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Căluşi T, Sorohan B, Iordache A, Domnişor L, Purcaru F. Association between peri-transplant acid-base parameters and graft dysfunction types in kidney transplantation. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2024; 62:178-183. [PMID: 38153886 DOI: 10.2478/rjim-2023-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Indexed: 12/30/2023]
Abstract
Perioperative acid-base disturbance could be informative regarding the possible slow graft function (SGF) or delayed graft function (DGF) development. There is a lack of data regarding the relationship between perioperative acid-base parameters and graft dysfunction in kidney transplant (KT) recipients. We aim to determine the incidence of graft dysfunction types and the association between them and acid-base parameters. We performed a prospective, cohort study on 54 adults, KT recipients, between 1st of January 2019 and 31st of December 2019. Graft function was defined and classified in three categories: immediate graft function (IGF) (serum creatinine < 3 mg/dL at day 5 after KT), SGF (serum creatinine ≥ 3mg/dL at day 5 or ≥ 2.5mg dL at day 7 after KT) and DGF (the need for at least one dialysis treatment in the first week after kidney transplantation). Among the 54 KT recipients, the incidence of SGF and DGF was 13% and 11.1%, respectively. SGF was significantly associated with lower intraoperative pH (7.26± 0.05 vs 7.35± 0.06, p= 0.004), preoperative and intraoperative base excess (BE) [-7.0 (-10.0 ߝ -6.0) vs -3.4 (-7.8 ߝ - 2.1) mmol/L, p= 0.04 and -10.3 (-11.0 ߝ -9.1) vs -4.0 (-6.3 ߝ - 3.0) mmol/L, p= 0.002, respectively] and serum bicarbonate (HCO3-) (16.0± 2.7 vs 19.3± 3.4 mmol/L, p= 0.01 and 14.1± 1.9 vs 18.8± 3.2 mmol/L, p= 0.002 respectively), compared to IGF. DGF was significantly associated with lower intraoperative values of pH (7.27± 0.05 vs 7.35± 0.06, p= 0.003), BE [-7.1 (-10.9 ߝ -6.1) vs -4.0 (-6.3 ߝ - 3.0) mmol/L, p= 0.02] and HCO3- (15.9± 2.4 vs 18.8± 3.2 mmol/L, p=0.02) compared to IGF. No differences were observed between SGF and DGF patients in any of the perioperative acid-base parameters. In conclusion we found that kidney graft dysfunction types are associated with perioperative acid-base parameters and perioperative metabolic acidosis could provide important information to predict SGF or DGF occurrence.
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Affiliation(s)
- Teodor Căluşi
- 1Intensive Care Unit, Department 2, Fundeni Clinical Institute, Fundeni Street No 258, District 2, Zip Code 022328, Bucharest, Romania
| | - Bogdan Sorohan
- 2Department of Nephrology, "Carol Davila" University of Medicine and Pharmacy, Dionisie Lupu Street No 37, Zip Code 020021, District 2, Bucharest, Romania
- 3Department of Kidney Transplantation, Fundeni Clinical Institute, Fundeni Street No 258, District 2, Zip Code 022328, Bucharest, Romania
| | - Alexandru Iordache
- 4Department of Urology, Fundeni Clinical Institute, Fundeni Street No 258, District 2, Zip Code 022328, Bucharest, Romania
| | - Liliana Domnişor
- 1Intensive Care Unit, Department 2, Fundeni Clinical Institute, Fundeni Street No 258, District 2, Zip Code 022328, Bucharest, Romania
| | - Florea Purcaru
- 5Craiova University of Medicine and Pharmacy, Petru Rareș Street No. 2, Zip Code 200349, Craiova, Romania
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2
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Heeger PS, Haro MC, Jordan S. Translating B cell immunology to the treatment of antibody-mediated allograft rejection. Nat Rev Nephrol 2024; 20:218-232. [PMID: 38168662 DOI: 10.1038/s41581-023-00791-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2023] [Indexed: 01/05/2024]
Abstract
Antibody-mediated rejection (AMR), including chronic AMR (cAMR), causes ~50% of kidney allograft losses each year. Despite attempts to develop well-tolerated and effective therapeutics for the management of AMR, to date, none has obtained FDA approval, thereby highlighting an urgent unmet medical need. Discoveries over the past decade from basic, translational and clinical studies of transplant recipients have provided a foundation for developing novel therapeutic approaches to preventing and treating AMR and cAMR. These interventions are aimed at reducing donor-specific antibody levels, decreasing graft injury and fibrosis, and preserving kidney function. Innovative approaches emerging from basic science findings include targeting interactions between alloreactive T cells and B cells, and depleting alloreactive memory B cells, as well as donor-specific antibody-producing plasmablasts and plasma cells. Therapies aimed at reducing the cytotoxic antibody effector functions mediated by natural killer cells and the complement system, and their associated pro-inflammatory cytokines, are also undergoing evaluation. The complexity of the pathogenesis of AMR and cAMR suggest that multiple approaches will probably be required to treat these disease processes effectively. Definitive answers await results from large, double-blind, multicentre, randomized controlled clinical trials.
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Affiliation(s)
- Peter S Heeger
- Comprehensive Transplant Center, Department of Medicine, Division of Nephrology Cedars-Sinai Medical Center Los Angeles, Los Angeles, CA, USA
| | - Maria Carrera Haro
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, Mount Sinai, NY, USA
| | - Stanley Jordan
- Comprehensive Transplant Center, Department of Medicine, Division of Nephrology Cedars-Sinai Medical Center Los Angeles, Los Angeles, CA, USA.
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3
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Klonarakis MP, Dhillon M, Sevinc E, Elliott MJ, James MT, Lam NN, McLaughlin KJ, Ronksley PE, Ruzycki SM, Harrison TG. The effect of goal-directed fluid therapy on delayed graft function in kidney transplant recipients: A systematic review and meta-analysis. Transplant Rev (Orlando) 2024; 38:100834. [PMID: 38335896 DOI: 10.1016/j.trre.2024.100834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/22/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Abstract
Delayed graft function (DGF) is a common post-operative complication with potential long-term sequelae for many kidney transplant recipients, and hemodynamic factors and fluid status play a role. Fixed perioperative fluid infusions are the standard of care, but more recent evidence in the non-transplant population has suggested benefit with goal-directed fluid strategies based on hemodynamic targets. We searched MEDLINE, EMBASE, Cochrane Controlled Trials Registry and Google Scholar through December 2022 for randomized controlled trials comparing risk of DGF between goal-directed and conventional fluid therapy in adults receiving a living or deceased donor kidney transplant. Effect estimates were reported with odds ratios (OR) and pooled using random effects meta-analysis. We identified 4 studies (205 participants) that met the inclusion criteria. The use of goal-directed fluid therapy had no significant effect on DGF (OR 1.37 95% CI, 0.34-5.6; p = 0.52; I2 = 0.11). Subgroup analysis examining effects among deceased and living kidney donation did not reveal significant differences in the effects of fluid strategy on DGF between subgroups. Overall, the strength of the evidence for goal-directed versus conventional fluid therapy to reduce DGF was of low certainty. Our findings highlight the need for larger trials to determine the effect of goal-directed fluid therapy on this patient-centered outcome.
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Affiliation(s)
| | - Mannat Dhillon
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Emir Sevinc
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Meghan J Elliott
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Matthew T James
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ngan N Lam
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kevin J McLaughlin
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Paul E Ronksley
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shannon M Ruzycki
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tyrone G Harrison
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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4
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Cooper M, Wiseman AC, Doshi MD, Hall IE, Parsons RF, Pastan S, Reddy KS, Schold JD, Mohan S, Hippen BE. Understanding Delayed Graft Function to Improve Organ Utilization and Patient Outcomes: Report of a Scientific Workshop Sponsored by the National Kidney Foundation. Am J Kidney Dis 2024; 83:360-369. [PMID: 37844725 DOI: 10.1053/j.ajkd.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/22/2023] [Accepted: 08/26/2023] [Indexed: 10/18/2023]
Abstract
Delayed graft function (DGF) is a common complication after kidney transplant. Despite extensive literature on the topic, the extant definition of DGF has not been conducive to advancing the scientific understanding of the influences and mechanisms contributing to its onset, duration, resolution, or long-term prognostic implications. In 2022, the National Kidney Foundation sponsored a multidisciplinary scientific workshop to comprehensively review the current state of knowledge about the diagnosis, therapy, and management of DGF and conducted a survey of relevant stakeholders on topics of clinical and regulatory interest. In this Special Report, we propose and defend a novel taxonomy for the clinical and research definitions of DGF, address key regulatory and clinical practice issues surrounding DGF, review the current state of therapies to reduce and/or attenuate DGF, offer considerations for clinical practice related to the outpatient management of DGF, and outline a prospective research and policy agenda.
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Affiliation(s)
- Matthew Cooper
- Department of Surgery, Division of Transplantation, Medical College of Wisconsin, Milwaukee, WI.
| | | | - Mona D Doshi
- Department of Medicine, Division of Nephrology, University of Michigan, Ann Arbor, Michigan
| | - Isaac E Hall
- Division of Nephrology & Hypertension, Department of Internal Medicine, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah
| | | | - Stephen Pastan
- Department of Medicine, Renal Division, Emory University School of Medicine, Atlanta, Georgia
| | - Kunam S Reddy
- Division of Transplant Surgery, Mayo Clinic Arizona, Phoenix, Arizona
| | - Jesse D Schold
- Departments of Surgery and Epidemiology, University of Colorado Anschutz Medical College, Aurora, Colorado
| | - Sumit Mohan
- Division of Nephrology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Benjamin E Hippen
- Global Medical Office, Fresenius Medical Care, Charlotte, North Carolina
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5
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Punukollu R, Ohara SY, Budhiraja P, Smith ML, Kumm K, Ruch B, Misra S, Reddy KS, Heilman RL, Jadlowiec CC. Duration of Dialysis in Acute Kidney Injury Donors and Transplant Outcomes. J Am Coll Surg 2024; 238:61-69. [PMID: 37870238 DOI: 10.1097/xcs.0000000000000870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) kidneys, including those from donors on dialysis, are often underutilized, although there is increasing data available demonstrating good transplant outcomes. To date, data on the duration of donor dialysis and transplant outcomes are limited. STUDY DESIGN This was a single-center study of deceased donor kidney transplants from 2010 to 2022. The study cohort consisted of recipients of deceased donor kidney transplants from donors with AKI and on dialysis. Three groups were identified based on the predetermined interquartile range of donor dialysis duration: 1 to 2 dialysis days, 3 to 4 dialysis days, and 5 or more dialysis days. RESULTS During this period, 765 AKI deceased donor transplants were performed, of which 230 were from donors on dialysis. The median dialysis duration was 2 days with a maximum of 13 days. Across the 3 groups, there were no differences in recipient age (p = 0.23) or dialysis vintage (p = 0.70). Donor age (p = 0.86) and kidney donor profile index (p = 0.57) were comparable between the groups. Recipients of deceased donor kidney transplants from donors on dialysis 5 or more days had lower terminal creatinine levels (p = 0.003) and longer cold ischemia times (p = 0.04). Posttransplant, the median length of hospital stay was 3 days for all groups (p = 0.75). There were no differences in delayed graft function occurrence (94.4% vs 86.8% vs 92.1%, p = 0.19), duration of delayed graft function (p = 0.56), or readmissions (p = 0.99). At 1 year posttransplant, the estimated glomerular filtration rate (p = 0.76), patient survival (p = 0.82), or death-censored graft survival (p = 0.28) were comparable. CONCLUSIONS Excellent outcomes have been observed in AKI deceased donor kidney transplants, including those coming from donors on dialysis. In this small cohort, the duration of donor dialysis did not adversely affect outcomes. Cautious expansion of the donor pool, including donors on dialysis, should be considered given the ongoing organ shortage.
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Affiliation(s)
- Rachana Punukollu
- From the Division of Transplant Surgery, Department of Surgery (Punukollu, Kumm, Ruch, Reddy, Jadlowiec) Mayo Clinic, Phoenix, AZ
| | - Stephanie Y Ohara
- Division of Surgery, Valleywise Health Medical Center, Creighton University (Ohara), Phoenix, AZ
| | - Pooja Budhiraja
- Division of Nephrology (Budhiraja, Misra, Heilman) Mayo Clinic, Phoenix, AZ
| | - Maxwell L Smith
- Division of Anatomic Pathology (Smith) Mayo Clinic, Phoenix, AZ
| | - Kayla Kumm
- From the Division of Transplant Surgery, Department of Surgery (Punukollu, Kumm, Ruch, Reddy, Jadlowiec) Mayo Clinic, Phoenix, AZ
| | - Brianna Ruch
- From the Division of Transplant Surgery, Department of Surgery (Punukollu, Kumm, Ruch, Reddy, Jadlowiec) Mayo Clinic, Phoenix, AZ
| | - Suman Misra
- Division of Nephrology (Budhiraja, Misra, Heilman) Mayo Clinic, Phoenix, AZ
| | - Kunam S Reddy
- From the Division of Transplant Surgery, Department of Surgery (Punukollu, Kumm, Ruch, Reddy, Jadlowiec) Mayo Clinic, Phoenix, AZ
| | - Raymond L Heilman
- Division of Nephrology (Budhiraja, Misra, Heilman) Mayo Clinic, Phoenix, AZ
| | - Caroline C Jadlowiec
- From the Division of Transplant Surgery, Department of Surgery (Punukollu, Kumm, Ruch, Reddy, Jadlowiec) Mayo Clinic, Phoenix, AZ
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6
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Rossi A, Asthana A, Riganti C, Sedrakyan S, Byers LN, Robertson J, Senger RS, Montali F, Grange C, Dalmasso A, Porporato PE, Palles C, Thornton ME, Da Sacco S, Perin L, Ahn B, McCully J, Orlando G, Bussolati B. Mitochondria Transplantation Mitigates Damage in an In Vitro Model of Renal Tubular Injury and in an Ex Vivo Model of DCD Renal Transplantation. Ann Surg 2023; 278:e1313-e1326. [PMID: 37450698 PMCID: PMC10631499 DOI: 10.1097/sla.0000000000006005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
OBJECTIVES To test whether mitochondrial transplantation (MITO) mitigates damage in 2 models of acute kidney injury (AKI). BACKGROUND MITO is a process where exogenous isolated mitochondria are taken up by cells. As virtually any morbid clinical condition is characterized by mitochondrial distress, MITO may find a role as a treatment modality in numerous clinical scenarios including AKI. METHODS For the in vitro experiments, human proximal tubular cells were damaged and then treated with mitochondria or placebo. For the ex vivo experiments, we developed a non-survival ex vivo porcine model mimicking the donation after cardiac death renal transplantation scenario. One kidney was treated with mitochondria, although the mate organ received placebo, before being perfused at room temperature for 24 hours. Perfusate samples were collected at different time points and analyzed with Raman spectroscopy. Biopsies taken at baseline and 24 hours were analyzed with standard pathology, immunohistochemistry, and RNA sequencing analysis. RESULTS In vitro, cells treated with MITO showed higher proliferative capacity and adenosine 5'-triphosphate production, preservation of physiological polarization of the organelles and lower toxicity and reactive oxygen species production. Ex vivo, kidneys treated with MITO shed fewer molecular species, indicating stability. In these kidneys, pathology showed less damage whereas RNAseq analysis showed modulation of genes and pathways most consistent with mitochondrial biogenesis and energy metabolism and downregulation of genes involved in neutrophil recruitment, including IL1A, CXCL8, and PIK3R1. CONCLUSIONS MITO mitigates AKI both in vitro and ex vivo.
