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Martin-Martin C, Suarez-Alvarez B, González M, Torres IB, Bestard O, Martín JE, Barceló-Coblijn G, Moreso F, Aransay AM, Lopez-Larrea C, Rodriguez RM. Exploring kidney allograft rejection: A proof-of-concept study using spatial transcriptomics. Am J Transplant 2024:S1600-6135(24)00287-9. [PMID: 38692412 DOI: 10.1016/j.ajt.2024.04.015] [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: 11/06/2023] [Revised: 04/25/2024] [Accepted: 04/25/2024] [Indexed: 05/03/2024]
Abstract
In this proof-of-concept study, spatial transcriptomics combined with public single-cell RNA-sequencing data were used to explore the potential of this technology to study kidney allograft rejection. We aimed to map gene expression patterns within diverse pathological states by examining biopsies classified across non-rejection, T cell-mediated acute rejection, and interstitial fibrosis and tubular atrophy (IFTA). Our results revealed distinct immune cell signatures, including those of T and B lymphocytes, monocytes, mast cells, and plasma cells, and their spatial organization within the renal interstitium. We also mapped chemokine receptors and ligands to study immune-cell migration and recruitment. Finally, our analysis demonstrated differential spatial enrichment of transcription signatures associated with kidney allograft rejection across various biopsy regions. Interstitium regions displayed higher enrichment scores for rejection-associated gene expression patterns than did tubular areas, which had negative scores. This implies that these signatures are primarily driven by processes unfolding in the renal interstitium. Overall, this study highlights the value of spatial transcriptomics for revealing cellular heterogeneity and immune signatures in renal transplant biopsies, and demonstrates its potential for studying the molecular and cellular mechanisms associated with rejection. However, certain limitations must be borne in mind regarding the development and future applications of this technology.
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Affiliation(s)
- Cristina Martin-Martin
- Translational Immunology, Health Research Institute of the Principality of Asturias (ISPA), Avenida de Roma S/N, 33011, Oviedo, Asturias, Spain; RICORS2040, Madrid, Spain
| | - Beatriz Suarez-Alvarez
- Translational Immunology, Health Research Institute of the Principality of Asturias (ISPA), Avenida de Roma S/N, 33011, Oviedo, Asturias, Spain; RICORS2040, Madrid, Spain
| | - Monika González
- CIC bioGUNE, Basque Research and Technology Alliance (BRTA), Bizkaia Technology Park, 801 bld., 48160, Derio, Bizkaia, Spain
| | - Irina B Torres
- Department of Nephrology, Hospital Universitari Vall d'Hebron, Nephrology and Renal Transplant Laboratory. Vall Hebron Research Institute (VHIR). Department of Medicine. Autonomous University of Barcelona. Barcelona, Spain
| | - Oriol Bestard
- Department of Nephrology, Hospital Universitari Vall d'Hebron, Nephrology and Renal Transplant Laboratory. Vall Hebron Research Institute (VHIR). Department of Medicine. Autonomous University of Barcelona. Barcelona, Spain
| | - José E Martín
- CIC bioGUNE, Basque Research and Technology Alliance (BRTA), Bizkaia Technology Park, 801 bld., 48160, Derio, Bizkaia, Spain
| | - Gwendolyn Barceló-Coblijn
- Lipids in Human Pathology, Institut d'Investigació Sanitària Illes Balears (IdISBa), Ctra. Valldemossa 79, E-07120 Palma, Balearic Islands, Spain; Research Unit, University Hospital Son Espases, Ctra. Valldemossa79, E-07120 Palma, Balearic Islands, Spain
| | - Francesc Moreso
- Department of Nephrology, Hospital Universitari Vall d'Hebron, Nephrology and Renal Transplant Laboratory. Vall Hebron Research Institute (VHIR). Department of Medicine. Autonomous University of Barcelona. Barcelona, Spain
| | - Ana M Aransay
- CIC bioGUNE, Basque Research and Technology Alliance (BRTA), Bizkaia Technology Park, 801 bld., 48160, Derio, Bizkaia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Carlos Lopez-Larrea
- Translational Immunology, Health Research Institute of the Principality of Asturias (ISPA), Avenida de Roma S/N, 33011, Oviedo, Asturias, Spain; RICORS2040, Madrid, Spain; Department of Immunology, Hospital Universitario Central de Asturias, 33011, Oviedo, Spain.
| | - Ramon M Rodriguez
- Lipids in Human Pathology, Institut d'Investigació Sanitària Illes Balears (IdISBa), Ctra. Valldemossa 79, E-07120 Palma, Balearic Islands, Spain; Research Unit, University Hospital Son Espases, Ctra. Valldemossa79, E-07120 Palma, Balearic Islands, Spain
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2
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Donadeu L, Jouve T, Bin S, Hartzell S, Crespo E, Torija A, Jarque M, Kevella D, Zúñiga J, Zhang W, Sun Z, Verlato A, Martínez-Gallo M, Font-Miñarro C, Meneghini M, Toapanta N, Torres IB, Sellarés J, Perelló M, Kaminski H, Couzi L, Loupy A, La Manna G, Moreso F, Cravedi P, Bestard O. High-dimensional Mass Cytometry identified circulating Natural Killer T-cell subsets associated with protection from Cytomegalovirus infection in kidney transplant recipients. Kidney Int 2024:S0085-2538(24)00310-7. [PMID: 38685562 DOI: 10.1016/j.kint.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/08/2024] [Accepted: 03/12/2024] [Indexed: 05/02/2024]
Abstract
Cytomegalovirus (CMV) infection is associated with poor kidney transplant outcomes. While innate and adaptive immune cells have been implicated in its prevention, an in-depth characterization of the in vivo kinetics of multiple cell subsets and their role in protecting against CMV infection has not been achieved. Here, we performed high-dimensional immune phenotyping by mass cytometry, and functional assays, on 112 serially collected samples from CMV seropositive kidney transplant recipients. Advanced unsupervised deep learning analysis was used to assess immune cell populations that significantly correlated with prevention against CMV infection and anti-viral immune function. Prior to infection, kidney transplant recipients who developed CMV infection showed significantly lower CMV-specific cell-mediated immune (CMI) frequencies than those that did not. A broad diversity of circulating cell subsets within innate and adaptive immune compartments were associated with CMV infection or protective CMV-specific CMI. While percentages of CMV (tetramer-stained)-specific T cells associated with high CMI responses and clinical protection, circulating CD3+CD8midCD56+ NK-T cells overall strongly associated with low CMI and subsequent infection. However, three NK-T cell subsets sharing the CD11b surface marker associated with CMV protection and correlated with strong anti-viral CMI frequencies in vitro. These data were validated in two external independent cohorts of kidney transplant recipients. Thus, we newly describe the kinetics of a novel NK-T cell subset that may have a protective role in post-transplantation CMV infection. Our findings pave the way to more mechanistic studies aimed at understanding the function of these cells in protection against CMV infection.
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Affiliation(s)
- Laura Donadeu
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Thomas Jouve
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Univ. Grenoble Alpes, CHU Grenoble Alpes, Inserm 1209, CNRS 5309, IAB, Grenoble
| | - Sofia Bin
- Translational Transplant Research Center (TTRC), Icahn School of Medicine at Mount Sinai, New York, USA; Nephrology, Dialysis and Renal Transplant Unit, IRCCS - Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Susan Hartzell
- Translational Transplant Research Center (TTRC), Icahn School of Medicine at Mount Sinai, New York, USA
| | - Elena Crespo
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alba Torija
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Jarque
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Delphine Kevella
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Zúñiga
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Kidney Transplant Unit, Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Weijia Zhang
- Translational Transplant Research Center (TTRC), Icahn School of Medicine at Mount Sinai, New York, USA
| | - Zeguo Sun
- Translational Transplant Research Center (TTRC), Icahn School of Medicine at Mount Sinai, New York, USA
| | - Alberto Verlato
- Translational Transplant Research Center (TTRC), Icahn School of Medicine at Mount Sinai, New York, USA
| | - Mónica Martínez-Gallo
- Immunology department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Font-Miñarro
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Meneghini
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Kidney Transplant Unit, Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nestor Toapanta
- Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Kidney Transplant Unit, Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Irina B Torres
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Kidney Transplant Unit, Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joana Sellarés
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Kidney Transplant Unit, Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manel Perelló
- Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Kidney Transplant Unit, Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Hannah Kaminski
- Department of Nephrology, Transplantation, Dialysis and Apheresis, CHU Bordeaux, Bordeaux, France; UMR 5164-ImmunoConcEpT, University of Bordeaux, CNRS, Bordeaux University, Bordeaux, France
| | - Lionel Couzi
- Department of Nephrology, Transplantation, Dialysis and Apheresis, CHU Bordeaux, Bordeaux, France; UMR 5164-ImmunoConcEpT, University of Bordeaux, CNRS, Bordeaux University, Bordeaux, France
| | - Alexandre Loupy
- Paris Translational Research Center for Organ Transplantation, Institut National de la Santé et de la Recherche Médicale UMR-S970, Université de Paris, Paris, France
| | - Gaetano La Manna
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS - Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesc Moreso
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Kidney Transplant Unit, Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Paolo Cravedi
- Translational Transplant Research Center (TTRC), Icahn School of Medicine at Mount Sinai, New York, USA.
| | - Oriol Bestard
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Kidney Transplant Unit, Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Bestard O, Moreso F, Dorling A. Prime Time for HLA Desensitization: Imlifidase in the Spotlight. Transpl Int 2023; 36:11616. [PMID: 37456683 PMCID: PMC10348404 DOI: 10.3389/ti.2023.11616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 06/02/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Oriol Bestard
- Kidney Transplant Unit, Nephrology Department, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Francesc Moreso
- Kidney Transplant Unit, Nephrology Department, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Anthony Dorling
- Centre for Nephrology, Urology and Transplantation, King’s College London, London, United Kingdom
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Zawada AM, Wolf M, Rincon Bello A, Ramos-Sanchez R, Hurtado Munoz S, Ribera Tello L, Mora-Macia J, Fernández-Robres MA, Soler-Garcia J, Aguilera Jover J, Moreso F, Stuard S, Stauss-Grabo M, Winter A, Canaud B. Assessment of a serum calcification propensity test for the prediction of all-cause mortality among hemodialysis patients. BMC Nephrol 2023; 24:35. [PMID: 36792998 PMCID: PMC9933331 DOI: 10.1186/s12882-023-03069-6] [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: 08/12/2022] [Accepted: 01/20/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Vascular calcification is a major contributor to the high cardiac burden among hemodialysis patients. A novel in vitro T50-test, which determines calcification propensity of human serum, may identify patients at high risk for cardiovascular (CV) disease and mortality. We evaluated whether T50 predicts mortality and hospitalizations among an unselected cohort of hemodialysis patients. METHODS This prospective clinical study included 776 incident and prevalent hemodialysis patients from 8 dialysis centers in Spain. T50 and fetuin-A were determined at Calciscon AG, all other clinical data were retrieved from the European Clinical Database. After their baseline T50 measurement, patients were followed for two years for the occurrence of all-cause mortality, CV-related mortality, all-cause and CV-related hospitalizations. Outcome assessment was performed with proportional subdistribution hazards regression modelling. RESULTS Patients who died during follow-up had a significantly lower T50 at baseline as compared to those who survived (269.6 vs. 287.7 min, p = 0.001). A cross-validated model (mean c statistic: 0.5767) identified T50 as a linear predictor of all-cause-mortality (subdistribution hazard ratio (per min): 0.9957, 95% CI [0.9933;0.9981]). T50 remained significant after inclusion of known predictors. There was no evidence for prediction of CV-related outcomes, but for all-cause hospitalizations (mean c statistic: 0.5284). CONCLUSION T50 was identified as an independent predictor of all-cause mortality among an unselected cohort of hemodialysis patients. However, the additional predictive value of T50 added to known mortality predictors was limited. Future studies are needed to assess the predictive value of T50 for CV-related events in unselected hemodialysis patients.
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Affiliation(s)
- Adam M Zawada
- grid.415062.4Fresenius Medical Care Deutschland GmbH, Else-Kroener-Str. 1, 61352 Bad Homburg, Germany
| | - Melanie Wolf
- Fresenius Medical Care Deutschland GmbH, Else-Kroener-Str. 1, 61352, Bad Homburg, Germany.
| | | | | | | | | | | | | | | | | | - Francesc Moreso
- Fresenius Medical Care Services Cataluña, S.L, Barcelona, Spain
| | - Stefano Stuard
- grid.415062.4Fresenius Medical Care Deutschland GmbH, Else-Kroener-Str. 1, 61352 Bad Homburg, Germany
| | - Manuela Stauss-Grabo
- grid.415062.4Fresenius Medical Care Deutschland GmbH, Else-Kroener-Str. 1, 61352 Bad Homburg, Germany
| | - Anke Winter
- grid.415062.4Fresenius Medical Care Deutschland GmbH, Else-Kroener-Str. 1, 61352 Bad Homburg, Germany
| | - Bernard Canaud
- grid.415062.4Fresenius Medical Care Deutschland GmbH, Else-Kroener-Str. 1, 61352 Bad Homburg, Germany ,grid.121334.60000 0001 2097 0141School of Medicine, University of Montpellier, Montpellier, France
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5
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Lopez-Martinez M, Torres I, Bermejo S, Moreso F, Garcia-Carro C, Vergara A, Ramos N, Perello M, Gabaldon A, Azancot MA, Bolufer M, Toapanta N, Bestard O, Agraz-Pamplona I, Soler MJ. Corrigendum: Enteric Budesonide in Transplant and Native IgA Nephropathy: Real-World Clinical Practice. Transpl Int 2023; 35:11073. [PMID: 36685666 PMCID: PMC9849238 DOI: 10.3389/ti.2022.11073] [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: 11/22/2022] [Accepted: 12/07/2022] [Indexed: 01/06/2023]
Abstract
[This corrects the article DOI: 10.3389/ti.2022.10693.].
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Affiliation(s)
- Marina Lopez-Martinez
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Irina Torres
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Sheila Bermejo
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Francesc Moreso
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain,*Correspondence: Francesc Moreso, ; Maria Jose Soler,
| | - Clara Garcia-Carro
- Department of Nephrology, San Carlos Clinical University Hospital, Madrid, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), San Carlos Clinical University Hospital, Madrid, Spain
| | - Ander Vergara
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Natalia Ramos
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Manel Perello
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Alejandra Gabaldon
- Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain,Department of Pathology, Vall d’Hebron University Hospital, Barcelona, Spain
| | - M. Antonieta Azancot
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Monica Bolufer
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Nestor Toapanta
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Oriol Bestard
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Irene Agraz-Pamplona
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Maria Jose Soler
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain,*Correspondence: Francesc Moreso, ; Maria Jose Soler,
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6
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Quiroga B, Soler MJ, Ortiz A, Jarava Mantecón CJ, Gomes Pérez VO, Bordils A, Lacueva J, Marin Franco AJ, Delgado Conde P, Muñoz Ramos P, Calderón González C, Cazorla López JM, Sanchez-Rodriguez J, Sánchez Horrillo A, Monzón Vázquez TR, Leyva A, Rojas J, Gansevoort RT, de Sequera P, Rodríguez MTJ, Valverde RL, Carretero MP, Díaz MO, Tocora DG, Suárez ER, Santolaya AJS, Cobo PA, Talavan T, Calero RC, Gracia-Iguacel C, González-Parra E, Pereira M, Martin-Cleary C, Ramos-Verde A, Giorgi M, Sánchez C, Giraldo YG, Horrillo AS, Suárez PR, Perpén AF, Ramos AF, Villanueva LS, Cortiñas A, Arias PAD, Cárdenas AC, de Santos A, Núñez A, Cuadrado GB, de Gante LM, Repollet R, Polo CR, Moreso F, Azancot MA, Ramos N, Toapanta OBN, Cidraque I, Bermejo S, Agraz I, Prat O, Medina C, Pardo E, Prat O, Saiz A, Vila MAM, Guldris SC, Granados NM, Cabo MJC, Alarcón WL, Sánchez SP, Alexandru S, Suarez LGP, Saico SP, Tapia MP, Zamora R, Hernández RS, Osorio LR, García-Fernández N, Moreno PLM, González NA, Ortiz AS, Iñarrea MNB, Cabrera SS, López RO, Peregrí CM, Morales MLA, Cabello MDN, Mazuecos A, García T, Narváez C, Orellana C, Márquez MGS, Novillo CL, Ganga PLQ, Carrión FV, Herrera ALG, Castro NB, Cendrero RMRC, Hidalgo-Barquero MVM, Gallego RH, Alvarez Á, Leo EV, León JLP, García MAM, Jiménez BG, Pérez VOG, de Dios Ramiro Moya J, Espinosa DL, Herrador AJ, Zurita MN, Álvarez LD, Martínez ÁG, Arroyo SB, Fernández RR, Vargas MJS, Casero RC, Useche G, García AB, Díaz ABM, de Miguel CS, Palacios Á, Henningsmeyer B, Calve EO, Moya JL, Sato Y, Marín MS, Tejedor S, Vaquera SM, di Riso MC, Torres I, Alfaro G, Halauko O, Rifai FEL, Martínez AD, Ávila PJ, Sánchez CA, Sainz MS, Martín JMB, del Río García L, Canga JLP, Ochoa PMV, Pacios LM, Machado LL, Morales AQ, Cavalotti IM, Zorita IN, López SO, González SO, Montañez CS, Rubio AB, Del Peso Gilsanz G, Gonzalez MO, Villanueva RS, Oliva MOL, Varela JC, Enríquez AG, Casas CC, Alonso PO, Tabares LG, Barreiro JML, Solla LP, Gándara A, de la Garza WN, Fleming FF, Goyanes MGR, Feijoo CC, Plaza MMM, Juan CB, de la Fuente GDA, del Valle KP, Contreras FJP, Lara NB, Ferri DG, de Bustillo Llorente EM, Rodríguez EG, De La Manzanara Perez VL, Arevalo MC, Calvo JAH, Carratalá MRL, Rodríguez LMM, Salazar MS, Prieto BB, Pérez JMP, Paraíso AG, Huarte E, Lanau M, Campos RA, Ubé JM, Godoy IB, Aguilera ET, Alea RT, Del Rosario Saldaña MS, Salgueira M, Aresté N, de los Ángeles Rodríguez M, Collantes R, Martínez AI, Moyano MJ, Víbora EJ, Gash SC, Martínez LR, Cervera MCA, De Tomas MTR, Prieto BA, Toyos C, Del Rio JM, Acosta AR, Zamacona AC, Martin MIJ, Ortega SB, Ruiz MIG, Rubio AH, Ledesma PG, Alvarez AG, Poch E, Cucchiari D, Monzo JB, Cabrera BE, Hernández APR, Rebollo MSG, Hernández JMR, González AY, Alonso JC, Más AM, Calvé M, Cardona MG, Balaguer VC, Pesquera JIM, de la Rosa EC, Santarelli DR, Garcia AS, Martin-Caro AC, Santamaria IM, Cervienka M, de la Pisa AMU, Monzon LS, Anachuri KA, Garcia EH, Gomez VO, Estupiñán RS, Amado FV, Borges PP, Beloso MD, Alonso FA, Felpete NP, Ameneiro AM, Mera MC, Casares BG, Larrondo SZ, Kareaga NM, del Valle AISS, García ARM, Linaza BV, del Toro Espinosa N, Perico PE, Oliva JMS, Manrique J, Castaño I, Purroi C, Gómez N, Mansilla C, Utzurrum A, de Arellano Serna MR, Perich LG, Rincón MM, De La Manzanara Perez VL, Arevalo MC, Calvo JAH, Villoria JG, De Salinas APM. Humoral response after the fourth dose of the SARS-CoV-2 vaccine in the CKD spectrum: a prespecified analysis of the SENCOVAC study. Nephrol Dial Transplant 2022; 38:969-981. [PMID: 36423334 DOI: 10.1093/ndt/gfac307] [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: 09/03/2022] [Indexed: 11/27/2022] Open
Abstract
Abstract
Background
There is scarce evidence on fourth doses of SARS-CoV-2 vaccines in chronic kidney disease (CKD) patients. We have evaluated the humoral response and effectivity of the fourth dose in the CKD spectrum: non-dialysis CKD (ND-CKD), hemodialysis (HD), peritoneal dialysis (PD) and kidney transplant (KT) recipients.
Methods
This is a prespecified analysis of the prospective, observational, multicentric SENCOVAC study. In patients with CKD who had received a complete initial vaccination and one or two boosters and had anti-Spike antibody determinations 6 and 12 months after the initial vaccination, we analyzed factors associated to persistent negative humoral response and to higher anti-Spike antibody titers as well as the efficacy of vaccination on COVID-19 severity.
Results
Of 2186 patients (18% KT, 8% PD, 69% HD and 5% ND-CKD), 30% had received a fourth dose. The fourth dose increased anti-Spike antibody titers in HD (P = 0.001) and ND-CKD (P = 0.014) patients and seroconverted 72% of previously negative patients. Higher anti-Spike antibody titers at 12 months were independently associated to repeated exposure to antigen (fourth dose, previous breakthrough infections), previous anti-Spike antibody titers and not being a KT. Breakthrough COVID-19 was registered in 137 (6%) patients, of whom 5% required admission. Admitted patients had prior titers below 620 UI/ml and median values were lower (P = 0.020) than in non-admitted patients.
