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Hejtmánková A, Caisová H, Tomanová T, Španielová H. The role of the DE and EF loop of BKPyV VP1 in the serological cross-reactivity between subtypes. Virus Res 2023; 324:199031. [PMID: 36587871 DOI: 10.1016/j.virusres.2022.199031] [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: 09/22/2022] [Revised: 12/12/2022] [Accepted: 12/21/2022] [Indexed: 12/31/2022]
Abstract
BK virus (BKPyV) is a causative agent of BKPyV-associated nephropathy and graft rejections in kidney transplant patients. It establishes persistent infection in the kidneys, which can lead to reactivation in an immunosuppressed state or transmission to kidney recipients. Complications in the case of donor-derived infections can be caused by differences between the four known BKPyV subtypes, as prior infection with one subtype does not guarantee protection against de novo infection with other subtypes. The recipient and donor pretransplant serotyping is not routinely performed since simple ELISA tests employing antigens derived from the major viral capsid protein 1 (VP1) are hindered by the high cross-reactivity of anti-VP1 antibodies against all subtypes. Identifying subtype-specific epitopes in VP1 could lead to the design of specific antigens and the improvement of serodiagnostics for kidney transplantation. We aimed to study the surface residues responsible for the interactions with the subtype-specific antibodies by focusing on the DE and EF loops of VP1, which have only a small number of distinct amino acid differences between the most common subtypes, BKPyV-I and BKPyV-IV. We designed two mutant virus-like particles (VLPs): we introduced BKPyV-I characteristic amino acid residues (either H139N in the DE loop or D175E and I178V changes in the EF loop) into the base sequence of a BKPyV-IV VP1. This way, we created BKPyV-IV mutant VLPs with the sequence of either the BKPyV-I DE loop or the BKPyV-I EF loop. These mutants were then used as competing antigens in an antigen competition assay with a panel of patient sera, and changes in antibody reactivity were assessed by ELISA. We found that the changes introduced into the BKPyV-IV VP1 EF loop restrict antibody recognition in most samples and that converting the BKPyV-IV DE loop into its BKPyV-I equivalent attracts anti-VP1 BKPyV-I antibodies. Although our results did not lead to the discovery of a subtype-specific epitope on the VP1, they suggested that the arrangement of the EF loop in VP1 might dictate the mode of interaction between virus and anti-VP1 antibodies in general and that the interactions between the antibodies and the viral capsid might be very complex. Consequently, an antigen competition assay as an assay to distinguish between BKPyV serotypes might prove difficult to interpret.
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Affiliation(s)
- Alžběta Hejtmánková
- Department of Genetics and Microbiology, Faculty of Science, Charles University, Viničná 5, 128 44 Prague 2, Czech Republic
| | - Helena Caisová
- Department of Genetics and Microbiology, Faculty of Science, Charles University, Viničná 5, 128 44 Prague 2, Czech Republic
| | - Tereza Tomanová
- Department of Genetics and Microbiology, Faculty of Science, Charles University, Viničná 5, 128 44 Prague 2, Czech Republic
| | - Hana Španielová
- Department of Genetics and Microbiology, Faculty of Science, Charles University, Viničná 5, 128 44 Prague 2, Czech Republic; Institute of Organic Chemistry and Biochemistry of the CAS, Flemingovo náměstí 542/2, 166 10, Praha 5, Czech Republic.
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2
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Myint TM, Chong CHY, Wyld M, Nankivell B, Kable K, Wong G. Polyoma BK Virus in Kidney Transplant Recipients: Screening, Monitoring, and Management. Transplantation 2022; 106:e76-e89. [PMID: 33908382 DOI: 10.1097/tp.0000000000003801] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Polyomavirus BK virus (BKPyV) infection is an important complication of kidney transplantation and allograft failure. The prevalence of viremia is 10%-15%, compared with BK-associated nephropathy (BKPyVAN) at 3%-5%. Given that there are no effective antiviral prophylaxis or treatment strategies for BKPyVAN, active screening to detect BKPyV viremia is recommended, particularly during the early posttransplant period. Immunosuppression reduction to allow viral clearance may avoid progression to severe and irreversible allograft damage. The frequency and duration of screening are highly variable between transplant centers because the evidence is reliant largely on observational data. While the primary treatment goals center on achieving viral clearance through immunosuppression reduction, prevention of subsequent acute rejection, premature graft loss, and return to dialysis remain as major challenges. Treatment strategies for BKPyV infection should be individualized to the recipient's underlying immunological risk and severity of the allograft infection. Efficacy data for adjuvant therapies including intravenous immunoglobulin and cidofovir are sparse. Future well-powered and high-quality randomized controlled trials are needed to inform evidence-based clinical practice for the management of BKPy infection.
