101
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Kummrow M, Hiho S, Hudson F, Cantwell L, Mulley WR, D'Orsogna L, Testro A, Pavlovic J, MacDonald P, Sullivan LC, Snell GI, Westall GP. Transfer of donor anti-HLA antibody expression to multiple transplant recipients: A potential variant of the passenger lymphocyte syndrome? Am J Transplant 2019; 19:1577-1581. [PMID: 30653828 DOI: 10.1111/ajt.15262] [Citation(s) in RCA: 5] [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: 11/25/2018] [Revised: 12/26/2018] [Accepted: 01/06/2019] [Indexed: 01/25/2023]
Abstract
Antibody-mediated rejection, whereby transplant recipient B cells and/or plasma cells produce alloreactive anti-human leukocyte antigen (HLA) antibodies, negatively influences transplant outcomes and is a major contributor to graft loss. An early humoral immune response is suggested by the production of anti-HLA donor-specific antibodies (DSA) that can be measured using solid phase assays. We report the early posttransplant coexistence of a shared anti-HLA antibody profile in 5 solid organ transplant recipients who received organs from the same donor. Retrospective analysis of the donor's serum confirmed the presence of the same anti-HLA profile, suggesting the transfer of donor-derived anti-HLA antibodies, or the cells that produce them, to multiple solid organ transplant recipients. The time frame and extent of transfer suggest a novel variant of the passenger lymphocyte syndrome. These findings have important implications for the consideration of all posttransplant antibody measurements, particularly the interpretation of non-DSAs in the sera of transplant recipients.
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Affiliation(s)
- Megan Kummrow
- Victorian Transplantation and Immunogenetics Service, Australian Red Cross Blood Service, Melbourne, Victoria, Australia
| | - Steven Hiho
- Victorian Transplantation and Immunogenetics Service, Australian Red Cross Blood Service, Melbourne, Victoria, Australia.,Lung Transplant Service, Alfred Hospital, Melbourne, Victoria, Australia
| | - Fiona Hudson
- Victorian Transplantation and Immunogenetics Service, Australian Red Cross Blood Service, Melbourne, Victoria, Australia
| | - Linda Cantwell
- Victorian Transplantation and Immunogenetics Service, Australian Red Cross Blood Service, Melbourne, Victoria, Australia
| | - William R Mulley
- Department of Nephrology, Monash Medical Centre, Clayton, Victoria, Australia
| | - Lloyd D'Orsogna
- Department of Clinical Immunology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Adam Testro
- Liver Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia
| | - Julie Pavlovic
- Liver Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia
| | - Peter MacDonald
- Heart Transplant Service, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Lucy C Sullivan
- Lung Transplant Service, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Gregory I Snell
- Lung Transplant Service, Alfred Hospital, Melbourne, Victoria, Australia
| | - Glen P Westall
- Lung Transplant Service, Alfred Hospital, Melbourne, Victoria, Australia
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102
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Triplette M, Crothers K, Mahale P, Yanik EL, Valapour M, Lynch CF, Schabath MB, Castenson D, Engels EA. Risk of lung cancer in lung transplant recipients in the United States. Am J Transplant 2019; 19:1478-1490. [PMID: 30565414 PMCID: PMC6872188 DOI: 10.1111/ajt.15181] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 10/23/2018] [Accepted: 11/06/2018] [Indexed: 01/25/2023]
Abstract
Lung transplant recipients have an increased risk of lung cancer that is poorly understood. Prior studies are largely descriptive and single-center, and have not examined risk factors or outcomes in this population. This registry-linkage study utilized matched transplant and cancer registry data from 17 US states/regions during 1987-2012. We used standardized incidence ratios (SIRs) to compare incidence with the general population, Poisson models to identify lung cancer risk factors, and Cox models to compare survival after diagnosis. Lung cancer risk was increased among lung recipients (SIR 4.8, 95% confidence interval [CI] 4.1-5.5). Those with single lung transplant had 13-fold (95% CI 11-15) increased risk in the native lung. Native lung cancer risk factors included age, prior smoking, time since transplant, and idiopathic pulmonary fibrosis. Compared with cases in the general population, lung cancers in recipients were more frequently localized stage (P = .02) and treated surgically (P = .05). However, recipients had higher all-cause (adjusted hazard ratio 1.90, 95% CI 1.52-2.37) and cancer-specific mortality (adjusted hazard ratio 1.67, 95% CI 1.28-2.18). In conclusion, lung cancer risk is increased after lung transplant, especially in the native lung of single lung recipients. Traditional risk factors are associated with lung cancer in these patients. Lung cancer survival is worse among lung recipients despite earlier diagnosis.
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Affiliation(s)
- Matthew Triplette
- Department of Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Parag Mahale
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Elizabeth L. Yanik
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Maryam Valapour
- Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN, USA
| | - Charles F. Lynch
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Matthew B. Schabath
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | | | - Eric A. Engels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
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103
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Kosztowski M, Zhou S, Bush E, Higgins RS, Segev DL, Gentry SE. Geographic disparities in lung transplant rates. Am J Transplant 2019; 19:1491-1497. [PMID: 30431704 PMCID: PMC6482076 DOI: 10.1111/ajt.15182] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 10/03/2018] [Accepted: 11/06/2018] [Indexed: 01/25/2023]
Abstract
In November 2017, in response to a lawsuit from a New York City lung transplant candidate, an emergency change to the lung allocation policy eliminated the donation service area (DSA) as the first geographic tier of allocation. The lawsuit claimed that DSA borders are arbitrary and that allocation should be based on medical priority. We investigated whether deceased-donor lung transplant (LT) rates differed substantially between DSAs in the United States before the policy change. We estimated LT rates per active person-year using multilevel Poisson regression and empirical Bayes methods. We found that the median incidence rate ratio (MIRR) of transplant rates between DSAs was 2.05, meaning a candidate could be expected to double their LT rate by changing their DSA. This can be compared directly to a 1.54-fold increase in LT rate that we found associated with an increase in lung allocation score (LAS) category from 38-42 to 42-50. Changing a candidate's DSA would have had a greater impact on the candidate's LT rate than changing LAS categories from 38-42 to 42-50. In summary, we found that the DSA of listing was a major determinant of LT rate for candidates across the country before the emergency lung allocation change.
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Affiliation(s)
- Martin Kosztowski
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Sheng Zhou
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Errol Bush
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert S Higgins
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
- Scientific Registry of Transplant Recipients, Minneapolis, Minnesota
| | - Sommer E Gentry
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Mathematics, United States Naval Academy, Annapolis, Maryland
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104
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Scozzi D, Ibrahim M, Liao F, Lin X, Hsiao HM, Hachem R, Tague LK, Ricci A, Kulkarni HS, Huang HJ, Sugimoto S, Krupnick AS, Kreisel D, Gelman AE. Mitochondrial damage-associated molecular patterns released by lung transplants are associated with primary graft dysfunction. Am J Transplant 2019; 19:1464-1477. [PMID: 30582269 PMCID: PMC6482093 DOI: 10.1111/ajt.15232] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 11/12/2018] [Accepted: 12/08/2018] [Indexed: 02/07/2023]
Abstract
Primary graft dysfunction (PGD) is a major limitation in short- and long-term lung transplant survival. Recent work has shown that mitochondrial damage-associated molecular patterns (mtDAMPs) can promote solid organ injury, but whether they contribute to PGD severity remains unclear. We quantitated circulating plasma mitochondrial DNA (mtDNA) in 62 patients, before lung transplantation and shortly after arrival to the intensive care unit. Although all recipients released mtDNA, high levels were associated with severe PGD development. In a mouse orthotopic lung transplant model of PGD, we detected airway cell-free damaged mitochondria and mtDNA in the peripheral circulation. Pharmacologic inhibition or genetic deletion of formylated peptide receptor 1 (FPR1), a chemotaxis sensor for N-formylated peptides released by damaged mitochondria, inhibited graft injury. An analysis of intragraft neutrophil-trafficking patterns reveals that FPR1 enhances neutrophil transepithelial migration and retention within airways but does not control extravasation. Using donor lungs that express a mitochondria-targeted reporter protein, we also show that FPR1-mediated neutrophil trafficking is coupled with the engulfment of damaged mitochondria, which in turn triggers reactive oxygen species (ROS)-induced pulmonary edema. Therefore, our data demonstrate an association between mtDAMP release and PGD development and suggest that neutrophil trafficking and effector responses to damaged mitochondria are drivers of graft damage.
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Affiliation(s)
- Davide Scozzi
- Department of Surgery, Washington University School, St. Louis, Missouri
- Department of Clinical & Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Mohsen Ibrahim
- Department of Surgery, Washington University School, St. Louis, Missouri
- Department Medical-Surgical Science & Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Fuyi Liao
- Department of Surgery, Washington University School, St. Louis, Missouri
| | - Xue Lin
- Department of Surgery, Washington University School, St. Louis, Missouri
| | - Hsi-Min Hsiao
- Department of Surgery, Washington University School, St. Louis, Missouri
| | - Ramsey Hachem
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Laneshia K Tague
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Alberto Ricci
- Department of Clinical & Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Hrishikesh S Kulkarni
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Howard J Huang
- Houston Methodist J. C. Walter Jr. Transplant Center, Houston, Texas
| | - Seiichiro Sugimoto
- Department of General Thoracic Surgery, Okayama University Hospital, Okayama, Japan
| | - Alexander S Krupnick
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Daniel Kreisel
- Department of Surgery, Washington University School, St. Louis, Missouri
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Andrew E Gelman
- Department of Surgery, Washington University School, St. Louis, Missouri
- Department Medical-Surgical Science & Translational Medicine, Sapienza University of Rome, Rome, Italy
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri
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105
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Dromparis P, Aboelnazar NS, Wagner S, Himmat S, White CW, Hatami S, Luc JGY, Rotich S, Freed DH, Nagendran J, Mengel M, Adam BA. Ex vivo perfusion induces a time- and perfusate-dependent molecular repair response in explanted porcine lungs. Am J Transplant 2019; 19:1024-1036. [PMID: 30230229 DOI: 10.1111/ajt.15123] [Citation(s) in RCA: 17] [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: 04/20/2018] [Revised: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 01/25/2023]
Abstract
Ex vivo lung perfusion (EVLP) shows promise in ameliorating pretransplant acute lung injury (ALI) and expanding the donor organ pool, but the mechanisms of ex vivo repair remain poorly understood. We aimed to assess the utility of gene expression for characterizing ALI during EVLP. One hundred sixty-nine porcine lung samples were collected in vivo (n = 25), after 0 (n = 11) and 12 (n = 11) hours of cold static preservation (CSP), and after 0 (n = 57), 6 (n = 8), and 12 (n = 57) hours of EVLP, utilizing various ventilation and perfusate strategies. The expression of 53 previously described ALI-related genes was measured and correlated with function and histology. Twenty-eight genes were significantly upregulated and 6 genes downregulated after 12 hours of EVLP. Aggregate gene sets demonstrated differential expression with EVLP (P < .001) but not CSP. Upregulated 28-gene set expression peaked after 6 hours of EVLP, whereas downregulated 6-gene set expression continued to decline after 12 hours. Cellular perfusates demonstrated a greater reduction in downregulated 6-gene set expression vs acellular perfusate (P < .038). Gene set expression correlated with relevant functional and histologic parameters, including P/F ratio (P < .001) and interstitial inflammation (P < .005). Further studies with posttransplant results are warranted to evaluate the clinical significance of this novel molecular approach for assessing organ quality during EVLP.
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Affiliation(s)
- Peter Dromparis
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Nader S Aboelnazar
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Siegfried Wagner
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Sayed Himmat
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Christopher W White
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Sanaz Hatami
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jessica G Y Luc
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Silas Rotich
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Darren H Freed
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jayan Nagendran
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Michael Mengel
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Benjamin A Adam
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
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106
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Klintmalm GB, Kaplan B, Kirk AD. FDA jeopardizes the lives of lung transplant recipients and in the process severely increases the cost to develop new immunosuppression. Am J Transplant 2019; 19:971-972. [PMID: 30552744 DOI: 10.1111/ajt.15215] [Citation(s) in RCA: 5] [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] [Received: 10/18/2018] [Revised: 11/21/2018] [Accepted: 11/26/2018] [Indexed: 01/25/2023]
Affiliation(s)
- Goran B Klintmalm
- Baylor Annette C. and Harold C. Simmons Transplant Institute, Dallas, Texas
| | - Bruce Kaplan
- Transplant Services, Baylor Scott & White Health, Temple, Texas
| | - Allan D Kirk
- Department of Surgery, Duke University, Durham, North Carolina
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107
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Kobashigawa J, Dadhania D, Bhorade S, Adey D, Berger J, Bhat G, Budev M, Duarte-Rojo A, Dunn M, Hall S, Harhay MN, Johansen KL, Joseph S, Kennedy CC, Kransdorf E, Lentine KL, Lynch RJ, McAdams-DeMarco M, Nagai S, Olymbios M, Patel J, Pinney S, Schaenman J, Segev DL, Shah P, Singer LG, Singer JP, Sonnenday C, Tandon P, Tapper E, Tullius SG, Wilson M, Zamora M, Lai JC. Report from the American Society of Transplantation on frailty in solid organ transplantation. Am J Transplant 2019; 19:984-994. [PMID: 30506632 PMCID: PMC6433498 DOI: 10.1111/ajt.15198] [Citation(s) in RCA: 147] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/06/2018] [Accepted: 11/24/2018] [Indexed: 02/06/2023]
Abstract
A consensus conference on frailty in kidney, liver, heart, and lung transplantation sponsored by the American Society of Transplantation (AST) and endorsed by the American Society of Nephrology (ASN), the American Society of Transplant Surgeons (ASTS), and the Canadian Society of Transplantation (CST) took place on February 11, 2018 in Phoenix, Arizona. Input from the transplant community through scheduled conference calls enabled wide discussion of current concepts in frailty, exploration of best practices for frailty risk assessment of transplant candidates and for management after transplant, and development of ideas for future research. A current understanding of frailty was compiled by each of the solid organ groups and is presented in this paper. Frailty is a common entity in patients with end-stage organ disease who are awaiting organ transplantation, and affects mortality on the waitlist and in the posttransplant period. The optimal methods by which frailty should be measured in each organ group are yet to be determined, but studies are underway. Interventions to reverse frailty vary among organ groups and appear promising. This conference achieved its intent to highlight the importance of frailty in organ transplantation and to plant the seeds for further discussion and research in this field.
