery and cross-validation of peripheral blood and renal biopsy gene expression signatures from ethnically diverse kidney transplant populations. Am J Transplant 2019; 19:3356-3366. [PMID: 31152474 PMCID: PMC6883121 DOI: 10.1111/ajt.15482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 04/15/2019] [Accepted: 05/04/2019] [Indexed: 01/25/2023]
Abstract
We determined peripheral blood (PB) and biopsy (Bx) RNA expression signatures in a Brazilian and US cohort of kidney transplant patients. Phenotypes assigned by precise histology were: acute rejection (AR), interstitial fibrosis/tubular atrophy/chronic rejection (CR), excellent functioning transplants (TX), and glomerulonephritis recurrence (GN). Samples were analyzed on microarrays and profiles from each cohort were cross-validated on the other cohort with similar phenotypes. We discovered signatures for each tissue: (1) AR vs TX, (2) CR vs TX, and (3) GN vs TX using the Random Forests algorithm. We validated biopsies signatures of AR vs TX (area under the curve [AUC] 0.97) and CR vs TX (AUC 0.87). We also validated both PB and Bx signatures of AR vs TX and CR vs TX with varying degrees of accuracy. Several biological pathways were shared between AR and CR, suggesting similar rejection mechanisms in these 2 clinical phenotypes. Thus, we identified gene expression signatures for AR and CR in transplant patients and validated them in independent cohorts of significantly different racial/ethnic backgrounds. These results reveal that there are strong unifying immune mechanisms driving transplant diseases and identified in the signatures discovered in each cohort, suggesting that molecular diagnostics across populations are feasible despite ethnic and environmental differences.
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Affiliation(s)
- Carlucci Gualberto Ventura
- Renal Transplant Service, Hospital das Clinicas - University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Thomas Whisenant
- University of California, San Diego, School of Medicine, Center for Computational Biology and Bioinformatics, La Jolla, California
| | - Terri Gelbart
- Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, California
| | - Daisa S.R. David
- Renal Transplant Service, Hospital das Clinicas - University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Fabiana Agena
- Renal Transplant Service, Hospital das Clinicas - University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Daniel R. Salomon
- Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, California
| | - Elias David-Neto
- Renal Transplant Service, Hospital das Clinicas - University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Sunil M. Kurian
- Scripps Center for Organ Transplantation, Scripps Green Hospital, La Jolla, California
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Levy A, Rangel-Santos A, Torres LC, Silveira-Abreu G, Agena F, Carneiro-Sampaio M. T cell receptor excision circles as a tool for evaluating thymic function in young children. ACTA ACUST UNITED AC 2019; 52:e8292. [PMID: 31241713 PMCID: PMC6596370 DOI: 10.1590/1414-431x20198292] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 04/18/2019] [Indexed: 11/21/2022]
Abstract
The thymus is a primary lymphoid organ responsible for the maturation of T cells as well as the immunological central tolerance. It is in the antenatal period and infancy that it plays its major role. In clinical practice, T cell receptor excision circles (TRECs) are considered a direct and reliable measure of the thymic function. TRECs are a by-product of DNA formation in gene rearrangement of T cell receptors. They are stable and they do not duplicate during mitosis, representing the recent emigrant T cells from the thymus. Despite their importance, TRECs have been neglected by physicians and there is a lack of data regarding thymic function during infancy of healthy children. In order to evaluate thymic function in the first years of life, we propose measuring TRECs as a valuable tool. One hundred and three blood samples from children and adolescents between 3 months and 20 years of age were analyzed. The mean TRECs count was 136.77±96.7 copies of TRECs/μL of DNA. The individuals between 0 and 5 years of age had significantly higher TRECs values than those between 10 and 20 years of age. No significant difference was observed in TRECs values among age groups below 5 years of age. An inverse correlation between TRECs and age was found (r=0.3 P=0.003). These data highlight and validate the evidence of decreased thymus function with age, even during infancy. Awareness should be raised with this important albeit ignored organ.