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Affiliation(s)
- Thida Maung Myint
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Newcastle Transplant Unit, John Hunter Hospital, Newcastle, NSW, Australia
| | - Chanel H Y Chong
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Melanie Wyld
- Department of Renal Medicine, Centre for Transplant and Renal Research, Westmead Hospital, Westmead, NSW, Australia
| | - Brian Nankivell
- Department of Renal Medicine, Centre for Transplant and Renal Research, Westmead Hospital, Westmead, NSW, Australia
| | - Kathy Kable
- Department of Renal Medicine, Centre for Transplant and Renal Research, Westmead Hospital, Westmead, NSW, Australia
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Department of Renal Medicine, Centre for Transplant and Renal Research, Westmead Hospital, Westmead, NSW, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
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Albasha W, Vahdani G, Ashoka A, Bracamonte E, Yau AA. Native BK virus nephropathy in lung transplant: a case report and literature review. Clin Kidney J 2021; 15:808-811. [PMID: 35371460 PMCID: PMC8967672 DOI: 10.1093/ckj/sfab251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Indexed: 11/14/2022] Open
Abstract
Classically described in renal allografts, BK virus nephropathy is increasingly recognized in native kidneys of other non-renal solid organ transplants. We discuss a 68-year-old woman with a history of bilateral lung transplant referred for worsening renal function, confirmed to have BK virus nephropathy by biopsy with a serum BK virus polymerase chain reaction of over 59 million copies/mL. She was managed with a reduction in immunosuppression and intravenous cidofovir with no improvement in her clinical parameters. The seven prior reported cases of polyoma virus nephropathy in lung transplant recipients are reviewed, and the challenges of screening and management are discussed.
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Affiliation(s)
- Waseem Albasha
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Arizona College of Medicine, USA
| | - Golnaz Vahdani
- Division of Nephrology, Department of Medicine, The Ohio State University, USA
| | - Ankita Ashoka
- Department of Medicine, University of Arizona College of Medicine, USA
| | - Erika Bracamonte
- Department of Pathology, University of Arizona College of Medicine, USA
| | - Amy A Yau
- Division of Nephrology, Department of Medicine, The Ohio State University, USA
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Munker D, Veit T, Schönermarck U, Arnold P, Leuschner G, Barton J, Mümmler C, Briegel I, Mumm JN, Zoller M, Kauke T, Sisic A, Ghiani A, Walter J, Milger K, Mueller S, Michel S, Munker S, Keppler O, Fischereder M, Meiser B, Behr J, Kneidinger N, Neurohr C. Polyomavirus exerts detrimental effects on renal function in patients after lung transplantation. J Clin Virol 2021; 145:105029. [PMID: 34798365 DOI: 10.1016/j.jcv.2021.105029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/03/2021] [Accepted: 11/10/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Chronic kidney disease (CKD) is associated with significant morbidity and mortality after lung transplantation (LTX). Calcineurin inhibitor (CNI) nephrotoxicity is the leading cause of CKD. After kidney transplantation, polyomavirus-associated nephropathy (PyVAN) is a well-recognized problem. This study aims to evaluate the role of polyomavirus in patients after LTX. METHODS From January 2017 to January 2020, all lung transplant recipients who performed follow-up visits in our center were included in the study and retrospectively assessed. We measured renal function (creatinine levels before and after transplantation), JCPyV, and BKPyV load by polymerase chain reaction (PCR) in serum and urine samples after transplantation. RESULTS In total, 104 consecutive patients (59 males, 56.7%) with a mean age of 49.6 ± 11.1 years were identified. JCPyV was found in urine of 36 patients (34.6%) and serum of 3 patients (2.9%). BKPyV was found in urine of 40 patients (38.5%) and serum of 4 patients (3.8%), respectively. Urine evidence for JCPyV (p < 0.001, coefficient: +21.44) and BKPyV (p < 0.001, coefficient: +29.65) correlated highly with further kidney function decline. CONCLUSION Kidney function deterioration is associated with JCPyV and BKPyV viruria in patients after LTX. This might indicate a role of PyVAN in lung transplant recipients.
