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Ichinose K, Sato S, Igawa T, Okamoto M, Takatani A, Endo Y, Tsuji S, Shimizu T, Sumiyoshi R, Koga T, Kawashiri SY, Iwamoto N, Tamai M, Nakamura H, Origuchi T, Yajima N, Sada KE, Miyawaki Y, Yoshimi R, Shimojima Y, Ohno S, Kajiyama H, Sato S, Fujiwara M, Kawakami A. Evaluating the safety profile of calcineurin inhibitors: cancer risk in patients with systemic lupus erythematosus from the LUNA registry-a historical cohort study. Arthritis Res Ther 2024; 26:48. [PMID: 38347556 PMCID: PMC10860233 DOI: 10.1186/s13075-024-03285-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/03/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Previous studies have shown conflicting evidence regarding the incidence of cancer in patients with systemic lupus erythematosus (SLE) compared with that in healthy individuals. Calcineurin inhibitors (CNIs) such as cyclosporine and tacrolimus have been widely used to treat SLE; however, their effects on cancer risk remain unclear. We aimed to investigate the incidence of cancer in patients with SLE and determine the potential association between CNI use and cancer risk. METHODS The standardized incidence ratio (SIR) of cancer among patients with lupus in the Lupus Registry of Nationwide Institutions (LUNA) was calculated based on the age-standardized incidence rate of cancer reported by Japan's Ministry of Health, Labour and Welfare. We also examined the association between CNI exposure and cancer risk, while considering potential confounding factors. The analysis accounted for confounding variables such as age, sex, smoking history, maximum glucocorticoid dose, treatment history with cyclophosphamide, ongoing hydroxychloroquine, Systemic Lupus International Collaboration Clinics/American College of Rheumatology Damage Index (SDI) value (excluding cancer occurrence), comorbidity of diabetes mellitus, and smoking history. RESULTS The study included 704 patients with SLE (625 females; 88.8%) with a median age of 44 years [interquartile range (IQR) = 34-55] years. The median past maximum glucocorticoid dose was 40 mg/day [IQR = 30-60 mg/day], and the SDI at registration was 1 [IQR = 0-2]. Among the patients, 246 (35.1%) had smoking histories, and 38 (5.4%) experienced cancer complications. Gynecological malignancies accounted for 63.2% of all cancers. The SIR of cancer in the LUNA cohort was 1.08 (95% confidence interval [CI] = 0.74-1.43). No statistically significant risks of cancer were found in relation to CNI treatment history; the odds ratio using multiple logistic regression was 1.12 (95% CI = 0.42-3.00), the risk ratio using standardization was 1.18 (95% CI = 0.47-2.16), and the risk ratio using inverse probability weighting was 1.8 (95% CI = 0.41-4.66). CONCLUSIONS The incidence of cancer in patients with SLE in the LUNA cohort did not significantly differ from that in the general population. These findings suggest that CNI treatment in this cohort did not pose a risk factor for cancer development.
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Affiliation(s)
- Kunihiro Ichinose
- Department of Immunology and Rheumatology, Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
- Department of Rheumatology, Shimane University Faculty of Medicine, 89-1 Enya-Cho, Izumo, 693-8501, Japan.
| | - Shuntaro Sato
- Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Takashi Igawa
- Department of Immunology and Rheumatology, Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Momoko Okamoto
- Department of Immunology and Rheumatology, Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Ayuko Takatani
- Department of Immunology and Rheumatology, Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yushiro Endo
- Department of Immunology and Rheumatology, Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Sosuke Tsuji
- Department of Immunology and Rheumatology, Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Toshimasa Shimizu
- Department of Immunology and Rheumatology, Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Remi Sumiyoshi
- Department of Immunology and Rheumatology, Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Tomohiro Koga
- Department of Immunology and Rheumatology, Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Shin-Ya Kawashiri
- Department of Immunology and Rheumatology, Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Naoki Iwamoto
- Department of Immunology and Rheumatology, Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Mami Tamai
- Department of Immunology and Rheumatology, Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Hideki Nakamura
- Department of Medicine, Division of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Tomoki Origuchi
- Department of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Nobuyuki Yajima
- Department of Internal Medicine, Division of Rheumatology, Showa University School of Medicine, Shinagawa-Ku, Tokyo, Japan
| | - Ken-Ei Sada
- Department of Clinical Epidemiology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Yoshia Miyawaki
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ryusuke Yoshimi
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yasuhiro Shimojima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
| | - Shigeru Ohno
- Center for Rheumatic Diseases, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiroshi Kajiyama
- Department of Rheumatology and Applied Immunology Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Shuzo Sato
- Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Michio Fujiwara
- Department of Rheumatology, Yokohama Rosai Hospital, Yokohama, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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Shimoji K, Nakashima T, Masuda T, Namba M, Sakamoto S, Yamaguchi K, Horimasu Y, Mimae T, Miyamoto S, Iwamoto H, Fujitaka K, Hamada H, Okada M, Hattori N. Hypoxia-inducible factor 1α modulates interstitial pneumonia-mediated lung cancer progression. J Transl Med 2023; 21:857. [PMID: 38012636 PMCID: PMC10680219 DOI: 10.1186/s12967-023-04756-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/24/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND The prognosis of patients with lung cancer accompanied by interstitial pneumonia is poorer than that of patients with lung cancer but without interstitial pneumonia. Moreover, the available therapeutic interventions for lung cancer patients with interstitial pneumonia are limited. Therefore, a new treatment strategy for these patients is required. The aim of the present study was to investigate the pathophysiological relationship between interstitial pneumonia and lung cancer and explore potential therapeutic agents. METHODS A novel hybrid murine model of lung cancer with interstitial pneumonia was established via bleomycin-induced pulmonary fibrosis followed by orthotopic lung cancer cell transplantation into the lungs. Changes in tumor progression, lung fibrosis, RNA expression, cytokine levels, and tumor microenvironment in the lung cancer with interstitial pneumonia model were investigated, and therapeutic agents were examined. Additionally, clinical data and samples from patients with lung cancer accompanied by interstitial pneumonia were analyzed to explore the potential clinical significance of the findings. RESULTS In the lung cancer with interstitial pneumonia model, accelerated tumor growth was observed based on an altered tumor microenvironment. RNA sequencing analysis revealed upregulation of the hypoxia-inducible factor 1 signaling pathway. These findings were consistent with those obtained for human samples. Moreover, we explored whether ascorbic acid could be an alternative treatment for lung cancer with interstitial pneumonia to avoid the disadvantages of hypoxia-inducible factor 1 inhibitors. Ascorbic acid successfully downregulated the hypoxia-inducible factor 1 signaling pathway and inhibited tumor progression and lung fibrosis. CONCLUSIONS The hypoxia-inducible factor 1 pathway is critical in lung cancer with interstitial pneumonia and could be a therapeutic target for mitigating interstitial pneumonia-mediated lung cancer progression.
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Affiliation(s)
- Kiyofumi Shimoji
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Taku Nakashima
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Takeshi Masuda
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Masashi Namba
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shinjiro Sakamoto
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kakuhiro Yamaguchi
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yasushi Horimasu
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Takahiro Mimae
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Shintaro Miyamoto
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hiroshi Iwamoto
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kazunori Fujitaka
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hironobu Hamada
- Department of Physical Analysis and Therapeutic Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Noboru Hattori
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Rousset-Jablonski C, Dalon F, Reynaud Q, Lemonnier L, Dehillotte C, Jacoud F, Berard M, Viprey M, Van Ganse E, Durieu I, Belhassen M. Cancer incidence and prevalence in cystic fibrosis patients with and without a lung transplant in France. Front Public Health 2022; 10:1043691. [PMID: 36483264 PMCID: PMC9723348 DOI: 10.3389/fpubh.2022.1043691] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/28/2022] [Indexed: 11/23/2022] Open
Abstract
Background Cystic fibrosis (CF) care and the life expectancy of affected patients have substantially improved in recent decades, leading to an increased number of patients being diagnosed with comorbidities, including cancers. Our objective was to characterize the epidemiology of cancers between 2006 and 2017 in CF patients with and without a lung transplant. Methods Medical records of CF patients from 2006 to 2016 in the French CF Registry were linked to their corresponding claims data (SNDS). The annual prevalence and incidence rates of cancers were estimated from 2006 to 2017 in CF patients without lung transplant and in those with lung transplant after transplantation. Results Of the 7,671 patients included in the French CF Registry, 6,187 patients (80.7%) were linked to the SNDS; among them, 1,006 (16.3%) received a lung transplant. The prevalence of any cancer increased between 2006 and 2017, from 0.3 to 1.0% and from 1.3 to 6.3% in non-transplanted and transplanted patients, respectively. When compared to the general population, the incidence of cancer was significantly higher in both non-transplanted [Standardized Incidence Ratio (SIR) = 2.57, 95%CI 2.05 to 3.17] and transplanted (SIR = 19.76, 95%CI 16.45 to 23.55) patients. The median time between transplant and the first cancer was 3.9 years. Among the 211 incident cancer cases, the most frequent malignant neoplasms were skin neoplasm (48 cases), lung cancers (31 cases), gastro-intestinal (24 cases), and hematologic cancers (17 cases). Conclusion The overall burden of cancer in CF patients is high, particularly following lung transplantation. Therefore, specific follow-up, screening and cancer prevention for CF patients with transplants are necessary.
