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Donadeu L, Jouve T, Bin S, Hartzell S, Crespo E, Torija A, Jarque M, Kevella D, Zúñiga J, Zhang W, Sun Z, Verlato A, Martínez-Gallo M, Font-Miñarro C, Meneghini M, Toapanta N, Torres IB, Sellarés J, Perelló M, Kaminski H, Couzi L, Loupy A, La Manna G, Moreso F, Cravedi P, Bestard O. High-dimensional Mass Cytometry identified circulating Natural Killer T-cell subsets associated with protection from Cytomegalovirus infection in kidney transplant recipients. Kidney Int 2024:S0085-2538(24)00310-7. [PMID: 38685562 DOI: 10.1016/j.kint.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/08/2024] [Accepted: 03/12/2024] [Indexed: 05/02/2024]
Abstract
Cytomegalovirus (CMV) infection is associated with poor kidney transplant outcomes. While innate and adaptive immune cells have been implicated in its prevention, an in-depth characterization of the in vivo kinetics of multiple cell subsets and their role in protecting against CMV infection has not been achieved. Here, we performed high-dimensional immune phenotyping by mass cytometry, and functional assays, on 112 serially collected samples from CMV seropositive kidney transplant recipients. Advanced unsupervised deep learning analysis was used to assess immune cell populations that significantly correlated with prevention against CMV infection and anti-viral immune function. Prior to infection, kidney transplant recipients who developed CMV infection showed significantly lower CMV-specific cell-mediated immune (CMI) frequencies than those that did not. A broad diversity of circulating cell subsets within innate and adaptive immune compartments were associated with CMV infection or protective CMV-specific CMI. While percentages of CMV (tetramer-stained)-specific T cells associated with high CMI responses and clinical protection, circulating CD3+CD8midCD56+ NK-T cells overall strongly associated with low CMI and subsequent infection. However, three NK-T cell subsets sharing the CD11b surface marker associated with CMV protection and correlated with strong anti-viral CMI frequencies in vitro. These data were validated in two external independent cohorts of kidney transplant recipients. Thus, we newly describe the kinetics of a novel NK-T cell subset that may have a protective role in post-transplantation CMV infection. Our findings pave the way to more mechanistic studies aimed at understanding the function of these cells in protection against CMV infection.
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Affiliation(s)
- Laura Donadeu
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Thomas Jouve
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Univ. Grenoble Alpes, CHU Grenoble Alpes, Inserm 1209, CNRS 5309, IAB, Grenoble
| | - Sofia Bin
- Translational Transplant Research Center (TTRC), Icahn School of Medicine at Mount Sinai, New York, USA; Nephrology, Dialysis and Renal Transplant Unit, IRCCS - Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Susan Hartzell
- Translational Transplant Research Center (TTRC), Icahn School of Medicine at Mount Sinai, New York, USA
| | - Elena Crespo
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alba Torija
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Jarque
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Delphine Kevella
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Zúñiga
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Kidney Transplant Unit, Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Weijia Zhang
- Translational Transplant Research Center (TTRC), Icahn School of Medicine at Mount Sinai, New York, USA
| | - Zeguo Sun
- Translational Transplant Research Center (TTRC), Icahn School of Medicine at Mount Sinai, New York, USA
| | - Alberto Verlato
- Translational Transplant Research Center (TTRC), Icahn School of Medicine at Mount Sinai, New York, USA
| | - Mónica Martínez-Gallo
- Immunology department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Font-Miñarro
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Meneghini
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Kidney Transplant Unit, Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nestor Toapanta
- Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Kidney Transplant Unit, Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Irina B Torres
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Kidney Transplant Unit, Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joana Sellarés
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Kidney Transplant Unit, Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manel Perelló
- Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Kidney Transplant Unit, Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Hannah Kaminski
- Department of Nephrology, Transplantation, Dialysis and Apheresis, CHU Bordeaux, Bordeaux, France; UMR 5164-ImmunoConcEpT, University of Bordeaux, CNRS, Bordeaux University, Bordeaux, France
| | - Lionel Couzi
- Department of Nephrology, Transplantation, Dialysis and Apheresis, CHU Bordeaux, Bordeaux, France; UMR 5164-ImmunoConcEpT, University of Bordeaux, CNRS, Bordeaux University, Bordeaux, France
| | - Alexandre Loupy
- Paris Translational Research Center for Organ Transplantation, Institut National de la Santé et de la Recherche Médicale UMR-S970, Université de Paris, Paris, France
| | - Gaetano La Manna
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS - Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesc Moreso
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Kidney Transplant Unit, Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Paolo Cravedi
- Translational Transplant Research Center (TTRC), Icahn School of Medicine at Mount Sinai, New York, USA.
