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Meng E, Jiang SM, Servito T, Payne D, El-Diasty M. Lung transplantation and concomitant cardiac surgical procedures: A systematic review and meta-analysis. J Card Surg 2022; 37:3342-3352. [PMID: 35811496 DOI: 10.1111/jocs.16740] [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: 04/18/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lung transplantation is an effective treatment option for end-stage lung diseases. In some cases, these patients may also have underlying cardiac disease which may require surgical intervention before or during transplantation. Concomitant cardiac surgery may often be preferred, as reduced lung function precludes these patients from pre-transplant surgery. Our meta-analysis sought to examine the impact of lung transplantation paired with concomitant cardiac surgery on long-term mortality. METHODS We conducted a systematic review of the MEDLINE, Embase, and Cochrane databases. Our primary outcome was overall mortality. Secondary outcomes included length of stay (LOS) in hospital and serious postoperative complication rates. We used a meta-analytic model to determine the differences in the above outcomes between patients who underwent lung transplantation with or without concomitant cardiac surgery. RESULTS Out of the 1876 articles screened, 7 met our pre-determined inclusion criteria. Lung transplantation with concomitant cardiac surgery was not associated with increased mortality compared to lung transplantation alone (hazard ratio = 1.02; 95% confidence interval [CI] = 0.80-1.31; I2 = 0%; p = .99). LOS in hospital was not significantly different between groups (standardized mean difference = 0.32; 95% CI = -0.91 to 1.55). Postoperative complication rates were also reported but not analyzed due to missing data. CONCLUSIONS There was no significant difference in mortality rates in patients undergoing lung transplantation with or without concomitant cardiac surgery at 1, 3, and 5 years. However, postoperative complication rates were higher in the concomitant group. The decision to perform concomitant procedures should be tailored to each patient's clinical condition.
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Affiliation(s)
- Eric Meng
- Division of Cardiac Surgery, Queen's University, Kingston, Ontario, Canada
| | - Stephanie M Jiang
- Division of Cardiac Surgery, Queen's University, Kingston, Ontario, Canada
| | - Therese Servito
- Division of Cardiac Surgery, Queen's University, Kingston, Ontario, Canada
| | - Darrin Payne
- Division of Cardiac Surgery, Queen's University, Kingston, Ontario, Canada
| | - Mohammad El-Diasty
- Division of Cardiac Surgery, Queen's University, Kingston, Ontario, Canada
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Crépin T, Legendre M, Carron C, Vachey C, Courivaud C, Rebibou JM, Ferrand C, Laheurte C, Vauchy C, Gaiffe E, Saas P, Ducloux D, Bamoulid J. Uraemia-induced immune senescence and clinical outcomes in chronic kidney disease patients. Nephrol Dial Transplant 2020; 35:624-632. [PMID: 30202981 DOI: 10.1093/ndt/gfy276] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 07/09/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) are more prone to develop premature age-related diseases. Data on immune senescence are scarce in CKD populations, except in end-stage renal disease and dialysis. We designed a longitudinal prospective study to evaluate immune senescence at different CKD stages and its influence on CKD patient outcomes. METHODS Clinical and biological data collections were performed on 222 patients at different CKD stages [1-2 (n = 85), 4 (n = 53) and 5 (n = 84)]. Immune senescence biomarkers were measured by cytometry on T cells (CD28, CD57, CD45RA, CD31, γH2A.X) or by quantitative polymerase chain reaction [relative telomere length (RTL)] on peripheral blood mononuclear cells and analysed according to CKD stages and outcomes. RESULTS CKD was associated with an increase in immune senescence and inflammation biomarkers, as follows: low thymic output (197 ± 25 versus 88 ± 13 versus 73 ± 21 CD4+CD45RA+CD31+ T cells/mm3), an increased proportion of terminally differentiated T cells (CD8+CD28-CD57+) (24 ± 18 versus 32 ± 17 versus 35 ± 19%) restricted to cytomegalovirus-positive patients, telomere shortening (1.11 ± 0.36 versus 0.78 ± 0.24 versus 0.97 ± 0.21 telomere:single copy ratio) and an increase in C-reactive protein levels [median 2.9 (range 1.8-4.9) versus 5.1 (27-9.6) versus 6.2 (3.4-10.5) mg/L]. In multivariate analysis, shorter RTL was associated with death {hazard ratio [HR] 4.12 [95% confidence interval (CI) 1.44-11.75]}. Low thymic output was associated with infections [HR 1.79 (95% CI (1.34-9.58)] and terminally differentiated CD8+ T-cell expansion with a risk of cardiovascular events [CEs; HR 4.86 (95% CI 1.72-13.72)]. CONCLUSION CKD was associated with premature immune ageing. Each of these alterations increased the risk of specific age-related diseases, such as RTL and death, thymic function and infections and terminally differentiated CD8+ T-cell expansion and CEs.