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Affiliation(s)
- Christine Rousset-Jablonski
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France,Department of Internal Medicine, Cystic Fibrosis Center, Hospices Civils de Lyon, Groupe Hospitalier Sud, Lyon, France,Département de chirurgie, Centre Léon Bérard, Lyon, France,*Correspondence: Christine Rousset-Jablonski
| | | | - Quitterie Reynaud
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France,Department of Internal Medicine, Cystic Fibrosis Center, Hospices Civils de Lyon, Groupe Hospitalier Sud, Lyon, France
| | | | | | - Flore Jacoud
- PELyon, PharmacoEpidemiologie Lyon, Lyon, France
| | | | - Marie Viprey
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France,Health Data Department, Hospices Civils de Lyon, Lyon, France
| | - Eric Van Ganse
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France,PELyon, PharmacoEpidemiologie Lyon, Lyon, France,Respiratory Medicine, Croix-Rousse University Hospital, Lyon, France
| | - Isabelle Durieu
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France,Department of Internal Medicine, Cystic Fibrosis Center, Hospices Civils de Lyon, Groupe Hospitalier Sud, Lyon, France
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Inoue S, Shioya A, Kunii K, Suga K, Morita N, Chikazawa I, Tanaka T, Miyazawa K. Recurrence of renal cell carcinoma after simultaneous radical nephrectomy and cadaver renal transplant. IJU Case Rep 2022; 5:397-400. [PMID: 36090937 PMCID: PMC9436674 DOI: 10.1002/iju5.12499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 06/02/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Shinya Inoue
- Department of Urology Kanazawa Medical University Uchinada Ishikawa Japan
| | - Akihiro Shioya
- Department of Pathology and Laboratory Medicine Kanazawa Medical University Uchinada Ishikawa Japan
| | - Kenshirou Kunii
- Department of Urology Kanazawa Medical University Uchinada Ishikawa Japan
| | - Kodai Suga
- Department of Urology Kanazawa Medical University Uchinada Ishikawa Japan
| | - Nobuyo Morita
- Department of Urology Kanazawa Medical University Uchinada Ishikawa Japan
| | - Ippei Chikazawa
- Department of Urology Kanazawa Medical University Uchinada Ishikawa Japan
| | - Tatsuro Tanaka
- Department of Urology Kanazawa Medical University Uchinada Ishikawa Japan
| | - Katsuhito Miyazawa
- Department of Urology Kanazawa Medical University Uchinada Ishikawa Japan
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5
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Current Knowledge of Immunosuppression as a Risk Factor for Skin Cancer Development. Crit Rev Oncol Hematol 2022; 177:103754. [DOI: 10.1016/j.critrevonc.2022.103754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 06/27/2022] [Accepted: 07/02/2022] [Indexed: 11/23/2022] Open
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Shen Y, Lian D, Shi K, Gao Y, Hu X, Yu K, Zhao Q, Feng C. Cancer Risk and Mutational Patterns Following Organ Transplantation. Front Cell Dev Biol 2022; 10:956334. [PMID: 35837331 PMCID: PMC9274140 DOI: 10.3389/fcell.2022.956334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/13/2022] [Indexed: 12/24/2022] Open
Abstract
The rapid development of medical technology and widespread application of immunosuppressive drugs have improved the success rate of organ transplantation significantly. However, the use of immunosuppressive agents increases the frequency of malignancy greatly. With the prospect of “precision medicine” for tumors and development of next-generation sequencing technology, more attention has been paid to the application of high-throughput sequencing technology in clinical oncology research, which is mainly applied to the early diagnosis of tumors and analysis of tumor-related genes. All generations of cancers carry somatic mutations, meanwhile, significant differences were observed in mutational signatures across tumors. Systematic sequencing of cancer genomes from patients after organ transplantation can reveal DNA damage and repair processes in exposed cancer cells and their precursors. In this review, we summarize the application of high-throughput sequencing and organoids in the field of organ transplantation, the mutational patterns of cancer genomes, and propose a new research strategy for understanding the mechanism of cancer following organ transplantation.
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Affiliation(s)
- Yangyang Shen
- College of Animal Science and Technology, Nanjing Agricultural University, Nanjing, China
| | - Di Lian
- State Key Laboratory of Agrobiotechnology, College of Biological Sciences, China Agricultural University, Beijing, China
| | - Kai Shi
- College of Animal Science and Technology, Nanjing Agricultural University, Nanjing, China
| | - Yuefeng Gao
- College of Applied Engineering, Henan University of Science and Technology, Sanmenxia, China
- Sanmenxia Polytechnic, Sanmenxia, China
| | - Xiaoxiang Hu
- State Key Laboratory of Agrobiotechnology, College of Biological Sciences, China Agricultural University, Beijing, China
| | - Kun Yu
- College of Animal Science and Technology, China Agricultural University, Beijing, China
- *Correspondence: Kun Yu, ; Qian Zhao, ; Chungang Feng,
| | - Qian Zhao
- College of Animal Science and Technology, Nanjing Agricultural University, Nanjing, China
- *Correspondence: Kun Yu, ; Qian Zhao, ; Chungang Feng,
| | - Chungang Feng
- College of Animal Science and Technology, Nanjing Agricultural University, Nanjing, China
- *Correspondence: Kun Yu, ; Qian Zhao, ; Chungang Feng,
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Gitto S, Magistri P, Marzi L, Mannelli N, De Maria N, Mega A, Vitale G, Valente G, Vizzutti F, Villa E, Marra F, Andreone P, Falcini M, Catellani B, Guerrini GP, Serra V, Di Sandro S, Ballarin R, Piai G, Schepis F, Margotti M, Cursaro C, De Simone P, Petruccelli S, Carrai P, Forte P, Campani C, Zoller H, Di Benedetto F. Predictors of solid extra-hepatic non-skin cancer in liver transplant recipients and analysis of survival: A long-term follow-up study. Ann Hepatol 2022; 27:100683. [PMID: 35151902 DOI: 10.1016/j.aohep.2022.100683] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/02/2022] [Accepted: 02/02/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES De novo malignancies represent an important cause of death for liver transplant recipients. Our aim was to analyze predictors of extra-hepatic non-skin cancer (ESNSC) and the impact of ESNSC on the long-term outcome. PATIENTS We examined data from patients transplanted between 2000 and 2005 and followed-up in five Italian transplant clinics with a retrospective observational cohort study. Cox Regression was performed to identify predictors of ESNSC. A 1:2 cohort sub-study was developed to analyze the impact of ESNSC on 10-year survival. RESULTS We analyzed data from 367 subjects (median follow-up: 15 years). Patients with ESNSC (n = 47) more often developed post-LT diabetes mellitus (DM) (57.4% versus 35,9%, p = 0.004). At multivariate analysis, post-LT DM independently predicted ESNSC (HR 1.929, CI 1.029-3.616, p = 0.040). Recipients with ESNSC showed a lower 10-year survival than matched controls (46,8% versus 68,1%, p = 0.023). CONCLUSIONS Post-LT DM seems to be a relevant risk factor for post-LT ESNSC. ESNSC could have a noteworthy impact on the long-term survival of LT recipients.
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Affiliation(s)
- Stefano Gitto
- Internal Medicine and Liver Unit, Department of Experimental and Clinical Medicine, University Hospital Careggi, University of Florence, Largo Brambilla 3, Florence 50134, Italy.
| | - Paolo Magistri
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Marzi
- Division of Gastroenterology, Bolzano Regional Hospital, Bolzano, Italy
| | - Nicolò Mannelli
- Internal Medicine and Liver Unit, Department of Experimental and Clinical Medicine, University Hospital Careggi, University of Florence, Largo Brambilla 3, Florence 50134, Italy
| | - Nicola De Maria
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Mega
- Division of Gastroenterology, Bolzano Regional Hospital, Bolzano, Italy
| | | | - Giovanna Valente
- Liver Unit for Transplant Management - SATTE, Department of Medical Sciences, AORN Sant'Anna e San Sebastiano, Caserta, Italy
| | - Francesco Vizzutti
- Internal Medicine and Liver Unit, Department of Experimental and Clinical Medicine, University Hospital Careggi, University of Florence, Largo Brambilla 3, Florence 50134, Italy
| | - Erica Villa
- Department of Gastroenterology, Azienda Ospedaliero-Universitaria di Modena and University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Marra
- Internal Medicine and Liver Unit, Department of Experimental and Clinical Medicine, University Hospital Careggi, University of Florence, Largo Brambilla 3, Florence 50134, Italy
| | - Pietro Andreone
- Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Italy; Internal and Metabolic Medicine, AOU di Modena and University of Modena and Reggio Emilia, Italy
| | - Margherita Falcini
- Internal Medicine and Liver Unit, Department of Experimental and Clinical Medicine, University Hospital Careggi, University of Florence, Largo Brambilla 3, Florence 50134, Italy
| | - Barbara Catellani
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Gian Piero Guerrini
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Valentina Serra
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Di Sandro
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto Ballarin
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Guido Piai
- Liver Unit for Transplant Management - SATTE, Department of Medical Sciences, AORN Sant'Anna e San Sebastiano, Caserta, Italy
| | - Filippo Schepis
- Department of Gastroenterology, Azienda Ospedaliero-Universitaria di Modena and University of Modena and Reggio Emilia, Modena, Italy
| | - Marzia Margotti
- Internal and Metabolic Medicine, AOU di Modena and University of Modena and Reggio Emilia, Italy
| | - Carmela Cursaro
- Internal and Metabolic Medicine, AOU di Modena and University of Modena and Reggio Emilia, Italy
| | - Paolo De Simone
- Hepatobiliary Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy
| | - Stefania Petruccelli
- Hepatobiliary Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy
| | - Paola Carrai
- Hepatobiliary Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy
| | - Paolo Forte
- Gastroenterology Unit, University Hospital Careggi, Florence, Italy
| | - Claudia Campani
- Gastroenterology Unit, University Hospital Careggi, Florence, Italy
| | - Heinz Zoller
- Department of Medicine I, Medical University of Innsbruck, Austria
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
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8
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Lucidi C, Biolato M, Lai Q, Lattanzi B, Lenci I, Milana M, Lionetti R, Liguori A, Angelico M, Tisone G, Avolio AW, Agnes S, Rossi M, Grieco A, Merli M. Cumulative incidence of solid and hematological De novo malignancy after liver transplantation in a multicentre cohort. Ann Hepatol 2022; 24:100309. [PMID: 33482364 DOI: 10.1016/j.aohep.2021.100309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/16/2020] [Accepted: 12/16/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Recent innovations in the field of liver transplantation have led to a wealth of new treatment regimes, with potential impact on the onset of de novo malignancies (DNM). The aim of this multicenter cohort study was to provide contemporary figures for the cumulative incidences of solid and hematological DNM after liver transplantation. METHODS We designed a retrospective cohort study including patients undergoing LT between 2000 and 2015 in three Italian transplant centers. Cumulative incidence was calculated by Kaplan-Meyer analysis. RESULTS The study included 789 LT patients with a median follow-up of 81 months (IQR: 38-124). The cumulative incidence of non-cutaneous DNM was 6.2% at 5-years, 11.6% at 10-years and 16.3% at 15-years. Post-Transplant Lymphoproliferative Disorders (PTLD) were demonstrated to have a cumulative incidence of 1.0% at 5-years, 1.6% at 10-years and 2.2% at 15-years. Solid Organ Tumors (SOT) demonstrated higher cumulative incidences - 5.3% at 5-years, 10.3% at 10-years and 14.4% at 15-years. The most frequently observed classifications of SOT were lung (rate 1.0% at 5-years, 2.5% at 10-years) and head & neck tumors (rate 1.3% at 5-years, 1.9% at 10-years). CONCLUSIONS Lung tumors and head & neck tumors are the most frequently observed SOT after LT.