| | - Oriol Bestard
- Laboratory of Nephrology and Transplantation, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron for Solid Organ Transplantation Research Group. Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Kidney Transplant Unit, Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Sanchez LC, Herrero CR, Cobos I, Bespin J, Gadea C, Cerdá-Cortés P, Palma J, Vicens-Zygmunt V, Bermudo G, Portillo K, Boldova A, Robles A, Arribas J, Figuerola J, Blavia R, Moreno A, Castillo D, Villar A, Belmonte Y, Badenes-Bonet D, Zayas D, Suarez-Cuartin G, Garcia-Bellmunt L, Sellarés J, Barril S, Sans J, Serra M, Perich D, Esteban L, Esteban L, Balcells E, Gil F, Ruiz E, Fina C, Molina-Molina M. Benefits of a Homecare Integral Patient Support Program in Idiopathic Pulmonary Fibrosis. Arch Bronconeumol 2023:S0300-2896(23)00107-2. [PMID: 37003881 DOI: 10.1016/j.arbres.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/13/2023] [Accepted: 03/13/2023] [Indexed: 03/29/2023]
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Chamoun B, Sánchez-Sancho P, Torres IB, Gabaldon A, Perelló M, Sellarés J, Moreso F, Serón D. Tocilizumab in the treatment of active chronic humoral rejection resistant to standard therapy. Nefrologia 2022; 42:578-584. [PMID: 36717307 DOI: 10.1016/j.nefroe.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 06/18/2023] Open
Abstract
INTRODUCTION There is no consensus on the most appropriate treatment for chronic active antibody-mediated rejection (cAMR). Recent studies suggest that treatment with tocilizumab (TCZ) may stabilize graft function, decrease the intensity of donor-specific HLA antibodies (DSAs) and reduce inflammation of microcirculation. PATIENTS AND METHODS Observational study with renal allograft recipients diagnosed with cAMR (n = 5) who had not submitted a response to traditional treatment based on the combination of plasma replacements, immunoglobulins, and rituximab. Patients were told to be treated with TCZ as compassionate use in six doses per month (8 mg/kg/month). Renal function, proteinuria, and the intensity of DSAs were monitored during follow-up. RESULTS Five patients, average age 60 ± 13 years, three male and two retrasplants (cPRA average 55%) with preformed DSAs. Treatment with TCZ was initiated within 47 ± 52 days of biopsy. In two cases treatment was discontinued after the first dose, by severe bicitopenia with cytomegalovirus viremia and by graft failure, respectively. In the three patients who completed treatment, no stability of renal function (serum creatinine from 1.73 ± 0.70 to 2.04 ± 0.52 mg/dL, e-FGR 4 6 ± 15 to 36 ± 16 mL/min), showed increased proteinuria (3.2 ± 4.0 to 6.9 ± 11.0 g/g) and the intensity of DSAs maintain stable. No changes were observed in the degree of inflammation of microcirculation (g+pt 4.2 ± 0.8 vs. 4.3 ± 1.0) or in the degree of transplant glomerulopathy (cg 1.2 ± 0.4 vs. 1.8 ± 1.0). CONCLUSIONS TCZ therapy does not appear to be effective in modifying the natural history of chronic active antibody-mediated rejection, does not improve the degree of inflammation of microcirculation and does not reduces the intensity of DSAs.
