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Schaapherder A, Wijermars LG, de Vries DK, de Vries AP, Bemelman FJ, van de Wetering J, van Zuilen AD, Christiaans MH, Hilbrands LH, Baas MC, Nurmohamed AS, Berger SP, Alwayn IP, Bastiaannet E, Lindeman JH. Equivalent Long-term Transplantation Outcomes for Kidneys Donated After Brain Death and Cardiac Death: Conclusions From a Nationwide Evaluation. EClinicalMedicine 2018; 4-5:25-31. [PMID: 31193600 PMCID: PMC6537547 DOI: 10.1016/j.eclinm.2018.09.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 09/12/2018] [Accepted: 09/24/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Despite growing waiting lists for renal transplants, hesitations persist with regard to the use of deceased after cardiac death (DCD) renal grafts. We evaluated the outcomes of DCD donations in The Netherlands, the country with the highest proportion of DCD procedures (42.9%) to test whether these hesitations are justified. METHODS This study included all procedures with grafts donated after brain death (DBD) (n = 3611) and cardiac death (n = 2711) performed between 2000 and 2017. Transplant outcomes were compared by Kaplan Meier and Cox regression analysis, and factors associated with short (within 90 days of transplantation) and long-term graft loss evaluated in multi-variable analyses. FINDINGS Despite higher incidences of early graft loss (+ 50%) and delayed graft function (+ 250%) in DCD grafts, 10-year graft and recipient survival were similar for the two graft types (Combined 10-year graft survival: 73.9% (95% CI: 72.5-75.2), combined recipient survival: 64.5% (95 CI: 63.0-66.0%)). Long-term outcome equivalence was explained by a reduced impact of delayed graft function on DCD graft survival (RR: 0.69 (95% CI: 0.55-0.87), p < 0.001). Mid and long-term graft function (eGFR), and the impact of incident delayed graft function on eGFR were similar for DBD and DCD grafts. INTERPRETATION Mid and long term outcomes for DCD grafts are equivalent to DBD kidneys. Poorer short term outcomes are offset by a lesser impact of delayed graft function on DCD graft survival. This nation-wide evaluation does not justify the reluctance to use of DCD renal grafts. A strong focus on short-term outcome neglects the superior recovery potential of DCD grafts.
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Affiliation(s)
- Alexander Schaapherder
- Department of Transplant Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Leonie G.M. Wijermars
- Department of Transplant Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Dorottya K. de Vries
- Department of Transplant Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Aiko P.J. de Vries
- Department of Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - Arjan D. van Zuilen
- Department of Nephrology, University Medical Center Utrecht, the Netherlands
| | | | - Luuk H. Hilbrands
- Department of Nephrology, Radboud University Medical Center, the Netherlands
| | - Marije C. Baas
- Department of Nephrology, Radboud University Medical Center, the Netherlands
| | | | - Stefan P. Berger
- Department of Nephrology, University Medical Center Groningen, the Netherlands
| | - Ian P. Alwayn
- Department of Transplant Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Esther Bastiaannet
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan H.N. Lindeman
- Department of Transplant Surgery, Leiden University Medical Center, Leiden, the Netherlands
- Corresponding author at: Department of Surgery, K6-R, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands.
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Reperfusion Activates AP-1 and Heat Shock Response in Donor Kidney Parenchyma after Warm Ischemia. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5717913. [PMID: 30186861 PMCID: PMC6116402 DOI: 10.1155/2018/5717913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/28/2018] [Accepted: 07/16/2018] [Indexed: 01/19/2023]
Abstract
Utilization of kidneys from extended criteria donors leads to an increase in average warm ischemia time (WIT), which is associated with larger degrees of ischemia-reperfusion injury (IRI). Kidney resuscitation by extracorporeal perfusion in situ allows up to 60 minutes of asystole after the circulatory death. Molecular studies of kidney grafts from human donors with critically expanded WIT are warranted. Transcriptomes of two human kidneys from two different donors were profiled after 35-45 minutes of WIT and after 120 minutes of normothermic perfusion and compared. Baseline gene expression patterns in ischemic grafts display substantial intrinsic differences. IRI does not lead to substantial change in overall transcription landscape but activates a highly connected protein network with hubs centered on Jun/Fos/ATF transcription factors and HSP1A/HSPA5 heat shock proteins. This response is regulated by positive feedback. IRI networks are enriched in soluble proteins and biofluids assayable substances, thus, indicating feasibility of the longitudinal, minimally invasive assessment in vivo. Mapping of IRI related molecules in ischemic and reperfused kidneys provides a rationale for possible organ conditioning during machine assisted ex vivo normothermic perfusion. A study of natural diversity of the transcriptional landscapes in presumably normal, transplantation-suitable human organs is warranted.
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Quintella AHDS, Lasmar MF, Fabreti-Oliveira RA, Nascimento E. Delayed Graft Function, Predictive Factors, and 7-Year Outcome of Deceased Donor Kidney Transplant Recipients With Different Immunologic Profiles. Transplant Proc 2018; 50:737-742. [PMID: 29661426 DOI: 10.1016/j.transproceed.2018.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Delayed graft function (DGF) is the major post-transplant cause of deleterious effects to the allograft and is associated with poor allograft survival. The aim of this study was to report the outcomes of 236 kidney transplant recipients with different immunologic profiles. METHODS All patients underwent transplantation (2008-2016) with a deceased donor at the University Hospital of the Faculty of Medical Science, Belo Horizonte, Minas Gerais, Brazil. Patients were classified into 3 groups according to immunologic profiles: nonsensitized (NS), sensitized without donor-specific antibody (SDSA-), or sensitized with donor-specific antibody (SDSA+). RESULTS DGF was observed in 128 (54.24%), including 63 (49.22%) NS, 51 (39.84%) SDSA-, and 14 (10.94%) SDSA+ patients. The development of DGF was associated with dialysis for ≥49.25 months (odds ratio [OR] 2.30), donor age ≥42.25 years (OR 1.77), donor end creatinine level >1.22 mg/dL (OR 1.94), and cold ischemia time >12 hours (OR 2.45). Of the 55 patients with rejections, 37 (15.68%) had T-cell-mediated rejection (TCMR) and 18 (7.63%) had antibody-mediated rejection (AMR). Nine patients (16.36%) exhibited graft loss, 2 (0.85%) via TCMR in the SDSA- DGF+ group and 7 (2.97%) via AMR, including 2 NS DGF-, 2 SDSA- DGF-, 1 SDSA- DGF+, and 2 SDSA+ DGF+ patients. Graft survival significantly differed between the NSDGF- and SDSA- DGF+ groups (P = .014) and between the NS DGF- and SDSA+ DGF- groups (P = .036). CONCLUSION In the 7-year period following transplantation, TCMR was more prevalent than AMR among patients with DGF. Graft loss was less prevalent among patients with TCMR than among those with AMR.
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Affiliation(s)
- A H D S Quintella
- University Hospital of the Faculty of Medical Science, Belo Horizonte, Minas Gerais, Brazil; Faculty of Medical Sciences, Belo Horizonte, Minas Gerais, Brazil
| | - M F Lasmar
- University Hospital of the Faculty of Medical Science, Belo Horizonte, Minas Gerais, Brazil; Faculty of Medical Sciences, Belo Horizonte, Minas Gerais, Brazil
| | - R A Fabreti-Oliveira
- Faculty of Medical Sciences, Belo Horizonte, Minas Gerais, Brazil; IMUNOLAB-Histocompatibility Laboratory, Belo Horizonte, Minas Gerais, Brazil
| | - E Nascimento
- Faculty of Medical Sciences, Belo Horizonte, Minas Gerais, Brazil; IMUNOLAB-Histocompatibility Laboratory, Belo Horizonte, Minas Gerais, Brazil.
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54
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Lesouhaitier M, Legeai C, Savoye E, Cantrelle C, Pipien I, Macher MA, Vigneau C, Dorent R. Impact of donor coronary angiography on kidney transplantation outcomes. Clin Transplant 2018; 32:e13355. [DOI: 10.1111/ctr.13355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/09/2018] [Accepted: 07/03/2018] [Indexed: 12/12/2022]
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55
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Lee JY, Ismail OZ, Zhang X, Haig A, Lian D, Gunaratnam L. Donor kidney injury molecule-1 promotes graft recovery by regulating systemic necroinflammation. Am J Transplant 2018; 18:2021-2028. [PMID: 29603641 DOI: 10.1111/ajt.14745] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/11/2018] [Accepted: 03/16/2018] [Indexed: 01/25/2023]
Abstract
Ischemia-reperfusion injury during kidney transplantation predisposes to delayed graft function, rejection, and premature graft failure. Exacerbation of tissue damage and alloimmune responses may be explained by necroinflammation: an autoamplification loop of cell death and inflammation, which is mediated by the release of damage-associated molecular patterns (eg, high-mobility group box-1; HMGB1) from necrotic cells that activate both innate and adaptive immune pathways. Kidney injury molecule-1 (KIM-1) is a phosphatidylserine receptor that is upregulated on injured proximal tubular epithelial cells and enables them to clear apoptotic and necrotic cells. Here we show a pivotal role for clearance of dying cells in regulating necroinflammation in a syngeneic murine kidney transplant model. We found persistent KIM-1 expression in KIM-1+/+ kidney grafts posttransplantation. Compared to recipients of KIM-1+/+ kidneys, recipients of KIM-1-/- kidneys exhibited significantly more renal dysfunction, apoptosis and necrosis, tubular obstruction, and graft failure. KIM-1-/- grafts also had more inflammatory cytokines, infiltrating neutrophils, and macrophages compared to KIM-1+/+ grafts. Most significantly, passive release of HMGB1 from apoptotic and necrotic cells led to dramatically higher serum HMGB1 levels and increased proinflammatory macrophages in recipients of KIM-1-/- grafts. Our data identify an endogenous protective mechanism against necroinflammation in kidney grafts that may be of therapeutic relevance in transplantation.
