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Andrade-Sierra J, Cueto-Manzano AM, Rojas-Campos E, Cardona-Muñoz E, Cerrillos-Gutiérrez JI, González-Espinoza E, Evangelista-Carrillo LA, Medina-Pérez M, Jalomo-Martínez B, Nieves Hernández J, Pazarín-Villaseñor L, Mendoza-Cerpa CA, Gómez-Navarro B, Miranda-Díaz AG. Donor-specific antibodies development in renal living-donor receptors: Effect of a single cohort. Int J Immunopathol Pharmacol 2021; 35:20587384211000545. [PMID: 33787382 PMCID: PMC8020398 DOI: 10.1177/20587384211000545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Minimization in immunosuppression could contribute to the appearance the donor-specific HLA antibodies (DSA) and graft failure. The objective was to compare the incidence of DSA in renal transplantation (RT) in recipients with immunosuppression with and without steroids. A prospective cohort from March 1st, 2013 to March 1st, 2014 and follow-up (1 year), ended in March 2015, was performed in living donor renal transplant (LDRT) recipients with immunosuppression and early steroid withdrawal (ESW) and compared with a control cohort (CC) of patients with steroid-sustained immunosuppression. All patients were negative cross-matched and for DSA pre-transplant. The regression model was used to associate the development of DSA antibodies and acute rejection (AR) in subjects with immunosuppressive regimens with and without steroids. Seventy-seven patients were included (30 ESW and 47 CC). The positivity of DSA class I (13% vs 2%; P < 0.05) and class II (17% vs 4%, P = 0.06) antibodies were higher in ESW versus CC. The ESW tended to predict DSA class II (RR 5.7; CI (0.93–34.5, P = 0.06). T-cell mediated rejection presented in 80% of patients with DSA class I (P = 0.07), and 86% with DSA II (P = 0.03), and was associated with DSA class II, (RR 7.23; CI (1.2–44), P = 0.03). ESW could favor the positivity of DSA. A most strictly monitoring the DSA is necessary for the early stages of the transplant to clarify the relationship between T-cell mediated rejection and DSA.
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Affiliation(s)
- Jorge Andrade-Sierra
- Department of Nephrology and Organ Transplant Unit, Specialties Hospital, National Western Medical Centre, Mexican Institute of Social Security, Guadalajara, Jalisco, México.,Department of Physiology, University Health Sciences Center, University of Guadalajara, Guadalajara, Jalisco, México
| | - Alfonso M Cueto-Manzano
- Medical Research Unit in Renal Diseases, Specialties Hospital, National Western Medical Centre, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Enrique Rojas-Campos
- Medical Research Unit in Renal Diseases, Specialties Hospital, National Western Medical Centre, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Ernesto Cardona-Muñoz
- Department of Physiology, University Health Sciences Center, University of Guadalajara, Guadalajara, Jalisco, México
| | - José I Cerrillos-Gutiérrez
- Department of Nephrology and Organ Transplant Unit, Specialties Hospital, National Western Medical Centre, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Eduardo González-Espinoza
- Department of Nephrology and Organ Transplant Unit, Specialties Hospital, National Western Medical Centre, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Luis A Evangelista-Carrillo
- Department of Nephrology and Organ Transplant Unit, Specialties Hospital, National Western Medical Centre, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Miguel Medina-Pérez
- Department of Nephrology and Organ Transplant Unit, Specialties Hospital, National Western Medical Centre, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Basilio Jalomo-Martínez
- Department of Nephrology and Organ Transplant Unit, Specialties Hospital, National Western Medical Centre, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Juan Nieves Hernández
- Department of Nephrology and Organ Transplant Unit, Specialties Hospital, National Western Medical Centre, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Leonardo Pazarín-Villaseñor
