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Joshi R, Secondulfo C, Caputo A, Zeppa P, Iacuzzo C, Apicella L, Borriello M, Bilancio G, Viggiano D. Gut mucosa alterations after kidney transplantation: a cross sectional study. J Nephrol 2024:10.1007/s40620-024-02067-7. [PMID: 39289297 DOI: 10.1007/s40620-024-02067-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 08/08/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND Kidney transplant recipients (KTRs) rely on immunosuppressants like mycophenolate to prevent organ rejection. However, mycophenolate often causes intestinal symptoms and inflammation in various organs, including the skin and the colon. While KTRs have an increased risk for skin cancer, the risk of colorectal cancer is not increased. Elucidating the histological alterations in the colon of KTRs and comparing these changes with known skin alterations would help understand how immunosuppressants influence cancer development and progression. METHODS Whole slide images from gut biopsies (Non-transplanted subjects n = 35, KTRs n = 49) were analyzed using the ImageJ and R programming environment. A total of 22,035 epithelial cells, 38,870 interstitial cells, 3465 epithelial cell mitoses, and 7477 endothelial cells, each characterized by multiple microscopy parameters, from a total of 1788 glands were analyzed. The large database was subsequently analyzed to verify the changes of inflammatory milieu in KTRs and in cancer. RESULTS KTRs without colon-cancer showed a significantly higher density of interstitial cells in the colon compared to non-transplanted patients. Moreover, the increase in interstitial cell number was accompanied by subtle modifications in the architecture of the colon glands, without altering the epithelial cell density. We could not identify significant structural modifications in cancer samples between KTRs and non-transplanted patients. CONCLUSIONS Our findings demonstrate an increased number of resident interstitial cells in the colon of KTRs, as in other patients treated with mycophenolate. These changes are associated with subtle alterations in the architecture of colon glands.
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Affiliation(s)
- Rashmi Joshi
- Department of Translational Medical Sciences, University of Campania, Via Pansini, 5, 80131, Naples, Italy
| | - Carmine Secondulfo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | | | - Pio Zeppa
- Unit of Pathology, University Hospital of Salerno, Salerno, Italy
| | - Candida Iacuzzo
- Unit of Nephrology, Dialysis and Transplantation, University Hospital of Salerno, Salerno, Italy
| | - Luca Apicella
- Unit of Nephrology, Dialysis and Transplantation, University Hospital of Salerno, Salerno, Italy
| | | | - Giancarlo Bilancio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Davide Viggiano
- Department of Translational Medical Sciences, University of Campania, Via Pansini, 5, 80131, Naples, Italy.
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Dogahe D, Cubilier E, Taghavi M, Kaysi S, Nortier J, Mesquita MDCF. Evaluation of Transplant Suitability in a Patient with Previous Colorectal Cancer and Subsequent Radiation Cystitis: Insights from a Complicated Case. Case Rep Nephrol 2023; 2023:7839441. [PMID: 37790841 PMCID: PMC10545455 DOI: 10.1155/2023/7839441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/07/2023] [Accepted: 08/25/2023] [Indexed: 10/05/2023] Open
Abstract
Assessing transplant suitability can be a meticulous process, involving multiple investigations and various specialties. This process is well described in the latest KDIGO guidelines. We recently asked ourselves if those guidelines are still relevant to current clinical practice given the rapid evolution of modern medicine, especially in the field of oncology. We present the complicated case of a 60-year-old woman with ESKD (end-stage kidney disease) and a prior history of cancer, with secondary urological complications, to illustrate different interesting considerations for KT (kidney transplant). Our patient was diagnosed with rectal cancer at the age of 46, for which she was treated with surgery and radiotherapy before developing chronic radiation cystitis. This was followed by repeated urinary tract infections and secondary nephrolithiasis, ultimately leading to severe bilateral hydronephrosis and obstructive ESKD. We know that the type of cancer and its characteristics should be evaluated in detail, and we should offer patient-tailored recommendations after a multidisciplinary evaluation. In our case, the prior rectal cancer is not to be feared because curative treatment has been achieved and the patient has been cancer-free for 14 years, knowing that this type of cancer is not at high risk of recurrence after transplantation. The frail urological anatomy, however, represents a bigger challenge. Not only does it complicate the technical feasibility of KT but it also increases the risk of complications and graft failure. It is difficult to clearly determine KT possibility when considering it in such patients. What is clear on the other hand is that such a decision should be taken considering the choice of the patient and the involved physicians. We should also consider the potential benefits and risks of KT in order to make an informed decision.
