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Cashion WT, Zhang X, Puttarajappa C, Sharma A, Mehta R, Ganoza A, Gunabushanam V, Sood P, Wu C, Cherukuri A, Shah N, Kaltenmeier C, Liu H, Dharmayan S, Hariharan S, Molinari M. Interaction between cold ischemia time and Kidney Donor Profile Index on postrenal transplant outcomes. Am J Transplant 2024; 24:781-794. [PMID: 38307416 DOI: 10.1016/j.ajt.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 12/11/2023] [Accepted: 01/15/2024] [Indexed: 02/04/2024]
Abstract
We analyzed whether there is an interaction between the Kidney Donor Profile Index (KDPI) and cold ischemia time (CIT) in recipients of deceased donor kidney transplant (KTs). Adults who underwent KTs in the United States between 2014 and 2020 were included and divided into 3 KDPI groups (≤20%, 21%-85%, >85%) and 4 CIT strata (<12, 12-17.9, 18-23.9, ≥24 hours). Multivariate analyses were used to test the interaction between KDPI and CIT for the following outcomes: primary graft nonfunction (PGNF), delayed graft function (DGF), estimated glomerular filtration rate (eGFR) at 6 and 12 months, patient survival, graft survival, and death-censored graft survival (DCGS). A total of 69,490 recipients were analyzed: 18,241 (26.3%) received a graft with KDPI ≤20%, 46,953 (67.6%) with KDPI 21%-85%, and 4,296 (6.2%) with KDPI >85%. Increasing KDPI and CIT were associated with worse post-KT outcomes. Contrary to our hypothesis, howerver, the interaction between KDPI and CIT was statistically significant only for PGNF and DGF and eGFR at 6 months. Paradoxically, the negative coefficient of the interaction suggested that increasing duration of CIT was more detrimental for low and intermediate-KDPI organs relative to high-KDPI grafts. Conversely, for mortality, graft survival, and DCGS, we found that the interaction between CIT and KDPI was not statistically significant. We conclude that, high KDPI and prolonged CIT are independent risk factors for inferior outcomes after KT. Their interaction, however, is statistically significant only for the short-term outcomes and more pronounced on low and intermediate-KDPI grafts than high-KDPI kidneys.
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Affiliation(s)
- Winn T Cashion
- Department of Medicine, Division of Nephrology, Maine Health, Portland, ME, USA
| | - Xingyu Zhang
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Chethan Puttarajappa
- Department of Medicine, Division of Nephrology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Akhil Sharma
- Department of Medicine, Division of Nephrology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Rajil Mehta
- Department of Medicine, Division of Nephrology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Armando Ganoza
- Department of Surgery, Division of Transplantation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Vikraman Gunabushanam
- Department of Surgery, Division of Transplantation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Puneet Sood
- Department of Medicine, Division of Nephrology, University of California San Francisco, CA, USA
| | - Christine Wu
- Department of Medicine, Division of Nephrology, Pittsburgh VA Medical Center, Pittsburgh, Pennsylvania, USA
| | - Aravind Cherukuri
- Department of Medicine, Division of Nephrology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nirav Shah
- Department of Medicine, Division of Nephrology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Christof Kaltenmeier
- Department of Surgery, Division of Transplantation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Hao Liu
- Department of Surgery, Division of Transplantation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Stalin Dharmayan
- Department of Surgery, Division of Transplantation, University Hospital of Lester, Lester, UK
| | - Sundaram Hariharan
- Department of Medicine, Division of Nephrology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michele Molinari
- Department of Surgery, Division of Transplantation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
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Hariharan S, Rogers N, Naesens M, Pestana JM, Ferreira GF, Requião-Moura LR, Foresto RD, Kim SJ, Sullivan K, Helanterä I, Goutaudier V, Loupy A, Kute VB, Cardillo M, Tanabe K, Åsberg A, Jensen T, Mahillo B, Jeong JC, Anantharaman V, Callaghan C, Ravanan R, Manas D, Israni AK, Mehta RB. Long-term Kidney Transplant Survival Across the Globe. Transplantation 2024:00007890-990000000-00694. [PMID: 38499511 DOI: 10.1097/tp.0000000000004977] [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: 03/20/2024]
Abstract
BACKGROUND The outcomes after kidney transplantation (KT), including access, wait time, and other issues around the globe, have been studied. However, issues do vary from one country to another. METHODS We obtained data from several countries from North America, South America, Europe, Asia, and Australia, including the number of patients awaiting KT from 2015, transplant rate per million population (pmp), proportion of living donor and deceased donor (LD/DD) KT, and posttransplant survival. We also sought opinions on key difficulties faced by each of these countries with respect to KT and long-term survival. RESULTS Variation in access to KT across the globe was noted. Countries with the highest rates of KT pmp included the United States (79%) and Spain (71%). A higher proportion of LD transplants was noted in Japan (93%), India (85%), Singapore (63%), and South Korea (63%). A higher proportion of DD KTs was noted in Spain (90%), Brazil (90%), France (85%), Italy (85%), Finland (85%), Australia-New Zealand (80%), and the United States (77%). The 5-y graft survival for LD was highest in South Korea (95%), Singapore (94%), Italy (93%), Finland (93%), and Japan (93%), whereas for DD, it was South Korea (93%), Italy (88%), Japan (86%), and Singapore (86%). The common issues surrounding KTs are access and a limited number of LDs and DDs. Key issues identified for long-term survival were increasing age of donors and recipients, higher recipient comorbidity, and posttransplant events, such as alloimmune injury to the kidney, infection, cancer, and suboptimal adherence to therapy. CONCLUSIONS A unified approach is necessary to improve issues surrounding KT as the demand continues to increase.
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Affiliation(s)
- Sundaram Hariharan
- Department of Medicine and Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Natasha Rogers
- Division of Nephrology and Transplantation, Department of Nephrology and Transplantation Medicine, Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Maarten Naesens
- Department of Medicine and Nephrology, University of KU Leuven, Leuven, Belgium
| | - J Medina Pestana
- Hospital do Rim, Fundação Oswaldo Ramos and Disciplina de Nefrologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Gustavo F Ferreira
- Hospital do Rim, Fundação Oswaldo Ramos and Disciplina de Nefrologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Lucio R Requião-Moura
- Hospital do Rim, Fundação Oswaldo Ramos and Disciplina de Nefrologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Renato D Foresto
- Hospital do Rim, Fundação Oswaldo Ramos and Disciplina de Nefrologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - S Joseph Kim
- Department of Medicine (Nephrology), University of Toronto, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | | | - Ilkka Helanterä
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Valentin Goutaudier
- Université Paris Cité, Paris Institute for Transplantation and Organ Regeneration, Paris, France
| | - Alexandre Loupy
- Department of Nephrology and Transplantation, Université Paris Cité, Paris Institute for Transplantation and Organ Regeneration, Paris, France
| | - Vivek B Kute
- Department of Nephology, Institute of Kidney Diseases and Research Centre, Ahmedabad, Gujarat, India
| | - Massimo Cardillo
- Centro Nazionale per i Trapianti, Istituto Superiore di Sanità, Roma, Italy
| | - Kazunari Tanabe
- Kidney Transplant/Robotic Surgery Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Anders Åsberg
- Section of Pharmacology and Pharmaceutical Bioscience, University of Oslo, Oslo, Norway
| | - Trond Jensen
- Department of Nephrology, University of Oslo, Oslo, Norway
| | | | - Jong Cheol Jeong
- Department of Medicine and Nephrology, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Vathsala Anantharaman
- National University Centre for Organ Transplantation, National University Hospital, Singapore, Singapore
| | - Chris Callaghan
- Department of Nephrology and Transplantation, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Derek Manas
- Newcastle Hospitals NHS Trust and Newcastle University, New Castle, United Kingdom
| | - Ajay K Israni
- Department of Medicine, Adjunct Faculty School of Public Health, University of Minnesota, Minneapolis, MN
| | - Rajil B Mehta
- Department of Medicine and Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
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Demetris AJ, Lesniak AJ, Popp BA, Frencho RJ, Minervini MI, Nalesnik MA, El Hag MI, Hariharan S, Randhawa PS. Banff scoring of kidney allograft biopsies: "Manual" application vs software-assisted sign-out. Am J Clin Pathol 2024:aqad180. [PMID: 38340346 DOI: 10.1093/ajcp/aqad180] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/06/2023] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVES Pathologists interpreting kidney allograft biopsies using the Banff system usually start by recording component scores (eg, i, t, cg) using histopathologic criteria committed to memory. Component scores are then melded into diagnoses using the same manual/mental processes. This approach to complex Banff rules during routine sign-out produces a lack of fidelity and needs improvement. METHODS We constructed a web-based "smart template" (software-assisted sign-out) system that uniquely starts with upstream Banff-defined additional diagnostic parameters (eg, infection) and histopathologic criteria (eg, percent interstitial inflammation) collectively referred to as feeder data that is then translated into component scores and integrated into final diagnoses using software-encoded decision trees. RESULTS Software-assisted sign-out enables pathologists to (1) accurately and uniformly apply Banff rules, thereby eliminating human inconsistencies (present in 25% of the cohort); (2) document areas of improvement; (3) show improved correlation with function; (4) examine t-Distributed Stochastic Neighbor Embedding clustering for diagnosis stratification; and (5) ready upstream incorporation of artificial intelligence-assisted scoring of biopsies. CONCLUSIONS Compared with the legacy approach, software-assisted sign-out improves Banff accuracy and fidelity, more closely correlates with kidney function, is practical for routine clinical work and translational research studies, facilitates downstream integration with nonpathology data, and readies biopsy scoring for artificial intelligence algorithms.
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Affiliation(s)
- Anthony J Demetris
- Department of Pathology, Division of Transplantation, University of Pittsburgh, Pittsburgh, PA, US
| | - Andrew J Lesniak
- Department of Pathology, Division of Transplantation, University of Pittsburgh, Pittsburgh, PA, US
| | - Benjamin A Popp
- Department of Pathology, Division of Transplantation, University of Pittsburgh, Pittsburgh, PA, US
| | | | - Marta I Minervini
- Department of Pathology, Division of Transplantation, University of Pittsburgh, Pittsburgh, PA, US
| | - Michael A Nalesnik
- Department of Pathology, Division of Transplantation, University of Pittsburgh, Pittsburgh, PA, US
| | - Mohamed I El Hag
- Department of Pathology, Division of Transplantation, University of Pittsburgh, Pittsburgh, PA, US
| | - Sundaram Hariharan
- Division of Transplant Nephrology, University of Pittsburgh Medical Center, Pittsburgh, PA, US
| | - Parmjeet S Randhawa
- Department of Pathology, Division of Transplantation, University of Pittsburgh, Pittsburgh, PA, US
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Sharma A, Verma S, Mirzai S, Viswanathan V, Kapoor S, Hariharan S, Dew MA, Puttarajappa CM. Implementing a self-reported immunosuppression adherence questionnaire to screen for non-adherence in routine care of kidney transplant recipients. Clin Transplant 2024; 38:e15157. [PMID: 37792310 DOI: 10.1111/ctr.15157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/20/2023] [Accepted: 09/24/2023] [Indexed: 10/05/2023]
Abstract
INTRODUCTION Self-reported measures of immunosuppression adherence have been largely examined in research settings. METHODS In this single center study of 610 kidney transplant recipients, we examined if a voluntary, non-anonymous self-report measure could identify non-adherence in a routine clinic setting and how patients perceived such a measure. Non-adherence was measured using the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS) and patient perception was elicited using a customized questionnaire. RESULTS Non-responders to the survey (15%) were younger, more likely to be black, and less likely to have had a pre-emptive transplant. Among complete responders (n = 485), 38% reported non-adherence with non-adherent patients being younger (54 y vs. 60 y; p = .01), less likely to have been on dialysis pre-transplant (59% vs. 68%; p = .04), further out from transplant (37 vs. 22 months; p < .001) and had more rejections in the preceding year (8% vs. 3%; p = .02). Self-reported non-adherence was associated with higher calcineurin inhibitor intra-patient variability (27.4% vs. 24.5%; p = .02), but not with donor-specific antibody detection (27.8% vs. 21.2%, p = .15). Of patients providing feedback (n = 500), the majority of patients felt comfortable reporting adherence (92%), that the survey was relevant to their visit (71%), and that the survey did not interfere with their clinic visit (88%). CONCLUSION In summary, a self-reported questionnaire during clinic visits identified immunosuppression non-adherence in a significant proportion of patients and was well received by patients. Integrating self-report measures into routine post-transplant care may enable early identification of non-adherence.
