1
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Shan J, Dang MH, Javaid MM, Kanaan Z, Ierino F. Delayed acute tubular necrosis following COVID-19. Intern Med J 2023; 53:1509-1510. [PMID: 37599227 DOI: 10.1111/imj.16171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 01/31/2023] [Indexed: 08/22/2023]
Affiliation(s)
- Jocelyn Shan
- Nephrology Department, St Vincent's Hospital, Melbourne, Victoria, Australia
- Woodlands Health, Singapore
| | - Minh H Dang
- Nephrology Department, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Muhammad M Javaid
- Woodlands Health, Singapore
- Deakin University, Melbourne, Victoria, Australia
| | - Zakariya Kanaan
- Nephrology Department, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Francesco Ierino
- Nephrology Department, St Vincent's Hospital, Melbourne, Victoria, Australia
- Melbourne University, Melbourne, Victoria, Australia
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2
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Knowles SR, Apputhurai P, Jenkins Z, O'flaherty E, Ierino F, Langham R, Ski CF, Thompson DR, Castle DJ. Impact of chronic kidney disease on illness perceptions, coping, self-efficacy, psychological distress and quality of life. PSYCHOL HEALTH MED 2023; 28:1963-1976. [PMID: 36794381 DOI: 10.1080/13548506.2023.2179644] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 02/07/2023] [Indexed: 02/17/2023]
Abstract
Chronic kidney disease (CKD) negatively impacts psychological well-being and quality of life (QoL). Underpinned by the Common Sense Model (CSM), this study evaluated the potential mediating role of self-efficacy, coping styles and psychological distress on the relationship between illness perceptions and QoL in patients living with CKD. Participants were 147 people with stage 3-5 kidney disease. Measures included eGFR, illness perceptions, coping styles, psychological distress, self-efficacy and QoL. Correlational analyses were performed, followed by regression modelling. Poorer QoL was associated with greater distress, engagement in maladaptive coping, poorer illness perceptions and lower self-efficacy. Regression analysis revealed that illness perceptions predicted QoL, with psychological distress acting as a mediator. The proportion of variance explained was 63.8%. These findings suggest that psychological interventions are likely to enhance QoL in CKD, if they target the mediating psychological processes associated with illness perceptions and psychological distress.
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Affiliation(s)
- Simon R Knowles
- School of Health Sciences, Swinburne University, Melbourne, Australia
| | | | - Zoe Jenkins
- Mental Health Services, St. Vincent's Hospital, Melbourne, Australia
| | - Emmet O'flaherty
- Nephrology Service, St. Vincent's Hospital, Melbourne, Australia
| | - Francesco Ierino
- Nephrology Service, St. Vincent's Hospital, Melbourne, Australia
| | - Robyn Langham
- St. Vincent's Hospital, University of Melbourne Department of Medicine, Melbourne, Australia
| | - Chantal F Ski
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
- Integrated Care Academy, University of Suffolk, Ipswich, UK
| | - David R Thompson
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - David J Castle
- Mental Health Services, St. Vincent's Hospital, Melbourne, Australia
- Centre for Complex Interventions, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
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3
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Panaccio D, Ierino F, Goodman D. Correctional health care and Australian prisoners as recipients of kidney transplants: Legal and ethical issues. Nephrology (Carlton) 2023. [PMID: 37381107 DOI: 10.1111/nep.14197] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/23/2023] [Accepted: 06/07/2023] [Indexed: 06/30/2023]
Abstract
AIM This research aims to examine the legal and ethical issues surrounding Australia prisoners as potential kidney transplant recipients. METHODS Examination of relevant statutory and common law including human rights law, state and territory corrections legislation and negligence law. Ethical principles considered, particularly in regards to practical and logistical considerations including adequate delivery of transplantation medical care and implications on the broader organ donation program. Approaches in the United States of America and United Kingdom are compared with the Australian approach. RESULTS Prisoners are more likely than non-incarcerated individuals to have chronic medical conditions. For most people with kidney failure, kidney transplantation improves both quality of life and life expectancy compared with dialysis therapy. Prisoners have a right to access reasonable medical care under state-based corrections legislation, which is underpinned by human rights law and ethical principles, primarily beneficence, transparency and justice. The right of prisoners to receive reasonable medical care likely extends to ensuring prisoners with kidney failure are considered for kidney transplantation and waitlisted if medically appropriate. Social factors and logistical factors can be relevant when considering eligibility for transplantation as they can relate to a person's ability to comply with medical therapy. Additionally, organ allocation decisions can be emotive, and a decision to offer a kidney transplant to a prisoner may generate significant negative publicity. CONCLUSION Prisoners with kidney failure should be considered for kidney transplantation. Logistical barriers, such as guard availability, should be addressed by state departments responsible for prisoner health.