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Affiliation(s)
- Cristina Lucidi
- Gastroenterology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Marco Biolato
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
| | - Quirino Lai
- Hepato-biliopancreatic and Liver Transplant Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Barbara Lattanzi
- Gastroenterology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Ilaria Lenci
- Hepatology Unit, Department of Experimental Medicine and Surgery, Tor Vergata University Hospital, Rome, Italy
| | - Martina Milana
- Hepatology Unit, Department of Experimental Medicine and Surgery, Tor Vergata University Hospital, Rome, Italy
| | - Raffaella Lionetti
- Infectious and Liver Diseases, Lazzaro Spallanzani National Infectious Disease Institute, Rome, Italy
| | | | - Mario Angelico
- Hepatology Unit, Department of Experimental Medicine and Surgery, Tor Vergata University Hospital, Rome, Italy
| | - Giuseppe Tisone
- Surgery Unit, Department of Experimental Medicine and Surgery, Tor Vergata University Hospital, Rome, Italy
| | - Alfonso Wolfango Avolio
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
| | - Salvatore Agnes
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
| | - Massimo Rossi
- Hepato-biliopancreatic and Liver Transplant Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Antonio Grieco
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
| | - Manuela Merli
- Gastroenterology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
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9
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Abstract
Benefits of solid organ transplantation in end stage organ diseases are indisputable. Malignancy is a feared complication of solid organ transplantation and is a leading cause of mortality in patients with organ transplantation. Iatrogenic immunosuppression to prevent graft rejection plays a crucial role in the cancer development in solid organ transplant recipients. Chronic exposure to immunosuppression increases the malignancy burden through deregulation of host immune defense mechanisms and unchecked proliferation of oncogenic viruses and malignancies associated with these viruses. Vigorous screening of candidates undergoing transplant evaluation for malignancies, careful assessment of donors, and vigilant monitoring of transplant recipients are necessary to prevent, detect, and manage this life-threatening complication.
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10
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Daniel L, Tassery M, Lateur C, Thierry A, Herbelin A, Gombert JM, Barbarin A. Allotransplantation Is Associated With Exacerbation of CD8 T-Cell Senescence: The Particular Place of the Innate CD8 T-Cell Component. Front Immunol 2021; 12:674016. [PMID: 34367138 PMCID: PMC8334557 DOI: 10.3389/fimmu.2021.674016] [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: 02/28/2021] [Accepted: 06/30/2021] [Indexed: 12/21/2022] Open
Abstract
Immunosenescence is a physiological process that is associated with changes in the immune system, particularly among CD8 T-cells. Recent studies have hypothesized that senescent CD8 T-cells are produced with chronologic age by chronic stimulation, leading to the acquisition of hallmarks of innate-like T-cells. While conventional CD8 T-cells are quite well characterized, CD8 T-cells sharing features of NK cells and memory CD8 T-cells, are a newly described immune cell population. They can be distinguished from conventional CD8 T-cells by their combined expression of panKIR/NKG2A and Eomesodermin (E), a unique phenotype closely associated with IFN-γ production in response to innate stimulation. Here, we first provided new evidence in favor of the innate character of panKIR/NKG2A(+) E(+) CD8 T-cells in normal subjects, documenting their position at an intermediate level in the innateness gradient in terms of both innate IFN-γ production and diminished mitochondrial mass. We also revealed that CD8 E(+) panKIR/NKG2A(+) T-cells, hereafter referred to as Innate E(+) CD8 T-cells, exhibit increased senescent (CD27(-) CD28(-)) phenotype, compared to their conventional memory counterparts. Surprisingly, this phenomenon was not dependent on age. Given that inflammation related to chronic viral infection is known to induce NK-like marker expression and a senescence phenotype among CD8 T-cells, we hypothesized that innate E(+) CD8 T-cells will be preferentially associated with exacerbated cellular senescence in response to chronic alloantigen exposure or CMV infection. Accordingly, in a pilot cohort of stable kidney allotransplant recipients, we observed an increased frequency of the Innate E(+) CD8 T-cell subset, together with an exacerbated senescent phenotype. Importantly, this phenotype cannot be explained by age alone, in clear contrast to their conventional memory counterparts. The senescent phenotype in CD8 T-cells was further increased in cytomegalovirus (CMV) positive serology transplant recipients, suggesting that transplantation and CMV, rather than aging by itself, may promote an exacerbated senescent phenotype of innate CD8 T-cells. In conclusion, we proposed that kidney transplantation, via the setting of inflammatory stimuli of alloantigen exposure and CMV infection, may exogenously age the CD8 T-cell compartment, especially its innate component. The physiopathological consequences of this change in the immune system remain to be elucidated.
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Affiliation(s)
- Lauren Daniel
- Inserm U1082, Poitiers, France.,Université de Poitiers, Poitiers, France
| | - Marion Tassery
- Service de Néphrologie, Hémodialyse et Transplantation, CHU de Poitiers, Poitiers, France
| | - Clara Lateur
- Service d'Immunologie et Inflammation, CHU de Poitiers, Poitiers, France
| | - Antoine Thierry
- Inserm U1082, Poitiers, France.,Université de Poitiers, Poitiers, France.,Service de Néphrologie, Hémodialyse et Transplantation, CHU de Poitiers, Poitiers, France
| | - André Herbelin
- Inserm U1082, Poitiers, France.,Université de Poitiers, Poitiers, France
| | - Jean-Marc Gombert
- Inserm U1082, Poitiers, France.,Université de Poitiers, Poitiers, France.,Service d'Immunologie et Inflammation, CHU de Poitiers, Poitiers, France
| | - Alice Barbarin
- Inserm U1082, Poitiers, France.,CHU de Poitiers, Poitiers, France
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11
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Abstract
In liver transplant patients, solid tumors and post-transplant lymphoproliferative disorders (PTLD) have emerged as significant long-term mortality causes. Additionally, it is assumed that de novo malignancy (DNM) after liver transplantation (LT) is the second-leading cause of death after cardiovascular complications. Well-established risk factors for PTLD and solid tumors are calcineurin inhibitors (CNIs), tacrolimus (TAC), and cyclosporine, the cornerstones of all immunosuppressive (IS) therapies used after LT. The loss of immunocompetence facilitated by the host immune system due to prolonged IS therapy leads to cancer development, including in LT patients. Hindering DNA repair mechanisms, promoting tumor cell invasiveness, and hampering apoptosis are critical events in tumorigenesis and tumor growth in LT patients resulting from IS administration. This paper aims to overview the refined mechanisms of IS-induced tumorigenesis after LT and the loss of immunocompetence facilitated by the host immune system due to prolonged IS therapy. In addition, we also discuss in detail the mechanisms of action in different types of IS regimen used after LT, and their putative effect on DNM.
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12
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Association of HLA mismatch and MTOR inhibitor regimens with malignancy and mortality after kidney transplantation. Transpl Immunol 2021; 66:101391. [PMID: 33838299 DOI: 10.1016/j.trim.2021.101391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/28/2021] [Accepted: 04/04/2021] [Indexed: 01/20/2023]
Abstract
Background The association of mammalian target of rapamycin inhibitors (MTORI) with malignancies and mortality in kidney transplant recipients (KTR) with different degrees of human leukocyte antigen mismatch (HLA-mm) at transplant has not been previously studied. Methods Our observational cohort study included 166, 256 adult KTRs in 2000-2018. Immunosuppression in the first post-transplant year were MTORIs in 13,056 (7.85%) and non-MTORIs in 153,200 (92.15%). We used Cox multivariable regression models to determine the cause-specific hazard ratio (HRcs) of non-melanoma skin cancer (NMSC),solid organ malignancies (SOM)] and all-cause death (deathac); and the HR of the composite outcomes of NMSC or deathac and SOM or deathac associated with MTORI versus non-MTORI regimens in the overall study sample and the 0, 1-3, and 4-6 HLA-A, B and DR mm subgroups. Results NMSC risk was lower with MTORI than non-MTORI in all HLA-mm subgroups [(0 mm, HRcs = 0.67; 95% CI = 0.46-0.97, 1-3 mm, HRcs = 0.73; 95% CI = 0.61-0.87, 4-6 mm, HRcs = 0.69; 95% CI = 0.62-0.76)]. SOM risks were similar between regimens in the 0 HLA mm subgroup (HRcs = 1.10 (95% CI = 0.78-1.57) and lower with MTORI than non-MTORI in the 1-3, and 4-6 HLA-mm subgroups, [(HR = 0.84; (95% CI = 0.71-0.99), and (HR = 0.86; 95% CI = 0.78-0.94); respectively]. Risks of deathac and composite outcomes (NMSC or deathac and SOM or deathac) were higher with MTORI than non-MTORI in almost all HLA-mm subgroups. Conclusion MTORIs are associated with protection from NMSC and SOM in almost all HLA-mm subgroups ca; however, their association with increased all-cause mortality in adult kidney transplant recipients needs further investigation.
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13
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Ishikawa G, Sugiyama T, Ito T, Otsuka A, Miyake H. Renal allograft rejection after treatment with nivolumab in patients with metastatic renal cell carcinoma. Int Cancer Conf J 2021; 10:116-118. [PMID: 33786286 DOI: 10.1007/s13691-020-00458-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/14/2020] [Indexed: 11/24/2022] Open
Abstract
In recent years, immune checkpoint inhibitors (ICIs), such as nivolumab, pembrolizumab and ipilimumab, have been introduced into routine clinical practice for treating patients with several types of advanced cancer, including renal cell carcinoma (RCC). However, activation of the immune system against cancer cells by the use of ICIs could result in the induction of allograft rejection in organ transplant patients, and to date, the safety of treatment for organ transplant patients with ICIs has not been well-investigated. Here, we report a case of renal allograft rejection in a kidney transplant recipient with metastatic RCC (mRCC) after the administration of nivolumab. Four weeks after initiating treatment with nivolumab, the renal function, in this case, was markedly impaired, and pathological findings of renal biopsy specimens showed acute rejection characterized by marked infiltration of inflammatory cells. Steroid pulse therapy was performed in this case, and despite the lack of improvement in the renal function, his graft was salvaged. Collectively, these findings suggest that it is necessary to pay special attention to the potential for allograft rejection when introducing ICIs for solid organ transplant recipients.
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Affiliation(s)
- Gaku Ishikawa
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takayuki Sugiyama
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Toshiki Ito
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Atsushi Otsuka
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideaki Miyake
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
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14
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Evidence of BK Polyomavirus Infection in Urothelial but not Renal Tumors from a Single Center Cohort of Kidney Transplant Recipients. Viruses 2021; 13:v13010056. [PMID: 33401589 PMCID: PMC7823775 DOI: 10.3390/v13010056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/22/2020] [Accepted: 12/30/2020] [Indexed: 12/21/2022] Open
Abstract
Emerging evidence indicates that reactivation of BK polyomavirus (BKPyV) in the kidney and urothelial tract of kidney transplant recipients (KTRs) may be associated with cancer in these sites. In this retrospective study of a single center cohort of KTRs (n = 1307), 10 clear cell renal cell carcinomas and 5 urinary bladder carcinomas were analyzed from 15 KTRs for the presence of BKPyV infection through immunohistochemistry and fluorescent in situ hybridization (FISH). Three of these patients had already exhibited biopsy-proven polyomavirus-associated nephropathies (PyVAN). Although the presence of BKPyV large-T antigen was evident in the urothelium from a kidney removed soon after PyVAN diagnosis, it was undetectable in all the formalin-fixed and paraffin-embedded (FFPE) blocks obtained from the 10 kidney tumors. By contrast, large-T antigen (LT) labeling of tumor cells was detected in two out of five bladder carcinomas. Lastly, the proportion of BKPyV DNA-FISH-positive bladder carcinoma nuclei was much lower than that of LT-positive cells. Taken together, our findings further strengthen the association between BKPyV reactivation and cancer development in KTRs, especially bladder carcinoma.
