51
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Mohan S, Campenot E, Chiles MC, Santoriello D, Bland E, Crew RJ, Rosenstiel P, Dube G, Batal I, Radhakrishnan J, Sandoval PR, Guarrera J, Stokes MB, D'Agati V, Cohen DJ, Ratner LE, Markowitz G. Association between Reperfusion Renal Allograft Biopsy Findings and Transplant Outcomes. J Am Soc Nephrol 2017; 28:3109-3117. [PMID: 28684646 DOI: 10.1681/asn.2016121330] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 05/06/2017] [Indexed: 11/03/2022] Open
Abstract
Biopsy findings at the time of procurement of deceased donor kidneys remain the most common reason cited for kidney discard. To determine the value of renal allograft histology in predicting outcomes, we evaluated the significance of histologic findings, read by experienced renal pathologists, in 975 postreperfusion biopsy specimens collected from 2005 to 2009 after living donor (n=427) or deceased donor (n=548) renal transplant. We evaluated specimens for the degree of glomerulosclerosis, interstitial fibrosis and tubular atrophy, and vascular disease; specimens with a score of 0 or 1 (scale, 0-3) for each parameter were considered optimal. Overall, 66.3% of living donor kidneys and 50.7% of deceased donor kidneys received an optimal histology score (P<0.001). Irrespective of donor status, suboptimal kidneys came from older donors with a higher incidence of diabetes mellitus, hypertension, and obesity and a higher mean kidney donor risk index (all P<0.001). Death-censored outcomes after transplant differed significantly between optimal and suboptimal kidneys only in the deceased donor transplants (P=0.02). Regardless of histologic classification, outcomes with deceased donor kidneys were inferior to outcomes with living donor kidneys. However, 73.2% of deceased donor kidneys with suboptimal histology remained functional at 5 years. Our findings suggest that histologic findings on postreperfusion biopsy associate with outcomes after deceased donor but not living donor renal transplants, thus donor death and organ preservation-related factors may be of greater prognostic importance. Discarding donated kidneys on the basis of histologic factors may be inappropriate and merits further study.
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Affiliation(s)
- Sumit Mohan
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons New York, New York; .,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York; and
| | | | - Mariana C Chiles
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons New York, New York
| | | | - Eric Bland
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons New York, New York
| | - R John Crew
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons New York, New York
| | | | - Geoffrey Dube
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons New York, New York
| | | | - Jai Radhakrishnan
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons New York, New York
| | - P Rodrigo Sandoval
- Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - James Guarrera
- Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | | | | | - David J Cohen
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons New York, New York
| | - Lloyd E Ratner
- Surgery, Columbia University College of Physicians and Surgeons, New York, New York
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52
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Sánchez-Escuredo A, Sagasta A, Revuelta I, Rodas LM, Paredes D, Musquera M, Diekmann F, Campistol JM, Solé M, Oppenheimer F. Histopathological evaluation of pretransplant donor biopsies in expanded criteria donors with high kidney donor profile index: a retrospective observational cohort study. Transpl Int 2017; 30:975-986. [PMID: 28403541 DOI: 10.1111/tri.12966] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 01/24/2017] [Accepted: 03/27/2017] [Indexed: 12/16/2022]
Abstract
There is no consensus on the allocation of renal transplants from expanded criteria donors (ECD). The Kidney Donor Profile Index (KDPI) is used without the need for pretransplant donor biopsies (PTDB). We explored whether PTDB based on Remuzzi Score (RS) allows identification of those marginal kidneys in the highest calculated KDPI risk group (>91%) that appropriate for single transplantation. A retrospective study was conducted of 485 consecutive kidneys procured from a single center and transplanted if the RS was ≤4. We compared 5-year kidney and patients survival between KDPI groups and between RS <4 or =4 in the highest KDPI group. The median KDPI (interquartile range) was 71 (66-76) for KDPI <80% (n = 77), 86 (81-90) for KDPI 81-90% (n = 82), and 97 (94-100) for KDPI >91% (n = 205). Patient survival at 5 years was 85.7%, 85.3%, and 76.09% (P = 0.058) and death-censored graft survival was 84.4%, 86.5%, 73.6% (P = 0.015), respectively for each KDPI group. In >91% calculated KDPI group, there were no differences in graft survival depending on the RS (<4 vs. =4) (P = 0.714). The implementation of PTDB based on RS used for allocation of organs with the highest KDPI range could support to the acceptance of suitable organs for single transplantation with good patient and graft survival rate.
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Affiliation(s)
- Ana Sánchez-Escuredo
- Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Amaia Sagasta
- Pathology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Ignacio Revuelta
- Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Lida M Rodas
- 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
| | - Fritz Diekmann
- Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Josep M Campistol
- Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Manel Solé
- Pathology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Federico Oppenheimer
- Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
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53
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Abstract
Zero-time kidney biopsies, obtained at time of transplantation, are performed in many transplant centers worldwide. Decisions on kidney discard, kidney allocation, and choice of peritransplant and posttransplant treatment are sometimes based on the histological information obtained from these biopsies. This comprehensive review evaluates the practical considerations of performing zero-time biopsies, the predictive performance of zero-time histology and composite histological scores, and the clinical utility of these biopsies. The predictive performance of individual histological lesions and of composite scores for posttransplant outcome is at best moderate. No single histological lesion or composite score is sufficiently robust to be included in algorithms for kidney discard. Dual kidney transplantation has been based on histological assessment of zero-time biopsies and improves outcome in individual patients, but the waitlist effects of this strategy remain obscure. Zero-time biopsies are valuable for clinical and translational research purposes, providing insight in risk factors for posttransplant events, and as baseline for comparison with posttransplant histology. The molecular phenotype of zero-time biopsies yields novel therapeutic targets for improvement of donor selection, peritransplant management and kidney preservation. It remains however highly unclear whether the molecular expression variation in zero-time biopsies could become a better predictor for posttransplant outcome than donor/recipient baseline demographic factors.