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Affiliation(s)
- Danielle Panaccio
- Department of Nephrology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Francesco Ierino
- Department of Nephrology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - David Goodman
- Department of Nephrology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
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4
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Lu JC, Lee P, Ierino F, MacIsaac RJ, Ekinci E, O'Neal D. Challenges of Glycemic Control in People With Diabetes and Advanced Kidney Disease and the Potential of Automated Insulin Delivery. J Diabetes Sci Technol 2023:19322968231174040. [PMID: 37162092 DOI: 10.1177/19322968231174040] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Diabetes is the leading cause of chronic kidney disease (CKD) and end-stage kidney disease in the world. It is known that maintaining optimal glycemic control can slow the progression of CKD. However, the failing kidney impacts glucose and insulin metabolism and contributes to increased glucose variability. Conventional methods of insulin delivery are not well equipped to adapt to this increased glycemic lability. Automated insulin delivery (AID) has been established as an effective treatment in patients with type 1 diabetes mellitus, and there is emerging evidence for their use in type 2 diabetes mellitus. However, few studies have examined their role in diabetes with concurrent advanced CKD. We discuss the potential benefits and challenges of AID use in patients with diabetes and advanced CKD, including those on dialysis.
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Affiliation(s)
- Jean C Lu
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
- Australian Centre for Accelerating Diabetes Innovations, The University of Melbourne, Parkville, VIC, Australia
| | - Petrova Lee
- Department of Nephrology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Francesco Ierino
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
- Department of Nephrology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
- St Vincent's Institute of Medical Research, Fitzroy, VIC, Australia
| | - Richard J MacIsaac
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
- Australian Centre for Accelerating Diabetes Innovations, The University of Melbourne, Parkville, VIC, Australia
| | - Elif Ekinci
- Australian Centre for Accelerating Diabetes Innovations, The University of Melbourne, Parkville, VIC, Australia
- Department of Endocrinology and Diabetes, Austin Health, Heidelberg, VIC, Australia
- Department of Medicine, Austin Hospital, The University of Melbourne, Heidelberg, VIC, Australia
| | - David O'Neal
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
- Australian Centre for Accelerating Diabetes Innovations, The University of Melbourne, Parkville, VIC, Australia
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5
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Hodgson R, Christiansen D, Ierino F, Sandrin M. Inducible Co-Stimulator (ICOS) in transplantation: A review. Transplant Rev (Orlando) 2022; 36:100713. [PMID: 35878486 DOI: 10.1016/j.trre.2022.100713] [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: 03/31/2022] [Revised: 06/26/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022]
Abstract
Prevention of T cell activation is one of the goals of successful organ and tissue transplantation. Blockade of T cell co-stimulation, particularly of the CD28:B7 interaction, has been shown to prolong graft survival. Inducible Co-Stimulator (ICOS) is the third member of the B7 family and here we review the literature on ICOS, its receptor (B7RP-1), and blockade of this pathway in transplant models. ICOS:B7RP-1 are a single receptor:ligand pair with a loss of function of either being implicated in some autoimmune diseases. ICOS has multiple functions, related to its constitutive expression on B cells and activated T cells. In in vitro transplant models, ICOS:B7RP-1 blockade has produced mixed results as to its ability to modulate lymphocyte proliferation. Several in vivo transplant models demonstrate varying degrees of success in prolonging graft survival. Timing and dose of treatment appear important, and combination with other immunosuppressive treatments may also be of benefit. As ICOS has multiple functions, it may be that the observed variable results are due to inadvertent inactivation of graft protective functions. If these barriers can be overcome, ICOS:B7RP-1 blockade could provide an important target for future immunosuppression regimens.