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15
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Cleland A, Malloy K, Donnelly MC, Davidson J, Simpson KJ, Petrik J. Design and evaluation of Taqman low density array for monitoring post-transplant viral infections. Transpl Infect Dis 2020; 23:e13499. [PMID: 33118224 DOI: 10.1111/tid.13499] [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: 01/02/2020] [Revised: 09/10/2020] [Accepted: 10/18/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The majority of transplant recipients undergo immunosuppressive treatment to prevent organ or tissue rejection. Consequently, they are more susceptible to infection agents including a number of viruses causing a significant morbidity and mortality. Only a limited number of viruses are currently tested for in transplant donors and recipients due to the cost and complexity. Taqman low density array (TLDA) may provide a suitable format to address more systematic testing approach. METHODS One hundred and one liver transplant recipient samples were retrospectively tested for 48 viral targets including two controls (bovine viral diarrhea virus and MS2) and two common viruses (TTV and HPgV), using a custom designed TLDA. Eight samples were analysed simultaneously on 384-well TLDA. Samples giving a signal considered positive/indeterminant were re-tested by different individual confirmatory assays. RESULTS Infections with six previously untested for viruses-EBV, HPIV3, HuPuV9, KIV, HMPV and HPV-were detected in fourteen patients. Previously detected HCV infections were also confirmed. These infections did not seem have an effect on 5 year post-transplant outcome. 55 of 79 and 17 of 87 samples available for confirmatory assays were positive for TTV and HPgV, included for the evaluation of the TLDA performance. CONCLUSIONS The custom viral TLDA can be successfully used for simultaneous detection of a range of post-transplant viral infections. To fully exploit its potential for monitoring and intervention, a whole blood testing should be applied in a prospective setting.
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Affiliation(s)
- Alexander Cleland
- Microbiology Research, Development and Innovation, Scottish National Blood Transfusion Service, Edinburgh, UK
| | - Kristen Malloy
- Microbiology Research, Development and Innovation, Scottish National Blood Transfusion Service, Edinburgh, UK
| | - Mhairi C Donnelly
- Department of Hepatology, Division of Health Sciences, Edinburgh Medical School, Edinburgh, UK
| | - Janice Davidson
- Scottish Liver Transplantation Unit, Royal Infirmary, Edinburgh, UK
| | - Kenneth J Simpson
- Department of Hepatology, Division of Health Sciences, Edinburgh Medical School, Edinburgh, UK
| | - Juraj Petrik
- Microbiology Research, Development and Innovation, Scottish National Blood Transfusion Service, Edinburgh, UK
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16
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Abstract
Cancer is an important cause of morbidity and mortality after liver transplantation and can occur through three mechanisms: recurrence of a recipient's pre-transplant malignancy, donor-related transmission and de novo development. Currently, the decision to list a patient with a history of malignancy is an individual one. Screening guidelines for potential donors and for recipients after transplant are still widely based on general population guidelines, while the role of chronic immunosuppression remains controversial. These shortcomings mean that patients present at diagnosis with advanced stages of the disease, often precluding curative treatments. The present review summarizes current recommendations for the screening of recipients and donors for pre- and post-transplant malignancies, and current management of recipients who develop cancer after a liver transplant.
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17
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Chu YH, Zhong W, Rehrauer W, Pavelec DM, Ong IM, Arjang D, Patel SS, Hu R. Clinicopathologic Characterization of Post-Renal Transplantation BK Polyomavirus-Associated Urothelial CarcinomaSingle Institutional Experience. Am J Clin Pathol 2020; 153:303-314. [PMID: 31628837 DOI: 10.1093/ajcp/aqz167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES To review rare cases of BK polyomavirus (BKPyV) associated urologic carcinomas in kidney transplant recipients at one institution and in the literature. METHODS We describe the clinicopathologic features of BKPyV-associated urologic carcinomas in a single-institution cohort. RESULTS Among 4,772 kidney recipients during 1994 to 2014, 26 (0.5%) and 26 (0.5%) developed posttransplantation urothelial carcinomas (UCs) and renal cell carcinomas (RCCs), respectively, as of 2017. Six (27%) UCs but none of the RCCs expressed large T antigen (TAg). TAg-expressing UCs were high grade with p16 and p53 overexpression (P < .05 compared to TAg-negative UCs). Tumor genome sequencing revealed BKPyV integration and a lack of pathogenic mutations in 50 cancer-relevant genes. Compared to TAg-negative UCs, TAg-expressing UCs more frequently presented at advanced stages (50% T3-T4) with lymph node involvement (50%) and higher UC-specific mortality (50%). CONCLUSIONS Post-renal transplantation BKPyV-associated UCs are aggressive and genetically distinct from most non-BKPyV-related UCs.
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Affiliation(s)
- Ying-Hsia Chu
- Department of Pathology and Laboratory Medicine, Madison
| | - Weixiong Zhong
- Department of Pathology and Laboratory Medicine, Madison
- Department of Pathology and Laboratory Medicine Service, William S. Middleton Memorial Veterans Hospital, Madison, WI
| | | | - Derek M Pavelec
- Department of Bioinformatics Resource Center, University of Wisconsin Biotechnology Center, Madison
- Department of Cancer Informatics Shared Resource, University of Wisconsin Carbone Cancer Center, Madison
| | - Irene M Ong
- Department of Bioinformatics Resource Center, University of Wisconsin Biotechnology Center, Madison
| | - Djamali Arjang
- Department of Medicine, University of Wisconsin Hospital and Clinics, Madison
| | - Sanjay S Patel
- Department of Pathology and Laboratory Medicine, Madison
| | - Rong Hu
- Department of Pathology and Laboratory Medicine, Madison
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18
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Themes in Literature Related to Incidence, Risk, and Prevention of Cancer in Solid-Organ Transplantation Recipients on Immunosuppressive Therapy. Cancer Nurs 2020; 42:E28-E35. [PMID: 29334522 DOI: 10.1097/ncc.0000000000000558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Solid-organ transplants provide a second chance to thousands of critically ill patients with end-organ failure each year. Immunosuppressants are administered to patients to prevent graft rejection of a transplanted organ, such as a heart, kidney, or liver, while placing the recipient at greater risk for infection and cancer. OBJECTIVE The literature provides evidence of various cancers that have been found to develop in patients' posttransplantation. The purpose of this comprehensive review is to investigate the incidence, risk, and prevention of cancer in solid-organ transplantation recipients on immunosuppressive therapy. METHODS Google Scholar, Cumulative Index to Nursing and Allied Health Literature and Ovid databases were searched to identify research articles in peer-reviewed journals from 2011 to 2016. Variables under examination included cancer risk, cancer type, incidence, demographic characteristics, prevention, screening modalities, and education tools. RESULTS Six articles met the inclusion criteria. Results indicate that malignancy is a prominent postoperative finding in at least 4% to 5% of solid-organ transplant recipients, with evidence of various cancer types. Risk factors include male sex, increased age, number of years posttransplant, fair skin, white race, and UV exposure. Screening intervals and educational tools have been found to increase awareness and target those at greater risk. CONCLUSION Skin cancer and non-Hodgkin lymphoma were the most commonly diagnosed cancers in transplant recipients. IMPLICATIONS FOR PRACTICE Practitioners may find utility in screening tools, self-examination education for patients, and follow-up protocols to prevent further complications in this patient population. Early detection of cancer and those at risk may help decrease morbidity and mortality rates in organ recipients.
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19
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Starrett GJ, Buck CB. The case for BK polyomavirus as a cause of bladder cancer. Curr Opin Virol 2019; 39:8-15. [PMID: 31336246 PMCID: PMC6901737 DOI: 10.1016/j.coviro.2019.06.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 06/20/2019] [Accepted: 06/21/2019] [Indexed: 12/17/2022]
Abstract
In 2014, the International Agency for Research on Cancer judged Merkel cell polyomavirus (MCPyV) to be a probable human carcinogen. BK polyomavirus (BKPyV, a distant cousin of MCPyV) was ruled a possible carcinogen. In this review, we argue that it has recently become reasonable to view both of these viruses as known human carcinogens. In particular, several complementary lines of evidence support a causal role for BKPyV in the development of bladder carcinomas affecting organ transplant patients. The expansion of inexpensive deep sequencing has opened new approaches to investigating the important question of whether BKPyV causes urinary tract cancers in the general population.
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Affiliation(s)
- Gabriel J Starrett
- National Cancer Institute, Building 37 Room 4118, 9000 Rockville Pike, Bethesda, MD 20892-4263, United States.
| | - Christopher B Buck
- National Cancer Institute, Building 37 Room 4118, 9000 Rockville Pike, Bethesda, MD 20892-4263, United States
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20
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Jäämaa-Holmberg S, Salmela B, Lemström K, Pukkala E, Lommi J. Cancer incidence and mortality after heart transplantation - A population-based national cohort study. Acta Oncol 2019; 58:859-863. [PMID: 30821595 DOI: 10.1080/0284186x.2019.1580385] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Cancer is currently one of the most important factors affecting the long-term health and survival of heart transplant patients. Material and methods: We calculated the standardized incidence ratios (SIR) for different cancer sites and the cancer-specific standardized mortality ratio (SMR) by linking a cohort of 479 adult heart transplant recipients transplanted in 1985-2014 (4491.6 person-years of follow-up) with data from the national Finnish Cancer Registry until the end of 2015, and with the data from the Statistics Finland's national registry of causes of death. Results: A total of 267 cancers occurred in 143 patients (SIR 6.0; 95% confidence interval (CI) 5.3-6.7). The SIR for overall cancer was considerably higher for men (SIR 6.7; 95% CI 5.9-7.5) than for women (1.4; 95% CI 0.6-2.6). Most frequent cancers were non-melanoma skin cancers (basal cell carcinoma 83 cases, squamous cell skin cancer (SCC) 56 cases), followed by Non-Hodgkin lymphoma (NHL) (36 cases), lung cancer (17), cancer of prostate (16) and cancer of kidney (12). SIRs were highest for SCC (51.9; 95% CI 39.2-67.4), lip cancer (47.4; 95% CI 19.1-97.7), cancer of tongue (26.3; 95% CI 7.2-67.4), and NHL (25.7; 95% CI 18.0-35.6). For most cancers, SIRs increased steadily by time since transplantation. Cancer mortality was three times higher for heart transplant recipients than for the population (SMR 3.1; 95% CI 2.1-4.1). Conclusions: Both cancer incidence and mortality are remarkably increased after heart transplantation, with the relative incidence most elevated for SCC, lip and other oral cancers, and for NHL.