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Affiliation(s)
- Dieter Munker
- Department of Medicine V, University hospital, LMU Munich; Comprehensive Pneumology Center (CPC-M); Member of the German Center for Lung Research (DZL), Munich, Germany.
| | - Tobias Veit
- Department of Medicine V, University hospital, LMU Munich; Comprehensive Pneumology Center (CPC-M); Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Ulf Schönermarck
- Department of Medicine IV, University hospital, LMU Munich, Germany
| | - Paola Arnold
- Department of Medicine V, University hospital, LMU Munich; Comprehensive Pneumology Center (CPC-M); Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Gabriela Leuschner
- Department of Medicine V, University hospital, LMU Munich; Comprehensive Pneumology Center (CPC-M); Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Jürgen Barton
- Department of Medicine V, University hospital, LMU Munich; Comprehensive Pneumology Center (CPC-M); Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Carlo Mümmler
- Department of Medicine V, University hospital, LMU Munich; Comprehensive Pneumology Center (CPC-M); Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Ignaz Briegel
- Department of Medicine V, University hospital, LMU Munich; Comprehensive Pneumology Center (CPC-M); Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Jan-Niclas Mumm
- Department of Urology, University hospital, LMU Munich, Germany
| | - Michael Zoller
- Department of Anesthesiology, University hospital, LMU Munich, Germany
| | - Teresa Kauke
- Department of Thoracic Surgery, University hospital, LMU Munich, Germany
| | - Alma Sisic
- Transplant Center, University hospital, LMU Munich, Germany
| | - Alessandro Ghiani
- Department of Pneumology and Respiratory Medicine, Schillerhoehe Clinic (affiliated to Rober-Bosch-Hospital GmbG, Stuttgart), Solitudestr. 18, 70839, Gerlingen, Germany
| | - Julia Walter
- Department of Medicine V, University hospital, LMU Munich; Comprehensive Pneumology Center (CPC-M); Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Katrin Milger
- Department of Medicine V, University hospital, LMU Munich; Comprehensive Pneumology Center (CPC-M); Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Susanna Mueller
- Department of Pathology, University hospital, LMU Munich, Germany
| | - Sebastian Michel
- Department of Thoracic Surgery, University hospital, LMU Munich, Germany; Transplant Center, University hospital, LMU Munich, Germany
| | - Stefan Munker
- Department of Internal Medicine II, University hospital, LMU Munich, Germany
| | - Oliver Keppler
- Department of Internal Medicine II, University hospital, LMU Munich, Germany
| | | | - Bruno Meiser
- Transplant Center, University hospital, LMU Munich, Germany
| | - Jürgen Behr
- Department of Medicine V, University hospital, LMU Munich; Comprehensive Pneumology Center (CPC-M); Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Nikolaus Kneidinger
- Department of Medicine V, University hospital, LMU Munich; Comprehensive Pneumology Center (CPC-M); Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Claus Neurohr
- Department of Virology, University hospital, LMU Munich, Germany; Department of Pneumology and Respiratory Medicine, Schillerhoehe Clinic (affiliated to Rober-Bosch-Hospital GmbG, Stuttgart), Solitudestr. 18, 70839, Gerlingen, Germany
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Tedesco-Silva H, Saliba F, Barten MJ, De Simone P, Potena L, Gottlieb J, Gawai A, Bernhardt P, Pascual J. An overview of the efficacy and safety of everolimus in adult solid organ transplant recipients. Transplant Rev (Orlando) 2021; 36:100655. [PMID: 34696930 DOI: 10.1016/j.trre.2021.100655] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/17/2021] [Accepted: 09/17/2021] [Indexed: 12/15/2022]
Abstract
As the risk of graft loss due to acute rejection has declined, the goal of post-transplant management has switched to long-term preservation of organ function. Minimizing calcineurin inhibitor (CNI)-related nephrotoxicity is a key component of this objective. Everolimus is a mammalian target of rapamycin inhibitor/proliferation-signal inhibitor with potent immunosuppressive and anti-proliferative effects. It has been widely investigated in large randomized clinical studies that have shown it to have similar anti-rejection efficacy compared with standard-of-care regimens across organ transplant indications. With demonstrated potential to facilitate the reduction of CNI therapy and preserve renal function, everolimus is an alternative to the current standard-of-care CNI-based regimens used in de novo and maintenance solid organ transplantation recipients. Here, we provide an overview of the evidence from the everolimus clinical study program across kidney, liver, heart, and lung transplants, as well as other key data associated with its use in CNI reduction strategies in adult transplant recipients.
