1
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Lee H, Lee H, Sun IO, Park JH, Park JW, Ban TH, Yang J, Kim MS, Yang CW, Chung BH. Pre-transplant crossmatch-negative donor-specific anti-HLA antibody predicts acute antibody-mediated rejection but not long-term outcomes in kidney transplantation: an analysis of the Korean Organ Transplantation Registry. Front Immunol 2024; 15:1420351. [PMID: 39055708 PMCID: PMC11269232 DOI: 10.3389/fimmu.2024.1420351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 07/01/2024] [Indexed: 07/27/2024] Open
Abstract
Background Pre-transplant donor-specific anti-human leukocyte antigen antibody (HLA-DSA) is a recognized risk factor for acute antibody-mediated rejection (ABMR) and allograft failure. However, the clinical relevance of pre-transplant crossmatch (XM)-negative HLA-DSA remains unclear. Methods We investigated the effect of XM-negative HLA-DSA on post-transplant clinical outcomes using data from the Korean Organ Transplantation Registry (KOTRY). This study included 2019 living donor kidney transplant recipients from 40 transplant centers in South Korea: 237 with HLA-DSA and 1782 without HLA-DSA. Results ABMR developed more frequently in patients with HLA-DSA than in those without (5.5% vs. 1.5%, p<0.0001). Multivariable analysis identified HLA-DSA as a significant risk factor for ABMR (odds ratio = 3.912, 95% confidence interval = 1.831-8.360; p<0.0001). Furthermore, the presence of multiple HLA-DSAs, carrying both class I and II HLA-DSAs, or having strong HLA-DSA were associated with an increased incidence of ABMR. However, HLA-DSA did not affect long-term clinical outcomes, such as allograft function and allograft survival, patient survival, and infection-free survival. Conclusion Pre-transplant XM-negative HLA-DSA increased the risk of ABMR but did not affect long-term allograft outcomes. HLA-incompatible kidney transplantation in the context of XM-negative HLA-DSA appears to be feasible with careful monitoring and ensuring appropriate management of any occurrence of ABMR. Furthermore, considering the characteristics of pre-transplant XM-negative HLA-DSA, the development of a more detailed and standardized desensitization protocol is warranted.
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Affiliation(s)
- Haeun Lee
- Division of Nephrology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of Korea
| | - Hanbi Lee
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, Seoul, Republic of Korea
| | - In O Sun
- Division of Nephrology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of Korea
| | - Jung Hwan Park
- Department of Nephrology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jong-Won Park
- Department of Nephrology, Yeungnam University Hospital, Daegu, Republic of Korea
| | - Tae Hyun Ban
- Division of Nephrology, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, Seoul, Republic of Korea
| | - Jaeseok Yang
- Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Myoung Soo Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chul Woo Yang
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, Seoul, Republic of Korea
| | - Byung Ha Chung
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, Seoul, Republic of Korea
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2
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Lee H, Lee H, Eum SH, Ko EJ, Min JW, Oh EJ, Yang CW, Chung BH. Impact of Low-Level Donor-Specific Anti-HLA Antibody on Posttransplant Clinical Outcomes in Kidney Transplant Recipients. Ann Lab Med 2023; 43:364-374. [PMID: 36843405 PMCID: PMC9989540 DOI: 10.3343/alm.2023.43.4.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/07/2022] [Accepted: 01/27/2023] [Indexed: 02/28/2023] Open
Abstract
Background The clinical significance of low-level donor-specific anti-HLA antibody (low-DSA) remains controversial. We investigated the impact of low-DSA on posttransplant clinical outcomes in kidney transplant (KT) recipients. Methods We retrospectively reviewed 1,027 KT recipients, namely, 629 living donor KT (LDKT) recipients and 398 deceased donor KT (DDKT) recipients, in Seoul St. Mary's Hospital (Seoul, Korea) between 2010 and 2018. Low-DSA was defined as a positive anti-HLA-DSA result in the Luminex single antigen assay (LABScreen single antigen HLA class I - combi and class II - group 1 kits; One Lambda, Canoga Park, CA, USA) but a negative result in a crossmatch test. We compared the incidence of biopsy-proven allograft rejection (BPAR), changes in allograft function, allograft survival, patient survival, and posttransplant infections between subgroups according to pretransplant low-DSA. Results The incidence of overall BPAR and T cell-mediated rejection did not differ between the subgroups. However, antibody-mediated rejection (ABMR) developed more frequently in patients with low-DSA than in those without low-DSA in the total cohort and the LDKT and DDKT subgroups. In multivariate analysis, low-DSA was identified as a risk factor for ABMR development. Its impact was more pronounced in DDKT (odds ratio [OR]: 9.60, 95% confidence interval [CI]: 1.79-51.56) than in LDKT (OR: 3.76, 95% CI: 0.99-14.26) recipients. There were no significant differences in other outcomes according to pretransplant low-DSA. Conclusions Pretransplant low-DSA has a significant impact on the development of ABMR, and more so in DDKT recipients than in LDKT recipients, but not on long-term outcomes.
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Affiliation(s)
- Haeun Lee
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hanbi Lee
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang Hun Eum
- Division of Nephrology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Eun Jeong Ko
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Transplant Research Center, Convergent Research Consortium for Immunologic Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji-Won Min
- Division of Nephrology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Eun-Jee Oh
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chul Woo Yang
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Transplant Research Center, Convergent Research Consortium for Immunologic Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byung Ha Chung
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Transplant Research Center, Convergent Research Consortium for Immunologic Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
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3
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Arat S, Huynh R, Kumpf S, Qian J, Shoieb A, Virgen-Slane R, Voigt F, Xie Z, Jakubczak JL. Effects of donor source on transcriptomic profiles of human kidney tissue. FASEB J 2023; 37:e22804. [PMID: 36753402 DOI: 10.1096/fj.202201754r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/27/2022] [Accepted: 01/24/2023] [Indexed: 02/09/2023]
Abstract
Normal human tissue is a critical reference control in biomedical research. However, the type of tissue donor can significantly affect the underlying biology of the samples. We investigated the impact of tissue donor source type by performing transcriptomic analysis on healthy kidney tissue from three donor source types: cadavers, organ donors, and normal-adjacent tissue from surgical resections of clear cell renal cell carcinomas, and we compared the gene expression profiles to those of clear cell renal cell carcinoma samples. Comparisons among the normal samples revealed general similarity, with notable differences in gene expression pathways involving immune system and inflammatory processes, response to extracellular stimuli, ion transport, and metabolism. When compared to tumors, the transcriptomic profiles of the normal adjacent tissue were highly similar to the profiles from cadaveric and organ donor tissue samples, arguing against the presence of a field cancerization effect in clear cell renal cell carcinoma. We conclude that all three normal source types are suitable for reference kidney control samples, but important differences must be noted for particular research areas and tissue banking strategies.
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Affiliation(s)
- Seda Arat
- Drug Safety Research and Development, Worldwide Research, Development and Medical, Pfizer Inc., Groton, Connecticut, USA
| | - Renee Huynh
- Drug Safety Research and Development, Worldwide Research, Development and Medical, Pfizer Inc., Groton, Connecticut, USA
| | - Steven Kumpf
- Drug Safety Research and Development, Worldwide Research, Development and Medical, Pfizer Inc., Groton, Connecticut, USA
| | - Jessie Qian
- Drug Safety Research and Development, Worldwide Research, Development and Medical, Pfizer Inc., Groton, Connecticut, USA
| | - Ahmed Shoieb
- Drug Safety Research and Development, Worldwide Research, Development and Medical, Pfizer Inc., Groton, Connecticut, USA
| | - Richard Virgen-Slane
- Drug Safety Research and Development, Worldwide Research, Development and Medical, Pfizer Inc., La Jolla, California, USA
| | - Frank Voigt
- Drug Safety Research and Development, Worldwide Research, Development and Medical, Pfizer Inc., Groton, Connecticut, USA
| | - Zhiyong Xie
- Drug Safety Research and Development, Worldwide Research, Development and Medical, Pfizer Inc., Cambridge, Massachusetts, USA
| | - John L Jakubczak
- Drug Safety Research and Development, Worldwide Research, Development and Medical, Pfizer Inc., Groton, Connecticut, USA
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4
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Lin CY, Li CC, Ke HL, Wu WJ, Chou YH, Wen SC. Safety and efficacy of laparoendoscopic single-site donor nephrectomy: A comparison of the transperitoneal and retroperitoneal approaches. UROLOGICAL SCIENCE 2022. [DOI: 10.4103/uros.uros_146_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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5
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Beksac AT, Eltemamy M, Hemal S, Schwen Z, Lenfant L, Abou Zeinab M, Aminsharifi A, Kaouk J. Single Port Donor Nephrectomy Via Modified Pfannenstiel Incision: Initial Preclinical Experience in A Cadaveric Model and Description of Technique. J Endourol 2021; 36:183-187. [PMID: 34314234 DOI: 10.1089/end.2021.0408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To describe the surgical technique for the single port (SP) transperitoneal donor nephrectomy through a modified Pfannenstiel incision using the da Vinci SP surgical system (Intuitive Surgical, Sunnyvale, CA, USA) on a cadaver. PATIENTS & METHODS In a male cadaver, the SP surgical system was used to perform transperitoneal donor nephrectomy. A 3 cm modified Pfannenstiel incision was made. Through the incision GelPOINT mini (Applied Medical, Rancho Santa Margarita, CA, USA) was inserted. The floating docking technique was used. Through the gel port, the dedicated 25 mm multichannel port and a 12 mm assistant port were introduced. The surgical steps for donor nephrectomy were performed in the following order. 1) Mobilization of the colon, 2) Identification of psoas muscle, ureter, and the gonadal vein, 3) hilum dissection, 4) perirenal dissection, 5) stapling the renal artery and renal vein, 6) removal of the kidney through the enlarged incision. RESULTS Transperitoneal SP donor nephrectomy was completed without any complications or capsulotomy. Additional ports were not needed. The total operative time was 63 minutes and 54 seconds. A good-quality kidney was harvested. Renal artery length was 4 cm. CONCLUSION We demonstrated the feasibility of single-port transperitoneal donor nephrectomy via modified Pfannenstiel incision, using the novel SP robotic platform. Further assessment is necessary in a clinical setting.
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Affiliation(s)
- Alp Tuna Beksac
- Cleveland Clinic Glickman Urological and Kidney Institute, 273142, Urology, 9500 Euclid Avenue Q10, Cleveland, Ohio, United States, 44195-0001;
| | - Mohamed Eltemamy
- Cleveland Clinic Glickman Urological and Kidney Institute, 273142, Urology, Cleveland, Ohio, United States;
| | - Sij Hemal
- Cleveland Clinic Glickman Urological and Kidney Institute, 273142, Urology, 9500 Euclid Avenue, Glickman Urological and Kidney Institute, Cleveland, Ohio, United States, 44195-0001;
| | - Zeyad Schwen
- Cleveland Clinic Glickman Urological and Kidney Institute, 273142, Urology, Cleveland, Ohio, United States;
| | - Louis Lenfant
- Cleveland Clinic's Glickman Urological and Kidney Institute Department of Urology, 537826, 9500 Euclid avenue, Cleveland, Ohio, United States, 44195-0001.,Hopital Universitaire Pitie Salpetriere, 26933, Paris, France, 75651;
| | - Mahmoud Abou Zeinab
- Cleveland Clinic Glickman Urological and Kidney Institute, 273142, Urology, Cleveland, Ohio, United States;
| | | | - Jihad Kaouk
- Cleveland Clinic Foundation, Glickman Urologic Institute, 9500 Euclid Ave, Cleveland, Ohio, United States, 44195;
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6
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Ghonge NP, Goyal N, Vohra S, Chowdhury V. Renal transplant evaluation: multimodality imaging of post-transplant complications. Br J Radiol 2021; 94:20201253. [PMID: 34233470 DOI: 10.1259/bjr.20201253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
With advancements in surgical techniques and immuno-suppression, renal transplantation is established as the most effective treatment option in patients with end-stage renal disease. Early detection of renal allograft complications is important for long-term graft survival. Late clinical presentation often causes diagnostic delays till the time allograft failure is advanced and irreversible. Imaging plays a key role in routine surveillance and in management of acute or chronic transplant dysfunction. Multimodality imaging approach is important with ultrasound-Doppler as the first-line imaging study in immediate, early and late post-transplant periods. Additional imaging studies are often required depending on clinical settings and initial ultrasound. Renal functional MRI is a rapidly growing field that has huge potential for early diagnosis of transplant dysfunction. Multiparametric MRI may be integrated in clinical practice as a noninvasive and comprehensive "one-stop" modality for early diagnosis and longitudinal monitoring of renal allograft dysfunctions, which is essential for guiding appropriate interventions to delay or prevent irreversible renal damage. With rapidly increasing numbers of renal transplantation along with improved patient survival, it is necessary for radiologists in all practice settings to be familiar with the normal appearances and imaging spectrum of anatomical and functional complications in a transplant kidney. Radiologist"s role as an integral part of multidisciplinary transplantation team continues to grow with increasing numbers of successful renal transplantation programs across the globe.
