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Benner SE, Eby Y, Zhu X, Fernandez RE, Patel EU, Ruff JE, Habtehyimer F, Schmidt HA, Kirby CS, Hussain S, Ostrander D, Desai NM, Florman S, Rana MM, Friedman-Moraco R, Pereira MR, Mehta S, Stock P, Gilbert A, Morris MI, Stosor V, Mehta SA, Small CB, Ranganna K, Santos CA, Aslam S, Husson J, Malinis M, Elias N, Blumberg EA, Doby BL, Massie AB, Smith ML, Odim J, Quinn TC, Laird GM, Siliciano RF, Segev DL, Redd AD, Durand CM, Tobian AA. The effect of induction immunosuppression for kidney transplant on the latent HIV reservoir. JCI Insight 2022; 7:162968. [PMID: 36345940 PMCID: PMC9675561 DOI: 10.1172/jci.insight.162968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/14/2022] [Indexed: 11/09/2022] Open
Abstract
The HIV latent viral reservoir (LVR) remains a major challenge in the effort to find a cure for HIV. There is interest in lymphocyte-depleting agents, used in solid organ and bone marrow transplantation to reduce the LVR. This study evaluated the LVR and T cell receptor repertoire in HIV-infected kidney transplant recipients using intact proviral DNA assay and T cell receptor sequencing in patients receiving lymphocyte-depleting or lymphocyte-nondepleting immunosuppression induction therapy. CD4+ T cells and intact and defective provirus frequencies decreased following lymphocyte-depleting induction therapy but rebounded to near baseline levels within 1 year after induction. In contrast, these biomarkers were relatively stable over time in the lymphocyte-nondepleting group. The lymphocyte-depleting group had early TCRβ repertoire turnover and newly detected and expanded clones compared with the lymphocyte-nondepleting group. No differences were observed in TCRβ clonality and repertoire richness between groups. These findings suggest that, even with significant decreases in the overall size of the circulating LVR, the reservoir can be reconstituted in a relatively short period of time. These results, while from a relatively unique population, suggest that curative strategies aimed at depleting the HIV LVR will need to achieve specific and durable levels of HIV-infected T cell depletion.
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Affiliation(s)
| | | | | | - Reinaldo E. Fernandez
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Eshan U. Patel
- Department of Pathology and
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Feben Habtehyimer
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | | | - Sarah Hussain
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Darin Ostrander
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Niraj M. Desai
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Meenakshi M. Rana
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Marcus R. Pereira
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Shikha Mehta
- Department of Medicine, University of Alabama Heersink School of Medicine, Birmingham, Alabama, USA
| | - Peter Stock
- Department of Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Alexander Gilbert
- Medstar Transplant Institute, Georgetown University School of Medicine, Washington, DC, USA
| | - Michele I. Morris
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Valentina Stosor
- Departments of Medicine and Surgery, Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Sapna A. Mehta
- Department of Surgery, New York University Grossman School of Medicine, NYU Langone Health, New York, New York, USA
| | - Catherine B. Small
- Department of Medicine, Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA
| | - Karthik Ranganna
- Department of Medicine, Drexel University, Philadelphia, Pennsylvania, USA
| | - Carlos A.Q. Santos
- Divison of Infectious Diseases, Rush University Medical Center, Chicago, Illinois, USA
| | - Saima Aslam
- Department of Medicine, University of California, San Diego, San Diego, California, USA
| | - Jennifer Husson
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Maricar Malinis
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Nahel Elias
- Department of Surgery and Transplant Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Emily A. Blumberg
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brianna L. Doby
- Positive Rhetoric LLC, Bowling Green, Kentucky, USA
- Department of Public Health Sciences, College of Health, Education, and Social Transformation, New Mexico State University, Las Cruces, New Mexico, USA
| | - Allan B. Massie
- Department of Surgery, New York University Grossman School of Medicine, NYU Langone Health, New York, New York, USA
| | - Melissa L. Smith
- Department of Biochemistry and Molecular Genetics, University of Louisville, Louisville, Kentucky, USA
| | - Jonah Odim
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | - Thomas C. Quinn
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | | | - Robert F. Siliciano
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Surgery, New York University Grossman School of Medicine, NYU Langone Health, New York, New York, USA
| | - Andrew D. Redd
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | - Christine M. Durand
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Yousefipour Z, Kwende S, Ranganna K, Selvam C. LP-26 Effect of Synthetic Curcumin in Prevention of Induction of Inflammatory and Oxidative Response Caused by Acrolein in the Small Intestine of Rats. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.768] [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]
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Mejia CD, Malat GE, Boyle SM, Ranganna K, Lee DH. Experience with a six-month regimen of Pneumocystis pneumonia prophylaxis in 122 HIV-positive kidney transplant recipients. Transpl Infect Dis 2020; 23:e13511. [PMID: 33217136 DOI: 10.1111/tid.13511] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 10/28/2020] [Accepted: 11/08/2020] [Indexed: 11/29/2022]
Abstract
Anti-Pneumocystis pneumonia (PCP) prophylaxis is recommended for 3 to 6 months post-transplant in HIV-negative kidney transplant recipients. For HIV-positive kidney transplant recipients, there is no definite duration of primary prophylaxis and is often prescribed life-long. The objective of this study was to determine the incidence of PCP in HIV-positive recipients who received 6 months of prophylaxis with trimethoprim-sulfamethoxazole or an alternative agent. One hundred and twenty-two HIV-positive recipients received a kidney transplant from 2001 to 2017 at Hahnemann University Hospital. Most patients received induction immunosuppression with an IL-2 receptor antagonist, with or without intravenous immunoglobulin. Only one patient received anti-thymocyte globulin. Maintenance immunosuppression included a calcineurin-inhibitor (tacrolimus or cyclosporine), an antiproliferative agent (mycophenolate or sirolimus), and prednisone. Mean CD4 cell count was 461 ± 127 cells/uL prior to transplant and 463 ± 229 cells/μL at 6 to 12 months after transplant. None of the recipients developed PCP after a median follow-up of 2.88 years (IQR 1.16-4.87). Based on our observation, a 6-month regimen of PCP prophylaxis may be sufficient among HIV-positive recipients, similar to those without HIV infection.
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Affiliation(s)
- Christina D Mejia
- Division of Nephrology, Johns Hopkins University, Baltimore, MD, USA
| | - Gregory E Malat
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Suzanne M Boyle
- Division of Nephrology, Hypertension, and Kidney Transplantation, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Karthik Ranganna
- Division of Nephrology, Drexel University College of Medicine, West Reading, PA, USA
| | - Dong Heun Lee
- Division of Infectious Diseases, University of California San Francisco, San Francisco, CA, USA
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4
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Boyle SM, Fehr K, Deering C, Raza A, Harhay MN, Malat G, Ranganna K, Lee DH. Barriers to kidney transplant evaluation in HIV-positive patients with advanced kidney disease: A single-center study. Transpl Infect Dis 2020; 22:e13253. [PMID: 31994821 DOI: 10.1111/tid.13253] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 01/09/2020] [Accepted: 01/12/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND HIV-positive kidney transplant (KT) recipients have similar outcomes to HIV-negative recipients. However, HIV-positive patients with advanced kidney disease might face additional barriers to initiating the KT evaluation process. We sought to characterize comorbidities, viral control and management, viral resistance, and KT evaluation appointment rates in a cohort of KT evaluation-eligible HIV-positive patients. METHODS We included patients seen between January 1, 2008, and December 31, 2015, at a primary care HIV clinic who met KT evaluation eligibility by an estimated glomerular filtration rate ≤20 mL/min/1.73 meters2 or dialysis dependence. The primary outcome was a documented appointment for KT evaluation. RESULTS Of 3735 patients evaluated at the HIV primary clinic during the study period, 42 (1.6%) were KT evaluation-eligible patients. The median age was 47 years, 77% were male, and 95%, black. Median CD4 count was 328 cells/mm3 (IQR 175-461). Among the 63% percent with antiretroviral therapy (ART) prescription, 40% had viral loads >200 copies. Among patients with HIV resistance profiles (50%, n = 21), 52% had resistance to at least one class of ART. A majority (60%, n = 25) were scheduled for KT evaluation appointment, but of those, only 8% (n = 2) had evidence of appointments before dialysis dependence. Those without appointments had more schizophrenia (29% vs 4%, P = .02), resistance (78% vs 33%, P = .04), ART prescription (76% vs 48%, P = .04), and more kidney disease of unknown etiology (53% vs 8%, P = .02). CONCLUSION Kidney transplant evaluation-eligible HIV-positive patients had a high rate of evaluation appointments, but a low rate of preemptive evaluation appointments. Schizophrenia and viral resistance disproportionally affected patients without evaluation appointments. These data precede the recommendation for universal ART for all HIV+ patients, regardless of CD4 count and viral load, and must be interpreted in the context of this limitation.
