51
|
Uchida J, Kosoku A, Kabei K, Nishide S, Shimada H, Iwai T, Kuwabara N, Naganuma T, Maeda K, Kumada N, Takemoto Y, Nakatani T. Clinical Outcomes of ABO-Incompatible Kidney Transplantation in Patients with End-Stage Kidney Disease due to Diabetes Nephropathy. Urol Int 2019; 102:341-347. [PMID: 30630163 DOI: 10.1159/000496029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/04/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Diabetes nephropathy is one of the most common causes of end-stage kidney disease (ESKD) worldwide. The data are clear that kidney transplantation is superior to remaining on dialysis for patients with diabetes. However, there have been no reports on ABO-incompatible kidney transplantation in patients with ESKD due to diabetes nephropathy. PATIENTS AND METHODS We conducted a retrospective, observational study to investigate the clinical outcomes of ABO-incompatible kidney transplantation for patients with pre-existing diabetes nephropathy at our institution from April 2011 to October 2017. A total of 14 recipients were enrolled in this study. RESULTS All 14 patients underwent successful kidney transplantation. Both overall patient and graft survival rates were 100, 89.9, and 89.9% at 1, 3, and 5 years, respectively. One patient died 20 months after transplantation with a functioning graft due to pancreas cancer. Two of the 14 patients (14.3%) developed biopsy-proven acute cellular rejection during the follow-up period. The median observation period was 32.0 months (range 5-83 months). CONCLUSION ABO-incompatible kidney transplantation may be an acceptable renal replacement therapy for ESKD patients with diabetes.
Collapse
Affiliation(s)
- Junji Uchida
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan,
| | - Akihiro Kosoku
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kazuya Kabei
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shunji Nishide
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hisao Shimada
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tomoaki Iwai
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Nobuyuki Kuwabara
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Toshihide Naganuma
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Keiko Maeda
- Department of Nursing, Osaka City University Hospital, Osaka, Japan
| | - Norihiko Kumada
- Department of Urology, Suita Municipal Hospital, Suita, Japan
| | - Yoshiaki Takemoto
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tatsuya Nakatani
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
52
|
Shah Y, Almeshari K, Broering D, Aleid H, Brockmann J, Alhumaidan H, Hammad E, Elgamal H, Alahmadi I, Hussein M, Ibrahim I, Ali T. ABO-Incompatible Kidney Transplantation: Low Rates of Infectious Complications and Excellent Patient Survival. Transplant Proc 2019; 51:512-516. [PMID: 30879579 DOI: 10.1016/j.transproceed.2019.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND A significant gap exists between demand and supply of organs for patients with end-stage renal disease. To increase the donor pool, kidney transplantation is performed across ABO- and HLA-incompatible barriers. ABO-incompatible kidney transplant (ABOi-KT) recipients are at increased risk of antibody-mediated rejection, infection, and mortality. Hypogammaglobulinemia secondary to immunosuppression is highly prevalent after solid organ transplantation, and intravenous immunoglobulin (IVIG) has been reported to reduce the risks of infections in various settings. We use high-dose IVIG in ABOi-KT recipients perioperatively. We aimed to determine the rate of infectious complications along with graft and patient survival in our ABOi-KT recipients. METHODS We included all adult patients who underwent ABOi-KT from the year 2007 to 2016. Patients received rituximab, plasma exchange, and IVIG (2 g/kg body weight). Thymoglobulin and intravenous methylprednisolone were used as induction treatment. Oral prednisone, mycophenolate mofetil, and tacrolimus were used as maintenance therapy. RESULTS A total of 77 ABOi-KTs were performed, and the recipients were followed up for a median of 1557 days. Two patients were diagnosed as having BK nephropathy. No patients were diagnosed as having pneumocystis infection, cytomegalovirus disease, herpes simplex, varicella zoster, or fungal infection. One-year graft and patient survival was 94.8% and 100%, respectively. CONCLUSIONS In our series of ABOi-KTs, we observed a low risk of infectious complications and excellent patient survival. High-dose IVIG might have reduced infections.
Collapse
Affiliation(s)
- Y Shah
- King Faisal Specialist Hospital & Research Center, Department of Kidney and Pancreas Transplant, Riyadh, Saudi Arabia
| | - K Almeshari
- King Faisal Specialist Hospital & Research Center, Department of Kidney and Pancreas Transplant, Riyadh, Saudi Arabia
| | - D Broering
- King Faisal Specialist Hospital & Research Center, Department of Kidney and Pancreas Transplant, Riyadh, Saudi Arabia
| | - H Aleid
- King Faisal Specialist Hospital & Research Center, Department of Kidney and Pancreas Transplant, Riyadh, Saudi Arabia
| | - J Brockmann
- King Faisal Specialist Hospital & Research Center, Department of Kidney and Pancreas Transplant, Riyadh, Saudi Arabia
| | - H Alhumaidan
- King Faisal Specialist Hospital & Research Center, Department of Kidney and Pancreas Transplant, Riyadh, Saudi Arabia
| | - E Hammad
- King Faisal Specialist Hospital & Research Center, Department of Kidney and Pancreas Transplant, Riyadh, Saudi Arabia
| | - H Elgamal
- King Faisal Specialist Hospital & Research Center, Department of Kidney and Pancreas Transplant, Riyadh, Saudi Arabia
| | - I Alahmadi
- King Faisal Specialist Hospital & Research Center, Department of Kidney and Pancreas Transplant, Riyadh, Saudi Arabia
| | - M Hussein
- King Faisal Specialist Hospital & Research Center, Department of Kidney and Pancreas Transplant, Riyadh, Saudi Arabia
| | - I Ibrahim
- King Faisal Specialist Hospital & Research Center, Department of Kidney and Pancreas Transplant, Riyadh, Saudi Arabia
| | - T Ali
- King Faisal Specialist Hospital & Research Center, Department of Kidney and Pancreas Transplant, Riyadh, Saudi Arabia.
| |
Collapse
|
53
|
Jha V, Bhalla AK, Anil Kumar BT, Chauhan M, Das P, Gandhi B, Hegde U, Jeloka T, Mali M, Jha P, Kher A, Mukkavilli K, Ramachandran R. ABO-incompatible kidney transplantation: Indian working group recommendations. INDIAN JOURNAL OF TRANSPLANTATION 2019. [DOI: 10.4103/ijot.ijot_39_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
54
|
Kosoku A, Uchida J, Nishide S, Kabei K, Shimada H, Iwai T, Kuwabara N, Maeda K, Naganuma T, Kumada N, Takemoto Y, Ishihara T, Shintani A, Nakatani T. ABO-incompatible kidney transplantation as a renal replacement therapy-A single low-volume center experience in Japan. PLoS One 2018; 13:e0208638. [PMID: 30596663 PMCID: PMC6312268 DOI: 10.1371/journal.pone.0208638] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 11/20/2018] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Living donor kidney transplantation is preferable to deceased donor transplantation due to its superior long-term patient and graft survivals. However, ABO blood group incompatibility is a major barrier to living donor kidney transplantation. ABO-incompatible kidney transplantation has been performed in Japan since the late 1980's, but it is still globally uncommon. The objective of this study is to compare the clinical outcomes of ABO-incompatible kidney transplantation (ABO-IKT) with that of ABO-compatible kidney transplantation (ABO-CKT) at an institution where only about two kidney transplants are performed a month on average. DESIGN A single center propensity score-matched cohort study. PATIENTS AND METHODS We retrospectively collected and analyzed the data of 240 patients with end-stage kidney disease (ESKD) who underwent living donor kidney transplantation at Osaka City University Hospital from January 1999 to December 2016, of which 66 patients were ABO-IKT. The remaining 174 patients who underwent ABO-CKT were studied as the control group, and the clinical outcomes of ABO-IKT and ABO-CKT recipients were compared based on propensity score matching. RESULTS After propensity score matching, there were no significant differences in both patient survival and death-censored graft survival rates between the ABO-IKT and ABO-CKT groups. Moreover, there were no significant differences in estimated glomerular filtration rate as well as frequency of acute cellular rejection, antibody-mediated rejection, infectious adverse events, malignancies, and post-operative bleeding between the two groups. CONCLUSION Currently, ABO-IKT may be an acceptable treatment for patients with ESKD even at a low-volume transplant center.