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Affiliation(s)
- Andrea Rossi
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Amish Asthana
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, NC
- Department of Surgery, Section of Transplantation, Wake Forest School of Medicine, Winston Salem, NC
| | - Chiara Riganti
- Department of Oncology, University of Torino, University of Turin, Turin, Italy
| | - Sargis Sedrakyan
- GOFARR Laboratory for Organ Regenerative Research and Cell Therapeutics in Urology, Saban Research Institute, Division of Urology, Children's Hospital Los Angeles, Los Angeles, CA
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Lori Nicole Byers
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, NC
- Department of Surgery, Section of Transplantation, Wake Forest School of Medicine, Winston Salem, NC
| | - John Robertson
- Department of Biomedical Engineering and Mechanics, College of Engineering, Virginia Tech, Blacksburg, VA
- DialySensors Inc., Blacksburg, VA
| | - Ryan S. Senger
- DialySensors Inc., Blacksburg, VA
- Department of Biological Systems Engineering, College of Life Sciences and Agriculture, Virginia Tech, Blacksburg, VA
- Department of Chemical Engineering, College of Engineering, Virginia Tech, Blacksburg, VA
| | | | - Cristina Grange
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Alessia Dalmasso
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Paolo E. Porporato
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Chris Palles
- J. Crayton Pruitt Family, Department of Biomedical Engineering, University of Florida, Gainesville, FL
| | - Matthew E. Thornton
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Stefano Da Sacco
- GOFARR Laboratory for Organ Regenerative Research and Cell Therapeutics in Urology, Saban Research Institute, Division of Urology, Children's Hospital Los Angeles, Los Angeles, CA
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Laura Perin
- GOFARR Laboratory for Organ Regenerative Research and Cell Therapeutics in Urology, Saban Research Institute, Division of Urology, Children's Hospital Los Angeles, Los Angeles, CA
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Bumsoo Ahn
- Department of Internal Medicine, Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston Salem, NC
| | - James McCully
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Giuseppe Orlando
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, NC
- Department of Surgery, Section of Transplantation, Wake Forest School of Medicine, Winston Salem, NC
| | - Benedetta Bussolati
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
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7
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Wahida A, Schmaderer C, Büttner-Herold M, Branca C, Donakonda S, Haberfellner F, Torrez C, Schmitz J, Schulze T, Seibt T, Öllinger R, Engleitner T, Haller B, Steiger K, Günthner R, Lorenz G, Yabal M, Bachmann Q, Braunisch MC, Moog P, Matevossian E, Aßfalg V, Thorban S, Renders L, Späth MR, Müller RU, Stippel DL, Weichert W, Slotta-Huspenina J, von Vietinghoff S, Viklicky O, Green DR, Rad R, Amann K, Linkermann A, Bräsen JH, Heemann U, Kemmner S. High RIPK3 expression is associated with a higher risk of early kidney transplant failure. iScience 2023; 26:107879. [PMID: 37868627 PMCID: PMC10585402 DOI: 10.1016/j.isci.2023.107879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 10/05/2022] [Accepted: 09/07/2023] [Indexed: 10/24/2023] Open
Abstract
Renal ischemia-reperfusion injury (IRI) is associated with reduced allograft survival, and each additional hour of cold ischemia time increases the risk of graft failure and mortality following renal transplantation. Receptor-interacting protein kinase 3 (RIPK3) is a key effector of necroptosis, a regulated form of cell death. Here, we evaluate the first-in-human RIPK3 expression dataset following IRI in kidney transplantation. The primary analysis included 374 baseline biopsy samples obtained from renal allografts 10 minutes after onset of reperfusion. RIPK3 was primarily detected in proximal tubular cells and distal tubular cells, both of which are affected by IRI. Time-to-event analysis revealed that high RIPK3 expression is associated with a significantly higher risk of one-year transplant failure and prognostic for one-year (death-censored) transplant failure independent of donor and recipient associated risk factors in multivariable analyses. The RIPK3 score also correlated with deceased donation, cold ischemia time and the extent of tubular injury.
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Affiliation(s)
- Adam Wahida
- Medical Department III of Hematology and Oncology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Christoph Schmaderer
- Department of Nephrology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Maike Büttner-Herold
- Department of Nephropathology, Friedrich-Alexander University (FAU) Erlangen-Nurnberg, Erlangen, Germany
| | - Caterina Branca
- Medical Department III of Hematology and Oncology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Sainitin Donakonda
- Nephropathology Unit, Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Flora Haberfellner
- Department of Nephrology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Carlos Torrez
- Department of Nephrology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Jessica Schmitz
- Nephropathology Unit, Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Tobias Schulze
- Medical Department III of Hematology and Oncology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Tobias Seibt
- Transplant Center, University Hospital Munich, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Rupert Öllinger
- Institute of Molecular Oncology and Functional Genomics, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Thomas Engleitner
- Institute of Molecular Oncology and Functional Genomics, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Bernhard Haller
- Institute of AI and Informatics in Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Katja Steiger
- Institute of Pathology, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Roman Günthner
- Department of Nephrology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Georg Lorenz
- Department of Nephrology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Monica Yabal
- Nephropathology Unit, Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Quirin Bachmann
- Department of Nephrology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Matthias C. Braunisch
- Department of Nephrology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Philipp Moog
- Department of Nephrology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Edouard Matevossian
- Clinic of General, Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital Munich, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Volker Aßfalg
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stefan Thorban
- Institute of Molecular Immunology and Experimental Oncology, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Lutz Renders
- Department of Nephrology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Martin R. Späth
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Roman-Ulrich Müller
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Dirk L. Stippel
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Wilko Weichert
- Institute of Pathology, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Julia Slotta-Huspenina
- Institute of Pathology, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Sibylle von Vietinghoff
- Nephrology Section, Medical Clinic 1, University Hospital Bonn, Rheinische Friedrich Wilhelm University of Bonn, Bonn, Germany
| | - Ondrej Viklicky
- Department of Nephrology, Transplant Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Douglas R. Green
- Department of Immunology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Roland Rad
- Nephropathology Unit, Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Kerstin Amann
- Department of Nephropathology, Friedrich-Alexander University (FAU) Erlangen-Nurnberg, Erlangen, Germany
| | - Andreas Linkermann
- Division of Nephrology, Clinic of Internal Medicine 3, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
- Division of Nephrology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jan Hinrich Bräsen
- Nephropathology Unit, Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Uwe Heemann
- Department of Nephrology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Stephan Kemmner
- Department of Nephrology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany
- Transplant Center, University Hospital Munich, Ludwig-Maximilians-University (LMU), Munich, Germany
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8
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Li JSY, Robertson H, Trinh K, Raghubar AM, Nguyen Q, Matigian N, Patrick E, Thomson AW, Mallett AJ, Rogers NM. Tolerogenic dendritic cells protect against acute kidney injury. Kidney Int 2023; 104:492-507. [PMID: 37244471 DOI: 10.1016/j.kint.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 04/12/2023] [Accepted: 05/11/2023] [Indexed: 05/29/2023]
Abstract
Ischemia reperfusion injury is a common precipitant of acute kidney injury that occurs following disrupted perfusion to the kidney. This includes blood loss and hemodynamic shock, as well as during retrieval for deceased donor kidney transplantation. Acute kidney injury is associated with adverse long-term clinical outcomes and requires effective interventions that can modify the disease process. Immunomodulatory cell therapies such as tolerogenic dendritic cells remain a promising tool, and here we tested the hypothesis that adoptively transferred tolerogenic dendritic cells can limit kidney injury. The phenotypic and genomic signatures of bone marrow-derived syngeneic or allogeneic, Vitamin-D3/IL-10-conditioned tolerogenic dendritic cells were assessed. These cells were characterized by high PD-L1:CD86, elevated IL-10, restricted IL-12p70 secretion and a suppressed transcriptomic inflammatory profile. When infused systemically, these cells successfully abrogated kidney injury without modifying infiltrating inflammatory cell populations. They also provided protection against ischemia reperfusion injury in mice pre-treated with liposomal clodronate, suggesting the process was regulated by live, rather than reprocessed cells. Co-culture experiments and spatial transcriptomic analysis confirmed reduced kidney tubular epithelial cell injury. Thus, our data provide strong evidence that peri-operatively administered tolerogenic dendritic cells have the ability to protect against acute kidney injury and warrants further exploration as a therapeutic option. This technology may provide a clinical advantage for bench-to-bedside translation to affect patient outcomes.
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Affiliation(s)
- Jennifer S Y Li
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia; Sydney Medical School, Faculty of Health and Medicine, University of Sydney, Sydney, New South Wales, Australia; Department of Renal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Harry Robertson
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia; School of Mathematics and Statistics, University of Sydney, Sydney, New South Wales, Australia
| | - Katie Trinh
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Arti M Raghubar
- Institute for Molecular Bioscience, the University of Queensland, Brisbane, Queensland, Australia
| | - Quan Nguyen
- Institute for Molecular Bioscience, the University of Queensland, Brisbane, Queensland, Australia
| | - Nicholas Matigian
- Institute for Molecular Bioscience, the University of Queensland, Brisbane, Queensland, Australia; Queensland Cyber Infrastructure Foundation Bioinformatics, Brisbane, Queensland, Australia
| | - Ellis Patrick
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia; School of Mathematics and Statistics, University of Sydney, Sydney, New South Wales, Australia
| | - Angus W Thomson
- Starzl Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Andrew J Mallett
- Institute for Molecular Bioscience, the University of Queensland, Brisbane, Queensland, Australia; Department of Renal Medicine, Townsville University Hospital, Townsville, Queensland, Australia; College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Natasha M Rogers
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia; Sydney Medical School, Faculty of Health and Medicine, University of Sydney, Sydney, New South Wales, Australia; Department of Renal Medicine, Westmead Hospital, Westmead, New South Wales, Australia.
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9
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Gaynor JJ, Tabbara MM, Ciancio G, Selvaggi G, Garcia J, Tekin A, Vianna R. The Importance Of Avoiding Time-Dependent Bias When Testing The Prognostic Value Of An Intervening Event - Two Acute Cellular Rejection Examples In Intestinal Transplantation. Am J Transplant 2023:S1600-6135(23)00308-8. [PMID: 36871628 DOI: 10.1016/j.ajt.2023.02.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/24/2023] [Indexed: 03/07/2023]
Abstract
In testing the prognostic value of the occurrence of an intervening event (clinical event that occurs post-transplant), 3 proper statistical methodologies for testing its prognostic value exist (time dependent covariate, landmark, and semi-Markov modelling methods). However, time-dependent bias has appeared in many clinical reports, whereby the intervening event is statistically treated as a baseline variable (as if it occurred at transplant). Using a single-center cohort of 445 intestinal transplant cases to test the prognostic value of 1st acute cellular rejection (ACR) and severe (grade of) ACR on the hazard rate of developing graft loss, we demonstrate how the inclusion of such time-dependent bias can lead to severe underestimation of the true hazard ratio (HR). The (statistically more powerful) time dependent covariate method in Cox's multivariable model yielded significantly unfavorable effects of 1st ACR (P<.0001; HR=2.492) and severe ACR (P<.0001; HR=4.531). In contrast, when using the time-dependent biased approach, multivariable analysis yielded an incorrect conclusion for the prognostic value of 1st ACR (P=.31, HR=0.877, 35.2% of 2.492) and a much smaller estimated effect of severe ACR (P=.0008; HR=1.589; 35.1% of 4.531). In conclusion, this study demonstrates the importance of avoiding time-dependent bias when testing the prognostic value of an intervening event.
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Affiliation(s)
- Jeffrey J Gaynor
- Miami Transplant Institute, Department of Surgery, University of Miami Miller School of Medicine; Miami, FL.
| | - Marina M Tabbara
- Miami Transplant Institute, Department of Surgery, University of Miami Miller School of Medicine; Miami, FL
| | - Gaetano Ciancio
- Miami Transplant Institute, Department of Surgery, University of Miami Miller School of Medicine; Miami, FL
| | - Gennaro Selvaggi
- Miami Transplant Institute, Department of Surgery, University of Miami Miller School of Medicine; Miami, FL
| | - Jennifer Garcia
- Miami Transplant Institute, Department of Pediatrics, University of Miami Miller School of Medicine; Miami, FL
| | - Akin Tekin
- Miami Transplant Institute, Department of Surgery, University of Miami Miller School of Medicine; Miami, FL
| | - Rodrigo Vianna
- Miami Transplant Institute, Department of Surgery, University of Miami Miller School of Medicine; Miami, FL
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10
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Abstract
PURPOSE OF REVIEW Delayed graft function is a common early posttransplant event predictive of adverse outcomes including hospital readmission, impaired long-term graft function, and decreased graft and patient survival. The purpose of this review is to summarize recent literature describing delayed graft function in hopes of better understanding and managing this condition. RECENT FINDINGS Recent research efforts have been garnered towards risk factor modification, prevention, and earlier detection of delayed graft function. In this review, we aim to summarize current innovative approaches and future directions. SUMMARY Delayed graft function portends worse graft and patient outcomes. Continued research to prevent, and detect early perturbations in allograft function, and more optimally manage this disease will hopefully improve graft function, along with graft/patient survival.
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11
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Belhoste M, Allenbach G, Agius T, Meier RPH, Venetz JP, Corpataux JM, Schneider A, Golshayan D, Prior JO, Déglise S, Nicod-Lalonde M, Longchamp A. Role of post-transplant graft scintigraphy in kidney donation after circulatory death. FRONTIERS IN TRANSPLANTATION 2022; 1:1065415. [PMID: 38994379 PMCID: PMC11235226 DOI: 10.3389/frtra.2022.1065415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 11/29/2022] [Indexed: 07/13/2024]
Abstract
Background There is no consensus on how to predict post-transplant function of donation after circulatory death (DCD) kidneys. Thus, we aimed to identify renal scintigraphy parameters that could predict 1-year kidney function. Methods In this single center study, we included all consecutive DCD kidney recipients between 2013 and 2021 (n = 29). Patients who did not have a scintigraphy within 10 days of transplantation (n = 3), recipients of multiple organs and less than 18 years old were excluded (n = 1). Primary endpoint was the estimated glomerular filtration rate (eGFR). Results Median eGFR and serum creatinine at 1 year were 67 µmol/L (56-81) and 111 ml/min (99-132), respectively. Among parameters tested, the 3rd/2nd-minute activity ratio had the best diagnostic performance (AUC: 0.74 and 0.71, for eGFR and creatinine) 1 year post transplantation. Using 1.21 as the best cut off, the 3rd/2nd-minute activity ratio specificity and sensitivity to predict eGFR >60 ml/min was 0.82 and 0.83. Renal function was significantly better at 1 week, 3, 6, and 12 months after transplantation in patients with 3rd/2nd-minute activity ratios above 1.21. Conclusion This study suggests that the 3rd/2nd-minute activity ratio can predict graft function at 1 year. The benefit of post-transplant scintigraphy should be further validated in a prospective cohort.
