1
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Chaemchoi T, Ittiwattanakul W, Ritteeverakul P, Intrarakamhang AL, Thammanatsakul K, Sinphurmsukskul S, Siwamogsatham S, Puwanant S, Ariyachaipanich A. The decline in kidney function after heart transplantation and its impact on survival. Clin Transplant 2023; 37:e15112. [PMID: 37676472 DOI: 10.1111/ctr.15112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/11/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Evidence of decline in native renal function after heart transplantation (HTx) in the Asian population is limited. This study determined the incidence and risk factors associated with declining kidney function after HTx and its impact on survival. METHODS A retrospective study of consecutive adult heart transplant patients was conducted in a single center between 2010 and 2020. The decline in kidney function was defined as the presence of one of the following criteria, including a ≥ 40% decline in eGFR, absolute value <15 mL/min/1.73 m2 (calculated by the CKD-EPI method), doubling of serum creatinine, or dialysis. RESULTS A total of 79 patients (77% male, mean age 44.5 ± 11.53 years, with a mean eGFR at discharge from the heart transplant admission of 87.9 ± 25.48 mL/min/1.73 m2 ) were included. During the median follow-up of 42 months, the rate of decline in eGFR was 3.9 mL/min/1.73 m2 per year, with a cumulative probability of decline in kidney function of 22% at 1 year and 43% at 5 years. The need for dialysis was 2.5% at 1 year and 5% at 5 years. The decline in kidney function within 1 year after discharge (hazard ratio (HR), 22.24; p = .007) and pre-HTx diabetes mellitus (DM) (HR, 8.99; p = .034) were independently associated with the need for dialysis. Post-HTx dialysis predicted all-cause mortality (HR, 4.47; p = .017). CONCLUSIONS Approximately 20% of HTx patients developed a decline in kidney function within 1 year after discharge. These individuals and pre-HTx DM patients needed preventive measures to prevent progression to chronic dialysis, which impacted survival. (thaiclinicaltrials.org number, TCTR20230620004).
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Affiliation(s)
- Tasigan Chaemchoi
- Department of Pharmacy, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Wannee Ittiwattanakul
- Department of Pharmacy, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Puangpen Ritteeverakul
- Department of Pharmacy, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Ai-Lada Intrarakamhang
- Excellent Center for Organ Transplantation, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Kanokwan Thammanatsakul
- Excellent Center for Organ Transplantation, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Supanee Sinphurmsukskul
- Excellent Center for Organ Transplantation, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Sarawut Siwamogsatham
- Chula Clinical Research Center, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sarinya Puwanant
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Aekarach Ariyachaipanich
- Excellent Center for Organ Transplantation, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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2
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Wong TCL, Selzner N. Adult living donor liver transplant for hepatorenal syndrome: Sooner better than later. Am J Transplant 2022; 22:2291-2292. [PMID: 35856828 DOI: 10.1111/ajt.17155] [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: 06/14/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Tiffany C L Wong
- Department of Surgery, The University of Hong Kong, Hong Kong S.A.R., China
| | - Nazia Selzner
- Ajmera Transplant Center, Department of Medicine, University of Toronto, Toronto, Canada
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3
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Hou Y, Xin Y, Liu S, Li Y, Meng X, Wang J, Xu Z, Sun T, Yang YG. A biocompatible nanoparticle-based approach to inhibiting renal ischemia reperfusion injury in mice by blocking thrombospondin-1 activity. Am J Transplant 2022; 22:2246-2253. [PMID: 35373451 DOI: 10.1111/ajt.17052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/13/2022] [Accepted: 03/30/2022] [Indexed: 01/25/2023]
Abstract
Thrombospondin-1 (TSP-1) is a key mediator of renal ischemia-reperfusion injury (IRI), a major cause of kidney dysfunction under various disease conditions and a risk factor of renal allograft rejection. In this study, we developed a nanotechnology-based therapy targeting TSP-1 to prevent renal IRI. A biocompatible nanoparticle (NP) capable of specific binding to TSP-1 was prepared by conjugating NPs with TSP-1-binding (LSKL) peptides. LSKL/NPs not only effectively adsorbed recombinant TSP-1 proteins in vitro, but also efficiently neutralized TSP-1 in mice undergoing renal IRI. IRI-induced elevation of TSP-1 in the kidney was significantly inhibited by post-IR treatment with LSKL/NPs, but not free LSKL or NPs. Furthermore, TSP-1 proteins adsorbed on LSKL/NPs were functionally inactive and unable to induce apoptosis in renal tubular epithelial cells. Importantly, LSKL/NPs induced strong protection against renal IRI, as shown by markedly diminished serum creatinine levels and improved histological lesions of the kidney. Thus, LSKL/NPs provide a useful means of depleting and inactivating TSP-1 and a potential therapy for renal IRI.
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Affiliation(s)
- Yue Hou
- Key Laboratory of Organ Regeneration and Transplantation of the Ministry of Education and The First Hospital, Jilin University, Changchun, Jilin, China
- National-local Joint Engineering Laboratory of Animal Models for Human Diseases, Changchun, Jilin, China
- Department of Nephrology, The First Hospital of Jilin University, Changchun, China
| | - Yanbao Xin
- Key Laboratory of Organ Regeneration and Transplantation of the Ministry of Education and The First Hospital, Jilin University, Changchun, Jilin, China
- National-local Joint Engineering Laboratory of Animal Models for Human Diseases, Changchun, Jilin, China
| | - Shuhan Liu
- Key Laboratory of Organ Regeneration and Transplantation of the Ministry of Education and The First Hospital, Jilin University, Changchun, Jilin, China
- National-local Joint Engineering Laboratory of Animal Models for Human Diseases, Changchun, Jilin, China
| | - Yong Li
- Key Laboratory of Organ Regeneration and Transplantation of the Ministry of Education and The First Hospital, Jilin University, Changchun, Jilin, China
| | - Xiandi Meng
- Key Laboratory of Organ Regeneration and Transplantation of the Ministry of Education and The First Hospital, Jilin University, Changchun, Jilin, China
- National-local Joint Engineering Laboratory of Animal Models for Human Diseases, Changchun, Jilin, China
| | - Jialiang Wang
- Key Laboratory of Organ Regeneration and Transplantation of the Ministry of Education and The First Hospital, Jilin University, Changchun, Jilin, China
- National-local Joint Engineering Laboratory of Animal Models for Human Diseases, Changchun, Jilin, China
| | - Zhonggao Xu
- Department of Nephrology, The First Hospital of Jilin University, Changchun, China
| | - Tianmeng Sun
- Key Laboratory of Organ Regeneration and Transplantation of the Ministry of Education and The First Hospital, Jilin University, Changchun, Jilin, China
- National-local Joint Engineering Laboratory of Animal Models for Human Diseases, Changchun, Jilin, China
- International Center of Future Science, Jilin University, Changchun, Jilin, China
| | - Yong-Guang Yang
- Key Laboratory of Organ Regeneration and Transplantation of the Ministry of Education and The First Hospital, Jilin University, Changchun, Jilin, China
- National-local Joint Engineering Laboratory of Animal Models for Human Diseases, Changchun, Jilin, China
- International Center of Future Science, Jilin University, Changchun, Jilin, China
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4
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Vaughan RH, Kresse J, Farmer LK, Thézénas ML, Kessler BM, Lindeman JHN, Sharples EJ, Welsh GI, Nørregaard R, Ploeg RJ, Kaisar M. Cytoskeletal protein degradation in brain death donor kidneys associates with adverse posttransplant outcomes. Am J Transplant 2022; 22:1073-1087. [PMID: 34878723 PMCID: PMC9305475 DOI: 10.1111/ajt.16912] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 01/25/2023]
Abstract
In brain death, cerebral injury contributes to systemic biological dysregulation, causing significant cellular stress in donor kidneys adversely impacting the quality of grafts. Here, we hypothesized that donation after brain death (DBD) kidneys undergo proteolytic processes that may deem grafts susceptible to posttransplant dysfunction. Using mass spectrometry and immunoblotting, we mapped degradation profiles of cytoskeletal proteins in deceased and living donor kidney biopsies. We found that key cytoskeletal proteins in DBD kidneys were proteolytically cleaved, generating peptide fragments, predominantly in grafts with suboptimal posttransplant function. Interestingly, α-actinin-4 and talin-1 proteolytic fragments were detected in brain death but not in circulatory death or living donor kidneys with similar donor characteristics. As talin-1 is a specific proteolytic target of calpain-1, we investigated a potential trigger of calpain activation and talin-1 degradation using human ex vivo precision-cut kidney slices and in vitro podocytes. Notably, we showed that activation of calpain-1 by transforming growth factor-β generated proteolytic fragments of talin-1 that matched the degradation fragments detected in DBD preimplantation kidneys, also causing dysregulation of the actin cytoskeleton in human podocytes; events that were reversed by calpain-1 inhibition. Our data provide initial evidence that brain death donor kidneys are more susceptible to cytoskeletal protein degradation. Correlation to posttransplant outcomes may be established by future studies.
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Affiliation(s)
- Rebecca H. Vaughan
- Research and DevelopmentNHS Blood and TransplantBristol & OxfordUK,Nuffield Department of Surgical SciencesOxford University Hospital OxfordBiomedical Research CentreUniversity of OxfordOxfordUK
| | | | - Louise K. Farmer
- Bristol RenalBristol Medical SchoolUniversity of BristolBristolUK
| | - Marie L. Thézénas
- Nuffield Department of MedicineTarget Discovery InstituteUniversity of OxfordOxfordUK
| | - Benedikt M. Kessler
- Nuffield Department of MedicineTarget Discovery InstituteUniversity of OxfordOxfordUK
| | - Jan H. N. Lindeman
- Department of SurgeryLeiden University Medical CentreLeidenThe Netherlands
| | | | - Gavin I. Welsh
- Bristol RenalBristol Medical SchoolUniversity of BristolBristolUK
| | | | - Rutger J. Ploeg
- Research and DevelopmentNHS Blood and TransplantBristol & OxfordUK,Nuffield Department of Surgical SciencesOxford University Hospital OxfordBiomedical Research CentreUniversity of OxfordOxfordUK,Department of SurgeryLeiden University Medical CentreLeidenThe Netherlands
| | - Maria Kaisar
- Research and DevelopmentNHS Blood and TransplantBristol & OxfordUK,Nuffield Department of Surgical SciencesOxford University Hospital OxfordBiomedical Research CentreUniversity of OxfordOxfordUK
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5
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Liu C, Alasfar S, Reese PP, Mohan S, Doshi MD, Hall IE, Thiessen Philbrook H, Jia Y, Stewart D, Parikh CR. Trends in the procurement and discard of kidneys from deceased donors with acute kidney injury. Am J Transplant 2022; 22:898-908. [PMID: 34897982 DOI: 10.1111/ajt.16920] [Citation(s) in RCA: 10] [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: 04/12/2021] [Revised: 11/11/2021] [Accepted: 12/02/2021] [Indexed: 01/25/2023]
Abstract
Kidney allocation trends from deceased donors with acute kidney injury (AKI) have not been characterized since initial Kidney Donor Profile Index reporting in 2012 and its use under the revised Kidney Allocation System (KAS) in 2014. We conducted a retrospective analysis of US registry data to characterize kidney procurement and discard trends in deceased donors with AKI, defined by ≥50% or ≥0.3 mg/dl (≥4.0 mg/dl or ≥200% for stage 3) increase in terminal serum creatinine from admission. From 2010 to 2020, 172 410 kidneys were procured from 93 341 deceased donors 16 years or older; 34 984 kidneys were discarded (17 559 from AKI donors). The proportion of stage 3 AKI donors doubled from 6% (412/6841) in 2010 to 12% (1365/11493) in 2020. Procurement of stage 3 AKI kidneys increased from 51% (423/824) to 80% (2183/2730). While discard of stage 3 AKI kidneys increased from 41% (175/423) in 2010 to 44% (960/2183) in 2020, this increase was not statistically significant in interrupted time-series analysis following KAS implementation (slope difference -0.41 [-3.22, 2.4], and level change 3.09 [-6.4, 12.6]). In conclusion, the absolute number of stage 3 AKI kidneys transplanted has increased. Ongoing high discard rates of these kidneys suggest opportunities for improved utilization.