- Department of Nephrology and Organ Transplant Unit, Specialties Hospital, National Western Medical Centre, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Claudia A Mendoza-Cerpa
- Department of Nephrology and Organ Transplant Unit, Specialties Hospital, National Western Medical Centre, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Benjamin Gómez-Navarro
- Department of Nephrology and Organ Transplant Unit, Specialties Hospital, National Western Medical Centre, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Alejandra G Miranda-Díaz
- Department of Physiology, University Health Sciences Center, University of Guadalajara, Guadalajara, Jalisco, México
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Early Steroid Withdrawal in Recipients of a Kidney Transplant From a Living Donor: Experience of a Single Mexican Center. Transplant Proc 2016; 48:42-9. [PMID: 26915841 DOI: 10.1016/j.transproceed.2015.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 11/25/2015] [Accepted: 12/10/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND Early steroid withdrawal (ESW) can improve lipid and hemodynamic profiles without severe acute rejection (AR) events in renal transplant patients. Our objective was to evaluate the effects of ESW on the frequency and severity of AR. METHODS A randomized, open-label, controlled clinical trial was performed on renal transplant recipients with a follow-up of 12 months. In the ESW group, patients were selected for corticosteroid treatment withdrawal on the fifth day post transplantation. In the Control group, patients continued with steroid treatment. All patients were over 18 years of age with panel reactive antibody (PRA) class I and II HLA <20%. RESULTS In total, 71 patients, 37 in the ESW group (52.1%) and 34 in the Control group (47.9%), had comparable AR incidences at the end of the follow-up (16% vs 15%) (NS) (RR = 1.20, 95% CI = 0.32-3.33). Although renal graft survival was similar between the ESW and Control groups (87% vs 94%), renal function was superior in the ESW group (85 vs 75 mL/min). Additionally, hypertension was less frequent in the ESW group (3% vs 35%), requiring the use of fewer antihypertensives (8% vs 50%). CONCLUSIONS ESW was also associated with better blood pressure control and similar AR risk. The ESW group exhibited stable renal function.
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Nagib AM, Abbas MH, Abu-Elmagd MM, Denewar AAEF, Neamatalla AH, Refaie AF, Bakr MA. Long-term study of steroid avoidance in renal transplant patients: a single-center experience. Transplant Proc 2016; 47:1099-104. [PMID: 26036529 DOI: 10.1016/j.transproceed.2014.11.063] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 11/13/2014] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Steroids have played a major role in renal transplantation for more than 4 decades. However, chronic use of steroids is associated with many comorbidities. This study aimed to assess the costs and benefits of a steroid-free immunosuppression regimen in a prospective randomized controlled study of living-donor renal transplantation, which was lacking in the literature. MATERIALS AND METHODS In our study, 428 patients were enrolled to receive tacrolimus (Tac), mycophenolic acid (MPA), basiliximab (Simulect, Novartis, Basel, Switzerland) induction and steroids only for 3 days (214 patients, study group) and steroid maintenance (214 patients, control group). Median follow-up was 66 ± 41 months. RESULTS We found that both groups showed comparable graft and patient survival, rejection episodes, and graft function. Posttransplantation hypertension was detected in 40% of the steroid-free group and 80% of the steroid maintenance group (P = .05), whereas posttransplantation diabetes mellitus was detected in 5% and 15% of these 2 groups, respectively (P = .3). CONCLUSIONS Among low-immunological-risk recipients of living-donor renal transplants, steroid avoidance was feasible, safe, and had less morbidity outcome using Simulect induction, then Tac and MPA as maintenance immunosuppression. Steroid avoidance was associated with a lower total cost despite comparable immunosuppression cost, which was attributed to the lower cost of associated morbidities.