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Affiliation(s)
- Manon Belhoste
- Department of Vascular Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Gilles Allenbach
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
| | - Thomas Agius
- Department of Biomedical Sciences, University of Lausanne, Lausanne, Switzerland
| | - Raphael P. H. Meier
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Jean-Pierre Venetz
- Transplantation Center, Lausanne University Hospital, Lausanne, Switzerland
| | - Jean-Marc Corpataux
- Department of Vascular Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Antoine Schneider
- Adult Intensive Care Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Déla Golshayan
- Transplantation Center, Lausanne University Hospital, Lausanne, Switzerland
| | - John O. Prior
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
| | - Sébastien Déglise
- Department of Vascular Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Marie Nicod-Lalonde
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
| | - Alban Longchamp
- Department of Vascular Surgery, Lausanne University Hospital, Lausanne, Switzerland
- Department of Biomedical Sciences, University of Lausanne, Lausanne, Switzerland
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12
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Wazir S, Abbas M, Ratanasrimetha P, Zhang C, Hariharan S, Puttarajappa CM. Preoperative blood pressure and risk of delayed graft function in deceased donor kidney transplantation. Clin Transplant 2022; 36:e14776. [PMID: 35821617 DOI: 10.1111/ctr.14776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/05/2022] [Accepted: 07/08/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND In kidney transplantation, delayed graft function (DGF) is associated with increased morbidity and a higher risk of graft failure. Prior research suggests that chronic hypotension increases DGF risk, but the relationship of preoperative blood pressure to DGF is unclear. METHODS In this single center study of adult deceased donor kidney transplant recipients transplanted between 2015 and 2019, we evaluated the question of whether preoperative mean arterial pressure (MAP) affected DGF risk. Additionally, we investigated whether the risk of DGF was moderated by certain donor and recipient characteristics. For recipient characteristics associated with increased DGF risk and preoperative MAP, we performed a mediation analysis to estimate the proportion of DGF risk mediated through preoperative MAP. RESULTS Among 562 deceased donor kidney recipients, DGF risk decreased as preoperative MAP increased, with a 2% lower risk per 1 mm Hg increase in MAP. This increased risk was similar, with no statistically significant interaction effect between preoperative MAP and donor (donation after circulatory death) and recipient characteristics (diabetes, body mass index, and use of anti-hypertensive medications). Preoperative MAP was negativity correlated with recipient BMI and duration of pre transplant dialysis. On mediation analysis, MAP accounted for 12% and 16% of the DGF risk associated with recipient BMI and pre-transplant dialysis duration, respectively. CONCLUSION In deceased donor kidney transplantation, each 1 mm Hg increase in preoperative MAP was associated with 2% lower DGF risk. Preoperative MAP was influenced by recipient BMI and dialysis duration, and likely contributes to some of the high DGF risk from obesity and long dialysis vintage.
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Affiliation(s)
- Shoaib Wazir
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Muhammad Abbas
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Praveen Ratanasrimetha
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Casey Zhang
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sundaram Hariharan
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Chethan M Puttarajappa
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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13
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Betjes MGH, Roelen DL, van Agteren M, Kal-van Gestel J. Causes of Kidney Graft Failure in a Cohort of Recipients With a Very Long-Time Follow-Up After Transplantation. Front Med (Lausanne) 2022; 9:842419. [PMID: 35733857 PMCID: PMC9207199 DOI: 10.3389/fmed.2022.842419] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/05/2022] [Indexed: 01/03/2023] Open
Abstract
Background Biopsy-proven causes of graft loss many years after kidney transplantation are scarcely documented. Methods Patients transplanted between 1995 and 2005 (n = 737) in a single center were followed on a regular basis until 2021. The recipients were divided according to age at transplantation into 3 groups; 18–39 years (young), 40–55 years (middle age), and older than 55 years (elderly). For cause biopsies of renal transplants were clustered into the categories, rejection, IFTA, return original disease, and diagnosis of de novo kidney disease. Results Rejection was the main cause of graft failure censored for death at every time period after transplantation. The incidence of T cell-mediated rejection (TCMR) became rare 6 years after transplantation while the cumulative incidence of antibody-mediated rejection (ABMR) increased over time (1.1% per year). ABMR was not diagnosed anymore beyond 15 years of follow-up in recipients without pre-transplant donor-specific antibodies (DSA). An episode of TCMR was associated with an increased incidence of ABMR diagnosis in the short-term but did not increase the overall incidence of AMBR not in the long-term. Death as a cause of graft failure was an important competitive risk factor long after transplantation and resulted in a significantly lower frequency of rejection-related graft loss in the elderly group (11 vs. 23% in the young group at 15 year follow-up). Conclusion Rejection is a major cause of graft loss but recipient’s age, time after transplantation, and the presence of DSA before transplantation determine the relative contribution to overall graft loss and the type of rejection involved.
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Affiliation(s)
- Michiel G. H. Betjes
- Department of Nephrology and Transplantation, Erasmus Medical Center, Rotterdam Transplantation Institute, Rotterdam, Netherlands
- *Correspondence: Michiel G. H. Betjes, ; orcid.org/0000-0001-9435-6208
| | - Dave L. Roelen
- Department of Immunology, Leiden University Medical Center, Leiden, Netherlands
| | - Madelon van Agteren
- Department of Nephrology and Transplantation, Erasmus Medical Center, Rotterdam Transplantation Institute, Rotterdam, Netherlands
| | - Judith Kal-van Gestel
- Department of Nephrology and Transplantation, Erasmus Medical Center, Rotterdam Transplantation Institute, Rotterdam, Netherlands
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14
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Jan MY, Moe SM, Adebiyi O, Chen J, Powelson J, Burney HN, Yaqub MS, Mishler DP, Moorthi RN, Taber TE, Anderson MD, Li Y, Li X, Fridell JA, Goggins WC, Sharfuddin AA. Vasopressin for Post-kidney Transplant Hypotension. Kidney Int Rep 2022; 7:1364-1376. [PMID: 35694563 PMCID: PMC9174042 DOI: 10.1016/j.ekir.2022.03.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 03/24/2022] [Accepted: 03/29/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Hypotension after deceased donor kidney transplant (DDKT) is a risk factor for delayed graft function (DGF) and poor graft survival (GS). We hypothesize that vasopressin use in hypotensive DDKT recipients (DDKTRs) to increase blood pressure (BP) reduces DGF rates and is safe without increasing mortality. Methods Group with vasopressin "study group" (n = 45) was defined as DDKTRs between 2012 and 2017 who required vasopressin for hypotension systolic BP (SBP) <120 mm Hg or diastolic BP (DBP) <60 mm Hg. DDKTRs with no-vasopressin "comparison group" (n = 90) were propensity score-matched DDKTRs between 2012 and 2017 without vasopressin use. Primary outcomes were GS, creatinine and allograft biopsy rate at 1 year, DGF rate, and death during transplant hospitalization. Results Vasopressin group had lower mean maximum and minimum SBP and DBP in the operating room (OR). Median vasopressin start time post-DDKT was 2 hours (interquartile range [IQR] 1-6), and duration of use was 42 hours (IQR 24-63). DGF, creatinine at 1 year, and allograft biopsy rates were comparable. No deaths occurred during transplant hospitalization. Multivariable analysis did not find an effect of vasopressin use on GS. Conclusion Treatment of hypotensive DDKTRs with vasopressin is safe and facilitated similar graft function and survival with that of nonhypotensive patients. In the absence of a randomized control trial, our study supports the safety of vasopressin therapy to prevent the adverse effects of hypotension.
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Affiliation(s)
- Muhammad Y. Jan
- Division of Nephrology and Hypertension, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sharon M. Moe
- Division of Nephrology and Hypertension, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Indiana Clinical and Translational Sciences Institute, Indianapolis, Indiana, USA
| | - Oluwafisayo Adebiyi
- Division of Nephrology and Hypertension, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jeannie Chen
- Department of Pharmacy, Indiana University Health, Indianapolis, Indiana, USA
| | - John Powelson
- Division Transplant Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Heather N. Burney
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Muhammad S. Yaqub
- Division of Nephrology and Hypertension, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Dennis P. Mishler
- Division of Nephrology and Hypertension, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ranjani N. Moorthi
- Division of Nephrology and Hypertension, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Tim E. Taber
- Division of Nephrology and Hypertension, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Melissa D. Anderson
- Division of Nephrology and Hypertension, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Yang Li
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Xiaochun Li
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jonathan A. Fridell
- Division Transplant Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - William C. Goggins
- Division Transplant Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Asif A. Sharfuddin
- Division of Nephrology and Hypertension, Indiana University School of Medicine, Indianapolis, Indiana, USA
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15
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Bachmann Q, Haberfellner F, Büttner-Herold M, Torrez C, Haller B, Assfalg V, Renders L, Amann K, Heemann U, Schmaderer C, Kemmner S. The Kidney Donor Profile Index (KDPI) Correlates With Histopathologic Findings in Post-reperfusion Baseline Biopsies and Predicts Kidney Transplant Outcome. Front Med (Lausanne) 2022; 9:875206. [PMID: 35573025 PMCID: PMC9100560 DOI: 10.3389/fmed.2022.875206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background The increasing organ shortage in kidney transplantation leads to the necessity to use kidneys previously considered unsuitable for transplantation. Numerous studies illustrate the need for a better decision guidance rather than only the classification into kidneys from standard or expanded criteria donors referred to as SCD/ECD-classification. The kidney donor profile index (KDPI) exhibits a score utilizing a much higher number of donor characteristics. Moreover, graft biopsies provide an opportunity to assess organ quality. Methods In a single center analysis 383 kidney transplantations (277 after deceased and 106 after living donation) performed between January 1st, 2006, and December 31st, 2016, retrospectively underwent SCD/ECD and KDPI scoring. Thereby, the quality of deceased donor kidneys was assessed by using the KDPI and the living donor kidneys by using the living KDPI, in the further analysis merged as (L)KDPI. Baseline biopsies taken 10 min after the onset of reperfusion were reviewed for chronic and acute lesions. Survival analyses were performed using Kaplan-Meier analysis and Cox proportional hazards analysis within a 5-year follow-up. Results The (L)KDPI correlated with glomerulosclerosis (r = 0.30, p < 0.001), arteriosclerosis (r = 0.33, p < 0.001), interstitial fibrosis, and tubular atrophy (r = 0.28, p < 0.001) as well as the extent of acute tubular injury (r = 0.20, p < 0.001). The C-statistic of the (L)KDPI concerning 5-year death censored graft survival was 0.692. Around 48% of ECD-kidneys were classified as (L)KDPI<85%. In a multivariate Cox proportional hazard analysis including (preformed) panel reactive antibodies, cold ischemia time, (L)KDPI, and SCD/ECD-classification, the (L)KDPI was significantly associated with risk of graft loss (hazard ratio per 10% increase in (L)KDPI: 1.185, 95% confidence interval: 1.033–1.360, p = 0.025). Survival analysis revealed decreased death censored (p < 0.001) and non-death censored (p < 0.001) graft survival in kidneys with an increasing (L)KDPI divided into groups of <35, 35–85, and >85%, respectively. Conclusion With a higher granularity compared to the SCD/ECD-classification the (L)KDPI is a promising tool to judge graft quality. The correlation with chronic and acute histological lesions in post-reperfusion kidney biopsies underlines the descriptive value of the (L)KDPI. However, its prognostic value is limited and underlines the urgent need for a more precise prognostic tool adopted to European kidney transplant conditions.
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Affiliation(s)
- Quirin Bachmann
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Flora Haberfellner
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Maike Büttner-Herold
- Department of Nephropathology, Institute of Pathology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Carlos Torrez
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Haller
- School of Medicine, Institute of AI and Informatics in Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Volker Assfalg
- Department of Surgery, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lutz Renders
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Kerstin Amann
- Department of Nephropathology, Institute of Pathology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Uwe Heemann
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christoph Schmaderer
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stephan Kemmner
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
- *Correspondence: Stephan Kemmner
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16
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Perfusate Metabolomics Content and Expression of Tubular Transporters During Human Kidney Graft Preservation by Hypothermic Machine Perfusion. Transplantation 2022; 106:1831-1843. [PMID: 35442245 DOI: 10.1097/tp.0000000000004129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Ischemia-related injury during the preimplantation period impacts kidney graft outcome. Evaluating these lesions by a noninvasive approach before transplantation could help us to understand graft injury mechanisms and identify potential biomarkers predictive of graft outcomes. This study aims to determine the metabolomic content of graft perfusion fluids and its dependence on preservation time and to explore whether tubular transporters are possibly involved in metabolomics variations. METHODS Kidneys were stored on hypothermic perfusion machines. We evaluated the metabolomic profiles of perfusion fluids (n = 35) using liquid chromatography coupled with tandem mass spectrometry and studied the transcriptional expression of tubular transporters on preimplantation biopsies (n = 26), both collected at the end of graft perfusion. We used univariate and multivariate analyses to assess the impact of perfusion time on these parameters and their relationship with graft outcome. RESULTS Seventy-two metabolites were found in preservation fluids at the end of perfusion, of which 40% were already present in the native conservation solution. We observed an increase of 23 metabolites with a longer perfusion time and a decrease of 8. The predictive model for time-dependent variation of metabolomics content showed good performance (R2 = 76%, Q2 = 54%, accuracy = 41%, and permutation test significant). Perfusion time did not affect the mRNA expression of transporters. We found no correlation between metabolomics and transporters expression. Neither the metabolomics content nor transporter expression was predictive of graft outcome. CONCLUSIONS Our results call for further studies, focusing on both intra- and extratissue metabolome, to investigate whether transporter alterations can explain the variations observed in the preimplantation period.
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17
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Pontrelli P, Simone S, Rascio F, Pesce F, Conserva F, Infante B, Castellano G, Sallustio F, Fiorentino M, Zaza G, Gallone A, Battaglia M, Ditonno P, Stallone G, Gesualdo L, Grandaliano G. Pre-Transplant Expression of CCR-2 in Kidney Transplant Recipients Is Associated With the Development of Delayed Graft Function. Front Immunol 2022; 13:804762. [PMID: 35371047 PMCID: PMC8967482 DOI: 10.3389/fimmu.2022.804762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 02/11/2022] [Indexed: 01/17/2023] Open
Abstract
Background Delayed graft function (DGF) leads to a reduced graft survival. Donors’ features have been always considered as key pathogenic factors in this setting. The aim of our study was to evaluate the recipients’ characteristics in the development of DGF. Methods We enrolled 932 kidney graft recipients from 466 donors; 226 recipients experienced DGF. In 290 donors, both recipients presented with early graft function (EGF, group A), in 50 both recipients experienced DGF (group B), and in 126 one recipient presented with DGF and the other with EGF (group C). In group C, we selected 7 couples of DGF/EGF recipients and we evaluated the transcriptomic profile by microarray on circulating mononuclear cells harvested before transplantation. Results were validated by qPCR in an independent group of 25 EGF/DGF couples. Findings In the whole study group, DGF was associated with clinical characteristics related to both donors and recipient. In group C, DGF was significantly associated with body mass index, hemodialysis, and number of mismatches. In the same group, we identified 411 genes differently expressed before transplantation between recipients discordant for the transplant outcome. Those genes were involved in immune dysfunction and inflammation. In particular, we observed a significant increase in DGF patients in the expression of C–C chemokine receptor type 2 (CCR2), the monocyte chemoattractant protein-1 (MCP-1) receptor. CCR-2 upregulation was confirmed in an independent cohort of patients. Conclusions Our results suggest that recipients’ clinical/immunological features, potentially modulated by dialysis, are associated with the development of DGF independently of donors’ features.