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Affiliation(s)
- Caroline Liu
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sami Alasfar
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Peter P Reese
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sumit Mohan
- Division of Nephrology, Department of Medicine, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Mona D Doshi
- Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Isaac E Hall
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Heather Thiessen Philbrook
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yaqi Jia
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Darren Stewart
- Research Department, United Network for Organ Sharing, Richmond, Virginia
| | - Chirag R Parikh
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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6
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Saunders EA, Engel B, Höfer A, Hartleben B, Vondran FWR, Richter N, Potthoff A, Zender S, Wedemeyer H, Jaeckel E, Taubert R. Outcome and safety of a surveillance biopsy guided personalized immunosuppression program after liver transplantation. Am J Transplant 2022; 22:519-531. [PMID: 34455702 DOI: 10.1111/ajt.16817] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 04/19/2021] [Revised: 08/08/2021] [Accepted: 08/19/2021] [Indexed: 01/25/2023]
Abstract
Graft survival beyond year 1 has not changed after orthotopic liver transplantation (OLT) over the last decades. Likewise, OLT causes comorbidities such as infection, renal impairment and cancer. We evaluated our single-center real-world individualized immunosuppression program after OLT, based on 211 baseline surveillance biopsies (svLbx) without any procedural complications. Patients were classified as low, intermediate and high rejection risk based on graft injury in svLbx and anti-HLA donor-specific antibodies. While 32% of patients had minimal histological inflammation, 57% showed histological inflammation and 23% advanced fibrosis (>F2), which was not predicted by lab parameters. IS was modified in 79% of patients after svLbx. After immunosuppression reduction in 69 patients, only 5 patients showed ALT elevations and three of these patients had a biopsy-proven acute rejection, two of them related to lethal comorbidities. The rate of liver enzyme elevation including rejection was not significantly increased compared to a svLbx control cohort prior to the initiation of our structured program. Immunosuppression reduction led to significantly better kidney function compared to this control cohort. In conclusion, a biopsy guided personalized immunosuppression protocol after OLT can identify patients requiring lower immunosuppression or patients with graft injury in which IS should not be further reduced.
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Affiliation(s)
- Emily A Saunders
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Bastian Engel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Anne Höfer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Björn Hartleben
- Institute for Pathology, Hannover Medical School, Hannover, Germany
| | - Florian W R Vondran
- Department for General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Nicolas Richter
- Department for General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Andrej Potthoff
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Steffen Zender
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Elmar Jaeckel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Richard Taubert
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
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7
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Klomjit N, El Ters M, Adam BA, Sampathkumar P, Razonable RR, Taler SJ, Taner T, Alexander MP. Diffuse C4d staining of peritubular capillaries in renal allograft following bamlanivimab therapy. Am J Transplant 2022; 22:289-293. [PMID: 34358400 DOI: 10.1111/ajt.16783] [Citation(s) in RCA: 2] [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: 04/18/2021] [Revised: 07/30/2021] [Accepted: 07/31/2021] [Indexed: 01/25/2023]
Abstract
Neutralizing monoclonal antibodies such as bamlanivimab emerged as promising agents in treating kidney transplant recipients with COVID-19. However, the impact of bamlanivimab on kidney allograft histology remains unknown. We report a case of a kidney transplant recipient who received bamlanivimab for COVID-19 with subsequent histologic findings of diffuse peritubular capillary C4d staining. A 33-year-old man with end-stage kidney disease secondary to hypertension who received an ABO compatible kidney from a living donor, presented for his 4-month protocol visit. He was diagnosed with COVID-19 44 days prior to his visit and had received bamlanivimab with an uneventful recovery. His 4-month surveillance biopsy showed diffuse C4d staining of the peritubular capillaries without other features of antibody-mediated rejection (ABMR). Donor-specific antibodies were negative on repeat evaluations. ABMR gene expression panel was negative. His creatinine was stable at 1.3 mg/dl, without albuminuria. Given the temporal relationship between bamlanivimab and our observations of diffuse C4d staining of the peritubular capillaries, we hypothesize that bamlanivimab might bind to angiotensin-converting enzyme 2, resulting in classical complement pathway and C4d deposition. We elected to closely monitor kidney function which has been stable at 6 months after the biopsy. In conclusion, diffuse C4d may present following bamlanivimab administration without any evidence of ABMR.
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Affiliation(s)
- Nattawat Klomjit
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Mireille El Ters
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Benjamin A Adam
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Sandra J Taler
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Timucin Taner
- Division of Transplant Surgery and Department of Immunology, Mayo Clinic, Rochester, Minnesota
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8
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Stone HK, VandenHeuvel K, Bondoc A, Flores FX, Hooper DK, Varnell CD. Primary hyperoxaluria diagnosed after kidney transplant: A review of the literature and case report of aggressive renal replacement therapy and lumasiran to prevent allograft loss. Am J Transplant 2021; 21:4061-4067. [PMID: 34254430 PMCID: PMC8639665 DOI: 10.1111/ajt.16762] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/01/2021] [Accepted: 07/03/2021] [Indexed: 01/25/2023]
Abstract
Primary hyperoxaluria type 1 is a rare inherited disorder caused by abnormal liver glyoxalate metabolism leading to overproduction of oxalate, progressive kidney disease, and systemic oxalosis. While the disorder typically presents with nephrocalcinosis, recurrent nephrolithiasis, and/or early chronic kidney disease, the diagnosis is occasionally missed until it recurs after kidney transplant. Allograft outcomes in these cases are typically very poor, often with early graft loss. Here we present the case of a child diagnosed with primary hyperoxaluria type 1 after kidney transplant who was able to maintain kidney function, thanks to aggressive renal replacement therapy as well as initiation of a new targeted therapy for this disease. This case highlights the importance of having a high index of suspicion for primary hyperoxaluria in patients with chronic kidney disease and nephrocalcinosis/nephrolithiasis or with end stage kidney disease of uncertain etiology, as initiating therapies early on may prevent poor outcomes.
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Affiliation(s)
- Hillarey K. Stone
- Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Katherine VandenHeuvel
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH,Division of Pathology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Alexander Bondoc
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Francisco X. Flores
- Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - David K. Hooper
- Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH,James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Charles D. Varnell
- Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH,James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
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9
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Park S, Park S, Kim JE, Yu MY, Kim YC, Kim DK, Joo KW, Kim YS, Han K, Lee H. Risk of active tuberculosis infection in kidney transplantation recipients: A matched comparative nationwide cohort study. Am J Transplant 2021; 21:3629-3639. [PMID: 33938138 DOI: 10.1111/ajt.16627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 04/01/2021] [Accepted: 04/21/2021] [Indexed: 01/25/2023]
Abstract
Large-scale evidence comparing the risk of Mycobacterium tuberculosis (TB) between kidney transplant (KT) recipients and dialysis patients is warranted. This is a nationwide retrospective cohort study based on the claims database of South Korea where a moderate prevalence of TB is reported. We included incident KT recipients from 2011 to 2015 and compared their active TB risks with 1:1 matched dialysis and general population control groups, respectively. The risk of incident active TB was assessed by multivariable Cox regression. Associations between active TB and posttransplant death or death-censored graft failure were investigated. The number of matched subjects included in each of the study groups was 7462. The KT group showed a significantly higher risk of active TB than the general population group (hazard ratio [HR] 3.39 [1.88-6.10]), whereas it showed a similar risk to that of the dialysis group (HR 0.98 [0.73-1.31]). In KT patients, active TB was a significant risk factor for both death (HR 2.33 [1.24-4.39]) and death-censored graft failure (HR 2.26 [1.39-3.67]). Although KT recipients may not have to burden the additional risk of active TB when compared with dialysis patients in recent medicine, active TB should not be overlooked as it is associated with a worse prognosis in posttransplant patients.
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Affiliation(s)
- Sehoon Park
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Armed Forces Capital Hospital, Seoul, Korea
| | - Sanghyun Park
- Department of Medical Statistics, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Ji Eun Kim
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Mi-Yeon Yu
- Department of Internal Medicine, Hanyang University Guri Hospital, Gyeonggi-do, Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Kidney Research Institute, Seoul National University, Seoul, Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Kidney Research Institute, Seoul National University, Seoul, Korea
| | - Yon Su Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Kidney Research Institute, Seoul National University, Seoul, Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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10
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Ku E, McCulloch CE, Roll GR, Posselt A, Grimes BA, Johansen KL. Bariatric surgery prior to transplantation and risk of early hospital re-admission, graft failure, or death following kidney transplantation. Am J Transplant 2021; 21:3750-3757. [PMID: 34331744 PMCID: PMC10184683 DOI: 10.1111/ajt.16779] [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: 03/01/2021] [Revised: 07/05/2021] [Accepted: 07/22/2021] [Indexed: 01/25/2023]
Abstract
Bariatric surgery has been shown to be safe in the dialysis population. Whether bariatric surgery before kidney transplantation influences posttransplant outcomes has not been examined nationally. We included severely obese (BMI >35) dialysis patients between 18 and 70 years who received a kidney transplant according to the US Renal Data System. We determined the association between history of bariatric surgery and risk of 30-day readmission, graft failure, or death after transplantation using multivariable logistic, Fine-Gray, and Cox models. We included 12 573 patients, of whom 503 (4%) received bariatric surgery before transplantation. Median age at transplant was 53 years; 42% were women. Overall, history of bariatric surgery was not statistically significantly associated with graft failure (HR 1.02; 95% CI 0.77-1.35) or death (HR 1.10; 95% CI 0.84-1.45). However, sleeve gastrectomy (vs. no bariatric surgery) was associated with lower risk of graft failure (HR 0.39; 95% CI 0.16-0.95). In conclusion, history of bariatric surgery prior to kidney transplantation was not associated with allograft or patient survival, but findings varied by surgery type. Sleeve gastrectomy was associated with better graft survival and should be considered in severely obese transplant candidates receiving dialysis.
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Affiliation(s)
- Elaine Ku
- Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, California.,Division of Pediatric Nephrology, Department of Pediatrics, University of California San Francisco, San Francisco, California.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Garrett R Roll
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Andrew Posselt
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Barbara A Grimes
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Kirsten L Johansen
- Division of Nephrology, Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
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11
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Maenosono R, Nian Y, Iske J, Liu Y, Minami K, Rommel T, Martin F, Abdi R, Azuma H, Rosner BA, Zhou H, Milford E, Elkhal A, Tullius SG. Recipient sex and estradiol levels affect transplant outcomes in an age-specific fashion. Am J Transplant 2021; 21:3239-3255. [PMID: 34050595 PMCID: PMC8924905 DOI: 10.1111/ajt.16611] [Citation(s) in RCA: 11] [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: 07/23/2020] [Revised: 03/17/2021] [Accepted: 04/03/2021] [Indexed: 01/25/2023]
Abstract
Sex-specific influences have been shown for a variety of diseases. Whether donor or recipient sex and sex hormone levels impact alloimmune responses remains unclear. In unifactorial and multifactorial analyses of more than 400 000 SRTR listed kidney transplant patients, we found that younger female recipients had an inferior death-censored graft survival that was independent of donor sex. In contrast, graft survival was superior in older female recipients, suggesting the impact of recipient sex hormones over chromosomal sex mismatches. Those clinical changes were delineated in experimental skin and heart transplant models showing a prolongation of graft survival in ovariectomized young female recipients. In contrast, graft survival was comparable in ovariectomized and naïve old female recipients. Young ovariectomized mice showed reduced amounts and a compromised T cell proliferation. Deprivation of female hormones dampened the production of interferon (IFN)-γ and interleukin (IL)-17+ by CD4+ T cells while augmenting systemic counts of Tregs. Increasing estradiol concentrations in vitro promoted the switch of naïve CD4+ T cells into Th1 cells; high physiological estradiol concentrations dampening Th1 responses, promoted Tregs, and prolonged graft survival. Thus, clinical observations demonstrate age-specific graft survival patterns in female recipients. Estrogen levels, in turn, impact the fate of T cell subsets, providing relevant and novel information on age- and sex-specific alloimmunity.
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Affiliation(s)
- Ryoichi Maenosono
- Division of Transplant Surgery, Department of Surgery and Transplant Surgery Research Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,Department of Urology, Osaka Medical College, Osaka, Japan
| | - Yeqi Nian
- Division of Transplant Surgery, Department of Surgery and Transplant Surgery Research Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,Department of Kidney Transplantation, Tianjin First Central Hospital, Nankai University, Tianjin, China
| | - Jasper Iske
- Division of Transplant Surgery, Department of Surgery and Transplant Surgery Research Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,Institute of Transplant Immunology, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Yang Liu
- Division of Transplant Surgery, Department of Surgery and Transplant Surgery Research Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,Institute of Hepatobiliary Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Koichiro Minami
- Division of Transplant Surgery, Department of Surgery and Transplant Surgery Research Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,Department of Urology, Osaka Medical College, Osaka, Japan
| | - Tabea Rommel
- Medical School, Justus Liebig University, Giessen, Germany
| | - Friederike Martin
- Department of General-, Visceral- and Transplantation Surgery, Charité-Medical University, Berlin, Germany
| | - Reza Abdi
- Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Haruhito Azuma
- Department of Urology, Osaka Medical College, Osaka, Japan
| | - Bernhard A Rosner
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Ma., USA
| | - Hao Zhou
- Division of Transplant Surgery, Department of Surgery and Transplant Surgery Research Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Edgar Milford
- Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Abdallah Elkhal
- Division of Transplant Surgery, Department of Surgery and Transplant Surgery Research Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Stefan G Tullius
- Division of Transplant Surgery, Department of Surgery and Transplant Surgery Research Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,to whom correspondence should be addressed: Address correspondence to: Stefan G, Tullius, M.D., Ph.D., FACS, Division of Transplant Surgery and Transplant Surgery Research Laboratory, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis ST, Boston, MA, 02115, USA, Phone: **1-617-732-6446
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12
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Alhamad T, Lubetzky M, Lentine KL, Edusei E, Parsons R, Pavlakis M, Woodside KJ, Adey D, Blosser CD, Concepcion BP, Friedewald J, Wiseman A, Singh N, Chang SH, Gupta G, Molnar MZ, Basu A, Kraus E, Ong S, Faravardeh A, Tantisattamo E, Riella L, Rice J, Dadhania DM. Kidney recipients with allograft failure, transition of kidney care (KRAFT): A survey of contemporary practices of transplant providers. Am J Transplant 2021; 21:3034-3042. [PMID: 33559315 DOI: 10.1111/ajt.16523] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 10/15/2020] [Revised: 01/13/2021] [Accepted: 01/20/2021] [Indexed: 01/25/2023]
Abstract
Kidney allograft failure and return to dialysis carry a high risk of morbidity. A practice survey was developed by the AST Kidney Pancreas Community of Practice workgroup and distributed electronically to the AST members. There were 104 respondents who represented 92 kidney transplant centers. Most survey respondents were transplant nephrologists at academic centers. The most common approach to immunosuppression management was to withdraw the antimetabolite first (73%), while only 12% responded they would withdraw calcineurin inhibitor (CNI) first. More than 60% reported that the availability of a living donor is the most important factor in their decision to taper immunosuppression, followed by risk of infection, risk of sensitization, frailty, and side effects of medications. More than half of respondents reported that embolization was either not available or offered to less than 10% as an option for surgical intervention. Majority reported that ≤50% of failed allograft patients were re-listed before dialysis, and less than a quarter of transplant nephrologists performed frequent visits with their patients with failed kidney allograft after they return to dialysis. This survey demonstrates heterogeneity in the care of patients with a failing allograft and the need for more evidence to guide improvements in clinical practice related to transition of care.