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Affiliation(s)
| | | | | | - Deborah Adey
- University of California at San Francisco, San Francisco, CA, USA
| | - Joseph Berger
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Geetha Bhat
- Advocate Christ Medical Center, Oak Lawn, IL, USA
| | | | | | | | | | | | | | | | | | - Evan Kransdorf
- Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | | | | | | | | | | | - Jignesh Patel
- Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | | | | | | | - Palak Shah
- Inova Heart and Vascular Institute, Falls Church, VA, USA
| | | | | | | | | | | | - Stefan G. Tullius
- Division of Transplant Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Jennifer C. Lai
- University of California at San Francisco, San Francisco, CA, USA
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108
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Suberviola B, Mons R, Ballesteros MA, Mora V, Delgado M, Naranjo S, Iturbe D, Miñambres E. Excellent long-term outcome with lungs obtained from uncontrolled donation after circulatory death. Am J Transplant 2019; 19:1195-1201. [PMID: 30582287 DOI: 10.1111/ajt.15237] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/04/2018] [Accepted: 12/08/2018] [Indexed: 01/25/2023]
Abstract
We aimed to propose a simple and effective preservation method in lungs procured for transplantation from uncontrolled donation after circulatory death (uDCD) associated with excellent long-term results. Outcome measures for lung recipients were survival and primary graft dysfunction (PGD) grade 3. Survival was estimated using the Kaplan-Meier method. A total of 9 lung uDCDs were evaluated and 8 lung transplants were performed. Mean no-flow time was 9.8 minutes (standard deviation [SD] 8.6). Mean time from cardiac arrest to topical cooling was 96.8 minutes (SD 16.8). Preservation time was 159 minutes (SD 31). Ex vivo lung perfusion was used to assess lung function prior to transplantation in 2 cases. Mean recipient age was 60.8 years (SD 3.1), and mean total ischemic time was 678 minutes (SD 132). PGD grade 3 was observed in 2 cases (25%). The 1-month, 1-year, and 5-year survival rates were 100%, 87.5%, and 87.5%, respectively. Mean follow-up was 52 months. The logistic complexity of procuring lungs from uDCDs for transplantation requires the development of new strategies designed to facilitate this type of donation. A program based on strict selection criteria, using a simple and effective preservation technique, may recover lung grafts with excellent long-term posttransplant outcomes.
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Affiliation(s)
- Borja Suberviola
- Transplant Coordination Unit & Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Roberto Mons
- Service of Thoracic Surgery, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Maria Angeles Ballesteros
- Transplant Coordination Unit & Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Victor Mora
- Service of Neumology, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - María Delgado
- Service of Thoracic Surgery, Complexo Hospitalario Universitario A Coruña, La Coruña, Spain
| | - Sara Naranjo
- Service of Thoracic Surgery, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - David Iturbe
- Service of Neumology, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Eduardo Miñambres
- Transplant Coordination Unit & Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.,School of Medicine, University of Cantabria, Santander, Spain
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109
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Scozzi D, Wang X, Liao F, Liu Z, Zhu J, Pugh K, Ibrahim M, Hsiao HM, Miller MJ, Yizhan G, Mohanakumar T, Krupnick AS, Kreisel D, Gelman AE. Neutrophil extracellular trap fragments stimulate innate immune responses that prevent lung transplant tolerance. Am J Transplant 2019; 19:1011-1023. [PMID: 30378766 PMCID: PMC6438629 DOI: 10.1111/ajt.15163] [Citation(s) in RCA: 29] [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: 04/03/2018] [Revised: 10/03/2018] [Accepted: 10/21/2018] [Indexed: 01/25/2023]
Abstract
Neutrophil extracellular traps (NETs) have been shown to worsen acute pulmonary injury including after lung transplantation. The breakdown of NETs by DNAse-1 can help restore lung function, but whether there is an impact on allograft tolerance remains less clear. Using intravital 2-photon microscopy, we analyzed the effects of DNAse-1 on NETs in mouse orthotopic lung allografts damaged by ischemia-reperfusion injury. Although DNAse-1 treatment rapidly degrades intragraft NETs, the consequential release of NET fragments induces prolonged interactions between infiltrating CD4+ T cells and donor-derived antigen presenting cells. DNAse-1 generated NET fragments also promote human alveolar macrophage inflammatory cytokine production and prime dendritic cells for alloantigen-specific CD4+ T cell proliferation through activating toll-like receptor (TLR) - Myeloid Differentiation Primary Response 88 (MyD88) signaling pathways. Furthermore, and in contrast to allograft recipients with a deficiency in NET generation due to a neutrophil-specific ablation of Protein Arginine Deiminase 4 (PAD4), DNAse-1 administration to wild-type recipients promotes the recognition of allo- and self-antigens and prevents immunosuppression-mediated lung allograft acceptance through a MyD88-dependent pathway. Taken together, these data show that the rapid catalytic release of NET fragments promotes innate immune responses that prevent lung transplant tolerance.
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Affiliation(s)
- Davide Scozzi
- Department of Surgery, Washington University School of
Medicine, St. Louis, MO. USA
| | - Xingan Wang
- Department of Surgery, Washington University School of
Medicine, St. Louis, MO. USA
| | - Fuyi Liao
- Department of Surgery, Washington University School of
Medicine, St. Louis, MO. USA
| | - Zhiyi Liu
- Department of Surgery, Washington University School of
Medicine, St. Louis, MO. USA
| | - Jihong Zhu
- Department of Surgery, Washington University School of
Medicine, St. Louis, MO. USA
| | - Katy Pugh
- Department of Surgery, Washington University School of
Medicine, St. Louis, MO. USA
| | - Mohsen Ibrahim
- Department of Surgery, Washington University School of
Medicine, St. Louis, MO. USA
| | - Hsi-Min Hsiao
- Department of Surgery, Washington University School of
Medicine, St. Louis, MO. USA
| | - Mark J. Miller
- Department of Medicine, Washington University School of
Medicine, St. Louis, MO. USA
| | - Guo Yizhan
- Department of Surgery, University of Virginia,
Charlottesville VA. USA
| | - Thalachallour Mohanakumar
- Norton Thoracic Institute Research Laboratory, St.
Joseph’s Hospital and Medical Center, Phoenix, AZ. USA
| | | | - Daniel Kreisel
- Department of Surgery, Washington University School of
Medicine, St. Louis, MO. USA,Department of Pathology & Immunology, Washington
University School of Medicine, St. Louis, MO. USA
| | - Andrew E. Gelman
- Department of Surgery, Washington University School of
Medicine, St. Louis, MO. USA,Department of Pathology & Immunology, Washington
University School of Medicine, St. Louis, MO. USA
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110
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Mooney JJ, Yang L, Hedlin H, Mohabir P, Dhillon GS. Multiple listing in lung transplant candidates: A cohort study. Am J Transplant 2019; 19:1098-1108. [PMID: 30253057 PMCID: PMC6433482 DOI: 10.1111/ajt.15124] [Citation(s) in RCA: 7] [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: 04/29/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 01/25/2023]
Abstract
Lung transplant candidates can be waitlisted at more than one transplant center, a practice known as multiple listing. The factors associated with multiple listing and whether multiple listing modifies waitlist mortality or likelihood of lung transplant is unknown. US lung transplant waitlist candidates were identified as either single or multiple listed using data from the Scientific Registry of Transplant Recipients. Characteristics of single and multiple listed candidates were compared and multivariable logistic regression was used to estimate associations with multiple listing. Multiple listed candidates were matched to single listed candidates using a combination of exact and propensity score matching methods. Cox proportional hazard models were used to estimate the relationship of multiple listing on waitlist mortality and receiving a transplant. Multiple listing occurred in 2.3% of lung transplant waitlist candidates. Younger age, female gender, white race, short stature, high antibody sensitization, college or postcollege education, lower lung allocation score, and a cystic fibrosis diagnosis were independently associated with multiple listing. Multiple listing was associated with an increased likelihood of lung transplant (adjusted hazard ratio [aHR] 2.74, 95% CI 2.37 to 3.16) but was not associated with waitlist mortality (aHR 0.99, 95% CI 0.68 to 1.44).
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Affiliation(s)
- Joshua J. Mooney
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA
| | - Lingyao Yang
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, CA
| | - Haley Hedlin
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, CA
| | - Paul Mohabir
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA
| | - Gundeep S Dhillon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA
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111
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Abbas AA, Young JC, Clarke EL, Diamond JM, Imai I, Haas AR, Cantu E, Lederer DJ, Meyer K, Milewski RK, Olthoff KM, Shaked A, Christie JD, Bushman FD, Collman RG. Bidirectional transfer of Anelloviridae lineages between graft and host during lung transplantation. Am J Transplant 2019; 19:1086-1097. [PMID: 30203917 PMCID: PMC6411461 DOI: 10.1111/ajt.15116] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 09/05/2018] [Accepted: 09/05/2018] [Indexed: 01/25/2023]
Abstract
Solid organ transplantation disrupts virus-host relationships, potentially resulting in viral transfer from donor to recipient, reactivation of latent viruses, and new viral infections. Viral transfer, colonization, and reactivation are typically monitored using assays for specific viruses, leaving the behavior of full viral populations (the "virome") understudied. Here we sought to investigate the temporal behavior of viruses from donor lungs and transplant recipients comprehensively. We interrogated the bronchoalveolar lavage and blood viromes during the peritransplant period and 6-16 months posttransplant in 13 donor-recipient pairs using shotgun metagenomic sequencing. Anelloviridae, ubiquitous human commensal viruses, were the most abundant human viruses identified. Herpesviruses, parvoviruses, polyomaviruses, and bacteriophages were also detected. Anelloviridae populations were complex, with some donor organs and hosts harboring multiple contemporaneous lineages. We identified transfer of Anelloviridae lineages from donor organ to recipient serum in 4 of 7 cases that could be queried, and immigration of lineages from recipient serum into the allograft in 6 of 10 such cases. Thus, metagenomic analyses revealed that viral populations move between graft and host in both directions, showing that organ transplantation involves implantation of both the allograft and commensal viral communities.
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Affiliation(s)
- A. A. Abbas
- Department of Microbiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - J. C. Young
- Department of Microbiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - E. L. Clarke
- Department of Microbiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - J. M. Diamond
- Pulmonary, Allergy and Critical Care Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - I Imai
- Pulmonary, Allergy and Critical Care Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - A. R. Haas
- Pulmonary, Allergy and Critical Care Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - E. Cantu
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - D. J. Lederer
- Departments of Medicine and Epidemiology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - K. Meyer
- School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - R. K. Milewski
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - K. M. Olthoff
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - A. Shaked
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - J. D. Christie
- Pulmonary, Allergy and Critical Care Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - F. D. Bushman
- Department of Microbiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - R. G. Collman
- Department of Microbiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA,Pulmonary, Allergy and Critical Care Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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112
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Courtwright AM, Rubin E, Robinson EM, Thomasson A, El-Chemaly S, Diamond JM, Goldberg HJ. In-hospital and subsequent mortality among lung transplant recipients with a prolonged initial hospitalization. Am J Transplant 2019; 19:532-539. [PMID: 29940091 DOI: 10.1111/ajt.14982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 06/15/2018] [Accepted: 06/16/2018] [Indexed: 01/25/2023]
Abstract
The care of lung transplant recipients with prolonged index hospitalizations can be ethically complex, with conflicts arising over whether the expected outcomes justify ongoing intensive interventions. There are limited data to guide these conversations. The objective of this study was to evaluate survival to discharge for lung transplant recipients based on length of stay (LOS). This was a retrospective cohort study of adult lung transplant recipients in the Scientific Registry of Transplant Recipients. For each day of the index hospitalization the mortality rate among patients who survived to that length of stay or longer was calculated. Post-discharge survival was compared in those with and without a prolonged hospitalization (defined as the 97th percentile [>90 days]). Among the 19 250 included recipients, the index hospitalization mortality was 5.4%. Posttransplant stroke and need for dialysis were the strongest predictors of index hospitalization mortality. No individual or combination of available risk factors, however, was associated with inpatient mortality consistently above 50%. Recipients with >90 day index hospitalization had a 28.8% subsequent inpatient mortality. Their 1, 3 and 5 year survival following discharge was 53%, 26%, and 16%. These data provide additional context to goals of care conversations for transplant recipients with prolonged index hospitalizations.
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Affiliation(s)
- Andrew M Courtwright
- Pulmonary and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.,Institute for Patient Care, Massachusetts General Hospital, Boston, MA, USA
| | - Emily Rubin
- Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Ellen M Robinson
- Institute for Patient Care, Massachusetts General Hospital, Boston, MA, USA.,Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston, MA, USA
| | - Arwin Thomasson
- Penn Transplant Center, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Souheil El-Chemaly
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Joshua M Diamond
- Pulmonary and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Hilary J Goldberg
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
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113
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Nickel IC, Boys JA, Dill EA, Weder MM, Krupnick AS, Walters DM. Pulmonary malakoplakia secondary to Rhodococcus equi infection mimicking a lung neoplasm in a lung transplant recipient. Am J Transplant 2019; 19:597-600. [PMID: 30063120 DOI: 10.1111/ajt.15045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 07/19/2018] [Accepted: 07/20/2018] [Indexed: 01/25/2023]
Abstract
Pulmonary masses occasionally occur after lung transplantation and vary in etiology, which includes malignant and benign conditions, such as infection. Here, we report a case of a patient presenting with a lung mass 3 years after lung transplant. To our knowledge, this is the first described case of pulmonary malakoplakia due to Rhodococcus equi infection in an allograft post-lung transplantation. This case outlines the challenges of differentiating benign from malignant masses after transplantation.
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Affiliation(s)
- Ian C Nickel
- Department of Surgery, The University of Virginia, Charlottesville, VA, USA
| | - Joshua A Boys
- Department of Surgery, The University of Virginia, Charlottesville, VA, USA
| | - Erik A Dill
- Department of Pathology, The University of Virginia, Charlottesville, VA, USA
| | - Max M Weder
- Department of Medicine, The University of Virginia, Charlottesville, VA, USA
| | | | - Dustin M Walters
- Department of Surgery, The University of Virginia, Charlottesville, VA, USA
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114
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Sommer W, Salman J, Avsar M, Hoeffler K, Jansson K, Siemeni TN, Knoefel AK, Ahrens L, Poyanmehr R, Tudorache I, Braubach P, Jonigk D, Haverich A, Warnecke G. Prediction of transplant outcome after 24-hour ex vivo lung perfusion using the Organ Care System in a porcine lung transplantation model. Am J Transplant 2019; 19:345-355. [PMID: 30106236 DOI: 10.1111/ajt.15075] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 07/22/2018] [Accepted: 07/22/2018] [Indexed: 01/25/2023]
Abstract
Ex vivo lung perfusion (EVLP) has become routine practice in lung transplantation. Still, running periods exceeding 12 hours have not been undertaken clinically to date, and it remains unclear how the perfusion solution for extended running periods should be composed and which parameters may predict outcomes. Twenty-four porcine lungs underwent EVLP for 24 hours using the Organ Care System (OCS). Lungs were ventilated and perfused with STEEN's solution enriched with erythrocytes (n = 8), acellular STEEN's solution (n = 8), or low-potassium dextran (LPD) solution enriched with erythrocytes (n = 8). After 24 hours, the left lungs were transplanted into recipient pigs. After clamping of the contralateral lung, the recipients were observed for 6 hours. The most favorable outcome was observed in organs utilizing STEEN solution enriched with erythrocytes as perfusate, whereas the least favorable outcome was seen with LPD solution enriched with erythrocytes for perfusion. Animals surviving the observation period showed lower peak airway pressure (PAWP) and pulmonary vascular resistance (PVR) during OCS preservation. The results suggest that transplantation of lungs following 24 hours of EVLP is feasible but dependent on the composition of the perfusate. PAWP and PVR during EVLP are early and late predictors of transplant outcome, respectively.
