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Short term ex vivo storage of kidneys cause progressive nuclear ploidy changes of renal tubular epitheliocytes. Sci Rep 2015; 5:10341. [PMID: 26036971 PMCID: PMC4453160 DOI: 10.1038/srep10341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 04/10/2015] [Indexed: 01/03/2023] Open
Abstract
In renal transplantation, there has been considerable success, mainly in term of post-transplant graft function. However, upon closer scrutiny, it is known that severe dysfunction, including persistence of renal failure is seen after transplantation. The major condition that potentially cause significant lesion may be hypothesized to be related to the hypothermic approach to storage. To systematically examine these issues, we stored mammalian (sheep) kidneys in UWS at 4 °C for four different time points (0, 1, 3 and 6 hours). We obtained renal histological sections and examined tubular architecture as well as nuclear characteristics of tubular epitheliocytes. The results of our preliminary investigations suggest that there are temporal changes of tubular epitheliocytes, as well as genomic changes. These changes were also seen in tissues stored at room temperature. Our observations suggest the need for additional studies for redesigning of improvised storage solutions. Pilot studies using Celsior also revealed similar kind of nuclear changes, suggesting that storage conditions are contributory, including perfusion versus static conditions. The results may explain persistence of tubular injury several days after orthotopic transplantation, and may potentially be contributory to delayed graft function (DGF).
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O'Neill S, Gallagher K, Hughes J, Wigmore SJ, Ross JA, Harrison EM. Challenges in early clinical drug development for ischemia-reperfusion injury in kidney transplantation. Expert Opin Drug Discov 2015; 10:753-62. [PMID: 25947288 DOI: 10.1517/17460441.2015.1044967] [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] [Indexed: 12/25/2022]
Abstract
INTRODUCTION In an effort to expand the donor pool, kidneys from donation after cardiac death (DCD) donors are increasingly utilised in renal transplantation. These kidneys suffer greater ischemia-reperfusion injury (IRI) and have a higher incidence of delayed graft function. In the last 25 years, relatively few pharmacological therapies to reduce IRI have been tested in randomised controlled trials in renal transplantation and currently no pharmacological agents are routinely utilised for this purpose. AREAS COVERED The authors look at why promising treatments in pre-clinical studies have not translated to significant clinical benefit in human trials. This may reflect a translational disconnect between the pre-clinical models used and clinical problems that are encountered in the transplant population. They also discuss the issues in conducting clinical trials and its implication on drug development. EXPERT OPINION Translating pharmacological strategies for reducing IRI is highly challenging at every stage of development from pre-clinical studies to clinical trials. Scientific knowledge of the complexity of IRI is rapidly evolving and new treatments are expected to emerge. There are ethical barriers that prevent donor treatments, particularly in the DCD setting. However, new clinical techniques such as normothermic regional and ex-vivo perfusion represent exciting opportunities to utilise pharmacological agents earlier in the process of transplantation.
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Affiliation(s)
- Stephen O'Neill
- University of Edinburgh, Chancellor's Building, MRC Centre for Inflammation Research, Tissue Injury and Repair Group, Royal Infirmary of Edinburgh , 49 Little France Crescent, Edinburgh EH16 4SA , UK +44 78 4959 2113 ; +44 13 1242 6520 ;
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Weissenbacher A, Oberhuber R, Cardini B, Weiss S, Ulmer H, Bösmüller C, Schneeberger S, Pratschke J, Öllinger R. The faster the better: anastomosis time influences patient survival after deceased donor kidney transplantation. Transpl Int 2015; 28:535-43. [DOI: 10.1111/tri.12516] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 10/17/2014] [Accepted: 12/30/2014] [Indexed: 01/22/2023]
Affiliation(s)
- Annemarie Weissenbacher
- Department of Visceral, Transplant and Thoracic Surgery; Center of Operative Medicine; Innsbruck Medical University; Innsbruck Austria
| | - Rupert Oberhuber
- Department of Visceral, Transplant and Thoracic Surgery; Center of Operative Medicine; Innsbruck Medical University; Innsbruck Austria
| | - Benno Cardini
- Department of Visceral, Transplant and Thoracic Surgery; Center of Operative Medicine; Innsbruck Medical University; Innsbruck Austria
| | - Sascha Weiss
- Department of Visceral, Transplant and Thoracic Surgery; Center of Operative Medicine; Innsbruck Medical University; Innsbruck Austria
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics; Innsbruck Medical University; Innsbruck Austria
| | - Claudia Bösmüller
- Department of Visceral, Transplant and Thoracic Surgery; Center of Operative Medicine; Innsbruck Medical University; Innsbruck Austria
| | - Stefan Schneeberger
- Department of Visceral, Transplant and Thoracic Surgery; Center of Operative Medicine; Innsbruck Medical University; Innsbruck Austria
| | - Johann Pratschke
- Department of Visceral, Transplant and Thoracic Surgery; Center of Operative Medicine; Innsbruck Medical University; Innsbruck Austria
- Department of General Visceral and Transplant Surgery; Charité Campus Virchow-Klinikum; Berlin Germany
| | - Robert Öllinger
- Department of Visceral, Transplant and Thoracic Surgery; Center of Operative Medicine; Innsbruck Medical University; Innsbruck Austria
- Department of General Visceral and Transplant Surgery; Charité Campus Virchow-Klinikum; Berlin Germany
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105