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Affiliation(s)
- Tarek Alhamad
- Washington University in St. Louis, Saint Louis, Missouri, USA
| | - Michelle Lubetzky
- New York Presbyterian Hospital- Weill Cornell Medicine, New York, New York, USA
| | | | - Emmanuel Edusei
- New York Presbyterian Hospital- Weill Cornell Medicine, New York, New York, USA
| | | | - Martha Pavlakis
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Deborah Adey
- University of California San Francisco, San Francisco, California, USA
| | | | | | | | | | - Neeraj Singh
- Willis Knighton Health System, Shreveport, Louisiana, USA
| | - Su-Hsin Chang
- Washington University in St. Louis, Saint Louis, Missouri, USA
| | - Gaurav Gupta
- Virginia Commonwealth University, Richmond, Virginia, USA
| | | | | | | | - Song Ong
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Arman Faravardeh
- SHARP Kidney and Pancreas Transplant Center, San Diego, California, USA
| | | | | | - Jim Rice
- Scripps Heath, San Diego, California, USA
| | - Darshana M Dadhania
- New York Presbyterian Hospital- Weill Cornell Medicine, New York, New York, USA
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13
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Mengel M, Mannon RB. Banff and ABMR: Are we going in the right direction? Am J Transplant 2021; 21:2321-2322. [PMID: 33621422 DOI: 10.1111/ajt.16546] [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: 01/15/2021] [Revised: 02/07/2021] [Accepted: 02/15/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Michael Mengel
- Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Canada
| | - Roslyn B Mannon
- Division of Nephrology, Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
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14
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Wilson C, Phillips CL, Klenk A, Kuhar M, Yaqub MS. Crystalglobulinemia causing cutaneous vasculopathy and acute nephropathy in a kidney transplant patient. Am J Transplant 2021; 21:2285-2289. [PMID: 33565232 DOI: 10.1111/ajt.16536] [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: 08/27/2020] [Revised: 01/20/2021] [Accepted: 01/31/2021] [Indexed: 01/25/2023]
Abstract
We present a rare case of crystalglobulinemia causing cutaneous vasculopathy and acute nephropathy in a 66-year-old female kidney transplant recipient. The patient presented with acute kidney injury (AKI), volume overload, anuria, retiform purpura, and blue-black necrosis of her toes. She received a living kidney transplant 7 months earlier with baseline creatinine of 0.6 mg/dl. Transplant kidney biopsy showed massive pseudo-thrombi filling glomerular capillary lumina. Electron microscopy of thrombi revealed an ultrastructural crystalline pattern of linear and curvilinear bundles with ladder-like periodicity typical of crystalglobulin-induced nephropathy. Similar crystalline pseudo-thrombi were detected ultrastructurally in a skin biopsy specimen, indicating systemic involvement. She required several sessions of hemodialysis. Plasmapheresis was initiated to decrease the number of circulating crystalglobulins. In order to treat the underlying paraproteinemia, the patient was started on bortezomib and dexamethasone. After treatment with five cycles of bortezomib, the patient's free kappa to lambda ratio improved to 2.35 from 5.52. Acute kidney injury (AKI) and the cutaneous vasculopathy gradually improved with treatment. This is an extremely rare occurrence of crystalglobulin in a living kidney transplant recipient.
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Affiliation(s)
- Chase Wilson
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Carrie L Phillips
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Alison Klenk
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Matthew Kuhar
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Muhammad S Yaqub
- Department of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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15
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Levey AS, Eckardt KU, Dorman NM, Christiansen SL, Cheung M, Jadoul M, Winkelmayer WC. Nomenclature for kidney function and disease: Executive summary and glossary from a Kidney Disease: Improving Global Outcomes (KDIGO) consensus conference. Am J Transplant 2021; 21:901-902. [PMID: 32592536 DOI: 10.1111/ajt.16114] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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)
- Andrew S Levey
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | - Michel Jadoul
- Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Wolfgang C Winkelmayer
- Section of Nephrology, Department of Medicine, Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas, USA
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16
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Legeai C, Durand L, Savoye E, Macher MA, Bastien O. Effect of preservation solutions for static cold storage on kidney transplantation outcomes: A National Registry Study. Am J Transplant 2020; 20:3426-3442. [PMID: 32400921 DOI: 10.1111/ajt.15995] [Citation(s) in RCA: 6] [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: 12/20/2019] [Revised: 03/25/2020] [Accepted: 04/22/2020] [Indexed: 01/25/2023]
Abstract
This study aimed to evaluate how 5 preservation solutions for static cold storage affected kidney transplant outcomes. It included all first single kidney transplants during 2010-2014 from donations after brain death in the French national transplant registry, excluding preemptive transplants and transplants of kidneys preserved with a hypothermic perfusion machine. The effects of each preservation solution on delayed graft function (DGF) and 1-year transplant failure were evaluated with hierarchical multivariable logistic regression models. The study finally included 7640 transplanted kidneys: 3473 (45.5%) preserved with Institut Georges Lopez-1 solution (IGL-1), 773 (10.1%) with University of Wisconsin solution, 731 (9.6%) with Solution de Conservation des Organes et Tissus (SCOT, organ and tissue preservation solution), 2215 (29.0%) with Celsior, and 448 (5.9%) with histidine-tryptophan-ketoglutarate. Primary nonfunction rates did not differ by solution. After adjustment for donor, recipient, and transplant characteristics, the DGF risk was significantly lower with IGL-1 than with all other solutions (odds ratio [OR] 0.55, 95% confidence interval [CI] 0.48-0.64). Conversely, SCOT was associated with a DGF risk significantly higher than the other solutions (OR 2.69, 95% CI 2.21-3.27) and triple that of IGL-1 (OR 3.37, 95% CI 2.72-4.16). One year after transplantation, the transplant failure rate did not differ significantly by preservation solution. The difference between the groups for 1-year mean creatinine clearance was not clinically relevant.
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Affiliation(s)
- Camille Legeai
- Organ and Tissue Procurement and Transplantation Department, Agence de la Biomédecine, Saint Denis La Plaine, France
| | - Louise Durand
- Organ and Tissue Procurement and Transplantation Department, Agence de la Biomédecine, Saint Denis La Plaine, France
| | - Emilie Savoye
- Organ and Tissue Procurement and Transplantation Department, Agence de la Biomédecine, Saint Denis La Plaine, France
| | - Marie-Alice Macher
- Organ and Tissue Procurement and Transplantation Department, Agence de la Biomédecine, Saint Denis La Plaine, France
| | - Olivier Bastien
- Organ and Tissue Procurement and Transplantation Department, Agence de la Biomédecine, Saint Denis La Plaine, France
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17
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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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18
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Purnajo I, Beaumont JL, Polinsky M, Alemao E, Everly MJ. Trajectories of health-related quality of life among renal transplant patients associated with graft failure and symptom distress: Analysis of the BENEFIT and BENEFIT-EXT trials. Am J Transplant 2020; 20:1650-1658. [PMID: 31874117 DOI: 10.1111/ajt.15757] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 06/26/2019] [Revised: 12/05/2019] [Accepted: 12/08/2019] [Indexed: 01/25/2023]
Abstract
Understanding the correlation between transplant symptoms, health-related quality of life (HRQoL), and graft outcomes is needed to support patient-focused drug development and posttransplant management. A post-hoc analysis of patient-reported outcomes from the Phase III belatacept trials was conducted in order to investigate the interrelationship between trajectories of HRQoL, symptom experience, and allograft outcomes. HRQoL and symptom experience were evaluated using Short-Form 36 Survey (SF-36) and Modified Transplant Symptom Occurrence and Distress Scale (MTSOSD-59R), respectively. HRQoL was captured in 831 eligible renal transplant patients at baseline, 12, 24, and 36 months posttransplant. Following transplantation, patients reported improvements in all SF-36 subscales compared to baseline. Latent class analysis revealed four trajectories in perceived general health, which were associated with graft failure after adjustment. Compared to patients with good perceived health, patients with fair and poor perceived health had 4.7 (95% confidence interval [CI] 1.5-14.8, P < .01) and 19.8 (95% CI 5.9-66.0, P < .01) times the risk of graft failure, respectively. Using multinomial logistic regression, different sets of symptoms were associated with perceived general health at baseline and 12 months posttransplant. The study supports monitoring HRQoL and symptom experience to capture each patient's health perspective, improve drug development, and optimize posttransplant management.
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Affiliation(s)
- Intan Purnajo
- Terasaki Research Institute, Los Angeles, California
| | | | | | - Evo Alemao
- Bristol Myers Squibb, Princeton, New Jersey
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19
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Jadlowiec CC, Heilman RL, Smith ML, Khamash HA, Huskey JL, Harbell J, Reddy KS, Moss AA. Transplanting kidneys from donation after cardiac death donors with acute kidney injury. Am J Transplant 2020; 20:864-869. [PMID: 31612611 DOI: 10.1111/ajt.15653] [Citation(s) in RCA: 24] [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: 06/12/2019] [Revised: 09/10/2019] [Accepted: 10/03/2019] [Indexed: 02/06/2023]
Abstract
Donation after cardiac death (DCD) and acute kidney injury (AKI) donors have historically been considered independent risk factors for delayed graft function (DGF), allograft failure, and inferior outcomes. With growing experience, updated analyses have shown good outcomes. There continues to be limited data, however, on outcomes specific to DCD donors who have AKI. Primary outcomes for this study were post-kidney transplant patient and allograft survival comparing two donor groups: DCD AKIN stage 2-3 and DBD AKIN stage 2-3. In comparing these groups, there were no short- or long-term differences in patient (hazard ratio [HR] 1.07, 95% confidence interval [CI] 0.54-1.93, P = .83) or allograft survival (HR 1.47, 95% CI 0.64-2.97, P = .32). In multivariate models, the DCD/DBD status had no significant impact on the estimated GFR (eGFR) at 1 (P = .38), 2 (P = .60), and 3 years (P = .52). DGF (57.9% vs 67.9%, P = .09), rejection (12.1% vs 13.9%, P = .12), and progression of interstitial fibrosis/tubular atrophy (IFTA) on protocol biopsy (P = .16) were similar between the two groups. With careful selection, good outcomes can be achieved utilizing severe AKI DCD kidneys. Historic concerns regarding primary nonfunction, DGF resulting in interstitial fibrosis and rejection, and inferior outcomes were not observed. Given the ongoing organ shortage, increased effort should be undertaken to further utilize these donors.
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Affiliation(s)
| | | | - Maxwell L Smith
- Division of Anatomic Pathology, Mayo Clinic, Phoenix, Arizona
| | - Hasan A Khamash
- Division of Transplant Nephrology, Mayo Clinic, Phoenix, Arizona
| | - Janna L Huskey
- Division of Transplant Nephrology, Mayo Clinic, Phoenix, Arizona
| | - Jack Harbell
- Division of Transplant Surgery, Mayo Clinic, Phoenix, Arizona
| | - Kunam S Reddy
- Division of Transplant Surgery, Mayo Clinic, Phoenix, Arizona
| | - Adyr A Moss
- Division of Transplant Surgery, Mayo Clinic, Phoenix, Arizona
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20
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Schold JD, Augustine JJ, Huml AM, O’Toole J, Sedor JR, Poggio ED. Modest rates and wide variation in timely access to repeat kidney transplantation in the United States. Am J Transplant 2020; 20:769-778. [PMID: 31599065 PMCID: PMC7204603 DOI: 10.1111/ajt.15646] [Citation(s) in RCA: 20] [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: 06/01/2019] [Revised: 09/08/2019] [Accepted: 09/17/2019] [Indexed: 02/06/2023]
Abstract
Success of transplantation is not limited to initial receipt of a donor organ. Many kidney transplant recipients experience graft loss following initial transplantation and the benefits of expedited placement on the waiting list and retransplantation extend to this population. Factors associated with access to repeat transplantation may be unique given experience with the transplant process and prior viability as a candidate. We examined the incidence, risk factors, secular changes, and center-level variation of preemptive relisting or transplantation (PRLT) for kidney transplant recipients in the United States with graft failure (not due to death) using Scientific Registry of Transplant Recipients data from 2007 to 2018 (n = 39 557). Overall incidence of PRLT was 15% and rates of relisting declined over time. Significantly lower PRLT was evident among patients who were African American and Hispanic, males, older, obese, publicly insured, had lower educational attainment, were diabetic, had longer dialysis time prior to initial transplant, shorter graft survival, longer distance to transplant center, and resided in distressed communities. There was significant variation in PRLT by center, median = 13%, 10th percentile = 6%, 90th percentile = 24%. Cumulatively, results indicate that despite prior access to transplantation, incidence of PRLT is modest with pronounced clinical, social, and center-level sources of variation suggesting opportunities to improve preemptive care among patients with failing grafts.