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Affiliation(s)
- Suzanne M Boyle
- Division Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Kallie Fehr
- Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Catylin Deering
- Division of Infectious Disease, Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Abbas Raza
- Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Meera N Harhay
- Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania.,Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania.,Tower Health System, Tower Health Transplant Institute, West Reading, Pennsylvania
| | - Gregory Malat
- Department of Medicine, Renal, Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karthik Ranganna
- Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania.,Tower Health System, Tower Health Transplant Institute, West Reading, Pennsylvania
| | - Dong Heun Lee
- Division of Infectious Disease and HIV Medicine, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
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Crow LD, Jambusaria‐Pahlajani A, Chung CL, Baran DA, Lowenstein SE, Abdelmalek M, Ahmed RL, Anadkat MJ, Arcasoy SM, Berg D, Bibee KP, Billingsley E, Black WH, Blalock TW, Bleicher M, Brennan DC, Brodland DG, Brown MR, Carroll BT, Carucci JA, Chang TW, Chaux G, Cusack CA, Dilling DF, Doyle A, Emtiazjoo AM, Ferguson NH, Fosko SW, Fox MC, Goral S, Gray AL, Griffin JR, Hachem RR, Hall SA, Hanlon AM, Hayes D, Hickey GW, Holtz J, Hopkins RS, Hu J, Huang CC, Brian Jiang SI, Kapnadak SG, Kraus ES, Lease ED, Leca N, Lee JC, Leitenberger JJ, Lim MA, Longo MI, Malik SM, Mallea JM, Menter A, Myers SA, Neuburg M, Nijhawan RI, Norman DJ, Otley CC, Paek SY, Parulekar AD, Patel MJ, Patel VA, Patton TJ, Pugliano‐Mauro M, Ranganna K, Ravichandran AK, Redenius R, Roll GR, Samie FH, Shin T, Singer JP, Singh P, Soon SL, Soriano T, Squires R, Stasko T, Stein JA, Taler SJ, Terrault NA, Thomas CP, Tokman S, Tomic R, Twigg AR, Wigger MA, Zeitouni NC, Arron ST. Initial skin cancer screening for solid organ transplant recipients in the United States: Delphi method development of expert consensus guidelines. Transpl Int 2019; 32:1268-1276. [DOI: 10.1111/tri.13520] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 03/25/2019] [Accepted: 09/02/2019] [Indexed: 12/25/2022]
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6
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Harhay MN, Ranganna K, Boyle SM, Brown AM, Bajakian T, Levin Mizrahi LB, Xiao G, Guy S, Malat G, Segev DL, Reich D, McAdams-DeMarco M. Association Between Weight Loss Before Deceased Donor Kidney Transplantation and Posttransplantation Outcomes. Am J Kidney Dis 2019; 74:361-372. [PMID: 31126666 PMCID: PMC6708783 DOI: 10.1053/j.ajkd.2019.03.418] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 03/07/2019] [Indexed: 12/25/2022]
Abstract
RATIONALE & OBJECTIVE There is debate on whether weight loss, a hallmark of frailty, signals higher risk for adverse outcomes among recipients of deceased donor kidney transplantation (DDKT). STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS Using national Organ Procurement and Transplantation Network data, we included all DDKT recipients in the United States between December 4, 2004, and December 3, 2014, who were adults (aged ≥ 18 years) when listed for DDKT. EXPOSURES Relative pre-DDKT weight change as a continuous predictor and categorized as <5% weight change from listing to DDKT, ≥5% to <10% weight loss, ≥10% weight loss, ≥5% to <10% weight gain, and ≥10% weight gain. OUTCOMES We examined 3 post-DDKT outcomes: (1) transplant hospitalization length of stay (LOS) in days, (2) all-cause graft failure, and (3) mortality. ANALYTIC APPROACH Unadjusted fractional polynomial methods, multivariable log-gamma models, and multivariable Cox proportional hazards models. RESULTS Among 94,465 recipients of DDKT, median pre-DDKT weight change was 0 (interquartile range, -3.5 to +3.9) kg. There were nonlinear unadjusted associations between relative pre-DDKT weight loss and longer transplant hospitalization LOS, higher all-cause graft loss, and higher mortality. Compared with recipients with <5% pre-DDKT weight change (n = 49,366; 52%), recipients who lost ≥10% of their listing weight (n = 10,614; 11%) had 0.66 (95% CI, 0.23-1.09) days longer average transplant hospitalization LOS (P = 0.003), 1.11-fold higher graft loss (adjusted HR [aHR], 1.11; 95% CI, 1.06-1.17; P < 0.001), and 1.18-fold higher mortality (aHR, 1.18; 95% CI, 1.11-1.25; P < 0.001) independent of recipient, donor, and transplant factors. Pre-DDKT dialysis exposure, listing body mass index category, and waiting time modified the association of pre-DDKT weight change with hospital LOS (interaction P < 0.10), but not with all-cause graft loss and mortality. LIMITATIONS Unmeasured confounders and inability to identify volitional weight change. Also, the higher significance level set to increase the power of detecting interactions with the fixed sample size may have resulted in increased risk for type 1 error. CONCLUSIONS DDKT recipients with ≥10% pre-DDKT weight loss are at increased risk for adverse outcomes and may benefit from augmented support post-DDKT.
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Affiliation(s)
- Meera Nair Harhay
- Division of Nephrology and Hypertension, Department of Medicine, Drexel University College of Medicine, Philadelphia, PA; Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA.
| | - Karthik Ranganna
- Division of Nephrology and Hypertension, Department of Medicine, Drexel University College of Medicine, Philadelphia, PA
| | - Suzanne M Boyle
- Division of Nephrology and Hypertension, Department of Medicine, Drexel University College of Medicine, Philadelphia, PA
| | - Antonia M Brown
- Division of Nephrology and Hypertension, Department of Medicine, Drexel University College of Medicine, Philadelphia, PA
| | - Thalia Bajakian
- Division of Nephrology and Hypertension, Department of Medicine, Drexel University College of Medicine, Philadelphia, PA
| | - Lissa B Levin Mizrahi
- Division of Nephrology and Hypertension, Department of Medicine, Drexel University College of Medicine, Philadelphia, PA
| | - Gary Xiao
- Division of Multiorgan Transplantation, Department of Surgery, Drexel University College of Medicine, Philadelphia, PA
| | - Stephen Guy
- Division of Multiorgan Transplantation, Department of Surgery, Drexel University College of Medicine, Philadelphia, PA
| | - Gregory Malat
- Division of Multiorgan Transplantation, Department of Surgery, Drexel University College of Medicine, Philadelphia, PA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - David Reich
- Division of Multiorgan Transplantation, Department of Surgery, Drexel University College of Medicine, Philadelphia, PA
| | - Mara McAdams-DeMarco
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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7
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Lee DH, Malat G, Boyle SM, Talluri S, Bias TE, Harhay MN, Ranganna K, Doyle A. Safety and Efficacy of Universal Postoperative Decolonization for Kidney Transplant Recipients. EXP CLIN TRANSPLANT 2019; 18:153-156. [PMID: 31266440 DOI: 10.6002/ect.2018.0341] [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: 11/05/2022]
Abstract
OBJECTIVES Infection is a common cause of morbidity and mortality after kidney transplant. Based on the well-documented successes of reducing infections with decolonization of patients in intensive care units, we began a universal immediate posttransplant decolonization program for all kidney transplant recipients. Herein, we report safety and efficacy of this decolonization program. MATERIALS AND METHODS We compared a consecutive cohort of kidney transplant recipients who underwent universal decolonization (intervention group) with a cohort of transplant patients from an era immediately prior to this practice (control group). Universal decolonization included daily chlorhexidine body wash and nasal mupirocin ointment. RESULTS Seventy-eight patients who underwent universal decolonization were compared with 43 patients in the control group. Ten microbiologically proven infections (8.3%) occurred in the 30 days after discharge: 7 (9%) in the intervention group and 3 (7%) in the control group. Forty-five transplant recipients (37.2%) were readmitted in the 30 days after discharge: 31 (39.7%) in the intervention group and 14 (32.6%) in the control group. No patients in the intervention group had adverse drug events from mupirocin and chlorhexidine use. CONCLUSIONS A universal decolonization protocol was successfully implemented and was well tolerated by all patients. Despite successful implementation, we did not observe any significant differences in infection rates between treated patients and historical controls.
