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Wysoczańska B, Dratwa M, Nieszporek A, Niepiekło-Miniewska W, Kamińska D, Ramuś T, Rasała J, Krajewska M, Bogunia-Kubik K. Analysis of IL-17A, IL-17F, and miR-146a-5p Prior to Transplantation and Their Role in Kidney Transplant Recipients. J Clin Med 2024; 13:2920. [PMID: 38792460 PMCID: PMC11122464 DOI: 10.3390/jcm13102920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 04/29/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: The balance between regulatory and Th17 cells plays an important role in maintaining the immune tolerance after kidney transplantation (KTx) which is essential for transplantation success, defined as a long graft survival and an absence of organ rejection. The present study aimed to assess whether the pretransplant characteristics of IL-17A and IL-17F, their receptors, as well as miR-146a-5p, an miRNA associated with IL-17A/F regulation, can predict KTx outcomes. Methods: A group of 108 pre-KTx dialysis patients and 125 healthy controls were investigated for single nucleotide substitutions within genes coding for IL-17A, IL-17F, their IL-17RA/RC receptors, and miR-146a-5p. Genotyping was performed using LightSNiP assays. In addition, IL17-A/F serum concentrations were determined using ELISA while miR-146a-5p expression was analyzed by RT-PCR. Results: The IL-17F (rs763780) G allele prevailed in KTx recipients as compared to healthy individuals (OR = 23.59, p < 0.0001) and was associated with a higher IL-17F serum level (p = 0.0381) prior to transplantation. Higher miR-146a-5p expression before KTx was more frequently detected in recipients with an increased IL-17A serum concentration (p = 0.0177). Moreover, IL-17A (rs2275913) GG homozygosity was found to be associated with an increased incidence of deaths before KTx (OR = 4.17, p = 0.0307). T-cell or acute rejection episodes were more frequently observed among patients with the C allele of miR-146a-5p (rs2910164) (OR = 5.38, p = 0.0531). IL17-RA/-RC genetic variants (p < 0.05) seem to be associated with eGFR values. Conclusions: These results imply that IL-17F (rs763780) polymorphism is associated with the serum level of this cytokine and may be related to the risk of renal disease and transplant rejection together with miR-146a-5p (rs2910164), while the IL-17A (rs2275913) genotype may affect patients' survival before KTx.
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Affiliation(s)
- Barbara Wysoczańska
- Laboratory of Clinical Immunogenetics and Pharmacogenetics, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53-114 Wroclaw, Poland; (M.D.); (K.B.-K.)
| | - Marta Dratwa
- Laboratory of Clinical Immunogenetics and Pharmacogenetics, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53-114 Wroclaw, Poland; (M.D.); (K.B.-K.)
| | - Artur Nieszporek
- Laboratory of Clinical Immunogenetics and Pharmacogenetics, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53-114 Wroclaw, Poland; (M.D.); (K.B.-K.)
- Biobank Research Group, Lukasiewicz Research Network—PORT Polish Center for Technology Development, 54-066 Wroclaw, Poland
| | - Wanda Niepiekło-Miniewska
- Laboratory of Tissue Immunology, Medical Center, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53-114 Wroclaw, Poland;
| | - Dorota Kamińska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland; (D.K.); (M.K.)
| | - Tomasz Ramuś
- Faculty of Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland;
| | | | - Magdalena Krajewska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland; (D.K.); (M.K.)
| | - Katarzyna Bogunia-Kubik
- Laboratory of Clinical Immunogenetics and Pharmacogenetics, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53-114 Wroclaw, Poland; (M.D.); (K.B.-K.)
- Laboratory of Tissue Immunology, Medical Center, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53-114 Wroclaw, Poland;
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2
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Ranawaka R, Dayasiri K, Sandamali E, Gamage M. Management strategies for common viral infections in pediatric renal transplant recipients. World J Transplant 2024; 14:89978. [PMID: 38576764 PMCID: PMC10989477 DOI: 10.5500/wjt.v14.i1.89978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/19/2023] [Accepted: 01/04/2024] [Indexed: 03/15/2024] Open
Abstract
Viral infections have been considered as a major cause of morbidity and mortality after kidney transplantation in pediatric cohort. Children are at high risk of acquiring virus-related complications due to immunological immaturity and the enhanced alloreactivity risk that led to maintenance of high immunosuppressive regimes. Hence, prevention, early detection, and prompt treatment of such infe ctions are of paramount importance. Among all viral infections, herpes viruses (herpes simplex virus, varicella zoster virus, Epstein-Barr virus, cytomegalovirus), hepatitis B and C viruses, BK polyomavirus, and respiratory viruses (respiratory syncytial virus, parainfluenza virus, influenza virus and adenovirus) are common in kidney transplant recipients. These viruses can cause systemic disease or allograft dysfunction affecting the clinical outcome. Recent advances in tech nology and antiviral therapy have improved management strategies in screening, monitoring, adoption of prophylactic or preemptive therapy and precise trea tment in the immunocompromised host, with significant impact on the outcome. This review discusses the etiology, screening and monitoring, diagnosis, pre vention, and treatment of common viral infections in pediatric renal transplant recipients.
