201
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Vieux L, Simcox AA, Mediouni Z, Wild P, Koller M, Studer RK, Danuser B. Predictors of Return to Work 12 Months After Solid Organ Transplantation: Results from the Swiss Transplant Cohort Study. J Occup Rehabil 2019; 29:462-471. [PMID: 30145704 DOI: 10.1007/s10926-018-9804-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Background Return to work with or after a chronic disease is not a very well understood process, influenced by a variety of personal, professional, societal and medical factors. The aim of this study is to identify predictors for return to work 12 months after a solid organ transplant applying a bio-psycho-social model. Methods This study is based on patients included in the Swiss Transplant Cohort Study, a national prospective multicentre cohort, who underwent a first solid organ transplant (kidney, liver, heart, lung). Bio-psycho-social factors were tested and predictors of return to work identified using logistic regression models. Results Among the 636 patients included in the study, 49.8% (317) were employed 12 months post-transplant. The major predictor for returning to work 12 months posttransplant was pre-transplant employment status (OR 10.8). Accordingly, the population was stratified in employed and not employed pre-transplant groups. Age, self-perceived health (6 months post-transplant) and the transplanted organ were significantly associated with post-transplant employment status in both groups. Return to work was influenced by education, depression (6 month post-transplant) and waiting time in the employed pre-transplant group and by invalidity pension in the not employed pre-transplant group. Conclusion Employment status pre-transplant being highly associated with employment status post-transplant, the process promoting return to work should be started well before surgery. Biomedical, psychological and social factors must be taken into account to promote return to work in transplanted patients.
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Affiliation(s)
- Laure Vieux
- Institut universitaire romand de Santé au Travail, Rte de la Corniche 2, 1066, Epalinges, Switzerland
| | - Amira A Simcox
- Institut universitaire romand de Santé au Travail, Rte de la Corniche 2, 1066, Epalinges, Switzerland
| | - Zakia Mediouni
- Institut universitaire romand de Santé au Travail, Rte de la Corniche 2, 1066, Epalinges, Switzerland.
| | - Pascal Wild
- Institut universitaire romand de Santé au Travail, Rte de la Corniche 2, 1066, Epalinges, Switzerland
| | - Michael Koller
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Hebelstrasse 10, 4031, Basel, Switzerland
| | - Regina K Studer
- Institut universitaire romand de Santé au Travail, Rte de la Corniche 2, 1066, Epalinges, Switzerland
| | - Brigitta Danuser
- Institut universitaire romand de Santé au Travail, Rte de la Corniche 2, 1066, Epalinges, Switzerland
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202
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Hopper CP, Wollborn J. Delivery of carbon monoxide via halogenated ether anesthetics. Nitric Oxide 2019; 89:93-95. [PMID: 31125687 DOI: 10.1016/j.niox.2019.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 04/04/2019] [Accepted: 05/21/2019] [Indexed: 01/31/2023]
Affiliation(s)
- Christopher P Hopper
- Department of Medicinal Chemistry, College of Pharmacy, The University of Florida, Gainesville, Florida, USA; Institute for Pharmacy and Food Chemistry, University of Wuerzburg, Germany; Institute for Experimental Biomedicine, University Hospital Wuerzburg, Germany.
| | - Jakob Wollborn
- Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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203
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Zahid MN, Wang S, Learn GH, Abt PL, Blumberg EA, Reese PP, Goldberg DS, Shaw GM, Bar KJ. High multiplicity infection following transplantation of hepatitis C virus-positive organs. J Clin Invest 2019; 129:3134-3139. [PMID: 31112523 DOI: 10.1172/jci127203] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Highly effective direct-acting antivirals against Hepatitis C virus (HCV) have created an opportunity to transplant organs from HCV-positive individuals into HCV-negative recipients, since de novo infection can be routinely cured. As this procedure is performed more widely, it becomes increasingly important to understand the biological underpinnings of virus transmission, especially the multiplicity of infection. Here, we used single genome sequencing of plasma virus in four genotype 1a HCV-positive organ donors and their seven organ recipients to assess the genetic bottleneck associated with HCV transmission following renal and cardiac transplantation. In all recipients, de novo infection was established by multiple genetically distinct viruses that reflect the full phylogenetic spectrum of replication-competent virus circulating in donor plasma. This was true in renal and cardiac transplantation and in recipients with peak viral loads ranging between 2.9 and 6.6 log10 IU/mL. The permissive transmission process characterized here contrasts sharply with sexual or injection-related transmission, which occurs less frequently per exposure and is generally associated with a stringent genetic bottleneck. These findings highlight the effectiveness of current anti-HCV regimens, while raising caution regarding the substantially higher multiplicity of infection seen in organ transplantation-associated HCV acquisition.
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204
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Tackmann E, Dettmer S. Measures influencing post-mortem organ donation rates in Germany, the Netherlands, Spain and the UK : A systematic review. Anaesthesist 2019; 68:377-83. [PMID: 31101922 DOI: 10.1007/s00101-019-0600-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/28/2019] [Accepted: 04/10/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND German post-mortem organ donation rates have been declining since 2010. Several transplantation scandals led to a negative portrayal of organ donation in the media. Spain, the UK and the Netherlands achieved a rise in organ donation rates while retaining organ donation legislation. METHODS A systematic review of publications focusing on (1) organ donation legislation, (2) data on post-mortem organ donation rates and (3) measures to increase post-mortem organ donation rates in Europe was conducted in November 2017 in PubMed, PsycINFO and Web of Science. Quality parameters of the World Bank and the World Health Organization (WHO) were studied to analyze national health services, frequent causes of death and life expectancy. RESULTS Quality parameters of national health services were similar in all countries. The Netherlands and Germany have an opt in system. An increase of 37.4% in post-mortem organ donation rates from 2008 to 2015 in the UK was accomplished through the establishment of a donation task force, adopting parts of the Spanish model, while maintaining an opt in system. Spain has the highest organ donation rate worldwide (39.7 per million persons in 2015). The implementation of transplantation coordinators and the change in legislation in Germany in 2012 has so far shown no effect. Public awareness of organ donation in the Netherlands increased following various information campaigns. CONCLUSION Donation after cardiac death (DCD), expanded donor criteria, increasing public awareness and introduction of an organ donor register should be discussed as measures to increase organ donation rates in Germany.
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205
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Kaviani M, Azarpira N, Aghdaie MH, Esfandiari E, Geramizadeh B, Nikeghbalian S, Dehghani M. Comparison of Human Mesenchymal Stem Cells Derived from Various Compartments of Human Adipose Tissue and Tunica Adventitia Layer of the Arteries Subsequent to Organ Donation. Int J Organ Transplant Med 2019; 10:65-73. [PMID: 31285803 PMCID: PMC6604757] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Mesenchymal stem cells are one of the most interesting cell sources used in regenerative medicine. OBJECTIVE In the present study, we isolated and characterized the mesenchymal stem cells from various compartments of human adipose tissue and tunica adventitia layer of the arteries. METHODS Tissue explant culture was done from various compartments of the human adipose tissue and tunica adventitia layer of the arteries, including adipose tissue far from the vessels, perivascular tissues that are completely attached to the vessels, and tunica adventitia layer of the arteries. After the cell culture, characterization of the cells was determined at 3rd-5th passages. Flow cytometry was performed for antigen expression analysis of CD34, CD45, CD44, CD90, CD29, CD73, and CD105. For the evaluation of cell differentiation potential, adipogenic and osteogenic differentiation was conducted under appropriate protocols. RESULTS The cells were positive for CD44, CD90, CD29, and CD73 and negative for CD34, CD45, and CD105. Adipogenic and osteogenic differentiation potentials were different among the cells from various compartments. The cells derived from perivascular tissue demonstrated better adipogenic and osteogenic differentiation. CONCLUSION It is essential to characterize the cells from different tissues and compartments for different purposes in regenerative medicine.
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Affiliation(s)
- M. Kaviani
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - N. Azarpira
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M. H. Aghdaie
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - E. Esfandiari
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - B. Geramizadeh
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - S. Nikeghbalian
- Department of Transplant, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M. Dehghani
- Department of Transplant, Shiraz University of Medical Sciences, Shiraz, Iran
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206
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Contiero PP, Wilson DM. Understanding ambivalence toward organ donation and transplantation: An exploratory study of nursing students. Nurse Educ Today 2019; 76:191-195. [PMID: 30822605 DOI: 10.1016/j.nedt.2019.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/16/2019] [Accepted: 02/12/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND There is a continuing shortage of organs for transplantation purposes worldwide. Determining why this is a recurring problem is necessary as organ transplantation is a highly successful life saving measure. It is possible that ambivalence is key to this shortage. OBJECTIVES To explore the possible existence of ambivalence toward organ donation and transplantation among Canadian nursing students, and gaining insights into this ambivalence when present. DESIGN An exploratory study using a structured questionnaire to explore the existence of ambivalence in relation to donating and receiving an organ for transplantation purposes. METHODS A total of 170 undergraduate nursing students at a Canadian university participated in this study by completing a brief questionnaire distributed to all five classes of nursing students who were taking a mandatory research course during the 2017-18 university calendar year. The survey tool was designed to collect quantitative and qualitative data in relation to their ambivalence toward organ donation and transplantation. RESULTS Nursing students are more willing to receive an organ than to donate. The willingness to donate or receive an organ was related to their personal beliefs and moral codes, religion, level of knowledge, and the existence of ambivalence. CONCLUSIONS This study reveals important insights into ambivalence about donating and receiving organs. The study found it was very easy to introduce ambivalence among nursing students, with this information highly relevant for student education and other applications.
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Affiliation(s)
- Paloma Peroni Contiero
- University of São Paulo, Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo 14040-902, Brazil.
| | - Donna M Wilson
- Faculty of Nursing, University of Alberta, Edmonton, Alberta T6G 1C9, Canada; Faculty of Education and Health Sciences, University of Limerick, Ireland; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
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207
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Been-Dahmen JMJ, Beck DK, Peeters MAC, van der Stege H, Tielen M, van Buren MC, Ista E, van Staa A, Massey EK. Evaluating the feasibility of a nurse-led self-management support intervention for kidney transplant recipients: a pilot study. BMC Nephrol 2019; 20:143. [PMID: 31029107 PMCID: PMC6486974 DOI: 10.1186/s12882-019-1300-7] [Citation(s) in RCA: 15] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 03/18/2019] [Indexed: 12/14/2022] Open
Abstract
Background To support effective self-management after kidney transplantation, a holistic nurse-led self-management support intervention was developed using the Intervention Mapping approach. The primary aim was to evaluate the feasibility, acceptability and fidelity of the intervention for kidney transplant recipients and professionals. The secondary aim was to explore preliminary effects on outcomes. Methods A pilot study was conducted in 2015–2017 to evaluate the intervention. Nurse Practitioners (NP) guided recipients in assessing 14 life areas using the Self-Management Web. Participants were supported in developing self-regulation skills which can be applied to self-management of the illness. Strategies included goal setting, action planning, and promotion of motivation and self-efficacy. Adult recipients from an outpatient clinic of a Dutch University Hospital who underwent their transplant at least 1 month ago, were invited to participate. NPs, nephrologists and recipients were interviewed to assess feasibility, fidelity and implementation experience. Consultations were videoed and analysed to assess fidelity. To assess the preliminary effects, the intervention group completed baseline (T0) and follow-up (T1) questionnaires on self-management behavior, self-efficacy, quality of life and quality of care. A historical control group of kidney transplant recipients completed the same questionnaires at T1. Results Twenty-seven recipients agreed to participate in the intervention group, of which 24 completed the intervention and 16 completed baseline and follow-up surveys. The control group consisted of 33 recipients. Professionals and recipients appraised the open, holistic focus of the intervention as a welcome addition to standard care and felt that this helped to build a relationship of trust. Recipients also felt they became more competent in problem-solving skills. The within-group analysis showed no significant increase in patients’ self-management skills. The between-groups analysis showed significantly higher medication adherence among the intervention group (P = 0.03; G = 0.81). The within-groups analysis showed a significantly higher perceived quality of care (P = 0.02) in the intervention group. Conclusion This holistic nurse-led self-management support intervention was found to be feasible and acceptable by professionals and recipients alike. This pilot had a small sample therefore further research is needed into the potential effects on self-management behavior and well-being of transplant recipients. ISRCTN Trial Registry: ISRCTN15057632 (registered retrospectively on 20-07-2018). Electronic supplementary material The online version of this article (10.1186/s12882-019-1300-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Janet M J Been-Dahmen
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, P.O. Box 25035, 3001, Rotterdam, HA, the Netherlands.,Department of Internal Medicine - Section Nephrology & Transplantation, Erasmus MC University Medical Center, P.O. Box 2040, 3000, Rotterdam, CA, the Netherlands
| | - Denise K Beck
- Department of Internal Medicine - Section Nephrology & Transplantation, Erasmus MC University Medical Center, P.O. Box 2040, 3000, Rotterdam, CA, the Netherlands
| | - Mariëlle A C Peeters
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, P.O. Box 25035, 3001, Rotterdam, HA, the Netherlands.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, Rotterdam, DR, the Netherlands
| | - Heleen van der Stege
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, P.O. Box 25035, 3001, Rotterdam, HA, the Netherlands
| | - Mirjam Tielen
- Department of Internal Medicine - Section Nephrology & Transplantation, Erasmus MC University Medical Center, P.O. Box 2040, 3000, Rotterdam, CA, the Netherlands
| | - Marleen C van Buren
- Department of Internal Medicine - Section Nephrology & Transplantation, Erasmus MC University Medical Center, P.O. Box 2040, 3000, Rotterdam, CA, the Netherlands
| | - Erwin Ista
- Department of Internal Medicine - Section Nursing Science, Erasmus MC University Medical Center, P.O. Box 2040, 3000, Rotterdam, CA, the Netherlands.,Intensive Care Unit, Erasmus MC University Medical Center-Sophia Children's Hospital, P.O. Box 2060, 3000, Rotterdam, DR, the Netherlands
| | - AnneLoes van Staa
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, P.O. Box 25035, 3001, Rotterdam, HA, the Netherlands.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, Rotterdam, DR, the Netherlands
| | - Emma K Massey
- Department of Internal Medicine - Section Nephrology & Transplantation, Erasmus MC University Medical Center, P.O. Box 2040, 3000, Rotterdam, CA, the Netherlands.