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Affiliation(s)
- Akhil Sharma
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Siddharth Verma
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Saeid Mirzai
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Vignesh Viswanathan
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sanjana Kapoor
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sundaram Hariharan
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Chethan M Puttarajappa
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Cherukuri A, Abou-Daya KI, Chowdhury R, Mehta RB, Hariharan S, Randhawa P, Rothstein DM. Transitional B cell cytokines risk stratify early borderline rejection after renal transplantation. Kidney Int 2023; 103:749-761. [PMID: 36436679 PMCID: PMC10038876 DOI: 10.1016/j.kint.2022.10.026] [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] [Received: 07/19/2022] [Revised: 10/26/2022] [Accepted: 10/31/2022] [Indexed: 11/27/2022]
Abstract
Borderline rejection (BL) in renal transplantation is associated with decreased allograft survival, yet many patients with BL maintain stable graft function. Identifying patients with early BL at risk for shortened allograft survival would allow for timely targeted therapeutic intervention aimed at improving outcomes. 851/1187 patients transplanted between 2013-18 underwent early biopsy (0-4 mos). 217/851 (25%) had BL and were compared to 387/851 without significant inflammation (NI). Serial surveillance and for-cause biopsies and seven-year follow-up were used to evaluate histological and clinical progression. To identify high-risk patients, we examined clinical/histological parameters using regression and non-linear dimensionality reduction (tSNE) and a biomarker based on peripheral blood transitional-1 B cell (T1B) IL-10/TNFα ratio. Compared to NI, early BL was associated with increased progression to late acute rejection (AR; 5-12 mos), premature interstitial fibrosis and tubular atrophy (IFTA) and decreased seven-year graft survival. However, decreased graft survival was limited to BL patients who progressed to late AR or IFTA, and was not influenced by treatment. Although tSNE clustered patients into groups based on clinical factors, the ability of these factors to risk stratify BL patients was modest. In contrast, a low T1B IL-10/TNFα ratio at 3 months identified BL patients at high risk for progression to AR (ROC AUC 0.87) and poor 7-yr graft survival (52% vs. 92%, p=0.003), while BL patients with a high ratio had similar graft survival to patients with NI (91%, p=NS). Thus, progressive early allograft inflammation manifested as BL that progresses to late AR in the first post-transplant year represents a high-risk clinical state for poor allograft outcomes. Such high-risk status can be predicted by the T1B IL-10/TNFα ratio before irreversible scarring sets in, thus allowing timely risk stratification.
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Affiliation(s)
- Aravind Cherukuri
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Renal and Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| | - Khodor I Abou-Daya
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Raad Chowdhury
- Renal and Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rajil B Mehta
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Renal and Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sundaram Hariharan
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Renal and Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Parmjeet Randhawa
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Division of Transplantation Pathology, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David M Rothstein
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Renal and Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Puttarajappa CM, Tevar AD, Hoffman W, Degenholtz H, Schinstock CA, Gunabushanam V, Zeevi A, Xu Q, Hariharan S. Virtual crossmatch for deceased donor kidney transplantation in the United States: A survey of histocompatibility lab directors and transplant surgeons. Hum Immunol 2023; 84:214-223. [PMID: 36581507 PMCID: PMC9991979 DOI: 10.1016/j.humimm.2022.12.001] [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] [Received: 09/02/2022] [Revised: 11/22/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022]
Abstract
Virtual crossmatch (VXM) is used as an alternative to or in conjunction with a cell-based physical crossmatch (PXM) for assessing HLA (human leukocyte antigen) compatibility prior to deceased donor kidney transplantation (DDKT). Data on practice patterns and perceptions regarding VXM use in the US are limited. We performed a survey of US HLA directors and transplant surgeons regarding HLA testing and crossmatch strategies. 53 (56 %) HLA directors and 68 surgeons (representing ∼ 23 % of US transplant centers) completed the survey. Both groups agreed that VXM could reduce cold ischemia time (CIT), costs and improve allocation efficiency. VXM use increased following the 2021 kidney allocation change. Reducing CIT was the primary reason for favoring VXM over PXM. Preference for VXM reduced as candidates' panel reactive antibodies increased. Regulations, program policies and limitations of HLA technology were cited as important reasons for preferring PXM over VXM. Surgeons reported similar perceptions, but findings are limited by the low response rate. Finally, half the labs reported lacking specific protocols for VXM use. In conclusion, improved HLA technology and protocols along with changes to institutional procedures and policy regulations are needed for safer expansion of VXM in DDKT.
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Affiliation(s)
- Chethan M Puttarajappa
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, USA.
| | - Amit D Tevar
- Department of Surgery, University of Pittsburgh, Pittsburgh, USA
| | | | - Howard Degenholtz
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, USA
| | | | | | - Adriana Zeevi
- Department of Pathology, University of Pittsburgh, Pittsburgh, USA
| | - Qingyong Xu
- Department of Pathology, University of Pittsburgh, Pittsburgh, USA
| | - Sundaram Hariharan
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, USA
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Puttarajappa CM, Hariharan S, Zhang X, Tevar A, Mehta R, Gunabushanam V, Sood P, Hoffman W, Mohan S. Early Effect of the Circular Model of Kidney Allocation in the United States. J Am Soc Nephrol 2023; 34:26-39. [PMID: 36302599 PMCID: PMC10101588 DOI: 10.1681/asn.2022040471] [Citation(s) in RCA: 5] [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: 04/21/2022] [Revised: 07/21/2022] [Accepted: 08/16/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND In March 2021, the United States implemented a new kidney allocation system (KAS250) for deceased donor kidney transplantation (DDKT), which eliminated the donation service area-based allocation and replaced it with a system on the basis of distance from donor hospital to transplant center within/outside a radius of 250 nautical miles. The effect of this policy on kidney discards and logistics is unknown. METHODS We examined discards, donor-recipient characteristics, cold ischemia time (CIT), and delayed graft function (DGF) during the first 9 months of KAS250 compared with a pre-KAS250 cohort from the preceding 2 years. Changes in discards and CIT after the onset of COVID-19 and the implementation of KAS250 were evaluated using an interrupted time-series model. Changes in allocation practices (biopsy, machine perfusion, and virtual cross-match) were also evaluated. RESULTS Post-KAS250 saw a two-fold increase in kidneys imported from nonlocal organ procurement organizations (OPO) and a higher proportion of recipients with calculated panel reactive antibody (cPRA) 81%-98% (12% versus 8%; P <0.001) and those with >5 years of pretransplant dialysis (35% versus 33%; P <0.001). CIT increased (mean 2 hours), including among local OPO kidneys. DGF was similar on adjusted analysis. Discards after KAS250 did not immediately change, but we observed a statistically significant increase over time that was independent of donor quality. Machine perfusion use decreased, whereas reliance on virtual cross-match increased, which was associated with shorter CIT. CONCLUSIONS Early trends after KAS250 show an increase in transplant access to patients with cPRA>80% and those with longer dialysis duration, but this was accompanied by an increase in CIT and a suggestion of worsening kidney discards.
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Affiliation(s)
- Chethan M. Puttarajappa
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sundaram Hariharan
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Xingyu Zhang
- Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Amit Tevar
- Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rajil Mehta
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Vikraman Gunabushanam
- Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Puneet Sood
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - William Hoffman
- Transplant Nephrology, UPMC Pinnacle, Harrisburg, Pennsylvania
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, Vagelos College of Physicians and Surgeons and Department of Medicine, Mailman School of Public Health, Columbia University, New York, New York
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8
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Mehta RB, Melgarejo I, Viswanathan V, Zhang X, Pittappilly M, Randhawa P, Puttarajappa C, Sood P, Wu C, Sharma A, Molinari M, Hariharan S. Long-term immunological outcomes of early subclinical inflammation on surveillance kidney allograft biopsies. Kidney Int 2022; 102:1371-1381. [PMID: 36049641 DOI: 10.1016/j.kint.2022.07.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 07/07/2022] [Accepted: 07/26/2022] [Indexed: 01/12/2023]
Abstract
The long-term impact of early subclinical inflammation (SCI) through surveillance biopsy has not been well studied. To do this, we recruited a prospective observational cohort that included 1000 sequential patients who received a kidney transplant from 2013-2017 at our center. A total of 586 patients who underwent a surveillance biopsy in their first year post-transplant were included after excluding those with clinical rejections, and those who were unable to undergo a surveillance biopsy. Patients were classified based on their biopsy findings: 282 with NSI (No Significant Inflammation) and 304 with SCI-T (SCI and Tubulitis) which was further subdivided into 182 with SC-BLR (Subclinical Borderline Changes) and 122 with SC-TCMR (Subclinical T Cell Mediated Rejection, Banff 2019 classification of 1A or more). We followed the clinical and immunological events including Clinical Biopsy Proven Acute Rejection [C-BPAR], long-term kidney function and death-censored graft loss over a median follow-up of five years. Episodes of C-BPAR were noted at a median of two years post-transplant. Adjusted odds of having a subsequent C-BPAR was significantly higher in the SCI-T group [SC-BLR and SC-TCMR] compared to NSI 3.8 (2.1-7.5). The adjusted hazard for death-censored graft loss was significantly higher with SCI-T compared to NSI [1.99 (1.04-3.84)]. Overall, SCI detected through surveillance biopsy within the first year post-transplant is a harbinger for subsequent immunological events and is associated with a significantly greater hazard for subsequent C-BPAR and death-censored graft loss. Thus, our study highlights the need for identifying patients with SCI through surveillance biopsy and develop strategies to prevent further alloimmune injuries.
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Affiliation(s)
- Rajil B Mehta
- Division of Transplant Nephrology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
| | - Ivy Melgarejo
- Division of Transplant Nephrology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Vignesh Viswanathan
- Division of Transplant Nephrology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Xingyu Zhang
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Matthew Pittappilly
- Division of Transplant Nephrology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Parmjeet Randhawa
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Chethan Puttarajappa
- Division of Transplant Nephrology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Puneet Sood
- Division of Transplant Nephrology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Christine Wu
- Division of Transplant Nephrology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Akhil Sharma
- Division of Transplant Nephrology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michele Molinari
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Sundaram Hariharan
- Division of Transplant Nephrology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Karthik V, Selvakumar P, Senthil Kumar P, Satheeskumar V, Godwin Vijaysunder M, Hariharan S, Antony K. Recent advances in electrochemical sensor developments for detecting emerging pollutant in water environment. Chemosphere 2022; 304:135331. [PMID: 35709842 DOI: 10.1016/j.chemosphere.2022.135331] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/07/2022] [Accepted: 06/10/2022] [Indexed: 06/15/2023]
Abstract
In the latest times, considerable studies have been performed closer to detecting emerging pollutant such as paracetamol in wastewater. Electrochemical sensor developments have recently started to determine in fewer concentrations effectively. The detection of paracetamol using standard protocols corresponding to electroanalytical techniques has a greater impact noticed in directing the detecting process toward biosensors. Non-enzymatic sensors are the peak of all electro analysis approaches. Functionalized materials, such as metal oxide nanoparticles, conducting polymers, and carbon-based materials for electrode surface functionalization have been used to create a fortification for distributing passive enzyme-free biosensors. Synergic effects are possible by enhancing loading capacity and mass transfer of reactants for attaining high analytical sensitivity using a variety of nanomaterials with large surface areas. The main focus of this study is to address the prevailing issues in the identification of paracetamol with the tasks in the non-enzymatic sensors field, followed by the useful methods of electro analysis studies.