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Affiliation(s)
- Randula Ranawaka
- Department of Paediatrics, Faculty of Medicine, University of Colombo and Lady Ridgeway Hospital for Children, Colombo 0094, Sri Lanka
| | - Kavinda Dayasiri
- Department of Paediatrics, Facullty of Medicine, University of Kelaniya, Ragama 0094, Sri Lanka
| | - Erandima Sandamali
- Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna, Galle 0094, Sri Lanka
| | - Manoji Gamage
- Division of Nutrition, Ministry of Health, Colombo 0094, Sri Lanka
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3
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Bahakel H, Waghmare A, Madan RP. Impact of Respiratory Viral Infections in Transplant Recipients. J Pediatric Infect Dis Soc 2024; 13:S39-S48. [PMID: 38417082 DOI: 10.1093/jpids/piad094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/23/2023] [Indexed: 03/01/2024]
Abstract
Respiratory viral infections (RVIs) are among the leading cause of morbidity and mortality in pediatric hematopoietic stem cell transplant (HCT) and solid organ transplant (SOT) recipients. Transplant recipients remain at high risk for super imposed bacterial and fungal pneumonia, chronic graft dysfunction, and graft failure as a result of RVIs. Recent multicenter retrospective studies and prospective studies utilizing contemporary molecular diagnostic techniques have better delineated the epidemiology and outcomes of RVIs in pediatric transplant recipients and have advanced the development of preventative vaccines and treatment interventions in this population. In this review, we will define the epidemiology and outcomes of RVIs in SOT and HSCT recipients, describe the available assays for diagnosing a suspected RVI, highlight evolving management and vaccination strategies, review the risk of donor derived RVI in SOT recipients, and discuss considerations for delaying transplantation in the presence of an RVI.
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Affiliation(s)
- Hannah Bahakel
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Alpana Waghmare
- Department of Pediatrics, University of Washington, Fred Hutchinson Cancer Research Center; Department of Infectious Diseases, Seattle Children's Hospital, Seattle, WA, USA
| | - Rebecca Pellet Madan
- New York University Grossman School of Medicine; Department of Infectious Diseases, Hassenfeld Children's Hospital, New York, NY, USA
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4
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Green M, Squires JE, Chinnock RE, Comoli P, Danziger-Isakov L, Dulek DE, Esquivel CO, Höcker B, L'Huillier AG, Mazariegos GV, Visner GA, Bollard CM, Dipchand AI, Ferry JA, Gross TG, Hayashi R, Maecker-Kolhoff B, Marks S, Martinez OM, Metes DM, Michaels MG, Preiksaitis J, Smets F, Swerdlow SH, Trappe RU, Wilkinson JD, Allen U, Webber SA, Dharnidharka VR. The IPTA Nashville consensus conference on Post-Transplant lymphoproliferative disorders after solid organ transplantation in children: II-consensus guidelines for prevention. Pediatr Transplant 2024; 28:e14350. [PMID: 36369745 DOI: 10.1111/petr.14350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022]
Abstract
The International Pediatric Transplant Association (IPTA) convened an expert consensus conference to assess current evidence and develop recommendations for various aspects of care relating to post-transplant lymphoproliferative disorder after solid organ transplantation in children. In this report from the Prevention Working Group, we reviewed the existing literature regarding immunoprophylaxis and chemoprophylaxis, and pre-emptive strategies. While the group made a strong recommendation for pre-emptive reduction of immunosuppression at the time of EBV DNAemia (low to moderate evidence), no recommendations for use could be made for any prophylactic strategy or alternate pre-emptive strategy, largely due to insufficient or conflicting evidence. Current gaps and future research priorities are highlighted.
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Affiliation(s)
- Michael Green
- Division of Pediatric Infectious Diseases, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - James E Squires
- Division of Gastroenterology, Hepatology and Nutrition, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Patrizia Comoli
- Cell Factory & Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico, San Matteo, Pavia, Italy
| | - Lara Danziger-Isakov
- Division of Infectious Disease, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Daniel E Dulek
- Division of Pediatric Infectious Diseases, Monroe Carell Jr. Children's Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Britta Höcker
- Pediatrics I, University Children's Hospital, Heidelberg, Germany
| | - Arnaud G L'Huillier
- Pediatric Infectious Diseases Unit and Laboratory of Virology, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - George Vincent Mazariegos
- Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh and Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Gary A Visner
- Division of Pulmonary Medicine, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Catherine M Bollard
- Center for Cancer and Immunology Research, Children's National Hospital, The George Washington University, Washington, District of Columbia, USA
| | - Anne I Dipchand
- Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Judith A Ferry
- Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thomas G Gross
- Center for Cancer and Blood Diseases, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Robert Hayashi
- Division of Pediatric Hematology/Oncology, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri, USA
| | | | - Stephen Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London, Great Ormond Street Institute of Child Health, London, UK
| | - Olivia M Martinez
- Department of Surgery and Program in Immunology, Stanford University School of Medicine, Stanford, California, USA
| | - Diana M Metes
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marian G Michaels
- Division of Pediatric Infectious Diseases, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jutta Preiksaitis
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Françoise Smets
- Pediatric Gastroenterology and Hepatology, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Stephen H Swerdlow
- Division of Hematopathology, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ralf U Trappe
- Department of Hematology and Oncology, DIAKO Ev. Diakonie-Krankenhaus Bremen, Bremen, Germany and Department of Internal Medicine II: Hematology and Oncology, University Medical Centre Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - James D Wilkinson
- Department of Pediatrics, Vanderbilt School of Medicine, Nashville, Tennessee, USA
| | - Upton Allen
- Division of Infectious Diseases and the Transplant and Regenerative Medicine Center, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Steven A Webber
- Department of Pediatrics, Vanderbilt School of Medicine, Nashville, Tennessee, USA
| | - Vikas R Dharnidharka
- Department of Pediatrics, Division of Pediatric Nephrology, Hypertension & Pheresis, Washington University School of Medicine & St. Louis Children's Hospital, St. Louis, Missouri, USA
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5
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Feltran LDS, Genzani CP, Fonseca MJBM, da Silva EF, Baptista JC, de Carvalho MFC, Koch-Nogueira PC. Strategy to Enable and Accelerate Kidney Transplant in Small Children and Results of the First 130 Transplants in Children ≤15 kg in a Single Center. Transplantation 2020; 104:e236-e242. [PMID: 32732842 DOI: 10.1097/tp.0000000000003300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Proper care of young children in need of kidney transplant (KT) requires many skilled professionals and an expensive hospital structure. Small children have lesser access to KT. METHODS We describe a strategy performed in Brazil to enable and accelerate KT in children ≤15 kg based on the establishment of one specialized transplant center, focused on small children, and cooperating with distant centers throughout the country. Actions on 3 fronts were implemented: (a) providing excellent medical assistance, (b) coordinating educational activities to disseminate expertise and establish a professional network, and (c) fostering research to promote scientific knowledge. We presented the number and outcomes of small children KT as a result of this strategy. RESULTS Three hundred forty-six pediatric KTs were performed in the specialized center from 2009 to 2017, being 130 in children ≤15 kg (38%, being 41 children ≤10 kg) and 216 in >15 kg (62%). Patient survival after 1 and 5 years of the transplant was 97% and 95% in the "small children" group, whereas, in the "heavier children" group, it was 99% and 96% (P = 0.923). Regarding graft survival, we observed in the "small children" group, 91% and 87%, whereas in the "heavier children" group, 94% and 87% (P = 0.873). These results are comparable to the literature data. Groups were similar in the incidence of reoperation, vascular thrombosis, posttransplant lymphoproliferative disease, and estimated glomerular filtration rate. CONCLUSIONS The strategy allowed an improvement in the number of KT in small children with excellent results. We believe this experience may be useful in other locations.