Collapse
Affiliation(s)
- Akihiro Kosoku
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Junji Uchida
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
- * E-mail:
| | - Shunji Nishide
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kazuya Kabei
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hisao Shimada
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tomoaki Iwai
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Nobuyuki Kuwabara
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Keiko Maeda
- Department of Nursing, Osaka City University Hospital, Osaka, Japan
| | - Toshihide Naganuma
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Norihiko Kumada
- Department of Urology, Suita Municipal Hospital, Suita, Japan
| | - Yoshiaki Takemoto
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takuma Ishihara
- Innovative and Clinical Research Promotion Center, Gifu University Hospital, Gifu, Japan
| | - Ayumi Shintani
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tatsuya Nakatani
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
55
|
Iwami D, Miura M, Chiba Y, Ota M, Matsumoto T, Hotta K, Sasaki H, Hirose T, Harada H, Shinohara N. Optimal Settings for Double Filtration Plasmapheresis With Targeted Removal Rate of Preexisting Antibody in Antibody-Incompatible Kidney Transplant. Transplant Proc 2018; 50:3478-3482. [DOI: 10.1016/j.transproceed.2018.05.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/23/2018] [Indexed: 11/24/2022]
|
56
|
Aikawa A. Current status and future aspects of kidney transplantation in Japan. RENAL REPLACEMENT THERAPY 2018. [DOI: 10.1186/s41100-018-0186-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
57
|
Outcomes of Pediatric ABO-incompatible Living Kidney Transplantations From 2002 to 2015: An Analysis of the Japanese Kidney Transplant Registry. Transplantation 2018; 102:1934-1942. [DOI: 10.1097/tp.0000000000002259] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
58
|
Nishimura H, Yamada Y, Hisano S, Mitsuke A, Tatarano S, Gotanda T, Hayami H, Nakagawa M, Enokida H. Long-term desensitization for ABO-incompatible living related kidney transplantation recipients with high refractory and rebound anti-blood type antibody: case report. BMC Nephrol 2018; 19:254. [PMID: 30290778 PMCID: PMC6173835 DOI: 10.1186/s12882-018-1053-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 09/20/2018] [Indexed: 12/28/2022] Open
Abstract
Background ABO-incompatible living related kidney transplantation (ABO-iLKT) has increased the possibilities for kidney transplantation in patients with end stage renal disease. Due to advancements in immunosuppressive agents and the identification of immunological conditions following ABO-iLKT, this transplantation technique has achieved the same success rate as ABO-compatible LKT. However, some patients continue to generate anti-blood type antibodies, despite conventional immunosuppressant treatment. Case presentation A 60-year-old man was referred to our hospital for kidney transplantation. The proposed transplant was ABO incompatible, from a donor with blood-type A to a recipient with blood-type O. The recipient’s anti-A blood-type IgG antibody titer was measured at 4096-fold dilution. Following desensitization therapy, including mycophenolate mofetil (MMF) 750 mg/day for 3 months, intravenous Rituximab 200 mg, and two sessions of double filtration plasmapheresis, the anti-A blood-type IgG antibody titer decreased to only 516-fold dilution and did not meet our target of less than 128-fold dilution. MMF was thus continued for an additional 4 months and four additional sessions of plasmapheresis were undertaken. Following these interventions, antibody titers decreased to 128-fold dilution and ABO-iLKT was performed. Following transplant, antibody-mediated rejection was not observed and renal function was preserved. However, a post-operative renal biopsy 1.5 months later showed evidence of T-cell-mediated rejection IB. The patient was treated with steroids, with no increase in serum creatinine. Conclusion Our findings suggest that the long-term single MMF desensitization therapy could be a suitable option for ABO-iLKT with high refractory and rebound anti-blood type antibody. Further studies are required to establish the optimal immunosuppression regimen to control B cell- mediated immunity in ABO-iLKT.
Collapse
Affiliation(s)
- Hiroaki Nishimura
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Yasutoshi Yamada
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Satoshi Hisano
- Department of Pathology, Fukuoka University school of Medicine, Fukuoka, Japan
| | - Akihiko Mitsuke
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Syuichi Tatarano
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Takenari Gotanda
- Department of Urology, Kagoshima City Hospital, Kagoshima, Japan
| | - Hiroshi Hayami
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Masayuki Nakagawa
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Hideki Enokida
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
| |
Collapse
|
59
|
Uchida J, Iwai T, Nishide S, Kabei K, Kuwabara N, Naganuma T, Kumada N, Takemoto Y, Nakatani T. Pilot Conversion Study From Mycophenolate Mofetil to Everolimus in Stable ABO-Incompatible Kidney Transplant Recipients: Analysis of 1-Year Follow-Up Data. EXP CLIN TRANSPLANT 2018; 17:190-195. [PMID: 30198840 DOI: 10.6002/ect.2017.0200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Here, we report our 1-year follow-up data of stable ABO-incompatible kidney transplant recipients who converted from mycophenolate mofetil plus a standard dose of a calcineurin inhibitor to everolimus plus low exposure to calcineurin inhibitors. MATERIALS AND METHODS Our study included 17 recipients of ABO-incompatible kidney transplant procedures performed at our institution. At baseline and at 3 and 12 months after conversion, graft biopsies were performed to check for acute rejection and C4d deposition. RESULTS Treatment with everolimus was stopped due to adverse events in 8 patients (47.1%). Conversion to everolimus with calcineurin inhibitor minimization did not induce acute rejection or C4d deposition at 3 and 12 months after conversion in ABO-incompatible kidney transplant recipients in whom everolimus was maintained or stopped within 1 year after conversion. CONCLUSIONS Everolimus elicited no acute rejection and no C4d deposition, whether everolimus was maintained or stopped within 1 year after conversion, in ABO-incompatible kidney transplant recipients.
Collapse
Affiliation(s)
- Junji Uchida
- From the Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
60
|
de Weerd AE, Betjes MGH. ABO-Incompatible Kidney Transplant Outcomes: A Meta-Analysis. Clin J Am Soc Nephrol 2018; 13:1234-1243. [PMID: 30012630 PMCID: PMC6086717 DOI: 10.2215/cjn.00540118] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/03/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES ABO blood group-incompatible kidney transplantation is considered a safe procedure, with noninferior outcomes in large cohort studies. Its contribution to living kidney transplantation programs is substantial and growing. Outcomes compared with center-matched ABO blood group-compatible control patients have not been ascertained. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Comprehensive searches were conducted in Embase, Medline, Cochrane, Web-of-Science, and Google Scholar. Meta-analyses Of Observational Studies in Epidemiology study guidelines for observational studies and Newcastle Ottawa bias scale were implemented to assess studies. Meta-analysis was performed using Review Manager 5.3. A subgroup analysis on antibody removal technique was performed. RESULTS After identifying 2728 studies addressing ABO-incompatible kidney transplantation, 26 studies were included, describing 1346 unique patients who were ABO-incompatible and 4943 ABO-compatible controls. Risk of bias was low (all studies ≥7 of 9 stars). Baseline patient characteristics revealed no significant differences in immunologic risk parameters. Statistical heterogeneity of studies was low (I2 0% for graft and patient survival). One-year uncensored graft survival of patients who were ABO-incompatible was 96% versus 98% in ABO-compatible controls (relative risk, 0.97; 95% confidence interval, 0.96 to 0.98; P<0.001). Forty-nine percent of reported causes of death in patients who were ABO-incompatible were of infectious origin, versus only 13% in patients who were ABO-compatible (P=0.02). Antibody-mediated rejection (3.86; 95% confidence interval, 2.05 to 7.29; P<0.001), severe nonviral infection (1.44; 95% confidence interval, 1.13 to 1.82; P=0.003), and bleeding (1.92; 95% confidence interval, 1.36 to 2.72; P<0.001) were also more common after ABO-incompatible transplantation. CONCLUSIONS ABO-incompatible kidney transplant recipients have good outcomes, albeit inferior to center-matched ABO-compatible control patients.
Collapse
Affiliation(s)
- Annelies E de Weerd
- Department of Nephrology and Kidney Transplantation, Erasmus Medical Center, Rotterdam, The Netherlands
| | | |
Collapse
|
61
|
Desensitization with the Use of an Antibody Removal–Free Protocol in ABO-Incompatible Kidney Transplant Recipients with a Low Anti-A/B Antibody Titer. Transplant Proc 2018; 50:982-986. [DOI: 10.1016/j.transproceed.2018.01.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 01/06/2018] [Accepted: 01/30/2018] [Indexed: 12/30/2022]
|
62
|
Mustian MN, Cannon RM, MacLennan PA, Reed RD, Shelton BA, McWilliams DM, Deierhoi MH, Locke JE. Landscape of ABO-Incompatible Live Donor Kidney Transplantation in the US. J Am Coll Surg 2018; 226:615-621. [PMID: 29309944 PMCID: PMC5869103 DOI: 10.1016/j.jamcollsurg.2017.12.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 12/13/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Widespread implementation of ABO-incompatible (ABOi) living donor kidney transplantation (LDKT) has been proposed as a means to partially ameliorate the national shortage of deceased donor kidneys. Acceptance of this practice has been encouraged by reports from experienced centers demonstrating acute rejection (AR) rates similar to those obtained with ABO-compatible (ABOc) LDKT. Acute rejection rate and graft survival after ABOi LDKT on a national level have yet to be fully determined. STUDY DESIGN We studied adult (>18 years) LDKT recipients, from 2000 to 2015, reported to the Scientific Registry of Transplant Recipients. Acute rejection rates in the first post-transplant year (modified Poisson regression) and graft survival (Cox proportional hazards) were assessed by ABO compatibility status (ABOi: 930; ABOc: 89,713). RESULTS Patients undergoing ABOi LDKT had an AR rate of 19.4% compared with 10.5% for ABOc recipients (p < 0.0001). After adjusting for recipient- and donor-related risk factors, patients undergoing ABOi LDKT were found to have a 1.76-fold greater risk for AR within 1 year of transplantation compared with ABOc LDKT recipients (adjusted relative risk [aRR] 1.76; 95% CI 1.54 to 2.01). Moreover, there was a 2.34-fold greater risk of death-censored graft loss at 1-year post-transplant among ABOi vs ABOc LDKT recipients (adjusted hazard ratio [aHR] 2.34; 95% CI 1.85 to 2.96). CONCLUSIONS Based on these findings, the low rates of AR and excellent short-term graft survival presented in single center series may not be sustainable on a national level. These findings highlight the potential utility for identification of centers of excellence and regionalization of ABOi LDKT.
