1
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Mirzakhani M, Shahbazi M, Akbari R, Dedinská I, Nemati E, Mohammadnia-Afrouzi M. Soluble CD30, the Immune Response, and Acute Rejection in Human Kidney Transplantation: A Systematic Review and Meta-Analysis. Front Immunol 2020; 11:295. [PMID: 32256486 PMCID: PMC7093023 DOI: 10.3389/fimmu.2020.00295] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 02/05/2020] [Indexed: 01/08/2023] Open
Abstract
Soluble CD30 (sCD30) is considered to be a marker for the activated immune system in which T cells can damage the allograft. Some studies reported that post-transplant sCD30 can predict early acute rejection and can thereby be used as a biomarker to detect acute rejection. However, several other studies found no relation between post-transplant sCD30 and acute rejection. This meta-analysis study aims to answer this main question of whether sCD30 can help clinicians to monitor transplant recipients. The electronic databases, including PubMed, Web of Science, ProQuest, Embase, Scopus, Google Scholar, the gray literature, and the key journals, were searched for observational studies from 1 January 1990 up to 30 April 2018. Eighteen studies, with a total of 1,453 patients, were included in this paper. With regard to the different measurement times, post-transplant sCD30 was separately analyzed and divided into five groups (i.e., 1, 2, 3, 4 week, and 1 month post-transplant sCD30). All groups indicated a strong association between sCD30 and the acute rejection. The standardized mean difference (SMD) is 1.22 in 1 week, 0.77 in 2 week, 1.11 in 3 week, 1.27 in 4 week, and 0.71 in 1 month groups. The association between sCD30 and acute rejection was consistent across all the subgroup analyses. We found that post-transplant sCD30 had a strong association with acute kidney rejection. We also found that the deceased donors had more association with the high amount of sCD30 than living donors in patients with acute rejection. Finally, we realized that donor type was an important factor leading to the heterogeneous results in the primary studies.
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Affiliation(s)
- Mohammad Mirzakhani
- Student Research Committee, School of Medicine, Babol University of Medical Sciences, Babol, Iran.,Immunoregulation Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mehdi Shahbazi
- Immunoregulation Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.,Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Roghayeh Akbari
- Kidney Transplantation Center, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Ivana Dedinská
- Surgery Clinic and Transplant Center, University Hospital Martin and Jessenius Faculty of Medicine Comenius University, Martin, Slovakia
| | - Eghlim Nemati
- Nephrology and Urology Research Center, Baqiyatollah University of Medical Sciences, Tehran, Iran
| | - Mousa Mohammadnia-Afrouzi
- Immunoregulation Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.,Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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2
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Dieudé M, Cardinal H, Hébert MJ. Injury derived autoimmunity: Anti-perlecan/LG3 antibodies in transplantation. Hum Immunol 2019; 80:608-613. [PMID: 31029511 DOI: 10.1016/j.humimm.2019.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/08/2019] [Accepted: 04/13/2019] [Indexed: 01/02/2023]
Abstract
Ischemic, immunologic or pharmacological stressors can induce vascular injury and endothelial apoptosis in organ donors, in transplant candidates due to the impact of end stage organ failure on the vasculature, and in association with peri-transplantation events. Vascular injury may shape innate and adaptive immune responses, leading to dysregulation in the balance between tolerance and immunoreactivity to vascular-derived antigens. Mounting evidence shows that the early stages of apoptosis, characterized by the absence of membrane permeabilization, are prone to trigger various modes of intercellular communication allowing neoantigen production, exposure, or both. In this review, we present the evidence for the release of LG3, an immunogenic fragment of perlecan, as a consequence of caspase-3 dependent vascular apoptosis leading to the genesis of anti-LG3 autoantibodies and the consequences of these autoantibodies in native and transplanted kidneys.
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Affiliation(s)
- Mélanie Dieudé
- Research Centre, Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada; Canadian Donation and Transplantation Research Program, Canada; Université de Montréal, Canada.
| | - Héloïse Cardinal
- Research Centre, Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada; Canadian Donation and Transplantation Research Program, Canada; Université de Montréal, Canada.
| | - Marie-Josée Hébert
- Research Centre, Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada; Canadian Donation and Transplantation Research Program, Canada; Université de Montréal, Canada.