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Affiliation(s)
| | - Camila Penteado Genzani
- Pediatric Kidney Transplantation Department, Hospital Samaritano de São Paulo, São Paulo, Brazil
| | | | - Erica Francisco da Silva
- Pediatric Kidney Transplantation Department, Hospital Samaritano de São Paulo, São Paulo, Brazil
| | - José Carlos Baptista
- Vascular Surgery Department, Federal University of São Paulo/UNIFESP, São Paulo, Brazil
| | | | - Paulo Cesar Koch-Nogueira
- Pediatric Kidney Transplantation Department, Hospital Samaritano de São Paulo, São Paulo, Brazil
- Department of Pediatrics, Federal University of São Paulo/UNIFESP, São Paulo, Brazil
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6
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El Hennawy HM. BK Polyomavirus Immune Response With Stress on BK-Specific T Cells. EXP CLIN TRANSPLANT 2018; 16:376-385. [PMID: 29766776 DOI: 10.6002/ect.2017.0354] [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
Polyomavirus-associated nephropathy is a pertinent cause of poor renal allograft survival. Absence of defensive immunity toward BK polyomavirus may favor the occurrence of BK polyomavirus-active infection and influence the progression to polyomavirus-associated nephropathy. Humoral immune responses may offer incomplete protection. In this review, available data on both humoral and cellular immunity were examined, with a concentration on BK polyomavirus-specific T cells; in addition, their roles in BK polyomavirus cellular immune response and immunotherapy were discussed. This traditional narrative review used PubMed and Medline searches for English language reports on BK polyomavirus immune response and BK-specific T cells published between January 1990 and November 2017. The search included the key words BK virus, BK polyomavirus, immune and response, and specific T cells. Monitoring BK polyomavirus-specific T cells has both therapeutic and prognostic value. Innovative cellular immunotherapy approaches, including development of vaccinations and infectious recombinant BK polyomavirus, could further contribute to the prevention of BK polyomavirus infection and related diseases.
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Affiliation(s)
- Hany M El Hennawy
- From the Transplant Surgery Section, Department of General Surgery, Armed Forces Hospital, Southern Region, Khamis Mushate, KSA
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Chiodini B, Herman J, Lolin K, Adams B, Hennaut E, Lingier P, Mikhalski D, Schurmans T, Knops N, Wissing KM, Abramowicz D, Ismaili K. Outcomes of kidney transplantations in children weighing 15 kilograms or less: a retrospective cohort study. Transpl Int 2018; 31:720-728. [DOI: 10.1111/tri.13108] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 11/12/2017] [Accepted: 12/15/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Benedetta Chiodini
- Department of Pediatric Nephrology; Hôpital Universitaire des Enfants - Reine Fabiola; Université Libre de Bruxelles (ULB); Brussels Belgium
| | - Jean Herman
- Department of Pediatric Nephrology and Solid Organ Transplantation; University Hospitals Leuven; Leuven Belgium
| | - Ksenija Lolin
- Department of Pediatric Nephrology; Hôpital Universitaire des Enfants - Reine Fabiola; Université Libre de Bruxelles (ULB); Brussels Belgium
| | - Brigitte Adams
- Department of Pediatric Nephrology; Hôpital Universitaire des Enfants - Reine Fabiola; Université Libre de Bruxelles (ULB); Brussels Belgium
| | - Elise Hennaut
- Department of Pediatric Nephrology; Hôpital Universitaire des Enfants - Reine Fabiola; Université Libre de Bruxelles (ULB); Brussels Belgium
| | - Pierre Lingier
- Renal transplant Unit; Erasme Hospital; Université Libre de Bruxelles (ULB); Brussels Belgium
| | - Dimitri Mikhalski
- Renal transplant Unit; Erasme Hospital; Université Libre de Bruxelles (ULB); Brussels Belgium
| | - Thierry Schurmans
- Department of Pediatrics; Hôpital Universitaire Civil Marie Curie; Université Libre de Bruxelles (ULB); Charleroi Belgium
| | - Noël Knops
- Department of Pediatric Nephrology and Solid Organ Transplantation; University Hospitals Leuven; Leuven Belgium
| | - Karl M. Wissing
- Department of Nephrology; UZ Brussel-VUB; Vrije Universiteit Brussel (VUB); Brussels Belgium
| | - Daniel Abramowicz
- Department of Nephrology; Antwerp University Hospital and Antwerp University; Antwerp Belgium
| | - Khalid Ismaili
- Department of Pediatric Nephrology; Hôpital Universitaire des Enfants - Reine Fabiola; Université Libre de Bruxelles (ULB); Brussels Belgium
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8
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Reusz GS, Molnar MZ. Are kidney transplantation outcomes improved in children weighting 15 kilograms or less in the last decades? Transpl Int 2018; 31:703-705. [PMID: 29341248 DOI: 10.1111/tri.13113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 01/10/2018] [Indexed: 11/28/2022]
Affiliation(s)
- George S Reusz
- First Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Miklos Z Molnar
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN, USA.,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
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9
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Correa Sierra CB, Kourí Cardellá V, Pérez Santos L, Silverio CE, Hondal N, Florin J. Herpesviruses excretion in saliva of pediatric transplant recipients. Transpl Infect Dis 2017; 19. [DOI: 10.1111/tid.12771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/15/2017] [Accepted: 06/05/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Consuelo Beatriz Correa Sierra