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208
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Liu Z, Liao F, Scozzi D, Furuya Y, Pugh KN, Hachem R, Chen DL, Cano M, Green JM, Krupnick AS, Kreisel D, Perl AKT, Huang HJ, Brody SL, Gelman AE. An obligatory role for club cells in preventing obliterative bronchiolitis in lung transplants. JCI Insight 2019; 5:124732. [PMID: 30990794 DOI: 10.1172/jci.insight.124732] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Obliterative bronchiolitis (OB) is a poorly understood airway disease characterized by the generation of fibrotic bronchiolar occlusions. In the lung transplant setting, OB is a pathological manifestation of bronchiolitis obliterans syndrome (BOS), which is a major impediment to long-term recipient survival. Club cells play a key role in bronchiolar epithelial repair, but whether they promote lung transplant tolerance through preventing OB remains unclear. We determined if OB occurs in mouse orthotopic lung transplants following conditional transgene-targeted club cell depletion. In syngeneic lung transplants club cell depletion leads to transient epithelial injury followed by rapid club cell-mediated repair. In contrast, allogeneic lung transplants develop severe OB lesions and poorly regenerate club cells despite immunosuppression treatment. Lung allograft club cell ablation also triggers the recognition of alloantigens, and pulmonary restricted self-antigens reported associated with BOS development. However, CD8+ T cell depletion restores club cell reparative responses and prevents OB. In addition, ex-vivo analysis reveals a specific role for alloantigen-primed effector CD8+ T cells in preventing club cell proliferation and maintenance. Taken together, we demonstrate a vital role for club cells in maintaining lung transplant tolerance and propose a new model to identify the underlying mechanisms of OB.
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Affiliation(s)
- Zhiyi Liu
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Fuyi Liao
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Davide Scozzi
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Kaitlyn N Pugh
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | | | | | - Jonathan M Green
- Department of Medicine.,Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Alexander S Krupnick
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Daniel Kreisel
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Anne Karina T Perl
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Howard J Huang
- Houston Methodist J.C. Walter Jr. Transplant Center, Houston, Texas, USA
| | | | - Andrew E Gelman
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
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209
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Rezahosseini O, Drabe CH, Sørensen SS, Rasmussen A, Perch M, Ostrowski SR, Nielsen SD. Torque-Teno virus viral load as a potential endogenous marker of immune function in solid organ transplantation. Transplant Rev (Orlando) 2019; 33:137-144. [PMID: 30981537 DOI: 10.1016/j.trre.2019.03.004] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [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: 01/31/2019] [Revised: 03/29/2019] [Accepted: 03/31/2019] [Indexed: 12/27/2022]
Abstract
Solid organ transplantation (SOT) recipients receive immunosuppressive therapy to avoid rejection of the transplanted organ. Immunosuppressive therapy increases the risk of infections. However, no existing marker reliably reveals the status of the immune function in SOT recipients. Torque-Teno virus or Transfusion-transmitted virus (TTV) has gained attention as a possible endogenous marker of the immune function. TTV is a non-enveloped, circular single strand DNA virus, and it may be considered a part of the human virome. In a bidirectional relationship, the immune system detects TTV and TTV may also modulate the activity of immune system. These characteristics have made the virus a possible candidate indicator of immune function. In this systematic review, we describe the role and potential function of TTV viral load as an endogenous marker of the immune function and consequently the level of immune suppression in SOT recipients.
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Affiliation(s)
- Omid Rezahosseini
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Camilla Heldbjerg Drabe
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Allan Rasmussen
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Michael Perch
- Department of Cardiology, Section for Lung Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sisse Rye Ostrowski
- Department of Clinical Immunology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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210
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Danet Danet A, Jimenez Cardoso PM. Emotional experiences of health professionals in organ procurement and transplantation. A systematic review. Cir Esp 2019; 97:364-376. [PMID: 30929746 DOI: 10.1016/j.ciresp.2019.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 12/20/2018] [Accepted: 01/24/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The objective was to explore, discuss and synthesize the emotional experiences of health professionals during the process of organ procurement and transplantation. METHODS A systematic review was made in Medline, Science Direct and the Virtual Library of the Andalusian Public Health System, selecting 16 original articles for inclusion in the review, with qualitative evaluation and narrative synthesis. RESULTS The results revealed the main use of qualitative methodology, and 4emergent themes were identified: working in organ procurement and transplantation; the transition of professional roles; emotional experiences; and, coping strategies and emotional management. This systematic review revealed the complex and diverse character of professionals' emotional experiences as well as the importance of the interpersonal relationship. CONCLUSIONS Intense emotional experiences related to the sense of responsibility, the work challenge and coping strategies based on reward searching explained important contradictions and tensions about professional roles and functions, especially during the donation interview.
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Affiliation(s)
- Alina Danet Danet
- Ciber Epidemiología y Salud Pública, Madrid, España; Escuela Andaluza de Salud Pública, Granada, España.
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211
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Dawson NA, Lamarche C, Hoeppli RE, Bergqvist P, Fung VC, McIver E, Huang Q, Gillies J, Speck M, Orban PC, Bush JW, Mojibian M, Levings MK. Systematic testing and specificity mapping of alloantigen-specific chimeric antigen receptors in regulatory T cells. JCI Insight 2019; 4:123672. [PMID: 30753169 DOI: 10.1172/jci.insight.123672] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [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: 07/18/2018] [Accepted: 02/05/2019] [Indexed: 12/19/2022] Open
Abstract
Chimeric antigen receptor (CAR) technology can be used to engineer the antigen specificity of regulatory T cells (Tregs) and improve their potency as an adoptive cell therapy in multiple disease models. As synthetic receptors, CARs carry the risk of immunogenicity, particularly when derived from nonhuman antibodies. Using an HLA-A*02:01-specific CAR (A2-CAR) encoding a single-chain variable fragment (Fv) derived from a mouse antibody, we developed a panel of 20 humanized A2-CARs (hA2-CARs). Systematic testing demonstrated variations in expression, and ability to bind HLA-A*02:01 and stimulate human Treg suppression in vitro. In addition, we developed a new method to comprehensively map the alloantigen specificity of CARs, revealing that humanization reduced HLA-A cross-reactivity. In vivo bioluminescence imaging showed rapid trafficking and persistence of hA2-CAR Tregs in A2-expressing allografts, with eventual migration to draining lymph nodes. Adoptive transfer of hA2-CAR Tregs suppressed HLA-A2+ cell-mediated xenogeneic graft-versus-host disease and diminished rejection of human HLA-A2+ skin allografts. These data provide a platform for systematic development and specificity testing of humanized alloantigen-specific CARs that can be used to engineer specificity and homing of therapeutic Tregs.
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Affiliation(s)
- Nicholas Aj Dawson
- Department of Medicine and.,BC Children's Hospital Research Institute (BCCHR), Vancouver, British Columbia, Canada
| | - Caroline Lamarche
- Department of Surgery, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute (BCCHR), Vancouver, British Columbia, Canada
| | - Romy E Hoeppli
- Department of Surgery, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute (BCCHR), Vancouver, British Columbia, Canada
| | - Peter Bergqvist
- Centre for Drug and Research and Development, Vancouver, British Columbia, Canada
| | - Vivian Cw Fung
- Department of Surgery, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute (BCCHR), Vancouver, British Columbia, Canada
| | - Emma McIver
- Department of Surgery, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute (BCCHR), Vancouver, British Columbia, Canada
| | - Qing Huang
- Department of Surgery, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute (BCCHR), Vancouver, British Columbia, Canada
| | - Jana Gillies
- Department of Surgery, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute (BCCHR), Vancouver, British Columbia, Canada
| | - Madeleine Speck
- Department of Surgery, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute (BCCHR), Vancouver, British Columbia, Canada
| | - Paul C Orban
- Department of Surgery, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute (BCCHR), Vancouver, British Columbia, Canada
| | - Jonathan W Bush
- BC Children's Hospital Research Institute (BCCHR), Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine and
| | - Majid Mojibian
- Department of Surgery, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute (BCCHR), Vancouver, British Columbia, Canada
| | - Megan K Levings
- Department of Surgery, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute (BCCHR), Vancouver, British Columbia, Canada.,School of Biomedical Engineering, UBC, Vancouver, British Columbia, Canada
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212
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Doh KC, Kim BM, Kim KW, Chung BH, Yang CW. Effects of resveratrol on Th17 cell-related immune responses under tacrolimus-based immunosuppression. BMC Complement Altern Med 2019; 19:54. [PMID: 30832648 DOI: 10.1186/s12906-019-2464-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 02/25/2019] [Indexed: 01/01/2023]
Abstract
Background We previously reported that tacrolimus (Tac) does not decrease T helper 17 cells (Th17) response in kidney transplantation. In this study, we evaluated whether Resveratrol (Resv) has immunosuppressive effects by decreasing Th17 responses in Tac-based immunosuppression. Methods We investigated the effects of Resv under Tac-treatment conditions, on CD4+ T cell differentiation to Th17 cells in peripheral blood mononuclear cells (PBMCs), and proliferation of CD4+ T cells co-cultured with human renal proximal tubular epithelial cells (HRPTEpiCs). The effects of Resv on Th17 cells were tested in the murine skin transplant model. Results In PBMCs, Tac did not but combination of Tac and Resv further suppressed Th17 immune response. In the co-culture study, combination of Resv to Tac significantly decreased HRPTEpiC-induced T cell proliferation compared to Tac alone. Resv treatment in the Jurkat cell induced the expression of AMP-activated protein kinase and suppressed the expression of mammalian target of rapamycin (mTOR), suggesting blocking Th17 pathway by Resv. In the murine skin transplant model, combination of Resv to Tac significantly prolonged skin graft survival accompanied by the suppression of Th17 cells, compared to either the Tac-alone or control groups. Conclusion The results of our study suggest that Resv provides additional immunosuppressive effects to Tac by suppressing effector CD4+ T cells, especially Th17 cells, in the transplantation setting.
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Li W, Feng G, Gauthier JM, Lokshina I, Higashikubo R, Evans S, Liu X, Hassan A, Tanaka S, Cicka M, Hsiao HM, Ruiz-Perez D, Bredemeyer A, Gross RW, Mann DL, Tyurina YY, Gelman AE, Kagan VE, Linkermann A, Lavine KJ, Kreisel D. Ferroptotic cell death and TLR4/Trif signaling initiate neutrophil recruitment after heart transplantation. J Clin Invest 2019; 129:2293-2304. [PMID: 30830879 DOI: 10.1172/jci126428] [Citation(s) in RCA: 263] [Impact Index Per Article: 52.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Non-apoptotic forms of cell death can trigger sterile inflammation through the release of danger-associated molecular patterns, which are recognized by innate immune receptors. However, despite years of investigation the mechanisms which initiate inflammatory responses after heart transplantation remain elusive. Here, we demonstrate that ferrostatin-1 (Fer-1), a specific inhibitor of ferroptosis, decreases the level of pro-ferroptotic hydroperoxy-arachidonoyl-phosphatidylethanolamine, reduces cardiomyocyte cell death and blocks neutrophil recruitment following heart transplantation. Inhibition of necroptosis had no effect on neutrophil trafficking in cardiac grafts. We extend these observations to a model of coronary artery ligation-induced myocardial ischemia reperfusion injury where inhibition of ferroptosis resulted in reduced infarct size, improved left ventricular systolic function, and reduced left ventricular remodeling. Using intravital imaging of cardiac transplants, we uncover that ferroptosis orchestrates neutrophil recruitment to injured myocardium by promoting adhesion of neutrophils to coronary vascular endothelial cells through a TLR4/TRIF/type I IFN signaling pathway. Thus, we have discovered that inflammatory responses after cardiac transplantation are initiated through ferroptotic cell death and TLR4/Trif-dependent signaling in graft endothelial cells. These findings provide a platform for the development of therapeutic strategies for heart transplant recipients and patients, who are vulnerable to ischemia reperfusion injury following restoration of coronary blood flow.