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Affiliation(s)
- Russell Hodgson
- Department of Surgery, University of Melbourne, Heidelberg, Australia; Division of Surgery, Northern Health, Epping, Australia.
| | - Dale Christiansen
- Department of Surgery, University of Melbourne, Heidelberg, Australia
| | - Francesco Ierino
- Department of Surgery, University of Melbourne, Heidelberg, Australia; Department of Nephrology, St Vincent's Hospital, Fitzroy, Australia
| | - Mauro Sandrin
- Department of Surgery, University of Melbourne, Heidelberg, Australia
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6
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Martin K, Lorenzo YSP, Leung PYM, Chung S, O'flaherty E, Barker N, Ierino F. Clinical Outcomes and Risk Factors for Tunneled Hemodialysis Catheter-Related Bloodstream Infections. Open Forum Infect Dis 2020; 7:ofaa117. [PMID: 32550235 PMCID: PMC7291682 DOI: 10.1093/ofid/ofaa117] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/03/2020] [Indexed: 11/13/2022] Open
Abstract
Diabetes and left internal jugular vein insertion site were significantly associated with increased risk of a catheter-related bloodstream infection from a tunneled hemodialysis catheter. Ex-smoker status was significantly associated with reduced risk.
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Affiliation(s)
- Kylie Martin
- Department of Nephrology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Yves S Poy Lorenzo
- Pharmacy Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.,University of Melbourne, Melbourne Medical School, Department of Medicine, Fitzroy, Victoria, Australia
| | - Po Yee Mia Leung
- Department of Nephrology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Sheri Chung
- Pharmacy Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Emmet O'flaherty
- Department of Nephrology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Nuala Barker
- Department of Nephrology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Francesco Ierino
- Department of Nephrology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.,University of Melbourne, Melbourne Medical School, Department of Medicine, Fitzroy, Victoria, Australia
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7
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RAO N, Kumar R, Ford S, Goodman D, Ierino F, Mayer R, Lahham Y, Michell I, Gock H. SUN-299 FACTORS ASSOCIATED WITH POSTOPERATIVE BLOOD TRANSFUSIONS FOLLOWING RENAL TRANSPLANTATION. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.836] [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: 11/29/2022] Open
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8
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Bongetti E, Kavanagh D, Martin K, Bendall A, Hill P, Steinberg A, Rajaram Y, Ierino F. Cocaine-associated atypical haemolytic uraemic syndrome in a genetically susceptible individual. Nephrology (Carlton) 2020; 25:518-521. [PMID: 31900968 DOI: 10.1111/nep.13690] [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: 09/21/2019] [Revised: 11/21/2019] [Accepted: 12/02/2019] [Indexed: 11/27/2022]
Abstract
Atypical haemolytic uraemic syndrome (aHUS) is a severe, life-threatening condition that requires early recognition and urgent treatment. In aHUS rare genetic variants in CFH, CFI, CD46, C3 and CFB predispose to complement over activation. This case describes a case of aHUS in which there was a strong temporal association between disease onset and the use of smoked cocaine. The patient was found to have a rare genetic variant in the CFI gene which may have been unmasked by first-time exposure to cocaine. The patient stabilized and improved with early administration of eculizumab, supporting the notion of an underlying immunological pathogenesis and the importance of early intervention.