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Affiliation(s)
- Wiebke Sommer
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jawad Salman
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Klaus Hoeffler
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Katharina Jansson
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Thierry N Siemeni
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Ann-Kathrin Knoefel
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Linda Ahrens
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Reza Poyanmehr
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Igor Tudorache
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Peter Braubach
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Danny Jonigk
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Gregor Warnecke
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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115
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Roux A, Levine DJ, Zeevi A, Hachem R, Halloran K, Halloran PF, Gibault L, Taupin JL, Neil DAH, Loupy A, Adam BA, Mengel M, Hwang DM, Calabrese F, Berry G, Pavlisko EN. Banff Lung Report: Current knowledge and future research perspectives for diagnosis and treatment of pulmonary antibody-mediated rejection (AMR). Am J Transplant 2019; 19:21-31. [PMID: 29956477 DOI: 10.1111/ajt.14990] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 06/19/2018] [Accepted: 06/19/2018] [Indexed: 01/25/2023]
Abstract
The Lung session of the 2017 14th Banff Foundation for Allograft Pathology Conference, Barcelona focused on the multiple aspects of antibody-mediated rejection (AMR) in lung transplantation. Multidimensional approaches for AMR diagnosis, including classification, histological and immunohistochemical analysis, and donor- specific antibody (DSA) characterization with their current strengths and limitations were reviewed in view of recent research. The group also discussed the role of tissue gene expression analysis in the context of unmet needs in lung transplantation. The current best practice for monitoring of AMR and the therapeutic approach are summarized and highlighted in this report. The working group reached consensus of the major gaps in current knowledge and focused on the unanswered questions regarding pulmonary AMR. An important outcome of the meeting was agreement on the need for future collaborative research projects to address these gaps in the field of lung transplantation.
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Affiliation(s)
- A Roux
- Pneumology, Adult CF Center and Lung Transplantation Department, Foch Hospital, Suresnes, France.,Paris Translational Research Center for Organ Transplantation, French National institute of Health and Medical Research (INSERM). Unit UMR S970, Paris, France.,Versailles Saint-Quentin-en-Yvelines University, UPRES EA 220, Suresnes, France
| | - D J Levine
- Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - A Zeevi
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - R Hachem
- Washington University, School of Medicine Division of Pulmonary & Critical Care, St. Louis, MO, USA
| | - K Halloran
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - P F Halloran
- Alberta Transplant Applied Genomics Center, University of Alberta, Edmonton, Alberta, Canada
| | - L Gibault
- Department of Pathology, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - J L Taupin
- Department of Immunology and Histocompatibility, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - D A H Neil
- Department of Pathology, Queen Elizabeth Hospital, Birmingham, UK
| | - A Loupy
- Paris Translational Research Center for Organ Transplantation, French National institute of Health and Medical Research (INSERM). Unit UMR S970, Paris, France
| | - B A Adam
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - M Mengel
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - D M Hwang
- Toronto Lung Transplant Program, University Health Network, University of Toronto, Ontario, Canada
| | - F Calabrese
- Department of Cardio-Thoracic and Vascular Sciences, Pathology Section, University of Padova, Italy
| | - G Berry
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - E N Pavlisko
- Department of Pathology, Duke University Hospital, Durham, NC, USA
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116
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Martinu T, Oishi H, Juvet SC, Cypel M, Liu M, Berry GJ, Hwang DM, Keshavjee S. Spectrum of chronic lung allograft pathology in a mouse minor-mismatched orthotopic lung transplant model. Am J Transplant 2019; 19:247-258. [PMID: 30378739 DOI: 10.1111/ajt.15167] [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: 05/21/2018] [Revised: 09/11/2018] [Accepted: 09/27/2018] [Indexed: 01/25/2023]
Abstract
Chronic lung allograft dysfunction (CLAD) is a fatal condition that limits survival after lung transplantation (LTx). The pathological hallmark of CLAD is obliterative bronchiolitis (OB). A subset of patients present with a more aggressive CLAD phenotype, called restrictive allograft syndrome (RAS), characterized by lung parenchymal fibrosis (PF). The mouse orthotopic single LTx model has proven relevant to the mechanistic study of allograft injury. The minor-alloantigen-mismatched strain combination using C57BL/10(B10) donors and C57BL/6(B6) recipients reportedly leads to OB. Recognizing that OB severity is a spectrum that may coexist with other pathologies, including PF, we aimed to characterize and quantify pathologic features of CLAD in this model. Left LTx was performed in the following combinations: B10→B6, B6→B10, B6→B6. Four weeks posttransplant, blinded pathologic semi-quantitative assessment showed that OB was present in 66% of B10→B6 and 30% of B6→B10 grafts. Most mice with OB also had PF with a pattern of pleuroparenchymal fibroelastosis, reminiscent of human RAS-related pathology. Grading of pathologic changes demonstrated variable severity of airway fibrosis, PF, acute rejection, vascular fibrosis, and epithelial changes, similar to those seen in human CLAD. These assessments can make the murine LTx model a more useful tool for further mechanistic studies of CLAD pathogenesis.
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Affiliation(s)
- Tereza Martinu
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Hisashi Oishi
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Stephen C Juvet
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Marcelo Cypel
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Mingyao Liu
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Gerald J Berry
- Department of Pathology, Stanford University Medical Center, Stanford, California
| | - David M Hwang
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada.,Department of Pathology, University Health Network, Toronto, Ontario, Canada
| | - Shaf Keshavjee
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
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117
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McCaughan JA, Battle RK, Singh SKS, Tikkanen JM, Moayedi Y, Ross HJ, Singer LG, Keshavjee S, Tinckam KJ. Identification of risk epitope mismatches associated with de novo donor-specific HLA antibody development in cardiothoracic transplantation. Am J Transplant 2018; 18:2924-2933. [PMID: 29847022 DOI: 10.1111/ajt.14951] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 04/26/2018] [Accepted: 05/22/2018] [Indexed: 01/25/2023]
Abstract
The development of de novo donor-specific HLA antibodies (dnDSA) after transplantation is associated with graft failure, mortality, and cost. There is no effective therapeutic intervention to prevent dnDSA or ameliorate associated injury. The aims of this study were to identify specific HLA factors associated with dnDSA development and to propose primary prevention strategies that could reduce the incidence of dnDSA without prohibitively limiting access to transplant. The investigation cohort included heart transplant recipients from 2008 to 2015 (n = 265). HLA typing was performed and HLA antibody testing was undertaken before and after transplantation. HLAMatchmaker analysis was performed for persistent dnDSA to identify potentially more immunogenic eplet differences. Validation was performed in recipients of lung transplants from 2008 to 2013 (n = 433). The majority of recipients with dnDSA had antibodies to identical eplet positions on DQ2 and DQ7. A high-risk epitope mismatch (found in DQA1*05 + DQB1*02/DQB1*03:01(7)) was associated with a 4.2- and 4.9-fold increased risk of dnDSA in heart and lung recipients respectively. HLA electrostatic potential modeling provided a plausible explanation for this observed immunogenicity. A theoretical allocation algorithm avoiding high-risk epitope mismatches was generated and predicted to reduce dnDSA by up to 72% without additional testing, eplet analysis, or cost.
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Affiliation(s)
- J A McCaughan
- HLA Laboratory, Laboratory Medicine Program, University Health Network, Toronto, Canada
| | - R K Battle
- Histocompatibility & Immunogenetics Laboratory, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - S K S Singh
- Division of Nephrology, Department of Medicine, University Health Network, Toronto, Canada
| | - J M Tikkanen
- Toronto Lung Transplant Program, University Health Network, Toronto, Canada
| | - Y Moayedi
- Toronto Heart Transplant Program, University Health Network, Toronto, Canada
| | - H J Ross
- Toronto Heart Transplant Program, University Health Network, Toronto, Canada
| | - L G Singer
- Toronto Lung Transplant Program, University Health Network, Toronto, Canada
| | - S Keshavjee
- Toronto Lung Transplant Program, University Health Network, Toronto, Canada
| | - K J Tinckam
- HLA Laboratory, Laboratory Medicine Program, University Health Network, Toronto, Canada.,Division of Nephrology, Department of Medicine, University Health Network, Toronto, Canada
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118
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Vos R, Wuyts WA, Gheysens O, Goffin KE, Schaevers V, Verleden SE, Van Herck A, Sacreas A, Heigl T, McDonough JE, Yserbyt J, Godinas L, Dupont LJ, Neyrinck AP, Van Raemdonck DE, Verbeken EK, Vanaudenaerde BM, Verleden GM. Pirfenidone in restrictive allograft syndrome after lung transplantation: A case series. Am J Transplant 2018; 18:3045-3059. [PMID: 30019840 DOI: 10.1111/ajt.15019] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/09/2018] [Accepted: 07/10/2018] [Indexed: 01/25/2023]
Abstract
Pirfenidone may attenuate the decline of pulmonary function in restrictive allograft syndrome (RAS) after lung transplantation. We retrospectively assessed all lung transplant recipients with RAS who were treated with pirfenidone for at least 3 months (n = 11) in our lung transplant center and report on their long-term outcomes following initiation of pirfenidone. Main outcome parameters included evolution of pulmonary function and overall survival. Pirfenidone appears to attenuate the decline in forced vital capacity and forced expiratory volume in 1 second. Notably, 3 patients were bridged to redo-transplantation with pirfenidone for 11 (5-12) months and are currently alive, while 3 other patients demonstrate long-term stabilization of pulmonary function after 26.6 (range 18.4-46.6) months of treatment. Median overall 3-year survival after RAS diagnosis was 54.5%. Subjective intolerance, mainly anorexia and nausea, necessitating pirfenidone dose de-escalation in 55% of patients, as well as calcineurin dose increase requirements with about 20% are important complications during pirfenidone treatment after lung transplantation. Our findings provide further evidence that pirfenidone appears to be safe and may attenuate the rate of decline in lung function in patients with RAS, but the actual clinical benefit cannot be assessed in the context of this study design and requires further investigation in a larger randomized trial.
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Affiliation(s)
- Robin Vos
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Division of Respiratory Diseases, KU Leuven, Leuven, Belgium
| | - Wim A Wuyts
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Division of Respiratory Diseases, KU Leuven, Leuven, Belgium
| | - Olivier Gheysens
- Department of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Karolien E Goffin
- Department of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Veronique Schaevers
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Stijn E Verleden
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Anke Van Herck
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Annelore Sacreas
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Tobias Heigl
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - John E McDonough
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Jonas Yserbyt
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Division of Respiratory Diseases, KU Leuven, Leuven, Belgium
| | - Laurent Godinas
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Division of Respiratory Diseases, KU Leuven, Leuven, Belgium
| | - Lieven J Dupont
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Division of Respiratory Diseases, KU Leuven, Leuven, Belgium
| | - Arne P Neyrinck
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Bart M Vanaudenaerde
- Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Division of Respiratory Diseases, KU Leuven, Leuven, Belgium
| | - Geert M Verleden
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Division of Respiratory Diseases, KU Leuven, Leuven, Belgium
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119
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Cheng Q, Patel K, Lei B, Rucker L, Allen DP, Zhu P, Vasu C, Martins PN, Goddard M, Nadig SN, Atkinson C. Donor pretreatment with nebulized complement C3a receptor antagonist mitigates brain-death induced immunological injury post-lung transplant. Am J Transplant 2018; 18:2417-2428. [PMID: 29504277 PMCID: PMC6123303 DOI: 10.1111/ajt.14717] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 02/16/2018] [Accepted: 02/19/2018] [Indexed: 01/25/2023]
Abstract
Donor brain death (BD) is an inherent part of lung transplantation (LTx) and a key contributor to ischemia-reperfusion injury (IRI). Complement activation occurs as a consequence of BD in other solid organ Tx and exacerbates IRI, but the role of complement in LTx has not been investigated. Here, we investigate the utility of delivering nebulized C3a receptor antagonist (C3aRA) pretransplant to BD donor lungs in order to reduce post-LTx IRI. BD was induced in Balb/c donors, and lungs nebulized with C3aRA or vehicle 30 minutes prior to lung procurement. Lungs were then cold stored for 18 hours before transplantation into C57Bl/6 recipients. Donor lungs from living donors (LD) were removed and similarly stored. At 6 hours and 5 days post-LTx, recipients of BD donor lungs had exacerbated IRI and acute rejection (AR), respectively, compared to recipients receiving LD lungs, as determined by increased histopathological injury, immune cells, and cytokine levels. A single pretransplant nebulized dose of C3aRA to the donor significantly reduced IRI as compared to vehicle-treated BD donors, and returned IRI and AR grades to that seen following LD LTx. These data demonstrate a role for complement inhibition in the amelioration of IRI post-LTx in the context of donor BD.