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Affiliation(s)
- V Karthik
- Department of Industrial Biotechnology, Government College of Technology, Coimbatore, 641013, India
| | - P Selvakumar
- Department of Chemical Engineering, School of Mechanical, Chemical and Materials Engineering, Adama Science and Technology University, Adama, 1888, Ethiopia
| | - P Senthil Kumar
- Department of Chemical Engineering, Sri Sivasubramaniya Nadar College of Engineering, Chennai, 603110, India; Centre of Excellence in Water Research (CEWAR), Sri Sivasubramaniya Nadar College of Engineering, Chennai, 603110, India; Department of Biotechnology Engineering and Food Technology, Chandigarh University, Mohali, 140413, India.
| | - V Satheeskumar
- Department of Civil Engineering, Government College of Technology, Coimbatore, 641013, India
| | - M Godwin Vijaysunder
- Department of Industrial Biotechnology, Government College of Technology, Coimbatore, 641013, India
| | - S Hariharan
- Department of Industrial Biotechnology, Government College of Technology, Coimbatore, 641013, India
| | - K Antony
- Department of Industrial Biotechnology, Government College of Technology, Coimbatore, 641013, India
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10
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Wazir S, Abbas M, Ratanasrimetha P, Zhang C, Hariharan S, Puttarajappa CM. Preoperative blood pressure and risk of delayed graft function in deceased donor kidney transplantation. Clin Transplant 2022; 36:e14776. [PMID: 35821617 DOI: 10.1111/ctr.14776] [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] [Received: 01/10/2022] [Revised: 05/05/2022] [Accepted: 07/08/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND In kidney transplantation, delayed graft function (DGF) is associated with increased morbidity and a higher risk of graft failure. Prior research suggests that chronic hypotension increases DGF risk, but the relationship of preoperative blood pressure to DGF is unclear. METHODS In this single center study of adult deceased donor kidney transplant recipients transplanted between 2015 and 2019, we evaluated the question of whether preoperative mean arterial pressure (MAP) affected DGF risk. Additionally, we investigated whether the risk of DGF was moderated by certain donor and recipient characteristics. For recipient characteristics associated with increased DGF risk and preoperative MAP, we performed a mediation analysis to estimate the proportion of DGF risk mediated through preoperative MAP. RESULTS Among 562 deceased donor kidney recipients, DGF risk decreased as preoperative MAP increased, with a 2% lower risk per 1 mm Hg increase in MAP. This increased risk was similar, with no statistically significant interaction effect between preoperative MAP and donor (donation after circulatory death) and recipient characteristics (diabetes, body mass index, and use of anti-hypertensive medications). Preoperative MAP was negativity correlated with recipient BMI and duration of pre transplant dialysis. On mediation analysis, MAP accounted for 12% and 16% of the DGF risk associated with recipient BMI and pre-transplant dialysis duration, respectively. CONCLUSION In deceased donor kidney transplantation, each 1 mm Hg increase in preoperative MAP was associated with 2% lower DGF risk. Preoperative MAP was influenced by recipient BMI and dialysis duration, and likely contributes to some of the high DGF risk from obesity and long dialysis vintage.
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Affiliation(s)
- Shoaib Wazir
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Muhammad Abbas
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Praveen Ratanasrimetha
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Casey Zhang
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sundaram Hariharan
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Chethan M Puttarajappa
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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11
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Molinari M, Kaltenmeier C, Liu H, Ashwat E, Jorgensen D, Puttarajappa C, Wu CM, Mehta R, Sood P, Shah N, Sharma A, Thompson A, Reddy D, Hariharan S. Function and longevity of renal grafts from high-KDPI donors. Clin Transplant 2022; 36:e14759. [PMID: 35778369 PMCID: PMC9786736 DOI: 10.1111/ctr.14759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 06/01/2022] [Accepted: 06/09/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND High kidney-donor profile index (KDPI) kidneys have a shorter survival than grafts with lower KDPI values. It is still unclear, however, whether their shorter longevity depends on an inferior baseline function, faster functional decline, or the combination of both. METHODS We analyzed the estimated glomerular filtration rate (eGFR) of 605 consecutive recipients of deceased donor kidney transplants (KT) at 1, 3, 6, 12, 18, 24, 36, 48, and 60 months. Comparisons were performed among four groups based on KDPI quartile: Group I-KDPI ≤ 25% (n = 151), Group II-KDPI 26-50% (n = 182), Group III-KDPI 51-75% (n = 176), and Group IV-KDPI 〉 75% (n = 96). Linear mixed model analysis was subsequently used to assess whether KDPI was independently associated with the decline in eGFR during the first 5-years after KT. We also analyzed the incidence of delayed graft function (DGF), rejection within the first year after KT, patient survival, graft survival, and death censored graft survival based on KDPI group. FINDINGS High-KDPI grafts had lower eGFR immediately after KT, had a higher incidence of DGF and rejection. However, there were no signifcant differences in the adjusted rate (slope) of decline in eGFR among the four KDPI groups (P = .06). Although patient survival was signigicantly lower for recipients of high-KDPI grafts, death-censored graft survival was similar among the four KDPI groups (P = .33). CONCLUSIONS The shorter functional survival of high-KDPI grafts seems to be due to their lower baseline eGFR rather than a more rapid functional decline after KT.
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Affiliation(s)
- Michele Molinari
- Department of SurgeryDivision of TransplantationUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Christof Kaltenmeier
- Department of SurgeryDivision of TransplantationUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Hao Liu
- Department of SurgeryUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Eishan Ashwat
- Department of SurgeryDivision of TransplantationUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Dana Jorgensen
- Department of SurgeryDivision of TransplantationUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA,Biostatistics, Division of TransplantationUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Chethan Puttarajappa
- Department of MedicineDivision of NephrologyUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Christine M. Wu
- Department of MedicineDivision of NephrologyUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Rajil Mehta
- Department of MedicineDivision of NephrologyUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Puneet Sood
- Department of MedicineDivision of NephrologyUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Nirav Shah
- Department of MedicineDivision of NephrologyUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Akhil Sharma
- Department of MedicineDivision of NephrologyUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Ann Thompson
- Department of SurgeryDivision of TransplantationUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Dheera Reddy
- Department of SurgeryUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Sundaram Hariharan
- Department of MedicineDivision of NephrologyUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
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12
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Haidar G, Agha M, Bilderback A, Lukanski A, Linstrum K, Troyan R, Rothenberger S, McMahon DK, Crandall MD, Sobolewksi MD, Nathan Enick P, Jacobs JL, Collins K, Klamar-Blain C, Macatangay BJC, Parikh UM, Heaps A, Coughenour L, Schwartz MB, Dueker JM, Silveira FP, Keebler ME, Humar A, Luketich JD, Morrell MR, Pilewski JM, McDyer JF, Pappu B, Ferris RL, Marks SM, Mahon J, Mulvey K, Hariharan S, Updike GM, Brock L, Edwards R, Beigi RH, Kip PL, Wells A, Minnier T, Angus DC, Mellors JW. Prospective Evaluation of Coronavirus Disease 2019 (COVID-19) Vaccine Responses Across a Broad Spectrum of Immunocompromising Conditions: the COVID-19 Vaccination in the Immunocompromised Study (COVICS). Clin Infect Dis 2022; 75:e630-e644. [PMID: 35179197 PMCID: PMC8903515 DOI: 10.1093/cid/ciac103] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND We studied humoral responses after coronavirus disease 2019 (COVID-19) vaccination across varying causes of immunodeficiency. METHODS Prospective study of fully vaccinated immunocompromised adults (solid organ transplant [SOT], hematologic malignancy, solid cancers, autoimmune conditions, human immunodeficiency virus [HIV]) versus nonimmunocompromised healthcare workers (HCWs). The primary outcome was the proportion with a reactive test (seropositive) for immunoglobulin G to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) receptor-binding domain. Secondary outcomes were comparisons of antibody levels and their correlation with pseudovirus neutralization titers. Stepwise logistic regression was used to identify factors associated with seropositivity. RESULTS A total of 1271 participants enrolled: 1099 immunocompromised and 172 HCW. Compared with HCW (92.4% seropositive), seropositivity was lower among participants with SOT (30.7%), hematological malignancies (50.0%), autoimmune conditions (79.1%), solid tumors (78.7%), and HIV (79.8%) (P < .01). Factors associated with poor seropositivity included age, greater immunosuppression, time since vaccination, anti-CD20 monoclonal antibodies, and vaccination with BNT162b2 (Pfizer) or adenovirus vector vaccines versus messenger RNA (mRNA)-1273 (Moderna). mRNA-1273 was associated with higher antibody levels than BNT162b2 or adenovirus vector vaccines after adjusting for time since vaccination, age, and underlying condition. Antibody levels were strongly correlated with pseudovirus neutralization titers (Spearman r = 0.89, P < .0001), but in seropositive participants with intermediate antibody levels, neutralization titers were significantly lower in immunocompromised individuals versus HCW. CONCLUSIONS Antibody responses to COVID-19 vaccines were lowest among SOT and anti-CD20 monoclonal recipients, and recipients of vaccines other than mRNA-1273. Among those with intermediate antibody levels, pseudovirus neutralization titers were lower in immunocompromised patients than HCWs. Additional SARS-CoV-2 preventive approaches are needed for immunocompromised persons, which may need to be tailored to the cause of immunodeficiency.
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Affiliation(s)
- Ghady Haidar
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Mounzer Agha
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Andrew Bilderback
- Wolff Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Amy Lukanski
- Wolff Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kelsey Linstrum
- Health Care Innovation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Rachel Troyan
- Wolff Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Scott Rothenberger
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Deborah K McMahon
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Melissa D Crandall
- Clinical Laboratory, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michele D Sobolewksi
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - P Nathan Enick
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jana L Jacobs
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Kevin Collins
- Clinical Analytics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Cynthia Klamar-Blain
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Bernard J C Macatangay
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Urvi M Parikh
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Amy Heaps
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Lindsay Coughenour
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Marc B Schwartz
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jeffrey M Dueker
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Fernanda P Silveira
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Mary E Keebler
- Department of Cardiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Abhinav Humar
- Division of Transplantation, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - James D Luketich
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Matthew R Morrell
- Division of Pulmonary and Critical Care, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Joseph M Pilewski
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - John F McDyer
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Bhanu Pappu
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Robert L Ferris
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Stanley M Marks
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - John Mahon
- Clinical Laboratory, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Katie Mulvey
- Clinical Laboratory, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Sundaram Hariharan
- Division of Transplantation, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Transplant Nephrology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Glenn M Updike
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- UPMC Magee-Womens Hospital, Pittsburgh, Pennsylvania, USAand
| | - Lorraine Brock
- Wolff Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Robert Edwards
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- UPMC Magee-Womens Hospital, Pittsburgh, Pennsylvania, USAand
| | - Richard H Beigi
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- UPMC Magee-Womens Hospital, Pittsburgh, Pennsylvania, USAand
| | - Paula L Kip
- Wolff Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Alan Wells
- Clinical Laboratory, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Tami Minnier
- Wolff Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Derek C Angus
- Health Care Innovation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - John W Mellors
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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13
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Sharma A, Jorgensen DR, Mehta RB, Sood P, Puttarajappa CM, Wu CM, Tevar AD, Molinari M, Zeevi A, Hariharan S. The Clinical Impact of Anti-HLA Donor Specific Antibody Detection Through First Year Screening on Stable Kidney Transplant Recipients. Transpl Int 2022; 35:10094. [PMID: 35368641 PMCID: PMC8967948 DOI: 10.3389/ti.2022.10094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/09/2022] [Indexed: 11/13/2022]
Abstract
Anti-HLA Donor Specific Antibody (DSA) detection post kidney transplant has been associated with adverse outcomes, though the impact of early DSA screening on stable patients remain unclear. We analyzed impact of DSA detection through screening in 1st year stable patients (n = 736) on subsequent estimated glomerular filtration rate (eGFR), death censored graft survival (DCGS), and graft failure (graft loss including return to dialysis or re-transplant, patient death, or eGFR < 20 ml/min at last follow up). Patients were grouped using 1st year screening into DSA+ (Class I, II; n = 131) or DSA- (n = 605). DSA+ group were more DR mismatched (p = 0.02), more sensitized (cPRA ≥90%, p = 0.002), less Caucasian (p = 0.04), and had less pre-emptive (p = 0.04) and more deceased donor transplants (p = 0.03). DSA+ patients had similar eGFR (54.8 vs. 53.8 ml/min/1.73 m2, p = 0.56), DCGS (91% vs. 94%, p = 0.30), and graft failure free survival (76% vs. 82%, p = 0.11). DSA timing and type did not impact survival. Among those with a protocol biopsy (n = 515), DSA detected on 1st year screening was a predictor for graft failure on multivariate analysis (1.91, 95% CI 1.03-3.55, p = 0.04). Overall, early DSA detection in stable patients was an independent risk factor for graft failure, though only among those who underwent a protocol biopsy.