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Affiliation(s)
- A Levy
- Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - A Rangel-Santos
- Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - L C Torres
- Laboratório de Pesquisa Translacional, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, PE, Brasil
| | - G Silveira-Abreu
- Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - F Agena
- Instituto Central, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - M Carneiro-Sampaio
- Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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15
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David-Neto E, Agena F, Silva Ribeiro David D, Paula FJD, Camera Pierrotti LC, Domingues Fink MC, Fonseca de Azevedo LS. Effect of polyoma viremia on 3-year allograft kidney function. Transpl Infect Dis 2019; 21:e13056. [PMID: 30712328 DOI: 10.1111/tid.13056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 01/10/2019] [Accepted: 01/27/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Polyoma viremia is associated with damage to renal tubular and urothelial cells. This may imply that a certain level of viremia, even cleared thereafter, could be associated with long-term renal dysfunction. METHODS We, retrospectively, analyzed 390 first renal transplants adult recipients (≥18 years) who were monitored for BK viremia in the first 12 months and evaluated estimated GFR (MDRD-4 equation) at 1 month and at the last follow-up (959 ± 392 days). RESULTS One hundred and ninety-nine patients (51%) developed at least one positive viremia: 105 (53%) low viremia (<104 copies/mL), 36 (18%) high viremia (4 × 104 > viremia ≥ 104 copies/mL) and 58 (15%) viremia (≥4 × 104 copies/mL) consistent with polyoma virus associated nephropathy (PyVAN). Out of these 58 patients, 24 (6%) developed bx-proven (SV40+) PyVAN and 34(8.7%) presumptive PyVAN (SV40-). Baseline characteristics, immunosuppression, KDRI, rejection episodes, etc., did not differ among groups but there were more deceased donors and ATG induction therapy in the high viremia group. At last follow-up, all patients in the low, high viremia and presumptive PyVAN (except 2) had cleared BK viremia. Bx-proven PyVAN led to 14 graft losses, 10 due to PyVAN. In the presumptive PyVAN there was only one graft loss registered as due to PyVAN. eGFR, at 1 month after KTx, did not differ among groups (51 ± 22 vs 48 ± 24 vs 45 ± 27 vs 43 ± 18 vs 46 ± 22 mL/min/1.73 m2 ), for no, low and high viremia as well for presumptive PyVAN and bx-proven PyVAN groups, respectively. At the last follow-up, eGFR did not differ between the no, low, and high viremia compared to baseline and to each other but was statistically lower in the presumptive and bx-proven PyVAN (38 ± 15 and 17 ± 7 mL/min/1.73 m2 ) either compared to baseline or to the other groups. CONCLUSIONS This study shows that low and high levels of BK viremia do not lead to GFR changes although very high viremia levels, compatible with presumptive or bx-proven PyVAN, even if cleared thereafter, lead to allograft damage and decreased GFR.
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Affiliation(s)
- Elias David-Neto
- Renal Transplantation Service, Division of Urology, Hospital das Clínicas, Sao Paulo University School of Medicine, São Paulo, Brazil.,Division of Nephrology, Hospital das Clínicas, Sao Paulo University School of Medicine, São Paulo, Brazil
| | - Fabiana Agena
- Renal Transplantation Service, Division of Urology, Hospital das Clínicas, Sao Paulo University School of Medicine, São Paulo, Brazil
| | - Daisa Silva Ribeiro David
- Division of Pathology, Hospital das Clínicas, Sao Paulo University School of Medicine, São Paulo, Brazil
| | - Flavio Jota de Paula
- Renal Transplantation Service, Division of Urology, Hospital das Clínicas, Sao Paulo University School of Medicine, São Paulo, Brazil
| | | | | | - Luiz Sergio Fonseca de Azevedo
- Renal Transplantation Service, Division of Urology, Hospital das Clínicas, Sao Paulo University School of Medicine, São Paulo, Brazil
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Freitas GRR, da Luz Fernandes M, Agena F, Jaluul O, Silva SC, Lemos FBC, Coelho V, Elias DN, Galante NZ. Aging and End Stage Renal Disease Cause A Decrease in Absolute Circulating Lymphocyte Counts with A Shift to A Memory Profile and Diverge in Treg Population. Aging Dis 2019; 10:49-61. [PMID: 30705767 PMCID: PMC6345336 DOI: 10.14336/ad.2018.0318] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/18/2018] [Indexed: 12/14/2022] Open
Abstract
There is a growing number of elderly kidney transplant (Ktx) recipients. Elderly recipients present lower acute rejection rates but higher incidence of infection and malignancies. Aging per se seems to result in a shift to memory profile and chronic kidney disease (CKD) in premature immunological aging. Understanding aging and CKD effects on the immune system can improve elderly Ktx immunosuppression. We analyzed the effects of aging and CKD in the immune system, comparing healthy adults (HAd) (n=14, 26±2y), healthy elderly (HEld) (n=15, 79±7y), end stage renal disease (ESRD) adults (EnAd) (n=18, 36±7y) and ESRD elderly (EnEld) (n=31, 65±3y) prior to Ktx regarding their naïve, memory and regulatory T and B peripheral lymphocytes. Aging and ESRD presented additive effect decreasing absolute numbers of B and T-lymphocytes, affecting memory, naive and regulatory subsets without synergic effect. Both resulted in higher percentages of T memory subsets and opposing effects on regulatory T (TREG) subsets, higher percentage in aging and lower in ESRD. Combined effect of aging and ESRD also resulted in higher regulatory B cell percentages. In addition to global lymphopenia and TCD4+ memory shift in both aging and ESRD, aging shifts to an immunoregulatory profile, inducing a increase in TREG percentages, contrasting with ESRD that decreases TREGs. Differential immunosuppression regimens for elderly Ktx may be required. (ClinicalTrials.gov number: NTC01631058).