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Salvadori M, Bertoni E. What's new in clinical solid organ transplantation by 2013. World J Transplant 2014; 4:243-66. [PMID: 25540734 PMCID: PMC4274595 DOI: 10.5500/wjt.v4.i4.243] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 07/11/2014] [Accepted: 07/27/2014] [Indexed: 02/05/2023] Open
Abstract
Innovative and exciting advances in the clinical science in solid organ transplantation continuously realize as the results of studies, clinical trials, international conferences, consensus conferences, new technologies and discoveries. This review will address to the full spectrum of news in transplantation, that verified by 2013. The key areas covered are the transplantation activity, with particular regards to the donors, the news for solid organs such as kidney, pancreas, liver, heart and lung, the news in immunosuppressive therapies, the news in the field of tolerance and some of the main complications following transplantation as infections and cancers. The period of time covered by the study starts from the international meetings held in 2012, whose results were published in 2013, up to the 2013 meetings, conferences and consensus published in the first months of 2014. In particular for every organ, the trends in numbers and survival have been reviewed as well as the most relevant problems such as organ preservation, ischemia reperfusion injuries, and rejections with particular regards to the antibody mediated rejection that involves all solid organs. The new drugs and strategies applied in organ transplantation have been divided into new way of using old drugs or strategies and drugs new not yet on the market, but on phase Ito III of clinical studies and trials.
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106
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Xin H, Ge YZ, Wu R, Yin Q, Zhou LH, Shen JW, Lu TZ, Hu ZK, Wang M, Zhou CC, Wu JP, Li WC, Zhu JG, Jia RP. Effect of high-dose erythropoietin on graft function after kidney transplantation: a meta-analysis of randomized controlled trials. Biomed Pharmacother 2014; 69:29-33. [PMID: 25661334 DOI: 10.1016/j.biopha.2014.10.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 10/27/2014] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Current evidence suggests that preconditioning with erythropoietin (EPO) can protect against ischemia reperfusion injury in rodents. However, randomized controlled trials (RCTs) assessing the efficacy and safety of high-dose EPO in kidney transplantation have yielded inconclusive results. Herein, we performed a meta-analysis of RCTs to assess whether the administration of high-dose EPO can improve graft function and the potential adverse events. METHODS Relevant RCT studies that investigated high-dose EPO on graft function after kidney transplantation were comprehensively searched in Pubmed, Embase, and Cochrane Library until July 10, 2014. All statistical analyses were performed using Review Manager 5.0 and STATA 12.0. RESULTS A total of 4 RCTs involving 356 patients were identified. Comprehensively, a trend of reduction in the incidence of delayed graft function could be observed in the EPO group (EPO vs. placebo groups: RR=0.88); however, the result did not reach the significance level (95% CI, 0.72-1.08; P=0.21). Furthermore, no significant difference in the incidences of adverse events was observed between the two groups. CONCLUSIONS The current meta-analysis indicates that the administration of high-dose EPO is, to some extent, prone to protect kidney function without increasing the susceptibility to adverse events.
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Affiliation(s)
- Hui Xin
- Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, 210006 Nanjing, PR China; Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, 210006 Nanjing, PR China
| | - Yu-Zheng Ge
- Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, 210006 Nanjing, PR China; Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, 210006 Nanjing, PR China
| | - Ran Wu
- Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, 210006 Nanjing, PR China; Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, 210006 Nanjing, PR China
| | - Qian Yin
- Department of Pharmacology, Nanjing Medical University School of Pharmacy, 140 Hanzhong Road, 210029 Nanjing, PR China; Central Laboratory, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, 210006 Nanjing, PR China
| | - Liu-Hua Zhou
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, 210006 Nanjing, PR China
| | - Jiang-Wei Shen
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, 210006 Nanjing, PR China
| | - Tian-Ze Lu
- Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, 210006 Nanjing, PR China; Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, 210006 Nanjing, PR China
| | - Zhi-Kai Hu
- Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, 210006 Nanjing, PR China; Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, 210006 Nanjing, PR China
| | - Min Wang
- Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, 210006 Nanjing, PR China; Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, 210006 Nanjing, PR China
| | - Chang-Cheng Zhou
- Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, 210006 Nanjing, PR China; Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, 210006 Nanjing, PR China
| | - Jian-Ping Wu
- Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, 210006 Nanjing, PR China; Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, 210006 Nanjing, PR China
| | - Wen-Cheng Li
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, 210006 Nanjing, PR China
| | - Jia-Geng Zhu
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, 210006 Nanjing, PR China
| | - Rui-Peng Jia
- Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, 210006 Nanjing, PR China; Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, 210006 Nanjing, PR China.