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3
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Jamshaid F, Froghi S, Di Cocco P, Dor FJ. Novel non-invasive biomarkers diagnostic of acute rejection in renal transplant recipients: A systematic review. Int J Clin Pract 2018; 72:e13220. [PMID: 30011113 DOI: 10.1111/ijcp.13220] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 06/07/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Acute rejection is a significant complication detrimental to kidney transplant function. Current accepted means of diagnosis is percutaneous renal biopsy, a costly and invasive procedure. There is an urgent need to detect and validate non-invasive biomarkers capable of replacing the biopsy. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS Comprehensive literature searches of Medline, EMBASE and Cochrane Central Register of Controlled Trials databases were performed. Eligible studies were included as per inclusion criteria and assessed for quality using the GRADE quality of evidence tool. Outcomes evaluated included biomarker diagnostic performance, number of patients/samples, mean age and gender ratio, immunosuppression regime, in addition to clinical applications of the biomarker(s) tested. PRISMA guidelines were followed. Where possible, statistical analysis of comparative performance data was performed. RESULTS 23 studies were included in this review, including 19 adult, 3 paediatric and 1 mixed studies. A total of 2858 participants and 50 candidate non-invasive tests were identified. Sensitivity, specificity and area under the curve performance values ranged 36%-100%, 30%-100% and 0.55-0.98, respectively. CONCLUSIONS Although larger, more robust multi-centre validation studies are needed before non-invasive biomarkers can replace the biopsy, numerous candidate tests have demonstrated significant promise for various facets of postoperative management. Suggested uses include: ruling out patients with a low risk of acute rejection to avoid the need for biopsy, non-invasive testing where the biopsy is contraindicated and a prompt diagnosis is needed, and integration into a serial blood monitoring protocol in conjunction with serum creatinine.
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Affiliation(s)
- Faisal Jamshaid
- MRC Centre for Transplantation, Guy's Campus, Kings College London School of Medicine, London, UK
| | - Saied Froghi
- MRC Centre for Transplantation, Guy's Campus, Kings College London School of Medicine, London, UK
- Imperial College London, Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| | - Pierpaolo Di Cocco
- Imperial College London, Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| | - Frank Jmf Dor
- Imperial College London, Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
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4
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Grenzi PC, Campos ÉF, Tedesco-Silva H, Felipe CR, Soares MF, Medina-Pestana J, Hansen HP, Gerbase-DeLima M. Influence of immunosuppressive drugs on the CD30 molecule in kidney transplanted patients. Hum Immunol 2018; 79:550-557. [PMID: 29656112 DOI: 10.1016/j.humimm.2018.04.002] [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: 12/03/2017] [Revised: 04/08/2018] [Accepted: 04/10/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Soluble CD30 (sCD30) is a suggested marker for kidney transplantation outcomes. We investigated whether sCD30 serum levels are influenced by immunosuppression and whether they correlate with findings in protocol biopsies and with CD30 gene expression in peripheral blood mononuclear cells (PBMC). METHODS We studied 118 kidney transplant recipients that initially received tacrolimus (TAC) and, at month-3, were converted or not to sirolimus (SRL). RESULTS sCD30 serum levels gradually declined after transplantation, being the decline more pronounced in the SRL group. CD30 gene expression in PBMC was higher in the SRL group than in the TAC group. Patients with IF/TA ≥ I in the month-24 protocol biopsy had higher sCD30 levels than patients without IF/TA, in the SRL group (P = .03) and in the TAC group (P = .07). CD30+ cells were observed in three out of 10 biopsies with inflammatory infiltrate from the SRL group. In mixed lymphocyte cultures, SRL and TAC diminished the number of CD30+ T cells and the sCD30 levels in the supernatant, but the effect of SRL was stronger. CONCLUSIONS Overall, sCD30 levels are lower in SRL-treated patients, but the association between increased sCD30 levels and IF/TA at month-24 post-transplantation is stronger in SRL than in TAC-treated patients.
