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Alam AH, Van Zyl J, Shakoor HI, Farsakh D, Abdelrehim AB, Maliakkal N, Jamil AK, Patel R, Felius J, McKean S, Hall SA. The impact of active cytomegalovirus infection on donor-derived cell-free DNA testing in heart transplant recipients. Clin Transplant 2024; 38:e15287. [PMID: 38477177 DOI: 10.1111/ctr.15287] [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: 01/09/2024] [Revised: 02/06/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Little is known about the relationship between cytomegalovirus (CMV) infections and donor-derived cell-free DNA (dd-cfDNA) in heart transplant recipients. METHODS In our study, CMV and dd-cfDNA results were prospectively collected on single-organ heart transplant recipients. If the CMV study was positive, a CMV study with dd-cfDNA was repeated 1-3 months later. The primary aim was to compare dd-cfDNA between patients with positive and negative CMV results. RESULTS Of 44 patients enrolled between August 2022 and April 2023, 12 tested positive for CMV infections, 25 were included as controls, and seven patients with a viral infection without CMV were excluded. Baseline characteristics did not differ significantly between CMV-positive and CMV-negative patients with the exception of a later median time post-transplant in the CMV-positive group (253 days vs. 120 days, p = .03). Dd-cfDNA levels were significantly higher in patients with CMV infections compared to those without (p < .001) with more patients in the CMV positive group showing dd-cfDNA results ≥.12% (75% vs. 8%, p < .001) and ≥.20% (58% vs. 8%, p = .002). Each 1 log10 copy/ml reduction in CMV viral load from visit 1 to visit 2 was associated with a.23% reduction in log10 dd-cfDNA (p = .002). CONCLUSION Our findings suggest that active CMV infections may raise dd-cfDNA levels in patients following heart transplantation. Larger studies are needed to validate these preliminary findings.
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Affiliation(s)
- Amit H Alam
- Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Johanna Van Zyl
- Texas A&M University Health Science Center College of Medicine, Dallas, Texas, USA
- Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, Texas, USA
| | - Hira I Shakoor
- Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, Texas, USA
| | - Dana Farsakh
- Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, Texas, USA
| | - Ahmad B Abdelrehim
- Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, Texas, USA
| | - Neville Maliakkal
- Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, Texas, USA
| | - Aayla K Jamil
- Texas A&M University Health Science Center College of Medicine, Dallas, Texas, USA
- Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, Texas, USA
| | - Raksha Patel
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas, USA
| | - Joost Felius
- Texas A&M University Health Science Center College of Medicine, Dallas, Texas, USA
- Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, Texas, USA
| | - Staci McKean
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas, USA
| | - Shelley A Hall
- Texas A&M University Health Science Center College of Medicine, Dallas, Texas, USA
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas, USA
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2
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Ramon DS, Troop DM, Kinard TN, Jadlowiec CC, Ryan MS, Hewitt WR, Olsen LG, Jaramillo A, Taner T, Heilman RL. Alloantibodies after simultaneous liver-kidney transplant: A story of primary nonfunction, retransplantation, and antibody-mediated rejection. Am J Transplant 2022; 22:977-985. [PMID: 34882942 DOI: 10.1111/ajt.16913] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 05/28/2021] [Revised: 12/02/2021] [Accepted: 12/02/2021] [Indexed: 01/25/2023]
Abstract
Simultaneous liver-kidney transplant (SLKT) in the presence of antihuman leukocyte antigen (HLA) donor-specific antibodies (DSA) is a well-accepted practice. Herein, we describe the evolution of alloantibodies in a patient who received an SLKT. The pre-SLKT serum sample showed multiple strong DSA. As expected, all DSA cleared in a sample collected 4 days after the SLKT. Because of the primary nonfunction of the liver in the SLKT, the patient had a second liver transplant 4 days later. An abrupt increase in DSA levels against the kidney was detected 10 days after the second liver transplant. These DSA were refractory to treatment, and the transplanted kidney was lost due to antibody-mediated rejection (AMR). A detailed study of the HLA epitopes recognized by DSA and, after normalization with third-party alloantibodies to address the effect of multiple transfusions and liver allograft neutralization, showed that the elimination of these antibodies depended on the HLA antigens expressed by the transplanted liver cells. The return of DSA after removal of the first transplanted liver was associated with AMR in the transplanted kidney.
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Affiliation(s)
- Daniel S Ramon
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Phoenix, Arizona
| | - Danielle M Troop
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Phoenix, Arizona
| | - Theresa N Kinard
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Phoenix, Arizona
| | - Caroline C Jadlowiec
- Division of Transplant and Hepatobiliary Surgery, Mayo Clinic Hospital, Phoenix, Arizona.,Transplant Center, Mayo Clinic Hospital, Phoenix, Arizona
| | - Margaret S Ryan
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Phoenix, Arizona
| | - Winston R Hewitt
- Division of Transplant and Hepatobiliary Surgery, Mayo Clinic Hospital, Phoenix, Arizona.,Transplant Center, Mayo Clinic Hospital, Phoenix, Arizona
| | - Linda G Olsen
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Phoenix, Arizona
| | - Andrés Jaramillo
- Department of Laboratory Medicine and Pathology, Mayo Clinic Hospital, Phoenix, Arizona
| | - Timucin Taner
- Division of Transplantation Surgery, Mayo Clinic, Rochester, Minnesota.,Department of Immunology, Mayo Clinic, Rochester, Minnesota
| | - Raymond L Heilman
- Transplant Center, Mayo Clinic Hospital, Phoenix, Arizona.,Division of Nephrology, Mayo Clinic Hospital, Phoenix, Arizona
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3
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Levitsky J, Kandpal M, Guo K, Kleiboeker S, Sinha R, Abecassis M. Donor-derived cell-free DNA levels predict graft injury in liver transplant recipients. Am J Transplant 2022; 22:532-540. [PMID: 34510731 DOI: 10.1111/ajt.16835] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [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: 04/25/2021] [Revised: 08/15/2021] [Accepted: 09/02/2021] [Indexed: 01/25/2023]
Abstract
Donor-derived cell-free DNA (dd-cfDNA) has been evaluated as a rejection marker in organ transplantation. This study sought to assess the utility of dd-cfDNA to diagnose graft injury in liver transplant recipients (LTR) and as a predictive biomarker prior to different causes of graft dysfunction. Plasma from single and multicenter LTR cohorts was analyzed for dd-cfDNA. Phenotypes of treated biopsy-proven acute rejection (AR, N = 57), normal function (TX, N = 94), and acute dysfunction no rejection (ADNR; N = 68) were divided into training and test sets. In the training set, dd-cfDNA was significantly different between AR versus TX (AUC 0.95, 5.3% cutoff) and AR versus ADNR (AUC 0.71, 20.4% cutoff). Using these cutoffs in the test set, the accuracy and NPV were 87% and 100% (AR vs. TX) and 66.7% and 87.8% (AR vs. ADNR). Blood samples collected serially from LTR demonstrated incremental elevations in dd-cfDNA prior to the onset of graft dysfunction (AR > ADNR), but not in TX. Dd-cfDNA also decreased following treatment of rejection. In conclusion, the serial elevation of dd-cfDNA identifies pre-clinical graft injury in the context of normal liver function tests and is greatest in rejection. This biomarker may help detect early signs of graft injury and rejection to inform LTR management strategies.
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Affiliation(s)
- Josh Levitsky
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Manoj Kandpal
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Biostatistics Collaboration Center, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kexin Guo
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Biostatistics Collaboration Center, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Rohita Sinha
- Eurofins Viracor Clinical Diagnostics, Lee's Summit, Missouri
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4
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Bestard O, Jouve T, Castells L, Lopez M, Muñoz M, Crespo E, Toapanta N, Esperalba J, Campos‐Varela I, Pont T, Len O, Campins M, Moreso F. Reconciling short-term clinical and immunological outcomes of SARS-CoV-2 vaccination in solid organ transplant recipients. Am J Transplant 2022; 22:673-675. [PMID: 34554648 PMCID: PMC8653131 DOI: 10.1111/ajt.16855] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/07/2021] [Accepted: 09/16/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Oriol Bestard
- Kidney Transplant UnitNephrology DepartmentVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de BarcelonaBarcelonaSpain,Laboratory of Nephrology and TransplantationVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Thomas Jouve
- Laboratory of Nephrology and TransplantationVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Lluís Castells
- Liver UnitVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)Instituto de Salud Carlos IIIMadridSpain
| | - Manuel Lopez
- Lung Transplant UnitVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Marina Muñoz
- Pediatric Transplant DepartmentVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Elena Crespo
- Laboratory of Nephrology and TransplantationVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Nestor Toapanta
- Kidney Transplant UnitNephrology DepartmentVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - Juliana Esperalba
- Microbiology DepartmentVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Isabel Campos‐Varela
- Liver UnitVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)Instituto de Salud Carlos IIIMadridSpain
| | - Teresa Pont
- Transplant Coordination DepartmentVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Oscar Len
- Infectious Disease DepartmentVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Magda Campins
- Deparment of Preventive Medicine and EpidemiologyVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Francesc Moreso
- Kidney Transplant UnitNephrology DepartmentVall d'Hebron Hospital UniversitariVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de BarcelonaBarcelonaSpain,Laboratory of Nephrology and TransplantationVall d'Hebron Institut de Recerca (VHIR)Vall d'Hebron Barcelona Hospital CampusUniversitat Autònoma de BarcelonaBarcelonaSpain
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5
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Chang JH, Alvarado Verduzco H, Toma K, Sritharan S, Mohan S, Husain SA. Donor-derived cell-free DNA and renal allograft rejection in surveillance biopsies and indication biopsies. Clin Transplant 2021; 36:e14561. [PMID: 34913202 DOI: 10.1111/ctr.14561] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/18/2021] [Accepted: 12/05/2021] [Indexed: 11/27/2022]
Abstract
To evaluate the role of circulating dd-cfDNA in allograft surveillance in immunologically high-risk patients, a retrospective cross-sectional study of 261 kidney transplant recipients who underwent outpatient allograft biopsy at our center between September 2020 and August 2021 was performed. Of the 236 dd-cfDNA results included, 37 samples were obtained at the time of a surveillance biopsy in sensitized recipients and 199 at the time of a clinically indicated biopsy. The median serum creatinine at the time of the biopsy was 1.3 mg/dl and 2.1 mg/dl for surveillance biopsies and clinically indicated biopsies, respectively (p<0.001). Rejection was diagnosed in 27% of surveillance biopsies and 29% of clinically indicated biopsies. Among surveillance biopsies, sensitivity and specificity to detect rejection were 0% and 89%, respectively, and among clinically indicated biopsies they were 28% and 96%, respectively. The sensitivity and specificity to detect antibody-mediated rejection were 0% and 91% among surveillance biopsies and 50% and 94% among clinically indicated biopsies. Nine biopsies without rejection findings had corresponding dd-cfDNA of ≥1%. Our data does not support dd-cfDNA as a biomarker for kidney allograft rejection, even in immunologically high-risk patients in the absence of graft dysfunction. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jae-Hyung Chang
- Division of Nephrology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Hector Alvarado Verduzco
- Division of Nephrology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Katherine Toma
- Division of Nephrology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Sharlinee Sritharan
- Division of Nephrology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Sumit Mohan
- Division of Nephrology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States.,Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States.,Columbia University Renal Epidemiology (CURE) group, New York, NY, United States
| | - Syed Ali Husain
- Division of Nephrology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States.,Columbia University Renal Epidemiology (CURE) group, New York, NY, United States
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6
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Newell LF, Dunlap J, Gatter K, Bagby GC, Press RD, Cook RJ, Fletcher L, Leonard JT, Leong KM, Bubalo JS, Olyaei A, Deloughery TG, Maziarz RT, Maynard E, Orloff SL, Enestvedt CK. Graft-versus-host disease after liver transplantation is associated with bone marrow failure, hemophagocytosis, and DNMT3A mutations. Am J Transplant 2021; 21:3894-3906. [PMID: 33961341 DOI: 10.1111/ajt.16635] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/16/2021] [Accepted: 04/30/2021] [Indexed: 01/25/2023]
Abstract
Graft-versus-host disease after liver transplantation (LT-GVHD) is rare, frequently fatal, and associated with bone marrow failure (BMF), cytopenias, and hyperferritinemia. Given hyperferritinemia and cytopenias are present in hemophagocytic lymphohistiocytosis (HLH), and somatic mutations in hematopoietic cells are associated with hyperinflammatory responses (clonal hematopoiesis of indeterminate potential, CHIP), we identified the frequency of hemophagocytosis and CHIP mutations in LT-GVHD. We reviewed bone marrow aspirates and biopsies, quantified blood/marrow chimerism, and performed next-generation sequencing (NGS) with a targeted panel of genes relevant to myeloid malignancies, CHIP, and BMF. In all, 12 marrows were reviewed from 9 LT-GVHD patients. In all, 10 aspirates were evaluable for hemophagocytosis; 7 had adequate DNA for NGS. NGS was also performed on marrow from an LT cohort (n = 6) without GVHD. Nine of 10 aspirates in LT-GVHD patients showed increased hemophagocytosis. Five (71%) of 7 with LT-GVHD had DNMT3A mutations; only 1 of 6 in the non-GVHD LT cohort demonstrated DNMT3A mutation (p = .04). Only 1 LT-GVHD patient survived. BMF with HLH features was associated with poor hematopoietic recovery, and DNMT3A mutations were over-represented, in LT-GVHD patients. Identification of HLH features may guide prognosis and therapeutics. Further studies are needed to clarify the origin and impact of CHIP mutations on the hyperinflammatory state.
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Affiliation(s)
- Laura F Newell
- Knight Cancer Institute, Hematology and Medical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Jennifer Dunlap
- Department of Pathology, Oregon Health & Science University, Portland, Oregon, USA
| | - Ken Gatter
- Department of Pathology, Oregon Health & Science University, Portland, Oregon, USA
| | - Grover C Bagby
- Knight Cancer Institute, Hematology and Medical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Richard D Press
- Department of Pathology, Oregon Health & Science University, Portland, Oregon, USA
| | - Rachel J Cook
- Knight Cancer Institute, Hematology and Medical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Luke Fletcher
- Knight Cancer Institute, Hematology and Medical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Jessica T Leonard
- Knight Cancer Institute, Hematology and Medical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Kelli M Leong
- Department of Pharmacy, Oregon Health & Science University, Portland, Oregon, USA
| | - Joseph S Bubalo
- Department of Pharmacy, Oregon Health & Science University, Portland, Oregon, USA
| | - Ali Olyaei
- Division of Nephrology and Hypertension, Oregon Health & Science University, Portland, Oregon, USA
| | - Thomas G Deloughery
- Knight Cancer Institute, Hematology and Medical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Richard T Maziarz
- Knight Cancer Institute, Hematology and Medical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Erin Maynard
- Department of Surgery, Division of Abdominal Organ Transplantation, Oregon Health & Science University, Portland, Oregon, USA
| | - Susan L Orloff
- Department of Surgery, Division of Abdominal Organ Transplantation, Oregon Health & Science University, Portland, Oregon, USA
| | - C Kristian Enestvedt
- Department of Surgery, Division of Abdominal Organ Transplantation, Oregon Health & Science University, Portland, Oregon, USA
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7
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Herrera S, Colmenero J, Pascal M, Escobedo M, Castel MA, Sole-González E, Palou E, Egri N, Ruiz P, Mosquera M, Moreno A, Juan M, Vilella A, Soriano A, Farrero M, Bodro M. Cellular and humoral immune response after mRNA-1273 SARS-CoV-2 vaccine in liver and heart transplant recipients. Am J Transplant 2021; 21:3971-3979. [PMID: 34291552 PMCID: PMC9800111 DOI: 10.1111/ajt.16768] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [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: 05/23/2021] [Revised: 07/02/2021] [Accepted: 07/17/2021] [Indexed: 01/25/2023]
Abstract
Recently published studies have found an impaired immune response after SARS-CoV-2 vaccination in solid organ recipients. However, most of these studies have not assessed immune cellular responses in liver and heart transplant recipients. We prospectively studied heart and liver transplant recipients eligible for SARS-CoV-2 vaccination. Patients with past history of SARS-CoV-2 infection or SARS-CoV-2 detectable antibodies (IgM or IgG) were excluded. We assessed IgM/IgG antibodies and ELISpot against the S protein 4 weeks after receiving the second dose of the mRNA-1273 (Moderna) vaccine. Side effects, troponin I, liver tests and anti-HLA donor-specific antibodies (DSA) were also assessed. A total of 58 liver and 46 heart recipients received two doses of mRNA-1273 vaccine. Median time from transplantation to vaccination was 5.4 years (IQR 0.3-27). Sixty-four percent of the patients developed SARS-CoV-2 IgM/IgG antibodies and 79% S-ELISpot positivity. Ninety percent of recipients developed either humoral or cellular response (87% in heart recipients and 93% in liver recipients). Factors associated with vaccine unresponsiveness were hypogammaglobulinemia and vaccination during the first year after transplantation. Local and systemic side effects were mild or moderate, and none presented DSA or graft dysfunction after vaccination. Ninety percent of our patients did develop humoral or cellular responses to mRNA-1273 vaccine. Factors associated with vaccine unresponsiveness were hypogammaglobulinemia and vaccination during the first year after transplantation, highlighting the need to further protect these patients.