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Affiliation(s)
- Geraldo Rubens Ramos Freitas
- 1Division of Nephrology, and.,2Renal Transplant Service, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Maria da Luz Fernandes
- 2Renal Transplant Service, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Fabiana Agena
- 2Renal Transplant Service, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Omar Jaluul
- 3Division of Geriatrics, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Sérgio Colenci Silva
- 3Division of Geriatrics, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | | | - Verônica Coelho
- 4Laboratory of Immunology, Heart Institute, University of Sao Paulo School of Medicine. Institute for Investigation in Immunology, Sao Paulo, Brazil
| | - David-Neto Elias
- 2Renal Transplant Service, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Nelson Zocoler Galante
- 2Renal Transplant Service, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
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Sarmento DJDS, Palmieri M, Galvão GS, Tozetto-Mendoza TR, Canto CMD, Pierrotti LC, David-Neto E, Agena F, Gallottini M, Pannuti CS, Fink MCD, Braz-Silva PH. BK virus salivary shedding and viremia in renal transplant recipients. J Appl Oral Sci 2019; 27:e20180435. [PMID: 30673031 PMCID: PMC6438661 DOI: 10.1590/1678-7757-2018-0435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/12/2018] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES This study aimed to verify the presence of polyomavirus BK (BKPyV) in the saliva of kidney transplant recipients and to correlate it with blood viremia. MATERIAL AND METHODS We have conducted a cross-sectional study with a sample involving 126 renal transplant recipients. 126 samples of saliva and 52 samples of blood were collected from these patients. Detection and quantification of BKPyV were performed using a real-time PCR. To compare the presence of BKPyV in blood and saliva, the binomial proportion test was used. To verify associations between salivary shedding BKPyV and post-transplant periods (in months), the Mann-Whitney test was used. Spearman's correlation was used to correlate the viral load in the saliva with blood of kidney transplant recipients. RESULTS The mean age of the study group was 51.11±12.45 years old, and 69 participants (54.8%) were female, with a mean post-transplantation time of 4.80±6.04 months. BKPyV was quantified in several samples of saliva and blood, with medians of 1,108 cp/mL and 1,255 cp/mL, respectively. Only 16/52 (30.8%) participants presented BKPyV in blood, and 59/126 (46.8%) excreted the virus in saliva (p=0.004). BKPyV shedding was found in patients at a shorter post-transplantation period (3.86±5.25, p=0.100). A weak correlation was observed between viral quantification in saliva and blood (Spearman's correlation coefficient=0.193). CONCLUSION The results of this study suggested that, although saliva excretes more BKPyV than blood, there is no reliable correlation between salivary shedding and blood viremia, showing two independent compartments of viral replication.
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Affiliation(s)
| | - Michelle Palmieri
- University of São Paulo, School of Dentistry, Stomatology Department, São Paulo, São Paulo, Brazil
| | - Gustavo Souza Galvão
- University of São Paulo, School of Dentistry, Stomatology Department, São Paulo, São Paulo, Brazil
| | - Tânia Regina Tozetto-Mendoza
- University of São Paulo, Institute of Tropical Medicine of São Paulo, Laboratory of Virology, São Paulo, São Paulo, Brazil
| | - Cynthia Motta do Canto
- University of São Paulo, Institute of Tropical Medicine of São Paulo, Laboratory of Virology, São Paulo, São Paulo, Brazil
| | - Ligia Camera Pierrotti
- University of São Paulo, Medical School, Hospital das Clínicas, Departament of Infectious and Parasitic Diseases, São Paulo, São Paulo, Brazil
| | - Elias David-Neto
- University of São Paulo, Medical School, Hospital das Clínicas, Serviço de Transplante Renal, São Paulo, São Paulo, Brazil
| | - Fabiana Agena
- University of São Paulo, Medical School, Hospital das Clínicas, Serviço de Transplante Renal, São Paulo, São Paulo, Brazil
| | - Marina Gallottini
- University of São Paulo, School of Dentistry, Stomatology Department, São Paulo, São Paulo, Brazil
| | - Claudio Sergio Pannuti
- University of São Paulo, Institute of Tropical Medicine of São Paulo, Laboratory of Virology, São Paulo, São Paulo, Brazil
| | - Maria Cristina Domingues Fink
- University of São Paulo, Institute of Tropical Medicine of São Paulo, Laboratory of Virology, São Paulo, São Paulo, Brazil
| | - Paulo Henrique Braz-Silva
- University of São Paulo, School of Dentistry, Stomatology Department, São Paulo, São Paulo, Brazil.,University of São Paulo, Institute of Tropical Medicine of São Paulo, Laboratory of Virology, São Paulo, São Paulo, Brazil