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Affiliation(s)
| | - Faouzi Saliba
- AP-HP_Hôpital Paul Brousse, Hepato-Biliary Centre, Villejuif, France; Université Paris-Saclay, INSERM Unit 1193, France
| | - Markus J Barten
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | | | - Luciano Potena
- Heart Failure and Transplant Program, Cardiology Unit, IRCCS Policlinico di Sant'Orsola, Bologna, Italy
| | - Jens Gottlieb
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | | | | | - Julio Pascual
- Department of Nephrology, Hospital del Mar, Barcelona, Spain.
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6
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Mallavarapu RK, Sanoff SL, Howell DN, Roberts JK. BK virus nephropathy in non-renal solid organ transplant recipients: Are we looking hard enough? Clin Transplant 2021; 35:e14265. [PMID: 33615555 DOI: 10.1111/ctr.14265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/06/2021] [Accepted: 02/11/2021] [Indexed: 01/02/2023]
Abstract
We retrospectively examined the clinical characteristics, pathological features, and outcomes of BK viremia and nephropathy in a population of non-renal solid organ transplant patients (NRSOT) referred for outpatient nephrology consultation over a period of 5 years. In the entire cohort of liver, heart, and lung transplant recipients referred to this clinic, 14% percent were found to have BK viremia with a median peak serum BK viral load of 35 500 copies/ml (range 250 to 21 100 000 copies/ml). BK viremia resolved in six of the seventeen patients (35%). Four out of five patients biopsied showed BK virus (BKV) nephropathy. Eleven out of seventeen patients with BK viremia developed advanced (stage 4 or 5) chronic kidney disease. Four patients developed rejection of their solid organ transplant within the first year post detection of BK viremia after immunosuppression reduction. We conclude that a multi-center study is required to evaluate whether implementation of a systematic BK screening program would be effective in early detection and management of this problem in the NRSOT population.
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Affiliation(s)
- Ravi K Mallavarapu
- Division of Transplant Nephrology, Augusta University-Medical College of Georgia, Augusta, GA, USA
| | - Scott L Sanoff
- Division of Nephrology, Duke University School of Medicine, Durham, NC, USA
| | - David N Howell
- Department of Pathology, Duke University School of Medicine, Durham, NC, USA
| | - John K Roberts
- Division of Nephrology, Duke University School of Medicine, Durham, NC, USA
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Nieto-Ríos JF, Benavides-Henao DA, Aristizabal-Alzate A, Morales-Contreras C, Chacón-Jaimes DC, Zuluaga-Valencia G, Serna-Higuita LM. BK virus nephropathy in a heart transplant recipient. J Bras Nefrol 2021; 43:434-439. [PMID: 33527977 PMCID: PMC8428640 DOI: 10.1590/2175-8239-jbn-2020-0049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 10/26/2020] [Indexed: 01/11/2023] Open
Abstract
BK virus nephropathy in kidney transplantation is widely recognized as an important cause of graft dysfunction and loss. In the case of transplants of organs other than kidney, BK virus nephropathy in native kidneys has been recognized as a cause of chronic kidney disease, which is related with immunosuppression; however, the diagnosis is usually late because the renal dysfunction is attributed to other causes, such as toxicity by anticalcineurinic drugs, interstitial nephritis due to medications, hemodynamic changes, diabetes, hypertension, etc. We report a case of BK virus nephropathy in a patient who underwent heart transplantation due to peripartum cardiomyopathy. The kidney biopsy reported active chronic tubulointerstitial nephritis associated with late stage polyomavirus nephritis and the blood viral load for BK virus was positive (logarithm 4.5). The immunosuppressive treatment was reduced, and after two years of follow-up, the patient had stable renal function with a serum creatinine of 2.5 mg/dL (GFR of 23.4 mL/min/1.73m2). We recommend that the BK virus be considered as a cause of renal dysfunction in heart transplant recipients, with the aim of detecting its replication in time to reduce immunosuppressive therapy before irreversible compromise of renal function may manifest.