Conclusions
A fourth vaccine dose increased anti-Spike antibody titers or seroconverted many CKD patients, but those with the highest need for a vaccine booster (i.e. those with lower pre-booster antibody titers or KT recipients) derived the least benefit in terms of antibody titers. Admission for breakthrough COVID-19 was associated with low anti-Spike antibody titers.
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Affiliation(s)
- Borja Quiroga
- IIS-La Princesa. Nephrology Department, Hospital Universitario de la Princesa , Madrid ( Spain )
| | - María José Soler
- Nephrology Department, Vall d'Hebrón University Hospital , 08035 Barcelona ( Spain )
- RICORS2040 (Kidney Disease )
| | - Alberto Ortiz
- RICORS2040 (Kidney Disease )
- IIS-Fundación Jiménez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Álvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III , Madrid ( Spain )
| | | | | | | | | | | | | | - Patricia Muñoz Ramos
- Nephrology Department, Hospital Universitario Infanta Leonor – Universidad Complutense de Madrid ( Spain )
| | | | | | - Jinny Sanchez-Rodriguez
- IIS-Fundación Jiménez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Álvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III , Madrid ( Spain )
| | - Ana Sánchez Horrillo
- IIS-La Princesa. Nephrology Department, Hospital Universitario de la Princesa , Madrid ( Spain )
| | | | - Alba Leyva
- R&D Department , VIRCELL SL, Granada ( Spain )
| | - José Rojas
- R&D Department , VIRCELL SL, Granada ( Spain )
| | - Ron T Gansevoort
- Dept. Internal Medicine, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Patricia de Sequera
- RICORS2040 (Kidney Disease )
- Nephrology Department, Hospital Universitario Infanta Leonor – Universidad Complutense de Madrid ( Spain )
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Hernández D, Vázquez-Sánchez T, Sola E, Lopez V, Ruiz-Esteban P, Caballero A, Salido E, Leon M, Rodriguez A, Serra N, Rodriguez C, Facundo C, Perello M, Silva I, Marrero-Miranda D, Cidraque I, Moreso F, Guirado L, Serón D, Torres A. Treatment of early borderline lesions in low immunological risk kidney transplant patients: a Spanish multicenter, randomized, controlled parallel-group study protocol: the TRAINING study. BMC Nephrol 2022; 23:357. [PMCID: PMC9639260 DOI: 10.1186/s12882-022-02989-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/24/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Background
Subclinical inflammation, including borderline lesions (BL), is very common (30–40%) after kidney transplantation (KT), even in low immunological risk patients, and can lead to interstitial fibrosis/tubular atrophy (IFTA) and worsening of renal function with graft loss. Few controlled studies have analyzed the therapeutic benefit of treating these BL on renal function and graft histology. Furthermore, these studies have only used bolus steroids, which may be insufficient to slow the progression of these lesions. Klotho, a transmembrane protein produced mainly in the kidney with antifibrotic properties, plays a crucial role in the senescence-inflammation binomial of kidney tissue. Systemic and local inflammation decrease renal tissue expression and soluble levels of α-klotho. It is therefore important to determine whether treatment of BL prevents a decrease in α-klotho levels, progression of IFTA, and loss of kidney function.
Methods
The TRAINING study will randomize 80 patients with low immunological risk who will receive their first KT. The aim of the study is to determine whether the treatment of early BL (3rd month post-KT) with polyclonal rabbit antithymocyte globulin (Grafalon®) (6 mg/kg/day) prevents or decreases the progression of IFTA and the worsening of graft function compared to conventional therapy after two years post-KT, as well as to analyze whether treatment of BL with Grafalon® can modify the expression and levels of klotho, as well as the pro-inflammatory cytokines that regulate its expression.
Discussion
This phase IV investigator-driven, randomized, placebo-controlled clinical trial will examine the efficacy and safety of Grafalon® treatment in low-immunological-risk KT patients with early BL.
Trial registration
clinicaltrials.gov: NCT04936282. Registered June 23, 2021, https://clinicaltrials.gov/ct2/show/NCT04936282?term=NCT04936282&draw=2&rank=1. Protocol Version 2 of 21 January 2022. Sponsor: Canary Isles Institute for Health Research Foundation, Canary Isles (FIISC). mgomez@fciisc.org.
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Porrini E, Montero N, Díaz JM, Lauzurrica R, Rodríguez JO, Torres IS, Moreso F, Cruzado JM, Ruiz RB, Vilaró MI, Lima MXM, Ramchand SK, Ruiz JC, Gainza de los Rios F, Alvarez CR, Guindo MDCDG, Macías M, Vela DB, Osuna A, Bayés-Genís B, Sanchez CA, Ruiz MDC, Rodríguez AER, Rollán RD, Rinne FG, Sosa AJ, Mallén PD, Rinne AG, Miranda DM, Torres A. Post-transplant diabetes mellitus and renal cell cancer after renal transplantation. Nephrol Dial Transplant 2022; 38:1552-1559. [DOI: 10.1093/ndt/gfac291] [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: 05/23/2022] [Indexed: 11/27/2022] Open
Abstract
ABSTRACT
Background
Diabetes is a risk factor for cancer in the general population. However, few data are available on the association between post-transplant diabetes mellitus (PTDM) and cancer after transplantation.
Methods
We analyzed this issue in a Spanish cohort of patients without diabetes before transplantation. PTDM was diagnosed with consensus criteria at 12 months after transplantation and 12 months before the diagnosis of cancer. The association between PTDM and cancer (overall and specific types) was evaluated with regression analysis.
Results
During a follow-up of 12 years (interquartile range 8–14), 85 cases of 603 developed cancer (829/100 000/year) and 164 (27%) PTDM. The most frequent cancers were renal cell cancer (RCC) n = 15, 146/cases/100 000/year), lung (n = 12, 117/cases/100 000/year), colon (n = 9, 88/cases/100 000/year) and prostate (n = 9, 88/cases/100 000/year). In logistic regression, PTDM was not associated with cancer. Eight of the 164 patients with PTDM (4.9%) vs 7 of the 439 without PTDM developed RCC (1.6%) (P = .027). In multivariate analysis, PTDM was independently associated with RCC [odds ratio (OR) 2.92, confidence interval (CI) 1.03–8.27], adjusting for smoking (OR 4.020, 95% CI 1.34–12.02) and other covariates. PTDM was not associated with other types of cancer.
Conclusions
Patients with PTDM must be considered a population at risk for RCC and accordingly, the subject of active surveillance.
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Affiliation(s)
- Esteban Porrini
- University of La Laguna, Faculty of Medicine, Instituto de Tecnologías Biomédicas (ITB), University of La Laguna. Tenerife , Spain
| | - Nuria Montero
- Hospital de Bellvitge, Nephrology Department , Barcelona , Spain
| | | | | | | | | | | | - Josep M Cruzado
- Hospital de Bellvitge, Nephrology Department , Barcelona , Spain
| | | | | | - Maria Xixiang Molina Lima
- University of La Laguna, Faculty of Medicine, Instituto de Tecnologías Biomédicas (ITB), University of La Laguna. Tenerife , Spain
| | - Simran Khemlani Ramchand
- University of La Laguna, Faculty of Medicine, Instituto de Tecnologías Biomédicas (ITB), University of La Laguna. Tenerife , Spain
| | - Juan Carlos Ruiz
- Nephrology Unit, Hospital Marqués de Valdecilla , Santander , Spain
| | | | | | | | - Manuel Macías
- Nephrology Unit, Hospital Nuestra Señora de la Candelaria , Tenerife , Spain
| | - David Bonet Vela
- Nephrology Unit, Hospital Germans Trias y Puyol , Badalona , Spain
| | - Antonio Osuna
- Nephrology Section, Hospital Nuestra Señora Virgen de las Nieves , Granada , Spain
| | | | | | | | | | | | | | | | | | - Ana González Rinne
- Nephrology Unit, Hospital Universitario de Canarias (HUC) , La Laguna , Spain
| | | | - Armando Torres
- University of La Laguna, Faculty of Medicine, Instituto de Tecnologías Biomédicas (ITB), University of La Laguna. Tenerife , Spain
- Nephrology Unit, Hospital Universitario de Canarias (HUC) , La Laguna , Spain
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9
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Lopez-Martinez M, Torres I, Bermejo S, Moreso F, Garcia-Carro C, Vergara A, Ramos N, Perello M, Gabaldon A, Azancot MA, Bolufer M, Toapanta N, Bestard O, Agraz-Pamplona I, Soler MJ. Enteric Budesonide in Transplant and Native IgA Nephropathy: Real-World Clinical Practice. Transpl Int 2022; 35:10693. [PMID: 36311259 PMCID: PMC9613952 DOI: 10.3389/ti.2022.10693] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/04/2022] [Indexed: 01/24/2023]
Affiliation(s)
- Marina Lopez-Martinez
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Irina Torres
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Sheila Bermejo
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Francesc Moreso
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain,*Correspondence: Francesc Moreso, ; Maria Jose Soler,
| | - Clara Garcia-Carro
- Department of Nephrology, San Carlos Clinical University Hospital, Madrid, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), San Carlos Clinical University Hospital, Madrid, Spain
| | - Ander Vergara
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Natalia Ramos
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Manel Perello
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Alejandra Gabaldon
- Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain,Department of Pathology, Vall d’Hebron University Hospital, Barcelona, Spain
| | - M. Antonieta Azancot
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Monica Bolufer
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Nestor Toapanta
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Oriol Bestard
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Irene Agraz-Pamplona
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Maria Jose Soler
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Vall d’Hebron University Hospital, Barcelona, Spain,*Correspondence: Francesc Moreso, ; Maria Jose Soler,
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Miret Alomar E, Moreso F, Toapanta N, Lorente D, Triquell M, Pont T, Pérez-Hoyos S, Serón D, Morote J, Trilla E. Surgeon preimplantation macroscopic graft appraisal improves risk stratification of deceased kidney donors: a prospective study. Minerva Urol Nephrol 2022; 74:615-624. [PMID: 33887895 DOI: 10.23736/s2724-6051.21.04345-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Preimplantation scores assist with correct kidney graft allocation, but macroscopic graft features have never been evaluated in this scenario. METHODS We designed a graft appraisal questionnaire, assessed its reproducibility by comparing the senior and junior surgeon responses and evaluated which features can predict transplant outcomes in 202 patients transplanted from 144 donors at a tertiary center. We created new prediction models in combination with validated preimplantation scores. The primary outcome was graft loss or eGFR<30 mL/min/1.73 m2 at six months and secondary outcomes were delayed graft function, early graft loss and graft function at six months. RESULTS Interrater correlation was very good for adherent perinephric fat (kappa=0.91) and acceptable for cortical surface roughness (kappa=0.51) and cortical color (kappa=0.47). Adherent perirenal fat (Odds ratio=4.77; 95% CI: 2.10-10.85) and surface roughness (OR=2.11, 95% CI: 1.25-3.58) were independent predictors of the primary outcome, improving the kidney donor risk index efficacy model (AUC 0.71 vs. 0.82, P≤0.001), while cortical color and adherent fat improved the Irish risk model for delayed graft function (AUC 0.76 vs. 0.82, P=0.03). We created nomograms to visually assess the risk of both endpoints. CONCLUSIONS Kidney graft macroscopic appraisal is reproducible between surgeons and can improve the accuracy of clinical preimplantational prediction scores.
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Affiliation(s)
- Enric Miret Alomar
- Department of Urology and Kidney Transplantation, Vall d'Hebrón Hospital, Autonomous University of Barcelona, Barcelona, Spain -
| | - Francesc Moreso
- Department of Nephrology and Kidney Transplantation, Vall d'Hebrón Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Nestor Toapanta
- Department of Nephrology and Kidney Transplantation, Vall d'Hebrón Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - David Lorente
- Department of Urology and Kidney Transplantation, Vall d'Hebrón Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Marina Triquell
- Department of Urology and Kidney Transplantation, Vall d'Hebrón Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Teresa Pont
- Transplant Coordination, Vall d'Hebrón Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Santiago Pérez-Hoyos
- Unit of Statistics and Bioinformatics, Vall d'Hebrón Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Daniel Serón
- Department of Nephrology and Kidney Transplantation, Vall d'Hebrón Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Juan Morote
- Department of Urology and Kidney Transplantation, Vall d'Hebrón Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Enrique Trilla
- Department of Urology and Kidney Transplantation, Vall d'Hebrón Hospital, Autonomous University of Barcelona, Barcelona, Spain
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11
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Chamoun B, Sánchez-Sancho P, Torres IB, Gabaldon A, Perelló M, Sellarés J, Moreso F, Serón D. Tocilizumab in the treatment of active chronic humoral rejection resistant to standard therapy. Nefrologia 2022; 42:578-584. [PMID: 36717307 DOI: 10.1016/j.nefroe.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 06/18/2023] Open
Abstract
INTRODUCTION There is no consensus on the most appropriate treatment for chronic active antibody-mediated rejection (cAMR). Recent studies suggest that treatment with tocilizumab (TCZ) may stabilize graft function, decrease the intensity of donor-specific HLA antibodies (DSAs) and reduce inflammation of microcirculation. PATIENTS AND METHODS Observational study with renal allograft recipients diagnosed with cAMR (n = 5) who had not submitted a response to traditional treatment based on the combination of plasma replacements, immunoglobulins, and rituximab. Patients were told to be treated with TCZ as compassionate use in six doses per month (8 mg/kg/month). Renal function, proteinuria, and the intensity of DSAs were monitored during follow-up. RESULTS Five patients, average age 60 ± 13 years, three male and two retrasplants (cPRA average 55%) with preformed DSAs. Treatment with TCZ was initiated within 47 ± 52 days of biopsy. In two cases treatment was discontinued after the first dose, by severe bicitopenia with cytomegalovirus viremia and by graft failure, respectively. In the three patients who completed treatment, no stability of renal function (serum creatinine from 1.73 ± 0.70 to 2.04 ± 0.52 mg/dL, e-FGR 4 6 ± 15 to 36 ± 16 mL/min), showed increased proteinuria (3.2 ± 4.0 to 6.9 ± 11.0 g/g) and the intensity of DSAs maintain stable. No changes were observed in the degree of inflammation of microcirculation (g+pt 4.2 ± 0.8 vs. 4.3 ± 1.0) or in the degree of transplant glomerulopathy (cg 1.2 ± 0.4 vs. 1.8 ± 1.0). CONCLUSIONS TCZ therapy does not appear to be effective in modifying the natural history of chronic active antibody-mediated rejection, does not improve the degree of inflammation of microcirculation and does not reduces the intensity of DSAs.
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Affiliation(s)
- Betty Chamoun
- Servicio de Nefrología, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - Pablo Sánchez-Sancho
- Servicio de Farmacia, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Irina B Torres
- Servicio de Nefrología, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - Alejandra Gabaldon
- Servicio de Patología, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Manel Perelló
- Servicio de Nefrología, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Joana Sellarés
- Servicio de Nefrología, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Francesc Moreso
- Servicio de Nefrología, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Daniel Serón
- Servicio de Nefrología, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
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12
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Chamoun B, Sánchez-Sancho P, Torres IB, Gabaldon A, Perelló M, Sellarés J, Moreso F, Serón D. Tocilizumab en el tratamiento del rechazo humoral crónico activo resistente a terapia estándar. Nefrologia 2022. [DOI: 10.1016/j.nefro.2021.06.009] [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: 10/20/2022] Open
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13
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Quiroga B, Soler MJ, Ortiz A, Mantecón CJJ, Pérez NN, Martín MS, Sato Y, Franco AJM, Zambrano DFP, Valverde RL, Diaz MO, González CC, López JMC, Pereira M, Parra EG, Horrillo AS, González CS, Toapanta N, Guldris SC, Hernández RS, Sánchez SP, Rincón MM, Garcia-Fernandez N, Castro NB, Mateo RC, Morales MAQ, Escamilla-Cabrera B, Godoy IB, Casanova BGC, Leyva A, Rojas J, Gansevoort RT, de Sequera P, Carretero MP, Tocora DG, Rodríguez MTJ, Zanón TT, Suárez ER, Santolaya AJS, Calero RC, Cobo PA, Ramos PM, Gracia-Iguacel C, Martin-Cleary C, Sánchez-Rodríguez J, Ramos-Verde A, Giraldo YG, Suárez PR, Perpén AF, Ramos AF, Villanueva LS, Cortiñas A, Arias PAD, Cárdenas AC, de Santos A, Núñez A, Cuadrado GB, Repollet R, Moreso F, Azancot MA, Ramos N, Bestard O, Cidraque I, Bermejo S, Agraz I, Prat O, Medina C, Pardo E, Saiz A, Granados NM, Cabo MJC, Alarcón WL, Alexandru S, Suarez LGP, Saico SP, Tapia MP, Osorio LR, Zamora R, Moreno PLM, González NA, Ortiz AS, Iñarrea MNB, García T, Narváez C, Orellana C, León JLP, García MAM, Jiménez BG, Moya JDDR, Espinosa DL, Herrador AJ, Zurita MN, Díaz Álvarez L, Martínez ÁG, Arroyo SB, Fernández RR, Vargas MJS, Casero RC, Useche G, de Miguel CS, Palacios Á, Henningsmeyer B, Calve EO, Moya JL, Gash SC, Martínez LR, Perez VLDLM, Arevalo MC, Calvo JAH, Salgueira M, Aresté N, Rodríguez MDLÁ, Collantes R, Martínez AI, Moyano MJ, Víbora EJ, Hernández APR, Rebollo MSG, Hernández JMR, Aguilera ET, Alea RT, Saldaña MSDR, de la Pisa AMU, Monzon LS, Anachuri KA, Garcia EH, Gomez VO, Cavalotti IM, Zorita IN, López SO, González SO, Montañez CS, Serna MRDA, Perich LG, de la Rosa EC. Anti-Spike antibodies three months after SARS-CoV-2 mRNA vaccine booster dose in patients on hemodialysis: the prospective SENCOVAC study. Clin Kidney J 2022; 15:1856-1864. [PMID: 36147708 PMCID: PMC9384616 DOI: 10.1093/ckj/sfac169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/05/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Patients on hemodialysis are at high-risk for complications derived from coronavirus disease-19 (COVID-19). The present analysis evaluated the impact of a booster vaccine dose and breakthrough severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections on humoral immunity three months after the booster dose.
Methods
This is a multicentric and prospective study assessing IgG anti-Spike antibodies 6 and 9 months after initial SARS-CoV-2 vaccination in patients on hemodialysis that had also received a booster dose before the 6-month assessment (early booster) or between the 6- and 9-month assessments (late booster). The impact of breakthrough infections, type of vaccine, time from the booster and clinical variables were assessed.
Results
A total of 711 patients (67% male, 67 [20-89] years) were included. Of which, 545 (77%) received an early booster and the rest a late booster. At 6 months, 64 (9%) patients had negative anti-Spike antibody titers (3% of early booster and 29% of late booster patients, p = 0.001). At 9 months, 91% of patients with 6-month negative response had seroconverted and there were no differences in residual prevalence of negative humoral response between early and late booster patients (0.9% vs 0.6%, p = 0.693). During follow-up, 35 patients (5%) developed breakthrough SARS-CoV-2 infection. Antibody titers at 9 months were independently associated to mRNA-1273 booster (p = 0.001), lower time from booster (p = 0.043) and past breakthrough SARS-CoV-2 infection (p<0.001).
Conclusions
In hemodialysis patients, higher titers of anti-Spike antibodies at 9 months were associated to mRNA-1273 booster, lower time from booster and past breakthrough SARS-CoV-2 infection.