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Affiliation(s)
- Qi Cheng
- Institute of Organ Transplantation, Department of Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan,430030, China,Department of Microbiology and Immunology, Medical University of South Carolina, 173 Ashley Avenue, Charleston, SC 29425, USA,Department of Surgery, Division of Transplant, Lee Patterson Allen Transplant Immunobiology Laboratory, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA
| | - Kunal Patel
- Department of Microbiology and Immunology, Medical University of South Carolina, 173 Ashley Avenue, Charleston, SC 29425, USA,Department of Surgery, Division of Transplant, Lee Patterson Allen Transplant Immunobiology Laboratory, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA
| | - Biao Lei
- Department of Microbiology and Immunology, Medical University of South Carolina, 173 Ashley Avenue, Charleston, SC 29425, USA
| | - Lindsay Rucker
- Department of Surgery, Division of Transplant, Lee Patterson Allen Transplant Immunobiology Laboratory, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA
| | - D. Patterson Allen
- Department of Surgery, Division of Transplant, Lee Patterson Allen Transplant Immunobiology Laboratory, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA
| | - Peng Zhu
- Institute of Organ Transplantation, Department of Surgery, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan,430030, China,Department of Microbiology and Immunology, Medical University of South Carolina, 173 Ashley Avenue, Charleston, SC 29425, USA,Department of Surgery, Division of Transplant, Lee Patterson Allen Transplant Immunobiology Laboratory, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA
| | - Chentha Vasu
- Department of Microbiology and Immunology, Medical University of South Carolina, 173 Ashley Avenue, Charleston, SC 29425, USA
| | - Paulo N. Martins
- University of Massachusetts, UMass Memorial Medical Center, Department of Surgery, Transplant Division, Worcester, MA 01655, USA
| | - Martin Goddard
- Pathology Department, Papworth Hospital NHS Trust, Papworth Everard, Cambridge, England, CB3 8RE
| | - Satish N. Nadig
- Department of Microbiology and Immunology, Medical University of South Carolina, 173 Ashley Avenue, Charleston, SC 29425, USA,Department of Surgery, Division of Transplant, Lee Patterson Allen Transplant Immunobiology Laboratory, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA,South Carolina Investigators in Transplantation (SCIT), Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA
| | - Carl Atkinson
- Department of Microbiology and Immunology, Medical University of South Carolina, 173 Ashley Avenue, Charleston, SC 29425, USA,Department of Surgery, Division of Transplant, Lee Patterson Allen Transplant Immunobiology Laboratory, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA,South Carolina Investigators in Transplantation (SCIT), Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA,Address for Correspondence. Dr Carl Atkinson, PhD. Department of Microbiology and Immunology, and Surgery. Medical University of South Carolina, Lee Patterson Allen Transplant Immunobiology Laboratory, Basic Science Department, 173 Ashley Avenue, Charleston, SC 29425 USA. Tel: 1-843-792-1716. Fax: 1-843-792-2464.
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120
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Snyder LD, Tinckam KJ. Another piece of the antibody puzzle: Observations from the HALT study. Am J Transplant 2018; 18:2111-2112. [PMID: 29862642 DOI: 10.1111/ajt.14959] [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: 05/09/2018] [Revised: 05/09/2018] [Accepted: 05/28/2018] [Indexed: 01/25/2023]
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121
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Ius F, Verboom M, Sommer W, Poyanmehr R, Knoefel A, Salman J, Kuehn C, Avsar M, Siemeni T, Erdfelder C, Hallensleben M, Boethig D, Schwerk N, Mueller C, Welte T, Falk C, Haverich A, Tudorache I, Warnecke G. Preemptive treatment of early donor-specific antibodies with IgA- and IgM-enriched intravenous human immunoglobulins in lung transplantation. Am J Transplant 2018; 18:2295-2304. [PMID: 29719115 PMCID: PMC6585979 DOI: 10.1111/ajt.14912] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 04/11/2018] [Accepted: 04/19/2018] [Indexed: 01/25/2023]
Abstract
This retrospective study presents our 4-year experience of preemptive treatment of early anti-HLA donor specific antibodies with IgA- and IgM-enriched immunoglobulins. We compared outcomes between patients with antibodies and treatment (case patients) and patients without antibodies (control patients). Records of patients transplanted at our institution between March 2013 and November 2017 were reviewed. The treatment protocol included one single 2 g/kg immunoglobulin infusion followed by successive 0.5 g/kg infusions for a maximum of 6 months, usually combined with a single dose of anti-CD20 antibody and, in case of clinical rejection or positive crossmatch, with plasmapheresis or immunoabsorption. Among the 598 transplanted patients, 128 (21%) patients formed the case group and 452 (76%) the control group. In 116 (91%) patients who completed treatment, 106 (91%) showed no antibodies at treatment end. Fourteen (13%) patients showed antibody recurrence thereafter. In case versus control patients and at 4-year follow-up, respectively, graft survival (%) was 79 versus 81 (P = .59), freedom (%) from biopsy-confirmed rejection 57 versus 53 (P = .34), and from chronic lung allograft dysfunction 82 versus 78 (P = .83). After lung transplantation, patients with early donor-specific antibodies and treated with IgA- and IgM-enriched immunoglobulins had 4-year graft survival similar to patients without antibodies and showed high antibody clearance.
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Affiliation(s)
- Fabio Ius
- Department of Cardiothoracic, Transplant, and Vascular SurgeryHannover Medical SchoolHannoverGermany
| | - Murielle Verboom
- Department of TransfusionMedicine Hannover Medical SchoolHannoverGermany
| | - Wiebke Sommer
- Department of Cardiothoracic, Transplant, and Vascular SurgeryHannover Medical SchoolHannoverGermany,German Center for Lung Research (DZL/BREATH)HannoverGermany
| | - Reza Poyanmehr
- Department of Cardiothoracic, Transplant, and Vascular SurgeryHannover Medical SchoolHannoverGermany
| | - Ann‐Kathrin Knoefel
- Department of Cardiothoracic, Transplant, and Vascular SurgeryHannover Medical SchoolHannoverGermany
| | - Jawad Salman
- Department of Cardiothoracic, Transplant, and Vascular SurgeryHannover Medical SchoolHannoverGermany
| | - Christian Kuehn
- Department of Cardiothoracic, Transplant, and Vascular SurgeryHannover Medical SchoolHannoverGermany
| | - Murat Avsar
- Department of Cardiothoracic, Transplant, and Vascular SurgeryHannover Medical SchoolHannoverGermany
| | - Thierry Siemeni
- Department of Cardiothoracic, Transplant, and Vascular SurgeryHannover Medical SchoolHannoverGermany
| | - Caroline Erdfelder
- Department of Cardiothoracic, Transplant, and Vascular SurgeryHannover Medical SchoolHannoverGermany
| | | | - Dietmar Boethig
- Department of Cardiothoracic, Transplant, and Vascular SurgeryHannover Medical SchoolHannoverGermany
| | - Nicolaus Schwerk
- Department of Respiratory MedicineHannover Medical SchoolHannoverGermany,Department of PaediatricsHannover Medical SchoolHannoverGermany
| | - Carsten Mueller
- Department of Respiratory MedicineHannover Medical SchoolHannoverGermany,Department of PaediatricsHannover Medical SchoolHannoverGermany
| | - Tobias Welte
- German Center for Lung Research (DZL/BREATH)HannoverGermany,Department of Respiratory MedicineHannover Medical SchoolHannoverGermany
| | - Christine Falk
- Institute of Transplant ImmunologyHannover Medical SchoolHannoverGermany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant, and Vascular SurgeryHannover Medical SchoolHannoverGermany,German Center for Lung Research (DZL/BREATH)HannoverGermany
| | - Igor Tudorache
- Department of Cardiothoracic, Transplant, and Vascular SurgeryHannover Medical SchoolHannoverGermany
| | - Gregor Warnecke
- Department of Cardiothoracic, Transplant, and Vascular SurgeryHannover Medical SchoolHannoverGermany,German Center for Lung Research (DZL/BREATH)HannoverGermany
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122
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Hachem RR, Kamoun M, Budev MM, Askar M, Ahya VN, Lee JC, Levine DJ, Pollack MS, Dhillon GS, Weill D, Schechtman KB, Leard LE, Golden JA, Baxter-Lowe L, Mohanakumar T, Tyan DB, Yusen RD. Human leukocyte antigens antibodies after lung transplantation: Primary results of the HALT study. Am J Transplant 2018; 18:2285-2294. [PMID: 29687961 PMCID: PMC6117197 DOI: 10.1111/ajt.14893] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 03/20/2018] [Accepted: 04/17/2018] [Indexed: 01/25/2023]
Abstract
Donor-specific antibodies (DSA) to mismatched human leukocyte antigens (HLA) are associated with worse outcomes after lung transplantation. To determine the incidence and characteristics of DSA early after lung transplantation, we conducted a prospective multicenter observational study that used standardized treatment and testing protocols. Among 119 transplant recipients, 43 (36%) developed DSA: 6 (14%) developed DSA only to class I HLA, 23 (53%) developed DSA only to class II HLA, and 14 (33%) developed DSA to both class I and class II HLA. The median DSA mean fluorescence intensity (MFI) was 3197. We identified a significant association between the Lung Allocation Score and the development of DSA (HR = 1.02, 95% CI: 1.001-1.03, P = .047) and a significant association between DSA with an MFI ≥ 3000 and acute cellular rejection (ACR) grade ≥ A2 (HR = 2.11, 95% CI: 1.04-4.27, P = .039). However, we did not detect an association between DSA and survival. We conclude that DSA occur frequently early after lung transplantation, and most target class II HLA. DSA with an MFI ≥ 3000 have a significant association with ACR. Extended follow-up is necessary to determine the impact of DSA on other important outcomes.
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Affiliation(s)
- Ramsey R. Hachem
- Pulmonary and Critical Care, Washington University School of Medicine
| | - Malek Kamoun
- Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine
| | | | | | - Vivek N. Ahya
- Pulmonary and Critical Care, University of Pennsylvania School of Medicine
| | - James C. Lee
- Pulmonary and Critical Care, University of Pennsylvania School of Medicine
| | - Deborah J. Levine
- Pulmonary and Critical Care, University of Texas Health Science Center, San Antonio
| | | | | | - David Weill
- Pulmonary and Critical Care, Stanford University School of Medicine
| | | | - Lorriana E. Leard
- Pulmonary and Critical Care, University of California, San Francisco
| | - Jeffrey A. Golden
- Pulmonary and Critical Care, University of California, San Francisco
| | - LeeAnn Baxter-Lowe
- Pediatrics, Keck School of Medicine of University of Southern California
| | | | | | - Roger D. Yusen
- Pulmonary and Critical Care, Washington University School of Medicine
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123
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Voskrebenzev A, Greer M, Gutberlet M, Schönfeld C, Renne J, Hinrichs J, Kaireit T, Welte T, Wacker F, Gottlieb J, Vogel-Claussen J. Detection of chronic lung allograft dysfunction using ventilation-weighted Fourier decomposition MRI. Am J Transplant 2018; 18:2050-2060. [PMID: 29607606 DOI: 10.1111/ajt.14759] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 03/04/2018] [Accepted: 03/25/2018] [Indexed: 01/25/2023]
Abstract
Chronic lung allograft dysfunction (CLAD) remains the leading cause of morbidity and mortality after lung transplantation. Diagnosis requires spirometric change, which becomes increasingly difficult with advancing CLAD. Fourier decomposition magnetic resonance imaging (FD-MRI) permits acquisition of ventilated-weighted images during free-breathing. This study evaluates FD-MRI in detecting CLAD in selected patients after bilateral lung transplantation (DLTx). DLTx recipients demonstrating CLAD at various stages participated. Radiologists remained blinded to clinical status until completion of image analysis. Image acquisition used a 1.5-T MR scanner using a spoiled gradient echo sequence. After FD processing and regional fractional ventilation (RFV) quantification, the volume defect percentage at 2 thresholds (VDP1,2 ), median lung RFV and quartile coefficient of dispersion (QCD) were calculated. Sixty-two patients participated. CLAD was present in 29/62 (47%) patients, of whom 17/62 (27%) had forced expiratory volume in 1 second ≤65% at image acquisition. VDP1 was higher among these participants compared to other groups (P < .001). Increased VDP1 was associated with subsequent graft loss, with values >2% showing reduced survival, independent of degree of graft dysfunction (P = .005). VDP2 discriminated between presence or absence of CLAD (area under the curve = 0.71; P = .03). QCD increased significantly with advancing disease (P < .001). In conclusion, FD-MRI-derived parameters demonstrate potential in quantitative CLAD diagnosis and assessment after DLTx.
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Affiliation(s)
- A Voskrebenzev
- Institute of Diagnostic and Interventional Radiology, Hanover Medical School, Hanover, Germany.,Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hanover, Germany
| | - M Greer
- Department of Respiratory Medicine, Hanover Medical School, Hanover, Germany.,Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hanover, Germany
| | - M Gutberlet
- Institute of Diagnostic and Interventional Radiology, Hanover Medical School, Hanover, Germany.,Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hanover, Germany
| | - C Schönfeld
- Institute of Diagnostic and Interventional Radiology, Hanover Medical School, Hanover, Germany.,Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hanover, Germany
| | - J Renne
- Institute of Diagnostic and Interventional Radiology, Hanover Medical School, Hanover, Germany.,Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hanover, Germany
| | - J Hinrichs
- Institute of Diagnostic and Interventional Radiology, Hanover Medical School, Hanover, Germany.,Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hanover, Germany
| | - T Kaireit
- Institute of Diagnostic and Interventional Radiology, Hanover Medical School, Hanover, Germany.,Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hanover, Germany
| | - T Welte
- Department of Respiratory Medicine, Hanover Medical School, Hanover, Germany.,Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hanover, Germany
| | - F Wacker
- Institute of Diagnostic and Interventional Radiology, Hanover Medical School, Hanover, Germany.,Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hanover, Germany
| | - J Gottlieb
- Department of Respiratory Medicine, Hanover Medical School, Hanover, Germany.,Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hanover, Germany
| | - J Vogel-Claussen
- Institute of Diagnostic and Interventional Radiology, Hanover Medical School, Hanover, Germany.,Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hanover, Germany
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124
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Greenland JR, Chong T, Wang AS, Martinez E, Shrestha P, Kukreja J, Hays SR, Golden JA, Singer JP, Tang Q. Suppressed calcineurin-dependent gene expression identifies lung allograft recipients at increased risk of infection. Am J Transplant 2018; 18:2043-2049. [PMID: 29673076 PMCID: PMC6699504 DOI: 10.1111/ajt.14886] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/21/2018] [Accepted: 04/08/2018] [Indexed: 01/25/2023]
Abstract
Lung transplant immunosuppression regimens generally include the calcineurin inhibitor tacrolimus. We hypothesized that mean residual expression (MRE) of calcineurin-dependent genes assesses rejection and infection risk better than does tacrolimus trough. We prospectively followed 44 lung allograft recipients at 2 to 18 months posttransplant and measured changes in whole blood interleukin-2, interferon-γ, and granulocyte-macrophage colony-stimulating factor gene expression following a tacrolimus dose. Posttransplant duration, immunosuppressive medication levels, and bronchoscopic rejection and infection assessments were compared with MRE by using generalized-estimating equation-adjusted models. Prednisolone effect on MRE was assessed ex vivo in blood samples from nontransplanted controls. Tacrolimus concentration inhibiting 50% of cytokine production (IC50 ) was measured in a pretransplant subset. Results showed that MRE did not change with diagnosis of rejection but that airway infection was associated with a 20% absolute decrease (95% confidence interval 11%-29%). MRE increased with time after transplant but was not associated with tacrolimus trough. Interestingly, MRE correlated inversely with corticosteroid dose in the study cohort and ex vivo. Pretransplant tacrolimus IC50 depended on the cytokine measured and varied between individuals, suggesting a range in baseline responses to tacrolimus. We conclude that MRE identifies infection risk in lung allograft recipients, potentially integrating calcineurin inhibitor and steroid effects on lymphocyte effector function.