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Romano P, Agena F, de Almeida Rezende Ebner P, Massakazu Sumita N, Kamada Triboni AH, Ramos F, dos Santos Garcia M, Coelho Duarte NJ, Brambate Carvalhinho Lemos F, Zocoler Galante N, David-Neto E. Longitudinal Pharmacokinetics of Mycophenolic Acid in Elderly Renal Transplant Recipients Compared to a Younger Control Group: Data from the nEverOld Trial. Eur J Drug Metab Pharmacokinet 2018; 44:189-199. [DOI: 10.1007/s13318-018-0506-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bicalho CS, Oliveira RDR, David DR, Fink MCDS, Agena F, Castro MC, Panutti C, David-Neto E, Pierrotti LC. Determination of viremia cut-off for risk to develop BKPyV-associated nephropathy among kidney transplant recipients. Transpl Infect Dis 2018; 20:e12969. [PMID: 30074295 DOI: 10.1111/tid.12969] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 06/18/2018] [Accepted: 07/08/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND BK polyomavirus (BKPyV)-associated nephropathy (BKPyVAN) is a consequence of BKPyV replication in the urinary tract in kidney transplant recipients (KTR). OBJECTIVES The objectives were to determine the prevalence of BKPyV replication and BKPyVAN, risk factors associated to sustained viremia and BKPyVAN, and viremia cut-off that best predict the occurrence of sustained viremia and nephropathy in KTR of a single University Hospital Kidney Transplant Center. PATIENTS AND METHODS All KTR undergoing transplantation from August 2010 to December 2011 were enrolled and monitored up to 2 years posttransplantation for BKPyV viruria by decoy cells shedding or polymerase chain reaction (PCR) and viremia by PCR. Kidney biopsy was indicated if sustained viremia (two or more viremia above 10 000 copies/mL) to confirm BKPyVAN diagnosis. RESULTS In this study, 326 transplants were performed and 246 patients were included. Prevalence of viruria was 36.9%, viremia 22.3% and nephropathy 3.2%. Male gender was the only risk factor associated to sustained viremia or nephropathy. Cut-off value of viremia that best discriminates the progression to sustained viremia and to BKPyVAN was 37 488 and 44 956 copies/mL, respectively. CONCLUSIONS Prevalence of viruria, viremia, and nephropathy were similar to those reported in literature but the cut-off value of viremia that best discriminates the risk of progression to nephropathy was greater than the value usually reported, which is 10 000 copies/mL.
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Affiliation(s)
- Camila Silva Bicalho
- Department of Infectious Diseases, Hospital das Clínicas da Faculdade de Medicina da, Universidade de São Paulo, São Paulo, Brazil
| | | | - Daísa Ribeiro David
- Department of Pathology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Fabiana Agena
- Renal Transplantation Service, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Maria Cristina Castro
- Renal Transplantation Service, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Cláudio Panutti
- São Paulo Institute of Tropical Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Elias David-Neto
- Renal Transplantation Service, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ligia Camera Pierrotti
- Department of Infectious Diseases, Hospital das Clínicas da Faculdade de Medicina da, Universidade de São Paulo, São Paulo, Brazil
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Reusing JO, Feitosa EB, Agena F, Pierrotti LC, Azevedo LSF, Kotton CN, David-Neto E. Cytomegalovirus prophylaxis in seropositive renal transplant recipients receiving thymoglobulin induction therapy: Outcome and risk factors for late CMV disease. Transpl Infect Dis 2018; 20:e12929. [PMID: 29809309 DOI: 10.1111/tid.12929] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 02/01/2018] [Revised: 03/29/2018] [Accepted: 04/04/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Anti-thymocyte globulin (ATG) therapy is a risk factor for cytomegalovirus (CMV) disease in renal transplant (RTx) recipients and therefore antiviral prophylaxis is commonly used. We evaluated the outcome of our current policy of 90 days of CMV prophylaxis in seropositive recipients given ATG and the risk factors for the occurrence of CMV disease after prophylaxis. METHODS We studied a retrospective cohort of 423 RTx (2010-2014) CMV-seropositive adults given ATG induction therapy. RESULTS 54 (13%) patients developed CMV disease at a median of 163 days after transplant, of which 29 (54%) had viral syndrome and 25 (46%) had invasive disease. Median prophylaxis time (94 days) and immunosuppressive drugs were similar between groups (CMV vs no-CMV). Those with CMV disease had more deceased donors and higher donor age, lower lymphocyte count, and lower median eGFR at day 90. Multivariable logistic regression analysis at day 90 and 180 found that eGFR ≤40 ml/min/1.73 m2 (but not acute rejection) was associated with late CMV disease. In a separate validation cohort of 124 patients with 8% late CMV disease, eGFR ≤45 and lymphocyte count ≤800 cells/mm3 at the end of prophylaxis remained predictive of late CMV disease occurrence. CONCLUSIONS These data indicate that antiviral prophylaxis adequately prevented CMV in seropositive recipients given ATG, but late disease still occurred. Low eGFR and low lymphocyte count at the end of prophylaxis may help identify patients at higher risk of CMV disease.