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Affiliation(s)
- Salla Jäämaa-Holmberg
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Birgitta Salmela
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Karl Lemström
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Eero Pukkala
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Jyri Lommi
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
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21
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Long-term care of transplant recipients: de novo neoplasms after liver transplantation. Curr Opin Organ Transplant 2019; 23:187-195. [PMID: 29324517 DOI: 10.1097/mot.0000000000000499] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Since the first liver transplantation in the early 1960s, there have been significant improvements in the recipients' long-term outcome. Patients who have undergone transplantation are exposed to a high risk of developing neoplastic disease, not only because of their chronic immunosuppression, but also related to physiological aging, lifestyle, chronic viral infections, liver disease cause, and carcinogenic immunosuppressants. The present review covers the latest and most relevant data on de novo neoplasms after liver transplantation, and discusses their implications for clinical practice. RECENT FINDINGS Given the impact of de novo neoplasms, in terms of morbidity and mortality, transplant teams must be prepared to diagnose and treat these conditions promptly. Dedicated cancer screening protocols are warranted. Although surveillance strategies are based on data concerning the general population, they should be customized in the light of each transplant recipient's risk factors. The resulting risk stratification is crucially important to the design of early intervention programs, and for addressing the modulation of individualized immunosuppressive regimens. SUMMARY De novo malignancies are a significant issue for the liver transplant population, but targeted screening programs have shown that survival rates similar to those of nonimmunosuppressed patients can be achieved. New oncological surveillance strategies covering the prophylaxis, monitoring, and treatment of de novo neoplasms should take high priority in clinical research.
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22
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Cangemi M, Montico B, Faè DA, Steffan A, Dolcetti R. Dissecting the Multiplicity of Immune Effects of Immunosuppressive Drugs to Better Predict the Risk of de novo Malignancies in Solid Organ Transplant Patients. Front Oncol 2019; 9:160. [PMID: 30972289 PMCID: PMC6445870 DOI: 10.3389/fonc.2019.00160] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 02/25/2019] [Indexed: 12/15/2022] Open
Abstract
De novo malignancies constitute an emerging cause of morbidity after solid organ transplant (SOT), significantly affecting the long-term survival of transplant recipients. Pharmacologic immunosuppression may functionally impair the immunosurveillance in these patients, thereby increasing the risk of cancer development. Nevertheless, the multiplicity and heterogeneity of the immune effects induced by immunosuppressive drugs limit the current possibilities to reliably predict the risk of de novo malignancy in SOT patients. Therefore, there is the pressing need to better characterize the immune dysfunctions induced by the different immunosuppressive regimens administered to prevent allograft rejection to tailor more precisely the therapeutic schedule and decrease the risk of de novo malignancies. We herein highlight the impact exerted by different classes of immunosuppressants on the most relevant immune cells, with a particular focus on the effects on dendritic cells (DCs), the main regulators of the balance between immunosurveillance and tolerance.
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Affiliation(s)
- Michela Cangemi
- Immunopathology and Cancer Biomarkers, Translational Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Barbara Montico
- Immunopathology and Cancer Biomarkers, Translational Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Damiana A Faè
- Immunopathology and Cancer Biomarkers, Translational Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Agostino Steffan
- Immunopathology and Cancer Biomarkers, Translational Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Riccardo Dolcetti
- Translational Research Institute, University of Queensland Diamantina Institute, Brisbane, QLD, Australia
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23
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Hendrikx S, Coso S, Prat-Luri B, Wetterwald L, Sabine A, Franco CA, Nassiri S, Zangger N, Gerhardt H, Delorenzi M, Petrova TV. Endothelial Calcineurin Signaling Restrains Metastatic Outgrowth by Regulating Bmp2. Cell Rep 2019; 26:1227-1241.e6. [DOI: 10.1016/j.celrep.2019.01.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 11/22/2018] [Accepted: 01/04/2019] [Indexed: 01/02/2023] Open
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24
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Tamura D, Maeda D, Halimi SA, Okimura M, Kudo-Asabe Y, Ito S, Sato N, Shibahara J, Nanjo H, Terada Y, Goto A. Adenomatoid tumour of the uterus is frequently associated with iatrogenic immunosuppression. Histopathology 2018; 73:1013-1022. [DOI: 10.1111/his.13726] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 08/07/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Daisuke Tamura
- Department of Cellular and Organ Pathology; Graduate School of Medicine; Akita University; Akita Japan
- Department of Obstetrics and Gynecology; Graduate School of Medicine; Akita University; Akita Japan
| | - Daichi Maeda
- Department of Cellular and Organ Pathology; Graduate School of Medicine; Akita University; Akita Japan
- Department of Clinical Genomics; Graduate School of Medicine; Osaka University; Osaka Japan
| | - Sultan Ahmad Halimi
- Department of Cellular and Organ Pathology; Graduate School of Medicine; Akita University; Akita Japan
- Department of Histopathology; Kabul Medical University; Kabul Afghanistan
| | - Masato Okimura
- Department of Cellular and Organ Pathology; Graduate School of Medicine; Akita University; Akita Japan
- Faculty of Medicine; Akita University; Akita Japan
| | - Yukitsugu Kudo-Asabe
- Department of Cellular and Organ Pathology; Graduate School of Medicine; Akita University; Akita Japan
| | - Satoru Ito
- Department of Pathology; Akita University Hospital; Akita Japan
| | - Naoki Sato
- Department of Obstetrics and Gynecology; Graduate School of Medicine; Akita University; Akita Japan
| | | | - Hiroshi Nanjo
- Department of Pathology; Akita University Hospital; Akita Japan
| | - Yukihiro Terada
- Department of Obstetrics and Gynecology; Graduate School of Medicine; Akita University; Akita Japan
| | - Akiteru Goto
- Department of Cellular and Organ Pathology; Graduate School of Medicine; Akita University; Akita Japan
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25
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Rahatli S, Altundag O, Ayvazoglu Soy E, Moray G, Haberal M. Posttransplant Malignancies in Adult Renal and Hepatic Transplant Patients. EXP CLIN TRANSPLANT 2018; 18:470-473. [PMID: 30119617 DOI: 10.6002/ect.2018.0177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The risk of some cancer types increases after organ transplant compared with that shown in the general population; this has been well documented in clinical studies. With patients having longer survival and with the higher number of transplant procedures, cancer is an increasing health concern at high-volume transplant centers. Malignancy has an important effect on short- and long-term graft and patient survival. In this study, we evaluated cancer frequency during transplant patient follow-up. MATERIALS AND METHODS This single-center retrospective study included patients who underwent solid-organ transplant at the Baskent University Medical Faculty Hospital from 1997 to 2017. Renal and hepatic transplant patients older than 16 years at the time of transplant and diagnosed with cancer after transplant were included the study. In total, 1176 of 2018 renal transplant recipients and 274 of 548 hepatic transplant recipients met the inclusion criteria. RESULTS We determined that 52 of 1176 renal transplant (4.5%) and 9 of 274 hepatic transplant patients (3.3%) developed posttransplant cancer during follow-up. Of 61 total patients with cancer posttransplant, 44 were males (72.1%) and 17 were females (27.9%), with median age at transplant of 39.2 years. Overall, the incidence of cancer in transplant recipients was 4.2%. The most frequent cancers were basal and squamous skin cancers, which were seen in 18 patients (29%), and Kaposi sarcoma, which was seen in 11 patients (18%). Of the 61 patients who developed cancer, 43 (70%) were still alive at the time of this study. CONCLUSIONS Despite recent positive developments in the use of immunosuppressive drugs, posttransplant malignancy is still a health problem. Fortunately, most cancers in this patient group have good prognosis and can be cured by surgical resection. Transplant physicians should aim for early detection of these diseases.
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Affiliation(s)
- Samed Rahatli
- Department of Medical Oncology, Baskent University Faculty of Medicine, Ankara, Turkey
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26
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Abstract
BACKGROUND The majority of malignancies after transplantation appear to be virally mediated and of recipient origin. Donor-derived neoplasms occur early, whereas recipient-origin tumors typically occur many years after transplantation. Sarcomas are a relatively rare form of cancer. The etiology of sarcomas remains largely unknown, although some are linked to viruses, familial cancer syndromes, or therapeutic radiation exposure. Primary sarcomas are extremely rare, accounting for <0.1% of all native pancreatic malignancies. The involvement of the allograft itself in the tumor is rare. CASE REPORT A 53-year-old white woman (body mass index, 20.1 kg/m2) with a history of type 1 diabetes, chronic kidney disease, coronary artery disease, dyslipidemia, and pancreas-alone transplantation in 2007 was admitted with small bowel obstruction secondary to a mass in the head of the pancreas allograft, for which a laparotomy with allograft pancreatectomy was required. Histopathologic exam revealed a stage III high-grade unclassified spindle cell sarcoma positive for polyomavirus. After surgery, the patient was managed with close monitoring for disease recurrence. Her most recent scan was negative for recurrence at postoperative day 489. CONCLUSIONS We report a previously unreported phenomenon of a soft tissue sarcoma arising in a pancreas allograft, likely of recipient origin and polyomavirus related. Standard treatment for sarcoma is wide excision of the tumor and close monitoring for recurrence. Systemic chemotherapy or radiotherapy is usually limited to advanced cases. Sarcomas may occur in a pancreas allograft. Allograft pancreatectomy and monitoring for recurrence is vital for a good outcome.