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Affiliation(s)
| | - Guoshuai Feng
- Department of Medicine, Washington University, Saint Louis, Missouri, USA
| | | | - Inessa Lokshina
- Department of Medicine, Washington University, Saint Louis, Missouri, USA
| | | | - Sarah Evans
- Department of Medicine, Washington University, Saint Louis, Missouri, USA
| | - Xinping Liu
- Department of Medicine, Washington University, Saint Louis, Missouri, USA
| | | | | | - Markus Cicka
- Department of Medicine, Washington University, Saint Louis, Missouri, USA
| | | | | | - Andrea Bredemeyer
- Department of Medicine, Washington University, Saint Louis, Missouri, USA
| | - Richard W Gross
- Department of Medicine, Washington University, Saint Louis, Missouri, USA
| | - Douglas L Mann
- Department of Medicine, Washington University, Saint Louis, Missouri, USA
| | - Yulia Y Tyurina
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Andrew E Gelman
- Department of Surgery and.,Department of Pathology and Immunology, Washington University, Saint Louis, Missouri, USA
| | - Valerian E Kagan
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Laboratory of Navigational Redox Lipidomics, I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Andreas Linkermann
- Department of Internal Medicine III, Division of Nephrology, University Hospital Carl Gustav Carus at Technische Universität Dresden, Dresden, Germany
| | - Kory J Lavine
- Department of Medicine, Washington University, Saint Louis, Missouri, USA.,Department of Pathology and Immunology, Washington University, Saint Louis, Missouri, USA.,Department of Developmental Biology, Washington University, Saint Louis, Missouri, USA
| | - Daniel Kreisel
- Department of Surgery and.,Department of Pathology and Immunology, Washington University, Saint Louis, Missouri, USA
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214
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Meyfroidt G, Gunst J, Martin-Loeches I, Smith M, Robba C, Taccone FS, Citerio G. Management of the brain-dead donor in the ICU: general and specific therapy to improve transplantable organ quality. Intensive Care Med 2019; 45:343-53. [PMID: 30741327 DOI: 10.1007/s00134-019-05551-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/28/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE To provide a practical overview of the management of the potential organ donor in the intensive care unit. METHODS Seven areas of donor management were considered for this review: hemodynamic management; fluids and electrolytes; respiratory management; endocrine management; temperature management; anaemia and coagulation; infection management. For each subchapter, a narrative review was conducted. RESULTS AND CONCLUSIONS Most elements in the current recommendations and guidelines are based on pathophysiological reasoning, epidemiological observations, or extrapolations from general ICU management strategies, and not on evidence from randomized controlled trials. The cardiorespiratory management of brain-dead donors is very similar to the management of critically ill patients, and the same applies to the management of anaemia and coagulation. Central diabetes insipidus is of particular concern, and should be diagnosed based on clinical criteria. Depending on the degree of vasopressor dependency, it can be treated with intermittent desmopressin or continuous vasopressin, intravenously. Temperature management of the donor is an area of uncertainty, but it appears reasonable to strive for a core temperature of > 35 °C. The indications and controversies regarding endocrine therapies, in particular thyroid hormone replacement therapy, and corticosteroid therapy, are discussed. The potential donor should be assessed clinically for infections, and screening tests for specific infections are an essential part of donor management. Although the rate of infection transmission from donor to receptor is low, certain infections are still a formal contraindication to organ donation. However, new antiviral drugs and strategies now allow organ donation from certain infected donors to be done safely.
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215
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Bekheit M, Catanzano M, Shand S, Ahmed I, ELKayal ELS, Shehata GM, Zaki A. The role of graft reperfusion sequence in the development of non-anastomotic biliary strictures following orthotopic liver transplantation: A meta-analysis. Hepatobiliary Pancreat Dis Int 2019; 18:4-11. [PMID: 30579736 DOI: 10.1016/j.hbpd.2018.12.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 11/22/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Liver transplant is a potential cure for liver failure and hepatic malignancy but there are many techniques which have been described for vascular reconstruction. This study was to compare the prevalence of non-anastomotic biliary stricture and other surgical complications based on Clavien-Dindo scoring system, in initial portal reperfusion (sequential) versus simultaneous or initial artery reperfusion. DATA SOURCES Meta-analysis of published studies comparing the outcomes of both techniques was carried out. Data search was conducted across the major databases and studies were selected under the guidance of the Cochrane guidelines for systematic reviews and meta-analysis. RESULTS Seven studies were included to address the primary and the secondary outcomes. No statistical difference was found in the incidence of non-anastomotic biliary strictures (OR = 0.40; P = 0.14), regardless of reperfusion technique. The pooled estimate of the Clavien-Dindo grading of complications was not significantly different between the techniques, though Clavien-Dindo II complications were higher in the simultaneous or initial artery reperfusion group than the initial portal reperfusion group (OR = 2.73; P = 0.01). Similarly, there was no difference in the operative time, hospital stay and other outcomes addressed in this report. CONCLUSIONS The available evidence suggests that there is no significant difference demonstrated in the rate of non-anastomotic biliary strictures or other complications, between the two techniques, except for Clavien-Dindo II complications.
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Affiliation(s)
- Mohamed Bekheit
- Center of Liver Surgery and Transplantation, Paul Brousse Hospital, University of Paris-Sud, Villejuif Cedex, France; Medical Research Institute, University of Alexandria, Alexandria, Egypt; HPB Surgery Unit Department of Surgery, Aberdeen Royal Infirmary, Aberdeen, UK; Department of Surgery, Elkabbary General Hospital, Alexandria, Egypt; University of Aberdeen, Aberdeen, UK.
| | | | - Stuart Shand
- HPB Surgery Unit Department of Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Irfan Ahmed
- HPB Surgery Unit Department of Surgery, Aberdeen Royal Infirmary, Aberdeen, UK; University of Aberdeen, Aberdeen, UK
| | - ELSaid ELKayal
- Department of Surgery, Alexandria Main University Hospital, Faculty of Medicine, Alexandria, Egypt
| | | | - Adel Zaki
- Medical Research Institute, University of Alexandria, Alexandria, Egypt
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216
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Kahl KG, Eckermann G, Frieling H, Hillemacher T. Psychopharmacology in transplantation medicine. Prog Neuropsychopharmacol Biol Psychiatry 2019; 88:74-85. [PMID: 30018020 DOI: 10.1016/j.pnpbp.2018.07.005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 06/07/2018] [Accepted: 07/05/2018] [Indexed: 12/18/2022]
Abstract
Organ transplantation has become a well-established treatment option in patients with end-stage organ diseases. Although quality of life has markedly improved, psychiatric disorders before and after transplantation are more frequent compared to the general population. Psychopharmacological treatment is recommended for almost all mental disorders according to current guidelines, but may pose particular problems in organ transplant patients. Changes in the metabolism and elimination of drugs during organ insufficiency, drug interactions, and overlapping side effects between psychopharmacological and immunosuppressive drugs are challenging problems in clinical management. Furthermore, questions frequently arise concerning the use of psychopharmacological treatment options for sleeping and anxiety disorders. This article reviews psychopharmacology in organ transplant patients, with particular attention to frequent psychiatric disorders observed in the disease course of end-stage organ diseases.
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Affiliation(s)
- Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Medical School, Hannover, Germany; Section Polypharmacy, Working Group on Neuropsychopharmacology and Pharmacopsychiatry (AGNP), Germany.
| | - Gabriel Eckermann
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Medical School, Hannover, Germany; Section Polypharmacy, Working Group on Neuropsychopharmacology and Pharmacopsychiatry (AGNP), Germany
| | - Helge Frieling
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Medical School, Hannover, Germany
| | - Thomas Hillemacher
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Medical School, Hannover, Germany; Department of Psychiatry and Psychotherapy, Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Germany
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217
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Nair VV, Narayan KV, Pulikottil SK, Kathayanat JT, Chooriyil N, Radhakrishnan R, Babu A, Nair JTK. Should all tubercular cavities be left alone? Lessons from a heart transplant. Indian J Thorac Cardiovasc Surg 2019; 35:64-67. [PMID: 33060973 DOI: 10.1007/s12055-018-0714-3] [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: 03/28/2018] [Revised: 07/04/2018] [Accepted: 07/16/2018] [Indexed: 10/28/2022] Open
Abstract
Fungal infection after solid organ transplantation poses a diagnostic and therapeutic challenge. We present the case of a 50-year-old man who underwent orthotopic heart transplantation for dilated cardiomyopathy with a history of treated pulmonary tuberculosis 10 years pre-transplant. One year post-transplantation, he was admitted with recurrent productive cough and was evaluated to have intracavitory aspergillosis of the lung. He was started on medical therapy with reduction in immunosuppression, but succumbed later with allograft rejection and multiorgan failure. Management of invasive aspergillosis in immunocompromised host is a real challenge. Management protocol should be individualised.
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Affiliation(s)
| | | | | | | | - Nidheesh Chooriyil
- Department of Cardiovascular and Thoracic Surgery, Government Medical College, Kottayam, India
| | - Ratish Radhakrishnan
- Department of Cardiovascular and Thoracic Surgery, Government Medical College, Kottayam, India
| | - Akash Babu
- Department of Cardiovascular and Thoracic Surgery, Government Medical College, Kottayam, India
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218
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Hu WS, Lin CL. Risk of new-onset atrial fibrillation among heart, kidney and liver transplant recipients: insights from a national cohort study. Intern Emerg Med 2019; 14:71-76. [PMID: 30255466 DOI: 10.1007/s11739-018-1950-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 09/13/2018] [Indexed: 12/18/2022]
Abstract
The objective of the study was to explore the incidence of atrial fibrillation (AF) in various populations of patients with organ transplantation (OT). We used a large national data set from Taiwan to investigate the incidence of AF after OT. Frequency matching method used to match controls: OT patients were 4:1. Kaplan-Meier analyses with the use of the Aalen-Johansen estimator was employed for estimating the cumulative incidences of new-onset AF. The Fine-Gray competing risks model was also employed to analyze the risk of AF for the OT cohort compared with the non-OT cohort. 6955 OT patients and 27,820 controls were included in this study. OT did lead to a 3.09-fold risk for AF [95% confidence interval (CI) = 2.07-4.62], especially in the subgroup of female gender [adjusted subhazard ratio (aSHR) = 6.66, 95% CI = 3.85-11.5], age ≤ 49 years (aSHR = 8.19, 95% CI = 3.99-16.8) and without comorbidity (aSHR = 4.61, 95% CI = 2.71-7.87). Moreover, liver recipients tended to be more likely to develop new-onset AF among those OT patients (aSHR = 4.07, 95% CI = 2.63-6.30) as compared to the controls. This study demonstrates an increased incidence of AF after OT. Heightened awareness and clinician vigilance are warranted to facilitate early diagnosis and improved outcomes.
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Affiliation(s)
- Wei-Syun Hu
- School of Medicine, College of Medicine, China Medical University, Taichung, 40402, Taiwan.
- Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, 2, Yuh-Der Road, Taichung, 40447, Taiwan.
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, 40447, Taiwan
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219
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Abstract
Human immunodeficiency virus (HIV) has become a chronic disease with a near normal life span resulting in increased risk of organ failure. HIV organ transplantation is a proven and accepted intervention in appropriately selected cases. HIV-positive organ transplantation into HIV-positive recipients is in its nascent stages. Hepatitis C virus, high rates of organ rejection, and immune dysregulation are significant remaining barriers to overcome. This article provides an overview of the transplantation needs in the HIV population focusing on kidney and liver transplants.