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Affiliation(s)
- Paola Pontrelli
- Department of Emergency and Organ Transplantation, Nephrology and Urology Units, University of Bari Aldo Moro, Bari, Italy
| | - Simona Simone
- Department of Emergency and Organ Transplantation, Nephrology and Urology Units, University of Bari Aldo Moro, Bari, Italy
| | - Federica Rascio
- Department of Medical and Surgical Sciences, Renal Unit, University of Foggia, Foggia, Italy
| | - Francesco Pesce
- Department of Emergency and Organ Transplantation, Nephrology and Urology Units, University of Bari Aldo Moro, Bari, Italy
| | - Francesca Conserva
- Department of Emergency and Organ Transplantation, Nephrology and Urology Units, University of Bari Aldo Moro, Bari, Italy
| | - Barbara Infante
- Department of Medical and Surgical Sciences, Renal Unit, University of Foggia, Foggia, Italy
| | - Giuseppe Castellano
- Department of Clinical Sciences and Community Health, Nephrology Unit, University of Milano and Fondazione Cà Grande Ospedale Maggiore Policlinico, Milano, Italy
| | - Fabio Sallustio
- Department of Internal Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Marco Fiorentino
- Department of Emergency and Organ Transplantation, Nephrology and Urology Units, University of Bari Aldo Moro, Bari, Italy
| | - Gianluigi Zaza
- Department of Medical and Surgical Sciences, Renal Unit, University of Foggia, Foggia, Italy
| | - Anna Gallone
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Michele Battaglia
- Department of Emergency and Organ Transplantation, Nephrology and Urology Units, University of Bari Aldo Moro, Bari, Italy
| | - Pasquale Ditonno
- Department of Emergency and Organ Transplantation, Nephrology and Urology Units, University of Bari Aldo Moro, Bari, Italy
| | - Giovanni Stallone
- Department of Medical and Surgical Sciences, Renal Unit, University of Foggia, Foggia, Italy
| | - Loreto Gesualdo
- Department of Emergency and Organ Transplantation, Nephrology and Urology Units, University of Bari Aldo Moro, Bari, Italy
| | - Giuseppe Grandaliano
- Department of Translational Medicine and Surgery, Nephrology Unit, Università Cattolica del Sacro Cuore and Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy
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Matas AJ, Helgeson E, Fieberg A, Leduc R, Gaston RS, Kasiske BL, Rush D, Hunsicker L, Cosio F, Grande JP, Cecka JM, Connett J, Mannon RB. Risk Prediction for Delayed Allograft Function: Analysis of the Deterioration of Kidney Allograft Function (DeKAF) Study Data. Transplantation 2022; 106:358-368. [PMID: 33675321 PMCID: PMC8380757 DOI: 10.1097/tp.0000000000003718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Delayed graft function (DGF) of a kidney transplant results in increased cost and complexity of management. For clinical care or a DGF trial, it would be ideal to accurately predict individual DGF risk and provide preemptive treatment. A calculator developed by Irish et al has been useful for predicting population but not individual risk. METHODS We analyzed the Irish calculator (IC) in the DeKAF prospective cohort (incidence of DGF = 20.4%) and investigated potential improvements. RESULTS We found that the predictive performance of the calculator in those meeting Irish inclusion criteria was comparable with that reported by Irish et al. For cohorts excluded by Irish: (a) in pump-perfused kidneys, the IC overestimated DGF risk; (b) in simultaneous pancreas kidney transplants, the DGF risk was exceptionally low. For all 3 cohorts, there was considerable overlap in IC scores between those with and those without DGF. Using a modified definition of DGF-excluding those with single dialysis in the first 24 h posttransplant-we found that the calculator had similar performance as with the traditional DGF definition. Studying whether DGF prediction could be improved, we found that recipient cardiovascular disease was strongly associated with DGF even after accounting for IC-predicted risk. CONCLUSIONS The IC can be a useful population guide for predicting DGF in the population for which it was intended but has limited scope in expanded populations (SPK, pump) and for individual risk prediction. DGF risk prediction can be improved by inclusion of recipient cardiovascular disease.
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Affiliation(s)
- Arthur J Matas
- Transplantation Division, Department of Surgery, University of Minnesota, Minneapolis, MN
| | - Erika Helgeson
- Biostatistics Division, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Ann Fieberg
- Biostatistics Division, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Robert Leduc
- Biostatistics Division, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Robert S Gaston
- Department of Medicine, University of Alabama, Birmingham, AL
| | | | - David Rush
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | | | - Fernando Cosio
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Joseph P Grande
- Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - J Michael Cecka
- Department of Pathology & Lab Medicine, David Geffen School of Medicine, University of California, UCLA Immunogenetics Center, Los Angeles, CA
| | - John Connett
- Biostatistics Division, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Roslyn B Mannon
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, NE
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19
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Boey CY, Yee SY, Amir Hassan SZ, Yahya R, Hashim H. Value of Baseline Post-Transplant MAG3 Renal Scintigraphy in the Evaluation of Graft Function. Transplant Proc 2022; 54:320-324. [DOI: 10.1016/j.transproceed.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/07/2021] [Accepted: 12/27/2021] [Indexed: 10/19/2022]
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20
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Thymoglobulin versus Alemtuzumab versus Basiliximab Kidney Transplantation from Donors After Circulatory Death. Kidney Int Rep 2022; 7:732-740. [PMID: 35497810 PMCID: PMC9039467 DOI: 10.1016/j.ekir.2022.01.1042] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/03/2022] [Accepted: 01/03/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction The Campath, Calcineurin inhibitor (CNI) reduction, and Chronic allograft nephropathy (3C), a study comparing alemtuzumab versus basiliximab induction immunosuppression in kidney transplants, has found lower acute rejection rate with alemtuzumab but same graft survival. The aim of the current study is to evaluate the effect of induction immunosuppression (thymoglobulin, alemtuzumab, basiliximab) on the outcome of kidneys of donors after circulatory death (DCD). Methods Data of the 274 DCD patients of the 3C obtained from the sponsor were compounded with the 140 DCD patients who received thymoglobulin in a single center with the same entry criteria as the 3C, giving 414 patients on 3 induction regimes. Results There were more male donors (P < 0.05) and human leukocyte antigen and DR mismatched patients in the thymoglobulin group (P < 0.001). Death-censored graft survival at 6 months was 98.6% in the thymoglobulin, 95.5% in the alemtuzumab (P = 0.08), and 95.7% in the basiliximab group (P = 0.09) and at 2 years 97.9% versus 94.8% (P = 0.13, hazard ratio [HR] 2.8, 95% CI 0.7–10.9) versus 94.3% (P = 0.06, HR 3.5, 95% CI 0.9–13.6), respectively. The 2-year overall graft survival was 95% in the thymoglobulin versus 88% in the alemtuzumab (unadjusted P = 0.038, adjusted HR 2.4, 95% CI 0.99–5.9) and 91.4% in the basiliximab group (P = 0.21). The 2-year patient survival was numerically less in the alemtuzumab compared with the thymoglobulin group (91.8% vs. 97.1%, P = 0.052, HR 2.90, 95% CI 0.93–9.2). Acute rejection was 17% in the basiliximab, 4.3% in the thymoglobulin, and 6% in the alemtuzumab group (P < 0.001). Conclusion In DCD transplants, thymoglobulin induction may provide advantage over alemtuzumab in patient survival and the same advantage as alemtuzumab over basiliximab in terms of acute rejection. Differing maintenance immunosuppression may contribute to the difference found.
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21
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Chun N, Ang RL, Chan M, Fairchild RL, Baldwin WM, Horwitz JK, Gelles JD, Chipuk JE, Kelliher MA, Pavlov VI, Li Y, Homann D, Heeger PS, Ting AT. T cell-derived tumor necrosis factor induces cytotoxicity by activating RIPK1-dependent target cell death. JCI Insight 2021; 6:148643. [PMID: 34752416 PMCID: PMC8783689 DOI: 10.1172/jci.insight.148643] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 11/03/2021] [Indexed: 12/31/2022] Open
Abstract
TNF ligation of TNF receptor 1 (TNFR1) promotes either inflammation and cell survival by (a) inhibiting RIPK1's death-signaling function and activating NF-κB or (b) causing RIPK1 to associate with the death-inducing signaling complex to initiate apoptosis or necroptosis. The cellular source of TNF that results in RIPK1-dependent cell death remains unclear. To address this, we employed in vitro systems and murine models of T cell-dependent transplant or tumor rejection in which target cell susceptibility to RIPK1-dependent cell death could be genetically altered. We show that TNF released by T cells is necessary and sufficient to activate RIPK1-dependent cell death in target cells and thereby mediate target cell cytolysis independently of T cell frequency. Activation of the RIPK1-dependent cell death program in target cells by T cell-derived TNF accelerates murine cardiac allograft rejection and synergizes with anti-PD1 administration to destroy checkpoint blockade-resistant murine melanoma. Together, the findings uncover a distinct immunological role for TNF released by cytotoxic effector T cells following cognate interactions with their antigenic targets. Manipulating T cell TNF and/or target cell susceptibility to RIPK1-dependent cell death can be exploited to either mitigate or augment T cell-dependent destruction of allografts and malignancies to improve outcomes.
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Affiliation(s)
- Nicholas Chun
- Department of Medicine and Translational Transplant Research Center and,Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rosalind L. Ang
- Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mark Chan
- Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Immunology, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert L. Fairchild
- Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, Ohio, USA
| | - William M. Baldwin
- Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, Ohio, USA
| | - Julian K. Horwitz
- Department of Medicine and Translational Transplant Research Center and,Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jesse D. Gelles
- Graduate School of Biomedical Sciences and,Tisch Cancer Institute and the Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jerry Edward Chipuk
- Tisch Cancer Institute and the Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michelle A. Kelliher
- Department of Molecular, Cell and Cancer Biology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Vasile I. Pavlov
- Department of Medicine and Translational Transplant Research Center and,Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yansui Li
- Department of Medicine and Translational Transplant Research Center and,Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dirk Homann
- Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Diabetes, Obesity & Metabolism Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Peter S. Heeger
- Department of Medicine and Translational Transplant Research Center and,Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Adrian T. Ting
- Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Immunology, Mayo Clinic, Rochester, Minnesota, USA
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22
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Švachová V, Krupičková L, Novotný M, Fialová M, Mezerová K, Čečrdlová E, Lánská V, Slavčev A, Viklický O, Viklický O, Stříž I. Changes in phenotypic patterns of blood monocytes after kidney transplantation and during acute rejection. Physiol Res 2021; 70:709-721. [PMID: 34505523 DOI: 10.33549/physiolres.934700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Peripheral blood monocytes, which serve as precursors for tissue macrophages and dendritic cells (DC), play a key role in the immune response to kidney allograft, reparation processes and homeostasis regulation. In this prospective study, we used multicolor flow cytometry to monitor the phenotypic patterns of peripheral monocytes in subjects with uncomplicated outcomes and those with acute rejection. We found a reciprocal increase in the proportion of "classical monocytes" (CD14+CD16-) along with a decline in pro-inflammatory "intermediary" (CD14+CD16+) and "non-classical" (CD14lowCD16+) monocytes in subjects with normal outcomes. In subjects with acute rejection, we observed no reduction in "intermediary" monocytes and no increase in "classical" monocytes. Patients with uncomplicated outcomes exhibited downregulated HLA-DR in all three monocyte subpopulations. However, non-classical monocytes were unaffected in subjects with acute rejection. Expression of CD47 was downregulated after transplantation, while patients with antibody-mediated rejection and donor-specific antibodies showed higher pre-transplant values. In monocytes isolated at the time of biopsy, CD47 expression was higher in individuals with acute rejection compared to patients with normal outcomes one year post-transplant. Expression of CD209 (DC-SIGN) and the proportion of CD163+CD206+ subpopulations were upregulated during the first week after kidney transplantation. CD209 was also upregulated in samples taken on the day of biopsy confirming acute rejection. Our data demonstrate that kidney allograft transplantation is associated with phenotypic changes in peripheral blood monocytes during acute rejection.
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Affiliation(s)
- V Švachová
- Department of Clinical and Transplant Immunology, Institute for Clinical and Experimental Medicine, Prague 4, Czech Republic.
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23
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Ville S, Lorent M, Kerleau C, Asberg A, Legendre C, Morelon E, Buron F, Garrigue V, Le Quintrec M, Girerd S, Ladrière M, Albano L, Sicard A, Glotz D, Lefaucheur C, Branchereau J, Jacobi D, Giral M. Timing of Kidney Clamping and Deceased Donor Kidney Transplant Outcomes. Clin J Am Soc Nephrol 2021; 16:1704-1714. [PMID: 34625421 PMCID: PMC8729417 DOI: 10.2215/cjn.03290321] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 09/22/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The fact that metabolism and immune function are regulated by an endogenous molecular clock that generates circadian rhythms suggests that the magnitude of ischemia reperfusion, and subsequent inflammation on kidney transplantation, could be affected by the time of the day. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We evaluated 5026 individuals who received their first kidney transplant from deceased heart-beating donors. In a cause-specific multivariable analysis, we compared delayed graft function and graft survival according to the time of kidney clamping and declamping. Participants were divided into those clamped between midnight and noon (ante meridiem [am] clamping group; 65%) or clamped between noon and midnight (post meridiem [pm] clamping group; 35%), and, similarly, those who underwent am declamping (25%) or pm declamping (75%). RESULTS Delayed graft function occurred among 550 participants (27%) with am clamping and 339 (34%) with pm clamping (adjusted odds ratio, 0.81; 95% confidence interval, 0.67 to 0.98; P=0.03). No significant association was observed between clamping time and overall death-censored graft survival (hazard ratio, 0.92; 95% confidence interval, 0.77 to 1.10; P=0.37). No significant association of declamping time with delayed graft function or graft survival was observed. CONCLUSIONS Clamping between midnight and noon was associated with a lower incidence of delayed graft function, whereas declamping time was not associated with kidney graft outcomes.