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Affiliation(s)
- Ji Yun Lee
- Department of Microbiology and Immunology, Western University, London, ON, Canada.,Matthew Mailing Centre for Translational Transplant Studies, Lawson Health Research Institute, London, ON, Canada
| | - Ola Z Ismail
- Matthew Mailing Centre for Translational Transplant Studies, Lawson Health Research Institute, London, ON, Canada
| | - Xizhong Zhang
- Matthew Mailing Centre for Translational Transplant Studies, Lawson Health Research Institute, London, ON, Canada
| | - Aaron Haig
- Department of Pathology, Western University, London, ON, Canada
| | - Dameng Lian
- Matthew Mailing Centre for Translational Transplant Studies, Lawson Health Research Institute, London, ON, Canada
| | - Lakshman Gunaratnam
- Department of Microbiology and Immunology, Western University, London, ON, Canada.,Matthew Mailing Centre for Translational Transplant Studies, Lawson Health Research Institute, London, ON, Canada.,Division of Nephrology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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56
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Girerd S, Jaisser F. Mineralocorticoid receptor antagonists in kidney transplantation: time to consider? Nephrol Dial Transplant 2018; 33:2080-2091. [DOI: 10.1093/ndt/gfy065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 02/27/2018] [Indexed: 12/28/2022] Open
Affiliation(s)
- Sophie Girerd
- Transplant Unit, Nephrology Department, Nancy University Hospital, Lorraine University, Vandoeuvre-lès-Nancy, France
- INSERM U1116, Clinical Investigation Centre, Lorraine University, Vandoeuvre-lès-Nancy, France
- INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Nancy, France
| | - Frédéric Jaisser
- INSERM U1116, Clinical Investigation Centre, Lorraine University, Vandoeuvre-lès-Nancy, France
- INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Nancy, France
- INSERM, UMRS 1138, Team 1, Centre de Recherche des Cordeliers, Pierre et Marie Curie University, Paris Descartes University, Paris, France
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Mottola C, Girerd N, Coiro S, Lamiral Z, Rossignol P, Frimat L, Girerd S. Evaluation of Subclinical Fluid Overload Using Lung Ultrasound and Estimated Plasma Volume in the Postoperative Period Following Kidney Transplantation. Transplant Proc 2018; 50:1336-1341. [PMID: 29880355 DOI: 10.1016/j.transproceed.2018.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 03/01/2018] [Indexed: 12/11/2022]
Abstract
AIM B-lines count measured with lung ultrasound (LUS) quantifies extravascular lung water and is validated in the setting of acute cardiac failure or chronic dialysis. Patients are often kept in moderately overhydrated states during the early postoperative period following kidney transplantation (KT). We described congestion changes during the early postoperative period following KT and the feasibility of LUS in this setting. METHODS LUS (28 scanning-points method) and inferior vena cava (IVC) measurements were routinely performed in 36 patients after KT. Estimated plasma volume (ePV) was calculated from hemoglobin and hematocrit levels. RESULTS No patient had >15 B-lines during the hospital stay. B-lines slightly increased until Day 4 after KT (Day 1, 1.7 ± 1.7; Day 4, 2.5 ± 2.5) and decreased up to Day 10 (1.4 ± 2.2; P vs Day 4 <.05). More B-lines were observed in patients aged older than 60 (P = .01 at Day 4) whereas IVC diameter and ePV were similar. In patients older than 60, B-lines had weak correlation with body weight variation (r = 0.64; P < .05), IVC diameters (r = 0.59 at Day 4 and r = 0.58 at Day 10; P < .05) but a strong correlation with ePV (r = 0.93 at Day 14; P < .05). B-line changes from Day 1 to Day 10 correlated with IVC diameter changes (r = 0.62; P < .05). CONCLUSION LUS identifies subtle congestion changes during the early postoperative period following KT. The hyperhydration strategy usually followed during this period does not result in overt pulmonary congestion as assessed by LUS, even in older recipients.
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Affiliation(s)
- C Mottola
- Transplant Unit, Nephrology Department, Nancy University Hospital, Lorraine University, Nancy, France
| | - N Girerd
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, INSERMU1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, Vandoeuvre-lès-Nancy, France; INI-Cardiovascular and Renal Clinical Trialists F-CRIN network, Nancy, France
| | - S Coiro
- INI-Cardiovascular and Renal Clinical Trialists F-CRIN network, Nancy, France; Division of Cardiology, University of Perugia, School of Medicine, Perugia, Italy
| | - Z Lamiral
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, INSERMU1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, Vandoeuvre-lès-Nancy, France
| | - P Rossignol
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, INSERMU1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, Vandoeuvre-lès-Nancy, France; INI-Cardiovascular and Renal Clinical Trialists F-CRIN network, Nancy, France
| | - L Frimat
- Transplant Unit, Nephrology Department, Nancy University Hospital, Lorraine University, Nancy, France; INI-Cardiovascular and Renal Clinical Trialists F-CRIN network, Nancy, France
| | - S Girerd
- Transplant Unit, Nephrology Department, Nancy University Hospital, Lorraine University, Nancy, France; INSERM, Centre d'Investigations Cliniques Plurithématique 1433, INSERMU1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, Vandoeuvre-lès-Nancy, France; INI-Cardiovascular and Renal Clinical Trialists F-CRIN network, Nancy, France.
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Schnuelle P, Benck U, Krämer BK. Response to "Comments on 'Impact of spontaneous donor hypothermia on graft outcomes after kidney transplantation'". Am J Transplant 2018; 18:764. [PMID: 29266808 DOI: 10.1111/ajt.14629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Peter Schnuelle
- Center for Renal Diseases, Weinheim, Germany.,Vth Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
| | - Urs Benck
- Vth Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
| | - Bernhard K Krämer
- Vth Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
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Schnuelle P, Mundt HM, Drüschler F, Schmitt WH, Yard BA, Krämer BK, Benck U. Impact of spontaneous donor hypothermia on graft outcomes after kidney transplantation. Am J Transplant 2018; 18:704-714. [PMID: 29027352 DOI: 10.1111/ajt.14541] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 09/22/2017] [Accepted: 10/01/2017] [Indexed: 01/25/2023]
Abstract
A previous donor intervention trial found that therapeutic hypothermia reduced delayed graft function (DGF) after kidney transplantation. This retrospective cohort study nested in the randomized dopamine trial (ClinicalTrials.gov identifier: NCT000115115) investigates the effects of spontaneous donor hypothermia (core body temperature <36°C) on initial kidney graft function, and evaluates 5-year graft survival. Hypothermia assessed by a singular measurement in the intensive care unit 4-20 hours before procurement was associated with less DGF after kidney transplantation (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.34-0.91). The benefit was greater when need for more than a single posttransplant dialysis session was analyzed (OR 0.48, 95%CI 0.28-0.82). Donor dopamine ameliorated dialysis requirement independently from hypothermia in a temporal relationship with exposure (OR 0.93, 95%CI 0.87-0.98, per hour). A lower core body temperature in the donor was associated with lower serum creatinine levels before procurement, which may reflect lower systemic inflammation and attenuated renal injury from brain death. Despite a considerable effect on DGF, our study failed to demonstrate a graft survival advantage (hazard ratio [HR] 0.83, 95%CI 0.54-1.27), whereas dopamine treatment was associated with improved long-term outcome (HR 0.95, 95%CI 0.91-0.99 per hour).
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Affiliation(s)
- P Schnuelle
- Center for Renal Diseases, Weinheim, Germany.,Vth Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
| | - H M Mundt
- Vth Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
| | - F Drüschler
- Division of Nephrology, University Hospital Heidelberg, Heidelberg, Germany
| | - W H Schmitt
- Center for Renal Diseases, Weinheim, Germany.,Vth Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
| | - B A Yard
- Vth Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
| | - B K Krämer
- Vth Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
| | - U Benck
- Vth Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
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Sandal S, Bansal P, Cantarovich M. The evidence and rationale for the perioperative use of loop diuretics during kidney transplantation: A comprehensive review. Transplant Rev (Orlando) 2017; 32:92-101. [PMID: 29242033 DOI: 10.1016/j.trre.2017.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/08/2017] [Accepted: 11/14/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE Loop diuretics (LD) attenuate ischemic injury in nephrons. They are thought to decrease delayed graft function (DGF) during kidney transplantation (KT). This review aimed to summarize the current evidence for the perioperative use of LD during KT. METHODS We performed an analysis of all articles that were published since the inception of Medline and Embase: 26 studies were selected for inclusion. Scope was LD use during the perioperative phase of KT only. RESULTS Six animal studies demonstrated mixed results in terms of renal function and survival. Of the 20 studies performed in humans, 4 were randomized clinical trials. The risk of bias was mostly unclear. Evidence supporting the role of LD to increase diuresis was mixed and to prevent DGF was weak. There was poor evidence to support LD use to improve initial and long-term graft function. No data on patient survival could be found. Overall, there was a lack of any robust clinical evidence for LD use perioperatively during KT. IMPLICATIONS There is poor evidence to support the perioperative use of LD during KT. Well-designed trials are needed to further explore their safety and efficacy, and we summarize several rationales. Pragmatic rationales include volume management. There is evidence to suggest that LD have a vasodilatory effect, and decrease edema, congestion and oxygen requirements. Lastly, there are several theoretical rationales to explore LD use during KT, in particular, attenuating ischemia-reperfusion injury and modulating autophagy.
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Affiliation(s)
- Shaifali Sandal
- Division of Nephrology and Multi-Organ Transplant Program, McGill University Health Centre, 1001 boul. Decarie, Montreal, QC, Canada. H4A 3J1.
| | - Pannya Bansal
- Michigan State University College of Osteopathic Medicine, East Fee Hall, 965 Fee Rd, East Lansing, MI 48825, USA
| | - Marcelo Cantarovich
- Division of Nephrology and Multi-Organ Transplant Program, McGill University Health Centre, 1001 boul. Decarie, Montreal, QC, Canada. H4A 3J1
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Wang Z, Yang H, Zhao C, Wei J, Wang J, Han Z, Tao J, Xu Z, Ju X, Tan R, Gu M. Proton Nuclear Magnetic Resonance (¹H-NMR)-Based Metabolomic Evaluation of Human Renal Allografts from Donations After Circulatory Death. Med Sci Monit 2017; 23:5472-5479. [PMID: 29149095 PMCID: PMC5702106 DOI: 10.12659/msm.905168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Delayed graft function (DGF) is a common complication that impairs allograft function after kidney transplantation. However, the mechanism of DGF remains unclear. Nuclear magnetic resonance (NMR)-based analysis has been widely used in recent times to assess changes in metabolite levels. MATERIAL AND METHODS Samples of perfusate from allografts donated after circulatory death were collected prior to transplantation, during static cold storage. ¹H-NMR-based metabolomics combined with the statistical methods, orthogonal partial least-squares discriminant analysis (OPLS-DA), and principle-component analysis (PCA), were employed to test different levels of metabolites between the allografts that exhibited DGF and those that exhibited immediate graft function (IGF). RESULTS The study population consisted of 36 subjects, 11 with DGF and 25 with IGF. Of the 37 detected and identified metabolites, a-glucose and citrate were significantly elevated in the perfusate of DGF allografts, and taurine and betaine were significantly decreased. CONCLUSIONS ¹H-NMR analysis of DGF and IGF perfusates revealed some significant differences in their metabolite profiles, which may help explain the mechanisms of kidney ischemia-reperfusion injury and DGF.
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Affiliation(s)
- Zijie Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Haiwei Yang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Chunchun Zhao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Jifu Wei
- Research Division of Clinical Pharmacology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Junsong Wang
- Center for Molecular Metabolism, Nanjing University of Science and Technology, Nanjing, Jiangsu, China (mainland)
| | - Zhijian Han
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Jun Tao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Zhen Xu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Xiaobin Ju
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Ruoyun Tan
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Min Gu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
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Gooran S, Khajavi MR, Javid A, Dehghani S, Kheiri E, Yaseri AMF, Pourmand G. Prognostic Value of Hemoglobin Concentration and Graft Vein Blood Oxygenation on Renal Transplant Outcomes. EXP CLIN TRANSPLANT 2017; 16:407-409. [PMID: 28969529 DOI: 10.6002/ect.2016.0370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Our objective was to investigate vein blood gas levels in the transplanted kidney during surgery as a predictive factor for delayed graft function after renal transplant. MATERIALS AND METHODS Sixty patients with renal transplant were enrolled in our study from January 2015 to January 2016. After vessels were declamped posttransplant, blood samples from the transplanted kidney veins were taken and acidosis and oxygenation in these samples were measured. Patients were classified based on acidosis and oxygenation of grafted vein and also hemoglobin concentration. We compared delayed graft function in recipients with acidosis versus normal pH, hypoxia versus normal oxygenation, and hemoglobin less than 10 g/dL versus more than 10 g/dL. RESULTS Of 60 patients, 6 (10%) experienced delayed graft function and needed hemodialysis. All patients needing hemodialysis were in the acidotic and hypoxic patient groups. Five of six recipients with delayed graft function had hemoglobin concentration < 10 g/dL. Hospital stay was significantly longer in patients with hypoxia, acidosis, and anemia. CONCLUSIONS Vein blood gas measurements of the grafted renal vein during surgery can be easily obtained and applied as a prognostic factor for delayed graft function.