- Sexually Transmitted Diseases Laboratory; Virology Department; Institute of Tropical Medicine “Pedro Kourí”; Havana Cuba
| | - Vivian Kourí Cardellá
- Sexually Transmitted Diseases Laboratory; Virology Department; Institute of Tropical Medicine “Pedro Kourí”; Havana Cuba
| | - Lissette Pérez Santos
- Sexually Transmitted Diseases Laboratory; Virology Department; Institute of Tropical Medicine “Pedro Kourí”; Havana Cuba
| | | | - Norma Hondal
- University Pediatric Hospital “William Soler”; Havana Cuba
| | - Jose Florin
- University Pediatric Hospital “Centro Habana”; Havana Cuba
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DeWolfe D, Gandhi J, Mackenzie MR, Broge TA, Bord E, Babwah A, Mandelbrot DA, Pavlakis M, Cardarelli F, Viscidi R, Chandraker A, Tan CS. Pre-transplant immune factors may be associated with BK polyomavirus reactivation in kidney transplant recipients. PLoS One 2017; 12:e0177339. [PMID: 28562595 PMCID: PMC5451008 DOI: 10.1371/journal.pone.0177339] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 04/26/2017] [Indexed: 12/14/2022] Open
Abstract
BK polyomavirus (BKPyV) reactivation in kidney transplant recipients can lead to allograft damage and loss. The elements of the adaptive immune system that are permissive of reactivation and responsible for viral control remain incompletely described. We performed a prospective study evaluating BKPyV-specific T-cell response, humoral response and overall T-cell phenotype beginning pre-transplant through one year post-transplant in 28 patients at two centers. We performed an exploratory analysis of risk factors for the development of viremia and viruria as well as compared the immune response to BKPyV in these groups and those who remained BK negative. 6 patients developed viruria and 3 developed viremia. BKPyV-specific CD8+ T-cells increased post-transplant in viremic and viruric but not BK negative patients. BKPyV-specific CD4+ T-cells increased in viremic, but not viruric or BK negative patients. Anti-BKPyV IgG antibodies increased in viruric and viremic patients but remained unchanged in BK negative patients. Viremic patients had a greater proportion of CD8+ effector cells pre-transplant and at 12 months post-transplant. Viremic patients had fewer CD4+ effector memory cells at 3 months post-transplant. Exploratory analysis demonstrated lower CD4 and higher total CD8 proportions, higher anti-BKPyV antibody titers and the cause of renal failure were associated BKPyV reactivation. In conclusion, low CD4, high CD8 and increased effector CD8 cells were found pre-transplant in patients who became viremic, a phenotype associated with immune senescence. This pre-transplant T-cell senescence phenotype could potentially be used to identify patients at increased risk of BKPyV reactivation.
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Affiliation(s)
- David DeWolfe
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Jinal Gandhi
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Matthew R. Mackenzie
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Thomas A. Broge
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Evelyn Bord
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Amaara Babwah
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Didier A. Mandelbrot
- The Transplant Institute, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Martha Pavlakis
- The Transplant Institute, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Francesca Cardarelli
- The Transplant Institute, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Raphael Viscidi
- Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Anil Chandraker
- Transplantation Research Center, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Chen S. Tan
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Infectious Disease Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
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11
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Jalanko H, Mattila I, Holmberg C. Renal transplantation in infants. Pediatr Nephrol 2016; 31:725-35. [PMID: 26115617 DOI: 10.1007/s00467-015-3144-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 05/27/2015] [Accepted: 06/08/2015] [Indexed: 01/28/2023]
Abstract
Renal transplantation (RTx) has become an accepted mode of therapy in infants with severe renal failure. The major indications are structural abnormalities of the urinary tract, congenital nephrotic syndrome, polycystic diseases, and neonatal kidney injury. Assessment of these infants needs expertise and time as well as active treatment before RTx to ensure optimal growth and development, and to avoid complications that could lead to permanent neurological defects. RTx can be performed already in infants weighing around 5 kg, but most operations occur in infants with a weight of 10 kg or more. Perioperative management focuses on adequate perfusion of the allograft and avoidance of thrombotic and other surgical complications. Important long-term issues include rejections, infections, graft function, growth, bone health, metabolic problems, neurocognitive development, adherence to medication, pubertal maturation, and quality of life. The overall outcome of infant RTx has dramatically improved, with long-term patient and graft survivals of over 90 and 80 %, respectively.
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Affiliation(s)
- Hannu Jalanko
- Department Pediatric Nephrology and Transplantation, Children's Hospital, University of Helsinki and Helsinki University Hospital, PO Box 281, Helsinki, 00290, Finland.