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Affiliation(s)
- Nitin P Ghonge
- Department of Radiology, Indraprastha Apollo Hospital, New Delhi, India
| | - Nidhi Goyal
- Department of Radiology, Indraprastha Apollo Hospital, New Delhi, India
| | - Sandeep Vohra
- Department of Radiology, Indraprastha Apollo Hospital, New Delhi, India
| | - Veena Chowdhury
- Department of Radiology, Indraprastha Apollo Hospital, New Delhi, India
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7
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Piemonti L, Sordi V, Pellegrini S, Scotti GM, Scavini M, Sioli V, Gianelli Castiglione A, Cardillo M. Circulating CXCL10 and IL-6 in solid organ donors after brain death predict graft outcomes. Sci Rep 2021; 11:6624. [PMID: 33758270 PMCID: PMC7988181 DOI: 10.1038/s41598-021-86085-6] [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: 07/21/2020] [Accepted: 03/10/2021] [Indexed: 11/09/2022] Open
Abstract
We tested the hypothesis that circulating CXCL10 and IL-6 in donor after brain death provide independent additional predictors of graft outcome. From January 1, 2010 to June 30, 2012 all donors after brain death managed by the NITp (n = 1100) were prospectively included in this study. CXCL10 and IL-6 were measured on serum collected for the crossmatch at the beginning of the observation period. Graft outcome in recipients who received kidney (n = 1325, follow-up 4.9 years), liver (n = 815, follow-up 4.3 years) and heart (n = 272, follow-up 5 years) was evaluated. Both CXCL-10 and IL-6 showed increased concentration in donors after brain death. The intensive care unit stay, the hemodynamic instability, the cause of death, the presence of risk factors for cardiovascular disease and the presence of ongoing infection resulted as significant determinants of IL-6 and CXCL10 donor concentrations. Both cytokines resulted as independent predictors of Immediate Graft Function. Donor IL-6 or CXCL10 were associated with graft failure after liver transplant, and acted as predictors of recipient survival after kidney, liver and heart transplantation. Serum donor IL-6 and CXCL10 concentration can provide independent incremental prediction of graft outcome among recipients followed according to standard clinical practice.
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Affiliation(s)
- Lorenzo Piemonti
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. .,Vita-Salute San Raffaele University, Milan, Italy.
| | - Valeria Sordi
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Silvia Pellegrini
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Giulia Maria Scotti
- Center for Translational Genomics and Bioinformatics, IRCCS San Raffaele Hospital, Milan, Italy
| | - Marina Scavini
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Viviana Sioli
- Transplant Coordination Unit, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Massimo Cardillo
- Transplant Coordination Unit, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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8
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Peelen DM, Hoogduijn MJ, Hesselink DA, Baan CC. Advanced in vitro Research Models to Study the Role of Endothelial Cells in Solid Organ Transplantation. Front Immunol 2021; 12:607953. [PMID: 33664744 PMCID: PMC7921837 DOI: 10.3389/fimmu.2021.607953] [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] [Received: 09/18/2020] [Accepted: 01/21/2021] [Indexed: 12/26/2022] Open
Abstract
The endothelium plays a key role in acute and chronic rejection of solid organ transplants. During both processes the endothelium is damaged often with major consequences for organ function. Also, endothelial cells (EC) have antigen-presenting properties and can in this manner initiate and enhance alloreactive immune responses. For decades, knowledge about these roles of EC have been obtained by studying both in vitro and in vivo models. These experimental models poorly imitate the immune response in patients and might explain why the discovery and development of agents that control EC responses is hampered. In recent years, various innovative human 3D in vitro models mimicking in vivo organ structure and function have been developed. These models will extend the knowledge about the diverse roles of EC in allograft rejection and will hopefully lead to discoveries of new targets that are involved in the interactions between the donor organ EC and the recipient's immune system. Moreover, these models can be used to gain a better insight in the mode of action of the currently prescribed immunosuppression and will enhance the development of novel therapeutics aiming to reduce allograft rejection and prolong graft survival.
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Affiliation(s)
- Daphne M Peelen
- Rotterdam Transplant Group, Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Martin J Hoogduijn
- Rotterdam Transplant Group, Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Dennis A Hesselink
- Rotterdam Transplant Group, Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Carla C Baan
- Rotterdam Transplant Group, Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC, Erasmus University Medical Center, Rotterdam, Netherlands
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9
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A Role for Human Renal Tubular Epithelial Cells in Direct Allo-Recognition by CD4+ T-Cells and the Effect of Ischemia-Reperfusion. Int J Mol Sci 2021; 22:ijms22041733. [PMID: 33572206 PMCID: PMC7915934 DOI: 10.3390/ijms22041733] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/03/2021] [Accepted: 02/06/2021] [Indexed: 02/08/2023] Open
Abstract
Direct allorecognition is the earliest and most potent immune response against a kidney allograft. Currently, it is thought that passenger donor professional antigen-presenting cells (APCs) are responsible. Further, many studies support that graft ischemia-reperfusion injury increases the probability of acute rejection. We evaluated the possible role of primary human proximal renal tubular epithelial cells (RPTECs) in direct allorecognition by CD4+ T-cells and the effect of anoxia-reoxygenation. In cell culture, we detected that RPTECs express all the required molecules for CD4+ T-cell activation (HLA-DR, CD80, and ICAM-1). Anoxia-reoxygenation decreased HLA-DR and CD80 but increased ICAM-1. Following this, RPTECs were co-cultured with alloreactive CD4+ T-cells. In T-cells, zeta chain phosphorylation and c-Myc increased, indicating activation of T-cell receptor and co-stimulation signal transduction pathways, respectively. T-cell proliferation assessed with bromodeoxyuridine assay and with the marker Ki-67 increased. Previous culture of RPTECs under anoxia raised all the above parameters in T-cells. FOXP3 remained unaffected in all cases, signifying that proliferating T-cells were not differentiated towards a regulatory phenotype. Our results support that direct allorecognition may be mediated by RPTECs even in the absence of donor-derived professional APCs. Also, ischemia-reperfusion injury of the graft may enhance the above capacity of RPTECs, increasing the possibility of acute rejection.
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10
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Veljančić N, Perović V. Evaluation of the - 318C/T (RS5742909) CTLA4 gene polymorphism influence on kidney function after transplantation. MEDICINSKI PODMLADAK 2021. [DOI: 10.5937/mp72-32455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction: The protein CTLA-4 (Cytotoxic T Lymphocyte Antigen-4) is a molecule that plays a significant role in maintaining immunological homeostasis. Recent studies demonstrated an unequivocal proof that CTLA-4 has an inhibitory effect on immune response. This gene has been identified with several single nucleotide polymorphisms which could change gene activity, consequently leading to structural protein change. This genetic variability is associated with acute rejection and delayed graft function as important indicators of kidney transplantation success. Aim: The aim of this study was to evaluate the potential association of CTLA4 (rs5742909) polymorphisms with acute rejection and delayed graft function in patients with kidney transplant. Material and methods: A total of 151 patients were included in this cross-sectional cohort study. Real-time polymerase chain reaction was used to determine the genotype which was then evaluated in relation to acute rejection and delayed graft function. Statistical significance was analyzed by Pearson's Chi-square and Fisher's exact test. Results: The most frequent genotype among 151 patient was CC (80.8%), then CT (17.9%) and TT (1.3%). The frequency of C allele is 89.7% whereas the frequency of T allele is 10.3%. There was no statistically significant difference in CTLA4 genotype and allele distribution nor their linkage to acute rejection and delayed graft function. The evaluation of C or T allele carriers showed no statistically significant difference with respect to previously mentioned posttransplant complications. Conclusion: In this study, no statistically significant association between -318C/T (rs5742909) CTLA4 polymorphism and AR/DGF was found.
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11
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Guillén-Gómez E, Silva I, Serra N, Caballero F, Leal J, Breda A, San Martín R, Pastor-Anglada M, Ballarín JA, Guirado L, Díaz-Encarnación MM. From Inflammation to the Onset of Fibrosis through A 2A Receptors in Kidneys from Deceased Donors. Int J Mol Sci 2020; 21:ijms21228826. [PMID: 33233484 PMCID: PMC7700266 DOI: 10.3390/ijms21228826] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/16/2020] [Accepted: 11/20/2020] [Indexed: 12/20/2022] Open
Abstract
Pretransplant graft inflammation could be involved in the worse prognosis of deceased donor (DD) kidney transplants. A2A adenosine receptor (A2AR) can stimulate anti-inflammatory M2 macrophages, leading to fibrosis if injury and inflammation persist. Pre-implantation biopsies of kidney donors (47 DD and 21 living donors (LD)) were used to analyze expression levels and activated intracellular pathways related to inflammatory and pro-fibrotic processes. A2AR expression and PKA pathway were enhanced in DD kidneys. A2AR gene expression correlated with TGF-β1 and other profibrotic markers, as well as CD163, C/EBPβ, and Col1A1, which are highly expressed in DD kidneys. TNF-α mRNA levels correlated with profibrotic and anti-inflammatory factors such as TGF-β1 and A2AR. Experiments with THP-1 cells point to the involvement of the TNF-α/NF-κB pathway in the up-regulation of A2AR, which induces the M2 phenotype increasing CD163 and TGF-β1 expression. In DD kidneys, the TNF-α/NF-κB pathway could be involved in the increase of A2AR expression, which would activate the PKA–CREB axis, inducing the macrophage M2 phenotype, TGF-β1 production, and ultimately, fibrosis. Thus, in inflamed DD kidneys, an increase in A2AR expression is associated with the onset of fibrosis, which may contribute to graft dysfunction and prognostic differences between DD and LD transplants.
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Affiliation(s)
- Elena Guillén-Gómez
- Molecular Biology Laboratory, Fundació Puigvert, 08025 Barcelona, Spain
- Nephrology Department, Fundació Puigvert, 08025 Barcelona, Spain; (I.S.); (N.S.); (J.A.B.); (L.G.)
- Institut Investigació Biosanitaria Sant Pau, Fundación Renal Iñigo Álvarez de Toledo (FRIAT), REDinREN, Autonomous University of Barcelona (UAB), 08025 Barcelona, Spain
- Correspondence: (E.G.-G.); (M.M.D.-E.)
| | - Irene Silva
- Nephrology Department, Fundació Puigvert, 08025 Barcelona, Spain; (I.S.); (N.S.); (J.A.B.); (L.G.)