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Affiliation(s)
- Betty Chamoun
- Servicio de Nefrología, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - Pablo Sánchez-Sancho
- Servicio de Farmacia, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Irina B Torres
- Servicio de Nefrología, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - Alejandra Gabaldon
- Servicio de Patología, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Manel Perelló
- Servicio de Nefrología, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Joana Sellarés
- Servicio de Nefrología, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Francesc Moreso
- Servicio de Nefrología, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Daniel Serón
- Servicio de Nefrología, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
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Chamoun B, Sánchez-Sancho P, Torres IB, Gabaldon A, Perelló M, Sellarés J, Moreso F, Serón D. Tocilizumab en el tratamiento del rechazo humoral crónico activo resistente a terapia estándar. Nefrologia 2022. [DOI: 10.1016/j.nefro.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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García-Carro C, Vergara A, Bermejo S, Azancot MA, Sellarés J, Soler MJ. A Nephrologist Perspective on Obesity: From Kidney Injury to Clinical Management. Front Med (Lausanne) 2021; 8:655871. [PMID: 33928108 PMCID: PMC8076523 DOI: 10.3389/fmed.2021.655871] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/15/2021] [Indexed: 12/13/2022] Open
Abstract
Obesity is one of the epidemics of our era. Its prevalence is higher than 30% in the U.S. and it is estimated to increase by 50% in 2030. Obesity is associated with a higher risk of all-cause mortality and it is known to be a cause of chronic kidney disease (CKD). Typically, obesity-related glomerulopathy (ORG) is ascribed to renal hemodynamic changes that lead to hyperfiltration, albuminuria and, finally, impairment in glomerular filtration rate due to glomerulosclerosis. Though not only hemodynamics are responsible for ORG: adipokines could cause local effects on mesangial and tubular cells and podocytes promoting maladaptive responses to hyperfiltration. Furthermore, hypertension and type 2 diabetes mellitus, two conditions generally associated with obesity, are both amplifiers of obesity injury in the renal parenchyma, as well as complications of overweight. As in the native kidney, obesity is also related to worse outcomes in kidney transplantation. Despite its impact in CKD and cardiovascular morbility and mortality, therapeutic strategies to fight against obesity-related CKD were limited for decades to renin-angiotensin blockade and bariatric surgery for patients who accomplished very restrictive criteria. Last years, different drugs have been approved or are under study for the treatment of obesity. Glucagon-like peptide-1 receptor agonists are promising in obesity-related CKD since they have shown benefits in terms of losing weight in obese patients, as well as preventing the onset of macroalbuminuria and slowing the decline of eGFR in type 2 diabetes. These new families of glucose-lowering drugs are a new frontier to be crossed by nephrologists to stop obesity-related CKD progression.
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Affiliation(s)
- Clara García-Carro
- Nephrology Department, San Carlos Clinical University Hospital, Madrid, Spain
| | - Ander Vergara
- Nephrology Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Nephrology Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Sheila Bermejo
- Nephrology Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Nephrology Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - María A. Azancot
- Nephrology Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Nephrology Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Joana Sellarés
- Nephrology Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Nephrology Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Maria José Soler
- Nephrology Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Nephrology Group, Vall d'Hebron Research Institute, Barcelona, Spain
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Toapanta N, Torres IB, Sellarés J, Chamoun B, Serón D, Moreso F. Kidney transplantation and COVID-19 renal and patient prognosis. Clin Kidney J 2021; 14:i21-i29. [PMID: 33815780 PMCID: PMC7995521 DOI: 10.1093/ckj/sfab030] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/27/2021] [Indexed: 02/07/2023] Open
Abstract
Coronavirus disease 2019 (COVD-19) emerged as a pandemic in December 2019. Infection has spread quickly and renal transplant recipients receiving chronic immunosuppression have been considered a population at high risk of infection, complications and infection-related death. During this year a large amount of information from nationwide registries, multicentre and single-centre studies have been reported. The number of renal transplant patients diagnosed with COVID-19 was higher than in the general population, but the lower threshold for testing may have contributed to its better identification. Major complications such as acute kidney injury and acute respiratory distress syndrome were very frequent in renal transplant patients, with a high comorbidity burden, but further studies are needed to support that organ transplant recipients receiving chronic immunosuppression are more prone to develop these complications than the general population. Kidney transplant recipients experience a high mortality rate compared with the general population, especially during the very early post-transplant period. Despite the fact that some studies report more favourable outcomes in patients with a kidney transplant than in patients on the kidney waiting list, the higher mortality described in the very early post-transplant period would advise against performing a kidney transplant in areas where the spread of infection is high, especially in recipients >60 years of age. Management of transplant recipients has been challenging for clinicians and strategies such as less use of lymphocyte-depleting agents for new transplants or anti-metabolite withdrawal and calcineurin inhibitor reduction for transplant patients with COVID-19 are not based on high-quality evidence.
