1
|
See SB, Yang X, Burger C, Lamarthée B, Snanoudj R, Shihab R, Tsapepas DS, Roy P, Larivière-Beaudoin S, Hamelin K, Rojas AM, van Besouw NM, Bartosic A, Daniel N, Vasilescu ER, Mohan S, Cohen D, Ratner L, Baan CC, Bromberg JS, Cardinal H, Anglicheau D, Sun Y, Zorn E. Natural Antibodies Are Associated With Rejection and Long-term Renal Allograft Loss in a Multicenter International Cohort. Transplantation 2023; 107:1580-1592. [PMID: 36728359 PMCID: PMC10290575 DOI: 10.1097/tp.0000000000004472] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Potentially harmful nonhuman leukocyte antigen antibodies have been identified in renal transplantation, including natural immunoglobulin G antibodies (Nabs) reactive to varied antigenic structures, including apoptotic cells. METHODS In this retrospective, multicenter study, we assessed Nabs by reactivity to apoptotic cells in sera collected from 980 kidney transplant recipients across 4 centers to determine their association with graft outcomes. RESULTS Elevated pretransplant Nabs were associated with graft loss (hazard ratio [HR] 2.71; 95% confidence interval [CI], 1.15-6.39; P = 0.0232), the composite endpoint of graft loss or severe graft dysfunction (HR 2.40; 95% CI, 1.13-5.10; P = 0.0232), and T cell-mediated rejection (odds ratio [OR] 1.77; 95% CI, 1.07-3.02; P = 0.0310). High pretransplant Nabs together with donor-specific antibodies (DSAs) were associated with increased risk of composite outcomes (HR 6.31; 95% CI, 1.81-22.0; P = 0.0039). In patients with high pretransplant Nabs, the subsequent development of posttransplant Nabs was associated with both T cell-mediated rejection (OR 3.64; 95% CI, 1.61-8.36; P = 0.0021) and mixed rejection (OR 3.10; 95% CI, 1.02-9.75; P = 0.0473). Finally, elevated pre- and posttransplant Nabs combined with DSAs were associated with increased risk of composite outcomes (HR 3.97; 95% CI, 1.51-10.43; P = 0.0052) and T cell-mediated rejection (OR 7.28; 95% CI, 2.16-25.96; P = 0.0016). CONCLUSIONS The presence of pre- and posttransplant Nabs, together with DSAs, was associated with increased risk of poor graft outcomes and rejection after renal transplantation.
Collapse
Affiliation(s)
- Sarah B. See
- Columbia Center for Translational Immunology, Columbia University Irving Medical Center, New York, USA
| | - Xue Yang
- Department of Biostatistics, Columbia University Irving Medical Center, New York, USA
| | - Carole Burger
- Department of Kidney Transplantation, Hôpital Universitaire Necker-Assistance Publique Hopitaux de Paris, France
| | - Baptiste Lamarthée
- Necker-Enfants Malades Institute, Inserm U1151, Université de Paris, Paris, France
| | - Renaud Snanoudj
- Department of Kidney Transplantation, Hôpital Kremlin Bicêtre, Paris, France
| | - Ronzon Shihab
- Columbia Center for Translational Immunology, Columbia University Irving Medical Center, New York, USA
| | - Demetra S. Tsapepas
- Department of Surgery, Columbia University Vagelos College of Physicians & Surgeons, New York, USA
| | - Poulomi Roy
- Columbia Center for Translational Immunology, Columbia University Irving Medical Center, New York, USA
| | - Stéphanie Larivière-Beaudoin
- Research Center, Centre Hospitalier de l’Université de Montréal, Montreal, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, Canada
| | - Katia Hamelin
- Research Center, Centre Hospitalier de l’Université de Montréal, Montreal, Canada
| | - Aleixandra Mendoza Rojas
- Department of Internal Medicine – Nephrology and Transplantation, Transplant Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Nicole M. van Besouw
- Department of Internal Medicine – Nephrology and Transplantation, Transplant Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Amanda Bartosic
- Department of Surgery, University of Maryland School of Medicine, Baltimore, USA
| | - Nikita Daniel
- Department of Surgery, University of Maryland School of Medicine, Baltimore, USA
| | - E. Rodica Vasilescu
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, USA
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians & Surgeons, New York, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, USA
| | - David Cohen
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians & Surgeons, New York, USA
| | - Lloyd Ratner
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians & Surgeons, New York, USA
| | - Carla C. Baan
- Department of Internal Medicine – Nephrology and Transplantation, Transplant Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jonathan S. Bromberg
- Department of Surgery, University of Maryland School of Medicine, Baltimore, USA
| | - Héloïse Cardinal
- Research Center, Centre Hospitalier de l’Université de Montréal, Montreal, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, Canada
| | - Dany Anglicheau
- Department of Kidney Transplantation, Hôpital Universitaire Necker-Assistance Publique Hopitaux de Paris, France
| | - Yifei Sun
- Department of Biostatistics, Columbia University Irving Medical Center, New York, USA
| | - Emmanuel Zorn
- Columbia Center for Translational Immunology, Columbia University Irving Medical Center, New York, USA
| |
Collapse
|
2
|
Doreille A, Azzi F, Larivière-Beaudoin S, Karakeussian-Rimbaud A, Trudel D, Hébert MJ, Dieudé M, Patey N, Cardinal H. Acute Kidney Injury, Microvascular Rarefaction, and Estimated Glomerular Filtration Rate in Kidney Transplant Recipients. Clin J Am Soc Nephrol 2021; 16:415-426. [PMID: 33648972 PMCID: PMC8011007 DOI: 10.2215/cjn.07270520] [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: 05/12/2020] [Accepted: 01/14/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Animal studies suggest that microvascular rarefaction is a key factor in the acute kidney disease to CKD transition. Hence, delayed graft function appears as a unique human model of AKI to further explore the role of microvascular rarefaction in kidney transplant recipients. Here, we assessed whether delayed graft function is associated with peritubular capillary loss and evaluated the association between this loss and long-term kidney graft function. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This observational, retrospective cohort study included 61 participants who experienced delayed graft function and 130 who had immediate graft function. We used linear regression models to evaluate associations between delayed graft function and peritubular capillary density expressed as the percentage of efficient cortical area occupied by peritubular capillaries in pre- and post-transplant graft biopsies. eGFRs 1 and 3 years post-transplant were secondary outcomes. RESULTS Post-transplant biopsies were performed at a median of 113 days (interquartile range, 101-128) after transplantation. Peritubular capillary density went from 15.4% to 11.5% in patients with delayed graft function (median change, -3.7%; interquartile range, -6.6% to -0.8%) and from 19.7% to 15.1% in those with immediate graft function (median change, -4.5%; interquartile range, -8.0% to -0.8%). Although the unadjusted change in peritubular capillary density was similar between patients with and without delayed graft function, delayed graft function was associated with more peritubular capillary loss in the multivariable analysis (adjusted difference in change, -2.9%; 95% confidence interval, -4.0 to -1.8). Pretransplant peritubular capillary density and change in peritubular capillary density were associated with eGFR 1 and 3 years post-transplantation. CONCLUSIONS Perioperative AKI is associated with lower density in peritubular capillaries before transplantation and with loss of peritubular capillaries following transplantation. Lower peritubular capillary density is linked to lower long-term eGFR.