- Institut Investigació Biosanitaria Sant Pau, Fundación Renal Iñigo Álvarez de Toledo (FRIAT), REDinREN, Autonomous University of Barcelona (UAB), 08025 Barcelona, Spain
- Renal Transplant Unit, Fundació Puigvert, 08025 Barcelona, Spain
| | - Núria Serra
- Nephrology Department, Fundació Puigvert, 08025 Barcelona, Spain; (I.S.); (N.S.); (J.A.B.); (L.G.)
- Institut Investigació Biosanitaria Sant Pau, Fundación Renal Iñigo Álvarez de Toledo (FRIAT), REDinREN, Autonomous University of Barcelona (UAB), 08025 Barcelona, Spain
- Renal Transplant Unit, Fundació Puigvert, 08025 Barcelona, Spain
| | - Francisco Caballero
- Department of Emergency Medicine and Transplant Coordination, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, 08041 Barcelona, Spain; (F.C.); (J.L.)
| | - Jesús Leal
- Department of Emergency Medicine and Transplant Coordination, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, 08041 Barcelona, Spain; (F.C.); (J.L.)
| | - Alberto Breda
- Urology Department, Autonomous University of Barcelona (UAB), Fundació Puigvert, 08025 Barcelona, Spain;
| | - Rody San Martín
- Molecular Pathology Laboratory, Institute of Biochemistry and Microbiology, Faculty of Sciences, Universidad Austral de Chile, 5110566 Valdivia, Chile;
| | - Marçal Pastor-Anglada
- Department of Biochemistry and Molecular Biomedicine, Institute of Biomedicine (IBUB), University of Barcelona, National Biomedical Research Institute of Liver and Gastrointestinal Diseases (CIBER EHD), 08028 Barcelona, Spain;
- Institut de Recerca Sant Joan de Déu (IR SJD), 08950 Esplugues de Llobregat Barcelona, Spain
| | - José A. Ballarín
- Nephrology Department, Fundació Puigvert, 08025 Barcelona, Spain; (I.S.); (N.S.); (J.A.B.); (L.G.)
- Institut Investigació Biosanitaria Sant Pau, Fundación Renal Iñigo Álvarez de Toledo (FRIAT), REDinREN, Autonomous University of Barcelona (UAB), 08025 Barcelona, Spain
| | - Lluís Guirado
- Nephrology Department, Fundació Puigvert, 08025 Barcelona, Spain; (I.S.); (N.S.); (J.A.B.); (L.G.)
- Renal Transplant Unit, Fundació Puigvert, 08025 Barcelona, Spain
| | - Montserrat M. Díaz-Encarnación
- Nephrology Department, Fundació Puigvert, 08025 Barcelona, Spain; (I.S.); (N.S.); (J.A.B.); (L.G.)
- Institut Investigació Biosanitaria Sant Pau, Fundación Renal Iñigo Álvarez de Toledo (FRIAT), REDinREN, Autonomous University of Barcelona (UAB), 08025 Barcelona, Spain
- Correspondence: (E.G.-G.); (M.M.D.-E.)
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12
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Vélez-Bermúdez M, Christensen AJ, Kinner EM, Roche AI, Fraer M. Exploring the Relationship Between Patient Activation, Treatment Satisfaction, and Decisional Conflict in Patients Approaching End-Stage Renal Disease. Ann Behav Med 2020; 53:816-826. [PMID: 30535065 DOI: 10.1093/abm/kay091] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patients approaching end-stage renal disease (ESRD) experience a high level of decisional conflict because they are often not provided with sufficient support and information regarding different treatment options prior to renal failure. Decisional conflict is an important correlate of treatment satisfaction, as it is associated with disease- and treatment-related knowledge that can inform decision-making. Patient activation, the willingness and ability to independently manage one's own health and healthcare, is an individual difference factor that may have important mitigating effects on decisional conflict. PURPOSE To identify modifiable factors that may enhance the decision-making process in patients approaching ESRD by exploring potential mediational effects between decisional conflict, treatment satisfaction, and patient activation. METHODS Sixty-four patients approaching ESRD completed self-report measures (32% response rate). Measures included the Decisional Conflict Scale, the Kidney Disease Treatment Questionnaire, and the Patient Activation Measure Short Form. RESULTS There was a high level of self-reported decisional conflict in this sample. Linear regressions revealed main effects among treatment satisfaction, patient activation, and decisional conflict. These variables were entered into PROCESS to assess a mediational pattern. Results showed that higher chronic kidney disease-related treatment satisfaction predicted lower decisional conflict through higher patient activation in a statistical mediational relationship. CONCLUSIONS While the link between treatment satisfaction and decision-making is well established, these results suggest this relationship might be partially explained by patient activation, a potentially modifiable process in patients approaching ESRD. Therefore, interventions that encourage patients to become actively involved in their care could also reduce decisional conflict among patients approaching ESRD.
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Affiliation(s)
| | - Alan J Christensen
- Department of Psychological & Brain Sciences, University of Iowa, Iowa City, Iowa.,Department of Internal Medicine, University of Iowa Hospitals & Clinics, Iowa City, IA
| | - Ellen M Kinner
- Department of Psychological & Brain Sciences, University of Iowa, Iowa City, Iowa
| | - Anne I Roche
- Department of Psychological & Brain Sciences, University of Iowa, Iowa City, Iowa
| | - Mony Fraer
- Department of Internal Medicine, University of Iowa Hospitals & Clinics, Iowa City, IA
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13
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Zolota A, Solonaki F, Katsanos G, Papagiannis A, Salveridis N, Tranta A, Deligiannidis T, Karakasi KE, Nikolaidou C, Papadimitriou C, Fouza A, Papanikolaou V, Miserlis G, Antoniadis N, Fouzas I. Long-Term (≥25 Years) Kidney Allograft Survivors: Retrospective Analysis at a Single Center. Transplant Proc 2020; 52:3044-3050. [PMID: 32571706 DOI: 10.1016/j.transproceed.2020.02.152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 01/14/2020] [Accepted: 02/05/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Despite great improvements in the short-term patient and kidney graft survival, the long-term morbidity and mortality in kidney transplant recipients still remains a significant problem. The aim of the study was to evaluate the impact of both donor and transplant recipient factors, as well as renal function indices on the very long-term (>25 years) kidney allograft survival. MATERIAL AND METHODS Retrospective analysis was performed on the data of 41 kidney transplant recipients (KTR), group A: follow-up = 25 years, 20 KTR, 10 male, mean age (mean [M] ± standard deviation [SD]): 34.6 ± 12.6 years, 14 living donors (LD), 6 cadaveric donors (CD); group B: follow-up > 25 years, 21 KTR, 16 male, mean age (M ± SD): 30.86 ± 12.37 years, 14 LD, 7 CD). Kidney graft origin, post-kidney transplantation diabetes mellitus, HLA compatibility, delayed graft function, and acute rejection episodes were also analyzed retrospectively. Statistical analysis with Mann-Whitney test and Kaplan-Meier survival analysis was performed (SPSS 20.0 for Windows). RESULTS The mean age of CDs was lower than that of LDs: CD mean age (M ± SD): 23.84 ± 16.26 years vs LD mean age: 52.75 ± 12.42 years (P < .001). Cadaveric kidney graft was associated with better renal allograft function 10, 15, and 25 years post kidney transplant. None of the other factors analyzed reached statistical significance between the 2 groups. CONCLUSION The age of the donor and the kidney graft origin are important co-factors of the very long-term kidney allograft survival.
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Affiliation(s)
- A Zolota
- Organ Transplantation Unit, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece.
| | - F Solonaki
- Organ Transplantation Unit, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - G Katsanos
- Organ Transplantation Unit, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - A Papagiannis
- Organ Transplantation Unit, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - N Salveridis
- Organ Transplantation Unit, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - A Tranta
- Organ Transplantation Unit, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - T Deligiannidis
- Organ Transplantation Unit, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - K E Karakasi
- Organ Transplantation Unit, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - C Nikolaidou
- Organ Transplantation Unit, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - C Papadimitriou
- Organ Transplantation Unit, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - A Fouza
- Organ Transplantation Unit, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - V Papanikolaou
- Organ Transplantation Unit, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - G Miserlis
- Organ Transplantation Unit, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - N Antoniadis
- Organ Transplantation Unit, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - I Fouzas
- Organ Transplantation Unit, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
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14
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Chan Chun Kong D, Akbari A, Malcolm J, Doyle MA, Hoar S. Determinants of Poor Glycemic Control in Patients with Kidney Transplants: A Single-Center Retrospective Cohort Study in Canada. Can J Kidney Health Dis 2020; 7:2054358120922628. [PMID: 32477582 PMCID: PMC7235535 DOI: 10.1177/2054358120922628] [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: 12/10/2019] [Accepted: 03/27/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Kidney transplant immunosuppressive medications are known to impair glucose metabolism, causing worsened glycemic control in patients with pre-transplant diabetes mellitus (PrTDM) and new onset of diabetes after transplant (NODAT). Objectives: To determine the incidence, risk factors, and outcomes of both PrTDM and NODAT patients. Design: This is a single-center retrospective observational cohort study. Setting: The Ottawa Hospital, Ontario, Canada. Participant: A total of 132 adult (>18 years) kidney transplant patients from 2013 to 2015 were retrospectively followed 3 years post-transplant. Measurements: Patient characteristics, transplant information, pre- and post-transplant HbA1C and random glucose, follow-up appointments, complications, and readmissions. Methods: We looked at the prevalence of poor glycemic control (HbA1c >8.5%) in the PrTDM group before and after transplant and compared the prevalence, follow-up appointments, and rate of complications and readmission rates in both the PrTDM and NODAT groups. We determined the risk factors of developing poor glycemic control in PrTDM patients and NODAT. Student t-test was used to compare means, chi-squared test was used to compare percentages, and univariate analysis to determine risk factors was performed by logistical regression. Results: A total of 42 patients (31.8%) had PrTDM and 12 patients (13.3%) developed NODAT. Poor glycemic control (HbA1c >8.5%) was more prevalent in the PrTDM (76.4%) patients compared to those with NODAT (16.7%; P < .01). PrTDM patients were more likely to receive follow-up with an endocrinologist (P < .01) and diabetes nurse (P < .01) compared to those with NODAT. There were no differences in the complication and readmission rates for PrTDM and NODAT patients. Receiving a transplant from a deceased donor was associated with having poor glycemic control, odds ratio (OR) = 3.34, confidence interval (CI = 1.08, 10.4), P = .04. Both patient age, OR = 1.07, CI (1.02, 1.3), P < .01, and peritoneal dialysis prior to transplant, OR = 4.57, CI (1.28, 16.3), P = .02, were associated with NODAT. Limitations: Our study was limited by our small sample size. We also could not account for any diabetes screening performed outside of our center or follow-up appointments with family physicians or community endocrinologists. Conclusion: Poor glycemic control is common in the kidney transplant population. Glycemic targets for patients with PrTDM are not being met in our center and our study highlights the gap in the literature focusing on the prevalence and outcomes of poor glycemic control in these patients. Closer follow-up and attention may be needed for those who are at risk for worse glycemic control, which include older patients, those who received a deceased donor kidney, and/or prior peritoneal dialysis.