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Affiliation(s)
- Néstor Toapanta
- Department of Nephrology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Irina B Torres
- Department of Nephrology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Joana Sellarés
- Department of Nephrology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Betty Chamoun
- Department of Nephrology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Daniel Serón
- Department of Nephrology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Francesc Moreso
- Department of Nephrology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
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Chamoun B, Torres IB, Gabaldón A, Sellarés J, Perelló M, Castellá E, Guri X, Salcedo M, Toapanta NG, Cidraque I, Moreso F, Seron D. Progression of Interstitial Fibrosis and Tubular Atrophy in Low Immunological Risk Renal Transplants Monitored by Sequential Surveillance Biopsies: The Influence of TAC Exposure and Metabolism. J Clin Med 2021; 10:jcm10010141. [PMID: 33406589 PMCID: PMC7796060 DOI: 10.3390/jcm10010141] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/21/2020] [Accepted: 12/30/2020] [Indexed: 02/06/2023] Open
Abstract
The combination of tacrolimus (TAC) and mycophenolate is the most widely employed maintenance immunosuppression in renal transplants. Different surrogates of tacrolimus exposure or metabolism such as tacrolimus trough levels (TAC-C0), coefficient of variation of tacrolimus (CV-TAC-C0), time in therapeutic range (TTR), and tacrolimus concentration dose ratio (C/D) have been associated with graft outcomes. We explore in a cohort of low immunological risk renal transplants (n = 85) treated with TAC, mycophenolate mofetil (MMF), and steroids and then monitored by paired surveillance biopsies the association between histological lesions and TAC-C0 at the time of biopsy as well as CV-TAC-C0, TTR, and C/D during follow up. Interstitial inflammation (i-Banff score ≥ 1) in the first surveillance biopsy was associated with TAC-C0 (odds ratio (OR): 0.69, 95% confidence interval (CI): 0.50–0.96; p = 0.027). In the second surveillance biopsy, inflammation was associated with time below the therapeutic range (OR: 1.05 and 95% CI: 1.01–1.10; p = 0.023). Interstitial inflammation in scarred areas (i-IFTA score ≥ 1) was not associated with surrogates of TAC exposure/metabolism. Progression of interstitial fibrosis/tubular atrophy (IF/TA) was observed in 35 cases (41.2%). Multivariate regression logistic analysis showed that mean C/D (OR: 0.48; 95% CI: 0.25–0.92; p = 0.026) and IF/TA in the first biopsy (OR: 0.43, 95% CI: 0.24–0.77, p = 0.005) were associated with IF/TA progression between biopsies. A low C/D ratio is associated with IF/TA progression, suggesting that TAC nephrotoxicity may contribute to fibrosis progression in well immunosuppressed patients. Our data support that TAC exposure is associated with inflammation in healthy kidney areas but not in scarred tissue.
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Affiliation(s)
- Betty Chamoun
- Nephrology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (B.C.); (I.B.T.); (J.S.); (M.P.); (N.G.T.); (I.C.); (D.S.)
| | - Irina B. Torres
- Nephrology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (B.C.); (I.B.T.); (J.S.); (M.P.); (N.G.T.); (I.C.); (D.S.)
| | - Alejandra Gabaldón
- Pathology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (A.G.); (M.S.)
| | - Joana Sellarés
- Nephrology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (B.C.); (I.B.T.); (J.S.); (M.P.); (N.G.T.); (I.C.); (D.S.)
| | - Manel Perelló
- Nephrology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (B.C.); (I.B.T.); (J.S.); (M.P.); (N.G.T.); (I.C.); (D.S.)
| | - Eva Castellá
- Radiology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (E.C.); (X.G.)
| | - Xavier Guri
- Radiology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (E.C.); (X.G.)
| | - Maite Salcedo
- Pathology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (A.G.); (M.S.)
| | - Nestor G. Toapanta
- Nephrology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (B.C.); (I.B.T.); (J.S.); (M.P.); (N.G.T.); (I.C.); (D.S.)
| | - Ignacio Cidraque
- Nephrology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (B.C.); (I.B.T.); (J.S.); (M.P.); (N.G.T.); (I.C.); (D.S.)
| | - Francesc Moreso
- Nephrology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (B.C.); (I.B.T.); (J.S.); (M.P.); (N.G.T.); (I.C.); (D.S.)
