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Klich A, Ecochard R, Subtil F. Unequal intra-group variance in trajectory classification. Stat Med 2018; 37:4155-4166. [DOI: 10.1002/sim.7921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 07/03/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Amna Klich
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique; Hospices Civils de Lyon; Lyon France
- Université de Lyon, Université Lyon 1, CNRS; Laboratoire de Biométrie et Biologie Evolutive UMR 5558; Villeurbanne France
| | - René Ecochard
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique; Hospices Civils de Lyon; Lyon France
- Université de Lyon, Université Lyon 1, CNRS; Laboratoire de Biométrie et Biologie Evolutive UMR 5558; Villeurbanne France
| | - Fabien Subtil
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique; Hospices Civils de Lyon; Lyon France
- Université de Lyon, Université Lyon 1, CNRS; Laboratoire de Biométrie et Biologie Evolutive UMR 5558; Villeurbanne France
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Chronic renal insufficiency in heart transplant recipients: risk factors and management options. Drugs 2015; 74:1481-94. [PMID: 25134671 DOI: 10.1007/s40265-014-0274-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Renal dysfunction after heart transplantation is a frequently observed complication, in some cases resulting in significant limitation of quality of life and reduced survival. Since the pathophysiology of renal failure (RF) is multifactorial, the current etiologic paradigm for chronic kidney disease after heart transplantation relies on the concept of calcineurin inhibitor (CNI)-related nephrotoxicity acting on a predisposed recipient. Until recently, the management of RF has been restricted to the minimization of CNI dosage and general avoidance of classic nephrotoxic risk factors, with somewhat limited success. The recent introduction of proliferation signal inhibitors (PSIs) (sirolimus and everolimus), a new class of immunosuppressive drugs lacking intrinsic nephrotoxicity, has provided a completely new alternative in this clinical setting. As clinical experience with these new drugs increases, new renal-sparing strategies are becoming available. PSIs can be used in combination with reduced doses of CNIs and even in complete CNI-free protocols. Different strategies have been devised, including de novo use to avoid acute renal toxicity in high-risk patients immediately after transplantation, or more delayed introduction in those patients developing chronic RF after prolonged CNI exposure. In this review, the main information on the clinical relevance and pathophysiology of RF after heart transplantation, as well as the currently available experience with renal-sparing immunosuppressive regimens, particularly focused on the use of PSIs, is reviewed and summarized, including the key practical points for their appropriate clinical usage.
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DePasquale EC, Schweiger M, Ross HJ. A contemporary review of adult heart transplantation: 2012 to 2013. J Heart Lung Transplant 2014; 33:775-84. [DOI: 10.1016/j.healun.2014.04.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 03/14/2014] [Accepted: 04/30/2014] [Indexed: 02/07/2023] Open
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Cornu C, Dufays C, Gaillard S, Gueyffier F, Redonnet M, Sebbag L, Roussoulières A, Gleissner CA, Groetzner J, Lehmkuhl HB, Potena L, Gullestad L, Cantarovich M, Boissonnat P. Impact of the reduction of calcineurin inhibitors on renal function in heart transplant patients: a systematic review and meta-analysis. Br J Clin Pharmacol 2014; 78:24-32. [PMID: 24251918 PMCID: PMC4168377 DOI: 10.1111/bcp.12289] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 10/31/2013] [Indexed: 01/13/2023] Open
Abstract
AIMS Calcineurin inhibitors (CNIs) taken after heart transplantation lead to excellent short-term outcomes, but long-term use may cause chronic nephrotoxicity. Our aim was to identify, appraise, select and analyse all high-quality research evidence relevant to the question of the clinical impact of CNI-sparing strategies in heart transplant patients. METHODS We carried out a systematic review and meta-analysis of randomized controlled trials on CNI reduction in heart transplant recipients. Primary outcomes were kidney function and acute rejection after 1 year. Secondary outcomes included graft loss, all-cause mortality and adverse events. RESULTS Eight open-label studies were included, with 723 patients (four tested de novo CNI reduction and four maintenance CNI reduction). Calcineurin inhibitor reduction did not improve creatinine clearance at 12 months 5.46 [-1.17, 12.03] P = 0.32 I(2) = 65.4%. Acute rejection at 12 months (55/360 vs. 52/332), mortality (18/301 vs. 15/270) and adverse event rates (55/294 vs. 52/281) did not differ between the low-CNI and standard-CNI groups. There was significant benefit on creatinine clearance in patients with impaired renal function at 6 months [+12.23 (+5.26, +18.82) ml min(-1) , P = 0.0003] and at 12 months 4.63 [-4.55, 13.82] P = 0.32 I(2) = 75%. CONCLUSIONS This meta-analysis did not demonstrate a favourable effect of CNI reduction on kidney function, but there was no increase in acute rejection. To provide a better analysis of the influence of CNI reduction patterns and associated treatments, a meta-analysis of individual patient data should be performed.