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Affiliation(s)
| | - Ayub Akbari
- Faculty of Medicine, University of Ottawa, ON, Canada.,Division of Nephrology, The Ottawa Hospital, ON, Canada
| | - Janine Malcolm
- Faculty of Medicine, University of Ottawa, ON, Canada.,Division of Endocrinology, The Ottawa Hospital, ON, Canada
| | - Mary-Anne Doyle
- Faculty of Medicine, University of Ottawa, ON, Canada.,Division of Endocrinology, The Ottawa Hospital, ON, Canada
| | - Stephanie Hoar
- Faculty of Medicine, University of Ottawa, ON, Canada.,Division of Nephrology, The Ottawa Hospital, ON, Canada
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15
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Kummer L, Zaradzki M, Vijayan V, Arif R, Weigand MA, Immenschuh S, Wagner AH, Larmann J. Vascular Signaling in Allogenic Solid Organ Transplantation - The Role of Endothelial Cells. Front Physiol 2020; 11:443. [PMID: 32457653 PMCID: PMC7227440 DOI: 10.3389/fphys.2020.00443] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/09/2020] [Indexed: 12/12/2022] Open
Abstract
Graft rejection remains the major obstacle after vascularized solid organ transplantation. Endothelial cells, which form the interface between the transplanted graft and the host’s immunity, are the first target for host immune cells. During acute cellular rejection endothelial cells are directly attacked by HLA I and II-recognizing NK cells, macrophages, and T cells, and activation of the complement system leads to endothelial cell lysis. The established forms of immunosuppressive therapy provide effective treatment options, but the treatment of chronic rejection of solid organs remains challenging. Chronic rejection is mainly based on production of donor-specific antibodies that induce endothelial cell activation—a condition which phenotypically resembles chronic inflammation. Activated endothelial cells produce chemokines, and expression of adhesion molecules increases. Due to this pro-inflammatory microenvironment, leukocytes are recruited and transmigrate from the bloodstream across the endothelial monolayer into the vessel wall. This mononuclear infiltrate is a hallmark of transplant vasculopathy. Furthermore, expression profiles of different cytokines serve as clinical markers for the patient’s outcome. Besides their effects on immune cells, activated endothelial cells support the migration and proliferation of vascular smooth muscle cells. In turn, muscle cell recruitment leads to neointima formation followed by reduction in organ perfusion and eventually results in tissue injury. Activation of endothelial cells involves antibody ligation to the surface of endothelial cells. Subsequently, intracellular signaling pathways are initiated. These signaling cascades may serve as targets to prevent or treat adverse effects in antibody-activated endothelial cells. Preventive or therapeutic strategies for chronic rejection can be investigated in sophisticated mouse models of transplant vasculopathy, mimicking interactions between immune cells and endothelium.
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Affiliation(s)
- Laura Kummer
- Department of Anesthesiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Marcin Zaradzki
- Institute of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Vijith Vijayan
- Institute for Transfusion Medicine, Hannover Medical School, Hanover, Germany
| | - Rawa Arif
- Institute of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus A Weigand
- Department of Anesthesiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Stephan Immenschuh
- Institute for Transfusion Medicine, Hannover Medical School, Hanover, Germany
| | - Andreas H Wagner
- Institute of Physiology and Pathophysiology, Heidelberg University, Heidelberg, Germany
| | - Jan Larmann
- Department of Anesthesiology, University Hospital Heidelberg, Heidelberg, Germany
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16
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Smeets S, Stangé G, Leuckx G, Roelants L, Cools W, De Paep DL, Ling Z, De Leu N, In't Veld P. Evidence of Tissue Repair in Human Donor Pancreas After Prolonged Duration of Stay in Intensive Care. Diabetes 2020; 69:401-412. [PMID: 31843955 DOI: 10.2337/db19-0529] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 12/10/2019] [Indexed: 11/13/2022]
Abstract
M2 macrophages play an important role in tissue repair and regeneration. They have also been found to modulate β-cell replication in mouse models of pancreatic injury and disease. We previously reported that β-cell replication is strongly increased in a subgroup of human organ donors characterized by prolonged duration of stay in an intensive care unit (ICU) and increased number of leukocytes in the pancreatic tissue. In the present study we investigated the relationship between duration of stay in the ICU, M2 macrophages, vascularization, and pancreatic cell replication. Pancreatic organs from 50 donors without diabetes with different durations of stay in the ICU were analyzed by immunostaining and digital image analysis. The number of CD68+CD206+ M2 macrophages increased three- to sixfold from ≥6 days' duration of stay in the ICU onwards. This was accompanied by a threefold increased vascular density and a four- to ninefold increase in pancreatic cells positive for the replication marker Ki67. A strong correlation was observed between the number of M2 macrophages and β-cell replication. These results show that a prolonged duration of stay in the ICU is associated with an increased M2 macrophage number, increased vascular density, and an overall increase in replication of all pancreatic cell types. Our data show evidence of marked levels of tissue repair in the human donor pancreas.
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Affiliation(s)
- Silke Smeets
- Diabetes Research Center, Vrije Universiteit Brussel, Brussels, Belgium
| | - Geert Stangé
- Diabetes Research Center, Vrije Universiteit Brussel, Brussels, Belgium
| | - Gunter Leuckx
- Beta Cell Neogenesis, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lisbeth Roelants
- Diabetes Research Center, Vrije Universiteit Brussel, Brussels, Belgium
| | - Wilfried Cools
- Interfaculty Center Data processing and Statistics, Vrije Universiteit Brussel, Brussels, Belgium
| | - Diedert Luc De Paep
- Diabetes Research Center, Vrije Universiteit Brussel, Brussels, Belgium
- Beta Cell Bank, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Department of Surgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Zhidong Ling
- Diabetes Research Center, Vrije Universiteit Brussel, Brussels, Belgium
- Beta Cell Bank, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Nico De Leu
- Beta Cell Neogenesis, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Endocrinology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Peter In't Veld
- Diabetes Research Center, Vrije Universiteit Brussel, Brussels, Belgium
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17
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Pretransplant Donor-Specific Anti-HLA Antibodies and the Risk for Rejection-Related Graft Failure of Kidney Allografts. J Transplant 2020; 2020:5694670. [PMID: 32099669 PMCID: PMC7008278 DOI: 10.1155/2020/5694670] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 12/16/2019] [Indexed: 02/07/2023] Open
Abstract
Background The presence of donor-specific antibodies (DSAs) against HLA before kidney transplantation has been variably associated with decreased long-term graft survival. Data on the relation of pretransplant DSA with rejection and cause of graft failure in recipients of donor kidneys are scarce. Methods Patients transplanted between 1995 and 2005 were included and followed until 2016. Donor-specific antibodies before transplantation were determined retrospectively. For cause, renal transplant biopsies were reviewed. Results Pretransplant DSAs were found in 160 cases on a total of 734 transplantations (21.8%). In 80.5% of graft failures, a diagnostic renal biopsy was performed. The presence of pretransplant DSA (DSApos) increased the risk of graft failure within the first 3 months after transplantation (5.2% vs. 9.4%) because of rejection with intragraft thrombosis (p < 0.01). One year after transplantation, DSApos recipients had an increased hazard for antibody-mediated rejection at 10 years (9% DSAneg vs. 15% DSApos, p < 0.01). One year after transplantation, DSApos recipients had an increased hazard for antibody-mediated rejection at 10 years (9% DSAneg vs. 15% DSApos, p < 0.01). One year after transplantation, DSApos recipients had an increased hazard for antibody-mediated rejection at 10 years (9% DSAneg vs. 15% DSApos. Conclusions Pretransplant DSAs are a risk factor for early graft loss and increase the incidence for humoral rejection and graft loss but do not affect the risk for T cell-mediated rejection.
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18
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Carey BS, Poulton KV, Poles A. HLA expression levels of unstimulated and cytokine stimulated human umbilical vein endothelial cells. HLA 2020; 95:505-515. [PMID: 31981308 DOI: 10.1111/tan.13808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/11/2020] [Accepted: 01/17/2020] [Indexed: 12/12/2022]
Abstract
Transplant rejection occurs following recipient recognition of mismatched HLA on donor tissue, but active rejection is dependent not only upon the severity of the T cell or alloantibody response, but also upon the cell surface expression of target HLA molecules. To investigate the variation in HLA expression using a model of endothelium, human umbilical vein endothelial cell (HUVEC) cultures were generated from 48 umbilical cords donated consecutively following planned caesarean section. HUVECs were stimulated using the cytokines tumour necrosis factor alpha and interferon gamma and HLA expression of unstimulated and stimulated cells determined using flow cytometry. HLA-A2, HLA-A3 and HLA-C antigens all showed a modest increase in expression for 12 hours post cell activation, followed by a more pronounced response over the next 24 to 36 hours. Each of these antigens increased by up to 40 times over unstimulated levels and in addition cells homozygous for specific HLA antigens on average had twice the amount of antigen expressed compared with cells heterozygous for that antigen, both when unstimulated and following cytokine stimulation. Cell activation is an important consideration in the assessment of transplant risk and may help progress towards understanding why rejection does not always occur in the presence of significant donor specific antibody. This data also confirms guidelines for transplantation, which recommend doubling the specific antibody level when considering immunological risk for homozygous donors.
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Affiliation(s)
- B Sean Carey
- Histocompatibility and Immunogenetics, Combined Laboratory, Derriford Hospital, Plymouth, United Kingdom
| | - Kay V Poulton
- Transplantation Laboratory, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Anthony Poles
- Histocompatibility and Immunogenetics, Combined Laboratory, Derriford Hospital, Plymouth, United Kingdom
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19
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20
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Kamburova EG, Wisse BW, Joosten I, Allebes WA, van der Meer A, Hilbrands LB, Baas MC, Spierings E, Hack CE, van Reekum FE, van Zuilen AD, Verhaar MC, Bots ML, Drop ACAD, Plaisier L, Seelen MAJ, Sanders JS.F, Hepkema BG, Lambeck AJA, Bungener LB, Roozendaal C, Tilanus MGJ, Voorter CE, Wieten L, van Duijnhoven EM, Gelens M, Christiaans MHL, van Ittersum FJ, Nurmohamed SA, Lardy NM, Swelsen W, van der Pant KA, van der Weerd NC, ten Berge IJM, Bemelman FJ, Hoitsma A, van der Boog PJM, de Fijter JW, Betjes MGH, Heidt S, Roelen DL, Claas FH, Otten HG. Differential effects of donor-specific HLA antibodies in living versus deceased donor transplant. Am J Transplant 2018; 18:2274-2284. [PMID: 29464832 PMCID: PMC6175247 DOI: 10.1111/ajt.14709] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 01/25/2023]
Abstract
The presence of donor-specific anti-HLA antibodies (DSAs) is associated with increased risk of graft failure after kidney transplant. We hypothesized that DSAs against HLA class I, class II, or both classes indicate a different risk for graft loss between deceased and living donor transplant. In this study, we investigated the impact of pretransplant DSAs, by using single antigen bead assays, on long-term graft survival in 3237 deceased and 1487 living donor kidney transplants with a negative complement-dependent crossmatch. In living donor transplants, we found a limited effect on graft survival of DSAs against class I or II antigens after transplant. Class I and II DSAs combined resulted in decreased 10-year graft survival (84% to 75%). In contrast, after deceased donor transplant, patients with class I or class II DSAs had a 10-year graft survival of 59% and 60%, respectively, both significantly lower than the survival for patients without DSAs (76%). The combination of class I and II DSAs resulted in a 10-year survival of 54% in deceased donor transplants. In conclusion, class I and II DSAs are a clear risk factor for graft loss in deceased donor transplants, while in living donor transplants, class I and II DSAs seem to be associated with an increased risk for graft failure, but this could not be assessed due to their low prevalence.