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27
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Peters FS, Peeters AMA, Mandaviya PR, van Meurs JBJ, Hofland LJ, van de Wetering J, Betjes MGH, Baan CC, Boer K. Differentially methylated regions in T cells identify kidney transplant patients at risk for de novo skin cancer. Clin Epigenetics 2018; 10:81. [PMID: 29946375 PMCID: PMC6006560 DOI: 10.1186/s13148-018-0519-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 06/11/2018] [Indexed: 01/08/2023] Open
Abstract
Background Cutaneous squamous cell carcinoma (cSCC) occurs 65–200 times more in immunosuppressed organ transplant patients than in the general population. T cells, which are targeted by the given immunosuppressive drugs, are involved in anti-tumor immune surveillance and are functionally regulated by DNA methylation. Prior to kidney transplantation, we aim to discover differentially methylated regions (DMRs) in T cells involved in de novo post-transplant cSCC development. Methods We matched 27 kidney transplant patients with a future de novo cSCC after transplantation to 27 kidney transplant patients without cSCC and studied genome-wide DNA methylation of T cells prior to transplantation. From 11 out of the 27 cSCC patients, the DNA methylation of T cells after transplantation was also examined to assess stability of the observed differences in DNA methylation. Raw methylation values obtained with the 450k array were confirmed with pyrosequencing. Results We found 16 DMRs between patients with a future cSCC and those who do not develop this complication after transplantation. The majority of the DMRs were located in regulatory genomic regions such as flanking bivalent transcription start sites and bivalent enhancer regions, and most of the DMRs contained CpG islands. Examples of genes annotated to the DMRs are ZNF577, coding for a zinc-finger protein, and FLOT1, coding for a protein involved in T cell migration. The longitudinal analysis revealed that DNA methylation of 9 DMRs changed significantly after transplantation. DNA methylation of 5 out of 16 DMRs was relatively stable, with a variation in beta-value lower than 0.05 for at least 50% of the CpG sites within that region. Conclusions This is the first study demonstrating that DNA methylation of T cells from patients with a future de novo post-transplant cSCC is different from patients without cSCC. These results were obtained before transplantation, a clinically relevant time point for cSCC risk assessment. Several DNA methylation profiles remained relatively stable after transplantation, concluding that these are minimally affected by the transplantation and possibly have a lasting effect on post-transplant cSCC development. Electronic supplementary material The online version of this article (10.1186/s13148-018-0519-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fleur S Peters
- 1Neprology and Transplantation, Department of Internal Medicine, Rotterdam Transplant Group, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Annemiek M A Peeters
- 1Neprology and Transplantation, Department of Internal Medicine, Rotterdam Transplant Group, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Pooja R Mandaviya
- 2Department of Internal Medicine, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joyce B J van Meurs
- 2Department of Internal Medicine, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Leo J Hofland
- 3Endocrinology, Department of Internal Medicine, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jacqueline van de Wetering
- 1Neprology and Transplantation, Department of Internal Medicine, Rotterdam Transplant Group, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Michiel G H Betjes
- 1Neprology and Transplantation, Department of Internal Medicine, Rotterdam Transplant Group, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Carla C Baan
- 1Neprology and Transplantation, Department of Internal Medicine, Rotterdam Transplant Group, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Karin Boer
- 1Neprology and Transplantation, Department of Internal Medicine, Rotterdam Transplant Group, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
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28
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Schaverien MV, Dean RA, Myers JN, Fang L, Largo RD, Yu P. Outcomes of microvascular flap reconstruction of the head and neck in patients receiving systemic immunosuppressive therapy for organ transplantation. J Surg Oncol 2018; 117:1575-1583. [DOI: 10.1002/jso.25035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 02/03/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Mark V. Schaverien
- Department of Plastic Surgery; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Riley A. Dean
- Department of Plastic Surgery; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Jeffrey N. Myers
- Department of Head & Neck Surgery; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Lin Fang
- Department of Plastic Surgery; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Rene D. Largo
- Department of Plastic Surgery; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Peirong Yu
- Department of Plastic Surgery; The University of Texas MD Anderson Cancer Center; Houston Texas
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29
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Bennett WM, Simonich EL, Garre AM, McEvoy KM, Farinola MA, Batiuk TD. Renal Cell Carcinoma in Renal Transplantation: The Case for Surveillance. Transplant Proc 2018; 49:1779-1782. [PMID: 28923624 DOI: 10.1016/j.transproceed.2017.06.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 06/01/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Between January 2013 and September 2015, 135 consecutive renal transplant patients were screened prospectively with ultrasound for renal cell carcinoma (RCC). RESULTS Eighteen ultrasound abnormalities were identified with 4 solid lesions detected. Fifty-six other patients were screened retrospectively by referring nephrology groups, with 6 additional malignancies found. CONCLUSION As a result of our data, we recommend and have instituted annual ultrasound screening of native kidneys in all renal transplant patients.
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Affiliation(s)
- W M Bennett
- Legacy Transplant Services, Legacy Good Samaritan Medical Center, Portland, Oregon, USA.
| | - E L Simonich
- Legacy Transplant Services, Legacy Good Samaritan Medical Center, Portland, Oregon, USA
| | - A M Garre
- Legacy Transplant Services, Legacy Good Samaritan Medical Center, Portland, Oregon, USA
| | - K M McEvoy
- Legacy Transplant Services, Legacy Good Samaritan Medical Center, Portland, Oregon, USA
| | - M A Farinola
- Department of Pathology, Legacy Health System, Portland, Oregon, USA
| | - T D Batiuk
- Legacy Transplant Services, Legacy Good Samaritan Medical Center, Portland, Oregon, USA
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30
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Iwamoto K, Iizuka J, Hashimoto Y, Kondo T, Takagi T, Hata K, Unagami K, Okumi M, Ishida H, Tanabe K. Radical Prostatectomy for Localized Prostate Cancer in Renal Transplant Recipients: 13 Cases Studied at a Single Center. Transplant Proc 2018; 50:2539-2544. [PMID: 30316394 DOI: 10.1016/j.transproceed.2018.03.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 03/06/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We aimed to evaluate the feasibility and efficacy of surgical prostatectomy in renal transplant recipients (RTRs). METHODS Between January 2008 and February 2017, we identified 13 RTRs who were diagnosed with localized prostate cancer and underwent radical prostatectomy. We reviewed all available clinicopathologic data for these 13 patients. RESULTS The median patient age was 61 years and median serum prostate-specific antigen (PSA) was 8.79 ng/mL. The mean period between transplantation and diagnosis of prostate cancer was 136 months. The sources for the kidney transplants included 10 living and 3 deceased donors. Biopsies indicated that the Gleason scores were 7 in 10 patients and 8 to 10 in 3 patients. Meanwhile, the D'Amico risk classification indicated an intermediate risk in 9 patients and a high risk in 4 patients. Eight patients were at stage cT1 and 5 were at stage cT2. The surgical procedure was retropubic radical prostatectomy in one recipient, laparoscopic radical prostatectomy in 3 recipients, and robot-assisted radical prostatectomy in 9 RTRs. Intraoperative complications were not noted in any patient, although one patient demonstrated postoperative complications (Clavien grade ≥ 3). An indwelling urinary catheter was required in 3 patients for over 3 weeks due to delayed wound healing. Biochemical recurrence evaluated by PSA monitoring occurred in four patients. Postoperative graft function was stable in all but one patient who required resumption of dialysis before prostatectomy; however, all patients are alive at the time of publication with 12 patients showing well-functioning renal allografts. CONCLUSION Prostatectomy may be a feasible and effective technique as an initial treatment for RTRs with localized prostate cancer.
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Affiliation(s)
- K Iwamoto
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - J Iizuka
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Y Hashimoto
- Department of Urology, Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan
| | - T Kondo
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - T Takagi
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - K Hata
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - K Unagami
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - M Okumi
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - H Ishida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - K Tanabe
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
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31
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National survey of de novo malignancy after solid organ transplantation in Japan. Surg Today 2018; 48:618-624. [DOI: 10.1007/s00595-018-1628-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 01/18/2018] [Indexed: 02/06/2023]
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32
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Hirai H, Tomioka H, Mochizuki Y, Oikawa Y, Tsushima F, Harada H. Clinical Course of Oral Squamous Cell Carcinoma in Patients on Immunosuppressant and Glucocorticoid Therapy. J Oral Maxillofac Surg 2017; 75:1980-1986. [DOI: 10.1016/j.joms.2017.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 01/06/2017] [Accepted: 01/06/2017] [Indexed: 11/16/2022]
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33
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Kang W, Sampaio MS, Huang E, Bunnapradist S. Association of Pretransplant Skin Cancer With Posttransplant Malignancy, Graft Failure and Death in Kidney Transplant Recipients. Transplantation 2017; 101:1303-1309. [PMID: 27336396 DOI: 10.1097/tp.0000000000001286] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Posttransplant malignancy (PTM) is one of the leading causes of late death in kidney recipients. Those with a cancer history may be more prone to develop a recurrent or a new cancer. We studied the association between pretransplant skin cancer, PTM, death, and graft failure. METHODS Primary adult kidney recipients transplanted between 2005 and 2013 were included. Malignancy information was obtained from Organ Procurement Kidney Transplant Network/United Network for Organ Sharing registration and follow-up forms. Posttransplant malignancy was classified into skin cancer, solid tumor, and posttransplant lymphoproliferative disorder (PTLD). Competing risk and survival analysis with adjustment for confounders were used to calculate risk for PTM, death and graft failure in recipients with pretransplant skin cancer compared with those without cancer. Risk was reported in hazard ratios (HR) with 95% confidence interval (CI). RESULTS The cohort included 1671 recipients with and 102 961 without pretransplant skin malignancy. The 5-year cumulative incidence of PTM in patients with and without a pretransplant skin cancer history was 31.6% and 7.4%, respectively (P < 0.001). Recipients with pretransplant skin cancer had increased risk of PTM (sub-HR [SHR], 2.60; 95% CI, 2.27-2.98), and posttransplant skin cancer (SHR, 2.92; 95% CI, 2.52-3.39), PTLD (SHR, 1.93; 95% CI, 1.01-3.66), solid tumor (SHR, 1.44; 95% CI, 1.04-1.99), death (HR, 1.20; 95% CI, 1.07-1.34), and graft failure (HR, 1.17; 95% CI, 1.05-1.30) when compared with those without pretransplant malignancy. CONCLUSIONS Pretransplant skin cancer was associated with an increased risk of posttransplant skin cancer, PTLD, solid organ cancer, death and graft failure.
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Affiliation(s)
- Woosun Kang
- 1 Division of Nephrology, UCLA Medical Center, Los Angeles, CA. 2 Division of Internal Medicine, Allegheny General Hospital, Pittsburgh, PA
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34
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Tong A, Sautenet B, Chapman JR, Harper C, MacDonald P, Shackel N, Crowe S, Hanson C, Hill S, Synnot A, Craig JC. Research priority setting in organ transplantation: a systematic review. Transpl Int 2017; 30:327-343. [PMID: 28120462 DOI: 10.1111/tri.12924] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 01/16/2017] [Accepted: 01/19/2017] [Indexed: 02/06/2023]
Abstract
Barriers to access and long-term complications remain a challenge in transplantation. Further advancements may be achieved through research priority setting with patient engagement to strengthen its relevance. We evaluated research priority setting in solid organ transplantation and described stakeholder priorities. Databases were searched to October 2016. We synthesized the findings descriptively. The 28 studies (n = 2071 participants) addressed kidney [9 (32%)], heart [7 (25%)], liver [3 (11%)], lung [1 (4%)], pancreas [1 (4%)], and nonspecified organ transplantation [7 (25%)] using consensus conferences, expert panel meetings, workshops, surveys, focus groups, interviews, and the Delphi technique. Nine (32%) reported patient involvement. The 336 research priorities addressed the following: organ donation [43 priorities (14 studies)]; waitlisting and allocation [43 (10 studies)]; histocompatibility and immunology [31 (8 studies)]; immunosuppression [21 (10 studies)]; graft-related complications [38 (13 studies)]; recipient (non-graft-related) complications [86 (14 studies)]; reproduction [14 (1 study)], psychosocial and lifestyle [49 (7 studies)]; and disparities in access and outcomes [10 (4 studies)]. The priorities identified were broad but only one-third of initiatives engaged patients/caregivers, and details of the process were lacking. Setting research priorities in an explicit manner with patient involvement can guide investment toward the shared priorities of patients and health professionals.