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Affiliation(s)
- Akhil Sharma
- Department of Medicine, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Dana R Jorgensen
- Department of Surgery, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Rajil B Mehta
- Department of Medicine, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Puneet Sood
- Department of Medicine, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Chethan M Puttarajappa
- Department of Medicine, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Christine M Wu
- Department of Medicine, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Amit D Tevar
- Department of Surgery, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Michele Molinari
- Department of Surgery, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Adriana Zeevi
- Department of Surgery, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, PA, United States.,Department of Immunology, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, PA, United States.,Department of Pathology, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Sundaram Hariharan
- Department of Medicine, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, PA, United States.,Department of Surgery, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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14
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DeBlasio RN, Myaskovsky L, DiMartini AF, Croswell E, Posluszny DM, Puttarajappa C, Switzer GE, Shapiro R, DeVito Dabbs AJ, Tevar AD, Hariharan S, Dew MA. The Combined Roles of Race/Ethnicity and Substance Use in Predicting Likelihood of Kidney Transplantation. Transplantation 2022; 106:e219-e233. [PMID: 35135973 PMCID: PMC9169160 DOI: 10.1097/tp.0000000000004054] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 11/25/2022]
Abstract
BACKGROUND Racial/ethnic minorities face known disparities in likelihood of kidney transplantation. These disparities may be exacerbated when coupled with ongoing substance use, a factor also reducing likelihood of transplantation. We examined whether race/ethnicity in combination with ongoing substance use predicted incidence of transplantation. METHODS Patients were enrolled between March 2010 and October 2012 at the time of transplant evaluation. Substance use data were retrieved from transplant evaluations. Following descriptive analyses, the primary multivariable analyses evaluated whether, relative to the referent group (White patients with no substance use), racial/ethnic minority patients using any substances at the time of evaluation were less likely to receive transplants by the end of study follow-up (August 2020). RESULTS Among 1152 patients, 69% were non-Hispanic White, 23% non-Hispanic Black, and 8% Other racial/ethnic minorities. White, Black, and Other patients differed in percentages of current tobacco smoking (15%, 26%, and 18%, respectively; P = 0.002) and illicit substance use (3%, 8%, and 9%; P < 0.001) but not heavy alcohol consumption (2%, 4%, and 1%; P = 0.346). Black and Other minority patients using substances were each less likely to receive transplants than the referent group (hazard ratios ≤0.45, P ≤ 0.021). Neither White patients using substances nor racial/ethnic minority nonusers differed from the referent group in transplant rates. Additional analyses indicated that these effects reflected differences in waitlisting rates; once waitlisted, study groups did not differ in transplant rates. CONCLUSIONS The combination of minority race/ethnicity and substance use may lead to unique disparities in likelihood of transplantation. To facilitate equity, strategies should be considered to remove any barriers to referral for and receipt of substance use care in racial/ethnic minorities.
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Affiliation(s)
- Richelle N DeBlasio
- Department of Psychiatry, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Larissa Myaskovsky
- Department of Internal Medicine, Center for Healthcare Equity in Kidney Disease, University of New Mexico School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Andrea F DiMartini
- Department of Psychiatry, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA
| | - Emilee Croswell
- Department of Psychiatry, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Donna M Posluszny
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA
| | | | - Galen E Switzer
- Department of Psychiatry, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
| | - Ron Shapiro
- Mount Sinai Recanati/Miller Transplantation Institute, Icahn School of Medicine, New York, NY
| | | | - Amit D Tevar
- Department of Surgery and Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA
| | - Sundaram Hariharan
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
- Department of Surgery and Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA
- Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, PA
- Departments of Psychology, Epidemiology, and Biostatistics, University of Pittsburgh, Pittsburgh, PA
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15
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Tandukar S, Wu C, Hariharan S, Puttarajappa C. Impact of Size Matching Based on Donor-Recipient Height on Kidney Transplant Outcomes. Transpl Int 2022; 35:10253. [PMID: 35572466 PMCID: PMC9099356 DOI: 10.3389/ti.2022.10253] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022]
Abstract
Transplantation of kidneys from shorter donors into taller recipients may lead to suboptimal allograft survival. The effect of discrepancy in donor and recipient heights (ΔHeight) on long term transplant outcomes is not known. Adult patients ≥18 years undergoing living or deceased donor (LD or DD) kidney transplants alone from donors ≥18 years between 2000 and 2016 in the United States were included in this observational study. The cohort was divided into three groups based on ΔHeight of 5 inches as 1) Recipient < Donor (DD: 31,688, LD: 12,384), 2) Recipient = Donor (DD: 84,711, LD: 54,709), and 3) Recipient > Donor (DD: 21,741, LD: 18,753). Univariate analysis showed a higher risk of DCGL and mortality in both DD and LD (p < 0.001 for both). The absolute difference in graft and patient survival between the two extremes of ΔHeight was 5.7% and 5.7% for DD, and 0.4% and 1.4% for LD. On multivariate analysis, the HR of DCGL for Recipient < Donor and Recipient > Donor was 0.95 (p = 0.05) and 1.07 (p = 0.01) in DD and 0.98 (p = 0.55) and 1.14 (p < 0.001) in LD. Similarly, the corresponding HR of mortality were 0.97 (p = 0.07) and 1.07 (p = 0.003) for DD and 1.01 (p < 0.001) and 1.05 (p = 0.13) for LD. For DGF, the HR were 1.04 (p = 0.1) and 1.01 (p = 0.7) for DD and 1.07 (p = 0.45) and 0.89 (p = 0.13) for LD. Height mismatch between the donor and recipient influences kidney transplant outcomes.
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Affiliation(s)
- Srijan Tandukar
- Willis-Knighton Medical Center, Shreveport, LA, United States
- *Correspondence: Srijan Tandukar,
| | - Christine Wu
- University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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16
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Mehta RB, Shimko K, Zhang X, Puttarajappa C, Wu C, Sharma A, Molinari M, Tevar AD, Hariharan S, Sood P. Rabbit antithymocyte globulin dose and early subclinical and clinical rejections in kidney transplantation. Clin Transplant 2022; 36:e14582. [PMID: 35000234 DOI: 10.1111/ctr.14582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/12/2021] [Accepted: 12/30/2021] [Indexed: 11/28/2022]
Abstract
Antithymocyte globulin (ATG) is a commonly used induction agent in kidney transplant recipients. However, the optimal dosing has not been well defined. Our protocol aims for a 5-6 mg/kg cumulative dose. It is unclear if a dose lower than 5 mg/kg is associated with more rejection. We performed a retrospective cohort study of patients who received a kidney transplant at our center between January 1, 2013 and December 31, 2016. Primary outcome was biopsy proven acute rejection (clinical and subclinical) in the first six months after kidney transplant. CMV viremia in high risk(D+/R-) recipients and BK viremia was compared as a secondary endpoint. Of the 543 patients, the Low Dose (LD) group (n = 56) received <5 mg/kg ATG and Regular Dose (RD) group (n = 487) received ≧5 mg/kg. Patients in RD were more sensitized (higher PRA and CPRA). LD received a dose of 4 ± 1.1 mg/kg ATG whereas RD received 5.6 ± 0.3 mg/kg ATG (p < 0.001). TCMR(Banff 1A or greater) was present in 34% of patients in LD vs. 22% in RD (p = 0.04) (OR 2.1;95%CI 1.12-3.81;p = 0.019). There was no difference in the incidence of CMV or BK viremia. ATG doses lower than 5 mg/kg may be associated with a heightened risk of rejection despite a low degree of sensitization. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Rajil B Mehta
- University of Pittsburgh Medical Center, Division of Transplant Nephrology.,University of Pittsburgh, Division of Transplant Surgery
| | - Kristen Shimko
- University of Pittsburgh Medical Center, Department of Pharmacy
| | - Xingyu Zhang
- University of Pittsburgh, Division of Transplant Surgery
| | | | - Christine Wu
- University of Pittsburgh Medical Center, Division of Transplant Nephrology
| | - Akhil Sharma
- University of Pittsburgh Medical Center, Division of Transplant Nephrology
| | | | - Amit D Tevar
- University of Pittsburgh, Division of Transplant Surgery
| | - Sundaram Hariharan
- University of Pittsburgh Medical Center, Division of Transplant Nephrology
| | - Puneet Sood
- University of Pittsburgh Medical Center, Division of Transplant Nephrology
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17
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Anbupriya M, Gayathri K, Hariharan S. Prior experience of physiotherapy treatment among the general public: A qualitative analysis. Asian J Pharm Res Health Care 2022. [DOI: 10.4103/ajprhc.ajprhc_51_22] [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: 11/16/2022]
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18
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Danovitch GM, Bunnapradist S, Cohen D, Hariharan S, McKay D, Ratner L, Stegall MD, Steiner RW, Stock PG, Vincenti F. Tests for the noninvasive diagnosis of kidney transplant rejection should be evaluated by kidney transplant programs. Am J Transplant 2021; 21:3811. [PMID: 34080294 DOI: 10.1111/ajt.16711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/26/2021] [Accepted: 06/01/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Gabriel M Danovitch
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Suphamai Bunnapradist
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - David Cohen
- Department of Surgery, Columbia University Medical School, New York, New York, USA
| | - Sundaram Hariharan
- Starzl Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Dianne McKay
- Department of Immunology and Microbiology, Scripps Research, San Diego, California, USA
| | - Lloyd Ratner
- Department of Surgery, Columbia University Medical School, New York, New York, USA
| | - Mark D Stegall
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert W Steiner
- Department of Medicine, University of California at San Diego, San Diego, California, USA
| | - Peter G Stock
- Department of Surgery, University of California at San Francisco, San Francisco, California, USA
| | - Flavio Vincenti
- Department of Surgery, University of California at San Francisco, San Francisco, California, USA
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19
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Billa V, Kothari J, Bichu S, Kumar R, Usulumarty D, Tilve P, Hariharan S. From Infection to Immunity - Impact of COVID-19 Across Nine Hemodialysis Centres in Mumbai. Indian J Nephrol 2021; 31:544-549. [PMID: 35068761 PMCID: PMC8722561 DOI: 10.4103/ijn.ijn_361_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/29/2020] [Accepted: 10/18/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION There are several studies of symptomatic hemodialysis patients with proven COVID-19 infection. However, there is paucity of data on asymptomatic COVID-19 infection in the outpatient hemodialysis population. The true prevalence and transmission of this infection in hemodialysis centres is unknown. This study was conducted across hemodialysis centers by testing all patients and staff for COVID-19 PCR and later for IgG antibody, irrespective of their symptoms. METHODS All 705 hemodialysis patients and 103 dialysis staff across nine centres, were tested for COVID-19 over a period of 54 days of the pandemic, and for COVID IgG antibody of available enrolled staff and patients, after 8 weeks of study termination. RESULTS The period prevalence of infection in patients and staff was 7.1% and 14.6% respectively. Mortality in patients was 18%, and all staff recovered. Clustering of patients and staff occurred at 3 of 9 centers. Of 26 HIV positive patients, only one contracted the COVID-19 infection and has recovered. Of those infected, seroconversion occurred in 80% of patients and 83% of staff. Seroconversion also occurred in 16% of patients and 37% of staff, who were asymptomatic and COVID PCR negative during the study period. CONCLUSIONS Testing a patient only when symptomatic, identified only 26% (13/50) of infected patients. For every single symptomatic patient who tested positive, there were 3 other asymptomatic infected ones. There was a high seroconversion rates in infected subjects. But antibodies also developed in asymptomatic subjects, indicating silent transmission and antibody generation in this population.