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Affiliation(s)
- Sabina Herrera
- Department of Infectious Diseases, Hospital Clínic, University of Barcelonae, Barcelona, Spain
| | - Jordi Colmenero
- Liver Transplantation, Liver Unit, Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Mariona Pascal
- Department of Immunology, CDB, Hospital Clínic, Barcelona, Spain,Immunoal·lergia Clínica Respiratoria i Experimental (IRCE), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain,Red Nacional de Alergia, Asma, Reacciones Adversas y Alérgicas (ARADyAL), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Miguel Escobedo
- Liver Transplantation, Liver Unit, Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - María A. Castel
- Unit for Heart Failure and Heart Transplantation, Department of Cardiology, Hospital Clínic, Barcelona, Spain
| | - Eduard Sole-González
- Unit for Heart Failure and Heart Transplantation, Department of Cardiology, Hospital Clínic, Barcelona, Spain
| | - Eduard Palou
- Department of Immunology, CDB, Hospital Clínic, Barcelona, Spain,Immunoal·lergia Clínica Respiratoria i Experimental (IRCE), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain,Red Nacional de Alergia, Asma, Reacciones Adversas y Alérgicas (ARADyAL), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Natalia Egri
- Department of Immunology, CDB, Hospital Clínic, Barcelona, Spain
| | - Pablo Ruiz
- Liver Transplantation, Liver Unit, Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Mar Mosquera
- Department of Microbiology, Hospital Clínic, Barcelona, Spain
| | - Asunción Moreno
- Department of Infectious Diseases, Hospital Clínic, University of Barcelonae, Barcelona, Spain
| | - Manel Juan
- Department of Immunology, CDB, Hospital Clínic, Barcelona, Spain,Immunoal·lergia Clínica Respiratoria i Experimental (IRCE), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain,Red Nacional de Alergia, Asma, Reacciones Adversas y Alérgicas (ARADyAL), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Anna Vilella
- Department of Preventive Medicine and Epidemiology, Hospital Clinic, University of barcelonae, Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clínic, University of Barcelonae, Barcelona, Spain
| | - Marta Farrero
- Unit for Heart Failure and Heart Transplantation, Department of Cardiology, Hospital Clínic, Barcelona, Spain,Correspondence Marta Bodro and Marta Farrero, Department of Infectious Diseases and Unit for Heart Failure and Heart Transplantation, Hospital Clínic of Barcelona, Carrer Villarroel, Barcelona, Spain. (M. B.) and (M. F.)
| | - Marta Bodro
- Department of Infectious Diseases, Hospital Clínic, University of Barcelonae, Barcelona, Spain,Correspondence Marta Bodro and Marta Farrero, Department of Infectious Diseases and Unit for Heart Failure and Heart Transplantation, Hospital Clínic of Barcelona, Carrer Villarroel, Barcelona, Spain. (M. B.) and (M. F.)
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8
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Fernández-Ruiz M, Olea B, Almendro-Vázquez P, Giménez E, Marcacuzco A, San Juan R, Justo I, Calvo-Pulido J, García-Sesma Á, Manrique A, Caso O, Cambra F, Talayero P, López-Medrano F, Remigia MJ, Ruiz-Merlo T, Parra P, Paz-Artal E, Jiménez C, Loinaz C, Navarro D, Laguna-Goya R, Aguado JM. T cell-mediated response to SARS-CoV-2 in liver transplant recipients with prior COVID-19. Am J Transplant 2021; 21:2785-2794. [PMID: 34092033 PMCID: PMC8222887 DOI: 10.1111/ajt.16708] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/11/2021] [Accepted: 05/30/2021] [Indexed: 01/25/2023]
Abstract
Whether immunosuppression impairs severe acute respiratory syndrome coronavirus 2-specific T cell-mediated immunity (SARS-CoV-2-CMI) after liver transplantation (LT) remains unknown. We included 31 LT recipients in whom SARS-CoV-2-CMI was assessed by intracellular cytokine staining (ICS) and interferon (IFN)-γ FluoroSpot assay after a median of 103 days from COVID-19 diagnosis. Serum SARS-CoV-2 IgG antibodies were measured by ELISA. A control group of nontransplant immunocompetent patients were matched (1:1 ratio) by age and time from diagnosis. Post-transplant SARS-CoV-2-CMI was detected by ICS in 90.3% (28/31) of recipients, with higher proportions for IFN-γ-producing CD4+ than CD8+ responses (93.5% versus 83.9%). Positive spike-specific and nucleoprotein-specific responses were found by FluoroSpot in 86.7% (26/30) of recipients each, whereas membrane protein-specific response was present in 83.3% (25/30). An inverse correlation was observed between the number of spike-specific IFN-γ-producing SFUs and time from diagnosis (Spearman's rho: -0.418; p value = .024). Two recipients (6.5%) failed to mount either T cell-mediated or IgG responses. There were no significant differences between LT recipients and nontransplant patients in the magnitude of responses by FluoroSpot to any of the antigens. Most LT recipients mount detectable-but declining over time-SARS-CoV-2-CMI after a median of 3 months from COVID-19, with no meaningful differences with immunocompetent patients.
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Affiliation(s)
- Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain,Correspondence Mario Fernández-Ruiz, Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain.
| | - Beatriz Olea
- Department of Microbiology, Hospital Clínico Universitario, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Patricia Almendro-Vázquez
- Department of Immunology, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Estela Giménez
- Department of Microbiology, Hospital Clínico Universitario, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Alberto Marcacuzco
- Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Rafael San Juan
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain,Department of Medicine, Universidad Complutense, Madrid, Spain
| | - Iago Justo
- Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Jorge Calvo-Pulido
- Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Álvaro García-Sesma
- Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Alejandro Manrique
- Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Oscar Caso
- Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Félix Cambra
- Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Paloma Talayero
- Department of Immunology, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Francisco López-Medrano
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain,Department of Medicine, Universidad Complutense, Madrid, Spain
| | - María José Remigia
- Department of Hematology, Hospital Clínico Universitario, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Tamara Ruiz-Merlo
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Patricia Parra
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Estela Paz-Artal
- Department of Immunology, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Carlos Jiménez
- Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain,Department of Surgery, Universidad Complutense, Madrid, Spain
| | - Carmelo Loinaz
- Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain,Department of Surgery, Universidad Complutense, Madrid, Spain
| | - David Navarro
- Department of Microbiology, Hospital Clínico Universitario, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain,School of Medicine, Universidad de Valencia, Valencia, Spain
| | - Rocío Laguna-Goya
- Department of Immunology, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - José M. Aguado
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Madrid, Spain,Department of Medicine, Universidad Complutense, Madrid, Spain
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9
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Gärtner BC, Sester M. Diversity of antibody responses after influenza infection or vaccination-Needed or nice to have? Am J Transplant 2021; 21:2631-2632. [PMID: 33638930 PMCID: PMC8014159 DOI: 10.1111/ajt.16554] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/17/2021] [Accepted: 02/19/2021] [Indexed: 01/25/2023]
Abstract
Gärtner and Sester contextualize recent findings on natural and vaccine‐induced immunity towards influenza in transplant recipients including implications for other vaccines. Hirzel et al.'s article is on page 2709.
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Affiliation(s)
- Barbara C. Gärtner
- Department of Medical Microbiology and HygieneSaarland UniversityHomburgGermany
| | - Martina Sester
- Department of Transplant and Infection ImmunologySaarland UniversityHomburgGermany
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10
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Sawinski DL, Mehta S, Alhamad T, Bromberg JS, Fischbach B, Aeschbacher T, Ghosh S, Shekhtman G, Dholakia S, Brennan DC, Poggio E, Bloom RD, Jordan SC. Association between dd-cfDNA levels, de novo donor specific antibodies, and eGFR decline: An analysis of the DART cohort. Clin Transplant 2021; 35:e14402. [PMID: 34184326 DOI: 10.1111/ctr.14402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/21/2021] [Accepted: 06/04/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Donor-derived cell-free DNA (dd-cfDNA) is a marker of allograft injury in transplant recipients; however, the relationship between dd-cfDNA and other clinical parameters associated with adverse allograft outcomes is not well-characterized. METHODS We performed a retrospective analysis of kidney transplant recipients from the DART cohort (ClinicalTrials.gov Identifier: NCT02424227) to evaluate the associations between eGFR decline, de novo donor-specific antibodies (dnDSA), and dd-cfDNA. RESULTS Both elevated dd-cfDNA (≥1%) and dd-cfDNA variability (≥.34%) in the first post-transplant year were associated with decline in eGFR ≥25% in the second year (21.4% vs. 4.1%, P = .005; 25% vs. 3.6%, P = .002, respectively). Compared to samples from DSA negative patients, samples from patients with concurrent de novo HLA DSAs had higher dd-cfDNA levels (P < .0001). DISCUSSION Abnormalities in dd-cfDNA levels are associated with clinical parameters commonly used as surrogate endpoints for adverse allograft outcomes, raising the possibility that molecular injury as characterized by dd-cfDNA could help identify patients at risk of these outcomes.
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Affiliation(s)
- Deirdre L Sawinski
- Renal, Electrolyte, and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Penn Transplant Institute, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shikha Mehta
- Section of Transplant Nephrology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tarek Alhamad
- Division of Nephrology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jonathan S Bromberg
- Department of Surgery and Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | | | | | | | | | - Daniel C Brennan
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Emilio Poggio
- Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, Ohio, USA
| | - Roy D Bloom
- Renal, Electrolyte, and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Penn Transplant Institute, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stanley C Jordan
- Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA.,Division of Nephrology, Cedars-Sinai Medical Center, Los Angeles, California, USA
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11
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Harden PN, Game DS, Sawitzki B, Van der Net JB, Hester J, Bushell A, Issa F, Brook MO, Alzhrani A, Schlickeiser S, Scotta C, Petchey W, Streitz M, Blancho G, Tang Q, Markmann J, Lechler RI, Roberts ISD, Friend PJ, Hilton R, Geissler EK, Wood KJ, Lombardi G. Feasibility, long-term safety, and immune monitoring of regulatory T cell therapy in living donor kidney transplant recipients. Am J Transplant 2021; 21:1603-1611. [PMID: 33171020 PMCID: PMC7613119 DOI: 10.1111/ajt.16395] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [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: 09/08/2020] [Revised: 10/14/2020] [Accepted: 10/31/2020] [Indexed: 01/25/2023]
Abstract
Short-term outcomes in kidney transplantation are marred by progressive transplant failure and mortality secondary to immunosuppression toxicity. Immune modulation with autologous polyclonal regulatory T cell (Treg) therapy may facilitate immunosuppression reduction promoting better long-term clinical outcomes. In a Phase I clinical trial, 12 kidney transplant recipients received 1-10 × 106 Treg per kg at Day +5 posttransplantation in lieu of induction immunosuppression (Treg Therapy cohort). Nineteen patients received standard immunosuppression (Reference cohort). Primary outcomes were rejection-free and patient survival. Patient and transplant survival was 100%; acute rejection-free survival was 100% in the Treg Therapy versus 78.9% in the reference cohort at 48 months posttransplant. Treg therapy revealed no excess safety concerns. Four patients in the Treg Therapy cohort had mycophenolate mofetil withdrawn successfully and remain on tacrolimus monotherapy. Treg infusion resulted in a long-lasting dose-dependent increase in peripheral blood Tregs together with an increase in marginal zone B cell numbers. We identified a pretransplantation immune phenotype suggesting a high risk of unsuccessful ex-vivo Treg expansion. Autologous Treg therapy is feasible, safe, and is potentially associated with a lower rejection rate than standard immunosuppression. Treg therapy may provide an exciting opportunity to minimize immunosuppression therapy and improve long-term outcomes.
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Affiliation(s)
- Paul N Harden
- Oxford Transplant Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - David S Game
- Department of Transplantation, Guys and St Thomas's Hospital NHS Trust, London, UK
| | - Birgit Sawitzki
- Institute of Medical Immunology, Charite University of Medicine, Berlin, Germany
| | - Jeroen B Van der Net
- Oxford Transplant Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Joanna Hester
- Transplantation Research Immunology Group, University of Oxford, Oxford, UK
| | - Andrew Bushell
- Transplantation Research Immunology Group, University of Oxford, Oxford, UK
| | - Fadi Issa
- Transplantation Research Immunology Group, University of Oxford, Oxford, UK
| | - Matthew O Brook
- Oxford Transplant Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Transplantation Research Immunology Group, University of Oxford, Oxford, UK
| | - Alaa Alzhrani
- Transplantation Research Immunology Group, University of Oxford, Oxford, UK
| | - Stephan Schlickeiser
- Institute of Medical Immunology, Charite University of Medicine, Berlin, Germany
| | - Cristiano Scotta
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Science, Kings College London, London, UK
| | - William Petchey
- Oxford Transplant Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mathias Streitz
- Institute of Medical Immunology, Charite University of Medicine, Berlin, Germany
| | - Gilles Blancho
- Centre of Research in Transplantation and Immunology, Nantes University, Nantes, France
| | - Quizhi Tang
- UCSF Transplantation Research Lab, Department of Surgery, University of California, San Francisco, California
| | - James Markmann
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, Massachusetts
| | - Robert I Lechler
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Science, Kings College London, London, UK
| | - Ian S D Roberts
- Department of Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Peter J Friend
- Oxford Transplant Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rachel Hilton
- Department of Transplantation, Guys and St Thomas's Hospital NHS Trust, London, UK
| | - Edward K Geissler
- Department of Surgery, Division of Experimental Surgery, University of Regensburg, Regensburg, Germany
| | - Kathryn J Wood
- Transplantation Research Immunology Group, University of Oxford, Oxford, UK
| | - Giovanna Lombardi
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Science, Kings College London, London, UK
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12
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Sabbah S, Liew A, Brooks AM, Kundu R, Reading JL, Flatt A, Counter C, Choudhary P, Forbes S, Rosenthal MJ, Rutter MK, Cairns S, Johnson P, Casey J, Peakman M, Shaw JA, Tree TIM. Autoreactive T cell profiles are altered following allogeneic islet transplantation with alemtuzumab induction and re-emerging phenotype is associated with graft function. Am J Transplant 2021; 21:1027-1038. [PMID: 32865886 DOI: 10.1111/ajt.16285] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/15/2020] [Accepted: 08/10/2020] [Indexed: 01/25/2023]
Abstract
Islet transplantation is an effective therapy for life-threatening hypoglycemia, but graft function gradually declines over time in many recipients. We characterized islet-specific T cells in recipients within an islet transplant program favoring alemtuzumab (ATZ) lymphodepleting induction and examined associations with graft function. Fifty-eight recipients were studied: 23 pretransplant and 40 posttransplant (including 5 with pretransplant phenotyping). The proportion with islet-specific T cell responses was not significantly different over time (pre-Tx: 59%; 1-6 m posttransplant: 38%; 7-12 m: 44%; 13-24 m: 47%; and >24 m: 45%). However, phenotype shifted significantly, with IFN-γ-dominated response in the pretransplant group replaced by IL-10-dominated response in the 1-6 m posttransplant group, reverting to predominantly IFN-γ-oriented response in the >24 m group. Clustering analysis of posttransplant responses revealed two main agglomerations, characterized by IFN-γ and IL-10 phenotypes, respectively. IL-10-oriented posttransplant response was associated with relatively low graft function. Recipients within the IL-10+ cluster had a significant decline in C-peptide levels in the period preceding the IL-10 response, but stable graft function following the response. In contrast, an IFN-γ response was associated with subsequently decreased C-peptide. Islet transplantation favoring ATZ induction is associated with an initial altered islet-specific T cell phenotype but reversion toward pretransplant profiles over time. Posttransplant autoreactive T cell phenotype may be a predictor of subsequent graft function.