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Affiliation(s)
- Elisa Bongetti
- Department of Nephrology, St. Vincent's Hospital, Melbourne, Australia
| | - David Kavanagh
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,The National Renal Complement Therapeutics Centre (NRCTC), Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Kylie Martin
- Department of Nephrology, St. Vincent's Hospital, Melbourne, Australia
| | - Anna Bendall
- Department of Nephrology, St. Vincent's Hospital, Melbourne, Australia
| | - Prue Hill
- Department of Nephrology, St. Vincent's Hospital, Melbourne, Australia
| | - Adam Steinberg
- Department of Nephrology, St. Vincent's Hospital, Melbourne, Australia
| | - Yogeshwar Rajaram
- Department of Nephrology, St. Vincent's Hospital, Melbourne, Australia
| | - Francesco Ierino
- Department of Nephrology, St. Vincent's Hospital, Melbourne, Australia
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9
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Metz DK, Holford N, Kausman JY, Walker A, Cranswick N, Staatz CE, Barraclough KA, Ierino F. Optimizing Mycophenolic Acid Exposure in Kidney Transplant Recipients: Time for Target Concentration Intervention. Transplantation 2019; 103:2012-2030. [PMID: 31584924 PMCID: PMC6756255 DOI: 10.1097/tp.0000000000002762] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [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: 01/28/2019] [Revised: 03/29/2019] [Accepted: 04/03/2019] [Indexed: 12/24/2022]
Abstract
The immunosuppressive agent mycophenolate is used extensively in kidney transplantation, yet dosing strategy applied varies markedly from fixed dosing ("one-dose-fits-all"), to mycophenolic acid (MPA) trough concentration monitoring, to dose optimization to an MPA exposure target (as area under the concentration-time curve [MPA AUC0-12]). This relates in part to inconsistent results in prospective trials of concentration-controlled dosing (CCD). In this review, the totality of evidence supporting mycophenolate CCD is examined: pharmacological characteristics, observational data linking exposure to efficacy and toxicities, and randomized controlled trials of CCD, with attention to dose optimization method and exposure achieved. Fixed dosing of mycophenolate consistently leads to underexposure associated with rejection, as well as overexposure associated with toxicities. When CCD is driven by pharmacokinetic calculation to a target concentration (target concentration intervention), MPA exposure is successfully controlled and clinical benefits are seen. There remains a need for consensus on practical aspects of mycophenolate target concentration intervention in contemporary tacrolimus-containing regimens and future research to define maintenance phase exposure targets. However, given ongoing consequences of both overimmunosuppression and underimmunosuppression in kidney transplantation, impacting short- and long-term outcomes, these should be a priority. The imprecise "one-dose-fits-all" approach should be replaced by the clinically proven MPA target concentration strategy.
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Affiliation(s)
- David K. Metz
- Department of Nephrology, Royal Children’s Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Clinical Pharmacology Unit, Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Nick Holford
- Department of Pharmacology and Clinical Pharmacology, University of Auckland, Auckland, New Zealand
| | - Joshua Y. Kausman
- Department of Nephrology, Royal Children’s Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children’s Research Institute, Melbourne, VIC, Australia
| | - Amanda Walker
- Department of Nephrology, Royal Children’s Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children’s Research Institute, Melbourne, VIC, Australia
| | - Noel Cranswick
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Clinical Pharmacology Unit, Royal Children’s Hospital, Melbourne, VIC, Australia
| | | | - Katherine A. Barraclough
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Department of Nephrology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Francesco Ierino
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Department of Nephrology, St Vincent’s Health, Melbourne, VIC, Australia
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10
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Martin K, Poy-Lorenzo Y, Leung P, Chung S, O'Flaherty E, Barker N, Ierino F. MON-133 CLINICAL OUTCOMES AND RISK FACTORS FOR TUNNELLED HAEMODIALYSIS CATHETER-RELATED BLOODSTREAM INFECTIONS. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.924] [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: 10/26/2022] Open
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11
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MARTIN K, Poy-Lorenzo Y, Still G, O'flaherty E, Barker N, Ierino F. SAT-052 VIGILANCE, SURVEILLANCE AND EDUCATION REDUCES RATES OF TUNNELLED HAEMODIALYSIS CATHETER-RELATED BLOODSTREAM INFECTIONS. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.075] [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: 11/27/2022] Open
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12
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Martin K, Roberts V, Chong G, Goodman D, Hill P, Ierino F. Eculizumab therapy in gemcitabine-induced thrombotic microangiopathy in a renal transplant recipient. Oxf Med Case Reports 2019; 2019:omz048. [PMID: 31214360 DOI: 10.1093/omcr/omz048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/11/2019] [Accepted: 04/13/2019] [Indexed: 11/14/2022] Open
Abstract
A renal transplant recipient 7 years post-transplantation, diagnosed with locally advanced pancreatic adenocarcinoma developed thrombotic microangiopathy (TMA) after treatment with gemcitabine and nab-paclitaxel. Gemcitabine was the most likely cause for TMA and was ceased. He received methylprednisolone and plasma exchange with fresh frozen plasma and albumin. Despite plasma exchange, his renal allograft function worsened, and he had persistent haematological evidence of haemolysis. Eculizumab was commenced with resolution-significant improvement in his renal and haematological markers. This case highlights an unusual occurrence of progressive gemcitabine-induced TMA in a renal allograft that had an excellent response to eculizumab. The clinical response also demonstrates involvement of complement dysregulation in gemcitabine-induced TNA.