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Affiliation(s)
- Viswanath Billa
- Apex Kidney Care, Mumbai, Maharashtra, India
- Apex Kidney Foundation, Mumbai, Maharashtra, India
- Sushrut Hospital and Research Centre, Mumbai, Maharashtra, India
- Bombay Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Jatin Kothari
- Apex Kidney Care, Mumbai, Maharashtra, India
- Apex Kidney Foundation, Mumbai, Maharashtra, India
- PD Hinduja Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Shrirang Bichu
- Apex Kidney Care, Mumbai, Maharashtra, India
- Apex Kidney Foundation, Mumbai, Maharashtra, India
- Bombay Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Rajesh Kumar
- Apex Kidney Care, Mumbai, Maharashtra, India
- Apex Kidney Foundation, Mumbai, Maharashtra, India
- LH Hiranandani Hospital, Mumbai, Maharashtra, India
| | - Deepa Usulumarty
- Apex Kidney Care, Mumbai, Maharashtra, India
- Apex Kidney Foundation, Mumbai, Maharashtra, India
- Sushrut Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Parag Tilve
- Apex Kidney Care, Mumbai, Maharashtra, India
- Apex Kidney Foundation, Mumbai, Maharashtra, India
- Bombay Hospital and Research Centre, Mumbai, Maharashtra, India
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20
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Choueiri TK, Larkin J, Pal S, Motzer RJ, Rini BI, Venugopal B, Alekseev B, Miyake H, Gravis G, Bilen MA, Hariharan S, Chudnovsky A, Ching KA, Mu XJ, Mariani M, Robbins PB, Huang B, di Pietro A, Albiges L. Erratum to 'Efficacy and correlative analyses of avelumab plus axitinib versus sunitinib in sarcomatoid renal cell carcinoma: post hoc analysis of a randomized clinical trial': [ESMO Open Volume 6, Issue 3, June 2021, 100101]. ESMO Open 2021; 6:100177. [PMID: 34474809 PMCID: PMC8411062 DOI: 10.1016/j.esmoop.2021.100177] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- T K Choueiri
- Department of Medical Oncology, The Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, USA.
| | - J Larkin
- Renal and Skin Units, The Royal Marsden NHS Foundation Trust, Chelsea, London, UK
| | - S Pal
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, USA
| | - R J Motzer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - B I Rini
- Department of Medicine, Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, USA
| | - B Venugopal
- Institute of Cancer Sciences, University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, Scotland, UK
| | - B Alekseev
- P. Hertsen Moscow Oncology Research Institute, Moscow, Russia
| | - H Miyake
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - G Gravis
- Department of Medical Oncology, Institut Paoli-Calmettes, Aix-Marseille Université, Inserm, CNRS, CRCM, Marseille, France
| | - M A Bilen
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, USA
| | | | | | - K A Ching
- Computational Biology, Pfizer, San Diego, USA
| | - X J Mu
- Computational Biology, Pfizer, San Diego, USA
| | - M Mariani
- Immuno-Oncology, Pfizer, Milan, Lombardia, Italy
| | - P B Robbins
- Translational Oncology, Pfizer, San Diego, USA
| | - B Huang
- Biostatistics, Pfizer, Groton, USA
| | - A di Pietro
- Immuno-Oncology, Pfizer, Milan, Lombardia, Italy
| | - L Albiges
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
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21
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Jung CW, Jorgensen D, Sood P, Mehta R, Molinari M, Hariharan S, Ganoza A, Van Der Windt D, Wijkstrom MN, Puttarajappa CM, Tevar AD. Outcomes and factors leading to graft failure in kidney transplants from deceased donors with acute kidney injury-A retrospective cohort study. PLoS One 2021; 16:e0254115. [PMID: 34437548 PMCID: PMC8389362 DOI: 10.1371/journal.pone.0254115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/20/2021] [Indexed: 11/18/2022] Open
Abstract
Due to shortage of donor, kidney transplants (KTs) from donors with acute kidney injury (AKI) are expanding. Although previous studies comparing clinical outcomes between AKI and non-AKI donors in KTs have shown comparable results, data on high-volume analysis of KTs outcomes with AKI donors are limited. This study aimed to analyze the selection trends of AKI donors and investigate the impact of AKI on graft failure using the United states cohort data. We analyzed a total 52,757 KTs collected in the Scientific Registry of Transplant Recipient (SRTR) from 2010 to 2015. The sample included 4,962 (9.4%) cases of KTs with AKI donors (creatinine ≥ 2 mg/dL). Clinical characteristics of AKI and non-AKI donors were analyzed and outcomes of both groups were compared. We also analyzed risk factors for graft failure in AKI donor KTs. Although the incidence of delayed graft function was higher in recipients of AKI donors compared to non-AKI donors, graft and patient survival were not significantly different between the two groups. We found donor hypertension, cold ischemic time, the proportion of African American donors, and high KDPI were risk factors for graft failure in AKI donor KTs. KTs from deceased donor with AKI showed comparable outcomes. Thus, donors with AKI need to be considered more actively to expand donor pool. Caution is still needed when donors have additional risk factors of graft failure.
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Affiliation(s)
- Cheol Woong Jung
- Department of Surgery, Korea University Anam Hospital, Seoul, Korea
| | - Dana Jorgensen
- Department of Surgery, Thomas E Starzl Transplantation Institute, University Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - Puneet Sood
- Department of Internal Medicine, Thomas E Starzl Transplantation Institute, University Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - Rajil Mehta
- Department of Internal Medicine, Thomas E Starzl Transplantation Institute, University Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - Michele Molinari
- Department of Surgery, Thomas E Starzl Transplantation Institute, University Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - Sundaram Hariharan
- Department of Internal Medicine, Thomas E Starzl Transplantation Institute, University Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - Armando Ganoza
- Department of Surgery, Thomas E Starzl Transplantation Institute, University Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - Dirk Van Der Windt
- Department of Surgery, Thomas E Starzl Transplantation Institute, University Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - Martin N. Wijkstrom
- Department of Surgery, Thomas E Starzl Transplantation Institute, University Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - Chethan M. Puttarajappa
- Department of Internal Medicine, Thomas E Starzl Transplantation Institute, University Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - Amit D. Tevar
- Department of Surgery, Thomas E Starzl Transplantation Institute, University Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
- * E-mail:
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22
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Affiliation(s)
- Sundaram Hariharan
- From the University of Pittsburgh Medical Center, Pittsburgh (S.H.); Hennepin Healthcare, the University of Minnesota, and the Scientific Registry of Transplant Recipients - all in Minneapolis (A.K.I.); and the University of California, Los Angeles, Los Angeles (G.D.)
| | - Ajay K Israni
- From the University of Pittsburgh Medical Center, Pittsburgh (S.H.); Hennepin Healthcare, the University of Minnesota, and the Scientific Registry of Transplant Recipients - all in Minneapolis (A.K.I.); and the University of California, Los Angeles, Los Angeles (G.D.)
| | - Gabriel Danovitch
- From the University of Pittsburgh Medical Center, Pittsburgh (S.H.); Hennepin Healthcare, the University of Minnesota, and the Scientific Registry of Transplant Recipients - all in Minneapolis (A.K.I.); and the University of California, Los Angeles, Los Angeles (G.D.)
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23
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Cherukuri A, Salama AD, Mehta R, Mohib K, Zheng L, Magee C, Harber M, Stauss H, Baker RJ, Tevar A, Landsittel D, Lakkis FG, Hariharan S, Rothstein DM. Transitional B cell cytokines predict renal allograft outcomes. Sci Transl Med 2021; 13:13/582/eabe4929. [PMID: 33627487 DOI: 10.1126/scitranslmed.abe4929] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 01/25/2021] [Indexed: 12/12/2022]
Abstract
Early immunological biomarkers that predict rejection and chronic allograft loss are needed to inform preemptive therapy and improve long-term outcomes. Here, we prospectively examined the ratio of interleukin-10 (IL-10) to tumor necrosis factor-α (TNFα) produced by transitional-1 B cells (T1B) 3 months after transplantation as a predictive biomarker for clinical and subclinical renal allograft rejection and subsequent clinical course. In both Training (n = 162) and Internal Validation (n = 82) Sets, the T1B IL-10/TNFα ratio 3 months after transplantation predicted both clinical and subclinical rejection anytime in the first year. The biomarker also predicted subsequent late rejection with a lead time averaging 8 months. Among biomarker high-risk patients, 60% had early rejection, of which 48% recurred later in the first posttransplant year. Among high-risk patients without early rejection, 74% developed rejection later in the first year. In contrast, only 5% of low-risk patients had early and 5% late rejection. The biomarker also predicted rejection in an External Validation Set (n = 95) and in key patient subgroups, confirming generalizability. Biomarker high-risk patients exhibited progressively worse renal function and decreased 5-year graft survival compared to low-risk patients. Treatment of B cells with anti-TNFα in vitro augmented the IL-10/TNFα ratio, restored regulatory activity, and inhibited plasmablast differentiation. To conclude, the T1B IL-10/TNFα ratio was validated as a strong predictive biomarker of renal allograft outcomes and provides a rationale for preemptive therapeutic intervention with TNF blockade.
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Affiliation(s)
- Aravind Cherukuri
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15261, USA.,Renal and Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Alan D Salama
- University College of London Department of Renal Medicine, Royal Free Hospital, London NW3 2QG, UK
| | - Rajil Mehta
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15261, USA.,Renal and Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Kanishka Mohib
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Leting Zheng
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15261, USA.,Department of Rheumatology and Immunology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Ciara Magee
- University College of London Department of Renal Medicine, Royal Free Hospital, London NW3 2QG, UK
| | - Mark Harber
- University College of London Department of Renal Medicine, Royal Free Hospital, London NW3 2QG, UK
| | - Hans Stauss
- UCL Institute of Immunity and Transplantation, Royal Free Hospital, London NW3 2QG, UK
| | - Richard J Baker
- Renal Unit, St. James's University Hospital, Leeds LS9 7TF, UK
| | - Amit Tevar
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Douglas Landsittel
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15261, USA.,Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA 15206, USA
| | - Fadi G Lakkis
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15261, USA.,Renal and Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA.,Department of Immunology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Sundaram Hariharan
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15261, USA.,Renal and Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - David M Rothstein
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15261, USA. .,Renal and Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA.,Department of Immunology, University of Pittsburgh, Pittsburgh, PA 15213, USA
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24
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van der Windt DJ, Mehta R, Jorgensen DR, Hariharan S, Randhawa PS, Sood P, Molinari M, Wijkstrom M, Ganoza A, Tevar AD. Donation after circulatory death is associated with increased fibrosis on 1-year post-transplant kidney allograft surveillance biopsy. Clin Transplant 2021; 35:e14399. [PMID: 34176169 DOI: 10.1111/ctr.14399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/28/2021] [Accepted: 06/14/2021] [Indexed: 11/29/2022]
Abstract
AIM The use of kidneys donated after circulatory death (DCD) provides an invaluable expansion of the organ supply for transplantation. Here, we investigated the effect of DCD on fibrotic changes on 1 1-year post 1-transplant surveillance kidney allograft biopsy. METHODS Recipients of a deceased donor kidney transplant between 2013 and 2017 at a single institution, who survived 1 year and underwent surveillance biopsy, were included in the analysis (n = 333: 87 DCD kidneys, 246 kidneys donated after brain death [DBD]). Banff scores for interstitial fibrosis and tubular atrophy were summed as IFTA and compared between the groups. RESULTS DCD and DBD groups were comparable for baseline characteristics. Delayed graft function was 39% in DCD versus 19% in DBD, P = .0002. Patient and graft survival were comparable for DCD and DBD cohorts. IFTA scores were higher in DCD compared to DBD (2.43±..13 vs. 2.01±..08, P = .0054). On multivariate analysis, the odds of IFTA > 2 in the DCD group was 2.5× higher (95%CI: 1.354.63) than in the DBD group. Within the DCD group, kidneys with IFTA > 2 had inferior 5-year graft survival (P = .037). CONCLUSION Compared to DBD kidneys, DCD kidneys developed a greater degree of fibrotic changes on 1-year post-transplant surveillance biopsy, which affected graft longevity within the DCD cohort.