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21
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Mine KL, Tedesco-Silva H, Mourão TB, Campos EF, Salzedas LA, Aguiar B, Felipe CR, Medina-Pestana JO, Gerbase-DeLima M. Heightened expression of HLA-DQB1 and HLA-DQB2 in pre-implantation biopsies predicts poor late kidney graft function. Hum Immunol 2018; 79:594-601. [DOI: 10.1016/j.humimm.2018.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/02/2018] [Accepted: 05/16/2018] [Indexed: 10/16/2022]
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22
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Hottenrott MC, Krebs J, Pelosi P, Luecke T, Rocco PRM, Sticht C, Breedijk A, Yard B, Tsagogiorgas C. Effects of mechanical ventilation on gene expression profiles in renal allografts from brain dead rats. Respir Physiol Neurobiol 2017; 246:17-25. [PMID: 28768153 DOI: 10.1016/j.resp.2017.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 07/26/2017] [Accepted: 07/27/2017] [Indexed: 10/19/2022]
Abstract
Pathophysiological changes of brain death (BD) are impairing distal organ function and harming potential renal allografts. Whether ventilation strategies influence the quality of renal allografts from BD donors has not been thoroughly studied. 28 adult male Wistar rats were randomly assigned to four groups: 1) no brain death (NBD) with low tidal volume/low positive endexpiratory pressure (PEEP) titrated to minimal static elastance of the respiratory system (LVT/OLPEEP); 2) NBD with high tidal volume/low PEEP (HVT/LPEEP); 3) brain death (BD) with LVT/OLPEEP; and 4) BD with HVT/LPEEP. We hypothesized that HVT/LPEEP in BD leads to increased interleukin 6 (IL-6) gene expression and impairs potential renal allografts after six hours of mechanical ventilation. We assessed inflammatory cytokines in serum, genome wide gene expression profiles and quantitative PCR (qPCR) in kidney tissue. The influence of BD on renal gene-expression profiles was greater than the influence of the ventilation strategy. In BD, LVT ventilation did not influence the inflammatory parameters or kidney function in our experimental model.
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Affiliation(s)
- Maximilia C Hottenrott
- Department of Anaesthesiology and Critical Care Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Department of Internal Medicine V, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Joerg Krebs
- Department of Anaesthesiology and Critical Care Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino- IST, University of Genoa, Genoa, Italy
| | - Thomas Luecke
- Department of Anaesthesiology and Critical Care Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Patricia R M Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carsten Sticht
- Centre for Medical Research (ZMF), University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Annette Breedijk
- Department of Internal Medicine V, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Benito Yard
- Department of Internal Medicine V, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Charalambos Tsagogiorgas
- Department of Anaesthesiology and Critical Care Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
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23
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Gholamnezhadjafari R, Tajik N, Falak R, Aflatoonian R, Dehghan S, Rezaei A. Innate inflammatory gene expression profiling in potential brain-dead donors: detailed investigation of the effect of common corticosteroid therapy. Innate Immun 2017; 23:440-448. [DOI: 10.1177/1753425917709508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Our study aimed to assess the influence of common methylprednisolone therapy on innate inflammatory factors in potential brain-dead organ donors (BDDs). The study groups consisted of 50 potential BDDs who received 15 mg/kg/d methylprednisolone and 25 live organ donors (LDs) as control group. Innate immunity gene expression profiling was performed by RT-PCR array. Soluble serum cytokines and chemokines, complement components, heat shock protein 70 (HSP70) and high mobility group box-1 (HMGB1) were measured by ELISA. Surface expression of TLR2 and TLR4 were determined using flow cytometry. Gene expression profiling revealed up-regulation of TLRs 1, 2, 4, 5, 6, 7 and 8, MYD88, NF-κB, NF-κB1A, IRAK1, STAT3, JAK2, TNF-α, IL-1β, CD86 and CD14 in the BDD group. Remarkably, the serum levels of C-reactive protein and HSP70 were considerably higher in the BDD group. In addition, serum amounts of IL-1β, IL-6, TNF-α, HMGB1, HSP70, C3a and C5a, but not IL-8, sCD86 or monocyte chemoattractant protein-1, were significantly increased in the BDD group. Significant differences were observed in flow cytometry analysis of TLR2 and TLR4 between the two groups. In summary, common methylprednisolone therapy in BDDs did not adequately reduce systemic inflammation, which could be due to inadequate doses or inefficient impact on other inflammatory-inducing pathways, for example oxidative stress or production of damage-associated molecules.
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Affiliation(s)
- Reza Gholamnezhadjafari
- Immunology Departatment, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nader Tajik
- Immunology Research Center (IRC), Iran University of Medical Sciences, Tehran, Iran
| | - Reza Falak
- Immunology Research Center (IRC), Iran University of Medical Sciences, Tehran, Iran
| | - Reza Aflatoonian
- Department of Endocrinology and Female Infertility at Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Sanaz Dehghan
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Rezaei
- Immunology Departatment, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Guillén-Gómez E, Dasilva I, Silva I, Arce Y, Facundo C, Ars E, Breda A, Ortiz A, Guirado L, Ballarín JA, Díaz-Encarnación MM. Early Macrophage Infiltration and Sustained Inflammation in Kidneys From Deceased Donors Are Associated With Long-Term Renal Function. Am J Transplant 2017; 17:733-743. [PMID: 27496082 DOI: 10.1111/ajt.13998] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/28/2016] [Accepted: 07/29/2016] [Indexed: 01/25/2023]
Abstract
Kidney transplants from living donors (LDs) have a better outcome than those from deceased donors (DDs). Different factors have been suggested to justify the different outcome. In this study, we analyzed the infiltration and phenotype of monocytes/macrophages and the expression of inflammatory and fibrotic markers in renal biopsy specimens from 94 kidney recipients (60 DDs and 34 LDs) at baseline and 4 months after transplantation. We evaluated their association with medium- and long-term renal function. At baseline, inflammatory gene expression was higher in DDs than in LDs. These results were confirmed by the high number of CD68-positive cells in DD kidneys, which correlated negatively with long-term renal function. Expression of the fibrotic markers vimentin, fibronectin, and α-smooth muscle actin was more elevated in biopsy specimens from DDs at 4 months than in those from LDs. Gene expression of inflammatory and fibrotic markers at 4 months and difference between 4 months and baseline correlated negatively with medium- and long-term renal function in DDs. Multivariate analysis point to transforming growth factor-β1 as the best predictor of long-term renal function in DDs. We conclude that early macrophage infiltration, sustained inflammation, and transforming growth factor-β1 expression, at least for the first 4 months, contribute significantly to the difference in DD and LD transplant outcome.
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Affiliation(s)
- E Guillén-Gómez
- Molecular Biology Laboratory, Fundació Puigvert, Barcelona, Spain.,UAB, REDinREN, Fundación Renal Iñigo Álvarez de Toledo (FRIAT), Institut Investigació Biosanitaria Sant Pau, Barcelona, Spain
| | - I Dasilva
- UAB, REDinREN, Fundación Renal Iñigo Álvarez de Toledo (FRIAT), Institut Investigació Biosanitaria Sant Pau, Barcelona, Spain.,Nephrology Department, Fundació Puigvert, Barcelona, Spain
| | - I Silva
- UAB, REDinREN, Fundación Renal Iñigo Álvarez de Toledo (FRIAT), Institut Investigació Biosanitaria Sant Pau, Barcelona, Spain.,Renal Transplant Unit, Fundació Puigvert, Barcelona, Spain
| | - Y Arce
- UAB, REDinREN, Fundación Renal Iñigo Álvarez de Toledo (FRIAT), Institut Investigació Biosanitaria Sant Pau, Barcelona, Spain.,Pathology Laboratory, Fundació Puigvert, Barcelona, Spain
| | - C Facundo
- UAB, REDinREN, Fundación Renal Iñigo Álvarez de Toledo (FRIAT), Institut Investigació Biosanitaria Sant Pau, Barcelona, Spain.,Renal Transplant Unit, Fundació Puigvert, Barcelona, Spain
| | - E Ars
- Molecular Biology Laboratory, Fundació Puigvert, Barcelona, Spain.,UAB, REDinREN, Fundación Renal Iñigo Álvarez de Toledo (FRIAT), Institut Investigació Biosanitaria Sant Pau, Barcelona, Spain
| | - A Breda
- UAB, REDinREN, Fundación Renal Iñigo Álvarez de Toledo (FRIAT), Institut Investigació Biosanitaria Sant Pau, Barcelona, Spain.,Urology Department, Fundació Puigvert, Barcelona, Spain
| | - A Ortiz
- IIS-Fundación Jiménez Díaz/UAM, REDinREN, Madrid, Spain
| | - L Guirado
- UAB, REDinREN, Fundación Renal Iñigo Álvarez de Toledo (FRIAT), Institut Investigació Biosanitaria Sant Pau, Barcelona, Spain.,Renal Transplant Unit, Fundació Puigvert, Barcelona, Spain
| | - J A Ballarín
- UAB, REDinREN, Fundación Renal Iñigo Álvarez de Toledo (FRIAT), Institut Investigació Biosanitaria Sant Pau, Barcelona, Spain.,Nephrology Department, Fundació Puigvert, Barcelona, Spain
| | - M M Díaz-Encarnación
- UAB, REDinREN, Fundación Renal Iñigo Álvarez de Toledo (FRIAT), Institut Investigació Biosanitaria Sant Pau, Barcelona, Spain.,Nephrology Department, Fundació Puigvert, Barcelona, Spain
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25
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Kwiatkowska E, Domanski L, Bober J, Safranow K, Pawlik A, Ciechanowski K. Activity of urine arylsulfatase A in brain-dead graft donors is a predictor of early and late graft function. POSTEP HIG MED DOSW 2017. [DOI: 10.5604/01.3001.0010.3784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
<b>Objective:</b> Human lysosomal arylsulfatase A (ASA) is a member of the sulfatase family. Arylsulfatase A is required to degrade sulfatides. Sulfatides occur in the myelin sheets of the central and peripheral nervous system. In this study we evaluated the urine activity of lysosomal enzyme arylsulfatase A in brain-dead donors as a marker and predictor of short – and long-term renal allograft function. <b>Patients/Methods: </b> We analyzed data from kidney recipients who received organs from brain‑dead donors. Data from 40 donors and 68 recipients were analyzed. <b>Results: </b> Urine activity of arylsulfatase A in graft donors correlated positively with creatinine clearance in graft recipients after transplantation: : significantly after 30 days (Rs=0.38, p=0.004) and after 3 years (Rs=0.38, p=0.03), and with borderline significance after 14 days (Rs=0.25, p=0.08) and after one year (Rs=0.23, p=0.07). <b>Conclusions: </b> The results of this study suggest that arylsulfatase A has a protective effect on kidney allograft, and the urine activity of this enzyme in kidney donors correlates positively with graft function.
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Affiliation(s)
- Ewa Kwiatkowska
- Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University in Szczecin, Poland
| | - Leszek Domanski
- Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University in Szczecin, Poland
| | - Joanna Bober
- Department of Medical Chemistry, Pomeranian Medical University, Szczecin, Poland
| | - Krzysztof Safranow
- Department of Biochemistry, Pomeranian Medical University, Szczecin, Poland
| | - Andrzej Pawlik
- Department of Physiology, Pomeranian Medical University, Szczecin, Poland
| | - Kazimierz Ciechanowski
- Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University in Szczecin, Poland
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Abstract
Gene induction, cytokine production, and programmed neuronal and myocardial cell death are concerns that have entered the areas of donor evaluation and care over the past several years. Following ischemic or traumatic brain injury and the evolution of brain death, a large number of proteins (cytokines) are produced as part of a regional inflammatory response. These cytokines and related compounds appear to contribute to programmed death (apoptosis) of individual cells and the severe cardiac and hemodynamic changes often encountered during donor care. In addition, these cytokines and related compounds may sensitize donor organs so that a faster and more severe form of rejection occurs in the recipient. Although no directed therapy for these cytokine effects is presently available, the organ procurement coordinator should be aware of these issues and concerns as new treatment options evolve in the near future.