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Affiliation(s)
- Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Benedicte Sautenet
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Jeremy R Chapman
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia
| | - Claudia Harper
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Peter MacDonald
- Heart Transplant Unit, St Vincent's Hospital, Sydney, NSW, Australia.,Transplantation Research Laboratory, Victor Chang, Cardiac Research Institute, Sydney, NSW, Australia
| | - Nicholas Shackel
- Department of Medicine, University of New South Wales, Sydney, NSW, Australia
| | | | - Camilla Hanson
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Sophie Hill
- Centre for Health Communication and Participation, La Trobe University, Melbourne, Vic., Australia
| | - Anneliese Synnot
- Centre for Health Communication and Participation, La Trobe University, Melbourne, Vic., Australia.,School of Preventive Medicine and Public Health, Monash University, Melbourne, Vic., Australia
| | - Jonathan C Craig
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
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35
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Amiot A, Jooste V, Gagniere C, Lévy M, Copie-Bergman C, Dupuis J, Le Baleur Y, Belhadj K, Sobhani I, Haioun C, Bouvier AM, Delchier JC. Second primary malignancies in patients treated for gastric mucosa-associated lymphoid tissue lymphoma. Leuk Lymphoma 2017; 58:1-11. [DOI: 10.1080/10428194.2017.1283033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Aurelien Amiot
- Department of Gastroenterology, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, Creteil, France
- Faculté de Médecine, Université Paris Est-Creteil (UPEC), Creteil, France
- EC2M3-EA7375 unit, Creteil, France
| | - Valerie Jooste
- Digestive Cancer Registry of Burgundy, University Hospital of Dijon, University of Burgundy, INSERM, U866, Dijon, France
| | - Charlotte Gagniere
- Department of Gastroenterology, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, Creteil, France
- Faculté de Médecine, Université Paris Est-Creteil (UPEC), Creteil, France
- EC2M3-EA7375 unit, Creteil, France
| | - Michaël Lévy
- Department of Gastroenterology, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, Creteil, France
| | - Christiane Copie-Bergman
- Faculté de Médecine, Université Paris Est-Creteil (UPEC), Creteil, France
- Department of Pathology, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, Creteil, France
- Unit UMR-S 955, INSERM, Creteil, France
| | - Jehan Dupuis
- Lymphoid Malignancies Unit, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, Creteil, France
| | - Yann Le Baleur
- Department of Gastroenterology, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, Creteil, France
| | - Karim Belhadj
- Lymphoid Malignancies Unit, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, Creteil, France
| | - Iradj Sobhani
- Department of Gastroenterology, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, Creteil, France
| | - Corinne Haioun
- Faculté de Médecine, Université Paris Est-Creteil (UPEC), Creteil, France
- Unit UMR-S 955, INSERM, Creteil, France
- Lymphoid Malignancies Unit, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, Creteil, France
| | - Anne-Marie Bouvier
- Digestive Cancer Registry of Burgundy, University Hospital of Dijon, University of Burgundy, INSERM, U866, Dijon, France
| | - Jean-Charles Delchier
- Department of Gastroenterology, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, Creteil, France
- Faculté de Médecine, Université Paris Est-Creteil (UPEC), Creteil, France
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36
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Katabathina VS, Menias CO, Tammisetti VS, Lubner MG, Kielar A, Shaaban A, Mansour J, Surabhi VR, Hara AK. Malignancy after Solid Organ Transplantation: Comprehensive Imaging Review. Radiographics 2016; 36:1390-407. [DOI: 10.1148/rg.2016150175] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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37
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De novo malignancy after lung transplantation in Japan. Gen Thorac Cardiovasc Surg 2016; 64:543-8. [DOI: 10.1007/s11748-016-0672-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 06/02/2016] [Indexed: 12/16/2022]
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38
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Katabathina V, Menias CO, Pickhardt P, Lubner M, Prasad SR. Complications of Immunosuppressive Therapy in Solid Organ Transplantation. Radiol Clin North Am 2016; 54:303-19. [DOI: 10.1016/j.rcl.2015.09.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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39
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Seldon TA, Pryor R, Palkova A, Jones ML, Verma ND, Findova M, Braet K, Sheng Y, Fan Y, Zhou EY, Marks JD, Munro T, Mahler SM, Barnard RT, Fromm PD, Silveira PA, Elgundi Z, Ju X, Clark GJ, Bradstock KF, Munster DJ, Hart DNJ. Immunosuppressive human anti-CD83 monoclonal antibody depletion of activated dendritic cells in transplantation. Leukemia 2016; 30:692-700. [PMID: 26286117 DOI: 10.1038/leu.2015.231] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 07/27/2015] [Indexed: 02/05/2023]
Abstract
Current immunosuppressive/anti-inflammatory agents target the responding effector arm of the immune response and their nonspecific action increases the risk of infection and malignancy. These effects impact on their use in allogeneic haematopoietic cell transplantation and other forms of transplantation. Interventions that target activated dendritic cells (DCs) have the potential to suppress the induction of undesired immune responses (for example, graft versus host disease (GVHD) or transplant rejection) and to leave protective T-cell immune responses intact (for example, cytomegalovirus (CMV) immunity). We developed a human IgG1 monoclonal antibody (mAb), 3C12, specific for CD83, which is expressed on activated but not resting DC. The 3C12 mAb and an affinity improved version, 3C12C, depleted CD83(+) cells by CD16(+) NK cell-mediated antibody-dependent cellular cytotoxicity, and inhibited allogeneic T-cell proliferation in vitro. A single dose of 3C12C prevented human peripheral blood mononuclear cell-induced acute GVHD in SCID mouse recipients. The mAb 3C12C depleted CMRF-44(+)CD83(bright) activated DC but spared CD83(dim/-) DC in vivo. It reduced human T-cell activation in vivo and maintained the proportion of CD4(+) FoxP3(+) CD25(+) Treg cells and also viral-specific CD8(+) T cells. The anti-CD83 mAb, 3C12C, merits further evaluation as a new immunosuppressive agent in transplantation.
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MESH Headings
- Animals
- Antibodies, Monoclonal/pharmacology
- Antigens, CD/genetics
- Antigens, CD/immunology
- CD4-Positive T-Lymphocytes/drug effects
- CD4-Positive T-Lymphocytes/immunology
- CD4-Positive T-Lymphocytes/pathology
- CD8-Positive T-Lymphocytes/drug effects
- CD8-Positive T-Lymphocytes/immunology
- CD8-Positive T-Lymphocytes/pathology
- Cell Proliferation/drug effects
- Cytotoxicity, Immunologic/drug effects
- Dendritic Cells/drug effects
- Dendritic Cells/immunology
- Dendritic Cells/pathology
- Female
- Gene Expression
- Graft Rejection/immunology
- Graft Rejection/mortality
- Graft Rejection/pathology
- Graft Rejection/prevention & control
- Graft vs Host Disease/immunology
- Graft vs Host Disease/mortality
- Graft vs Host Disease/pathology
- Graft vs Host Disease/prevention & control
- Humans
- Immunoglobulins/genetics
- Immunoglobulins/immunology
- Immunosuppressive Agents/pharmacology
- Killer Cells, Natural/drug effects
- Killer Cells, Natural/immunology
- Killer Cells, Natural/pathology
- Leukocytes, Mononuclear/cytology
- Leukocytes, Mononuclear/immunology
- Leukocytes, Mononuclear/transplantation
- Membrane Glycoproteins/antagonists & inhibitors
- Membrane Glycoproteins/genetics
- Membrane Glycoproteins/immunology
- Mice
- Mice, SCID
- Survival Analysis
- Transplantation, Heterologous
- CD83 Antigen
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Affiliation(s)
- T A Seldon
- DC Program, Mater Medical Research Institute, Brisbane, Queensland, Australia
- Co-operative Research Centre for Biomarker Translation, Melbourne, Victoria, Australia
| | - R Pryor
- DC Program, Mater Medical Research Institute, Brisbane, Queensland, Australia
| | - A Palkova
- DC Program, Mater Medical Research Institute, Brisbane, Queensland, Australia
| | - M L Jones
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, Queensland, Australia
| | - N D Verma
- Dendritic Cell Research, ANZAC Research Institute, Concord, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - M Findova
- DC Program, Mater Medical Research Institute, Brisbane, Queensland, Australia
| | - K Braet
- DC Program, Mater Medical Research Institute, Brisbane, Queensland, Australia
| | - Y Sheng
- DC Program, Mater Medical Research Institute, Brisbane, Queensland, Australia
- Co-operative Research Centre for Biomarker Translation, Melbourne, Victoria, Australia
| | - Y Fan
- Anesthesia, Helen Diller Family Comprehensive Cancer Centre, University of California, San Francisco, CA, USA
| | - E Y Zhou
- Anesthesia, Helen Diller Family Comprehensive Cancer Centre, University of California, San Francisco, CA, USA
| | - J D Marks
- Anesthesia, Helen Diller Family Comprehensive Cancer Centre, University of California, San Francisco, CA, USA
| | - T Munro
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, Queensland, Australia
| | - S M Mahler
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, Queensland, Australia
| | - R T Barnard
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
| | - P D Fromm
- Dendritic Cell Research, ANZAC Research Institute, Concord, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - P A Silveira
- Dendritic Cell Research, ANZAC Research Institute, Concord, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - Z Elgundi
- Dendritic Cell Research, ANZAC Research Institute, Concord, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - X Ju
- Dendritic Cell Research, ANZAC Research Institute, Concord, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - G J Clark
- DC Program, Mater Medical Research Institute, Brisbane, Queensland, Australia
- Co-operative Research Centre for Biomarker Translation, Melbourne, Victoria, Australia
- Dendritic Cell Research, ANZAC Research Institute, Concord, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - K F Bradstock
- Dendritic Cell Research, ANZAC Research Institute, Concord, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - D J Munster
- DC Program, Mater Medical Research Institute, Brisbane, Queensland, Australia
- Co-operative Research Centre for Biomarker Translation, Melbourne, Victoria, Australia
| | - D N J Hart
- DC Program, Mater Medical Research Institute, Brisbane, Queensland, Australia
- Co-operative Research Centre for Biomarker Translation, Melbourne, Victoria, Australia
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, Queensland, Australia
- Dendritic Cell Research, ANZAC Research Institute, Concord, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
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40
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Papadimitriou JC, Randhawa P, Rinaldo CH, Drachenberg CB, Alexiev B, Hirsch HH. BK Polyomavirus Infection and Renourinary Tumorigenesis. Am J Transplant 2016; 16:398-406. [PMID: 26731714 DOI: 10.1111/ajt.13550] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/25/2015] [Accepted: 09/28/2015] [Indexed: 01/25/2023]
Abstract
BK polyomavirus (BKPyV) infection represents a major problem in transplantation, particularly for renal recipients developing polyomavirus-associated nephropathy (PyVAN). The possibility that BKPyV may also be oncogenic is not routinely considered. Twenty high-grade renourinary tumors expressing polyomavirus large T antigen in the entirety of the neoplasm in 19 cases, including the metastases in six, have been reported in transplant recipients with a history of PyVAN or evidence of BKPyV infection. Morphological and phenotypical features consistent with inactivation of the tumor suppressors pRB and p53 were found in the bladder tumors, suggesting a carcinogenesis mechanism involving the BKPyV large tumor oncoprotein/antigen. The pathogenesis of these tumors is unclear, but given the generally long interval between transplantation and tumor development, the risk for neoplasms after BKPyV infections may well be multifactorial. Other elements potentially implicated include exposure to additional exogenous carcinogens, further viral mutations, and cell genomic instability secondary to viral integration, as occurs with the Merkel cell PyV-associated carcinoma. The still scarce but increasingly reported association between longstanding PyVAN and renourinary neoplasms requires a concerted effort from the transplant community to better understand, diagnose, and treat the putative association between the BKPyV and these neoplasms.