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Affiliation(s)
- John R Greenland
- Medical Service, Veterans Affairs Health Care System, San Francisco CA, 94121,Department of Medicine, University of California, San Francisco CA, 94143,Corresponding author:
| | - Tiffany Chong
- Department of Medicine, University of California, San Francisco CA, 94143
| | - Angelia S Wang
- Department of Medicine, University of California, San Francisco CA, 94143
| | - Emily Martinez
- Department of Medicine, University of California, San Francisco CA, 94143
| | - Pavan Shrestha
- Department of Medicine, University of California, San Francisco CA, 94143
| | - Jasleen Kukreja
- Department of Surgery, University of California, San Francisco CA, 94143
| | - Steven R. Hays
- Department of Medicine, University of California, San Francisco CA, 94143
| | - Jeffrey A Golden
- Department of Medicine, University of California, San Francisco CA, 94143,Department of Surgery, University of California, San Francisco CA, 94143
| | - Jonathan P Singer
- Department of Medicine, University of California, San Francisco CA, 94143
| | - Qizhi Tang
- Department of Surgery, University of California, San Francisco CA, 94143
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125
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Singer JP, Diamond JM, Anderson MR, Katz PP, Covinsky K, Oyster M, Blue T, Soong A, Kalman L, Shrestha P, Arcasoy SM, Greenland JR, Shah L, Kukreja J, Blumenthal NP, Easthausen I, Golden JA, McBurnie A, Cantu E, Sonett J, Hays S, Robbins H, Raza K, Bacchetta M, Shah RJ, D’Ovidio F, Venado A, Christie JD, Lederer DJ. Frailty phenotypes and mortality after lung transplantation: A prospective cohort study. Am J Transplant 2018; 18:1995-2004. [PMID: 29667786 PMCID: PMC6105397 DOI: 10.1111/ajt.14873] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [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: 01/10/2018] [Revised: 03/26/2018] [Accepted: 03/31/2018] [Indexed: 01/25/2023]
Abstract
Frailty is associated with increased mortality among lung transplant candidates. We sought to determine the association between frailty, as measured by the Short Physical Performance Battery (SPPB), and mortality after lung transplantation. In a multicenter prospective cohort study of adults who underwent lung transplantation, preoperative frailty was assessed with the SPPB (n = 318) and, in a secondary analysis, the Fried Frailty Phenotype (FFP; n = 299). We tested the association between preoperative frailty and mortality following lung transplantation with propensity score-adjusted Cox models. We calculated postestimation marginalized standardized risks for 1-year mortality by frailty status using multivariate logistic regression. SPPB frailty was associated with an increased risk of both 1- and 4-year mortality (adjusted hazard ratio [aHR]: 7.5; 95% confidence interval [CI]: 1.6-36.0 and aHR 3.8; 95%CI: 1.8-8.0, respectively). Each 1-point worsening in SPPB was associated with a 20% increased risk of death (aHR: 1.20; 95%CI: 1.08-1.33). Frail subjects had an absolute increased risk of death within the first year after transplantation of 12.2% (95%CI: 3.1%-21%). In secondary analyses, FFP frailty was associated with increased risk of death within the first postoperative year (aHR: 3.8; 95%CI: 1.1-13.2) but not over longer follow-up. Preoperative frailty is associated with an increased risk of death after lung transplantation.
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Affiliation(s)
| | - Joshua M. Diamond
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Michaela R. Anderson
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Patricia P. Katz
- Department of Medicine, University of California, San Francisco, CA
| | - Ken Covinsky
- Department of Medicine, University of California, San Francisco, CA
| | - Michelle Oyster
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Tatiana Blue
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Allison Soong
- Department of Medicine, University of California, San Francisco, CA
| | - Laurel Kalman
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Pavan Shrestha
- Department of Medicine, University of California, San Francisco, CA
| | - Selim M. Arcasoy
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
| | | | - Lori Shah
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Jasleen Kukreja
- Department of Surgery, University of California, San Francisco, CA
| | | | - Imaani Easthausen
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
| | | | - Amika McBurnie
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Ed Cantu
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Joshua Sonett
- Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Steven Hays
- Department of Medicine, University of California, San Francisco, CA
| | - Hilary Robbins
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Kashif Raza
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Matthew Bacchetta
- Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Rupal J. Shah
- Department of Medicine, University of California, San Francisco, CA
| | - Frank D’Ovidio
- Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Aida Venado
- Department of Medicine, University of California, San Francisco, CA
| | - Jason D. Christie
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - David J. Lederer
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
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126
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Berger M, Liu M, Uknis ME, Koulmanda M. Alpha-1-antitrypsin in cell and organ transplantation. Am J Transplant 2018; 18:1589-1595. [PMID: 29607607 PMCID: PMC6055806 DOI: 10.1111/ajt.14756] [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: 12/22/2017] [Revised: 02/14/2018] [Accepted: 03/13/2018] [Indexed: 01/25/2023]
Abstract
Limited availability of donor organs and risk of ischemia-reperfusion injury (IRI) seriously restrict organ transplantation. Therapeutics that can prevent or reduce IRI could potentially increase the number of transplants by increasing use of borderline organs and decreasing discards. Alpha-1 antitrypsin (AAT) is an acute phase reactant and serine protease inhibitor that limits inflammatory tissue damage. Purified plasma-derived AAT has been well tolerated in more than 30 years of use to prevent emphysema in AAT-deficient individuals. Accumulating evidence suggests that AAT has additional anti-inflammatory and tissue-protective effects including improving mitochondrial membrane stability, inhibiting apoptosis, inhibiting nuclear factor kappa B activation, modulating pro- vs anti-inflammatory cytokine balance, and promoting immunologic tolerance. Cell culture and animal studies have shown that AAT limits tissue injury and promotes cell and tissue survival. AAT can promote tolerance in animal models by downregulating early inflammation and favoring induction and stabilization of regulatory T cells. The diverse intracellular and immune-modulatory effects of AAT and its well-established tolerability in patients suggest that it might be useful in transplantation. Clinical trials, planned and/or in progress, should help determine whether the promise of the animal and cellular studies will be fulfilled by improving outcomes in human organ transplantation.
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Affiliation(s)
| | | | | | - Maria Koulmanda
- Transplant Institute at Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMAUSA
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127
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Yeung JC, Zamel R, Klement W, Bai XH, Machuca TN, Waddell TK, Liu M, Cypel M, Keshavjee S. Towards donor lung recovery-gene expression changes during ex vivo lung perfusion of human lungs. Am J Transplant 2018; 18:1518-1526. [PMID: 29446226 DOI: 10.1111/ajt.14700] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/23/2018] [Accepted: 02/07/2018] [Indexed: 01/25/2023]
Abstract
We and others have demonstrated that acellular normothermic ex vivo lung perfusion of high-risk donor lungs can result in posttransplant outcomes equivalent to that of contemporaneous lung transplantation using standard donor lungs. However, the mechanism of this effect remains unclear. Given the restoration of cellular metabolic activity during normothermic perfusion, one possibility is that of lung healing via natural innate recovery mechanisms. We explored this by examining the gene expression changes occurring in human lungs during ex vivo lung perfusion. Human lungs clinically rejected for transplantation were perfused for 12 hours of EVLP with biopsies taken at the start, at 1 hour, at 3 hours, and then every 3 hours thereafter to 12 hours. Temporal changes were identified in 2585 genes using the Short Time-series Expression Miner and used for pathway analysis. Despite increases in endothelial markers of inflammation, circulating leukocyte cell-specific gene expression fell over 12 hours of ex vivo lung perfusion (EVLP), suggesting an interrupted inflammation response secondary to washout of circulating leukocytes. Analysis of these gene changes suggests lung recovery follows specific stages: cellular death, cellular preservation, cellular reorganization, and cellular invasion. EVLP may improve posttransplant lung function by washout of leukocytes and facilitating innate mechanisms of repair.
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Affiliation(s)
- Jonathan C Yeung
- Toronto Lung Transplant Program, University of Toronto, Toronto, ON, Canada
| | - Ricardo Zamel
- Toronto Lung Transplant Program, University of Toronto, Toronto, ON, Canada
| | - William Klement
- Toronto Lung Transplant Program, University of Toronto, Toronto, ON, Canada
| | - Xiao-Hui Bai
- Toronto Lung Transplant Program, University of Toronto, Toronto, ON, Canada
| | - Tiago N Machuca
- Toronto Lung Transplant Program, University of Toronto, Toronto, ON, Canada
| | - Thomas K Waddell
- Toronto Lung Transplant Program, University of Toronto, Toronto, ON, Canada
| | - Mingyao Liu
- Toronto Lung Transplant Program, University of Toronto, Toronto, ON, Canada
| | - Marcelo Cypel
- Toronto Lung Transplant Program, University of Toronto, Toronto, ON, Canada
| | - Shaf Keshavjee
- Toronto Lung Transplant Program, University of Toronto, Toronto, ON, Canada
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128
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Benvenuto LJ, Anderson DR, Kim HP, Hook JL, Shah L, Robbins HY, D'Ovidio F, Bacchetta M, Sonett JR, Arcasoy SM. Geographic disparities in donor lung supply and lung transplant waitlist outcomes: A cohort study. Am J Transplant 2018; 18:1471-1480. [PMID: 29266733 DOI: 10.1111/ajt.14630] [Citation(s) in RCA: 30] [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: 11/05/2017] [Revised: 11/30/2017] [Accepted: 12/10/2017] [Indexed: 01/25/2023]
Abstract
Despite the Final Rule mandate for equitable organ allocation in the United States, geographic disparities exist in donor lung allocation, with the majority of donor lungs being allocated locally to lower-priority candidates. We conducted a retrospective cohort study of 19 622 lung transplant candidates waitlisted between 2006 and 2015. We used multivariable adjusted competing risk survival models to examine the relationship between local lung availability and waitlist outcomes. The primary outcome was a composite of death and removal from the waitlist for clinical deterioration. Waitlist candidates in the lowest quartile of local lung availability had an 84% increased risk of death or removal compared with candidates in the highest (subdistribution hazard ratio [SHR]: 1.84, 95% confidence interval [CI]: 1.51-2.24, P < .001). The transplantation rate was 57% lower in the lowest quartile compared with the highest (SHR: 0.43, 95% CI: 0.39-0.47). The adjusted death or removal rate decreased by 11% with a 50% increase in local lung availability (SHR: 0.89, 95% CI: 0.85-0.93, P < .001) and the adjusted transplantation rate increased by 19% (SHR: 1.19, 95% CI: 1.17-1.22, P < .001). There are geographically disparate waitlist outcomes in the current lung allocation system. Candidates listed in areas of low local lung availability have worse waitlist outcomes.
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Affiliation(s)
- Luke J Benvenuto
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - David R Anderson
- Department of Management, Zicklin School of Business, Baruch College, New York, NY, USA
| | | | - Jaime L Hook
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Lori Shah
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Hilary Y Robbins
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Frank D'Ovidio
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Matthew Bacchetta
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Joshua R Sonett
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Selim M Arcasoy
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, NY, USA
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129
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Ensor CR, Iasella CJ, Harrigan KM, Morrell MR, Moore CA, Shigemura N, Zeevi A, McDyer JF, Venkataramanan R. Increasing tacrolimus time-in-therapeutic range is associated with superior one-year outcomes in lung transplant recipients. Am J Transplant 2018; 18:1527-1533. [PMID: 29513387 DOI: 10.1111/ajt.14723] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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: 12/15/2017] [Revised: 02/16/2018] [Accepted: 02/20/2018] [Indexed: 02/06/2023]
Abstract
Calcineurin inhibitors (CNIs) are the backbone of traditional immunosuppressive regimens for lung transplant recipients (LTR). The CNIs are both narrow therapeutic index drugs with significant interpatient and intrapatient variability that require therapeutic drug monitoring to ensure safety and effectiveness. We hypothesized that tacrolimus time-in-therapeutic range (TTR) affects acute and chronic rejection rates in LTRs. This was a single-center, observational, cross-sectional study of 292 adult LTRs. Subjects who received tacrolimus posttransplant for the first year were included. TTR was calculated at 1 year using protocol goal ranges (12-15 mg/mL months 0-6; 10-12 mg/mL for months 7-12). The primary outcome was acute cellular rejection (ACR) burden at 1 year. Chronic lung allograft dysfunction (CLAD), mortality, and infection rate were assessed as secondary outcomes at 1 year. Primary and secondary outcomes were assessed using logistic regression. Increasing TTR by 10% was associated with a significantly lower likelihood of high-burden ACR at 1 year on univariable (OR 0.46, 95% CI 0.40-0.54, P < .001) and multivariable (OR 0.64, 95% CI 0.47-0.86, P = .003) assessment, controlling for age and induction agent. Increasing TTR by 10% was also associated with lower rates of CLAD (P < .001) and mortality (P < .001) at 1 year. Prospective studies confirming these findings appear warranted.
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Affiliation(s)
- Christopher R Ensor
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA.,Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Carlo J Iasella
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
| | - Kate M Harrigan
- Department of Pharmacy Systems, Outcomes & Policy, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
| | - Matthew R Morrell
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Cody A Moore
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Norihisa Shigemura
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Adriana Zeevi
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - John F McDyer
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Raman Venkataramanan
- Department of Pharmaceutical Sciences, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA.,Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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130
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Bobylev D, Salman J, Sommer W, Ius F, Siemeni T, Avsar M, Kühn C, Niehaus A, Gottlieb J, Haverich A, Tudorache I, Warnecke G. Single lung transplantation from a donor 8 months after double lung transplantation. Am J Transplant 2018; 18:1275-1277. [PMID: 29314647 DOI: 10.1111/ajt.14644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 11/15/2017] [Accepted: 12/16/2017] [Indexed: 01/25/2023]
Abstract
Scarcity of donors leads transplant surgeons to consider extended-criteria lungs and occasionally to accept the unlikely. Here we report a case of successful single lung transplantation from a donor 8 months after double lung transplantation.