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Affiliation(s)
- Jose O Reusing
- Renal Transplantation Service, Hospital das Clínicas, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Emanoela B Feitosa
- Renal Transplantation Service, Hospital das Clínicas, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Fabiana Agena
- Renal Transplantation Service, Hospital das Clínicas, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Lígia C Pierrotti
- Renal Transplantation Service, Hospital das Clínicas, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Luiz S F Azevedo
- Renal Transplantation Service, Hospital das Clínicas, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Camille N Kotton
- Transplant and Immunocompromised Host Infectious Diseases, Harvard Medical School, Infectious Diseases Division, Massachusetts General Hospital, Boston, MA, USA
| | - Elias David-Neto
- Renal Transplantation Service, Hospital das Clínicas, University of Sao Paulo Medical School, São Paulo, Brazil
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de Almeida M, Medeiros E, Agena F, Oliveira C, Sawamura M, Costa S, Carmona M, de Sa Malbouisson L. Ventilator-associated events as a quality indicator in intensive care units. J Hosp Infect 2018; 99:104-105. [DOI: 10.1016/j.jhin.2018.02.010] [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] [Received: 01/10/2018] [Accepted: 02/12/2018] [Indexed: 10/18/2022]
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David-Neto E, Triboni AHK, Ramos F, Agena F, Galante NZ, Altona M, Lemos FBC, Sapienza MT, Nahas WC. Evaluation of MDRD4, CKD-EPI, BIS-1, and modified Cockcroft-Gault equations to estimate glomerular filtration rate in the elderly renal-transplanted recipients. Clin Transplant 2016; 30:1558-1563. [DOI: 10.1111/ctr.12857] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2016] [Indexed: 01/29/2023]
Affiliation(s)
- Elias David-Neto
- Renal Transplantation Service; University of Sao Paulo School of Medicine; Sao Paulo Brazil
| | | | - Fernanda Ramos
- Renal Transplantation Service; University of Sao Paulo School of Medicine; Sao Paulo Brazil
| | - Fabiana Agena
- Renal Transplantation Service; University of Sao Paulo School of Medicine; Sao Paulo Brazil
| | - Nelson Zocoler Galante
- Renal Transplantation Service; University of Sao Paulo School of Medicine; Sao Paulo Brazil
| | - Marcelo Altona
- Geriatrics Service of the Hospital das Clinicas; University of Sao Paulo School of Medicine; Sao Paulo Brazil
| | | | - Marcelo Tatit Sapienza
- Nuclear Medicine Institute; University of Sao Paulo School of Medicine; Sao Paulo Brazil
| | - William Carlos Nahas
- Renal Transplantation Service; University of Sao Paulo School of Medicine; Sao Paulo Brazil
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Canto CM, Sumita LM, Agena F, Mendoza TT, Henrique P, Silva B, Domingues Fink MC. Shedding of Polyomavirus BK and JC in Saliva of Kidney Transplant Patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2015. [DOI: 10.1016/j.oooo.2014.07.228] [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: 10/24/2022]
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de Souza PS, David-Neto E, Panajotopolous N, Agena F, Rodrigues H, Ronda C, David DR, Kalil J, Nahas WC, de Castro MCR. Dynamics of anti-human leukocyte antigen antibodies after renal transplantation and their impact on graft outcome. Clin Transplant 2014; 28:1234-43. [DOI: 10.1111/ctr.12451] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Patrícia Soares de Souza
- Renal Transplantation Service of Urology Division; Hospital das Clínicas de São Paulo; Sao Paulo University; Sao Paulo Brazil
- Nephrology Department; Hospital das Clínicas de São Paulo; Sao Paulo University; Sao Paulo Brazil
| | - Elias David-Neto
- Renal Transplantation Service of Urology Division; Hospital das Clínicas de São Paulo; Sao Paulo University; Sao Paulo Brazil
- Nephrology Department; Hospital das Clínicas de São Paulo; Sao Paulo University; Sao Paulo Brazil
| | - Nicolas Panajotopolous
- Laboratory of Immunology of Instituto do Coração (InCor); Hospital das Clínicas de São Paulo; Sao Paulo University; Sao Paulo Brazil
| | - Fabiana Agena