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Affiliation(s)
- Dong Heun Lee
- From the Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
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8
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Harhay MN, Harhay MO, Ranganna K, Boyle SM, Levin Mizrahi L, Guy S, Malat GE, Xiao G, Reich DJ, Patzer RE. Association of the kidney allocation system with dialysis exposure before deceased donor kidney transplantation by preemptive wait-listing status. Clin Transplant 2018; 32:e13386. [PMID: 30132986 DOI: 10.1111/ctr.13386] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/08/2018] [Accepted: 08/16/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND It is unknown whether the new kidney transplant allocation system (KAS) has attenuated the advantages of preemptive wait-listing as a strategy to minimize pretransplant dialysis exposure. METHODS We performed a retrospective study of adult US deceased donor kidney transplant (DDKT) recipients between December 4, 2011-December 3, 2014 (pre-KAS) and December 4, 2014-December 3, 2017 (post-KAS). We estimated pretransplant dialysis durations by preemptive listing status in the pre- and post-KAS periods using multivariable gamma regression models. RESULTS Among 65 385 DDKT recipients, preemptively listed recipients (21%, n = 13 696) were more likely to be white (59% vs 34%, P < 0.001) and have private insurance (64% vs 30%, P < 0.001). In the pre- and post-KAS periods, average adjusted pretransplant dialysis durations for preemptively listed recipients were <2 years in all racial groups. Compared to recipients who were listed after starting dialysis, preemptively listed recipients experienced 3.85 (95% Confidence Interval [CI] 3.71-3.99) and 4.53 (95% CI 4.32-4.74) fewer average years of pretransplant dialysis in the pre- and post-KAS periods, respectively (P < 0.001 for all comparisons). CONCLUSIONS Preemptively wait-listed DDKT recipients continue to experience substantially fewer years of pretransplant dialysis than recipients listed after dialysis onset. Efforts are needed to improve both socioeconomic and racial disparities in preemptive wait-listing.
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Affiliation(s)
- Meera N Harhay
- Division of Nephrology and Hypertension, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania.,Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Michael O Harhay
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karthik Ranganna
- Division of Nephrology and Hypertension, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Suzanne M Boyle
- Division of Nephrology and Hypertension, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Lissa Levin Mizrahi
- Division of Nephrology and Hypertension, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Stephen Guy
- Division of Multi-Organ Transplantation and Hepatobiliary Surgery, Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Gregory E Malat
- Division of Multi-Organ Transplantation and Hepatobiliary Surgery, Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Gary Xiao
- Division of Multi-Organ Transplantation and Hepatobiliary Surgery, Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - David J Reich
- Division of Multi-Organ Transplantation and Hepatobiliary Surgery, Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Rachel E Patzer
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
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9
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Siddiqui WJ, Alvarez C, Aslam M, Bakar A, Khan MH, Aslam A, Hanif MO, Hasni SF, Ranganna K, Eisen H, Aggarwal S. Meta-Analysis Comparing Outcomes and Need for Renal Replacement Therapy of Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement. Am J Cardiol 2018; 122:468-476. [PMID: 29958709 DOI: 10.1016/j.amjcard.2018.04.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/11/2018] [Accepted: 04/17/2018] [Indexed: 11/18/2022]
Abstract
Acute kidney injury (AKI) is commonly associated with aortic valve replacement. Surgical aortic valve replacement (SAVR) is a known risk factor for AKI but little is known about the short- and long-term effects of transcatheter aortic valve implantation (TAVI). The purpose of our analysis is to identify the short- and long-term effect of TAVI on renal outcomes. We searched Medline and PUBMED from January 1, 2000 to November 6, 2017 for randomized control trials (RCTs) comparing TAVI to SAVR in patients with severe aortic stenosis. Three hundred sixty-nine trials were identified, 6 RCTs were included in our analysis. RevMan version 5.3 was used for statistical analysis. Heterogeneity is calculated using I2 statistics. Primary outcomes were AKI within 30 days and 1 year of TAVI, and requirement for renal replacement therapy. We included 5,536 patients (2,796 in TAVI and 2,740 in SAVR arm) from 6 RCTs. Baseline characteristics were similar. There was reduced incidence of AKI at 30 days of TAVI compared with SAVR, 57 versus 133 (odds ratio [OR] 0.40, confidence interval [CI] 0.28 to 0.56, p <0.00001, I2 = 7%) with no difference at 1 year (OR 0.65, CI 0.32 to 1.32, p = 0.23, I2 = 76%) and need for renal replacement therapy OR 0.95, CI 0.50 to 1.80, p = 0.87, I2 = 0%). Permanent pacemaker was more frequent in the TAVI arm compared with SAVR arm, 379 versus 110, (OR 3.75, CI 1.67 to 8.42, p = 0.001, I2 = 89%). In conclusion, TAVI is associated with a reduction in AKIs at 30 days despite the exposure to contrast and higher incidence of new permanent pacemaker placement.
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Affiliation(s)
- Waqas Javed Siddiqui
- Drexel University College of Medicine, Philadelphia, Pennsylvania; Hahnemann University Hospital, Philadelphia, Pennsylvania.
| | - Chikezie Alvarez
- Seton Hall University, St. Francis Medical Center, Trenton, New Jersey
| | - Muhammad Aslam
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Abu Bakar
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Aysha Aslam
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts
| | - Muhammad Owais Hanif
- Drexel University College of Medicine, Philadelphia, Pennsylvania; Hahnemann University Hospital, Philadelphia, Pennsylvania
| | - Syed Farhan Hasni
- Drexel University College of Medicine, Philadelphia, Pennsylvania; Hahnemann University Hospital, Philadelphia, Pennsylvania
| | - Karthik Ranganna
- Drexel University College of Medicine, Philadelphia, Pennsylvania; Hahnemann University Hospital, Philadelphia, Pennsylvania
| | - Howard Eisen
- Drexel University College of Medicine, Philadelphia, Pennsylvania; Hahnemann University Hospital, Philadelphia, Pennsylvania
| | - Sandeep Aggarwal
- Drexel University College of Medicine, Philadelphia, Pennsylvania; Hahnemann University Hospital, Philadelphia, Pennsylvania
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Harhay MN, McKenna RM, Boyle SM, Ranganna K, Mizrahi LL, Guy S, Malat GE, Xiao G, Reich DJ, Harhay MO. Association between Medicaid Expansion under the Affordable Care Act and Preemptive Listings for Kidney Transplantation. Clin J Am Soc Nephrol 2018; 13:1069-1078. [PMID: 29929999 PMCID: PMC6032587 DOI: 10.2215/cjn.00100118] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 04/13/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Before 2014, low-income individuals in the United States with non-dialysis-dependent CKD had fewer options to attain health insurance, limiting their opportunities to be preemptively wait-listed for kidney transplantation. We examined whether expanding Medicaid under the Affordable Care Act was associated with differences in the number of individuals who were pre-emptively wait-listed with Medicaid coverage. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Using the United Network of Organ Sharing database, we performed a retrospective observational study of adults (age≥18 years) listed for kidney transplantation before dialysis dependence between January 1, 2011-December 31, 2013 (pre-Medicaid expansion) and January 1, 2014-December 31, 2016 (post-Medicaid expansion). In multinomial logistic regression models, we compared trends in insurance types used for pre-emptive wait-listing in states that did and did not expand Medicaid with a difference-in-differences approach. RESULTS States that fully implemented Medicaid expansion on January 1, 2014 ("expansion states," n=24 and the District of Columbia) had a 59% relative increase in Medicaid-covered pre-emptive listings from the pre-expansion to postexpansion period (from 1094 to 1737 listings), compared with an 8.8% relative increase (from 330 to 359 listings) among 19 Medicaid nonexpansion states (P<0.001). From the pre- to postexpansion period, the adjusted proportion of listings with Medicaid coverage decreased by 0.3 percentage points among nonexpansion states (from 4.0% to 3.7%, P=0.09), and increased by 3.0 percentage points among expansion states (from 7.0% to 10.0%, P<0.001). Medicaid expansion was associated with absolute increases in Medicaid coverage by 1.4 percentage points among white listings, 4.0 percentage points among black listings, 5.9 percentage points among Hispanic listings, and 5.3 percentage points among other listings (P<0.001 for all comparisons). CONCLUSIONS Medicaid expansion was associated with an increase in the proportion of new pre-emptive listings for kidney transplantation with Medicaid coverage, with larger increases in Medicaid coverage among racial and ethnic minority listings than among white listings.