- Department of Medicine, Autonomous University of Barcelona, 08035 Barcelona, Spain
- Correspondence: ; Tel.: +34-93-274-46-66
| | - Daniel Seron
- Nephrology Departments, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (B.C.); (I.B.T.); (J.S.); (M.P.); (N.G.T.); (I.C.); (D.S.)
- Department of Medicine, Autonomous University of Barcelona, 08035 Barcelona, Spain
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Favà A, Cucchiari D, Montero N, Toapanta N, Centellas FJ, Vila-Santandreu A, Coloma A, Meneghini M, Manonelles A, Sellarés J, Torres I, Gelpi R, Lorenzo I, Ventura-Aguiar P, Cofan F, Torregrosa JV, Perelló M, Facundo C, Seron D, Oppenheimer F, Bestard O, Cruzado JM, Moreso F, Melilli E. Clinical characteristics and risk factors for severe COVID-19 in hospitalized kidney transplant recipients: A multicentric cohort study. Am J Transplant 2020; 20:3030-3041. [PMID: 32777153 PMCID: PMC7436908 DOI: 10.1111/ajt.16246] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/16/2020] [Accepted: 07/24/2020] [Indexed: 01/25/2023]
Abstract
Kidney transplant recipients might be at higher risk for severe coronavirus disease 2019 (COVID-19). However, risk factors for relevant outcomes remain uncertain in this population. This is a multicentric kidney transplant cohort including 104 hospitalized patients between March 4 and April 17, 2020. Risk factors for death and acute respiratory distress syndrome (ARDS) were investigated, and clinical and laboratory data were analyzed. The mean age was 60 years. Forty-seven patients (54.8%) developed ARDS. Obesity was associated to ARDS development (OR 2.63; P = .04). Significant age differences were not found among patients developing and not developing ARDS (61.3 vs 57.8 years, P = .16). Seventy-six (73%) patients were discharged, and 28 (27%) died. Death was more common among the elderly (55 and 70.8 years, P < .001) and those with preexisting pulmonary disease (OR 2.89, P = .009). At admission, higher baseline lactate dehydrogenase (257 vs 358 IU/mL, P = .001) or ARDS conferred higher risk of death (HR 2.09, P = .044). In our cohort, ARDS was equally present among young and old kidney recipients. However, the elderly might be at higher risk of death, along with those showing higher baseline LDH at admission.
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Affiliation(s)
- Alexandre Favà
- Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain,Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
| | - David Cucchiari
- Nephrology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Nuria Montero
- Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain,Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain,Correspondence Nuria Montero
| | - Nestor Toapanta
- Nephrology Department, Hospital de Vall d’ Hebron, Barcelona, Spain
| | | | | | - Ana Coloma
- Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain,Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
| | - Maria Meneghini
- Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain,Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
| | - Anna Manonelles
- Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain,Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
| | - Joana Sellarés
- Nephrology Department, Hospital de Vall d’ Hebron, Barcelona, Spain
| | - Irina Torres
- Nephrology Department, Hospital de Vall d’ Hebron, Barcelona, Spain
| | - Rosana Gelpi
- Nephrology Department, Fundació Puigvert, Barcelona, Spain
| | | | | | - Frederic Cofan
- Nephrology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Manel Perelló
- Nephrology Department, Hospital de Vall d’ Hebron, Barcelona, Spain
| | - Carme Facundo
- Nephrology Department, Fundació Puigvert, Barcelona, Spain
| | - Daniel Seron
- Nephrology Department, Hospital de Vall d’ Hebron, Barcelona, Spain
| | | | - Oriol Bestard
- Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain,Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
| | - Josep M. Cruzado
- Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain,Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain,Josep M. Cruzado
| | - Francesc Moreso
- Nephrology Department, Hospital de Vall d’ Hebron, Barcelona, Spain
| | - Edoardo Melilli
- Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain,Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
