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Helanterä I, Snyder J, Åsberg A, Cruzado JM, Bell S, Legendre C, Tedesco-Silva H, Barcelos GT, Geissbühler Y, Prieto L, Christian JB, Scalfaro E, Dreyer NA. Demonstrating Benefit-Risk Profiles of Novel Therapeutic Strategies in Kidney Transplantation: Opportunities and Challenges of Real-World Evidence. Transpl Int 2022; 35:10329. [PMID: 35592446 PMCID: PMC9110654 DOI: 10.3389/ti.2022.10329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/11/2022] [Indexed: 11/28/2022]
Abstract
While great progress has been made in transplantation medicine, long-term graft failure and serious side effects still pose a challenge in kidney transplantation. Effective and safe long-term treatments are needed. Therefore, evidence of the lasting benefit-risk of novel therapies is required. Demonstrating superiority of novel therapies is unlikely via conventional randomized controlled trials, as long-term follow-up in large sample sizes pose statistical and operational challenges. Furthermore, endpoints generally accepted in short-term clinical trials need to be translated to real-world (RW) care settings, enabling robust assessments of novel treatments. Hence, there is an evidence gap that calls for innovative clinical trial designs, with RW evidence (RWE) providing an opportunity to facilitate longitudinal transplant research with timely translation to clinical practice. Nonetheless, the current RWE landscape shows considerable heterogeneity, with few registries capturing detailed data to support the establishment of new endpoints. The main recommendations by leading scientists in the field are increased collaboration between registries for data harmonization and leveraging the development of technology innovations for data sharing under high privacy standards. This will aid the development of clinically meaningful endpoints and data models, enabling future long-term research and ultimately establish optimal long-term outcomes for transplant patients.
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Affiliation(s)
- Ilkka Helanterä
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jon Snyder
- Hennepin Healthcare Research Institute, Minneapolis, MN, United States
| | - Anders Åsberg
- Department of Transplantation Medicine, Oslo University Hospital-Rikshospitalet, Oslo, Norway
- Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Josep Maria Cruzado
- Department of Nephrology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- Clinical Sciences Department, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Samira Bell
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
- The Scottish Renal Registry, Scottish Health Audits, Public Health and Intelligence, Information Services, Glasgow, United Kingdom
| | - Christophe Legendre
- Hôpital Necker, Assistance Publique Hôpitaux de Paris (AP-HP) and Université Paris Descartes, Paris, France
| | - Hélio Tedesco-Silva
- Nephrology Division, Hospital do Rim, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Shipkova M, Valbuena H. Liquid chromatography tandem mass spectrometry for therapeutic drug monitoring of immunosuppressive drugs: Achievements, lessons and open issues. Trends Analyt Chem 2016. [DOI: 10.1016/j.trac.2016.01.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Shipkova M, Wieland E. Editorial: Immune monitoring in solid organ transplantation. Clin Biochem 2016; 49:317-9. [PMID: 26794634 DOI: 10.1016/j.clinbiochem.2016.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 01/04/2016] [Indexed: 11/18/2022]
Abstract
Solid organ transplantation is inevitably associated with the activation of the immune system of the graft recipient. An advanced knowledge of the immunological mechanisms leading to acute and chronic rejection, the advent of powerful immunosuppressive drugs, and refined surgical techniques have made solid organ transplantation a standard therapy to replace irretrievable loss of vital functions. The immune system is a complex network involving immune cells, cytokines, chemokines, antibodies, and the complement system. Monitoring and ideally influencing the allo-response of the organ recipient against the donor antigens may help to personalize the immunosuppressive therapy including the disclosure of those patients who are suitable for weaning or even discontinuation of immunosuppression. Immune monitoring comprises as plethora of candidate biomarkers capable of reflecting the donor specific and non-donor specific net activation state of the immune system in transplant recipients both before and after initiation of the immunosuppressive therapy. This special issue of Clinical Biochemistry on Immune Monitoring addresses the basic effects of immune activation in solid organ transplantation and critically reviews candidate biomarkers for immune monitoring and their analytical as well as clinical performance.
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Affiliation(s)
- Maria Shipkova
- Central Institute for Clinical Chemistry and Laboratory Medicine, Klinikum Stuttgart, Kriegsbergstrasse 62, D-70174 Stuttgart, Germany.
| | - Eberhard Wieland
- Central Institute for Clinical Chemistry and Laboratory Medicine, Klinikum Stuttgart, Kriegsbergstrasse 62, D-70174 Stuttgart, Germany.
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Shipkova M, Vogeser M, Ramos PA, Verstraete AG, Orth M, Schneider C, Wallemacq P. Multi-center analytical evaluation of a novel automated tacrolimus immunoassay. Clin Biochem 2014; 47:1069-77. [DOI: 10.1016/j.clinbiochem.2014.03.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 03/19/2014] [Accepted: 03/28/2014] [Indexed: 01/29/2023]
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Luo L, Sun Z, Fang Q, Huang S, Bai X, Luo G. Effects of tolerogenic dendritic cells generated by siRNA-mediated RelB silencing on immune defense and surveillance functions of T cells. Cell Immunol 2013; 282:28-37. [DOI: 10.1016/j.cellimm.2013.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 02/05/2013] [Accepted: 03/26/2013] [Indexed: 01/09/2023]
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Abstract
BACKGROUND Living donor liver transplantation (LDLT) has recently emerged as an effective therapeutic alternative for patients with end-stage liver disease. In the meantime, the health-related quality of life (HRQoL) of the donors is becoming better appreciated. Here we aimed to review the current literature and summarize the effects of liver donation on the long-term HRQoL of living donors. DATA SOURCES A literature search of PubMed using "donors", "living donor liver transplantation", "health-related quality of life", and "donation" was performed, and all the information was collected. RESULTS The varied postoperative outcomes of liver donors are attributive to the different evaluation instruments used. On the whole, donors experienced good long-term physical and mental well-being with a few complaining of compromised quality of life due to mild symptoms or psychiatric problems. The psychosocial dimension has received increasing attention with the vocational, interpersonal and financial impact of liver donation on donors mostly studied. CONCLUSIONS Generally, donors have a good HRQoL after LDLT. Nevertheless, to achieve an ideal donor outcome, further work is necessary to minimize the negative effects as well as to incorporate recent progress in regenerative medicine.
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Dieterlen MT, Eberhardt K, Tarnok A, Bittner HB, Barten MJ. Flow Cytometry-Based Pharmacodynamic Monitoring After Organ Transplantation. Methods Cell Biol 2011; 103:267-84. [DOI: 10.1016/b978-0-12-385493-3.00011-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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