Collapse
Affiliation(s)
- Margaux N Mustian
- Department of Surgery, Division of Transplantation, University of Alabama at Birmingham, Birmingham, AL
| | - Robert M Cannon
- Department of Surgery, Division of Transplantation, University of Louisville, Louisville, KY
| | - Paul A MacLennan
- Department of Surgery, Division of Transplantation, University of Alabama at Birmingham, Birmingham, AL
| | - Rhiannon D Reed
- Department of Surgery, Division of Transplantation, University of Alabama at Birmingham, Birmingham, AL
| | - Brittany A Shelton
- Department of Surgery, Division of Transplantation, University of Alabama at Birmingham, Birmingham, AL
| | - Deanna M McWilliams
- Department of Surgery, Division of Transplantation, University of Alabama at Birmingham, Birmingham, AL
| | - Mark H Deierhoi
- Department of Surgery, Division of Transplantation, University of Alabama at Birmingham, Birmingham, AL
| | - Jayme E Locke
- Department of Surgery, Division of Transplantation, University of Alabama at Birmingham, Birmingham, AL.
| |
Collapse
|
63
|
Emergency Kidney Transplantation in Recipients With Iliocaval Thrombosis Using Splenic Vessel Anastomosis After Splenectomy: A Case Series. Transplant Proc 2018; 50:99-103. [PMID: 29407339 DOI: 10.1016/j.transproceed.2017.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/17/2017] [Accepted: 12/05/2017] [Indexed: 11/18/2022]
|
64
|
Evaluation of Microvascular Inflammation in ABO-Incompatible Kidney Transplantation. Transplantation 2017; 101:1423-1432. [PMID: 27495756 DOI: 10.1097/tp.0000000000001403] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND In ABO-incompatible kidney transplantation, the diagnostic criteria for antibody-mediated rejection remain controversial because C4d deposition is commonly observed. Thus, we investigated microvascular inflammation (MVI score ≥ 2) within 1 year as a predictor of graft outcome. METHODS A total of 148 recipients without preformed or de novo donor-specific anti-HLA antibody were stratified based on MVI score less than 2 (n = 117) and MVI score of 2 or greater (n = 31). RESULTS We found that 5-year graft survival was significantly lower (P = 0.0129) in patients with MVI (89.8%) than in patients without MVI (97.0%). Graft function, as characterized by serum estimated glomerular filtration rate, was also significantly worse for patients with MVI than it was for patients without MVI, between 3 months and 10 years after transplantation (P = 0.048). Multivariate analysis indicated that HLA class II mismatch (P = 0.0085) was an independent marker of MVI. CONCLUSIONS Microvascular inflammation score of 2 or greater is significantly associated with poor graft outcome after ABO-incompatible kidney transplantation. We suggest that MVI score of 2 or greater in ABOi transplantation be used as a basis to diagnose antibody-mediated rejection.
Collapse
|
65
|
Lentine KL, Kasiske BL, Levey AS, Adams PL, Alberú J, Bakr MA, Gallon L, Garvey CA, Guleria S, Li PKT, Segev DL, Taler SJ, Tanabe K, Wright L, Zeier MG, Cheung M, Garg AX. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation 2017; 101:S1-S109. [PMID: 28742762 PMCID: PMC5540357 DOI: 10.1097/tp.0000000000001769] [Citation(s) in RCA: 207] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 03/20/2017] [Indexed: 12/17/2022]
Abstract
The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors is intended to assist medical professionals who evaluate living kidney donor candidates and provide care before, during and after donation. The guideline development process followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach and guideline recommendations are based on systematic reviews of relevant studies that included critical appraisal of the quality of the evidence and the strength of recommendations. However, many recommendations, for which there was no evidence or no systematic search for evidence was undertaken by the Evidence Review Team, were issued as ungraded expert opinion recommendations. The guideline work group concluded that a comprehensive approach to risk assessment should replace decisions based on assessments of single risk factors in isolation. Original data analyses were undertaken to produce a "proof-in-concept" risk-prediction model for kidney failure to support a framework for quantitative risk assessment in the donor candidate evaluation and defensible shared decision making. This framework is grounded in the simultaneous consideration of each candidate's profile of demographic and health characteristics. The processes and framework for the donor candidate evaluation are presented, along with recommendations for optimal care before, during, and after donation. Limitations of the evidence are discussed, especially regarding the lack of definitive prospective studies and clinical outcome trials. Suggestions for future research, including the need for continued refinement of long-term risk prediction and novel approaches to estimating donation-attributable risks, are also provided.In citing this document, the following format should be used: Kidney Disease: Improving Global Outcomes (KDIGO) Living Kidney Donor Work Group. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation. 2017;101(Suppl 8S):S1-S109.
Collapse
Affiliation(s)
| | | | | | | | - Josefina Alberú
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | | | | | - Dorry L. Segev
- Johns Hopkins University, School of Medicine, Baltimore, MD
| | | | | | | | | | | | | |
Collapse
|
66
|
Ko EJ, Yu JH, Yang CW, Chung BH. Clinical outcomes of ABO- and HLA-incompatible kidney transplantation: a nationwide cohort study. Transpl Int 2017; 30:1215-1225. [PMID: 28493630 DOI: 10.1111/tri.12979] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/13/2017] [Accepted: 05/05/2017] [Indexed: 12/26/2022]
Abstract
This was a nationwide cohort study to investigate the impact of anti-A/B and donor-specific anti-HLA (HLA-DSA) antibodies on the clinical outcomes in kidney transplant recipients (KTRs). We classified a total of 1964 KTRs into four groups: transplants from ABO-incompatible donors (ABOi, n = 248); transplants in recipients with HLA-DSA (HLAi, n = 144); transplants from combined ABOi and HLAi donors (ABOi + HLAi, n = 31); and a control group for whom neither ABOi nor HLAi was applicable (CONT, n = 1541). We compared the incidence of biopsy-proven acute rejection (BPAR), allograft and patient survival rates. The incidence of BPAR was higher in the HLAi and ABOi + HLAi groups relative to the CONT group; in contrast, it was not higher in the ABOi group. Death-censored graft survival rates did not differ across the four groups. However, relative to the CONT group, patient survival rate was reduced in the ABOi and ABOi + HLAi groups, and with infection being the most common cause of death. Further, multivariable analysis revealed that desensitization therapy because of ABOi or HLAi was independent risk factors for patient mortality. HLAi was a more important risk factor for BPAR compared with ABOi. However, pretransplant desensitization therapy for either ABOi or HLAi significantly increased the risk of infection-related mortality.
Collapse
Affiliation(s)
- Eun Jeong Ko
- Transplantation Research Centre, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Hyun Yu
- Transplantation Research Centre, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chul Woo Yang
- Transplantation Research Centre, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byung Ha Chung
- Transplantation Research Centre, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | |
Collapse
|
67
|
Lonze BE, Bae S, Kraus ES, Holechek MJ, King KE, Alachkar N, Naqvi FF, Dagher NN, Sharif A, Desai NM, Segev DL, Montgomery RA. Outcomes and risk stratification for late antibody-mediated rejection in recipients of ABO-incompatible kidney transplants: a retrospective study. Transpl Int 2017; 30:874-883. [DOI: 10.1111/tri.12969] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 10/20/2016] [Accepted: 03/27/2017] [Indexed: 12/29/2022]
Affiliation(s)
- Bonnie E. Lonze
- Transplant Institute; NYU Langone Medical Center; New York NY USA
| | - Sunjae Bae
- Department of Surgery; The Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Edward S. Kraus
- Department of Medicine; The Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Mary J. Holechek
- Department of Surgery; The Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Karen E. King
- Department of Pathology; The Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Nada Alachkar
- Department of Medicine; The Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Fizza F. Naqvi
- Department of Medicine; The Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Nabil N. Dagher
- Transplant Institute; NYU Langone Medical Center; New York NY USA
| | - Adnan Sharif
- Department of Nephrology and Transplantation; Queen Elizabeth Hospital Birmingham; Birmingham UK
| | - Niraj M. Desai
- Department of Surgery; The Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Dorry L. Segev
- Department of Surgery; The Johns Hopkins University School of Medicine; Baltimore MD USA
- Department of Epidemiology; The Johns Hopkins University School of Public Health; Baltimore MD USA
| | | |
Collapse
|
68
|
Chow KV, Flint SM, Shen A, Landgren A, Finlay M, Murugasu A, Masterson R, Hughes P, Cohney SJ. Histological and Extended Clinical Outcomes After ABO-Incompatible Renal Transplantation Without Splenectomy or Rituximab. Transplantation 2017; 101:1433-1440. [DOI: 10.1097/tp.0000000000001415] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
69
|
Tasaki M, Saito K, Nakagawa Y, Imai N, Ito Y, Aoki T, Kamimura M, Narita I, Tomita Y, Takahashi K. Acquired Downregulation of Donor-Specific Antibody Production After ABO-Incompatible Kidney Transplantation. Am J Transplant 2017; 17:115-128. [PMID: 27343838 DOI: 10.1111/ajt.13937] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 05/31/2016] [Accepted: 06/21/2016] [Indexed: 01/25/2023]
Abstract
The mechanism of long-term B cell immunity against donor blood group antigens in recipients who undergo ABO-incompatible (ABOi) living-donor kidney transplantation (LKTx) is unknown. To address this question, we evaluated serial anti-A and anti-B antibody titers in 50 adult recipients. Donor-specific antibody titers remained low (≤1:4) in 42 recipients (84%). However, antibodies against nondonor blood group antigens were continuously produced in recipients with blood type O. We stimulated recipients' peripheral blood mononuclear cells in vitro to investigate whether B cells produced antibodies against donor blood group antigens in the absence of graft adsorption in vivo. Antibodies in cell culture supernatant were measured using specific enzyme-linked immunosorbent assays (ELISAs). Thirty-five healthy volunteers and 57 recipients who underwent ABO-compatible LKTx served as controls. Antibody production in vitro against donor blood group antigens by cells from ABOi LKTx patients was lower than in the control groups. Immunoglobulin deposits were undetectable in biopsies of grafts of eight recipients with low antibody titers (≤1:4) after ABOi LKTx. One patient with blood type A1 who received a second ABOi LKTx from a type B donor did not produce B-specific antibodies. These findings suggest diminished donor-specific antibody production function in the setting of adult ABOi LKTx.