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Affiliation(s)
- Alan J Taege
- Department of Infectious Disease, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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220
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Li W, Gauthier JM, Higashikubo R, Hsiao HM, Tanaka S, Vuong L, Ritter JH, Tong AY, Wong BW, Hachem RR, Puri V, Bharat A, Krupnick AS, Hsieh CS, Baldwin WM, Kelly FL, Palmer SM, Gelman AE, Kreisel D. Bronchus-associated lymphoid tissue-resident Foxp3+ T lymphocytes prevent antibody-mediated lung rejection. J Clin Invest 2018; 129:556-568. [PMID: 30561386 DOI: 10.1172/jci122083] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [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: 05/08/2018] [Accepted: 11/06/2018] [Indexed: 12/19/2022] Open
Abstract
Antibody-mediated rejection (AMR) is a principal cause of acute and chronic failure of lung allografts. However, mechanisms mediating this oftentimes fatal complication are poorly understood. Here, we show that Foxp3+ T cells formed aggregates in rejection-free human lung grafts and accumulated within induced bronchus-associated lymphoid tissue (BALT) of tolerant mouse lungs. Using a retransplantation model, we show that selective depletion of graft-resident Foxp3+ T lymphocytes resulted in the generation of donor-specific antibodies (DSA) and AMR, which was associated with complement deposition and destruction of airway epithelium. AMR was dependent on graft infiltration by B and T cells. Depletion of graft-resident Foxp3+ T lymphocytes resulted in prolonged interactions between B and CD4+ T cells within transplanted lungs, which was dependent on CXCR5-CXCL13. Blockade of CXCL13 as well as inhibition of the CD40 ligand and the ICOS ligand suppressed DSA production and prevented AMR. Thus, we have shown that regulatory Foxp3+ T cells residing within BALT of tolerant pulmonary allografts function to suppress B cell activation, a finding that challenges the prevailing view that regulation of humoral responses occurs peripherally. As pulmonary AMR is largely refractory to current immunosuppression, our findings provide a platform for developing therapies that target local immune responses.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ramsey R Hachem
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | | | - Ankit Bharat
- Department of Surgery, Northwestern University, Chicago, Illinois, USA
| | - Alexander S Krupnick
- Department of Surgery, The University of Virginia, Charlottesville, Virginia, USA
| | - Chyi S Hsieh
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - William M Baldwin
- Department of Immunology, Cleveland Clinic, Lerner Research Institute, Cleveland, Ohio, USA
| | - Francine L Kelly
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Scott M Palmer
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Andrew E Gelman
- Department of Surgery.,Department of Pathology & Immunology, and
| | - Daniel Kreisel
- Department of Surgery.,Department of Pathology & Immunology, and
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221
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Lederer AK, Haffa D, Martini V, Huber R, Makowiec F, Fichtner-Feigl S, Kousoulas L. Surgical outcomes of renal transplant recipients after abdominal surgery not connected with transplantation. A retrospective case-control study. Int J Surg 2018; 61:53-59. [PMID: 30540965 DOI: 10.1016/j.ijsu.2018.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/21/2018] [Accepted: 12/04/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Due to the increasing number of patients after kidney transplantation, elective and emergency surgery of transplanted patients is becoming a relevant challenge in clinical routine. The current data on complication rate of patients after kidney transplantation, which must undergo another elective or emergency abdominal surgery, is inhomogeneous. Therefore, the aim of our study was to evaluate the outcome of renal transplant patients undergoing abdominal and abdominal wall surgery. MATERIAL AND METHODS We performed an observational study of patients after kidney transplantation undergoing graft-unrelated abdominal surgery between 2005 and 2015. We randomly created a non-transplanted control for a case-matched controlled analysis. Primary endpoint was the comparison of complication rate. Secondary, a risk analysis of all patients was performed and differences in mortality, length of hospital stay and reoperation rates were calculated. RESULTS Overall 101 kidney transplanted patients were eligible for inclusion. 20 (19.8%) died after graft-unrelated surgery and 60 (59.4%) suffered from postoperative complications. Case-matched analysis could be performed for 84 out of these 101 patients. We found no significant difference in morbidity rate (58.3% vs. 45.2%, p = 0.090). Transplanted patients had, however, a significantly higher mortality (19% vs. 2.4%, p = 0.001), a longer hospital stay (28.2 vs. 16.9 days, p = 0.020) and a higher rate of re-operations (38.1% vs. 20.2%, p = 0.017). . CONCLUSIONS Patients after renal transplantation undergoing graft-unrelated abdominal surgery have a significantly increased mortality risk, are more frequently re-operated and have to stay significantly longer in hospital than non-transplanted patients.
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Affiliation(s)
- Ann-Kathrin Lederer
- Center for Complementary Medicine, Institute for Infection Prevention and Hospital Epidemiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
| | - Dominic Haffa
- Department for General and Visceral Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
| | - Verena Martini
- Department for General and Visceral Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
| | - Roman Huber
- Center for Complementary Medicine, Institute for Infection Prevention and Hospital Epidemiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
| | - Frank Makowiec
- Quality Management, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
| | - Stefan Fichtner-Feigl
- Department for General and Visceral Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
| | - Lampros Kousoulas
- Department for General and Visceral Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
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Abstract
In their recent paper in this journal, Zümrüt Alpinar-Şencan and colleagues review existing dignity-based objections to organ markets and outline a new form of dignity-based objection they believe has more merit: one grounded in a social account of dignity. This commentary clarifies some aspects of the social account of dignity and then shows how this revised account can be applied to other perennial issues in bioethics, including the ethics of human embryo research and the ethics of creating part-human chimeras.
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223
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Xiao J, Peng Z, Liao Y, Sun H, Chen W, Chen X, Wei Z, Yang C, Nüssler AK, Liu J, Yang W. Organ transplantation and gut microbiota: current reviews and future challenges. Am J Transl Res 2018; 10:3330-3344. [PMID: 30662590 PMCID: PMC6291689] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 10/21/2018] [Indexed: 06/09/2023]
Abstract
Organ transplantation is often the only effective treatment for patients with end-stage diseases, such as heart, liver, kidney and small bowel failure and is carried out frequently worldwide. Still the post-transplantation complications remain health- and life-threatening outcome that needed to be resolved. With the rapid development of molecular technologies in recent years, more and more researchers realize that the gut microbiota may play a critical role in human diseases. The intestinal microbiome has been proved to provide a lot of functions to the host, such as digesting food, modulating metabolism, promoting angiogenesis and regulating the immune system. Several studies have investigated the alteration of intestinal microbiota in post-transplantation patients and observed significant changes in the intestinal microbiome compared to the pre-transplant condition. Due to the abovementioned features that the gut microbiota may be used in the prognosis of clinical outcome of organ transplantation. In addition, the FMT (fecal microbiota transplantation), probiotics and prebiotics as the newest therapy methods, effectiveness of which has been verified in some diseases, such as Clostridium difficile infection, inflammatory bowel disease and other chronic disorders, might be used as the prognosis tool in organ transplantation as well. The purpose of this present review is to elucidate the relationship between gut microbiota and organ transplantation as well as the potential use of new therapies like fecal microbiota transplantation, probiotic and prebiotic administration after the transplantation, and provide some ideas for future researches in field of organ transplantation.
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Affiliation(s)
- Jie Xiao
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan 430022, Hubei, China
- Department of Cardio-Thoracic Surgery, Ganzhou People’s HospitalGanzhou 341000, Jiangxi, China
| | - Zhao Peng
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Tongji Medical College, Huazhong University of Science and Technology13 Hangkong Road, Wuhan 430030, China
- Department of Nutrition and Food Hygiene and MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology13 Hangkong Road, Wuhan 430030, China
| | - Yuxiao Liao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Tongji Medical College, Huazhong University of Science and Technology13 Hangkong Road, Wuhan 430030, China
- Department of Nutrition and Food Hygiene and MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology13 Hangkong Road, Wuhan 430030, China
| | - Hui Sun
- Department of Cardio-Thoracic Surgery, Ganzhou People’s HospitalGanzhou 341000, Jiangxi, China
| | - Weiqiang Chen
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan 430022, Hubei, China
| | - Xing Chen
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan 430022, Hubei, China
| | - Zhanjie Wei
- Department of Thyroid Surgery, Central Hospital of WuhanWuhan 430022, Hubei, China
| | - Chuanlei Yang
- Department of Cardiovascular Surgery, Central Hospital of WuhanWuhan 430022, Hubei, China
| | - Andreas K Nüssler
- Department of Traumatology, BG Trauma Center, University of TübingenSchnarrenbergstr. 95, Tübingen 72076, Germany
| | - Jinping Liu
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan 430022, Hubei, China
| | - Wei Yang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Tongji Medical College, Huazhong University of Science and Technology13 Hangkong Road, Wuhan 430030, China
- Department of Nutrition and Food Hygiene and MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology13 Hangkong Road, Wuhan 430030, China
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Savage TM, Shonts BA, Obradovic A, Dewolf S, Lau S, Zuber J, Simpson MT, Berglund E, Fu J, Yang S, Ho SH, Tang Q, Turka LA, Shen Y, Sykes M. Early expansion of donor-specific Tregs in tolerant kidney transplant recipients. JCI Insight 2018; 3:124086. [PMID: 30429370 DOI: 10.1172/jci.insight.124086] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/10/2018] [Indexed: 12/23/2022] Open
Abstract
Allograft tolerance, in which a graft is accepted without long-term immunosuppression, could overcome numerous obstacles in transplantation. Human allograft tolerance has been intentionally induced across HLA barriers via combined kidney and bone marrow transplantation (CKBMT) with a regimen that induces only transient chimerism. Tregs are enriched early after CKBMT. While deletional tolerance contributes to long-term tolerance, the role of Tregs remains unclear. We have optimized a method for identifying the donor-specific Treg repertoire and used it to interrogate the fate of donor-specific Tregs after CKBMT. We expanded Tregs with several different protocols. Using functional analyses and T cell receptor sequencing, we found that expanding sorted Tregs with activated donor B cells identified the broadest Treg repertoire with the greatest potency and donor specificity of suppression. This method outperformed both alloantigen stimulation with CTLA4Ig and sequencing of CFSElo cells from the primary mixed lymphocyte reaction. In 3 tolerant and 1 nontolerant CKBMT recipients, we sequenced donor-specific Tregs before transplant and tracked them after transplant. Preexisting donor-specific Tregs were expanded at 6 months after CKBMT in tolerant patients and were reduced in the nontolerant patient. These results suggest that early expansion of donor-specific Tregs is involved in tolerance induction following CKBMT.
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Affiliation(s)
- Thomas M Savage
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Brittany A Shonts
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Aleksandar Obradovic
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Susan Dewolf
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Saiping Lau
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Julien Zuber
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Michael T Simpson
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Erik Berglund
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Jianing Fu
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Suxiao Yang
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Siu-Hong Ho
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Qizhi Tang
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Laurence A Turka
- Center for Translational Sciences, Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA.,Immune Tolerance Network, Bethesda, Maryland, USA
| | - Yufeng Shen
- Center for Computational Biology and Bioinformatics, Department of Systems Biology, Columbia University, New York, New York, USA
| | - Megan Sykes
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Medical Center, New York, New York, USA.,Department of Microbiology & Immunology, Columbia University Medical Center, Columbia University, New York, New York, USA.,Department of Surgery, Columbia University Medical Center, Columbia University, New York, New York, USA
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225
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Halloran PF, Reeve J, Aliabadi AZ, Cadeiras M, Crespo-Leiro MG, Deng M, Depasquale EC, Goekler J, Jouven X, Kim DH, Kobashigawa J, Loupy A, Macdonald P, Potena L, Zuckermann A, Parkes MD. Exploring the cardiac response to injury in heart transplant biopsies. JCI Insight 2018; 3:123674. [PMID: 30333303 DOI: 10.1172/jci.insight.123674] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 09/11/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Because injury is universal in organ transplantation, heart transplant endomyocardial biopsies present an opportunity to explore response to injury in heart parenchyma. Histology has limited ability to assess injury, potentially confusing it with rejection, whereas molecular changes have potential to distinguish injury from rejection. Building on previous studies of transcripts associated with T cell-mediated rejection (TCMR) and antibody-mediated rejection (ABMR), we explored transcripts reflecting injury. METHODS Microarray data from 889 prospectively collected endomyocardial biopsies from 454 transplant recipients at 14 centers were subjected to unsupervised principal component analysis and archetypal analysis to detect variation not explained by rejection. The resulting principal component and archetype scores were then examined for their transcript, transcript set, and pathway associations and compared to the histology diagnoses and left ventricular function. RESULTS Rejection was reflected by principal components PC1 and PC2, and by archetype scores S2TCMR, and S3ABMR, with S1normal indicating normalness. PC3 and a new archetype score, S4injury, identified unexplained variation correlating with expression of transcripts inducible in injury models, many expressed in macrophages and associated with inflammation in pathway analysis. S4injury scores were high in recent transplants, reflecting donation-implantation injury, and both S4injury and S2TCMR were associated with reduced left ventricular ejection fraction. CONCLUSION Assessment of injury is necessary for accurate estimates of rejection and for understanding heart transplant phenotypes. Biopsies with molecular injury but no molecular rejection were often misdiagnosed rejection by histology.TRAIL REGISTRATION. ClinicalTrials.gov NCT02670408FUNDING. Roche Organ Transplant Research Foundation, the University of Alberta Hospital Foundation, and Alberta Health Services.