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Affiliation(s)
- Simon Ville
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France
| | - Marine Lorent
- CRTI UMR 1064, Institut National de la Santé et de la Recherche Médicale (INSERM), University of Nantes, ITUN, CHU Nantes, RTRS Centaure, Nantes, France
| | - Clarisse Kerleau
- CRTI UMR 1064, Institut National de la Santé et de la Recherche Médicale (INSERM), University of Nantes, ITUN, CHU Nantes, RTRS Centaure, Nantes, France
| | - Anders Asberg
- Department of Transplantation Medicine, Oslo University Hospital, Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Christophe Legendre
- Kidney Transplant Center, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, RTRS Centaure, Paris Descartes and Sorbonne Paris Cité Universities, Paris, France
| | - Emmanuel Morelon
- Nephrology, Transplantation and Clinical Immunology Department, RTRS Centaure, Edouard Herriot University Hospital, Hospices Civils, Lyon, France
| | - Fanny Buron
- Nephrology, Transplantation and Clinical Immunology Department, RTRS Centaure, Edouard Herriot University Hospital, Hospices Civils, Lyon, France
| | - Valérie Garrigue
- Nephrology, Dialysis and Transplantation Department, Lapeyronie University Hospital, Montpellier, France
| | - Moglie Le Quintrec
- Nephrology, Dialysis and Transplantation Department, Lapeyronie University Hospital, Montpellier, France
| | - Sophie Girerd
- Renal Transplantation Department, Brabois University Hospital, Nancy, France
| | - Marc Ladrière
- Renal Transplantation Department, Brabois University Hospital, Nancy, France
| | - Laetitia Albano
- Department of Nephrology and Renal Transplantation, Hospital Pasteur, Nice, France
| | - Antoine Sicard
- Department of Nephrology and Renal Transplantation, Hospital Pasteur, Nice, France
| | - Denis Glotz
- Department of Nephrology and Renal Transplantation, CHU Paris-GH Saint-Louis, Lariboisière, France
| | - Carmen Lefaucheur
- Department of Nephrology and Renal Transplantation, CHU Paris-GH Saint-Louis, Lariboisière, France
| | - Julien Branchereau
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France,Urology Unit, University of Nantes, ITUN, CHU Nantes, Nantes, France
| | - David Jacobi
- Thorax Institut, INSERM, Centre National de la Recherche Scientifique (CNRS), University of Nantes, CHU Nantes, Nantes, France
| | - Magali Giral
- Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France,INSERM, UMR 1246 SPHERE, Nantes University, Tours University, Nantes, France,Center for Clinical Investigation in Biotherapy, Nantes, France
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24
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Schrezenmeier E, Müller M, Friedersdorff F, Khadzhynov D, Halleck F, Staeck O, Dürr M, Zhang K, Eckardt KU, Budde K, Lehner LJ. Evaluation of severity of delayed graft function in kidney transplant recipients. Nephrol Dial Transplant 2021; 37:973-981. [PMID: 34665258 DOI: 10.1093/ndt/gfab304] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The most common definition of delayed graft function (DGF) relies on dialysis during the first week post-transplant and does not consider DGF severity. The impact of DGF severity on long-term graft outcome remains controversial. METHODS We analyzed 627 deceased-donor kidney transplant recipients (KTR) transplanted 2005-2015 at our center for DGF-severity, associated risk factors and long-term consequences of DGF. RESULTS We found 349 (55.7%) KTR with DGF, which were classified into 4 groups according to DGF duration (0-1, 2-7, 8-14, >14 days) and were compared to KTR with no DGF. Increasing duration of DGF was associated with progressive worsening of 10-year death-censored graft survival (no DGF: 88.3% (95%CI: 82.4-94.2), 0-1 day: 81.3% (95%CI: 68.2-94.4), 2-7 days: 61.5% (95%CI: 43.1.1-79.9), 8-14 days: 66.6% (95%CI: 47.4-85.8), >14 days: 51.2% (95%CI: 33-69.4); p < 0.001). In kidneys with a Kidney Donor Profile Index (KDPI) ≥85% all DGF severity groups demonstrated reduced graft survival. However, in < 85%KDPI kidneys, only > 14 days DGF duration showed worse outcomes. CONCLUSIONS DGF had a duration-dependent effect on graft survival, which varied depending on KDPI. Of note, 0-1-day DGF showed comparable results to no DGF in the whole cohort.
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Affiliation(s)
- Eva Schrezenmeier
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Mia Müller
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Frank Friedersdorff
- Department of Urology, Charité Universitätsmedizin Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Dmytro Khadzhynov
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Fabian Halleck
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Oliver Staeck
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Dürr
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Kun Zhang
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Klemens Budde
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lukas J Lehner
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
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25
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Savoye E, Legeai C, Branchereau J, Gay S, Riou B, Gaudez F, Veber B, Bruyere F, Cheisson G, Kerforne T, Badet L, Bastien O, Antoine C. Optimal donation of kidney transplants after controlled circulatory death. Am J Transplant 2021; 21:2424-2436. [PMID: 36576341 DOI: 10.1111/ajt.16425] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/27/2020] [Accepted: 11/18/2020] [Indexed: 01/25/2023]
Abstract
Controlled donation after circulatory death (cDCD) is used for "extended criteria" donors with poorer kidney transplant outcomes. The French cDCD program started in 2015 and is characterized by normothermic regional perfusion, hypothermic machine perfusion, and short cold ischemia time. We compared the outcomes of kidney transplantation from cDCD and brain-dead (DBD) donors, matching cDCD and DBD kidney transplants by propensity scoring for donor and recipient characteristics. The matching process retained 442 of 499 cDCD and 809 of 6185 DBD transplantations. The DGF rate was 20% in cDCD recipients compared with 28% in DBD recipients (adjusted relative risk [aRR], 1.43; 95% confidence interval [CI] 1.12-1.82). When DBD transplants were ranked by cold ischemia time and machine perfusion use and compared with cDCD transplants, the aRR of DGF was higher for DBD transplants without machine perfusion, regardless of the cold ischemia time (aRR with cold ischemia time <18 h, 1.57; 95% CI 1.20-2.03, vs aRR with cold ischemia time ≥18 h, 1.79; 95% CI 1.31-2.44). The 1-year graft survival rate was similar in both groups. Early outcome was better for kidney transplants from cDCD than from matched DBD transplants with this French protocol.
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Affiliation(s)
- Emilie Savoye
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Camille Legeai
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Julien Branchereau
- Department of Urology, Nantes University Hospital, University of Nantes, Nantes, France
| | - Samuel Gay
- Intensive Care Unit, Centre Hospitalier Annecy-genevois, Annecy, France
| | - Bruno Riou
- Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Francois Gaudez
- Department of Urology, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Benoit Veber
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | | | - Gaelle Cheisson
- Department of Surgical Anesthesia and Intensive Care, South Paris University hospital, Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Thomas Kerforne
- Anesthesia and Intensive Care Unit, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Lionel Badet
- Groupement Hospitalier Edouard Herriot, Service d'urologie chirurgie de la Transplantation, Lyon, France
| | - Olivier Bastien
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Corinne Antoine
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
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26
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Maia LF, Lasmar MF, Fabreti-Oliveira RA, Nascimento E. Effect of Delayed Graft Function on the Outcome and Allograft Survival of Kidney Transplanted Patients from a Deceased Donor. Transplant Proc 2021; 53:1470-1476. [PMID: 34006380 DOI: 10.1016/j.transproceed.2021.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/21/2021] [Accepted: 04/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND In kidney transplantation (KT), delayed graft function (DGF) is a significant early complication observed in the first week. The study aimed to investigate the impact of DGF on the outcome, allograft, and patient survival after KT with organs from deceased donors. METHODS This retrospective study was conducted using 304 KT patients who received an organ from deceased donors from 2008 to 2018. The patients were divided into 2 groups, DGF positive (DGF+) and DGF negative (DGF-). The database containing the clinical, laboratory, and immunologic information of donors and recipients was statistically analyzed using the SSPS program. RESULTS In this study, 189 (62.17%) were DGF+ and 115 (37.83%) were DGF-. Until 6 months after KT, the estimate glomerular filtration rate was better in group DGF-, but it was similar between the groups during 10-year follow-up. Graft losses were higher in DGF+ group than in the DGF- (P = .046). The serum creatinine level was persistently higher in DGF+ group until the sixth month (P ≤ .05). Allograft survival rates were better in patients who were DGF- (P = .033). Those who had DGF for more than 15 days had a worse graft survival (P = .003), but in 10 year follow-up, patient survival rates were similar (P = .705). CONCLUSION DGF+ patients were associated with dialysis time before KT, ischemia time, and the donors' clinical status, such as age, organ quality, and serum creatinine. All these factors had a great impact on graft survival but not on patient survival.
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Affiliation(s)
- Lorena Fernandes Maia
- Faculty of Medical Sciences, Belo Horizonte, Minas Gerais, Brazil; University Jose do Rosário Vellano - UNIFENAS, Belo Horizonte, Minas Gerais, Brazil
| | - Marcus Faria Lasmar
- Faculty of Medical Sciences, Belo Horizonte, Minas Gerais, Brazil; University Hospital of the Faculty of Medical Science, Belo Horizonte, Minas Gerais, Brazil
| | - Raquel Aparecida Fabreti-Oliveira
- Faculty of Medical Sciences, Belo Horizonte, Minas Gerais, Brazil; IMUNOLAB - Laboratory of Histocompatibility, Belo Horizonte, Minas Gerais, Brazil.
| | - Evaldo Nascimento
- Faculty of Medical Sciences, Belo Horizonte, Minas Gerais, Brazil; IMUNOLAB - Laboratory of Histocompatibility, Belo Horizonte, Minas Gerais, Brazil
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27
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Dolla C, Mella A, Vigilante G, Fop F, Allesina A, Presta R, Verri A, Gontero P, Gobbi F, Balagna R, Giraudi R, Biancone L. Recipient pre-existing chronic hypotension is associated with delayed graft function and inferior graft survival in kidney transplantation from elderly donors. PLoS One 2021; 16:e0249552. [PMID: 33819285 PMCID: PMC8021200 DOI: 10.1371/journal.pone.0249552] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 03/20/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pre-existing chronic hypotension affects a percentage of kidney transplanted patients (KTs). Although a relationship with delayed graft function (DGF) has been hypothesized, available data are still scarce and inconclusive. METHODS A monocentric retrospective observational study was performed on 1127 consecutive KTs from brain death donors over 11 years (2003-2013), classified according to their pre-transplant Mean Blood Pressure (MBP) as hypotensive (MBP < 80 mmHg) or normal-hypertensive (MBP ≥ 80 mmHg, with or without effective antihypertensive therapy). RESULTS Univariate analysis showed that a pre-existing hypotension is associated to DGF occurrence (p<0.01; OR for KTs with MBP < 80 mmHg, 4.5; 95% confidence interval [CI], 2.7 to 7.5). Chronic hypotension remained a major predictive factor for DGF development in the logistic regression model adjusted for all DGF determinants. Adjunctive evaluations on paired grafts performed in two different recipients (one hypotensive and the other one normal-hypertensive) confirmed this assumption. Although graft survival was only associated with DGF but not with chronic hypotension in the overall population, stratification according to donor age revealed that death-censored graft survival was significantly lower in hypotensive patients who received a KT from >50 years old donor. CONCLUSIONS Our findings suggest that pre-existing recipient hypotension, and the subsequent hypotension-related DGF, could be considered a significant detrimental factor, especially when elderly donors are involved in the transplant procedure.
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Affiliation(s)
- Caterina Dolla
- Renal Transplant Center “A. Vercellone,” Nephrology, Dialysis, and Renal Transplant Division, Department of Medical Sciences, “AOU Città Della Salute e Della Scienza di Torino” University Hospital, University of Turin, Turin, Italy
| | - Alberto Mella
- Renal Transplant Center “A. Vercellone,” Nephrology, Dialysis, and Renal Transplant Division, Department of Medical Sciences, “AOU Città Della Salute e Della Scienza di Torino” University Hospital, University of Turin, Turin, Italy
| | - Giacinta Vigilante
- Renal Transplant Center “A. Vercellone,” Nephrology, Dialysis, and Renal Transplant Division, Department of Medical Sciences, “AOU Città Della Salute e Della Scienza di Torino” University Hospital, University of Turin, Turin, Italy
| | - Fabrizio Fop
- Renal Transplant Center “A. Vercellone,” Nephrology, Dialysis, and Renal Transplant Division, Department of Medical Sciences, “AOU Città Della Salute e Della Scienza di Torino” University Hospital, University of Turin, Turin, Italy
| | - Anna Allesina
- Renal Transplant Center “A. Vercellone,” Nephrology, Dialysis, and Renal Transplant Division, Department of Medical Sciences, “AOU Città Della Salute e Della Scienza di Torino” University Hospital, University of Turin, Turin, Italy
| | - Roberto Presta
- Renal Transplant Center “A. Vercellone,” Nephrology, Dialysis, and Renal Transplant Division, Department of Medical Sciences, “AOU Città Della Salute e Della Scienza di Torino” University Hospital, University of Turin, Turin, Italy
| | - Aldo Verri
- Department of Vascular Surgery, “AOU Città Della Salute e Della Scienza” Hospital, University of Turin, Turin, Italy
| | - Paolo Gontero
- Department of Urology, "AOU Città della Salute e della Scienza” Hospital, University of Turin, Turin, Italy
| | - Fabio Gobbi
- Department of Anesthesia, Intensive Care and Emergency, “AOU Città Della Salute e Della Scienza” Hospital, University of Turin, Turin, Italy
| | - Roberto Balagna
- Department of Anesthesia, Intensive Care and Emergency, “AOU Città Della Salute e Della Scienza” Hospital, University of Turin, Turin, Italy
| | - Roberta Giraudi
- Renal Transplant Center “A. Vercellone,” Nephrology, Dialysis, and Renal Transplant Division, Department of Medical Sciences, “AOU Città Della Salute e Della Scienza di Torino” University Hospital, University of Turin, Turin, Italy
| | - Luigi Biancone
- Renal Transplant Center “A. Vercellone,” Nephrology, Dialysis, and Renal Transplant Division, Department of Medical Sciences, “AOU Città Della Salute e Della Scienza di Torino” University Hospital, University of Turin, Turin, Italy
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28
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Schold JD, Mohan S, Huml A, Buccini LD, Sedor JR, Augustine JJ, Poggio ED. Failure to Advance Access to Kidney Transplantation over Two Decades in the United States. J Am Soc Nephrol 2021; 32:913-926. [PMID: 33574159 PMCID: PMC8017535 DOI: 10.1681/asn.2020060888] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/02/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Extensive research and policies have been developed to improve access to kidney transplantation among patients with ESKD. Despite this, wide variation in transplant referral rates exists between dialysis facilities. METHODS To evaluate the longitudinal pattern of access to kidney transplantation over the past two decades, we conducted a retrospective cohort study of adult patients with ESKD initiating ESKD or placed on a transplant waiting list from 1997 to 2016 in the United States Renal Data System. We used cumulative incidence models accounting for competing risks and multivariable Cox models to evaluate time to waiting list placement or transplantation (WLT) from ESKD onset. RESULTS Among the study population of 1,309,998 adult patients, cumulative 4-year WLT was 29.7%, which was unchanged over five eras. Preemptive WLT (prior to dialysis) increased by era (5.2% in 1997-2000 to 9.8% in 2013-2016), as did 4-year WLT incidence among patients aged 60-70 (13.4% in 1997-2000 to 19.8% in 2013-2016). Four-year WLT incidence diminished among patients aged 18-39 (55.8%-48.8%). Incidence of WLT was substantially lower among patients in lower-income communities, with no improvement over time. Likelihood of WLT after dialysis significantly declined over time (adjusted hazard ratio, 0.80; 95% confidence interval, 0.79 to 0.82) in 2013-2016 relative to 1997-2000. CONCLUSIONS Despite wide recognition, policy reforms, and extensive research, rates of WLT following ESKD onset did not seem to improve in more than two decades and were consistently reduced among vulnerable populations. Improving access to transplantation may require more substantial interventions.