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Affiliation(s)
- Jesse D. Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio,Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Anne M. Huml
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - John O’Toole
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - John R. Sedor
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Emilio D. Poggio
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
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21
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Oellerich M, Shipkova M, Asendorf T, Walson PD, Schauerte V, Mettenmeyer N, Kabakchiev M, Hasche G, Gröne H, Friede T, Wieland E, Schwenger V, Schütz E, Beck J. Absolute quantification of donor-derived cell-free DNA as a marker of rejection and graft injury in kidney transplantation: Results from a prospective observational study. Am J Transplant 2019; 19:3087-3099. [PMID: 31062511 PMCID: PMC6899936 DOI: 10.1111/ajt.15416] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [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: 01/11/2019] [Revised: 04/04/2019] [Accepted: 04/28/2019] [Indexed: 01/25/2023]
Abstract
Donor-derived cell-free DNA (dd-cfDNA) is a noninvasive biomarker for comprehensive monitoring of allograft injury and rejection in kidney transplantation (KTx). dd-cfDNA quantification of copies/mL plasma (dd-cfDNA[cp/mL]) was compared to dd-cfDNA fraction (dd-cfDNA[%]) at prespecified visits in 189 patients over 1 year post KTx. In patients (N = 15, n = 22 samples) with biopsy-proven rejection (BPR), median dd-cfDNA(cp/mL) was 3.3-fold and median dd-cfDNA(%) 2.0-fold higher (82 cp/mL; 0.57%, respectively) than medians in Stable Phase patients (N = 83, n = 408) without rejection (25 cp/mL; 0.29%). Results for acute tubular necrosis (ATN) were not significantly different from those with biopsy-proven rejection (BPR). dd-cfDNA identified unnecessary biopsies triggered by a rise in plasma creatinine. Receiver operating characteristic (ROC) analysis showed superior performance (P = .02) of measuring dd-cfDNA(cp/mL) (AUC = 0.83) compared to dd-cfDNA(%) (area under the curve [AUC] = 0.73). Diagnostic odds ratios were 7.31 for dd-cfDNA(cp/mL), and 6.02 for dd-cfDNA(%) at thresholds of 52 cp/mL and 0.43%, respectively. Plasma creatinine showed a low correlation (r = 0.37) with dd-cfDNA(cp/mL). In a patient subset (N = 24) there was a significantly higher rate of patients with elevated dd-cfDNA(cp/mL) with lower tacrolimus levels (<8 μg/L) compared to the group with higher tacrolimus concentrations (P = .0036) suggesting that dd-cfDNA may detect inadequate immunosuppression resulting in subclinical graft damage. Absolute dd-cfDNA(cp/mL) allowed for better discrimination than dd-cfDNA(%) of KTx patients with BPR and is useful to avoid unnecessary biopsies.
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Affiliation(s)
- Michael Oellerich
- Department of Clinical PharmacologyUniversity Medical Center GoettingenGoettingenGermany
| | - Maria Shipkova
- Central Institute for Clinical Chemistry and Laboratory MedicineKlinikum StuttgartStuttgartGermany
| | - Thomas Asendorf
- Department of Medical StatisticsUniversity Medical Center GoettingenGoettingenGermany
| | - Philip D. Walson
- Department of Clinical PharmacologyUniversity Medical Center GoettingenGoettingenGermany
| | - Verena Schauerte
- Department of NephrologyTransplant CenterKlinikum StuttgartStuttgartGermany
| | - Nina Mettenmeyer
- Department of Clinical PharmacologyUniversity Medical Center GoettingenGoettingenGermany
- Chronix BiomedicalGoettingenGermany
| | - Mariana Kabakchiev
- Central Institute for Clinical Chemistry and Laboratory MedicineKlinikum StuttgartStuttgartGermany
| | | | - Hermann‐Josef Gröne
- Department of Cellular and Molecular PathologyGerman Cancer Research CenterHeidelbergGermany
| | - Tim Friede
- Department of Medical StatisticsUniversity Medical Center GoettingenGoettingenGermany
| | - Eberhard Wieland
- Central Institute for Clinical Chemistry and Laboratory MedicineKlinikum StuttgartStuttgartGermany
| | - Vedat Schwenger
- Department of NephrologyTransplant CenterKlinikum StuttgartStuttgartGermany
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22
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Reeve J, Böhmig GA, Eskandary F, Einecke G, Gupta G, Madill-Thomsen K, Mackova M, Halloran PF. Generating automated kidney transplant biopsy reports combining molecular measurements with ensembles of machine learning classifiers. Am J Transplant 2019; 19:2719-2731. [PMID: 30868758 DOI: 10.1111/ajt.15351] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [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: 12/20/2018] [Revised: 02/10/2019] [Accepted: 03/03/2019] [Indexed: 01/25/2023]
Abstract
We previously reported a system for assessing rejection in kidney transplant biopsies using microarray-based gene expression data, the Molecular Microscope® Diagnostic System (MMDx). The present study was designed to optimize the accuracy and stability of MMDx diagnoses by replacing single machine learning classifiers with ensembles of diverse classifier methods. We also examined the use of automated report sign-outs and the agreement between multiple human interpreters of the molecular results. Ensembles generated diagnoses that were both more accurate than the best individual classifiers, and nearly as stable as the best, consistent with expectations from the machine learning literature. Human experts had ≈93% agreement (balanced accuracy) signing out the reports, and random forest-based automated sign-outs showed similar levels of agreement with the human experts (92% and 94% for predicting the expert MMDx sign-outs for T cell-mediated (TCMR) and antibody-mediated rejection (ABMR), respectively). In most cases disagreements, whether between experts or between experts and automated sign-outs, were in biopsies near diagnostic thresholds. Considerable disagreement with histology persisted. The balanced accuracies of MMDx sign-outs for histology diagnoses of TCMR and ABMR were 73% and 78%, respectively. Disagreement with histology is largely due to the known noise in histology assessments (ClinicalTrials.gov NCT01299168).
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Affiliation(s)
- Jeff Reeve
- Alberta Transplant Applied Genomics Centre, Alberta, Canada.,Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Georg A Böhmig
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Farsad Eskandary
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Gunilla Einecke
- Department of Nephrology, Medizinische Hochschule Hannover, Hannover, Germany
| | - Gaurav Gupta
- Division of Nephrology, Virginia Commonwealth University, Richmond, Virginia
| | | | | | - Philip F Halloran
- Alberta Transplant Applied Genomics Centre, Alberta, Canada.,Department of Medicine, Division of Nephrology and Transplant Immunology, University of Alberta, Edmonton, Alberta, Canada
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23
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Denic A, Morales MC, Park WD, Smith BH, Kremers WK, Alexander MP, Cosio FG, Rule AD, Stegall MD. Using computer-assisted morphometrics of 5-year biopsies to identify biomarkers of late renal allograft loss. Am J Transplant 2019; 19:2846-2854. [PMID: 30947386 PMCID: PMC8214914 DOI: 10.1111/ajt.15380] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 12/18/2018] [Revised: 03/20/2019] [Accepted: 03/28/2019] [Indexed: 01/25/2023]
Abstract
The current Banff scoring system was not developed to predict graft loss and may not be ideal for use in clinical trials aimed at improving allograft survival. We hypothesized that scoring histologic features of digitized renal allograft biopsies using a continuous, more objective, computer-assisted morphometric (CAM) system might be more predictive of graft loss. We performed a nested case-control study in kidney transplant recipients with a surveillance biopsy obtained 5 years after transplantation. Patients that developed death-censored graft loss (n = 67) were 2:1 matched on age, gender, and follow-up time to controls with surviving grafts (n = 134). The risk of graft loss was compared between CAM-based models vs a model based on Banff scores. Both Banff and CAM identified chronic lesions associated with graft loss (chronic glomerulopathy, arteriolar hyalinosis, and mesangial expansion). However, the CAM-based models predicted graft loss better than the Banff-based model, both overall (c-statistic 0.754 vs 0.705, P < .001), and in biopsies without chronic glomerulopathy (c-statistic 0.738 vs 0.661, P < .001) where it identified more features predictive of graft loss (% luminal stenosis and % mesangial expansion). Using 5-year renal allograft surveillance biopsies, CAM-based models predict graft loss better than Banff models and might be developed into biomarkers for future clinical trials.
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Affiliation(s)
- Aleksandar Denic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Martha C. Morales
- Department of Surgery and Immunology, Mayo Clinic, Rochester, Minnesota
| | - Walter D. Park
- Department of Surgery and Immunology, Mayo Clinic, Rochester, Minnesota
| | - Byron H. Smith
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Walter K. Kremers
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Mariam P. Alexander
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Fernando G. Cosio
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Andrew D. Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Mark D. Stegall
- Department of Surgery and Immunology, Mayo Clinic, Rochester, Minnesota
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24
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Forker CM, Miano TA, Reilly JP, Oyster ML, Porteous MK, Cantu EE, Ware LB, Diamond JM, Christie JD, Shashaty MGS. Postreperfusion plasma endothelial activation markers are associated with acute kidney injury after lung transplantation. Am J Transplant 2019; 19:2366-2373. [PMID: 31017370 PMCID: PMC6658345 DOI: 10.1111/ajt.15402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 10/12/2018] [Revised: 03/31/2019] [Accepted: 04/03/2019] [Indexed: 01/25/2023]
Abstract
Acute kidney injury (AKI) is common after lung transplantation, but molecular markers remain poorly studied. The endothelial activation markers soluble thrombomodulin (sTM), protein C, and plasminogen activator inhibitor-1 (PAI-1) are implicated in kidney microcirculatory injury in animal models of AKI. We tested the association of 6-hour postreperfusion plasma levels of these markers with posttransplant AKI severity in patients enrolled in the Lung Transplant Outcomes Group prospective cohort study at the University of Pennsylvania during two eras: 2004-06 (n = 61) and 2013-15 (n = 67). We defined AKI stage through postoperative day 5 using Kidney Disease Improving Global Outcomes creatinine criteria. We used multivariable ordinal logistic regression to determine the association of each biomarker with AKI, adjusted for primary graft dysfunction and extracorporeal life support. AKI occurred in 57 (45%) patients across both eras: 28 (22%) stage 1, 29 (23%) stage 2-3. Higher sTM and lower protein C plasma levels were associated with AKI stage in each era and remained so in multivariable models utilizing both eras (sTM: OR 1.76 [95% CI 1.19-2.60] per standard deviation, P = .005; protein C: OR 0.54 [1.19-2.60], P = .003). We conclude that 6-hour postreperfusion plasma sTM and protein C levels are associated with early postlung transplant AKI severity.
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Affiliation(s)
- Caitlin M. Forker
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Todd A. Miano
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John P. Reilly
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michelle L. Oyster
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mary K. Porteous
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Edward E. Cantu
- Division of Cardiovascular Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lorraine B. Ware
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Joshua M. Diamond
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jason D. Christie
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael G. S. Shashaty
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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25
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Faraci M, Bertaina A, Dalissier A, Ifversen M, Schulz A, Gennery A, Burkhardt B, Badell Serra I, Diaz-de-Heredia C, Lanino E, Lankester AC, Gruhn B, Matthes-Martin S, Kühl JS, Varotto S, Paillard C, Guilmatre A, Sastre A, Abecasis M, Garwer B, Sedlacek P, Boelens JJ, Beohou E, Bader P. Solid organ transplantation after hematopoietic stem cell transplantation in childhood: A multicentric retrospective survey. Am J Transplant 2019; 19:1798-1805. [PMID: 30586230 DOI: 10.1111/ajt.15240] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/24/2018] [Accepted: 12/14/2018] [Indexed: 01/25/2023]
Abstract
We report data obtained from a retrospective multicenter pediatric survey on behalf of the European Society for Blood and Marrow Transplantation (EBMT). Information on solid organ transplantation (SOT) performed in pediatric recipients of either autologous or allogeneic hematopoietic stem cell transplantation (HSCT) between 1984 and 2016 was collected in 20 pediatric EBMT Centers (25.6%). Overall, we evaluated data on 44 SOTs following HSCT including 20 liver (LTx), 12 lung (LuTx), 6 heart (HTx), and 6 kidney (KTx) transplantations. The indication for SOT was organ failure related to intractable graft-vs-host disease in 16 children (36.3%), acute or chronic HSCT-related toxicity in 18 (40.9%), and organ dysfunction related to the underlying disease in 10 (22.8%). The median follow-up was 10.9 years (95% confidence interval: 1.7-29.5). The overall survival rate at 1 and 5 years after SOT was 85.7% and 80.4%, respectively: it was 74% and 63.2% after LTx, 83.2% after HTx, and 100% equally after LuTx and KTx. This multicenter survey confirms that SOT represents a promising option in children with severe organ failure occurring after HSCT. Additional studies are needed to further establish the effectiveness of SOT after HSCT and to better understand the mechanism underlying this encouraging success.