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Affiliation(s)
- Borja Quiroga
- IIS-La Princesa. Nephrology Department, Hospital Universitario de la Princesa , Madrid ( Spain )
| | - María José Soler
- Nephrology Department, Vall d'Hebrón University Hospital , 08035 Barcelona ( Spain )
- RICORS2040 (Kidney Disease)
| | - Alberto Ortiz
- RICORS2040 (Kidney Disease)
- IIS-Fundación Jiménez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Álvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III , Madrid ( Spain )
| | | | | | | | | | | | | | - Rafael Lucena Valverde
- Nephrology Department, Hospital Universitario Infanta Leonor – Universidad Complutense de Madrid ( Spain )
| | - Mayra Ortega Diaz
- Nephrology Department, Hospital Universitario Infanta Leonor – Universidad Complutense de Madrid ( Spain )
| | | | | | - Mónica Pereira
- IIS-Fundación Jiménez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Álvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III , Madrid ( Spain )
| | - Emilio González Parra
- IIS-Fundación Jiménez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Álvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III , Madrid ( Spain )
| | - Ana Sánchez Horrillo
- IIS-La Princesa. Nephrology Department, Hospital Universitario de la Princesa , Madrid ( Spain )
| | - Carmen Sánchez González
- IIS-La Princesa. Nephrology Department, Hospital Universitario de la Princesa , Madrid ( Spain )
| | - Néstor Toapanta
- Nephrology Department, Vall d'Hebrón University Hospital , 08035 Barcelona ( Spain )
| | | | | | | | | | | | | | | | | | | | | | | | - Alba Leyva
- R&D Department , VIRCELL SL, Granada ( Spain )
| | - José Rojas
- R&D Department , VIRCELL SL, Granada ( Spain )
| | - Ron T Gansevoort
- Dept. Internal Medicine, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Patricia de Sequera
- RICORS2040 (Kidney Disease)
- Nephrology Department, Hospital Universitario Infanta Leonor – Universidad Complutense de Madrid ( Spain )
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Crespo E, Vidal-Alabró A, Jouve T, Fontova P, Stein M, Mocka S, Meneghini M, Sefrin A, Hruba P, Gomà M, Torija A, Donadeu L, Favà A, Cruzado JM, Melilli E, Moreso F, Viklicky O, Bemelman F, Reinke P, Grinyó J, Lloberas N, Bestard O. Tacrolimus CYP3A Single-Nucleotide Polymorphisms and Preformed T- and B-Cell Alloimmune Memory Improve Current Pretransplant Rejection-Risk Stratification in Kidney Transplantation. Front Immunol 2022; 13:869554. [PMID: 35833145 PMCID: PMC9272702 DOI: 10.3389/fimmu.2022.869554] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/23/2022] [Indexed: 11/19/2022] Open
Abstract
Achieving fast immunosuppression blood exposure after kidney transplantation is key to abrogating both preformed and de novo anti-donor humoral and cellular alloresponses. However, while tacrolimus (TAC) is the cornerstone immunosuppressant inhibiting adaptive alloimmunity, its blood exposure is directly impacted by different single-nucleotide polymorphisms (SNPs) in CYP3A TAC-metabolizing enzymes. Here, we investigated how functional TAC-CYP3A genetic variants (CYP3A4*22/CYP3A5*3) influence the main baseline clinical and immunological risk factors of biopsy-proven acute rejection (BPAR) by means of preformed donor-specific antibodies (DSAs) and donor-specific alloreactive T cells (DSTs) in a large European cohort of 447 kidney transplants receiving TAC-based immunosuppression. A total of 70 (15.7%) patients developed BPAR. Preformed DSAs and DSTs were observed in 12 (2.7%) and 227 (50.8%) patients, respectively. According to the different CYP3A4*22 and CYP3A5*3 functional allele variants, we found 4 differential new clusters impacting fasting TAC exposure after transplantation; 7 (1.6%) were classified as high metabolizers 1 (HM1), 71 (15.9%) as HM2, 324 (72.5%) as intermediate (IM), and 45 (10.1%) as poor metabolizers (PM1). HM1/2 showed significantly lower TAC trough levels and higher dose requirements than IM and PM (p < 0.001) and more frequently showed TAC underexposure (<5 ng/ml). Multivariate Cox regression analyses revealed that CYP3A HM1 and IM pharmacogenetic phenotypes (hazard ratio (HR) 12.566, 95% CI 1.99–79.36, p = 0.007, and HR 4.532, 95% CI 1.10–18.60, p = 0.036, respectively), preformed DSTs (HR 3.482, 95% CI 1.99–6.08, p < 0.001), DSAs (HR 4.421, 95% CI 1.63–11.98, p = 0.003), and delayed graft function (DGF) (HR 2.023, 95% CI 1.22–3.36, p = 0.006) independently predicted BPAR. Notably, a significant interaction between T-cell depletion and TAC underexposure was observed, showing a reduction of the BPAR risk (HR 0.264, 95% CI 0.08–0.92, p = 0.037). Such variables except for DSAs displayed a higher predictive risk for the development of T cell-mediated rejection (TCMR). Refinement of pretransplant monitoring by incorporating TAC CYP3A SNPs with preformed DSAs as well as DSTs may improve current rejection-risk stratification and help induction treatment decision-making.
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Affiliation(s)
- Elena Crespo
- Nephrology and Transplant Laboratory, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
- *Correspondence: Oriol Bestard, ; Elena Crespo,
| | - Anna Vidal-Alabró
- Experimental Nephrology and Transplantation Laboratory, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Thomas Jouve
- Nephrology and Transplant Laboratory, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
- Faculty of Health, Université Grenoble Alpes, Grenoble, France
- Institute for Advanced Biosciences, INSERM 1209, CNRS 5309, Grenoble, France
| | - Pere Fontova
- Experimental Nephrology and Transplantation Laboratory, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Maik Stein
- Berlin Center for Advanced Therapies (BeCAT), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Sonila Mocka
- Experimental Nephrology and Transplantation Laboratory, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Maria Meneghini
- Nephrology and Transplant Laboratory, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
- Kidney Transplant Unit and Nephrology Department, Vall d’Hebron Hospital, Barcelona, Spain
| | - Anett Sefrin
- Berlin Center for Advanced Therapies (BeCAT), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Petra Hruba
- Department of Nephrology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - Montserrat Gomà
- Pathology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Alba Torija
- Nephrology and Transplant Laboratory, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
| | - Laura Donadeu
- Nephrology and Transplant Laboratory, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
| | - Alex Favà
- Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Josep M. Cruzado
- Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Edoardo Melilli
- Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Francesc Moreso
- Kidney Transplant Unit and Nephrology Department, Vall d’Hebron Hospital, Barcelona, Spain
| | - Ondrej Viklicky
- Department of Nephrology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - Frederike Bemelman
- Renal Transplant Unit, Department of Internal Medicine, Amsterdam University Medical Centers, Academic Medical Center—University of Amsterdam, Amsterdam, Netherlands
| | - Petra Reinke
- Berlin Center for Advanced Therapies (BeCAT), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Josep Grinyó
- Department of Clinical Sciences, Barcelona University, Barcelona, Spain
| | - Nuria Lloberas
- Experimental Nephrology and Transplantation Laboratory, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Oriol Bestard
- Nephrology and Transplant Laboratory, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
- Kidney Transplant Unit and Nephrology Department, Vall d’Hebron Hospital, Barcelona, Spain
- *Correspondence: Oriol Bestard, ; Elena Crespo,
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Castañeda Amado Z, Toapanta N, Jimenez S, Molina Gomez M, Maruri Kareaga N, Llinás L, Villanego F, Canal C, Rodriguez M, Montero N, Vazquez-Sanchez T, Gutierrez Dalmau A, Beneyto I, Franco Esteve A, María Vicente A, Lourdes Pérez Tamajón M, Leticia Martin-Moreno P, Ramos A, Bestard O, Moreso F. MO1017: Induction Immunosuppression and Outcome in Early Kidney Transplant Recipients with Covid-19. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac088.019] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
COVID-19 in kidney transplants has a high risk of complications and mortality, especially in older recipients diagnosed during the early period after transplantation. Management of immunosuppression has been challenging during the pandemic. We investigated the impact of induction immunosuppression, either basiliximab or thymoglobulin, on the clinical evolution of kidney transplants developing COVID-19 during the early period after transplantation.
METHOD
Kidney transplant recipients with <6 months with a functioning graft diagnosed of COVID-19 from the initial pandemic outbreak (March 2020) until 31 July 2021 from different Spanish centres participating in a nationwide registry.
RESULTS
A total of 127 patients from 17 Spanish centres developed COVID-19 during the first 6 months after transplantation, 73 (57.5%) received basiliximab and 54 (42.5%) thymoglobulin. Demographics were not different between groups, but patients receiving thymoglobulin were more sensitized (cPRA of 32.7% ± 40.8% versus 5.6% ± 18.5%) and more frequently re-transplanted (30% versus 4%). Recipients older than 65 years treated with thymoglobulin showed the highest rate of acute respiratory distress syndrome [64.7% versus 37.1% for older recipients receiving thymoglobulin and basiliximab (P < .05), and 23.7% and 18.9% for young recipients receiving basiliximab and thymoglobulin (P > .05)] and the poorest survival [mortality rate of 64.7% and 42.9% for older recipients treated with thymoglobulin and basiliximab, respectively (P < .05), and 8.1% and 10.5% for young recipients treated with thymoglobulin and basiliximab (P > .05)]. Older recipients treated with thymoglobulin showed the poorest survival in the Cox's regression model adjusted for comorbidities.
CONCLUSION
Thymoglobulin should be used with caution in older recipients during the present pandemic era.
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Affiliation(s)
- Zaira Castañeda Amado
- Department of Nephrology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Nephrology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Néstor Toapanta
- Department of Nephrology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Sara Jimenez
- Department of Nephrology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Maria Molina Gomez
- Department of Nephrology, University Hospital Germans Trias I Pujol, Barcelona, Spain
| | | | | | | | - Cristina Canal
- Department of Nephrology, Fundación Puigvert, Barcelona, , Spain
| | | | | | | | | | - Isabel Beneyto
- Department of Nephrology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | | | | | | | - Ana Ramos
- Hospital Universitario Fundación Jimenez Díaz, Madrid, Spain
| | - Oriol Bestard
- Department of Nephrology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Francesc Moreso
- Department of Nephrology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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16
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Toapanta N, Jiménez S, Molina-Gómez M, Maruri-Kareaga N, Llinàs-Mallol L, Villanego F, Facundo C, Rodríguez-Ferrero M, Montero N, Vázquez-Sanchez T, Gutiérrez-Dalmau A, Beneyto I, Franco A, Vicente AH, Pérez-Tamajon ML, Martin P, Ramos-Verde AM, Castañeda Z, Bestard O, Moreso F. Induction immunosuppression and outcome in kidney transplant recipients with early COVID-19 after transplantation. Clin Kidney J 2022; 15:2039-2045. [PMCID: PMC9129170 DOI: 10.1093/ckj/sfac112] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
COVID-19 in kidney transplants has a high risk of complications and mortality, especially in older recipients diagnosed during the early period after transplantation. Management of immunosuppression has been challenging during the pandemic. We investigated the impact of induction immunosuppression, either basiliximab or thymoglobulin, on the clinical evolution of kidney transplants developing COVID-19 during the early period after transplantation. Kidney transplant recipients with less than 6 months with a functioning graft diagnosed of COVID-19 from the initial pandemic outbreak (March 2020) until July 31st, 2021 from different Spanish centers participating in a nationwide registry. A total of 127 patients from 17 Spanish centers developed COVID-19 during the first 6 months after transplantation, 73 (57.5%) received basiliximab and 54 (42.5%) thymoglobulin. Demographics were not different between groups but patients receiving thymoglobulin were more sensitized (cPRA of 32.7±40.8% vs. 5.6±18.5%) and were more frequently re-transplants (30% vs. 4%). Recipients older than 65 years treated with thymoglobulin showed the highest rate of acute respiratory distress syndrome (64.7% vs. 37.1% for older recipients receiving thymoglobulin and basiliximab [p<0.05], and 23.7% and 18.9% for young recipients receiving basiliximab and thymoglobulin [p>0.05]) and the poorest survival (mortality rate of 64.7% and 42.9% for older recipients treated with thymoglobulin and basiliximab, respectively [p<0.05], and 8.1% and 10.5% for young recipients treated with thymoglobulin and basiliximab [p>0.05]). Older recipients treated with thymoglobulin showed the poorest survival in the Cox's regression model adjusted for comorbidities. Thus, thymoglobulin should be used with caution in older recipients during the present pandemic era.
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Affiliation(s)
- Néstor Toapanta
- Kidney Transplant Unit, Nephrology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sara Jiménez
- Kidney Transplant Unit, Nephrology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - María Molina-Gómez
- Kidney Transplant Unit, Nephrology Department, Hospital Universitario Germans Trias i Pujol, Badalona, Spain
| | - Naroa Maruri-Kareaga
- Kidney Transplant Unit, Nephrology Department, Hospital Universitario de Cruces, Barakaldo, Spain
| | - Laura Llinàs-Mallol
- Kidney Transplant Unit, Nephrology Department, Hospital del Mar, Barcelona, Spain
| | - Florentino Villanego
- Kidney Transplant Unit, Nephrology Department, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Carme Facundo
- Kidney Transplant Unit, Nephrology Department, Fundació Puigvert, Barcelona, Spain
| | - Marisa Rodríguez-Ferrero
- Kidney Transplant Unit, Nephrology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Nuria Montero
- Kidney Transplant Unit, Nephrology Department, Hospital Universitari de Bellvitge, L' Hospitalet de Llobregat, Barcelona, Spain
| | - Teresa Vázquez-Sanchez
- Kidney Transplant Unit, Nephrology Department, Hospital Universitario Regional de Malaga, Spain
| | - Alex Gutiérrez-Dalmau
- Kidney Transplant Unit, Nephrology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Isabel Beneyto
- Kidney Transplant Unit, Nephrology Department, Hospital Universitario la Fe, Valencia, Spain
| | - Antonio Franco
- Kidney Transplant Unit, Nephrology Department, Hospital General Universitario de Alicante, Spain
| | - Ana Hernández Vicente
- Kidney Transplant Unit, Nephrology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Lourdes Pérez-Tamajon
- Kidney Transplant Unit, Nephrology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - Paloma Martin
- Kidney Transplant Unit, Nephrology Department, Clínica Universitaria de Navarra, Spain
| | | | - Zaira Castañeda
- Kidney Transplant Unit, Nephrology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oriol Bestard
- Kidney Transplant Unit, Nephrology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francesc Moreso
- Kidney Transplant Unit, Nephrology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
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17
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Favà A, Donadeu L, Jouve T, Gonzalez-Costello J, Lladó L, Santana C, Toapanta N, Lopez M, Pernin V, Facundo C, Cabañas NS, Thaunat O, Crespo M, Llinàs-Mallol L, Revuelta I, Sabé N, Rombauts A, Calatayud L, Ardanuy C, Esperalba J, Fernandez C, Lozano JJ, Preyer R, Strecker K, Couceiro C, García-Romero E, Cachero A, Meneghini M, Torija A, Le Quintrec M, Melilli E, Cruzado JM, Polo C, Moreso F, Crespo E, Bestard O. A comprehensive assessment of long-term SARS-CoV-2-specific adaptive immune memory in convalescent COVID-19 Solid Organ Transplant recipients. Kidney Int 2022; 101:1027-1038. [PMID: 35124011 PMCID: PMC8813192 DOI: 10.1016/j.kint.2021.12.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 11/25/2021] [Accepted: 12/09/2021] [Indexed: 01/08/2023]
Affiliation(s)
- Alexandre Favà
- Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Laura Donadeu
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Thomas Jouve
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Laura Lladó
- Liver Transplant Unit, Bellvitge University Hospital, Barcelona, Spain
| | - Carolina Santana
- Primary Care Baix Llobregat Centre, Direcció d'Atenció Primària Costa Ponent, Equip d'Atenció Primària Gavarra, Cornellà de Llobregat, Barcelona, Spain
| | - Néstor Toapanta
- Kidney Transplant Unit, Nephrology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Lopez
- Lung Transplant Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Vincent Pernin
- Kidney Transplant Unit, Hospital de Montpellier, Montpellier, France
| | - Carme Facundo
- Kidney Transplant Unit, Nephrology Department, Fundació PuigVert, Barcelona, Spain
| | - Nuria Serra Cabañas
- Kidney Transplant Unit, Nephrology Department, Fundació PuigVert, Barcelona, Spain
| | - Olivier Thaunat
- Department of Transplantation, Nephrology and Clinical Immunology, Edouard Herriot Hospital Lyon, Hospices Civils de Lyon, Lyon, France
| | - Marta Crespo
- Kidney Transplant Unit, Nephrology Department, Hospital del Mar, Barcelona, Spain
| | - Laura Llinàs-Mallol
- Kidney Transplant Unit, Nephrology Department, Hospital del Mar, Barcelona, Spain
| | - Ignacio Revuelta
- Kidney Transplant Unit, Nephrology Department, Hospital Clínic, Barcelona, Spain
| | - Nuria Sabé
- Infectious Disease Department, Bellvitge University Hospital, Barcelona, Spain
| | - Alexander Rombauts
- Infectious Disease Department, Bellvitge University Hospital, Barcelona, Spain
| | - Laura Calatayud
- Microbiology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Carmen Ardanuy
- Microbiology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Juliana Esperalba
- Microbiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Candela Fernandez
- Microbiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan J Lozano
- Bioinformatics Platform, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Catalonia, Spain
| | | | | | - Carlos Couceiro
- Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona, Spain
| | | | - Alba Cachero
- Liver Transplant Unit, Bellvitge University Hospital, Barcelona, Spain
| | - Maria Meneghini
- Kidney Transplant Unit, Nephrology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alba Torija
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Edoardo Melilli
- Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Josep Maria Cruzado
- Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Carolina Polo
- Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Francesc Moreso
- Kidney Transplant Unit, Nephrology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Crespo
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oriol Bestard
- Kidney Transplant Unit, Nephrology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Bestard O, Jouve T, Castells L, Lopez M, Muñoz M, Crespo E, Toapanta N, Esperalba J, Campos‐Varela I, Pont T, Len O, Campins M, Moreso F. Reconciling short-term clinical and immunological outcomes of SARS-CoV-2 vaccination in solid organ transplant recipients. Am J Transplant 2022; 22:673-675. [PMID: 34554648 PMCID: PMC8653131 DOI: 10.1111/ajt.16855] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/07/2021] [Accepted: 09/16/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Oriol Bestard
- Kidney Transplant UnitNephrology DepartmentVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de BarcelonaBarcelonaSpain,Laboratory of Nephrology and TransplantationVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Thomas Jouve
- Laboratory of Nephrology and TransplantationVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Lluís Castells
- Liver UnitVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)Instituto de Salud Carlos IIIMadridSpain
| | - Manuel Lopez
- Lung Transplant UnitVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Marina Muñoz
- Pediatric Transplant DepartmentVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Elena Crespo
- Laboratory of Nephrology and TransplantationVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Nestor Toapanta
- Kidney Transplant UnitNephrology DepartmentVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - Juliana Esperalba
- Microbiology DepartmentVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Isabel Campos‐Varela
- Liver UnitVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)Instituto de Salud Carlos IIIMadridSpain
| | - Teresa Pont
- Transplant Coordination DepartmentVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Oscar Len
- Infectious Disease DepartmentVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Magda Campins
- Deparment of Preventive Medicine and EpidemiologyVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Francesc Moreso
- Kidney Transplant UnitNephrology DepartmentVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de BarcelonaBarcelonaSpain,Laboratory of Nephrology and TransplantationVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
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19