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Affiliation(s)
- Patricia Cristina Grenzi
- Instituto de Imunogenética - AFIP, Rua Loefgreen 1235, 04040-031 São Paulo, SP, Brazil; Universidade Federal de São Paulo, Rua Sena Madureira 1500, 04021-001 São Paulo, SP, Brazil; University Clinic Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
| | | | - Hélio Tedesco-Silva
- Universidade Federal de São Paulo, Rua Sena Madureira 1500, 04021-001 São Paulo, SP, Brazil; Hospital do Rim, Rua Borges Lagoa 960, 04038-002 São Paulo, SP, Brazil
| | - Claudia Rosso Felipe
- Universidade Federal de São Paulo, Rua Sena Madureira 1500, 04021-001 São Paulo, SP, Brazil; Hospital do Rim, Rua Borges Lagoa 960, 04038-002 São Paulo, SP, Brazil
| | - Maria Fernanda Soares
- Universidade Federal do Paraná, Rua XV de Novembro 1299, 80060-000 Curitiba, PR, Brazil
| | - José Medina-Pestana
- Universidade Federal de São Paulo, Rua Sena Madureira 1500, 04021-001 São Paulo, SP, Brazil; Hospital do Rim, Rua Borges Lagoa 960, 04038-002 São Paulo, SP, Brazil
| | | | - Maria Gerbase-DeLima
- Instituto de Imunogenética - AFIP, Rua Loefgreen 1235, 04040-031 São Paulo, SP, Brazil; Universidade Federal de São Paulo, Rua Sena Madureira 1500, 04021-001 São Paulo, SP, Brazil
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5
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Süsal C, Slavcev A, Pham L, Zeier M, Morath C. The possible critical role of T-cell help in DSA-mediated graft loss. Transpl Int 2018; 31:577-584. [DOI: 10.1111/tri.13126] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 08/14/2017] [Accepted: 01/29/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Caner Süsal
- Institute of Immunology; University of Heidelberg; Heidelberg Germany
| | - Antonij Slavcev
- Department of Immunogenetics; Institute for Clinical and Experimental Medicine (IKEM); Prague Czech Republic
| | - Lien Pham
- Institute of Immunology; University of Heidelberg; Heidelberg Germany
| | - Martin Zeier
- Division of Nephrology; University of Heidelberg; Heidelberg Germany
| | - Christian Morath
- Division of Nephrology; University of Heidelberg; Heidelberg Germany
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6
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Dicks SG, Northam H, van Haren FMP, Boer DP. An exploration of the relationship between families of deceased organ donors and transplant recipients: A systematic review and qualitative synthesis. Health Psychol Open 2018; 5:2055102918782172. [PMID: 30083368 PMCID: PMC6069040 DOI: 10.1177/2055102918782172] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Following deceased organ donation and transplantation, the narratives of families of donors and organ recipients become connected. This is acknowledged when parties receive anonymous information from donation agencies and transplant centres, when they exchange correspondence or when they meet in person. This article reviews literature describing the experience from the points of view of donor families, recipients, and other stakeholders to explore the dynamic system that evolves around this relationship. Findings highlight a link between identity development and ongoing adjustment and will assist those supporting donor families and recipients to make decisions that fit meaningfully.
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Affiliation(s)
| | | | - Frank MP van Haren
- University of Canberra, Australia
- Australian National University,
Australia
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7
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Danger R, Sawitzki B, Brouard S. Immune monitoring in renal transplantation: The search for biomarkers. Eur J Immunol 2017; 46:2695-2704. [PMID: 27861809 DOI: 10.1002/eji.201545963] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/02/2016] [Accepted: 11/07/2016] [Indexed: 11/11/2022]
Abstract
It is now widely accepted that in order to improve long-term graft function and survival, a more personalized immunosuppressive treatment of transplant patients according to the individual anti-donor immune response status is needed. This applies to the identification of potentially "high-risk" patients likely to develop acute rejection episodes or display an accelerated decline of graft function, patients who might need immunosuppression intensification, and operationally tolerant patients suitable for immunosuppression minimization or weaning off. Such a patient stratification would benefit from biomarkers, which enable categorization into low and high risk or, ideally, identification of operational tolerant patients. Here, we report on recent developments regarding identification and performance analysis of noninvasive biomarkers such as mRNA and miRNA expression profiles, chemokines, or changes in immune cell subsets in either blood or urine of renal transplant patients. We will also discuss which future steps are needed to accelerate their clinical implementation.