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Affiliation(s)
- Kylie Martin
- Department of Nephrology, St Vincent's Hospital Melbourne, Fitzroy 3065 Victoria, Australia
| | - Veena Roberts
- Department of Nephrology, St Vincent's Hospital Melbourne, Fitzroy 3065 Victoria, Australia
| | - Geoff Chong
- Olivia-Newton John Cancer, Wellness and Research Centre, Austin Hospital, Heidelberg, Australia
| | - David Goodman
- Department of Nephrology, St Vincent's Hospital Melbourne, Fitzroy 3065 Victoria, Australia
| | - Prue Hill
- Department of Nephrology, St Vincent's Hospital Melbourne, Fitzroy 3065 Victoria, Australia
| | - Francesco Ierino
- Department of Nephrology, St Vincent's Hospital Melbourne, Fitzroy 3065 Victoria, Australia
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13
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Rodrigues TS, Azraai M, Crosthwaite A, Patel S, Farouque O, Ramchand J, Lim R, Roberts M, Ierino F, Burrell L. The Peguero-Lo Presti Criteria Improve the Sensitivity of the Electrocardiogram to Diagnose Left Ventricular Hypertrophy in Patients with End-Stage Kidney Disease. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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14
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Ducharlet K, Thyagarajan D, Ierino F, McMahon LP, Lee D. Perioperative risk assessment for successful kidney transplant in leigh syndrome: a case report. BMC Nephrol 2018; 19:23. [PMID: 29390978 PMCID: PMC5796450 DOI: 10.1186/s12882-018-0816-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 01/17/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Leigh syndrome (LS) is a rare neurodegenerative mitochondrial disorder which typically presents in childhood but has a varied clinical course. Renal involvement such as proximal tubulopathy in patients with mitochondrial disorders has been described. However, end stage renal disease (ESRD) is uncommon and literature regarding patients undergoing kidney transplantation is limited. Successful deceased donor renal transplant has not been previously described in a patient with Leigh Syndrome. CASE PRESENTATION We report a 21-year-old Han Chinese man who presented with limb weakness and unsteady gait, which progressed rapidly over a period of months until he was wheelchair-bound. He subsequently developed ESRD and was commenced on hemodialysis. Investigations revealed a m.13513G > A mutation with clinical and radiological features consistent with LS. His mitochondrial disease stabilised and he underwent a multidisciplinary assessment for deceased donor kidney transplantation to identify and minimise the LS-associated perioperative risks and potential negative effects of immunosuppressants on his LS. Successful kidney transplantation followed with excellent graft function three and a half years post-transplant and improvement in the patient's physical function. CONCLUSION This case highlights the importance of careful pre-transplant perioperative risk assessment and post-transplant care in a rare and heterogeneous neurological disease to achieve an ultimately excellent clinical outcome. To our knowledge, this is the first report of successful deceased donor kidney transplant in a patient with known LS.
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Affiliation(s)
- Kathryn Ducharlet
- Department of Renal Medicine, Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, Clayton, VIC, Australia.