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Quiroga B, Soler MJ, Ortiz A, Bernat A, Díaz ABM, Mantecón CJJ, Pérez VOG, González CC, Cervienka M, Mazuecos A, Cazorla JM, Riso MCD, Martínez S, Diaz MO, Valverde RL, Márquez MGS, Novillo CL, Parra EG, Gracia-Iguacel C, De Tomas MTR, Cervera MCA, Giorgi M, Ramos PM, Carmona NM, Toapanta N, Guldris SC, Millán JCRS, Estupiñán RS, Crespo M, Linaza BV, Martín MIJ, Jiménez LRO, Soriano S, Ferri DG, Sánchez MSP, Yugueros A, Leyva A, Rojas J, Gansevoort RT, de Sequera P, Carretero MP, Tocora DG, Rodríguez MJ, Zanón TT, Suárez ER, Santolaya AJS, Calero RC, Cobo PA, Martin-Cleary C, Sánchez-Rodríguez J, Pereira M, Ramos-Verde A, Sánchez C, Giraldo YG, Horrillo AS, Suárez PR, Perpén AF, Ramos AF, Villanueva LS, Cortiñas A, Arias PAD, Cárdenas AC, de Santos A, Núñez A, Cuadrado GB, Repollet R, Moreso F, Azancot MA, Ramos N, Bestard O, Cidraque I, Bermejo S, Agraz I, Prat O, Medina C, Pardo E, Saiz A, Vila MAM, Granados NM, Cabo MJC, Alarcón WL, Alexandru S, Suarez LGP, Saico SP, Tapia MP, Hernández RS, García-Fernández N, Moreno PLM, González NA, Ortiz AS, Iñarrea MNB, López RO, Peregrí CM, Morales MLA, Cabello MDN, Ribera AMT, Valcarce EG, Vergara EG, García T, Narváez C, Orellana C, Ganga PLQ, Carrión FV, Herrera ALG, Chamoun B, Barbosa F, Faura A, Pachón DR, Castro NB, Cendrero RMRC, Hidalgo-Barquero MVM, Gallego RH, Alvarez Á, Leo EV, León JLP, García MAM, Jiménez BG, Moya JDDR, Espinosa DL, Herrador AJ, Zurita MN, Álvarez LD, Martínez ÁG, Arroyo SB, Fernández RR, Vargas MJS, Casero RC, Useche G, de Miguel CS, Palacios Á, Henningsmeyer B, Calve EO, Moya JL, Sato Y, Marín MS, Torres I, Conde PD, Alfaro G, Halauko O, Rifai FEL, Martínez AD, Ávila PJ, Franco AM, Sainz MS, Martín JMB, García LDR, Canga JLP, Ochoa PMV, Pacios LM, Machado LL, Morales AQ, Cavalotti IM, Zorita IN, López SO, González SO, Montañez CS, Rubio AB, Gilsanz GDP, Gonzalez MO, Villanueva RS, Oliva MOL, Varela JC, Enríquez AG, Casas CC, Alonso PO, Tabares LG, Barreiro JML, Solla LP, Gándara A, de la Garza WN, Fleming FF, Goyanes MGR, Feijoo CC, Plaza MMM, Juan CB, Cecilio RVS, Haces CP, Kislikova M, Rodrigo E, Contreras FJP, Lara NB, Llorente EMDB, Díaz LS, Bustamante AMC, Ruiz JM, Rodríguez EG, Perez VLDLM, Arevalo MC, Calvo JAH, Carratalá MRL, Rodríguez LMM, Salazar MS, Prieto BB, Pérez JMP, Rueda DA, Ferrero MLR, Martínez AV, Estébanez SA, Paraíso AG, Huarte E, Lanau M, Campos RA, Ubé JM, Pérez PS, Godoy IB, Aguilera ET, Alea RT, Saldaña MSDR, Salvetti ML, Valmajor MC, Sánchez MP, Barragán ML, Aunatell LR, Salgueira M, Aresté N, de Los Ángeles Rodríguez M, Collantes R, Martínez AI, Moyano MJ, Víbora EJ, Gash SC, Martínez LR, Prieto BA, Toyos C, Rio JM, Acosta AR, Zamacona AC, Ortega SB, Ruiz MIG, Rubio AH, Ledesma PG, Alvarez AG, de Briñas EPL, Cucchiari D, Monzo JB, Cabrera BE, Hernández APR, Rebollo MSG, Hernández JMR, Alonso JC, Más AM, Calvé M, Cardona MG, Balaguer VC, Pesquera JIM, Serrano AG, Simó PT, Mancilla HDR, Gómez MP, Gumpert JV, de la Fuente GDA, Del Valle KP, de la Rosa EC, Santarelli DR, Garcia AS, Martin-Caro AC, Santamaria IM, Umpierrez AM, Ruiz EH, Corbella AM, Perdomo KT, Martín YM, de la Pisa AMU, Monzon LS, Anachuri KA, Garcia EH, Gomez VO, Amado FV, Borges PP, Vázquez RM, Beloso MD, Alonso FA, Felpete NP, Ameneiro AM, Mera MC, Casares BG, Larrondo SZ, Kareaga NM, Del Valle AISS, García ARM, Del Toro Espinosa N, Perico PE, Oliva JMS, Manrique J, Castaño I, Purroi C, Gómez N, Mansilla C, Utzurrum A. Loss of humoral response 3 months after SARS-CoV-2 vaccination in the CKD spectrum: the multicentric SENCOVAC study. Nephrol Dial Transplant 2022; 37:994-999. [PMID: 35022757 PMCID: PMC9383183 DOI: 10.1093/ndt/gfac007] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Borja Quiroga
- Nephrology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - María José Soler
- Nephrology Department, Vall d'Hebrón University Hospital, Barcelona, Spain.,RICORS2040 (Kidney Disease)
| | - Alberto Ortiz
- RICORS2040 (Kidney Disease).,IIS-Fundación Jimenez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Alvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | - Mayra Ortega Diaz
- Nephrology Department, Hospital Universitario Infanta Leonor - Universidad Complutense de Madrid, Spain
| | - Rafael Lucena Valverde
- Nephrology Department, Hospital Universitario Infanta Leonor - Universidad Complutense de Madrid, Spain
| | | | | | - Emilio González Parra
- IIS-Fundación Jimenez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Alvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | - Carolina Gracia-Iguacel
- IIS-Fundación Jimenez Diaz, School of Medicine, Universidad Autónoma de Madrid, Fundación Renal Iñigo Alvarez de Toledo-IRSIN, REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | | | | | - Martín Giorgi
- Nephrology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | | | | | - Néstor Toapanta
- Nephrology Department, Vall d'Hebrón University Hospital, Barcelona, Spain
| | | | | | - Raquel Santana Estupiñán
- Nephrology Department, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Marta Crespo
- Nephrology Department, Hospital del Mar, Barcelona, Spain
| | | | | | | | | | | | | | - Alejandra Yugueros
- Nephrology Department, Hospital Lluis Alcanyis De Xátiva, Valencia, Spain
| | - Alba Leyva
- R&D Department, VIRCELL SL, Granada, Spain
| | - José Rojas
- R&D Department, VIRCELL SL, Granada, Spain
| | - Ron T Gansevoort
- Dept. Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Patricia de Sequera
- RICORS2040 (Kidney Disease).,Nephrology Department, Hospital Universitario Infanta Leonor - Universidad Complutense de Madrid, Spain
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20
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de la Oliva Valentín M, Hernández D, Crespo M, Mahillo B, Beneyto I, Martínez I, Kanter J, Calderari E, Gil-Vernet S, Sánchez S, Agüera ML, Bernal G, de Santiago C, Díaz-Corte C, Díaz C, Espinosa L, Facundo C, Fernández-Lucas M, Ferreiro T, García-Erauzkin G, García-Alvarez T, Fraile P, González-Rinne A, González-Soriano MJ, González E, Gutiérrez-Dalmau A, Jiménez C, Lauzurica R, Lorenzo I, Martín-Moreno PL, Moreso F, de Gracia MC, Pérez-Flores I, Ramos-Verde A, Revuelta I, Rodríguez-Ferrero ML, Ruiz JC, Sánchez-Sobrino B, Domínguez-Gil B. Live donor kidney transplantation. Situation analysis and roadmap. Nefrologia 2022; 42:85-93. [PMID: 36153903 DOI: 10.1016/j.nefroe.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/17/2021] [Indexed: 06/16/2023] Open
Abstract
Living donor kidney transplantation (LDKT) is the best treatment option for end stage renal disease in terms of both patient and graft survival. However, figures on LDKT in Spain that had been continuously growing from 2005 to 2014, have experienced a continuous decrease in the last five years. One possible explanation for this decrease is that the significant increase in the number of deceased donors in Spain during the last years, both brain death and controlled circulatory death donors, might have generated the false idea that we have coped with the transplant needs. Moreover, a greater number of deceased donor kidney transplants have caused a heavy workload for the transplant teams. Furthermore, the transplant teams could have moved on to a more conservative approach to the information and assessment of patients and families considering the potential long-term risks for donors in recent papers. However, there is a significant variability in the LDKT rate among transplant centers and regions in Spain independent of their deceased donor rates. This fact and the fact that LDKT is usually a preemptive option for patients with advanced chronic renal failure, as time on dialysis is a negative independent factor for transplant outcomes, lead us to conclude that the decrease in LDKT depends on other factors. Thus, in the kidney transplant annual meeting held at ONT site in 2018, a working group was created to identify other causes for the decrease of LDKT in Spain and its relationship with the different steps of the process. The group was formed by transplant teams, a representative of the transplant group of the Spanish Society of Nephrology (SENTRA), a representative of the Spanish Society of Transplants (SET) and representatives of the Spanish National Transplant Organization (ONT). A self-evaluation survey that contains requests about the phases of the LDKT processes (information, donor work out, informed consent, surgeries, follow-up and human resources) were developed and sent to 33 LDKT teams. All the centers answered the questionnaire. The analysis of the answers has resulted in the creation of a national analysis of strengths, weaknesses, opportunities, threats (SWOT) of the LDKT program in Spain and the development of recommendations targeted to improve every step of the donation process. The work performed, the conclusions and recommendations provided, have been reflected in the following report: Spanish living donor kidney transplant program assessment: recommendations for optimization. This document has also been reviewed by a panel of experts, representatives of the scientific societies (Spanish Society of Urology (AEU), Spanish Society of Nephrology Nursery (SEDEN), Spanish Society of Immunology (SEI/GETH)) and the patient association ALCER. Finally, the report has been submitted to public consultation, reaching ample consensus. In addition, the transplant competent authorities of the different regions in Spainhave adopted the report at institutional level. The work done and the recommendations to optimize LDKT are summarized in the present manuscript, organized by the different phases of the donation process.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Sara Sánchez
- Organización Nacional de Trasplantes, Madrid, Spain
| | | | | | | | | | - Cándido Díaz
- H. Clínico U. de Santiago, Santiago de Compostela, Spain
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21
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Fernandez Rivera C, Calvo Rodríguez M, Poveda JL, Pascual J, Crespo M, Gomez G, Cabello Pelegrin S, Paul J, Lauzurica R, Perez Mir M, Moreso F, Perelló M, Andres A, González E, Fernandez A, Mendiluce A, Fernández Carbajo B, Sanchez Fructuoso A, Calvo N, Suarez A, Bernal Blanco G, Osuna A, Ruiz-Fuentes MC, Melilli E, Montero Perez N, Ramos A, Fernández B, López V, Hernandez D. Bioavailability of once-daily tacrolimus formulations used in clinical practice in the management of De Novo kidney transplant recipients: the better study. Clin Transplant 2021; 36:e14550. [PMID: 34851532 PMCID: PMC9285676 DOI: 10.1111/ctr.14550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/26/2021] [Accepted: 11/13/2021] [Indexed: 12/21/2022]
Abstract
Multicenter, prospective, observational study to compare the relative bioavailability of once‐daily tacrolimus formulations in de novo kidney transplant recipients. De novo kidney transplant recipients who started a tacrolimus‐based regimen were included 14 days post‐transplant and followed up for 6 months. Data from 218 participants were evaluated: 129 in the LCPT group (Envarsus) and 89 in the PR‐Tac (Advagraf) group. Patients in the LCPT group exhibited higher relative bioavailability (Cmin /total daily dose [TDD]) vs. PR‐Tac (61% increase; P < .001) with similar Cmin and 30% lower TDD levels (P < .0001). The incidence of treatment failure was 3.9% in the LCPT group and 9.0% in the PR‐Tac group (P = .117). Study discontinuation rates were 6.2% in the LCPT group and 12.4% in the PR‐Tac group (P = .113). Adverse events, renal function and other complications were comparable between groups. The median accumulated dose of tacrolimus in the LCPT group from day 14 to month 6 was 889 mg. Compared to PR‐Tac, LCPT showed higher relative bioavailability, similar effectiveness at preventing allograft rejection, comparable effect on renal function, safety, adherence, treatment failure and premature discontinuation rates.
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Affiliation(s)
| | | | | | - Julio Pascual
- Nephrology Department, University Hospital del Mar, Barcelona, Spain
| | - Marta Crespo
- Nephrology Department, University Hospital del Mar, Barcelona, Spain
| | - Gonzalo Gomez
- Nephrology Department, University Hospital Son Espases, Palma de Mallorca, Spain
| | | | - Javier Paul
- Nephrology Department, Hospital Miguel Servet, Zaragoza, Spain
| | - Ricardo Lauzurica
- Nephrology Department, University Hospital Germans Trias y Pujol, Badalona, Spain
| | - Mònica Perez Mir
- Nephrology Department, University Hospital Germans Trias y Pujol, Badalona, Spain
| | - Francesc Moreso
- University Hospital Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Nephrology Department, Barcelona, Spain
| | - Manel Perelló
- University Hospital Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Nephrology Department, Barcelona, Spain
| | - Amado Andres
- Nephrology Department, University Hospital Doce de Octubre, Madrid, Spain
| | - Esther González
- Nephrology Department, University Hospital Doce de Octubre, Madrid, Spain
| | - Ana Fernandez
- Nephrology Department, University Hospital Ramón y Cajal, Madrid, Spain
| | - Alicia Mendiluce
- Nephrology Department, University Hospital Clínico de Valladolid, Valladolid, Spain
| | | | | | - Natividad Calvo
- Nephrology Department, University Hospital Clínico San Carlos, Madrid, Spain
| | - Alejandro Suarez
- Nephrology Department, University Hospital Virgen del Rocio, Sevilla, Spain
| | | | - Antonio Osuna
- Nephrology Department, University Hospital Virgen de las Nieves, Granada, Spain
| | | | - Edoardo Melilli
- Nephrology Department, University Hospital Bellvitge, Hospitalet de Llobregat, Spain
| | - Nuria Montero Perez
- Nephrology Department, University Hospital Bellvitge, Hospitalet de Llobregat, Spain
| | - Ana Ramos
- Nephrology Department, Fundación Jiménez Díaz, Madrid, Spain
| | | | - Verónica López
- University Hospital Regional, Málaga, IBIMA, University of Málaga, REDinREN (RED16/0009/0006), Nephrology Department, Spain
| | - Domingo Hernandez
- University Hospital Regional, Málaga, IBIMA, University of Málaga, REDinREN (RED16/0009/0006), Nephrology Department, Spain
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22
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Franco A, Moreso F, Sancho A, Esforzado N, Paul J, Llorente S, Crespo M, Guirado L, Melilli E, Roncero FG. Protocol for Optimizing the Use of Kidneys From Donors With Seropositivity for Hepatitis C Virus in Seronegative Recipients. Transplant Proc 2021; 53:2655-2658. [PMID: 34657711 DOI: 10.1016/j.transproceed.2021.09.013] [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] [Indexed: 12/27/2022]
Abstract
BACKGROUND The rapid identification of the viral load from hepatitis C virus (HCV) in seropositive donors enables the determination of their infection capacity and the subsequent design of a strategy to optimize the use of direct-action antivirals (DAA) in seronegative recipients. In 2017, we designed an optimization protocol; this study aims to assess its efficacy and safety. METHODS This is a prospective, multicenter observational study that complies with the Declarations of Helsinki and Istanbul. Donors were HCV seropositive. The HCV and human immunodeficiency virus loads were immediately determined in the donors. For viremic donors, recipients were treated with DAA for 8 weeks. For nonviremic donors, DAA was started if a viral load was detected during the follow-up period. The minimum follow-up period was 6 months posttransplant. RESULTS This study recruited 28 donors. Just over half of the donors (n = 15; 53.5%) had a nonactive history of injection drug use. Eight (22.4%) donors were viremic, and 20 (87.6%) were nonviremic; 13 (65%) had been treated previously. Nine grafts were ineligible for the protocol. We performed a total of 47 transplants. Procedure I (viremic donors) was performed in 13 recipients (27.7%). Posttransplant viremia was observed in 6 participants. Posttransplant viremia was low (<100 IU/mL) in 4 participants but high (36,000 and 138,000 IU/mL) in 2 participants who had initiated DAA after the transplant; all these patients had a sustained viral response. Seroconversion was observed in 11 of 13 (84.6%) patients. Procedure II (nonviremic donors) was undertaken in 34 (82.3%) patients. No positive viral loads were observed. Seroconversion occurred in 7 of 34 (20.5%) recipients. All recipients maintained kidney function at 6 months posttransplant, except 1 patient with a graft that had never been functional and another patient who died of pancreatitis. Both patients had received kidneys from nonviremic donors. CONCLUSIONS Our experience supports the efficacy and safety of this protocol.
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Affiliation(s)
- Antonio Franco
- Department of Nephrology, Hospital General Universitario, Alicante, Spain.
| | - Francesc Moreso
- Department of Nephrology, Hospital Valld´Hebron, Barcelona, Spain; Department of Nephrology, Hospital Doctor Peset, Valencia, Spain
| | - Asuncion Sancho
- Department of Nephrology, Hospital Doctor Peset, Valencia, Spain
| | | | - Javier Paul
- Department of Nephrology, Hospital Miguel Servet, Zaragoza, Spain
| | - Santiago Llorente
- Department of Nephrology, Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Marta Crespo
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Luis Guirado
- Department of Nephrology, Hospital Puigvert, Barcelona, Spain
| | - Eduardo Melilli
- Department of Nephrology, Hospital Belvitge, Barcelona, Spain
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23
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Montero N, Toapanta N, Pallarès N, Crespo M, Diekmann F, Guirado L, Esteban R, Codina S, Melilli E, Buxeda A, Velis G, Torres IB, Revuelta I, Molina Andujar A, Facundo C, Bardají B, Riera L, Fiol M, Cruzado JM, Comas J, Giral M, Naesens M, Åsberg A, Moreso F, Bestard O. Deciphering transplant outcomes of expanded kidney allografts donated after controlled circulatory death in the current transplant era. A call for caution. Transpl Int 2021; 34:2494-2506. [PMID: 34626501 DOI: 10.1111/tri.14131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/20/2021] [Accepted: 10/03/2021] [Indexed: 01/20/2023]
Abstract
Outcomes of kidney transplantation (KT) after controlled circulatory death (cDCD) with highly expanded criteria donors (ECD) and recipients have not been thoroughly evaluated. We analyzed in a multicenter cohort of 1161 consecutive KT, granular baseline donor and recipient factors predicting transplant outcomes, selected by bootstrapping and Cox proportional hazards, and were validated in a contemporaneous European KT cohort (n = 1585). 74.3% were DBD and 25.7% cDCD-KT. ECD-KT showed the poorest graft survival rates, irrespective of cDCD or DBD (log-rank < 0.001). Besides standard ECD classification, dialysis vintage, older age, and previous cardiovascular recipient events together with low class-II-HLA match, long cold ischemia time and combining a diabetic donor with a cDCD predicted graft loss (C-Index 0.715, 95% CI 0.675-0.755). External validation showed good prediction accuracy (C-Index 0.697, 95%CI 0.643-0.741). Recipient older age, male gender, dialysis vintage, previous cardiovascular events, and receiving a cDCD independently predicted patient death. Benefit/risk assessment of undergoing KT was compared with concurrent waitlisted candidates, and despite the fact that undergoing KT outperformed remaining waitlisted, remarkably high mortality rates were predicted if KT was undertaken under the worst risk-prediction model. Strategies to increase the donor pool, including cDCD transplants with highly expanded donor and recipient candidates, should be performed with caution.
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Affiliation(s)
- Nuria Montero
- Kidney Transplant Unit, Nephrology Department, Hospital Universitari de Bellvitge, L' Hospitalet de Llobregat, Barcelona, Spain
| | - Néstor Toapanta
- Kidney Transplant Unit, Nephrology Department, Hospital Universitari Vall Hebrón, Barcelona, Spain
| | - Natàlia Pallarès
- Biostatistics Unit, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Marta Crespo
- Kidney Transplant Unit, Nephrology Department, Hospital del Mar, Barcelona, Spain
| | - Fritz Diekmann
- Kidney Transplant Unit, Nephrology Department, Hospital Clínic Provincial, Institut d'Investigació Biomèdica August Pi i Sunyer, RedInRen, Barcelona, Spain
| | - Lluis Guirado
- Kidney Transplant Unit, Nephrology Department, Fundació Puigvert, Barcelona, Spain
| | - Rafael Esteban
- Kidney Transplant Unit, Nephrology Department, Hospital Universitari de Bellvitge, L' Hospitalet de Llobregat, Barcelona, Spain
| | - Sergi Codina
- Kidney Transplant Unit, Nephrology Department, Hospital Universitari de Bellvitge, L' Hospitalet de Llobregat, Barcelona, Spain
| | - Edoardo Melilli
- Kidney Transplant Unit, Nephrology Department, Hospital Universitari de Bellvitge, L' Hospitalet de Llobregat, Barcelona, Spain
| | - Anna Buxeda
- Kidney Transplant Unit, Nephrology Department, Hospital del Mar, Barcelona, Spain
| | - Gonzalo Velis
- Kidney Transplant Unit, Nephrology Department, Hospital del Mar, Barcelona, Spain
| | - Irina B Torres
- Kidney Transplant Unit, Nephrology Department, Hospital Universitari Vall Hebrón, Barcelona, Spain
| | - Ignacio Revuelta
- Kidney Transplant Unit, Nephrology Department, Hospital Clínic Provincial, Institut d'Investigació Biomèdica August Pi i Sunyer, RedInRen, Barcelona, Spain
| | - Alicia Molina Andujar
- Kidney Transplant Unit, Nephrology Department, Hospital Clínic Provincial, Institut d'Investigació Biomèdica August Pi i Sunyer, RedInRen, Barcelona, Spain
| | - Carme Facundo
- Kidney Transplant Unit, Nephrology Department, Fundació Puigvert, Barcelona, Spain
| | - Beatriz Bardají
- Kidney Transplant Unit, Nephrology Department, Fundació Puigvert, Barcelona, Spain
| | - Lluís Riera
- Urology Department, Hospital Universitari de Bellvitge, L' Hospitalet de Llobregat, Barcelona, Spain
| | - Maria Fiol
- Urology Department, Hospital Universitari de Bellvitge, L' Hospitalet de Llobregat, Barcelona, Spain
| | - Josep M Cruzado
- Kidney Transplant Unit, Nephrology Department, Hospital Universitari de Bellvitge, L' Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Comas
- Catalan Organ Transplant Organization, Barcelona, Spain
| | - Magali Giral
- CRTI UMR 1064, Inserm, Université de Nantes, ITUN, CHU Nantes, RTRS Centaure, Nantes, France
| | - Maarten Naesens
- Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
| | - Anders Åsberg
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.,Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Francesc Moreso
- Kidney Transplant Unit, Nephrology Department, Hospital Universitari Vall Hebrón, Barcelona, Spain
| | - Oriol Bestard
- Kidney Transplant Unit, Nephrology Department, Hospital Universitari de Bellvitge, L' Hospitalet de Llobregat, Barcelona, Spain
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24
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Coll E, Fernández-Ruiz M, Padilla M, Moreso F, Hernández-Vicente A, Yañez I, Molina M, Vázquez-Sánchez T, Crespo M, Facundo C, Rodríguez-Ferrero ML, Ruiz Fuentes MC, Loinaz C, Bernal G, Melilli E, Bravo C, Diekmann F, Lladó L, García-Álvarez TM, Salcedo M, Beneyto I, Castells L, Alonso R, Rodríguez-Benot A, Díaz-Corte C, Graus J, Ortiz-Bautista C, García-Cosío MD, Hinojal R, Peña L, Domínguez-Gil B. COVID-19 in Solid Organ Transplant Recipients in Spain Throughout 2020: Catching the Wave? Transplantation 2021; 105:2146-2155. [PMID: 34241988 PMCID: PMC8487705 DOI: 10.1097/tp.0000000000003873] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Few studies have analyzed differences in clinical presentation and outcomes in solid organ transplant (SOT) recipients with coronavirus disease 2019 (COVID-19) across different pandemic waves. METHODS In this multicenter, nationwide, prospective study, we compared demographics and clinical features, therapeutic management, and outcomes in SOT recipients diagnosed with COVID-19 in Spain before (first wave) or after (second wave) 13 July 2020. RESULTS Of 1634 SOT recipients, 690 (42.2%) and 944 (57.8%) were diagnosed during the first and second periods, respectively. Compared with the first wave, recipients in the second were younger (median: 63 y [interquartile range, IQR: 53-71] versus 59 y [IQR: 49-68]; P < 0.001) and less likely to receive anti-severe acute respiratory syndrome coronavirus 2 drugs (81.8% versus 8.1%; P < 0.001), with no differences in immunomodulatory therapies (46.8% versus 47.0%; P = 0.931). Adjustment of immunosuppression was less common during the second period (76.4% versus 53.6%; P < 0.001). Hospital admission (86.7% versus 58.1%; P < 0.001), occurrence of acute respiratory distress syndrome (34.1% versus 21.0%; P < 0.001), and case-fatality rate (25.8% versus 16.7%; P < 0.001) were lower in the second period. In multivariate analysis, acquiring COVID-19 during the first wave was associated with an increased risk of death (OR: 1.47; 95% confidence interval [CI], 1.12-1.93; P = 0.005), although this impact was lost in the subgroup of patients requiring hospital (OR: 0.97; 95% CI, 0.73-1.29; P = 0.873) or intensive care unit admission (OR: 0.65; 95% CI, 0.35-1.18; P = 0.157). CONCLUSIONS We observed meaningful changes in demographics, therapeutic approaches, level of care, and outcomes between the first and second pandemic waves. However, outcomes have not improved in the more severe cases of posttransplant COVID-19.