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Affiliation(s)
- Richard Danger
- Inserm, , Center for Research in Transplantation and Immunology (CRTI) U1064, Nantes, France.,Université de Nantes, , UMR1064, Nantes, France.,CHU Nantes, Institut de Transplantation Urologie Néphrologie (ITUN), Nantes, France
| | - Birgit Sawitzki
- Institute of Medical Immunology, Charité University Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité University Berlin, Germany
| | - Sophie Brouard
- Inserm, , Center for Research in Transplantation and Immunology (CRTI) U1064, Nantes, France.,Université de Nantes, , UMR1064, Nantes, France.,CHU Nantes, Institut de Transplantation Urologie Néphrologie (ITUN), Nantes, France.,CIC Biotherapy, CHU Nantes, , 30 bd Jean-Monnet, Nantes, France
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8
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Yang B, Dieudé M, Hamelin K, Hénault-Rondeau M, Patey N, Turgeon J, Lan S, Pomerleau L, Quesnel M, Peng J, Tremblay J, Shi Y, Chan JS, Hébert MJ, Cardinal H. Anti-LG3 Antibodies Aggravate Renal Ischemia-Reperfusion Injury and Long-Term Renal Allograft Dysfunction. Am J Transplant 2016; 16:3416-3429. [PMID: 27172087 DOI: 10.1111/ajt.13866] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 05/04/2016] [Accepted: 05/07/2016] [Indexed: 01/25/2023]
Abstract
Pretransplant autoantibodies to LG3 and angiotensin II type 1 receptors (AT1R) are associated with acute rejection in kidney transplant recipients, whereas antivimentin autoantibodies participate in heart transplant rejection. Ischemia-reperfusion injury (IRI) can modify self-antigenic targets. We hypothesized that ischemia-reperfusion creates permissive conditions for autoantibodies to interact with their antigenic targets and leads to enhanced renal damage and dysfunction. In 172 kidney transplant recipients, we found that pretransplant anti-LG3 antibodies were associated with an increased risk of delayed graft function (DGF). Pretransplant anti-LG3 antibodies are inversely associated with graft function at 1 year after transplantation in patients who experienced DGF, independent of rejection. Pretransplant anti-AT1R and antivimentin were not associated with DGF or its functional outcome. In a model of renal IRI in mice, passive transfer of anti-LG3 IgG led to enhanced dysfunction and microvascular injury compared with passive transfer with control IgG. Passive transfer of anti-LG3 antibodies also favored intrarenal microvascular complement activation, microvascular rarefaction and fibrosis after IRI. Our results suggest that anti-LG3 antibodies are novel aggravating factors for renal IRI. These results provide novel insights into the pathways that modulate the severity of renal injury at the time of transplantation and their impact on long-term outcomes.
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Affiliation(s)
- B Yang
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Canadian National Transplant Research Program, Edmonton, Alberta, T6G 2E1, Canada.,Université de Montréal, Montreal, QC, Canada
| | - M Dieudé
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Canadian National Transplant Research Program, Edmonton, Alberta, T6G 2E1, Canada.,Université de Montréal, Montreal, QC, Canada
| | - K Hamelin
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Canadian National Transplant Research Program, Edmonton, Alberta, T6G 2E1, Canada.,Université de Montréal, Montreal, QC, Canada
| | - M Hénault-Rondeau
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Canadian National Transplant Research Program, Edmonton, Alberta, T6G 2E1, Canada.,Université de Montréal, Montreal, QC, Canada
| | - N Patey
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Canadian National Transplant Research Program, Edmonton, Alberta, T6G 2E1, Canada.,Université de Montréal, Montreal, QC, Canada.,Department of Pathology, CHU Ste-Justine, Université de Montréal, Montreal, QC, Canada
| | - J Turgeon
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Canadian National Transplant Research Program, Edmonton, Alberta, T6G 2E1, Canada.,Université de Montréal, Montreal, QC, Canada
| | - S Lan
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Canadian National Transplant Research Program, Edmonton, Alberta, T6G 2E1, Canada.,Université de Montréal, Montreal, QC, Canada
| | - L Pomerleau
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - M Quesnel
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - J Peng
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - J Tremblay
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Y Shi
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Université de Montréal, Montreal, QC, Canada
| | - J S Chan
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Université de Montréal, Montreal, QC, Canada
| | - M J Hébert
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Canadian National Transplant Research Program, Edmonton, Alberta, T6G 2E1, Canada.,Université de Montréal, Montreal, QC, Canada
| | - H Cardinal
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Canadian National Transplant Research Program, Edmonton, Alberta, T6G 2E1, Canada.,Université de Montréal, Montreal, QC, Canada
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9
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Abstract
INTRODUCTION Identification of allograft injury, including acute clinical and subclinical injury, is vital in increasing the longevity of the transplanted organ. Acute rejection, which occurs as a result of a variety of immune and non-immune factors including the infiltration of immune cells and antibodies to the donor specific epitopes, poses a significant risk to the organ. Recent years have marked an increase in the discovery of new genomic, transcriptomic, and proteomic biomarkers in molecular diagnostics, which offer better potential for personalized management of the transplanted organ by providing earlier detection of rejection episodes. Areas covered: This review was compiled from key word searches of full-text publications relevant to the field. Expert commentary: Many of the recent advancements in the molecular diagnostics of allograft injury show much promise, but before they can be fully realized further validation in larger sample sets must be conducted. Additionally, for better informed therapeutic decisions, more work must be completed to differentiate between different causes of injury. Moreover, the diagnostics field is looking at methodologies that allow for multiplexing, the ability to identify multiple targets simultaneously, in order to provide more robust biomarkers and better understanding.