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Affiliation(s)
- Meera N. Harhay
- Division of Nephrology and Hypertension, Department of Medicine, and
- Epidemiology and Biostatistics and
| | - Ryan M. McKenna
- Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Suzanne M. Boyle
- Division of Nephrology and Hypertension, Department of Medicine, and
| | - Karthik Ranganna
- Division of Nephrology and Hypertension, Department of Medicine, and
| | | | - Stephen Guy
- Division of Multi-Organ Transplantation and Hepatobiliary Surgery, Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania; Departments of
| | - Gregory E. Malat
- Division of Multi-Organ Transplantation and Hepatobiliary Surgery, Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania; Departments of
| | - Gary Xiao
- Division of Multi-Organ Transplantation and Hepatobiliary Surgery, Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania; Departments of
| | - David J. Reich
- Division of Multi-Organ Transplantation and Hepatobiliary Surgery, Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania; Departments of
| | - Michael O. Harhay
- Palliative and Advanced Illness Research Center and
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, and
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; and
- Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Pennsylvania
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11
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Lee DH, Boyle SM, Malat GE, Kern C, Milrod C, DeBellis S, Harhay MN, Ranganna K, Guy S, Talluri S, Bias T, Doyle A. Barriers to listing for HIV-infected patients being evaluated for kidney transplantation. Transpl Infect Dis 2017; 19. [PMID: 28921783 DOI: 10.1111/tid.12777] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 09/12/2016] [Revised: 06/04/2017] [Accepted: 06/14/2017] [Indexed: 12/14/2022]
Abstract
Human immunodeficiency virus (HIV)-infected patients have excellent outcomes following kidney transplantation (KT) but still might face barriers in the evaluation and listing process. The aim of this study was to characterize the patient population, referral patterns, and outcomes of HIV-infected patients who present for KT evaluation. We performed a single-center retrospective cohort study of HIV-infected patients who were evaluated for KT. The primary outcome was time to determination of eligibility for KT. Between 2011 and 2015, 105 HIV-infected patients were evaluated for KT. Of the 105 patients, 73 were listed for transplantation by the end of the study period. For those who were deemed ineligible, the most common reasons cited were active substance abuse (n = 7, 22%) and failure to complete the full transplant evaluation (n = 7, 22%). Our cohort demonstrated a higher proportion of HIV-infected patients eligible for KT than in previous studies, likely secondary to advances in HIV management. Among those who were denied access to transplantation, we identified that many were unable to complete the evaluation process, and that active substance abuse was common. Future prospective studies should examine reasons and potential interventions for the lack of follow-through and drug use we observed in this population.
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Affiliation(s)
- Dong Heun Lee
- Department of Medicine, Drexel University, Philadelphia, PA, USA
| | - Suzanne M Boyle
- Department of Medicine, Drexel University, Philadelphia, PA, USA
| | - Gregory E Malat
- Department of Surgery, Drexel University, Philadelphia, PA, USA
| | - Christopher Kern
- Department of Medicine, Drexel University, Philadelphia, PA, USA
| | - Charles Milrod
- Department of Medicine, Drexel University, Philadelphia, PA, USA
| | - Shannon DeBellis
- Department of Medicine, Drexel University, Philadelphia, PA, USA
| | - Meera N Harhay
- Department of Medicine, Drexel University, Philadelphia, PA, USA
| | - Karthik Ranganna
- Department of Medicine, Drexel University, Philadelphia, PA, USA
| | - Stephen Guy
- Department of Surgery, Drexel University, Philadelphia, PA, USA
| | - Sindhura Talluri
- Department of Medicine, Drexel University, Philadelphia, PA, USA
| | - Tiffany Bias
- Department of Medicine, Drexel University, Philadelphia, PA, USA
| | - Alden Doyle
- Department of Medicine, Drexel University, Philadelphia, PA, USA
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12
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Boyle SM, Malat G, Harhay MN, Lee DH, Pang L, Talluri S, Sharma A, Bias TE, Ranganna K, Doyle AM. Association of tenofovir disoproxil fumarate with primary allograft survival in HIV-positive kidney transplant recipients. Transpl Infect Dis 2017; 19. [PMID: 28520146 DOI: 10.1111/tid.12727] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/09/2017] [Accepted: 03/18/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Tenofovir disoproxil fumarate (TDF) is an antiretroviral agent frequently used to treat human immunodeficiency virus (HIV). There are concerns regarding its potential to cause acute kidney injury, chronic kidney disease, and proximal tubulopathy. Although TDF can effectively suppress HIV after kidney transplantation, it is unknown whether use of TDF-based antiretroviral therapy (ART) after kidney transplantation adversely affects allograft survival. METHODS We examined 104 HIV+ kidney transplant (KT) recipients at our center between 2001 and 2014. We generated a propensity score for TDF treatment using recipient and donor characteristics. We then fit Cox proportional hazards models to investigate the association between TDF treatment and 3-year, death-censored primary allograft failure, adjusting for the propensity score and delayed graft function (DGF). RESULTS Of the 104 HIV+ KT candidates who underwent transplantation during the study period, 23 (22%) were maintained on TDF-based ART at the time of transplantation, and 81 (78%) were on non-TDF-based ART. Median age of the cohort was 48 years; 87% were male; 88% were black; and median CD4 count at transplantation was 450 cells/mm3 . Median kidney donor risk index was 1.2. At 3 years post transplantation, primary allograft failure occurred in 26% of patients on TDF-based ART and in 28% of patients on non-TDF-based ART (P=.5). TDF treatment was not associated with primary allograft failure at 3 years post transplant after adjusting for DGF and a propensity score for TDF use (hazard ratio 2.12, 95% confidence interval 0.41-10.9). CONCLUSIONS In a large single-center experience of HIV+ kidney transplantation, TDF use following kidney transplantation was not significantly associated with primary allograft failure. These results may help inform management for HIV+ KT recipients in need of TDF therapy for adequate viral suppression.
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Affiliation(s)
- Suzanne M Boyle
- Division of Nephrology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Gregory Malat
- Department of Pharmacy, Hahnemann University Hospital, Philadelphia, PA, USA
| | - Meera N Harhay
- Division of Nephrology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Dong H Lee
- Division of Infectious Disease, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Lisa Pang
- Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sindhura Talluri
- Division of Nephrology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Akshay Sharma
- Division of Nephrology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Tiffany E Bias
- Department of Pharmacy, Hahnemann University Hospital, Philadelphia, PA, USA
| | - Karthik Ranganna
- Division of Nephrology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Alden M Doyle
- Division of Nephrology, University of Virginia School of Medicine, Charlottesville, VA, USA
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13
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Lee DH, Malat G, Aldea A, Bluen B, Talluri S, Bias T, Harhay M, Ranganna K, Guy S, Doyle A. Two years' Experience of Universal Postoperative Decolonization for Kidney Transplant Recipients. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1857] [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: 11/13/2022] Open
Affiliation(s)
- Dong Heun Lee
- Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, PA
| | - Gregory Malat
- Department of Surgery, Drexel University College of Medicine, Philadelphia, PA
| | - Ana Aldea
- Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, PA
| | - Benjamin Bluen
- Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, PA
| | - Sindhura Talluri
- Division of Nephrology, Drexel University College of Medicine, Philadelphia, PA
| | - Tiffany Bias
- Pharmacy, Hahnemann University Hospital, Philadelphia, PA
| | - Meera Harhay
- Division of Nephrology, Drexel University College of Medicine, Philadelphia, PA
| | - Karthik Ranganna
- Division of Nephrology, Drexel University College of Medicine, Philadelphia, PA
| | - Stephen Guy
- Department of Surgery, Drexel University College of Medicine, Philadelphia, PA
| | - Alden Doyle
- Division of Nephrology, Drexel University College of Medicine, Philadelphia, PA
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14
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Aldea A, Bias T, Law N, Boyle S, Malat G, Talluri S, Harhay M, Ranganna K, Doyle A, Lee DH. Value of Leukocytosis and Fever for Presence of Bacteremia in Adult Solid Organ Transplantation. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1859] [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)
- Ana Aldea
- Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, PA
| | - Tiffany Bias
- Pharmacy, Hahnemann University Hospital, Philadelphia, PA
| | - Nancy Law
- Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, PA
| | - Suzanne Boyle
- Division of Nephrology, Drexel University College of Medicine, Philadelphia, PA
| | - Gregory Malat
- Surgery, Hahnemann University Hospital, Philadelphia, PA
| | - Sindhura Talluri
- Division of Nephrology, Drexel University College of Medicine, Philadelphia, PA
| | - Meera Harhay
- Division of Nephrology, Drexel University College of Medicine, Philadelphia, PA
| | - Karthik Ranganna
- Division of Nephrology, Drexel University College of Medicine, Philadelphia, PA
| | - Alden Doyle
- Division of Nephrology, Drexel University College of Medicine, Philadelphia, PA
| | - Dong Heun Lee
- Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, PA
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15
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Lee DH, Malat GE, Bias TE, Harhay MN, Ranganna K, Doyle AM. Serum creatinine elevation after switch to dolutegravir in a human immunodeficiency virus-positive kidney transplant recipient. Transpl Infect Dis 2016; 18:625-7. [PMID: 27159656 DOI: 10.1111/tid.12545] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 03/23/2016] [Accepted: 04/03/2016] [Indexed: 12/21/2022]
Abstract
Dolutegravir is a preferred antiretroviral drug for human immunodeficiency virus (HIV)-infected patients following solid organ transplantation. It has potent antiretroviral activity and does not interact with calcineurin inhibitors. We describe a case of an HIV-infected kidney transplant patient, who was noted to have a rising serum creatinine following initiation of dolutegravir. At first, an acute rejection episode was suspected, but this finding was later attributed to inhibition of creatinine secretion by dolutegravir. We suggest that an awareness of this potential effect of dolutegravir is important for providers who take care of HIV-positive kidney transplant recipients, in order to prevent potentially unnecessary testing.