| | - Ilkka Mattila
- Department of Cardiac and Transplantation Surgery, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Christer Holmberg
- Department Pediatric Nephrology and Transplantation, Children's Hospital, University of Helsinki and Helsinki University Hospital, PO Box 281, Helsinki, 00290, Finland
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Lofaro D, Vogelzang JL, van Stralen KJ, Jager KJ, Groothoff JW. Infection-related hospitalizations over 30 years of follow-up in patients starting renal replacement therapy at pediatric age. Pediatr Nephrol 2016; 31:315-23. [PMID: 26463555 PMCID: PMC4689769 DOI: 10.1007/s00467-015-3209-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 07/29/2015] [Accepted: 08/12/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND Pediatric renal replacement therapy (RRT) patients surviving long-term are at a much higher risk of mortality compared with the age-matched general population. Recently, we demonstrated a transition from cardiovascular disease to infection as the main cause of death in a long-term follow-up study of pediatric RRT. Here, we explore the burden of infections requiring hospitalization over 30 years of follow-up on RRT. METHODS The cohort comprised all 234 Dutch patients on RRT under 15 years of age between 1972 and 1992. We analyzed infection-related hospitalizations during the period 1980–2010. We evaluated the Hospital Admission Rate (HAR) per patient-years (py) and infectious over noninfectious HAR ratio (HARR). RESULTS The HAR decreased significantly over time for all patients. The rate of hemodialysis-related infections decreased between 1980 and 1999, but stabilized during 2000–2010, whereas peritoneal dialysis-related infections decreased progressively. Transplantation-related infections did not change, except for urinary tract infections (UTIs), which increased significantly from 3.3/100 py [95%CI 3.2–3.4] in 1980–1989 to 4.4/100 py [4.2–4.5] in 2000–2010 (p <0.001). The contribution of infection to HAR increased significantly in transplanted patients (HARR: 1980–1989: 0.25 [0.2–0.3]; 2000–2010: 1.0 [0.79–1.27], p <0.001). CONCLUSIONS Our findings indicate a relative increase in infections requiring hospitalization over time in patients starting RRT during the pediatric age, especially severe UTIs in transplantation. More attention paid to urological abnormalities in cases of recurrent UTI and tailored adjustment of immunosuppression may reduce risk in these patients.
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Affiliation(s)
- Danilo Lofaro
- />Kidney and Transplantation Research Centre, Department of Nephrology, Dialysis and Transplantation, Annunziata Hospital, Via F. Migliori, 87100 Cosenza, Italy
| | - Judith L. Vogelzang
- />Department of Pediatric Nephrology, Academic Medical Center, Emma Children’s Hospital, Amsterdam, The Netherlands
| | - Karlijn J van Stralen
- />ERA-EDTA Registry and ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Kitty J. Jager
- />ERA-EDTA Registry and ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jaap W. Groothoff
- />Department of Pediatric Nephrology, Academic Medical Center, Emma Children’s Hospital, Amsterdam, The Netherlands
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Quantitative analysis of BKV-specific CD4+ T cells before and after kidney transplantation. Transpl Immunol 2015; 33:20-6. [PMID: 26048051 DOI: 10.1016/j.trim.2015.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 05/29/2015] [Accepted: 05/29/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND BK virus (BKV) is the main infectious cause of renal allograft dysfunction. Although recent studies showed an inverse correlation between BKV-specific T-cell responses and viral load after transplantation, the importance of pre-transplant response in the process of virus reactivation has only been studied once. In this study, we aimed to determine whether pre-transplant CD4+ T-cell response can be used for prediction of BKV reactivation and BKV nephropathy (BKVN), by a method that can practically be used in routine patient monitoring. METHODS BKV-specific CD4+ T-cell responses of 31 kidney recipients (all from live donors) were measured by an IFN-γ-enzyme-linked-immunospot (ELISPOT) method using mixture of peptides, at day 0 and +1, +3, and +6 months posttransplant. Additionally, seven other reactivation patients as another group were also analyzed. BKV viral loads in plasma were measured by real-time polymerase chain reaction (PCR). Responses of 10 healthy people were also included as controls in the analysis. RESULTS All but one patient and all of the controls had detectable CD4+ T-cell responses. Reactivation occurred in 8 out of 31 patients. There was no significant association between pretransplant BKV-specific CD4+ T-cell responses and BKV reactivation and between BKV DNA levels and CD4+ T-cell responses. In the additional group consisting of reactivation patients, four patients who had BKVN showed negative correlation between BKV-DNA levels and BKV-specific CD4+ T-cell responses (p<0.05). One patient who developed BKVN, however, was not able to mount a similar CD4+ T-cell response to viral reactivation despite immunosuppressive reduction. CONCLUSION Even though our cohort is small, our results may suggest that pre-transplant measurement of BKV specific CD4+ T-cell response may not be necessary, and that post-transplant monitoring, particularly during reactivation, may be more helpful in the management of the infection.
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Ahn YH, Min SI, Ha J, Ha IS, Cheong HI, Kang HG. Pharmacodynamic Monitoring of Calcineurin Inhibitor in Pediatric Kidney Transplantation. KOREAN JOURNAL OF TRANSPLANTATION 2015. [DOI: 10.4285/jkstn.2015.29.1.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Yo Han Ahn
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul, Korea
| | - Sang Il Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jongwon Ha
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Il-Soo Ha
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul, Korea
| | - Hae Il Cheong
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul, Korea
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul, Korea
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Soares SFDS, Donatti TL, Souto FJD. Serological markers of viral, syphilitic and toxoplasmic infection in children and teenagers with nephrotic syndrome: case series from Mato Grosso State, Brazil. Rev Inst Med Trop Sao Paulo 2015; 56:499-504. [PMID: 25351544 PMCID: PMC4296870 DOI: 10.1590/s0036-46652014000600008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 03/25/2014] [Indexed: 11/21/2022] Open
Abstract
Some infections can be the cause of secondary nephrotic syndrome. The
aim of this study was to describe the experience of a Renal Disease Reference
Clinic from Central Brazil, in which serological markers of some infectious
agents are systematically screened in children with nephrotic syndrome. Data
were obtained from the assessment of medical files of all children under fifteen
years of age, who matched nephrotic syndrome criteria. Subjects were tested for
IgG and IgM antibodies against T. gondii and cytomegalovirus;
antibodies against Herpes simplex, hepatitis C virus and HIV; and surface
antigen (HBsAg) of hepatitis B virus. The VDRL test was also
performed. 169 cases were studied. The median age on the first visit was 44
months and 103 (60.9%) patients were male. Anti-CMV IgG and IgM
were found in 70.4% and 4.1%, respectively. IgG and IgM against
Toxoplasma gondii were present in 32.5% and 5.3%,
respectively. Two patients were positive for HBsAg, but none showed markers for
HIV, hepatitis C, or Treponema pallidum. IgG and IgM against
herpes simplex virus were performed on 54 patients, of which 48.1% and
22.2% were positive. IgM antibodies in some children with clinical signs of
recent infection suggest that these diseases may play a role in the genesis of
nephrotic syndrome.