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Affiliation(s)
- Michael Nasr
- Sarwal Lab, University of California, San Francisco
- University of California, San Francisco, Department of Bioengineering & Therapeutic Sciences
- University of California, Berkeley, Department of Bioengineering
| | - Tara Sigdel
- Sarwal Lab, University of California, San Francisco
- Unversity of California, San Francisco Department of Surgery
| | - Minnie Sarwal
- Sarwal Lab, University of California, San Francisco
- Unversity of California, San Francisco Department of Surgery
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10
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Oweira H, Lahdou I, Daniel V, Opelz G, Schmidt J, Zidan A, Mehrabi A, Sadeghi M. Early post-operative acute phase response in patients with early graft dysfunction is predictive of 6-month and 12-month mortality in liver transplant recipients. Hum Immunol 2016; 77:952-960. [PMID: 27476050 DOI: 10.1016/j.humimm.2016.07.234] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 07/25/2016] [Accepted: 07/26/2016] [Indexed: 02/08/2023]
Abstract
UNLABELLED Early allograft dysfunction (EAD) after liver transplantation is mostly a reversible event caused by factors related to ischemia/reperfusion (I/R) injury. EAD represents a hepatic injury associated with pre- and early post-transplant inflammatory cytokine responses. Aim of the present study was to evaluate the prognostic and diagnostic value of CRP in liver transplant recipients with EAD. MATERIALS AND METHODS Forty-seven patients with EAD were compared with 115 non-EAD patients. Pre- and post-transplant parameters were analyzed. EAD was defined based on postoperative liver function tests such as INR, bilirubin and liver enzymes. Statistical analysis was performed using SPSS version 18.0. RESULTS Pre-transplant liver enzyme were not significantly different in the two groups. At day 3, 5 and 10 post-transplant CRP was significantly higher in patients with EAD than in non-EAD patients (p⩽0.001 for all investigations) and remained consistently high in patients with EAD and low in non-EAD patients. EAD patients with high CRP at post-transplant days 3 and 5 showed lower survival at 6-month and 12-month post-transplant than patients with low CRP. CONCLUSION Our results indicate a prognostic and diagnostic value of CRP in patients with early graft dysfunction and predict 6-month and 12-month mortality in liver transplant recipients.
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Affiliation(s)
- Hani Oweira
- Department of Visceral Surgery, University of Heidelberg, Heidelberg, Germany; Zürich Surgical Center, Vascular and Visceral Surgery, Kappelistr. 7, CH-8002 Zürich, Switzerland.
| | - Imad Lahdou
- Transplantation Immunology, University of Heidelberg, Germany.
| | - Volker Daniel
- Transplantation Immunology, University of Heidelberg, Germany.
| | - Gerhard Opelz
- Transplantation Immunology, University of Heidelberg, Germany.
| | - Jan Schmidt
- Department of Visceral Surgery, University of Heidelberg, Heidelberg, Germany; Zürich Surgical Center, Vascular and Visceral Surgery, Kappelistr. 7, CH-8002 Zürich, Switzerland.
| | - Ahmed Zidan
- Department of Visceral Surgery, University of Heidelberg, Heidelberg, Germany; Department of HPB and Liver Transplantation Surgery, Rajhy Liver Hospital, Assiut University Hospital, Assuit, Egypt.
| | - Arianeb Mehrabi
- Department of Visceral Surgery, University of Heidelberg, Heidelberg, Germany.
| | - Mahmoud Sadeghi
- Department of Visceral Surgery, University of Heidelberg, Heidelberg, Germany.