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Affiliation(s)
- Shahram Gooran
- Urology Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
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63
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Lee JS. Immunologic Mechanism of Ischemia Reperfusion Injury in Transplantation. KOREAN JOURNAL OF TRANSPLANTATION 2017. [DOI: 10.4285/jkstn.2017.31.3.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jong Soo Lee
- Division of Nephrology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
- Biomedical Research Center, Ulsan, Korea
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Liu J, Kumar S, Dolzhenko E, Alvarado GF, Guo J, Lu C, Chen Y, Li M, Dessing MC, Parvez RK, Cippà PE, Krautzberger AM, Saribekyan G, Smith AD, McMahon AP. Molecular characterization of the transition from acute to chronic kidney injury following ischemia/reperfusion. JCI Insight 2017; 2:94716. [PMID: 28931758 PMCID: PMC5612583 DOI: 10.1172/jci.insight.94716] [Citation(s) in RCA: 185] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 08/10/2017] [Indexed: 12/16/2022] Open
Abstract
Though an acute kidney injury (AKI) episode is associated with an increased risk of chronic kidney disease (CKD), the mechanisms determining the transition from acute to irreversible chronic injury are not well understood. To extend our understanding of renal repair, and its limits, we performed a detailed molecular characterization of a murine ischemia/reperfusion injury (IRI) model for 12 months after injury. Together, the data comprising RNA-sequencing (RNA-seq) analysis at multiple time points, histological studies, and molecular and cellular characterization of targeted gene activity provide a comprehensive profile of injury, repair, and long-term maladaptive responses following IRI. Tubular atrophy, interstitial fibrosis, inflammation, and development of multiple renal cysts were major long-term outcomes of IRI. Progressive proximal tubular injury tracks with de novo activation of multiple Krt genes, including Krt20, a biomarker of renal tubule injury. RNA-seq analysis highlights a cascade of temporal-specific gene expression patterns related to tubular injury/repair, fibrosis, and innate and adaptive immunity. Intersection of these data with human kidney transplant expression profiles identified overlapping gene expression signatures correlating with different stages of the murine IRI response. The comprehensive characterization of incomplete recovery after ischemic AKI provides a valuable resource for determining the underlying pathophysiology of human CKD.
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Affiliation(s)
- Jing Liu
- Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Sanjeev Kumar
- Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.,Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Egor Dolzhenko
- Molecular and Computational Biology, Division of Biological Sciences, University of Southern California, Los Angeles, California, USA
| | - Gregory F Alvarado
- Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Jinjin Guo
- Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Can Lu
- Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Yibu Chen
- Norris Medical Library, University of Southern California, Los Angeles, California
| | - Meng Li
- Norris Medical Library, University of Southern California, Los Angeles, California
| | - Mark C Dessing
- Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Riana K Parvez
- Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Pietro E Cippà
- Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - A Michaela Krautzberger
- Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Gohar Saribekyan
- Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Andrew D Smith
- Molecular and Computational Biology, Division of Biological Sciences, University of Southern California, Los Angeles, California, USA
| | - Andrew P McMahon
- Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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Abstract
BACKGROUND Ischemia-reperfusion injury (IRI) leading to delayed graft function (DGF), defined by the United Network for Organ Sharing as dialysis in the first week (UNOS-DGF), associates with poor kidney transplant outcomes. Controversies remain, however, about dialysis initiation thresholds and the utility for other criteria to denote less severe IRI, or slow graft function (SGF). METHODS Multicenter, prospective study of deceased-donor kidney recipients to compare UNOS-DGF to a definition that combines impaired creatinine reduction in the first 48 hours or greater than 1 dialysis session for predicting 12-month estimated glomerular filtration rate (eGFR). We also assessed 10 creatinine and urine output-based SGF definitions relative to 12-month eGFR. RESULTS In 560 recipients, 215 (38%) had UNOS-DGF, 330 (59%) met the combined definition, 14 (3%) died, and 23 (4%) had death-censored graft failure by 12 months. Both DGF definitions were associated with lower adjusted 12-month eGFR (95% confidence interval)-by 7.3 (3.6-10.9) and 7.4 (3.8-11.0) mL/min per 1.73 m, respectively. Adjusted relative risks for 12-month eGFR less than 30 mL/min per 1.73 m were 1.9 (1.2-3.1) and 2.1 (1.1-3.7), with unadjusted areas under the curve of 0.618 and 0.627, respectively. For SGF definitions, postoperative day (POD) 7 creatinine had the strongest association with 12-month eGFR, and POD5 creatinine and creatinine reduction between POD1 and POD2 demonstrated modest separations in 12-month eGFR. CONCLUSIONS Although UNOS-DGF does not adequately predict 12-month function on its own, our findings do not support changing the definition. Postoperative day 7 creatinine is correlated with 12-month eGFR, but large translational studies are needed to understand the biological link between IRI severity at transplant and longer-term outcomes.
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Association Between Slow and Delayed Graft Function With Graft Outcomes in Pediatric and Adolescent Deceased Donor Kidney Transplant Recipients. Transplantation 2017; 101:1906-1912. [PMID: 27575687 DOI: 10.1097/tp.0000000000001464] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Delayed graft function (DGF) is associated with an increased risk of graft loss in adult kidney transplant recipients but the association remains inconsistent in pediatric recipients. The aim of this study is to examine the association between DGF and graft loss in pediatric and adolescent deceased donor kidney transplant recipients aged 21 years or younger using Australia and New Zealand Dialysis and Transplant registry. METHODS The associations between DGF status, overall and death-censored graft loss (DCGL) were examined using adjusted Cox regression analyses. RESULTS There were 367 recipients followed up for a median of 9.7 years between 1990 and 2012, with 82 (22%) experiencing DGF requiring dialysis (DGF-D) in the first 72 hours after transplant. Compared with recipients who did not experienced DGF-D, the adjusted hazard ratios for overall graft loss and DCGL in recipients who have experienced DGF-D was 2.08 (95% confidence interval [95% CI], 1.39-3.11; P < 0.001) and 2.09 (95% CI, 1.38-3.17; P < 0.001), respectively, independent of era, age, and initial immunosuppression. Slow graft function, defined as no immediate function but not requiring dialysis, was associated with adjusted hazard ratios of 2.60 (95% CI, 1.50-4.51; P = 0.001) for overall graft loss and 2.49 (95% CI, 1.39-4.47; P = 0.002) for DCGL. CONCLUSIONS This study has shown that DGF, encompassing a spectrum of renal dysfunction after kidney transplantation including those who may or may not require dialysis, is an independent risk factor for long-term graft loss.
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67
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Peperhove M, Vo Chieu VD, Jang MS, Gutberlet M, Hartung D, Tewes S, Warnecke G, Fegbeutel C, Haverich A, Gwinner W, Lehner F, Bräsen JH, Haller H, Wacker F, Gueler F, Hueper K. Assessment of acute kidney injury with T1 mapping MRI following solid organ transplantation. Eur Radiol 2017; 28:44-50. [PMID: 28710580 DOI: 10.1007/s00330-017-4943-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 04/08/2017] [Accepted: 06/09/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To evaluate T1 mapping as a non-invasive, functional MRI biomarker in patients shortly after solid organ transplantation to detect acute postsurgical kidney damage and to correlate T1 times with renal function. METHODS 101 patients within 2 weeks after solid organ transplantation (49 kidney transplantation, 52 lung transplantation) and 14 healthy volunteers were examined by MRI between July 2012 and April 2015 using the modified Look-Locker inversion recovery (MOLLI) sequence. T1 times in renal cortex and medulla and the corticomedullary difference were compared between groups using one-way ANOVA adjusted for multiple comparison with the Tukey test, and T1 times were correlated with renal function using Pearson's correlation. RESULTS Compared to healthy volunteers T1 times were significantly increased after solid organ transplantation in the renal cortex (healthy volunteers 987 ± 102 ms; kidney transplantation 1299 ± 101 ms, p < 0.001; lung transplantation 1058 ± 96 ms, p < 0.05) and to a lesser extent in the renal medulla. Accordingly, the corticomedullary difference was diminished shortly after solid organ transplantation. T1 changes were more pronounced following kidney compared to lung transplantation, were associated with the stage of renal impairment and significantly correlated with renal function. CONCLUSIONS T1 mapping may be helpful for early non-invasive assessment of acute kidney injury and renal pathology following major surgery such as solid organ transplantation. KEY POINTS • Renal cortical T1 relaxation times are prolonged after solid organ transplantation. • Cortical T1 values increase with higher stages of renal function impairment. • Corticomedullary difference decreases with higher stages of renal function impairment. • Renal cortical T1 relaxation time and corticomedullary difference correlate with renal function. • T1 mapping may be helpful for non-invasive assessment of post-operative renal pathology.
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Affiliation(s)
- Matti Peperhove
- Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Van Dai Vo Chieu
- Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Mi-Sun Jang
- Nephrology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Marcel Gutberlet
- Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Dagmar Hartung
- Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Susanne Tewes
- Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Gregor Warnecke
- Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Christiane Fegbeutel
- Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Axel Haverich
- Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Wilfried Gwinner
- Nephrology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Frank Lehner
- General, Abdominal and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Jan Hinrich Bräsen
- Pathology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Hermann Haller
- Nephrology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Frank Wacker
- Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Faikah Gueler
- Nephrology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Katja Hueper
- Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Grenda R. Delayed graft function and its management in children. Pediatr Nephrol 2017; 32:1157-1167. [PMID: 27778091 DOI: 10.1007/s00467-016-3528-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/27/2016] [Accepted: 09/29/2016] [Indexed: 01/06/2023]
Abstract
Delayed graft function (DGF) is commonly defined as the requirement for dialysis within the first 7 days following renal transplantation. The major underlying mechanism is related to ischaemia/reperfusion injury, which includes microvascular inflammation and cell death and apoptosis, and to the regeneration processes. Several clinical factors related to donor, recipient and organ procurement/transplantation procedures may increase the risk of DGF, including donor cardiovascular instability, older donor age, donor creatinine concentration, long cold ischaemia time and marked body mass index of both the donor and recipient. Some of these parameters have been used in specific predictive formulas created to assess the risk of DGF. A variety of other pre-, intra- and post-transplant clinical factors may also increase the risk of DGF, such as potential drug nephrotoxicity, surgical problems and/or hyperimmunization of the recipient. DGF may decrease the long-term graft function, but data on this effect are inconsistent, partially due to the many different types of organ donation. Relevant management strategies may be classified into the classic clinical approach, which has the aim of minimizing the individual risk factors of DGF, and specific pharmacologic strategies, which are designed to prevent or treat ischaemia/reperfusion injury. Both strategies are currently being evaluated in clinical trials.
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Affiliation(s)
- Ryszard Grenda
- Department of Nephrology & Kidney Transplantation, The Children's Memorial Health Institute, Warsaw, Poland.
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69
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Abstract
Complement is a major contributor to inflammation and graft injury. This system is especially important in ischemia-reperfusion injury/delayed graft function as well as in acute and chronic antibody-mediated rejection (AMR). The latter is increasingly recognized as a major cause of late graft loss, for which we have few effective therapies. C1 inhibitor (C1-INH) regulates several pathways which contribute to both acute and chronic graft injuries. However, C1-INH spares the alternative pathway and the membrane attack complex (C5–9) so innate antibacterial defenses remain intact. Plasma-derived C1-INH has been used to treat hereditary angioedema for more than 30 years with excellent safety. Studies with C1-INH in transplant recipients are limited, but have not revealed any unique toxicity or serious adverse events attributed to the protein. Extensive data from animal and ex vivo models suggest that C1-INH ameliorates ischemia-reperfusion injury. Initial clinical studies suggest this effect may allow transplantation of donor organs which are now discarded because the risk of primary graft dysfunction is considered too great. Although the incidence of severe early AMR is declining, accumulating evidence strongly suggests that complement is an important mediator of chronic AMR, a major cause of late graft loss. Thus, C1-INH may also be helpful in preserving function of established grafts. Early clinical studies in transplantation suggest significant beneficial effects of C1-INH with minimal toxicity. Recent results encourage continued investigation of this already-available therapeutic agent.