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Affiliation(s)
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Group for the Study of Infection in Transplantation and the Immunocompromised Host (GESITRA-IC) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC)
| | | | - Francesc Moreso
- Kidney Transplant Unit, Nephrology Department, Hospital Universitario Vall d´Hebrón, Barcelona, Spain
| | | | - Iñigo Yañez
- Nephrology Service, Hospital Universitario de Cruces, Barakaldo, Spain
| | - María Molina
- Nephrology Service, Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - Marta Crespo
- Nephrology Service, Hospital del Mar, Barcelona, Spain; Transplant Working Group of the Spanish Society of Nephrology, REDinREN (RD16/0009/0013)
| | - Carme Facundo
- Kidney Transplant Unit, Fundación Puigvert, Barcelona, Spain
| | | | | | - Carmelo Loinaz
- Hepato-Biliary Surgery and Transplant Unit, General Surgery Service, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Gabriel Bernal
- Kidney Transplant Unit, Clinical Management Unit Nephrology-Urology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Edoardo Melilli
- Kidney Transplant Unit, Nephrology Service, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Carlos Bravo
- Department of Pulmonology, Lung transplant Unit, Hospital Universitario Vall d´Hebrón, Barcelona, Spain
| | - Fritz Diekmann
- Kidney Transplant Unit, Nephrology Service, Hospital Clinic, Barcelona, Spain
| | - Laura Lladó
- Liver Transplant Unit, Hospital Universitario de Bellvitge, IDIBELL, Barcelona, Spain
| | | | - Magdalena Salcedo
- Hepatology and Liver Transplantation Unit, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Isabel Beneyto
- Kidney Transplant Unit, Nephrology Service, Hospital Universitario La Fe, Valencia, Spain
| | - Lluis Castells
- Liver Unit, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitario Vall d´Hebron, Barcelona, Spain
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - Rodrigo Alonso
- Lung Transplant Unit, Neumology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Alberto Rodríguez-Benot
- Kidney Transplant Unit, Nephrology Service, Hospital Universitario Reina Sofía, Instituto para la Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Carmen Díaz-Corte
- Kidney Transplant Unit, Nephrology Service, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Javier Graus
- Gastroenterology Service, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Carlos Ortiz-Bautista
- Heart Failure and Transplant Unit, Cardiology Service, Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | - María Dolores García-Cosío
- Cardiology Service, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Rosa Hinojal
- Organización Nacional de Trasplantes, Madrid, Spain
| | - Lucía Peña
- Organización Nacional de Trasplantes, Madrid, Spain
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25
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Valentín MDLO, Hernández D, Crespo M, Mahillo B, Beneyto I, Martínez I, Kanter J, Calderari E, Gil-Vernet S, Sánchez S, Agüera ML, Bernal G, de Santiago C, Díaz-Corte C, Díaz C, Espinosa L, Facundo C, Fernández-Lucas M, Ferreiro T, García-Erauzkin G, García-Alvarez T, Fraile P, González-Rinne A, González-Soriano MJ, González E, Gutiérrez-Dalmau A, Jiménez C, Lauzurica R, Lorenzo I, Martín-Moreno PL, Moreso F, de Gracia MC, Pérez-Flores I, Ramos-Verde A, Revuelta I, Rodríguez-Ferrero ML, Ruiz JC, Sánchez-Sobrino B, Domínguez-Gil B. Live donor kidney transplantation. Situation analysis and roadmap. Nefrologia 2021; 42:S0211-6995(21)00113-2. [PMID: 34294484 DOI: 10.1016/j.nefro.2021.03.008] [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: 03/08/2021] [Accepted: 03/17/2021] [Indexed: 10/20/2022] Open
Abstract
Living donor kidney transplantation (LDKT) is the best treatment option for end stage renal disease in terms of both patient and graft survival. However, figures on LDKT in Spain that had been continuously growing from 2005 to 2014, have experienced a continuous decrease in the last five years. One possible explanation for this decrease is that the significant increase in the number of deceased donors in Spain during the last years, both brain death and controlled circulatory death donors, might have generated the false idea that we have coped with the transplant needs. Moreover, a greater number of deceased donor kidney transplants have caused a heavy workload for the transplant teams. Furthermore, the transplant teams could have moved on to a more conservative approach to the information and assessment of patients and families considering the potential long-term risks for donors in recent papers. However, there is a significant variability in the LDKT rate among transplant centers and regions in Spain independent of their deceased donor rates. This fact and the fact that LDKT is usually a preemptive option for patients with advanced chronic renal failure, as time on dialysis is a negative independent factor for transplant outcomes, lead us to conclude that the decrease in LDKT depends on other factors. Thus, in the kidney transplant annual meeting held at ONT site in 2018, a working group was created to identify other causes for the decrease of LDKT in Spain and its relationship with the different steps of the process. The group was formed by transplant teams, a representative of the transplant group of the Spanish Society of Nephrology (SENTRA), a representative of the Spanish Society of Transplants (SET) and representatives of the Spanish National Transplant Organization (ONT). A self-evaluation survey that contains requests about the phases of the LDKT processes (information, donor work out, informed consent, surgeries, follow-up and human resources) were developed and sent to 33 LDKT teams. All the centers answered the questionnaire. The analysis of the answers has resulted in the creation of a national analysis of strengths, weaknesses, opportunities, threats (SWOT) of the LDKT program in Spain and the development of recommendations targeted to improve every step of the donation process. The work performed, the conclusions and recommendations provided, have been reflected in the following report: Spanish living donor kidney transplant program assessment: recommendations for optimization. This document has also been reviewed by a panel of experts, representatives of the scientific societies (Spanish Society of Urology (AEU), Spanish Society of Nephrology Nursery (SEDEN), Spanish Society of Immunology (SEI/GETH)) and the patient association ALCER. Finally, the report has been submitted to public consultation, reaching ample consensus. In addition, the transplant competent authorities of the different regions in Spain have adopted the report at institutional level. The work done and the recommendations to optimize LDKT are summarized in the present manuscript, organized by the different phases of the donation process.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Sara Sánchez
- Organización Nacional de Trasplantes, Madrid, España
| | | | | | | | | | - Cándido Díaz
- H. Clínico U. de Santiago, Santiago de Compostela, España
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26
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Villanego F, Mazuecos A, Pérez‐Flores IM, Moreso F, Andrés A, Jiménez‐Martín C, Molina M, Canal C, Sánchez‐Cámara LA, Zárraga S, Ruiz‐Fuentes MDC, Aladrén MJ, Melilli E, López V, Sánchez‐Álvarez E, Crespo M, Pascual J. Predictors of severe COVID-19 in kidney transplant recipients in the different epidemic waves: Analysis of the Spanish Registry. Am J Transplant 2021; 21:2573-2582. [PMID: 33756067 PMCID: PMC8250925 DOI: 10.1111/ajt.16579] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/22/2021] [Accepted: 03/18/2021] [Indexed: 01/25/2023]
Abstract
SARS-CoV-2 infection has produced high mortality in kidney transplant (KT) recipients, especially in the elderly. Until December 2020, 1011 KT with COVID-19 have been prospectively included in the Spanish Registry and followed until recovery or death. In multivariable analysis, age, pneumonia, and KT performed ≤6 months before COVID-19 were predictors of death, whereas gastrointestinal symptoms were protective. Survival analysis showed significant increasing mortality risk in four subgroups according to recipient age and time after KT (age <65 years and posttransplant time >6 months, age <65 and time ≤6, age ≥65 and time >6 and age ≥65 and time ≤6): mortality rates were, respectively, 11.3%, 24.5%, 35.4%, and 54.5% (p < .001). Patients were significantly younger, presented less pneumonia, and received less frequently specific anti-COVID-19 treatment in the second wave (July-December) than in the first one (March-June). Overall mortality was lower in the second wave (15.1 vs. 27.4%, p < .001) but similar in critical patients (66.7% vs. 58.1%, p = .29). The interaction between age and time post-KT should be considered when selecting recipients for transplantation in the COVID-19 pandemic. Advanced age and a recent KT should foster strict protective measures, including vaccination.
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Affiliation(s)
| | | | | | - Francesc Moreso
- Department of NephrologyHospital Vall d´HebronBarcelonaSpain
| | - Amado Andrés
- Department of NephrologyHospital Universitario Doce de OctubreMadridSpain
| | | | - María Molina
- Department of NephrologyHospital Germans Trias i PujolBarcelonaSpain
| | | | | | - Sofía Zárraga
- Department of NephrologyHospital Universitario de CrucesBilbaoSpain
| | | | - María José Aladrén
- Department of NephrologyHospital Universitario Miguel ServetZaragozaSpain
| | - Edoardo Melilli
- Department of NephrologyHospital Universitario BellvitgeBarcelonaSpain
| | - Verónica López
- Department of NephrologyHospital Regional Universitario de MálagaUniversity of MálagaIBIMAREDinRENMálagaSpain
| | | | - Marta Crespo
- Department of NephrologyHospital del MarInstitute Mar for Medical ResearchREDinRENBarcelonaSpain
| | - Julio Pascual
- Department of NephrologyHospital del MarInstitute Mar for Medical ResearchREDinRENBarcelonaSpain
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27
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Larrosa-Garcia M, Garcia-Garcia S, Los-Arcos I, Moreso F, Berastegui C, Castells L, Gorgas Torner MQ, Miarons M. Long-term effects of COVID-19 in solid organ transplantation recipients. Transpl Infect Dis 2021; 23:e13677. [PMID: 34174006 PMCID: PMC8420400 DOI: 10.1111/tid.13677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/23/2021] [Accepted: 05/25/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Maria Larrosa-Garcia
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Sonia Garcia-Garcia
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Ibai Los-Arcos
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Francesc Moreso
- Nephrology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Cristina Berastegui
- Pneumology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Lluís Castells
- Liver Unit, Internal Medicine Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Maria Q Gorgas Torner
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Marta Miarons
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
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28
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Jacobs Cachá C, Puig Gay N, Vergara A, Gabaldon A, Sellares J, Villena Y, Agraz I, Seron Micas D, Moreso F, Soler MJ, López Hellín J. MO298A SPECIFIC TUBULAR APOA-I DISTRIBUTION IS ASSOCIATED TO FSGS RECURRENCE AFTER KIDNEY TRANSPLANTATION. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab104.0056] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
A major complication primary focal segmental glomerulosclerosis (FSGS) is its recurrence after kidney transplantation that happens in 30 to 40% of the patients. The diagnosis of this relapses is not always easy as the histological lesions are not highly specific and appear after the proteinuria increase. Currently, there are no accurate biomarkers to detect FSGS recurrence. Our group identified a modified form of Apolipoprotein A-I (ApoA-I), named ApoA-Ib, specifically present in urine of recurrent FSGS patients after kidney transplantation. Aberrant forms of ApoA-I have also been described in urine of native primary FSGS patients and have associated this feature to a prominent staining of ApoA-I at the apical membrane of the tubular cells. In this study we aim to analyze the ApoA-I distribution in kidney allograft biopsies of recurrent FSGS patients.
Method
We detected ApoA-I by immunohistochemistry in kidney allograft biopsies of patients with FSGS relapse after kidney transplantation (urinary ApoA-Ib positive) and in kidney allograft biopsies of patients with a disease different from FSGS in the native kidney (No-FSGS, urinary ApoA-Ib negative).
Results
In ApoA-Ib positive recurrent FSGS patients, ApoA-I was prominently localized at the brush border of the tubular cells while in the No-FSGS patients ApoA-I was found along the cytoplasm of the tubular cells (Figure 1).
Conclusion
The localization of ApoA-I at the brush border of the tubular cells is a specific feature of primary FSGS in relapse. This suggests that ApoA-I staining in kidney biopsies, coupled with ApoA-Ib measurement in urine, could be used as a diagnostic tool of primary FSGS relapse after kidney transplantation due to its highly specific tubular distribution.
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Affiliation(s)
| | - Natàlia Puig Gay
- Vall d’Hebron Barcelona Hospital Campus., Biochemistry, Barcelona, Spain
| | - Ander Vergara
- Vall d’Hebron Barcelona Hospital Campus., Nephrology, Barcelona, Spain
| | | | - Joana Sellares
- Vall d’Hebron Barcelona Hospital Campus., Nephrology, Barcelona, Spain
| | - Yolanda Villena
- Vall d’Hebron Barcelona Hospital Campus., Biochemistry, Barcelona, Spain
| | - Irene Agraz
- Vall d’Hebron Barcelona Hospital Campus., Nephrology, Barcelona, Spain
| | | | - Francesc Moreso
- Vall d’Hebron Barcelona Hospital Campus., Nephrology, Barcelona, Spain
| | - María José Soler
- Vall d’Hebron Barcelona Hospital Campus., Nephrology, Barcelona, Spain
| | - Joan López Hellín
- Vall d’Hebron Barcelona Hospital Campus., Biochemistry, Barcelona, Spain
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29
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Coll E, Fernández-Ruiz M, Sánchez-Álvarez JE, Martínez-Fernández JR, Crespo M, Gayoso J, Bada-Bosch T, Oppenheimer F, Moreso F, López-Oliva MO, Melilli E, Rodríguez-Ferrero ML, Bravo C, Burgos E, Facundo C, Lorenzo I, Yañez Í, Galeano C, Roca A, Cabello M, Gómez-Bueno M, García-Cosío M, Graus J, Lladó L, de Pablo A, Loinaz C, Aguado B, Hernández D, Domínguez-Gil B. COVID-19 in transplant recipients: The Spanish experience. Am J Transplant 2021; 21:1825-1837. [PMID: 33098200 PMCID: PMC9906239 DOI: 10.1111/ajt.16369] [Citation(s) in RCA: 125] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/06/2020] [Accepted: 10/09/2020] [Indexed: 02/06/2023]
Abstract
We report the nationwide experience with solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients diagnosed with coronavirus disease 2019 (COVID-19) in Spain until 13 July 2020. We compiled information for 778 (423 kidney, 113 HSCT, 110 liver, 69 heart, 54 lung, 8 pancreas, 1 multivisceral) recipients. Median age at diagnosis was 61 years (interquartile range [IQR]: 52-70), and 66% were male. The incidence of COVID-19 in SOT recipients was two-fold higher compared to the Spanish general population. The median interval from transplantation was 59 months (IQR: 18-131). Infection was hospital-acquired in 13% of cases. No donor-derived COVID-19 was suspected. Most patients (89%) were admitted to the hospital. Therapies included hydroxychloroquine (84%), azithromycin (53%), protease inhibitors (37%), and interferon-β (5%), whereas immunomodulation was based on corticosteroids (41%) and tocilizumab (21%). Adjustment of immunosuppression was performed in 85% of patients. At the time of analysis, complete follow-up was available from 652 patients. Acute respiratory distress syndrome occurred in 35% of patients. Ultimately, 174 (27%) patients died. In univariate analysis, risk factors for death were lung transplantation (odds ratio [OR]: 2.5; 95% CI: 1.4-4.6), age >60 years (OR: 3.7; 95% CI: 2.5-5.5), and hospital-acquired COVID-19 (OR: 3.0; 95% CI: 1.9-4.9).
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Affiliation(s)
- Elisabeth Coll
- Organización Nacional de Trasplantes (Spanish National Transplant Organization), Madrid, Spain
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario 12 de Octubre. Instituto de Investigación Sanitaria, Hospital Universitario 12 de Octubre (imas12), President of the Group for the Study of Infection in Transplantation and the Immunocompromised Host (GESITRA-IC) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain
- Group for the Study of Infection in Transplantation and the Immunocompromised Host (GESITRA-IC) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain
| | - J. Emilio Sánchez-Álvarez
- Department of Nephrology, Hospital Universitario de Cabueñes, Gijón, Spain
- Spanish Society of Nephrology (SEN), Gijón, Spain
| | | | - Marta Crespo
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
- Transplant Working Group of the Spanish Society of Nephrology (SEN), Barcelona, Spain
- REDinREN (RD16/0009/0013), Barcelona, Spain
| | - Jorge Gayoso
- Organización Nacional de Trasplantes (Spanish National Transplant Organization), Madrid, Spain
| | - Teresa Bada-Bosch
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Francesc Moreso
- Kidney Transplant Unit, Department of Nephrology, Hospital Universitario Vall d´Hebrón, Barcelona, Spain
| | | | - Edoardo Melilli
- Kidney Transplant Unit, Department of Nephrology, Hospital Universitario de Bellvitge, Barcelona, Spain
| | | | - Carlos Bravo
- Department of Pulmonology, Lung transplant Unit, Hospital Universitario Vall d´Hebrón, Barcelona, Spain
| | - Elena Burgos
- Department of Nephrology, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Carme Facundo
- Kidney Transplant Unit, Fundación Puigvert, Barcelona, Spain
| | - Inmaculada Lorenzo
- Department of Nephrology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Íñigo Yañez
- Department of Nephrology, Hospital Universitario de Cruces, Barakaldo, Spain
| | - Cristina Galeano
- Kidney Transplant Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ana Roca
- Department of Nephrology, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Mercedes Cabello
- Department of Nephrology, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Manuel Gómez-Bueno
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - MaDolores García-Cosío
- Cardiology Service, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | - Javier Graus
- Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Laura Lladó
- Liver Transplant Unit, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Alicia de Pablo
- Lung Transplant Unit, Department of Pneumology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carmelo Loinaz
- Transplant Unit, Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Beatriz Aguado
- Transplant Unit. Department of Hematology, Hospital Universitario La Princesa, Madrid, Spain
| | - Domingo Hernández
- Department of Nephrology, Hospital Regional Universitario, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- Spanish Society of Transplantation (SET), Málaga, Spain
| | - Beatriz Domínguez-Gil
- Organización Nacional de Trasplantes (Spanish National Transplant Organization), Madrid, Spain
| | - the Spanish Group for the Study of COVID-19 in Transplant Recipients
- Organización Nacional de Trasplantes (Spanish National Transplant Organization), Madrid, Spain
- Unit of Infectious Diseases, Hospital Universitario 12 de Octubre. Instituto de Investigación Sanitaria, Hospital Universitario 12 de Octubre (imas12), President of the Group for the Study of Infection in Transplantation and the Immunocompromised Host (GESITRA-IC) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain
- Group for the Study of Infection in Transplantation and the Immunocompromised Host (GESITRA-IC) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Madrid, Spain
- Department of Nephrology, Hospital Universitario de Cabueñes, Gijón, Spain
- Spanish Society of Nephrology (SEN), Gijón, Spain
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
- Transplant Working Group of the Spanish Society of Nephrology (SEN), Barcelona, Spain
- REDinREN (RD16/0009/0013), Barcelona, Spain
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Department of Nephrology, Hospital Clinic, Barcelona, Spain
- Kidney Transplant Unit, Department of Nephrology, Hospital Universitario Vall d´Hebrón, Barcelona, Spain
- Department oof Nephrology, Hospital Universitario La Paz, Madrid, Spain
- Kidney Transplant Unit, Department of Nephrology, Hospital Universitario de Bellvitge, Barcelona, Spain
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Department of Pulmonology, Lung transplant Unit, Hospital Universitario Vall d´Hebrón, Barcelona, Spain
- Department of Nephrology, Hospital Germans Trias i Pujol, Badalona, Spain
- Kidney Transplant Unit, Fundación Puigvert, Barcelona, Spain
- Department of Nephrology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
- Department of Nephrology, Hospital Universitario de Cruces, Barakaldo, Spain
- Kidney Transplant Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Department of Nephrology, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
- Department of Nephrology, Hospital Regional Universitario de Málaga, Málaga, Spain
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
- Cardiology Service, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
- Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Liver Transplant Unit, Hospital Universitario de Bellvitge, Barcelona, Spain
- Lung Transplant Unit, Department of Pneumology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Transplant Unit, Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario 12 de Octubre, Madrid, Spain
- Transplant Unit. Department of Hematology, Hospital Universitario La Princesa, Madrid, Spain
- Department of Nephrology, Hospital Regional Universitario, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- Spanish Society of Transplantation (SET), Málaga, Spain
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30
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Montero N, Moreso F, Cruzado JM. HIV-positive deceased donor-to-HIV-positive recipient kidney transplantation: The HOPE must go on. Am J Transplant 2021; 21:1683-1684. [PMID: 32810390 DOI: 10.1111/ajt.16272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/10/2020] [Accepted: 08/14/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Nuria Montero
- Nephrology Department, Hospital Universitari de Bellvitge, Feixa llarga s/n, L' Hospitalet de Llobregat, Spain.,Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Gran Via de l'Hospitalet, Hospitalet de Llobregat, Spain
| | - Francesc Moreso
- Nephrology Department, Hospital Universitari Vall d' Hebron, Universitat Autònoma Barcelona, Passeig Vall d'Hebron, Barcelona, Spain
| | - Josep M Cruzado
- Nephrology Department, Hospital Universitari de Bellvitge, Feixa llarga s/n, L' Hospitalet de Llobregat, Spain.,Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Gran Via de l'Hospitalet, Hospitalet de Llobregat, Spain.,Departament de Ciències Clíniques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Feixa llarga s/n, L' Hospitalet de Llobregat, Spain
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31
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Pérez-Sáez MJ, Gutiérrez-Dalmau Á, Moreso F, Rodríguez-Mañas L, Pascual J. Frailty and kidney transplant candidates. Nefrologia 2021; 41:237-243. [PMID: 36166241 DOI: 10.1016/j.nefroe.2021.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/07/2020] [Indexed: 06/16/2023] Open
Abstract
Frailty is a concept that has been mainly developed in geriatrics and it came from the need of identifying subjects at risk to develop complications when they faced a stressful event. Frail patients have higher risk of mortality, poor outcomes and disability, and this is independent from their age or comorbidities. Chronic kidney disease patients present with high prevalence of frailty, especially those who are in renal replacement therapy. Frail or pre-frail patients on the kidney transplant waiting list represent 20-30%, and these patients are proven to have poorer results after the transplant, which is a stressful event itself. Tools for frailty assessment, both scales or indexes, may be useful to identify which subjects might be at risk for complications after transplant, and this is necessary to adapt our clinical practice and minimize morbidity. The most used frailty scale in kidney patients is Fried scale, which is based in five phenotypic items. Besides that, knowing frail population allows potential interventions such as prehabilitation while the patient is waiting for the kidney transplant, which the aim of improving their vulnerability prior to transplant and, therefore, optimizing results after transplant. More studies are needed amongst kidney patients to improve and prevent frailty.