| | - Dominic Thyagarajan
- Department of Neurosciences, Monash Health, 246 Clayton Road, Clayton, VIC, Australia
| | - Francesco Ierino
- Department of Nephrology, St Vincent's Hospital Melbourne, 55 Victoria Parade, Fitzroy, VIC, Australia
| | - Lawrence P McMahon
- Department of Renal Medicine, Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, Clayton, VIC, Australia
| | - Darren Lee
- Department of Renal Medicine, Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, Clayton, VIC, Australia
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15
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Urbancic K, Ierino F, Phillips E, Mount P, Mahony A, Trubiano J. Taking the challenge: A protocolized approach to optimize Pneumocystis pneumonia prophylaxis in renal transplant recipients. Am J Transplant 2018; 18:462-466. [PMID: 28898546 PMCID: PMC5790633 DOI: 10.1111/ajt.14498] [Citation(s) in RCA: 18] [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: 06/19/2017] [Revised: 09/05/2017] [Accepted: 09/06/2017] [Indexed: 01/25/2023]
Abstract
While trimethoprim-sulfamethoxazole is considered first-line therapy for Pneumocystis pneumonia prevention in renal transplant recipients, reported adverse drug reactions may limit use and increase reliance on costly and less effective alternatives, often aerosolized pentamidine. We report our experience implementing a protocolized approach to trimethoprim-sulfamethoxazole adverse drug reaction assessment and rechallenge to optimize prophylaxis in this patient cohort. We retrospectively reviewed 119 patients receiving Pneumocystis pneumonia prophylaxis prior to and after protocol implementation. Forty-two patients (35%) had 48 trimethoprim-sulfamethoxazole adverse drug reactions documented either at baseline or during the prophylaxis period, of which 83% were non-immune-mediated and 17% were immune-mediated. Significantly more patients underwent trimethoprim-sulfamethoxazole rechallenge after protocol implementation (4/22 vs 23/27; P = .0001), with no recurrence of adverse drug reactions in 74%. In those who experienced a new or recurrent reaction (26%), all were mild and self-limiting with only 1 recurrence of an immune-mediated reaction. After protocol implementation, aerosolized pentamidine-associated costs were reduced. The introduction of a standard approach to trimethoprim-sulfamethoxazole rechallenge in the context of both prior immune and non-immune-mediated reactions was safe and successful in improving the uptake of first-line Pneumocystis pneumonia prophylaxis in renal transplant recipients.
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Affiliation(s)
- K.F Urbancic
- Pharmacy Department, Austin Health, Heidelberg, VIC, Australia,Infectious Diseases Department, Austin Health, Heidelberg, VIC, Australia,National Centre for Infections in Cancer, National Health and Medical Research Council Centre of Research Excellence, Peter MacCallum Cancer Centre, Department of Oncology, University of Melbourne, Parkville, VIC, Australia,Department of Medicine, University of Melbourne, Parkville, VIC Australia
| | - F Ierino
- Nephrology Department, St Vincent's Hospital, Melbourne, VIC, Australia
| | - E Phillips
- Infectious Diseases Department, Vanderbilt University Medical Center, Nashville, Tennessee, U.S
| | - P.F Mount
- Nephrology Department, Austin Health, Heidelberg, VIC, Australia
| | - A Mahony
- Infectious Diseases Department, Austin Health, Heidelberg, VIC, Australia,Department of Medicine, University of Melbourne, Parkville, VIC Australia
| | - J.A Trubiano
- Infectious Diseases Department, Austin Health, Heidelberg, VIC, Australia,National Centre for Infections in Cancer, National Health and Medical Research Council Centre of Research Excellence, Peter MacCallum Cancer Centre, Department of Oncology, University of Melbourne, Parkville, VIC, Australia,Department of Medicine, University of Melbourne, Parkville, VIC Australia
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16
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Chen Y, Colville D, Ierino F, Symons A, Savige J. Temporal retinal thinning and the diagnosis of Alport syndrome and Thin basement membrane nephropathy. Ophthalmic Genet 2017; 39:208-214. [PMID: 29172845 DOI: 10.1080/13816810.2017.1401088] [Citation(s) in RCA: 12] [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] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Alport syndrome is an inherited disease characterized by renal failure, hearing loss, and ocular abnormalities, including temporal retinal thinning. This study compared retinal thinning in Alport syndrome and other renal diseases. METHODS Alport syndrome was diagnosed on renal biopsy and genetic testing. Subjects underwent optical coherence tomography (OCT) (Spectralis OCT, Heidelberg Instruments). Retinal thinning was determined from horizontal macular OCT scans through the foveal center using the formula: Temporal thickness index (TTI) = (nasal - temporal thickness) ÷ nasal thickness × 100%, and compared with the normal range for each age group. Statistical analysis was performed using Student's t test, Mann-Whitney U test, and ROC analysis (SPPS, IBM). RESULTS The mean temporal retinal thickness index was 12.4 ± 5.2% in men (n = 19) and 7.4 ± 1.4% in women (n = 28) with X-linked Alport syndrome; 13.1 ± 4.5% (n = 4) in recessive disease; 6.4 ± 2.2% (n = 5) in Thin basement membrane nephropathy; and 6.3 ± 3.3% (n = 14) in other renal diseases. Thinning was worse in men than women with X-linked disease (p < 0.01), and worse in men who developed early onset renal failure (R2 = 0.75). Temporal retinal thinning was 84% sensitive for men with X-linked Alport syndrome and 67% specific (AUC = 0.83) compared with other renal diseases. CONCLUSIONS Retinal temporal thinning is diagnostic for X-linked Alport syndrome in men and distinguishes them this condition from Thin basement membrane nephropathy, but only in men (p = 0.002). Temporal retinal thinning may also identify men and women with the rarer autosomal recessive disease.
