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Zens TJ, Danobeitia JS, Leverson G, Chlebeck PJ, Zitur LJ, Redfield RR, D'Alessandro AM, Odorico S, Kaufman DB, Fernandez LA. The impact of kidney donor profile index on delayed graft function and transplant outcomes: A single-center analysis. Clin Transplant 2019; 32:e13190. [PMID: 29314286 DOI: 10.1111/ctr.13190] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2017] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Renal transplant outcomes result from a combination of factors. Traditionally, donor factors were summarized by classifying kidneys as extended criteria or standard criteria. In 2014, the nomenclature changed to describe donor factors with the kidney donor profile index (KDPI). We aim to evaluate the relationship between KDPI and delayed graft function (DGF), and the impact KDPI on transplant outcomes for both donor after cardiac death (DCD) and donor after brain death (DBD). METHODS An IRB-approved single-center retrospective chart review was performed from January 1999 to July 2013. The patients were divided into six groups: DBD KDPI ≤60, DBD KPDI 61-84, DBD KDPI ≥85, DCD KDPI ≤60, DCD KPDI 61-84, and DCD KDPI ≥85. Rates of DGF, patient survival, and graft survival were examined among groups. RESULTS A total of 2161 kidney transplants were included. DGF rates increased, and graft and patient survival decreased with increasing KDPI (P < .001). DCD kidneys had higher DGF rates than their DBD counterparts (P < .001). In DCD kidneys, a higher KDPI score did not significantly affect the DGF rates (P > .302). There was no significant difference in graft or patient survival in all-comers when comparing DCD and DBD kidneys with equivalent KDPIs (P > .317). Patients with DGF across all categories demonstrated worse graft half-lives. CONCLUSION The KDPI system is an accurate predictor of donor contributions to transplant outcomes. Recipients of DBD kidneys experience an increase in the rate of DGF as their KDPI increases. DCD kidneys have higher DGF rates than their DBD counterparts with similar KDPIs. Patients with documented post-transplant DGF had between 3- and 5-year shorter graft half-lives when compared to recipients that did not experience DGF. Initiatives to reduce the rate of DGF could provide a significant impact on graft survival and result in a reduction in the number of patients requiring retransplant.
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Affiliation(s)
- Tiffany J Zens
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Juan S Danobeitia
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Glen Leverson
- Division of Statistics, Department of Surgery, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Peter J Chlebeck
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Laura J Zitur
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Robert R Redfield
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Anthony M D'Alessandro
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Scott Odorico
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Dixon B Kaufman
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Luis A Fernandez
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
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Lou I, Odorico S, Yu XM, Harrison A, Jaskula-Sztul R, Chen H. Notch3 as a novel therapeutic target in metastatic medullary thyroid cancer. Surgery 2017; 163:104-111. [PMID: 29128180 DOI: 10.1016/j.surg.2017.07.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 07/28/2017] [Accepted: 07/28/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Medullary thyroid cancer portends poor survival once liver metastasis occurs. We hypothesize that Notch3 overexpression in medullary thyroid cancer liver metastasis will decrease proliferation and growth of the tumor. METHODS TT cells were modified genetically to overexpress Notch3 in the presence of doxycycline, creating the TT-Notch3 cell line. Mice were injected intrasplenically with either TT-Notch3 or control vector TT-TRE cells. Each cell line had 3 treatment groups: control with 12 weeks of standard chow, early DOX with doxycycline chow at day 0 and for 70 days thereafter, and late DOX with doxycycline chow at 8 weeks. Each animal underwent micro-computed tomography to evaluate for tumor formation and tumor quantification was performed. Animals were killed at 12 weeks, and the harvested liver was stained with Ki-67, hematoxylin and eosin, and Notch3. RESULTS Induction of Notch3 did not prevent formation of medullary thyroid cancer liver metastases as all mice in the early DOX group developed tumors. However, induction of Notch after medullary thyroid cancer liver tumor formation decreased tumor size, as seen on micro-computed tomography scans (late DOX group). This translated to a 37-fold decrease in tumor volume (P = .001). Notch3 overexpression also resulted in decreased Ki-67 index (P = .038). Moreover, Notch3 induction led to increased areas of neutrophil infiltration and necrosis on hematoxylin and eosin staining of the tumors CONCLUSION: Notch3 overexpression demonstrates an antiproliferative effect on established metastatic medullary thyroid cancer liver tumors and is a potential therapeutic target in treatment.