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Affiliation(s)
- Shereen Sabbah
- Department of Immunobiology, Faculty of Life Sciences & Medicine, King's College London, London, UK.,NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Aaron Liew
- Newcastle University Translational and Clinical Research Institute, Newcastle, UK
| | - Augustin M Brooks
- Newcastle University Translational and Clinical Research Institute, Newcastle, UK
| | - Rhiannon Kundu
- Department of Immunobiology, Faculty of Life Sciences & Medicine, King's College London, London, UK.,NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - James L Reading
- Department of Immunobiology, Faculty of Life Sciences & Medicine, King's College London, London, UK.,NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Anneliese Flatt
- Newcastle University Translational and Clinical Research Institute, Newcastle, UK
| | - Claire Counter
- Organ Donation and Transplantation, NHS Blood and Transplant, Bristol, UK
| | - Pratik Choudhary
- Diabetes Research Group, Guy's, King's and St. Thomas' School of Medicine, King's College London, London, UK
| | - Shareen Forbes
- Edinburgh Transplant Centre and Endocrinology Unit, University of Edinburgh, Edinburgh, UK
| | | | - Martin K Rutter
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Manchester, UK.,Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Stephanie Cairns
- Clinical Immunology Department, Scottish National Blood Transfusion Service, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Paul Johnson
- Oxford Centre for Diabetes Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - John Casey
- Edinburgh Transplant Centre and Endocrinology Unit, University of Edinburgh, Edinburgh, UK
| | - Mark Peakman
- Department of Immunobiology, Faculty of Life Sciences & Medicine, King's College London, London, UK.,NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - James A Shaw
- Newcastle University Translational and Clinical Research Institute, Newcastle, UK.,Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Timothy I M Tree
- Department of Immunobiology, Faculty of Life Sciences & Medicine, King's College London, London, UK.,NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
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13
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Candon S, Guerrot D, Drouot L, Lemoine M, Lebourg L, Hanoy M, Boyer O, Bertrand D. T cell and antibody responses to SARS-CoV-2: Experience from a French transplantation and hemodialysis center during the COVID-19 pandemic. Am J Transplant 2021; 21:854-863. [PMID: 33047493 PMCID: PMC7675512 DOI: 10.1111/ajt.16348] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/08/2020] [Accepted: 09/25/2020] [Indexed: 01/25/2023]
Abstract
Immunosuppressed organ-transplanted patients are considered at risk for severe forms of COVID-19. Moreover, exaggerated innate and adaptive immune responses might be involved in severe progression of the disease. However, no data on the immune response to SARS-CoV-2 in transplanted patients are currently available. Here, we report the first assessment of antibody and T cell responses to SARS-CoV-2 in 11 kidney-transplanted patients recovered from RT-PCR-confirmed (n = 5) or initially suspected (n = 6) COVID-19. After reduction of immunosuppressive therapy, RT-PCR-confirmed COVID-19 transplant patients were able to mount vigorous antiviral T cell and antibody responses, as efficiently as two nontherapeutically immunosuppressed COVID-19 patients on hemodialysis. By contrast, six RT-PCR-negative patients displayed no antibody response. Among them, three showed very low numbers of SARS-CoV-2-reactive T cells, whereas no T cell response was detected in the other three, potentially ruling out COVID-19 diagnosis. Low levels of T cell reactivity to SARS-CoV-2 were also detected in seronegative healthy controls without known exposure to the virus. These results suggest that during COVID-19, monitoring both T cell and serological immunity might be helpful for the differential diagnosis of COVID-19 but are also needed to evaluate a potential role of antiviral T cells in the development of severe forms of the disease.
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Affiliation(s)
- Sophie Candon
- Department of Immunology and BiotherapiesRouen University HospitalRouenFrance,INSERM U1234University of Rouen NormandyRouenFrance
| | - Dominique Guerrot
- Department of Nephrology, Transplantation and hemodialysisRouen University HospitalRouenFrance
| | | | - Mathilde Lemoine
- Department of Nephrology, Transplantation and hemodialysisRouen University HospitalRouenFrance
| | - Ludivine Lebourg
- Department of Nephrology, Transplantation and hemodialysisRouen University HospitalRouenFrance
| | - Mélanie Hanoy
- Department of Nephrology, Transplantation and hemodialysisRouen University HospitalRouenFrance
| | - Olivier Boyer
- Department of Immunology and BiotherapiesRouen University HospitalRouenFrance,INSERM U1234University of Rouen NormandyRouenFrance
| | - Dominique Bertrand
- Department of Nephrology, Transplantation and hemodialysisRouen University HospitalRouenFrance
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14
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Dugger DT, Fung M, Hays SR, Singer JP, Kleinhenz ME, Leard LE, Golden JA, Shah RJ, Lee JS, Deiter F, Greenland NY, Jones KD, Langelier CR, Greenland JR. Chronic lung allograft dysfunction small airways reveal a lymphocytic inflammation gene signature. Am J Transplant 2021; 21:362-371. [PMID: 32885581 PMCID: PMC8009189 DOI: 10.1111/ajt.16293] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/27/2020] [Accepted: 08/16/2020] [Indexed: 01/25/2023]
Abstract
Chronic lung allograft dysfunction (CLAD) is the major barrier to long-term survival following lung transplantation, and new mechanistic biomarkers are needed. Lymphocytic bronchitis (LB) precedes CLAD and has a defined molecular signature. We hypothesized that this LB molecular signature would be associated with CLAD in small airway brushings independent of infection. We quantified RNA expression from small airway brushings and transbronchial biopsies, using RNAseq and digital RNA counting, respectively, for 22 CLAD cases and 27 matched controls. LB metagene scores were compared across CLAD strata by Wilcoxon rank sum test. We performed unbiased host transcriptome pathway and microbial metagenome analysis in airway brushes and compared machine-learning classifiers between the two tissue types. This LB metagene score was increased in CLAD airway brushes (p = .002) and improved prediction of graft failure (p = .02). Gene expression classifiers based on airway brushes outperformed those using transbronchial biopsies. While infection was associated with decreased microbial alpha-diversity (p ≤ .04), neither infection nor alpha-diversity was associated with LB gene expression. In summary, CLAD was associated with small airway gene expression changes not apparent in transbronchial biopsies in this cohort. Molecular analysis of airway brushings for diagnosing CLAD merits further examination in multicenter cohorts.
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Affiliation(s)
- Daniel T. Dugger
- Department of Medicine, University of California, San Francisco, CA 94143,Veterans Affairs Health Care System, San Francisco, CA 94121
| | - Monica Fung
- Department of Medicine, University of California, San Francisco, CA 94143
| | - Steven R. Hays
- Department of Medicine, University of California, San Francisco, CA 94143
| | - Jonathan P. Singer
- Department of Medicine, University of California, San Francisco, CA 94143
| | | | - Lorriana E. Leard
- Department of Medicine, University of California, San Francisco, CA 94143
| | - Jeffrey A. Golden
- Department of Medicine, University of California, San Francisco, CA 94143
| | - Rupal J. Shah
- Department of Medicine, University of California, San Francisco, CA 94143
| | - Joyce S. Lee
- Department of Medicine, University of Colorado, Denver, CO 80045
| | - Fred Deiter
- Department of Medicine, University of California, San Francisco, CA 94143
| | - Nancy Y. Greenland
- Veterans Affairs Health Care System, San Francisco, CA 94121,Department of Anatomic Pathology, University of California, San Francisco, CA 94143
| | - Kirk D. Jones
- Department of Anatomic Pathology, University of California, San Francisco, CA 94143
| | | | - John R. Greenland
- Department of Medicine, University of California, San Francisco, CA 94143,Veterans Affairs Health Care System, San Francisco, CA 94121
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15
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Affiliation(s)
- Edward J Filippone
- Division of Nephrology, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ballabh Das
- Department of Pathology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Allen J Norin
- Department of Medicine and Cell Biology, Transplant Immunology and Immunogenetics, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Mepur H Ravindranath
- Department of Hematology and Oncology, Children's Hospital, Los Angeles, California, USA
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16
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Davis S, Wiebe C, Campbell K, Anobile C, Aubrey M, Stites E, Grafals M, Pomfret E, Nickerson P, Cooper JE. Adequate tacrolimus exposure modulates the impact of HLA class II molecular mismatch: a validation study in an American cohort. Am J Transplant 2021; 21:322-328. [PMID: 32888256 PMCID: PMC7821185 DOI: 10.1111/ajt.16290] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 05/13/2020] [Revised: 08/07/2020] [Accepted: 08/24/2020] [Indexed: 02/06/2023]
Abstract
Clinicians have few tools to predict the risk of alloimmune injury that would guide immunosuppression management in renal transplant patients. We evaluated human leukocyte antigen (HLA)-DR/DQ molecular mismatch to predict de novo donor-specific antibodies (DSAs) during the first year of transplant and explored how differences in tacrolimus exposure may modulate this risk. HLA-DR and -DQ eplet mismatches were determined between 444 donor-recipient pairs in Denver, Colorado between 2007 and 2013. Previously defined mismatch thresholds stratified recipients into low- (N = 119), intermediate- (N = 153), and high- (N = 172) risk categories. The area under the curve for DSA at 1 year was 0.84 and 0.82 for HLA-DR and HLA-DQ eplet mismatches, respectively. Compared to low-risk patients, there was a graded increase in risk of DR/DQ DSA in intermediate (HR 15.39, 95% CI 2.01-118.09, p = .009) and high-risk (HR 23.81, 95% CI 3.17-178.66, p = 0.002) categories. Intermediate- and high-risk patients with a mean tacrolimus <6 ng/ml versus >8 ng/ml had increased risk of DR/DQ DSA at 1 year (HR 2.34, 95% CI 1.05-5.22, p = .04). HLA molecular mismatch represents a reproducible, objective, and clinically relevant tool to stratify patients by alloimmune risk and may help guide personalized immunosuppression management.
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Affiliation(s)
- Scott Davis
- Department of MedicineUniversity of ColoradoAuroraColoradoUSA
| | - Christopher Wiebe
- Department of MedicineRady Faculty of Health SciencesWinnipegManitobaUSA
| | | | | | | | - Erik Stites
- Department of MedicineUniversity of ColoradoAuroraColoradoUSA
| | - Monica Grafals
- Department of MedicineUniversity of ColoradoAuroraColoradoUSA
| | | | - Peter Nickerson
- Department of MedicineRady Faculty of Health SciencesWinnipegManitobaUSA
| | - James E. Cooper
- Department of MedicineUniversity of ColoradoAuroraColoradoUSA
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17
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Affiliation(s)
| | - Carolyn Glass
- Department of Pathology, Duke University, Durham, North Carolina, USA
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18
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Dreyer GJ, Groeneweg KE, Heidt S, Roelen DL, van Pel M, Roelofs H, Huurman VAL, Bajema IM, Moes DJAR, Fibbe WE, Claas FHJ, van Kooten C, Rabelink RJ, de Fijter JW, Reinders MEJ. Human leukocyte antigen selected allogeneic mesenchymal stromal cell therapy in renal transplantation: The Neptune study, a phase I single-center study. Am J Transplant 2020; 20:2905-2915. [PMID: 32277568 PMCID: PMC7586810 DOI: 10.1111/ajt.15910] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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: 01/15/2020] [Revised: 03/10/2020] [Accepted: 03/29/2020] [Indexed: 01/25/2023]
Abstract
Mesenchymal stromal cells (MSC) hold promise as a novel immune-modulatory therapy in organ transplantation. First clinical studies have used autologous MSCs; however, the use of allogeneic "off-the-shelf" MSCs is more sustainable for broad clinical implementation, although with the risk of causing sensitization. We investigated safety and feasibility of allogeneic MSCs in renal transplantation, using a matching strategy that prevented repeated mismatches. Ten patients received two doses of 1.5 × 106 /kg allogeneic MSCs 6 months after transplantation in a single-center nonrandomized phase Ib trial, followed by lowering of tacrolimus (trough level 3 ng/mL) in combination with everolimus and prednisone. Primary end point was safety, measured by biopsy proven acute rejection (BPAR) and graft loss 12 months after transplantation. Immune monitoring was performed before and after infusion. No BPAR or graft loss occurred and renal function remained stable. One patient retrospectively had DSAs against MSCs, formed before infusion. No major alterations in T and B cell populations or plasma cytokines were observed upon MSC infusion. Administration of HLA selected allogeneic MSCs combined with low-dose tacrolimus 6 months after transplantation is safe at least in the first year after renal transplantation. This sets the stage to further explore the efficacy of third-party MSCs in renal transplantation.
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Affiliation(s)
- Geertje J. Dreyer
- Department of Internal Medicine (Nephrology) and Transplant CenterLeiden University Medical CenterLeidenthe Netherlands
| | - Koen E. Groeneweg
- Department of Internal Medicine (Nephrology) and Transplant CenterLeiden University Medical CenterLeidenthe Netherlands
| | - Sebastiaan Heidt
- Department of Immunohematology and Blood TransfusionLeiden University Medical CenterLeidenthe Netherlands
| | - Dave L. Roelen
- Department of Immunohematology and Blood TransfusionLeiden University Medical CenterLeidenthe Netherlands
| | - Melissa van Pel
- Department of Immunohematology and Blood TransfusionLeiden University Medical CenterLeidenthe Netherlands
| | - Helene Roelofs
- Department of Immunohematology and Blood TransfusionLeiden University Medical CenterLeidenthe Netherlands
| | - Volkert A. L. Huurman
- Department of Transplant Surgery and Transplant CenterLeiden University Medical CenterLeidenthe Netherlands
| | - Ingeborg M. Bajema
- Department of PathologyLeiden University Medical CenterLeidenthe Netherlands
| | - Dirk Jan A. R. Moes
- Department of Clinical Pharmacy and ToxicologyLeiden University Medical CenterLeidenthe Netherlands
| | - Willem E. Fibbe
- Department of Immunohematology and Blood TransfusionLeiden University Medical CenterLeidenthe Netherlands
| | - Frans H. J. Claas
- Department of Immunohematology and Blood TransfusionLeiden University Medical CenterLeidenthe Netherlands
| | - Cees van Kooten
- Department of Internal Medicine (Nephrology) and Transplant CenterLeiden University Medical CenterLeidenthe Netherlands
| | - Rabelink J. Rabelink
- Department of Internal Medicine (Nephrology) and Transplant CenterLeiden University Medical CenterLeidenthe Netherlands
| | - Johan W. de Fijter
- Department of Internal Medicine (Nephrology) and Transplant CenterLeiden University Medical CenterLeidenthe Netherlands
| | - Marlies E. J. Reinders
- Department of Internal Medicine (Nephrology) and Transplant CenterLeiden University Medical CenterLeidenthe Netherlands
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19
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Stites E, Kumar D, Olaitan O, John Swanson S, Leca N, Weir M, Bromberg J, Melancon J, Agha I, Fattah H, Alhamad T, Qazi Y, Wiseman A, Gupta G. High levels of dd-cfDNA identify patients with TCMR 1A and borderline allograft rejection at elevated risk of graft injury. Am J Transplant 2020; 20:2491-2498. [PMID: 32056331 PMCID: PMC7496411 DOI: 10.1111/ajt.15822] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 01/30/2020] [Accepted: 02/02/2020] [Indexed: 01/25/2023]
Abstract
The clinical importance of subclinical, early T cell-mediated rejection (Banff TCMR 1A and borderline lesions) remains unclear, due, in part to the fact that histologic lesions used to characterize early TCMR can be nonspecific. Donor-derived cell-free DNA (dd-cfDNA) is an important molecular marker of active graft injury. Over a study period from June 2017 to May 2019, we assessed clinical outcomes in 79 patients diagnosed with TCMR 1A/borderline rejection across 11 US centers with a simultaneous measurement of dd-cfDNA. Forty-two patients had elevated dd-cfDNA (≥0.5%) and 37 patients had low levels (<0.5%). Elevated levels of dd-cfDNA predicted adverse clinical outcomes: among patients with elevated cfDNA, estimated glomerular filtration rate declined by 8.5% (interquartile rate [IQR] -16.22% to -1.39%) (-3.50 mL/min/1.73 m2 IQR -8.00 to -1.00) vs 0% (-4.92%, 4.76%) in low dd-cfDNA patients (P = .004), de novo donor-specific antibody formation was seen in 40% (17/42) vs 2.7% (P < .0001), and future or persistent rejection occurred in 9 of 42 patients (21.4%) vs 0% (P = .003). The use of dd-cfDNA may complement the Banff classification and to risk stratify patients with borderline/TCMR 1A identified on biopsy.