Collapse
Affiliation(s)
- Alice Doreille
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Immunopathology axis, Montreal, Quebec, Canada,Faculté de Médecine, Université Paris-Sud, Paris, France
| | - Féryel Azzi
- Institut du cancer de Montréal, Montreal, Quebec, Canada
| | - Stéphanie Larivière-Beaudoin
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Immunopathology axis, Montreal, Quebec, Canada,Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - Annie Karakeussian-Rimbaud
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Immunopathology axis, Montreal, Quebec, Canada,Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - Dominique Trudel
- Institut du cancer de Montréal, Montreal, Quebec, Canada,Pathology Department, Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - Marie-Josée Hébert
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Immunopathology axis, Montreal, Quebec, Canada,Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada,Nephrology Department, Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - Mélanie Dieudé
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Immunopathology axis, Montreal, Quebec, Canada,Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - Natacha Patey
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Immunopathology axis, Montreal, Quebec, Canada,Pathology Department, Sainte-Justine Hospital, Montreal, Quebec, Canada
| | - Héloïse Cardinal
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Immunopathology axis, Montreal, Quebec, Canada,Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada,Nephrology Department, Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| |
Collapse
|
3
|
Lepeytre F, Delmas-Frenette C, Zhang X, Larivière-Beaudoin S, Sapir-Pichhadze R, Foster BJ, Cardinal H. Donor Age, Donor-Recipient Size Mismatch, and Kidney Graft Survival. Clin J Am Soc Nephrol 2020; 15:1455-1463. [PMID: 32843375 PMCID: PMC7536765 DOI: 10.2215/cjn.02310220] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/27/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Small donor and/or kidney sizes relative to recipient size are associated with a higher risk of kidney allograft failure. Donor and recipient ages are associated with graft survival and may modulate the relationship between size mismatch and the latter. The aim of this study was to determine whether the association between donor-recipient size mismatch and graft survival differs by donor and recipient age. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENT We performed a retrospective cohort study of first adult deceased donor kidney transplantations performed between 2000 and 2018 recorded in the Scientific Registry of Transplant Recipients. We used multivariable Cox proportional hazards models to assess the association between donor-recipient body surface area ratio and death-censored graft survival, defined as return to dialysis or retransplantation. We considered interactions between donor-recipient body surface area ratio and each of recipient and donor age. RESULTS Among the 136,321 kidney transplant recipients included in this study, 23,614 (17%) experienced death-censored graft loss over a median follow-up of 4.3 years (interquartile range, 1.9-7.8 years). The three-way donor-recipient body surface area ratio by donor age by recipient age interaction was statistically significant (P=0.04). The magnitude of the association between severe size mismatch (donor-recipient body surface area ratio <0.80 versus ≥1.00) and death-censored graft survival was stronger with older donor age and recipient age. In all recipient age categories except the youngest (18-30 years), 5- and 10-year graft survival rates were similar or better with a size-mismatched donor aged <40 years than a nonsize-mismatched donor aged 40 years or older. CONCLUSIONS The association of donor-recipient size mismatch on long-term graft survival is modulated by recipient and donor age. Size-mismatched kidneys yield excellent graft survival when the donor is young. Donor age was more strongly associated with graft survival than size mismatch.
Collapse
Affiliation(s)
- Fanny Lepeytre
- Immunopathology Division, Research Centre, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Catherine Delmas-Frenette
- Immunopathology Division, Research Centre, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Xun Zhang
- Centre for Outcomes Research and Evaluation (CORE), McGill University Health Centre, Montréal, Quebéc, Canada
| | - Stéphanie Larivière-Beaudoin
- Immunopathology Division, Research Centre, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Ruth Sapir-Pichhadze
- Centre for Outcomes Research and Evaluation (CORE), McGill University Health Centre, Montréal, Quebéc, Canada.,Division of Nephrology and the Multi Organ Transplant Program, Royal Victoria Hospital, McGill University Health Centre, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Bethany J Foster
- Centre for Outcomes Research and Evaluation (CORE), McGill University Health Centre, Montréal, Quebéc, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.,Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montréal, Québec, Canada
| | - Héloïse Cardinal
- Immunopathology Division, Research Centre, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| |
Collapse
|