Collapse
Affiliation(s)
- M Tasaki
- Division of Urology, Department of Regenerative & Transplant Medicine, Niigata Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - K Saito
- Division of Urology, Department of Regenerative & Transplant Medicine, Niigata Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Y Nakagawa
- Division of Urology, Department of Regenerative & Transplant Medicine, Niigata Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - N Imai
- Division of Clinical Nephrology and Rheumatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Y Ito
- Division of Clinical Nephrology and Rheumatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - T Aoki
- Division of Transfusion Medicine and Regenerative Medicine, Bioscience Medical Center, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - M Kamimura
- Division of Transfusion Medicine and Regenerative Medicine, Bioscience Medical Center, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - I Narita
- Division of Clinical Nephrology and Rheumatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Y Tomita
- Division of Urology, Department of Regenerative & Transplant Medicine, Niigata Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - K Takahashi
- Division of Urology, Department of Regenerative & Transplant Medicine, Niigata Graduate School of Medical and Dental Sciences, Niigata, Japan.,Niigata Prefecture Organ Transplant Promotion Foundation, Tokyo, Japan
| |
Collapse
|
70
|
Iwasaki K, Miwa Y, Uchida K, Kodera Y, Kobayashi T. Negative regulation of HLA-DR expression on endothelial cells by anti-blood group A/B antibody ligation and mTOR inhibition. Transpl Immunol 2016; 40:22-30. [PMID: 28017877 DOI: 10.1016/j.trim.2016.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 12/16/2016] [Accepted: 12/20/2016] [Indexed: 02/01/2023]
Abstract
Donor-specific antibody (DSA), particularly against HLA class II, is a major cause of chronic antibody-mediated rejection (CAMR) after transplantation, although ABO-incompatible kidney transplantation has recently demonstrated favorable graft outcomes. The condition of no injury even in the presence of anti-donor antibody has been referred to as "accommodation", which would be one of the key factors for successful long-term graft survival. The purpose of this study was to analyze the beneficial effect of anti-blood group A/B antibody ligation on endothelial cells against HLA-DR antibody-mediated, complement-dependent cytotoxicity (CDC). Blood group A/B-expressing endothelial cells EA.hy926 or Human Umbilical Vein Endothelia Cells (HUVEC) were incubated with IFNγ in the presence or absence of anti-blood group A/B antibody or mTOR inhibitor (mTOR-i) for 48h. The effects on signaling pathway, HLA expression, complement regulatory factors, and CDC were investigated. Expression of HLA-DR on EA.hy926 or HUVEC were successfully elicited by IFNγ treatment, although little or no expression was observed in quiescent cells. Pre-incubation with anti-blood group A/B antibody had resistance to HLA-DR antibody-mediated CDC against IFNγ-treated cells in a concentration-dependent manner. This finding was ascribed to decreased expression of HLA-DR by post-translational regulation and increased expression of CD55/59, which was related to ERK and mTOR pathway inhibition. mTOR-i also inhibited HLA-DR expression by itself. Furthermore, the combination of mTOR-I and anti-blood group A/B ligation had an additive effect in preventing HLA-DR antibody-mediated CDC. Anti-blood group A/B antibody might play a preventive role in CAMR. Inhibition of the ERK and mTOR pathways may contribute to the development of a novel treatment in the maintenance period after transplantation.
Collapse
Affiliation(s)
- Kenta Iwasaki
- Department of Kidney Disease and Transplant Immunology, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan.
| | - Yuko Miwa
- Department of Kidney Disease and Transplant Immunology, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Kazuharu Uchida
- Department of Kidney Disease and Transplant Immunology, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takaaki Kobayashi
- Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagoya, Japan.
| |
Collapse
|
71
|
Ray D, Thukral S. Outcome of ABO-Incompatible Living Donor Renal Transplantations: A Single-Center Experience From Eastern India. Transplant Proc 2016; 48:2622-2628. [DOI: 10.1016/j.transproceed.2016.06.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 06/22/2016] [Indexed: 02/08/2023]
|
72
|
Snell GI, Davis AK, Menahem S, Kotecha S, Whitford HM, Levvey BJ, Paraskeva M, Webb A, Westall GW, Walker RG. ABO incompatible renal transplantation following lung transplantation. Transpl Immunol 2016; 39:30-33. [PMID: 27663090 DOI: 10.1016/j.trim.2016.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 08/10/2016] [Accepted: 09/17/2016] [Indexed: 11/28/2022]
Abstract
We present management strategies utilised for the first case of an urgent live-donor ABO incompatible B blood group renal transplant, in a patient with a prior A blood group lung transplant for cystic fibrosis. Three years on, renal function is excellent and stable, whilst lung function has improved.
Collapse
Affiliation(s)
- G I Snell
- Lung Transplant Service, Alfred Hospital and Monash University, Melbourne, Australia.
| | - A K Davis
- Department of Haematology, Alfred Hospital and Monash University, Melbourne, Australia
| | - S Menahem
- Department of Renal Medicine, Alfred Hospital and Monash University, Melbourne, Australia
| | - S Kotecha
- Lung Transplant Service, Alfred Hospital and Monash University, Melbourne, Australia
| | - H M Whitford
- Lung Transplant Service, Alfred Hospital and Monash University, Melbourne, Australia
| | - B J Levvey
- Lung Transplant Service, Alfred Hospital and Monash University, Melbourne, Australia
| | - M Paraskeva
- Lung Transplant Service, Alfred Hospital and Monash University, Melbourne, Australia
| | - A Webb
- Department of Haematology, Alfred Hospital and Monash University, Melbourne, Australia
| | - G W Westall
- Lung Transplant Service, Alfred Hospital and Monash University, Melbourne, Australia
| | - R G Walker
- Department of Renal Medicine, Alfred Hospital and Monash University, Melbourne, Australia
| |
Collapse
|
73
|
|
74
|
Takahashi K, Saito K, Takahara S, Fuchinoue S, Yagisawa T, Aikawa A, Watarai Y, Yoshimura N, Tanabe K, Morozumi K, Shimazu M. Results of a multicenter prospective clinical study in Japan for evaluating efficacy and safety of desensitization protocol based on rituximab in ABO-incompatible kidney transplantation. Clin Exp Nephrol 2016; 21:705-713. [DOI: 10.1007/s10157-016-1321-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 08/04/2016] [Indexed: 02/01/2023]
|
75
|
Ogata H, Akizawa T, Kinugasa E. What are the Newer Applications for Therapeutic Apheresis in Nephrology?: Clinical Application of Therapeutic Apheresis in Nephrology in Japan. Semin Dial 2016; 29:359-65. [PMID: 27461967 DOI: 10.1111/sdi.12525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Hiroaki Ogata
- Department of Internal Medicine, Showa University Northern Yokohama Hospital, Yokohama, Japan.
| | - Tadao Akizawa
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Eriko Kinugasa
- Department of Internal Medicine, Showa University Northern Yokohama Hospital, Yokohama, Japan
| |
Collapse
|
76
|
Sánchez-Escuredo A, Oppenheimer F, Solé M, Revuelta I, Cid J, Lozano M, Blasco M, Esforzado N, Ricart MJ, Cofán F, Torregrosa JV, Paredes D, Musquera M, Ercilla G, Campistol JM, Diekmann F. Borderline rejection in ABO-incompatible kidney transplantation. Clin Transplant 2016; 30:872-9. [DOI: 10.1111/ctr.12759] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2016] [Indexed: 12/26/2022]
Affiliation(s)
- Anna Sánchez-Escuredo
- Nephrology and Renal Transplant Department; Hospital Clinic; Universitat de Barcelona; Barcelona Spain
| | - Federico Oppenheimer
- Nephrology and Renal Transplant Department; Hospital Clinic; Universitat de Barcelona; Barcelona Spain
| | - Manel Solé
- Pathology Department; Hospital Clinic; Universitat de Barcelona; Barcelona Spain
| | - Ignacio Revuelta
- Nephrology and Renal Transplant Department; Hospital Clinic; Universitat de Barcelona; Barcelona Spain
| | - Joan Cid
- Apheresis Unit; Hemotherapy and Hemostasis Department; CDB; IDIBAPS Hospital Clinic; University of Barcelona; Barcelona Spain
| | - Miguell Lozano
- Apheresis Unit; Hemotherapy and Hemostasis Department; CDB; IDIBAPS Hospital Clinic; University of Barcelona; Barcelona Spain
| | - Miquel Blasco
- Nephrology and Renal Transplant Department; Hospital Clinic; Universitat de Barcelona; Barcelona Spain
| | - Nuria Esforzado
- Nephrology and Renal Transplant Department; Hospital Clinic; Universitat de Barcelona; Barcelona Spain
| | - Maria Jose Ricart
- Nephrology and Renal Transplant Department; Hospital Clinic; Universitat de Barcelona; Barcelona Spain
| | - Federico Cofán
- Nephrology and Renal Transplant Department; Hospital Clinic; Universitat de Barcelona; Barcelona Spain
| | - Josep Vicens Torregrosa
- Nephrology and Renal Transplant Department; Hospital Clinic; Universitat de Barcelona; Barcelona Spain
| | - David Paredes
- Transplant Service Foundation; Hospital Clinic; Universitat de Barcelona; Barcelona Spain
| | - Mireia Musquera
- Urology Department; Hospital Clinic; Universitat de Barcelona; Barcelona Spain
| | - Guadalupe Ercilla
- Immunology Department; Hospital Clinic; Universitat de Barcelona; Barcelona Spain
| | - Josep M. Campistol
- Nephrology and Renal Transplant Department; Hospital Clinic; Universitat de Barcelona; Barcelona Spain
| | - Fritz Diekmann
- Nephrology and Renal Transplant Department; Hospital Clinic; Universitat de Barcelona; Barcelona Spain
| |
Collapse
|
77
|
Drexler B, Holbro A, Sigle J, Gassner C, Frey BM, Schaub S, Amico P, Plattner A, Infanti L, Menter T, Mihatsch MJ, Stern M, Buser A, Dickenmann M. Impact of donor ABH-secretor status in ABO-mismatched living donor kidney transplantation. Transfusion 2016; 56:2355-61. [PMID: 27397630 DOI: 10.1111/trf.13711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 03/22/2016] [Accepted: 04/25/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND The ABO blood group is a major determinant in living donor kidney transplantation since AB antigens are expressed on renal tissue. Little attention has been directed to the ABH-secretor status of the donor kidney. As renal tissue is capable of secreting soluble ABH antigens in secretors, we examined the influence of the ABH-secretor status of kidney donors on outcome in ABO-mismatched living donor kidney transplantation. STUDY DESIGN AND METHODS We retrospectively analyzed all patients who underwent ABO-mismatched kidney transplantation at the University Hospital Basel from September 2005 to October 2013. The ABH-secretor status was determined in all donors by molecular genetic analysis. RESULTS Of all 55 patients who received transplants, we excluded all patients with donor-specific antibodies (n = 4). Forty-one donors were secretors (78%) and 11 were nonsecretors (22%). Recipients of ABH-secretor donor organs showed a significantly higher glomerular filtration rate throughout the first 6 months posttransplant, whereas no significant influence on posttransplant anti-A/B titers was found. Regression analysis revealed a significant impact on humoral rejection, whereas not on vascular or interstitial rejection in protocol kidney biopsies. CONCLUSION The donor ABH-secretor status may have an influence on early posttransplant renal function in patients undergoing ABO-mismatched living donor kidney transplantation. Further prospective studies with long-term follow-up are needed to elucidate involved pathomechanisms.