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Affiliation(s)
- Maura Faraci
- Hematopoietic Stem Cell Transplantation Unit, Hematology-Oncology, Istituto G Gaslini, Genova, Italy
| | - Alice Bertaina
- Dipartimento di Onco-Ematologia Pediatrica, IRCSS Ospedale Pediatrico Bambino Gesù, Rome, Italy.,Division of Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
| | - Arnaud Dalissier
- European Society for Blood and Marrow Transplantation Pediatric Disease Working Party, Paris, France
| | - Marianne Ifversen
- Department for Children and Adolescents, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ansgar Schulz
- Department of Pediatrics, University Medical Center, Ulm, Germany
| | - Andrew Gennery
- Institute of Cellular Medicine, Pediatric Immunology Department, Newcastle University, Great North Children's Hospital, Newcastle-upon-Tyne, UK
| | - Birgit Burkhardt
- Pediatric Hematology and Oncology, University Hospital Münster, Muenster, Germany
| | - Isabel Badell Serra
- Pediatric Hematopoietic Transplant Unit, Sant Pau Hospital, Barcelona, Spain
| | - Cristina Diaz-de-Heredia
- Department of Pediatric Oncology and Hematology, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Edoardo Lanino
- Hematopoietic Stem Cell Transplantation Unit, Hematology-Oncology, Istituto G Gaslini, Genova, Italy
| | - Arjan C Lankester
- Department of Pediatrics Stem Cell Transplantation Program, Leiden University Medical Center, Leiden, The Netherlands
| | - Bernd Gruhn
- Department of Pediatrics, Jena University Hospital, Jena, Germany
| | | | - Joern S Kühl
- Department Pediatric Hematology, Oncology, Hemostaseology, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Stefania Varotto
- Clinic of Pediatric Hemato-Oncology, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Catherine Paillard
- Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, Hôpital Hautepierre, Strasbourg, France
| | - Audrey Guilmatre
- Service of Pediatric Hematology-Oncology, Hôpital Armand Trousseau, Paris, France
| | - Ana Sastre
- Unidad de Hematología y Oncología Pediátrica, Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | - Jaap J Boelens
- Pediatric Blood and Marrow Transplantation Program, Laboratory for Translational Immunology Tumor-immunology, University Medical Center, Utrecht, The Netherlands.,Stem Cell Transplant and Cellular Therapies Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Eric Beohou
- European Society for Blood and Marrow Transplantation Pediatric Disease Working Party, Paris, France
| | - Peter Bader
- Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
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26
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Mannon RB, Askar M, Jackson AM, Newell K, Mengel M. Meeting report of the STAR-Sensitization in Transplantation Assessment of Risk: Naïve Abdominal Transplant Organ subgroup focus on kidney transplantation. Am J Transplant 2018; 18:2120-2134. [PMID: 29943908 DOI: 10.1111/ajt.14977] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/30/2018] [Accepted: 05/31/2018] [Indexed: 01/25/2023]
Abstract
The development of de novo donor-specific HLA antibody (dnDSA) is a critical feature contributing to late allograft failure. The complexity of the issue is further complicated by organ-specific differences, detection techniques, reliance of tissue histopathology and changing diagnostic criteria, ineffective therapies, and lack of consensus. To tackle these issues, the Sensitization in Transplantation Assessment of Risk (STAR) 2017 was initiated as a collaboration of the American Society of Transplantation and American Society of Histocompatibility and Immunogenetics consisting of 8 working groups with the goal to provide guidelines on how to assess risk and risk stratify patients based on their potential alloimmune and DSA status. Herein is a summary of discussions by the Naïve Abdominal Working Group, highlighting currently available data and identifying gaps in our knowledge on the development and impact of dnDSA following kidney transplantation.
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Affiliation(s)
- Roslyn B Mannon
- Department of Medicine, Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Medhat Askar
- Transplant Immunology, Baylor University Medical Center, Dallas, TX, USA
| | - Annette M Jackson
- Department of Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Michael Mengel
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
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27
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Kamburova EG, Wisse BW, Joosten I, Allebes WA, van der Meer A, Hilbrands LB, Baas MC, Spierings E, Hack CE, van Reekum FE, van Zuilen AD, Verhaar MC, Bots ML, Drop ACAD, Plaisier L, Seelen MAJ, Sanders JS.F, Hepkema BG, Lambeck AJA, Bungener LB, Roozendaal C, Tilanus MGJ, Voorter CE, Wieten L, van Duijnhoven EM, Gelens M, Christiaans MHL, van Ittersum FJ, Nurmohamed SA, Lardy NM, Swelsen W, van der Pant KA, van der Weerd NC, ten Berge IJM, Bemelman FJ, Hoitsma A, van der Boog PJM, de Fijter JW, Betjes MGH, Heidt S, Roelen DL, Claas FH, Otten HG. Differential effects of donor-specific HLA antibodies in living versus deceased donor transplant. Am J Transplant 2018; 18:2274-2284. [PMID: 29464832 PMCID: PMC6175247 DOI: 10.1111/ajt.14709] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 01/25/2023]
Abstract
The presence of donor-specific anti-HLA antibodies (DSAs) is associated with increased risk of graft failure after kidney transplant. We hypothesized that DSAs against HLA class I, class II, or both classes indicate a different risk for graft loss between deceased and living donor transplant. In this study, we investigated the impact of pretransplant DSAs, by using single antigen bead assays, on long-term graft survival in 3237 deceased and 1487 living donor kidney transplants with a negative complement-dependent crossmatch. In living donor transplants, we found a limited effect on graft survival of DSAs against class I or II antigens after transplant. Class I and II DSAs combined resulted in decreased 10-year graft survival (84% to 75%). In contrast, after deceased donor transplant, patients with class I or class II DSAs had a 10-year graft survival of 59% and 60%, respectively, both significantly lower than the survival for patients without DSAs (76%). The combination of class I and II DSAs resulted in a 10-year survival of 54% in deceased donor transplants. In conclusion, class I and II DSAs are a clear risk factor for graft loss in deceased donor transplants, while in living donor transplants, class I and II DSAs seem to be associated with an increased risk for graft failure, but this could not be assessed due to their low prevalence.
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28
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Peters-Sengers H, Houtzager JHE, Heemskerk MBA, Idu MM, Minnee RC, Klaasen RW, Joor SE, Hagenaars JAM, Rebers PM, van der Heide JJH, Roodnat JI, Bemelman FJ. DCD donor hemodynamics as predictor of outcome after kidney transplantation. Am J Transplant 2018; 18:1966-1976. [PMID: 29380523 DOI: 10.1111/ajt.14676] [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: 08/24/2017] [Revised: 12/29/2017] [Accepted: 01/19/2018] [Indexed: 01/25/2023]
Abstract
Insufficient hemodynamics during agonal phase-ie, the period between withdrawal of life-sustaining treatment and circulatory arrest-in Maastricht category III circulatory-death donors (DCD) potentially exacerbate ischemia/reperfusion injury. We included 409 Dutch adult recipients of DCD donor kidneys transplanted between 2006 and 2014. Peripheral oxygen saturation (SpO2-with pulse oximetry at the fingertip) and systolic blood pressure (SBP-with arterial catheter) were measured during agonal phase, and were dichotomized into minutes of SpO2 > 60% or SpO2 < 60%, and minutes of SBP > 80 mmHg or SBP < 80 mmHg. Outcome measures were and primary non-function (PNF), delayed graft function (DGF), and three-year graft survival. Primary non-function (PNF) rate was 6.6%, delayed graft function (DGF) rate was 67%, and graft survival at three years was 76%. Longer periods of agonal phase (median 16 min [IQR 11-23]) contributed significantly to an increased risk of DGF (P = .012), but not to PNF (P = .071) and graft failure (P = .528). Multiple logistic regression analysis showed that an increase from 7 to 20 minutes in period of SBP < 80 mmHg was associated with 2.19 times the odds (95% CI 1.08-4.46, P = .030) for DGF. In conclusion, duration of agonal phase is associated with early transplant outcome. SBP < 80 mmHg during agonal phase shows a better discrimination for transplant outcome than SpO2 < 60% does.
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Affiliation(s)
- H Peters-Sengers
- Department of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Center for Experimental and Molecular Medicine (CEMM), Academic Medical Center, University of Amsterdam, the Netherlands
| | - J H E Houtzager
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | | | - M M Idu
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - R C Minnee
- Department of Surgery, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - R W Klaasen
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - S E Joor
- Department of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - J A M Hagenaars
- Department of Surgery, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - P M Rebers
- Department of Surgery, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - J J Homan van der Heide
- Department of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - J I Roodnat
- Department of Nephrology, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - F J Bemelman
- Department of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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29
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Williams C, Borges K, Banh T, Vasilevska-Ristovska J, Chanchlani R, Ng VL, Dipchand AI, Solomon M, Hebert D, Kim SJ, Astor BC, Parekh RS. Patterns of kidney injury in pediatric nonkidney solid organ transplant recipients. Am J Transplant 2018; 18:1481-1488. [PMID: 29286569 DOI: 10.1111/ajt.14638] [Citation(s) in RCA: 18] [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: 11/27/2016] [Revised: 10/31/2017] [Accepted: 12/10/2017] [Indexed: 01/25/2023]
Abstract
The incidence of acute kidney injury (AKI) and its impact on chronic kidney disease (CKD) following pediatric nonkidney solid organ transplantation is unknown. We aimed to determine the incidence of AKI and CKD and examine their relationship among children who received a heart, lung, liver, or multiorgan transplant at the Hospital for Sick Children between 2002 and 2011. AKI was assessed in the first year posttransplant. Among 303 children, perioperative AKI (within the first week) occurred in 67% of children, and AKI after the first week occurred in 36%, with the highest incidence among lung and multiorgan recipients. Twenty-three children (8%) developed CKD after a median follow-up of 3.4 years. Less than 5 children developed end-stage renal disease, all within 65 days posttransplant. Those with 1 AKI episode by 3 months posttransplant had significantly greater risk for developing CKD after adjusting for age, sex, and estimated glomerular filtration rate at transplant (hazard ratio: 2.77, 95% confidence interval, 1.13-6.80, P trend = .008). AKI is common in the first year posttransplant and associated with significantly greater risk of developing CKD. Close monitoring for kidney disease may allow for earlier implementation of kidney-sparing strategies to decrease risk for progression to CKD.
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Affiliation(s)
- C Williams
- Department of Medicine, University of Toronto, Toronto, Canada.,Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Canada
| | - K Borges
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Canada
| | - T Banh
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Canada
| | - J Vasilevska-Ristovska
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Canada
| | - R Chanchlani
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Canada.,Division of Nephrology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, Canada.,Division of Pediatric Nephrology, Hospital for Sick Children, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - V L Ng
- Department of Medicine, University of Toronto, Toronto, Canada.,Division of Pediatric Gastroenterology Hepatology and Nutrition, Hospital for Sick Children, Toronto, Canada.,Transplant and Regenerative Medicine Centre, Hospital for Sick Children, Toronto, Canada
| | - A I Dipchand
- Department of Medicine, University of Toronto, Toronto, Canada.,Transplant and Regenerative Medicine Centre, Hospital for Sick Children, Toronto, Canada.,Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Canada
| | - M Solomon
- Department of Medicine, University of Toronto, Toronto, Canada.,Transplant and Regenerative Medicine Centre, Hospital for Sick Children, Toronto, Canada.,Division of Pediatric Respiratory Medicine, Hospital for Sick Children, Toronto, Canada
| | - D Hebert
- Department of Medicine, University of Toronto, Toronto, Canada.,Division of Pediatric Nephrology, Hospital for Sick Children, Toronto, Canada.,Transplant and Regenerative Medicine Centre, Hospital for Sick Children, Toronto, Canada
| | - S J Kim
- Department of Medicine, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Department of Medicine, University Health Network, Toronto, Canada
| | - B C Astor
- Departments of Medicine and Population Health Sciences, University of Wisconsin, Madison, WI, USA
| | - R S Parekh
- Department of Medicine, University of Toronto, Toronto, Canada.,Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Canada.,Division of Pediatric Nephrology, Hospital for Sick Children, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Department of Medicine, University Health Network, Toronto, Canada
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30
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Snanoudj R, Legendre C. Response to: "Renal allograft histology at 10 years after transplantation in the tacrolimus era: Evidence of pervasive chronic injury". Am J Transplant 2018; 18:1292. [PMID: 29194941 DOI: 10.1111/ajt.14612] [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] [Indexed: 01/25/2023]
Affiliation(s)
- Renaud Snanoudj
- Nephrology and Transplantation Department, Foch Hospital, Suresnes, France
| | - Christophe Legendre
- Nephrology and Transplantation Department, Necker Hospital, Paris, France.,University Sorbonne Paris Cité, Paris, France
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31
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Benway CJ, Iacomini J. Defining a microRNA-mRNA interaction map for calcineurin inhibitor induced nephrotoxicity. Am J Transplant 2018; 18:796-809. [PMID: 28925592 DOI: 10.1111/ajt.14503] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 08/21/2017] [Accepted: 09/04/2017] [Indexed: 02/06/2023]
Abstract
Calcineurin inhibitors induce nephrotoxicity through poorly understood mechanisms thereby limiting their use in transplantation and other diseases. Here we define a microRNA (miRNA)-messenger RNA (mRNA) interaction map that facilitates exploration into the role of miRNAs in cyclosporine-induced nephrotoxicity (CIN) and the gene pathways they regulate. Using photoactivatable ribonucleoside-enhanced crosslinking and immunoprecipitation (PAR-CLIP), we isolated RNAs associated with Argonaute 2 in the RNA-induced silencing complex (RISC) of cyclosporine A (CsA) treated and control human proximal tubule cells and identified mRNAs undergoing active targeting by miRNAs. CsA causes specific changes in miRNAs and mRNAs associated with RISC, thereby altering post-transcriptional regulation of gene expression. Pathway enrichment analysis identified canonical pathways regulated by miRNAs specifically following CsA treatment. RNA-seq performed on total RNA indicated that only a fraction of total miRNAs and mRNAs are actively targeted in the RISC, indicating that PAR-CLIP more accurately defines meaningful targeting interactions. Our data also revealed a role for miRNAs in calcineurin-independent regulation of JNK and p38 MAPKs caused by targeting of MAP3K1. Together, our data provide a novel resource and unique insights into molecular pathways regulated by miRNAs in CIN. The gene pathways and miRNAs defined may represent novel targets to reduce calcineurin induced nephrotoxicity.