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Affiliation(s)
- Philip F Halloran
- Alberta Transplant Applied Genomics Centre, Edmonton, Alberta, Canada.,Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jeff Reeve
- Alberta Transplant Applied Genomics Centre, Edmonton, Alberta, Canada.,Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Martin Cadeiras
- Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | | | - Mario Deng
- Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | | | | | | | - Daniel H Kim
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Peter Macdonald
- The Victor Chang Cardiac Research Institute, Sydney, Australia
| | - Luciano Potena
- Cardiovascular Department, University of Bologna, Bologna, Italy
| | | | - Michael D Parkes
- Alberta Transplant Applied Genomics Centre, Edmonton, Alberta, Canada
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226
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Bromberg JS, Hittle L, Xiong Y, Saxena V, Smyth EM, Li L, Zhang T, Wagner C, Fricke WF, Simon T, Brinkman CC, Mongodin EF. Gut microbiota-dependent modulation of innate immunity and lymph node remodeling affects cardiac allograft outcomes. JCI Insight 2018; 3:121045. [PMID: 30282817 DOI: 10.1172/jci.insight.121045] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [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: 03/13/2018] [Accepted: 08/21/2018] [Indexed: 12/26/2022] Open
Abstract
We hypothesized that the gut microbiota influences survival of murine cardiac allografts through modulation of immunity. Antibiotic pretreated mice received vascularized cardiac allografts and fecal microbiota transfer (FMT), along with tacrolimus immunosuppression. FMT source samples were from normal, pregnant (immune suppressed), or spontaneously colitic (inflammation) mice. Bifidobacterium pseudolongum (B. pseudolongum) in pregnant FMT recipients was associated with prolonged allograft survival and lower inflammation and fibrosis, while normal or colitic FMT resulted in inferior survival and worse histology. Transfer of B. pseudolongum alone resulted in reduced inflammation and fibrosis. Stimulation of DC and macrophage lines with B. pseudolongum induced the antiinflammatory cytokine IL-10 and homeostatic chemokine CCL19 but induced lesser amounts of the proinflammatory cytokines TNFα and IL-6. In contrast, LPS and Desulfovibrio desulfuricans (D. desulfuricans), more abundant in colitic FMT, induced a more inflammatory cytokine response. Analysis of mesenteric and peripheral lymph node structure showed that B. pseudolongum gavage resulted in a higher laminin α4/α5 ratio in the lymph node cortical ridge, indicative of a suppressive environment, while D. desulfuricans resulted in a lower laminin α4/α5 ratio, supportive of inflammation. Discrete gut bacterial species alter immunity and may predict graft outcomes through stimulation of myeloid cells and shifts in lymph node structure and permissiveness.
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Affiliation(s)
- Jonathan S Bromberg
- University of Maryland School of Medicine, Center for Vascular and Inflammatory Diseases, Departments of Surgery, Microbiology and Immunology, Baltimore, Maryland, USA
| | - Lauren Hittle
- University of Maryland School of Medicine, Institute for Genome Sciences, Baltimore, Maryland, USA
| | - Yanbao Xiong
- University of Maryland School of Medicine, Center for Vascular and Inflammatory Diseases, Departments of Surgery, Microbiology and Immunology, Baltimore, Maryland, USA
| | - Vikas Saxena
- University of Maryland School of Medicine, Center for Vascular and Inflammatory Diseases, Departments of Surgery, Microbiology and Immunology, Baltimore, Maryland, USA
| | - Eoghan M Smyth
- University of Maryland School of Medicine, Institute for Genome Sciences, Baltimore, Maryland, USA
| | - Lushen Li
- University of Maryland School of Medicine, Center for Vascular and Inflammatory Diseases, Departments of Surgery, Microbiology and Immunology, Baltimore, Maryland, USA
| | - Tianshu Zhang
- University of Maryland School of Medicine, Department of Surgery, Baltimore, Maryland, USA
| | - Chelsea Wagner
- University of Maryland School of Medicine, Center for Vascular and Inflammatory Diseases, Departments of Surgery, Microbiology and Immunology, Baltimore, Maryland, USA
| | - W Florian Fricke
- Institute of Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany
| | - Thomas Simon
- CNRS, Institut de Pharmacologie Moléculaire et Cellulaire, Université Côte d'Azur, Valbonne, France
| | - Colin C Brinkman
- University of Maryland School of Medicine, Center for Vascular and Inflammatory Diseases, Departments of Surgery, Microbiology and Immunology, Baltimore, Maryland, USA
| | - Emmanuel F Mongodin
- University of Maryland School of Medicine, Institute for Genome Sciences, Baltimore, Maryland, USA
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227
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Ekser B, Cooper DKC. Xenotransplantation research and the 'International Journal of Surgery'. Int J Surg 2018; 58:57-59. [PMID: 30237083 DOI: 10.1016/j.ijsu.2018.09.006] [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: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 11/23/2022]
Affiliation(s)
- Burcin Ekser
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - David K C Cooper
- Xenotransplantation Program, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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228
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Abstract
Religious beliefs and values impact Muslim patients' attitudes toward a variety of healthcare decisions, including organ donation. Muslim physician attitudes toward organ donation, however, are less well studied. Utilizing a national survey of physician members of the Islamic Medical Association of North America, relationships between religiosity, patterns of bioethics resource utilization, and sociodemographic characteristics with attitudes toward organ donation were assessed. Of 255 respondents, 251 answered the target question, "in your understanding, does Islamic bioethics and law permit organ donation?." 177 respondents (70%) answered positively, 30 (12%) negatively, and 46 (18%) did not know. Despite the overwhelming majority of respondents believing organ donation to be permitted by Islamic bioethics and law, fewer than one-third (n = 72, 30%) are registered donors. Several sociodemographic features had a positive association with believing organ donation to be permitted: ethnic descent other than that of South Asian, having immigrated to the USA as an adult, and male sex. When using a logistic regression model controlling for these three variables as potential confounders, the best predictor of Muslim physicians believing organ donation to be permissible was utilization of an Imam as a bioethical resource (odds ratio 5.9, p = 0.02). Religiosity variables were not found to be associated with views on the Islamic permissibility of organ donation. While Muslim American physicians appear to believe there is religious support for organ donation, only a minority sign up to be donors. Greater study is needed to understand how physicians' attitudes regarding donation impact discussions between patients and physicians regarding the possibility of donating and of receiving a transplant.
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Affiliation(s)
- Mustafa Ahmed
- Division of Cardiovascular Medicine, University of Florida College of Medicine, 1600 SW Archer Rd, P.O. Box 100277, Gainesville, FL, 32610, USA.
| | - Paul Kubilis
- Department of Neurosurgery, University of Florida, 1600 SW Archer Rd, P.O. Box 100265, Gainesville, FL, 32610, USA
| | - Aasim Padela
- Initiative on Islam and Medicine, Program on Medicine and Religion, University of Chicago, 5841 South Maryland Ave., MC 5068, Chicago, IL, 60637, USA
- Section of Emergency Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
- MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL, USA
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229
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Miura K, Vail A, Chambers D, Hopkins PM, Ferguson L, Grant M, Rhodes LE, Green AC. Omega-3 fatty acid supplement skin cancer prophylaxis in lung transplant recipients: A randomized, controlled pilot trial. J Heart Lung Transplant 2018; 38:59-65. [PMID: 30352778 DOI: 10.1016/j.healun.2018.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 09/07/2018] [Accepted: 09/12/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Lung transplant recipients (LTRs) are at very high risk of skin cancer. Omega-3 fatty acids (FAs) are anti-inflammatory and immune-modulating and could potentially reduce this risk. We assessed the feasibility of omega-3 FA supplementation to reduce skin cancer among these patients. METHODS LTRs aged 18+ years, at least 1 year post-transplant, were recruited from the outpatient clinic of The Prince Charles Hospital, Brisbane. Participants were randomly allocated to 4-times-daily supplements containing either omega-3 FA (3.36 eicosapentaenoic acid [EPA] + docosahexaenoic acid) or placebo (4 g olive oil) for 12 months. Primary outcomes were rates of recruitment, retention, adherence (assessed by plasma omega-3 FA), and safety. Secondary outcomes were incident skin cancers. RESULTS Among 106 eligible lung transplant recipients, 49 consented to take part (46%) with 25 allocated to omega-3 FA and 24 to placebo supplements. Of these, 22 (88%) and 20 (83%), respectively, completed the trial. After 12 months, median plasma EPA increased substantially in the intervention group (125.0 to 340.0 µmol/L), but not the placebo group (98.0 to 134.5 µmol/L). In the intervention group, 6 patients developed skin cancers compared with 11 in the placebo group, giving an odds ratio (95% confidence interval) of 0.34 (0.09 to 1.32). There were no serious, active intervention-related adverse events. CONCLUSIONS This pilot trial among LTRs showed acceptable recruitment and high retention and adherence. We demonstrated a signal for reduction of new skin cancer cases in those taking omega-3 FA supplements, which supports the notion that a larger, more definitive trial is warranted.
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Affiliation(s)
- Kyoko Miura
- Cancer and Population Studies Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.
| | - Andy Vail
- Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Daniel Chambers
- Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Queensland, Australia; School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Peter M Hopkins
- Queensland Lung Transplant Service, The Prince Charles Hospital Campus and School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Lisa Ferguson
- Cancer and Population Studies Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Michelle Grant
- Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Lesley E Rhodes
- Dermatology Research Centre, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Adèle C Green
- Cancer and Population Studies Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia; CRUK Manchester Institute, University of Manchester, Manchester, UK
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230
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Abikhair Burgo M, Roudiani N, Chen J, Santana AL, Doudican N, Proby C, Felsen D, Carucci JA. Ruxolitinib inhibits cyclosporine-induced proliferation of cutaneous squamous cell carcinoma. JCI Insight 2018; 3:120750. [PMID: 30185657 PMCID: PMC6171807 DOI: 10.1172/jci.insight.120750] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 07/26/2018] [Indexed: 01/05/2023] Open
Abstract
Organ transplant recipients (OTRs) on cyclosporine A (CSA) are prone to catastrophic cutaneous squamous cell carcinoma (SCC). Allograft-sparing, cancer-targeting systemic treatments are unavailable. We have shown increased risk for catastrophic SCC in OTRs via CSA-mediated induction of IL-22. Herein, we found that CSA drives SCC proliferation and tumor growth through IL-22 and JAK/STAT pathway induction. We in turn inhibited SCC growth with an FDA-approved JAK1/2 inhibitor, ruxolitinib. In human SCC cells, the greatest proliferative response to IL-22 and CSA treatment occurred in nonmetastasizing lines. IL-22 treatment upregulated JAK1 and STAT1/3 in A431 SCC cells. JAK/STAT pathway genes were highly expressed in tumors from a cohort of CSA-exposed OTRs and in SCC with high risk for metastasis. Compared with immunocompetent SCC, genes associated with innate immunity, response to DNA damage, and p53 regulation were differentially expressed in SCC from OTRs. In nude mice engrafted with human A431 cells, IL-22 and CSA treatment increased tumor growth and upregulated IL-22 receptor, JAK1, and STAT1/3 expression. Ruxolitinib treatment significantly reduced tumor volume and reversed the accelerated tumor growth. CSA and IL-22 exacerbate aggressive behavior in SCC. Targeting the IL-22 axis via selective JAK/STAT inhibition may reduce the progression of aggressive SCC in OTRs, without compromising immunosuppression.
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Affiliation(s)
- Melody Abikhair Burgo
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA
| | - Nazanin Roudiani
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA
| | - Jie Chen
- Institute for Pediatric Urology, Department of Urology, Weill Cornell Medicine, New York, New York, USA
| | - Alexis L. Santana
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA
| | - Nicole Doudican
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA
| | - Charlotte Proby
- Division of Cancer Research, Jacqui Wood Cancer Centre, University of Dundee, Dundee, Scotland, United Kingdom
| | - Diane Felsen
- Institute for Pediatric Urology, Department of Urology, Weill Cornell Medicine, New York, New York, USA
| | - John A. Carucci
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA
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231
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Affiliation(s)
- George Cholankeril
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA. .,Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Andrew A Li
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Rosann Cholankeril
- Department of Medicine, Roger Williams Medical Center, Providence, RI, USA
| | - Alice E Toll
- United Network for Organ Sharing, Richmond, VA, USA
| | - Jeffrey S Glenn
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Aijaz Ahmed
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
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232
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Pollara J, Edwards RW, Lin L, Bendersky VA, Brennan TV. Circulating mitochondria in deceased organ donors are associated with immune activation and early allograft dysfunction. JCI Insight 2018; 3:121622. [PMID: 30089724 PMCID: PMC6129133 DOI: 10.1172/jci.insight.121622] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/21/2018] [Indexed: 12/22/2022] Open
Abstract
Brain death that occurs in the setting of deceased organ donation for transplantation is associated with systemic inflammation of unknown origin. It has recently been recognized that mitochondria-derived damage-associated molecular patterns (mtDAMPs) released into the circulation in the setting of trauma and tissue injury are associated with a systemic inflammatory response. We examined the blood of deceased organ donors and found elevated levels of inflammatory cytokines and chemokines that correlated with levels of mtDAMPs. We also found that donor neutrophils are activated and that donor plasma contains a neutrophil-activating factor that is blocked by cyclosporin H, a formyl peptide receptor-1 antagonist. Examination of donor plasma by electron microscopy and flow cytometry revealed that free- and membrane-bound mitochondria are elevated in donor plasma. Interestingly, we demonstrated a correlation between donor plasma mitochondrial DNA levels and early allograft dysfunction in liver transplant recipients, suggesting a role for circulating mtDAMPs in allograft outcomes. Current approaches to prolong allograft survival focus on immune suppression in the transplant recipient; our data indicate that targeting inflammatory factors in deceased donors prior to organ procurement is another potential strategy for improving transplant outcomes.