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Affiliation(s)
- John Fredy Nieto-Ríos
- Hospital Pablo Tobón Uribe, Department of Nephrology and Kidney Transplant, Medellín, Colombia.,University of Antioquia, Nephrology Section, Department of Internal Medicine, Medellin, Colombia
| | | | | | - Carol Morales-Contreras
- University of Antioquia, Nephrology Section, Department of Internal Medicine, Medellin, Colombia
| | | | | | - Lina María Serna-Higuita
- Eberhard Karls University, Institute for Clinical Epidemiology and Applied Biometrics, Tuebingen, Germany
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Crowhurst T, Nolan J, Faull R, Holmes M, Holmes-Liew CL. BK virus-associated nephropathy in a lung transplant patient: case report and literature review. BMC Infect Dis 2020; 20:600. [PMID: 32795251 PMCID: PMC7427921 DOI: 10.1186/s12879-020-05292-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/26/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND BK virus-associated nephropathy (BKVAN) is a relatively common cause of renal dysfunction in the first six months after renal transplantation. It arises from reactivation of the latent and usually harmless BK virus (BK virus) due to immunosuppression and other factors including some that are unique to renal transplantation such as allograft injury. BKVAN is much rarer in non-renal solid organ transplantation, where data regarding diagnosis and management are extremely limited. CASE PRESENTATION We report a case of a 58-year-old man found to have worsening renal dysfunction nine months after bilateral sequential lung transplantation for chronic obstructive pulmonary disease (COPD). He had required methylprednisolone for acute allograft rejection but achieved good graft function. Urine microscopy and culture and renal ultrasound were normal. BK virus PCR was positive at high levels in urine and blood. Renal biopsy subsequently confirmed BKVAN. The patient progressed to end-stage renal failure requiring haemodialysis despite reduction in immunosuppression, including switching mycophenolate for everolimus, and the administration of intravenous immunoglobulin (IVIG). CONCLUSIONS This very rare case highlights the challenges presented by BK virus in the non-renal solid organ transplant population. Diagnosis can be difficult, especially given the heterogeneity with which BKV disease has been reported to present in such patients, and the optimal approach to management is unknown. Balancing reduction in immunosuppression against prevention of allograft rejection is delicate. Improved therapeutic options are clearly required.
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Affiliation(s)
- Thomas Crowhurst
- Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia.
- SA Lung Transplant Service, Royal Adelaide Hospital, Central Adelaide Local Health Network, 1 Port Road, Adelaide, SA, 5000, Australia.
| | - James Nolan
- SA Pathology, Royal Adelaide Hospital, Central Adelaide Local Health Network, 1 Port Road, Adelaide, SA, 5000, Australia
| | - Randall Faull
- Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Central Adelaide Local Health Network, 1 Port Road, Adelaide, SA, 5000, Australia
| | - Mark Holmes
- Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia
- SA Lung Transplant Service, Royal Adelaide Hospital, Central Adelaide Local Health Network, 1 Port Road, Adelaide, SA, 5000, Australia
| | - Chien-Li Holmes-Liew
- Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia
- SA Lung Transplant Service, Royal Adelaide Hospital, Central Adelaide Local Health Network, 1 Port Road, Adelaide, SA, 5000, Australia
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