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Affiliation(s)
| | - Dhiren Kumar
- Medicine/NephrologyVirginia Commonwealth University School of MedicineRichmondVirginiaUSA
| | | | | | - Nicolae Leca
- Division of NephrologyDepartment of MedicineUniversity of Washington Medical CenterSeattleWashingtonUSA
| | - Matthew Weir
- Division of NephrologyUniversity of MarylandBaltimoreMarylandUSA
| | | | - Joseph Melancon
- SurgeryGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Irfan Agha
- Medical City Dallas HospitalDallasTexasUSA
| | - Hasan Fattah
- University of Kentucky Medical CenterLexingtonKentuckyUSA
| | - Tarek Alhamad
- Washington University in Saint LouisSaint LouisMissouriUSA
| | - Yasir Qazi
- Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Internal MedicineDivision of NephrologyLos AngelesCaliforniaUSA
| | | | - Gaurav Gupta
- Medicine/NephrologyVirginia Commonwealth University School of MedicineRichmondVirginiaUSA
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20
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Randhawa PS. The molecular microscope diagnostic system (MMDx) in transplantation: A pathologist's perspective. Am J Transplant 2020; 20:1965-1966. [PMID: 32239633 DOI: 10.1111/ajt.15887] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/16/2020] [Accepted: 03/18/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Parmjeet S Randhawa
- Department of Pathology, Division of Transplantation Pathology, The Thomas E Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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21
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Doberer K, Bond G. An author's reply to the editorial "Torque Teno virus load as a surrogate marker for the net state of immunosuppression: The beneficial side of the virome". Am J Transplant 2020; 20:2280-2281. [PMID: 32350993 PMCID: PMC7496435 DOI: 10.1111/ajt.15962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Konstantin Doberer
- Division of Nephrology and DialysisDepartment of Medicine IIIMedical UniversityViennaAustria
| | - Gregor Bond
- Division of Nephrology and DialysisDepartment of Medicine IIIMedical UniversityViennaAustria
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22
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Doberer K, Schiemann M, Strassl R, Haupenthal F, Dermuth F, Görzer I, Eskandary F, Reindl‐Schwaighofer R, Kikić Ž, Puchhammer‐Stöckl E, Böhmig GA, Bond G. Torque teno virus for risk stratification of graft rejection and infection in kidney transplant recipients-A prospective observational trial. Am J Transplant 2020; 20:2081-2090. [PMID: 32034850 PMCID: PMC7496119 DOI: 10.1111/ajt.15810] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [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: 12/08/2019] [Revised: 01/28/2020] [Accepted: 01/31/2020] [Indexed: 01/25/2023]
Abstract
The nonpathogenic and ubiquitous torque teno virus (TTV) is associated with immunosuppression in solid organ transplant recipients. Studies in kidney transplant patients proposed TTV quantification for risk stratification of graft rejection and infection. In this prospective trial (DRKS00012335) 386 consecutive kidney transplant recipients were subjected to longitudinal per-protocol monitoring of plasma TTV load by polymerase chain reaction for 12 months posttransplant. TTV load peaked at the end of month 3 posttransplant and reached steady state thereafter. TTV load after the end of month 3 was analyzed in the context of subsequent rejection diagnosed by indication biopsy and infection within the first year posttransplant, respectively. Each log increase in TTV load decreased the odds for rejection by 22% (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.62-0.97; P = .027) and increased the odds for infection by 11% (OR 1.11, 95% CI 1.06-1.15; P < .001). TTV was quantified at a median of 14 days before rejection was diagnosed and 27 days before onset of infection, respectively. We defined a TTV load between 1 × 106 and 1 × 108 copies/mL as optimal range to minimize the risk for rejection and infection. These data support the initiation of an interventional trial assessing the efficacy of TTV-guided immunosuppression to reduce infection and graft rejection in kidney transplant recipients.
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Affiliation(s)
- Konstantin Doberer
- Division of Nephrology and DialysisDepartment of Medicine IIIMedical University ViennaViennaAustria
| | - Martin Schiemann
- Division of Nephrology and DialysisDepartment of Medicine IIIMedical University ViennaViennaAustria
| | - Robert Strassl
- Division of VirologyDepartment of Laboratory MedicineMedical University ViennaViennaAustria
| | - Frederik Haupenthal
- Division of Nephrology and DialysisDepartment of Medicine IIIMedical University ViennaViennaAustria
| | - Florentina Dermuth
- Division of Nephrology and DialysisDepartment of Medicine IIIMedical University ViennaViennaAustria
| | - Irene Görzer
- Center for VirologyMedical University ViennaViennaAustria
| | - Farsad Eskandary
- Division of Nephrology and DialysisDepartment of Medicine IIIMedical University ViennaViennaAustria
| | | | - Željko Kikić
- Division of Nephrology and DialysisDepartment of Medicine IIIMedical University ViennaViennaAustria
| | | | - Georg A. Böhmig
- Division of Nephrology and DialysisDepartment of Medicine IIIMedical University ViennaViennaAustria
| | - Gregor Bond
- Division of Nephrology and DialysisDepartment of Medicine IIIMedical University ViennaViennaAustria
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23
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Savage TM, Shonts BA, Lau S, Obradovic A, Robins H, Shaked A, Shen Y, Sykes M. Deletion of donor-reactive T cell clones after human liver transplant. Am J Transplant 2020; 20:538-545. [PMID: 31509321 PMCID: PMC6984984 DOI: 10.1111/ajt.15592] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 05/22/2019] [Revised: 07/11/2019] [Accepted: 08/23/2019] [Indexed: 01/25/2023]
Abstract
We recently developed a high throughput T cell receptor β chain (TCRβ) sequencing-based approach to identifying and tracking donor-reactive T cells. To address the role of clonal deletion in liver allograft tolerance, we applied this method in samples from a recent randomized study, ITN030ST, in which immunosuppression withdrawal was attempted within 2 years of liver transplantation. We identified donor-reactive T cell clones via TCRβ sequencing following a pre-transplant mixed lymphocyte reaction and tracked these clones in the circulation following transplantation in 3 tolerant and 5 non-tolerant subjects. All subjects showed a downward trend and significant reductions in donor-reactive TCRβ sequences were detected post-transplant in 6 of 8 subjects, including 2 tolerant and 4 non-tolerant recipients. Reductions in donor-reactive TCRβ sequences were greater than those of all other TCRβ sequences, including 3rd party-reactive sequences, in all 8 subjects, demonstrating an impact of the liver allograft after accounting for repertoire turnover. Although limited by patient number and heterogeneity, our results suggest that partial deletion of donor-reactive T cell clones may be a consequence of liver transplantation and does not correlate with success or failure of early immunosuppression withdrawal. These observations underscore the organ- and/or protocol-specific nature of tolerance mechanisms in humans.
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Affiliation(s)
- Thomas M. Savage
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Brittany A. Shonts
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Saiping Lau
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Aleksandar Obradovic
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Harlan Robins
- Fred Hutchinson Cancer Research Center and Adaptive Biotechnologies, Inc., Seattle, Washington
| | - Abraham Shaked
- Division of Transplant Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yufeng Shen
- Departments of Systems Biology and Biomedical Informatics, Columbia University, New York, New York
| | - Megan Sykes
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Medical Center, New York, New York,Department of Microbiology & Immunology, Columbia University Medical Center, Columbia University,
New York, New York,Department of Surgery, Columbia University Medical Center, Columbia University, New York, New York
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24
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Greenland JR, Wang P, Brotman JJ, Ahuja R, Chong TA, Kleinhenz ME, Leard LE, Golden JA, Hays SR, Kukreja J, Singer JP, Rajalingam R, Jones K, Laszik ZG, Trivedi NN, Greenland NY, Blanc PD. Gene signatures common to allograft rejection are associated with lymphocytic bronchitis. Clin Transplant 2019; 33:e13515. [PMID: 30849195 DOI: 10.1111/ctr.13515] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 01/10/2019] [Revised: 02/04/2019] [Accepted: 02/14/2019] [Indexed: 12/28/2022]
Abstract
Lymphocytic bronchitis (LB) precedes chronic lung allograft dysfunction. The relationships of LB (classified here as Endobronchial or E-grade rejection) to small airway (A- and B-grade) pathologies are unclear. We hypothesized that gene signatures common to allograft rejection would be present in LB. We studied LB in two partially overlapping lung transplant recipient cohorts: Cohort 1 included large airway brushes (6 LB cases and 18 post-transplant referents). Differential expression using DESeq2 was used for pathway analysis and to define an LB-associated metagene. In Cohort 2, eight biopsies for each pathology subtype were matched with pathology-free biopsies from the same subject (totaling 48 samples from 24 subjects). These biopsies were analyzed by multiplexed digital counting of immune transcripts. Metagene score differences were compared by paired t tests. Compared to referents in Cohort 1, LB demonstrated upregulation of allograft rejection pathways, and upregulated genes in these cases characterized an LB-associated metagene. We observed statistically increased expression in Cohort 2 for this LB-associated metagene and four other established allograft rejection metagenes in rejection vs paired non-rejection biopsies for both E-grade and A-grade subtypes, but not B-grade pathology. Gene expression-based categorization of allograft rejection may prove useful in monitoring lung allograft health.
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Affiliation(s)
- John R Greenland
- Medical Service, Veterans Affairs Health Care System, San Francisco, California.,Department of Medicine, University of California, San Francisco, California
| | - Ping Wang
- Department of Medicine, University of California, San Francisco, California
| | - Joshua J Brotman
- Department of Medicine, University of California, San Francisco, California
| | - Rahul Ahuja
- Medical Service, Veterans Affairs Health Care System, San Francisco, California
| | - Tiffany A Chong
- Department of Medicine, University of California, San Francisco, California
| | | | - Lorriana E Leard
- Department of Medicine, University of California, San Francisco, California
| | - Jeffrey A Golden
- Department of Medicine, University of California, San Francisco, California
| | - Steven R Hays
- Department of Medicine, University of California, San Francisco, California
| | - Jasleen Kukreja
- Department of Surgery, University of California, San Francisco, California
| | - Jonathan P Singer
- Department of Medicine, University of California, San Francisco, California
| | - Raja Rajalingam
- Department of Surgery, University of California, San Francisco, California
| | - Kirk Jones
- Department of Pathology, University of California, San Francisco, California
| | - Zoltan G Laszik
- Department of Pathology, University of California, San Francisco, California
| | - Neil N Trivedi
- Medical Service, Veterans Affairs Health Care System, San Francisco, California.,Department of Medicine, University of California, San Francisco, California
| | - Nancy Y Greenland
- Department of Pathology, University of California, San Francisco, California
| | - Paul D Blanc
- Medical Service, Veterans Affairs Health Care System, San Francisco, California.,Department of Medicine, University of California, San Francisco, California
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25
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Luque S, Lúcia M, Melilli E, Lefaucheur C, Crespo M, Loupy A, Bernal-Casas D, Gomà M, Jarque M, Crespo E, Montero N, Manonelles A, Cruzado JM, Gil-Vernet S, Grinyó JM, Bestard O. Value of monitoring circulating donor-reactive memory B cells to characterize antibody-mediated rejection after kidney transplantation. Am J Transplant 2019; 19:368-380. [PMID: 30085394 DOI: 10.1111/ajt.15055] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [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: 05/09/2018] [Revised: 07/06/2018] [Accepted: 07/29/2018] [Indexed: 01/25/2023]
Abstract
Antibody-mediated rejection (ABMR) is defined by specific histopathological lesions and evidence of circulating donor-specific antibodies (DSA). Although DSA are not always detectable, monitoring donor-reactive memory B cells (mBC) could identify patients at risk of developing ABMR. Peripheral donor-reactive mBC using a novel HLA B cell ELISpot assay, serum DSA, and numbers of different B cell subsets were assessed in 175 consecutive kidney transplants undergoing either for-cause or 6- and 24-month surveillance biopsies for their association with main histological lesions of ABMR and impact on allograft outcome. In 85 incident for-cause biopsies, high frequencies of donor-reactive mBC were detected in all 16 (100%) acute ABMR/DSA+ and most chronic ABMR, with or without DSA (24/30[80%] and 21/29[72.4%], respectively). In a longitudinal cohort of 90 nonsensitized patients, a progressively higher expansion of donor-reactive mBC than de novo DSA was observed at 6 and 24 months (8.8% vs 7.7% and 15.5% vs 11.1%, respectively) and accurately identified patients with ongoing subclinical ABMR (area under the curve = 0.917 and area under the curve = 0.809, respectively). An unsupervised hierarchical cluster analysis revealed a strong association between donor-reactive mBC with main fundamental allograft lesions associated with ABMR and conferred a significant deleterious impact on graft outcome. Monitoring donor-reactive mBC may be useful to further characterize humoral rejection after kidney transplantation.