- Renal Transplantation Service of Urology Division; Hospital das Clínicas de São Paulo; Sao Paulo University; Sao Paulo Brazil
- Nephrology Department; Hospital das Clínicas de São Paulo; Sao Paulo University; Sao Paulo Brazil
| | - Hélcio Rodrigues
- Laboratory of Immunology of Instituto do Coração (InCor); Hospital das Clínicas de São Paulo; Sao Paulo University; Sao Paulo Brazil
| | - Carla Ronda
- Laboratory of Immunology of Instituto do Coração (InCor); Hospital das Clínicas de São Paulo; Sao Paulo University; Sao Paulo Brazil
| | - Daísa Ribeiro David
- Pathology Division; Hospital das Clínicas de São Paulo; Sao Paulo University; Sao Paulo Brazil
| | - Jorge Kalil
- Laboratory of Immunology of Instituto do Coração (InCor); Hospital das Clínicas de São Paulo; Sao Paulo University; Sao Paulo Brazil
| | - Wiliam Carlos Nahas
- Nephrology Department; Hospital das Clínicas de São Paulo; Sao Paulo University; Sao Paulo Brazil
| | - Maria Cristina Ribeiro de Castro
- Renal Transplantation Service of Urology Division; Hospital das Clínicas de São Paulo; Sao Paulo University; Sao Paulo Brazil
- Nephrology Department; Hospital das Clínicas de São Paulo; Sao Paulo University; Sao Paulo Brazil
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Azevedo L, Gerhard J, Miraglia J, Precioso A, Tavares Timenetsky M, Agena F, Gamba C, Shikanai Yasuda M, David-Neto E, Pierrotti L. Seroconversion of 2009 pandemic influenza A (H1N1) vaccination in kidney transplant patients and the influence of different risk factors. Transpl Infect Dis 2013; 15:612-8. [DOI: 10.1111/tid.12140] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 11/07/2012] [Accepted: 04/21/2013] [Indexed: 01/02/2023]
Affiliation(s)
- L.S. Azevedo
- Renal Transplantation Service; Hospital das Clínicas - University of São Paulo Medical School; São Paulo Brazil
| | - J. Gerhard
- Division of Infectious Diseases; Hospital das Clínicas - University of São Paulo Medical School; São Paulo Brazil
| | - J.L. Miraglia
- Division of Clinical Trials and Pharmacovigilance; Instituto Butantan; São Paulo Brazil
| | - A.R. Precioso
- Division of Clinical Trials and Pharmacovigilance; Instituto Butantan; São Paulo Brazil
| | | | - F. Agena
- Renal Transplantation Service; Hospital das Clínicas - University of São Paulo Medical School; São Paulo Brazil
| | - C. Gamba
- Division of Infectious Diseases; Hospital das Clínicas - University of São Paulo Medical School; São Paulo Brazil
| | - M.A. Shikanai Yasuda
- Division of Infectious Diseases; Hospital das Clínicas - University of São Paulo Medical School; São Paulo Brazil
| | - E. David-Neto
- Renal Transplantation Service; Hospital das Clínicas - University of São Paulo Medical School; São Paulo Brazil
| | - L. Pierrotti
- Division of Infectious Diseases; Hospital das Clínicas - University of São Paulo Medical School; São Paulo Brazil
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Silva HM, Takenaka MCS, Moraes-Vieira PMM, Monteiro SM, Hernandez MO, Chaara W, Six A, Agena F, Sesterheim P, Barbé-Tuana FM, Saitovitch D, Lemos F, Kalil J, Coelho V. Preserving the B-cell compartment favors operational tolerance in human renal transplantation. Mol Med 2012; 18:733-43. [PMID: 22252714 DOI: 10.2119/molmed.2011.00281] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 01/10/2012] [Indexed: 12/18/2022] Open
Abstract
Transplanted individuals in operational tolerance (OT) maintain long-term stable graft function after completely stopping immunosuppression. Understanding the mechanisms involved in OT can provide valuable information about pathways to human transplantation tolerance. Here we report that operationally tolerant individuals display quantitative and functional preservation of the B-cell compartment in renal transplantation. OT exhibited normal numbers of circulating total B cells, naive, memory and regulatory B cells (Bregs) as well as preserved B-cell receptor repertoire, similar to healthy individuals. In addition, OT also displayed conserved capacity to activate the cluster of differentiation 40 (CD40)/signal transducer and activator of transcription 3 (STAT3) signaling pathway in Bregs, in contrast, with chronic rejection. Rather than expansion or higher activation, we show that the preservation of the B-cell compartment favors OT.