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Affiliation(s)
- Christopher J Benway
- Department of Integrative Physiology and Pathobiology, Tufts University School of Medicine, Boston, MA, USA.,Graduate Program in Genetics, Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, MA, USA
| | - John Iacomini
- Department of Integrative Physiology and Pathobiology, Tufts University School of Medicine, Boston, MA, USA.,Graduate Program in Genetics, Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, MA, USA.,Graduate Program in Immunology, Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, MA, USA.,Tufts University School of Medicine, Boston, MA, USA
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32
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Affiliation(s)
- Michael Mengel
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - Mark Haas
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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33
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Affiliation(s)
- Konrad S Famulski
- University of Alberta, Edmonton, Alberta, Canada.,Alberta Transplant Applied Genomics Centre, Edmonton, Alberta, Canada
| | - Philip F Halloran
- University of Alberta, Edmonton, Alberta, Canada.,Alberta Transplant Applied Genomics Centre, Edmonton, Alberta, Canada
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34
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Del Bello A, Cointault O, Delas A, Kamar N. Recurrence of oxalate nephropathy after isolated kidney transplantation for primary hyperoxaluria type 2. Am J Transplant 2018; 18:525-526. [PMID: 29068142 DOI: 10.1111/ajt.14550] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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)
- Arnaud Del Bello
- Department of Nephrology and Organ Transplantation, CHU Rangueil Toulouse, Toulouse, France
| | - Olivier Cointault
- Department of Nephrology and Organ Transplantation, CHU Rangueil Toulouse, Toulouse, France
| | - Audrey Delas
- Department of Pathology, Institut Universitaire du Cancer, CHU Toulouse, Toulouse, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, CHU Rangueil Toulouse, Toulouse, France.,Université Paul Sabatier Toulouse, Toulouse, France.,INSERM U1043, IFR-BMT, CHU Purpan, CHU Toulouse, Toulouse, France
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35
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Meier RPH, Piller V, Hagen ME, Joliat C, Buchs J, Nastasi A, Ruttimann R, Buchs NC, Moll S, Vallée J, Lazeyras F, Morel P, Bühler L. Intra-Abdominal Cooling System Limits Ischemia-Reperfusion Injury During Robot-Assisted Renal Transplantation. Am J Transplant 2018; 18:53-62. [PMID: 28637093 PMCID: PMC5763420 DOI: 10.1111/ajt.14399] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 03/24/2017] [Revised: 06/04/2017] [Accepted: 06/14/2017] [Indexed: 01/25/2023]
Abstract
Robot-assisted kidney transplantation is feasible; however, concerns have been raised about possible increases in warm ischemia times. We describe a novel intra-abdominal cooling system to continuously cool the kidney during the procedure. Porcine kidneys were procured by standard open technique. Groups were as follows: Robotic renal transplantation with (n = 11) and without (n = 6) continuous intra-abdominal cooling and conventional open technique with intermittent 4°C saline cooling (n = 6). Renal cortex temperature, magnetic resonance imaging, and histology were analyzed. Robotic renal transplantation required a longer anastomosis time, either with or without the cooling system, compared to the open approach (70.4 ± 17.7 min and 74.0 ± 21.5 min vs. 48.7 ± 11.2 min, p-values < 0.05). The temperature was lower in the robotic group with cooling system compared to the open approach group (6.5 ± 3.1°C vs. 22.5 ± 6.5°C; p = 0.001) or compared to the robotic group without the cooling system (28.7 ± 3.3°C; p < 0.001). Magnetic resonance imaging parenchymal heterogeneities and histologic ischemia-reperfusion lesions were more severe in the robotic group without cooling than in the cooled (open and robotic) groups. Robot-assisted kidney transplantation prolongs the warm ischemia time of the donor kidney. We developed a novel intra-abdominal cooling system that suppresses the noncontrolled rewarming of donor kidneys during the transplant procedure and prevents ischemia-reperfusion injuries.
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Affiliation(s)
- R. P. H. Meier
- Visceral and Transplant SurgeryDepartment of SurgeryGeneva University Hospitals and Medical SchoolGenevaSwitzerland
| | - V. Piller
- Visceral and Transplant SurgeryDepartment of SurgeryGeneva University Hospitals and Medical SchoolGenevaSwitzerland
| | - M. E. Hagen
- Visceral and Transplant SurgeryDepartment of SurgeryGeneva University Hospitals and Medical SchoolGenevaSwitzerland
| | - C. Joliat
- Visceral and Transplant SurgeryDepartment of SurgeryGeneva University Hospitals and Medical SchoolGenevaSwitzerland
| | - J.‐B. Buchs
- Visceral and Transplant SurgeryDepartment of SurgeryGeneva University Hospitals and Medical SchoolGenevaSwitzerland
| | - A. Nastasi
- Visceral and Transplant SurgeryDepartment of SurgeryGeneva University Hospitals and Medical SchoolGenevaSwitzerland
| | - R. Ruttimann
- Visceral and Transplant SurgeryDepartment of SurgeryGeneva University Hospitals and Medical SchoolGenevaSwitzerland
| | - N. C. Buchs
- Visceral and Transplant SurgeryDepartment of SurgeryGeneva University Hospitals and Medical SchoolGenevaSwitzerland
| | - S. Moll
- Division of Clinical PathologyDepartment of Pathology and ImmunologyGeneva University Hospital and Medical SchoolGenevaSwitzerland
| | - J.‐P. Vallée
- Department of Radiology and Medical InformaticsFaculty of MedicineUniversity of GenevaGenevaSwitzerland
| | - F. Lazeyras
- Department of Radiology and Medical InformaticsFaculty of MedicineUniversity of GenevaGenevaSwitzerland
| | - P. Morel
- Visceral and Transplant SurgeryDepartment of SurgeryGeneva University Hospitals and Medical SchoolGenevaSwitzerland
| | - L. Bühler
- Visceral and Transplant SurgeryDepartment of SurgeryGeneva University Hospitals and Medical SchoolGenevaSwitzerland
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36
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Dhondup T, Lorenz EC, Milliner DS, Lieske JC. Combined Liver-Kidney Transplantation for Primary Hyperoxaluria Type 2: A Case Report. Am J Transplant 2018; 18:253-257. [PMID: 28681512 PMCID: PMC5739996 DOI: 10.1111/ajt.14418] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [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: 01/17/2017] [Revised: 06/16/2017] [Accepted: 06/18/2017] [Indexed: 01/25/2023]
Abstract
Combined liver/kidney transplant is the preferred transplant option for most patients with primary hyperoxaluria type 1 (PH1) since orthotopic liver transplantation replaces the deficient liver-specific AGT enzyme, thus restoring normal metabolic oxalate production. However, primary hyperoxaluria type 2 (PH2) is caused by deficient glyoxylate reductase/hydroxypyruvate reductase (GRHPR), and this enzyme is widely distributed throughout the body. Though the relative abundance and activity of GRHPR in various tissues is not clear, some evidence suggests that the majority of enzyme activity may indeed reside within the liver. Thus the effectiveness of liver transplantation in correcting this metabolic disorder has not been demonstrated. Here we report a case of 44-year-old man with PH2, frequent stone events, and end-stage renal disease; he received a combined liver/kidney transplant. Although requiring confirmation in additional cases, the normalization of plasma oxalate, urine oxalate, and urine glycerate levels observed in this patient within a month of the transplant that remain reduced at the most recent follow-up at 13 months suggests that correction of the GRHPR deficiency in PH2 can be achieved by liver transplantation.
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Affiliation(s)
- Tsering Dhondup
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | | | - Dawn S. Milliner
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - John C. Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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37
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Bertrand D, Cheddani L, Etienne I, François A, Hanoy M, Laurent C, Lebourg L, Le Roy F, Lelandais L, Loron MC, Godin M, Guerrot D. Belatacept Rescue Therapy in Kidney Transplant Recipients With Vascular Lesions: A Case Control Study. Am J Transplant 2017; 17:2937-2944. [PMID: 28707779 DOI: 10.1111/ajt.14427] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 02/16/2017] [Revised: 06/02/2017] [Accepted: 07/06/2017] [Indexed: 02/07/2023]
Abstract
Immunosuppression in kidney transplant recipients with decreased graft function and severe histological vascular changes can be particularly challenging. Belatacept could be a valuable option, as a rescue therapy in this context. We report a retrospective case control study comparing a CNI to belatacept switch in 17 patients with vascular damage and low eGFR to a control group of 18 matched patients with CNI continuation. Belatacept switch was performed on average 51.5 months after kidney transplantation (6.2-198 months). There was no difference between the two groups regarding eGFR at inclusion, and 3 months before inclusion. In the "CNI to belatacept switch group," mean eGFR increased significantly from 23.5 ± 6.7 mL/min/1.73m2 on day 0, to 30.4 ± 9.1 mL/min/1.73 m2 on month 6 (p < 0.001) compared to the control group, in which no improvement was observed. These results were still significant on month 12. Two patients experienced biopsy-proven acute rejection. One was effectively treated without belatacept discontinuation. Two patients needed belatacept discontinuation for infection. In conclusion, the remplacement of CNI with belatacept in patients with decreased allograft function and vascular lesions is associated with an improvement in eGFR.
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Affiliation(s)
- D Bertrand
- Department of Nephrology and Transplantation Centre, Rouen, France
| | - L Cheddani
- Department of Nephrology and Transplantation Centre, Rouen, France
| | - I Etienne
- Department of Nephrology and Transplantation Centre, Rouen, France
| | - A François
- Department of Anatomy and Pathology, University Hospital, Rouen, France
| | - M Hanoy
- Department of Nephrology and Transplantation Centre, Rouen, France
| | - C Laurent
- Department of Nephrology and Transplantation Centre, Rouen, France
| | - L Lebourg
- Department of Nephrology and Transplantation Centre, Rouen, France
| | - F Le Roy
- Department of Nephrology and Transplantation Centre, Rouen, France
| | - L Lelandais
- Department of Nephrology and Transplantation Centre, Rouen, France
| | - M C Loron
- Department of Nephrology and Transplantation Centre, Rouen, France
| | - M Godin
- Department of Nephrology and Transplantation Centre, Rouen, France
| | - D Guerrot
- Department of Nephrology and Transplantation Centre, Rouen, France
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38
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Dharancy S, Coilly A, Fougerou-Leurent C, Duvoux C, Kamar N, Leroy V, Tran A, Houssel-Debry P, Canva V, Moreno C, Conti F, Dumortier J, Di Martino V, Radenne S, De Ledinghen V, D'Alteroche L, Silvain C, Besch C, Perré P, Botta-Fridlund D, Francoz C, Habersetzer F, Montialoux H, Abergel A, Debette-Gratien M, Rohel A, Rossignol E, Samuel D, Duclos-Vallée JC, Pageaux GP. Direct-acting antiviral agent-based regimen for HCV recurrence after combined liver-kidney transplantation: Results from the ANRS CO23 CUPILT study. Am J Transplant 2017; 17:2869-2878. [PMID: 28898563 DOI: 10.1111/ajt.14490] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 08/16/2017] [Accepted: 08/20/2017] [Indexed: 01/25/2023]
Abstract
Hepatitis C virus (HCV) infection is associated with reduced patient survival following combined liver-kidney transplantation (LKT). The aim of this study was to assess the efficacy and safety of second-generation direct-acting antivirals (DAAs) in this difficult-to-treat population. The ANRS CO23 "Compassionate use of Protease Inhibitors in Viral C Liver Transplantation" (CUPILT) study is a prospective cohort including transplant recipients with recurrent HCV infection treated with DAAs. The present work focused on recipients with recurrent infection following LKT. The study population included 23 patients. All patients received at least one NS5B inhibitor (sofosbuvir) in their antiviral regimen an average of 90 months after LKT. Ninety-six percent of recipients achieved a sustained virological response (SVR) at week 12 (SVR12). In terms of tolerance, 39% of recipients presented with at least one serious adverse event. None of the patients experienced acute rejection during therapy and there were no deaths during follow-up. The glomerular filtration rate (GFR) decreased significantly from baseline to the end of therapy. However, this study did not show that the decline in GFR persisted over time or that it was directly related to DAAs. The DAA-based regimen is well tolerated with excellent results in terms of efficacy. It will become the gold standard for the treatment of recurrent HCV following LKT.