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Affiliation(s)
- Sergi Luque
- Experimental Nephrology Laboratory, IDIBELL, Barcelona, Spain
| | - Marc Lúcia
- Experimental Nephrology Laboratory, IDIBELL, Barcelona, Spain
| | - Edoardo Melilli
- Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Carmen Lefaucheur
- Paris Translational Research Center for Organ Transplantation, Institut National de la Santé et de la Recherche Médicale, UMR-S970, Paris, France
| | - Marta Crespo
- Kidney Transplant Unit, Nephrology Department, Hospital del Mar, Barcelona, Spain
| | - Alex Loupy
- Paris Translational Research Center for Organ Transplantation, Institut National de la Santé et de la Recherche Médicale, UMR-S970, Paris, France
| | - David Bernal-Casas
- Experimental Nephrology Laboratory, IDIBELL, Barcelona, Spain.,Department of Genetics, Microbiology and Statistics, Section of Statistics, University of Barcelona, Barcelona, Spain
| | - Montse Gomà
- Pathology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Marta Jarque
- Experimental Nephrology Laboratory, IDIBELL, Barcelona, Spain
| | - Elena Crespo
- Experimental Nephrology Laboratory, IDIBELL, Barcelona, Spain
| | - Núria Montero
- Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Anna Manonelles
- Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Josep M Cruzado
- Experimental Nephrology Laboratory, IDIBELL, Barcelona, Spain.,Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Salvador Gil-Vernet
- Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Josep M Grinyó
- Experimental Nephrology Laboratory, IDIBELL, Barcelona, Spain.,Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Oriol Bestard
- Experimental Nephrology Laboratory, IDIBELL, Barcelona, Spain.,Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona, Spain
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26
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Uva PD, Papadimitriou JC, Drachenberg CB, Toniolo MF, Quevedo A, Dotta AC, Chuluyan E, Casadei DH. Graft dysfunction in simultaneous pancreas kidney transplantation (SPK): Results of concurrent kidney and pancreas allograft biopsies. Am J Transplant 2019; 19:466-474. [PMID: 29985562 DOI: 10.1111/ajt.15012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 06/22/2018] [Accepted: 06/28/2018] [Indexed: 01/25/2023]
Abstract
Simultaneous pancreas and kidney transplants offer significant therapeutic advantages but present a diagnostic approach dilemma in the diagnosis of rejection. Because both organs are from the same donor, the kidney has been treated traditionally as the "sentinel" organ to biopsy, presumably representing the status of both allografts. Truly concurrent biopsy studies, however, are needed to confirm this hypothesis. We examined 101 concurrent biopsies from 70 patients with dysfunction in either or both organs. Results showed concurrent rejection in 23 of 57 (40%) of cases with rejection; 19 of 57 (33.5%) and 15 of 57 (26.5%) showed kidney or pancreas only rejection, respectively. The degree and type of rejection differed in the majority (13 of 23, 56.5%) of cases with concurrent rejection, with the pancreas more often showing higher rejection grade. Taking into account pancreas dysfunction, a positive kidney biopsy should correctly predict pancreas rejection in 86% of the instances. However, the lack of complete concordance between the 2 organs, the discrepancies in grade and type of rejection, and the tendency for higher rejection grades in concurrent or pancreas only rejections, all support the rationale for pancreas biopsies. The latter provide additional data on the overall status of the organ, as well as information on nonrejection-related pathologies.
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Affiliation(s)
- Pablo D Uva
- Kidney Pancreas Transplantation, Instituto de Nefrología-Nephrology, Buenos Aires, Argentina.,CEFYBO-CONICET, Buenos Aires, Argentina
| | - John C Papadimitriou
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Cinthia B Drachenberg
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - María F Toniolo
- Kidney Pancreas Transplantation, Instituto de Nefrología-Nephrology, Buenos Aires, Argentina
| | - Alejandra Quevedo
- Kidney Pancreas Transplantation, Instituto de Nefrología-Nephrology, Buenos Aires, Argentina
| | - Ana C Dotta
- Kidney Pancreas Transplantation, Instituto de Nefrología-Nephrology, Buenos Aires, Argentina
| | | | - Domingo H Casadei
- Kidney Pancreas Transplantation, Instituto de Nefrología-Nephrology, Buenos Aires, Argentina
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27
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Kervella D, Scharbarg E, Mahot-Moreau P, Renaudin K, Branchereau J, Karam G, Chaillous L, Bach K, Cantarovich D. Remission of type 1 diabetes mellitus recurrence 6 years after simultaneous pancreas and kidney transplantation. Am J Transplant 2018; 18:2610-2611. [PMID: 29745003 DOI: 10.1111/ajt.14927] [Citation(s) in RCA: 2] [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] [Indexed: 01/25/2023]
Affiliation(s)
- Delphine Kervella
- Centre de Recherche en Transplantation et Immunologie, Inserm Nantes, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France
| | - Emeric Scharbarg
- Service d'endocrinologie, maladies métaboliques, et nutrition, CHU Nantes, Nantes, France
| | - Pascale Mahot-Moreau
- Service d'endocrinologie, maladies métaboliques, et nutrition, CHU Nantes, Nantes, France
| | - Karine Renaudin
- Centre de Recherche en Transplantation et Immunologie, Inserm Nantes, Université de Nantes, Nantes, France.,Service d'anatomie et cytologie pathologique Nantes, CHU Nantes, Nantes, France
| | - Julien Branchereau
- Centre de Recherche en Transplantation et Immunologie, Inserm Nantes, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France
| | - Georges Karam
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France
| | - Lucy Chaillous
- Service d'endocrinologie, maladies métaboliques, et nutrition, CHU Nantes, Nantes, France
| | - Kalyane Bach
- Service de Biochimie, CHU Nantes, Nantes, France
| | - Diego Cantarovich
- Centre de Recherche en Transplantation et Immunologie, Inserm Nantes, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France
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28
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Thareja G, Yang H, Hayat S, Mueller FB, Lee JR, Lubetzky M, Dadhania DM, Belkadi A, Seshan SV, Suhre K, Suthanthiran M, Muthukumar T. Single nucleotide variant counts computed from RNA sequencing and cellular traffic into human kidney allografts. Am J Transplant 2018; 18:2429-2442. [PMID: 29659169 PMCID: PMC6160347 DOI: 10.1111/ajt.14870] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 12/17/2017] [Revised: 03/06/2018] [Accepted: 03/31/2018] [Indexed: 01/25/2023]
Abstract
Advances in bioinformatics allow identification of single nucleotide polymorphisms (variants) from RNA sequence data. In an allograft biopsy, 2 genomes contribute to the RNA pool, 1 from the donor organ and the other from the infiltrating recipient's cells. We hypothesize that imbalances in genetic variants of RNA sequence data of kidney allograft biopsies provide an objective measure of cellular infiltration of the allograft. We performed mRNA sequencing of 40 kidney allograft biopsies, selected to represent a comprehensive range of diagnostic categories. We analyzed the sequencing reads of these biopsies and of 462 lymphoblastoid cell lines from the 1000 Genomes Project, for RNA variants. The ratio of heterozygous to nonreference genome homozygous variants (Het/Hom ratio) on all autosomes was determined for each sample, and the estimation of stromal and immune cells in malignant tumors using expression data (ESTIMATE) score was computed as a complementary estimate of the degree of cellular infiltration into biopsies. The Het/Hom ratios (P = .02) and the ESTIMATE scores (P < .001) were associated with the biopsy diagnosis. Both measures correlated significantly (r = .67, P < .0001), even though the Het/Hom ratio is based on mRNA sequence variation, while the ESTIMATE score uses mRNA expression. Het/Hom ratio and the ESTIMATE score may offer unbiased and quantitative parameters for characterizing cellular traffic into human kidney allografts.
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Affiliation(s)
- Gaurav Thareja
- Department of Physiology and Biophysics, Weill Cornell Medical College in Qatar, Doha, Qatar
| | - Hua Yang
- Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Shahina Hayat
- Department of Physiology and Biophysics, Weill Cornell Medical College in Qatar, Doha, Qatar
| | - Franco B. Mueller
- Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medical College, New York, NY
| | - John R. Lee
- Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medical College, New York, NY,Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY
| | - Michelle Lubetzky
- Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medical College, New York, NY,Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY
| | - Darshana M. Dadhania
- Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medical College, New York, NY,Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY
| | - Aziz Belkadi
- Department of Physiology and Biophysics, Weill Cornell Medical College in Qatar, Doha, Qatar
| | - Surya V. Seshan
- Division of Renal Pathology, Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY
| | - Karsten Suhre
- Department of Physiology and Biophysics, Weill Cornell Medical College in Qatar, Doha, Qatar
| | - Manikkam Suthanthiran
- Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medical College, New York, NY,Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY
| | - Thangamani Muthukumar
- Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medical College, New York, NY,Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY
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29
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Dipchand AI, Webber S, Mason K, Feingold B, Bentlejewski C, Mahle WT, Shaddy R, Canter C, Blume ED, Lamour J, Zuckerman W, Diop H, Morrison Y, Armstrong B, Ikle D, Odim J, Zeevi A. Incidence, characterization, and impact of newly detected donor-specific anti-HLA antibody in the first year after pediatric heart transplantation: A report from the CTOTC-04 study. Am J Transplant 2018; 18:2163-2174. [PMID: 29442424 PMCID: PMC6092243 DOI: 10.1111/ajt.14691] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 08/27/2017] [Revised: 01/30/2018] [Accepted: 02/04/2018] [Indexed: 01/25/2023]
Abstract
Data on the clinical importance of newly detected donor-specific anti-HLA antibodies (ndDSAs) after pediatric heart transplantation are lacking despite mounting evidence of the detrimental effect of de novo DSAs in solid organ transplantation. We prospectively tested 237 pediatric heart transplant recipients for ndDSAs in the first year posttransplantation to determine their incidence, pattern, and clinical impact. One-third of patients developed ndDSAs; when present, these were mostly detected within the first 6 weeks after transplantation, suggesting that memory responses may predominate over true de novo DSA production in this population. In the absence of preexisting DSAs, patients with ndDSAs had significantly more acute cellular rejection but not antibody-mediated rejection, and there was no impact on graft and patient survival in the first year posttransplantation. Risk factors for ndDSAs included common sensitizing events. Given the early detection of the antibody response, memory responses may be more important in the first year after pediatric heart transplantation and patients with a history of a sensitizing event may be at risk even with a negative pretransplantation antibody screen. The impact on late graft and patient outcomes of first-year ndDSAs is being assessed in an extended cohort of patients.
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Affiliation(s)
- A. I. Dipchand
- Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - S. Webber
- Vanderbilt University Medical Center, Nashville, TN
| | | | - B. Feingold
- Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA
| | | | - W. T. Mahle
- Children’s Healthcare of Atlanta, Atlanta, GA
| | - R. Shaddy
- Children’s Hospital of Philadelphia, Philadelphia, PA
| | - C. Canter
- St Louis Children’s Hospital, St Louis, MO
| | | | - J. Lamour
- Montefiore Children’s Hospital, New York, NY
| | | | - H. Diop
- National Institutes of Health, Bethesda, MD
| | | | | | | | - J. Odim
- National Institutes of Health, Bethesda, MD
| | - A. Zeevi
- Department of Pathology, UPMC, Pittsburgh, PA
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30
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Arasaratnam RJ, Tzannou I, Gray T, Aguayo-Hiraldo PI, Kuvalekar M, Naik S, Gaikwad A, Liu H, Miloh T, Vera JF, Himes RW, Munoz FM, Leen AM. Dynamics of virus-specific T cell immunity in pediatric liver transplant recipients. Am J Transplant 2018; 18:2238-2249. [PMID: 29900673 PMCID: PMC6117219 DOI: 10.1111/ajt.14967] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 05/11/2018] [Accepted: 06/06/2018] [Indexed: 01/25/2023]
Abstract
Immunosuppression following solid organ transplantation (SOT) has a deleterious effect on cellular immunity leading to frequent and prolonged viral infections. To better understand the relationship between posttransplant immunosuppression and circulating virus-specific T cells, we prospectively monitored the frequency and function of T cells directed to a range of latent (CMV, EBV, HHV6, BK) and lytic (AdV) viruses in 16 children undergoing liver transplantation for up to 1 year posttransplant. Following transplant, there was an immediate decline in circulating virus-specific T cells, which recovered posttransplant, coincident with the introduction and subsequent routine tapering of immunosuppression. Furthermore, 12 of 14 infections/reactivations that occurred posttransplant were successfully controlled with immunosuppression reduction (and/or antiviral use) and in all cases we detected a temporal increase in the circulating frequency of virus-specific T cells directed against the infecting virus, which was absent in 2 cases where infections remained uncontrolled by the end of follow-up. Our study illustrates the dynamic changes in virus-specific T cells that occur in children following liver transplantation, driven both by active viral replication and modulation of immunosuppression.
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Affiliation(s)
- R J Arasaratnam
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Houston Methodist Hospital, Houston, TX, USA
| | - I Tzannou
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Houston Methodist Hospital, Houston, TX, USA
| | - T Gray
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Houston Methodist Hospital, Houston, TX, USA
| | - P I Aguayo-Hiraldo
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Houston Methodist Hospital, Houston, TX, USA
| | - M Kuvalekar
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Houston Methodist Hospital, Houston, TX, USA
| | - S Naik
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Houston Methodist Hospital, Houston, TX, USA
| | - A Gaikwad
- Department of Pediatric Hematology/Oncology, Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - H Liu
- Biostatistics Core of the Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - T Miloh
- Department of Pediatrics, Division of Pediatric Gastroenterology and Nutrition, Texas Children's Hospital, Houston, TX, USA
| | - J F Vera
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Houston Methodist Hospital, Houston, TX, USA
| | - R W Himes
- Department of Pediatrics, Division of Pediatric Gastroenterology and Nutrition, Texas Children's Hospital, Houston, TX, USA
| | - F M Munoz
- Departments of Pediatrics, Infectious Diseases Section, and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - A M Leen
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Houston Methodist Hospital, Houston, TX, USA
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31
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Hachem RR, Kamoun M, Budev MM, Askar M, Ahya VN, Lee JC, Levine DJ, Pollack MS, Dhillon GS, Weill D, Schechtman KB, Leard LE, Golden JA, Baxter-Lowe L, Mohanakumar T, Tyan DB, Yusen RD. Human leukocyte antigens antibodies after lung transplantation: Primary results of the HALT study. Am J Transplant 2018; 18:2285-2294. [PMID: 29687961 PMCID: PMC6117197 DOI: 10.1111/ajt.14893] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [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: 12/07/2017] [Revised: 03/20/2018] [Accepted: 04/17/2018] [Indexed: 01/25/2023]
Abstract
Donor-specific antibodies (DSA) to mismatched human leukocyte antigens (HLA) are associated with worse outcomes after lung transplantation. To determine the incidence and characteristics of DSA early after lung transplantation, we conducted a prospective multicenter observational study that used standardized treatment and testing protocols. Among 119 transplant recipients, 43 (36%) developed DSA: 6 (14%) developed DSA only to class I HLA, 23 (53%) developed DSA only to class II HLA, and 14 (33%) developed DSA to both class I and class II HLA. The median DSA mean fluorescence intensity (MFI) was 3197. We identified a significant association between the Lung Allocation Score and the development of DSA (HR = 1.02, 95% CI: 1.001-1.03, P = .047) and a significant association between DSA with an MFI ≥ 3000 and acute cellular rejection (ACR) grade ≥ A2 (HR = 2.11, 95% CI: 1.04-4.27, P = .039). However, we did not detect an association between DSA and survival. We conclude that DSA occur frequently early after lung transplantation, and most target class II HLA. DSA with an MFI ≥ 3000 have a significant association with ACR. Extended follow-up is necessary to determine the impact of DSA on other important outcomes.
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Affiliation(s)
- Ramsey R. Hachem
- Pulmonary and Critical Care, Washington University School of Medicine
| | - Malek Kamoun
- Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine
| | | | | | - Vivek N. Ahya
- Pulmonary and Critical Care, University of Pennsylvania School of Medicine
| | - James C. Lee
- Pulmonary and Critical Care, University of Pennsylvania School of Medicine
| | - Deborah J. Levine
- Pulmonary and Critical Care, University of Texas Health Science Center, San Antonio
| | | | | | - David Weill
- Pulmonary and Critical Care, Stanford University School of Medicine
| | | | - Lorriana E. Leard
- Pulmonary and Critical Care, University of California, San Francisco
| | - Jeffrey A. Golden
- Pulmonary and Critical Care, University of California, San Francisco
| | - LeeAnn Baxter-Lowe
- Pediatrics, Keck School of Medicine of University of Southern California
| | | | | | - Roger D. Yusen
- Pulmonary and Critical Care, Washington University School of Medicine
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32
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Wiebe C, Ho J, Gibson IW, Rush DN, Nickerson PW. Carpe diem-Time to transition from empiric to precision medicine in kidney transplantation. Am J Transplant 2018; 18:1615-1625. [PMID: 29603637 DOI: 10.1111/ajt.14746] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 01/05/2018] [Revised: 03/13/2018] [Accepted: 03/20/2018] [Indexed: 02/06/2023]
Abstract
The current immunosuppressive pipeline in kidney transplantation is limited. In part, this is due to excellent one-year allograft outcomes with the current standard of care (ie, calcineurin inhibitor in combination with anti-proliferative agents). Despite this success, a recent Federal government-sponsored systematic review has identified gaps/limits in the evidence of what constitutes optimal calcineurin inhibitor use in the short- and long-term. Moreover, recent empiric approaches to minimize/withdraw/convert from calcineurin inhibitors have come with the price of increased alloreactivity. As the time horizon to replace calcineurin inhibitors on a global scale may be distant, the transplant community should seize the opportunity to develop ways to personalize calcineurin inhibitor immunosuppression to the individual-transitioning from empiricism to precision. The authors argue in this viewpoint that the path to precision will require measures capable of detecting subclinical alloreactivity to define adequacy of immunosuppression, as well as novel genetic analytics to accurately define alloimmune risk at the individual level-both approaches will require validation in clinical trials.