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70
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Kidney Transplantation With Corticosteroids Alone After Haploidentical HSCT From The Same Donor. Transplantation 2017; 100:2219-21. [PMID: 27136263 DOI: 10.1097/tp.0000000000001213] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Allogeneic hematopoietic stem cell transplantation (HSCT) can lead to donor-specific tolerance. Patients reported in the literature that underwent kidney transplantation (KT) after a previous HSCT from the same haploidentical donor typically received short-term immunosuppression, mainly for safety reasons and concerns of triggering graft-versus-host disease. METHODS We describe the case of a 22-year-old patient who developed chronic kidney failure after receiving haploidentical HSCT from his father for the treatment of metastatic rhabdomyosarcoma. Five years after HSCT, he received a preemptive kidney transplant from his father. Steroid treatment, which had been prescribed for the underlying kidney disease, was withdrawn within 2 months posttransplant, and no de novo immunosuppression was given. Donor-specific tolerance was assessed with mixed lymphocyte reaction and INF-γ ELISPOT before (D0) and after KT (D9). Furthermore, the exact level of donor-derived T cells was measured with real-time polymerase chain reaction before and 1 year after KT. RESULTS In vitro assays (mixed lymphocyte reaction and ELISPOT) revealed donor-specific tolerance before and after transplantation, respectively. The number of recipient-derived T cells was low before KT and virtually did not change over time (0.0139% ± 0.0039 and 0.0120% ± 0.0067; P = NS). Graft function was excellent throughout the follow-up (36 months post KT: serum creatinine, 1.18 mg/dL). Protocol biopsies performed 1 and 12 months after transplantation confirmed the absence of rejection. CONCLUSIONS This is one of the first cases of kidney transplantation from the same donor after previous haploidentical HSCT with a corticosteroid taper alone. Our results suggest that immunosuppression can be avoided in such cases.
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71
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Moser MAJ, Ginther N, Luo Y, Beck G, Ginther R, Ewen M, Matsche-Neufeld R, Shoker A, Sawicki G. Early experience with hypothermic machine perfusion of living donor kidneys - a retrospective study. Transpl Int 2017; 30:706-712. [PMID: 28390094 DOI: 10.1111/tri.12964] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 12/31/2016] [Accepted: 03/24/2017] [Indexed: 02/06/2023]
Abstract
Although hypothermic machine perfusion (HMP) has been shown to be beneficial to deceased donor kidneys, the effect of HMP on living donor kidneys (LDK) is unknown. LDK are subjected to minutes of normothermic ischemia at the time of recovery. Comparison of 16 LDK preserved by HMP with 16 LDK preserved by static cold storage (SCS). Outcomes of interest are resistive indices (RI), both while on HMP and postoperatively, and creatinine clearance (CrCl). Injury markers NGAL and LDH were seen in the perfusate of LDK in amounts similar to what is found for donation after neurological determination of death kidneys. Compared to SCS kidneys, CrCl was significantly higher in the HMP group from days 2 through 7 post-transplant [ie: day 7 (78.8 ± 5.4 vs. 54.0 ± 4.6 ml/min, P = 0.005)]. CrCl at 1 year was higher in the HMP group (81.2 ± 5.8 vs. 70.0 ± 5.3 ml/min, P = 0.03). Early post-transplant RI was significantly lower in the HMP group (0.61 ± 0.02 vs. 0.71 ± 0.02, P < 0.0001). Our data support the assertion that injury does occur during LDK procurement and suggest that some of this injury may be reversed with HMP, resulting in more favorable early RI and graft function compared to SCS kidneys.
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Affiliation(s)
- Michael A J Moser
- Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada.,Saskatchewan Renal Transplant Program, Saskatoon, SK, Canada
| | - Nathan Ginther
- Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada
| | - Yigang Luo
- Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada.,Saskatchewan Renal Transplant Program, Saskatoon, SK, Canada
| | - Gavin Beck
- Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada.,Saskatchewan Renal Transplant Program, Saskatoon, SK, Canada
| | - Ronn Ginther
- Saskatchewan Renal Transplant Program, Saskatoon, SK, Canada
| | - Marla Ewen
- Saskatchewan Renal Transplant Program, Saskatoon, SK, Canada
| | | | - Ahmed Shoker
- Saskatchewan Renal Transplant Program, Saskatoon, SK, Canada.,Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Grzegorz Sawicki
- Department of Pharmacology, University of Saskatchewan, Saskatoon, SK, Canada.,Department of Clinical Chemistry, Medical University of Wroclaw, Wroclaw, Poland
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Schnuelle P, Schmitt WH, Weiss C, Habicht A, Renders L, Zeier M, Drüschler F, Heller K, Pisarski P, Banas B, Krämer BK, Jung M, Lopau K, Olbricht CJ, Weihprecht H, Schenker P, De Fijter JW, Yard BA, Benck U. Effects of Dopamine Donor Pretreatment on Graft Survival after Kidney Transplantation: A Randomized Trial. Clin J Am Soc Nephrol 2017; 12:493-501. [PMID: 28213388 PMCID: PMC5338714 DOI: 10.2215/cjn.07600716] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 12/12/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Donor dopamine improves initial graft function after kidney transplantation due to antioxidant properties. We investigated if a 4 µg/kg per minute continuous dopamine infusion administered after brain-death confirmation affects long-term graft survival and examined the exposure-response relationship with treatment duration. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Five-year follow-up of 487 renal transplant patients from 60 European centers who had participated in the randomized, multicenter trial of dopamine donor pretreatment between 2004 and 2007 (ClinicalTrials.gov identifier: NCT00115115). RESULTS Follow-up was complete in 99.2%. Graft survival was 72.6% versus 68.7% (P=0.34), and 83.3% versus 80.4% (P=0.42) after death-censoring in treatment and control arms according to trial assignment. Although infusion times varied substantially in the treatment arm (range 0-32.2 hours), duration of the dopamine infusion and all-cause graft failure exhibited an exposure-response relationship (hazard ratio, 0.96; 95% confidence interval [95% CI], 0.92 to 1.00, per hour). Cumulative frequency curves of graft survival and exposure time of the dopamine infusion indicated a maximum response rate at 7.10 hours (95% CI, 6.99 to 7.21), which almost coincided with the optimum infusion time for improvement of early graft function (7.05 hours; 95% CI, 6.92 to 7.18). Taking infusion time of 7.1 hours as threshold in subsequent graft survival analyses indicated a relevant benefit: Overall, 81.5% versus 68.5%; P=0.03; and 90.3% versus 80.2%; P=0.04 after death-censoring. CONCLUSIONS We failed to show a significant graft survival advantage on intention-to-treat. Dopamine infusion time was very short in a considerable number of donors assigned to treatment. Our finding of a significant, nonlinear exposure-response relationship disclosed a threshold value of the dopamine infusion time that may improve long-term kidney graft survival.
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Affiliation(s)
- Peter Schnuelle
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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Zhou CC, Ge YZ, Yao WT, Wu R, Xin H, Lu TZ, Li MH, Song KW, Wang M, Zhu YP, Zhu M, Geng LG, Gao XF, Zhou LH, Zhang SL, Zhu JG, Jia RP. Limited Clinical Utility of Remote Ischemic Conditioning in Renal Transplantation: A Meta-Analysis of Randomized Controlled Trials. PLoS One 2017; 12:e0170729. [PMID: 28129389 PMCID: PMC5271340 DOI: 10.1371/journal.pone.0170729] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 12/28/2016] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE We conducted this meta-analysis of randomized controlled trials (RCTs) to investigate whether remote ischemic conditioning (RIC) could improve graft functions in kidney transplantation. METHODS PubMed, Web of Science, and Cochrane Library were comprehensively searched to identify all eligible studies by October 5, 2016. The treatment effects were examined with risk ratio (RR) and weighted mean difference with the corresponding 95% confidence intervals (CI). The statistical significance and heterogeneity were assessed with both Z-test and Q-test. RESULTS A total of six RCTs including 651 recipients, were eventually identified. Compared to the controls, RIC could reduce the incidence of delayed graft function (DGF) after kidney transplantation (random-effects model: RR = 0.89; fixed-effect model: RR = 0.84). However, the decrease did not reveal statistical significance. The subgroup analysis by RIC type demonstrated no significant difference among the three interventions in protecting renal allografts against DGF. Furthermore, no significant difference could be observed in the incidence of acute rejection, graft loss, 50% fall in serum creatinine, as well as the estimated glomerular filtration rate and hospital stay between the RIC and Control groups. CONCLUSIONS This meta-analysis suggested that RIC might exert renoprotective functions in human kidney transplantation, and further well-designed RCTs with large sample size are warranted to assess its clinical efficacy.
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Affiliation(s)
- Chang-Cheng Zhou
- Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Urology, Nanjing First Hospital, Nanjing Medical University,Nanjing, Jiangsu, China
| | - Yu-Zheng Ge
- Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Urology, Nanjing First Hospital, Nanjing Medical University,Nanjing, Jiangsu, China
| | - Wen-Tao Yao
- Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Urology, Nanjing First Hospital, Nanjing Medical University,Nanjing, Jiangsu, China
| | - Ran Wu
- Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Urology, Nanjing First Hospital, Nanjing Medical University,Nanjing, Jiangsu, China
| | - Hui Xin
- Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Urology, Nanjing First Hospital, Nanjing Medical University,Nanjing, Jiangsu, China
| | - Tian-Ze Lu
- Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Urology, Nanjing First Hospital, Nanjing Medical University,Nanjing, Jiangsu, China
| | - Ming-Hao Li
- Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Urology, Nanjing First Hospital, Nanjing Medical University,Nanjing, Jiangsu, China
| | - Kai-Wei Song
- Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Urology, Nanjing First Hospital, Nanjing Medical University,Nanjing, Jiangsu, China
| | - Min Wang
- Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Urology, Nanjing First Hospital, Nanjing Medical University,Nanjing, Jiangsu, China
| | - Yun-Peng Zhu
- Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Urology, Nanjing First Hospital, Nanjing Medical University,Nanjing, Jiangsu, China
| | - Meng Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Li-Guo Geng
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiao-Fei Gao
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Liu-Hua Zhou
- Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Urology, Nanjing First Hospital, Nanjing Medical University,Nanjing, Jiangsu, China
| | - Sheng-Li Zhang
- Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Urology, Nanjing First Hospital, Nanjing Medical University,Nanjing, Jiangsu, China
| | - Jia-Geng Zhu
- Department of Urology, Nanjing First Hospital, Nanjing Medical University,Nanjing, Jiangsu, China
| | - Rui-Peng Jia
- Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Urology, Nanjing First Hospital, Nanjing Medical University,Nanjing, Jiangsu, China
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Yang B, Dieudé M, Hamelin K, Hénault-Rondeau M, Patey N, Turgeon J, Lan S, Pomerleau L, Quesnel M, Peng J, Tremblay J, Shi Y, Chan JS, Hébert MJ, Cardinal H. Anti-LG3 Antibodies Aggravate Renal Ischemia-Reperfusion Injury and Long-Term Renal Allograft Dysfunction. Am J Transplant 2016; 16:3416-3429. [PMID: 27172087 DOI: 10.1111/ajt.13866] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 05/04/2016] [Accepted: 05/07/2016] [Indexed: 01/25/2023]
Abstract
Pretransplant autoantibodies to LG3 and angiotensin II type 1 receptors (AT1R) are associated with acute rejection in kidney transplant recipients, whereas antivimentin autoantibodies participate in heart transplant rejection. Ischemia-reperfusion injury (IRI) can modify self-antigenic targets. We hypothesized that ischemia-reperfusion creates permissive conditions for autoantibodies to interact with their antigenic targets and leads to enhanced renal damage and dysfunction. In 172 kidney transplant recipients, we found that pretransplant anti-LG3 antibodies were associated with an increased risk of delayed graft function (DGF). Pretransplant anti-LG3 antibodies are inversely associated with graft function at 1 year after transplantation in patients who experienced DGF, independent of rejection. Pretransplant anti-AT1R and antivimentin were not associated with DGF or its functional outcome. In a model of renal IRI in mice, passive transfer of anti-LG3 IgG led to enhanced dysfunction and microvascular injury compared with passive transfer with control IgG. Passive transfer of anti-LG3 antibodies also favored intrarenal microvascular complement activation, microvascular rarefaction and fibrosis after IRI. Our results suggest that anti-LG3 antibodies are novel aggravating factors for renal IRI. These results provide novel insights into the pathways that modulate the severity of renal injury at the time of transplantation and their impact on long-term outcomes.