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Affiliation(s)
- D Bobylev
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - J Salman
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - W Sommer
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.,Member of the German Centre for Lung Research, Hannover, Germany
| | - F Ius
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - T Siemeni
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - M Avsar
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - C Kühn
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - A Niehaus
- German Organ Transplantation Foundation (DSO), Frankfurt, Germany
| | - J Gottlieb
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - A Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.,Member of the German Centre for Lung Research, Hannover, Germany
| | - I Tudorache
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - G Warnecke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.,Member of the German Centre for Lung Research, Hannover, Germany
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131
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Michel SG, Madariaga MLL, LaMuraglia GMII, Villani V, Sekijima M, Farkash EA, Colvin RB, Sachs DH, Yamada K, Rosengard BR, Allan JS, Madsen JC. The effects of brain death and ischemia on tolerance induction are organ-specific. Am J Transplant 2018; 18:1262-1269. [PMID: 29377632 PMCID: PMC5910264 DOI: 10.1111/ajt.14674] [Citation(s) in RCA: 6] [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: 07/18/2017] [Revised: 12/29/2017] [Accepted: 01/18/2018] [Indexed: 01/25/2023]
Abstract
We have previously shown that 12 days of high-dose calcineurin inhibition induced tolerance in MHC inbred miniature swine receiving MHC-mismatched lung, kidney, or co-transplanted heart/kidney allografts. However, if lung grafts were procured from donation after brain death (DBD), and transplanted alone, they were rejected within 19-45 days. Here, we investigated whether donor brain death with or without allograft ischemia would also prevent tolerance induction in kidney or heart/kidney recipients. Four kidney recipients treated with 12 days of calcineurin inhibition received organs from donors rendered brain dead for 4 hours. Six heart/kidney recipients also treated with calcineurin inhibition received organs from donors rendered brain dead for 4 hours, 8 hours, or 4 hours with 4 additional hours of cold storage. In contrast to lung allograft recipients, all isolated kidney or heart/kidney recipients that received organs from DBD donors achieved long-term survival (>100 days) without histologic evidence of rejection. Proinflammatory cytokine gene expression was upregulated in lungs and hearts, but not kidney allografts, after brain death. These data suggest that the deleterious effects of brain death and ischemia on tolerance induction are organ-specific, which has implications for the application of tolerance to clinical transplantation.
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Affiliation(s)
- SG Michel
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA,Clinic of Cardiac Surgery, Ludwig-Maximilians-University Munich, Germany
| | - MLL Madariaga
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - GMII LaMuraglia
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA,Emory Transplant Center, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - V Villani
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - M Sekijima
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA,Division of Organ Replacement and Xenotransplantation Surgery, Kagoshima University, Japan
| | - EA Farkash
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA,University of Michigan Health System Department of Pathology, Ann Arbor, MI, USA
| | - RB Colvin
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - DH Sachs
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA,Center for Translational Immunology, Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - K Yamada
- Center for Translational Immunology, Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | | | - JS Allan
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA,Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - JC Madsen
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA,Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
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132
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Aguilar PR, Carpenter D, Ritter J, Yusen RD, Witt CA, Byers DE, Mohanakumar T, Kreisel D, Trulock EP, Hachem RR. The role of C4d deposition in the diagnosis of antibody-mediated rejection after lung transplantation. Am J Transplant 2018; 18:936-944. [PMID: 28992372 PMCID: PMC5878693 DOI: 10.1111/ajt.14534] [Citation(s) in RCA: 35] [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: 06/09/2017] [Revised: 09/10/2017] [Accepted: 09/29/2017] [Indexed: 01/25/2023]
Abstract
Antibody-mediated rejection (AMR) is an increasingly recognized form of lung rejection. C4d deposition has been an inconsistent finding in previous reports and its role in the diagnosis has been controversial. We conducted a retrospective single-center study to characterize cases of C4d-negative probable AMR and to compare these to cases of definite (C4d-positive) AMR. We identified 73 cases of AMR: 28 (38%) were C4d-positive and 45 (62%) were C4d-negative. The two groups had a similar clinical presentation, and although more patients in the C4d-positive group had neutrophilic capillaritis (54% vs. 29%, P = .035), there was no significant difference in the presence of other histologic findings. Despite aggressive antibody-depleting therapy, 19 of 73 (26%) patients in the overall cohort died within 30 days, but there was no significant difference in freedom from chronic lung allograft dysfunction (CLAD) or survival between the two groups. We conclude that AMR may cause allograft failure, but that the diagnosis requires a multidisciplinary approach and a high index of suspicion. C4d deposition does not appear to be a necessary criterion for the diagnosis, and although some cases may respond initially to therapy, there is a high incidence of CLAD and poor survival after AMR.
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Affiliation(s)
- PR Aguilar
- Baylor University Medical Center Division of Pulmonary & Critical Care, Dallas, TX
| | - D Carpenter
- St. Louis University School of Medicine Department of Pathology, St. Louis, MO
| | - J Ritter
- Washington University School of Medicine Department of Pathology & Immunology, St. Louis, MO
| | - RD Yusen
- Washington University School of Medicine Division of Pulmonary & Critical Care, St Louis, MO
| | - CA Witt
- Washington University School of Medicine Division of Pulmonary & Critical Care, St Louis, MO
| | - DE Byers
- Washington University School of Medicine Division of Pulmonary & Critical Care, St Louis, MO
| | | | - D Kreisel
- Washington University School of Medicine Division of Cardiothoracic Surgery, St. Louis, MO
| | - EP Trulock
- Washington University School of Medicine Division of Pulmonary & Critical Care, St Louis, MO
| | - RR Hachem
- Washington University School of Medicine Division of Pulmonary & Critical Care, St Louis, MO
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133
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Shahabeddin Parizi A, Krabbe PFM, Verschuuren EAM, Hoek RAS, Kwakkel‐van Erp JM, Erasmus ME, van der Bij W, Vermeulen KM. Patient-reported health outcomes in long-term lung transplantation survivors: A prospective cohort study. Am J Transplant 2018; 18:684-695. [PMID: 28889654 PMCID: PMC5836864 DOI: 10.1111/ajt.14492] [Citation(s) in RCA: 15] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 08/23/2017] [Accepted: 08/30/2017] [Indexed: 01/25/2023]
Abstract
During the last three decades lung transplantation (LTx) has become a proven modality for increasing both survival and health-related quality of life (HRQoL) in patients with various end-stage lung diseases. Most previous studies have reported improved HRQoL shortly after LTx. With regard to long-term effects on HRQoL, however, the evidence is less solid. This prospective cohort study was started with 828 patients who were on the waiting list for LTx. Then, in a longitudinal follow-up, 370 post-LTx patients were evaluated annually for up to 15 years. For all wait-listed and follow-up patients, the following four HRQoL instruments were administered: State-Trait Anxiety Inventory, Zung Self-rating Depression Scale, Nottingham Health Profile, and a visual analogue scale. Cross-sectional and generalized estimating equation (GEE) analysis for repeated measures were performed to assess changes in HRQoL during follow-up. After LTx, patients showed improvement in all HRQoL domains except pain, which remained steady throughout the long-term follow-up. The level of anxiety and depressive symptoms decreased significantly and remained constant. In conclusion, this study showed that HRQoL improves after LTx and tends to remain relatively constant for the entire life span.
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Affiliation(s)
- A. Shahabeddin Parizi
- Department of EpidemiologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - P. F. M. Krabbe
- Department of EpidemiologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - E. A. M. Verschuuren
- Department of Pulmonology and TuberculosisUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - R. A. S. Hoek
- Department of PulmonologyErasmus MC‐University Medical CenterRotterdamThe Netherlands
| | | | - M. E. Erasmus
- Department of Cardiothoracic SurgeryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - W. van der Bij
- Department of Pulmonology and TuberculosisUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - K. M. Vermeulen
- Department of EpidemiologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
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134
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Stjärne Aspelund A, Hammarström H, Inghammar M, Larsson H, Hansson L, Christensson B, Påhlman LI. Heparin-binding protein, lysozyme, and inflammatory cytokines in bronchoalveolar lavage fluid as diagnostic tools for pulmonary infection in lung transplanted patients. Am J Transplant 2018; 18:444-452. [PMID: 28787761 PMCID: PMC5813223 DOI: 10.1111/ajt.14458] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 07/21/2017] [Accepted: 07/29/2017] [Indexed: 01/25/2023]
Abstract
Pulmonary infection is a common complication after lung transplantation, and early detection is crucial for outcome. However, the condition can be clinically difficult to diagnose and to distinguish from rejection. The aim of this prospective study was to evaluate heparin-binding protein (HBP), lysozyme, and the cytokines interleukin (IL)-1β, IL-6, IL-8, IL-10 and tumor necrosis factor (TNF) in bronchoalveolar lavage fluid (BALF) as potential biomarkers for pulmonary infection in lung-transplanted patients. One hundred thirteen BALF samples from 29 lung transplant recipients were collected at routine scheduled bronchoscopies at 3 and 6 months, or on clinical indication. Samples were classified into no, possible, probable, or definite infection at the time of sampling. Rejection was defined by biopsy results. HBP, lysozyme, and cytokines were analyzed in BALF and correlated to likelihood of infection and rejection. All biomarkers were significantly increased in BALF during infection, whereas patients with rejection presented low levels that were comparable to noninfection samples. HBP, IL-1β, and IL-8 were the best diagnostic markers of infection with area under the receiver-operating characteristic curve values of 0.88, 0.91, and 0.90, respectively. In conclusion, HBP, IL-1β, and IL-8 could be useful diagnostic markers of pulmonary infection in lung-transplanted patients.
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Affiliation(s)
- Anna Stjärne Aspelund
- Department of Infection ControlSkåne CountyLundSweden,Division of Infection MedicineDepartment of Clinical Sciences LundLund UniversitySkåne University HospitalLundSweden
| | - Helena Hammarström
- Department of Infectious DiseasesSahlgrenska Academy at University of GothenburgGöteborgSweden
| | - Malin Inghammar
- Division of Infection MedicineDepartment of Clinical Sciences LundLund UniversitySkåne University HospitalLundSweden
| | - Hillevi Larsson
- Division of Respiratory Medicine and AllergologyDepartment of Clinical SciencesLund UniversitySkåne University HospitalLundSweden
| | - Lennart Hansson
- Division of Respiratory Medicine and AllergologyDepartment of Clinical SciencesLund UniversitySkåne University HospitalLundSweden
| | - Bertil Christensson
- Division of Infection MedicineDepartment of Clinical Sciences LundLund UniversitySkåne University HospitalLundSweden
| | - Lisa I. Påhlman
- Division of Infection MedicineDepartment of Clinical Sciences LundLund UniversitySkåne University HospitalLundSweden
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135
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Solé A, García-Robles AA, Jordá C, Cases Viedma E, Mancheño N, Poveda-Andrés JL, Reig Mezquida JP, Pemán J. Salvage therapy with topical posaconazole in lung transplant recipients with invasive Scedosporium infection. Am J Transplant 2018; 18:504-509. [PMID: 29116676 DOI: 10.1111/ajt.14580] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/06/2017] [Accepted: 10/25/2017] [Indexed: 01/25/2023]
Abstract
Scedosporium is an important pathogen in cystic fibrosis (CF) and post-transplantation, but it rarely causes invasive infection. Treatment remains challenging, particularly due to the inherent resistance to multiple antifungal agents. We present 3 complicated invasive tracheobronchial and lung Scedosporium apiospermum infections following lung transplantation. In 2 of 3 cases, the infection was clinically and radiologically cured with frequent cleansing bronchoscopies, combining triazole with terbinafine therapy and nebulized posaconazole. These cases highlight the importance of adjunctive nebulized therapy in addition to prolonged triazole treatment to manage complex invasive Scedosporium infections in immunosuppressed patients. Posaconazole (PSZ) was delivered during the bronchoscopy procedure through intrabronchial administration, whereas an eFlow rapid® device was used for nebulized therapy. Topical posaconazole was well tolerated in 2 patients, with only a slight cough during administrations; the third patient had local irritation with poor tolerance, which led to its withdrawal. This is the first report on compassionate use of topical PSZ as salvage therapy for resistant mold infections in lung transplant recipients. These 3 cases represent the entire experience using this approach; no additional patients have received this therapy due to there not having been any additional cases of Scedosporium tracheobronchitis presented.
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Affiliation(s)
- Amparo Solé
- Lung Transplant and Cystic Fibrosis Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Carlos Jordá
- Lung Transplant and Cystic Fibrosis Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Enrique Cases Viedma
- Respiratory Endoscopy Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Nuria Mancheño
- Pathology Service, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Juan Pablo Reig Mezquida
- Lung Transplant and Cystic Fibrosis Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Javier Pemán
- Microbiology Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
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136
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Takahashi T, Hsiao HM, Tanaka S, Li W, Higashikubo R, Scozzi D, Bharat A, Ritter JH, Krupnick AS, Gelman AE, Kreisel D. PD-1 expression on CD8 + T cells regulates their differentiation within lung allografts and is critical for tolerance induction. Am J Transplant 2018; 18:216-225. [PMID: 28730633 PMCID: PMC5739961 DOI: 10.1111/ajt.14437] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 06/18/2017] [Accepted: 07/11/2017] [Indexed: 01/25/2023]
Abstract
Immunological requirements for rejection and tolerance induction differ between various organs. While memory CD8+ T cells are considered a barrier to immunosuppression-mediated acceptance of most tissues and organs, tolerance induction after lung transplantation is critically dependent on central memory CD8+ T lymphocytes. Here we demonstrate that costimulation blockade-mediated tolerance after lung transplantation is dependent on programmed cell death 1 (PD-1) expression on CD8+ T cells. In the absence of PD-1 expression, CD8+ T cells form prolonged interactions with graft-infiltrating CD11c+ cells; their differentiation is skewed towards an effector memory phenotype and grafts are rejected acutely. These findings extend the notion that requirements for tolerance induction after lung transplantation differ from other organs. Thus, immunosuppressive strategies for lung transplant recipients need to be tailored based on the unique immunological properties of this organ.
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Affiliation(s)
- T Takahashi
- Department of Surgery, Washington University in St. Louis
| | - HM Hsiao
- Department of Surgery, Washington University in St. Louis
| | - S Tanaka
- Department of Surgery, Washington University in St. Louis
| | - W Li
- Department of Surgery, Washington University in St. Louis
| | - R Higashikubo
- Department of Surgery, Washington University in St. Louis
| | - D Scozzi
- Department of Surgery, Washington University in St. Louis
| | - A Bharat
- Department of Surgery, Northwestern University
| | - JH Ritter
- Department of Pathology & Immunology, Washington University in St. Louis
| | - AS Krupnick
- Department of Surgery, University of Virginia
| | - AE Gelman
- Department of Surgery, Washington University in St. Louis,Department of Pathology & Immunology, Washington University in St. Louis
| | - D Kreisel
- Department of Surgery, Washington University in St. Louis,Department of Pathology & Immunology, Washington University in St. Louis,Corresponding author: Daniel Kreisel, M.D., Ph.D., Professor of Surgery, Pathology & Immunology, Campus Box 8234, 660 South Euclid Avenue, Washington University School of Medicine, St. Louis, MO 63110, Tel: (314) 362-6021, Fax: (314) 367-8459,
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137
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Maldonado DA, RoyChoudhury A, Lederer DJ. A novel patient-centered "intention-to-treat" metric of U.S. lung transplant center performance. Am J Transplant 2018; 18:226-231. [PMID: 28862792 PMCID: PMC5739968 DOI: 10.1111/ajt.14486] [Citation(s) in RCA: 11] [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: 06/02/2017] [Revised: 07/31/2017] [Accepted: 08/22/2017] [Indexed: 01/25/2023]
Abstract
Despite the importance of pretransplantation outcomes, 1-year posttransplantation survival is typically considered the primary metric of lung transplant center performance in the United States. We designed a novel lung transplant center performance metric that incorporates both pre- and posttransplantation survival time. We performed an ecologic study of 12 187 lung transplant candidates listed at 56 U.S. lung transplant centers between 2006 and 2012. We calculated an "intention-to-treat" survival (ITTS) metric as the percentage of waiting list candidates surviving at least 1 year after transplantation. The median center-level 1-year posttransplantation survival rate was 84.1%, and the median center-level ITTS was 66.9% (mean absolute difference 19.6%, 95% limits of agreement 4.3 to 35.1%). All but 10 centers had ITTS values that were significantly lower than 1-year posttransplantation survival rates. Observed ITTS was significantly lower than expected ITTS for 7 centers. These data show that one third of lung transplant candidates do not survive 1 year after transplantation, and that 12% of centers have lower than expected ITTS. An "intention-to-treat" survival metric may provide a more realistic expectation of patient outcomes at transplant centers and may be of value to transplant centers and policymakers.
