1
|
Ashoor IF, Dharnidharka VR. Non-immunologic allograft loss in pediatric kidney transplant recipients. Pediatr Nephrol 2019; 34:211-222. [PMID: 29480356 DOI: 10.1007/s00467-018-3908-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/26/2018] [Accepted: 01/26/2018] [Indexed: 01/13/2023]
Abstract
Non-immunologic risk factors are a major obstacle to realizing long-term improvements in kidney allograft survival. A standardized approach to assess donor quality has recently been introduced with the new kidney allocation system in the USA. Delayed graft function and surgical complications are important risk factors for both short- and long-term graft loss. Disease recurrence in the allograft remains a major cause of graft loss in those who fail to respond to therapy. Complications of over immunosuppression including opportunistic infections and malignancy continue to limit graft survival. Alternative immunosuppression strategies are under investigation to limit calcineurin inhibitor toxicity. Finally, recent studies have confirmed long-standing observations of the significant negative impact of a high-risk age window in late adolescence and young adulthood on long-term allograft survival.
Collapse
Affiliation(s)
- Isa F Ashoor
- Division of Nephrology, LSU Health New Orleans and Children's Hospital, 200 Henry Clay Avenue, New Orleans, LA, 70130, USA.
| | - Vikas R Dharnidharka
- Washington University and St. Louis Children's Hospital, 600 South Euclid Ave, St. Louis, MO, 63110, USA
| |
Collapse
|
2
|
Stabouli S, Printza N, Dotis J, Gkogka C, Kollios K, Kotsis V, Papachristou F. Long-Term Changes in Blood Pressure After Pediatric Kidney Transplantation. Am J Hypertens 2016; 29:860-5. [PMID: 26657420 DOI: 10.1093/ajh/hpv192] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 11/13/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Hypertension presents high prevalence rates following kidney transplantation (Tx). The aims of the present study were to investigate the prevalence and possible risk factors for hypertension and blood pressure (BP) control over time after pediatric kidney Tx, as well as to assess possible effects of hypertension on graft survival. METHODS We reviewed the medical records of all pediatric kidney recipients followed up in our pediatric nephrology department. Hypertension was defined as systolic and/or diastolic BP greater than the 95th percentile for age and sex, or as being on antihypertensive medication. BP control was defined as normotension while on antihypertensive medication. RESULTS The study population included 74 pediatric kidney recipients (median age 11 years). The prevalence of hypertension was found 77% before Tx, 82.4%, 71.7%, and 61% at 1, 5, and 10 years after Tx, respectively. Deceased donor Tx and pre-transplant hypertension on antihypertensive medication were significant risk factors for hypertension after kidney Tx over the follow-up period. BP control among patients on antihypertensive treatment was 16.7% before Tx, 43.8%, 66.7%, and 42.9% at 1, 5, and 10 years post-Tx, respectively. Hypertensive patients at 10 years post-Tx had 8.079 times higher hazard of graft loss compared to normotensives (95% CI 1.561-41.807, P < 0.05). CONCLUSIONS Hypertension remains a frequent complication in pediatric kidney recipients even years after kidney Tx. BP control by antihypertensive treatment is unsatisfactory in about half of the patients. The adverse effects of hypertension on graft survival may appear in the long-term.
Collapse
Affiliation(s)
- Stella Stabouli
- Pediatric Nephrology Unit, 1st Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece;
| | - Nikoleta Printza
- Pediatric Nephrology Unit, 1st Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - John Dotis
- Pediatric Nephrology Unit, 1st Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Chrysa Gkogka
- Pediatric Nephrology Unit, 1st Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Kollios
- 3rd Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasilios Kotsis
- 3rd Department of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Fotios Papachristou
- Pediatric Nephrology Unit, 1st Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
3
|
Cargnin S, Quaglia M, Canonico PL, Stratta P, Terrazzino S. Impact of recipient ACE I/D genotype on kidney function in renal transplant patients: a meta-analysis of cross-sectional and longitudinal studies. Pharmacogenomics 2015; 16:1887-902. [DOI: 10.2217/pgs.15.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Aim: To perform a systematic review and meta-analysis of studies evaluating the influence of recipient angiotensin-converting enzyme insertion/deletion (ACE I/D) polymorphism on kidney function in renal transplant recipients. Materials & methods: A comprehensive search was performed through PubMed, Web of Knowledge and Cochrane databases up to December 2014. The methodological quality of identified studies was assessed using the MINORS criteria. Results: A total of 15 studies evaluating the role of recipient ACE I/D were included in the meta-analysis. In overall analyzes and subsequent subgroup and sensitivity analyzes, no evidence emerged of an effect of ACE I/D on serum creatinine levels, creatinine clearance or glomerular filtration rate. Conclusion: Although further investigation is still needed to determine the role of donor ACE genotype, recipient ACE I/D does not play a significant role on kidney function in renal transplant patients.