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Affiliation(s)
- Catherine Cornu
- INSERM, CIC201Lyon, France
- CHU Lyon, Service de Pharmacologie CliniqueLyon, France
- Université de Lyon, UMR 5558Lyon, France
- Hospices Civils de Lyon, Hôpital Louis PradelBron Cedex, France
| | - Christophe Dufays
- INSERM, CIC201Lyon, France
- CHU Lyon, Service de Pharmacologie CliniqueLyon, France
- Université de Lyon, UMR 5558Lyon, France
- Hospices Civils de Lyon, Hôpital Louis PradelBron Cedex, France
| | - Ségolène Gaillard
- INSERM, CIC201Lyon, France
- CHU Lyon, Service de Pharmacologie CliniqueLyon, France
- Université de Lyon, UMR 5558Lyon, France
- Hospices Civils de Lyon, Hôpital Louis PradelBron Cedex, France
| | - François Gueyffier
- INSERM, CIC201Lyon, France
- CHU Lyon, Service de Pharmacologie CliniqueLyon, France
- Université de Lyon, UMR 5558Lyon, France
- Hospices Civils de Lyon, Hôpital Louis PradelBron Cedex, France
| | - Michel Redonnet
- Département de Chirurgie Cardiaque, Hôpital Charles Nicolle, Université de RouenRouen, France
| | - Laurent Sebbag
- Hospices Civils de Lyon, Hôpital Louis Pradel, Pôle médico-chirurgical de Transplantation cardiaque adulteBron Cedex, France
| | - Ana Roussoulières
- Hospices Civils de Lyon, Hôpital Louis Pradel, Pôle médico-chirurgical de Transplantation cardiaque adulteBron Cedex, France
| | - Christian A Gleissner
- Department of Cardiology, Angiology and Pneumonology, University of HeidelbergHeidelberg, Germany
| | - Jan Groetzner
- Department of Cardiac Surgery, Ludwig-Maximilians-University GrosshadernMunich, Germany
| | | | - Luciano Potena
- Dipartimento Cardiovascolare, Policlinico S. Orsola-MalpighiBologna, Italy
| | - Lars Gullestad
- Department of Cardiology, Oslo University HospitalRikshospitalet, Oslo, Norway
- Faculty of Medicine, University of OsloOslo, Norway
| | - Marcelo Cantarovich
- Department of Medicine, Multi-Organ Transplant Program, Royal Victoria Hospital, McGill University Health CenterMontreal, Quebec, Canada
| | - Pascale Boissonnat
- Hospices Civils de Lyon, Hôpital Louis Pradel, Pôle médico-chirurgical de Transplantation cardiaque adulteBron Cedex, France
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Teixeira RAP, Mimura KKO, Araujo LP, Greco KV, Oliani SM. The essential role of annexin A1 mimetic peptide in the skin allograft survival. J Tissue Eng Regen Med 2013; 10:E44-53. [PMID: 23897745 DOI: 10.1002/term.1773] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 04/15/2013] [Accepted: 04/16/2012] [Indexed: 12/11/2022]
Abstract
Immunosuppressive drugs have a critical role in inhibiting tissue damage and allograft rejection. Studies have demonstrated the anti-inflammatory effects of the annexin A1 (AnxA1) in the regulation of transmigration and apoptosis of leucocytes. In the present study, an experimental skin allograft model was used to evaluate a potential protective effect of AnxA1 in transplantation survival. Mice were used for the skin allograft model and pharmacological treatments were carried out using either the AnxA1 mimetic peptide Ac2-26, with or without cyclosporine A (CsA), starting 3 days before surgery until rejection. Graft survival, skin histopathology, leucocyte transmigration and expression of AnxA1 and AnxA5 post-transplantation were analysed. Pharmacological treatment with Ac2-26 increased skin allograft survival related with inhibition of neutrophil transmigration and induction of apoptosis, thereby reducing the tissue damage compared with control animals. Moreover, AnxA1 and AnxA5 expression increased after Ac2-26 treatment in neutrophils. Interestingly, the combination of Ac2-26 and cyclosporine A showed similar survival of transplants when compared with the cyclosporine A group, which could be attributed to a synergistic effect of both drugs. Investigations in vitro revealed that cyclosporine A inhibited extracellular-signal-regulated kinase (ERK) phosphorylation induced by Ac2-26 in neutrophils. Overall, the results suggest that AnxA1 has an essential role in augmenting the survival of skin allograft, mainly owing to inhibition of neutrophil transmigration and enhancement of apoptosis. This effect may lead to the development of new therapeutic approaches relevant to transplant rejection.
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Affiliation(s)
| | | | - Leandro Pires Araujo
- Post-Graduation in Structural and Functional Biology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Karin Vicente Greco
- Department of Surgical Research, Northwick Park Institute for Medical Research - University College London, London, UK
| | - Sonia Maria Oliani
- Post-Graduation in Structural and Functional Biology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.,Department of Biology, Instituto de Biociências, Letras e Ciências Exatas (IBILCE), São Paulo State University (UNESP), São José do Rio Preto, Brazil
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