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Affiliation(s)
- Justin Pollara
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - R. Whitney Edwards
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Liwen Lin
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Victoria A. Bendersky
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Todd V. Brennan
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
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233
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Abstract
In this review article, typical imaging findings of diseases elicited by immunomodulatory drugs are presented. Progressive multifocal leucoencephalopathy (PML), a subacute infection due to reactivation of the JC virus, has a typical magnetic resonance imaging (MRI) pattern, which must be considered in the framework of immunomodulatory multiple sclerosis (MS) treatment with natalizumab, fingolimod, rituximab and fumarate and also in lymphoproliferative diseases or other forms of immunosuppression. Restoration of the immune system may result in an overlapping and overwhelming immune response in terms of an immune reconstitution inflammatory syndrome (IRIS). Further conditions with typical MRI patterns comprise methotrexate-associated leucoencephalopathy and posterior reversible encephalopathy syndrome (PRES). In immunotherapy with activation of T‑lymphocytes, attention should always be paid to the fact that the T‑lymphocytes activated by different processes not only target the diseased tissue but also normal brain tissue.
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Affiliation(s)
| | - H Urbach
- Klinik für Neuroradiologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland.
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234
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Shoeibi N, Abrishami M, Mohammad Esmaeil E, Hosseini SM. Visual prognosis, clinical features, and predisposing factors in non-HIV patients with cytomegalovirus retinitis. Int Ophthalmol 2018; 39:1709-1715. [PMID: 30030661 DOI: 10.1007/s10792-018-0991-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 07/14/2018] [Indexed: 01/27/2023]
Abstract
PURPOSE To study the characteristics and visual outcome of cytomegalovirus retinitis in patients of a tertiary referral ophthalmology center. METHODS This retrospective cross-sectional study included 16 patients who presented with CMV retinitis between February 2014 and January 2017. Demographics, clinical signs, course of treatment, and visual and anatomical results were analyzed. RESULTS Twenty five eyes of 16 patients were included. Eleven (68.8%) were females. The mean age was 29.37 ± 17.12 (range 11-73) years. Involvement was bilateral in 9 (56.2%) cases. HIV serology was negative in all patients. Best-corrected visual acuity was 0.57 ± 0.55 logarithm of the minimal angle of resolution (LogMAR) at the time of presentation and decreased to 0.69 ± 0.55 LogMAR on final visit (P = 0.332). None of the patients participating in this study was HIV-positive. CONCLUSION CMV retinitis is a devastating complication in immunosuppressed. The visual acuity usually decreases despite aggressive appropriate treatment. This observation supports the increasing incidence of CMV infection in non-HIV patients.
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Affiliation(s)
- Nasser Shoeibi
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Abrishami
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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235
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D'Addio F, Vergani A, Potena L, Maestroni A, Usuelli V, Ben Nasr M, Bassi R, Tezza S, Dellepiane S, El Essawy B, Iascone M, Iacovoni A, Borgese L, Liu K, Visner G, Dhe-Paganon S, Corradi D, Abdi R, Starling RC, Folli F, Zuccotti GV, Sayegh MH, Heeger PS, Chandraker A, Grigioni F, Fiorina P. P2X7R mutation disrupts the NLRP3-mediated Th program and predicts poor cardiac allograft outcomes. J Clin Invest 2018; 128:3490-3503. [PMID: 30010623 DOI: 10.1172/jci94524] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 05/23/2018] [Indexed: 12/23/2022] Open
Abstract
Purinergic receptor-7 (P2X7R) signaling controls Th17 and Th1 generation/differentiation, while NOD-like receptor P3 (NLRP3) acts as a Th2 transcriptional factor. Here, we demonstrated the existence of a P2X7R/NLRP3 pathway in T cells that is dysregulated by a P2X7R intracellular region loss-of-function mutation, leading to NLRP3 displacement and to excessive Th17 generation due to abrogation of the NLRP3-mediated Th2 program. This ultimately resulted in poor outcomes in cardiac-transplanted patients carrying the mutant allele, who showed abnormal Th17 generation. Transient NLRP3 silencing in nonmutant T cells or overexpression in mutant T cells normalized the Th profile. Interestingly, IL-17 blockade reduced Th17 skewing of human T cells in vitro and abrogated the severe allograft vasculopathy and abnormal Th17 generation observed in preclinical models in which P2X7R was genetically deleted. This P2X7R intracellular region mutation thus impaired the modulatory effects of P2X7R on NLRP3 expression and function in T cells and led to NLRP3 dysregulation and Th17 skewing, delineating a high-risk group of cardiac-transplanted patients who may benefit from personalized therapy.
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Affiliation(s)
- Francesca D'Addio
- International Center for Type 1 Diabetes, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, "L. Sacco" Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Andrea Vergani
- Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Luciano Potena
- Heart Failure and Heart Transplant Program, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater-University of Bologna, Bologna, Italy
| | - Anna Maestroni
- International Center for Type 1 Diabetes, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, "L. Sacco" Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Vera Usuelli
- Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Moufida Ben Nasr
- International Center for Type 1 Diabetes, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, "L. Sacco" Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.,Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Roberto Bassi
- Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sara Tezza
- Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sergio Dellepiane
- Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Basset El Essawy
- Medicine, Al-Azhar University, Cairo, Egypt.,Transplantation Research Center, Nephrology Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Attilio Iacovoni
- Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Laura Borgese
- Heart Failure and Heart Transplant Program, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater-University of Bologna, Bologna, Italy
| | - Kaifeng Liu
- Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Gary Visner
- Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sirano Dhe-Paganon
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Domenico Corradi
- Department of Biomedical, Biotechnological and Translational Sciences, Unit of Pathology, University of Parma, Parma, Italy
| | - Reza Abdi
- Transplantation Research Center, Nephrology Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Randall C Starling
- Heart Failure Center, Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Franco Folli
- Endocrinology and Metabolism, Department of Health Science, University of Milan, ASST Santi Paolo e Carlo, Milan, Italy
| | - Gian Vincenzo Zuccotti
- International Center for Type 1 Diabetes, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, "L. Sacco" Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.,Department of Pediatrics, Children's Hospital Buzzi, Milan, Italy
| | | | - Peter S Heeger
- Department of Medicine and Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anil Chandraker
- Transplantation Research Center, Nephrology Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Francesco Grigioni
- Heart Failure and Heart Transplant Program, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater-University of Bologna, Bologna, Italy
| | - Paolo Fiorina
- International Center for Type 1 Diabetes, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, "L. Sacco" Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.,Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Endocrinology Division, ASST Fatebenefratelli Sacco, Milan, Italy
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Mistry U, Dargan PI, Wood DM. Pesticide-Poisoned Patients: Can They Be Used as Potential Organ Donors? J Med Toxicol 2018; 14:278-82. [PMID: 29987646 DOI: 10.1007/s13181-018-0673-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/17/2018] [Accepted: 06/28/2018] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION The gap between the number of patients on transplant waiting lists and patients receiving transplants is growing. Use of organs from donors who have died following pesticide exposure remains controversial. This study reviews the literature related to transplantation from this group. METHODS A literature search was undertaken on PubMed using the following keywords: 'insecticide', 'pesticide', 'rodenticide', 'organophosphate', 'carbamate', 'paraquat', 'poisoning', 'toxicity', 'overdose', 'intoxication', 'ingestion', 'organ donation or procurement', 'transplant', 'allograft transplant', and 'expanded criteria organ donation'; 21 specific pesticides/insecticides were also added to the search; the indexes for EAPCCT/NACCT meeting abstracts 2008-2017 were also searched. Identified publications were reviewed and if described human donation/transplantation of ≥ 1 solid organ(s), the following was extracted: (i) compound(s) ingested; (ii) donor demographics; (iii) organ(s) transplanted; and (iv) graft function at follow-up. RESULTS Ten papers were identified describing 20 fatalities (1999-2017) related to the following pesticide exposures: organophosphate, 8 cases; aldicarb, 4; paraquat, 3; parathion, 1; malathion, 1; carbofuran/carbamate, 1; carbamate, 1; and brodifacoum, 1 and no further cases were identified from EAPCCT/NACCT abstracts. Donors were aged 12-50 (25.9 ± 11.9) years. Forty-four organs were transplanted: 28 kidneys, 7 livers, 6 corneas, and 3 hearts. Forty recipients had outcome reported: 3 (7.5%) patients died, 3 (7.5%) had graft failure/dysfunction and 34 (85.0%) had good graft function. Overall survival with good function was 96%, 71%, 83%, and 67% for kidneys, livers, corneas and hearts respectively. CONCLUSION Review of the published literature suggests that solid organ donation following exposure to a pesticide is associated with good short-to-medium-term graft organ function following transplantation, particularly for transplanted kidneys and corneas.
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237
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Dayoub JC, Cortese F, Anžič A, Grum T, de Magalhães JP. The effects of donor age on organ transplants: A review and implications for aging research. Exp Gerontol 2018; 110:230-240. [PMID: 29935294 PMCID: PMC6123500 DOI: 10.1016/j.exger.2018.06.019] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/15/2018] [Accepted: 06/18/2018] [Indexed: 12/21/2022]
Abstract
Despite the considerable amount of data available on the effect of donor age upon the outcomes of organ transplantation, these still represent an underutilized resource in aging research. In this review, we have compiled relevant studies that analyze the effect of donor age in graft and patient survival following liver, kidney, pancreas, heart, lung and cornea transplantation, with the aim of deriving insights into possible differential aging rates between the different organs. Overall, older donor age is associated with worse outcomes for all the organs studied. Nonetheless, the donor age from which the negative effects upon graft or patient survival starts to be significant varies between organs. In kidney transplantation, this age is within the third decade of life while the data for heart transplantation suggest a significant effect starting from donors over age 40. This threshold was less defined in liver transplantation where it ranges between 30 and 50 years. The results for the pancreas are also suggestive of a detrimental effect starting at a donor age of around 40, although these are mainly derived from simultaneous pancreas-kidney transplantation data. In lung transplantation, a clear effect was only seen for donors over 65, with negative effects of donor age upon transplantation outcomes likely beginning after age 50. Corneal transplants appear to be less affected by donor age as the majority of studies were unable to find any effect of donor age during the first few years posttransplantation. Overall, patterns of the effect of donor age in patient and graft survival were observed for several organ types and placed in the context of knowledge on aging. Data on the effects of donor age upon the outcomes of organ transplantation are an underutilized resource in biogerontology We compiled data on the effect of donor age following liver, kidney, pancreas, heart, lung and cornea transplantation Older donor age is associated with worse outcomes for all the organs studied The donor age from which the negative effects upon survival starts to be significant varies between organs
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Affiliation(s)
- Jose Carlos Dayoub
- Integrative Genomics of Ageing Group, Institute of Ageing and Chronic Disease, University of Liverpool, William Henry Duncan Building, Room 281, 6 West Derby Street, Liverpool L7 8TX, United Kingdom
| | - Franco Cortese
- Biogerontology Research Foundation, Research Department, Oxford, United Kingdom
| | - Andreja Anžič
- Integrative Genomics of Ageing Group, Institute of Ageing and Chronic Disease, University of Liverpool, William Henry Duncan Building, Room 281, 6 West Derby Street, Liverpool L7 8TX, United Kingdom
| | - Tjaša Grum
- Integrative Genomics of Ageing Group, Institute of Ageing and Chronic Disease, University of Liverpool, William Henry Duncan Building, Room 281, 6 West Derby Street, Liverpool L7 8TX, United Kingdom
| | - João Pedro de Magalhães
- Integrative Genomics of Ageing Group, Institute of Ageing and Chronic Disease, University of Liverpool, William Henry Duncan Building, Room 281, 6 West Derby Street, Liverpool L7 8TX, United Kingdom; Biogerontology Research Foundation, Research Department, Oxford, United Kingdom.
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238
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Mitchell RM, Jones AM, Barry PJ. CFTR modulator therapy in patients with cystic fibrosis and an organ transplant. Paediatr Respir Rev 2018; 27:6-8. [PMID: 30158080 DOI: 10.1016/j.prrv.2018.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/17/2018] [Indexed: 11/24/2022]
Abstract
CFTR modulators are a class of drugs which directly target the defective CFTR protein in cystic fibrosis (CF), improving its function with resultant clinical improvements. Currently these drugs are confined to people with a limited selection of genetic mutations. New modulators are in development which will lead to the majority of patients with CF becoming eligible for treatment. CFTR modulators are currently considered contraindicated in patients with a solid organ transplant. This excludes many patients who may benefit from the multisystem effects of CFTR modulator treatment. In this review, we discuss issues regarding drug interactions, organ transplantation and CFTR modulation.