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Affiliation(s)
- Sébastien Dharancy
- CHRU Lille, Hepatology Unit, Claude Huriez Hospital, CHRU Lille, Lille, France
| | - Audrey Coilly
- Hepatobiliary Center, AP-HP Paul Brousse Hospital, Villejuif, France.,Paris Sud University, Paris Sud Saclay University, UMR-S 1193, Villejuif, France.,INSERM, Unité 1193, Villejuif, France.,DHU Hepatinov, Villejuif, France
| | - Claire Fougerou-Leurent
- INSERM, CIC 1414 Clinical Investigation Center, Rennes, France.,Pharmacology Unit, CHU Rennes, Rennes, France
| | | | - Nassim Kamar
- Nephrology and Organ Transplantation Unit, CHU Rangueil, INSERM U1043, IFR-BMT, Paul Sabatier University, Toulouse, France
| | - Vincent Leroy
- Hepato-Gastroenterolgy Unit, Pôle Digidune, CHU Grenoble, Grenoble, France
| | - Albert Tran
- Hepatogastroenterology Unit, Nice University Hospital, INSERM, U1065, Equipe 8, Nice Sophia Antipolis University, Faculty of Medicine, Nice, Cedex 2, France
| | - Pauline Houssel-Debry
- Hepatology and Liver Transplant Unit, Pontchaillou University Hospital, Rennes, France
| | - Valérie Canva
- CHRU Lille, Hepatology Unit, Claude Huriez Hospital, CHRU Lille, Lille, France
| | - Christophe Moreno
- Hepatogastroenterology Unit, CUB Hôpital Erasme, Brussels University, Bruxelles, Belgique
| | - Filoména Conti
- Hepatology and Liver Transplant Unit, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Jérome Dumortier
- Liver Transplant Unit, Digestive Diseases Federation, Edouard Herriot Hospital, Hospices Civils de Lyon Université Claude Bernard Lyon 1, Lyon, France
| | - Vincent Di Martino
- Hepatology Unit, CHRU Jean Minjoz Franche Comté University, Besançon, France
| | - Sylvie Radenne
- Hepatology Unit, HCL, Hôpital de la Croix-Rousse, Lyon, France
| | - Victor De Ledinghen
- Hepatogastroenterology Unit, Haut Leveque Hospital, CHU Bordeaux & INSERM U1053, Bordeaux, France
| | | | | | - Camille Besch
- Liver Transplant and Digestive Surgery Unit, Strasbourg University, Strasbourg, France
| | - Philippe Perré
- Infectious Diseases Unit, CHD Vendée, La Roche sur Yon, France
| | | | - Claire Francoz
- Hepatology Unit, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - François Habersetzer
- Universitary Hospitals of Strasbourg, Inserm U 1110, LabEx HepSYS, Strasbourg University, Strasbourg, France
| | | | - Armand Abergel
- Hepatogastroenterology Unit, CHU Estaing Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Alexandra Rohel
- Unité de recherche Clinique et Fondamentale sur les Hépatites Virales, ANRS (France REcherche Nord&sud Sida-hiv Hépatites), Paris, France
| | - Emilie Rossignol
- INSERM, CIC 1414 Clinical Investigation Center, Rennes, France.,Pharmacology Unit, CHU Rennes, Rennes, France
| | - Didier Samuel
- Hepatobiliary Center, AP-HP Paul Brousse Hospital, Villejuif, France.,Paris Sud University, Paris Sud Saclay University, UMR-S 1193, Villejuif, France.,INSERM, Unité 1193, Villejuif, France.,DHU Hepatinov, Villejuif, France
| | - Jean-Charles Duclos-Vallée
- Hepatobiliary Center, AP-HP Paul Brousse Hospital, Villejuif, France.,Paris Sud University, Paris Sud Saclay University, UMR-S 1193, Villejuif, France.,INSERM, Unité 1193, Villejuif, France.,DHU Hepatinov, Villejuif, France
| | - Georges-Philippe Pageaux
- Liver transplant and Hepatogastroenterology Unit, CHU Saint-Eloi, Montpellier University, Montpellier, France
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39
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Kulkarni S, Kirkiles-Smith NC, Deng YH, Formica RN, Moeckel G, Broecker V, Bow L, Tomlin R, Pober JS. Eculizumab Therapy for Chronic Antibody-Mediated Injury in Kidney Transplant Recipients: A Pilot Randomized Controlled Trial. Am J Transplant 2017; 17:682-691. [PMID: 27501352 DOI: 10.1111/ajt.14001] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [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: 01/29/2016] [Revised: 07/24/2016] [Accepted: 07/24/2016] [Indexed: 01/25/2023]
Abstract
We hypothesized that de novo donor-specific antibody (DSA) causes complement-dependent endothelial cell injury in kidney transplants, as assessed by expression of endothelial cell-associated transcripts (ENDATs), that may be attenuated through complement inhibition. In total, 15 participants (five control, 10 treatment) with DSA and deteriorating renal function were enrolled. The treatment group received 6 mo of eculizumab followed by 6 mo of observation, whereas controls were observed. The primary end point was percentage change in estimated GFR (eGFR) trajectory over the treatment period. The treatment group had an improved eGFR trajectory versus control, based on our predetermined two-sided 0.10 significance level (p = 0.09). Within-subject analysis of treated participants at 6-mo intervals did not show significant change (p = 0.60). Modeling C1q status showed that C1q-positive patients had significantly higher mean eGFR than patients with negative C1q (p = 0.04). Biopsies revealed elevated renal ENDATs in most participants, but ENDATs were not reduced with complement inhibition. Our data suggest that eculizumab treatment may stabilize kidney function in patients with chronic persistent DSA based on our pilot a priori significance threshold. ENDAT expression predicative of acute humoral injury is not reduced with complement inhibition in this chronic setting. Further studies will be necessary to determine which patients may benefit from eculizumab.
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Affiliation(s)
- S Kulkarni
- Department of Surgery, Yale School of Medicine, New Haven, CT.,Department of Medicine, Yale School of Medicine, New Haven, CT
| | | | - Y H Deng
- Center for Analytical Science, Yale School of Public Health, New Haven, CT
| | - R N Formica
- Department of Surgery, Yale School of Medicine, New Haven, CT.,Department of Medicine, Yale School of Medicine, New Haven, CT
| | - G Moeckel
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | - V Broecker
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - L Bow
- Department of Surgery, Yale School of Medicine, New Haven, CT
| | - R Tomlin
- Department of Surgery, Yale School of Medicine, New Haven, CT
| | - J S Pober
- Department of Immunobiology, Yale School of Medicine, New Haven, CT.,Department of Pathology, Yale School of Medicine, New Haven, CT
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40
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Liapis H, Gaut JP, Klein C, Bagnasco S, Kraus E, Farris AB, Honsova E, Perkowska‐Ptasinska A, David D, Goldberg J, Smith M, Mengel M, Haas M, Seshan S, Pegas KL, Horwedel T, Paliwa Y, Gao X, Landsittel D, Randhawa P. Banff Histopathological Consensus Criteria for Preimplantation Kidney Biopsies. Am J Transplant 2017; 17:140-150. [PMID: 27333454 PMCID: PMC6139430 DOI: 10.1111/ajt.13929] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [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: 01/08/2016] [Revised: 06/14/2016] [Accepted: 06/15/2016] [Indexed: 01/25/2023]
Abstract
The Banff working group on preimplantation biopsy was established to develop consensus criteria (best practice guidelines) for the interpretation of preimplantation kidney biopsies. Digitally scanned slides were used (i) to evaluate interobserver variability of histopathologic findings, comparing frozen sections with formalin-fixed, paraffin-embedded tissue of wedge and needle core biopsies, and (ii) to correlate consensus histopathologic findings with graft outcome in a cohort of biopsies from international medical centers. Intraclass correlations (ICCs) and univariable and multivariable statistical analyses were performed. Good to fair reproducibility was observed in semiquantitative scores for percentage of glomerulosclerosis, arterial intimal fibrosis and interstitial fibrosis on frozen wedge biopsies. Evaluation of frozen wedge and core biopsies was comparable for number of glomeruli, but needle biopsies showed worse ICCs for glomerulosclerosis, interstitial fibrosis and tubular atrophy. A consensus evaluation form is provided to help standardize the reporting of histopathologic lesions in donor biopsies. It should be recognized that histologic parameters may not correlate with graft outcome in studies based on organs deemed to be acceptable after careful clinical assessment. Significant limitations remain in the assessment of implantation biopsies.
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Affiliation(s)
- H. Liapis
- Department of Pathology & ImmunologyWashington University School of MedicineSt LouisMO,NephropathLittle RockAR
| | - J. P. Gaut
- Department of Pathology & ImmunologyWashington University School of MedicineSt LouisMO
| | | | - S. Bagnasco
- Department of Pathology & Internal MedicineJohns Hopkins University HospitalBaltimoreMD
| | - E. Kraus
- Department of Pathology & Internal MedicineJohns Hopkins University HospitalBaltimoreMD
| | | | | | | | - D. David
- University of Sao PauloRenal Transplant ServiceSao PauloBrazil
| | - J. Goldberg
- INCUCAI (Argentinian Nacional Institute for procurement and Implants) and CUCAIBA (Buenos Aires Inst of procurement and implants)Buenos AiresArgentina
| | | | - M. Mengel
- Department of PathologyUniversity of AlbertaAlbertaCanada
| | - M. Haas
- Cedars‐Sinai Medical CenterDepartment of Pathology & Lab MedicineLos AngelesCA
| | - S. Seshan
- Department of PathologyCornell UniversityNew YorkNY
| | - K. L. Pegas
- Santa Casa de Misericordia de Porto Alegre Hospital and Universidade Federal de Ciências da Saúde de Porto AlegreRio Grande do SulBrazil
| | - T. Horwedel
- Department of PharmacyBarnes‐Jewish HospitalSaint LouisMO
| | - Y. Paliwa
- Department of PathologyUniversity of PittsburghThomas E Starzl Transplant InstitutePittsburghPA
| | - X. Gao
- Department of PathologyUniversity of PittsburghThomas E Starzl Transplant InstitutePittsburghPA
| | - D. Landsittel
- Department of PathologyUniversity of PittsburghThomas E Starzl Transplant InstitutePittsburghPA
| | - P. Randhawa
- Department of PathologyUniversity of PittsburghThomas E Starzl Transplant InstitutePittsburghPA
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41
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Rose C, Gill J, Zalunardo N, Johnston O, Mehrotra A, Gill JS. Timing of Pregnancy After Kidney Transplantation and Risk of Allograft Failure. Am J Transplant 2016; 16:2360-7. [PMID: 26946063 DOI: 10.1111/ajt.13773] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [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: 06/05/2015] [Revised: 02/12/2016] [Accepted: 02/12/2016] [Indexed: 01/25/2023]
Abstract
The optimal timing of pregnancy after kidney transplantation remains uncertain. We determined the risk of allograft failure among women who became pregnant within the first 3 posttransplant years. Among 21 814 women aged 15-45 years who received a first kidney-only transplant between 1990 and 2010 captured in the United States Renal Data System, n = 729 pregnancies were identified using Medicare claims. The probability of allograft failure from any cause including death (ACGL) at 1, 3, and 5 years after pregnancy was 9.6%, 25.9%, and 36.6%. In multivariate analyses, pregnancy in the first posttransplant year was associated with an increased risk of ACGL (hazard ratio [HR]: 1.18; 95% confidence interval [CI] 1.00, 1.40) and death censored graft loss (DCGL) (HR:1.25; 95% CI 1.04, 1.50), while pregnancy in the second posttransplant year was associated with an increased risk of DCGL (HR: 1.26; 95% CI 1.06, 1.50). Pregnancy in the third posttransplant year was not associated with an increased risk of ACGL or DCGL. These findings demonstrate a higher incidence of allograft failure after pregnancy than previously reported and that the increased risk of allograft failure extends to pregnancies in the second posttransplant year.