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Affiliation(s)
- B Yang
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Canadian National Transplant Research Program, Edmonton, Alberta, T6G 2E1, Canada.,Université de Montréal, Montreal, QC, Canada
| | - M Dieudé
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Canadian National Transplant Research Program, Edmonton, Alberta, T6G 2E1, Canada.,Université de Montréal, Montreal, QC, Canada
| | - K Hamelin
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Canadian National Transplant Research Program, Edmonton, Alberta, T6G 2E1, Canada.,Université de Montréal, Montreal, QC, Canada
| | - M Hénault-Rondeau
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Canadian National Transplant Research Program, Edmonton, Alberta, T6G 2E1, Canada.,Université de Montréal, Montreal, QC, Canada
| | - N Patey
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Canadian National Transplant Research Program, Edmonton, Alberta, T6G 2E1, Canada.,Université de Montréal, Montreal, QC, Canada.,Department of Pathology, CHU Ste-Justine, Université de Montréal, Montreal, QC, Canada
| | - J Turgeon
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Canadian National Transplant Research Program, Edmonton, Alberta, T6G 2E1, Canada.,Université de Montréal, Montreal, QC, Canada
| | - S Lan
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Canadian National Transplant Research Program, Edmonton, Alberta, T6G 2E1, Canada.,Université de Montréal, Montreal, QC, Canada
| | - L Pomerleau
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - M Quesnel
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - J Peng
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - J Tremblay
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Y Shi
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Université de Montréal, Montreal, QC, Canada
| | - J S Chan
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Université de Montréal, Montreal, QC, Canada
| | - M J Hébert
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Canadian National Transplant Research Program, Edmonton, Alberta, T6G 2E1, Canada.,Université de Montréal, Montreal, QC, Canada
| | - H Cardinal
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Canadian National Transplant Research Program, Edmonton, Alberta, T6G 2E1, Canada.,Université de Montréal, Montreal, QC, Canada
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75
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Wang L, Song J, Buggs J, Wei J, Wang S, Zhang J, Zhang G, Lu Y, Yip KP, Liu R. A new mouse model of hemorrhagic shock-induced acute kidney injury. Am J Physiol Renal Physiol 2016; 312:F134-F142. [PMID: 28042109 DOI: 10.1152/ajprenal.00347.2016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 10/25/2016] [Accepted: 10/31/2016] [Indexed: 11/22/2022] Open
Abstract
Current animal models of hemorrhagic shock-induced acute kidney injury (HS-induced AKI) require extensive surgical procedures and constant monitoring of hemodynamic parameters. Application of these HS-induced AKI models in mice to produce consistent kidney injury is challenging. In the present study, we developed a simple and highly reproducible mouse model of HS-induced AKI by combining moderate bleeding and renal pedicle clamping, which was abbreviated as HS-AKI. HS was induced by retroorbital bleeding of 0.4 ml blood in C57BL/6 mice. Mice were left in HS stage for 30 min, followed by renal pedicle clamping for 18 min at 36.8-37.0°C. Mean arterial pressure (MAP) and heart rate were monitored with preimplanted radio transmitters throughout the experiment. The acute response in renal blood flow (RBF) triggered by HS was measured with transonic flow probe. Mice received sham operation; bleeding alone and renal pedicle clamping alone served as respective controls. MAP was reduced from 77 ± 4 to 35 ± 3 mmHg after bleeding. RBF was reduced by 65% in the HS period. Plasma creatinine and kidney injury molecule-1 levels were increased by more than 22-fold 24 h after reperfusion. GFR was declined by 78% of baseline 3 days after reperfusion. Histological examination revealed a moderate-to-severe acute tubular damage, mostly at the cortex-medulla junction area, followed by the medullar and cortex regions. HS alone did not induce significant kidney injury, but synergistically enhanced pedicle clamping-induced AKI. This is a well-controlled, simple, and reliable mouse model of HS-AKI.
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Affiliation(s)
- Lei Wang
- Department of Molecular Pharmacology & Physiology, University of South Florida College of Medicine, Tampa, Florida;
| | - Jiangping Song
- Department of Molecular Pharmacology & Physiology, University of South Florida College of Medicine, Tampa, Florida
| | | | - Jin Wei
- Department of Molecular Pharmacology & Physiology, University of South Florida College of Medicine, Tampa, Florida
| | - Shaohui Wang
- Department of Molecular Pharmacology & Physiology, University of South Florida College of Medicine, Tampa, Florida
| | - Jie Zhang
- Department of Molecular Pharmacology & Physiology, University of South Florida College of Medicine, Tampa, Florida
| | - Gensheng Zhang
- Department of Molecular Pharmacology & Physiology, University of South Florida College of Medicine, Tampa, Florida.,Department of Physiology, Zhejiang University School of Medicine, Hangzhou, China
| | - Yan Lu
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi; and
| | - Kay-Pong Yip
- Department of Molecular Pharmacology & Physiology, University of South Florida College of Medicine, Tampa, Florida
| | - Ruisheng Liu
- Department of Molecular Pharmacology & Physiology, University of South Florida College of Medicine, Tampa, Florida
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76
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Donor and recipient genetic variants in NLRP3 associate with early acute rejection following kidney transplantation. Sci Rep 2016; 6:36315. [PMID: 27819323 PMCID: PMC5098240 DOI: 10.1038/srep36315] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 10/13/2016] [Indexed: 12/16/2022] Open
Abstract
NLRP3 (NOD-like receptor family, pyrin domain containing 3) is a member of the inflammasome family and is of special interest in renal disease. Experimental studies have shown that Nlrp3 plays a significant role in the induction of renal damage and dysfunction in acute and chronic renal injury. However, the role of NLRP3 in human renal disease is completely unknown. From a retrospective cohort study, we determined in 1271 matching donor and recipient samples if several NLRP3 single nucelotide polymorphisms (SNPs) were associated with primary non-function (PNF), delayed graft function (DGF), biopsy-proven acute rejection (BPAR) and death-censored graft and patient survival. NLRP3 gain-of-function SNP (rs35829419) in donors was associated with an increased risk of BPAR while NLRP3 loss-of-function SNP (rs6672995) in the recipient was associated with a decreased risk of BPAR in the first year following renal transplantation (HR 1.91, 95% CI 1.38–2.64, P < 0.001 and HR 0.73, 95% CI 0.55–0.97, P = 0.03 resp.). NLRP3 SNPs in both donor and recipient were not associated with PNF, DGF, graft survival or patient survival. We conclude that genetic variants in the NLRP3 gene affect the risk of acute rejection following kidney transplantation.
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77
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Thuret R, Timsit MO, Kleinclauss F. [Chronic kidney disease and kidney transplantation]. Prog Urol 2016; 26:882-908. [PMID: 27727091 DOI: 10.1016/j.purol.2016.09.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 09/01/2016] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To report epidemiology and characteristics of end-stage renal disease (ESRD) patients and renal transplant candidates, and to evaluate access to waiting list and results of renal transplantation. MATERIAL AND METHODS An exhaustive systematic review of the scientific literature was performed in the Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using different associations of the following keywords: "chronic kidney disease, epidemiology, kidney transplantation, cost, survival, graft, brain death, cardiac arrest, access, allocation". French legal documents have been reviewed using the government portal (http://www.legifrance.gouv.fr). Articles were selected according to methods, language of publication and relevance. The reference lists were used to identify additional historical studies of interest. Both prospective and retrospective series, in French and English, as well as review articles and recommendations were selected. In addition, French national transplant and health agencies (http://www.agence-biomedecine.fr and http://www.has-sante.fr) databases were screened using identical keywords. A total of 3234 articles, 6 official reports and 3 newspaper articles were identified; after careful selection 99 publications were eligible for our review. RESULTS The increasing prevalence of chronic kidney disease (CKD) leads to worsen organ shortage. Renal transplantation remains the best treatment option for ESRD, providing recipients with an increased survival and quality of life, at lower costs than other renal replacement therapies. The never-ending lengthening of the waiting list raises issues regarding treatment strategies and candidates' selection, and underlines the limits of organ sharing without additional source of kidneys available for transplantation. CONCLUSION Allocation policies aim to reduce medical or geographical disparities regarding enrollment on a waiting list or access to an allotransplant.
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Affiliation(s)
- R Thuret
- Service d'urologie et transplantation rénale, CHU de Montpellier, 34090 Montpellier, France; Université de Montpellier, 34090 Montpellier, France.
| | - M O Timsit
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - F Kleinclauss
- Service d'urologie et transplantation rénale, CHRU de Besançon, 25030 Besançon, France; Université de Franche-Comté, 25030 Besançon, France; Inserm UMR 1098, 25030 Besançon, France
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78
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Sá H, Leal R, Rosa MS. Renal transplant immunology in the last 20 years: A revolution towards graft and patient survival improvement. Int Rev Immunol 2016; 36:182-203. [PMID: 27682364 DOI: 10.1080/08830185.2016.1225300] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
To deride the hope of progress is the ultimate fatuity, the last word in poverty of spirit and meanness of mind. There is no need to be dismayed by the fact that we cannot yet envisage a definitive solution of our problems, a resting-place beyond which we need not try to go. -P.B. Medawar, 1969 * Thomas E. Starlz, also known as the Father of Clinical Transplantation, once said that organ transplantation was the supreme exception to the rule that most major advances in medicine spring from discoveries in basic science [Starzl T. The mystique of organ transplantation. J Am Coll Surg 2005 Aug;201(2):160-170]. In fact, the first successful identical-twin kidney transplantation performed by Murray's team in December 1954 (Murray J et al. Renal homotransplantations in identical twins. Surg Forum 1955;6:432-436) was the example of an upside down translation medicine: Human clinical transplantation began and researchers tried to understand the underlying immune response and how to control the powerful rejection pathways through experimental models. In the last 20 years, we have witnessed an amazing progress in the knowledge of immunological mechanisms regarding alloimmune response and an outstanding evolution on the identification and characterization of major and minor histocompatibility antigens. This review presents an historical and clinical perspective of those important advances in kidney transplantation immunology in the last 20 years, which contributed to the improvement in patients' quality of life and the survival of end-stage renal patients. In spite of these significant progresses, some areas still need substantial progress, such as the definition of non-invasive biomarkers for acute rejection; the continuous reduction of immunosuppression; the extension of graft survival, and finally the achievement of real graft tolerance extended to HLA mismatch donor: recipient pairs.