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Affiliation(s)
- Chris Wiebe
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Diagnostic Services of Manitoba, Winnipeg, MB, Canada
| | - Julie Ho
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Immunology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Ian W Gibson
- Diagnostic Services of Manitoba, Winnipeg, MB, Canada.,Department of Pathology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - David N Rush
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Peter W Nickerson
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Immunology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Diagnostic Services of Manitoba, Winnipeg, MB, Canada
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33
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Tambur AR, Campbell P, Claas FH, Feng S, Gebel HM, Jackson AM, Mannon RB, Reed EF, Tinckam K, Askar M, Chandraker A, Chang PP, Colvin M, Demetris AJ, Diamond JM, Dipchand AI, Fairchild RL, Ford ML, Friedewald J, Gill RG, Glotz D, Goldberg H, Hachem R, Knechtle S, Kobashigawa J, Levine DJ, Levitsky J, Mengel M, Milford E, Newell KA, O'Leary JG, Palmer S, Randhawa P, Smith J, Snyder L, Starling RC, Sweet S, Taner T, Taylor CJ, Woodle S, Zeevi A, Nickerson P. Sensitization in Transplantation: Assessment of Risk (STAR) 2017 Working Group Meeting Report. Am J Transplant 2018; 18:1604-1614. [PMID: 29603613 DOI: 10.1111/ajt.14752] [Citation(s) in RCA: 183] [Impact Index Per Article: 30.5] [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: 01/05/2018] [Revised: 02/25/2018] [Accepted: 03/20/2018] [Indexed: 02/06/2023]
Abstract
The presence of preexisting (memory) or de novo donor-specific HLA antibodies (DSAs) is a known barrier to successful long-term organ transplantation. Yet, despite the fact that laboratory tools and our understanding of histocompatibility have advanced significantly in recent years, the criteria to define presence of a DSA and assign a level of risk for a given DSA vary markedly between centers. A collaborative effort between the American Society for Histocompatibility and Immunogenetics and the American Society of Transplantation provided the logistical support for generating a dedicated multidisciplinary working group, which included experts in histocompatibility as well as kidney, liver, heart, and lung transplantation. The goals were to perform a critical review of biologically driven, state-of-the-art, clinical diagnostics literature and to provide clinical practice recommendations based on expert assessment of quality and strength of evidence. The results of the Sensitization in Transplantation: Assessment of Risk (STAR) meeting are summarized here, providing recommendations on the definition and utilization of HLA diagnostic testing, and a framework for clinical assessment of risk for a memory or a primary alloimmune response. The definitions, recommendations, risk framework, and highlighted gaps in knowledge are intended to spur research that will inform the next STAR Working Group meeting in 2019.
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Affiliation(s)
| | | | - Frans H Claas
- Leiden University Medical Center, Leiden, Netherlands
| | - Sandy Feng
- UCSF Medical Center, San Francisco, California
| | | | | | | | - Elaine F Reed
- UCLA Pathology & Laboratory Medicine, Los Angeles, California
| | | | | | | | | | | | | | | | | | | | - Mandy L Ford
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | | | - Ramsey Hachem
- Washington University School of Medicine, St. Louis, Missouri
| | | | | | | | | | | | - Edgar Milford
- Brigham and Women's' Hospital, Boston, Massachusetts
| | | | | | - Scott Palmer
- Duke University School of Medicine, Durham, North Carolina
| | | | - John Smith
- Royal Brompton & Harefield NHS Foundation Trust, Harefield, UK
| | - Laurie Snyder
- Duke University School of Medicine, Durham, North Carolina
| | | | - Stuart Sweet
- Washington University School of Medicine, St. Louis, Missouri
| | | | | | | | - Adriana Zeevi
- University of Pittsburg Medical Center, Pittsburgh, Pennsylvania
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34
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Sannier A, Stroumza N, Caligiuri G, Le Borgne-Moynier M, Andreata F, Senemaud J, Louedec L, Even G, Gaston AT, Deschildre C, Couvelard A, Ou P, Cheynier R, Nataf P, Dorent R, Nicoletti A. Thymic function is a major determinant of onset of antibody-mediated rejection in heart transplantation. Am J Transplant 2018; 18:964-971. [PMID: 29160947 DOI: 10.1111/ajt.14595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 10/20/2017] [Accepted: 11/05/2017] [Indexed: 01/25/2023]
Abstract
Thymic function decreases progressively with age but may be boosted in certain circumstances. We questioned whether heart transplantation was such a situation and whether thymic function was related to the onset of rejection. Twenty-eight antithymocyte globulin-treated heart transplant recipients were included. Patients diagnosed for an antibody-mediated rejection on endomyocardial biopsy had a higher proportion of circulating recent thymic emigrant CD4+ T cells and T cell receptor excision circle levels than other transplanted subjects. Thymus volume and density, assessed by computed tomography in a subset of patients, was also higher in patients experiencing antibody-mediated rejection. We demonstrate that thymic function is a major determinant of onset of antibody-mediated rejection and question whether thymectomy could be a prophylactic strategy to prevent alloimmune humoral responses.
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Affiliation(s)
- A Sannier
- INSERM U1148, Paris, France.,Denis Diderot University, Paris, France.,Department of Pathology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | | | | | | | | | - G Even
- INSERM U1148, Paris, France
| | | | | | - A Couvelard
- Denis Diderot University, Paris, France.,Department of Pathology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - P Ou
- INSERM U1148, Paris, France.,Denis Diderot University, Paris, France.,Department of Radiology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - R Cheynier
- INSERM U1016, Cochin Institute, Paris, France
| | - P Nataf
- INSERM U1148, Paris, France.,Denis Diderot University, Paris, France.,Department of Cardiac Surgery, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - R Dorent
- INSERM U1148, Paris, France.,Department of Cardiac Surgery, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - A Nicoletti
- INSERM U1148, Paris, France.,Denis Diderot University, Paris, France
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35
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Carpenter DJ, Granot T, Matsuoka N, Senda T, Kumar BV, Thome JJC, Gordon CL, Miron M, Weiner J, Connors T, Lerner H, Friedman A, Kato T, Griesemer AD, Farber DL. Human immunology studies using organ donors: Impact of clinical variations on immune parameters in tissues and circulation. Am J Transplant 2018; 18:74-88. [PMID: 28719147 PMCID: PMC5740015 DOI: 10.1111/ajt.14434] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [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: 05/02/2017] [Revised: 06/23/2017] [Accepted: 07/11/2017] [Indexed: 01/25/2023]
Abstract
Organ donors are sources of physiologically healthy organs and tissues for life-saving transplantation, and have been recently used for human immunology studies which are typically confined to the sampling of peripheral blood. Donors comprise a diverse population with different causes of death and clinical outcomes during hospitalization, and the effects of such variations on immune parameters in blood and tissues are not known. We present here a coordinate analysis of innate and adaptive immune components in blood, lymphoid (bone marrow, spleen, lymph nodes), and mucosal (lungs, intestines) sites from a population of brain-dead organ donors (2 months-93 years; n = 291) across eight clinical parameters. Overall, the blood of donors exhibited similar monocyte and lymphocyte content and low serum levels of pro-inflammatory cytokines as healthy controls; however, donor blood had increased neutrophils and serum levels of IL-8, IL-6, and MCP-1 which varied with cause of death. In tissues, the frequency and composition of monocytes, neutrophils, B lymphocytes and T cell subsets in lymphoid or mucosal sites did not vary with clinical state, and was similar in donors independent of the extent of clinical complications. Our results reveal that organ donors maintain tissue homeostasis, and are a valuable resource for fundamental studies in human immunology.
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Affiliation(s)
- D J Carpenter
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY, USA
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - T Granot
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY, USA
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - N Matsuoka
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY, USA
| | - T Senda
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY, USA
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - B V Kumar
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY, USA
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, NY, USA
| | - J J C Thome
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY, USA
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, NY, USA
| | - C L Gordon
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY, USA
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - M Miron
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY, USA
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, NY, USA
| | - J Weiner
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - T Connors
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY, USA
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | | | | | - T Kato
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - A D Griesemer
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY, USA
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - D L Farber
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY, USA
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, NY, USA
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36
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Mularoni A, Gallo A, Riva G, Barozzi P, Miele M, Cardinale G, Vizzini G, Volpes R, Grossi P, Di Carlo D, Luca A, Trenti T, Luppi M, Conaldi PG. Successful Treatment of Kaposi Sarcoma-Associated Herpesvirus Inflammatory Cytokine Syndrome After Kidney-Liver Transplant: Correlations With the Human Herpesvirus 8 miRNome and Specific T Cell Response. Am J Transplant 2017; 17:2963-2969. [PMID: 28489271 DOI: 10.1111/ajt.14346] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 03/28/2017] [Revised: 04/20/2017] [Accepted: 04/27/2017] [Indexed: 01/25/2023]
Abstract
After transplant, patient infection with human herpesvirus 8 (HHV-8) and Kaposi sarcoma-associated herpesvirus (KSHV) is known to cause aggressive tumors and severe nonneoplastic complications. These latter syndromes are driven by HHV-8/KSHV lytic reactivations and related hyperinflammatory host responses typically characterized by high viral loads, elevated levels of cytokines and other inflammation biomarkers, cytopenia, organ failure, high fever, and worsening conditions (with no evidence of B cell neoplasias). These disorders are associated with a high mortality rate, often due to lack of prompt diagnosis, effective therapeutic approaches, and adequate follow-up. These features resemble most of those defining the so-called KSHV-associated inflammatory cytokine syndrome (KICS), which was recently recognized in patients positive for human immunodeficiency virus (HIV). In this report, we describe-for the first time-a case of a KICS-like nonneoplastic recurrent complication occurring after transplant in an HIV-negative patient that was successfully treated by a combination of anti-CD20 monoclonal therapy, antivirals, and modification of the immunosuppressive regimen. In addition to clinical and laboratory findings collected during 3-year follow-up, we report novel experimental data on HHV-8-specific T cell dynamics and circulating microRNA profile, showing correlations with clinical course and other laboratory markers (including viral load, C-reactive protein, and cytokine levels), providing useful information about abnormal cellular and cytokine dynamics underlying HHV-8-associated inflammatory disorders in posttransplant patients.
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Affiliation(s)
- A Mularoni
- Infectious Disease and Infection Control Service, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - A Gallo
- Department of Laboratory Medicine and Advanced Biotechnologies, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - G Riva
- Section of Hematology, Department of Surgical and Medical Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy.,Department of Laboratory Medicine and Pathology USL, Modena, Italy
| | - P Barozzi
- Section of Hematology, Department of Surgical and Medical Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - M Miele
- Fondazione Ri.MED, Palermo, Italy
| | - G Cardinale
- Division of Hematology, Department of Oncology, A.R.NA.S. Civico-Benfratelli, G. Di Cristina e M. Ascoli, Palermo, Italy
| | - G Vizzini
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - R Volpes
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - P Grossi
- Infectious Disease and Infection Control Service, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy.,Department of Infectious and Tropical Diseases, University of Insubria, University Hopital Ospedale di Circolo-Fondazioni Macchi, Varese, Italy
| | - D Di Carlo
- Department of Laboratory Medicine and Advanced Biotechnologies, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - A Luca
- Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - T Trenti
- Department of Laboratory Medicine and Pathology USL, Modena, Italy
| | - M Luppi
- Section of Hematology, Department of Surgical and Medical Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - P G Conaldi
- Department of Laboratory Medicine and Advanced Biotechnologies, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy.,Fondazione Ri.MED, Palermo, Italy
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37
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Toby TK, Abecassis M, Kim K, Thomas PM, Fellers RT, LeDuc RD, Kelleher NL, Demetris J, Levitsky J. Proteoforms in Peripheral Blood Mononuclear Cells as Novel Rejection Biomarkers in Liver Transplant Recipients. Am J Transplant 2017; 17:2458-2467. [PMID: 28510335 PMCID: PMC5612406 DOI: 10.1111/ajt.14359] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/20/2017] [Accepted: 05/06/2017] [Indexed: 01/25/2023]
Abstract
Biomarker profiles of acute rejection in liver transplant recipients could enhance the diagnosis and management of recipients. Our aim was to identify diagnostic proteoform signatures of acute rejection in circulating immune cells, using an emergent "top-down" proteomics methodology. We prepared differentially processed and cryopreserved cell lysates from 26 nonviral liver transplant recipients by molecular weight-based fractionation and analyzed them by mass spectrometry of whole proteins in three steps: (i) Nanocapillary liquid chromatography coupled with high-resolution tandem mass spectrometry; (ii) database searching to identify and characterize intact proteoforms; (iii) data processing through a hierarchical linear model matching the study design to quantify proteoform fold changes in patients with rejection versus normal liver function versus acute dysfunction without rejection. Differentially expressed proteoforms were seen in patients with rejection versus normal and nonspecific controls, most evidently in the cell preparations stored in traditional serum-rich media. Mapping analysis of these proteins back to genes through gene ontology and pathway analysis tools revealed multiple signaling pathways, including inflammation mediated by cytokines and chemokines. Larger studies are needed to validate these novel rejection signatures and test their predictive value for use in clinical management.
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Affiliation(s)
- T. K. Toby
- Department of Molecular Biosciences and Chemistry, Northwestern University, Chicago, IL
| | - M. Abecassis
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - K. Kim
- Department of Molecular Biosciences and Chemistry, Northwestern University, Chicago, IL
| | - P. M. Thomas
- Department of Molecular Biosciences and Chemistry, Northwestern University, Chicago, IL,National Resource for Translational & Developmental Proteomics, Northwestern University, Chicago, IL
| | - R. T. Fellers
- National Resource for Translational & Developmental Proteomics, Northwestern University, Chicago, IL
| | - R. D. LeDuc
- National Resource for Translational & Developmental Proteomics, Northwestern University, Chicago, IL
| | - N. L. Kelleher
- Department of Molecular Biosciences and Chemistry, Northwestern University, Chicago, IL,National Resource for Translational & Developmental Proteomics, Northwestern University, Chicago, IL
| | - J. Demetris
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA
| | - J. Levitsky
- Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL,Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL,Corresponding author: Josh Levitsky,
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38
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Krams SM, Schaffert S, Lau AH, Martinez OM. Applying Mass Cytometry to the Analysis of Lymphoid Populations in Transplantation. Am J Transplant 2017; 17:1992-1999. [PMID: 27888565 PMCID: PMC5526773 DOI: 10.1111/ajt.14145] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 09/29/2016] [Revised: 11/15/2016] [Accepted: 11/19/2016] [Indexed: 01/25/2023]
Abstract
Single-cell flow cytometric techniques have been indispensable to improving our understanding of the phenotype and function of immune cell subsets that are important in both rejection and tolerance after transplant. Mass cytometry, or cytometry by time of flight, is a single-cell-based platform that utilizes antibodies conjugated to rare heavy metal ions for analysis of cellular proteins by a time-of-flight mass spectrometer. This new technology allows for the evaluation of >40 simultaneous cellular parameters in a single sample because the limitation of spectral overlap, seen in conventional flow cytometry, is eliminated. In this review, we discuss the current state of mass cytometry, describe the advantages and disadvantages compared with multiparameter flow cytometry, introduce novel methods of high-dimensional data analysis and visualization, and review some recent studies using mass cytometry to profile the immune systems of healthy people and transplant recipients.