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Affiliation(s)
- Dawn A. Maldonado
- Department of Medicine, College of Physicians & Surgeons, Columbia University, New York, New York
| | - Arindam RoyChoudhury
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - David J. Lederer
- Department of Medicine, College of Physicians & Surgeons, Columbia University, New York, New York,Department of Biostatistics Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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138
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Shino MY, Weigt SS, Li N, Derhovanessian A, Sayah DM, Saggar R, Huynh RH, Gregson AL, Ardehali A, Ross DJ, Lynch JP, Elashoff RM, Belperio JA. The Prognostic Importance of Bronchoalveolar Lavage Fluid CXCL9 During Minimal Acute Rejection on the Risk of Chronic Lung Allograft Dysfunction. Am J Transplant 2018; 18:136-144. [PMID: 28637080 PMCID: PMC5739954 DOI: 10.1111/ajt.14397] [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: 03/13/2017] [Revised: 06/11/2017] [Accepted: 06/12/2017] [Indexed: 01/25/2023]
Abstract
The clinical significance and treatment strategies for minimal acute rejection (grade A1), the most common form of acute rejection (AR), remain controversial. In this retrospective single-center cohort study of 441 lung transplant recipients, we formally evaluate the association between minimal AR and chronic lung allograft dysfunction (CLAD) and test a novel hypothesis using bronchoalveolar lavage (BAL) CXCL9 concentration during minimal AR as a biomarker of subsequent CLAD development. In univariable and multivariable models adjusted for all histopathologic injury patterns, minimal AR was not associated with CLAD development. However, minimal AR with elevated BAL CXCL9 concentrations markedly increased CLAD risk in a dose-response manner. Minimal AR with CXCL9 concentrations greater than the 25th, 50th, and 75th percentile had adjusted hazard ratios (HRs) for CLAD of 1.1 (95% confidence interval [CI] 0.8-1.6), 1.6 (95% CI 1.1-2.3), and 2.2 (95% CI 1.4-3.4), respectively. Thus we demonstrate the utility of BAL CXCL9 measurement as a prognostic biomarker that allows discrimination of recipients at increased risk of CLAD development after minimal AR. BAL CXCL9 measurement during transbronchial biopsies may provide clinically useful prognostic data and guide treatment decisions for this common form of AR, as a possible strategy to minimize CLAD development.
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Affiliation(s)
- MY Shino
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690
| | - SS Weigt
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690
| | - N Li
- Department of Biomathematics, University of California at Los Angeles, Los Angeles, CA 90095-1652
| | - A Derhovanessian
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690
| | - DM Sayah
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690
| | - R Saggar
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690
| | - Richard H. Huynh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690
| | - AL Gregson
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1688
| | - A Ardehali
- Division of Cardiothoracic Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1741
| | - DJ Ross
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690
| | - JP Lynch
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690
| | - RM Elashoff
- Department of Biomathematics, University of California at Los Angeles, Los Angeles, CA 90095-1652
| | - JA Belperio
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1690
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139
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Kulkarni HS, Witt CA. Voriconazole in lung transplant recipients - how worried should we be? Am J Transplant 2018; 18:5-6. [PMID: 28941318 PMCID: PMC6195419 DOI: 10.1111/ajt.14517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 09/12/2017] [Accepted: 09/21/2017] [Indexed: 01/25/2023]
Affiliation(s)
- Hrishikesh S. Kulkarni
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University in Saint Louis, MO, United States
| | - Chad A. Witt
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University in Saint Louis, MO, United States
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140
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van Berkel V. The dangers of oversimplification - quality metrics and lung transplantation. Am J Transplant 2018; 18:11-12. [PMID: 28925582 DOI: 10.1111/ajt.14505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 09/05/2017] [Accepted: 09/10/2017] [Indexed: 01/25/2023]
Affiliation(s)
- Victor van Berkel
- University of Louisville, Cardiovascular and Thoracic Surgery, Louisville, KY, USA
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141
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Mulvihill MS, Hartwig MG. Getting to transplantation. Am J Transplant 2018; 18:7-8. [PMID: 28858433 DOI: 10.1111/ajt.14482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 08/06/2017] [Accepted: 08/06/2017] [Indexed: 01/25/2023]
Affiliation(s)
- Michael S Mulvihill
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Matthew G Hartwig
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
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142
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Hayanga AJ, Du AL, Joubert K, Tuft M, Baird R, Pilewski J, Morrell M, D'Cunha J, Shigemura N. Mechanical Ventilation and Extracorporeal Membrane Oxygenation as a Bridging Strategy to Lung Transplantation: Significant Gains in Survival. Am J Transplant 2018; 18:125-135. [PMID: 28695576 DOI: 10.1111/ajt.14422] [Citation(s) in RCA: 35] [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: 03/03/2017] [Revised: 06/18/2017] [Accepted: 06/25/2017] [Indexed: 01/25/2023]
Abstract
Mechanical ventilation (MV) and extracorporeal membrane oxygenation (ECMO) are increasingly used to bridge patients to lung transplantation. We investigated the impact of using MV, with or without ECMO, before lung transplantation on survival after transplantation by performing a retrospective analysis of 826 patients who underwent transplantation at our high-volume center. Recipient characteristics and posttransplant outcomes were analyzed. Most lung transplant recipients (729 patients) did not require bridging; 194 of these patients were propensity matched with patients who were bridged using MV alone (48 patients) or MV and ECMO (49 patients). There was no difference in overall survival between the MV and MV+ECMO groups (p = 0.07). The MV+ECMO group had significantly higher survival conditioned on surviving to 1 year (median 1,811 days ([MV] vs. not reached ([MV+ECMO], p = 0.01). Recipients in the MV+ECMO group, however, were more likely to require ECMO after lung transplantation (16.7% MV vs. 57.1% MV+ECMO, p < 0.001). There were no differences in duration of postoperative MV, hospital stay, graft survival, or the incidence of acute rejection, renal failure, bleeding requiring reoperation, or airway complications. In this contemporary series, the combination of MV and ECMO was a viable bridging strategy to lung transplantation that led to acceptable patient outcomes.
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Affiliation(s)
- A J Hayanga
- Division of Cardiothoracic Transplantation, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - A L Du
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - K Joubert
- Division of Cardiothoracic Transplantation, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - M Tuft
- Division of Cardiothoracic Transplantation, Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - R Baird
- Division of Cardiothoracic Transplantation, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - J Pilewski
- Division of Pulmonary Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - M Morrell
- Division of Pulmonary Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - J D'Cunha
- Division of Cardiothoracic Transplantation, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - N Shigemura
- Division of Cardiothoracic Transplantation, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
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143
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Hamandi B, Fegbeutel C, Silveira FP, Verschuuren EA, Younus M, Mo J, Yan J, Ussetti P, Chin-Hong PV, Solé A, Holmes-Liew CL, Billaud EM, Grossi PA, Manuel O, Levine DJ, Barbers RG, Hadjiliadis D, Aram J, Singer LG, Husain S. Voriconazole and squamous cell carcinoma after lung transplantation: A multicenter study. Am J Transplant 2018; 18:113-124. [PMID: 28898527 DOI: 10.1111/ajt.14500] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/04/2017] [Accepted: 08/30/2017] [Indexed: 01/25/2023]
Abstract
This study evaluated the independent contribution of voriconazole to the development of squamous cell carcinoma (SCC) in lung transplant recipients, by attempting to account for important confounding factors, particularly immunosuppression. This international, multicenter, retrospective, cohort study included adult patients who underwent lung transplantation during 2005-2008. Cox regression analysis was used to assess the effects of voriconazole and other azoles, analyzed as time-dependent variables, on the risk of developing biopsy-confirmed SCC. Nine hundred lung transplant recipients were included. Median follow-up time from transplantation to end of follow-up was 3.51 years. In a Cox regression model, exposure to voriconazole alone (adjusted hazard ratio 2.39, 95% confidence interval 1.31-4.37) and exposure to voriconazole and other azole(s) (adjusted hazard ratio 3.45, 95% confidence interval 1.07-11.06) were associated with SCC compared with those unexposed after controlling for important confounders including immunosuppressants. Exposure to voriconazole was associated with increased risk of SCC of the skin in lung transplant recipients. Residual confounding could not be ruled out because of the use of proxy variables to control for some confounders. Benefits of voriconazole use when prescribed to lung transplant recipients should be carefully weighed versus the potential risk of SCC. EU PAS registration number: EUPAS5269.
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Affiliation(s)
- B Hamandi
- Department of Pharmacy, University Health Network, Toronto, ON, Canada
| | - C Fegbeutel
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - F P Silveira
- Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - E A Verschuuren
- Department of Pulmonary Diseases, University Hospital Groningen, Groningen, the Netherlands
| | | | - J Mo
- Pfizer Inc., New York, NY, USA
| | - J Yan
- Pfizer Inc., New York, NY, USA
| | - P Ussetti
- Respiratory Department, Hospital Puerta de Hierro, Madrid, Spain
| | - P V Chin-Hong
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - A Solé
- Respiratory Department, University and Polytechnic Hospital La Fe, Universidad de Valencia, Valencia, Spain
| | - C L Holmes-Liew
- Lung Research, Hanson Institute, and Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia
| | - E M Billaud
- Service de Pharmacologie, AP-HP, Hôpital Européen G Pompidou, Paris, France
| | - P A Grossi
- Infectious Diseases Department, University of Insubria, Varese, Italy
| | - O Manuel
- Infectious Diseases Service and Transplantation Center, University Hospital of Lausanne, Lausanne, Switzerland
| | - D J Levine
- Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - R G Barbers
- Division of Pulmonary and Critical Care, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - D Hadjiliadis
- Department of Medicine, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - J Aram
- Pfizer Inc., New York, NY, USA
| | - L G Singer
- Toronto Lung Transplant Program, University Health Network, Toronto, ON, Canada
| | - S Husain
- Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
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144
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Avriel A, Klement AH, Johnson SR, de Perrot M, Granton J. Impact of Left Ventricular Diastolic Dysfunction on Lung Transplantation Outcome in Patients With Pulmonary Arterial Hypertension. Am J Transplant 2017; 17:2705-2711. [PMID: 28508451 DOI: 10.1111/ajt.14352] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 03/31/2017] [Accepted: 05/02/2017] [Indexed: 01/25/2023]
Abstract
Diastolic dysfunction may influence perioperative outcome, early graft function, and long-term survival. We compared the outcomes of double lung transplantation (DLTx) for patients with pulmonary arterial hypertension (PAH) with preoperative left ventricular (LV) diastolic dysfunction with the outcomes of patients without diastolic dysfunction. Of 116 consecutive patients with PAH (who underwent transplantation between January 1995 and December 2013), 44 met our inclusion and exclusion criteria. Fourteen (31.8%) patients with diastolic dysfunction pretransplantation had a higher body mass index (29 [IQR 21.5-32.6] vs 22.4 [IQR 19.9-25.3] kg/m2 ) and mean pulmonary arterial pressure (54.6 ± 10 mmHg vs 47 ± 11.3 mmHg) and right atrial pressure (16.5 ± 5.2 mmHg vs 10.6 ± 5.2 mmHg). The patients received extracorporeal life support more frequently (33% vs 7% [p = 0.02]), had worse APACHE II scores (21.7 ± 7.4 vs 15.3 ± 5.3 [p = 0.02]), and a trend toward worse ventilator-free days (2.5 [IQR 6.5-32.5] vs 17 [IQR 3-23] [p = 0.08]). There was no effect on development of primary graft dysfunction or intensive care unit/hospital survival. One-year survival was worse (hazard ratio [HR] 4.45, 95% confidence interval [CI] 1.3-22, p = 0.02). Diastolic dysfunction was the only variable that correlated with overall survival (HR 5.4, 95% CI 1.3-22, p = 0.02). Diastolic dysfunction leads to early postoperative morbidity and worse survival in patients with PAH after DLTx.
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Affiliation(s)
- A Avriel
- Pulmonology Institute, Department of Medicine, Soroka Medical Center, Faculty of Health Sciences Ben-Gurion University, Beer-Sheva, Israel
| | - A H Klement
- Meir Medical Center, Faculty of Health Sciences, Tel- Aviv University, Tel-Aviv, Israel
| | - S R Johnson
- Division of Rheumatology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - M de Perrot
- Multiorgan Transplant Program, University Health Network, and the Division of Thoracic Surgery, University Health Network, Toronto, Ontario, Canada
| | - J Granton
- Multiorgan Transplant Program, University Health Network, and the Division of Respirology, University Health Network, Toronto, Ontario, Canada
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145
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Bozso SJ, Nagendran J. Life After Death: Breathing Life Into Lung Transplantation From Donation After Circulatory Death Donors. Am J Transplant 2017; 17:2507-2508. [PMID: 28678405 DOI: 10.1111/ajt.14413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 06/07/2017] [Accepted: 06/25/2017] [Indexed: 01/25/2023]
Affiliation(s)
- S J Bozso
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - J Nagendran
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.,Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada.,Alberta Transplant Institute, Edmonton, Alberta, Canada.,Canadian National Transplant Research Program, Edmonton, Alberta, Canada
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146
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van Suylen V, Luijk B, Hoek RAS, van de Graaf EA, Verschuuren EA, Van De Wauwer C, Bekkers JA, Meijer RCA, van der Bij W, Erasmus ME. A Multicenter Study on Long-Term Outcomes After Lung Transplantation Comparing Donation After Circulatory Death and Donation After Brain Death. Am J Transplant 2017; 17:2679-2686. [PMID: 28470870 DOI: 10.1111/ajt.14339] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [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: 11/06/2016] [Revised: 04/13/2017] [Accepted: 04/21/2017] [Indexed: 01/25/2023]
Abstract
The implementation of donation after circulatory death category 3 (DCD3) was one of the attempts to reduce the gap between supply and demand of donor lungs. In the Netherlands, the total number of potential lung donors was greatly increased by the availability of DCD3 lungs in addition to the initial standard use of donation after brain death (DBD) lungs. From the three lung transplant centers in the Netherlands, 130 DCD3 recipients were one-to-one nearest neighbor propensity score matched with 130 DBD recipients. The primary end points were primary graft dysfunction (PGD), posttransplant lung function, freedom from chronic lung allograft dysfunction (CLAD), and overall survival. PGD did not differ between the groups. Posttransplant lung function was comparable after bilateral lung transplantation, but seemed worse after DCD3 single lung transplantation. The incidence of CLAD (p = 0.17) nor the freedom from CLAD (p = 0.36) nor the overall survival (p = 0.40) were significantly different between both groups. The presented multicenter results are derived from a national context where one third of the lung transplantations are performed with DCD3 lungs. We conclude that the long-term outcome after lung transplantation with DCD3 donors is similar to that of DBD donors and that DCD3 donation can substantially enlarge the donor pool.