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54
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Abstract
The old-for-old allocation policy used for kidney transplantation (KT) has confirmed the survival benefit compared to remaining listed on dialysis. Shortage of standard donors has stimulated the development of strategies aimed to expand acceptance criteria, particularly of kidneys from elderly donors. We have systematically reviewed the literature on those different strategies. In addition to the review of outcomes of expanded criteria donor or advanced age kidneys, we assessed the value of the Kidney Donor Profile Index policy, preimplantation biopsy, dual KT, machine perfusion and special immunosuppressive protocols. Survival and functional outcomes achieved with expanded criteria donor, high Kidney Donor Profile Index or advanced age kidneys are poorer than those with standard ones. Outcomes using advanced age brain-dead or cardiac-dead donor kidneys are similar. Preimplantation biopsies and related scores have been useful to predict function, but their applicability to transplant or refuse a kidney graft has probably been overestimated. Machine perfusion techniques have decreased delayed graft function and could improve graft survival. Investing 2 kidneys in 1 recipient does not make sense when a single KT would be enough, particularly in elderly recipients. Tailored immunosuppression when transplanting an old kidney may be useful, but no formal trials are available.Old donors constitute an enormous source of useful kidneys, but their retrieval in many countries is infrequent. The assumption of limited but precious functional expectancy for an old kidney and substantial reduction of discard rates should be generalized to mitigate these limitations.
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55
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Vanhove T, Kinashi H, Nguyen TQ, Metalidis C, Poesen K, Naesens M, Lerut E, Goldschmeding R, Kuypers DRJ. Tubulointerstitial expression and urinary excretion of connective tissue growth factor 3 months after renal transplantation predict interstitial fibrosis and tubular atrophy at 5 years in a retrospective cohort analysis. Transpl Int 2017; 30:695-705. [PMID: 28390067 DOI: 10.1111/tri.12960] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 02/27/2017] [Accepted: 03/23/2017] [Indexed: 11/29/2022]
Abstract
Connective tissue growth factor (CTGF) is an important mediator of renal allograft fibrosis, and urinary CTGF (CTGFu) levels correlate with the development of human allograft interstitial fibrosis. We evaluated the predictive value of CTGF protein expression in 160 kidney transplant recipients with paired protocol biopsies at 3 months and 5 years after transplantation. At month 3 and year 1, CTGFu was measured using ELISA, and biopsies were immunohistochemically stained for CTGF, with semiquantitative scoring of tubulointerstitial CTGF-positive area (CTGFti). Predictors of interstitial fibrosis and tubular atrophy (IF/TA) severity at 5 years were donor age [OR 1.05 (1.02-1.08), P = 0.001], female donor [OR 0.40 (0.18-0.90), P = 0.026], induction therapy [OR 2.76 (1.10-6.89), P = 0.030], and CTGFti >10% at month 3 [OR 2.72 (1.20-6.15), P = 0.016]. In subgroups of patients with little histologic damage at 3 months [either ci score 0 (n = 119), IF/TA score ≤1 (n = 123), or absence of IF/TA, interstitial inflammation, and tubulitis (n = 45)], consistent predictors of progression of chronic histologic damage by 5 years were donor age, induction therapy, CTGFti >10%, and CTGFu. These results suggest that, even in patients with favorable histology at 3 months, significant CTGF expression is often present which may predict accelerated accumulation of histologic damage.
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Affiliation(s)
- Thomas Vanhove
- Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Hiroshi Kinashi
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Nephrology, Nagoya University Hospital, Nagoya, Japan
| | - Tri Q Nguyen
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Christoph Metalidis
- Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Koen Poesen
- Clinical Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Maarten Naesens
- Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Evelyne Lerut
- Department of Imaging and Pathology, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Roel Goldschmeding
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dirk R J Kuypers
- Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Nephrology, University Hospitals Leuven, Leuven, Belgium
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56
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Identification of the activating cytotoxicity receptor NKG2D as a senescence marker in zero-hour kidney biopsies is indicative for clinical outcome. Kidney Int 2017; 91:1447-1463. [PMID: 28233611 DOI: 10.1016/j.kint.2016.12.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 12/09/2016] [Accepted: 12/15/2016] [Indexed: 11/21/2022]
Abstract
The definition of biological donor organ age rather than chronological age seems obvious for the establishment of a valid pre-transplant risk assessment. Therefore, we studied gene expression for candidate markers in 60 zero-hour kidney biopsies. Compared with 29 younger donors under age 55, 31 elderly donors age 55 and older had significant mRNA expression for immunoproteasome subunits (PSMB8, PSMB9 and PSMB10), HLA-DRB, and transcripts of the activating cytotoxicity receptor NKG2D. Gene expression was validated in an independent donor cohort consisting of 37 kidneys from donors 30 years and under (Group I), 75 kidneys from donors age 31-54 years (Group II) and 75 kidneys from donors age 55 and older (Group III). Significant gene induction was confirmed in kidneys from Group III for PSMB9 and PSMB10. Strikingly, transcripts of NKG2D had the significantly highest gene induction in Group III versus Group II and Group I. Similar results were obtained for CDKN2A, but not for telomere length. Both NKG2D and CDKN2A mRNA expression were significantly correlated with creatinine levels at 24 months after transplantation. Univariate regression analysis showed significant predictive power regarding graft function at 6 and 12 months for NKG2D and CDKN2A. However, only NKG2D remained significantly predictive in the multivariate model at 12 months. Thus, our results reveal novel candidate markers in aged renal allografts, which could be helpful in the assessment of organ quality.