Collapse
Affiliation(s)
- Beatrice Drexler
- Department of Haematology, University Hospital Basel, Basel. .,Blood Transfusion Centre, Swiss Red Cross, Basel, Switzerland.
| | - Andreas Holbro
- Department of Haematology, University Hospital Basel, Basel.,Blood Transfusion Centre, Swiss Red Cross, Basel, Switzerland
| | - Joerg Sigle
- Blood Transfusion Centre, Swiss Red Cross, Aarau, Switzerland
| | | | - Beat M Frey
- Blood Transfusion Service, Swiss Red Cross, Zurich, Switzerland
| | | | | | - Alexandra Plattner
- Department of Haematology, University Hospital Basel, Basel.,Blood Transfusion Centre, Swiss Red Cross, Basel, Switzerland
| | - Laura Infanti
- Department of Haematology, University Hospital Basel, Basel.,Blood Transfusion Centre, Swiss Red Cross, Basel, Switzerland
| | - Thomas Menter
- Institute for Pathology, University Hospital Basel, Basel, Switzerland
| | | | - Martin Stern
- Immunotherapy Laboratory, Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Andreas Buser
- Department of Haematology, University Hospital Basel, Basel.,Blood Transfusion Centre, Swiss Red Cross, Basel, Switzerland
| | | |
Collapse
|
78
|
Axelrod D, Segev DL, Xiao H, Schnitzler MA, Brennan DC, Dharnidharka VR, Orandi B, Naik AS, Randall H, Tuttle-Newhall JE, Lentine KL. Economic Impacts of ABO-Incompatible Live Donor Kidney Transplantation: A National Study of Medicare-Insured Recipients. Am J Transplant 2016; 16:1465-73. [PMID: 26603690 PMCID: PMC4844838 DOI: 10.1111/ajt.13616] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/11/2015] [Accepted: 10/02/2015] [Indexed: 01/25/2023]
Abstract
The infrequent use of ABO-incompatible (ABOi) kidney transplantation in the United States may reflect concern about the costs of necessary preconditioning and posttransplant care. Medicare data for 26 500 live donor kidney transplant recipients (2000 to March 2011), including 271 ABOi and 62 A2-incompatible (A2i) recipients, were analyzed to assess the impact of pretransplant, transplant episode and 3-year posttransplant costs. The marginal costs of ABOi and A2i versus ABO-compatible (ABOc) transplants were quantified by multivariate linear regression including adjustment for recipient, donor and transplant factors. Compared with ABOc transplantation, patient survival (93.2% vs. 88.15%, p = 0.0009) and death-censored graft survival (85.4% vs. 76.1%, p < 0.05) at 3 years were lower after ABOi transplant. The average overall cost of the transplant episode was significantly higher for ABOi ($65 080) compared with A2i ($36 752) and ABOc ($32 039) transplantation (p < 0.001), excluding organ acquisition. ABOi transplant was associated with high adjusted posttransplant spending (marginal costs compared to ABOc - year 1: $25 044; year 2: $10 496; year 3: $7307; p < 0.01). ABOi transplantation provides a clinically effective method to expand access to transplantation. Although more expensive, the modest increases in total spending are easily justified by avoiding long-term dialysis and its associated morbidity and cost.
Collapse
Affiliation(s)
- David Axelrod
- Division of Abdominal Transplantation, Department of Surgery, Dartmouth Hitchcock Medical Center, Hanover, NH
| | - Dorry L. Segev
- Division of Abdominal Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD
| | - Huiling Xiao
- Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO
| | - Mark A. Schnitzler
- Division of Abdominal Transplantation, Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO
| | - Daniel C. Brennan
- Transplant Nephrology, Washington University School of Medicine, St. Louis, MO
| | | | - Babak Orandi
- Division of Abdominal Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD
| | - Abhijit S. Naik
- Division of Nephrology, University of Michigan, Ann Arbor, MI
| | - Henry Randall
- Division of Abdominal Transplantation, Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO
| | | | - Krista L. Lentine
- Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO,Division of Abdominal Transplantation, Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO
| |
Collapse
|
79
|
Okumi M, Toki D, Nozaki T, Shimizu T, Shirakawa H, Omoto K, Inui M, Ishida H, Tanabe K. ABO-Incompatible Living Kidney Transplants: Evolution of Outcomes and Immunosuppressive Management. Am J Transplant 2016; 16:886-96. [PMID: 26555133 DOI: 10.1111/ajt.13502] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 08/23/2015] [Accepted: 08/23/2015] [Indexed: 01/25/2023]
Abstract
ABO-incompatible living kidney transplantation (ABO-ILKT) has steadily become more widespread. However, the optimal immunosuppressive regimen for ABO-ILKT remains uncertain. We aimed to determine the longitudinal changes in the outcomes from ABO-ILKT compared with those from ABO-compatible living kidney transplantation (ABO-CLKT) over the last 25 years. Of 1195 patients who underwent living kidney transplantations (LKT) at our institute between 1989 and 2013, 1032-including 247 ABO-ILKT and 785 ABO-CLKT cases-were evaluated for graft survival, patient survival, infectious adverse events, and renal function. The patients were divided into four groups according to the transplantation era and ABO-compatibility. In the past decade, ABO-ILKT and ABO-CLKT recipients yielded almost equivalent outcomes with respect to the 9-year graft survival rates, which were 86.9% and 92.0%, respectively (hazard ratio [HR] 1.38, 95% confidence interval [CI] 0.59-3.22, p = 0.455). The graft survival rate for ABO-ILKT conducted between 2005 and 2013 was better than that for ABO-ILKT conducted between 1998 and 2004 (HR 0.30, 95% CI 0.13-0.72, p = 0.007). ABO-ILKT recipients showed substantial improvements in the graft survival rate over time. Graft survival was almost identical over the past decade, regardless of ABO-incompatibility. Currently, ABO-ILKT is an acceptable treatment for patients with end-stage renal disease.
Collapse
Affiliation(s)
- M Okumi
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - D Toki
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - T Nozaki
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - T Shimizu
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - H Shirakawa
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - K Omoto
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - M Inui
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - H Ishida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - K Tanabe
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
80
|
ABO incompatible renal transplants and decreased likelihood for developing immune responses to HLA and kidney self-antigens. Hum Immunol 2015; 77:76-83. [PMID: 26476207 DOI: 10.1016/j.humimm.2015.10.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 10/12/2015] [Accepted: 10/13/2015] [Indexed: 12/22/2022]
Abstract
Immune responses to HLA and tissue-restricted self-antigens (SAgs) have been proposed to play a role in the pathogenesis of renal allograft (KTx) rejection. However, ABO incompatible (ABOi) KTx recipients (KTxR) following depletion of antibodies (Abs) to blood group antigens had fewer rejections. To determine the mechanisms, pre- and post-transplant sera from ABOi (n=18) and ABO-compatible (ABOc) (n=45) KTxR were analyzed for Abs against HLA class I and II by LABScreen single antigen assay. The development of Abs to SAgs was measured by ELISA. Immunity to Collagen IV (Col-IV) and cytokines induced were measured by ELISPOT. While 8/45 (18%) ABOc KTxR developed new donor specific antibodies to HLA (DSA) following transplantation, 0/18 ABOi KTxR developed DSA. ABOi KTxR failed to develop Abs to kidney SAgs (Col-IV and fibronectin (FN)). In contrast, 7 ABOc KTxR developed Abs to both Col-IV and FN. Col-IV stimulation of lymphocytes from ABOc KTxR demonstrated increased IFNγ, IL-17 and decreased IL-10. In contrast ABOi recipients following stimulation with antigens resulted in more IL10 and reduced IFN-γ and IL17 production. At one year, the GFR in ABOi KTxR were significantly better (p<0.04) than ABOc KTxR. De novo DSA and immune responses to SAgs are reduced or absent in ABOi KTxR which we propose leads to less acute rejection and better long term function following ABOi KTx.