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Affiliation(s)
| | - Teresinha Lermen Donatti
- Hospital Universitário Júlio Muller, Universidade Federal de Mato Grosso, Cuiabá, Mato Grosso State, Brazil
| | - Francisco José Dutra Souto
- Hospital Universitário Júlio Muller, Universidade Federal de Mato Grosso, Cuiabá, Mato Grosso State, Brazil
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16
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Posttransplant Soluble B-Cell Activating Factor Kinetics in Pediatric Recipients of First Kidney Allograft. Transplantation 2015; 99:243-9. [DOI: 10.1097/tp.0000000000000276] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
Viral infections associate temporally with the onset of many glomerular diseases, particularly in children. In other cases of glomerulonephritis, when infection is clinically silent, viral syndromes can still be implicated as a trigger. However, strong evidence for viral causality in most glomerular disease is still lacking. While numerous case reports in children document the occurrence of specific forms of glomerular disease after seroconversion to a wide range of viruses, relatively few reports provide pathologic evidence of viral infection associated with glomerular lesions on kidney biopsy. Strong associations between hepatitis viruses and glomerular injury have been acknowledged in adults, but hepatitis C virus appears not to be an etiology in children. In the context of treating glomerular diseases, when diagnosed, the treatment of hepatitis B virus, cytomegalovirus and human immunodeficiency virus in children with membranoproliferative, membranous and collapsing glomerulopathy plays an important role. Otherwise, there is no evidence suggesting that the identification of a viral infection in a child with glomerulopathy should change the management of the infection or the glomerulonephritis. Therefore, additional research into this topic is very much needed.
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Hashim F, Gregg JA, Dharnidharka VR. Efficacy of Extended Valganciclovir Prophylaxis in Preventing Cytomegalovirus Infection in Pediatric Kidney Transplantation. ACTA ACUST UNITED AC 2014; 7:152-157. [PMID: 25821528 PMCID: PMC4366268 DOI: 10.2174/1874303x01407010152] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 10/01/2014] [Accepted: 10/02/2014] [Indexed: 12/11/2022]
Abstract
Cytomegalovirus (CMV) is one of the most frequent opportunistic infection in renal transplant (RTx)
recipients. Valganciclovir (VGC) has been showed to be safe and highly effective in prophylaxis of CMV infection in
RTx recipients. Recently, an increase in delayed onset CMV disease has been noted with some arguing that longer
prophylaxis may decrease the late-onset disease. We retrospectively tested the hypothesis that extended term prophylaxis (ETP) of VGC for 12 months is more effective
than short term prophylaxis (STP) of 6 months in preventing CMV infection and disease in pediatric RTx performed at the
University of Florida from July 2003 to December 2010. In this period, all recipients underwent prospective CMV PCR
(Polymerase Chain Reaction) monitoring and were maintained on similar immunosuppression. Eighty six patients received RTx during that period. All eligible subjects had to have at least 12 months of graft survival and
18 months of follow up, leaving 73 eligible subjects in final study group. CMV infection or disease occurred in 6/29 (20%) in
the STP group vs 6/44 (14%) in the ETP group with no statistical significant difference (P= 0.42). Donor positive/recipients
negative CMV serology status (D+/R-) were associated with a higher risk of CMV infection in both univariate and
multivariate analysis (P=0.01). Anemia and Leucopenia directly associated with VGC were similar in both groups (P=0.58
and P=0.2 respectively). Biopsy-proven acute rejection was also non-significant in both groups (P=0.39). Although ETP for CMV from 6 months to 12 months is safe and has minimal adverse effect, it did not reduce CMV
infection or disease. Further controlled studies in pediatrics age group are considered to compare longer versus shorter
periods of prophylaxis and their impact on prevention of CMV infection, resistance, cost, and toxicity.
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Affiliation(s)
- Faris Hashim
- Divisions of Transplant Nephrology, University of Florida College of Medicine, Gainesville, FL USA
| | - Jon A Gregg
- Pediatric Nephrology and Transplant Nephrology, University of Florida College of Medicine, Gainesville, FL USA
| | - Vikas R Dharnidharka
- Divisions of Transplant Nephrology, University of Florida College of Medicine, Gainesville, FL USA
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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.
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20
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Kourí V, Correa C, Martínez PA, Sanchez L, Alvarez A, González G, Silverio CE, Hondal N, Florin J, Pérez L, Duran DP, Perez Y, Cazorla N, Gonzalez D, Jaime JC, Arencibia A, Sarduy S, Pérez L, Soto Y, González M, Alvarez I, Dorticós E, Marchena JJ, Solar L, Acosta B, Savón C, Hengge U. Prospective, comprehensive, and effective viral monitoring in Cuban children undergoing solid organ transplantation. SPRINGERPLUS 2014; 3:247. [PMID: 24877035 PMCID: PMC4035497 DOI: 10.1186/2193-1801-3-247] [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: 03/16/2014] [Accepted: 05/07/2014] [Indexed: 12/30/2022]
Abstract
PURPOSE In Cuba, viral monitoring in the post-transplant period was not routinely performed. The aim of this research is to identify the most frequent viruses that affect transplanted Cuban children, by implementing a viral follow-up during the post-transplant period. METHODS The study population included all Cuban pediatric patients who underwent solid organ transplantation (SOT) between November 2009 and December 2012. A total of 34 transplanted pediatric patients of kidney (n = 11) and liver (n = 23) were prospectively monitored during a 34-week period for viral DNAemia and DNAuria by simultaneous detection of cytomegalovirus (CMV), Epstein-Barr virus, herpes simplex virus type 1 and 2, varicella zoster virus, human herpesvirus 6, human adenovirus, and polyomaviruses (BKV and JCV) using quantitative real-time polymerase chain reaction (qRT-PCR). RESULTS Viral genome of at least one virus was detected in 21 of 34 recipients, 18 patients excreted virus in urine while 12 presented DNAemia. CMV (41.2%) and BKV (35.3%) were the most frequent viruses detected during the follow-up. CMV was the virus mainly associated with clinical symptoms and DNAemia. Its excretion in urine (with cut off value of 219 copies/mL) was associated with detection in plasma (p < 0.001); furthermore, CMV viruria was predictive of CMV viremia (OR:8.4, CI:2.4-29.1, p = 0.001). There was no association between high viral load and clinical complications, due to the prompt initiation of preemptive ganciclovir. CONCLUSION This comprehensive viral monitoring program effectively prevents the development of critical viral disease, thus urge the implementation of qRT-PCR as routine for viral monitoring of transplanted Cuban organ recipients.