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57
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Kaboré R, Haller MC, Harambat J, Heinze G, Leffondré K. Risk prediction models for graft failure in kidney transplantation: a systematic review. Nephrol Dial Transplant 2017; 32:ii68-ii76. [DOI: 10.1093/ndt/gfw405] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 10/03/2016] [Indexed: 01/01/2023] Open
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58
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Factors influencing renal graft survival: 7-Year experience of a single center. Medicina (B Aires) 2017; 53:224-232. [DOI: 10.1016/j.medici.2017.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 06/29/2017] [Accepted: 07/17/2017] [Indexed: 11/22/2022] Open
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59
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Wang ZG. Adherence to standardization and integrity in translational medicine research. Chin J Traumatol 2016; 29:212-8. [PMID: 25471422 DOI: 10.1016/j.trre.2015.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 04/13/2015] [Accepted: 04/27/2015] [Indexed: 12/20/2022] Open
Affiliation(s)
- Zheng-Guo Wang
- Professor, Daping Hospital & Research Institute of Surgery, Third Military Medical University, Chongqing 400042, China
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60
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Durrbach A, Pestana JM, Florman S, del Carmen Rial M, Rostaing L, Kuypers D, Matas A, Wekerle T, Polinsky M, Meier‐Kriesche HU, Munier S, Grinyó JM. Long-Term Outcomes in Belatacept- Versus Cyclosporine-Treated Recipients of Extended Criteria Donor Kidneys: Final Results From BENEFIT-EXT, a Phase III Randomized Study. Am J Transplant 2016; 16:3192-3201. [PMID: 27130868 PMCID: PMC5516151 DOI: 10.1111/ajt.13830] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 04/01/2016] [Accepted: 04/08/2016] [Indexed: 01/25/2023]
Abstract
In the Belatacept Evaluation of Nephroprotection and Efficacy as First-Line Immunosuppression Trial-Extended Criteria Donors (BENEFIT-EXT), extended criteria donor kidney recipients were randomized to receive belatacept-based (more intense [MI] or less intense [LI]) or cyclosporine-based immunosuppression. In prior analyses, belatacept was associated with significantly better renal function compared with cyclosporine. In this prospective analysis of the intent-to-treat population, efficacy and safety were compared across regimens at 7 years after transplant. Overall, 128 of 184 belatacept MI-treated, 138 of 175 belatacept LI-treated and 108 of 184 cyclosporine-treated patients contributed data to these analyses. Hazard ratios (HRs) comparing time to death or graft loss were 0.915 (95% confidence interval [CI] 0.625-1.339; p = 0.65) for belatacept MI versus cyclosporine and 0.927 (95% CI 0.634-1.356; p = 0.70) for belatacept LI versus cyclosporine. Mean estimated GFR (eGFR) plus or minus standard error at 7 years was 53.9 ± 1.9, 54.2 ± 1.9, and 35.3 ± 2.0 mL/min per 1.73 m2 for belatacept MI, belatacept LI and cyclosporine, respectively (p < 0.001 for overall treatment effect). HRs comparing freedom from death, graft loss or eGFR <20 mL/min per 1.73 m2 were 0.754 (95% CI 0.536-1.061; p = 0.10) for belatacept MI versus cyclosporine and 0.706 (95% CI 0.499-0.998; p = 0.05) for belatacept LI versus cyclosporine. Acute rejection rates and safety profiles of belatacept- and cyclosporine-based treatment were similar. De novo donor-specific antibody incidence was lower for belatacept (p ≤ 0.0001). Relative to cyclosporine, belatacept was associated with similar death and graft loss and improved renal function at 7 years after transplant and had a safety profile consistent with previous reports.
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Affiliation(s)
- A. Durrbach
- University Hôpital of BicêtreLe Kremlin‐BicêtreFrance,Université Paris‐SaclayPlateau de SaclayFrance
| | | | | | | | | | - D. Kuypers
- University Hospitals LeuvenLeuvenBelgium
| | - A. Matas
- University of MinnesotaMinneapolisMN
| | - T. Wekerle
- Medical University of ViennaViennaAustria
| | | | | | - S. Munier
- Bristol‐Myers SquibbBraine‐l'AlleudBelgium
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61
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Matos AC, Câmara NO, REQUIãO-MOURA LR, Tonato EJ, Filiponi TC, SOUZA-DURãO M, Malheiros DENISEM, Fregonesi M, Borrelli M, Pacheco-Silva A. Presence of arteriolar hyalinosis in post-reperfusion biopsies represents an additional risk to ischaemic injury in renal transplant. Nephrology (Carlton) 2016; 21:923-929. [DOI: 10.1111/nep.12699] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 10/16/2015] [Accepted: 12/07/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Ana Cristina Matos
- Renal Transplant Division; Hospital Israelita Albert Einstein; São Paulo São Paulo Brazil
| | - Niels O Câmara
- Nephrology Department; Federal University of São Paulo; São Paulo Brazil
- Immunology Department; São Paulo University; São Paulo Brazil
| | - Lúcio R REQUIãO-MOURA
- Renal Transplant Division; Hospital Israelita Albert Einstein; São Paulo São Paulo Brazil
| | - Eduardo J Tonato
- Renal Transplant Division; Hospital Israelita Albert Einstein; São Paulo São Paulo Brazil
| | - Thiago C Filiponi
- Renal Transplant Division; Hospital Israelita Albert Einstein; São Paulo São Paulo Brazil
| | - Marcelino SOUZA-DURãO
- Renal Transplant Division; Hospital Israelita Albert Einstein; São Paulo São Paulo Brazil
| | - DENISE M Malheiros
- Pathology Department; Hospital Israelita Albert Einstein; São Paulo Brazil
| | - Maurício Fregonesi
- Renal Transplant Division; Hospital Israelita Albert Einstein; São Paulo São Paulo Brazil
| | - Milton Borrelli
- Renal Transplant Division; Hospital Israelita Albert Einstein; São Paulo São Paulo Brazil
| | - Alvaro Pacheco-Silva
- Renal Transplant Division; Hospital Israelita Albert Einstein; São Paulo São Paulo Brazil
- Nephrology Department; Federal University of São Paulo; São Paulo Brazil
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62