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Affiliation(s)
- Jesse D. Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio,Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, Columbia University Vagelos College of Physicians & Surgeons, New York, New York,Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Anne Huml
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Laura D. Buccini
- Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - John R. Sedor
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Emilio D. Poggio
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
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29
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Sabah TK, Khalid U, Ilham MA, Ablorsu E, Szabo L, Griffin S, Chavez R, Asderakis A. Induction with ATG in DCD kidney transplantation; efficacy and relation of dose and cell markers on delayed graft function and renal function. Transpl Immunol 2021; 66:101388. [PMID: 33775865 DOI: 10.1016/j.trim.2021.101388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/30/2022]
Abstract
AIM We aimed to analyse the efficacy of the Thymoglobulin dose used for induction in controlled DCD kidneys, and its initial impact on blood cell and CD3 count, as predictors of efficacy. METHODS 140 DCD patients who received ATG induction, were analysed. Intended dose was 1.25 mg/kg/day over 5 days, rounded to nearest 25 mg and not exceeding 125 mg/dose. Outcomes included the total dose in relation with rejection, DGF, graft survival, eGFR. The cell count response to ATG was assessed as predictors of outcome. RESULTS Graft survival, was 96.2%, 92.4%, 85% at 1, 3 and 5 years. Rejection was 7% at 1 year and associated with eGFR at 3 (p = 0.003) and 5 years. ATG dose was not predictive of rejection but was associated with the day5 leucocyte and lymphocyte count (p < 0.001) and negatively with DGF (p = 0.05). In 31 patients day3 CD3 count was available and it was associated with rejection (p = 0.002), less DGF (p = 0.09), and 3 years eGFR (p = 0.01). CONCLUSION Thymoglobulin provides excellent results in DCD kidneys that do not significantly differ with small dose variations. In higher doses it reduces DGF. Lymphocytes and CD3 count, may be useful surrogate markers of efficacy and outcome.
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Affiliation(s)
- Tarique Karim Sabah
- Cardiff Transplant Unit, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom.
| | - Usman Khalid
- Cardiff Transplant Unit, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom.
| | - Mohamed Adel Ilham
- Cardiff Transplant Unit, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom.
| | - Elijah Ablorsu
- Cardiff Transplant Unit, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom.
| | - Laszlo Szabo
- Cardiff Transplant Unit, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom.
| | - Sian Griffin
- Cardiff Transplant Unit, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom.
| | - Rafael Chavez
- Cardiff Transplant Unit, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom.
| | - Argiris Asderakis
- Cardiff Transplant Unit, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom.
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30
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Xue W, Wang C, Chen J, Sun X, Wu X, Peng L, Chen Z, Qu Q, Zhang X, Fu Y, Dong Z, Chen Z, Feng G, Lin T, Men T, Yu L, Sun Q, Zhao Y, Zhou J, Zeng L, Zhao M, Tan J, Ye Q, Shi B, Ming Y, Zhu T, Sui W, Huang C, Fu Y. A prediction model of delayed graft function in deceased donor for renal transplant: a multi-center study from China. Ren Fail 2021; 43:520-529. [PMID: 33719820 PMCID: PMC7971200 DOI: 10.1080/0886022x.2021.1895838] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background Kidneys obtained from deceased donors increase the incidence of delayed graft function (DGF) after renal transplantation. Here we investigated the influence of the risk factors of donors with DGF, and developed a donor risk scoring system for DGF prediction. Methods This retrospective study was conducted in 1807 deceased kidney donors and 3599 recipients who received donor kidneys via transplants in 29 centers in China. We quantified DGF associations with donor clinical characteristics. A donor risk scoring system was developed and validated using an independent sample set. Results The incidence of DGF from donors was 19.0%. Six of the donor characteristics analyzed, i.e., age, cause of death, history of hypertension, terminal serum creatinine, persistence of hypotension, and cardiopulmonary resuscitation (CPR) time were risk factors for DGF. A 49-point scoring system of donor risk was established for DGF prediction and exhibited a superior degree of discrimination. External validation of DGF prediction revealed area under the receiver-operating characteristic (AUC) curves of 0.7552. Conclusions Our study determined the deceased donor risk factors related to DGF after renal transplantation pertinent to the Chinese cohort. The scoring system developed here had superior diagnostic significance and consistency and can be used by clinicians to make evidence-based decisions on the quality of kidneys from deceased donors and guide renal transplantation therapy.
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Affiliation(s)
- Wujun Xue
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Institute of Organ Transplantation of Xi'an Jiaotong University, Xi'an, China
| | - Changxi Wang
- The First Affiliated Hospital Of Sun Yat-sen University, Guangzhou, China
| | - Jianghua Chen
- First Affiliated Hospital Of Zhejiang University Medical School, Hangzhou, China
| | - Xuyong Sun
- The Chinese People's Liberation Army 923 Hospital, Nanjing, China
| | - Xiaotong Wu
- Second People's Hospital of Shanxi Province, Taiyuan, China
| | - Longkai Peng
- The Second Xiangya Hospital Of Central South University, Changsha, China
| | - Zhishui Chen
- Tongji Hospital Affiliated to Tongji Medical College Huazhong University of Science and Technology, Wuhan, China
| | - Qingshan Qu
- People's Hospital of Zhengzhou City, Zhengzhou, China
| | - Xiaodong Zhang
- Beijing Chaoyang Hospital Affiliated to The Capital University of Medical Sciences, Beijing, China
| | - Yaowen Fu
- Bethune First Hospital of Jilin University, Changchun, China
| | - Zhen Dong
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zheng Chen
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guiwen Feng
- The First Affiliated Hospital Of Zhengzhou University, Zhengzhou, China
| | - Tao Lin
- West China Hospital of Sichuan University, Chengdu, China
| | - Tongyi Men
- The First Affiliated Hospital of the First Shandong Medical University, Jinan, China
| | - Lixin Yu
- Nanfang Hospital of Southern Medical University, Guangzhou, China
| | - Qiquan Sun
- The Third Hospital Affiliated of Sun-Yet University, Guangzhou, China
| | - Yongheng Zhao
- Kunming City First People's Hospital, Kunming, China
| | | | - Li Zeng
- Changhai Hospital of Naval Military Medical University, Shanghai, China
| | - Ming Zhao
- Zhujiang Hospital, of Southern Medical University, Guangzhou, China
| | - Jianming Tan
- The 900 Hospital of Joint Logistic Support Department of PLA, Fuzhou, China
| | - Qifa Ye
- Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Bingyi Shi
- The Eighth Medical Center of People's Liberation Army General Hospital, Beijing, China
| | - Yingzi Ming
- The Third Xiangya Hospital of Central South University, Changsha, China
| | - Tongyu Zhu
- Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Weiguo Sui
- The 924 Hospital of Joint Logistic Support Department of PLA, Guilin, China
| | - Chibing Huang
- The Second Affiliated Hospital of Army Military Medical University, Chongqing, China
| | - Yingxin Fu
- Tianjin First Central Hospital, Tianjin, China
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31
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Kim KD, Lee KW, Kim SJ, Lee O, Lim M, Jeong ES, Kwon J, Yang J, Oh J, Park JB. Safety and effectiveness of kidney transplantation using a donation after brain death donor with acute kidney injury: a retrospective cohort study. Sci Rep 2021; 11:5572. [PMID: 33692385 PMCID: PMC7946918 DOI: 10.1038/s41598-021-84977-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/22/2021] [Indexed: 12/29/2022] Open
Abstract
The use of kidneys from donation after brain death (DBD) donors with acute kidney injury (AKI) is a strategy to expand the donor pool. The aim of this study was to evaluate how kidney transplantation (KT) from a donor with AKI affects long-term graft survival in various situations. All patients who underwent KT from DBD donors between June 2003 and April 2016 were retrospectively reviewed. The KDIGO (Kidney Disease: Improving Global Outcomes) criteria were used to classify donor AKI. The cohort included 376 donors (no AKI group, n = 117 [31.1%]; AKI group n = 259 [68.9%]). Death-censored graft survival was similar according to the presence of AKI, AKI severity, and the AKI trend (p = 0.929, p = 0.077, and p = 0.658, respectively). Patients whose donors had AKI who received using low dose (1.5 mg/kg for three days) rabbit anti-thymocyte globulin (r-ATG) as the induction agent had significantly superior death-censored graft survival compared with patients in that group who received basiliximab (p = 0.039). AKI in DBD donors did not affect long-term death-censored graft survival. Low-dose r-ATG may be considered as an induction immunosuppression in recipients receiving kidneys with AKI because it showed better graft survival than basiliximab.
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Affiliation(s)
- Kyeong Deok Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06355, Republic of Korea
| | - Kyo Won Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06355, Republic of Korea.
| | - Sang Jin Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06355, Republic of Korea
| | - Okjoo Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06355, Republic of Korea
| | - Manuel Lim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06355, Republic of Korea
| | - Eun Sung Jeong
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06355, Republic of Korea
| | - Jieun Kwon
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06355, Republic of Korea
| | - Jaehun Yang
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06355, Republic of Korea
| | - Jongwook Oh
- Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Jae Berm Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06355, Republic of Korea
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Kaur U, Sahu S, Srivastava D, Singh TK, Mishra P, Srivastava A. To compare intraoperative goal directed fluid therapy by trans-oesophageal Doppler vis-à-vis FloTrac™ in patients undergoing living related renal transplantation-a prospective randomised controlled study. Indian J Anaesth 2020; 64:S220-S226. [PMID: 33311723 PMCID: PMC7714010 DOI: 10.4103/ija.ija_605_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/23/2020] [Accepted: 08/26/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Optimal intra-operative fluid therapy in renal transplantation (RT) is essential to ensure adequate graft function while preventing fluid overload related complications. This RCT was to compare the intraoperative goal directed fluid therapy (GDFT) based either on corrected flow time (CFT), measured by trans oesophageal Doppler (TED) or on the stroke volume variation (SVV), by FloTrac in patients undergoing living donor RT. Methods: This prospective, randomised controlled trial (RCT) was done on 60 end stage renal disease (ESRD) patients, American Society of Anaesthesiologists(ASA) grade III–IV, age 18 to 65 years of either sex, scheduled for living donor RT under general anaesthesia. They were randomly divided into two groups: TED group (n = 30) and FloTrac™ group (n = 30) and administered GDFT, based upon CFT (TED) and SVV (FloTrac™). The primary outcome was to compare the total fluid and number of fluid boluses administered intraoperatively, while the secondary outcomes were to compare any postoperative complications due to fluid overload and allograft function, assessed by serial serum creatinine levels up to 90 days postoperatively. Results: The mean total intra-operative fluid [3991.67 ± 856.32 vs. 3543.33 ± 1131.35, P = 0.089] and the amount of fluid administered per kg body weight per hour [13.32 ± 4.67 vs. 11.82 ± 4.76, P = 0.222] were lesser in the FloTrac compared to TED group, though not statistically significant. However, the postoperative incidence of allograft dysfunction, including rejection (P = 0.743) and acute tubular necrosis (ATN) (P = 0.999), and other complications (P = 0.643) were comparable. Conclusions: Both TED and FloTrac devices can be used effectively to guide GDFT in RT, However, lesser total fluid was required in the FloTrac group, which may lead to a lesser number of fluid-related postoperative complications.
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Affiliation(s)
- Ushkiran Kaur
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sandeep Sahu
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Divya Srivastava
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Tapas Kumar Singh
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Prabhakar Mishra
- Department of Biostatistics and Health Informatics and, Uttar Pradesh, India
| | - Aneesh Srivastava
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Chen R, Wang H, Song L, Hou J, Peng J, Dai H, Peng L. Predictors and one-year outcomes of patients with delayed graft function after deceased donor kidney transplantation. BMC Nephrol 2020; 21:526. [PMID: 33276737 PMCID: PMC7716446 DOI: 10.1186/s12882-020-02181-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/22/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Delayed graft function (DGF) is closely associated with the use of marginal donated kidneys due to deficits during transplantation and in recipients. We aimed to predict the incidence of DGF and evaluate its effect on graft survival. METHODS This retrospective study on kidney transplantation was conducted from January 1, 2018, to December 31, 2019, at the Second Xiangya Hospital of Central South University. We classified recipients whose operations were performed in different years into training and validation cohorts and used data from the training cohort to analyze predictors of DGF. A nomogram was then constructed to predict the likelihood of DGF based on these predictors. RESULTS The incidence rate of DGF was 16.92%. Binary logistic regression analysis showed correlations between the incidence of DGF and cold ischemic time (CIT), warm ischemic time (WIT), terminal serum creatine (Scr) concentration, duration of pretransplant dialysis, primary cause of donor death, and usage of LifePort. The internal accuracy of the nomogram was 83.12%. One-year graft survival rates were 93.59 and 99.74%, respectively, for the groups with and without DGF (P < 0.05). CONCLUSION The nomogram established in this study showed good accuracy in predicting DGF after deceased donor kidney transplantation; additionally, DGF decreased one-year graft survival.
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Affiliation(s)
- Rao Chen
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China.,Clinical Research Center for Organ Transplantation in Hunan Province, Changsha, Hunan, 410011, China
| | - Haifeng Wang
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China.,Clinical Research Center for Organ Transplantation in Hunan Province, Changsha, Hunan, 410011, China
| | - Lei Song
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China.,Clinical Research Center for Organ Transplantation in Hunan Province, Changsha, Hunan, 410011, China
| | - Jianfei Hou
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China.,Clinical Research Center for Organ Transplantation in Hunan Province, Changsha, Hunan, 410011, China
| | - Jiawei Peng
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China.,Clinical Research Center for Organ Transplantation in Hunan Province, Changsha, Hunan, 410011, China
| | - Helong Dai
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China. .,Clinical Research Center for Organ Transplantation in Hunan Province, Changsha, Hunan, 410011, China. .,Clinical Immunology Center, Central South University, Changsha, Hunan, 410011, China.
| | - Longkai Peng
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China. .,Clinical Research Center for Organ Transplantation in Hunan Province, Changsha, Hunan, 410011, China.
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Abstract
BACKGROUND In a recent trial, targeted mild hypothermia in brain-dead organ donors significantly reduced the incidence of delayed graft function after kidney transplantation. This trial was stopped early for efficacy. Here, we report long-term graft survival for all organs along with donor critical care end points. METHODS We assessed graft survival through 1 year of all solid organs transplanted from 370 donors who had been randomly assigned to hypothermia (34-35°C) or normothermia (36.5-37.5°C) before donation. Additionally, changes in standardized critical care end points were compared between donors in each group. RESULTS Mild hypothermia was associated with a nonsignificant improvement in 1-year kidney transplant survival (95% versus 92%; hazard ratio, 0.61 [0.31-1.20]; P = 0.15). Mild hypothermia was associated with higher 1-year graft survival in the subgroup of standard criteria donors (97% versus 93%; hazard ratio, 0.39 [0.15 to -1.00]; P = 0.05). There were no significant differences in graft survival of extrarenal organs. There were no differences in critical care end points between groups. CONCLUSIONS Mild hypothermia in the donor safely reduced the rate of delayed graft function in kidney transplant recipients without adversely affecting donor physiology or extrarenal graft survival. Kidneys from standard criteria donors who received targeted mild hypothermia had improved 1-year graft survival.