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Affiliation(s)
- Yan Chen
- a Department of Medicine, Melbourne Health and Northern Health , The University of Melbourne , Melbourne , Australia
| | - Deb Colville
- a Department of Medicine, Melbourne Health and Northern Health , The University of Melbourne , Melbourne , Australia
| | - Francesco Ierino
- b Department of Nephrology , Austin Health, Heidelberg , Heidelberg , Australia
| | - Andrew Symons
- c Department of Ophthalmology and Surgery , Melbourne Health , Melbourne , Australia
| | - Judy Savige
- a Department of Medicine, Melbourne Health and Northern Health , The University of Melbourne , Melbourne , Australia
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Degen D, Kanellis J, Hughes P, Barit D, Ierino F. Primary central nervous system posttransplant lymphoproliferative disease: An uncommon diagnostic dilemma. Nephrology (Carlton) 2016; 21:528. [PMID: 27188412 DOI: 10.1111/nep.12626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 09/12/2015] [Accepted: 09/14/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Dov Degen
- Department of Nephrology, Austin Health, Melbourne, Victoria, Australia.
| | - John Kanellis
- Department of Nephrology, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Peter Hughes
- Department of Nephrology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - David Barit
- Department of Nephrology, Northern Hospital, Melbourne, Victoria, Australia
| | - Francesco Ierino
- Department of Nephrology, Austin Health, Melbourne, Victoria, Australia
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18
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Ooi QL, Tow FKNFH, Deva R, Kawasaki R, Wong TY, Colville D, Ierino F, Hutchinson A, Savige J. Microvascular Disease After Renal Transplantation. Kidney Blood Press Res 2015; 40:575-83. [DOI: 10.1159/000368533] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2015] [Indexed: 11/19/2022] Open
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19
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Chadban S, Eris J, Russ G, Campbell S, Chapman J, Pussell B, Trevillian P, Ierino F, Thomson N, Hutchison B, Irish A, Woodcock C, Kurstjens N, Walker R. Enteric-coated mycophenolate sodium in combination with full dose or reduced dose cyclosporine, basiliximab and corticosteroids in Australian de novo kidney transplant patients. Nephrology (Carlton) 2013; 18:63-70. [PMID: 23110508 DOI: 10.1111/nep.12004] [Citation(s) in RCA: 5] [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] [Accepted: 10/18/2012] [Indexed: 11/28/2022]
Abstract
AIM Cyclosporine (CsA), dosed to achieve C2 targets, has been shown to provide safe and efficacious immunosuppression when used with a mycophenolate and steroids for de novo kidney transplant recipients. This study examined whether use of enteric-coated mycophenolate sodium (EC-MPS) together with basiliximab and steroids would enable use of CsA dosed to reduced C2 targets in order to achieve improved graft function. METHODS Twelve-month, prospective, randomized, open-label trial in de novo kidney transplant recipients in Australia. Seventy-five patients were randomized to receive either usual exposure (n = 33) or reduced exposure (n = 42) CsA, EC-MPS 720 mg twice daily, basiliximab and corticosteroids. RESULTS There was no significant difference in mean Cockcroft-Gault CrCl (creatinine clearance) (60.2 ± 17.6 mL/min per 1.73 m(2) vs 63.2 ± 24.3, P = 0.64 for usual versus reduced exposure respectively) at 6 months. There was no significant difference between treatment groups in the incidence of treatment failure defined as biopsy proven acute rejection, graft loss or death (secondary endpoint: 30.3% full exposure vs 35.7% reduced exposure). At 12 months the incidence of overall adverse events was the same in both groups. CONCLUSION This exploratory study suggests de novo renal transplant patients can safely receive a treatment regimen of either full or reduced exposure CsA in combination with EC-MPS, corticosteroids and basiliximab, with no apparent difference in efficacy or graft function during the first year after transplant.