Collapse
|
81
|
Koch M, Wiech T, Marget M, Peine S, Thude H, Achilles EG, Fischer L, Lehnhardt A, Thaiss F, Nashan B. De novomTOR inhibitor-based immunosuppression in ABO-incompatible kidney transplantation. Clin Transplant 2015; 29:1021-8. [DOI: 10.1111/ctr.12624] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2015] [Indexed: 01/05/2023]
Affiliation(s)
- Martina Koch
- Department of Hepatobiliary Surgery and Transplantation; Universitätsklinikum Hamburg Eppendorf; Hamburg Germany
| | - Thorsten Wiech
- Section Nephropathology; Institute of Pathology; Universitätsklinikum Hamburg Eppendorf; Hamburg Germany
| | - Matthias Marget
- HLA Laboratory; Institute of Transfusion Medicine; Universitätsklinikum Hamburg Eppendorf; Hamburg Germany
| | - Sven Peine
- HLA Laboratory; Institute of Transfusion Medicine; Universitätsklinikum Hamburg Eppendorf; Hamburg Germany
| | - Hansjörg Thude
- Department of Hepatobiliary Surgery and Transplantation; Universitätsklinikum Hamburg Eppendorf; Hamburg Germany
| | - Eike G. Achilles
- Department of Hepatobiliary Surgery and Transplantation; Universitätsklinikum Hamburg Eppendorf; Hamburg Germany
| | - Lutz Fischer
- Department of Hepatobiliary Surgery and Transplantation; Universitätsklinikum Hamburg Eppendorf; Hamburg Germany
| | - Anja Lehnhardt
- Department of Hepatobiliary Surgery and Transplantation; Universitätsklinikum Hamburg Eppendorf; Hamburg Germany
| | - Friedrich Thaiss
- III. Medical Clinic/Nephrology; Universitätsklinikum Hamburg Eppendorf; Hamburg Germany
| | - Bjoern Nashan
- Department of Hepatobiliary Surgery and Transplantation; Universitätsklinikum Hamburg Eppendorf; Hamburg Germany
| |
Collapse
|
82
|
Sethi SK, Jha P, Bansal SB, Kher V. Overcoming the ABO incompatibility barrier in pediatric renal transplantation. Indian Pediatr 2015; 52:704-6. [DOI: 10.1007/s13312-015-0702-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
|
83
|
Koo TY, Yang J. Current progress in ABO-incompatible kidney transplantation. Kidney Res Clin Pract 2015; 34:170-9. [PMID: 26484043 PMCID: PMC4608875 DOI: 10.1016/j.krcp.2015.08.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 08/12/2015] [Accepted: 08/12/2015] [Indexed: 02/07/2023] Open
Abstract
ABO-incompatible kidney transplantation (ABOi KT) was introduced to expand the donor pool and minimize shortage of kidneys for transplantation. Because improved outcomes of ABOi KT were reported in Japan in the early 2000s, the number of ABOi KTs has been increasing worldwide. In addition, a better understanding of immune pathogenesis and subsequent aggressive immunosuppression has helped to make effective desensitization protocols. Current strategies of ABOi KT consist of pretransplant antibody removal using plasmapheresis or immunoadsorption to prevent hyperacute rejection and potent maintenance immunosuppression, such as tacrolimus and mycophenolate mofetil, to inhibit antibody-mediated rejection. Recent outcomes of ABOi KT are comparable with ABO-compatible KT. However, there are still many problems to be resolved. Very high anti-ABO antibody producers are difficult to desensitize. In addition, ABOi KT is associated with an increased risk of infection and possibly malignancy due to aggressive immunosuppression. Optimization of desensitization and patient-tailored immunosuppression protocols are needed to achieve better outcomes of ABOi KT. This review provides an overview of the history, immune mechanism, immunosuppressive protocol, outcomes, current obstacles, and future perspectives in ABOi KT.
Collapse
Affiliation(s)
- Tai Yeon Koo
- Transplantation Center, Seoul National University Hospital, Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jaeseok Yang
- Transplantation Center, Seoul National University Hospital, Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
84
|
The Reuse of Immunoadsorption Columns in ABO-Incompatible Kidney Transplantation Is Efficient: The Swiss Experience. Transplantation 2015; 99:1030-5. [PMID: 25340594 DOI: 10.1097/tp.0000000000000457] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND We developed a multicentric Swiss protocol for ABO-incompatible kidney transplantation including immunoadsorption column reuse. The aim of this study was to assess efficacy and safety of immunoadsorption column reuse in ABO-incompatible kidney transplantation. METHODS We performed a multicentric prospective trial including all ABO-incompatible kidney transplantations in Switzerland from 2005 to 2011. Patients received rituximab and standardized immunosuppression with tacrolimus, mycophenolate mofetil, and steroids. Antigen-specific perioperative immunoadsorption was performed. Immunoadsorption columns were reused after restoration. Graft survival, patient survival, kidney function, rejections, number of columns, adverse events after column reuse, and anti-A/anti-B antibody titers were assessed. RESULTS Seventy-one ABO-incompatible patients underwent antigen-specific immunoadsorption and could be transplanted across the blood group barrier. Kaplan-Meier estimates for both, patient-censored and death-censored graft survivals were both 97.2% at 5 years. Allograft function was excellent with a mean estimated glomerular filtration rate of 54 mL per min after 1 year. The median number of pretransplant immunoadsorptions was 5. All centers performed column reuse. A total of 394 immunoadsorption procedures were performed with reused filters. Patient survival, graft survival, and adverse events did not differ when filters were reused. Column reuse resulted in cost savings of 21,458 USD per patient. CONCLUSION We have introduced a national protocol for ABO-incompatible kidney transplantation including immunoadsorption column reuse. Column reuse was efficient and safe.
Collapse
|
85
|
Assessment of Hemostasis after Plasma Exchange Using Rotational Thrombelastometry (ROTEM). PLoS One 2015; 10:e0130402. [PMID: 26121484 PMCID: PMC4488284 DOI: 10.1371/journal.pone.0130402] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 05/21/2015] [Indexed: 12/21/2022] Open
Abstract
Background Therapeutic plasma exchange (TPE)-based protocols immediately before cadaveric donor kidney transplantation have been extensively used in highly sensitized recipients. Plasma is generally preferred over human albumin as replacement fluid to avoid depletion of coagulation factors and perioperative bleeding. The aim of this study was to estimate bleeding risk after TPE replaced with albumin using rotational thromboelastography (ROTEM). Methodology Ten patients without overt coagulation abnormalities underwent TPE. Standard laboratory coagulation tests (thromboplastin time, activated partial thromboplastin time (aPTT), international normalized ratio (INR), thrombin clotting time, fibrinogen levels and antithrombin activity) were compared with thrombelastometry analysis (EXTEM and INTEM tests) before and after TPE. Principal Findings TPE significantly reduced fibrinogen levels (482 ± 182 vs. 223 ± 122 mg/dL), antithrombin activity (103 ± 11 vs. 54 ± 11 %), and prolonged aPTT (28 ± 3 vs. 45 ± 8 s), thromboplastin time (108 ± 11 vs. 68 ± 11 %), INR (0.95 ± 0.06 vs. 1.25 ± 0.16), and thrombin clotting time (18 ± 2 vs. 20 ± 3 s). INTEM and EXTEM analyses revealed significantly prolonged clot-formation time and reduced maximum clot firmness. Conclusions/Significance TPE replaced with albumin induces significant changes in global hemostasis parameters thus potentially increasing bleeding risk. Therefore, pretransplant TPE should be considered carefully in indicated patients before kidney transplantation. The role of the ROTEM point-of-care test to estimate the risk of bleeding in renal transplantation needs to be evaluated in further studies.
Collapse
|
86
|
Thölking G, Koch R, Pavenstädt H, Schuette-Nuetgen K, Busch V, Wolters H, Kelsch R, Reuter S, Suwelack B. Antigen-Specific versus Non-Antigen-Specific Immunoadsorption in ABO-Incompatible Renal Transplantation. PLoS One 2015; 10:e0131465. [PMID: 26121389 PMCID: PMC4488147 DOI: 10.1371/journal.pone.0131465] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 06/02/2015] [Indexed: 02/06/2023] Open
Abstract
Introduction ABO-incompatible (ABOi) renal transplantation (RTx) from living donors is an established procedure to expand the donor pool for patients with end stage renal disease. Immunoadsorption (IA) is a standard procedure for the removal of preformed antibodies against the allograft. In this study, antigen-specific and non-antigen-specific IA in ABOi RTx were compared. Patients and Methods 10 patients underwent antigen-specific IA (Glycosorb group) and 13 patients non-antigen-specific IA (Immunosorba group). The effects of both procedures regarding antibody reduction, number of treatments, complications, costs, as well as the allograft function and patient survival were compared between both groups. Results Although the IgG levels were reduced equally by both procedures (p=0.82), the reduction of the IgM level was more effective in the Glycosorb group (p=0.0172). Patients in both groups required a median number of 6 IA before ABOi RTx. Allograft function at one year after AB0i RTx was similar in both groups (estimated glomerular filtration rate: 66 vs. 64 ml/min/1.73m² respectively), with a death-censored graft survival of 90.0% and 92.3% respectively. Complication rates did not differ between procedures. Due to the reuse of non-antigen-specific Immunosorba columns, costs were considerably lower in this group; however, the use of the Immunosorba-based IA was less time-efficient. Conclusion Considering upcoming alternatives as simultaneous performance of dialysis and IA or a possible reuse of Glycosorb columns, this might become less relevant in the future.