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Affiliation(s)
- Dirk J van der Windt
- Division of Transplant Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Section of Transplant Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Rajil Mehta
- Division of Transplant Nephrology, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Dana R Jorgensen
- Division of Transplant Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Sundaram Hariharan
- Division of Transplant Nephrology, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Parmjeet S Randhawa
- Division of Transplant Pathology, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Puneet Sood
- Division of Transplant Nephrology, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michele Molinari
- Division of Transplant Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Martin Wijkstrom
- Division of Transplant Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Armando Ganoza
- Division of Transplant Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Amit D Tevar
- Division of Transplant Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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25
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Puttarajappa CM, Mehta RB, Hariharan S. Donor-derived Cell-free DNA for the Diagnosis of Kidney Transplant Rejection: An Attractive Test With Ambiguous Answers! Transplantation 2021; 105:1171-1172. [PMID: 33606484 DOI: 10.1097/tp.0000000000003696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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]
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26
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Choueiri TK, Larkin J, Pal S, Motzer RJ, Rini BI, Venugopal B, Alekseev B, Miyake H, Gravis G, Bilen MA, Hariharan S, Chudnovsky A, Ching KA, Mu XJ, Mariani M, Robbins PB, Huang B, di Pietro A, Albiges L. Efficacy and correlative analyses of avelumab plus axitinib versus sunitinib in sarcomatoid renal cell carcinoma: post hoc analysis of a randomized clinical trial. ESMO Open 2021; 6:100101. [PMID: 33901870 PMCID: PMC8099757 DOI: 10.1016/j.esmoop.2021.100101] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Among patients with advanced renal cell carcinoma (RCC), those with sarcomatoid histology (sRCC) have the poorest prognosis. This analysis assessed the efficacy of avelumab plus axitinib versus sunitinib in patients with treatment-naive advanced sRCC. METHODS The randomized, open-label, multicenter, phase III JAVELIN Renal 101 trial (NCT02684006) enrolled patients with treatment-naive advanced RCC. Patients were randomized 1 : 1 to receive either avelumab plus axitinib or sunitinib following standard doses and schedules. Assessments in this post hoc analysis of patients with sRCC included efficacy (including progression-free survival) and biomarker analyses. RESULTS A total of 108 patients had sarcomatoid histology and were included in this post hoc analysis; 47 patients in the avelumab plus axitinib arm and 61 in the sunitinib arm. Patients in the avelumab plus axitinib arm had improved progression-free survival [stratified hazard ratio, 0.57 (95% confidence interval, 0.325-1.003)] and a higher objective response rate (46.8% versus 21.3%; complete response in 4.3% versus 0%) versus those in the sunitinib arm. Correlative gene expression analyses of patients with sRCC showed enrichment of gene pathway scores for cancer-associated fibroblasts and regulatory T cells, CD274 and CD8A expression, and tumors with The Cancer Genome Atlas m3 classification. CONCLUSIONS In this subgroup analysis of JAVELIN Renal 101, patients with sRCC in the avelumab plus axitinib arm had improved efficacy outcomes versus those in the sunitinib arm. Correlative analyses provide insight into this subtype of RCC and suggest that avelumab plus axitinib may increase the chance of overcoming the aggressive features of sRCC.
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Affiliation(s)
- T K Choueiri
- Department of Medical Oncology, The Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, USA.
| | - J Larkin
- Renal and Skin Units, The Royal Marsden NHS Foundation Trust, Chelsea, London, UK
| | - S Pal
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, USA
| | - R J Motzer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - B I Rini
- Department of Medicine, Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, USA
| | - B Venugopal
- Institute of Cancer Sciences, University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, Scotland, UK
| | - B Alekseev
- P. Hertsen Moscow Oncology Research Institute, Moscow, Russia
| | - H Miyake
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - G Gravis
- Department of Medical Oncology, Institut Paoli-Calmettes, Aix-Marseille Université, Inserm, CNRS, CRCM, Marseille, France
| | - M A Bilen
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, USA
| | | | | | - K A Ching
- Computational Biology, Pfizer, San Diego, USA
| | - X J Mu
- Computational Biology, Pfizer, San Diego, USA
| | - M Mariani
- Immuno-Oncology, Pfizer, Milan, Lombardia, Italy
| | - P B Robbins
- Translational Oncology, Pfizer, San Diego, USA
| | - B Huang
- Biostatistics, Pfizer, Groton, USA
| | - A di Pietro
- Immuno-Oncology, Pfizer, Milan, Lombardia, Italy
| | - L Albiges
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
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Puttarajappa CM, Schinstock CA, Wu CM, Leca N, Kumar V, Vasudev BS, Hariharan S. KDOQI US Commentary on the 2020 KDIGO Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation. Am J Kidney Dis 2021; 77:833-856. [PMID: 33745779 DOI: 10.1053/j.ajkd.2020.11.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022]
Abstract
Evaluation of patients for kidney transplant candidacy is a comprehensive process that involves a detailed assessment of medical and surgical issues, psychosocial factors, and patients' physical and cognitive abilities with an aim of balancing the benefits of transplantation and potential risks of surgery and long-term immunosuppression. There is considerable variability among transplant centers in their approach to evaluation and decision-making regarding transplant candidacy. The 2020 KDIGO (Kidney Disease: Improving Guidelines Outcome) clinical practice guideline on the evaluation and management of candidates for kidney transplantation provides practice recommendations that can serve as a useful reference guide to transplant professionals. The guideline, covering a broad range of topics, was developed by an international group of experts from transplant and nephrology through a review of literature published until May 2019. A work group of US transplant nephrologists convened by NKF-KDOQI (National Kidney Foundation-Kidney Disease Quality Initiative) chose key topics for this commentary with a goal of presenting a broad discussion to the US transplant community. Each section of this article has a summary of the key KDIGO guideline recommendations, followed by a brief commentary on the recommendations, their clinical utility, and potential implementation challenges. The KDOQI work group agrees broadly with the KDIGO recommendations but also recognizes and highlights the decision-making challenges that arise from lack of high-quality evidence and the need to balance equity with utility of organ transplantation.
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Affiliation(s)
- Chethan M Puttarajappa
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Carrie A Schinstock
- Division of Nephrology & Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Christine M Wu
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Nicolae Leca
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA
| | - Vineeta Kumar
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Brahm S Vasudev
- Division of Nephrology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Sundaram Hariharan
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.
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Vinodkumar A, Senthilkumar T, Hariharan S, Alzabut J. Exponential stabilization of fixed and random time impulsive delay differential system with applications. Math Biosci Eng 2021; 18:2384-2400. [PMID: 33892551 DOI: 10.3934/mbe.2021121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In this work, we study the problem of p-th moment global exponential stability for functional differential equations and scalar chaotic delayed equations under random impulsive effects. Meanwhile, the p-th moment global exponential synchronization for the proposed equations is also discussed, whereas the main results are proved by using Lyapunov function and Razumikhin technique. Furthermore, the impact of fixed and random time impulses are presented by applying the results to Mackey Glass blood cell production model and Ikeda bistable resonator model. Finally, the effectiveness of fixed and random impulses are depicted via graphical representations.
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Affiliation(s)
- A Vinodkumar
- Department of Mathematics, Amrita School of Engineering, Amrita Vishwa Vidyapeetham, Coimbatore 641112, India
| | - T Senthilkumar
- Department of Mathematics, Amrita School of Arts & Science, Amrita Vishwa Vidyapeetham, Kochi, Kerala 682024, India
| | - S Hariharan
- Department of Mathematics, D G Vaishnav College, Chennai, India
| | - J Alzabut
- Department of Mathematics and General Sciences, Prince Sultan University, Riyadh 11586, Saudi Arabia
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Melgarejo I, Jorgensen D, Hariharan S, Puttarajappa CM. Bimonthly viral monitoring for late-onset cytomegalovirus infection in kidney transplant recipients. Clin Transplant 2021; 35:e14259. [PMID: 33605490 DOI: 10.1111/ctr.14259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/04/2021] [Accepted: 02/13/2021] [Indexed: 12/25/2022]
Abstract
Kidney transplant recipients with high-risk cytomegalovirus (CMV) serostatus (seropositive donor to seronegative recipient) are at risk for late-onset CMV after cessation of antiviral prophylaxis. We report findings from a strategy of bimonthly (every 2 weeks) CMV screening for late-onset CMV. This is a single-center retrospective cohort study of 70 high-risk CMV kidney transplant recipients transplanted between June 2016 and September 2018. Patients were monitored at 6-12 months post-transplantation for late-onset CMV using bimonthly CMV nucleic acid testing (NAT). Adherence to screening and its correlation with CMV-related hospitalizations were assessed. Failure to prevent CMV-related hospitalization was classified into three categories (non-adherence to CMV testing, rapid CMV progression, and health system failure). Twenty-one (30%) patients developed CMV DNAemia, of whom 10 (14%) required hospitalization. Reasons for CMV-related hospitalization despite screening were (i) screening non-adherence (50%), (ii) rapid progression (40%), and (iii) health system failure (10%). Adherence to screening was associated with lower viral counts at diagnosis (r = -.44, p = .049) and a trend towards lower risk of CMV-related hospitalization (OR: 0.97 per 1% increase in adherence; 95% CI: 0.94-1.00; p = .06). Bimonthly monitoring for late-onset CMV allows for early CMV detection and may lower CMV-related hospitalization.
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Affiliation(s)
- Ivy Melgarejo
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dana Jorgensen
- Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sundaram Hariharan
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chethan M Puttarajappa
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, PA, USA
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Puttarajappa CM, Mehta RB, Hariharan S. Author response to comments on economic analysis of subclinical rejection screening in kidney transplantation. Am J Transplant 2021; 21:1348-1349. [PMID: 33068499 DOI: 10.1111/ajt.16356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 09/14/2020] [Accepted: 09/30/2020] [Indexed: 01/25/2023]
Affiliation(s)
| | - Rajil B Mehta
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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31
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Sood P, Cherikh WS, Toll AE, Mehta RB, Hariharan S. Kidney allograft rejection: Diagnosis and treatment practices in USA- A UNOS survey. Clin Transplant 2021; 35:e14225. [PMID: 33455009 DOI: 10.1111/ctr.14225] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 09/22/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 12/11/2022]
Abstract
We studied diverse rejection management strategies across centers by conducting a UNOS survey of kidney transplant program directors in 2017. There were 104 total responses from 235 kidney transplant programs representing 88 unique transplant programs (response rate 37%). Information was collected on center-specific management practices. Pertinent center-specific data were obtained from the OPTN database. Of the respondents, 33% were considered large centers (>100 transplants/year). Thymoglobulin was the most commonly used induction agent at 84%, 72% responders do rapid steroid withdrawal, and mycophenolic acid (MPA) is the major antimetabolite (100%). For diagnosing TCMR, 100% used indication biopsy, 28% used protocol biopsy, 2% used serum biomarkers, and none used urine cytokines. For ABMR, 99% used indication biopsy, 34% used protocol biopsy, 72% used DSA, 21% used C1q positive DSA, and none used gene profiling (ENDATS). The treatment of subclinical and clinical TCMR included iv/PO steroids. PP/IVIG were the commonest treatments for ABMR. The use of rituximab, bortezomib, and eculizumab increased from C4D-ABMR to recurrent ABMR. There are diverse management practices for diagnosing and treating rejection. An effort to harmonize these diverse practices for management of TCMR and ABMR will give an opportunity to pool data for evaluating clinical outcomes.
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Affiliation(s)
- Puneet Sood
- Department of Medicine and Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Alice E Toll
- United Network for Organ Sharing, Richmond, VA, USA
| | - Rajil B Mehta
- Department of Medicine and Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sundaram Hariharan
- Department of Medicine and Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Puttarajappa CM, Mehta R, Roberts MS, Smith KJ, Hariharan S. Economic analysis of screening for subclinical rejection in kidney transplantation using protocol biopsies and noninvasive biomarkers. Am J Transplant 2021; 21:186-197. [PMID: 32558153 PMCID: PMC7744316 DOI: 10.1111/ajt.16150] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/03/2020] [Accepted: 06/08/2020] [Indexed: 02/07/2023]
Abstract
Subclinical rejection (SCR) screening in kidney transplantation (KT) using protocol biopsies and noninvasive biomarkers has not been evaluated from an economic perspective. We assessed cost-effectiveness from the health sector perspective of SCR screening in the first year after KT using a Markov model that compared no screening with screening using protocol biopsy or biomarker at 3 months, 12 months, 3 and 12 months, or 3, 6, and 12 months. We used 12% subclinical cellular rejection and 3% subclinical antibody-mediated rejection (SC-ABMR) for the base-case cohort. Results favored 1-time screening at peak SCR incidence rather than repeated screening. Screening 2 or 3 times was favored only with age <35 years and with high SC-ABMR incidence. Compared to biomarkers, protocol biopsy yielded more quality-adjusted life years (QALYs) at lower cost. A 12-month biopsy cost $13 318/QALY for the base-case cohort. Screening for cellular rejection in the absence of SC-ABMR was less cost effective with 12-month biopsy costing $46 370/QALY. Screening was less cost effective in patients >60 years. Using biomarker twice or thrice was cost effective only if biomarker cost was <$700. In conclusion, in KT, screening for SCR more than once during the first year is not economically reasonable. Screening with protocol biopsy was favored over biomarkers.