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Fernandes Serodio J, Hernández-Rodríguez J, Espígol-Frigolé G, Alba M, Marco-Hernández J, Sánchez M, Hernández-González F, Sellarés J, Cid MC, Prieto-González S. THU0305 PREVALENCE AND CLINICAL OUTCOME OF INTERSTITIAL LUNG DISEASE IN ANCA ASSOCIATED VASCULITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Lung involvement is frequent in ANCA-associated vasculitis (AAV). Classical lung manifestations consist of capillaritis with lung haemorrhage, inflammatory infiltrates and nodules. Interstitial lung disease (ILD) is increasingly recognized among patients with AAV. However, little is known concerning risk factors and clinical course of these patients.Objectives:The aim of our study was to characterize the prevalence and clinical course of ILD in patients with AAV.Methods:We have performed a clinical retrospective single-centre observational analysis (1990-2019) of all patients with the diagnosis of microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA) diagnosed according to 2018 Draft Classification Criteria for GPA and MPA1. Demographic, clinical and immunologic data were reviewed. Radiologic pattern of ILD were assessed by high-resolution-CT. Main outcome evaluated was overall-all survival.Results:The study population consisted of 123 patients, 56% female, aged 59.3±18.2 years old at the time of diagnosis. Clinical diagnosis was of MPA in 54% of patients and GPA in 46%. While 108 (88%) ANCA positive patients had PR3 (n=25) or MPO (n=83), 15 (12%) patients had negative or atypical ANCA. Any lung involvement was present in 82 (71%) and ILD was identified in 24 (20%) of all patients. ILD pattern was of usual interstitial pneumonia (UIP) in 12 patients, non-specified interstitial pneumonia (NSIP) in 9 and chronic organizing pneumonia (OP) in 3. There was an association between the presence of ILD and ANCA specificity: MPO were present in 100% of patients with UIP and in 75% of patients with NSIP/OP (p=0.017). Bronchiectasis were more prevalent among patients with ILD (19/24; p<0.001). During the median follow-up time period of 68 (23-126) months, mortality was of 42% among patients with ILD-AAV compared with 11% in no ILD-AAV (log-rank p=0.0001). On the multivariate Cox regression model, ILD was an independent predictor of mortality HR 2.95 (95%CI 1.09-7.96; p=0.033).Conclusion:ILD is a frequent manifestation of MPA and GPA patients. The presence of ILD, particularly UIP, is associated with ANCA-MPO and is a predictor of mortality. Therefore, a better management of fibrotic lung involvement in AAV is warranted.References:[1]Robson JC, Grayson PC, Ponte C, et al. Draft classification criteria for the ANCA associated vasculitides. Ann Rheum Dis 2018;77 (suppl 2):60-1.Disclosure of Interests:João Fernandes Serodio: None declared, José Hernández-Rodríguez: None declared, Georgina Espígol-Frigolé: None declared, Marco Alba: None declared, Javier Marco-Hernández: None declared, Marcelo Sánchez: None declared, Fernanda Hernández-González: None declared, Jacobo Sellarés: None declared, Maria C. Cid Grant/research support from: Kiniksa Pharmaceuticals, Consultant of: Janssen, Abbvie, Roche, GSK, Speakers bureau: Vifor, Sergio Prieto-González: None declared
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Los-Arcos I, Len O, Perello M, Torres IB, Codina G, Esperalba J, Sellarés J, Moreso F, Seron D, Gavaldà J. Is antibody-mediated rejection in kidney transplant recipients a risk factor for developing cytomegalovirus or BK virus infection? Results from a case-control study. J Clin Virol 2018; 110:45-50. [PMID: 30537648 DOI: 10.1016/j.jcv.2018.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/08/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Data are scarce on cytomegalovirus (CMV) and BK virus (BKV) infection after antibody-mediated rejection (ABMR). OBJECTIVES We hypothesized that the immunological response in patients with ABMR or the immune modulation associated with its treatment could predispose to CMV and BKV infection. Our objective was to investigate this hypothesis. STUDY DESIGN We conducted a single-center, matched case-control study (1:2 ratio) to analyze CMV and BKV replication during the first year after the ABMR diagnosis in kidney transplant recipients. Adult recipients with a histopathological diagnosis of ABMR between 2007-2015 were included as cases. Controls were kidney recipients who underwent transplantation immediately before and after the index case. RESULTS Fifty-eight patients diagnosed with ABMR (33 chronic active ABMR and 25 acute ABMR), with their matched controls (116) were included. Forty-four cases received treatment for ABMR, including plasmapheresis (41), immunoglobulins (40), and rituximab (31). Within 1 year after ABMR, cases showed CMV replication more often than controls (9/58, 15.5% vs 7/116, 6%, OR = 4.21, CI 1.10-16.16, p = 0.04). Over the study period, CMV PCR determinations were requested more frequently in cases than controls (46/58, 79.3% vs 63/116, 54.3%, OR = 4.58, CI 1.92-10.9, p = 0.001). On multivariate analysis adjusted for CMV PCR determinations, retransplantation, antithymocyte globulin treatment and methylprednisolone treatment for acute rejection, CMV replication remained more common in cases than in controls (OR = 2.41, CI 0.49-11.73, p = 0.28). There were no differences in BKV replication in either urine or blood. CONCLUSIONS ABMR may be a risk factor for CMV but not for BKV replication in kidney transplant recipients.