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Affiliation(s)
- Hernandez M Silva
- Laboratory of Immunology, Heart Institute-InCor, University of São Paulo Medical School, São Paulo, Brazil
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Moraes-Vieira PMM, Takenaka MC, Silva HM, Monteiro SM, Agena F, Lemos F, Saitovitch D, Kalil J, Coelho V. GATA3 and a dominant regulatory gene expression profile discriminate operational tolerance in human transplantation. Clin Immunol 2012; 142:117-26. [DOI: 10.1016/j.clim.2011.08.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 07/06/2011] [Accepted: 08/30/2011] [Indexed: 10/17/2022]
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David-Neto E, Souza PS, Panajotopoulos N, Rodrigues H, Ventura CG, David DSR, Lemos FBC, Agena F, Nahas WC, Kalil JE, Castro MCR. The impact of pretransplant donor-specific antibodies on graft outcome in renal transplantation: a six-year follow-up study. Clinics (Sao Paulo) 2012; 67:355-61. [PMID: 22522761 PMCID: PMC3317258 DOI: 10.6061/clinics/2012(04)09] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 12/21/2011] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE The significance of pretransplant, donor-specific antibodies on long-term patient outcomes is a subject of debate. This study evaluated the impact and the presence or absence of donor-specific antibodies after kidney transplantation on short- and long-term graft outcomes. METHODS We analyzed the frequency and dynamics of pretransplant donor-specific antibodies following renal transplantation from a randomized trial that was conducted from 2002 to 2004 and correlated these findings with patient outcomes through 2009. Transplants were performed against a complement-dependent T- and B-negative crossmatch. Pre- and posttransplant sera were available from 94 of the 118 patients (80%). Antibodies were detected using a solid-phase (Luminex®), single-bead assay, and all tests were performed simultaneously. RESULTS Sixteen patients exhibited pretransplant donor-specific antibodies, but only 3 of these patients (19%) developed antibody-mediated rejection and 2 of them experienced early graft losses. Excluding these 2 losses, 6 of 14 patients exhibited donor-specific antibodies at the final follow-up exam, whereas 8 of these patients (57%) exhibited complete clearance of the donor-specific antibodies. Five other patients developed ''de novo'' posttransplant donor-specific antibodies. Death-censored graft survival was similar in patients with pretransplant donor-specific and non-donor-specific antibodies after a mean follow-up period of 70 months. CONCLUSION Pretransplant donor-specific antibodies with a negative complement-dependent cytotoxicity crossmatch are associated with a risk for the development of antibody-mediated rejection, although survival rates are similar when patients transpose the first months after receiving the graft. Our data also suggest that early posttransplant donor-specific antibody monitoring should increase knowledge of antibody dynamics and their impact on long-term graft outcome.
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Affiliation(s)
- Elias David-Neto
- Renal Transplantation Service, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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Agena F, da Silva GCA, Pierin AMG. [Home blood pressure monitoring: updates and the nurse's role]. Rev Esc Enferm USP 2011; 45:258-63. [PMID: 21445517 DOI: 10.1590/s0080-62342011000100036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Accepted: 07/01/2010] [Indexed: 11/22/2022] Open
Abstract
This is a review article on home blood pressure monitoring (HBPM) developed with the purpose to increase the current scientific knowledge and present the importance of this approach in the care to patients with hypertension in our setting. This technique has advantages over the causal measurement, as it provides more measurements, a better relationship with the target-organs injuries, it also quantifies the white-coat effect, has good reproducibility, good acceptability by the patients, assesses blood pressure without the influence from the observer and the environment of the appointment, reduces the number of visits to the doctor and promotes greater adherence to treatment. The importance of nursing practice in HBPM is associated with the education process, using teaching-learning strategies, implementing team-patient communication and encouraging patients towards performing self-care.
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Affiliation(s)
- Fabiana Agena
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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Agena F, Prado EDS, Souza PS, da Silva GV, Lemos FBC, Mion D, Nahas WC, David-Neto E. Home blood pressure (BP) monitoring in kidney transplant recipients is more adequate to monitor BP than office BP. Nephrol Dial Transplant 2011; 26:3745-9. [PMID: 21441398 DOI: 10.1093/ndt/gfr143] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Hypertension is highly prevalent among kidney transplantation recipients and considered as an important cardiovascular risk factor influencing patient survival and kidney graft survival. Aim. Compare the blood pressure (BP) control in kidney transplant patients through the use of home blood pressure monitoring (HBPM) is more comparable with the results of ambulatory blood pressure monitoring compared to the measurement of office blood pressure. METHODS From March 2008 to April 2009 prospectively were evaluated 183 kidney transplant recipients with time after transplantation between 1 and 10 years. Patients underwent three methods for measuring BP: office blood pressure measurement (oBP), HBPM and ambulatory blood pressure monitoring (ABPM). RESULTS In total, 183 patients were evaluated, among them 94 were men (54%) and 89 women (46%). The average age was 50 ± 11 years. The average time of transplant was 57 ± 32 months. Ninety-nine patients received grafts from deceased donors (54%) and 84 were recipients of living donors (46%). When assessed using oBP, 56.3% presented with uncontrolled and 43.7% with adequate control of BP with an average of 138.9/82.3 ± 17.8/12.1 mmHg. However, when measured by HBPM, 55.2% of subjects were controlled and 44.8% presented with uncontrolled BP with an average of 131.1/78.5 ± 17.4/8.9 mmHg. Using the ABPM, we observed that 63.9% of subjects were controlled and 36.1% of patients presented uncontrolled BP with an average 128.8/80.5 ± 12.5/8.1 mmHg. We found that the two methods (oBP and HBPM) have a significant agreement, but the HBPM has a higher agreement that oBP, confirmed P = 0.026. We found that there is no symmetry in the data for both methods with McNemar test. The correlation index of Pearson linear methods for the ABPM with the other two methods were 0.494 for office measurement and 0.768 for HBPM, best value of HBPM with ABPM. Comparing the errors of the two methods by paired t-test, we obtained the descriptive level of 0.837. Looking at the receiver operating characteristic curve for BP measurements in each method, we observed that oBP is lower than those obtained by HBPM in relation to ABPM. CONCLUSION We conclude that the results obtained with HBPM were closer to the ABPM results than those obtained with BP obtained at oBP, being more sensitive to detect poor control of hypertension in renal transplant recipients.