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Affiliation(s)
- D H Lee
- Division of Infectious Diseases and HIV Medicine, Drexel University, Philadelphia, Pennsylvania, USA
| | - G E Malat
- Department of Surgery, Drexel University, Philadelphia, Pennsylvania, USA
| | - T E Bias
- Division of Infectious Diseases and HIV Medicine, Drexel University, Philadelphia, Pennsylvania, USA
| | - M N Harhay
- Division of Nephrology, Drexel University, Philadelphia, Pennsylvania, USA
| | - K Ranganna
- Division of Nephrology, Drexel University, Philadelphia, Pennsylvania, USA
| | - A M Doyle
- Division of Nephrology, Drexel University, Philadelphia, Pennsylvania, USA
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16
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Guy S, Potluri A, Xiao G, Vega ML, Malat G, Ranganna K, Cusack C, Doyle AM. Successful treatment of acute severe graft-versus-host-disease in a pancreas-after-kidney transplant recipient: case report. Transplant Proc 2014; 46:2446-9. [PMID: 25179161 DOI: 10.1016/j.transproceed.2014.06.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 06/17/2014] [Indexed: 10/24/2022]
Abstract
The development of acute graft-versus-host-disease (GVHD) in recipients of pancreas transplants is a rare and quite often a fatal post-transplantation complication. We present a 38-year-old male with a longstanding history of type 1 diabetes mellitus and end-stage kidney disease, with a living unrelated kidney transplant from his wife for 3 years, who received an enteric-drained 5-antigen HLA-mismatched deceased-donor pancreas. Five weeks after transplantation, he presented with spiking fevers, severe skin rash, diarrhea, pancytopenia, and increasingly abnormal liver function tests. Skin biopsies were consistent with grade 3 acute GVHD. The patient was treated for GVHD with escalated doses of tacrolimus, pulse doses of steroids, and basiliximab. He was discharged after a 4-week hospital stay with complete resolution of his rash, fever, abnormal liver enzymes, and leukopenia. He remained in good health with excellent kidney and pancreas allograft function 3 years later.
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Affiliation(s)
- S Guy
- Division of Solid Organ Transplantation, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - A Potluri
- Division of Solid Organ Transplantation, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - G Xiao
- Division of Solid Organ Transplantation, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - M L Vega
- Division of Dermatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - G Malat
- Division of Solid Organ Transplantation, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - K Ranganna
- Division of Solid Organ Transplantation, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - C Cusack
- Division of Dermatology, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - A M Doyle
- Division of Solid Organ Transplantation, Drexel University College of Medicine, Philadelphia, Pennsylvania.
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17
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Philosophe B, Malat GE, Soundararajan S, Barth RN, Manitpisikul W, Wilson NS, Ranganna K, Drachenberg CB, Papadimitriou JC, Neuman BP, Munivenkatappa RB. Validation of the Maryland Aggregate Pathology Index (MAPI), a pre-implantation scoring system that predicts graft outcome. Clin Transplant 2014; 28:897-905. [DOI: 10.1111/ctr.12400] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Benjamin Philosophe
- Department of Surgery; School of Medicine; Johns Hopkins University; Baltimore MD USA
| | - Gregory E. Malat
- Department of Pharmacy; College of Medicine; Drexel University; Philadelphia PA USA
| | | | - Rolf N. Barth
- Department of Surgery; School of Medicine; University of Maryland; Baltimore MD USA
| | - Wana Manitpisikul
- Department of Pharmacy; University of Maryland Medical Center; Baltimore MD USA
| | - Nikita S. Wilson
- Department of Pharmacy; University of Maryland Medical Center; Baltimore MD USA
| | - Karthik Ranganna
- Department of Surgery; School of Medicine; University of Maryland; Baltimore MD USA
- Department of Nephrology; College of Medicine; Drexel University; Philadelphia PA USA
| | | | - John C. Papadimitriou
- Department of Pathology; School of Medicine; University of Maryland; Baltimore MD USA
| | - Brian P. Neuman
- Department of Surgery; School of Medicine; Johns Hopkins University; Baltimore MD USA
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18
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Kaur N, Abraham M, Malat G, Ranganna K. Kidney Transplant Outcomes in Lupus Nephritis Patients: An Analysis of Charlson Co-Morbidity Index (CCI) and Lupus Activity. Transplantation 2014. [DOI: 10.1097/00007890-201407151-01796] [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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19
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Shahid N, Arora S, Abid S, Sass D, Xiao G, Doyle A, Ranganna K. 280 Changes in Serum Electrolytes During Liver Transplantation and Risk of Central Pontine Myelinolysis: Is Sodium the Only Culprit? Am J Kidney Dis 2011. [DOI: 10.1053/j.ajkd.2011.02.283] [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: 11/11/2022]
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20
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Matthew D, Levin L, Malat G, Doyle A, Ranganna K. 195 Outcomes of Kidney Transplantation in HIV Alone and HIV-HCV Coinfected Recipients. Am J Kidney Dis 2011. [DOI: 10.1053/j.ajkd.2011.02.198] [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: 11/11/2022]
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21
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Abid S, Shahid N, Sass D, Rothstein K, Reich D, Ranganna K, Ahmed Z. 1 Norepinephrine Infusion for Treatment of Type 1 Hepatorenal Syndrome. Am J Kidney Dis 2011. [DOI: 10.1053/j.ajkd.2011.02.004] [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: 11/11/2022]
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22
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Ahmed I, Matthew D, Arora S, Xiao G, Malat G, Doyle A, Ranganna K. 9 Incidence of BK Virus Nephropathy in HIV Positive Renal Transplant Patients. Am J Kidney Dis 2011. [DOI: 10.1053/j.ajkd.2011.02.012] [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: 11/11/2022]
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23
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Lone U, Lone HM, Mirzan SH, Chauhan V, Ranganna K, Ahmed Z. 173 Magnitude of Interarm Blood Pressure Difference in Inpatients with Hypertension and CKD. Am J Kidney Dis 2011. [DOI: 10.1053/j.ajkd.2011.02.176] [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: 11/11/2022]
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24
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Palya A, Srinagesh P, Malat G, Vania S, Lone U, Ahmed Z, Doyle A, Kumar M, Ranganna K. 228: Influence of Hepatitis C (HCV) Co-Infection on C4D Staining and Presence of DSA in HIV Positive Recipients. Am J Kidney Dis 2010. [DOI: 10.1053/j.ajkd.2010.02.235] [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: 11/11/2022]
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25
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Levin L, Malat G, Gupta M, Saeed M, Kulkarni S, Zafar S, Doyle A, Ahmed Z, Ranganna K, Kumar MA. 173: Delayed Graft Function (DGF) in HIV+ Kidney Transplant Recipients Predicts Worse Long-Term Renal Function. Am J Kidney Dis 2010. [DOI: 10.1053/j.ajkd.2010.02.180] [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: 11/11/2022]
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26
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Malat GE, Culkin C, Palya A, Ranganna K, Kumar MSA. African American kidney transplantation survival: the ability of immunosuppression to balance the inherent pre- and post-transplant risk factors. Drugs 2010; 69:2045-62. [PMID: 19791826 DOI: 10.2165/11318570-000000000-00000] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Among organ transplant recipients, the African American population historically has received special attention. This is because secondary to their disposition to certain disease states, for example hypertension, an African American patient has a propensity to reach end-stage renal disease and require renal replacement earlier than a Caucasian patient. Regardless of the initiative to replace dialysis therapy with organ transplantation, the African American patient has many barriers to kidney transplantation, thus extending their time on dialysis and waiting time on the organ transplant list. These factors are among the many negative causes of decreased kidney graft survival, realized before kidney transplantation. Unfortunately, once the African American recipient receives a kidney graft, the literature documents that many post-transplant barriers exist which limit successful outcomes. The primary post-transplant barrier relates to designing proper immunosuppression protocols. The difficulty in designing protocols revolves around (i) altered genetic metabolism/lower absorption, (ii) increased immuno-active cytokines and (iii) detrimental effects of noncompliance. Based on the literature, dosing of immunosuppression must be aggressive and requires a diligent practitioner. Research has indicated that, despite some success with proven levels of immunosuppression, the African American recipient usually requires a higher 'dose per weight' regimen. However, even with aggressive immunosuppressant dosing, African Americans still have worse outcomes than Caucasian recipients. Additionally, many of the targeted sites of action that immunosuppression exerts its effects on have been found to be amplified in the African American population. Finally, noncompliance is the most discouraging inhibitor of long-term success in organ transplantation. The consequences of noncompliance are biased by ethnicity and affect the African American population more severely. All of these factors are discussed further in this review in the hope of identifying an ideal healthcare model for caring for the African American transplant recipient, from diagnosing chronic kidney disease through to successful kidney graft outcomes. An indepth review of the literature is described and organized in a fashion that highlights all of the issues affecting success in African Americans. The compilation of the literature in this review will enable the reader to get closer to understanding the caveats of kidney transplantation in the African American patient, but falls short of delivering an actual 'equation' for post-transplant care in an African American kidney recipient.