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De Vusser K, Pieters N, Janssen B, Lerut E, Kuypers D, Jochmans I, Monbaliu D, Pirenne J, Nawrot T, Naesens M. Telomere length, cardiovascular risk and arteriosclerosis in human kidneys: an observational cohort study. Aging (Albany NY) 2016; 7:766-75. [PMID: 26539975 PMCID: PMC4637205 DOI: 10.18632/aging.100814] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Replicative senescence, associated with telomere shortening, plays an important role in aging and cardiovascular disease. The relation between telomere length, cardiovascular risk, and renal disease is unknown. METHODS Our study consisted of a cohort of 257 kidney donors for transplantation, divided into a test and a validation cohort. We used quantitative RT-PCR to measure relative telomere length (log T/S ratio) in peripheral blood leucocytes, and in kidney biopsies performed prior to implantation. The association between leucocyte and intrarenal telomere length, cardiovascular risk factors, and renal histology, was studied using multiple regression models, adjusted for calendar age, gender and other donor demographics. RESULTS Subjects with intrarenal arteriosclerosis had significantly shorter leucocyte telomere length compared with patients without arteriosclerosis (log T/S ratio -0.3±0.4 vs. 0.1±0.2 with vs. without arteriosclerosis; p=0.0008). Intrarenal arteriosclerosis was associated with shorter telomere length, independent of gender, calendar age, history of hypertension and history of cardiovascular events. For each increase of one standard deviation of the log T/S ratio, the odds for intrarenal arteriosclerosis decreased with 64% (Odds ratio 0.36; 95% CI 0.17-0.77; p=0.02). In accordance with leucocyte telomere length, shorter intrarenal telomere length associated significantly with the presence of renal arteriosclerosis (log T/S ratio -0.04±0.06 vs. 0.08±0.01 with vs. without arteriosclerosis, p=0.007), and not with other histological lesions. INTERPRETATION We demonstrate that arteriosclerosis in smaller intrarenal arteries is associated with shorter telomere length. Our study suggests a central role of replicative senescence in the progression of renovascular disease, independent of calendar age.
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Affiliation(s)
- Katrien De Vusser
- Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Nicky Pieters
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Bram Janssen
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Evelyne Lerut
- Department of Imaging and Pathology, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Dirk Kuypers
- Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Ina Jochmans
- Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Abdominal Transplantation Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Diethard Monbaliu
- Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Abdominal Transplantation Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jacques Pirenne
- Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Abdominal Transplantation Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Tim Nawrot
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium.,Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
| | - Maarten Naesens
- Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
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63
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Oppong YD, Farber JL, Chervoneva I, Martinez Cantarin MP. Correlation of acute tubular injury in reperfusion biopsy with renal transplant outcomes. Clin Transplant 2016; 30:836-44. [PMID: 27146243 DOI: 10.1111/ctr.12757] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2016] [Indexed: 11/28/2022]
Abstract
Acute tubular injury (ATI) is common at reperfusion, but its relationship to graft outcomes is unclear. Prior studies lack standardization of morphological assessments and included elements of acute and chronic tubular injury. This study aimed to evaluate the impact of ATI on graft outcomes. Reperfusion biopsies from 2004 to 2009 were retrospectively reviewed. ATI was assessed by a new standardized scoring system. We also assessed chronic injury (CI) by the Banff criteria. Outcomes evaluated included glomerular filtration rate (GFR) at 1 and 5 years and delayed graft function (DGF), acute rejection (AR), graft and patient survival. ATI did not correlate with DGF, AR, graft or overall survival. Mild-moderate ATI was not predictive of GFR post-transplant. Moderate-severe CI was associated with lower GFR at 5 years with a mean difference of -7.14 mL/min/1.73 m(2) (P=.04) and overall survival (HR 2.44, P=.01). Other predictors of graft function included donor age, DGF, and AR. Histologic criteria of ATI at implantation in the absence of donor demographics or clinical information do not provide sufficient predictability in outcomes after transplantation. On the other hand, histologic assessment of CI correlates with GFR and overall survival.
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Affiliation(s)
- Yaa D Oppong
- Division of Hospital Medicine, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - John L Farber
- Department of Pathology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Inna Chervoneva
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
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64
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Pisarski P, Schleicher C, Hauser I, Becker JU. German recommendations for pretransplantation donor kidney biopsies. Langenbecks Arch Surg 2016; 401:133-40. [PMID: 26994917 DOI: 10.1007/s00423-016-1384-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 02/12/2016] [Indexed: 12/20/2022]
Abstract
PURPOSE This manuscript reviews the data about the histopathologic and develops recommendations to standardise and improve the biopsy procedure, the biopsy handling, the histopathological evaluation, the communication of results and the collection of data from pretransplantation kidney biopsies of deceased donors in Germany. METHODS The recommendations are based on this literature review, on discussions at two workshops held by the German Society of Pathology and the German Organ Transplantation Foundation and on personal experiences of the authors. RESULTS These German recommendations advocate the use of punch biopsies, paraffin embedding and detailed descriptive reporting of histopathological findings. CONCLUSIONS These recommendations constitute only a starting point. Periodical revisions will help to simplify and optimise the recommendations with the ultimate goal to prospectively gather data for the elaboration of a computer-based algorithm that allows the exact prediction of transplantation outcome for a given match of donor and recipient.