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Affiliation(s)
- V van Suylen
- Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - B Luijk
- Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - R A S Hoek
- Department of Respiratory Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - E A van de Graaf
- Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - E A Verschuuren
- Department of Pulmonary Medicine and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - C Van De Wauwer
- Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - J A Bekkers
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - R C A Meijer
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - W van der Bij
- Department of Pulmonary Medicine and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - M E Erasmus
- Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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147
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Kawakami T, Ito K, Matsuda Y, Noda M, Sakurada A, Hoshikawa Y, Okada Y, Ogasawara K. Cytotoxicity of Natural Killer Cells Activated Through NKG2D Contributes to the Development of Bronchiolitis Obliterans in a Murine Heterotopic Tracheal Transplant Model. Am J Transplant 2017; 17:2338-2349. [PMID: 28251796 DOI: 10.1111/ajt.14257] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 01/26/2017] [Accepted: 02/17/2017] [Indexed: 01/25/2023]
Abstract
Bronchiolitis obliterans after lung transplantation is a major cause of postoperative mortality in which T cell-mediated immunity is known to play an important role. However, the exact contribution of natural killer (NK) cells, which have functions similar to CD8+ T cells, has not been defined. Here, we assessed the role of NK cells in murine bronchiolitis obliterans through heterotopic tracheal transplantations and found a greater percentage of NK cells in allografts than in isografts. Depletion of NK cells using an anti-NK1.1 antibody attenuated bronchiolitis obliterans in transplant recipients compared with controls. In terms of NK cell effector functions, an improvement in bronchiolitis obliterans was observed in perforin-KO recipient mice compared to wild type (WT). Furthermore, we found upregulation of NKG2D-ligand in allografts and demonstrated the significance of this using grafts expressing Rae-1, a murine NKG2D-ligand, which induced severe bronchiolitis obliterans in WT and Rag-1 KO recipients. This effect was ameliorated by injection of anti-NKG2D blocking antibody. Together, these results suggest that cytotoxicity resulting from activation of NK cells through NKG2D leads to the development of murine bronchiolitis obliterans.
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Affiliation(s)
- T Kawakami
- Department of Immunobiology, Institute of Development, Aging and Cancer, Tohoku University, Aoba-ku, Sendai, Miyagi, Japan.,Department of Thoracic Surgery, Graduate School of Medicine, Tohoku University, Aoba-ku, Sendai, Miyagi, Japan
| | - K Ito
- Department of Immunobiology, Institute of Development, Aging and Cancer, Tohoku University, Aoba-ku, Sendai, Miyagi, Japan
| | - Y Matsuda
- Department of Thoracic Surgery, Graduate School of Medicine, Tohoku University, Aoba-ku, Sendai, Miyagi, Japan
| | - M Noda
- Department of Thoracic Surgery, Graduate School of Medicine, Tohoku University, Aoba-ku, Sendai, Miyagi, Japan
| | - A Sakurada
- Department of Thoracic Surgery, Graduate School of Medicine, Tohoku University, Aoba-ku, Sendai, Miyagi, Japan
| | - Y Hoshikawa
- Department of Thoracic Surgery, Graduate School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Y Okada
- Department of Thoracic Surgery, Graduate School of Medicine, Tohoku University, Aoba-ku, Sendai, Miyagi, Japan
| | - K Ogasawara
- Department of Immunobiology, Institute of Development, Aging and Cancer, Tohoku University, Aoba-ku, Sendai, Miyagi, Japan
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148
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Greenland JR, Sun H, Calabrese D, Chong T, Singer JP, Kukreja J, Hays SR, Golden JA, Caughey GH, Venstrom JM, Rajalinginam R. HLA Mismatching Favoring Host-Versus-Graft NK Cell Activity Via KIR3DL1 Is Associated With Improved Outcomes Following Lung Transplantation. Am J Transplant 2017; 17:2192-2199. [PMID: 28375571 PMCID: PMC5519429 DOI: 10.1111/ajt.14295] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/07/2017] [Accepted: 03/24/2017] [Indexed: 01/25/2023]
Abstract
Chronic lung allograft dysfunction (CLAD) is linked to rejection and limits survival following lung transplantation. HLA-Bw4 recipients of HLA-Bw6 grafts have enhanced host-versus-graft (HVG) natural killer (NK) cell activity mediated by killer cell immunoglobulin-like receptor (KIR)3DL1 ligand. Because NK cells may promote tolerance by depleting antigen-presenting cells, we hypothesized improved outcomes for HLA-Bw4 recipients of HLA-Bw6 grafts. We evaluated differences in acute cellular rejection and CLAD-free survival across 252 KIR3DL1+ recipients from University of California, San Francisco (UCSF). For validation, we assessed survival and freedom from bronchiolitis obliterans syndrome (BOS), retransplantation, or death in 12 845 non-KIR typed recipients from the United Network for Organ Sharing (UNOS) registry. Cox proportional hazards models were adjusted for age, gender, ethnicity, transplant type, and HLA mismatching. HVG-capable subjects in the UCSF cohort had a decreased risk of CLAD or death (hazard ratio [HR] 0.57, 95% confidence interval [CI] 0.36-0.88) and decreased early lymphocytic bronchitis. The HVG effect was not significant in subjects with genotypes predicting low KIR3DL1 expression. In the UNOS cohort, HVG-capable subjects had a decreased risk of BOS, retransplant, or death (HR 0.95, 95% CI 0.91-0.99). Survival improved with the higher-affinity Bw4-80I ligand and in Bw4 homozygotes. Improved outcomes in HVG-capable recipients are consistent with a protective NK cell role. Augmentation of NK activity could supplement current immunosuppression techniques.
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Affiliation(s)
- John R. Greenland
- Medical Service, Veterans Affairs Medical Center, San Francisco CA, 94121,Department of Medicine, University of California, San Francisco CA, 94143,Corresponding author:
| | - Haibo Sun
- Immunogenetics and Transplantation Laboratory, Department of Surgery, University of California, San Francisco CA, 94143
| | - Daniel Calabrese
- Department of Medicine, University of California, San Francisco CA, 94143
| | - Tiffany Chong
- Department of Medicine, University of California, San Francisco CA, 94143
| | - Jonathan P. Singer
- Department of Medicine, University of California, San Francisco CA, 94143
| | - Jasleen Kukreja
- Department of Surgery, University of California, San Francisco CA, 94143
| | - Steven R. Hays
- Department of Medicine, University of California, San Francisco CA, 94143
| | - Jeffrey A. Golden
- Department of Medicine, University of California, San Francisco CA, 94143,Department of Surgery, University of California, San Francisco CA, 94143
| | - George H. Caughey
- Medical Service, Veterans Affairs Medical Center, San Francisco CA, 94121,Department of Medicine, University of California, San Francisco CA, 94143,Cardiovascular Research Institute, University of California, San Francisco CA, 94143
| | | | - Raja Rajalinginam
- Immunogenetics and Transplantation Laboratory, Department of Surgery, University of California, San Francisco CA, 94143
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149
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Verleden SE, Martens A, Ordies S, Heigl T, Bellon H, Vandermeulen E, Van Herck A, Sacreas A, Verschakelen J, Coudyzer W, Van Raemdonck DE, Vos R, Weynand B, Verleden GM, Vanaudenaerde B, Neyrinck A. Radiological Analysis of Unused Donor Lungs: A Tool to Improve Donor Acceptance for Transplantation? Am J Transplant 2017; 17:1912-1921. [PMID: 28251829 DOI: 10.1111/ajt.14255] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 02/20/2017] [Accepted: 02/20/2017] [Indexed: 01/25/2023]
Abstract
Despite donor organ shortage, a large proportion of possible donor lungs are declined for transplantation. Criteria for accepting/declining lungs remain controversial because of the lack of adequate tools to aid in decision-making. We collected, air-inflated, and froze a large series of declined/unused donor lungs and subjected these lung specimens to CT examination. Affected target regions were scanned by using micro-CT. Lungs from 28 donors were collected. Two lungs were unused, six were declined for non-allograft-related reasons (collectively denominated nonallograft declines, n = 8), and 20 were declined because of allograft-related reasons. CT scanning demonstrated normal lung parenchyma in only four of eight nonallograft declines, while relatively normal parenchyma was found in 12 of 20 allograft-related declines. CT and micro-CT examinations confirmed the reason for decline in most lungs and revealed unexpected (unknown from clinical files or physical inspection) CT abnormalities in other lungs. CT-based measurements showed a higher mass and density in the lungs with CT alterations compared with lungs without CT abnormalities. CT could aid in the decision-making to accept or decline donor lungs which could lead to an increase in the quantity and quality of lung allografts.
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Affiliation(s)
- S E Verleden
- Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.,Department of Respiratory Disease, UZ Leuven, Leuven, Belgium
| | - A Martens
- Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.,Department of Respiratory Disease, UZ Leuven, Leuven, Belgium.,Department of Anesthesiology, UZ Leuven, Leuven, Belgium
| | - S Ordies
- Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.,Department of Respiratory Disease, UZ Leuven, Leuven, Belgium.,Department of Anesthesiology, UZ Leuven, Leuven, Belgium
| | - T Heigl
- Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.,Department of Respiratory Disease, UZ Leuven, Leuven, Belgium
| | - H Bellon
- Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.,Department of Respiratory Disease, UZ Leuven, Leuven, Belgium
| | - E Vandermeulen
- Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.,Department of Respiratory Disease, UZ Leuven, Leuven, Belgium
| | - A Van Herck
- Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.,Department of Respiratory Disease, UZ Leuven, Leuven, Belgium
| | - A Sacreas
- Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.,Department of Respiratory Disease, UZ Leuven, Leuven, Belgium
| | | | - W Coudyzer
- Departement of Radiology, UZ Leuven, Leuven, Belgium
| | - D E Van Raemdonck
- Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.,Department of Respiratory Disease, UZ Leuven, Leuven, Belgium.,Department of Thoracic Surgery, UZ Gasthuisberg, Leuven, Belgium
| | - R Vos
- Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.,Department of Respiratory Disease, UZ Leuven, Leuven, Belgium
| | - B Weynand
- Department of Pathology, UZ Gasthuisberg, Leuven, Belgium
| | - G M Verleden
- Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.,Department of Respiratory Disease, UZ Leuven, Leuven, Belgium
| | - B Vanaudenaerde
- Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.,Department of Respiratory Disease, UZ Leuven, Leuven, Belgium
| | - A Neyrinck
- Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.,Department of Respiratory Disease, UZ Leuven, Leuven, Belgium.,Department of Anesthesiology, UZ Leuven, Leuven, Belgium
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150
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Tanabe T, Watanabe H, Shah JA, Sahara H, Shimizu A, Nomura S, Asfour A, Danton M, Boyd L, Meyers AD, Ekanayake-Alper DK, Sachs DH, Yamada K. Role of Intrinsic (Graft) Versus Extrinsic (Host) Factors in the Growth of Transplanted Organs Following Allogeneic and Xenogeneic Transplantation. Am J Transplant 2017; 17:1778-1790. [PMID: 28117931 PMCID: PMC5489354 DOI: 10.1111/ajt.14210] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 12/08/2016] [Accepted: 01/09/2017] [Indexed: 01/25/2023]
Abstract
In our studies of life-supporting α-1,3-galactocyltransferase knockout (GalT-KO) pig-to-baboon kidneys, we found that some recipients developed increased serum creatinine with growth of the grafts, without histological or immunological evidence of rejection. We hypothesized that the rapid growth of orthotopic pig grafts in smaller baboon recipients may have led to deterioration of organ function. To test this hypothesis for both kidneys and lungs, we assessed whether the growth of outbred (Yorkshire) organ transplants in miniature swine was regulated by intrinsic (graft) or extrinsic (host environment) factors. Yorkshire kidneys exhibited persistent growth in miniature swine, reaching 3.7 times their initial volume over 3 mo versus 1.2 times for miniature swine kidneys over the same time period. Similar rapid early growth of lung allografts was observed and, in this case, led to organ dysfunction. For xenograft kidneys, a review of our results suggests that there is a threshold for kidney graft volume of 25 cm3 /kg of recipient body weight at which cortical ischemia is induced in transplanted GalT-KO kidneys in baboons. These results suggest that intrinsic factors are responsible, at least in part, for growth of donor organs and that this property should be taken into consideration for growth-curve-mismatched transplants, especially for life-supporting organs transplanted into a limited recipient space.
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Affiliation(s)
- Tatsu Tanabe
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY,Transplantation Biology Research Center Laboratory, Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Hironosuke Watanabe
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY
| | - Jigesh A Shah
- Transplantation Biology Research Center Laboratory, Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Hisashi Sahara
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY,Division of Organ Replacement and Xenotransplantation Surgery, Center for Advanced Biomedical Science and Swine Research, Kagoshima University, Japan
| | - Akira Shimizu
- Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Shunichiro Nomura
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY
| | - Arsenoi Asfour
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY
| | - Makenzie Danton
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY
| | - Lennan Boyd
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY
| | - Adrienne Dardenne Meyers
- Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation, Orangeburg, New York
| | | | - David H Sachs
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY,Transplantation Biology Research Center Laboratory, Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Kazuhiko Yamada
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY,Transplantation Biology Research Center Laboratory, Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA,Corresponding author: Kazuhiko Yamada, M.D, PhD., Columbia Center for Translational Immunology, 630 W 168th St, BB1705, New York, NY, USA, Tel: +1-212-304-5695,
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