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McIntosh CM, Chen L, Shaiber A, Eren AM, Alegre ML. Gut microbes contribute to variation in solid organ transplant outcomes in mice. Microbiome 2018; 6:96. [PMID: 29793539 PMCID: PMC5968713 DOI: 10.1186/s40168-018-0474-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 05/06/2018] [Indexed: 05/16/2023]
Abstract
BACKGROUND Solid organ transplant recipients show heterogeneity in the occurrence and timing of acute rejection episodes. Understanding the factors responsible for such variability in patient outcomes may lead to improved diagnostic and therapeutic approaches. Rejection kinetics of transplanted organs mainly depends on the extent of genetic disparities between donor and recipient, but a role for environmental factors is emerging. We have recently shown that major alterations of the microbiota following broad-spectrum antibiotics, or use of germ-free animals, promoted longer skin graft survival in mice. Here, we tested whether spontaneous differences in microbial colonization between genetically similar individuals can contribute to variability in graft rejection kinetics. RESULTS We compared rejection kinetics of minor mismatched skin grafts in C57BL/6 mice from Jackson Laboratory (Jax) and Taconic Farms (Tac), genetically similar animals colonized by different commensal microbes. Female Tac mice rejected skin grafts from vendor-matched males more quickly than Jax mice. We observed prolonged graft survival in Tac mice when they were exposed to Jax mice microbiome through co-housing or fecal microbiota transplantation (FMT) by gastric gavage. In contrast, exposure to Tac mice did not change graft rejection kinetics in Jax mice, suggesting a dominant suppressive effect of Jax microbiota. High-throughput sequencing of 16S rRNA gene amplicons from Jax and Tac mice fecal samples confirmed a convergence of microbiota composition after cohousing or fecal transfer. Our analysis of amplicon data associated members of a single bacterial genus, Alistipes, with prolonged graft survival. Consistent with this finding, members of the genus Alistipes were absent in a separate Tac cohort, in which fecal transfer from Jax mice failed to prolong graft survival. CONCLUSIONS These results demonstrate that differences in resident microbiome in healthy individuals may translate into distinct kinetics of graft rejection, and contribute to interpersonal variability in graft outcomes. The association between Alistipes and prolonged skin graft survival in mice suggests that members of this genus might affect host physiology, including at sites distal to the gastrointestinal tract. Overall, these findings allude to a potential therapeutic role for specific gut microbes to promote graft survival through the administration of probiotics, or FMT.
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Affiliation(s)
| | - Luqiu Chen
- Department of Medicine, The University of Chicago, Chicago, USA
| | - Alon Shaiber
- Department of Medicine, The University of Chicago, Chicago, USA
| | - A Murat Eren
- Department of Medicine, The University of Chicago, Chicago, USA
- Marine Biological Laboratory, Woods Hole, USA
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240
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Hsiao HM, Fernandez R, Tanaka S, Li W, Spahn JH, Chiu S, Akbarpour M, Ruiz-Perez D, Wu Q, Turam C, Scozzi D, Takahashi T, Luehmann HP, Puri V, Budinger GRS, Krupnick AS, Misharin AV, Lavine KJ, Liu Y, Gelman AE, Bharat A, Kreisel D. Spleen-derived classical monocytes mediate lung ischemia-reperfusion injury through IL-1β. J Clin Invest 2018; 128:2833-2847. [PMID: 29781811 DOI: 10.1172/jci98436] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [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: 11/03/2017] [Accepted: 04/04/2018] [Indexed: 12/16/2022] Open
Abstract
Ischemia-reperfusion injury, a form of sterile inflammation, is the leading risk factor for both short-term mortality following pulmonary transplantation and chronic lung allograft dysfunction. While it is well recognized that neutrophils are critical mediators of acute lung injury, processes that guide their entry into pulmonary tissue are not well understood. Here, we found that CCR2+ classical monocytes are necessary and sufficient for mediating extravasation of neutrophils into pulmonary tissue during ischemia-reperfusion injury following hilar clamping or lung transplantation. The classical monocytes were mobilized from the host spleen, and splenectomy attenuated the recruitment of classical monocytes as well as the entry of neutrophils into injured lung tissue, which was associated with improved graft function. Neutrophil extravasation was mediated by MyD88-dependent IL-1β production by graft-infiltrating classical monocytes, which downregulated the expression of the tight junction-associated protein ZO-2 in pulmonary vascular endothelial cells. Thus, we have uncovered a crucial role for classical monocytes, mobilized from the spleen, in mediating neutrophil extravasation, with potential implications for targeting of recipient classical monocytes to ameliorate pulmonary ischemia-reperfusion injury in the clinic.
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Affiliation(s)
- Hsi-Min Hsiao
- Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Ramiro Fernandez
- Department of Surgery, Northwestern University, Chicago, Illinois, USA
| | - Satona Tanaka
- Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Wenjun Li
- Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jessica H Spahn
- Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Stephen Chiu
- Department of Surgery, Northwestern University, Chicago, Illinois, USA
| | - Mahzad Akbarpour
- Department of Surgery, Northwestern University, Chicago, Illinois, USA
| | - Daniel Ruiz-Perez
- Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Qiang Wu
- Department of Surgery, Northwestern University, Chicago, Illinois, USA
| | - Cem Turam
- Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Davide Scozzi
- Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Tsuyoshi Takahashi
- Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Hannah P Luehmann
- Department of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Varun Puri
- Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | | | - Alexander S Krupnick
- Department of Surgery, The University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Yongjian Liu
- Department of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Andrew E Gelman
- Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, USA.,Department of Pathology & Immunology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Ankit Bharat
- Department of Surgery, Northwestern University, Chicago, Illinois, USA.,Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Daniel Kreisel
- Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, USA.,Department of Pathology & Immunology, Washington University in St. Louis, St. Louis, Missouri, USA
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Hendrikx J, Van Raemdonck D, Pirenne J, Fieuws S, Rex S. Outcome of transplantation performed outside the regular working hours: A systematic review and meta-analysis of the literature. Transplant Rev (Orlando) 2018; 32:168-77. [PMID: 29907370 DOI: 10.1016/j.trre.2018.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 04/27/2018] [Accepted: 05/01/2018] [Indexed: 12/31/2022]
Abstract
Transplant procedures are frequently performed outside the regular working hours (after hours). In general surgery, several studies observed worse outcomes for operations performed after hours. The predetermined hypothesis was that patients undergoing transplantation during after hours might suffer from an excess in post-operative mortality and morbidity when compared to patients undergoing transplantations during the regular working hours. A systematic review of the PubMed database identified 11,993 records, of which eleven cohort studies including a total of 287,741 patients investigated the association between the starting time of transplant surgery and postoperative mortality (primary outcome) and/or morbidity (secondary outcome). Eight studies evaluated kidney transplants (in 165,277 patients), two studies analyzed liver transplants (in 95,346 patients), and one study investigated transplantations of thoracic organs (in 27,118 patients). Results were conflicting with two studies (in liver and lung transplantation) showing an increased mortality for transplantations performed after hours, and five studies showing no effects on mortality. A meta-analysis on estimates from four studies yielded a hazard ratio of 1.01 (95% CI, 0.98 to 1.04) for mortality comparing transplantations performed during versus outside the regular working hours. The evidence was also inconclusive for a variety of morbidity outcomes with studies demonstrating either a deterioration of outcome, no effect or an improved outcome for after hours procedures. On the basis of the available evidence, it appears impossible to give an unequivocal recommendation regarding starting times in transplant surgery.
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242
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Lieber SR, Schiano TD, Rhodes R. Should living donor liver transplantation be an option when deceased donation is not? J Hepatol 2018; 68:1076-1082. [PMID: 29100996 PMCID: PMC5893415 DOI: 10.1016/j.jhep.2017.10.024] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 09/20/2017] [Accepted: 10/15/2017] [Indexed: 12/20/2022]
Abstract
When a liver transplantation candidate is declined for listing to receive a deceased organ, sometimes a loved one comes forward and offers to be a living donor. This raises the ethical question of whether a patient who is not eligible for deceased donor liver transplantation should be eligible for living donor liver transplantation. We compare living organ donation in kidney and liver transplantation and explore key ethical concepts of justice, fairness, and societal trust. Ultimately, because there is no alternative life-preserving therapy in end-stage liver disease, and because transplantation with a living donor organ does not involve removing a resource from the common pool of transplant organs, we argue that a standard of "slightly less benefit" than that required for deceased transplantation should be used to determine the acceptability of living donor liver transplantation.
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Affiliation(s)
- Sarah R Lieber
- University of North Carolina Hospitals Department of Gastroenterology and Hepatology, Chapel Hill, NC, United States.
| | - Thomas D Schiano
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY, United States; Recanati/Miller Liver Transplantation Institute, New York, NY, United States
| | - Rosamond Rhodes
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY, United States
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243
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Abstract
Obesity is linked to inferior transplant outcome. Bariatric surgery (BS) is an established treatment of morbid obesity. We provide an overview on BS in the field of kidney (KT) and liver transplantation (LT). In end-stage renal disease (ESRD) and KT patients, BS seems safe and feasible. Complication rates were slightly higher compared to the non-transplant population, whereas weight loss and improvement of comorbidities were comparable. Sleeve gastrectomy (SG) was the preferred procedure before KT and superior to gastric bypass (GB) in regard to mortality and morbidity. If conducted after KT, both procedures showed comparable results. BS before LT was associated with high complication rates, in particular after GB. Albeit distinct complications, SG conducted after LT showed the best results. Immunosuppression (IS) changes after BS were rare.
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Affiliation(s)
- Tomasz Dziodzio
- Department of Surgery, Campus Virchow and Mitte, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13352, Berlin, Germany.
| | - Matthias Biebl
- Department of Surgery, Campus Virchow and Mitte, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13352, Berlin, Germany
| | - Robert Öllinger
- Department of Surgery, Campus Virchow and Mitte, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13352, Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Campus Virchow and Mitte, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13352, Berlin, Germany
| | - Christian Denecke
- Department of Surgery, Campus Virchow and Mitte, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13352, Berlin, Germany
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Montero Salinas A, Martínez-Isasi S, Fieira Costa E, Fernández García A, Castro Dios DJ, Fernández García D. [Knowledge and attitudes toward organ donation among health professionals in a third level hospital]. Rev Esp Salud Publica 2018; 92:e201804007. [PMID: 29662051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 12/28/2017] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVE The Spanish model is the model adopted by many countries to increase their donation rate, being the implication of the healthcare professionals one of the keys to this success. The attitude of these before the donation is crucial for the hour of influence on the population. Organ transplantation has been established as an effective treatment that has been improving over the years. The objective was to determine the knowledge and attitudes of health professionals before the donation of organs. METHODS Cross-sectional descriptive study. An ad hoc questionnaire was conducted and distributed among the health professionals (medical staff, nurses and nursing assistants) of a tertiary hospital during February 2015. A total of 615 potential participants were estimated in the different areas of the hospital. A total of 342 completed questionnaires were collected (55%). The statistical analysis with SPSS® Statistics for Windows. Version 20.0. A level of significance P lower than 0.05 was used in all the analyses. RESULTS The average age of the respondents was 43.34 (SD = 10.37) years, being 86.6% women and 60% nurses. 35.5% showed good knowledge about the donation process, being higher in men (51.1% Vs 33.1%, p lower than 0.05), medical personnel (55% vs 34.3% vs 31.9%). %; p lower than 0.05) and lower in those services with a direct relationship with the donation process (36.8% vs 31.9%, p lower than 0.05). 71% of the professionals expressed their willingness to donate their organs, with special sensitivity towards donation those services in direct relation with the donation program (82.2% vs 65.9%, OR: 1.24, p lower than 0.001 ). 50% of the professionals would donate the organs of a family member; the medical group had the highest percentage (70% vs 50.7% vs 40.4%, OR: 3.8, p lower than 0.05). 74.5% knew some Spanish legal document about donation and transplants. CONCLUSIONS Health professionals as a whole have a low level of knowledge; but a good attitude towards donation.
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Affiliation(s)
- Alejandro Montero Salinas
- Oficina Coordinación de Trasplantes A Coruña. Complexo Hospitalario Universitario A Coruña CHUAC.SERGAS. A Coruña. España
| | - Santiago Martínez-Isasi
- Grupo Cardiopatías Familiares. Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS. A Coruña. España
- Unidad de investigación en salud y podología. Departamento de Ciencias de la Salud. Facultad de Enfermería y Podología. Universidade da Coruña. A Coruña. España
| | - Eva Fieira Costa
- Servicio de Cirugía Torácica. Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS. A Coruña. España
| | - Antón Fernández García
- Oficina Coordinación de Trasplantes A Coruña. Complexo Hospitalario Universitario A Coruña CHUAC.SERGAS. A Coruña. España
| | - Diana Josefa Castro Dios
- Grupo Cardiopatías Familiares. Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS. A Coruña. España
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Allard J, Ballesteros F, Anthony SJ, Dumez V, Hartell D, Knoll G, Wright L, Fortin MC. What does patient engagement mean for Canadian National Transplant Research Program Researchers? Res Involv Engagem 2018; 4:13. [PMID: 29657835 PMCID: PMC5890351 DOI: 10.1186/s40900-018-0096-0] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 02/20/2018] [Indexed: 05/26/2023]
Abstract
PLAIN ENGLISH SUMMARY In recent years, the importance of involving patients in research has been increasingly recognized because it increases the relevance and quality of research, facilitates recruitment, enhances public trust and allows for more effective dissemination of results. The Canadian National Transplant Research Program (CNTRP) is an interdisciplinary research team looking at a variety of issues related to organ and tissue donation and transplantation. The aim of this study was to gather the perspectives of CNTRP researchers on engaging patients in research.We conducted interviews with 10 researchers who attended a national workshop on priority-setting in organ donation and transplant research. The researchers viewed patient engagement in research as necessary and important. They also considered that patients could be engaged at every step of the research process. Participants in this study identified scientific language, time, money, power imbalance, patient selection and risk of tokenism as potential barriers to patient engagement in research. Training, adequate resources and support from the institution were identified as facilitators of patient engagement.This study showed a positive attitude among researchers in the field of organ donation and transplantation. Further studies are needed to study the implementation and impact of patient engagement in research within the CNTRP. ABSTRACT Background Involving patients in research has been acknowledged as a way to enhance the quality, relevance and transparency of medical research. No previous studies have looked at researchers' perspectives on patient engagement (PE) in organ donation and transplant research in Canada. Objective The aim of this study was to gather the perspectives of Canadian National Transplant Research Program (CNTRP) researchers on PE in research. Methods We conducted semi-structured interviews with ten researchers who attended a national workshop on priority-setting in organ donation and transplant research. The interviews were digitally recorded and transcribed verbatim, and the transcripts were subjected to qualitative thematic and content analyses. Results The researchers viewed PE in research as necessary and important. PE was a method to incorporate the voice of the patient. They also considered that patients could be engaged at every step of the research process. The following were identified as the main barriers to PE in research: (i) scientific jargon; (ii) resources (time and money); (iii) tokenism; (iv) power imbalance; and (v) patient selection. Facilitating factors included (i) training for patients and researchers, (ii) adequate resources and (iii) institutional support. Conclusion This study revealed a favourable attitude and willingness among CNTRP researchers to engage and partner with patients in research. Further studies are needed to assess the implementation of PE strategy within the CNTRP and its impact.