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Affiliation(s)
- Przemyslav Pisarski
- Department of General and Visceral Surgery, University Hospital Freiburg, Freiburg, Germany
| | | | - Ingeborg Hauser
- Medical Clinic III, Nephrology, University Hospital Frankfurt, Frankfurt, Germany
| | - Jan U Becker
- Institute of Pathology, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
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65
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Bar Y, Barregard L, Sallsten G, Wallin M, Mölne J. Quantitative and semi-quantitative histopathological examination of renal biopsies in healthy individuals, and associations with kidney function. APMIS 2016; 124:393-400. [DOI: 10.1111/apm.12520] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 01/03/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Yael Bar
- Department of Occupational and Environmental Medicine; Sahlgrenska University Hospital and Academy; University of Gothenburg; Gothenburg Sweden
| | - Lars Barregard
- Department of Occupational and Environmental Medicine; Sahlgrenska University Hospital and Academy; University of Gothenburg; Gothenburg Sweden
| | - Gerd Sallsten
- Department of Occupational and Environmental Medicine; Sahlgrenska University Hospital and Academy; University of Gothenburg; Gothenburg Sweden
| | - Maria Wallin
- Department of Occupational and Environmental Medicine; Sahlgrenska University Hospital and Academy; University of Gothenburg; Gothenburg Sweden
| | - Johan Mölne
- Department of Clinical Pathology and Genetics; Sahlgrenska University Hospital and Academy; University of Gothenburg; Gothenburg Sweden
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Ferrari D, Gambari R, Idzko M, Müller T, Albanesi C, Pastore S, La Manna G, Robson SC, Cronstein B. Purinergic signaling in scarring. FASEB J 2016; 30:3-12. [PMID: 26333425 PMCID: PMC4684510 DOI: 10.1096/fj.15-274563] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 08/17/2015] [Indexed: 12/23/2022]
Abstract
Adenosine (ADO) and nucleotides such as ATP, ADP, and uridine 5'-triphosphate (UTP), among others, may serve as extracellular signaling molecules. These mediators activate specific cell-surface receptors-namely, purinergic 1 and 2 (P1 and P2)-to modulate crucial pathophysiological responses. Regulation of this process is maintained by nucleoside and nucleotide transporters, as well as the ectonucleotidases ectonucleoside triphosphate diphosphohydrolase [ENTPD; cluster of differentiation (CD)39] and ecto-5'-nucleotidase (5'-NT; CD73), among others. Cells involved in tissue repair, healing, and scarring respond to both ADO and ATP. Our recent investigations have shown that modulation of purinergic signaling regulates matrix deposition during tissue repair and fibrosis in several organs. Cells release adenine nucleotides into the extracellular space, where these mediators are converted by CD39 and CD73 into ADO, which is anti-inflammatory in the short term but may also promote dermal, heart, liver, and lung fibrosis with repetitive signaling under defined circumstances. Extracellular ATP stimulates cardiac fibroblast proliferation, lung inflammation, and fibrosis. P2Y2 (UTP/ATP) and P2Y6 [ADP/UTP/uridine 5'-diphosphate (UDP)] have been shown to have profibrotic effects, as well. Modulation of purinergic signaling represents a novel approach to preventing or diminishing fibrosis. We provide an overview of the current understanding of purinergic signaling in scarring and discuss its potential to prevent or decrease fibrosis.
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Affiliation(s)
- Davide Ferrari
- *Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy; Department of Pneumology, University of Freiburg, Freiburg, Germany; Laboratory of Immunology and Laboratory of Tissue Engineering and Cutaneous Physiopathology, Istituto Dermopatico dell'Immacolata, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy; Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna, Bologna, Italy; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts, USA; and Department of Medicine, New York University, New York, New York, USA
| | - Roberto Gambari
- *Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy; Department of Pneumology, University of Freiburg, Freiburg, Germany; Laboratory of Immunology and Laboratory of Tissue Engineering and Cutaneous Physiopathology, Istituto Dermopatico dell'Immacolata, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy; Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna, Bologna, Italy; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts, USA; and Department of Medicine, New York University, New York, New York, USA
| | - Marco Idzko
- *Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy; Department of Pneumology, University of Freiburg, Freiburg, Germany; Laboratory of Immunology and Laboratory of Tissue Engineering and Cutaneous Physiopathology, Istituto Dermopatico dell'Immacolata, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy; Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna, Bologna, Italy; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts, USA; and Department of Medicine, New York University, New York, New York, USA
| | - Tobias Müller
- *Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy; Department of Pneumology, University of Freiburg, Freiburg, Germany; Laboratory of Immunology and Laboratory of Tissue Engineering and Cutaneous Physiopathology, Istituto Dermopatico dell'Immacolata, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy; Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna, Bologna, Italy; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts, USA; and Department of Medicine, New York University, New York, New York, USA
| | - Cristina Albanesi
- *Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy; Department of Pneumology, University of Freiburg, Freiburg, Germany; Laboratory of Immunology and Laboratory of Tissue Engineering and Cutaneous Physiopathology, Istituto Dermopatico dell'Immacolata, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy; Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna, Bologna, Italy; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts, USA; and Department of Medicine, New York University, New York, New York, USA
| | - Saveria Pastore
- *Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy; Department of Pneumology, University of Freiburg, Freiburg, Germany; Laboratory of Immunology and Laboratory of Tissue Engineering and Cutaneous Physiopathology, Istituto Dermopatico dell'Immacolata, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy; Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna, Bologna, Italy; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts, USA; and Department of Medicine, New York University, New York, New York, USA
| | - Gaetano La Manna
- *Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy; Department of Pneumology, University of Freiburg, Freiburg, Germany; Laboratory of Immunology and Laboratory of Tissue Engineering and Cutaneous Physiopathology, Istituto Dermopatico dell'Immacolata, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy; Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna, Bologna, Italy; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts, USA; and Department of Medicine, New York University, New York, New York, USA