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11
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Pratschke J, Dragun D, Hauser IA, Horn S, Mueller TF, Schemmer P, Thaiss F. Immunological risk assessment: The key to individualized immunosuppression after kidney transplantation. Transplant Rev (Orlando) 2016; 30:77-84. [DOI: 10.1016/j.trre.2016.02.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 02/10/2016] [Indexed: 12/18/2022]
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12
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Crespo E, Bestard O. Biomarkers to assess donor-reactive T-cell responses in kidney transplant patients. Clin Biochem 2015; 49:329-37. [PMID: 26279496 DOI: 10.1016/j.clinbiochem.2015.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 07/23/2015] [Accepted: 08/09/2015] [Indexed: 02/07/2023]
Abstract
Different to antibody-mediated rejection (ABMR), T-cell mediated rejection (TCMR) still unpredictably occurs after kidney transplantation in a great part because of a poor immunologic evaluation of the cellular allogeneic immune response. However, in the last years, important efforts have focused on the development of novel and more sensitive assays to monitor T-cell alloimmune responses at different biological levels that may improve the understanding of the functional status of the cellular immune compartment in patients undergoing organ transplantation. In this direction, immune assays evaluating T-cell proliferation, intracellular ATP release, multiparameter flow cytometry, profiling T-cell receptor repertoires and measurements of frequencies of cytokine-producing T-cells using an IFN-γ enzyme-linked immunospot assay (IFN-γ ELISPOT) have been reported showing interesting associations between the cellular alloimmune response and kidney transplant outcomes. In summary, an important progress has been made in the assessment of alloreactive T-cell responses in the context of organ transplantation using novel immune assays at different biological levels. However, there is an urgent need for prospective, randomized clinical studies to validate these encouraging preliminary data to ultimately introduce them in current clinical practice for refining current immune-risk stratification in kidney transplantation.
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Affiliation(s)
- Elena Crespo
- Laboratory of Experimental Nephrology, IDIBELL, Barcelona, Spain
| | - Oriol Bestard
- Laboratory of Experimental Nephrology, IDIBELL, Barcelona, Spain; Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona University, Barcelona, Spain.
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13
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Grenzi PC, Campos ÉF, Silva HT, Felipe CR, Franco MF, Soares MF, Medina-Pestana JO, Gerbase-DeLima M. Post-transplant soluble CD30 levels are associated with early subclinical rejection in kidney transplantation. Transpl Immunol 2015; 32:61-5. [PMID: 25698648 DOI: 10.1016/j.trim.2015.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 02/06/2015] [Accepted: 02/09/2015] [Indexed: 11/25/2022]
Abstract
Several studies have shown association of high pre- or post-transplant levels of soluble CD30 (sCD30) with acute rejection and poor late kidney transplant outcome. Our goal was to investigate whether sCD30 levels at month-3 post-transplant are associated with subclinical rejection, presence of CD30(+) cells within the graft, and expression of immune response genes in peripheral blood mononuclear cells. The study comprised 118 adult first kidney graft recipients, transplanted at a single center, receiving tacrolimus in low concentration. All were submitted to a protocol biopsy at month-3. Subclinical rejection was identified in 10 biopsies and sCD30 levels ≥ 61.88 ng/mL (P = 0.004), younger recipient age (P = 0.030) and non-Caucasian ethnicity (P = 0.011) were independently associated with this outcome. Rare CD30(+) cells were present in only two biopsies. There was a correlation between sCD30 levels and CD30 gene expression in peripheral blood mononuclear cells (r = 0.385, P = 0.043). These results show that high sCD30 levels are independent predictors of graft dysfunction and may contribute to patient selection protocols by indicating those who could benefit from a more thorough evaluation.
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Affiliation(s)
- Patricia C Grenzi
- Instituto de Imunogenética-AFIP, Rua Loefgreen 1235, 04040-031 São Paulo, SP, Brazil; Universidade Federal de São Paulo, Rua Sena Madureira 1500, 04021-001 São Paulo, SP, Brazil.
| | - Érika F Campos
- Instituto de Imunogenética-AFIP, Rua Loefgreen 1235, 04040-031 São Paulo, SP, Brazil; Universidade Federal de São Paulo, Rua Sena Madureira 1500, 04021-001 São Paulo, SP, Brazil.
| | - Hélio T Silva
- Hospital do Rim e Hipertensão, Rua Borges Lagoa 960, 04038-002 São Paulo, SP, Brazil.
| | - Claudia R Felipe
- Hospital do Rim e Hipertensão, Rua Borges Lagoa 960, 04038-002 São Paulo, SP, Brazil.
| | - Marcelo F Franco
- Universidade Federal de São Paulo, Rua Sena Madureira 1500, 04021-001 São Paulo, SP, Brazil.
| | - Maria F Soares
- Universidade Federal do Paraná, Rua XV de Novembro 1299, 80060-000 Curitiba, PR, Brazil.
| | - José O Medina-Pestana
- Universidade Federal de São Paulo, Rua Sena Madureira 1500, 04021-001 São Paulo, SP, Brazil; Hospital do Rim e Hipertensão, Rua Borges Lagoa 960, 04038-002 São Paulo, SP, Brazil.
| | - Maria Gerbase-DeLima
- Instituto de Imunogenética-AFIP, Rua Loefgreen 1235, 04040-031 São Paulo, SP, Brazil; Universidade Federal de São Paulo, Rua Sena Madureira 1500, 04021-001 São Paulo, SP, Brazil.