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Affiliation(s)
- Chethan M. Puttarajappa
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania,Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rajil Mehta
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania,Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mark S. Roberts
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kenneth J. Smith
- Department of Medicine, Section of Decision Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sundaram Hariharan
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania,Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
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Krishnakumar S, Vidyasakar A, Anbalagan S, Godson PS, Kasilingam K, Parthasarathy P, Pradhap D, Saravanan P, Hariharan S, Rajkumar A, Neelavannan K, Magesh NS. Bioavailable trace metals and their ecological risks in the tourist beaches of the Southeast coast of India. Mar Pollut Bull 2020; 160:111562. [PMID: 32853841 DOI: 10.1016/j.marpolbul.2020.111562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/31/2020] [Accepted: 08/09/2020] [Indexed: 05/12/2023]
Abstract
The concentration of Acid Leachable Trace Metals (ALTMs) was assessed in urbanized tourist beaches (96 samples from Marina beach, 34 samples from Edward Elliot's beach, and 28 samples from Silver beach) of southeast coast of India. The concentration of metals accumulated in the beach sediment was less than the Upper Continental Crust (UCC) background reference values. The mean enrichment of ALTMs in the studied urban tourist beaches showed the following descending order: Marina beach - Cr > Pb > Ni > Zn > Cu > Mn > Co; Edward Elliot's beach - Cr > Pb > Ni > Mn > Co > Zn > Cu; Silver beach - Cr > Pb > Ni > Co > Mn > Cu > Zn. The ALTMs such as Fe, Mn, Co, Cu, and Zn were probably derived from natural weathering and mild anthropogenic influences whereas other metals were derived from anthropogenic induced factors.
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Affiliation(s)
- S Krishnakumar
- Department of Geology, University of Madras, Guindy Campus, Chennai 600025, India.
| | - A Vidyasakar
- Department of Geology, Periyar University PG Extension Centre, Dharmapuri 636701, India
| | - S Anbalagan
- Institute for Ocean Management, Anna University, Chennai 600025, India
| | - Prince S Godson
- Department of Environmental Sciences, University of Kerala, Thiruvananthapuram 695581, India
| | - K Kasilingam
- Department of Geology, University of Madras, Guindy Campus, Chennai 600025, India
| | - P Parthasarathy
- Department of Geology, A.V.S College of Arts and Science, Salem 636 106, India
| | - D Pradhap
- Department of Geology, University of Madras, Guindy Campus, Chennai 600025, India
| | - P Saravanan
- Department of Geology, University of Madras, Guindy Campus, Chennai 600025, India
| | - S Hariharan
- Department of Geology, Central University of Karnataka, Kadaganchi, Karnataka 585367, India
| | - A Rajkumar
- Department of Geology, University of Madras, Guindy Campus, Chennai 600025, India
| | - K Neelavannan
- Institute for Ocean Management, Anna University, Chennai 600025, India
| | - N S Magesh
- National Centre for Polar and Ocean Research, Ministry of Earth Sciences, Headland Sada, Vasco-da-Gama, Goa 403 804, India.
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Hariharan S, Chikte K, Shankar T, Rajesh A, Fouziya Sulthana S. Optimization of feedback bits using firefly algorithm for interference reduction in LTE femtocell networks. Soft comput 2020. [DOI: 10.1007/s00500-020-04871-2] [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: 10/24/2022]
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35
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Steinberg G, Saltstein D, Shore N, Cesari R, Vermette J, Pierce K, Blake-Haskins J, Hariharan S, Bedke J, Powles T. 795TiP Phase III study of the programmed cell death protein 1 inhibitor PF-06801591 plus bacillus Calmette-Guérin for non-muscle invasive bladder cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.867] [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: 10/23/2022] Open
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36
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Cherukuri A, Mehta R, Sharma A, Sood P, Rothstein DM, Hariharan S. The authors reply. Kidney Int 2020; 98:516. [PMID: 32709297 DOI: 10.1016/j.kint.2020.04.016] [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] [Received: 03/24/2020] [Accepted: 04/02/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Aravind Cherukuri
- St. James's University Hospital, Renal Transplant Unit, Lincoln Wing Beckett Street Leeds, Leeds, West Yorkshire, UK; Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| | - Rajil Mehta
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Akhil Sharma
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Puneet Sood
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - David M Rothstein
- Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sundaram Hariharan
- Ringgold Standard Institution, Nephrology Section, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Mehta RB, Tandukar S, Jorgensen D, Randhawa P, Sood P, Puttarajappa C, Zeevi A, Tevar AD, Hariharan S. Early subclinical tubulitis and interstitial inflammation in kidney transplantation have adverse clinical implications. Kidney Int 2020; 98:436-447. [PMID: 32624181 DOI: 10.1016/j.kint.2020.03.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 09/24/2019] [Revised: 02/11/2020] [Accepted: 03/05/2020] [Indexed: 10/24/2022]
Abstract
This prospective observational cohort study compared the impact of subclinical tubulitis with or without interstitial inflammation to interstitial inflammation alone and to no inflammation in early post kidney transplant biopsies. A study cohort of 415 patients (living and deceased donor recipients) was divided into three groups on the basis of their three-month biopsy: 149 patients with No Inflammation (NI), 83 patients with Isolated Interstitial Inflammation (IIF), and 183 patients with Tubulitis [(with or without interstitial inflammation) (TIF) but not meeting criteria for Banff IA]. TIF was further divided into 56 patients with tubulitis without interstitial inflammation (TIF0) and 127 patients with tubulitis alongside interstitial inflammation (TIF1). TIF was significantly associated with higher incidence of subsequent T-cell mediated rejection (clinical or subclinical) at one year compared to IIF (31% vs 15%) and NI (31% vs 17%). Chronicity on one-year biopsy was significantly higher in TIF compared to IIF (22% vs 11%) and NI (22% vs 7%). De novo donor-specific antibody development was significantly higher in TIF compared to NI (6% vs 0.7%). Tubulitis subgroups (TIF0 and TIF1) revealed comparable effects on de novo donor-specific antibody and interstitial fibrosis/tubular atrophy development. However, tubulitis with interstitial inflammation had a significantly higher incidence of subsequent rejection and posed an increased hazard for the composite end point (subsequent acute rejection and death censored graft loss) compared to other groups [adjusted hazard 2.1 (95% confidence interval 1.2-3.5)]. Thus, subclinical tubulitis is a marker of adverse immunological events, but tubulitis with interstitial inflammation has a worse prognosis. Hence, the Banff 1997 (TIF1) and Banff 2005 classifications (TIF) for borderline change may have different implications.
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Affiliation(s)
- Rajil B Mehta
- Division of Transplant Nephrology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
| | - Srijan Tandukar
- Division of Transplant Nephrology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Dana Jorgensen
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Parmjeet Randhawa
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Puneet Sood
- Division of Transplant Nephrology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Chethan Puttarajappa
- Division of Transplant Nephrology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Adriana Zeevi
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Department of Immunology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Amit D Tevar
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Sundaram Hariharan
- Division of Transplant Nephrology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Jorgensen DR, Wu CM, Hariharan S. Epidemiology of end-stage renal failure among twins and diagnosis, management, and current outcomes of kidney transplantation between identical twins. Am J Transplant 2020; 20:761-768. [PMID: 31595679 DOI: 10.1111/ajt.15638] [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: 03/31/2019] [Revised: 09/03/2019] [Accepted: 09/22/2019] [Indexed: 01/25/2023]
Abstract
The aim of the study is to provide a comprehensive overview of identical twin kidney transplantation in the modern era. We provide epidemiologic trends in the US twin population from 1959 to 2000, current methods to identify zygosity, outcomes for identical twin transplants, and a comprehensive management strategy for identical twin kidney transplantation. By 2019, we project that 433 010 dizygotic and monozygotic twins will be alive and at risk for developing ESRF. Monozygosity between a donor-recipient pair can be confirmed by concordance in sex, blood type, and HLA antigen match with precision testing using 13/17 Short Tandem Repeat sequencing to a likelihood of nearly 100%. Among identical twin transplants from 2001 to 2017, excellent patient and kidney graft survival rates were noted. Approximately 50% of kidney transplant recipients of identical twins transplant did not receive maintenance immunosuppression, and no differences in graft survival were noted among patients with and without immunosuppression at 6 and 12 months (P = .8 and .7). Patients with glomerulonephritis as the cause of ESRF had lower graft survival (P = .06) suggesting that recurrent glomerulonephritis as a likely cause of graft loss among these recipients.
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Affiliation(s)
- Dana R Jorgensen
- Department of Medicine, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Christine M Wu
- Department of Medicine, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Sundaram Hariharan
- Department of Medicine, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
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Shukla SK, Hariharan S, Rao TS. Uranium bioremediation by acid phosphatase activity of Staphylococcus aureus biofilms: Can a foe turn a friend? J Hazard Mater 2020; 384:121316. [PMID: 31607578 DOI: 10.1016/j.jhazmat.2019.121316] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/13/2019] [Accepted: 09/24/2019] [Indexed: 06/10/2023]
Abstract
In this study, Staphylococcus aureus biofilms, which are considered a foe for being pathogenic, were tested for their uranium bioremediation capacity to find out if they can turn out to be a friend. Acid phosphatase activity, which is speculated to aid in bio-precipitation of U(VI) from uranyl nitrate solution, was assayed in biofilms of seven different S. aureus strains. The presence of acid phosphatase enzyme was detected in the biofilms of all S. aureus strains (in the range of 3.1 ± 0.21 to 26.90 ± 2.32 μi.u./g), and found to be higher when compared to that of their planktonic phenotypes. Among all, S. aureus V329 biofilm showed highest biofilm formation ability along with maximum phosphatase activity (26.9 ± 2.32 μi.u./g of biomass). Addition of phosphate enhanced the U(VI) remediation when treated with uranyl nitrate solution. S. aureus V329 biofilm showed significant U tolerance with only a 3-log reduction when exposed to 10 ppm U(VI) for 1 h. When treated in batch mode, V329 biofilm successfully remediated up to 47% of the 10 ppm U(VI). This new approach using the acid phosphatase from the S. aureus V329 biofilm presents an alternative method for the remediation of uranium contamination.
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Affiliation(s)
- Sudhir K Shukla
- Biofouling & Thermal Ecology Section, Water & Steam Chemistry Division, BARC Facilities, Kalpakkam, Tamil Nadu, 603102, India
| | - S Hariharan
- Department of Biotechnology, Sri Venkateswara College of Engineering, Sriperumbudur, Chennai, 602117, India
| | - T Subba Rao
- Biofouling & Thermal Ecology Section, Water & Steam Chemistry Division, BARC Facilities, Kalpakkam, Tamil Nadu, 603102, India; Homi Bhabha National Institute, Mumbai, 400094, India.