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Affiliation(s)
- Fabiana Agena
- Nephrology Division, Renal Transplantation Service, University of Sao Paulo School of Medicine.
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Medeiros FSR, Sapienza MT, Prado ES, Agena F, Shimizu MHM, Lemos FBC, Buchpiguel CA, Ianhez LE, David-Neto E. Validation of plasma clearance of 51Cr-EDTA in adult renal transplant recipients: comparison with inulin renal clearance. Transpl Int 2008; 22:323-31. [PMID: 19055616 DOI: 10.1111/j.1432-2277.2008.00799.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Plasma clearance of (51)Cr-EDTA ((51)Cr-EDTA-Cl) is an alternative method to evaluate glomerular filtration rate (GFR). This study aimed to investigate the concordance between (51)Cr-EDTA-Cl and renal inulin clearance (In-Cl) in renal transplant recipients as well to determine the repeatability of (51)Cr-EDTA-Cl in kidney donors. Forty four kidney recipients and 22 kidney donors were enrolled. Simultaneous measurements of (51)Cr-EDTA-Cl and In-Cl were performed. A single dose of 3.7MBq of (51)Cr-EDTA was injected and the plasma disappearance curve was created by taking blood samples at 2, 4, 6 and 8 h after injection. Bland and Altman statistical approach was used to quantify the agreement between In-Cl and (51)Cr-EDTA-Cl and to determine the better concordance between all possibilities of measure for the (51)Cr-EDTA-Cl. The mean of In-Cl was 44.5 +/- 17.9 ml/min/1.73 m(2). There was a positive correlation between In-Cl and all possible measurements of (51)Cr-EDTA-Cl. (51)Cr-EDTA-Cl with two samples taken at 4 and 8 h or at 4 and 6 h presenting the narrow limits of agreement and a difference (bias) of 2.8 and 2.7 ml/min, respectively. Two plasma sampling for (51)Cr-EDTA-Cl was a reliable method to measure GFR compared with In-Cl and comprises a suitable method to be used in kidney transplanted patients.
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David-Neto E, Lemos FC, Fadel LM, Agena F, Sato MY, Coccuza C, Pereira LM, de Castro MCR, Lando VS, Nahas WC, Ianhez LE. The dynamics of glucose metabolism under calcineurin inhibitors in the first year after renal transplantation in nonobese patients. Transplantation 2007; 84:50-5. [PMID: 17627237 DOI: 10.1097/01.tp.0000267647.03550.22] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [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: 01/14/2023]
Abstract
BACKGROUND The incidence of glucose metabolism disturbances after transplantation often is based on the use of hypoglycemic agents and not on the results of glucose tolerance tests (GTTs), which may camouflage the real incidence. A lack of information also exists regarding the profile of glucose metabolism during the first year after transplant. METHODS Oral GTT along with insulin measurements and drugs pharmacokinetics were prospectively performed at days 30, 60, 180, and 360 after transplant to diagnose disturbances of glucose metabolism after renal transplantation, in nonobese patients receiving either tacrolimus (n=55) or cyclosporine (n=29), along with mycophenolate mofetil and steroids. RESULTS The incidence of impaired glucose tolerance or diabetes mellitus reached a peak at 60 days and decreased at 1 year. It could not be adequately diagnosed using fasting plasma glucose in a decreased abnormal (>99 ng/mL) range. In both groups, insulin secretion, evaluated by the Homeostasis Model Assesment (HoMA-beta), decreased (P<0.005) from the condition of normal GTT (101+/-56%) to impaired glucose tolerance (72+/-35%) and diabetes mellitus (54+/-25%). In the cyclosporine group, insulin secretion was normal and stable throughout the study period, but in the tacrolimus group, insulin secretion recovered over time and was inversely correlated with tacrolimus exposure. Insulin resistance (HoMA-IR) did not change. CONCLUSIONS This study shows the need to perform an oral GTT at 60 days and at the end of the first year of renal transplantation to adequately diagnose impaired glucose metabolism.
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Affiliation(s)
- Elias David-Neto
- Renal Transplantation Unit, Hospital das Clinicas, University of São Paulo School of Medicine, São Paulo, Brazil.
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