| | - Simon C Robson
- *Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy; Department of Pneumology, University of Freiburg, Freiburg, Germany; Laboratory of Immunology and Laboratory of Tissue Engineering and Cutaneous Physiopathology, Istituto Dermopatico dell'Immacolata, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy; Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna, Bologna, Italy; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts, USA; and Department of Medicine, New York University, New York, New York, USA
| | - Bruce Cronstein
- *Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy; Department of Pneumology, University of Freiburg, Freiburg, Germany; Laboratory of Immunology and Laboratory of Tissue Engineering and Cutaneous Physiopathology, Istituto Dermopatico dell'Immacolata, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy; Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna, Bologna, Italy; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts, USA; and Department of Medicine, New York University, New York, New York, USA
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Sagasta A, Sánchez-Escuredo A, Oppenheimer F, Paredes D, Musquera M, Campistol JM, Solé M. Pre-implantation analysis of kidney biopsies from expanded criteria donors: testing the accuracy of frozen section technique and the adequacy of their assessment by on-call pathologists. Transpl Int 2015; 29:234-40. [DOI: 10.1111/tri.12709] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 08/20/2015] [Accepted: 10/23/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Amaia Sagasta
- Pathology Department; Hospital Clinic; Universitat de Barcelona; Barcelona Spain
| | - Ana Sánchez-Escuredo
- Nephrology and Renal Transplant Department; Hospital Clinic; Universitat de Barcelona; Barcelona Spain
| | - Frederic Oppenheimer
- Nephrology and Renal Transplant Department; Hospital Clinic; Universitat de Barcelona; Barcelona Spain
| | - David Paredes
- Transplant Service Fundation; Hospital Clinic; Universitat de Barcelona; Barcelona Spain
| | - Mireia Musquera
- Urology Department; Hospital Clinic; Universitat de Barcelona; Barcelona Spain
| | - Josep Maria Campistol
- Nephrology and Renal Transplant Department; Hospital Clinic; Universitat de Barcelona; Barcelona Spain
| | - Manel Solé
- Pathology Department; Hospital Clinic; Universitat de Barcelona; Barcelona Spain
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EXP CLIN TRANSPLANTExp Clin Transplant 2015; 13. [DOI: 10.6002/ect.2015.0193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Schwenger V, Hankel V, Seckinger J, Macher-Göppinger S, Morath C, Zeisbrich M, Zeier M, Kihm LP. Contrast-enhanced ultrasonography in the early period after kidney transplantation predicts long-term allograft function. Transplant Proc 2015; 46:3352-7. [PMID: 25498050 DOI: 10.1016/j.transproceed.2014.04.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 04/22/2014] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Real-time contrast-enhanced sonography (CES) can assess microvascular tissue perfusion using gas-filled microbubbles. The purpose of the study was to evaluate the feasibility of early CES in predicting long-term kidney allograft function in comparison to color Doppler ultrasonography (CDUS). METHODS We prospectively studied 68 consecutive kidney transplant recipients using CES and conventional CDUS investigation 1 week after transplantation. Transplant tissue perfusion imaging was performed by low-power imaging during intravenous administration of the sonocontrast SonoVue. Renal tissue perfusion was assessed quantitatively using flash replenishment kinetics of microbubbles to estimate renal blood flow (RBF). The obtained sonography values were correlated with clinical data 1 week up to 1 year after transplantation. RESULTS In contrast with conventional CDUS resistive indices, RBF estimated by CES 1 week posttransplantation significantly correlated with kidney function after 1 year (r = 0.67; P < .001). Determination of RBF by CES revealed a significant correlation with donor age but not recipient age, whereas conventional CDUS resistive index was significantly correlated to recipient age (r = 0.54; P < .001) but not donor age. Furthermore RBF was associated with vascular fibrosis and intimal thickening of the engraftment biopsies. CONCLUSION This is the first prospective study demonstrating the prognostic value of CES early after kidney transplantation. In contrast with CDUS, CES reveals information about kidney allograft perfusion independent of recipient vascular compliance.
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Affiliation(s)
- V Schwenger
- Department of Nephrology, University Hospital, Heidelberg, Germany
| | - V Hankel
- Department of Radiation Oncology, University of Munich, Munich, Germany
| | - J Seckinger
- Department of Nephrology, University Hospital, Heidelberg, Germany
| | | | - C Morath
- Department of Nephrology, University Hospital, Heidelberg, Germany
| | - M Zeisbrich
- Department of Nephrology, University Hospital, Heidelberg, Germany
| | - M Zeier
- Department of Nephrology, University Hospital, Heidelberg, Germany
| | - L P Kihm
- Department of Nephrology, University Hospital, Heidelberg, Germany; Department of Endocrinology, University Hospital, Heidelberg, Germany.
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Richterman A, Sawinski D, Reese PP, Lee DH, Clauss H, Hasz RD, Thomasson A, Goldberg DS, Abt PL, Forde KA, Bloom RD, Doll SL, Brady KA, Blumberg EA. An Assessment of HIV-Infected Patients Dying in Care for Deceased Organ Donation in a United States Urban Center. Am J Transplant 2015; 15:2105-16. [PMID: 25976241 DOI: 10.1111/ajt.13308] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/05/2015] [Accepted: 03/05/2015] [Indexed: 01/25/2023]
Abstract
Organ transplantation is an acceptable option for human immunodeficiency virus (HIV)-infected patients with end-stage kidney or liver disease. With worse outcomes on the waitlist, HIV-infected patients may actually be disproportionately affected by the organ shortage in the United States. One potential solution is the use of HIV-infected deceased donors (HIVDD), recently legalized by the HIV Organ Policy Equity (HOPE) Act. This is the first analysis of patient-specific data from potential HIVDD, retrospectively examining charts of HIV-infected patients dying in care at six HIV clinics in Philadelphia, Pennsylvania from January 1, 2009 to June 30, 2014. Our data suggest that there are four to five potential HIVDD dying in Philadelphia annually who might yield two to three kidneys and three to five livers for transplant. Extrapolated nationally, this would approximate 356 potential HIVDD yielding 192 kidneys and 247 livers annually. However, several donor risk indices raise concerns about the quality of kidneys that could be recovered from HIVDD as a result of older donor age and comorbidities. On the other hand, livers from these potential HIVDD are of similar quality to HIV-negative donors dying locally, although there is a high prevalence of positive hepatitis C antibody.