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Affiliation(s)
- Vivian Kourí
- Sexually Transmitted Diseases Laboratory, Virology Department, Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba ; Virology Department, Institute of Tropical Medicine ¨Pedro Kourí¨, Autopista Novia del Mediodia Km 6., La Lisa, Havana City, Cuba
| | - Consuelo Correa
- Sexually Transmitted Diseases Laboratory, Virology Department, Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba
| | - Pedro A Martínez
- Sexually Transmitted Diseases Laboratory, Virology Department, Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba
| | - Lizet Sanchez
- Epidemiology and Statistic Department, Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba
| | - Alina Alvarez
- Sexually Transmitted Diseases Laboratory, Virology Department, Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba
| | - Grehete González
- Respiratory Viruses Laboratory, Virology Department, Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba
| | - César E Silverio
- University Pediatric Hospital "William Soler", Havana City, Cuba
| | - Norma Hondal
- University Pediatric Hospital "William Soler", Havana City, Cuba
| | - Jose Florin
- University Pediatric Hospital of "Centro Habana", Havana City, Cuba
| | - Lourdes Pérez
- University Pediatric Hospital of "Centro Habana", Havana City, Cuba
| | - Diana P Duran
- University Pediatric Hospital of "Centro Habana", Havana City, Cuba
| | - Yardelis Perez
- University Pediatric Hospital of "Centro Habana", Havana City, Cuba
| | - Nancy Cazorla
- University Pediatric Hospital of "Centro Habana", Havana City, Cuba
| | | | - Juan C Jaime
- National Institute of Haematology and Immunology, Havana City, Cuba
| | | | - Sandra Sarduy
- National Institute of Haematology and Immunology, Havana City, Cuba
| | - Lissette Pérez
- Sexually Transmitted Diseases Laboratory, Virology Department, Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba
| | - Yudira Soto
- Sexually Transmitted Diseases Laboratory, Virology Department, Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba
| | - Mabel González
- University Pediatric Hospital "William Soler", Havana City, Cuba
| | - Iliana Alvarez
- University Pediatric Hospital "William Soler", Havana City, Cuba
| | - Elvira Dorticós
- National Institute of Haematology and Immunology, Havana City, Cuba
| | - Juan J Marchena
- University Pediatric Hospital of "Centro Habana", Havana City, Cuba
| | - Luis Solar
- University Pediatric Hospital of "Centro Habana", Havana City, Cuba
| | - Belsy Acosta
- Respiratory Viruses Laboratory, Virology Department, Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba
| | - Clara Savón
- Respiratory Viruses Laboratory, Virology Department, Institute of Tropical Medicine "Pedro Kourí", Havana City, Cuba
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Basso S, Zecca M, Calafiore L, Rubert L, Fiocchi R, Paulli M, Quartuccio G, Guido I, Sebastiani R, Croci GA, Beschi C, Nardiello I, Ginevri F, Cugno C, Comoli P. Successful treatment of a classic Hodgkin lymphoma-type post-transplant lymphoproliferative disorder with tailored chemotherapy and Epstein-Barr virus-specific cytotoxic T lymphocytes in a pediatric heart transplant recipient. Pediatr Transplant 2013; 17:E168-73. [PMID: 23992468 DOI: 10.1111/petr.12146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2013] [Indexed: 12/14/2022]
Abstract
CHL type is the least common major form of EBV-related PTLD but rarely occurs in pediatric recipients; development of CHL subsequent to other PTLD subtypes in the same transplant recipient is even more unusual. Because of its rarity, indications on the best treatment strategy are limited. Patients have been mostly treated with standard HL chemotherapy/radiotherapy, and prognosis seems more favorable than other monomorphic PTLDs. Herein, we describe a pediatric case of EBV-associated, stage IV-B, CHL arising in a heart allograft recipient eight yr after diagnosis of B-cell polymorphic PTLD. The patient was successfully treated with adjusted-dose HL chemotherapy and autologous EBV-specific CTL, without discontinuation of maintenance immunosuppression. At two yr from therapy completion, the patient is in CR with stable organ function. With this strategy, it may be possible to reproduce the good prognostic data reported for CHL-type PTLD, with decreased risk of organ toxicity or rejection.