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Affiliation(s)
- J C Papadimitriou
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD
| | - P Randhawa
- Division of Transplantation Pathology, Department of Pathology, The Thomas E Starzl Transplantation Institute, University of Pittsburgh, Pennsylvania, PA
| | - C Hanssen Rinaldo
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
| | - C B Drachenberg
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD
| | - B Alexiev
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD
| | - H H Hirsch
- Metabolic and Renal Research Group, UiT, The Arctic University of Norway, Tromsø, Norway.,Transplantation and Clinical Virology, Department of Biomedicine, University of Basel, Basel, Switzerland.,Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
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41
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Bottomley MJ, Harden PN, Wood KJ. CD8+ Immunosenescence Predicts Post-Transplant Cutaneous Squamous Cell Carcinoma in High-Risk Patients. J Am Soc Nephrol 2015; 27:1505-15. [PMID: 26563386 DOI: 10.1681/asn.2015030250] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 08/05/2015] [Indexed: 01/19/2023] Open
Abstract
Most morbidity associated with malignancy in long-term renal transplant recipients is due to cutaneous squamous cell carcinoma (SCC). Previously identified measures to stratify SCC risk have limited use, however. We hypothesized that an increased proportion of senescent, terminally differentiated CD8(+) T cells would identify renal transplant recipients at elevated SCC risk. Peripheral blood lymphocytes were isolated from 117 stable transplant recipients at high risk of SCC and analyzed phenotypically by flow cytometry. Participants were followed up prospectively for SCC development. The predictive value of variables was assessed using Cox regression. Age at transplant and enrollment, dialysis duration, and previous disease were predictive of SCC development during follow-up. Previously published clinical phenotype-based risk scores lost predictive value with the removal of age as a covariate. The percentage of CD57-expressing CD8(+) T cells was the strongest immunologic predictor of future SCC and correlated with increasing CD8(+) T cell differentiation. We dichotomized participants into those with a majority (CD57hi) and a minority (CD57lo) of CD8(+) T cells expressing CD57; CD57hi participants were more likely to develop SCC during follow-up (hazard ratio, 2.9; 95% confidence interval, 1.0 to 8.0), independent of potential confounders, and tended to develop earlier recurrence. The CD57hi phenotype was stable with time and associated with increasing age and cytomegalovirus seropositivity. Our results show that the CD57hi phenotype is a strong predictor of SCC development and recurrence in this cohort of long-term, high-risk renal transplant recipients. This information may allow identification of recipients who may benefit from intensive dermatologic screening and immunosuppression reduction.
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Affiliation(s)
- Matthew J Bottomley
- Transplantation Research Immunology Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom; and Oxford Kidney Unit, Churchill Hospital, Oxford, United Kingdom
| | - Paul N Harden
- Oxford Kidney Unit, Churchill Hospital, Oxford, United Kingdom
| | - Kathryn J Wood
- Transplantation Research Immunology Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom; and
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42
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Ameline M, Bonnecarrere L, Tressières B, Hue K, Claudeon J, Blanchet P, Chout R, Saliou P, Cordel N. [Incidence of skin and non-skin cancers in Afro-Caribbean renal transplant recipients: Guadeloupe data from 2004 to 2011]. Ann Dermatol Venereol 2015; 142:534-40. [PMID: 26283424 DOI: 10.1016/j.annder.2015.06.017] [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: 07/08/2014] [Revised: 04/12/2015] [Accepted: 06/15/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cancer is the main complication of transplantation surgery. The literature concerning renal transplant recipients among the Afro-Caribbean population is scant. The aim of this study was to determine the incidence of cancer in these patients, with the secondary objective being to identify predisposing factors for cancer. PATIENTS AND METHODS This was an epidemiological and retrospective study that included all Guadeloupians of phototype V-VI undergoing renal transplantation from 01/01/2004 to 31/12/2011. Skin cancer screening was performed before transplantation and during an annual dermatological consultation following transplantation. Screening for non-cutaneous cancers was guided by clinical symptoms or by the results of the screening examinations recommended in the current guidelines. At the study time-point (31/12/2011), all patients were examined by a dermatologist. RESULTS One hundred and two patients were included : 42 women and 60 men (mean age: 52.1±11.6 years at transplantation). Eight cancers were diagnosed. The cumulative incidence of cancer was 7.8% at 3 years. Three factors were associated with more rapid onset of cancer: personal history or familial history of cancer, and genital lesion induced by HPV. CONCLUSION Our results suggest a low incidence of cancer in Afro-Caribbean renal transplant patients. Personal or family history of cancer and HPV-induced genital lesions would appear to accelerate the onset of cancer in this population.
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Affiliation(s)
- M Ameline
- Service de dermatologie, hôpital Morvan, CHRU de Brest, 2, avenue Foch, 29609 Brest cedex, France
| | - L Bonnecarrere
- UF dermatologie-médecine interne, centre hospitalier universitaire de Pointe-à-Pitre, route de Chauvel, BP 465, 97159 Pointe-à-Pitre cedex, Guadeloupe
| | - B Tressières
- Centre d'investigation clinique Antilles Guyane, Inserm/DGOS CIC 1424, CHU de Pointe-à-Pitre, route de Chauvel, 97159 Pointe-à-Pitre cedex, Guadeloupe
| | - K Hue
- Service de néphrologie, clinique de Choisy, D119, 97190 Le Gosier, Guadeloupe
| | - J Claudeon
- Unité de transplantation rénale, CHU de Pointe-à-Pitre, route de Chauvel, 97159 Pointe-à-Pitre cedex, Guadeloupe
| | - P Blanchet
- Inserm U 1085, service d'urologie, CHU de Pointe-à-Pitre, université Antilles Guyane, route de Chauvel, 97159 Pointe-à-Pitre cedex, Guadeloupe
| | - R Chout
- Laboratoire d'hématologie-immunologie-histocompatibilité, CHU de Pointe-à-Pitre, route de Chauvel, 97159 Pointe-à-Pitre cedex, Guadeloupe
| | - P Saliou
- Laboratoire d'hygiène et de santé publique, hôpital Morvan, CHRU de Brest, 2, avenue Foch, 29609 Brest cedex, France
| | - N Cordel
- EA 4546, UF de dermatologie-médecine interne, centre hospitalier universitaire de Pointe-à-Pitre, université Antilles-Guyane, route de Chauvel, BP 465, 97159 Pointe-à-Pitre cedex, Guadeloupe.
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44
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The authors' reply. Transplantation 2014; 98:e37-8. [PMID: 25171528 DOI: 10.1097/tp.0000000000000302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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45
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Stolp J, Turka LA, Wood KJ. B cells with immune-regulating function in transplantation. Nat Rev Nephrol 2014; 10:389-97. [PMID: 24846332 DOI: 10.1038/nrneph.2014.80] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In transplantation, the contribution of B cells to the rejection or acceptance of the allograft is a topic of major interest. The presence of donor-specific antibodies in transplant recipients is often associated with decreased graft function and rejection, clearly indicating a pathogenetic role of B cells in transplantation. However, data from studies in humans and rodents suggest that under certain conditions, B cells have the capacity to control or regulate the immune response to a transplanted organ. Although a great deal of attention has been focused on B cells in human and murine models of autoimmunity, our understanding of the role of these cells in transplantation is limited at present. Indeed, results in this setting are controversial and seem to depend on the model system used or the clinical situation studied. Here, we review the current understanding of the various phenotypes and roles that have been associated with immune-regulating B cells. We also discuss the mechanisms employed by subsets of these regulatory B cells to control the immune response in transplant recipients and in animal models of transplantation.
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Affiliation(s)
- Jessica Stolp
- Transplantation Research Immunology Group, Nuffield Department of Surgical Sciences, University of Oxford John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Laurence A Turka
- Transplantation Biology Research Centre, Massachusetts General Hospital, Room 5102, Charlestown, MA 02129, USA
| | - Kathryn J Wood
- Transplantation Research Immunology Group, Nuffield Department of Surgical Sciences, University of Oxford John Radcliffe Hospital, Oxford OX3 9DU, UK
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46
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Kornberg A. Liver Transplantation for Hepatocellular Carcinoma beyond Milan Criteria: Multidisciplinary Approach to Improve Outcome. ISRN HEPATOLOGY 2014; 2014:706945. [PMID: 27335840 PMCID: PMC4890913 DOI: 10.1155/2014/706945] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 01/03/2014] [Indexed: 12/12/2022]
Abstract
The implementation of the Milan criteria (MC) in 1996 has dramatically improved prognosis after liver transplantation (LT) in patients with hepatocellular carcinoma (HCC). Liver transplantation has, thereby, become the standard therapy for patients with "early-stage" HCC on liver cirrhosis. The MC were consequently adopted by United Network of Organ Sharing (UNOS) and Eurotransplant for prioritization of patients with HCC. Recent advancements in the knowledge about tumor biology, radiographic imaging techniques, locoregional interventional treatments, and immunosuppressive medications have raised a critical discussion, if the MC might be too restrictive and unjustified keeping away many patients from potentially curative LT. Numerous transplant groups have, therefore, increasingly focussed on a stepwise expansion of selection criteria, mainly based on tumor macromorphology, such as size and number of HCC nodules. Against the background of a dramatic shortage of donor organs, however, simple expansion of tumor macromorphology may not be appropriate to create a safe extended criteria system. In contrast, rather the implementation of reliable prognostic parameters of tumor biology into selection process prior to LT is mandatory. Furthermore, a multidisciplinary approach of pre-, peri-, and posttransplant modulating of the tumor and/or the patient has to be established for improving prognosis in this special subset of patients.
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Affiliation(s)
- A. Kornberg
- Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaningerstraße 22, D-81675 Munich, Germany
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