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Affiliation(s)
- Gregory E Malat
- Department of Pharmacy, Hahnemann University Hospital/Drexel University, Philadelphia, Pennsylvania, USA
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Abstract
Renal failure in cirrhosis poses unique diagnostic and therapeutic challenges. Laboratory values and predictive equations grossly overestimate renal function in patients with cirrhosis. Development of renal failure connotes a worse prognosis; mortality is especially high with hepatorenal syndrome. Classification of the causes of renal failure in patients with cirrhosis is provided with more extensive discussion of selected causes. Finally, a suggested diagnostic approach to renal failure in cirrhosis is given.
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Affiliation(s)
- Lina Mackelaite
- Division of Nephrology, Department of Medicine, Drexel University College of Medicine, 245 North 15th Street, Room 6144, Philadelphia, PA 19102, USA
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28
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Ranganna K, Yatsu F, Mathew O. Abstract: P241 EPIGENETIC REGULATION AND CHROMATIN REMODELING IN BUTYRATE ARRESTED VASCULAR SMOOTH MUSCLE CELL (VSMC) PROLIFERATION. ATHEROSCLEROSIS SUPP 2009. [DOI: 10.1016/s1567-5688(09)70306-x] [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: 11/24/2022]
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29
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Anil Kumar MS, Irfan Saeed M, Ranganna K, Malat G, Sustento-Reodica N, Kumar AMS, Meyers WC. Comparison of four different immunosuppression protocols without long-term steroid therapy in kidney recipients monitored by surveillance biopsy: five-year outcomes. Transpl Immunol 2008; 20:32-42. [PMID: 18773960 DOI: 10.1016/j.trim.2008.08.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Revised: 08/01/2008] [Accepted: 08/08/2008] [Indexed: 12/18/2022]
Abstract
Induction and maintenance immunosuppression protocols with or without long-term steroid therapy in kidney transplant recipients are variable and are transplant center-specific. The aim of this prospective randomized pilot study was to compare 5-year outcomes in kidney recipients maintained on 4 different calcineurin inhibitor (CNI)-based immunosuppression protocols without long-term steroid therapy. Two hundred consenting patients who received kidney transplants between June 2000 and October 2004 were enrolled in 4 immunosuppression protocol groups, with 50 patients in each group: cyclosporine (CSA)/mycophenolate mofetil (MMF), CSA/sirolimus (SRL), tacrolimus (TAC)/MMF, and TAC/SRL. Induction therapy was done with basiliximab and methylprednisolone. Steroids were withdrawn on post-transplant day 2, and long-term steroid therapy was not used. Demographic characteristics among the four groups were comparable; approximately 50% of the recipients were African American and > or =80% of the kidneys transplanted were from deceased donors. Clinical acute rejection (CAR) was confirmed by biopsy and treated with intravenous pulse steroid therapy. Steroid-unresponsive CAR was treated with Thymoglobulin. Surveillance biopsies were performed at 1, 6, 12, 24, 36, 48, and 60 months to evaluate subclinical acute rejection (SCAR), chronic allograft injury (CAI), and other pathological changes per the Banff 2005 schema. The primary end point was CAR, and secondary end points were 5-year patient and graft survival rates, renal function, SCAR, CAI, and adverse events. In the first year post-transplant, the incidence of CAR was 18% in the CSA/MMF group, 8% in the CSA/SRL group, 14% in the TAC/MMF group, and 4% in the TAC/SRL group (CSA/MMF vs. TAC/SRL; p=0.05). The incidence of SCAR was 22% in the CSA/MMF group, 8% in the CSA/SRL group, 16% in the TAC/MMF group, and 6% in the TAC/SRL group (CSA/MMF vs. CSA/SRL and TAC/SRL; p=0.05). After the first year, the incidences of CAR and SCAR decreased and were comparable in all 4 groups. At 5 years post-transplant, cumulative CAI due to interstitial fibrosis/tubular atrophy (IF/TA), hypertension (HTN), and chronic calcineurin inhibitor (CNI) toxicity was observed in 54%, 48%, and 8% of the CSA/MMF group vs. 16%, 36%, and 12% of the CSA/SRL group vs. 38%, 24% and 6% of the TAC/MMF group vs. 14%, 25% and 12% of the TAC/SLR group (IF/TA: CSA/MMF vs. CSA/SRL and TAC/SRL; p=0.04, HTN: CSA/MMF vs. TAC/MMF and TAC/SRL; p=0.05, CNI toxicity: TAC/SRL and CSA/SRL vs. TAC/MMF; p=0.05). Five-year patient and graft survival rates were 82% and 60% in the CSA/MMF group, 82% and 60% in the CSA/SRL group, 84% and 62% in the TAC/MMF group, and 82% and 64% in the TAC/SRL group (p=0.9). Serum creatinine levels and creatinine clearances at 5 years were comparable among the groups. Our data show that the rates of CAR and SCAR in the first year post-transplant were significantly lower in the CSA/SRL and TAC/SRL groups and that cumulative CAI rates due to IF/TA and HTN at 5 years were significantly lower in the TAC/MMF, TAC/SRL, and CSA/SRL groups than in the CSA/MMF group. Despite significant differences in the incidences of CAR and SCAR and prevalence of different types of CAI at 5 years, renal function and patient and graft survival rates at 5 years were comparable among kidney recipients maintained on 4 different immunosuppression protocols without long-term steroid therapy.
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Affiliation(s)
- Mysore S Anil Kumar
- Department of Surgery, Drexel University College of Medicine, Philadelphia, PA 19102, USA.