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Affiliation(s)
| | | | - Francesc Moreso
- Servicio de Nefrología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - Julio Pascual
- Servicio de Nefrología, Hospital del Mar, Barcelona, Spain
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32
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Jarque M, Crespo E, Melilli E, Gutiérrez A, Moreso F, Guirado L, Revuelta I, Montero N, Torras J, Riera L, Meneghini M, Taco O, Manonelles A, Paul J, Seron D, Facundo C, Cruzado JM, Gil Vernet S, Grinyó JM, Bestard O. Cellular Immunity to Predict the Risk of Cytomegalovirus Infection in Kidney Transplantation: A Prospective, Interventional, Multicenter Clinical Trial. Clin Infect Dis 2021; 71:2375-2385. [PMID: 32076718 DOI: 10.1093/cid/ciz1209] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 12/20/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Improving cytomegalovirus (CMV) immune-risk stratification in kidney transplantation is highly needed to establish guided preventive strategies. METHODS This prospective, interventional, multicenter clinical trial assessed the value of monitoring pretransplant CMV-specific cell-mediated immunity (CMI) using an interferon-γ release assay to predict CMV infection in kidney transplantation. One hundred sixty donor/recipient CMV-seropositive (D+/R+) patients, stratified by their baseline CMV (immediate-early protein 1)-specific CMI risk, were randomized to receive either preemptive or 3-month antiviral prophylaxis. Also, 15-day posttransplant CMI risk stratification and CMI specific to the 65 kDa phosphoprotein (pp65) CMV antigen were investigated. Immunosuppression consisted of basiliximab, tacrolimus, mycophenolate mofetil, and corticosteroids in 80% of patients, whereas 20% received thymoglobulin induction therapy. RESULTS Patients at high risk for CMV based on pretransplant CMI developed significantly higher CMV infection rates than those deemed to be at low risk with both preemptive (73.3% vs 44.4%; odds ratio [OR], 3.44 [95% confidence interval {CI}, 1.30-9.08]) and prophylaxis (33.3% vs 4.1%; OR, 11.75 [95% CI, 2.31-59.71]) approaches. The predictive capacity for CMV-specific CMI was only found in basiliximab-treated patients for both preemptive and prophylaxis therapy. Fifteen-day CMI risk stratification better predicted CMV infection (81.3% vs 9.1%; OR, 43.33 [95% CI, 7.89-237.96]). CONCLUSIONS Pretransplant CMV-specific CMI identifies D+/R+ kidney recipients at high risk of developing CMV infection if not receiving T-cell-depleting antibodies. Monitoring CMV-specific CMI soon after transplantation further defines the CMV infection prediction risk. Monitoring CMV-specific CMI may guide decision making regarding the type of CMV preventive strategy in kidney transplantation. CLINICAL TRIALS REGISTRATION NCT02550639.
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Affiliation(s)
- Marta Jarque
- Experimental Nephrology Laboratory, Bellvitge Biomedical Research Institute, IDIBELL, Hospitalet de Llobregat, Spain
| | - Elena Crespo
- Experimental Nephrology Laboratory, Bellvitge Biomedical Research Institute, IDIBELL, Hospitalet de Llobregat, Spain
| | - Edoardo Melilli
- Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Alex Gutiérrez
- Kidney Transplant Unit, Nephrology Department, Hospital Miguel Servet, Zaragoza, Spain
| | - Francesc Moreso
- Kidney Transplant Unit, Nephrology Department, Vall d'Hebrón University Hospital, Barcelona, Spain
| | - Lluís Guirado
- Kidney Transplant Unit, Nephrology Department, Fundació Puigvert, Barcelona, Spain
| | - Ignacio Revuelta
- Kidney Transplant Unit, Nephrology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Nuria Montero
- Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Joan Torras
- Experimental Nephrology Laboratory, Bellvitge Biomedical Research Institute, IDIBELL, Hospitalet de Llobregat, Spain
- Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Lluís Riera
- Urology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Maria Meneghini
- Experimental Nephrology Laboratory, Bellvitge Biomedical Research Institute, IDIBELL, Hospitalet de Llobregat, Spain
- Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Omar Taco
- Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Anna Manonelles
- Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Javier Paul
- Kidney Transplant Unit, Nephrology Department, Hospital Miguel Servet, Zaragoza, Spain
| | - Daniel Seron
- Kidney Transplant Unit, Nephrology Department, Vall d'Hebrón University Hospital, Barcelona, Spain
| | - Carme Facundo
- Kidney Transplant Unit, Nephrology Department, Fundació Puigvert, Barcelona, Spain
| | - Josep M Cruzado
- Experimental Nephrology Laboratory, Bellvitge Biomedical Research Institute, IDIBELL, Hospitalet de Llobregat, Spain
- Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Salvador Gil Vernet
- Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Josep M Grinyó
- Experimental Nephrology Laboratory, Bellvitge Biomedical Research Institute, IDIBELL, Hospitalet de Llobregat, Spain
- Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Oriol Bestard
- Experimental Nephrology Laboratory, Bellvitge Biomedical Research Institute, IDIBELL, Hospitalet de Llobregat, Spain
- Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona, Spain
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33
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Toapanta N, Torres IB, Sellarés J, Chamoun B, Serón D, Moreso F. Kidney transplantation and COVID-19 renal and patient prognosis. Clin Kidney J 2021; 14:i21-i29. [PMID: 33815780 PMCID: PMC7995521 DOI: 10.1093/ckj/sfab030] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/27/2021] [Indexed: 02/07/2023] Open
Abstract
Coronavirus disease 2019 (COVD-19) emerged as a pandemic in December 2019. Infection has spread quickly and renal transplant recipients receiving chronic immunosuppression have been considered a population at high risk of infection, complications and infection-related death. During this year a large amount of information from nationwide registries, multicentre and single-centre studies have been reported. The number of renal transplant patients diagnosed with COVID-19 was higher than in the general population, but the lower threshold for testing may have contributed to its better identification. Major complications such as acute kidney injury and acute respiratory distress syndrome were very frequent in renal transplant patients, with a high comorbidity burden, but further studies are needed to support that organ transplant recipients receiving chronic immunosuppression are more prone to develop these complications than the general population. Kidney transplant recipients experience a high mortality rate compared with the general population, especially during the very early post-transplant period. Despite the fact that some studies report more favourable outcomes in patients with a kidney transplant than in patients on the kidney waiting list, the higher mortality described in the very early post-transplant period would advise against performing a kidney transplant in areas where the spread of infection is high, especially in recipients >60 years of age. Management of transplant recipients has been challenging for clinicians and strategies such as less use of lymphocyte-depleting agents for new transplants or anti-metabolite withdrawal and calcineurin inhibitor reduction for transplant patients with COVID-19 are not based on high-quality evidence.
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Affiliation(s)
- Néstor Toapanta
- Department of Nephrology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Irina B Torres
- Department of Nephrology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Joana Sellarés
- Department of Nephrology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Betty Chamoun
- Department of Nephrology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Daniel Serón
- Department of Nephrology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Francesc Moreso
- Department of Nephrology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
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34
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Chamoun B, Torres IB, Gabaldón A, Sellarés J, Perelló M, Castellá E, Guri X, Salcedo M, Toapanta NG, Cidraque I, Moreso F, Seron D. Progression of Interstitial Fibrosis and Tubular Atrophy in Low Immunological Risk Renal Transplants Monitored by Sequential Surveillance Biopsies: The Influence of TAC Exposure and Metabolism. J Clin Med 2021; 10:jcm10010141. [PMID: 33406589 PMCID: PMC7796060 DOI: 10.3390/jcm10010141] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/21/2020] [Accepted: 12/30/2020] [Indexed: 02/06/2023] Open
Abstract
The combination of tacrolimus (TAC) and mycophenolate is the most widely employed maintenance immunosuppression in renal transplants. Different surrogates of tacrolimus exposure or metabolism such as tacrolimus trough levels (TAC-C0), coefficient of variation of tacrolimus (CV-TAC-C0), time in therapeutic range (TTR), and tacrolimus concentration dose ratio (C/D) have been associated with graft outcomes. We explore in a cohort of low immunological risk renal transplants (n = 85) treated with TAC, mycophenolate mofetil (MMF), and steroids and then monitored by paired surveillance biopsies the association between histological lesions and TAC-C0 at the time of biopsy as well as CV-TAC-C0, TTR, and C/D during follow up. Interstitial inflammation (i-Banff score ≥ 1) in the first surveillance biopsy was associated with TAC-C0 (odds ratio (OR): 0.69, 95% confidence interval (CI): 0.50–0.96; p = 0.027). In the second surveillance biopsy, inflammation was associated with time below the therapeutic range (OR: 1.05 and 95% CI: 1.01–1.10; p = 0.023). Interstitial inflammation in scarred areas (i-IFTA score ≥ 1) was not associated with surrogates of TAC exposure/metabolism. Progression of interstitial fibrosis/tubular atrophy (IF/TA) was observed in 35 cases (41.2%). Multivariate regression logistic analysis showed that mean C/D (OR: 0.48; 95% CI: 0.25–0.92; p = 0.026) and IF/TA in the first biopsy (OR: 0.43, 95% CI: 0.24–0.77, p = 0.005) were associated with IF/TA progression between biopsies. A low C/D ratio is associated with IF/TA progression, suggesting that TAC nephrotoxicity may contribute to fibrosis progression in well immunosuppressed patients. Our data support that TAC exposure is associated with inflammation in healthy kidney areas but not in scarred tissue.
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Affiliation(s)
- Betty Chamoun
- Nephrology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (B.C.); (I.B.T.); (J.S.); (M.P.); (N.G.T.); (I.C.); (D.S.)
| | - Irina B. Torres
- Nephrology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (B.C.); (I.B.T.); (J.S.); (M.P.); (N.G.T.); (I.C.); (D.S.)
| | - Alejandra Gabaldón
- Pathology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (A.G.); (M.S.)
| | - Joana Sellarés
- Nephrology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (B.C.); (I.B.T.); (J.S.); (M.P.); (N.G.T.); (I.C.); (D.S.)
| | - Manel Perelló
- Nephrology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (B.C.); (I.B.T.); (J.S.); (M.P.); (N.G.T.); (I.C.); (D.S.)
| | - Eva Castellá
- Radiology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (E.C.); (X.G.)
| | - Xavier Guri
- Radiology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (E.C.); (X.G.)
| | - Maite Salcedo
- Pathology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (A.G.); (M.S.)
| | - Nestor G. Toapanta
- Nephrology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (B.C.); (I.B.T.); (J.S.); (M.P.); (N.G.T.); (I.C.); (D.S.)
| | - Ignacio Cidraque
- Nephrology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (B.C.); (I.B.T.); (J.S.); (M.P.); (N.G.T.); (I.C.); (D.S.)
| | - Francesc Moreso
- Nephrology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (B.C.); (I.B.T.); (J.S.); (M.P.); (N.G.T.); (I.C.); (D.S.)
- Department of Medicine, Autonomous University of Barcelona, 08035 Barcelona, Spain
- Correspondence: ; Tel.: +34-93-274-46-66
| | - Daniel Seron
- Nephrology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (B.C.); (I.B.T.); (J.S.); (M.P.); (N.G.T.); (I.C.); (D.S.)
- Department of Medicine, Autonomous University of Barcelona, 08035 Barcelona, Spain
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35
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Miarons M, Larrosa-García M, García-García S, Los-Arcos I, Moreso F, Berastegui C, Castells L, Pérez-Hoyos S, Varela J, Pau-Parra A, Varón-Galcera C, Parramon-Teixidó CJ, Martínez-Casanova J, Domènech L, García-Ortega P, Sánchez-Sancho P, Alonso-Martínez C, Gómez-Ganda L, Roch-Santed M, Gracia-Moya A, Del-Rio-Gutiérrez JM, Guillén-Del-Castillo A, Sans-Pola C, Antón A, Montoro B, Gorgas-Torner MQ. COVID-19 in Solid Organ Transplantation: A Matched Retrospective Cohort Study and Evaluation of Immunosuppression Management. Transplantation 2021; 105:138-150. [PMID: 32941394 DOI: 10.1097/tp.0000000000003460] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [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: 02/06/2023]
Abstract
BACKGROUND The epidemiological and clinical characteristics of solid organ transplant (SOT) patients during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic remains unclear. We conducted a matched retrospective cohort study to compare clinical outcomes among SOT recipients with the general population and to assess immunosuppression management. METHODS Adult SOT recipients with laboratory polymerase chain reaction-confirmed SARS-CoV-2 infection admitted to a tertiary-care hospital in Barcelona, Spain, from March 11 to April 25, 2020, were matched to controls (1:4) on the basis of sex, age, and age-adjusted Charlson's Index. Patients were followed for up to 28 days from admission or until censored. Primary endpoint was mortality at 28 days. Secondary endpoints included admission to the intensive care unit and secondary complications. Drug-drug interactions (DDI) between immunosuppressants and coronavirus disease 2019 (COVID-19) management medication were collected. RESULTS Forty-six transplant recipients and 166 control patients were included. Mean (SD) age of transplant recipients and controls was 62.7 (12.6) and 66.0 (12.7) years, 33 (71.7%) and 122 (73.5%) were male, and median (interquartile range) Charlson's Index was 5 (3-7) and 4 (2-7), respectively. Mortality was 37.0% in SOT recipients and 22.9% in controls (P = 0.51). Thirty-three (71.7%) patients underwent transitory discontinuation of immunosuppressants due to potential or confirmed DDI. CONCLUSIONS In conclusion, hospitalized SOT recipients with COVID-19 had a trend toward higher mortality compared with controls, although it was not statistically significant, and a notable propensity for DDI.
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Affiliation(s)
- Marta Miarons
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - María Larrosa-García
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Sonia García-García
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Ibai Los-Arcos
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Francesc Moreso
- Nephrology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Cristina Berastegui
- Pneumology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Lluís Castells
- Liver Unit, Internal Medicine Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - Santiago Pérez-Hoyos
- Statistic Unit, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Javier Varela
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Alba Pau-Parra
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Carlota Varón-Galcera
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | | | - Javier Martínez-Casanova
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Laura Domènech
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Patricia García-Ortega
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Pablo Sánchez-Sancho
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Carla Alonso-Martínez
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Laura Gómez-Ganda
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Maria Roch-Santed
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Ariadna Gracia-Moya
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | | | - Alfredo Guillén-Del-Castillo
- Internal Medicine Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Carla Sans-Pola
- Pharmacology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Andrés Antón
- Respiratory Viruses Unit, Microbiology Department, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Bruno Montoro
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Maria-Queralt Gorgas-Torner
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
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Murakami N, Mulvaney P, Danesh M, Abudayyeh A, Diab A, Abdel-Wahab N, Abdelrahim M, Khairallah P, Shirazian S, Kukla A, Owoyemi IO, Alhamad T, Husami S, Menon M, Santeusanio A, Blosser CD, Zuniga SC, Soler MJ, Moreso F, Mithani Z, Ortiz-Melo D, Jaimes EA, Gutgarts V, Lum E, Danovitch GM, Cardarelli F, Drews RE, Bassil C, Swank JL, Westphal S, Mannon RB, Shirai K, Kitchlu A, Ong S, Machado SM, Mothi SS, Ott PA, Rahma O, Hodi FS, Sise ME, Gupta S, Leaf DE, Devoe CE, Wanchoo R, Nair VV, Schmults CD, Hanna GJ, Sprangers B, Riella LV, Jhaveri KD. A multi-center study on safety and efficacy of immune checkpoint inhibitors in cancer patients with kidney transplant. Kidney Int 2020; 100:196-205. [PMID: 33359528 DOI: 10.1016/j.kint.2020.12.015] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/03/2020] [Accepted: 12/07/2020] [Indexed: 02/07/2023]
Abstract
Immune checkpoint inhibitors (ICIs) are widely used for various malignancies. However, their safety and efficacy in patients with a kidney transplant have not been defined. To delineate this, we conducted a multicenter retrospective study of 69 patients with a kidney transplant receiving ICIs between January 2010 and May 2020. For safety, we assessed the incidence, timing, and risk factors of acute graft rejection. For efficacy, objective response rate and overall survival were assessed in cutaneous squamous cell carcinoma and melanoma, the most common cancers in our cohort, and compared with stage-matched 23 patients with squamous cell carcinoma and 14 with melanoma with a kidney transplant not receiving ICIs. Following ICI treatment, 29 out of 69 (42%) patients developed acute rejection, 19 of whom lost their allograft, compared with an acute rejection rate of 5.4% in the non-ICI cohort. Median time from ICI initiation to rejection was 24 days. Factors associated with a lower risk of rejection were mTOR inhibitor use (odds ratio 0.26; 95% confidence interval, 0.09-0.72) and triple-agent immunosuppression (0.67, 0.48-0.92). The objective response ratio was 36.4% and 40% in the squamous cell carcinoma and melanoma subgroups, respectively. In the squamous cell carcinoma subgroup, overall survival was significantly longer in patients treated with ICIs (median overall survival 19.8 months vs. 10.6 months), whereas in the melanoma subgroup, overall survival did not differ between groups. Thus, ICIs were associated with a high risk of rejection in patients with kidney transplants but may lead to improved cancer outcomes. Prospective studies are needed to determine optimal immunosuppression strategies to improve patient outcomes.
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Affiliation(s)
- Naoka Murakami
- Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Patrick Mulvaney
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Melissa Danesh
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ala Abudayyeh
- Section of Nephrology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Adi Diab
- Department of Melanoma Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Noha Abdel-Wahab
- Department of Melanoma Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of General Internal Medicine, Section of Rheumatology and Clinical Immunology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Rheumatology and Rehabilitation, Faculty of Medicine, Assiut University Hospitals, Assiut, Egypt
| | - Maen Abdelrahim
- Institute for Academic Medicine and Weill Cornell Medical College, Houston Methodist Cancer Center, Houston, Texas, USA
| | - Pascale Khairallah
- Division of Nephrology, Columbia University Medical Center, New York, New York, USA
| | - Shayan Shirazian
- Division of Nephrology, Columbia University Medical Center, New York, New York, USA
| | - Aleksandra Kukla
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Itunu O Owoyemi
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Tarek Alhamad
- Division of Nephrology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Samir Husami
- Division of Nephrology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Madhav Menon
- Division of Nephrology, Recanati Millar Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Andrew Santeusanio
- Division of Nephrology, Recanati Millar Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Maria Jose Soler
- Nephrology Department, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Francesc Moreso
- Nephrology Department, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Zain Mithani
- Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - David Ortiz-Melo
- Division of Nephrology, Duke University Medical Center, Durham, North Carolina, USA
| | - Edgar A Jaimes
- Renal Service, Memorial Sloan Kettering Cancer Center and Weil Cornell Medical College, New York, New York, USA
| | - Victoria Gutgarts
- Renal Service, Memorial Sloan Kettering Cancer Center and Weil Cornell Medical College, New York, New York, USA
| | - Erik Lum
- Division of Nephrology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Gabriel M Danovitch
- Division of Nephrology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Francesca Cardarelli
- Division of Nephrology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Reed E Drews
- Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Claude Bassil
- Division of Nephrology and Hypertension, University of South Florida, Tampa, Florida; Renal Service, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - Jennifer L Swank
- Division of Nephrology and Hypertension, University of South Florida, Tampa, Florida; Renal Service, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - Scott Westphal
- Division of Nephrology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Roslyn B Mannon
- Division of Nephrology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Keisuke Shirai
- Department of Hematology-Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Abhijat Kitchlu
- Division of Nephrology, University Health Network, University of Toronto, Ontario, Canada
| | - Song Ong
- Division of Nephrology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Shana M Machado
- Division of Nephrology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Suraj S Mothi
- Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Patrick A Ott
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Osama Rahma
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - F Stephen Hodi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Meghan E Sise
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shruti Gupta
- Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David E Leaf
- Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Craig E Devoe
- Division of Medical Oncology and Hematology, Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Rimda Wanchoo
- Division of Kidney Disease and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Vinay V Nair
- Division of Kidney Disease and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | | | - Glenn J Hanna
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Ben Sprangers
- Laboratory of Molecular Immunology, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Belgium; Department of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Leonardo V Riella
- Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA; Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kenar D Jhaveri
- Division of Kidney Disease and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.