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Affiliation(s)
- Helena Sá
- a Department of Nephrology , Centro Hospitalar e Universitário de Coimbra , Coimbra , Portugal.,b Faculty of Medicine , University of Coimbra , Coimbra , Portugal.,c Immunology Center, Faculty of Medicine , University of Coimbra , Coimbra , Portugal
| | - Rita Leal
- a Department of Nephrology , Centro Hospitalar e Universitário de Coimbra , Coimbra , Portugal
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79
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Wijermars LGM, Schaapherder AF, Kostidis S, Wüst RCI, Lindeman JH. Succinate Accumulation and Ischemia-Reperfusion Injury: Of Mice but Not Men, a Study in Renal Ischemia-Reperfusion. Am J Transplant 2016; 16:2741-6. [PMID: 26999803 DOI: 10.1111/ajt.13793] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 02/23/2016] [Accepted: 03/11/2016] [Indexed: 01/25/2023]
Abstract
A recent seminal paper implicated ischemia-related succinate accumulation followed by succinate-driven reactive oxygen species formation as a key driver of ischemia-reperfusion injury. Although the data show that the mechanism is universal for all organs tested (kidney, liver, heart, and brain), a remaining question is to what extent these observations in mice translate to humans. We showed in this study that succinate accumulation is not a universal event during ischemia and does not occur during renal graft procurement; in fact, tissue succinate content progressively decreased with increasing graft ischemia time (p < 0.007). Contrasting responses were also found with respect to mitochondrial susceptibility toward ischemia and reperfusion, with rodent mitochondria robustly resistant toward warm ischemia but human and pig mitochondria highly susceptible to warm ischemia (p < 0.05). These observations suggest that succinate-driven reactive oxygen formation does not occur in the context of kidney transplantation. Moreover, absent allantoin release from the reperfused grafts suggests minimal oxidative stress during clinical reperfusion.
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Affiliation(s)
- L G M Wijermars
- Department of Transplantation Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - A F Schaapherder
- Department of Transplantation Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - S Kostidis
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, the Netherlands
| | - R C I Wüst
- Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, the Netherlands
| | - J H Lindeman
- Department of Transplantation Surgery, Leiden University Medical Center, Leiden, the Netherlands
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80
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Yu ZX, Qi S, Lasaro MA, Bouchard K, Dow C, Moore K, Wu Z, Barama A, Xu J, Johnson K, Marozsan AJ, Wang Y. Targeting Complement Pathways During Cold Ischemia and Reperfusion Prevents Delayed Graft Function. Am J Transplant 2016; 16:2589-97. [PMID: 27003920 DOI: 10.1111/ajt.13797] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/11/2016] [Indexed: 01/25/2023]
Abstract
The complement system plays a critical role in ischemia-reperfusion injury (IRI)-mediated delayed graft function (DGF). To better understand the roles of complement activation pathways in IRI in kidney transplantation, donor kidneys were treated ex vivo with terminal complement pathway (TP) inhibitor, anti-rat C5 mAb 18A10, or complement alternative pathway (AP) inhibitor TT30 for 28 h at 4°C pretransplantation in a syngeneic kidney transplantation rat model. All 18A10- and 67% of TT30-pretreated grafts, but only 16.7% of isotype control-pretreated grafts, survived beyond day 21 (p < 0.01). Inhibitor treatment in the final 45 min of 28-h cold ischemia (CI) similarly improved graft survival. Systemic posttransplant treatment with 18A10 resulted in 60% increased graft survival beyond day 21 (p < 0.01), while no TT30-treated rat survived > 6 days. Our results demonstrate that AP plays a prominent role during CI and that blocking either the AP or, more effectively the TP prevents ischemic injury and subsequent DGF. Multiple complement pathways may be activated and contribute to reperfusion injury; blocking the TP, but not the AP, posttransplant is effective in preventing reperfusion injury and increasing graft survival. These results demonstrate the feasibility of using complement inhibitors for prevention of DGF in humans.
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Affiliation(s)
- Z X Yu
- Pre-Clinical Sciences, Alexion Pharmaceuticals, Inc., Cheshire, CT, Canada
| | - S Qi
- Research Centre, Centre Hospitalier de l'Université de Montréal, Department of Surgery, Hôpital Notre Dame and Université de Montréal, Montréal, Quebec, Canada
| | - M A Lasaro
- Pre-Clinical Sciences, Alexion Pharmaceuticals, Inc., Cheshire, CT, Canada
| | - K Bouchard
- Pre-Clinical Sciences, Alexion Pharmaceuticals, Inc., Cheshire, CT, Canada
| | - C Dow
- Pre-Clinical Sciences, Alexion Pharmaceuticals, Inc., Cheshire, CT, Canada
| | - K Moore
- Pre-Clinical Sciences, Alexion Pharmaceuticals, Inc., Cheshire, CT, Canada
| | - Z Wu
- Research Centre, Centre Hospitalier de l'Université de Montréal, Department of Surgery, Hôpital Notre Dame and Université de Montréal, Montréal, Quebec, Canada
| | - A Barama
- Research Centre, Centre Hospitalier de l'Université de Montréal, Department of Surgery, Hôpital Notre Dame and Université de Montréal, Montréal, Quebec, Canada
| | - J Xu
- Research Centre, Centre Hospitalier de l'Université de Montréal, Department of Surgery, Hôpital Notre Dame and Université de Montréal, Montréal, Quebec, Canada
| | - K Johnson
- Pre-Clinical Sciences, Alexion Pharmaceuticals, Inc., Cheshire, CT, Canada
| | - A J Marozsan
- Pre-Clinical Sciences, Alexion Pharmaceuticals, Inc., Cheshire, CT, Canada
| | - Y Wang
- Pre-Clinical Sciences, Alexion Pharmaceuticals, Inc., Cheshire, CT, Canada
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81
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Defective postreperfusion metabolic recovery directly associates with incident delayed graft function. Kidney Int 2016; 90:181-91. [DOI: 10.1016/j.kint.2016.02.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 02/18/2016] [Accepted: 02/25/2016] [Indexed: 01/09/2023]
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82
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The risk of allograft failure and the survival benefit of kidney transplantation are complicated by delayed graft function. Kidney Int 2016; 89:1331-6. [DOI: 10.1016/j.kint.2016.01.028] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 01/08/2016] [Accepted: 01/14/2016] [Indexed: 11/22/2022]
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83
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Zhang LM, Liu JH, Xue CB, Li MQ, Xing S, Zhang X, He WT, Jiang FC, Lu X, Zhou P. Pharmacological inhibition of MyD88 homodimerization counteracts renal ischemia reperfusion-induced progressive renal injury in vivo and in vitro. Sci Rep 2016; 6:26954. [PMID: 27246399 PMCID: PMC4887891 DOI: 10.1038/srep26954] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 05/11/2016] [Indexed: 12/19/2022] Open
Abstract
The activation of innate immunity via myeloid differentiation factor 88 (MyD88) contributes to ischemia reperfusion (I/R) induced acute kidney injury (AKI) and chronic kidney injury. However, since there have not yet been any effective therapy, the exact pharmacological role of MyD88 in the prevention and treatment of renal ischemia reperfusion injury (IRI) is not known. We designed a small molecular compound, TJ-M2010-2, which inhibited MyD88 homodimerization. We used an established unilateral I/R mouse model. All mice undergoing 80 min ischemia through uninephrectomy died within five days without intervention. However, treatment with TJ-M2010-2 alone significantly improved the survival rate to 58.3%. Co-treatment of TJ-M2010-2 with the CD154 antagonist increased survival rates up to 100%. Twenty-eight days post-I/R of 60 min ischemia without nephrectomy, TJ-M2010-2 markedly attenuated renal interstitial and inhibited TGF-β1-induced epithelial-mesenchymal transition (EMT) of renal tubular epithelial cells. Furthermore, TJ-M2010-2 remarkably inhibited TLR/MyD88 signaling in vivo and in vitro. In conclusion, our findings highlight the promising clinical potential of MyD88 inhibitor in preventing and treating acute or chronic renal I/R injuries, and the therapeutic functionality of dual-system inhibition strategy in IRI-induced AKI. Moreover, MyD88 inhibition ameliorates renal I/R injury-induced tubular interstitial fibrosis by suppressing EMT.
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Affiliation(s)
- Li-Min Zhang
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Key Laboratory of Organ Transplantation, Ministry of Health, and Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan 430030, China
| | - Jian-Hua Liu
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Key Laboratory of Organ Transplantation, Ministry of Health, and Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan 430030, China
| | - Cheng-Biao Xue
- Institute of Hepatobiliary Diseases of Wuhan University, Zhongnan Hospital of Wuhan University; Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan 430071, China
| | | | - Shuai Xing
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Key Laboratory of Organ Transplantation, Ministry of Health, and Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan 430030, China
| | - Xue Zhang
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Key Laboratory of Organ Transplantation, Ministry of Health, and Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan 430030, China
| | - Wen-Tao He
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Feng-Chao Jiang
- Academy of Pharmacology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xia Lu
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Key Laboratory of Organ Transplantation, Ministry of Health, and Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan 430030, China
| | - Ping Zhou
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Key Laboratory of Organ Transplantation, Ministry of Health, and Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan 430030, China
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Chatzikyrkou C, Eichler J, Karch A, Clajus C, Scurt FG, Ramackers W, Lehner F, Menne J, Haller H, Mertens PR, Schiffer M. Short- and long-term effects of the use of RAAS blockers immediately after renal transplantation. Blood Press 2016; 26:30-38. [DOI: 10.1080/08037051.2016.1182856] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Christos Chatzikyrkou
- Division of Nephrology and Hypertension, Department of Medicine, Hannover Medical School, Hannover, Germany
- Division of Nephrology and Hypertension, Diabetology and Endocrinology, University Hospital of Magedburg, Magedburg, Germany
| | - Jenny Eichler
- Division of Nephrology and Hypertension, Department of Medicine, Hannover Medical School, Hannover, Germany
| | - Annika Karch
- Institute for Biostatistics, Hannover Medical School, Hannover, Germany
| | - Christian Clajus
- Division of Nephrology and Hypertension, Department of Medicine, Hannover Medical School, Hannover, Germany
| | - Florian Gunnar Scurt
- Division of Nephrology and Hypertension, Diabetology and Endocrinology, University Hospital of Magedburg, Magedburg, Germany
| | - Wolf Ramackers
- Department of General, Visceral and Transplantation Surgery, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
| | - Frank Lehner
- Department of General, Visceral and Transplantation Surgery, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
| | - Jan Menne
- Division of Nephrology and Hypertension, Department of Medicine, Hannover Medical School, Hannover, Germany
| | - Hermann Haller
- Division of Nephrology and Hypertension, Department of Medicine, Hannover Medical School, Hannover, Germany
| | - Peter R. Mertens
- Division of Nephrology and Hypertension, Diabetology and Endocrinology, University Hospital of Magedburg, Magedburg, Germany
| | - Mario Schiffer
- Division of Nephrology and Hypertension, Department of Medicine, Hannover Medical School, Hannover, Germany
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85
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Epigenetics in Kidney Transplantation: Current Evidence, Predictions, and Future Research Directions. Transplantation 2016; 100:23-38. [PMID: 26356174 DOI: 10.1097/tp.0000000000000878] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Epigenetic modifications are changes to the genome that occur without any alteration in DNA sequence. These changes include cytosine methylation of DNA at cytosine-phosphate diester-guanine dinucleotides, histone modifications, microRNA interactions, and chromatin remodeling complexes. Epigenetic modifications may exert their effect independently or complementary to genetic variants and have the potential to modify gene expression. These modifications are dynamic, potentially heritable, and can be induced by environmental stimuli or drugs. There is emerging evidence that epigenetics play an important role in health and disease. However, the impact of epigenetic modifications on the outcomes of kidney transplantation is currently poorly understood and deserves further exploration. Kidney transplantation is the best treatment option for end-stage renal disease, but allograft loss remains a significant challenge that leads to increased morbidity and return to dialysis. Epigenetic modifications may influence the activation, proliferation, and differentiation of the immune cells, and therefore may have a critical role in the host immune response to the allograft and its outcome. The epigenome of the donor may also impact kidney graft survival, especially those epigenetic modifications associated with early transplant stressors (e.g., cold ischemia time) and donor aging. In the present review, we discuss evidence supporting the role of epigenetic modifications in ischemia-reperfusion injury, host immune response to the graft, and graft response to injury as potential new tools for the diagnosis and prediction of graft function, and new therapeutic targets for improving outcomes of kidney transplantation.