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14
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Valke LLFG, van Cranenbroek B, Hilbrands LB, Joosten I. Soluble CD30 does not predict late acute rejection or safe tapering of immunosuppression in renal transplantation. Transpl Immunol 2014; 32:18-22. [PMID: 25446808 DOI: 10.1016/j.trim.2014.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 10/27/2014] [Accepted: 10/28/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Previous reports revealed the potential value of the soluble CD30 level (sCD30) as biomarker for the risk of acute rejection and graft failure after renal transplantation, here we examined its use for the prediction of safe tapering of calcineurin inhibitors as well as late acute rejection. METHODS In a cohort of renal transplant patients receiving triple immunosuppressive therapy we examined whether sCD30 can be used as a marker for safe (rejection-free) discontinuation of tacrolimus at six months after transplantation (TDS cohort: 24 rejectors and 44 non-rejecting controls). Also, in a second cohort of patients (n=22, rejectors n=11 and non-rejectors n=11), participating in a clinical trial of rituximab as induction therapy after renal transplantation (RITS cohort), we examined whether sCD30 could predict the occurrence of late (>3months post-transplant) acute rejection episodes. sCD30 was measured by ELISA in serum taken before and at several time points after transplantation. RESULTS Overall, in the TDS cohort sCD30 decreased after transplantation. No difference in sCD30 was observed between rejectors and non-rejecting controls at any of the time points measured. In addition, in the RITS cohort, sCD30 measured at three months after transplantation were not indicative for the occurrence of late acute rejection. CONCLUSION In two prospectively followed cohorts of renal transplant patients we found no association between sCD30 and the occurrence of either late acute rejection or acute rejection after reduction of immunosuppression.
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Affiliation(s)
- Lars L F G Valke
- Department of Laboratory Medicine, Laboratory of Medical Immunology, Radboud University Medical Centre, PO Box 9101 6500HB Nijmegen, the Netherlands; Department of Nephrology, Radboud University Medical Centre, PO Box 9101 6500HB Nijmegen, the Netherlands.
| | - Bram van Cranenbroek
- Department of Laboratory Medicine, Laboratory of Medical Immunology, Radboud University Medical Centre, PO Box 9101 6500HB Nijmegen, the Netherlands.
| | - Luuk B Hilbrands
- Department of Nephrology, Radboud University Medical Centre, PO Box 9101 6500HB Nijmegen, the Netherlands.
| | - Irma Joosten
- Department of Laboratory Medicine, Laboratory of Medical Immunology, Radboud University Medical Centre, PO Box 9101 6500HB Nijmegen, the Netherlands.
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15
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Vondran FWR, Timrott K, Kollrich S, Steinhoff AK, Kaltenborn A, Schrem H, Klempnauer J, Lehner F, Schwinzer R. Pre-transplant immune state defined by serum markers and alloreactivity predicts acute rejection after living donor kidney transplantation. Clin Transplant 2014; 28:968-79. [PMID: 24931031 DOI: 10.1111/ctr.12399] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2014] [Indexed: 02/06/2023]
Abstract
Acute rejection (AR) remains a major cause for long-term kidney allograft failure. Reliable immunological parameters suitable to define the pre-transplant immune state and hence the individual risk of graft rejection are highly desired to preferably adapt the immunosuppressive regimen in advance. Donor and third party alloreactivities were determined by mixed lymphocyte cultures. Soluble forms of CD25, CD30, and CD44 were detected in patients' serum by ELISA. Various lymphocyte subpopulations were measured using flow cytometry. All patients received triple immunosuppression (tacrolimus/mycophenolate mofetil/steroids) and were grouped according to biopsy results within the first year: rejection-free (RF, n = 13), borderline (BL, n = 5), or acute rejection (AR, n = 7). Patients with AR showed the highest pre-transplant alloreactivities and serum levels (sCD25/sCD30/sCD44) according to the pattern RF < BL < AR. Relying on serum analysis only, multivariate logistic regression (logit link function) yielded a prognostic score for prediction of rejection with 75.0% sensitivity and 69.2% specificity. Patients with rejection showed markedly higher pre-transplant frequencies of CD4(+) /CD8(+) T cells lacking CD28, but lower numbers of CD8(+) CD161(bright) T cells and NK cells than RF individuals. Pre-transplant immune state defined by alloreactivity, serum markers, and particular lymphocyte subsets seems to correlate with occurrence of graft rejection after kidney transplantation. A prognostic score based on pre-transplant serum levels has shown great potential for prediction of rejection episodes and should be further evaluated.