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Affiliation(s)
- A M Nagib
- Department of Dialysis and Transplantation, the Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
| | - M H Abbas
- Department of Dialysis and Transplantation, the Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - M M Abu-Elmagd
- Department of Dialysis and Transplantation, the Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - A A E F Denewar
- Department of Dialysis and Transplantation, the Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - A H Neamatalla
- Department of Dialysis and Transplantation, the Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - A F Refaie
- Department of Dialysis and Transplantation, the Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - M A Bakr
- Department of Dialysis and Transplantation, the Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Chon WJ, Desai A, Wing C, Arwindekar D, Tang IYS, Josephson MA, Akkina S. Impact of Maintenance Steroids versus Rapid Steroid Withdrawal in African-American Kidney Transplant Recipients: Comparison of Two Urban Centers. ACTA ACUST UNITED AC 2016; 7:204-216. [PMID: 27088051 PMCID: PMC4829964 DOI: 10.4236/ijcm.2016.73021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Rapid steroid withdrawal (RSW) is used increasingly in kidney transplantation but long-term outcomes in African-American (AA) recipients are not well known. We compared 1 and 5 year transplant outcomes in a large cohort of AA patients who were maintained on continued steroid therapy (CST) to those who underwent RSW. Methods Post-transplant courses of A as receiving kidney allografts from 2003–2011 at two urban transplant centers in Chicago were followed. Prior to outcome analysis, we used Inverse Probability of Treatment Weights (IPTW) to match the two groups on a set of baseline risk factors. Graft and patient survival, GFR at 1 and 5 years, incidence and type of rejection, incidence of post-transplant diabetes mellitus (PTDM), delayed graft function, CMV and BK viremia were compared. Results There were 150 AA recipients in the CST analytic group and 157 in the RSW analytic group. Graft and patient survival was similar between the two groups. Rates of CMV viremia were higher in the RSW compared to the CST analytic group at 1 year. Biopsy-proven acute rejection and PTDM were similar between the RSW and CST groups. Conclusions In AA recipients, RSW has similar long-term outcomes to CST.
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Affiliation(s)
- W James Chon
- Department of Medicine, Division of Nephrology, University of Chicago Medicine, Chicago, IL, USA
| | - Amishi Desai
- Department of Medicine, Division of Nephrology, Loyola University Medical Center, Maywood, IL, USA
| | - Coady Wing
- School of Public and Environmental Affairs, Indiana University, Bloomington, IN, USA
| | - Divya Arwindekar
- Department of Medicine, Division of Nephrology, University of Illinois Hospital & Health Sciences System, Chicago, IL, USA
| | - Ignatius Y S Tang
- Department of Medicine, Division of Nephrology, University of Illinois Hospital & Health Sciences System, Chicago, IL, USA; Department of Medicine, Division of Nephrology, Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Michelle A Josephson
- Department of Medicine, Division of Nephrology, University of Chicago Medicine, Chicago, IL, USA
| | - Sanjeev Akkina
- Department of Medicine, Division of Nephrology, Loyola University Medical Center, Maywood, IL, USA
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Lipoxygenase products in the urine correlate with renal function and body temperature but not with acute transplant rejection. Lipids 2012; 48:167-75. [PMID: 23275077 DOI: 10.1007/s11745-012-3751-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 12/10/2012] [Indexed: 12/20/2022]
Abstract
Acute transplant rejection is the leading cause of graft loss in the first months after kidney transplantation. Lipoxygenase products mediate pro- and anti-inflammatory actions and thus we aimed to correlate the histological reports of renal transplant biopsies with urinary lipoxygenase products concentrations to evaluate their role as a diagnostic marker. This study included a total of 34 kidney transplant recipients: 17 with an acute transplant rejection and 17 controls. LTE4, LTB4, 12-HETE and 15-HETE concentrations were measured by enzyme immunoassay. Urinary lipoxygenase product concentrations were not significantly changed during an acute allograft rejection. Nevertheless, LTB4 concentrations correlated significantly with the body temperature (P ≤ 0.05) 3 months after transplantation, and 12- and 15-HETE concentrations correlated significantly with renal function (P ≤ 0.05) 2 weeks after transplantation. In conclusion, our data show a correlation for LTB4 with the body temperature 3 months after transplantation and urinary 12- and 15-HETE concentrations correlate positively with elevated serum creatinine concentrations but do not predict acute allograft rejection.
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