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Akhtar MZ, Huang H, Kaisar M, Lo Faro ML, Rebolledo R, Morten K, Heather LC, Dona A, Leuvenink HG, Fuggle SV, Kessler BM, Pugh CW, Ploeg RJ. Using an Integrated -Omics Approach to Identify Key Cellular Processes That Are Disturbed in the Kidney After Brain Death. Am J Transplant 2016; 16:1421-40. [PMID: 26602379 DOI: 10.1111/ajt.13626] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 10/26/2015] [Accepted: 11/12/2015] [Indexed: 01/25/2023]
Abstract
In an era where we are becoming more reliant on vulnerable kidneys for transplantation from older donors, there is an urgent need to understand how brain death leads to kidney dysfunction and, hence, how this can be prevented. Using a rodent model of hemorrhagic stroke and next-generation proteomic and metabolomic technologies, we aimed to delineate which key cellular processes are perturbed in the kidney after brain death. Pathway analysis of the proteomic signature of kidneys from brain-dead donors revealed large-scale changes in mitochondrial proteins that were associated with altered mitochondrial activity and morphological evidence of mitochondrial injury. We identified an increase in a number of glycolytic proteins and lactate production, suggesting a shift toward anaerobic metabolism. Higher amounts of succinate were found in the brain death group, in conjunction with increased markers of oxidative stress. We characterized the responsiveness of hypoxia inducible factors and found this correlated with post-brain death mean arterial pressures. Brain death leads to metabolic disturbances in the kidney and alterations in mitochondrial function and reactive oxygen species generation. This metabolic disturbance and alteration in mitochondrial function may lead to further cellular injury. Conditioning the brain-dead organ donor by altering metabolism could be a novel approach to ameliorate this brain death-induced kidney injury.
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Affiliation(s)
- M Z Akhtar
- Centre for Cellular and Molecular Physiology, Oxford University, Oxford, UK.,Oxford Transplant Centre, Nuffield Department of Surgical Sciences, Churchill Hospital, Oxford, UK
| | - H Huang
- Oxford Transplant Centre, Nuffield Department of Surgical Sciences, Churchill Hospital, Oxford, UK.,Target Discovery Institute, Oxford University, Oxford, UK
| | - M Kaisar
- Oxford Transplant Centre, Nuffield Department of Surgical Sciences, Churchill Hospital, Oxford, UK.,Target Discovery Institute, Oxford University, Oxford, UK
| | - M L Lo Faro
- Centre for Cellular and Molecular Physiology, Oxford University, Oxford, UK.,Oxford Transplant Centre, Nuffield Department of Surgical Sciences, Churchill Hospital, Oxford, UK
| | - R Rebolledo
- Surgical Research Laboratory, University of Groningen, Groningen, the Netherlands
| | - K Morten
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, UK
| | - L C Heather
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - A Dona
- Department of Surgery, Imperial College, London, UK.,Kolling Institute for Medical Research, The University of Sydney, New South Wales, Australia
| | - H G Leuvenink
- Surgical Research Laboratory, University of Groningen, Groningen, the Netherlands
| | - S V Fuggle
- Oxford Transplant Centre, Nuffield Department of Surgical Sciences, Churchill Hospital, Oxford, UK
| | - B M Kessler
- Target Discovery Institute, Oxford University, Oxford, UK
| | - C W Pugh
- Centre for Cellular and Molecular Physiology, Oxford University, Oxford, UK
| | - R J Ploeg
- Oxford Transplant Centre, Nuffield Department of Surgical Sciences, Churchill Hospital, Oxford, UK
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Ritschl PV, Ashraf MI, Oberhuber R, Mellitzer V, Fabritius C, Resch T, Ebner S, Sauter M, Klingel K, Pratschke J, Kotsch K. Donor brain death leads to differential immune activation in solid organs but does not accelerate ischaemia-reperfusion injury. J Pathol 2016; 239:84-96. [DOI: 10.1002/path.4704] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 01/21/2016] [Accepted: 02/10/2016] [Indexed: 01/24/2023]
Affiliation(s)
- Paul Viktor Ritschl
- Department of General, Visceral and Transplantation Surgery; Charité-Universitätsmedizin Berlin; Germany
| | - Muhammad Imtiaz Ashraf
- Department of General, Visceral and Transplantation Surgery; Charité-Universitätsmedizin Berlin; Germany
| | - Rupert Oberhuber
- Centre for Operative Medicine, Department of Visceral, Transplant and Thoracic Surgery; Medical University of Innsbruck; Austria
| | - Vanessa Mellitzer
- Centre for Operative Medicine, Department of Visceral, Transplant and Thoracic Surgery; Medical University of Innsbruck; Austria
| | - Cornelia Fabritius
- Centre for Operative Medicine, Department of Visceral, Transplant and Thoracic Surgery; Medical University of Innsbruck; Austria
| | - Thomas Resch
- Centre for Operative Medicine, Department of Visceral, Transplant and Thoracic Surgery; Medical University of Innsbruck; Austria
| | - Susanne Ebner
- Centre for Operative Medicine, Department of Visceral, Transplant and Thoracic Surgery; Medical University of Innsbruck; Austria
| | - Martina Sauter
- Department of Molecular Pathology; University Hospital Tübingen; Germany
| | - Karin Klingel
- Department of Molecular Pathology; University Hospital Tübingen; Germany
| | - Johann Pratschke
- Department of General, Visceral and Transplantation Surgery; Charité-Universitätsmedizin Berlin; Germany
| | - Katja Kotsch
- Department of General, Visceral and Transplantation Surgery; Charité-Universitätsmedizin Berlin; Germany
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The Impact of Ischemia/Reperfusion Injury on Liver Allografts from Deceased after Cardiac Death versus Deceased after Brain Death Donors. PLoS One 2016; 11:e0148815. [PMID: 26863224 PMCID: PMC4749185 DOI: 10.1371/journal.pone.0148815] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 01/22/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND AIMS The shortage of organs for transplantation has led to increased use of organs procured from donors after cardiac death (DCD). The effects of cardiac death on the liver remain poorly understood, however. Using livers obtained from DCD versus donors after brain death (DBD), we aimed to understand how ischemia/reperfusion (I/R) injury alters expression of pro-inflammatory markers ceramides and influences graft leukocyte infiltration. METHODS Hepatocyte inflammation, as assessed by ceramide expression, was evaluated in DCD (n = 13) and DBD (n = 10) livers. Allograft expression of inflammatory and cell death markers, and allograft leukocyte infiltration were evaluated from a contemporaneous independent cohort of DCD (n = 22) and DBD (n = 13) livers. RESULTS When examining the differences between transplant stages in each group, C18, C20, C24 ceramides showed significant difference in DBD (p<0.05) and C22 ceramide (p<0.05) were more pronounced for DCD. C18 ceramide is correlated to bilirubin, INR, and creatinine after transplant in DCD. Prior to transplantation, DCD livers have reduced leukocyte infiltration compared to DBD allografts. Following reperfusion, the neutrophil infiltration and platelet deposition was less prevalent in DCD grafts while cell death and recipients levels of serum aspartate aminotransferase (AST) of DCD allografts had significantly increased. CONCLUSION These data suggest that I/R injury generate necrosis in the absence of a strong inflammatory response in DCD livers with an appreciable effect on early graft function. The long-term consequences of increased inflammation in DBD and increased cell death in DCD allografts are unknown and warrant further investigation.
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30
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Shivaswamy V, Boerner B, Larsen J. Post-Transplant Diabetes Mellitus: Causes, Treatment, and Impact on Outcomes. Endocr Rev 2016; 37:37-61. [PMID: 26650437 PMCID: PMC4740345 DOI: 10.1210/er.2015-1084] [Citation(s) in RCA: 192] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Post-transplant diabetes mellitus (PTDM) is a frequent consequence of solid organ transplantation. PTDM has been associated with greater mortality and increased infections in different transplant groups using different diagnostic criteria. An international consensus panel recommended a consistent set of guidelines in 2003 based on American Diabetes Association glucose criteria but did not exclude the immediate post-transplant hospitalization when many patients receive large doses of corticosteroids. Greater glucose monitoring during all hospitalizations has revealed significant glucose intolerance in the majority of recipients immediately after transplant. As a result, the international consensus panel reviewed its earlier guidelines and recommended delaying screening and diagnosis of PTDM until the recipient is on stable doses of immunosuppression after discharge from initial transplant hospitalization. The group cautioned that whereas hemoglobin A1C has been adopted as a diagnostic criterion by many, it is not reliable as the sole diabetes screening method during the first year after transplant. Risk factors for PTDM include many of the immunosuppressant medications themselves as well as those for type 2 diabetes. The provider managing diabetes and associated dyslipidemia and hypertension after transplant must be careful of the greater risk for drug-drug interactions and infections with immunosuppressant medications. Treatment goals and therapies must consider the greater risk for fluctuating and reduced kidney function, which can cause hypoglycemia. Research is actively focused on strategies to prevent PTDM, but until strategies are found, it is imperative that immunosuppression regimens are chosen based on their evidence to prolong graft survival, not to avoid PTDM.
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Affiliation(s)
- Vijay Shivaswamy
- Division of Diabetes, Endocrinology, and Metabolism (V.S., B.B., J.L.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska 68198; and VA Nebraska-Western Iowa Health Care System (V.S.), Omaha, Nebraska 68105
| | - Brian Boerner
- Division of Diabetes, Endocrinology, and Metabolism (V.S., B.B., J.L.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska 68198; and VA Nebraska-Western Iowa Health Care System (V.S.), Omaha, Nebraska 68105
| | - Jennifer Larsen
- Division of Diabetes, Endocrinology, and Metabolism (V.S., B.B., J.L.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska 68198; and VA Nebraska-Western Iowa Health Care System (V.S.), Omaha, Nebraska 68105
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31
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. EXP CLIN TRANSPLANT 2015; 13. [DOI: 10.6002/ect.2015.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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32
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Lim WH, Gray NA, Chadban SJ, Pilmore H, Wong G. Graft and patient outcomes of zero-human leucocyte-antigen-mismatched deceased and live donor kidney transplant recipients. Transpl Int 2015; 28:610-8. [DOI: 10.1111/tri.12542] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 11/26/2014] [Accepted: 02/09/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Wai H. Lim
- Department of Renal Medicine; Sir Charles Gairdner Hospital; Perth WA Australia
- Australia and New Zealand Dialysis and Transplant Registry; Adelaide SA Australia
| | - Nicholas A. Gray
- Australia and New Zealand Dialysis and Transplant Registry; Adelaide SA Australia
- Department of Renal Medicine; Nambour General Hospital; Nambour Qld Australia
| | - Steven J. Chadban
- Australia and New Zealand Dialysis and Transplant Registry; Adelaide SA Australia
- Renal Unit; Royal Prince Alfred Hospital; Sydney NSW Australia
| | - Helen Pilmore
- Australia and New Zealand Dialysis and Transplant Registry; Adelaide SA Australia
- Renal Unit; Auckland Hospital; Auckland New Zealand
- Department of Medicine; Auckland University; Auckland New Zealand
| | - Germaine Wong
- Australia and New Zealand Dialysis and Transplant Registry; Adelaide SA Australia
- Sydney School of Public Health; University of Sydney; Camperdown NSW Australia
- Centre for Kidney Research; The Children's Hospital at Westmead; Westmead NSW Australia
- Centre for Transplant and Renal Research; Westmead Hospital; Westmead NSW Australia
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33
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Ghonge NP, Gadanayak S, Rajakumari V. MDCT evaluation of potential living renal donor, prior to laparoscopic donor nephrectomy: What the transplant surgeon wants to know? Indian J Radiol Imaging 2014; 24:367-78. [PMID: 25489130 PMCID: PMC4247506 DOI: 10.4103/0971-3026.143899] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
As Laparoscopic Donor Nephrectomy (LDN) offers several advantages for the donor such as lesser post-operative pain, fewer cosmetic concerns and faster recovery time, there is growing global trend towards LDN as compared to open nephrectomy. Comprehensive pre-LDN donor evaluation includes assessment of renal morphology including pelvi-calyceal and vascular system. Apart from donor selection, evaluation of the regional anatomy allows precise surgical planning. Due to limited visualization during laparoscopic renal harvesting, detailed pre-transplant evaluation of regional anatomy, including the renal venous anatomy is of utmost importance. MDCT is the modality of choice for pre-LDN evaluation of potential renal donors. Apart from appropriate scan protocol and post-processing methods, detailed understanding of surgical techniques is essential for the Radiologist for accurate image interpretation during pre-LDN MDCT evaluation of potential renal donors. This review article describes MDCT evaluation of potential living renal donor, prior to LDN with emphasis on scan protocol, post-processing methods and image interpretation. The article laid special emphasis on surgical perspectives of pre-LDN MDCT evaluation and addresses important points which transplant surgeons want to know.