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Affiliation(s)
- Sabrina Basso
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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23
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Immunity to Polyomavirus BK Infection: Immune Monitoring to Regulate the Balance between Risk of BKV Nephropathy and Induction of Alloimmunity. Clin Dev Immunol 2013; 2013:256923. [PMID: 24000288 PMCID: PMC3755406 DOI: 10.1155/2013/256923] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Revised: 07/09/2013] [Accepted: 07/17/2013] [Indexed: 12/16/2022]
Abstract
Polyomavirus BK-associated nephropathy (PyVAN) is the main infectious cause of allograft damage after kidney transplantation. A number of studies revealed an association between the presence of BKV-specific cellular immunity and BK viral clearance, with patients failing to recover specific T cells progressing to PyVAN. Evolution to allograft dysfunction can be prevented by restoration of BKV-specific immunity through a stepwise reduction of maintenance immunosuppressive drugs. Prospective monitoring of BK viral load and specific immunity, together with B-cell alloimmune surveillance, may allow a targeted modification/reduction of immunosuppression, with the aim of obtaining viral clearance while preventing graft injury due to deposition of de novo donor-specific HLA antibodies and late/chronic antibody-mediated allograft injury. Innovative, immune-based therapies may further contribute to BKV infection prevention and control.
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Comoli P, Cioni M, Basso S, Gagliardone C, Potenza L, Verrina E, Luppi M, Zecca M, Ghiggeri GM, Ginevri F. Immunity to Polyomavirus BK Infection: Immune Monitoring to Regulate the Balance between Risk of BKV Nephropathy and Induction of Alloimmunity. Clin Dev Immunol 2013. [PMID: 24000288 DOI: 10.1154/2013/256923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Polyomavirus BK-associated nephropathy (PyVAN) is the main infectious cause of allograft damage after kidney transplantation. A number of studies revealed an association between the presence of BKV-specific cellular immunity and BK viral clearance, with patients failing to recover specific T cells progressing to PyVAN. Evolution to allograft dysfunction can be prevented by restoration of BKV-specific immunity through a stepwise reduction of maintenance immunosuppressive drugs. Prospective monitoring of BK viral load and specific immunity, together with B-cell alloimmune surveillance, may allow a targeted modification/reduction of immunosuppression, with the aim of obtaining viral clearance while preventing graft injury due to deposition of de novo donor-specific HLA antibodies and late/chronic antibody-mediated allograft injury. Innovative, immune-based therapies may further contribute to BKV infection prevention and control.
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Affiliation(s)
- Patrizia Comoli
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
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Lowe D, Higgins R, Krishnan N. Meeting report: 2nd international conference: antibody incompatible transplantation and transplant infectious disease. Int J Immunogenet 2013; 40:439-44. [PMID: 23919843 DOI: 10.1111/iji.12082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 06/12/2013] [Accepted: 07/15/2013] [Indexed: 02/04/2023]
Abstract
The 2nd International Conference on Antibody Incompatible Transplantation and Transplant Infectious Disease took place at the University of Warwick on 23rd and 24th November 2012. The aims of the meeting were to discuss the pertinent clinical and laboratory issues surrounding antibody incompatible transplantation and to provide a contemporary analysis of transplant infectious disease. This report summarises the key points discussed at the meeting.
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Affiliation(s)
- D Lowe
- Department of Histocompatibility and Immunogenetics, NHS Blood and Transplant, Birmingham, UK
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Baez CF, Guimarães MAAM, Martins RAG, Zalona ACJ, Cossatis JJ, Zalis MG, Cavalcanti SMB, Varella RB. Detection of merkel cell polyomavirus in oral samples of renal transplant recipients without Merkel cell carcinoma. J Med Virol 2013; 85:2016-9. [DOI: 10.1002/jmv.23687] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2013] [Indexed: 01/16/2023]
Affiliation(s)
- Camila Freze Baez
- Department of Microbiology and Parasitology; Fluminense Federal University; RJ Brazil
| | | | - Rosângela A. G. Martins
- Division of Research, University Hospital Clementino Fraga Filho; Federal University of Rio de Janeiro; RJ Brazil
| | | | - João José Cossatis
- Department of Microbiology and Parasitology; Fluminense Federal University; RJ Brazil
| | - Mariano Gustavo Zalis
- Department of Preventive Medicine; Faculty of Medicine, Federal University of Rio de Janeiro; RJ Brazil
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Chehade H, Girardin E, Delich V, Pascual MA, Venetz JP, Cachat F. Acute norovirus-induced agranulocytosis in a pediatric kidney transplant recipient. Transpl Infect Dis 2012; 14:E27-9. [PMID: 22676808 DOI: 10.1111/j.1399-3062.2012.00754.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 12/07/2011] [Accepted: 02/12/2012] [Indexed: 11/27/2022]
Abstract
Norovirus (NoV) infection is usually limited to the gastrointestinal (GI) tract. However, in immunocompromised patients, this infection might lead to severe life-threatening complications. We herein describe a pediatric kidney transplant patient who presented with an acute NoV infection complicated by febrile agranulocytosis that resolved with improvement of her GI illness. This unusual presentation has not been described before, to our knowledge. The aim of this article is to highlight the sometimes dramatic clinical presentation of NoV infection in immunosuppressed patients, and the importance of including this infection in the differential diagnosis of neutropenia in that specific population.
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Affiliation(s)
- H Chehade
- Department of Paediatric Nephrology, Lausanne University Hospital, Lausanne, Switzerland.
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Ranchin B, Hees L, Stamm D, Bertholet-Thomas A, Billaud G, Lina G, Cochat P, Gillet Y. [Kidney transplantation and infection in childhood]. Nephrol Ther 2011; 7:608-10. [PMID: 22118791 DOI: 10.1016/j.nephro.2011.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Infectious risk is more important in the transplanted child than in adult because children are less often immunised against pathogens ant more exposed than adults to numerous infectious agents (virus but also bacteria including pneumococcus). The application of the standard immunisation schedule must be a permanent concern of transplantation (Tx) teams. Some vaccines that are not planned in the standard immunization schedule are particularly advised for the child and his family circle, as well as for caregivers. Immunisation response must be evaluated by a serological follow-up before Tx, in particular during the pre-Tx diagnostic work-up, then regularly after Tx. The more frequent absence of immunisation against Epstein Barr Virus (EBV) in children explains the increased frequency of post-transplant lymphoproliferative disorder at the pediatric age.
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Affiliation(s)
- Bruno Ranchin
- Service de Néphrologie Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon et Université de Lyon.
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