Collapse
Affiliation(s)
- Sarah Cargnin
- Dipartimento di Scienze del Farmaco & Centro di Ricerca Interdipartimentale di Farmacogenetica e Farmacogenomica (CRIFF), Università del Piemonte Orientale “A. Avogadro”, Largo Donegani 2, 28100 Novara, Italy
| | - Marco Quaglia
- Department of Translational Medicine, Nephrology & Kidney Transplant Unit, University of Eastern Piedmont, Novara, Italy
| | - Pier Luigi Canonico
- Dipartimento di Scienze del Farmaco & Centro di Ricerca Interdipartimentale di Farmacogenetica e Farmacogenomica (CRIFF), Università del Piemonte Orientale “A. Avogadro”, Largo Donegani 2, 28100 Novara, Italy
| | - Piero Stratta
- Department of Translational Medicine, Nephrology & Kidney Transplant Unit, University of Eastern Piedmont, Novara, Italy
| | - Salvatore Terrazzino
- Dipartimento di Scienze del Farmaco & Centro di Ricerca Interdipartimentale di Farmacogenetica e Farmacogenomica (CRIFF), Università del Piemonte Orientale “A. Avogadro”, Largo Donegani 2, 28100 Novara, Italy
| |
Collapse
|
4
|
Canales CP, Krall P, Kairath P, Perez IC, Fragoso MA, Carmona-Mora P, Ruiz P, Reiser J, Young JI, Walz K. Characterization of a Trpc6 Transgenic Mouse Associated with Early Onset FSGS. ACTA ACUST UNITED AC 2015; 5:1198-2012. [PMID: 34012910 PMCID: PMC8130885 DOI: 10.9734/bjmmr/2015/12493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Rationale: Mutations in Transient Receptor Potential Channel 6 (TRPC6) gene are associated with autosomal dominant focal and segmental glomerulosclerosis (FSGS). The majority of the identified mutations affect the ion channel function. Since calcium channels are promising candidate drug targets, there is an an urgent need for a mouse model to assess new therapeutic drugs and to help delineate the pathogenic process leading to FSGS. We have previously reported the generation of three independent transgenic mouse lines carrying different Trpc6 mutations that display a glomerular disease comparable to the phenotype presented by individuals with FSGS. However, the utility of these models for drug testing is dampened by the late-onset of the presentation and the mild phenotypic manifestations. Methodology: In order to obtain a time-effective mouse model for Trpc6-associated FSGS we generated a new transgenic mutant Trpc6 mouse model emulating the amino acid change carried by the first pediatric patient of FSGS associated with a TRPC6 mutation: M132T. Results: Mice carrying the orthologous Trpc6 M131T transgene showed early onset proteinuria and early signs of FSGS. When exploring molecular consequences of the overexpression of this mutated form of Trpc6 in podocytes, differences in expression levels of Axin2 and β-catenin were found in glomeruli from transgenic Trpc6 M131T mice. These data supports the proposed molecular mechanisms related to the activation of calcineurin-NFAT/Wnt signaling, as outcome of the increased calcium influx caused by the mutated form of Trpc6. Conclusion: Given that the Trpc6 M131T mouse develops an early onset of FSGS-like phenotypes it represents a promising model for studying the pathogenesis of FSGS caused by TRpC6, facilitating the assessment of new drugs as treatments and allowing further studies to understand underlying molecular pathways involved in the development of the TRPC6 mediated disease.