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Brief Bubble and Intermittent Surface Oxygenation Is a Simple and Effective Alternative for Membrane Oxygenation During Hypothermic Machine Perfusion in Kidneys. Transplant Direct 2020; 6:e571. [PMID: 32766426 PMCID: PMC7339262 DOI: 10.1097/txd.0000000000001016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 02/03/2023] Open
Abstract
Background. The aim of this feasibility study was to determine an alternative oxygenation technique (easy, cheap, and compatible with air transport) for membrane oxygenation during hypothermic machine perfusion (HMP) to improve early graft function in a porcine ischemia-reperfusion autotransplant model. Methods. The left kidney of a ±40- kg pig was exposed to 30 minutes of warm ischemia before 22 hours of preservation and autotransplantation. In the experimental group, oxygenation of the perfusate during HMP was obtained by direct bubble and 30-minute surface oxygenation at start and 1-hour end ischemic (n = 4) and outcome measures compared with historical HMP without active oxygenation (n = 6), 22-hour continuous oxygenated HMP (HMPO2) (n = 8), and 2-hour HMPO2 + 20-hour HMP (n = 6) using membrane oxygenation in both historical oxygenated control groups. Results. Brief bubble and 30-minute surface oxygenation of the perfusate effectively maintained supraphysiological Po2 levels during the first 2 hours of HMP with improved flow dynamics. Although the metabolic profile of the perfusate (ie, flavin mononucleotide) and tissue (ie, glutamate, ATP) after brief O2 uploading at the start of HMP seemed to be slightly better with the use of a membrane oxygenator compared with bubble and interrupted surface oxygenation, both techniques yielded similar, superior early graft function when compared with HMP without active oxygenation. Conclusions. The data presented in this feasibility study support the conclusion that brief bubble and intermittent surface oxygenation could be an alternative oxygenation technique during HMP to achieve an improved kidney graft function compared with HMP without active oxygenation and similar functional outcome when compared with membrane HMPO2.
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Abstract
BACKGROUND The Kidney Donor Risk Index (KDRI) is a score applicable to deceased kidney donors which reflects relative graft failure risk associated with deceased donor characteristics. The KDRI is widely used in kidney transplant outcomes research. Moreover, an abbreviated version of KDRI is the basis, for allocation purposes, of the "top 20%" designation for deceased donor kidneys. Data upon which the KDRI model was based used kidney transplants performed between 1995 and 2005. Our purpose in this report was to evaluate the need to update the coefficients in the KDRI formula, with the objective of either (a) proposing new coefficients or (b) endorsing continued used of the existing formula. METHODS Using data obtained from the Scientific Registry of Transplant Recipients, we analyzed n = 156069 deceased donor adult kidney transplants occurring from 2000 to 2016. Cox regression was used to model the risk of graft failure. We then tested for differences between the original and updated regression coefficients and compared the performance of the original and updated KDRI formulas with respect to discrimination and predictive accuracy. RESULTS In testing for equality between the original and updated KDRIs, few coefficients were significantly different. Moreover, the original and updated KDRI yielded very similar risk discrimination and predictive accuracy. CONCLUSIONS Overall, our results indicate that the original KDRI is robust and is not meaningfully improved by an update derived through modeling analogous to that originally employed.
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Butler CR, Perkins JD, Johnson CK, Blosser CD, De Castro I, Leca N, Sibulesky L. Contemporary patterns in kidney graft survival from donors after circulatory death in the United States. PLoS One 2020; 15:e0233610. [PMID: 32469937 PMCID: PMC7259576 DOI: 10.1371/journal.pone.0233610] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 05/08/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Kidney transplants from donors after circulatory death (DCD) make up an increasing proportion of all deceased donor kidney transplants in the United States (US). However, DCD grafts are considered to be of lower quality than kidneys from donors after brain death (DBD). It is unclear whether graft survival is different for these two types of donor kidneys. MATERIALS AND METHODS We conducted a retrospective cohort study of US deceased donor kidney recipients using data from the United Network of Organ Sharing from 12/4/2014 to 6/30/2018. We employed a Cox proportional hazard model with mixed effects to compare all-cause graft loss and death-censored graft loss for DCD versus DBD deceased donor kidney transplant recipients. We used transplant center as the random effects term to account for cluster-specific random effects. In the multivariable analysis, we adjusted for recipient characteristics, donor factors, and transplant logistics. RESULTS Our cohort included 27,494 DBD and 7,770 DCD graft recipients transplanted from 2014 to 2018 who were followed over a median of 1.92 years (IQR 1.08-2.83). For DCD compared with DBD recipients, we did not find a significant difference in all-cause graft loss (hazard ratio [HR] 0.96, 95% confidence interval [CI] 0.87-1.05 in univariable and HR 1.03 [95% CI 0.95-1.13] in multivariable analysis) or for death-censored graft loss (HR 0.97 (95% CI 0.91-1.06) in univariable and 1.05 (95% CI 0.99-1.11) in multivariable analysis). CONCLUSIONS For a contemporary cohort of deceased donor kidney transplant recipients, we did not find a difference in the likelihood of graft loss for DCD compared with DBD grafts. These findings signal a need for additional investigation into whether DCD status independently contributes to other important outcomes for current kidney transplant recipients and indices of graft quality.
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Affiliation(s)
- Catherine R. Butler
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - James D. Perkins
- Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, WA, United States of America
| | - Christopher K. Johnson
- Division of Nephrology, Department of Medicine, University of Illinois College of Medicine, Peoria, IL, United States of America
| | - Christopher D. Blosser
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Iris De Castro
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Nicolae Leca
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Lena Sibulesky
- Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, WA, United States of America
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Ostróżka-Cieślik A, Dolińska B. The Role of Hormones and Trophic Factors as Components of Preservation Solutions in Protection of Renal Function before Transplantation: A Review of the Literature. Molecules 2020; 25:E2185. [PMID: 32392782 PMCID: PMC7248710 DOI: 10.3390/molecules25092185] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/29/2020] [Accepted: 05/05/2020] [Indexed: 12/12/2022] Open
Abstract
Transplantation is currently a routine method for treating end-stage organ failure. In recent years, there has been some progress in the development of an optimal composition of organ preservation solutions, improving the vital functions of the organ and allowing to extend its storage period until implantation into the recipient. Optimizations are mostly based on commercial solutions, routinely used to store grafts intended for transplantation. The paper reviews hormones with a potential nephroprotective effect, which were used to modify the composition of renal perfusion and preservation solutions. Their effectiveness as ingredients of preservation solutions was analysed based on a literature review. Hormones and trophic factors are innovative preservation solution supplements. They have a pleiotropic effect and affect normal renal function. The expression of receptors for melatonin, prolactin, thyrotropin, corticotropin, prostaglandin E1 and trophic factors was confirmed in the kidneys, which suggests that they are a promising therapeutic target for renal IR (ischemia-reperfusion) injury. They can have anti-inflammatory, antioxidant and anti-apoptotic effects, limiting IR injury.
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Affiliation(s)
- Aneta Ostróżka-Cieślik
- Department of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Kasztanowa 3, 41-200 Sosnowiec, Poland;
| | - Barbara Dolińska
- Department of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Kasztanowa 3, 41-200 Sosnowiec, Poland;
- “Biochefa” Pharmaceutical Research and Production Plant, Kasztanowa 3, 41-200 Sosnowiec, Poland
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Monárrez-Espino J, Ramírez-Santana I, Aguilar-Madrid G, Ramírez-García G. Identification of Factors Associated With Acute Tubular Necrosis Following Kidney Transplant in Northern Mexico: Increased Risk With Cold Ischemia After 8 Hours. Transplant Proc 2020; 52:1110-1117. [PMID: 32169365 DOI: 10.1016/j.transproceed.2020.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 02/05/2020] [Indexed: 12/14/2022]
Abstract
AIM To identify potential risk factors associated with the incidence of acute tubular necrosis (ATN) following kidney transplant in a sample of patients from northern Mexico. METHODS Secondary analysis of data extracted from clinical files of patients who underwent a kidney transplant between 2000 and 2017 at Christus Muguerza Hospital in the city of Chihuahua. The final sample with complete data included 485 patients. ATN was diagnosed in 13.2% of patients using pathologic, clinical, and laboratory criteria. Adjusted odds ratio (ORs) with 95% CIs from multivariate binary logistic regression were used to identify predictors of ATN. RESULTS Only 4 of 21 variables analyzed remained statistically significant in the final adjusted model. Cold and warm ischemia followed time-trend patterns with higher odds with longer ischemia times. For cold ischemia, compared with 0 to 240 minutes, ORs were 1.32 (95% CI, 0.49-3.51) for 241-480 minutes, 4.87 (95% CI, 2.29-10.3) for 481-960 minutes, and 10.0 (95% CI, 2.86-35.0) for > 960 minutes; for warm ischemia, compared with 40 to 59 minutes, these were 6.27 (95% CI, 1.95-20.8) for 60-70 minutes and 10.32 (95% CI, 1.95-54.4) for 71-110 minutes. Hypotension during surgery was associated with a higher chance of ATN (OR, 15.9; 95% CI, 4.97-50.9). When the recipients' age was 30 years or older, the probability also increased significantly (OR, 2.88; 95% CI, 1.09-7.57). The final model fitted well and explained 27% of the probability to develop ATN after a kidney transplant. CONCLUSION Shortening the duration of ischemia and avoiding hypotension during surgery is essential to prevent ATN following a kidney transplant.
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Affiliation(s)
- Joel Monárrez-Espino
- Department of Health Research, Christus Muguerza Hospital, Chihuahua, Mexico; Public Health Research Group, Claustro Universitario, Chihuahua, Mexico.
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Schröppel B, Akalin E, Baweja M, Bloom RD, Florman S, Goldstein M, Haydel B, Hricik DE, Kulkarni S, Levine M, Mehrotra A, Patel A, Poggio ED, Ratner L, Shapiro R, Heeger PS. Peritransplant eculizumab does not prevent delayed graft function in deceased donor kidney transplant recipients: Results of two randomized controlled pilot trials. Am J Transplant 2020; 20:564-572. [PMID: 31452319 DOI: 10.1111/ajt.15580] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/25/2019] [Accepted: 08/12/2019] [Indexed: 01/25/2023]
Abstract
Animal models and observational human data indicate that complement, including C5a, pathogenically participates in ischemia reperfusion (IR) injury that manifests as delayed graft function (DGF) following deceased donor kidney transplantation. We report on the safety/efficacy of anti-C5 monoclonal antibody eculizumab (Ecu) administered in the operating room prior to reperfusion, to prevent DGF in recipients of deceased donor kidney transplants in two related, investigator-sponsored, randomized controlled trials. Eight recipients from a single center were enrolled in a pilot study that led to a 19-subject multicenter trial. Together, 27 deceased donor kidney transplant recipients, 16 Ecu-treated and 11 controls, were treated with rabbit antithymocyte globulin, tacrolimus, mycophenolate mofetil with or without glucocorticoids, and followed for 6 months. Data analysis showed no epidemiological or transplant-related differences between study arms. Ecu was well tolerated with a similar severe adverse event incidence between groups. The DGF rate did not differ between Ecu-treated (44%) and control (45%, P = 1.0) subjects. Serum creatinine reduction in the first week after transplantation, and graft function up to 180-days post-transplant, were also similar. Ecu administration was safe but did not reduce the rate of DGF in a high-risk population of deceased donor recipients.
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Affiliation(s)
- Bernd Schröppel
- Nephrology Division, Department of Medicine and Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, New York.,Section of Nephrology, University Hospital, Ulm, Germany
| | - Enver Akalin
- Nephrology Division, Department of Medicine, Montefiore Medical Center, Bronx, New York
| | - Mukta Baweja
- Nephrology Division, Department of Medicine and Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Roy D Bloom
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sander Florman
- Recanati Miller Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael Goldstein
- Recanati Miller Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brandy Haydel
- Recanati Miller Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Donald E Hricik
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Sanjay Kulkarni
- Yale New Haven Transplant Center, Yale University School of Medicine, New Haven, Connecticut
| | - Matthew Levine
- Department of Surgery, Transplant Program, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anita Mehrotra
- Nephrology Division, Department of Medicine and Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anup Patel
- Saint Barnabas Medical Center, Livingston, New Jersey
| | - Emilio D Poggio
- Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, Ohio
| | - Lloyd Ratner
- Department of Surgery, Columbia University Medical Center, New York, New York
| | - Ron Shapiro
- Recanati Miller Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Peter S Heeger
- Nephrology Division, Department of Medicine and Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, New York.,Recanati Miller Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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Okada K, Nomura-Nakayama K, Okushi Y, Okino K, Mukai K, Hayashi N, Fujimoto K, Adachi H, Yokoyama H. Changes in double-strand DNA breaks predict delayed graft function (DGF) in Japanese renal allograft recipients. Clin Exp Nephrol 2019; 24:96-104. [PMID: 31811409 DOI: 10.1007/s10157-019-01793-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 09/11/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although delayed graft function (DGF) is a serious complication following kidney transplantation, a reliable and early diagnostic test is lacking to identify the grade of DGF. METHODS We investigated changes in double-strand DNA breaks (DSBs), and factors related to DGF, such as ischemic times at transplantation and serum creatinine (sCr) levels. DSBs were detected by phospho-histone H2A.X (γ-H2AX) expression and cellular regeneration by Ki-67 before (0 h) and 1 h after allograft reperfusion (1 h) in each subject. RESULTS The expression of γ-H2AX or Ki-67 at 0 h showed no difference between the living and deceased donors. γ-H2AX at 1 h decreased in the living donors, but increased in the deceased donors compared with that of 0 h(p = 0.017). Changes (Δ) in γ-H2AX between 0 and 1 h were different among subgroups, i.e., immediate function, slow graft function with dialysis < 7 days, DGF with dialysis < 4 weeks, severe DGF with dialysis > 4 weeks, or primary non-function (PNF) (p = 0.04). Severe DGF and PNF cases showed greater increase in Δγ-H2AX (p = 0.019), and were distinguished by > 12% of Δγ-H2AX at 100% sensitivity and 88.2% specificity (ROC analysis, AUC: 0.922, p = 0.023). In a multivariate regression analysis, donor sCr and Δγ-H2AX were two main predictors of the grade of DGF (p = 0.002). The expression of Ki-67 was very low at both 0 h and 1 h. CONCLUSION The combination of donor sCr and Δγ-H2AX from 0 to 1 h after reperfusion may predict severe DGF and PNF in the early phase.
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Affiliation(s)
- Keiichiro Okada
- Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Kanae Nomura-Nakayama
- Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Yuki Okushi
- Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Kazuaki Okino
- Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Kiyotaka Mukai
- Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Norifumi Hayashi
- Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Keiji Fujimoto
- Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Hiroki Adachi
- Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Hitoshi Yokoyama
- Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan.
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Induction Therapy With ATG Compared With Anti-IL2 Basiliximab in Low-Immunologic Risk Kidney Transplant Recipients. Transplant Proc 2019; 51:3259-3264. [PMID: 31732198 DOI: 10.1016/j.transproceed.2019.07.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/30/2019] [Accepted: 07/09/2019] [Indexed: 11/22/2022]
Abstract
Practically all kidney allograft recipients require immunosuppressive therapy to prevent rejection and loss of the allograft. The aim of this study was to determine the occurrence of biopsy-proven acute rejection in low-immunologic risk kidney transplant recipients according to the type of induction (basiliximab vs low-dose of rabbit antithymocyte globulin [rATG], 3.5 mg/kg). MATERIALS AND METHODS A total of 125 patients after primary kidney transplant were included in the retrospective analysis with 6-month follow-up. The immunosuppression regimen included tacrolimus, mycophenolic acid, and corticoids. RESULTS We did not find any significant difference in the occurrence of acute rejection or difference in the occurrence of infection complications. Patients in the rATG group had a significantly longer period of cold ischemia, more frequently received kidney transplants from expanded criteria donors, and had significantly more mismatches in HLA-DR. Delayed graft function (DGF) was identified as an independent risk factor for biopsy-proven acute rejection (hazard ratio, 3.4859; P = .003). There was comparable incidence of DGF between the 2 groups despite that there were several factors that are more commonly associated with DGF in the rATG group. CONCLUSION Patients with low immunologic risk and high risk of DGF benefit from the rATG induction in dose of 3.5 mg/kg without the increased risk of infection complications with the assumption of good graft function in long-term post-transplant period.