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Affiliation(s)
- A Richterman
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - D Sawinski
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - P P Reese
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - D H Lee
- Department of Medicine, Drexel University, Philadelphia, PA
| | - H Clauss
- Department of Medicine, Temple University, Philadelphia, PA
| | - R D Hasz
- Gift of Life Donor Program, Philadelphia, PA
| | - A Thomasson
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - D S Goldberg
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - P L Abt
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - K A Forde
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - R D Bloom
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - S L Doll
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - K A Brady
- Philadelphia Department of Public Health, Philadelphia, PA
| | - E A Blumberg
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Wang CJ, Wetmore JB, Crary GS, Kasiske BL. The Donor Kidney Biopsy and Its Implications in Predicting Graft Outcomes: A Systematic Review. Am J Transplant 2015; 15:1903-14. [PMID: 25772854 DOI: 10.1111/ajt.13213] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 01/06/2015] [Accepted: 01/07/2015] [Indexed: 01/25/2023]
Abstract
Despite a growing organ shortage in the United States, many deceased donor kidneys removed for transplantation are discarded. Kidney biopsy findings often play a role in these discards, although it is not clear whether biopsies reliably inform acceptance decisions. Therefore, we carried out a systematic review of the medical literature on the utility of both procurement and implantation biopsies for predicting posttransplant outcomes. Between January 1, 1994 and July 1, 2014, 47 studies were published in the English language literature that examined the association between pretransplant donor biopsy findings from 50 or more donors (with more than half being from deceased donors) and either posttransplant graft failure, delayed graft function, or graft function. In general, study quality was poor. All were retrospective or did not indicate if they were prospective. Results were heterogeneous, with authors as often as not concluding that biopsy results did not predict posttransplant outcomes. The percent glomerular sclerosis was most often examined, and failed to predict graft failure in 7 of 14 studies. Of 15 semiquantitative scoring systems proposed, none consistently predicted posttransplant outcomes across studies. Routine use of biopsies to help determine whether or not to transplant a kidney should be reexamined.
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Affiliation(s)
- C J Wang
- Division of Nephrology, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - J B Wetmore
- Division of Nephrology, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - G S Crary
- Department of Pathology, Hennepin County Medical Center, Minneapolis, MN
| | - B L Kasiske
- Division of Nephrology, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN
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Tepel M, Borst C, Bistrup C, Marcussen N, Pagonas N, Seibert FS, Arndt R, Zidek W, Westhoff TH. Urinary calprotectin and posttransplant renal allograft injury. PLoS One 2014; 9:e113006. [PMID: 25402277 PMCID: PMC4234472 DOI: 10.1371/journal.pone.0113006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 10/17/2014] [Indexed: 11/18/2022] Open
Abstract
Objective Current methods do not predict the acute renal allograft injury immediately after kidney transplantation. We evaluated the diagnostic performance of urinary calprotectin for predicting immediate posttransplant allograft injury. Methods In a multicenter, prospective-cohort study of 144 incipient renal transplant recipients, we postoperatively measured urinary calprotectin using an enzyme-linked immunosorbent assay and estimated glomerular filtration rate (eGFR) after 4 weeks, 6 months, and 12 months. Results We observed a significant inverse association of urinary calprotectin concentrations and eGFR 4 weeks after transplantation (Spearman r = −0.33; P<0.001). Compared to the lowest quartile, patients in the highest quartile of urinary calprotectin had an increased risk for an eGFR less than 30 mL/min/1.73 m2 four weeks after transplantation (relative risk, 4.3; P<0.001; sensitivity, 0.92; 95% CI, 0.77 to 0.98; specificity, 0.48; 95% CI, 0.31 to 0.66). Higher urinary calprotectin concentrations predicted impaired kidney function 4 weeks after transplantation, as well as 6 months and 12 months after transplantation. When data were analyzed using the urinary calprotectin/creatinine-ratio similar results were obtained. Urinary calprotectin was superior to current use of absolute change of plasma creatinine to predict allograft function 12 months after transplantation. Urinary calprotectin predicted an increased risk both in transplants from living and deceased donors. Multivariate linear regression showed that higher urinary calprotectin concentrations and older donor age predicted lower eGFR four weeks, 6 months, and 12 months after transplantation. Conclusions Urinary calprotectin is an early, noninvasive predictor of immediate renal allograft injury after kidney transplantation.