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Affiliation(s)
- C Rose
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - J Gill
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcomes Sciences, University of British Columbia, Vancouver, Canada
| | - N Zalunardo
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - O Johnston
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Mehrotra
- Division of Nephrology, Mount Sinai School of Medicine, New York, NY
| | - J S Gill
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcomes Sciences, University of British Columbia, Vancouver, Canada.,Tufts-New England Medical Center, Boston, MA
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42
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Cameron AM, Wesson RN, Ahmadi AR, Singer AL, Hu X, Okabayashi T, Wang Y, Shigoka M, Fu Y, Gao W, Raccusen LC, Montgomery RA, Williams GM, Sun Z. Chimeric Allografts Induced by Short-Term Treatment With Stem Cell Mobilizing Agents Result in Long-Term Kidney Transplant Survival Without Immunosuppression: II, Study in Miniature Swine. Am J Transplant 2016; 16:2066-76. [PMID: 26748958 DOI: 10.1111/ajt.13703] [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: 08/13/2015] [Revised: 12/21/2015] [Accepted: 12/27/2015] [Indexed: 01/25/2023]
Abstract
Transplantation is now lifesaving therapy for patients with end-stage organ failure but requires lifelong immunosuppression with resultant morbidity. Current immunosuppressive strategies inhibit T cell activation and prevent donor-recipient engagement. Therefore, it is not surprising that few host cells are demonstrated in donor grafts. However, our recent small animal studies found large numbers of recipient stem cells present after transplantation and pharmacological mobilization, resulting in a chimeric, repopulated organ. We now confirm these findings in a well-characterized large animal preclinical model. Here, we show that AMD3100 and FK506 mobilization of endogenous stem cells immediately post kidney transplantation combined with repeat therapy at 1, 2, and 3 months led to drug-free long-term survival in maximally immunologically mismatched swine. Three long-term recipients have stable chimeric transplants, preserved antidonor skin graft responses, and normal serum creatinine levels despite withdrawal of all medication for 3 years.
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Affiliation(s)
- A M Cameron
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - R N Wesson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - A R Ahmadi
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - A L Singer
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Transplant Center, Mayo Clinic, Phoenix, AZ, USA
| | - X Hu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - T Okabayashi
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Surgery, Kochi Health Center, Kochi University, Kochi, Japan
| | - Y Wang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - M Shigoka
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Y Fu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Transplant Center, Tianjin First Central Hospital, Tianjin, China
| | - W Gao
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Transplant Center, Tianjin First Central Hospital, Tianjin, China
| | - L C Raccusen
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - R A Montgomery
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - G M Williams
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Z Sun
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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43
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Boyarsky BJ, Durand CM, Palella FJ, Segev DL. Challenges and Clinical Decision-Making in HIV-to-HIV Transplantation: Insights From the HIV Literature. Am J Transplant 2015; 15:2023-30. [PMID: 26080612 DOI: 10.1111/ajt.13344] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 03/23/2015] [Accepted: 04/04/2015] [Indexed: 01/25/2023]
Abstract
Life expectancy among HIV-infected (HIV+) individuals has improved dramatically with effective antiretroviral therapy. Consequently, chronic diseases such as end-stage liver and kidney disease are growing causes of morbidity and mortality. HIV+ individuals can have excellent outcomes after solid organ transplantation, and the need for transplantation in this population is increasing. However, there is a significant organ shortage, and HIV+ individuals experience higher mortality rates on transplant waitlists. In South Africa, the use of organs from HIV+ deceased donors (HIVDD) has been successful, but until recently federal law prohibited this practice in the United States. With the recognition that organs from HIVDD could fill a critical need, the HIV Organ Policy Equity (HOPE) Act was passed in November 2013, reversing the federal ban on the use of HIV+ donors for HIV+ recipients. In translating this policy into practice, the biologic risks of using HIV+ donors need to be carefully considered. In this mini-review, we explore relevant aspects of HIV virology, antiretroviral treatment, drug resistance, opportunistic infections and HIV-related organ dysfunction that are critical to a transplant team considering HIV-to-HIV transplantation.
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Affiliation(s)
- B J Boyarsky
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - C M Durand
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - F J Palella
- Department of Medicine, Feinberg School of Medicine, Northwestern University Chicago, Chicago, IL
| | - D L Segev
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
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44
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Yuan J, Benway CJ, Bagley J, Iacomini J. MicroRNA-494 promotes cyclosporine-induced nephrotoxicity and epithelial to mesenchymal transition by inhibiting PTEN. Am J Transplant 2015; 15:1682-91. [PMID: 25854542 DOI: 10.1111/ajt.13161] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [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: 12/08/2014] [Accepted: 12/11/2014] [Indexed: 01/25/2023]
Abstract
A major complication associated with cyclosporine (CsA) treatment is nephrotoxicity. In this study, we examined whether microRNAs play a role in cyclosporine-induced nephrotoxicity. Treatment of mice with CsA resulted in nephrotoxicity that was associated with an early increase in expression of microRNA mmu-miR-494 (miR-494). Similarly, tubular epithelial cell epithelial-mesenchymal transition (EMT) induced by CsA toxicity resulted in the upregulation of microRNA-494 and a decrease in PTEN levels in vitro. miR-494 directly targeted Pten and negatively regulated its expression. Preventing Pten targeting by miR-494 was sufficient to prevent CsA induced EMT. Knockdown of miR-494 prevented the downregulation of PTEN in tubular epithelial cells following CsA treatment and also prevented CsA induced EMT. Thus, miR-494 plays a major role in promoting CsA induced nephrotoxicity through its ability to target Pten thereby contributing to EMT. We suggest that manipulating miR-494 expression may represent a novel approach to preventing EMT associated with CsA induced nephrotoxicity.
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Affiliation(s)
- J Yuan
- Department of Developmental, Molecular and Chemical Biology, Tufts University School of Medicine, Boston, MA
| | - C J Benway
- Department of Developmental, Molecular and Chemical Biology, Tufts University School of Medicine, Boston, MA.,Sackler School of Biomedical Sciences Programs in Immunology and Genetics, Boston, MA
| | - J Bagley
- Department of Developmental, Molecular and Chemical Biology, Tufts University School of Medicine, Boston, MA
| | - J Iacomini
- Department of Developmental, Molecular and Chemical Biology, Tufts University School of Medicine, Boston, MA.,Sackler School of Biomedical Sciences Programs in Immunology and Genetics, Boston, MA
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45
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Hall IE, Schröppel B, Doshi MD, Ficek J, Weng FL, Hasz RD, Thiessen-Philbrook H, Reese PP, Parikh CR. Associations of deceased donor kidney injury with kidney discard and function after transplantation. Am J Transplant 2015; 15:1623-31. [PMID: 25762442 PMCID: PMC4563988 DOI: 10.1111/ajt.13144] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [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: 10/12/2014] [Revised: 12/01/2014] [Accepted: 12/02/2014] [Indexed: 02/06/2023]
Abstract
Deceased donor kidneys with acute kidney injury (AKI) are often discarded due to fear of poor outcomes. We performed a multicenter study to determine associations of AKI (increasing admission-to-terminal serum creatinine by AKI Network stages) with kidney discard, delayed graft function (DGF) and 6-month estimated glomerular filtration rate (eGFR). In 1632 donors, kidney discard risk increased for AKI stages 1, 2 and 3 (compared to no AKI) with adjusted relative risks of 1.28 (1.08-1.52), 1.82 (1.45-2.30) and 2.74 (2.0-3.75), respectively. Adjusted relative risk for DGF also increased by donor AKI stage: 1.27 (1.09-1.49), 1.70 (1.37-2.12) and 2.25 (1.74-2.91), respectively. Six-month eGFR, however, was similar across AKI categories but was lower for recipients with DGF (48 [interquartile range: 31-61] vs. 58 [45-75] ml/min/1.73m(2) for no DGF, p < 0.001). There was significant favorable interaction between donor AKI and DGF such that 6-month eGFR was progressively better for DGF kidneys with increasing donor AKI (46 [29-60], 49 [32-64], 52 [36-59] and 58 [39-71] ml/min/1.73m(2) for no AKI, stage 1, 2 and 3, respectively; interaction p = 0.05). Donor AKI is associated with kidney discard and DGF, but given acceptable 6-month allograft function, clinicians should consider cautious expansion into this donor pool.
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Affiliation(s)
- Isaac E. Hall
- Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, CT,Section of Nephrology, Yale University School of Medicine, New Haven, CT
| | - Bernd Schröppel
- Section of Nephrology, Department of Internal Medicine 1, University Hospital, Ulm, Germany
| | | | - Joseph Ficek
- Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, CT
| | | | | | | | | | - Chirag R. Parikh
- Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, CT,Section of Nephrology, Yale University School of Medicine, New Haven, CT,Veterans Affairs Connecticut Healthcare System, New Haven, CT
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46
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Levine MH, Wang Z, Bhatti TR, Wang Y, Aufhauser DD, McNeal S, Liu Y, Cheraghlou S, Han R, Wang L, Hancock WW. Class-specific histone/protein deacetylase inhibition protects against renal ischemia reperfusion injury and fibrosis formation. Am J Transplant 2015; 15:965-73. [PMID: 25708614 PMCID: PMC5493154 DOI: 10.1111/ajt.13106] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [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: 06/20/2014] [Revised: 11/11/2014] [Accepted: 11/13/2014] [Indexed: 01/25/2023]
Abstract
Renal ischemia-reperfusion injury (IRI) is a common cause of renal dysfunction and renal failure. Histone/protein deacetylases (HDACs) regulate gene accessibility and higher order protein structures and may alter cellular responses to a variety of stresses. We investigated whether use of pan- and class-specific HDAC inhibitors (HDACi) could improve IRI tolerance in the kidney. Using a model of unilateral renal IRI, we investigated early renal function after IRI, and calculated fibrosis after IRI using an automated scoring system. We found that pan-HDAC inhibition using trichostatin (TSA) yielded significant renal functional benefit at 24-96 hours (p < 0.001). Treated mice developed significantly less fibrosis at 30 days (p < 0.0004). Class I HDAC inhibition with MS-275 yielded similar effects. Protection from fibrosis formation was also noted in a cold ischemia transplant model (p < 0.008) with a trend toward improved cold ischemic survival in TSA-treated mice. These effects were not accompanied by induction of typical ischemic tolerance pathways or by priming of heat shock protein expression. In fact, heat shock protein 70 deletion or overexpression did not alter renal ischemia tolerance. Micro-RNA 21, known to be enhanced in vitro in renal tubular cells that survive stress, was enhanced by treatment with HDACi, pointing to possible mechanism.
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Affiliation(s)
- M. H. Levine
- Department of Surgery, Transplant Surgery, University of Pennsylvania, Philadelphia, PA,Department of Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Z. Wang
- Department of Surgery, Transplant Surgery, University of Pennsylvania, Philadelphia, PA
| | - T. R. Bhatti
- Department of Pathology and Laboratory Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Y. Wang
- Department of Surgery, Transplant Surgery, University of Pennsylvania, Philadelphia, PA
| | - D. D. Aufhauser
- Department of Surgery, Transplant Surgery, University of Pennsylvania, Philadelphia, PA
| | - S. McNeal
- Department of Surgery, Transplant Surgery, University of Pennsylvania, Philadelphia, PA
| | - Y. Liu
- Department of Pathology and Laboratory Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - S. Cheraghlou
- Department of Surgery, Transplant Surgery, University of Pennsylvania, Philadelphia, PA
| | - R. Han
- Department of Pathology and Laboratory Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - L. Wang
- Department of Pathology and Laboratory Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - W. W. Hancock
- Department of Pathology and Laboratory Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA,Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA
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47
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Charbit-Henrion F, Lacaille F, McKiernan P, Girard M, de Lonlay P, Valayannopoulos V, Ottolenghi C, Chakrapani A, Preece M, Sharif K, Chardot C, Hubert P, Dupic L. Early and late complications after liver transplantation for propionic acidemia in children: a two centers study. Am J Transplant 2015; 15:786-91. [PMID: 25683683 DOI: 10.1111/ajt.13027] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [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: 05/29/2014] [Revised: 09/10/2014] [Accepted: 09/14/2014] [Indexed: 01/25/2023]
Abstract
Propionic acidemia (PA) is a severe metabolic disorder with cardiac and neurologic complications and a poor quality of life. Liver transplantation (LT) was thus proposed in PA to increase enzyme activity. We studied retrospectively LT in PA in two European centers. Twelve patients underwent 17 LTs between 1991 and 2013. They developed severe, unusual and unexpected complications, with high mortality (58%). When present, the cardiomyopathy resolved and no acute metabolic decompensation occurred allowing dietary relaxation. Renal failure was present in half of the patients before LT and worsened in all of them. We suggest that cardiac and renal functions should be assessed before LT and monitored closely afterward. A renal sparing immunosuppression should be used. We speculate that some complications may be related to accumulated toxicity of the disease and that earlier LT could prevent some of these consequences. As kidney transplantation has been performed successfully in methylmalonic acidemia, a metabolic disease in the same biochemical pathway, the choice of the organ to transplant could be further discussed.
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Affiliation(s)
- F Charbit-Henrion
- Laboratory of Intestinal Immunity, Unité INSERM UMR1163, Institut IMAGINE, Paris, France
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