Collapse
Affiliation(s)
- Gerold Thölking
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, Münster, Germany
- * E-mail:
| | - Raphael Koch
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Hermann Pavenstädt
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, Münster, Germany
| | - Katharina Schuette-Nuetgen
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, Münster, Germany
| | - Veit Busch
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, Münster, Germany
| | - Heiner Wolters
- Department of General Surgery, University Hospital of Münster, Münster, Germany
| | - Reinhard Kelsch
- Institute of Transfusion Medicine and Transplantation Immunology, University Hospital of Münster, Münster, Germany
| | - Stefan Reuter
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, Münster, Germany
| | - Barbara Suwelack
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, Münster, Germany
| |
Collapse
|
87
|
Sugiyama K, Hyodo Y, Aikawa A. Evaluation of blood group antibodies in ABO-incompatible living-donor kidney transplantation. Int J Urol 2015; 22:931-6. [DOI: 10.1111/iju.12845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 05/24/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Ken Sugiyama
- Department of Urology; Ota Memorial Hospital; Gunma Japan
| | - Yoji Hyodo
- Department of Nephrology; Toho University; Tokyo Japan
| | | |
Collapse
|
88
|
Schachtner T, Stein M, Reinke P. ABO desensitization affects cellular immunity and infection control after renal transplantation. Transpl Int 2015; 28:1179-94. [PMID: 26033637 DOI: 10.1111/tri.12616] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 04/07/2015] [Accepted: 05/27/2015] [Indexed: 02/06/2023]
Abstract
The impact of ABO desensitization on overall immunity, infectious control, and alloreactivity remains unknown. We compared 35 ABO-incompatible kidney transplant recipients (KTRs) to a control of 62 ABO compatible KTRs. Samples were collected before, at +1, +2, +3, +6, and +12 months post-transplantation. CMV-, BKV-specific, and alloreactive T cells were measured using an interferon-γ ELISPOT assay. The extent of immunosuppression was quantified by enumeration of lymphocyte subpopulations and cytokines. No differences were observed for 5-year allograft survival and function between both groups (P > 0.05). However, ABO-incompatible KTRs were more likely to develop CMV infection, BKV-associated nephropathy, and severe sepsis (P = 0.001). Interestingly, ABO-incompatible KTRs with poor HLA-match showed the highest rates of infections and inferior allograft function (P < 0.05). CD3+, CD4+ T-cell counts, interferon-γ and IL-10 levels were lower in ABO-incompatible KTRs early post-transplantation (P < 0.05). Likewise, ABO-incompatible KTRs showed impaired BKV- and CMV-specific T-cell immunity (P < 0.05). ABO-incompatible KTRs showed lower frequencies of alloreactive T cells (P < 0.05). Our data suggest T-cell depletion due to ABO desensitization, which may contribute to the increased risk of T-cell-dependent infections. Elimination of B cells serving as antigen-presenting cells, thereby causing impaired T-cell activation, plays a significant role in both impaired infection control and reduced alloreactive T-cell activation.
Collapse
Affiliation(s)
- Thomas Schachtner
- Department of Nephrology and Internal Intensive Care, Charité University Medicine Berlin, Berlin, Germany.,Berlin-Brandenburg Center of Regenerative Therapies (BCRT), Berlin, Germany
| | - Maik Stein
- Berlin-Brandenburg Center of Regenerative Therapies (BCRT), Berlin, Germany
| | - Petra Reinke
- Department of Nephrology and Internal Intensive Care, Charité University Medicine Berlin, Berlin, Germany.,Berlin-Brandenburg Center of Regenerative Therapies (BCRT), Berlin, Germany
| |
Collapse
|
89
|
|
90
|
Fan DM, Zhao QC, Wang WZ, Shi H, Wang M, Chen DL, Zheng JY, Li MB, Wu GS. Successful ABO-incompatible living-related intestinal transplantation: a 2-year follow-up. Am J Transplant 2015; 15:1432-5. [PMID: 25808777 DOI: 10.1111/ajt.13121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 11/20/2014] [Accepted: 11/23/2014] [Indexed: 01/25/2023]
Abstract
ABO-incompatible intestinal transplantation has rarely been performed due to poor patient outcomes. Herein we present a case of successful ABO-incompatible intestinal transplantation with a 2-year follow-up. A 16-year-old female with a history of extensive bowel resection received an ABO-incompatible living donor bowel graft from her father (blood type AB graft into a type A recipient). Posttransplant immunosuppression consisted of an initial anti-CD20, plasmapheresis/intravenous immunoglobulin before transplantation, followed by an anti-thymocyte globulin (ATG) induction and splenectomy, and maintenance with tacrolimus and prednisone. Her postoperative course was remarkable for a single episode of rejection on day 14 which responded promptly to treatment with methyprednisolone and ATG. Three months after transplantation, the patient developed an abdominal abscess requiring open surgical drainage. No viral infections were encountered. Posttransplant anti-B antibody titers and anti-B7 donor-specific antibody levels remained low. At a 2-year follow-up, the patient showed a progressive weight gain of 5.0 kg. This case illustrates that ABO-incompatible living-related bowel transplantation is immunologically feasible and is associated with good outcomes for the recipient. The management of blood type antibodies and the use of adequate immunosuppression in the early period of the procedure may be the keys to the success of future cases.
Collapse
Affiliation(s)
- D M Fan
- Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, Xi'an, China
| | | | | | | | | | | | | | | | | |
Collapse
|
91
|
Chung BH, Joo YY, Lee J, Kim HD, Kim JI, Moon IS, Choi BS, Oh EJ, Park CW, Kim YS, Yang CW. Impact of ABO Incompatibility on the Development of Acute Antibody-Mediated Rejection in Kidney Transplant Recipients Presensitized to HLA. PLoS One 2015; 10:e0123638. [PMID: 25897756 PMCID: PMC4405275 DOI: 10.1371/journal.pone.0123638] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 02/20/2015] [Indexed: 01/22/2023] Open
Abstract
Whether the coexistence of anti-A/B antibody and donor specific anti-HLA antibody (HLA-DSA) has a synergistic impact on the development of acute antibody-mediated rejection (AAMR) in kidney transplant recipients (KTRs) is unclear. This study includes 92 KTRs who received a kidney from an ABO-incompatible (ABOi) donor or were presensitized to donor HLA (HLAs) and 292 controls (CONT). HLAs was defined as a crossmatch positivity or the presence of HLA-DSA. We compared the incidence of AAMR among ABOi (n = 58), ABOi+HLAs (n = 12), HLAs (n = 22), and CONT (n = 292) groups and evaluated the risk factors and antibody type (anti-A/B vs. HLA-DSA) responsible for AAMR. AAMR developed less frequently in ABOi and CONT than in the ABOi+HLAs or HLAs (P < 0.05 for all); however, there was no difference between the ABOi+HLAs and HLAs groups. AAMR developed more frequently with strong HLA-DSA at baseline; however, high baseline anti-A/B titer did not affect AAMR development. Strong baseline HLA-DSA was an independent predictor for AAMR, however the baseline anti-A/B titer was not. All four AAMR episodes in ABOi+HLAs were positive to HLA-DSA but not to anti-A/B. In conclusion, ABO incompatibility does not increase the risk for AAMR in HLAs KTRs.
Collapse
Affiliation(s)
- Byung Ha Chung
- Transplant research center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yu Young Joo
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jaesin Lee
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyung Duk Kim
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji-Il Kim
- Transplant research center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Sung Moon
- Transplant research center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bum Soon Choi
- Transplant research center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun-Jee Oh
- Deparment of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Cheol Whee Park
- Transplant research center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong-Soo Kim
- Transplant research center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chul Woo Yang
- Transplant research center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- * E-mail:
| |
Collapse
|
92
|
Kim MH, Jun KW, Hwang JK, Kim JI, Chung BH, Choi BS, Kim YS, Yang CW, Moon IS. Risk factors for postoperative bleeding in ABO-incompatible kidney transplantation. Clin Transplant 2015; 29:365-72. [DOI: 10.1111/ctr.12525] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2015] [Indexed: 12/19/2022]
Affiliation(s)
- Mi Hyeong Kim
- Division of Vascular and Transplant Surgery; Department of Surgery; Seoul St. Mary's Hospital; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Kang Woong Jun
- Division of Vascular and Transplant Surgery; Department of Surgery; Seoul St. Mary's Hospital; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Jeong Kye Hwang
- Division of Vascular and Transplant Surgery; Department of Surgery; Daejeon St. Mary's Hospital, College of Medicine; The Catholic University of Korea; Daejeon Korea
| | - Ji Il Kim
- Division of Vascular and Transplant Surgery; Department of Surgery; Seoul St. Mary's Hospital; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Byung Ha Chung
- Division of Nephrology; Department of Internal Medicine; Seoul St. Mary's Hospital; College of Medicine; The Catholic University of Korea; Seocho-gu Seoul Korea
| | - Bum Soon Choi
- Division of Nephrology; Department of Internal Medicine; Seoul St. Mary's Hospital; College of Medicine; The Catholic University of Korea; Seocho-gu Seoul Korea
| | - Yong Soo Kim
- Division of Nephrology; Department of Internal Medicine; Seoul St. Mary's Hospital; College of Medicine; The Catholic University of Korea; Seocho-gu Seoul Korea
| | - Chul Woo Yang
- Division of Nephrology; Department of Internal Medicine; Seoul St. Mary's Hospital; College of Medicine; The Catholic University of Korea; Seocho-gu Seoul Korea
| | - In Sung Moon
- Division of Vascular and Transplant Surgery; Department of Surgery; Seoul St. Mary's Hospital; College of Medicine; The Catholic University of Korea; Seoul Korea
| |
Collapse
|
93
|
Colvin MM, Cook JL, Chang P, Francis G, Hsu DT, Kiernan MS, Kobashigawa JA, Lindenfeld J, Masri SC, Miller D, O'Connell J, Rodriguez ER, Rosengard B, Self S, White-Williams C, Zeevi A. Antibody-mediated rejection in cardiac transplantation: emerging knowledge in diagnosis and management: a scientific statement from the American Heart Association. Circulation 2015; 131:1608-39. [PMID: 25838326 DOI: 10.1161/cir.0000000000000093] [Citation(s) in RCA: 225] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|
94
|
Böger CA, Banas B. Titer rebound after ABO-incompatible kidney transplantation - is all accommodated for? Transpl Int 2015; 28:281-3. [DOI: 10.1111/tri.12507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 12/12/2014] [Indexed: 12/12/2022]
Affiliation(s)
- Carsten A. Böger
- Department of Nephrology; University Hospital Regensburg; Regensburg Germany
| | - Bernhard Banas
- Department of Nephrology; University Hospital Regensburg; Regensburg Germany
| |
Collapse
|
95
|
A systematic review of the use of rituximab for desensitization in renal transplantation. Transplantation 2014; 98:794-805. [PMID: 25321163 DOI: 10.1097/tp.0000000000000362] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Rituximab is a B lymphocyte-depleting agent used to treat lymphoma and autoimmune diseases. Recently, it has been used for desensitization therapy in ABO-incompatible and highly sensitized recipients undergoing renal transplantation. METHODS A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Four databases and three trial registries were searched for studies comparing rituximab with non-rituximab desensitization protocols. A lack of randomized evidence precluded meta-analysis, and thus a narrative review was conducted. RESULTS Forty-five records met the inclusion criteria, relating to 21 individual studies (two randomized controlled trials and 19 retrospective cohort studies). Ten studies investigated the use of rituximab in ABO-incompatible patients; most found no significant differences in patient and graft outcomes when compared most frequently to splenectomy-based protocols. Nine studies of limited quality focused on highly sensitized recipients (positive cross-match, donor-specific antibody, and elevated panel reactive antibody) and demonstrated some benefits in graft survival, acute and chronic rejection, and sensitization levels with rituximab. The remaining two studies combined ABO-incompatible and highly sensitized recipients and found no statistically significant increase in infectious complications with rituximab. CONCLUSION Evidence of limited quality was identified to support the use of rituximab desensitization in highly sensitized recipients. Among ABO-incompatible recipients, rituximab was found to be equivalent to splenectomy, indicating that this invasive surgical procedure is not necessary. Further randomized controlled trials are required to better define the efficacy, long-term safety, and optimal dosing regimen of rituximab in this setting.