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Affiliation(s)
- Irene Lou
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Scott Odorico
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Xiao-Min Yu
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - April Harrison
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | | | - Herbert Chen
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
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Zens TJ, Danobeitia JS, Chlebeck PJ, Zitur LJ, Odorico S, Brunner K, Coonen J, Capuano S, D’Alessandro AM, Matkowskyj K, Zhong W, Torrealba J, Fernandez L. Guidelines for the management of a brain death donor in the rhesus macaque: A translational transplant model. PLoS One 2017; 12:e0182552. [PMID: 28926566 PMCID: PMC5604963 DOI: 10.1371/journal.pone.0182552] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 07/20/2017] [Indexed: 01/08/2023] Open
Abstract
Introduction The development of a translatable brain death animal model has significant potential to advance not only transplant research, but also the understanding of the pathophysiologic changes that occur in brain death and severe traumatic brain injury. The aim of this paper is to describe a rhesus macaque model of brain death designed to simulate the average time and medical management described in the human literature. Methods Following approval by the Institutional Animal Care and Use Committee, a brain death model was developed. Non-human primates were monitored and maintained for 20 hours after brain death induction. Vasoactive agents and fluid boluses were administered to maintain hemodynamic stability. Endocrine derangements, particularly diabetes insipidus, were aggressively managed. Results A total of 9 rhesus macaque animals were included in the study. The expected hemodynamic instability of brain death in a rostral to caudal fashion was documented in terms of blood pressure and heart rate changes. During the maintenance phase of brain death, the animal’s temperature and hemodynamics were maintained with goals of mean arterial pressure greater than 60mmHg and heart rate within 20 beats per minute of baseline. Resuscitation protocols are described so that future investigators may reproduce this model. Conclusion We have developed a reproducible large animal primate model of brain death which simulates clinical scenarios and treatment. Our model offers the opportunity for researchers to have translational model to test the efficacy of therapeutic strategies prior to human clinical trials.
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Affiliation(s)
- Tiffany J. Zens
- University of Wisconsin Department of Surgery, Division of Transplantation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Juan S. Danobeitia
- University of Wisconsin Department of Surgery, Division of Transplantation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Peter J. Chlebeck
- University of Wisconsin Department of Surgery, Division of Transplantation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Laura J. Zitur
- University of Wisconsin Department of Surgery, Division of Transplantation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Scott Odorico
- University of Wisconsin Department of Surgery, Division of Transplantation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Kevin Brunner
- Wisconsin Primate Research Center, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Jennifer Coonen
- Wisconsin Primate Research Center, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Saverio Capuano
- Wisconsin Primate Research Center, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Anthony M. D’Alessandro
- University of Wisconsin Department of Surgery, Division of Transplantation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Kristina Matkowskyj
- University of Wisconsin Department of Pathology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Weixiong Zhong
- University of Wisconsin Department of Pathology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Jose Torrealba
- University of Texas Southwestern Medical Center Department of Pathology, Dallas, Texas, United States of America
| | - Luis Fernandez
- University of Wisconsin Department of Surgery, Division of Transplantation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
- * E-mail:
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Golden S, Yu XM, Odorico S, Jain V, Marin A, Ma S, Kenney S, Chen H. The Epstein-Barr virus EBNA2 protein induces a subset of NOTCH target genes in thyroid cancer cell lines but fails to suppress proliferation. Surgery 2016; 161:195-201. [PMID: 27847111 DOI: 10.1016/j.surg.2016.06.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 05/23/2016] [Accepted: 06/03/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Epstein-Barr virus is associated with lymphoid and epithelial malignancies and has been reported to infect thyroid cells. The Epstein-Barr virus protein, EBNA2, regulates viral and cellular promoters by binding to RBP-jκ. Similarly, NOTCH1, a tumor suppressor protein in thyroid epithelial cells, competes with EBNA2 for binding to overlapping sites on RBP-jκ. EBNA2 activates a subset of NOTCH-responsive genes in lymphocytes and myocytes; however, the effect of EBNA2 expression on NOTCH targets in epithelial cells is unknown. Here we have explored whether EBNA2 activates NOTCH1 targets in thyroid cancer lines and examined its effect on cellular proliferation. METHODS Two human thyroid cancer lines, follicular FTC-236 and anaplastic HTh7, were transfected with EBNA2, NOTCH1, or control vectors. Notch targets were measured using quantitative reverse transcriptase polymerase chain reaction. Cellular proliferation was measured by MTT analysis. RESULTS EBNA2 activated only a subset of NOTCH1 targets. Expression of HES1 and HEY1 were increased 10-fold in FTC-236 and HTh7 cells, respectively, but the majority of NOTCH1 targets examined were not affected. In contrast to NOTCH1, EBNA2 did not suppress proliferation. CONCLUSION EBNA2 does not activate most Notch1-responsive genes or suppress proliferation in human thyroid cancer cells. Instead, EBNA2 may compete with NOTCH1 for limiting amounts of RBP-jκ in epithelial cells and inhibit certain aspects of NOTCH1 signaling.
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Affiliation(s)
- Sean Golden
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Xiao-Min Yu
- Department of Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Scott Odorico
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Vansh Jain
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Ana Marin
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Shidong Ma
- Department of Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Shannon Kenney
- Department of Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Herbert Chen
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
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