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Affiliation(s)
- Julie Allard
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), 900 Saint-Denis St., Room 12-454, Montréal, QC, H2X 0A9 Canada
- Canadian National Transplant Research Program, Edmonton, Canada
| | - Fabián Ballesteros
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), 900 Saint-Denis St., Room 12-454, Montréal, QC, H2X 0A9 Canada
- Canadian National Transplant Research Program, Edmonton, Canada
| | - Samantha J. Anthony
- Canadian National Transplant Research Program, Edmonton, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Vincent Dumez
- Direction collaboration et partenariat patient, Faculty of Medicine, Université de Montréal, Montréal, Canada
- Centre of Excellence on Partnership with Patients and the Public, Université de Montréal, Montréal, Canada
| | - David Hartell
- Canadian National Transplant Research Program, Edmonton, Canada
| | - Greg Knoll
- Canadian National Transplant Research Program, Edmonton, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Linda Wright
- Canadian National Transplant Research Program, Edmonton, Canada
- Department of Surgery and Joint Centre for Bioethics, University of Toronto, Toronto, Canada
| | - Marie-Chantal Fortin
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), 900 Saint-Denis St., Room 12-454, Montréal, QC, H2X 0A9 Canada
- Canadian National Transplant Research Program, Edmonton, Canada
- Université de Montréal, Montréal, Canada
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Abstract
Immunosuppressive drugs are a prerequisite in organ transplantation to prevent rejection and are also widely used in inflammatory diseases such as inflammatory bowel disease (IBD) or also in some hematologic malignancies-depending on the mode of action. For thiopurine analogs the polymorphic thiopurine S-methyltransferase (TPMT) was early detected to be associated with thiopurine-induced leukopenia; recent studies identified also NUDT15 to be related to this severe side effect. For drugs like methotrexate and mycophenolate mofetil a number of ADME genes like UDP-glucuronosyltransferases (UGTs) and ABC efflux transporters were investigated, however, with partly contradicting results. For calcineurin inhibitors like cyclosporine and in particular tacrolimus however, cytochrome P450 3A4 and 3A5 variants were found to significantly affect the pharmacokinetics. Genetic variants in genes encoding relevant pharmacodynamic proteins, however, lacked compelling evidence to affect the clinical outcome. This chapter reviews the current evidence on the association of pharmacogenetic traits to dose finding and clinical outcome of small-molecule immunosuppressants. Moreover this chapter critically summarizes suitability to apply pharmacogenetics in clinical practice in order to optimize immunosuppressant therapy.
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Affiliation(s)
- Ingolf Cascorbi
- Institute of Experimental and Clinical Pharmacology, University Hospital Schleswig-Holstein, Kiel, Germany.
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247
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Yu K, Davidson CL, Wójtowicz A, Lisboa L, Wang T, Airo AM, Villard J, Buratto J, Sandalova T, Achour A, Humar A, Boggian K, Cusini A, van Delden C, Egli A, Manuel O, Mueller N, Bochud PY, Burshtyn DN. LILRB1 polymorphisms influence posttransplant HCMV susceptibility and ligand interactions. J Clin Invest 2018. [PMID: 29528338 DOI: 10.1172/jci96174] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
UL18 is a human CMV (HCMV) MHC class I (MHCI) homolog that efficiently inhibits leukocyte immunoglobulin-like receptor subfamily B member 1 (LILRB1)+ NK cells. We found an association of LILRB1 polymorphisms in the regulatory regions and ligand-binding domains with control of HCMV in transplant patients. Naturally occurring LILRB1 variants expressed in model NK cells showed functional differences with UL18 and classical MHCI, but not with HLA-G. The altered functional recognition was recapitulated in binding assays with the binding domains of LILRB1. Each of 4 nonsynonymous substitutions in the first 2 LILRB1 immunoglobulin domains contributed to binding with UL18, classical MHCI, and HLA-G. One of the polymorphisms controlled addition of an N-linked glycan, and that mutation of the glycosylation site altered binding to all ligands tested, including enhancing binding to UL18. Together, these findings indicate that specific LILRB1 alleles that allow for superior immune evasion by HCMV are restricted by mutations that limit LILRB1 expression selectively on NK cells. The polymorphisms also maintained an appropriate interaction with HLA-G, fitting with a principal role of LILRB1 in fetal tolerance.
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Affiliation(s)
- Kang Yu
- Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Chelsea L Davidson
- Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Agnieszka Wójtowicz
- Infectious Diseases Service, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Luiz Lisboa
- Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta, Canada.,Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ting Wang
- Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Adriana M Airo
- Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Jean Villard
- Immunology and Transplant Unit, Service of Nephrology, Geneva University Hospital, Geneva, Switzerland
| | - Jeremie Buratto
- Science for Life Laboratory, Department of Medicine Solna, Karolinska Institute, and Department of Infectious Diseases, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Tatyana Sandalova
- Science for Life Laboratory, Department of Medicine Solna, Karolinska Institute, and Department of Infectious Diseases, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Adnane Achour
- Science for Life Laboratory, Department of Medicine Solna, Karolinska Institute, and Department of Infectious Diseases, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Atul Humar
- Multi-Organ Transplant Program, University of Toronto, Toronto, Ontario, Canada
| | - Katia Boggian
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Alexia Cusini
- Department of Infectious Diseases and Hospital Epidemiology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Christian van Delden
- Transplant Infectious Diseases Unit, University Hospitals Geneva, Geneva, Switzerland
| | - Adrian Egli
- Division of Clinical Microbiology, University Hospital Basel, Basel, Switzerland.,Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Oriol Manuel
- Infectious Diseases Service and Transplantation Center, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Nicolas Mueller
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Pierre-Yves Bochud
- Infectious Diseases Service, University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Deborah N Burshtyn
- Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta, Canada
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248
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Wilmes D, Coche E, Rodriguez-Villalobos H, Kanaan N. Bacterial pneumonia in kidney transplant recipients. Respir Med 2018; 137:89-94. [PMID: 29605219 DOI: 10.1016/j.rmed.2018.02.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/06/2018] [Accepted: 02/26/2018] [Indexed: 12/16/2022]
Abstract
Bacterial pathogens are the most frequent cause of pneumonia after transplantation. Early after transplantation, recipients are at higher risk for nosocomial infections. The most commonly encountered pathogens during this period are gram-negative bacilli (Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa …), but gram-positive coccus such as Staphylococcus aureus or Streptococcus pneumoniae and anaerobic bacteria can also be found. Empirical antibiotic therapy should be guided by previous colonisation of the recipient and bacterial resistance pattern in the hospital. Six months after transplantation, pneumonias are mostly due to community-acquired bacteria (S. pneumonia, H. influenza, Mycoplasma, Chlamydia and others). Opportunistic pathogens take advantage of the state of immunosuppression which is usually highest from one to six months after transplantation. During this period, but also occurring many years later in the setting of a chronically depressed immune system, bacterial pathogens with low intrinsic virulence can cause pneumonia. The diagnosis of pneumonia caused by opportunistic pathogens can be challenging. The delay in diagnosis preventing the early instauration of adequate treatment in kidney transplant recipients with a depressed immune system, frequently coupled with co-morbid conditions and a state of frailty, will affect prognosis and outcome, increasing morbidity and mortality. This review will focus on the most common opportunistic bacterial pathogens causing pneumonia in kidney transplant recipients: Legionella, Nocardia, Mycobacterium tuberculosis/nontuberculous, and Rhodococcus. Recognition of their specificities in the setting of immunosuppression will allow early diagnosis, crucial for initiation of effective therapy and successful outcome. Interactions with immunosuppressive therapy should be considered as well as reducing immunosuppression if necessary.
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Affiliation(s)
- D Wilmes
- Division of Internal Medicine, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - E Coche
- Division of Radiology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - H Rodriguez-Villalobos
- Division of Microbiology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - N Kanaan
- Division of Nephrology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
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249
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De Winter BCM, Hesselink DA, Kamar N. Dosing ribavirin in hepatitis E-infected solid organ transplant recipients. Pharmacol Res 2018; 130:308-315. [PMID: 29499270 DOI: 10.1016/j.phrs.2018.02.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 02/06/2018] [Accepted: 02/26/2018] [Indexed: 12/22/2022]
Abstract
Hepatitis E virus (HEV) is the most common cause of viral hepatitis worldwide. Genotypes 1 and 2 (GT1 and GT2) are mainly present in developing countries, while GT3 and GT4 are prevalent in developed and high-income countries. In the majority of cases, HEV causes a self-limiting hepatitis. GT3 and GT4 can be responsible for a chronic hepatitis that can lead to cirrhosis in immunocompromized patients, i.e. solid-organ- and stem-cell-transplant-patients, human immunodeficiency virus-infected patients, and patients receiving chemotherapy or immunotherapy. HEV has also been associated with extra-hepatic manifestations such as neurologic disorders (Guillain-Barré Syndrome and neuralgic amyotrophy) and kidney disease. In patients with chronic hepatitis, reduction of immunosuppression, when possible, is the first therapeutic option. In the remaining patients, ribavirin therapy has been shown to very efficient for treating HEV infection leading to a sustained virological response in nearly 80-85% of patients. However, the mechanism of action of ribavirin in this setting is still unknown, as is the impact of HEV RNA polymerase mutations. There are unmet needs with regard to the treatment of chronic HEV with ribavirin. These include the optimal dosing and duration of treatment, and the potential beneficial effects of therapeutic drug monitoring on the virological response and the incidence of side effects. In the present review, we will provide an overview of HEV epidemiology, its mode of transmission and clinical manifestations, as well as its treatment by ribavirin with a focus on the drug's pharmacokinetics and dosing.
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Affiliation(s)
- Brenda C M De Winter
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Dennis A Hesselink
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands; Rotterdam Transplant Group, Division of Nephrology and Organ Transplantation, CHU Rangueil, INSERM U1043, IFR-BMT, Université Paul Sabatier, Toulouse, France
| | - Nassim Kamar
- Department of Internal Medicine, Division of Nephrology and Organ Transplantation, CHU Rangueil, INSERM U1043, IFR-BMT, Université Paul Sabatier, Toulouse, France.
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250
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Kaundal U, Bagai U, Rakha A. Immunomodulatory plasticity of mesenchymal stem cells: a potential key to successful solid organ transplantation. J Transl Med 2018; 16:31. [PMID: 29448956 PMCID: PMC5815241 DOI: 10.1186/s12967-018-1403-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/07/2018] [Indexed: 02/06/2023] Open
Abstract
Organ transplantation remains to be a treatment of choice for patients suffering from irreversible organ failure. Immunosuppressive (IS) drugs employed to maintain the allograft have shown excellent short-term graft survival, but, their long-term use could contribute to immunological and non-immunological risk factors, resulting in graft dysfunctionalities. Upcoming IS regimes have highlighted the use of cell-based therapies, which can eliminate the risk of drug-borne toxicities while maintaining efficacy of the treatment. Mesenchymal stem cells (MSCs) have been considered as an invaluable cell type, owing to their unique immunomodulatory properties, which makes them desirable for application in transplant settings, where hyper-activation of the immune system is evident. The immunoregulatory potential of MSCs holds true for preclinical studies while achieving it in clinical studies continues to be a challenge. Understanding the biological factors responsible for subdued responses of MSCs in vivo would allow uninhibited use of this therapy for countless conditions. In this review, we summarize the variations in the preclinical and clinical studies utilizing MSCs, discuss the factors which might be responsible for variability in outcome and propose the advancements likely to occur in future for using this as a "boutique/personalised therapy" for patient care.
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Affiliation(s)
- Urvashi Kaundal
- Department of Translational and Regenerative Medicine, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
- Department of Zoology, Panjab University, Sector 14, Chandigarh, India
| | - Upma Bagai
- Department of Zoology, Panjab University, Sector 14, Chandigarh, India
| | - Aruna Rakha
- Department of Translational and Regenerative Medicine, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
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