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37
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Pérez-Sáez MJ, Gutiérrez-Dalmau Á, Moreso F, Rodríguez Mañas L, Pascual J. [Frailty and kidney transplant candidates]. Nefrologia 2020; 41:237-243. [PMID: 33339673 DOI: 10.1016/j.nefro.2020.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/08/2020] [Revised: 08/25/2020] [Accepted: 09/07/2020] [Indexed: 01/14/2023] Open
Abstract
Frailty is a concept that has been mainly developed in geriatrics and it came from the need of identifying subjects at risk to develop complications when they faced a stressful event. Frail patients have higher risk of mortality, poor outcomes and disability, and this is independent from their age or comorbidities. Chronic kidney disease patients present with high prevalence of frailty, especially those who are in renal replacement therapy. Frail or pre-frail patients on the kidney transplant waiting list represent 20-30%, and these patients are proven to have poorer results after the transplant, which is a stressful event itself. Tools for frailty assessment, both scales or indexes, may be useful to identify which subjects might be at risk for complications after transplant, and this is necessary to adapt our clinical practice and minimize morbidity. The most used frailty scale in kidney patients is Fried scale, which is based in five phenotypic items. Besides that, knowing frail population allows potential interventions such as prehabilitation while the patient is waiting for the kidney transplant, which the aim of improving their vulnerability prior to transplant and, therefore, optimizing results after transplant. More studies are needed amongst kidney patients to improve and prevent frailty.
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Affiliation(s)
| | | | - Francesc Moreso
- Servicio de Nefrología, Hospital Universitario Vall d'Hebron, Barcelona, España
| | | | - Julio Pascual
- Servicio de Nefrología, Hospital del Mar, Barcelona, España
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38
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Favà A, Cucchiari D, Montero N, Toapanta N, Centellas FJ, Vila-Santandreu A, Coloma A, Meneghini M, Manonelles A, Sellarés J, Torres I, Gelpi R, Lorenzo I, Ventura-Aguiar P, Cofan F, Torregrosa JV, Perelló M, Facundo C, Seron D, Oppenheimer F, Bestard O, Cruzado JM, Moreso F, Melilli E. Clinical characteristics and risk factors for severe COVID-19 in hospitalized kidney transplant recipients: A multicentric cohort study. Am J Transplant 2020; 20:3030-3041. [PMID: 32777153 PMCID: PMC7436908 DOI: 10.1111/ajt.16246] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/16/2020] [Accepted: 07/24/2020] [Indexed: 01/25/2023]
Abstract
Kidney transplant recipients might be at higher risk for severe coronavirus disease 2019 (COVID-19). However, risk factors for relevant outcomes remain uncertain in this population. This is a multicentric kidney transplant cohort including 104 hospitalized patients between March 4 and April 17, 2020. Risk factors for death and acute respiratory distress syndrome (ARDS) were investigated, and clinical and laboratory data were analyzed. The mean age was 60 years. Forty-seven patients (54.8%) developed ARDS. Obesity was associated to ARDS development (OR 2.63; P = .04). Significant age differences were not found among patients developing and not developing ARDS (61.3 vs 57.8 years, P = .16). Seventy-six (73%) patients were discharged, and 28 (27%) died. Death was more common among the elderly (55 and 70.8 years, P < .001) and those with preexisting pulmonary disease (OR 2.89, P = .009). At admission, higher baseline lactate dehydrogenase (257 vs 358 IU/mL, P = .001) or ARDS conferred higher risk of death (HR 2.09, P = .044). In our cohort, ARDS was equally present among young and old kidney recipients. However, the elderly might be at higher risk of death, along with those showing higher baseline LDH at admission.
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Affiliation(s)
- Alexandre Favà
- Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain,Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
| | - David Cucchiari
- Nephrology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Nuria Montero
- Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain,Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain,Correspondence Nuria Montero
| | - Nestor Toapanta
- Nephrology Department, Hospital de Vall d’ Hebron, Barcelona, Spain
| | | | | | - Ana Coloma
- Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain,Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
| | - Maria Meneghini
- Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain,Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
| | - Anna Manonelles
- Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain,Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
| | - Joana Sellarés
- Nephrology Department, Hospital de Vall d’ Hebron, Barcelona, Spain
| | - Irina Torres
- Nephrology Department, Hospital de Vall d’ Hebron, Barcelona, Spain
| | - Rosana Gelpi
- Nephrology Department, Fundació Puigvert, Barcelona, Spain
| | | | | | - Frederic Cofan
- Nephrology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Manel Perelló
- Nephrology Department, Hospital de Vall d’ Hebron, Barcelona, Spain
| | - Carme Facundo
- Nephrology Department, Fundació Puigvert, Barcelona, Spain
| | - Daniel Seron
- Nephrology Department, Hospital de Vall d’ Hebron, Barcelona, Spain
| | | | - Oriol Bestard
- Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain,Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
| | - Josep M. Cruzado
- Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain,Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain,Josep M. Cruzado
| | - Francesc Moreso
- Nephrology Department, Hospital de Vall d’ Hebron, Barcelona, Spain
| | - Edoardo Melilli
- Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain,Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
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39
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Franco A, Moreso F, Sancho A, Esforzado N, Paul J, Llorente S, Roncero F, Crespo M, Mazuecos A, Mellini E, Guirado L. PROTOCOL BASED ON HEPATITIS C VIRUS NUCLEIC ACID TESTING TO OPTIMIZE RENAL TRANSPLANT FROM SEROPOSITIVE DONORS TO SERONEGATIVE RECIPIENTS. AN EUROPEAN EXPERIENCE. Transplantation 2020. [DOI: 10.1097/01.tp.0000699840.73466.a8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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40
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Jacobs-Cachá C, Vergara A, García-Carro C, Agraz I, Toapanta-Gaibor N, Ariceta G, Moreso F, Serón D, López-Hellín J, Soler MJ. Challenges in primary focal segmental glomerulosclerosis diagnosis: from the diagnostic algorithm to novel biomarkers. Clin Kidney J 2020; 14:482-491. [PMID: 33623672 PMCID: PMC7886539 DOI: 10.1093/ckj/sfaa110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 11/12/2019] [Accepted: 05/04/2020] [Indexed: 12/11/2022] Open
Abstract
Primary or idiopathic focal segmental glomerulosclerosis (FSGS) is a kidney entity that involves the podocytes, leading to heavy proteinuria and in many cases progresses to end-stage renal disease. Idiopathic FSGS has a bad prognosis, as it involves young individuals who, in a considerably high proportion (∼15%), are resistant to corticosteroids and other immunosuppressive treatments as well. Moreover, the disease recurs in 30–50% of patients after kidney transplantation, leading to graft function impairment. It is suspected that this relapsing disease is caused by a circulating factor(s) that would permeabilize the glomerular filtration barrier. However, the exact pathologic mechanism is an unsettled issue. Besides its poor outcome, a major concern of primary FSGS is the complexity to confirm the diagnosis, as it can be confused with other variants or secondary forms of FSGS and also with other glomerular diseases, such as minimal change disease. New efforts to optimize the diagnostic approach are arising to improve knowledge in well-defined primary FSGS cohorts of patients. Follow-up of properly classified primary FSGS patients will allow risk stratification for predicting the response to different treatments. In this review we will focus on the diagnostic algorithm used in idiopathic FSGS both in native kidneys and in disease recurrence after kidney transplantation. We will emphasize those potential confusing factors as well as their detection and prevention. In addition, we will also provide an overview of ongoing studies that recruit large cohorts of glomerulopathy patients (Nephrotic Syndrome Study Network and Cure Glomerulonephropathy, among others) and the experimental studies performed to find novel reliable biomarkers to detect primary FSGS.
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Affiliation(s)
- Conxita Jacobs-Cachá
- Nephrology Research Group, Vall d'hebrón Institut de Recerca (VHIR), Barcelona, Spain.,Department of Nephrology, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.,Red de Investigaciones Renales (RedInRen), Madrid, Spain
| | - Ander Vergara
- Nephrology Research Group, Vall d'hebrón Institut de Recerca (VHIR), Barcelona, Spain.,Department of Nephrology, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Clara García-Carro
- Nephrology Research Group, Vall d'hebrón Institut de Recerca (VHIR), Barcelona, Spain.,Department of Nephrology, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.,Red de Investigaciones Renales (RedInRen), Madrid, Spain
| | - Irene Agraz
- Nephrology Research Group, Vall d'hebrón Institut de Recerca (VHIR), Barcelona, Spain.,Department of Nephrology, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.,Red de Investigaciones Renales (RedInRen), Madrid, Spain
| | - Nestor Toapanta-Gaibor
- Nephrology Research Group, Vall d'hebrón Institut de Recerca (VHIR), Barcelona, Spain.,Department of Nephrology, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Gema Ariceta
- Red de Investigaciones Renales (RedInRen), Madrid, Spain.,Department of Paediatric Nephrology, Hospital Universitari Vall d'Hebron. Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Francesc Moreso
- Nephrology Research Group, Vall d'hebrón Institut de Recerca (VHIR), Barcelona, Spain.,Department of Nephrology, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.,Red de Investigaciones Renales (RedInRen), Madrid, Spain
| | - Daniel Serón
- Nephrology Research Group, Vall d'hebrón Institut de Recerca (VHIR), Barcelona, Spain.,Department of Nephrology, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.,Red de Investigaciones Renales (RedInRen), Madrid, Spain
| | - Joan López-Hellín
- Red de Investigaciones Renales (RedInRen), Madrid, Spain.,Department of Biochemistry, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.,Biochemistry Research Group, Vall d'hebrón Institut de Recerca (VHIR), Barcelona, Spain
| | - Maria José Soler
- Nephrology Research Group, Vall d'hebrón Institut de Recerca (VHIR), Barcelona, Spain.,Department of Nephrology, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.,Red de Investigaciones Renales (RedInRen), Madrid, Spain
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41
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Rincón A, Moreso F, López-Herradón A, Fernández-Robres MA, Cidraque I, Nin J, Méndez O, López M, Pájaro C, Satorra À, Stuard S, Ramos R. The keys to control a COVID-19 outbreak in a haemodialysis unit. Clin Kidney J 2020; 13:542-549. [PMID: 32885797 PMCID: PMC7454433 DOI: 10.1093/ckj/sfaa119] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/25/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The high rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreading represents a challenge to haemodialysis (HD) units. While fast isolation of suspected cases plays an essential role to avoid disease outbreaks, significant rates of asymptomatic cases have recently been described. After detecting an outbreak in one of our HD clinics, wide SARS-CoV-2 screening and segregation of confirmed cases were performed. METHODS The entire clinic population, 192 patients, underwent testing for SARS-CoV-2 detection by real-time reverse-transcriptase polymerase chain reaction . We used univariate and multivariate logistic regression to define variables involved in SARS-CoV-2 infection in our dialysis unit. Later, we analysed differences between symptomatic and asymptomatic SARS-CoV-2-positive patients. RESULTS In total, 22 symptomatic and 14 of the 170 asymptomatic patients had a SARS-CoV-2-positive result. Living in a nursing home/homeless [odds ratio (OR) 3.54; P = 0.026], having been admitted to the reference hospital within the previous 2 weeks (OR 5.19; P = 0.002) and sharing health-care transportation with future symptomatic (OR 3.33; P = 0.013) and asymptomatic (OR 4.73; P = 0.002) positive patients were independent risk factors for a positive test. Nine positive patients (25.7%) remained asymptomatic after a 3-week follow-up. We found no significant differences between symptomatic and asymptomatic SARS-CoV-2-positive patients. CONCLUSIONS Detection of asymptomatic SARS-CoV-2-positive patients is probably one of the key points to controlling an outbreak in an HD unit. Sharing health-care transportation to the dialysis unit, living in a nursing home and having been admitted to the reference hospital within the previous 2 weeks, are major risk factors for SARS-CoV-2 infection.
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Affiliation(s)
- Abraham Rincón
- Medical Department, Fresenius Medical Care Spain, Madrid, Spain
| | - Francesc Moreso
- Medical Department, Fresenius Medical Care Spain, Madrid, Spain
| | | | | | - Ignacio Cidraque
- Tarrasa Dialysis Center, Fresenius Medical Care Spain, Tarrasa, Barcelona, Spain
| | - Jordi Nin
- Hospitalet Dialysis Center, Fresenius Medical Care Spain, Hospitalet de Llobregat, Barcelona, Spain
| | - Orleans Méndez
- Hospitalet Dialysis Center, Fresenius Medical Care Spain, Hospitalet de Llobregat, Barcelona, Spain
| | - Marisol López
- Hospitalet Dialysis Center, Fresenius Medical Care Spain, Hospitalet de Llobregat, Barcelona, Spain
| | - Carlota Pájaro
- Tarrasa Dialysis Center, Fresenius Medical Care Spain, Tarrasa, Barcelona, Spain
| | - Àngels Satorra
- Hospitalet Dialysis Center, Fresenius Medical Care Spain, Hospitalet de Llobregat, Barcelona, Spain
| | - Stefano Stuard
- Global Medical Office - Clinical & Therapeutic Governance EMEA, Fresenius Medical Care, Bad Homburg, Germany
| | - Rosa Ramos
- Medical Department, Fresenius Medical Care Spain, Madrid, Spain
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42
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Chamoun Huacon B, Torres I, Gabaldon A, Toapanta N, Sellares J, Perello M, Moreso F, Seron Micas D. P1741TACROLIMUS FAST METABOLIZERS SHOW A HIGHER PROGRESSION OF INTERTITIAL FIBROSIS AND TUBULAR ATROPHY DURING THE FIRST YEAR AFTER RENAL TRASPLANTATION. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1741] [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] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and Aims
Fast tacrolimus metabolizers (expressed as the blood concentration/ dose ratio; C / D; ng / mL * mg) showed poorer renal function at 2 years, a higher incidence of nephrotoxicity and BK polyomavirus infection. Greater variability of tacrolimus trough levels (CV) from six to twelve months is associated with the appearance of HLA antibodies, interstitial fibrosis / tubular atrophy (IFTA) progression and allograft loss. We evaluate the relationship between C / D, CV and IFTA progression.
Method
We evaluated a cohort of 87 low immunological risk renal transplants treated with prolonged-release tacrolimus, mycophenolate mofetil and steroids. We analyzed paired protocol biopsies at 4 and 18 months. Biopsies were evaluated according to the Banff classification and the progression of IFTA was defined as the difference of ci + ct score> 0 between 18 and 4 months. The C / D ratio was calculated as the average of the value recorded at 3, 6 and 12 months of follow-up. The tacrolimus CV between 6 and 12 months was calculated using all the available determinations.
Results
IFTA progression was observed in 36 cases (41%). In the univariate analysis, it was found that the progression of IFTA was associated with the ci + ct score at 4 months (0.92 ± 0.94 for progressors vs. 1.89 ± 1.26 not progressors, p = 0.0003), and with the average of the C / D ratio (1.70 ± 0.73 for progressors vs. 2.28 ± 1.25 not progressors; p = 0.0144, table 1). An independent association between the C/D ratio and the progression of IFTA was observed in the multivariate analysis (OR: 0.42; 95% CI: 0.22-0.82, p = 0.027).
Conclusion
The results of our work suggest that fast tacrolimus metabolizers (lower C / D ratio) are more susceptible to the nephrotoxic effect of tacrolimus.
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Affiliation(s)
| | - Irina Torres
- Hospital Universitari Vall d'Hebron, Neprhology, Barcelona, Spain
| | | | - Néstor Toapanta
- Hospital Universitari Vall d'Hebron, Neprhology, Barcelona, Spain
| | - Joana Sellares
- Hospital Universitari Vall d'Hebron, Neprhology, Barcelona, Spain
| | - Manel Perello
- Hospital Universitari Vall d'Hebron, Neprhology, Barcelona, Spain
| | - Francesc Moreso
- Hospital Universitari Vall d'Hebron, Neprhology, Barcelona, Spain
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Jacobs Cachá C, Puig Gay N, Helm D, Rettel M, Sellares J, Meseguer A, Savitski MM, Moreso F, Soler MJ, Seron Micas D, López Hellín J. P0349A MISSPROCESSED FORM OF APOLIPOPROTEIN A-I IS SPECIFICALLY ASSOCIATED TO RECURRENT FOCAL SEGMENTAL GLOMERULOSCLEROSIS. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0349] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Recurrence of idiopathic FSGS, a glomerular disease of unknown aetiology, is a serious complication after kidney transplantation. There are no accurate means to diagnose the relapses or to detect the patients at risk. In an exploratory study we detected Apolipoprotein A-Ib (ApoA-Ib), a high molecular weight form of ApoA-I, specifically in urine of kidney transplanted patients that relapsed of FSGS. The diagnostic performance of ApoA-Ib has been assessed in two independent cohorts obtaining high specificity (94,1 %) and sensitivity (87,5 %) to detect FSGS relapses. It has also a potential to detect patients at risk of relapse as ApoA-Ib predates the recurrence episodes in most of the cases. As urinary ApoA-Ib is strongly associated to primary FSGS we aimed to unravel the nature of the modification present in ApoA-Ib.
Method
The whole APOA1 gene was sequenced in ApoA-Ib positive and negative patients and the protein structure was studied using 2D electrophoresis followed by mass spectrometry.
Results
No genetic variations in the APOA1 gene were found in the ApoA-Ib positive patients that could explain the increase in the molecular mass. The mass spectrometry analysis revealed three extra amino acids at the N-Terminal end of ApoA-Ib that were not present in the standard plasmatic form of ApoA-I. These amino acids corresponded to half of the propeptide sequence of the immature form of ApoA-I (proApoA-I). These results suggest that proApoA-I is miss-cleaved producing ApoA-Ib probably due to an altered protease activity in recurrent FSGS patients
Conclusion
ApoA-Ib, found specifically in urine of recurrent FSGS patients, is a misprocessed form of ApoA-I that retains three aminoacids of the six-aminoacid N-terminal propeptide of proApoA-I. The description of ApoA-Ib could be relevant not only to allow the automated analysis of this biomarker in the clinical laboratory but also to shed light into the molecular mechanism of idiopathic FSGS.
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Affiliation(s)
- Conxita Jacobs Cachá
- Vall d'Hebrón Institut de Recerca (VHIR), Nephrology research group, Barcelona, Spain
- Hospital Universitari Vall d'Hebrón, Nephrology department, Barcelona, Spain
| | - Natàlia Puig Gay
- Vall d'Hebrón Institut de Recerca (VHIR), Renal Pathophysiology Group, Barcelona, Spain
| | - Dominic Helm
- European molecular biology laboratory, Proteomics core facility, Heidelberg, Germany
| | - Mandy Rettel
- European molecular biology laboratory, Proteomics core facility, Heidelberg, Germany
| | - Joana Sellares
- Vall d'Hebrón Institut de Recerca (VHIR), Nephrology research group, Barcelona, Spain
- Hospital Universitari Vall d'Hebrón, Nephrology department, Barcelona, Spain
| | - Anna Meseguer
- Vall d'Hebrón Institut de Recerca (VHIR), Renal Pathophysiology Group, Barcelona, Spain
| | - Mikhail M Savitski
- European molecular biology laboratory, Proteomics core facility, Heidelberg, Germany
- European molecular biology laboratory, Genome Biology, Heidelberg, Germany
| | - Francesc Moreso
- Vall d'Hebrón Institut de Recerca (VHIR), Nephrology research group, Barcelona, Spain
- Hospital Universitari Vall d'Hebrón, Nephrology department, Barcelona, Spain
| | - María José Soler
- Vall d'Hebrón Institut de Recerca (VHIR), Nephrology research group, Barcelona, Spain
- Hospital Universitari Vall d'Hebrón, Nephrology department, Barcelona, Spain
| | - Daniel Seron Micas
- Hospital Universitari Vall d'Hebrón, Biochemistry department, Barcelona, Spain
- Vall d'Hebrón Institut de Recerca (VHIR), Biochemistry Research Group, Barcelona, Spain
| | - Joan López Hellín
- Hospital Universitari Vall d'Hebrón, Biochemistry department, Barcelona, Spain
- Vall d'Hebrón Institut de Recerca (VHIR), Biochemistry Research Group, Barcelona, Spain
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Moreso F, Sellarès J, Soler MJ, Serón D. Transcriptome Analysis in Renal Transplant Biopsies Not Fulfilling Rejection Criteria. Int J Mol Sci 2020; 21:ijms21062245. [PMID: 32213927 PMCID: PMC7139324 DOI: 10.3390/ijms21062245] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/11/2020] [Accepted: 03/20/2020] [Indexed: 01/02/2023] Open
Abstract
The clinical significance of renal transplant biopsies displaying borderline changes suspicious for T-cell mediated rejection (TCMR) or interstitial fibrosis and tubular atrophy (IFTA) with interstitial inflammation has not been well defined. Molecular profiling to evaluate renal transplant biopsies using microarrays has been shown to be an objective measurement that adds precision to conventional histology. We review the contribution of transcriptomic analysis in surveillance and indication biopsies with borderline changes and IFTA associated with variable degrees of inflammation. Transcriptome analysis applied to biopsies with borderline changes allows to distinguish patients with rejection from those in whom mild inflammation mainly represents a response to injury. Biopsies with IFTA and inflammation occurring in unscarred tissue display a molecular pattern similar to TCMR while biopsies with IFTA and inflammation in scarred tissue, apart from T-cell activation, also express B cell, immunoglobulin and mast cell-related genes. Additionally, patients at risk for IFTA progression can be identified by genes mainly reflecting fibroblast dysregulation and immune activation. At present, it is not well established whether the expression of rejection gene transcripts in patients with fibrosis and inflammation is the consequence of an alloimmune response, tissue damage or a combination of both.