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Affiliation(s)
- David Dogahe
- Nephrology and Dialysis Department, Brugmann University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Edouard Cubilier
- Nephrology and Dialysis Department, Brugmann University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Maxime Taghavi
- Nephrology and Dialysis Department, Brugmann University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Saleh Kaysi
- Nephrology and Dialysis Department, Brugmann University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Joëlle Nortier
- Nephrology and Dialysis Department, Brugmann University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Al-Qudimat AR, Al Darwish MB, Altahtamouni SB, Singh K, Al-Zoubi RM, Aboumarzouk OM, Al-Ansari A. Chronic kidney diseases and the risk of colorectal cancer: A systematic review and meta-analysis. Arab J Urol 2023; 21:258-266. [PMID: 38178950 PMCID: PMC10763595 DOI: 10.1080/2090598x.2023.2225315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/11/2023] [Indexed: 01/06/2024] Open
Abstract
Objective We conducted this review to offer a comprehensive search and up-to-date overview of the currently available information about the probability risk of colorectal cancer among chronic kidney disease patients. Method We performed a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews (PRISMA) and meta-analysis guidelines. We identified, reviewed, and extracted from Scopus, PubMed, EMBASE, and Komaki Databases for research publications on chronic kidney disease and colorectal cancer published between February 2016 and January 2023. We meta-analyzed the prevalence of colorectal cancer with chronic kidney disease. We ran a random effect meta-regression. Risk-of-bias assessment was evaluated using the Newcastle-Ottawa Scale. The systematic review was registered with PROSPERO (CRD42023400983). Results The risk of CRC in chronic kidney diseases was reported in 50 research studies, which included 4,337,966 people from 16 different countries. SIR of CRC was obtained from 14 studies and showed a significant relationship between CRC with CKD patients, with a pooled SIR of 1.33; 95% CI (1.30-1.36), with higher heterogeneity (Q = 121.82, P < 0.001, and I2 = 86.9%). Metaregression showed that there was no significant correlation between the risk of CRC and the proportion of males or age. Conclusion Overall, this study shows that patients with chronic kidney disease have a significantly increased risk of colorectal cancer. More studies with larger sample sizes, and robust surveillance are needed.
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Affiliation(s)
- Ahmad R. Al-Qudimat
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
- Department of Public Health, QU-Health, College of Health Sciences, Qatar University, Doha, Qata
| | - Mohamed B. Al Darwish
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Saif B. Altahtamouni
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Kalapan Singh
- Department of Nursing, Hamad Medical Corporation, Doha, Qatar
| | - Raed M. Al-Zoubi
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
- College of Pharmacy, QU Health, Qatar University, Doha, Qata
- Department of Chemistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Omar M. Aboumarzouk
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
- School of Medicine, Dentistry and Nursing, The University of Glasgow, Glasgow, UK
| | - Abdulla Al-Ansari
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
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Pośpiech M, Kolonko A, Nieszporek T, Kozak S, Kozaczka A, Karkoszka H, Winder M, Chudek J. Transplanted kidney loss during colorectal cancer chemotherapy: A case report. World J Clin Cases 2022; 10:6647-6655. [PMID: 35979324 PMCID: PMC9294886 DOI: 10.12998/wjcc.v10.i19.6647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/02/2022] [Accepted: 04/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The overall risk of de novo malignancies in kidney transplant recipients (KTRs) is higher than that in the general population. It is associated with long-lasting exposure to immunosuppressive agents and impaired oncological vigilance due to chronic kidney disease. Colorectal cancer (CRC), frequently diagnosed in an advanced stage, is one of the most common malignancies in this cohort and is associated with poor prognosis. Still, because of the scarcity of data concerning adjuvant chemotherapy in this group, there are no clear guidelines for the specific management of the CRCs in KTRs. We present a patient who lost her transplanted kidney shortly after initiation of adjuvant chemotherapy for colon cancer.
CASE SUMMARY A 36-year-old woman with a medical history of kidney transplantation (2005) because of end-stage kidney disease, secondary to chronic glomerular nephritis, and long-term immunosuppression was diagnosed with locally advanced pT4AN1BM0 (clinical stage III) colon adenocarcinoma G2. After right hemicolectomy, the patient was qualified to receive adjuvant chemotherapy that consisted of oxaliplatin, leucovorin and 5-fluorouracil (FOLFOX-4). The deterioration of kidney graft function after two cycles caused chemotherapy cessation and initiation of hemodialysis therapy after a few months. Shortly after that, the patient started palliative chemotherapy because of cancer recurrence with intraperitoneal spread.
CONCLUSION Initiation of adjuvant chemotherapy for colon cancer increases the risk of rapid kidney graft loss driven also by under-immunosuppression.
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Affiliation(s)
- Marta Pośpiech
- Department of Internal Diseases and Oncological Chemotherapy, Medical University of Silesia in Katowice, Katowice 40-027, Poland
| | - Aureliusz Kolonko
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia in Katowice, Katowice 40-027, Poland
| | - Teresa Nieszporek
- Department of Nephrology, Transplantation and Internal Medicine, Mielecki Clinical Hospital of the Medical University of Silesia, Katowice 40-027, Poland
| | - Sylwia Kozak
- Department of Internal Diseases and Oncological Chemotherapy, Medical University of Silesia in Katowice, Katowice 40-027, Poland
| | - Anna Kozaczka
- Department of Internal Diseases and Oncological Chemotherapy, Mielecki Clinical Hospital, Katowice 40-027, Poland
| | - Henryk Karkoszka
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia in Katowice, Katowice 40-027, Poland
| | - Mateusz Winder
- Department of Radiology and Nuclear Medicine, Medical University of Silesia in Katowice, Katowice 40-752, Poland
| | - Jerzy Chudek
- Department of Internal Diseases and Oncological Chemotherapy, Medical University of Silesia in Katowice, Katowice 40-027, Poland
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