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Affiliation(s)
- Nitin P Ghonge
- Department of Radiology, Indraprastha Apollo Hospital, New Delhi, India
| | | | - Vijaya Rajakumari
- Department of Renal Transplantation, Indraprastha Apollo Hospital, New Delhi, India
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34
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Michel SG, La Muraglia GM, Madariaga MLL, Titus JS, Selig MK, Farkash EA, Allan JS, Anderson LM, Madsen JC. Preservation of donor hearts using hypothermic oxygenated perfusion. Ann Transplant 2014; 19:409-16. [PMID: 25139381 DOI: 10.12659/aot.890797] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Hypothermic machine perfusion of donor hearts enables continuous aerobic metabolism and washout of toxic metabolic byproducts. We evaluated the effect of machine perfusion on cardiac myocyte integrity in hearts preserved for 4 h in a novel device that provides pulsatile oxygenated hypothermic perfusion (Paragonix Sherpa Perfusion™ Cardiac Transport System). MATERIAL AND METHODS Pig hearts were harvested and stored in Celsior® solution for 4 h using either conventional cold storage on ice (4-h CS, n=6) or the Sherpa device (4-h pulsatile perfusion (PP), n=6). After cold preservation, hearts were evaluated using a non-working heart Langendorff system. Controls (n=3) were reperfused immediately after organ harvest. Biopsies were taken from the apex of the left ventricle before storage, after storage, and after reperfusion to measure ATP content and endothelin-1 in the tissue. Ultrastructural analysis using electron microscopy was performed. RESULTS Four-hour CS, 4-h PP, and control group did not show any significant differences in systolic or diastolic function (+dP/dt, -dP/dt, EDP). Four-hour PP hearts showed significantly more weight gain than 4-h CS after preservation, which shows that machine perfusion led to myocardial edema. Four-hour CS led to higher endothelin-1 levels after preservation, suggesting more endothelial dysfunction compared to 4-h PP. Electron microscopy revealed endothelial cell rupture and damaged muscle fibers in the 4-h CS group after reperfusion, but the cell structures were preserved in the 4-h PP group. CONCLUSIONS Hypothermic pulsatile perfusion of donor hearts leads to a better-preserved cell structure compared to the conventional cold storage method. This may lead to less risk of primary graft failure after orthotopic heart transplantation.
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Affiliation(s)
- Sebastian G Michel
- Department of Surgery, Transplantation Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Glenn M La Muraglia
- Department of Surgery, Transplantation Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Maria Lucia L Madariaga
- Department of Surgery, Transplantation Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - James S Titus
- Department of Surgery, Division of Cardiac Surgery, Massachusetts General Hospital, Boston, USA
| | - Martin K Selig
- Department of Pathology, Massachusetts General Hospital, Boston, USA
| | - Evan A Farkash
- Department of Pathology, Massachusetts General Hospital, Boston, USA
| | - James S Allan
- Department of Surgery, Transplantation Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | | | - Joren C Madsen
- Department of Surgery, Transplantation Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, USA
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35
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Franke D, Winkel S, Gellermann J, Querfeld U, Pape L, Ehrich JHH, Haffner D, Pavičić L, Zivičnjak M. Growth and maturation improvement in children on renal replacement therapy over the past 20 years. Pediatr Nephrol 2013; 28:2043-51. [PMID: 23708760 DOI: 10.1007/s00467-013-2502-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 03/31/2013] [Accepted: 04/29/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND The attainment of normal growth and maturation remains a major challenge in the management of children and adolescents requiring renal replacement therapy (RRT). METHODS We compared growth and maturation in 384 German children with RRT who were followed between 1998 and 2009 with 732 children who were enrolled in the European Dialysis and Transplant Association (EDTA) Registry from 1985 to 1988; of these children, 78 and 88 %, respectively, were transplanted. RESULTS The data on the German patients included in the EDTA registry did not differ significantly from those of the patients from other European countries. Overall, the mean height standard deviation score (SDS) has improved over the past 20 years from -3.03 to -1.80 (p < 0.001). Until the age of 6 years, the difference in height SDS was not significant, whereas it improved significantly in adolescence (-3.40 vs. -1.52; p < 0.001). Significant improvements in the delay of the pubertal growth spurt, age at menarche, bone maturation and body mass index (BMI) were noted in the recent German group compared to the EDTA group (each p < 0.001). CONCLUSIONS Our findings demonstrate a marked improvement of growth and maturation in paediatric patients on RRT during the past 20 years.
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Affiliation(s)
- Doris Franke
- Department of Paediatric Kidney, Liver and Metabolic Diseases, Children's Hospital, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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36
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Oltean S, Pullerits R, Flodén A, Olausson M, Oltean M. Increased resistin in brain dead organ donors is associated with delayed graft function after kidney transplantation. J Transl Med 2013; 11:233. [PMID: 24070260 PMCID: PMC3849100 DOI: 10.1186/1479-5876-11-233] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 09/24/2013] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Resistin increases during several inflammatory diseases and after intracerebral bleeding or head trauma. Resistin activates the endothelium and may initiate an inflammatory response. No data are available on resistin in brain dead donors (DBD) that regularly manifest a pronounced inflammatory state. METHODS We analyzed plasma resistin in 63 DBDs and correlated results with donor variables and the postoperative course following kidney transplantation using organs from these donors. Endocan and monocyte chemotactic protein (MCP)-1 were also studied. Twenty-six live kidney donors (LD) and the corresponding kidney transplantations were used as controls. RESULTS DBDs had higher resistin (median/range 30.75 ng/ml, 5.41-173.6) than LD (7.71 ng/ml, 2.41-15.74, p < 0.0001). Resistin in DBD correlated with delayed graft function (DGF) in the kidney recipients (r = 0.321, p < 0.01); receiver operating characteristic curve revealed an area under the curve of 0.765 (95% confidence interval [CI] 0.648-0.881, p < 0.01) and a cut-off value for resistin of 25 ng/ml; MCP-1 and endocan were higher in DBDs (p < 0.0001) but did not correlate with DGF or acute rejection. No relationship was found between the studied molecules and the postoperative course of LD kidney transplants. CONCLUSIONS High resistin levels in the DBD before organ retrieval are associated with DGF after kidney transplantation. The resistin increase seems related to the inflammatory state after brain death but not to the cause of death.
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Affiliation(s)
- Simona Oltean
- The Transplant Institute, Sahlgrenska University Hospital, Gothenburg 41345, Sweden.
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Auråen H, Mollnes TE, Bjørtuft Ø, Bakkan PA, Geiran O, Kongerud J, Fiane A, Holm AM. Multiorgan procurement increases systemic inflammation in brain dead donors. Clin Transplant 2013; 27:613-8. [DOI: 10.1111/ctr.12175] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2013] [Indexed: 12/15/2022]
Affiliation(s)
| | | | - Øystein Bjørtuft
- Department of Respiratory Medicine; Oslo University Hospital Rikshospitalet; Oslo; Norway
| | - Per A. Bakkan
- Department of Transplantation; Oslo University Hospital Rikshospitalet; Oslo; Norway
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Influence of delayed graft function and acute rejection on outcomes after kidney transplantation from donors after cardiac death. Transplantation 2013; 94:1218-23. [PMID: 23154212 DOI: 10.1097/tp.0b013e3182708e30] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Delayed graft function (DGF) and acute rejection (AR) exert an adverse impact on graft outcomes after kidney transplantation using organs from donation after brain-stem death (DBD) donors. Here, we examine the impact of DGF and AR on graft survival in kidney transplants using organs from donation after cardiac death (DCD) donors. METHODS We conducted a single-center retrospective study of DCD and DBD donor kidney transplants. We compared 1- and 4-year graft and patient survival rates, as well as death-censored graft survival (DCGS) rates, between the two groups using univariate analysis, and the impact of DGF and AR on graft function was compared using multivariate analysis. RESULTS Eighty DCD and 206 DBD donor transplants were analyzed. Median follow-up was 4.5 years. The incidence of DGF was higher among DCD recipients (73% vs. 27%, P<0.001), and AR was higher among DBD recipients (23% vs. 9%, P<0.001). One-year and 4-year graft survival rates were similar (DCD 94% and 79% vs. DBD 90% and 82%). Among recipients with DGF, the 4-year DCGS rate was better for DCD recipients compared with DBD recipients (100% vs. 92%, P=0.04). Neither DGF nor AR affected the 1-year graft survival rate in DCD recipients, whereas in DBD recipients, the 1-year graft survival rate was worse in the presence of DGF (88% vs. 96%, P=0.04) and the 4-year DCGS rate was worse in the presence of AR (88% vs. 96%, P=0.04). CONCLUSION Despite the high incidence of DGF, medium-term outcomes of DCD kidney transplants are comparable to those from DBD transplants. Short-term graft survival from DCD transplants is not adversely influenced by DGF and AR, unlike in DBD transplants.
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Brain death induces renal expression of heme oxygenase-1 and heat shock protein 70. J Transl Med 2013; 11:22. [PMID: 23356498 PMCID: PMC3568717 DOI: 10.1186/1479-5876-11-22] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 01/25/2013] [Indexed: 01/08/2023] Open
Abstract
Background Kidneys derived from brain dead donors have lower graft survival and higher graft-function loss compared to their living donor counterpart. Heat Shock Proteins (HSP) are a large family of stress proteins involved in maintaining cell homeostasis. We studied the role of stress-inducible genes Heme Oxygenase-1 (HO-1), HSP27, HSP40, and HSP70 in the kidney following a 4 hour period of brain death. Methods Brain death was induced in rats (n=6) by inflating a balloon catheter in the epidural space. Kidneys were analysed for HSPs using RT-PCR, Western blotting, and immunohistochemistry. Results RT-PCR data showed a significant increase in gene expression for HO-1 and HSP70 in kidneys of brain dead rats. Western blotting revealed a massive increase in HO-1 protein in brain dead rat kidneys. Immunohistochemistry confirmed these findings, showing extensive HO-1 protein expression in the renal cortical tubules of brain dead rats. HSP70 protein was predominantly increased in renal distal tubules of brain dead rats treated for hypotension. Conclusion Renal stress caused by brain death induces expression of the cytoprotective genes HO-1 and HSP70, but not of HSP27 and HSP40. The upregulation of these cytoprotective genes indicate that renal damage occurs during brain death, and could be part of a protective or recuperative mechanism induced by brain death-associated stress.