Collapse
Affiliation(s)
- Cesar P Canales
- John P. Hussman Institute for Human Genomics, University of Miami Leonard Miller School of Medicine, Miami, Florida, USA.,Cellular and Genetic Medicine Unit, School of Medical Sciences, UNSW, Sydney, Australia
| | - Paola Krall
- Nephrology Unit, Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile
| | - Pamela Kairath
- School of Biochemistry, Faculty of Sciences, Universidad Austral de Chile, Valdivia, Chile
| | - Irene C Perez
- John P. Hussman Institute for Human Genomics, University of Miami Leonard Miller School of Medicine, Miami, Florida, USA
| | - Miryam A Fragoso
- John P. Hussman Institute for Human Genomics, University of Miami Leonard Miller School of Medicine, Miami, Florida, USA
| | - Paulina Carmona-Mora
- John P. Hussman Institute for Human Genomics, University of Miami Leonard Miller School of Medicine, Miami, Florida, USA.,Cellular and Genetic Medicine Unit, School of Medical Sciences, UNSW, Sydney, Australia
| | - Phillip Ruiz
- Department of Surgery and Pathology, University of Miami Leonard Miller School of Medicine, Miami, Florida, USA.,Division of Nephrology and Hypertension, University of Miami Leonard Miller School of Medicine, Miami, Florida, USA
| | - Jochen Reiser
- Department of Internal Medicine, Rush University, Chicago, USA
| | - Juan I Young
- John P. Hussman Institute for Human Genomics, University of Miami Leonard Miller School of Medicine, Miami, Florida, USA.,Department of Human Genetics, University of Miami Leonard Miller School of Medicine, Miami, Florida, USA
| | - Katherina Walz
- John P. Hussman Institute for Human Genomics, University of Miami Leonard Miller School of Medicine, Miami, Florida, USA.,Division of Nephrology and Hypertension, University of Miami Leonard Miller School of Medicine, Miami, Florida, USA.,Department of Human Genetics, University of Miami Leonard Miller School of Medicine, Miami, Florida, USA
| |
Collapse
|
5
|
Feingold B, Brooks MM, Zeevi A, Ohmann EL, Burckart GJ, Ferrell RE, Chinnock R, Canter C, Addonizio L, Bernstein D, Kirklin JK, Naftel DC, Webber SA. Renal function and genetic polymorphisms in pediatric heart transplant recipients. J Heart Lung Transplant 2012; 31:1003-8. [PMID: 22789135 DOI: 10.1016/j.healun.2012.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 05/11/2012] [Accepted: 05/14/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Common genetic variations influence rejection, infection, drug metabolism, and side effect profiles after pediatric heart transplantation. Reports in adults suggest that genetic background may influence post-transplant renal function. In this multicenter study, we investigated the association of genetic polymorphisms (GPs) in a panel of candidate genes on renal function in 453 pediatric heart transplant recipients. METHODS We performed genotyping for functional GPs in 19 candidate genes. Renal function was determined annually after transplantation by calculation of the estimated glomerular filtration rate (eGFR). Mixed-effects and Cox proportional hazard models were used to assess recipient characteristics and the effect of GPs on longitudinal eGFR and time to eGFR < 60 mL/min/1.73m(2). RESULTS Mean age at transplantation was 6.2 ± 6.1 years. Mean follow-up was 5.1 ± 2.5 years. Older age at transplant and black race were independently associated with post-transplant renal dysfunction. Univariate analyses showed FASL (C-843T) T allele (p = 0.014) and HO-1 (A326G) G allele (p = 0.0017) were associated with decreased renal function. After adjusting for age and race, these associations were attenuated (FASL, p = 0.075; HO-1, p = 0.053). We found no associations of other GPs with post-transplant renal function, including GPs in TGFβ1, CYP3A5, ABCB1, and ACE. CONCLUSIONS In this multicenter, large, sample of pediatric heart transplant recipients, we found no strong associations between GPs in 19 candidate genes and post-transplant renal function. Our findings contradict reported associations of CYP3A5 and TGFβ1 with renal function and suggest that genotyping for these GPs will not facilitate individualized immunosuppression for the purpose of protecting renal function after pediatric heart transplantation.
Collapse
Affiliation(s)
- Brian Feingold
- Pediatric Cardiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|