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Affiliation(s)
- Florian W R Vondran
- Transplant Laboratory, Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
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16
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Grenzi PC, Campos ÉF, Tedesco-Silva H, Felipe CR, Franco MF, Soares MF, Medina-Pestana JO, Gerbase-Delima M. Association of high post-transplant soluble CD30 serum levels with chronic allograft nephropathy. Transpl Immunol 2013; 29:34-8. [PMID: 23928467 DOI: 10.1016/j.trim.2013.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 07/29/2013] [Accepted: 07/29/2013] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to evaluate the association of post-transplant soluble CD30 (sCD30) levels, isolated or in combination with of anti-HLA class II antibodies and of serum creatinine levels, with kidney graft loss due to chronic allograft nephropathy (CAN), and type of lesions in graft biopsies for cause. The study comprised 511 first kidney graft recipients, transplanted at a single center, with a graft functioning for at least 2.8 years. A single blood sample was collected from each patient. sCD30 levels were determined by ELISA, and HLA antibodies by Luminex assay. The minimum follow-up after testing was 9.3 years. High sCD30 levels, set at sCD30 ≥ 34.15 ng/mL, the presence of HLA class II antibodies, and serum creatinine ≥ 1.9 mg/dL were independently associated with CAN-graft loss (P values <0.0001, 0.05, <0.0001, respectively), and the combined hazard ratio for CAN-graft loss was 20.2. Analyses of 166 biopsies for cause showed that high sCD30 levels and creatinine were independently associated with interstitial lesions. Post-transplant sCD30 serum levels, especially in conjunction with information regarding HLA class II antibodies and serum creatinine levels, provide valuable information regarding graft outcome and could be useful for the management of kidney transplant recipients.
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Affiliation(s)
- Patricia C Grenzi
- Instituto de Imunogenética, AFIP, São Paulo, SP, Brazil; Universidade Federal de São Paulo, São Paulo, SP, Brazil
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17
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Solgi G, Gadi V, Paul B, Mytilineos J, Pourmand G, Mehrsai A, Ranjbar M, Mohammadnia M, Nikbin B, Amirzargar AA. Five-year clinical effects of donor bone marrow cells infusions in kidney allograft recipients: improved graft function and higher graft survival. CHIMERISM 2013; 4:87-94. [PMID: 23639966 DOI: 10.4161/chim.24719] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Augmentation of microchimerism in solid organ transplant recipients by donor bone marrow cells (DBMC) infusion may promote immune hyporesponsiveness and consequently improve long-term allograft survival. Between March 2005 and July 2007, outcomes for 20 living unrelated donor (LURD) primary kidney recipients with concurrent DBMC infusion (an average of 2.19 ± 1.13 x 10⁹ donor cells consisting of 2.66 ± 1.70 x 10⁷ CD34⁺ cells) were prospectively compared with 20 non-infused control allograft recipients given similar conventional immunosuppressive regimens. With five years of clinical follow up, a total of 11 cases experienced rejection episodes (3 DBMI patients vs. 8 controls, p = 0.15). One DBMC-infused patient experienced chronic rejection vs. two episodes (1 biopsy-confirmed) in the control patients. Actuarial and death-censored 5-y graft survival was significantly higher in infused patients compared with controls (p = 0.01 and p = 0.03, respectively). Long-term graft survival was significantly associated with pre-transplant anti-HLA antibodies (p = 0.01), slightly with peripheral microchimerism (p = 0.09) and CD4⁺CD25⁺FoxP3⁺ T cells (p = 0.09). Immunosuppressant dosing was lower in infused patients than controls, particularly for mycophenolate mofetil (p = 0.001). The current findings as well as our previous reports on these patients indicates clinical improvement in long-term graft survival of renal transplant patients resulting from low-dose DBMC infusion given without induction therapy.
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Affiliation(s)
- Ghasem Solgi
- Immunology Department; School of Medicine; Hamadan University of Medical Sciences; Hamadan, Iran
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