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Ranganna K, Mathew O, Yatsu F. G1/S PHASE CELL CYCLE PROTEINS ARE MODULATED IN BUTYRATE- INHIBITED VASCULAR SMOOTH MUSCLE CELL PROLIFERATION. ATHEROSCLEROSIS SUPP 2008. [DOI: 10.1016/s1567-5688(08)70115-6] [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: 11/30/2022]
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Modi N, Ahmed Z, Mahmood I, Kumar A, Ranganna K, Chowdhury D. 173: Use of Erythrocyte Stimulating Agent During Renal Transplantation. Am J Kidney Dis 2008. [DOI: 10.1053/j.ajkd.2008.02.182] [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: 11/11/2022]
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Mackelaite L, Shahid N, Mahmood I, Xiao G, Ahmed Z, Ranganna K. 149: Infection Patterns in HIV Positive and HIV Negative Renal Transpltan Patients. Am J Kidney Dis 2008. [DOI: 10.1053/j.ajkd.2008.02.158] [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: 11/11/2022]
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Mackalaite L, Geng Q, Ranganna K, Kumar A, Ahmed Z. 150: Is Asymptomatic Pyuria a Risk Factor of Infectiuous Complications After Surveillance Renal Transplant Biopsy? Am J Kidney Dis 2008. [DOI: 10.1053/j.ajkd.2008.02.159] [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: 11/11/2022]
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Anil Kumar MS, Khan S, Ranganna K, Malat G, Sustento-Reodica N, Meyers WC. Long-term outcome of early steroid withdrawal after kidney transplantation in African American recipients monitored by surveillance biopsy. Am J Transplant 2008; 8:574-85. [PMID: 18294153 DOI: 10.1111/j.1600-6143.2007.02099.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Generally chronic steroid therapy is standard care for African American (AA) kidney recipients because of their higher incidence of rejections and lower long-term graft survival. This prospective study evaluated the long-term safety and efficacy of early steroid withdrawal (ESW) in AA recipients. A total of 206 recipients were studied; 103 AA and 103 non-AA recipients monitored by serial surveillance biopsies from 1 to 60 months posttransplantation to evaluate subclinical acute rejections (SCAR) and chronic allograft injury (CAI). Biopsy-proven clinical acute rejections (BPAR) and SCAR were treated. Primary end point was BPAR and secondary end points were 5-year SCAR, CAI and survival. Incidences of BPAR was 16% versus 14% (p = 1.0), prevalence of CAI due to hypertension was 48% versus 30% (p = 0.05) and interstitial fibrosis/tubular atrophy was 47% versus 32% (p = 0.05) and the mean serum creatinine levels were 2.1 versus 1.8 mg/dL (p = 0.05) at 5-years in AA versus non-AA recipients. The incidence of SCAR was 23% versus 11% at 1 month (p = 0.04), 12% versus 3% at 3 years (p = 0.04) and 10% versus 1% at 5 years (p = 0.04) in AA and non-AA recipients, respectively. Five-year patient survivals were 81% and 88% (p = 0.09) and graft survivals were 71% and 73%(p = 0.19) in AA and non-AA groups, respectively. After early steroid withdrawal AA kidney recipients have significantly lower renal function and higher SCAR and CAI but 5-year graft survival are comparable to non-AA recipients.
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Affiliation(s)
- M S Anil Kumar
- Division of Transplantation, Department of Surgery, Drexel University College of Medicine, Philadelphia, PA, USA.
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Ranganna K, Yatsu F, Mathew O. PO8-198 ARREST OF VASCULAR SMOOTH MUSCLE CELL PROLIFERATION BY BUTYRATE UP-REGULATES GLUTATHIONE PEROXIDASES AND MODULATES INTRACELLULAR LEVELS OF GLUTATHIONE AND ROS. ATHEROSCLEROSIS SUPP 2007. [DOI: 10.1016/s1567-5688(07)71208-4] [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: 11/30/2022]
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Saggio J, Qattash I, Weingarten M, Ranganna K, Ahmed Z. 176. Am J Kidney Dis 2007. [DOI: 10.1053/j.ajkd.2007.02.183] [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: 11/11/2022]
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Vania S, Jaglan S, Ranganna K, Ahmed Z, Levison S. 228. Am J Kidney Dis 2007. [DOI: 10.1053/j.ajkd.2007.02.236] [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: 11/11/2022]
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Jere C, Khan M, Chowdhury R, Grafals M, Ranganna K, Ahmed Z. 107. Am J Kidney Dis 2007. [DOI: 10.1053/j.ajkd.2007.02.113] [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: 11/11/2022]
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Yousefipour Z, Ranganna K, Newaz MA, Milton SG. Mechanism of acrolein-induced vascular toxicity. J Physiol Pharmacol 2005; 56:337-53. [PMID: 16204758] [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] [Subscribe] [Scholar Register] [Received: 02/15/2005] [Accepted: 07/04/2005] [Indexed: 05/04/2023]
Abstract
Acrolein, an environmental pollutant and a lipid peroxidation product, is implicated in vascular pathogenesis. Although evidence indicates a link between vascular pathogenesis and acrolein, no direct studies relating to effects of acrolein on vascular function and responses are known. This study investigated the effects of acrolein on vascular function to understand the underlying mechanism of acrolein-induced vascular responses. Male Sprague-Dawley rats were treated with acrolein (2 or 4 mg/kg; i.p.) for 3 or 7 days. Urine and blood samples were collected. Changes in systolic blood pressure (SBP) and responses to acetylcholine and phenylephrine were determined. Acrolein (4 mg/kg, 7 days) significantly increased SBP by 25%, phenylephrine vasoconstriction by 2-fold, but decreased urinary excretion of nitrite by 25%. Acrolein inhibited generation of cyclic guanosine 3'5'-monophosphate (cGMP) by 98%, and did not alter expression of nitric oxide synthase (eNOS). Acrolein increased the generation of lipid hydroperoxide in plasma and aortic tissue by 21% and 124% respectively, increased glutathione-S-transferase (GST) and glutathione peroxidase (GSH-Px) activities. Acrolein up-regulated the expression of GST by 2 fold. These data suggest that induced SBP and altered vasoconstriction/vasodilatation in acrolein treated rats may be due to reduced availability of NO via increased free radical generation and reduced antioxidant defense.
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Affiliation(s)
- Z Yousefipour
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX 77004, USA.
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Verma A, Ranganna K. Carvedilol is reno-protective in patients with chronic systolic heart failure. J Card Fail 2004. [DOI: 10.1016/j.cardfail.2004.06.384] [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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Kode R, Fa K, Chowdhury S, Ranganna K, Fyfe B, Stabler S, Damask A, Laftavi MR, Kumar AM, Pankewycz O. Basiliximab plus low-dose cyclosporin vs. OKT3 for induction immunosuppression following renal transplantation. Clin Transplant 2003; 17:369-76. [PMID: 12868995 DOI: 10.1034/j.1399-0012.2003.00061.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Current immunosuppressive therapies are very effective in preventing acute rejection (AR) and graft loss following renal transplantation. Newer agents now make it possible to develop equally efficacious but better tolerated and less toxic strategies. This is especially relevant for our ageing recipients. We now compare the efficacy of basiliximab combined with early low-dose cyclosporin therapy to standard OKT3 induction therapy. METHODS In this single-centre study, 100 consecutive recipients of cadaveric kidney transplants from November 1998 to August 2000 were treated with basiliximab combined with early low-dose cyclosporin, reduced steroids and mycophenolate mofetil (MMF). Clinical outcomes at 100 d and 1 yr were compared with a group of 26 patients transplanted from March 1995 to November 1998 who received OKT3, delayed full-dose cyclosporin, high-dose steroids and MMF. Amongst basiliximab treated patients, we compared clinical outcomes in those older and younger than 60 yr. RESULTS Both groups were similar except for a shorter cold ischaemic time in the basiliximab group. Length of stay, number of readmissions, total hospitalization days and cytomegalovirus infections were lower in the basiliximab group. Despite a 40% reduction in steroids, basiliximab-treated patients had fewer biopsy-proven episodes of AR (basiliximab 14% vs. OKT3 35%) and required less antilymphocyte antibody therapy. Clinical outcomes including patient and graft survival were no different between groups. Long-term graft survival for patients over 60 yr was limited primarily by mortality. CONCLUSIONS Compared with OKT3 induction therapy, the combination of early low-dose cyclosporin and basiliximab is steroid sparing, effective, well tolerated and relatively safe.
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Affiliation(s)
- Ravi Kode
- MCP-Hahnemann University, Philadelphia, PA, University of Pennsylvania, Philadelphia, PA and SUNY-University at Buffalo, Buffalo General Hospital, Buffalo, NY 14203, USA
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Abstract
Bleeding after hemodialysis catheter placement is commonly seen and can happen because of anticoagulation, poor platelet function in dialysis patients, and trauma to the vessel and tunnel tract during placement. We wish to present here two cases of prolonged exist site bleeding with tunneled dialysis catheters (SchonCath dialysis catheter, Angio-Dynamics, Queensbury, N.Y.) due to unsuspected catheter leak within the tunneled portion of the catheter, which was identified with angiogram.