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Affiliation(s)
- Sheri M. Krams
- Division of Abdominal Transplantation, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA,Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, Stanford, CA, USA
| | - Steven Schaffert
- Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, Stanford, CA, USA
| | - Audrey H. Lau
- Division of Abdominal Transplantation, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Olivia M. Martinez
- Division of Abdominal Transplantation, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA,Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, Stanford, CA, USA
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39
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Affiliation(s)
- R K Battle
- Histocompatibility and Immunogenetics, Scottish National Blood Transfusion Service, Edinburgh, Scotland
| | - A A Abel
- Histocompatibility and Immunogenetics, Scottish National Blood Transfusion Service, Edinburgh, Scotland
| | - D M Turner
- Histocompatibility and Immunogenetics, Scottish National Blood Transfusion Service, Edinburgh, Scotland
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40
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Nocera A, Tagliamacco A, Cioni M, Innocente A, Fontana I, Barbano G, Carrea A, Ramondetta M, Sementa A, Basso S, Quartuccio G, Klersy C, Bertocchi M, Verrina E, Garibotto G, Ghiggeri GM, Cardillo M, Comoli P, Ginevri F. Kidney Intragraft Homing of De Novo Donor-Specific HLA Antibodies Is an Essential Step of Antibody-Mediated Damage but Not Per Se Predictive of Graft Loss. Am J Transplant 2017; 17:692-702. [PMID: 27501275 DOI: 10.1111/ajt.14000] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 07/07/2016] [Accepted: 08/02/2016] [Indexed: 01/25/2023]
Abstract
Donor-specific HLA antibody (DSA)-mediated graft injury is the major cause of kidney loss. Among DSA characteristics, graft homing has been suggested as an indicator of severe tissue damage. We analyzed the role of de novo DSA (dnDSA) graft homing on kidney transplantation outcome. Graft biopsy specimens and parallel sera from 48 nonsensitized pediatric kidney recipients were analyzed. Serum samples and eluates from graft biopsy specimens were tested for the presence of dnDSAs with flow bead technology. Intragraft dnDSAs (gDSAs) were never detected in the absence of serum dnDSAs (sDSAs), whereas in the presence of sDSAs, gDSAs were demonstrated in 72% of biopsy specimens. A significantly higher homing capability was expressed by class II sDSAs endowed with high mean fluorescence intensity and C3d- and/or C1q-fixing properties. In patients with available sequential biopsy specimens, we detected gDSAs before the appearance of antibody-mediated rejection. In sDSA-positive patients, gDSA positivity did not allow stratification for antibody-mediated graft lesions and graft loss. However, a consistent detection of skewed unique DSA specificities was observed over time within the graft, likely responsible for the damage. Our results indicate that gDSAs could represent an instrumental tool to identify, among sDSAs, clinically relevant antibody specificities requiring monitoring and possibly guiding patient management.
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Affiliation(s)
- A Nocera
- Transplant Immunology Research Laboratory at Clinical Nephrology Unit, Department of Internal Medicine (DIMI), University of Genova, Genova, Italy
| | - A Tagliamacco
- Transplant Immunology Research Laboratory at Clinical Nephrology Unit, Department of Internal Medicine (DIMI), University of Genova, Genova, Italy
| | - M Cioni
- Nephrology, Dialysis and Transplantation Unit, G. Gaslini Institute, Genova, Italy
| | - A Innocente
- Transplantation Immunology, Fondazione Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - I Fontana
- Kidney Transplant Surgery Unit, IRCCS Azienda Ospedaliera Universitaria S. Martino-Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - G Barbano
- Nephrology, Dialysis and Transplantation Unit, G. Gaslini Institute, Genova, Italy
| | - A Carrea
- Nephrology, Dialysis and Transplantation Unit, G. Gaslini Institute, Genova, Italy
| | - M Ramondetta
- Transplantation Immunology, Fondazione Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - A Sementa
- Pathology Unit, Istituto G. Gaslini, Genova, Italy
| | - S Basso
- Pediatric Hematology/Oncology, Fondazione Policlinico S. Matteo, Pavia, Italy
| | - G Quartuccio
- Pediatric Hematology/Oncology, Fondazione Policlinico S. Matteo, Pavia, Italy
| | - C Klersy
- Biometry and Statistics Service, Fondazione Policlinico S. Matteo, Pavia, Italy
| | - M Bertocchi
- Kidney Transplant Surgery Unit, IRCCS Azienda Ospedaliera Universitaria S. Martino-Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - E Verrina
- Nephrology, Dialysis and Transplantation Unit, G. Gaslini Institute, Genova, Italy
| | - G Garibotto
- Nephrology Unit, Department of Internal Medicine, University of Genova, Genova, Italy
| | - G M Ghiggeri
- Nephrology, Dialysis and Transplantation Unit, G. Gaslini Institute, Genova, Italy
| | - M Cardillo
- Transplantation Immunology, Fondazione Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - P Comoli
- Pediatric Hematology/Oncology, Fondazione Policlinico S. Matteo, Pavia, Italy
| | - F Ginevri
- Nephrology, Dialysis and Transplantation Unit, G. Gaslini Institute, Genova, Italy
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41
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Schlößer HA, Thelen M, Dieplinger G, von Bergwelt-Baildon A, Garcia-Marquez M, Reuter S, Shimabukuro-Vornhagen A, Wennhold K, Haustein N, Buchner D, Heiermann N, Kleinert R, Wahba R, Ditt V, Kurschat C, Cingöz T, Becker J, Stippel DL, von Bergwelt-Baildon M. Prospective Analyses of Circulating B Cell Subsets in ABO-Compatible and ABO-Incompatible Kidney Transplant Recipients. Am J Transplant 2017; 17:542-550. [PMID: 27529836 DOI: 10.1111/ajt.14013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 06/16/2016] [Revised: 07/24/2016] [Accepted: 08/09/2016] [Indexed: 01/25/2023]
Abstract
Immunosuppressive strategies applied in renal transplantation traditionally focus on T cell inhibition. B cells were mainly examined in the context of antibody-mediated rejection, whereas the impact of antibody-independent B cell functions has only recently entered the field of transplantation. Similar to T cells, distinct B cell subsets can enhance or inhibit immune responses. In this study, we prospectively analyzed the evolution of B cell subsets in the peripheral blood of AB0-compatible (n = 27) and AB0-incompatible (n = 10) renal transplant recipients. Activated B cells were transiently decreased and plasmablasts were permanently decreased in patients without signs of rejection throughout the first year. In patients with histologically confirmed renal allograft rejection, activated B cells and plasmablasts were significantly elevated on day 365. Rituximab treatment in AB0-incompatible patients resulted in long-lasting B cell depletion and in a naïve phenotype of repopulating B cells 1 year following transplantation. Acute allograft rejection was correlated with an increase of activated B cells and plasmablasts and with a significant reduction of regulatory B cell subsets. Our study demonstrates the remarkable effects of standard immunosuppression on circulating B cell subsets. Furthermore, the B cell compartment was significantly altered in rejecting patients. A specific targeting of deleterious B cell subsets could be of clinical benefit in renal transplantation.
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Affiliation(s)
- H A Schlößer
- Department of General, Visceral and Cancer Surgery, University of Cologne, Köln, Germany.,Cologne Interventional Immunology, University of Cologne, Köln, Germany.,Cologne Transplant Center, University of Cologne, Köln, Germany
| | - M Thelen
- Cologne Interventional Immunology, University of Cologne, Köln, Germany
| | - G Dieplinger
- Department of General, Visceral and Cancer Surgery, University of Cologne, Köln, Germany.,Cologne Transplant Center, University of Cologne, Köln, Germany
| | - A von Bergwelt-Baildon
- Cologne Transplant Center, University of Cologne, Köln, Germany.,Department of Internal Medicine II, University of Cologne, Köln, Germany
| | - M Garcia-Marquez
- Cologne Interventional Immunology, University of Cologne, Köln, Germany
| | - S Reuter
- Cologne Interventional Immunology, University of Cologne, Köln, Germany
| | - A Shimabukuro-Vornhagen
- Cologne Interventional Immunology, University of Cologne, Köln, Germany.,Cologne Transplant Center, University of Cologne, Köln, Germany
| | - K Wennhold
- Cologne Interventional Immunology, University of Cologne, Köln, Germany
| | - N Haustein
- Cologne Interventional Immunology, University of Cologne, Köln, Germany
| | - D Buchner
- Department of General, Visceral and Cancer Surgery, University of Cologne, Köln, Germany.,Cologne Transplant Center, University of Cologne, Köln, Germany
| | - N Heiermann
- Department of General, Visceral and Cancer Surgery, University of Cologne, Köln, Germany.,Cologne Transplant Center, University of Cologne, Köln, Germany
| | - R Kleinert
- Department of General, Visceral and Cancer Surgery, University of Cologne, Köln, Germany.,Cologne Transplant Center, University of Cologne, Köln, Germany
| | - R Wahba
- Department of General, Visceral and Cancer Surgery, University of Cologne, Köln, Germany.,Cologne Transplant Center, University of Cologne, Köln, Germany
| | - V Ditt
- Institute for Clinical Transfusion Medicine, Merheim Medical Center Cologne, Köln, Germany
| | - C Kurschat
- Cologne Transplant Center, University of Cologne, Köln, Germany.,Department of Internal Medicine II, University of Cologne, Köln, Germany
| | - T Cingöz
- Cologne Transplant Center, University of Cologne, Köln, Germany.,Department of Internal Medicine II, University of Cologne, Köln, Germany
| | - J Becker
- Cologne Transplant Center, University of Cologne, Köln, Germany.,Institute of Pathology, University of Cologne, Köln, Germany
| | - D L Stippel
- Department of General, Visceral and Cancer Surgery, University of Cologne, Köln, Germany.,Cologne Transplant Center, University of Cologne, Köln, Germany
| | - M von Bergwelt-Baildon
- Cologne Interventional Immunology, University of Cologne, Köln, Germany.,Department of Internal Medicine I, University of Cologne, Köln, Germany
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42
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Kaminski H, Couzi L, Garrigue I, Moreau JF, Déchanet-Merville J, Merville P. Easier Control of Late-Onset Cytomegalovirus Disease Following Universal Prophylaxis Through an Early Antiviral Immune Response in Donor-Positive, Recipient-Negative Kidney Transplants. Am J Transplant 2016; 16:2384-94. [PMID: 26953216 DOI: 10.1111/ajt.13781] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 01/03/2016] [Revised: 02/07/2016] [Accepted: 02/25/2016] [Indexed: 01/25/2023]
Abstract
Universal prophylaxis for cytomegalovirus (CMV) prevention is viable but, compared with a preemptive strategy, leads to higher incidence of late-onset disease (LOD) associated with poor patient and graft survival. The purpose of this study was to compare LOD with early onset disease (EOD), with a focus on the highest risk kidney transplant recipients (KTRs): CMV seronegative recipients transplanted from seropositive donors (D+R-). Since CMV control depends on both antiviral treatment and specific immune response, we also compared Vδ2-negative (Vδ2(neg) ) γδ T cell expansion involved in CMV infection resolution. EOD was defined as occurring <3 mo and LOD as occurring >3 mo after transplantation. Depending on the period, universal prophylaxis or preemptive treatment was used. Overall, 168 D+R- KTRs were included between 2003 and 2011. LOD was associated with a lower peak DNAemia (p = 0.04), fewer recurrences (odds ratio 0.16; 95% confidence interval 0.05-0.55; p = 0.01) and shorter anti-CMV curative treatment (40 vs. 60 days, p < 0.0001). As a corollary, we found that Vδ2(neg) γδ T cell expansion was faster in LOD than in EOD (31 vs. 168 days after the beginning of CMV disease, p < 0.0001). In D+R- KTRs, universal prophylaxis is associated with more LOD, which had better infection management and a faster immune response. These results support the use of universal prophylaxis over a preemptive strategy and reappraise outcomes of LOD.
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Affiliation(s)
- H Kaminski
- Department of Nephrology, Transplantation and Dialysis, Bordeaux, France
| | - L Couzi
- Department of Nephrology, Transplantation and Dialysis, Bordeaux, France.,National Center of Scientific Research (CNRS), Research Unit 5234, Bordeaux, France
| | - I Garrigue
- Virology Laboratory, Bordeaux, France.,National Center of Scientific Research, Mix Unit of Research 5164, Bordeaux, France
| | - J-F Moreau
- National Center of Scientific Research (CNRS), Research Unit 5234, Bordeaux, France.,Immunology Laboratory, Pellegrin Hospital, Bordeaux, France
| | - J Déchanet-Merville
- National Center of Scientific Research (CNRS), Research Unit 5234, Bordeaux, France
| | - P Merville
- Department of Nephrology, Transplantation and Dialysis, Bordeaux, France.,National Center of Scientific Research (CNRS), Research Unit 5234, Bordeaux, France
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43
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Staley EM, Carruba SS, Manning M, Pham HP, Williams LA, Marques MB, Locke JE, Lorenz RG. Anti-Blood Group Antibodies in Intravenous Immunoglobulin May Complicate Interpretation of Antibody Titers in ABO-Incompatible Transplantation. Am J Transplant 2016; 16:2483-6. [PMID: 26913485 DOI: 10.1111/ajt.13760] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 10/08/2015] [Revised: 02/09/2016] [Accepted: 02/14/2016] [Indexed: 01/25/2023]
Abstract
Patients receiving ABO-incompatible (ABOi) kidney transplants are treated before and after transplant with combination therapy, such as intravenous immunoglobulin (IVIG) and therapeutic plasma exchange, to prevent allograft rejection by reducing anti-A and anti-B titers. Although generally considered safe, it is well known that commercial IVIG products contain detectable anti-A and anti-B, which can be associated with hemolysis. Different preparative manufacturing techniques during the production of IVIG affect ABO antibody levels in IVIG preparations; therefore, some manufacturers now use new methods to reduce anti-A/B levels at the preproduction stage. The variations in implementing these strategies creates the potential for significant variation in antibody titers between products and, in some cases, even between lots of the same IVIG product. We report a case of persistently elevated anti-A titers in an ABOi kidney transplant recipient associated with elevated ABO antibody titers present in the preparation of IVIG used at our facility.