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40
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Windt DJ, Mehta R, Jorgensen DR, Bou‐Samra P, Hariharan S, Randhawa PS, Sood P, Molinari M, Wijkstrom M, Ganoza A, Tevar AD. Donor acute kidney injury and its effect on 1‐year post‐transplant kidney allograft fibrosis. Clin Transplant 2020; 34:e13770. [DOI: 10.1111/ctr.13770] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 11/27/2019] [Accepted: 12/04/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Dirk J. Windt
- Division of Transplant Surgery Thomas E. Starzl Transplantation Institute University of Pittsburgh Medical Center Pittsburgh PA USA
| | - Rajil Mehta
- Division of Transplant Nephrology Thomas E. Starzl Transplantation Institute University of Pittsburgh Medical Center Pittsburgh PA USA
| | - Dana R. Jorgensen
- Division of Transplant Surgery Thomas E. Starzl Transplantation Institute University of Pittsburgh Medical Center Pittsburgh PA USA
| | - Patrick Bou‐Samra
- Division of Transplant Surgery Thomas E. Starzl Transplantation Institute University of Pittsburgh Medical Center Pittsburgh PA USA
| | - Sundaram Hariharan
- Division of Transplant Nephrology Thomas E. Starzl Transplantation Institute University of Pittsburgh Medical Center Pittsburgh PA USA
| | - Parmjeet S. Randhawa
- Division of Transplant Pathology Thomas E. Starzl Transplantation Institute University of Pittsburgh Medical Center Pittsburgh PA USA
| | - Puneet Sood
- Division of Transplant Nephrology Thomas E. Starzl Transplantation Institute University of Pittsburgh Medical Center Pittsburgh PA USA
| | - Michele Molinari
- Division of Transplant Surgery Thomas E. Starzl Transplantation Institute University of Pittsburgh Medical Center Pittsburgh PA USA
| | - Martin Wijkstrom
- Division of Transplant Surgery Thomas E. Starzl Transplantation Institute University of Pittsburgh Medical Center Pittsburgh PA USA
| | - Armando Ganoza
- Division of Transplant Surgery Thomas E. Starzl Transplantation Institute University of Pittsburgh Medical Center Pittsburgh PA USA
| | - Amit D. Tevar
- Division of Transplant Surgery Thomas E. Starzl Transplantation Institute University of Pittsburgh Medical Center Pittsburgh PA USA
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Arjun S, Karthik S, Arjunan K, Hariharan S, Seenivasan P, Sankar V. Preparation and Evaluation of Rosuvastatin Calcium Nanosuspension and Solid Dispersion Tablets by Wet Granulation and Direct Compression Techniques using Tamarind Gum as a Binder. Indian J Pharm Sci 2020. [DOI: 10.36468/pharmaceutical-sciences.620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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42
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Nair U. K. A, Hema V, Sinija VR, Hariharan S. Millet milk: A comparative study on the changes in nutritional quality of dairy and nondairy milks during processing and malting. J FOOD PROCESS ENG 2019. [DOI: 10.1111/jfpe.13324] [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: 11/29/2022]
Affiliation(s)
- Aruna Nair U. K.
- Indian Institute of Food Processing TechnologyMinistry of Food Processing IndustriesGovernment of India Thanjavur Tamil Nadu India
| | - Vincent Hema
- Indian Institute of Food Processing TechnologyMinistry of Food Processing IndustriesGovernment of India Thanjavur Tamil Nadu India
| | - V. R. Sinija
- Indian Institute of Food Processing TechnologyMinistry of Food Processing IndustriesGovernment of India Thanjavur Tamil Nadu India
| | - S. Hariharan
- Indian Institute of Food Processing TechnologyMinistry of Food Processing IndustriesGovernment of India Thanjavur Tamil Nadu India
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43
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Puttarajappa CM, Tevar AD, Hariharan S, Silver SJ, Soman P, Hendrick S, Mour G, Wu CM. Screening coronary angiography in patients with long-standing diabetes mellitus undergoing kidney transplant evaluation. Clin Transplant 2019; 33:e13501. [PMID: 30776157 DOI: 10.1111/ctr.13501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/28/2018] [Accepted: 02/05/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The utility of coronary angiography in patients with diabetes mellitus undergoing kidney transplant evaluation is unclear. Predictors of critical angiography lesions in these patients will aid in appropriate use of angiography. METHODS Single-center study of 80 patients with ≥15 years of diabetes mellitus who underwent a screening coronary angiography despite a negative cardiac stress test. Risk factors for needing coronary intervention (CI) (percutaneous or bypass grafting) were analyzed. RESULTS Eighteen patients (23%) had a ≥70% occlusion in one or more major coronary vessel(s), with right coronary artery being the most commonly involved (71%). Fifteen patients (19%) underwent coronary intervention: ten percutaneously and five with bypass surgery. Risk factors for needing CI were not being on statin (OR 3.54, P = 0.047) and history of stroke or peripheral vascular disease (PVD; OR 3.5, P = 0.034). A model that included statin use, stroke/PVD history, and glycosylated hemoglobin had a receiver operating characteristic curve area under the curve of 0.8 to predict CI. CONCLUSION Despite a negative stress test, the prevalence of critical coronary lesions was high among kidney transplant candidates with long-standing diabetes. Risk factors for needing coronary intervention were absence of statin use and a history of stroke or peripheral vascular disease.
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Affiliation(s)
- Chethan M Puttarajappa
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Amit D Tevar
- Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sundaram Hariharan
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Saul J Silver
- Department of Medicine, Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Prem Soman
- Department of Medicine, Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Shelly Hendrick
- Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Girish Mour
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Christine M Wu
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania
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44
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Ascierto P, Nathan P, Kasturi V, Dirix L, Fenig E, Hennessy M, Reed J, Engelsberg A, Hariharan S, Lebbe C. Avelumab in European patients (pts) with metastatic Merkel cell carcinoma (mMCC): Experience from an ad hoc expanded access program (EAP). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy487.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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45
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Nathan P, Kasturi V, Dirix L, Fenig E, Ascierto P, Hennessy M, Reed J, Engelsberg A, Hariharan S, Lebbé C. Avelumab in European patients (pts) with metastatic Merkel cell carcinoma (mMCC): Experience from an ad-hoc expanded access program (EAP). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy289.046] [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: 11/13/2022] Open
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46
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Abstract
The transplantation of living cells, tissues or organs from one species to another is termed xenotransplantation. The history of xenotransplantation is as old as allogeneic transplantation itself. Early attempts were made at a time when the immunologic basis of organ rejection were poorly understood. The advent of potent immunosuppressive medications along with the parallel advances in the field of genetic engineering has provided a fresh perspective on the role of xenotransplantation as a means to alleviate the disparity between the number of candidates on the waitlist and the available organs. As the science behind xenotransplantation advances, the transplantation community must take it upon themselves to educate the community at large regarding both the benefits and potential risks of this promising field.
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Affiliation(s)
- Srijan Tandukar
- a Division of Transplant Nephrology , University of Pittsburgh Medical Center , Pittsburgh , PA , USA
| | - Sundaram Hariharan
- a Division of Transplant Nephrology , University of Pittsburgh Medical Center , Pittsburgh , PA , USA
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47
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Perez-Gutierrez A, Metes DM, Lu L, Hariharan S, Thomson AW, Ezzelarab MB. Characterization of eomesodermin and T-bet expression by allostimulated CD8 + T cells of healthy volunteers and kidney transplant patients in relation to graft outcome. Clin Exp Immunol 2018; 194:259-272. [PMID: 30246373 DOI: 10.1111/cei.13162] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Memory T cell (Tmem) responses play a critical role in the outcome of allo-transplantation. While the role of the T-box transcription factor Eomesodermin (Eomes) in the maintenance of antigen-specific Tmem is well studied, little is known about Eomes+ CD8+ T cell responses after transplantation. We evaluated the phenotype and function of allo-reactive Eomes+ CD8+ T cells in healthy volunteers and kidney transplant patients and their relation to transplant outcome. High Eomes expression by steady-state CD8+ T cells correlated with effector and memory phenotype. Following allo-stimulation, the expression of both the T-box proteins Eomes and T-bet by proliferating cells increased significantly, where high expression of Eomes and T-bet correlated with higher incidence of allo-stimulated IFNγ+ TNFα+ CD8+ T cells. In patients with no subsequent rejection, Eomes but not T-bet expression by donor-stimulated CD8+ T cells, increased significantly after transplantation. This was characterized by increased Eomeshi T-bet-/lo and decreased Eomes-/lo T-bethi CD8+ T cell subsets, with no significant changes in the Eomeshi T-bethi CD8+ T cell subset. No upregulation of exhaustion markers programmed-death-1 (PD-1) and cytotoxic-T-lymphocyte-associated-antigen-4 (CTLA4) by donor-stimulated Eomes+ CD8+ T cells was observed. Before transplantation, in patients without rejection, there were higher incidences of Eomeshi T-bet-/lo , and lower incidences of Eomeshi T-bethi and Eomes-/lo T-bethi donor-stimulated CD8+ T cell subsets, compared to those with subsequent rejection. Overall, our findings indicate that high Eomes expression by allo-stimulated T-bet+ CD8+ T cells is associated with enhanced effector function, and that an elevated incidence of donor-stimulated CD8+ T cells co-expressing high levels of Eomes and T-bet before transplantation, may correlate with an increased incidence of acute cellular rejection.
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Affiliation(s)
- A Perez-Gutierrez
- Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - D M Metes
- Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Departments of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - L Lu
- Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - S Hariharan
- Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - A W Thomson
- Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - M B Ezzelarab
- Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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48
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Cherukuri A, Mehta R, Sood P, Hariharan S. Early allograft inflammation and scarring associate with graft dysfunction and poor outcomes in renal transplant recipients with delayed graft function: a prospective single center cohort study. Transpl Int 2018; 31:1369-1379. [DOI: 10.1111/tri.13318] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 04/27/2018] [Accepted: 07/09/2018] [Indexed: 01/10/2023]
Affiliation(s)
- Aravind Cherukuri
- Department of Immunology; University of Pittsburgh Medical Center; Pittsburgh PA USA
| | - Rajil Mehta
- Department of Medicine; University of Pittsburgh Medical Center; Pittsburgh PA USA
| | - Puneet Sood
- Department of Medicine; University of Pittsburgh Medical Center; Pittsburgh PA USA
| | - Sundaram Hariharan
- Department of Medicine; University of Pittsburgh Medical Center; Pittsburgh PA USA
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49
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Mehta R, Bhusal S, Randhawa P, Sood P, Cherukuri A, Wu C, Puttarajappa C, Hoffman W, Shah N, Mangiola M, Zeevi A, Tevar AD, Hariharan S. Short-term adverse effects of early subclinical allograft inflammation in kidney transplant recipients with a rapid steroid withdrawal protocol. Am J Transplant 2018; 18:1710-1717. [PMID: 29247472 DOI: 10.1111/ajt.14627] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 12/03/2017] [Accepted: 12/10/2017] [Indexed: 01/25/2023]
Abstract
The impact of subclinical inflammation (SCI) noted on early kidney allograft biopsies remains unclear. This study evaluated the outcome of SCI noted on 3-month biopsy. A total of 273/363 (75%) kidney transplant recipients with a functioning kidney underwent allograft biopsies 3-months posttransplant. Among those with stable allograft function at 3 months, 200 biopsies that did not meet the Banff criteria for acute rejection were identified. These were Group I: No Inflammation (NI, n = 71) and Group II: Subclinical Inflammation (SCI, n = 129). We evaluated differences in kidney function at 24-months and allograft histology score at 12-month biopsy. SCI patients had a higher serum creatinine (1.6 ± 0.7 vs 1.38 ± 0.45; P = .02) at 24-months posttransplant, and at last follow-up at a mean of 42.5 months (1.69 ± 0.9 vs 1.46 ± 0.5 mg/dL; P = .027). The allograft chronicity score (ci + ct + cg + cv) at 12-months posttransplant was higher in the SCI group (2.4 ± 1.35 vs 1.9 ± 1.2; P = .02). The incidence of subsequent rejections within the first year in SCI and NI groups was 24% vs 10%, respectively (P = .015). De novo donor-specific antibody within 12 months was more prevalent in the SCI group (12/129 vs 1/71, P = .03). SCI is likely not a benign finding and may have long-term implications for kidney allograft function.
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Affiliation(s)
- Rajil Mehta
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sushma Bhusal
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Parmjeet Randhawa
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Puneet Sood
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Aravind Cherukuri
- Department of Immunology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Christine Wu
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Chethan Puttarajappa
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - William Hoffman
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Nirav Shah
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Massimo Mangiola
- Department of Immunology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Adriana Zeevi
- Department of Immunology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Amit D Tevar
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sundaram Hariharan
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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50
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Gauthey A, Kasturi V, Hariharan S, Reed J, Jaroud F, Chabac S. Carcinome de Merkel (CCM) métastatique : données cliniques et démographiques sur les patients traités par avélumab sous Autorisation temporaire d’utilisation (ATU) de cohorte en France. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.04.056] [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] Open
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