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Ramos R, González M, Moreso F, Castelao A, Grinyó J. Chylous Ascites: An Unusual Complication of Percutaneous Peritoneal Catheter Implantation. Perit Dial Int 2020. [DOI: 10.1177/089686080602600623] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- R. Ramos
- Nephrology Department Hospital Universitario Bellvitge L'Hospitalet de Llobregat Barcelona, Spain
| | - M.T. González
- Nephrology Department Hospital Universitario Bellvitge L'Hospitalet de Llobregat Barcelona, Spain
| | - F. Moreso
- Nephrology Department Hospital Universitario Bellvitge L'Hospitalet de Llobregat Barcelona, Spain
| | - A.M. Castelao
- Nephrology Department Hospital Universitario Bellvitge L'Hospitalet de Llobregat Barcelona, Spain
| | - J.M. Grinyó
- Nephrology Department Hospital Universitario Bellvitge L'Hospitalet de Llobregat Barcelona, Spain
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46
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Ramos R, Moreso F, Borras M, Ponz E, Buades JM, Teixidó J, Morey A, Garcia C, Vera M, Doñate MT, de Arellano MR, Barbosa F, González MT. Sevelamer Hydrochloride in Peritoneal Dialysis Patients: Results of a Multicenter Cross-Sectional Study. Perit Dial Int 2020. [DOI: 10.1177/089686080702700618] [Citation(s) in RCA: 11] [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: 11/17/2022] Open
Abstract
Background Sevelamer hydrochloride is a phosphate binder widely employed in hemodialysis patients. Until now, information about its efficacy and safety in peritoneal dialysis patients has been scarce. Patients and Methods In September 2005 a cross-sectional study of demographic, biochemical, and therapeutic data of patients from 10 peritoneal dialysis units in Catalonia and the Balearic Islands, Spain, was conducted. Results We analyzed data from 228 patients. At the time of the study, 128 patients (56%) were receiving sevelamer. Patients receiving sevelamer were younger ( p < 0.01), showed a longer period of time on dialysis ( p < 0.01), and had a lower Charlson Comorbidity Index ( p < 0.01). Serum calcium and intact parathyroid hormone levels were not different between the two groups, while phosphate levels <5.5 mg/dL were observed more frequently in patients not receiving sevelamer (79% vs 61%, p < 0.01). Serum total cholesterol (167 ± 41 vs 189 ± 42 mg/dL, p < 0.01) and low density lipoprotein (LDL) cholesterol (90 ± 34 vs 109 ± 34 mg/dL, p < 0.01), but not high density lipoprotein cholesterol or triglycerides, were lower in sevelamer-treated patients. Moreover, sevelamer-treated patients displayed a higher serum albumin (38 ± 5 vs 36 ± 4 g/L, p < 0.01) and a lower C-reactive protein (4.9 ± 12.8 vs 8.8 ± 15.7 mg/L, p < 0.01). Blood bicarbonate levels <22 mmol/L were observed more frequently in patients receiving sevelamer (22% vs 5%, p < 0.01). Logistic regression analysis adjusting by confounding variables confirmed that sevelamer therapy was associated with serum total cholesterol <200 mg/dL [relative risk (RR): 2.77, 95% confidence interval (CI): 1.44 – 5.26, p = 0.002] and blood bicarbonate <22 mmol/L (RR: 8.5, 95% CI: 2.6 – 27.0, p < 0.001), but not with serum phosphate >5.5 mg/dL, calcium–phosphate product >55 mg2/dL2, serum albumin <35 g/L, or C-reactive protein >5 mg/L. Conclusions This uncontrolled cross-sectional study in peritoneal dialysis patients showed that sevelamer hydro-chloride treatment allows an adequate serum phosphate level in about 60% of patients and significantly reduces total and LDL-cholesterol levels. Since this treatment is associated with metabolic acidosis in 22% of patients, we recommend close monitoring of bicarbonate levels in this group of patients until the clinical significance of this result is clarified.
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Affiliation(s)
- Rosa Ramos
- Servei de Nefrologia, Hospital Universitari de Bellvitge, L'Hospitalet, Barcelona
| | - Francesc Moreso
- Servei de Nefrologia, Hospital Universitari de Bellvitge, L'Hospitalet, Barcelona
| | | | | | | | | | | | | | | | | | | | | | - M. Teresa González
- Servei de Nefrologia, Hospital Universitari de Bellvitge, L'Hospitalet, Barcelona
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47
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Palomo M, Blasco M, Molina P, Lozano M, Praga M, Torramade-Moix S, Martinez-Sanchez J, Cid J, Escolar G, Carreras E, Paules C, Crispi F, Quintana LF, Poch E, Rodas L, Goma E, Morelle J, Espinosa M, Morales E, Avila A, Cabello V, Ariceta G, Chocron S, Manrique J, Barros X, Martin N, Huerta A, Fraga-Rodriguez GM, Cao M, Martin M, Romera AM, Moreso F, Manonelles A, Gratacos E, Pereira A, Campistol JM, Diaz-Ricart M. Complement Activation and Thrombotic Microangiopathies. Clin J Am Soc Nephrol 2019; 14:1719-1732. [PMID: 31694864 PMCID: PMC6895490 DOI: 10.2215/cjn.05830519] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/02/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Atypical hemolytic uremic syndrome is a form of thrombotic microangiopathy caused by dysregulation of the alternative complement pathway. There is evidence showing complement activation in other thrombotic microangiopathies. The aim of this study was to evaluate complement activation in different thrombotic microangiopathies and to monitor treatment response. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Complement activation was assessed by exposing endothelial cells to sera or activated-patient plasma-citrated plasma mixed with a control sera pool (1:1)-to analyze C5b-9 deposits by immunofluorescence. Patients with atypical hemolytic uremic syndrome (n=34) at different stages of the disease, HELLP syndrome (a pregnancy complication characterized by hemolysis, elevated liver enzymes, and low platelet count) or severe preeclampsia (n=10), and malignant hypertension (n=5) were included. RESULTS Acute phase atypical hemolytic uremic syndrome-activated plasma induced an increased C5b-9 deposition on endothelial cells. Standard and lower doses of eculizumab inhibited C5b-9 deposition in all patients with atypical hemolytic uremic syndrome, except in two who showed partial remission and clinical relapse. Significant fibrin formation was observed together with C5b-9 deposition. Results obtained using activated-plasma samples were more marked and reproducible than those obtained with sera. C5b-9 deposition was also increased with samples from patients with HELLP (all cases) and preeclampsia (90%) at disease onset. This increase was sustained in those with HELLP after 40 days, and levels normalized in patients with both HELLP and preeclampsia after 6-9 months. Complement activation in those with malignant hypertension was at control levels. CONCLUSIONS The proposed methodology identifies complement overactivation in patients with atypical hemolytic uremic syndrome at acute phase and in other diseases such as HELLP syndrome and preeclampsia. Moreover, it is sensitive enough to individually assess the efficiency of the C5 inhibition treatment.
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Affiliation(s)
- Marta Palomo
- Josep Carreras Leukaemia Research Institute; .,Hematopathology, Department of Pathology, Centre de Diagnostic Biomedic (CDB), Hospital Clinic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,Barcelona Endothelium Team, Barcelona, Spain
| | - Miquel Blasco
- Department of Nephrology and Renal Transplantation, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain.,Group of nephro-urological diseases and renal transplantation (IDIBAPS), Barcelona, Spain
| | - Patricia Molina
- Hematopathology, Department of Pathology, Centre de Diagnostic Biomedic (CDB), Hospital Clinic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Miquel Lozano
- Apheresis Unit, Department of Hemotherapy and Hemostasis, Institut Clinic de Malalties Hematologiques i Oncologiques (ICMHO), IDIBAPS, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Manuel Praga
- Department of Nephrology, Hospital Universitario 12 de Octubre and Research Institute i+12, Madrid, Spain.,Department of Medicine, Universidad Complutense, Madrid, Spain
| | - Sergi Torramade-Moix
- Hematopathology, Department of Pathology, Centre de Diagnostic Biomedic (CDB), Hospital Clinic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Julia Martinez-Sanchez
- Josep Carreras Leukaemia Research Institute.,Hematopathology, Department of Pathology, Centre de Diagnostic Biomedic (CDB), Hospital Clinic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,Barcelona Endothelium Team, Barcelona, Spain
| | - Joan Cid
- Apheresis Unit, Department of Hemotherapy and Hemostasis, Institut Clinic de Malalties Hematologiques i Oncologiques (ICMHO), IDIBAPS, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Gines Escolar
- Hematopathology, Department of Pathology, Centre de Diagnostic Biomedic (CDB), Hospital Clinic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Enric Carreras
- Josep Carreras Leukaemia Research Institute.,Barcelona Endothelium Team, Barcelona, Spain
| | - Cristina Paules
- Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clinic de Barcelona and Hospital Sant Joan de Deu), ICGON, IDIBAPS, Universitat de Barcelona and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER), Barcelona, Spain
| | - Fatima Crispi
- Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clinic de Barcelona and Hospital Sant Joan de Deu), ICGON, IDIBAPS, Universitat de Barcelona and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER), Barcelona, Spain
| | - Luis F Quintana
- Department of Nephrology and Renal Transplantation, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain.,Group of nephro-urological diseases and renal transplantation (IDIBAPS), Barcelona, Spain
| | - Esteban Poch
- Department of Nephrology and Renal Transplantation, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain.,Group of nephro-urological diseases and renal transplantation (IDIBAPS), Barcelona, Spain
| | - Lida Rodas
- Department of Nephrology and Renal Transplantation, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain
| | - Emma Goma
- Department of Nephrology and Renal Transplantation, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain
| | - Johann Morelle
- Division of Nephrology, Cliniques universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Mario Espinosa
- Department of Nephrology, Hospital Universitario Reina Sofía e Instituto Maimonides de Investigaciones Biológicas de Córdoba (IMIBIC), Córdoba, Spain
| | - Enrique Morales
- Department of Nephrology, Hospital Universitario 12 de Octubre and Research Institute i+12, Madrid, Spain
| | - Ana Avila
- Department of Nephrology and Renal Transplantation, Hospital Universitario Dr Peset, Valencia, Spain
| | - Virginia Cabello
- Department of Nephrology, Hospital Virgen del Rocio, Sevilla, Spain
| | - Gema Ariceta
- Department of Pediatric Nephrology, Hospital Materno-Infantil, Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Sara Chocron
- Department of Pediatric Nephrology, Hospital Materno-Infantil, Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Joaquin Manrique
- Department of Nephrology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Xoana Barros
- Department of Nephrology, Hospital Universitari Josep Trueta, Girona, Spain
| | - Nadia Martin
- Department of Nephrology, Hospital Universitari Josep Trueta, Girona, Spain
| | - Ana Huerta
- Department of Nephrology, Hospital Puerta de Hierro Majadahonda, Madrid, Spain
| | - Gloria M Fraga-Rodriguez
- Department of Pediatric Nephrology, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Mercedes Cao
- Department of Nephrology, Complejo Hospitalario Universitario A Coruña, Coruña, Spain
| | - Marisa Martin
- Department of Nephrology, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Ana Maria Romera
- Department of Nephrology, Hospital General Universitario, Ciudad Real, Spain
| | - Francesc Moreso
- Department of Nephrology, Hospital Universitari Vall d'Hebron, Universitat Autonoma Barcelona, Barcelona, Spain
| | - Anna Manonelles
- Kidney Transplant Unit, Department of Nephrology, Hospital de Bellvitge, Universitat de Barcelona, Barcelona, Spain; and
| | - Eduard Gratacos
- Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clinic de Barcelona and Hospital Sant Joan de Deu), ICGON, IDIBAPS, Universitat de Barcelona and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER), Barcelona, Spain
| | | | - Josep M Campistol
- Department of Nephrology and Renal Transplantation, Hospital Clinic de Barcelona, Universitat de Barcelona, Spain
| | - Maribel Diaz-Ricart
- Hematopathology, Department of Pathology, Centre de Diagnostic Biomedic (CDB), Hospital Clinic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,Barcelona Endothelium Team, Barcelona, Spain
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Porrini E, Díaz JM, Moreso F, Lauzurrica R, Ibernon M, Torres IS, Ruiz RB, Rodríguez Rodríguez AE, Mallén PD, Bayés-Genís B, Gainza FJ, Osorio JM, Osuna A, Domínguez R, Ruiz JC, Sosa AJ, Rinne AG, Miranda DM, Macías M, Torres A. Prediabetes is a risk factor for cardiovascular disease following renal transplantation. Kidney Int 2019; 96:1374-1380. [PMID: 31611066 DOI: 10.1016/j.kint.2019.06.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 04/12/2019] [Revised: 06/04/2019] [Accepted: 06/27/2019] [Indexed: 12/14/2022]
Abstract
Prediabetes and post-transplant diabetes mellitus affect about 20-30% of renal transplant patients. The latter is a risk factor for cardiovascular disease. However, no clear evidence linking prediabetes and cardiovascular disease is available. To study this we analyzed the impact of prediabetes on cardiovascular disease in 603 renal transplant patients followed with repeated oral glucose tests for up to five years and a long term survival evaluation. Prediabetes and post-transplant diabetes mellitus were defined at 12 months after transplantation to avoid their high reversibility rate before this period. 73 cardiovascular events were observed. The incidence of events was significantly higher in patients with either prediabetes, (17%; 0.023 person/year) or post-transplant diabetes mellitus (20%; 0.028 person/year) than in normal individuals, (7%; 0.0095 person/year). The incidence of events was comparable between prediabetes and post-transplant diabetes mellitus. Prediabetes at 12 months was a risk factor for cardiovascular events in univariate and multivariate Cox survival analyses (hazard ratio 2.24, 95% confidence interval 1.11-4.52). Prediabetes at three months and hemoglobin A1c at 12 months were not significantly associated with cardiovascular disease. Thus, prediabetes is a risk factor for cardiovascular disease in renal transplantation, a population at high risk for cardiovascular events. Since prediabetes is potentially a reversible condition, there is an opportunity to prevent cardiovascular disease in this population.
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Affiliation(s)
- Esteban Porrini
- Instituto de Tecnologías Biomédicas, University of La Laguna, Tenerife, Spain.
| | | | | | | | | | | | | | | | | | | | | | - José Manuel Osorio
- Nephrology Section, Hospital Nuestra Señora Virgen de las Nieves, Granada, Spain
| | - Antonio Osuna
- Nephrology Section, Hospital Nuestra Señora Virgen de las Nieves, Granada, Spain
| | - Rosa Domínguez
- Nephrology Unit, Hospital Marqués de Valdecilla, Santander, Spain
| | - Juan Carlos Ruiz
- Nephrology Unit, Hospital Marqués de Valdecilla, Santander, Spain
| | | | | | | | - Manuel Macías
- Nephrology Unit, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, Spain
| | - Armando Torres
- Instituto de Tecnologías Biomédicas, University of La Laguna, Tenerife, Spain; Nephrology Unit, Hospital Universitario de Canarias, La Laguna, Spain
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49
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Pérez-Sáez MJ, Lafuente Covarrubias O, Hernández D, Moreso F, Melilli E, Juega J, de Sousa E, López-Sánchez P, Rodríguez-Ferrero ML, Maruri-Kareaga N, Navarro MD, Valero R, Mazuecos MA, Llamas F, Martín-Moreno P, Fernández-García A, Espí J, Jiménez C, Ramos A, Gavela E, Pascual J, Portolés JM. Early outcomes of kidney transplantation from elderly donors after circulatory death (GEODAS study). BMC Nephrol 2019; 20:233. [PMID: 31242927 PMCID: PMC6593497 DOI: 10.1186/s12882-019-1412-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 06/06/2019] [Indexed: 01/20/2023] Open
Abstract
Background Spain has dramatically increased the number of controlled circulatory death donors (cDCD). The initial selection criteria for considering cDCD for kidney transplantation (KT) have been expanded progressively, with practically no limits in donor age during the last years. We aimed to analyze the early clinical outcomes using expanded (> 65 years) cDCD in comparison with standard ones. Methods Observational multicenter study including 19 transplant centers in Spain. We performed a systematic inclusion in a central database of every KT from expanded cDCD at each participant unit from January-2012 to January-2017. Surgical procedures and immunosuppressive protocols were based on local practices. Data was analyzed in the central office using logistic and Cox regression or competitive-risk models for multivariate analysis. Median time of follow-up was 18.1 months. Results 561 KT were performed with kidneys from cDCD, 135 from donors older than 65 years. As expected, recipients from older cDCD were also older (65.8 (SD 8.8) vs 53.7 (SD 11.4) years; p < 0.001) and with higher comorbidity. At 1 year, no differences were found amongst older and younger cDCD KT recipients in terms of serum creatinine (1.6 (SD 0.7) vs 1.5 (SD 0.8) mg/dl; p = 0.29). Non-death censored graft survival was inferior, but death-censored graft survival was not different (95.5 vs 98.2% respectively; p = 0.481). They also presented a trend towards higher delayed graft function (55.4 vs 46.7%; p = 0.09) but a similar rate of primary non-function (3.7 vs 3.1%; p = 0.71), and acute rejection (3.0 vs 6.3%; p = 0.135). In the multivariate analysis, in short follow-up, donor age was not related with worse survival or poor kidney function (eGFR < 30 ml/min). Conclusions The use of kidneys from expanded cDCD is increasing for older and comorbid patients. Short-term graft outcomes are similar for expanded and standard cDCD, so they constitute a good-enough source of kidneys to improve the options of KT wait-listed patients.
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Affiliation(s)
- María José Pérez-Sáez
- Nephrology Department and Kidney Transplantation Program, Hospital del Mar, Parc de Salut Mar, Universitat Autónoma Barcelona and Universitat Pompeu Fabra, Nephropaties Research Group Institute Mar for Medical Research, Passeig Maritim 25-29, 08003, Barcelona, Spain
| | - Omar Lafuente Covarrubias
- Nephrology & Transplant Department, University Hospital Puerta de Hierro, Universidad Autónoma Madrid, Public Research Net RedInRen ISCIII 016/009, C/Manuel de Falla s/n, 28222, Majadahonda, Madrid, Spain
| | | | | | | | | | | | - Paula López-Sánchez
- Nephrology & Transplant Department, University Hospital Puerta de Hierro, Universidad Autónoma Madrid, Public Research Net RedInRen ISCIII 016/009, C/Manuel de Falla s/n, 28222, Majadahonda, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | - Julio Pascual
- Nephrology Department and Kidney Transplantation Program, Hospital del Mar, Parc de Salut Mar, Universitat Autónoma Barcelona and Universitat Pompeu Fabra, Nephropaties Research Group Institute Mar for Medical Research, Passeig Maritim 25-29, 08003, Barcelona, Spain.
| | - Jose M Portolés
- Nephrology & Transplant Department, University Hospital Puerta de Hierro, Universidad Autónoma Madrid, Public Research Net RedInRen ISCIII 016/009, C/Manuel de Falla s/n, 28222, Majadahonda, Madrid, Spain.
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50
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Jacobs Cachá C, Puig Gay N, Joana S, Guirado L, Gonzalez-Roncero F, Jiménez C, Zárraga S, Paul J, Lauzurica R, Alonso ÁN, Fernandez A, Mazuecos A, Hernandez D, Rodriguez-Benot A, Crespo M, Meseguer A, Moreso F, Seron D, Cantarell C, Lopez-Hellin J. FP205APOLIPOPROTEIN A-IB AS BIOMARKER OF FSGS RECURRENCE AFTER KIDNEY TRANSPLANTATION: DIAGNOSTIC PERFORMANCE AND ASSESSMENT OF ITS PROGNOSTIC VALUE. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz106.fp205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - Sellarés Joana
- Hospital Vall d'Hebrón Institut de Recerca, Barcelona, Spain
| | | | | | | | | | | | | | - ÁNgel Alonso
- Hospital Universitario de A Coruña, A Coruña, Spain
| | | | | | | | | | | | - Anna Meseguer
- Hospital Vall d'Hebrón Institut de Recerca, Barcelona, Spain
| | - Francesc Moreso
- Hospital Vall d'Hebrón Institut de Recerca, Barcelona, Spain
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