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Han SS, Hwang JH, Oh YJ, Cha RH, Ahn C, Kim YS. Change in body compositions of Asian recipients after kidney transplantation. J Korean Med Sci 2012; 27:1182-7. [PMID: 23091315 PMCID: PMC3468754 DOI: 10.3346/jkms.2012.27.10.1182] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 07/30/2012] [Indexed: 11/25/2022] Open
Abstract
Kidney transplantation and accompanying medical conditions may result in changes in body composition. Such changes have been evaluated in Caucasian recipients, but not in Asian recipients. Herein, we conducted a study on Asian recipients because Asians have a different body composition from Caucasians. A total of 50 Asian recipients was enrolled as a prospective cohort. Using bioelectrical impedance analysis, body composition (muscle and fat mass) was assessed after 2 weeks (baseline), and at 1, 3, 6, 9, and 12 months following kidney transplantation. To find predictors related to changes, the data were analyzed by multivariate analysis using forward selection. All of the patients had good graft function during the study period. Patients gained approximately 3 kg within 1 yr of kidney transplantation. The proportion of muscle mass significantly decreased (P(trend) = 0.001) and the proportion of fat mass significantly increased over time (P(trend) = 0.002). The multivariate results revealed that male recipients, deceased donor type, and low protein intake were associated with an increase in fat mass and a decrease in muscle mass. The results from this study may help to investigate differences in body composition changes between races, as well as the factors related to these changes.
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Affiliation(s)
- Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Ho Hwang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yoon Jung Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ran-hui Cha
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Kidney Research Institute, Seoul National University, Seoul, Korea
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Floerchinger B, Oberhuber R, Tullius SG. Effects of brain death on organ quality and transplant outcome. Transplant Rev (Orlando) 2012; 26:54-9. [PMID: 22459036 DOI: 10.1016/j.trre.2011.10.001] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2011] [Accepted: 10/18/2011] [Indexed: 12/27/2022]
Abstract
The inferiority of organs from brain dead donors is reflected by impaired graft survival and patient outcome. Brain death effects hemodynamic stability, hormonal changes, and neuroimmunologic effects and unleashes a cascade of inflammatory events. Despite considerable efforts in experimental and clinical research, most of the mechanisms linked to brain death are only appreciated on a descriptive level. This overview presents our current understanding of the pathophysiology and consequences of brain death on organ injury and summarizes available therapeutic interventions.
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Affiliation(s)
- Bernhard Floerchinger
- Transplant Surgery Laboratory, Brigham and Women's Hospital, Harvard Medical, School, Boston, MA 02115, USA
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42
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Eftekhar E, Hajirahimkhan A, Taghizadeh Afshari A, Nourooz-Zadeh J. Plasma glutathione peroxidase activity in kidney recipients with and without adverse outcome. Ren Fail 2012; 34:628-33. [PMID: 22563921 DOI: 10.3109/0886022x.2012.669321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Kidney function is routinely monitored utilizing classic biochemical parameters including serum or plasma creatinine (Cr), and blood urea nitrogen (BUN) concentrations. This study demonstrates that the simultaneous assessment of plasma glutathione peroxidase (pGPx) and Cr levels provides a better strategy for the immediate follow-up of kidney function in organ recipients. Kidney recipients (Krs; n = 22) were recruited. Blood sampling schedule commenced at day 1 (pre-transplantation) and post-transplantation days (i.e., everyday from 1 until day 14, and thereafter on days 21, 28, 35, 42, 49, and 56). pGPx was measured spectrophotometrically. Candidates for transplantation exhibited lower pGPx than control subjects (42 ± 24 vs. 143 ± 31 U/L; p < 0.005). In Krs with a stable post-transplant outcome, pGPx increased to a maximum at day 28 (214 ± 61 U/L). In a Kr diagnosed with acute tubulonecrosis, pGPx provided a better predictive value (threefold increase) than Cr. In a Kr diagnosed with acute rejection, the increment in Cr values was found to be more pronounced than in pGPx values. The pGPx test is simple, inexpensive and automatable, and should be a valuable diagnostic tool of kidney function in organ recipients with and without troublesome outcome for the follow-up during hospitalization period.
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Affiliation(s)
- Ebrahim Eftekhar
- Department of Biochemistry, Shiraz University of Medical Sciences, Shiraz, Iran
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Abstract
Acute kidney injury occurs with kidney transplantation and too frequently progresses to the clinical diagnosis of delayed graft function (DGF). Poor kidney function in the first week of graft life is detrimental to the longevity of the allograft. Challenges to understand the root cause of DGF include several pathologic contributors derived from the donor (ischemic injury, inflammatory signaling) and recipient (reperfusion injury, the innate immune response and the adaptive immune response). Progressive demand for renal allografts has generated new organ categories that continue to carry high risk for DGF for deceased donor organ transplantation. New therapies seek to subdue the inflammatory response in organs with high likelihood to benefit from intervention. Future success in suppressing the development of DGF will require a concerted effort to anticipate and treat tissue injury throughout the arc of the transplantation process.
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Affiliation(s)
- Andrew Siedlecki
- Nephrology Division, Department of Internal Medicine, Washington University in St. Louis School of Medicine, St Louis, MO
| | - William Irish
- CTI, Clinical Trial and Consulting Services, Raleigh, NC
| | - Daniel C. Brennan
- Nephrology Division, Department of Internal Medicine, Washington University in St. Louis School of Medicine, St Louis, MO
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Ma LL, Li G, Huang Y, Hou XF, Zhao L, Wang GL, Tang WH, Chen YT. Do multiple renal arteries in the remnant kidney have a negative influence on kidney donors after kidney donation? Nephrology (Carlton) 2011; 16:612-6. [PMID: 21676070 DOI: 10.1111/j.1440-1797.2011.01485.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To investigate whether the presence of multiple renal arteries in the remnant kidney has implications for lower renal function or increased incidence of hypertension. METHODS We reviewed the intraoperative and follow-up data of 101 live kidney donors who underwent nephrectomies at our institution. Sixty-nine donors (68.3%) had single artery in the remnant kidney (Group A), while 32 donors (31.7%) had multiple renal arteries in the remnant kidney (Group B). We compared the demographic and intraoperative data between the two groups. The follow-up data of donors in each group were divided into three subgroups based on the length of the follow-up period (12-24 months, 24-48 months and ≥48 months). Subgroups were created based on blood pressure and serum creatinine level. The δblood pressure (follow-up blood pressure minus preoperative blood pressure) and δserum creatinine (follow-up serum creatinine minus preoperative serum creatinine) in each subgroup in Group A were compared with the counterparts in Group B. RESULTS Renal arterial stenosis and calcification of renal arterial wall were not observed in all donors. There were no significant differences in the intraoperative characteristics (e.g. age, body mass index, operative duration and estimated blood loss) between the two groups. In addition, the blood pressure and serum creatinine level among subgroups within each group were similar. Furthermore, significant differences in δblood pressure and δserum creatinine were not observed between subgroups within the same follow-up period. Recipient survival rate and serum creatinine level were similar and acceptable in both groups. CONCLUSIONS The presence of multiple renal arteries in the remnant kidney does not have additional negative influence on kidney donors after kidney donation.
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Affiliation(s)
- Lu-Lin Ma
- Department of Urology, Peking University Third Hospital, Beijing, China
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Zhang SJ, Wang T. The influence of brain death on donor liver and the potential mechanisms of protective intervention. Front Med 2011. [PMID: 21681669 DOI: 10.1007/s11684-011-0109-yr] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Brain-dead donors have become one of the main sources of organs for transplantation in Western countries. The quality of donor organs is closely related to the outcome of the transplantation. Experimental studies have confirmed the inferior graft survival of livers from brain-dead donors compared with those from living donors. Studies conducted in the past 10 years have shown that brain death is associated with effects on the decreased donor organ quality. However, whether the decrease in the viability of donor organs is caused by brain death or by the events before and after brain death remains uncertain. The purpose of this review is to introduce the advances and controversies regarding the influence of brain death on the viability of donor livers and to summarize the mechanisms of the different protective interventions for donor livers.
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Affiliation(s)
- Shui-Jun Zhang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
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The influence of brain death on donor liver and the potential mechanisms of protective intervention. Front Med 2011; 5:8-14. [PMID: 21681669 DOI: 10.1007/s11684-011-0109-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 12/28/2010] [Indexed: 10/17/2022]
Abstract
Brain-dead donors have become one of the main sources of organs for transplantation in Western countries. The quality of donor organs is closely related to the outcome of the transplantation. Experimental studies have confirmed the inferior graft survival of livers from brain-dead donors compared with those from living donors. Studies conducted in the past 10 years have shown that brain death is associated with effects on the decreased donor organ quality. However, whether the decrease in the viability of donor organs is caused by brain death or by the events before and after brain death remains uncertain. The purpose of this review is to introduce the advances and controversies regarding the influence of brain death on the viability of donor livers and to summarize the mechanisms of the different protective interventions for donor livers.
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Kim EJ, Kwon OJ. The Graft Outcomes of Living Donor Renal Transplantation according to Gender, Age, and BMI Matching between Donors and Recipients. KOREAN JOURNAL OF TRANSPLANTATION 2010. [DOI: 10.4285/jkstn.2010.24.3.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Eun Jin Kim
- Department of Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Oh Jung Kwon
- Department of Surgery, Hanyang University College of Medicine, Seoul, Korea
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Urinary soluble HLA-DR is a potential biomarker for acute renal transplant rejection. Transplantation 2010; 89:1071-8. [PMID: 20098353 DOI: 10.1097/tp.0b013e3181d15492] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND.: Urine is a potentially rich source of biomarkers for monitoring kidney dysfunction. In this study, we have investigated the potential of soluble human leukocyte antigen (sHLA)-DR in the urine for noninvasive monitoring of renal transplant patients. METHODS.: Urinary soluble HLA-DR levels were measured by sandwich enzyme-linked immunosorbent assay in 103 patients with renal diseases or after renal transplantation. sHLA-DR in urine was characterized by Western blotting and mass spectrometry. RESULTS.: Acute graft rejection was associated with a significantly elevated level of urinary sHLA-DR (P<0.0001), compared with recipients with stable graft function or healthy individuals. A receiver operating characteristic curve analysis showed the area under the curve to be 0.88 (P<0.001). At a selected threshold, the sensitivity was 80% and specificity was 98% for detection of acute renal transplant rejection. sHLA-DR was not exosomally associated and was of lower molecular weight compared with the HLA-DR expressed as heterodimer on the plasma membrane of antigen-presenting cells. CONCLUSIONS.: sHLA-DR excreted into urine is a promising indicator of renal transplant rejection.
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49
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Singhal AK, Sheng X, Drakos SG, Stehlik J. Impact of donor cause of death on transplant outcomes: UNOS registry analysis. Transplant Proc 2010; 41:3539-44. [PMID: 19917340 DOI: 10.1016/j.transproceed.2009.06.192] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Accepted: 06/03/2009] [Indexed: 11/30/2022]
Abstract
Donor cause of death (DCOD) has been described to influence allograft survival. Whether this effect is independent of other donor characteristics and whether it is similar across different solid organ allografts is not known. The aim of our study was to determine the impact of DCOD on organ utilization and on transplantation outcomes-graft rejection, function, and survival. The registry data were provided by the United Network for Organ Sharing/Organ Procurement and Transplantation Network. Stroke, head trauma, and anoxia were the cause of brain death in 97% of the more than 86,000 donors whose data were recorded between 1989 and 2008. In univariate analysis, stroke DCOD was associated with worse graft survival across all organs. After adjustment in a multivariable analysis, modest differences persisted in survival of heart, kidney, and liver allografts. DCOD also appeared to affect the incidence of allograft rejection. Anoxia DCOD was associated with significantly less rejection relative to donor death caused by head trauma and stroke. In summary, this multi-institutional study confirms that DCOD is a modest predictor of survival and rejection of solid organ allografts of different types.
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Affiliation(s)
- A K Singhal
- Department of Surgery, University of Utah, Salt Lake City, Utah, USA
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50
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Muerte encefálica: repercusión sobre órganos y tejidos. Med Intensiva 2009; 33:434-41. [DOI: 10.1016/j.medin.2009.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Revised: 02/26/2009] [Accepted: 03/05/2009] [Indexed: 11/21/2022]
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