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Affiliation(s)
- Thomas Crépin
- INSERM, UMR1098, Federation Hospitalo-Universitaire, INCREASE, Besançon, France.,University of Bourgogne-Franche-Comté, Faculté de Médecine et de Pharmacie, LabEx LipSTIC, Besançon and Dijon, France.,CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, Besançon, France
| | - Mathieu Legendre
- INSERM, UMR1098, Federation Hospitalo-Universitaire, INCREASE, Besançon, France.,University of Bourgogne-Franche-Comté, Faculté de Médecine et de Pharmacie, LabEx LipSTIC, Besançon and Dijon, France
| | - Clémence Carron
- INSERM, UMR1098, Federation Hospitalo-Universitaire, INCREASE, Besançon, France
| | - Clément Vachey
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, Besançon, France.,CHU Besançon, CIC Biothérapie, INSERM CIC-1431, Besançon, France
| | - Cécile Courivaud
- INSERM, UMR1098, Federation Hospitalo-Universitaire, INCREASE, Besançon, France.,University of Bourgogne-Franche-Comté, Faculté de Médecine et de Pharmacie, LabEx LipSTIC, Besançon and Dijon, France.,CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, Besançon, France
| | - Jean-Michel Rebibou
- INSERM, UMR1098, Federation Hospitalo-Universitaire, INCREASE, Besançon, France.,University of Bourgogne-Franche-Comté, Faculté de Médecine et de Pharmacie, LabEx LipSTIC, Besançon and Dijon, France
| | - Christophe Ferrand
- INSERM, UMR1098, Federation Hospitalo-Universitaire, INCREASE, Besançon, France.,University of Bourgogne-Franche-Comté, Faculté de Médecine et de Pharmacie, LabEx LipSTIC, Besançon and Dijon, France.,EFS Bourgogne Franche-Comté, Plateforme de Biomonitoring, INSERM CIC-1431/UMR1098, Besançon, France
| | - Caroline Laheurte
- INSERM, UMR1098, Federation Hospitalo-Universitaire, INCREASE, Besançon, France.,EFS Bourgogne Franche-Comté, Plateforme de Biomonitoring, INSERM CIC-1431/UMR1098, Besançon, France
| | - Charline Vauchy
- CHU Besançon, CIC Biothérapie, INSERM CIC-1431, Besançon, France
| | - Emilie Gaiffe
- CHU Besançon, CIC Biothérapie, INSERM CIC-1431, Besançon, France
| | - Philippe Saas
- INSERM, UMR1098, Federation Hospitalo-Universitaire, INCREASE, Besançon, France.,University of Bourgogne-Franche-Comté, Faculté de Médecine et de Pharmacie, LabEx LipSTIC, Besançon and Dijon, France.,CHU Besançon, CIC Biothérapie, INSERM CIC-1431, Besançon, France.,EFS Bourgogne Franche-Comté, Plateforme de Biomonitoring, INSERM CIC-1431/UMR1098, Besançon, France
| | - Didier Ducloux
- INSERM, UMR1098, Federation Hospitalo-Universitaire, INCREASE, Besançon, France.,University of Bourgogne-Franche-Comté, Faculté de Médecine et de Pharmacie, LabEx LipSTIC, Besançon and Dijon, France.,CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, Besançon, France.,CHU Besançon, CIC Biothérapie, INSERM CIC-1431, Besançon, France
| | - Jamal Bamoulid
- INSERM, UMR1098, Federation Hospitalo-Universitaire, INCREASE, Besançon, France.,University of Bourgogne-Franche-Comté, Faculté de Médecine et de Pharmacie, LabEx LipSTIC, Besançon and Dijon, France.,CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, Besançon, France.,CHU Besançon, CIC Biothérapie, INSERM CIC-1431, Besançon, France
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5