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Ashraf MI, Schwelberger HG, Brendel KA, Feurle J, Andrassy J, Kotsch K, Regele H, Pratschke J, Maier HT, Aigner F. Exogenous Lipocalin 2 Ameliorates Acute Rejection in a Mouse Model of Renal Transplantation. Am J Transplant 2016; 16:808-20. [PMID: 26595644 PMCID: PMC4996417 DOI: 10.1111/ajt.13521] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 09/02/2015] [Accepted: 09/04/2015] [Indexed: 01/25/2023]
Abstract
Lipocalin 2 (Lcn2) is rapidly produced by damaged nephron epithelia and is one of the most promising new markers of renal injury, delayed graft function and acute allograft rejection (AR); however, the functional importance of Lcn2 in renal transplantation is largely unknown. To understand the role of Lcn2 in renal AR, kidneys from Balb/c mice were transplanted into C57Bl/6 mice and vice versa and analyzed for morphological and physiological outcomes of AR at posttransplantation days 3, 5, and 7. The allografts showed a steady increase in intensity of interstitial infiltration, tubulitis and periarterial aggregation of lymphocytes associated with a substantial elevation in serum levels of creatinine, urea and Lcn2. Perioperative administration of recombinant Lcn2:siderophore:Fe complex (rLcn2) to recipients resulted in functional and morphological amelioration of the allograft at day 7 almost as efficiently as daily immunosuppression with cyclosporine A (CsA). No significant differences were observed in various donor-recipient combinations (C57Bl/6 wild-type and Lcn2(-/-) , Balb/c donors and recipients). Histochemical analyses of the allografts showed reduced cell death in recipients treated with rLcn2 or CsA. These results demonstrate that Lcn2 plays an important role in reducing the extent of kidney AR and indicate the therapeutic potential of Lcn2 in transplantation.
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Affiliation(s)
- M. I. Ashraf
- Department of VisceralTransplant and Thoracic SurgeryMedical University InnsbruckInnsbruckAustria,Department for General, Visceral and Transplantation Surgery, Campus Virchow‐KlinikumCharité UniversitätsmedizinBerlinGermany
| | - H. G. Schwelberger
- Department of VisceralTransplant and Thoracic SurgeryMedical University InnsbruckInnsbruckAustria
| | - K. A. Brendel
- Institute of PathologyMedical University InnsbruckInnsbruckAustria
| | - J. Feurle
- Department of VisceralTransplant and Thoracic SurgeryMedical University InnsbruckInnsbruckAustria
| | - J. Andrassy
- Department of Surgery, Clinic GrosshadernLudwig‐Maximilian‐University MunichMunichGermany
| | - K. Kotsch
- Department of VisceralTransplant and Thoracic SurgeryMedical University InnsbruckInnsbruckAustria
| | - H. Regele
- Institute of PathologyMedical University InnsbruckInnsbruckAustria
| | - J. Pratschke
- Department of VisceralTransplant and Thoracic SurgeryMedical University InnsbruckInnsbruckAustria,Department for General, Visceral and Transplantation Surgery, Campus Virchow‐KlinikumCharité UniversitätsmedizinBerlinGermany
| | - H. T. Maier
- Department of VisceralTransplant and Thoracic SurgeryMedical University InnsbruckInnsbruckAustria
| | - F. Aigner
- Department of VisceralTransplant and Thoracic SurgeryMedical University InnsbruckInnsbruckAustria,Department for General, Visceral and Transplantation Surgery, Campus Virchow‐KlinikumCharité UniversitätsmedizinBerlinGermany
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87
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Osband AJ, James NT, Segev DL. Extraction Time of Kidneys From Deceased Donors and Impact on Outcomes. Am J Transplant 2016; 16:700-3. [PMID: 26414911 DOI: 10.1111/ajt.13457] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 06/25/2015] [Accepted: 07/15/2015] [Indexed: 01/25/2023]
Abstract
Cold ischemia time (from flush to out-of-ice) and warm ischemia time (from out-of-ice to reperfusion) are known to impact delayed graft function (DGF) rates and long-term allograft survival following deceased donor kidney transplantation. We propose an additional ischemia time, extraction time, beginning with aortic cross-clamp and perfusion/cooling of the kidneys, and ending with removal of the kidneys and placement on ice on the backtable. During this time the kidneys rewarm, suffering an additional ischemic insult, which may impair transplant function. We measured extraction times of 576 kidneys recovered and transplanted locally between January 2006 and December 2008, then linked to Scientific Registry of Transplant Recipients (SRTR) data for outcomes. Extraction time ranged from 14 to 123 min, with a mean of 44.7 min. In SRTR-adjusted analyses, longer extraction time and DGF were statistically associated (odds ratio [OR] = 1.19 per 5 min beyond 60 min, 95% confidence interval [CI] 1.02-1.39, p = 0.03). Up to 60 min of extraction time, DGF incidence was 27.8%; by 120 min it doubled to nearly 60%. Although not statistically significant (OR = 1.19, 95% CI 0.96-1.49, p = 0.11), primary nonfunction rate also rose dramatically to nearly 20% by 120 min extraction time. Extraction time is a novel and important factor to consider when evaluating a deceased donor kidney offer and when strategizing personnel for kidney recovery.
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Affiliation(s)
- A J Osband
- Kidney/Pancreas Transplant, Rutgers/Robert Wood Johnson Medical School, New Brunswick, NJ
| | - N T James
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - D L Segev
- Johns Hopkins University School of Medicine, Baltimore, MD
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88
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Feng S. Got It! Let's Cool It! But What's Next in Organ Donor Research? Am J Transplant 2016; 16:5-6. [PMID: 26551003 DOI: 10.1111/ajt.13516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 08/26/2015] [Accepted: 08/27/2015] [Indexed: 01/25/2023]
Affiliation(s)
- S Feng
- University of California San Francisco, San Francisco, CA
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89
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Tennankore KK, Kim SJ, Alwayn IPJ, Kiberd BA. Prolonged warm ischemia time is associated with graft failure and mortality after kidney transplantation. Kidney Int 2015; 89:648-58. [PMID: 26880458 DOI: 10.1016/j.kint.2015.09.002] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 09/17/2015] [Accepted: 09/24/2015] [Indexed: 11/29/2022]
Abstract
Warm ischemia time is a potentially modifiable insult to transplanted kidneys, but little is known about its effect on long-term outcomes. Here we conducted a study of United States kidney transplant recipients (years 2000-2013) to determine the association between warm ischemia time (the time from organ removal from cold storage to reperfusion with warm blood) and death/graft failure. Times under 10 minutes were potentially attributed to coding error. Therefore, the 10-to-under-20-minute interval was chosen as the reference group. The primary outcome was mortality and graft failure (return to chronic dialysis or preemptive retransplantation) adjusted for recipient, donor, immunologic, and surgical factors. The study included 131,677 patients with 35,901 events. Relative to the reference patients, times of 10 to under 20, 20 to under 30, 30 to under 40, 40 to under 50, 50 to under 60, and 60 and more minutes were associated with hazard ratios of 1.07 (95% confidence interval, 0.99-1.15), 1.13 (1.06-1.22), 1.17 (1.09-1.26), 1.20 (1.12-1.30), and 1.23 (1.15-1.33) for the composite event, respectively. Association between prolonged warm ischemia time and death/graft failure persisted after stratification by donor type (living vs. deceased donor) and delayed graft function status. Thus, warm ischemia time is associated with adverse long-term patient and graft survival after kidney transplantation. Identifying strategies to reduce warm ischemia time is an important consideration for future study.
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Affiliation(s)
- Karthik K Tennankore
- Department of Medicine (Division of Nephrology), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.
| | - S Joseph Kim
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ian P J Alwayn
- Department of Surgery, Multi-Organ Transplant Program, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Bryce A Kiberd
- Department of Medicine (Division of Nephrology), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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90
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The impact of slow graft function on graft outcome is comparable to delayed graft function in deceased donor kidney transplantation. Int Urol Nephrol 2015; 48:431-9. [DOI: 10.1007/s11255-015-1163-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 11/09/2015] [Indexed: 01/30/2023]
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91
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Decruyenaere A, Decruyenaere P, Peeters P, Vermassen F, Dhaene T, Couckuyt I. Prediction of delayed graft function after kidney transplantation: comparison between logistic regression and machine learning methods. BMC Med Inform Decis Mak 2015; 15:83. [PMID: 26466993 PMCID: PMC4607098 DOI: 10.1186/s12911-015-0206-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 09/30/2015] [Indexed: 01/05/2023] Open
Abstract
Background Predictive models for delayed graft function (DGF) after kidney transplantation are usually developed using logistic regression. We want to evaluate the value of machine learning methods in the prediction of DGF. Methods 497 kidney transplantations from deceased donors at the Ghent University Hospital between 2005 and 2011 are included. A feature elimination procedure is applied to determine the optimal number of features, resulting in 20 selected parameters (24 parameters after conversion to indicator parameters) out of 55 retrospectively collected parameters. Subsequently, 9 distinct types of predictive models are fitted using the reduced data set: logistic regression (LR), linear discriminant analysis (LDA), quadratic discriminant analysis (QDA), support vector machines (SVMs; using linear, radial basis function and polynomial kernels), decision tree (DT), random forest (RF), and stochastic gradient boosting (SGB). Performance of the models is assessed by computing sensitivity, positive predictive values and area under the receiver operating characteristic curve (AUROC) after 10-fold stratified cross-validation. AUROCs of the models are pairwise compared using Wilcoxon signed-rank test. Results The observed incidence of DGF is 12.5 %. DT is not able to discriminate between recipients with and without DGF (AUROC of 52.5 %) and is inferior to the other methods. SGB, RF and polynomial SVM are mainly able to identify recipients without DGF (AUROC of 77.2, 73.9 and 79.8 %, respectively) and only outperform DT. LDA, QDA, radial SVM and LR also have the ability to identify recipients with DGF, resulting in higher discriminative capacity (AUROC of 82.2, 79.6, 83.3 and 81.7 %, respectively), which outperforms DT and RF. Linear SVM has the highest discriminative capacity (AUROC of 84.3 %), outperforming each method, except for radial SVM, polynomial SVM and LDA. However, it is the only method superior to LR. Conclusions The discriminative capacities of LDA, linear SVM, radial SVM and LR are the only ones above 80 %. None of the pairwise AUROC comparisons between these models is statistically significant, except linear SVM outperforming LR. Additionally, the sensitivity of linear SVM to identify recipients with DGF is amongst the three highest of all models. Due to both reasons, the authors believe that linear SVM is most appropriate to predict DGF.