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107
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Molecular pathogenesis of post-transplant acute kidney injury: assessment of whole-genome mRNA and miRNA profiles. PLoS One 2014; 9:e104164. [PMID: 25093671 PMCID: PMC4122455 DOI: 10.1371/journal.pone.0104164] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 07/07/2014] [Indexed: 12/13/2022] Open
Abstract
Acute kidney injury (AKI) affects roughly 25% of all recipients of deceased donor organs. The prevention of post-transplant AKI is still an unmet clinical need. We prospectively collected zero-hour, indication as well as protocol kidney biopsies from 166 allografts between 2011 and 2013. In this cohort eight cases with AKI and ten matched allografts without pathology serving as control group were identified with a follow-up biopsy within the first twelve days after engraftment. For this set the zero-hour and follow-up biopsies were subjected to genome wide microRNA and mRNA profiling and analysis, followed by validation in independent expression profiles of 42 AKI and 21 protocol biopsies for strictly controlling the false discovery rate. Follow-up biopsies of AKI allografts compared to time-matched protocol biopsies, further baseline adjustment for zero-hour biopsy expression level and validation in independent datasets, revealed a molecular AKI signature holding 20 mRNAs and two miRNAs (miR-182-5p and miR-21-3p). Next to several established biomarkers such as lipocalin-2 also novel candidates of interest were identified in the signature. In further experimental evaluation the elevated transcript expression level of the secretory leukocyte peptidase inhibitor (SLPI) in AKI allografts was confirmed in plasma and urine on the protein level (p<0.001 and p = 0.003, respectively). miR-182-5p was identified as a molecular regulator of post-transplant AKI, strongly correlated with global gene expression changes during AKI. In summary, we identified an AKI-specific molecular signature providing the ground for novel biomarkers and target candidates such as SLPI and miR-182-5p in addressing AKI.
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108
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Bassi R, Vergani A, D'Addio F, Ben Nasr M, Mocci A, Rastaldi MP, Ichimura T, Bonventre JV, Fiorina P. Positive effects of a novel non-peptidyl low molecular weight radical scavenger in renal ischemia/reperfusion: a preliminary report. SPRINGERPLUS 2014; 3:158. [PMID: 24741476 PMCID: PMC3979974 DOI: 10.1186/2193-1801-3-158] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 03/11/2014] [Indexed: 01/17/2023]
Abstract
Ischemia/reperfusion (I/R) is one of the most common causes of acute kidney injury. Reactive oxygen species have been recognized to be an important contributor to the pathogenesis of I/R injury. We hypothesize that a non-peptidyl low molecular weight radical scavenger (IAC) therapy may counteract this factor, ultimately providing some protection after acute phase renal I/R injury. The aim of this preliminary study was to assess the ability of IAC to reduce acute kidney injury in C57BL/6 mice after 30-minute of bilateral ischemia followed by reperfusion. The rise in serum creatinine level was higher in C57BL/6 control mice after I/R when compared to IAC (1 mg)-treated mice. Control mice showed greater body weight loss compared to IAC-treated mice, and at pathology, reduced signs of tubular necrosis were also evident in IAC-treated mice. These preliminary evidences lay the basis for more comprehensive studies on the positive effects of IAC as a complementary therapeutic approach for acute phase renal I/R injury.