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Coronary Artery Disease and Coronary Artery Bypass Grafting at the Time of Lung Transplantation Do Not Impact Overall Survival. Transplantation 2019; 103:2190-2195. [PMID: 30801514 DOI: 10.1097/tp.0000000000002609] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Coronary artery disease (CAD) is common in lung transplant candidates and may require revascularization before or at the time of their transplant. We reviewed the survival of lung transplant recipients with CAD requiring surgical intervention (CAD-coronary artery bypass grafting [CABG]) and those who did not (CAD-NoCABG) at the time of transplant, compared to a cohort with no CAD (NoCAD). METHODS We conducted a retrospective cohort study of adult patients transplanted in our program between 2004 and 2013. Our primary outcome was the association between 3-way CAD status (CAD-CABG, CAD-NoCABG, NoCAD) and overall retransplant-free survival via proportional hazards modeling, adjusting for age, gender, and transplant indication. Secondary endpoints included 1-year survival, survival by Kaplan-Meier analysis, duration of ventilation, intensive care unit stay, and hospitalization. RESULTS A total of 333 patients underwent transplant during the study timeframe. A total of 24 (7%) had CAD requiring CABG, 82 (25%) had CAD not requiring CABG, and the remaining 227 had no CAD. The 3-way CAD status was not associated with overall retransplant-free survival after adjustment for age, gender, and transplant indication. Duration of mechanical ventilation, intensive care unit stay and hospitalization were longer in both CAD groups compared with the NoCAD group. CONCLUSIONS CAD status does not impact overall retransplant-free survival, despite greater perioperative complexity. Prospective studies comparing treatment strategies in these patient groups are warranted.
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Ducloux D, Bamoulid J, Crepin T, Rebibou JM, Courivaud C, Saas P. Posttransplant Immune Activation: Innocent Bystander or Insidious Culprit of Posttransplant Accelerated Atherosclerosis. Cell Transplant 2018; 26:1601-1609. [PMID: 29113470 PMCID: PMC5680959 DOI: 10.1177/0963689717735404] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Cardiovascular disease is a major cause of morbidity, disability, and mortality in kidney transplant patients. Cumulative reports indicate that the excessive risk of cardiovascular events is not entirely explained by the increased prevalence of traditional cardiovascular risk factors. Atherosclerosis is a chronic inflammatory disease, and it has been postulated that posttransplant immune disturbances may explain the gap between the predicted and observed risks of cardiovascular events. Although concordant data suggest that innate immunity contributes to the posttransplant accelerated atherosclerosis, only few arguments plead for a role of adaptive immunity. We report and discuss here consistent data demonstrating that CD8+ T cell activation is a frequent posttransplant immune feature that may have pro-atherogenic effects. Expansion of exhausted/activated CD8+ T cells in kidney transplant recipients is stimulated by several factors including cytomegalovirus infections, lymphodepletive therapy (e.g., antithymocyte globulins), chronic allogeneic stimulation, and a past history of renal insufficiency. This is observed in the setting of decreased thymic activity, a process also found in elderly individuals and reflecting accelerated immune senescence.