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Affiliation(s)
| | | | - Patrick Peeters
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Frank Vermassen
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Tom Dhaene
- Department of Information Technology (INTEC), Ghent University - iMinds, Ghent, Belgium
| | - Ivo Couckuyt
- Department of Information Technology (INTEC), Ghent University - iMinds, Ghent, Belgium
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92
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Reducing Ischemia-Reperfusion Injury in Renal Transplantation. J Urol 2015; 194:1531-2. [PMID: 26386276 DOI: 10.1016/j.juro.2015.09.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2015] [Indexed: 11/20/2022]
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93
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Silver SA, Cardinal H, Colwell K, Burger D, Dickhout JG. Acute kidney injury: preclinical innovations, challenges, and opportunities for translation. Can J Kidney Health Dis 2015; 2:30. [PMID: 26331054 PMCID: PMC4556308 DOI: 10.1186/s40697-015-0062-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 07/02/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a clinically important condition that has attracted a great deal of interest from the biomedical research community. However, acute kidney injury AKI research findings have yet to be translated into significant changes in clinical practice. OBJECTIVE This article reviews many of the preclinical innovations in acute kidney injury AKI treatment, and explores challenges and opportunities to translate these finding into clinical practice. SOURCES OF INFORMATION MEDLINE, ISI Web of Science. FINDINGS This paper details areas in biomedical research where translation of pre-clinical findings into clinical trials is ongoing, or nearing a point where trial design is warranted. Further, the paper examines ways that best practice in the management of AKI can reach a broader proportion of the patient population experiencing this condition. LIMITATIONS This review highlights pertinent literature from the perspective of the research interests of the authors for new translational work in AKI. As such, it does not represent a systematic review of all of the AKI literature. IMPLICATIONS Translation of findings from biomedical research into AKI therapy presents several challenges. These may be partly overcome by targeting populations for interventional trials where the likelihood of AKI is very high, and readily predictable. Further, specific clinics to follow-up with patients after AKI events hold promise to provide best practice in care, and to translate therapies into treatment for the broadest possible patient populations.
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Affiliation(s)
- Samuel A. Silver
- />Division of Nephrology, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Héloise Cardinal
- />Division of Nephrology, Centre Hospitalier de l’Université de Montréal and CHUM research center, Montreal, Quebec Canada
| | - Katelyn Colwell
- />Department of Medicine, Division of Nephrology, McMaster University and St. Joseph’s Healthcare Hamilton, Hamilton, Ontario Canada
| | - Dylan Burger
- />Kidney Research Centre, Ottawa Hospital Research Institute, Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - Jeffrey G. Dickhout
- />Department of Medicine, Division of Nephrology, McMaster University and St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6 Canada
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94
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Center-level variation in the development of delayed graft function after deceased donor kidney transplantation. Transplantation 2015; 99:997-1002. [PMID: 25340600 DOI: 10.1097/tp.0000000000000450] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patient-level risk factors for delayed graft function (DGF) have been well described. However, the Organ Procurement and Transplantation Network definition of DGF is based on dialysis in the first week, which is subject to center-level practice patterns. It remains unclear if there are center-level differences in DGF and if measurable center characteristics can explain these differences. METHODS Using the 2003 to 2012 Scientific Registry of Transplant Recipients data, we developed a hierarchical (multilevel) model to determine the association between center characteristics and DGF incidence after adjusting for known patient risk factors and to quantify residual variability across centers after adjustment for these factors. RESULTS Of 82,143 deceased donor kidney transplant recipients, 27.0% developed DGF, with a range across centers of 3.2% to 63.3%. A center's proportion of preemptive transplants (odds ratio [OR], 0.83; per 5% increment; 95% confidence interval [95% CI], 0.74-;0.93; P = 0.001) and kidneys with longer than 30 hr of cold ischemia time (CIT) (OR, 0.95; per 5% increment; 95% CI, 0.92-;0.98; P = 0.001) were associated with less DGF. A center's proportion of donation after cardiac death donors (OR, 1.12; per 5% increment; 95% CI, 1.03-;1.17; P < 0.001) and imported kidneys (OR, 1.06; per 5% increment; 95% CI, 1.03-;1.10; P < 0.001) were associated with more DGF. After patient-level and center-level adjustments, only 41.8% of centers had DGF incidences consistent with the national median and 28.2% had incidences above the national median. CONCLUSION Significant heterogeneity in DGF incidences across centers, even after adjusting for patient-level and center-level characteristics, calls into question the generalizability and validity of the current DGF definition. Enhanced understanding of center-level variability and improving the definition of DGF accordingly may improve DGF's utility in clinical care and as a surrogate endpoint in clinical trials.
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95
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Pianta TJ, Peake PW, Pickering JW, Kelleher M, Buckley NA, Endre ZH. Evaluation of biomarkers of cell cycle arrest and inflammation in prediction of dialysis or recovery after kidney transplantation. Transpl Int 2015; 28:1392-404. [DOI: 10.1111/tri.12636] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 12/30/2014] [Accepted: 07/07/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Timothy J. Pianta
- Prince of Wales Clinical School; University of New South Wales; Sydney NSW Australia
- Northern Clinical School; Melbourne Medical School; University of Melbourne; Epping Vic Australia
| | - Philip W. Peake
- Prince of Wales Clinical School; University of New South Wales; Sydney NSW Australia
| | - John W. Pickering
- Department of Medicine; University of Otago; Christchurch New Zealand
| | - Michaela Kelleher
- Department of Nephrology; Prince of Wales Hospital; Sydney NSW Australia
| | | | - Zoltan H. Endre
- Prince of Wales Clinical School; University of New South Wales; Sydney NSW Australia
- Department of Medicine; University of Otago; Christchurch New Zealand
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96
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Cruzado JM, Manonelles A, Vila H, Melilli E, Sala N, Bestard O, Torras J, Tebé C, Riera L, Grinyó JM. Residual urinary volume is a risk factor for primary nonfunction in kidney transplantation. Transpl Int 2015; 28:1276-82. [DOI: 10.1111/tri.12625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 02/26/2015] [Accepted: 06/15/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Josep M. Cruzado
- Nephrology Department; Hospital Universitari de Bellvitge; University of Barcelona; IDIBELL; L'Hospitalet de Llobregat Spain
| | - Anna Manonelles
- Nephrology Department; Hospital Universitari de Bellvitge; University of Barcelona; IDIBELL; L'Hospitalet de Llobregat Spain
| | - Helena Vila
- Urology Department; Hospital Universitari de Bellvitge; L'Hospitalet de Llobregat Spain
| | - Edoardo Melilli
- Nephrology Department; Hospital Universitari de Bellvitge; University of Barcelona; IDIBELL; L'Hospitalet de Llobregat Spain
| | - Neus Sala
- Nephrology Department; Hospital Universitari de Bellvitge; University of Barcelona; IDIBELL; L'Hospitalet de Llobregat Spain
| | - Oriol Bestard
- Nephrology Department; Hospital Universitari de Bellvitge; University of Barcelona; IDIBELL; L'Hospitalet de Llobregat Spain
| | - Joan Torras
- Nephrology Department; Hospital Universitari de Bellvitge; University of Barcelona; IDIBELL; L'Hospitalet de Llobregat Spain
| | - Cristian Tebé
- Statistical Advisory Service; Bellvitge Biomedical Institute-IDIBELL; Faculty of Medicine and Health Sciences; University Rovira i Virgili; L'Hospitalet de Llobregat Spain
| | - Lluís Riera
- Urology Department; Hospital Universitari de Bellvitge; L'Hospitalet de Llobregat Spain
| | - Josep M. Grinyó
- Nephrology Department; Hospital Universitari de Bellvitge; University of Barcelona; IDIBELL; L'Hospitalet de Llobregat Spain
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97
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Hébert MJ, Jevnikar AM. The Impact of Regulated Cell Death Pathways on Alloimmune Responses and Graft Injury. CURRENT TRANSPLANTATION REPORTS 2015. [DOI: 10.1007/s40472-015-0067-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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98
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Podestà MA, Cucchiari D, Ponticelli C. The diverging roles of dendritic cells in kidney allotransplantation. Transplant Rev (Orlando) 2015; 29:114-20. [DOI: 10.1016/j.trre.2015.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 03/09/2015] [Accepted: 04/08/2015] [Indexed: 12/23/2022]
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99
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Salvadori M, Rosso G, Bertoni E. Update on ischemia-reperfusion injury in kidney transplantation: Pathogenesis and treatment. World J Transplant 2015; 5:52-67. [PMID: 26131407 PMCID: PMC4478600 DOI: 10.5500/wjt.v5.i2.52] [Citation(s) in RCA: 249] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 01/12/2015] [Accepted: 04/29/2015] [Indexed: 02/05/2023] Open
Abstract
Ischemia/reperfusion injury is an unavoidable relevant consequence after kidney transplantation and influences short term as well as long-term graft outcome. Clinically ischemia/reperfusion injury is associated with delayed graft function, graft rejection, chronic rejection and chronic graft dysfunction. Ischemia/reperfusion affects many regulatory systems at the cellular level as well as in the renal tissue that result in a distinct inflammatory reaction of the kidney graft. Underlying factors of ischemia reperfusion include energy metabolism, cellular changes of the mitochondria and cellular membranes, initiation of different forms of cell death-like apoptosis and necrosis together with a recently discovered mixed form termed necroptosis. Chemokines and cytokines together with other factors promote the inflammatory response leading to activation of the innate immune system as well as the adaptive immune system. If the inflammatory reaction continues within the graft tissue, a progressive interstitial fibrosis develops that impacts long-term graft outcome. It is of particular importance in kidney transplantation to understand the underlying mechanisms and effects of ischemia/reperfusion on the graft as this knowledge also opens strategies to prevent or treat ischemia/reperfusion injury after transplantation in order to improve graft outcome.
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100
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Hueper K, Gueler F, Bräsen JH, Gutberlet M, Jang MS, Lehner F, Richter N, Hanke N, Peperhove M, Martirosian P, Tewes S, Vo Chieu VD, Großhennig A, Haller H, Wacker F, Gwinner W, Hartung D. Functional MRI detects perfusion impairment in renal allografts with delayed graft function. Am J Physiol Renal Physiol 2015; 308:F1444-51. [DOI: 10.1152/ajprenal.00064.2015] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 04/28/2015] [Indexed: 11/22/2022] Open
Abstract
Delayed graft function (DGF) after kidney transplantation is not uncommon, and it is associated with long-term allograft impairment. Our aim was to compare renal perfusion changes measured with noninvasive functional MRI in patients early after kidney transplantation to renal function and allograft histology in biopsy samples. Forty-six patients underwent MRI 4–11 days after transplantation. Contrast-free MRI renal perfusion images were acquired using an arterial spin labeling technique. Renal function was assessed by estimated glomerular filtration rate (eGFR), and renal biopsies were performed when indicated within 5 days of MRI. Twenty-six of 46 patients had DGF. Of these, nine patients had acute rejection (including borderline), and eight had other changes (e.g., tubular injury or glomerulosclerosis). Renal perfusion was significantly lower in the DGF group compared with the group with good allograft function (231 ± 15 vs. 331 ± 15 ml·min−1·100 g−1, P < 0.001). Living donor allografts exhibited significantly higher perfusion values compared with deceased donor allografts ( P < 0.001). Renal perfusion significantly correlated with eGFR ( r = 0.64, P < 0.001), resistance index ( r = −0.57, P < 0.001), and cold ischemia time ( r = −0.48, P < 0.01). Furthermore, renal perfusion impairment early after transplantation predicted inferior renal outcome and graft loss. In conclusion, noninvasive functional MRI detects renal perfusion impairment early after kidney transplantation in patients with DGF.
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Affiliation(s)
- Katja Hueper
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Faikah Gueler
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| | | | - Marcel Gutberlet
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Mi-Sun Jang
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| | - Frank Lehner
- Department of General, Abdominal and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Nicolas Richter
- Department of General, Abdominal and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Nils Hanke
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| | - Matti Peperhove
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Petros Martirosian
- Section on Experimental Radiology, University of Tübingen, Tübingen, Germany; and
| | - Susanne Tewes
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Van Dai Vo Chieu
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Anika Großhennig
- Institute for Biostatistics, Hannover Medical School, Hannover, Germany
| | - Hermann Haller
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| | - Frank Wacker
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Wilfried Gwinner
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| | - Dagmar Hartung
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
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