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Affiliation(s)
- Roberto Bassi
- Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston, MA USA ; DiSTeBA, Universita' del Salento, Lecce, Italy ; Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Vergani
- Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston, MA USA
| | - Francesca D'Addio
- Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston, MA USA ; Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Moufida Ben Nasr
- Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston, MA USA
| | - Alessio Mocci
- Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston, MA USA ; Department of Accident and Emergency, ASL, Bologna, Italy
| | - Maria Pia Rastaldi
- Renal Research Laboratory, Fondazione IRCCS Ospedale Maggiore Policlinico & Fondazione D'Amico per la Ricerca sulle Malattie Renali, Milan, Italy
| | - Takaharu Ichimura
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA
| | | | - Paolo Fiorina
- Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston, MA USA ; Medicine, San Raffaele Scientific Institute, Milan, Italy ; Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA
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109
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Xue C, Liu Y, Li C, Li Y, Yang T, Xie L, Zhou P. Powerful protection against renal ischemia reperfusion injury by T cell-specific NF-κB inhibition. Transplantation 2014; 97:391-6. [PMID: 24398854 DOI: 10.1097/01.tp.0000438622.89310.95] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND NF-κB plays a key role in ischemia reperfusion injury (IRI). Systemic inhibition of NF-κB by various methods has been proven to ameliorate IRI. However, NF-κB is also responsible for tissue protection against IRI. Systemic NF-κB inhibition may not be the optimal way for preventing IRI because of its complex roles. T cells are essential in mediating IRI. NF-κB is an important molecule during T cell activation. It is not clear the effect of T cell-specific NF-κB inhibition on IRI. We aimed to study the effect of T cell-specific NF-κB inhibition on renal IRI in IκBαΔN-Tg mice. We also compared the different effects between T cell-specific and systemic NF-κB inhibition on IRI. METHODS Renal IRI was induced by left renal pedicle clamping for 60 or 80 min in wild-type, ursolic acid-treated or IκBαΔN-Tg mice. Renal function, histologic examination and overall survival after lethal IRI was evaluated in each group. RESULTS Serum creatinine, BUN, and pathologic damage were all reduced in IκBαDN-Tg mice and ursolic acid-treated mice than those in the control group. All the above indexes were improved better in IκBαDN-Tg mice than those in ursolic acid-treated mice. The survival rate of IκBαDN-Tg mice was higher than that of ursolic acid-treated mice after lethal kidney ischemia reperfusion injury. Immunohistochemistry showed a significant reduced CD4+ T cells and neutrophil infiltration in IκBαDN-Tg mice. CONCLUSION T cell-specific NF-κB inhibition provides powerful protective effect against renal IRI.
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Affiliation(s)
- ChengBiao Xue
- 1 Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Key Laboratory of Ministry of Health, and Key Laboratory of Ministry of Education, China. 2 Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 3 Address correspondence to: Ping Zhou, 1095 Jiefang Road, Tongji Hospital, Institute of Organ Transplantation, Wuhan, Hubei 430030, China
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110
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Delayed kidney graft function: from mechanism to translation. Kidney Int 2014; 86:251-8. [PMID: 24522494 DOI: 10.1038/ki.2014.18] [Citation(s) in RCA: 154] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 12/17/2013] [Accepted: 12/19/2013] [Indexed: 12/16/2022]
Abstract
In as many as 50% of cases the immediate post-kidney transplant course is complicated by delayed graft function that is most commonly related to ischemia and reperfusion injury. In addition to the acute complications related to renal failure and the associated economic impact of prolonged hospitalization, the development of delayed graft function is associated with an increased risk of chronic allograft nephropathy and shortened allograft survival. Challenges in understanding its mechanisms include the complexity, as contributors are derived from both the donor and the recipient. This acute kidney injury is modulated and caused by a complex interplay of events that lead to hypoxic and ischemic injury as well as to altered repair mechanisms. New therapies primarily seek to suppress the inflammatory homing of adaptive immune cells to the kidney, limit cell death, and/or interrupt detrimental signaling of necrosis. Although there are several promising novel targets and innovative therapeutics available, many challenges remain in their translation from bench to bedside. Identifying organs at risk and clearly defined end points will be critical in designing interventional trials.
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111
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Legendre C, Canaud G, Martinez F. Factors influencing long-term outcome after kidney transplantation. Transpl Int 2013; 27:19-27. [DOI: 10.1111/tri.12217] [Citation(s) in RCA: 151] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 09/27/2013] [Accepted: 10/16/2013] [Indexed: 02/06/2023]
Affiliation(s)
- Christophe Legendre
- Service de Néphrologie-Transplantation; Hôpital Necker; Paris France
- Université Paris Descartes; Sorbonne Paris Cité; Paris France
- INSERM U845; Hôpital Necker; Paris France
| | - Guillaume Canaud
- Service de Néphrologie-Transplantation; Hôpital Necker; Paris France
- Université Paris Descartes; Sorbonne Paris Cité; Paris France
- INSERM U845; Hôpital Necker; Paris France
| | - Frank Martinez
- Service de Néphrologie-Transplantation; Hôpital Necker; Paris France
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