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Affiliation(s)
- Didier Ducloux
- 1 Inserm, UMR1098, Federation Hospitalo-Universitaire INCREASE, Besançon, France.,2 Department of Nephrology, Dialysis, and Renal Transplantation, CHU Besançon, Besançon, France
| | - Jamal Bamoulid
- 1 Inserm, UMR1098, Federation Hospitalo-Universitaire INCREASE, Besançon, France.,2 Department of Nephrology, Dialysis, and Renal Transplantation, CHU Besançon, Besançon, France
| | - Thomas Crepin
- 1 Inserm, UMR1098, Federation Hospitalo-Universitaire INCREASE, Besançon, France.,2 Department of Nephrology, Dialysis, and Renal Transplantation, CHU Besançon, Besançon, France
| | - Jean-Michel Rebibou
- 1 Inserm, UMR1098, Federation Hospitalo-Universitaire INCREASE, Besançon, France.,3 Department of Nephrology, Dialysis, and Renal Transplantation, CHU Dijon, Dijon, France
| | - Cecile Courivaud
- 1 Inserm, UMR1098, Federation Hospitalo-Universitaire INCREASE, Besançon, France.,2 Department of Nephrology, Dialysis, and Renal Transplantation, CHU Besançon, Besançon, France
| | - Philippe Saas
- 1 Inserm, UMR1098, Federation Hospitalo-Universitaire INCREASE, Besançon, France.,4 EFS, UMR1098, Plateforme de BioMonitoring, Besançon, France.,5 Université Bourgogne Franche-Comté (UBFC), UMR1098, Besançon, France.,6 INSERM CIC-1431, Besançon, France
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7
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Yap M, Tilly G, Giral M, Brouard S, Degauque N. Benefits of Using CD45RA and CD28 to Investigate CD8 Subsets in Kidney Transplant Recipients. Am J Transplant 2016; 16:999-1006. [PMID: 26820487 DOI: 10.1111/ajt.13581] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 10/06/2015] [Accepted: 10/12/2015] [Indexed: 01/25/2023]
Abstract
The deleterious role of CD8 T cells in kidney graft outcome has regained interest over the years, and memory T cells are considered as one of the main hurdles to achieve transplantation success. Monitoring the CD8 immune response in transplant recipients involved a heterogeneous combination of markers, but the justification of their choice is rarely stated. Whereas the number of parameters is not an issue in phenotypic analysis, functional assays have to accommodate the cell number with the narrowing of the subset. The aim of the study was to investigate the similarities and differences of the subsets identified using three nomenclatures (CD45RA and CCR7/CD27/CD28) in kidney transplant recipients with stable graft function. We found that all three nomenclatures can identify naïve and effector memory (EM) rheumatoid arthritis T cell CD8 with similar features. Whereas CM CD8 could only be documented using CCR7 and CD45RA, the characteristics of EM CD8 will differ according to the nomenclature. We found that the use of the CD45RA and CD28 gives the benefit of examining two EM populations at early and late differentiation states. This systematic comparison provides a cohesive layout of the advantages of using these nomenclature strategies in kidney transplant recipients to guide the choice of their use.
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Affiliation(s)
- M Yap
- INSERM, UMR, 1064, Nantes, France
- Université de Nantes, Faculté de Médecine, Nantes, France
| | - G Tilly
- INSERM, UMR, 1064, Nantes, France
- Université de Nantes, Faculté de Médecine, Nantes, France
| | - M Giral
- INSERM, UMR, 1064, Nantes, France
- Université de Nantes, Faculté de Médecine, Nantes, France
- CHU de Nantes, ITUN, Nantes, France
- CIC biothérapie, Nantes, France
- CHU Nantes, CRB, Nantes, France
| | - S Brouard
- INSERM, UMR, 1064, Nantes, France
- CHU de Nantes, ITUN, Nantes, France
- CIC biothérapie, Nantes, France
- CHU Nantes, CRB, Nantes, France
| | - N Degauque
- INSERM, UMR, 1064, Nantes, France
- CHU de Nantes, ITUN, Nantes, France
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