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Affiliation(s)
- E M Staley
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL
| | - S S Carruba
- Pharmacy Department, University of Alabama at Birmingham, Birmingham, AL
| | - M Manning
- Pharmacy Department, University of Alabama at Birmingham, Birmingham, AL
| | - H P Pham
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL
| | - L A Williams
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL
| | - M B Marques
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL
| | - J E Locke
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - R G Lorenz
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL
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44
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Comoli P, Cioni M, Tagliamacco A, Quartuccio G, Innocente A, Fontana I, Trivelli A, Magnasco A, Nocco A, Klersy C, Rubert L, Ramondetta M, Zecca M, Garibotto G, Ghiggeri GM, Cardillo M, Nocera A, Ginevri F. Acquisition of C3d-Binding Activity by De Novo Donor-Specific HLA Antibodies Correlates With Graft Loss in Nonsensitized Pediatric Kidney Recipients. Am J Transplant 2016; 16:2106-16. [PMID: 26725780 DOI: 10.1111/ajt.13700] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 12/23/2015] [Accepted: 12/28/2015] [Indexed: 01/25/2023]
Abstract
Alloantibody-mediated graft injury is a major cause of kidney dysfunction and loss. The complement-binding ability of de novo donor-specific antibodies (dnDSAs) has been suggested as a prognostic tool to stratify patients for clinical risk. In this study, we analyzed posttransplant kinetics of complement-fixing dnDSAs and their role in antibody-mediated rejection development and graft loss. A total of 114 pediatric nonsensitized recipients of first kidney allograft were periodically monitored for dnDSAs using flow bead assays, followed by C3d and C1q assay in case of positivity. Overall, 39 patients developed dnDSAs, which were C1q(+) and C3d(+) in 25 and nine patients, respectively. At follow-up, progressive acquisition over time of dnDSA C1q and C3d binding ability, within the same antigenic specificity, was observed, paralleled by an increase in mean fluorescence intensity that correlated with clinical outcome. C3d-fixing dnDSAs were better fit to stratify graft loss risk when the different dnDSA categories were evaluated in combined models because the 10-year graft survival probability was lower in patients with C3d-binding dnDSA than in those without dnDSAs or with C1q(+) /C3d(-) or non-complement-binding dnDSAs (40% vs. 94%, 100%, and 100%, respectively). Based on the kinetics profile, we favor dnDSA removal or modulation at first confirmed positivity, with treatment intensification guided by dnDSA biological characteristics.
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Affiliation(s)
- P Comoli
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - M Cioni
- Nephrology, Dialysis and Transplantation Unit, G. Gaslini Institute, Genova, Italy
| | - A Tagliamacco
- Clinical Nephrology Unit and Transplant Immunology Research Laboratory, Department of Internal Medicine - DIMI, University of Genova, Genova, Italy
| | - G Quartuccio
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - A Innocente
- Transplantation Immunology, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - I Fontana
- Vascular and Endovascular Unit and Kidney Transplant Surgery Unit, University of Genova, IRCCS San Martino University Hospital IST, Genova, Italy
| | - A Trivelli
- Nephrology, Dialysis and Transplantation Unit, G. Gaslini Institute, Genova, Italy
| | - A Magnasco
- Nephrology, Dialysis and Transplantation Unit, G. Gaslini Institute, Genova, Italy
| | - A Nocco
- Transplantation Immunology, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - C Klersy
- Biometry and Statistics Service, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - L Rubert
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - M Ramondetta
- Transplantation Immunology, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - M Zecca
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - G Garibotto
- Clinical Nephrology Unit and Transplant Immunology Research Laboratory, Department of Internal Medicine - DIMI, University of Genova, Genova, Italy
| | - G M Ghiggeri
- Nephrology, Dialysis and Transplantation Unit, G. Gaslini Institute, Genova, Italy
| | - M Cardillo
- Transplantation Immunology, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - A Nocera
- Clinical Nephrology Unit and Transplant Immunology Research Laboratory, Department of Internal Medicine - DIMI, University of Genova, Genova, Italy
| | - F Ginevri
- Nephrology, Dialysis and Transplantation Unit, G. Gaslini Institute, Genova, Italy
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45
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Starling RC, Stehlik J, Baran DA, Armstrong B, Stone JR, Ikle D, Morrison Y, Bridges ND, Putheti P, Strom TB, Bhasin M, Guleria I, Chandraker A, Sayegh M, Daly KP, Briscoe DM, Heeger PS. Multicenter Analysis of Immune Biomarkers and Heart Transplant Outcomes: Results of the Clinical Trials in Organ Transplantation-05 Study. Am J Transplant 2016; 16:121-36. [PMID: 26260101 PMCID: PMC4948061 DOI: 10.1111/ajt.13422] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 05/20/2015] [Accepted: 06/14/2015] [Indexed: 01/25/2023]
Abstract
Identification of biomarkers that assess posttransplant risk is needed to improve long-term outcomes following heart transplantation. The Clinical Trials in Organ Transplantation (CTOT)-05 protocol was an observational, multicenter, cohort study of 200 heart transplant recipients followed for the first posttransplant year. The primary endpoint was a composite of death, graft loss/retransplantation, biopsy-proven acute rejection (BPAR), and cardiac allograft vasculopathy (CAV) as defined by intravascular ultrasound (IVUS). We serially measured anti-HLA- and auto-antibodies, angiogenic proteins, peripheral blood allo-reactivity, and peripheral blood gene expression patterns. We correlated assay results and clinical characteristics with the composite endpoint and its components. The composite endpoint was associated with older donor allografts (p < 0.03) and with recipient anti-HLA antibody (p < 0.04). Recipient CMV-negativity (regardless of donor status) was associated with BPAR (p < 0.001), and increases in plasma vascular endothelial growth factor-C (OR 20; 95%CI:1.9-218) combined with decreases in endothelin-1 (OR 0.14; 95%CI:0.02-0.97) associated with CAV. The remaining biomarkers showed no relationships with the study endpoints. While suboptimal endpoint definitions and lower than anticipated event rates were identified as potential study limitations, the results of this multicenter study do not yet support routine use of the selected assays as noninvasive approaches to detect BPAR and/or CAV following heart transplantation.
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Affiliation(s)
| | - Josef Stehlik
- University of Utah Health Sciences Center, Salt Lake City UT
| | | | | | | | | | - Yvonne Morrison
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville MD
| | - Nancy D. Bridges
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville MD
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46
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Leventhal J, Mathew J, Salomon D, Kurian S, Friedewald J, Gallon L, Konieczna I, Tambur A, charette J, Levitsky J, Jie C, Kanwar YS, Abecassis MM, Miller J. Nonchimeric HLA-Identical Renal Transplant Tolerance: Regulatory Immunophenotypic/Genomic Biomarkers. Am J Transplant 2016; 16:221-34. [PMID: 26227106 PMCID: PMC4718825 DOI: 10.1111/ajt.13416] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [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: 04/01/2015] [Revised: 05/14/2015] [Accepted: 06/02/2015] [Indexed: 01/25/2023]
Abstract
We previously described early results of a nonchimeric operational tolerance protocol in human leukocyte antigen (HLA)-identical living donor renal transplants and now update these results. Recipients given alemtuzumab, tacrolimus/MPA with early sirolimus conversion were multiply infused with donor hematopoietic CD34(+) stem cells. Immunosuppression was withdrawn by 24 months. Twelve months later, operational tolerance was confirmed by rejection-free transplant biopsies. Five of the first eight enrollees were initially tolerant 1 year off immunosuppression. Biopsies of three others after total withdrawal showed Banff 1A acute cellular rejection without renal dysfunction. With longer follow-up including 5-year posttransplant biopsies, four of the five tolerant recipients remain without rejection while one developed Banff 1A without renal dysfunction. We now add seven new subjects (two operationally tolerant), and demonstrate time-dependent increases of circulating CD4(+) CD25(+++) CD127(-) FOXP3(+) Tregs versus losses of Tregs in nontolerant subjects (p < 0.001). Gene expression signatures, developed using global RNA expression profiling of sequential whole blood and protocol biopsy samples, were highly associative with operational tolerance as early as 1 year posttransplant. The blood signature was validated by an external Immune Tolerance Network data set. Our approach to nonchimeric operational HLA-identical tolerance reveals association with Treg immunophenotypes and serial gene expression profiles.
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Affiliation(s)
- J.R. Leventhal
- Comprehensive Transplant Center; Northwestern University, Chicago, Illinois, U.S.A,Department of Surgery- Transplantation; Northwestern University, Chicago, Illinois, U.S.A
| | - J.M. Mathew
- Comprehensive Transplant Center; Northwestern University, Chicago, Illinois, U.S.A,Department of Surgery- Transplantation; Northwestern University, Chicago, Illinois, U.S.A,Department of Microbiology-Immunology; Northwestern University, Chicago, Illinois, U.S.A
| | - D.R. Salomon
- Department of Molecular and Experimental Medicine; The Scripps Research Institute, La Jolla, California, U.S.A
| | - S.M. Kurian
- Department of Molecular and Experimental Medicine; The Scripps Research Institute, La Jolla, California, U.S.A
| | - J.J. Friedewald
- Comprehensive Transplant Center; Northwestern University, Chicago, Illinois, U.S.A,Department of Medicine-Nephrology; Northwestern University, Chicago, Illinois, U.S.A
| | - L. Gallon
- Comprehensive Transplant Center; Northwestern University, Chicago, Illinois, U.S.A,Department of Medicine-Nephrology; Northwestern University, Chicago, Illinois, U.S.A
| | - I. Konieczna
- Comprehensive Transplant Center; Northwestern University, Chicago, Illinois, U.S.A
| | - A.R. Tambur
- Comprehensive Transplant Center; Northwestern University, Chicago, Illinois, U.S.A,Department of Surgery- Transplantation; Northwestern University, Chicago, Illinois, U.S.A
| | - j. charette
- Comprehensive Transplant Center; Northwestern University, Chicago, Illinois, U.S.A,Department of Surgery- Transplantation; Northwestern University, Chicago, Illinois, U.S.A
| | - J. Levitsky
- Comprehensive Transplant Center; Northwestern University, Chicago, Illinois, U.S.A,Department of Medicine-Hepatology; Northwestern University, Chicago, Illinois, U.S.A
| | - C. Jie
- Comprehensive Transplant Center; Northwestern University, Chicago, Illinois, U.S.A
| | - Y. S. Kanwar
- Department of Pathology; Northwestern University, Chicago, Illinois, U.S.A
| | - M. M. Abecassis
- Comprehensive Transplant Center; Northwestern University, Chicago, Illinois, U.S.A,Department of Surgery- Transplantation; Northwestern University, Chicago, Illinois, U.S.A,Department of Microbiology-Immunology; Northwestern University, Chicago, Illinois, U.S.A
| | - J. Miller
- Comprehensive Transplant Center; Northwestern University, Chicago, Illinois, U.S.A,Department of Surgery- Transplantation; Northwestern University, Chicago, Illinois, U.S.A
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47
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Feng S, Fairchild RL. On the road, looking for signposts to tolerance: making progress or spinning wheels? Am J Transplant 2015; 15:2793-4. [PMID: 26462130 DOI: 10.1111/ajt.13481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 07/31/2015] [Accepted: 08/04/2015] [Indexed: 01/25/2023]
Affiliation(s)
- S Feng
- University of California-San Francisco, San Francisco, CA
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48
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Chattopadhyay PK, Roederer M. A mine is a terrible thing to waste: high content, single cell technologies for comprehensive immune analysis. Am J Transplant 2015; 15:1155-61. [PMID: 25708158 DOI: 10.1111/ajt.13193] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [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: 11/05/2014] [Revised: 12/22/2014] [Accepted: 12/26/2014] [Indexed: 01/25/2023]
Abstract
In recent years, an incredible variety of single cell technologies have become available to analyze immune responses. These technologies include polychromatic flow cytometry, mass cytometry, highly multiplexed single cell qPCR, RNA sequencing, microtools, and high-resolution imaging. In this article, we review these platforms, describing their power and limitations for comprehensive analysis of the immune system. We relate the properties of these technologies to the various cellular states relevant to an immune response, in order to address which technologies are most appropriate for which settings.
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Affiliation(s)
- P K Chattopadhyay
- Vaccine Research Center, National Institutes of Health, Bethesda, MD
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49
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Sherston SN, Vogt K, Schlickeiser S, Sawitzki B, Harden PN, Wood KJ. Demethylation of the TSDR is a marker of squamous cell carcinoma in transplant recipients. Am J Transplant 2014; 14:2617-22. [PMID: 25250867 PMCID: PMC4497351 DOI: 10.1111/ajt.12899] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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: 02/21/2014] [Revised: 06/19/2014] [Accepted: 06/20/2014] [Indexed: 01/25/2023]
Abstract
Malignancy is an important cause of death in transplant recipients. Cutaneous squamous cell carcinoma (cSCC) causes significant morbidity and mortality as 30% of transplant recipients will develop cSCC within 10 years of transplantation. Previously we have shown that high numbers of regulatory T cells (Tregs) are associated with the development of cSCC in kidney transplant recipients (KTRs). Demethylation analysis of the Treg-specific demethylated region (TSDR) provides a more accurate association with cSCC risk after transplantation. Age, gender and duration of immunosuppression matched KTRs with (n=32) and without (n=27) cSCC, were re-analyzed for putative clinical and immunological markers of cancer risk. The proportion of FOXP3+ CD4+ cells was higher in the population with a previous SCC. Major T cell subsets remained stable over time; although B cell, CD8 and CD4 subpopulations demonstrated age-related changes. TSDR methylation analysis allowed clarification of Treg numbers, enhancing the association of high Treg levels in KTRs with cSCC compared to the cSCC-free cohort. These data validate and expand on previous findings in long-term KTRs, and show that immune markers remain stable over time. TSDR demethylation analysis provides a more accurate biomarker of cancer posttransplantation.
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Affiliation(s)
- S N Sherston
- Transplantation Research Immunology Group, Nuffield Department of Surgical Sciences, University of OxfordOxford, United Kingdom
| | - K Vogt
- Institute for Medical Immunology, Charité–University MedicineBerlin, Germany
| | - S Schlickeiser
- Institute for Medical Immunology, Charité–University MedicineBerlin, Germany
| | - B Sawitzki
- Institute for Medical Immunology, Charité–University MedicineBerlin, Germany,BCRT Berlin Brandenburg Center for Regenerative Therapies, Charite University MedicineBerlin, Germany
| | - P N Harden
- Oxford Transplant Centre, Churchill HospitalOxford, United Kingdom
| | - K J Wood
- Transplantation Research Immunology Group, Nuffield Department of Surgical Sciences, University of OxfordOxford, United Kingdom,*Corresponding author: Kathryn J. Wood,
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50
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Schmidt T, Schub D, Wolf M, Dirks J, Ritter M, Leyking S, Singh M, Zawada AM, Blaes-Eise AB, Samuel U, Sester U, Sester M. Comparative analysis of assays for detection of cell-mediated immunity toward cytomegalovirus and M. tuberculosis in samples from deceased organ donors. Am J Transplant 2014; 14:2159-67. [PMID: 25040687 DOI: 10.1111/ajt.12787] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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: 03/10/2014] [Revised: 04/07/2014] [Accepted: 04/16/2014] [Indexed: 01/25/2023]
Abstract
Cell-mediated immunity assays could be valuable for risk assessment of organ donors, but no data exist on their feasibility in deceased donors. In this study, 105 deceased donors (52.3 ± 16.9 years) were screened at the time of organ procurement. Pathogen-specific stimulation was performed using a cytomegalovirus (CMV) lysate, tuberculin (purified protein derivative [PPD]) and soluble Mycobacterium tuberculosis-specific ESAT-6/CFP-10 proteins in combination with an in-house fluorescence-activated cell sorting (FACS) assay or commercial assay formats (QuantiFERON-CMV/TB for ELISA, T-SPOT.TB for ELISPOT). CMV-IgG antibody titers were determined as gold standard for CMV infection; 51.4% of samples were CMV seropositive. Indeterminate results were observed in 47.6% of ELISA, 12.5% of FACS and 0% of ELISPOT assays. Agreement with serology was highest for FACS (95.6%, κ = 0.91), followed by ELISPOT (84.0%, κ = 0.68) and ELISA (80.0%, κ = 0.60). Agreement between ELISA and serology increased if the CMV lysate was used as stimulus (96.7%, κ = 0.92). Among the T cell assays, agreement between ELISPOT and FACS was highest (κ = 0.70). PPD-positive results among valid samples differed between assays (26.5% for ELISA, 23.1% for FACS and 50.5% for ELISPOT); 2.0% were QuantiFERON-TB positive, 3.3% were ESAT-6/CFP-10-positive in FACS and 13.4% were positive in the T-SPOT.TB assay. In conclusion, cellular immunity may be analyzed from samples of deceased donors, although the assays differ in the rate of positivity and indeterminate results.
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Affiliation(s)
- T Schmidt
- Department of Transplant and Infection Immunology, Saarland University, Homburg, Germany
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