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Affiliation(s)
- Martin Tepel
- Department of Nephrology, Odense University Hospital, and University of Southern Denmark, Institute of Molecular Medicine, Cardiovascular and Renal Research, Institute of Clinical Research, Odense, Denmark
| | - Christoffer Borst
- Department of Nephrology, Odense University Hospital, and University of Southern Denmark, Institute of Molecular Medicine, Cardiovascular and Renal Research, Institute of Clinical Research, Odense, Denmark
| | - Claus Bistrup
- Department of Nephrology, Odense University Hospital, and University of Southern Denmark, Institute of Molecular Medicine, Cardiovascular and Renal Research, Institute of Clinical Research, Odense, Denmark
| | - Niels Marcussen
- Department of Pathology, Odense University Hospital, and University of Southern Denmark, Odense, Denmark
| | - Nikolaos Pagonas
- Department of Nephrology, Charité, Campus Benjamin Franklin, Berlin, Germany
- Medizinische Klinik I, Univ.-Klinik Marienhospital Herne, Ruhr-University Bochum, Bochum, Germany
| | - Felix S. Seibert
- Department of Nephrology, Charité, Campus Benjamin Franklin, Berlin, Germany
- Medizinische Klinik I, Univ.-Klinik Marienhospital Herne, Ruhr-University Bochum, Bochum, Germany
| | - Robert Arndt
- Department of Nephrology, Charité, Campus Benjamin Franklin, Berlin, Germany
| | - Walter Zidek
- Department of Nephrology, Charité, Campus Benjamin Franklin, Berlin, Germany
| | - Timm H. Westhoff
- Department of Nephrology, Charité, Campus Benjamin Franklin, Berlin, Germany
- Medizinische Klinik I, Univ.-Klinik Marienhospital Herne, Ruhr-University Bochum, Bochum, Germany
- * E-mail:
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Lee APK, Abramowicz D. Is the Kidney Donor Risk Index a step forward in the assessment of deceased donor kidney quality? Nephrol Dial Transplant 2014; 30:1285-90. [DOI: 10.1093/ndt/gfu304] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 08/21/2014] [Indexed: 11/14/2022] Open
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Abstract
PURPOSE OF REVIEW The current era of organ shortage has necessitated a widening of criteria for donation, considering donors who would have been considered unsuitable before. This review summarizes the recent advances in strategies to maximize the use of marginal kidneys without compromising the outcomes. RECENT FINDINGS Various strategies have been studied and implemented to optimize procurement and allocation of marginal kidneys, and to preserve their function. In particular, a growing number of transplant centers are using donors after circulatory death. Whereas normothermic ex-vivo and postmortem perfusion are promising procedures to improve the outcomes of marginal grafts in the future, dual-kidney transplantation is a viable approach which is at present potentially underutilized. Despite active research on new strategies to evaluate organ quality, pretransplant biopsy assessment currently remains the most reliable method. The practice of using living donors with advanced age is supported by available evidence, whereas the use of young living donors with minor medical abnormalities needs further investigation. SUMMARY Progress has been made in the recent years, clarifying the best criteria for evaluating, recovering, and allocating marginal kidney donors. However, further research is needed, with special regards to the criteria for using marginal living-kidney donors.
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Affiliation(s)
- Umberto Maggiore
- aTrapianti Rene-Pancreas (U.O.C. Nefrologia), Azienda Ospedaliero-Universitaria di Parma, Parma, Italy bRenal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Limited efficacy of immunosuppressive drugs on CD8+ T cell-mediated and natural killer cell-mediated lysis of human renal tubular epithelial cells. Transplantation 2014; 97:1110-8. [PMID: 24704664 DOI: 10.1097/tp.0000000000000108] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although CD8+ T cell-mediated and natural killer (NK) cell-mediated cytotoxicity against renal tubular epithelial cells (TECs) plays a crucial role during rejection, the degree of inhibition of these lytic immune responses by immunosuppressive drugs is unknown. We investigated the CD8 T-cell and NK cell responses induced by TECs in vitro and questioned how these processes are affected by immunosuppressive drugs. METHODS Donor-derived TECs were co-cultured with recipient peripheral blood monocyte cells. Proliferation of CD8+ T cells and NK cell subsets was assessed using PKH dilution assay. CD107a degranulation and europium release assay were performed to explore CD8+-mediated and NK cell-mediated TEC lysis. Experiments were conducted in the absence or presence of tacrolimus (10 ng/mL), everolimus (10 ng/mL), and prednisolone (200 ng/mL). RESULTS Tubular epithelial cells induce significant CD8+ T-cell and NK cell proliferation. All immunosuppressive drugs significantly inhibited TEC-induced CD8+ T-cell proliferation. Interestingly, prednisolone was the most powerful inhibitor of NK cell proliferation. CD8-mediated and NK cell-mediated early lytic responses were marked by strong degranulation after an encounter of unstimulated TECs, represented by a high cell surface expression of CD107a. However, with the use of interferon-γ-activated and tumor necrosis factor-α-activated TECs, the NK degranulation response was significantly reduced and CD8 degranulation response was even more enhanced (P<0.05). Tubular epithelial cell-induced CD8 degranulation and CD8-mediated TEC lysis were preferentially inhibited by tacrolimus and prednisolone, and not by everolimus. Although tacrolimus showed the most inhibitory effect on the degranulation of NK cells, NK cell-mediated TEC lysis was efficiently inhibited by prednisolone (P<0.05). CONCLUSION Overall, our data point to a limited efficacy of immunosuppressive drugs on CD8+ T cell-mediated and NK cell-mediated lysis of human renal TECs.
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Abstract
Donor organ scarcity remains a significant clinical challenge in transplantation. Older organs, increasingly utilized to meet the growing demand for donor organs, have been linked to inferior transplant outcomes. Susceptibility to organ injury, reduced repair capacity, and increased immunogenicity are interrelated and impacted by physiological and pathological aging processes. Insights into the underlying mechanisms are needed to develop age-specific interventional strategies with regards to organ preservation, immunosuppression, and allocation. In this overview, we summarize current knowledge of injury and repair mechanisms and the effects of aging relevant to transplantation.
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Yilmaz S. Chronic Allograft Nephropathy (Chronic Allograft Damage): Can It Be Avoided? CURRENT TRANSPLANTATION REPORTS 2014. [DOI: 10.1007/s40472-014-0009-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Nickeleit V. Foretelling the future: predicting graft outcome by evaluating kidney baseline transplant biopsies. J Am Soc Nephrol 2013; 24:1716-9. [PMID: 23990674 PMCID: PMC3810094 DOI: 10.1681/asn.2013070761] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Volker Nickeleit
- Division of Nephropathology, Department of Pathology and Laboratory Medicine, The University of North Carolina, Chapel Hill, North Carolina
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