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Live Confocal Tissue Assessment With SYTO16/PI and WGA Staining Visualizes Acute Organ Damage and Predicts Delayed Graft Function in Kidney Transplantation. Ann Surg 2019; 270:915-922. [DOI: 10.1097/sla.0000000000003511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kwong JCC, Kroczak T, D'A Honey JR, Stewart RJ, Pace KT, Ordon M, Lee JY. Peritoneal dialysis catheter removal at the time of renal transplantation: Choosing the optimal candidate. Can Urol Assoc J 2019; 14:E13-E19. [PMID: 31658012 DOI: 10.5489/cuaj.5825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Concurrent peritoneal dialysis (PD) catheter removal during renal transplantation is controversial, with limited evidence supporting this practice. Our objective was to determine the rate of delayed graft function (DGF) in patients on preoperative PD. Additionally, we sought to identify which patients can safely have their PD catheter removed during transplantation due to a low risk of DGF. METHODS We conducted a retrospective observational study between June 2011 and December 2015. The primary outcome was the diagnosis of DGF, defined as the need for dialysis within the first week of transplantation. Clinical and transplant factors, including graft type and donor criteria, were assessed for association with the primary outcome. Catheter-related complication rates were also compared between post-transplant PD and hemodialysis (HD). RESULTS Of our cohort of 567 patients, 145 patients (25.6%) developed DGF. Obesity (odds ratio [OR] 1.06; 95% confidence interval [CI] 1.00-1.11; p=0.04) and increased perioperative blood loss (OR 1.002; 95% CI 1.000-1.003; p=0.03) were predictors of DGF. Protective factors included living donor (LD) grafts (OR 0.15; 95% CI 0.05-0.49; p=0.002) and intraoperative graft urine production (OR 0.39; 95% CI 0.23-0.65; p<0.001). In our PD cohort, only LD grafts demonstrated lower DGF rates (0 LD vs. 20.8% deceased donor; p=0.003). In terms of post-transplant renal replacement therapy, patients on PD and HD had similar duration of temporary dialysis (one day PD vs. two days HD; p=0.48) and catheter-related complication rates (4.5% PD vs. 2.6% HD; p=0.30). CONCLUSIONS Carefully selected patients, such as those receiving LD grafts, may benefit from concurrent PD catheter removal.
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Affiliation(s)
| | - Tad Kroczak
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - John R D'A Honey
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Robert J Stewart
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Kenneth T Pace
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Michael Ordon
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jason Y Lee
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
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Choi J, Chandraker A. Immunologic Risk Assessment and Approach to Immunosuppression Regimen in Kidney Transplantation. Clin Lab Med 2019; 39:643-656. [PMID: 31668275 DOI: 10.1016/j.cll.2019.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The outcomes of kidney transplantation show a steady improvement with an increasing number of transplantations and decreasing incidence of acute rejection episodes. Successful transplantation begins with a comprehensive immunologic risk assessment and judicious choice of therapeutic agents. In this review, we discuss the trends in transplant immunosuppression practices and outcomes in the United States. We discuss practical testing algorithms for clinical decision making in induction therapy and fine-tuning maintenance immunosuppression. We introduce assessment tools for immune monitoring after transplantation and speculate on future directions in management.
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Affiliation(s)
- John Choi
- Transplantation Research Center, Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anil Chandraker
- Transplantation Research Center, Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Scherberich JE, Gruber R, Nockher WA, Christensen EI, Schmitt H, Herbst V, Block M, Kaden J, Schlumberger W. Serum uromodulin-a marker of kidney function and renal parenchymal integrity. Nephrol Dial Transplant 2019; 33:284-295. [PMID: 28206617 PMCID: PMC5837243 DOI: 10.1093/ndt/gfw422] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 11/07/2016] [Indexed: 11/12/2022] Open
Abstract
Background An ELISA to analyse uromodulin in human serum (sUmod) was developed, validated and tested for clinical applications. Methods We assessed sUmod, a very stable antigen, in controls, patients with chronic kidney disease (CKD) stages 1-5, persons with autoimmune kidney diseases and recipients of a renal allograft by ELISA. Results Median sUmod in 190 blood donors was 207 ng/mL (women: men, median 230 versus 188 ng/mL, P = 0.006). sUmod levels in 443 children were 193 ng/mL (median). sUmod was correlated with cystatin C (rs = -0.862), creatinine (rs = -0.802), blood urea nitrogen (BUN) (rs = -0.645) and estimated glomerular filtration rate (eGFR)-cystatin C (rs = 0.862). sUmod was lower in systemic lupus erythematosus-nephritis (median 101 ng/mL), phospholipase-A2 receptor- positive glomerulonephritis (median 83 ng/mL) and anti-glomerular basement membrane positive pulmorenal syndromes (median 37 ng/mL). Declining sUmod concentrations paralleled the loss of kidney function in 165 patients with CKD stages 1-5 with prominent changes in sUmod within the 'creatinine blind range' (71-106 µmol/L). Receiver-operating characteristic analysis between non-CKD and CKD-1 was superior for sUmod (AUC 0.90) compared with eGFR (AUC 0.39), cystatin C (AUC 0.39) and creatinine (AUC 0.27). sUmod rapidly recovered from 0 to 62 ng/mL (median) after renal transplantation in cases with immediate graft function and remained low in delayed graft function (21 ng/mL, median; day 5-9: relative risk 1.5-2.9, odds ratio 1.5-6.4). Immunogold labelling disclosed that Umod is transferred within cytoplasmic vesicles to both the apical and basolateral plasma membrane. Umod revealed a disturbed intracellular location in kidney injury. Conclusions We conclude that sUmod is a novel sensitive kidney-specific biomarker linked to the structural integrity of the distal nephron and to renal function.
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Affiliation(s)
- Jürgen E Scherberich
- Klinikum München-Harlaching, Teaching Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
| | - Rudolf Gruber
- Krankenhaus Barmherzige Brüder, Teaching Hospital of the University of Regensburg, Regensburg, Germany
| | | | | | | | - Victor Herbst
- Institute for Experimental Immunology, Euroimmun AG, Lübeck, Germany
| | - Matthias Block
- Institute for Experimental Immunology, Euroimmun AG, Lübeck, Germany
| | - Jürgen Kaden
- Kidney Transplant Centre, Municipal Hospital Berlin-Friedrichshain, Teaching Hospital of the Charité Berlin, Berlin, Germany
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Association Between Duration of Delayed Graft Function, Acute Rejection, and Allograft Outcome After Deceased Donor Kidney Transplantation. Transplantation 2019; 103:412-419. [PMID: 29762458 DOI: 10.1097/tp.0000000000002275] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Prolonged duration of delayed graft function (DGF) may be associated with adverse allograft outcomes, but the association between threshold duration of DGF, acute rejection and long-term allograft loss remains undefined. We aimed to determine the impact of DGF duration on allograft outcomes and to assess whether this association was mediated by acute rejection. METHODS Using data from the Australian and New Zealand Dialysis and Transplant Registry, Cox proportional modeling was used to determine the association between quartiles of DGF duration, acute rejection at 6 months and death-censored graft loss (DCGL). Mediation analysis was conducted to determine whether acute rejection was a causal intermediate between DGF and DCGL. RESULTS Of 7668 deceased donor kidney transplants between 1997 and 2014, 1497 (19.5%) recipients experienced DGF requiring dialysis. The median (interquartile range) duration of DGF was 7 (9) days, with 25% requiring dialysis for 14 days or longer. Among recipients who had experienced a DGF duration of 1 to 4 days, the adjusted hazard ratio for duration of 5 to 7, 8 to 13, and 14 days or longer were 1.13 (95% confidence interval [CI], 0.83-1.55; P = 0.43), 1.44 (95% CI, 1.08-1.91; P = 0.013), and 1.99 (95% CI, 1.50-2.65; P < 0.001), respectively, for acute rejection; and were 1.10 (95% CI< 0.73-1.67; P = 0.64), 1.45 (95% CI, 1.00-2.11; P = 0.05) and 1.60 (95% CI, 1.10-2.31; P = 0.01), respectively, for DCGL. On average, 8% of the effects between DGF duration and DCGL were explained by acute rejection. CONCLUSIONS There was a direct dose-dependent effect between DGF duration and DCGL, with acute rejection explaining less than 10% of the effects between DGF duration and DCGL. Future research identifying other potential modifiable mediators that lies in the causal pathway between DGF duration and allograft loss is essential.
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Benjamens S, Pol RA, Berger SP, Glaudemans AWJM, Dibbets-Schneider P, Slart RHJA, de Geus-Oei LF. Limited clinical value of two consecutive post-transplant renal scintigraphy procedures. Eur Radiol 2019; 30:452-460. [PMID: 31338652 PMCID: PMC6890596 DOI: 10.1007/s00330-019-06334-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/03/2019] [Accepted: 06/14/2019] [Indexed: 12/24/2022]
Abstract
Objectives Duration of delayed graft function (DGF) and length of hospital stay (LOS) are outcomes of interest in an era that warrants increased efficacy of transplant care whereas renal allografts originate increasingly from marginal donors. While earlier studies investigate the predictive capability of a single renal scintigraphy, this study focuses on the value for both DGF duration and LOS of consecutively performed scintigraphies. Methods From 2011 to 2014, renal transplant recipients referred for a Tc-99m MAG3 renal scintigraphy were included in a single-center retrospective study. Primary endpoints were DGF duration and LOS. Both the first (≤ 3 days) and second scintigraphies (3–7 days after transplantation) were analyzed using a 4-grade qualitative scale and quantitative indices (TFS, cTER, MUC10, average upslope). Results We evaluated 200 first and 108 (54%) consecutively performed scintigraphies. The Kaplan-Meier curves for DGF duration and qualitative grading of the first and second scintigraphy showed significant differences between the grades (p < 0.01). The Kaplan-Meier curve for the delta grades between these procedures (lower, equal, or higher grade) did not show significant differences (p = 0.18). Multivariate analysis showed a significant association between the qualitative grades, from the first and second scintigraphy, and DGF duration, HR 1.8 (1.4–2.2, p < 0.01) and 2.8 (1.8–4.3, p < 0.01), respectively. Conclusions Qualitative grades of single renal scintigraphies, performed within 7 days after transplantation, can be used to make a reliable image-guided decision on the need for dialysis and to predict LOS. A consecutive renal scintigraphy, however, did not show an additional value in the assessment of DGF. Key Points • Post-transplant renal scintigraphy procedures provide information to predict delayed graft function duration and length of hospital stay. • Performing two consecutive renal scintigraphy procedures within 1 week after transplantation does not strengthen the prediction of delayed graft function duration and length of hospital stay. • Single renal scintigraphy procedures can be used to provide clinicians and patients with a reliable indication of the need for dialysis after transplantation and the expected duration of hospitalization. Electronic supplementary material The online version of this article (10.1007/s00330-019-06334-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stan Benjamens
- Department of Radiology, Division of Nuclear Medicine, Leiden University Medical Center, Leiden University, Leiden, The Netherlands. .,Department of Surgery, Division of Transplant Surgery, University Medical Center Groningen, University of Groningen, P.O. Box 30 001, 9700 RB, Groningen, The Netherlands. .,Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Robert A Pol
- Department of Surgery, Division of Transplant Surgery, University Medical Center Groningen, University of Groningen, P.O. Box 30 001, 9700 RB, Groningen, The Netherlands
| | - Stefan P Berger
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Andor W J M Glaudemans
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Petra Dibbets-Schneider
- Department of Radiology, Division of Nuclear Medicine, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
| | - Riemer H J A Slart
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Biomedical Photonic Imaging, MedTech Centre, University of Twente, Enschede, The Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Division of Nuclear Medicine, Leiden University Medical Center, Leiden University, Leiden, The Netherlands.,Department of Biomedical Photonic Imaging, MedTech Centre, University of Twente, Enschede, The Netherlands
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Factors That Influence Delayed Graft Function in Kidney Transplants: A Single-Center Paired Kidney Analysis. Transplant Proc 2019; 51:1568-1570. [DOI: 10.1016/j.transproceed.2019.01.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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50
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Carminatti M, Tedesco-Silva H, Silva Fernandes NM, Sanders-Pinheiro H. Chronic kidney disease progression in kidney transplant recipients: A focus on traditional risk factors. Nephrology (Carlton) 2019; 24:141-147. [PMID: 30159972 DOI: 10.1111/nep.13483] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2018] [Indexed: 12/31/2022]
Abstract
Kidney transplant recipients are a subset of patients with chronic kidney disease (CKD) that remain at high risk for progression to dialysis and mortality. Recent advances in immunosuppression have only partially improved long-term graft and patient survival. Discovery of new immunosuppressive regimens is a slow and resource-intensive process. Hence, recognition and management of modifiable allogeneic and non-allogeneic risk factors for progression to CKD among kidney transplant recipients is of major interest for improving long-term outcomes. Graft survival is mainly determined by the quality of the allograft and by the patient's alloimmune response, which is influenced by human leukocyte antigen matching and the presence of donor-specific antibodies. Alloimmune responses manifest as acute and chronic forms of cell- and antibody-mediated rejection, which can be worsened by patient non-adherence or under-immunosuppression. However, donor and patient ages, glomerular disease recurrence, time on dialysis, pre-existing cardiovascular burden, medication side-effects and traditional risk factors, such as hypertension, proteinuria, anaemia, dyslipidaemia, diabetes and bone mineral disorder, which can ultimately lead to severe endothelial derangement, also contribute to graft loss and mortality. These traditional risk factors, common to pre-dialysis patients, often are considered of secondary importance when compared to alloimmunity and immunosuppression concerns. In this review article, we focus on the epidemiological, pathophysiological and therapeutic features of non-allogeneic traditional risk factors for CKD. We also discuss the benefit of adopting a multidisciplinary approach to pursue the same therapeutic targets recommended for pre-dialysis patients.
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Affiliation(s)
- Moisés Carminatti
- Nephrology Division, Interdisciplinary Nucleus of Studies and Research in Nephrology (NIEPEN), Renal Transplantation Unit, Juiz de Fora, Brazil
| | - Hélio Tedesco-Silva
- Nephrology Division, Hospital do Rim, Federal University of São Paulo UNIFESP, São Paulo, Brazil
| | - Natália Maria Silva Fernandes
- Nephrology Division, Interdisciplinary Nucleus of Studies and Research in Nephrology (NIEPEN), Renal Transplantation Unit, Juiz de Fora, Brazil
| | - Helady Sanders-Pinheiro
- Nephrology Division, Interdisciplinary Nucleus of Studies and Research in Nephrology (NIEPEN), Renal Transplantation Unit, Juiz de Fora, Brazil
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