Collapse
|
96
|
Hatakeyama S, Fujita T, Murakami R, Suzuki Y, Sugiyama N, Yamamoto H, Okamoto A, Imai A, Tobisawa Y, Yoneyama T, Mori K, Yoneyama T, Hashimoto Y, Koie T, Narumi S, Ohyama C. Outcome comparison of ABO-incompatible kidney transplantation with low-dose rituximab and ABO-compatible kidney transplantation: a single-center experience. Transplant Proc 2014; 46:445-8. [PMID: 24655984 DOI: 10.1016/j.transproceed.2013.09.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 09/20/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND The development of immunosuppressive techniques has helped overcome the ABO incompatibility barrier. However, the outcomes of ABO-incompatible (ABOi) kidney transplantation remain a controversial issue with the advent of the anti-CD20 chimeric antibody rituximab. Herein, we report the outcomes of ABOi kidney transplantation with low-dose rituximab. PATIENTS AND METHODS Between June 2006 and April 2013, 42 patients underwent living-related kidney transplantation at our hospital. The patients were divided into 2 groups: ABO-compatible (ABOc; n = 29) and ABOi kidney transplants using low-dose rituximab (100 mg/m(2)) without splenectomy (n = 13). The basic immunosuppression regimen (calcineurin inhibitor [CNI], mycophenolate mofetil [MMF], and steroids) was the same for both groups, except for the use of rituximab and therapeutic apheresis in the ABOi group. We compared post-transplantation renal function, incidents of virus infection, episodes of rejection, and graft survival between the 2 groups. RESULTS In our hospital, 30% of recipients received ABOi kidney transplants. The estimated glomerular filtration rate (eGFR) did not differ between the groups. Rejection episodes confirmed by biopsy in the ABOc and ABOi groups were 8 (28%) and 4 (31%) patients (P = .833), acute antibody-mediated rejection was observed in 1 (3.5%) and 2 (15%) patients (P = .165), and virus infection was observed in 14 (48%) and 3 (23%) patients (P = .252), respectively. The 5-year patient survival rate was 100% in both groups, and the 5-year graft survival rates were 95% for ABOc and 100% for ABOi transplants (P = .527). CONCLUSIONS These results suggest that the outcomes of ABOi kidney transplantation with low-dose rituximab are similar to those of ABOc kidney transplantation. Further study is necessary to address the efficacy and safety of ABOi kidney transplantation.
Collapse
Affiliation(s)
- S Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
| | - T Fujita
- Department of Cardiology, Respiratory Medicine and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - R Murakami
- Department of Cardiology, Respiratory Medicine and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Y Suzuki
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - N Sugiyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - H Yamamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - A Okamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - A Imai
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Y Tobisawa
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - T Yoneyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - K Mori
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - T Yoneyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Y Hashimoto
- Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - T Koie
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - S Narumi
- Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Hirosaki, Japan
| | - C Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| |
Collapse
|
97
|
Ueda N, Nishimura K, Yoshida Y, Hirai T, Kishikawa H, Ichikawa Y. Living-donor kidney transplant from a type a donor to a type a subgroup recipient. EXP CLIN TRANSPLANT 2014; 13:193-5. [PMID: 25078093 DOI: 10.6002/ect.2013.0247] [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
Type A subgroup is rare in Japan, and kidney transplant to a type A subgroup recipient is rare worldwide. A 65-year-old man presented for living-donor kidney transplant. Blood group testing showed that his wife (kidney donor) had blood group type A. The patient (recipient) had a type A subgroup because reverse blood grouping showed a weak reaction with A1 antigen. Further testing showed that the recipient had type A subgroup between Ax and Ael because adsorption elution experiments and flow cytometry showed a few A antigens that were not detected on forward grouping, and DNA analysis was not consistent with Ael. The patient was given a milder protocol for immunosuppressive preoperative therapy than typically used for ABO-incompatible kidney transplant; mycophenolate mofetil and prednisolone were started 3 weeks and cyclosporine 2 weeks before transplant, rituximab (100 mg) was given once, and double filtration plasmapheresis and plasma exchange were not used. Follow-up at 9 months after transplant showed stable clinical status and no allograft rejection. In summary, the present case showed that when type A subgroup recipient has low level of anti-A1 antibody and is receiving a kidney transplant from a blood type A donor, milder immunosuppressive preoperative therapy appears safe.
Collapse
Affiliation(s)
- Norichika Ueda
- Department of Kidney Transplantation Center, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Hyogo, Japan
| | | | | | | | | | | |
Collapse
|
98
|
Abstract
PURPOSE OF REVIEW Renal transplantation in childhood is a well established procedure with excellent short-term outcomes. However, waiting times for transplantation are still relatively long if living donation cannot be performed, and long-term outcomes after transplantation have not significantly improved during the last decade. RECENT FINDINGS This review describes alternative modalities to improve donation rates such as en bloc kidney transplantation from young donors, ABO-incompatible transplantation and kidney paired donation. This review also deals with long-term post-transplant morbidities, such as follows: first, medication side-effects (metabolic syndrome, cardiovascular disease) and with the benefits of steroid and calcineurin inhibitor drug minimization; second, the deleterious impact of viral infections and their management and third, chronic antibody-mediated rejection, its therapeutic and prevention possibilities. SUMMARY Donor shortage and long-term morbidities, after transplantation, are still relevant issues in paediatric renal transplantation medicine. Significant research and efforts have been made to advance the field and create novel approaches for improvement of transplantation rates and post-transplant graft or patient survival. These modalities are to be established in the routine setting.
Collapse
|
99
|
Maggiore U, Oberbauer R, Pascual J, Viklicky O, Dudley C, Budde K, Sorensen SS, Hazzan M, Klinger M, Abramowicz D. Strategies to increase the donor pool and access to kidney transplantation: an international perspective. Nephrol Dial Transplant 2014; 30:217-22. [PMID: 24907023 PMCID: PMC4309190 DOI: 10.1093/ndt/gfu212] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
In this position article, DESCARTES (Developing Education Science and Care for Renal Transplantation in European States) board members describe the current strategies aimed at expanding living and deceased donor kidney pools. The article focuses on the recent progress in desensitization and kidney paired exchange programmes and on the expanded criteria for the use of donor kidneys and organs from donors after circulatory death. It also highlights differences in policies and practices across different regions with special regard to European Union countries. Living donor kidney paired exchange, the deceased donor Acceptable Mismatch Programme and kidneys from donors after circulatory death are probably the most promising innovations for expanding kidney transplantation in Europe over the coming decade. To maximize success, an effort is needed to standardize transplant strategies, policies and legislation across European countries.
Collapse
Affiliation(s)
- Umberto Maggiore
- Department of Nephrology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Rainer Oberbauer
- KH Elisabethinen Linz and Department of Nephrology, Medical University of Vienna, Vienna, Austria
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Ondrej Viklicky
- Department of Nephrology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | - Klemens Budde
- Department of Nephrology, Charité Medical University Berlin, Berlin, Germany
| | | | - Marc Hazzan
- Service de Néphrologie, Univ Lille Nord de France, Lille, France
| | - Marian Klinger
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Daniel Abramowicz
- Department of Nephrology, Antwerp University Hospital, Antwerp, Belgium
| | | |
Collapse
|
100
|
Chu HC, Hsieh CB, Hsu KF, Fan HL, Hsieh TY, Chen TW. Simultaneous splenectomy during liver transplantation augments anti-viral therapy in patients infected with hepatitis C virus. Am J Surg 2014; 209:180-6. [PMID: 24928331 DOI: 10.1016/j.amjsurg.2014.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 03/23/2014] [Accepted: 03/23/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Simultaneous splenectomy in liver transplantation (LT) is selectively indicated because of splenoportal venous thromboses and increased sepsis. Therefore, its impact should be further investigated. METHODS Of the 160 liver transplant patients, only 40 underwent simultaneous splenectomy. Clinicopathologic characteristics and outcomes were compared between the splenectomy and non-splenectomy group using retrospective analysis. RESULTS Although the groups were similar and had no significant difference in the intra- and postoperative data, non-splenectomy group had more male patients. However, splenectomy group showed significantly higher platelet and leukocyte counts at 1 month and 6 months after the transplantation and higher hepatitis C virus anti-viral therapy completion. Furthermore, 3 patients developed portal or splenic vein thrombosis during the postoperative follow-up, but the overall survival rate did not significantly differ between these groups. CONCLUSION Simultaneous splenectomy in LT can be safely performed, particularly in patients with hepatitis C virus cirrhosis, small-for-size grafts, hypersplenism, and ABO blood group incompatible (ABO - incompatible) LT.
Collapse
Affiliation(s)
- Heng-Cheng Chu
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Chung-Bao Hsieh
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan; Division of Transplantation, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Kuo-Feng Hsu
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Hsiu-Lung Fan
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Tsai-Yuan Hsieh
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Teng-Wei Chen
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan; Division of Transplantation, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan.
| |
Collapse
|