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Affiliation(s)
- E Y Huang
- Department of Medicine, Nephrology and Hypertension Division, Medical College of Pennsylvania, MCP Hahnemann University, 3300 Henry Avenue, Philadelphia, PA 19129, USA
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Ong SH, Ranganna K, Lee J, Tunkel AR, Ahmed Z. Vancomycin is the preferred antimicrobial agent for empiric therapy in hemodialysis-related infections. Am J Kidney Dis 2001. [DOI: 10.1016/s0272-6386(01)80210-9] [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]
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Majid A, Ranganna K, Rabiei A, Scheier CR, Chowdhury S, Huang E, Hasni K, Cuhaci B, Lee J, Ahmed Z. Do angiotensin converting enzyme inhibitors/angiotensin receptor blockers increase the incidence of hyperkalemia in hemodilayis patients? Am J Kidney Dis 2001. [DOI: 10.1016/s0272-6386(01)80196-7] [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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Chowdhury S, Kode RK, Ranganna K, Damask AM, Lam A, Fyfe B, Stabler S, Kumar AM, Tomeny MB, Kumar MS, Pankewycz O. Induction strategy using basiliximab combined with mycophenolate MMF and immediate low-dose cyclosporin is steroid sparing and more effective than OKT3. Transplant Proc 2001; 33:1057-8. [PMID: 11267189 DOI: 10.1016/s0041-1345(00)02414-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- S Chowdhury
- Division of Transplantation, MCP Hahnemann University, Philadelphia, PA, USA
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Kode RK, Pankewycz O, Ranganna K, Sierka D, Ardron M, Kumar AM, Kumar MS. RAPID STEROID REDUCTION IN KIDNEY TRANSPLANT RECIPIENTS WITH SIMULECT, NEORAL, AND CELLCEPT. Transplantation 2000. [DOI: 10.1097/00007890-200004271-00427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ranganna K, Yatsu FM, Hayes BE, Milton SG, Jayakumar A. Butyrate inhibits proliferation-induced proliferating cell nuclear antigen expression (PCNA) in rat vascular smooth muscle cells. Mol Cell Biochem 2000; 205:149-61. [PMID: 10821433 DOI: 10.1023/a:1007078200482] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Arterial injury-induced vascular smooth muscle cell (VSMC) proliferation in intima is the important etiologic factor in vascular proliferative disorders such as atherosclerosis, hypertension and restenosis after balloon angioplasty. Butyrate, a naturally occurring short chain fatty acid, is produced by bacterial fermentation of dietary fiber and by mammary glands of certain mammals. Studies have shown that butyrate at millimolar concentrations, which are physiological, induces growth arrest, differentiation and apoptosis. We examined the effect of physiological concentrations of butyrate on rat VSMC proliferation and proliferation-induced PCNA expression to determine anti-atherogenic potential of butyrate. Butyrate concentrations, closer to physiological range, exhibited antiproliferative effects on both serum-induced proliferation of serum-starved quiescent VSMCs and actively proliferating non-confluent VSMCs. Treatment of serum-starved quiescent VSMCs with 1-8 mmol/l concentration of butyrate caused a concentration-dependent decrease in serum-induced VSMC proliferation and cell proliferation-associated increase in total cellular proteins and RNA levels. Similarly, exposure of actively growing VSMCs to 5 mmol/l butyrate resulted in the inhibition of cell proliferation and proliferation-induced increase in cellular proteins and RNA levels. Furthermore, cellular morphology was significantly altered. Analysis of cell cycle regulatory proteins indicated that levels of PCNA, an excellent marker for cell proliferation, was significantly altered by butyrate both in actively proliferating and serum-induced quiescent VSMCs. These observations suggest that butyrate exhibits potential antiatherogenic capability by inhibiting VSMC proliferation and proliferation-associated increase in PCNA expression and thus merits further investigations regarding therapeutic significance of butyrate in vascular proliferative disorders.
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Affiliation(s)
- K Ranganna
- College of Pharmacy and Health Sciences, Texas Southern University, Houston 77004, USA
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Ranganna K, Yatsu FM. Inhibition of platelet-derived growth factor BB-induced expression of glyceraldehyde-3-phosphate dehydrogenase by sodium butyrate in rat vascular smooth muscle cells. Arterioscler Thromb Vasc Biol 1997; 17:3420-7. [PMID: 9437188 DOI: 10.1161/01.atv.17.12.3420] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [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: 02/05/2023]
Abstract
Glyceraldehyde-3-phosphate dehydrogenase (GAPDH), a key regulatory enzyme of glycolysis, which exists in nuclei and functions as a DNA-binding protein as well as a nuclear protein, appears to be modulated by cellular activities. Exposure of quiescent rat smooth muscle cells (SMCs) to platelet-derived growth factor BB (PDGF-BB), which stimulates SMCs proliferation, caused a time-dependent increase in mRNA for GAPDH and its catalytic activity. Treatment of quiescent SMCs with sodium butyrate (SB), which is shown to inhibit PDGF-BB-induced SMC proliferation, caused a time- and concentration-dependent decrease in PDGF-BB-induced GAPDH mRNA expression and its catalytic activity. Nuclear run-on studies revealed that the PDGF-BB-induced rate of GAPDH gene transcription was reduced by about 50% in the presence of 5 mmol/L SB. The protein synthesis inhibitor, cycloheximide, failed to abolish the SB-inhibited PDGF-BB-induced rate of transcription of GAPDH, suggesting that SB is not dependent on ongoing protein synthesis to exert its effects on PDGF-BB-induced GAPDH transcription. Furthermore, measurement of GAPDH mRNA stability at various times after the inhibition of transcription with actinomycin D indicated that 5 mmol/L SB has no significant effect on the half-life of PDGF-BB-induced mRNA. The reduction in PDGF-BB-induced GAPDH expression by SB is probably caused by a cycloheximide-insensitive transcriptional mechanism. Thus, the inhibition of PDGF-BB-induced expression of GAPDH by SB suggests a link between SMC proliferation, energy consumption, and GAPDH gene upregulation.
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Affiliation(s)
- K Ranganna
- Department of Neurology, University of Texas-Houston School of Medicine, Houston 77030, USA
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Ranganna K, Joshi T, Yatsu FM. Sodium butyrate inhibits platelet-derived growth factor-induced proliferation of vascular smooth muscle cells. Arterioscler Thromb Vasc Biol 1995; 15:2273-83. [PMID: 7489253 DOI: 10.1161/01.atv.15.12.2273] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Sodium butyrate (SB), a naturally occurring short-chain fatty acid, was investigated for its therapeutic value as an antiproliferative agent for vascular smooth muscle cells (SMCs). At 5-mmol/L concentration, SB had no significant effect on rat SMC proliferation. However, at the same concentration, SB inhibited platelet-derived growth factor (PDGF)-AA-, -AB-, and -BB-induced proliferation of SMCs. Exposure of SMCs to PDGF-BB resulted in activation of receptor intrinsic tyrosine kinase activity and autophosphorylation of beta-PDGF-receptor (beta-PDGFR). The activated beta-PDGFR physically associated and phosphorylated signaling molecules such as ras-GTPase activating protein (GAP) and phospholipase C gamma (PLC gamma). SB, in the absence of PDGF-BB, caused neither beta-PDGFR tyrosine phosphorylation nor phosphorylation and association of GAP and PLC gamma with beta-PDGFR. PDGF-BB-enhanced activation of receptor intrinsic tyrosine kinase activity and autophosphorylation of tyrosine residues of beta-PDGFR were unaffected by SB irrespective of whether SMCs were preincubated with SB before exposure to PDGF-BB plus SB or incubated concomitantly with PDGF-BB plus SB. Likewise, phosphorylation and association of GAP and PLC gamma with PDGF-BB-activated beta-PDGFR were unaffected. In addition, SB did not block PDGF-BB-stimulated, PLC gamma-mediated production of inositol triphosphate. Similarly, PDGF-BB-induced beta-PDGFR degradation was unaffected when SMCs were exposed to PDGF-BB plus SB, and SB by itself had no influence on beta-PDGFR degradation. Unlike beta-PDGFR kinase activity, mitogen-activated protein kinase (MAP-kinase) activity was stimulated by SB by about 2.7-fold. Exposure of SMCs to PDGF-BB caused an approximately 11.4-fold increase in MAP-kinase activity and this increase in activity was not significantly affected when cells were coincubated with PDGF-BB and SB (10.3-fold). However, pretreatment of SMCs with SB for 30 minutes and subsequent incubation in PDGF-BB plus SB abolished most of the PDGF-BB-induced MAP-kinase activity (4.6-fold). Transcription of growth response genes such as c-fos, c-jun, and c-myc were induced by PDGF-BB, and their induction was suppressed, particularly c-myc, by incubating SMCs with PDGF-BB plus SB. Similarly, preincubation of cells with SB for 30 minutes and subsequent incubation in PDGF-BB plus SB diminished PDGF-BB-induced transcription of c-fos, c-jun, and c-myc. However, SB by itself had no significant effect on c-fos, c-jun, and c-myc transcription.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- K Ranganna
- Department of Neurology, University of Texas Health Science Center at Houston 77030, USA
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