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Affiliation(s)
- Steve Chadban
- Transplantation, Royal Prince Alfred Hospital, Sydney, Australia.
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20
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Lin WX, Christiansen D, Roberts MA, Sandrin MS, Ierino F. IMMUNO-MONITORING OF PERIPHERAL BLOOD T REGULATORY CELLS IN RENAL & LIVER TRANSPLANT RECIPIENTS POST-TRANSPLANTATION. Transplantation 2010. [DOI: 10.1097/00007890-201007272-00961] [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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21
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Abstract
This report describes a case of adenovirus infection in a renal allograft 36 days after transplantation that presented with transient macroscopic hematuria, prominent systemic features and acute renal dysfunction. The patient had persistent high fevers despite broad antibiotic cover. A CT scan demonstrated a new discrete space occupying lesion in the allograft, which was devoid of blood flow on Doppler sonography. A targeted renal biopsy showed florid and focal necrotizing interstitial nephritis with intranuclear tubular viral inclusions. Treatment with ganciclovir and reduction in immunosuppression resulted in a rapid improvement. Immunohistochemistry and electron microscopy confirmed adenovirus infection. This case demonstrates an uncommon presentation of necrotizing adenoviral nephropathy, which should be considered in cases of renal allograft mass lesions.
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Affiliation(s)
- Andy Kim Ho Lim
- Department of Nephrology, Austin Health, Studley Road, Heidelberg, Melbourne, Victoria 3084, Australia
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22
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Lian M, Mulley W, Kan K, MacGregor D, Tosolini A, Ierino F. Nephrotic range proteinuria in a renal transplant associated with oncocytoma of the native kidney. Nephrol Dial Transplant 2004; 19:482-5. [PMID: 14736980 DOI: 10.1093/ndt/gfg526] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michael Lian
- Department of Nephrology, Austin Health, Heidelberg, Victoria, Australia
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23
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Alwayn IP, Buhler L, Basker M, Goepfert C, Kawai T, Kozlowski T, Ierino F, Sachs DH, Sackstein R, Robson SC, Cooper DK. Coagulation/thrombotic disorders associated with organ and cell xenotransplantation. Transplant Proc 2000; 32:1099. [PMID: 10936376 DOI: 10.1016/s0041-1345(00)01141-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- I P Alwayn
- Transplantation Biology Research Center, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts 02129, USA
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Abstract
Permanent tolerance to vascularized skeletal tissue allografts can be induced in miniature swine with minor antigen differences using a 12-day course of CsA. Demonstration of skeletal tissue allograft survival in a large animal model without long-term immunosuppression represents an important step toward transplantation of skeletal tissue allografts in humans.
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Affiliation(s)
- W P Lee
- Plastic Surgery Research Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA
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25
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Banerjee PT, Ierino F, Kaynor GC, Giovino M, Sablinski T, Emery DW, Rosa MD, LeGuern C, Sachs DH, Monroy RL. Retrovirus-mediated transfer and expression of swine MHC class II genes in CD34+ monkey stem cells. Transplant Proc 1996; 28:747-8. [PMID: 8623378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- P T Banerjee
- BioTransplant, Inc., Charlestown, Massachusetts 02129, USA
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26
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Loftus WK, Ierino F, Mathew TH. Enalapril and anaemia. Med J Aust 1988; 148:209-10. [PMID: 2828897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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