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Affiliation(s)
- Ibai Los-Arcos
- Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oscar Len
- Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Manel Perello
- Nephrology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Irina B Torres
- Nephrology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Gemma Codina
- Microbiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Juliana Esperalba
- Microbiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Joana Sellarés
- Nephrology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Francesc Moreso
- Nephrology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Daniel Seron
- Nephrology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Joan Gavaldà
- Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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Torres IB, Reisaeter AV, Moreso F, Âsberg A, Vidal M, Garcia-Carro C, Midtvedt K, Reinholt FP, Scott H, Castellà E, Salcedo M, Dörje C, Sellarés J, Azancot MA, Perello M, Holdaas H, Serón D. Tacrolimus and mycophenolate regimen and subclinical tubulo-interstitial inflammation in low immunological risk renal transplants. Transpl Int 2017; 30:1119-1131. [PMID: 28667664 DOI: 10.1111/tri.13002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 05/08/2017] [Accepted: 06/23/2017] [Indexed: 10/19/2022]
Abstract
The aim was to evaluate the relationship between maintenance immunosuppression, subclinical tubulo-interstitial inflammation and interstitial fibrosis/tubular atrophy (IF/TA) in surveillance biopsies performed in low immunological risk renal transplants at two transplant centers. The Barcelona cohort consisted of 109 early and 66 late biopsies in patients receiving high tacrolimus (TAC-C0 target at 1-year 6-10 ng/ml) and reduced MMF dose (500 mg bid at 1-year). The Oslo cohort consisted of 262 early and 237 late biopsies performed in patients treated with low TAC-C0 (target 3-7 ng/ml) and standard MMF dose (750 mg bid). Subclinical inflammation, adjusted for confounders, was associated with low TAC-C0 in the early (OR: 0.75, 95% CI: 0.61-0.92; P = 0.006) and late biopsies (OR: 0.69, 95% CI: 0.50-0.95; P = 0.023) from Barcelona. In the Oslo cohort, it was associated with low MMF in early biopsies (OR: 0.90, 95% CI: 0.83-0.98; P = 0.0101) and with low TAC-C0 in late biopsies (OR: 0.77, 95% CI: 0.61-0.97; P = 0.0286). MMF dose was significantly reduced in Oslo between early and late biopsies. IF/TA was not associated with TAC-C0 or MMF dose in the multivariate analysis. Our data suggest that in TAC- and MMF-based regimens, TAC-C0 levels are associated with subclinical inflammation in patients receiving reduced MMF dose.
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Affiliation(s)
- Irina B Torres
- Department of Nephrology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna V Reisaeter
- Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Francesc Moreso
- Department of Nephrology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anders Âsberg
- Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,School of Pharmacy, University of Oslo, Norway
| | - Marta Vidal
- Department of Pathology, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Clara Garcia-Carro
- Department of Nephrology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Karsten Midtvedt
- Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Finn P Reinholt
- Department of Pathology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Helge Scott
- Department of Pathology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Eva Castellà
- Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Maite Salcedo
- Department of Pathology, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Christina Dörje
- Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Joana Sellarés
- Department of Nephrology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria A Azancot
- Department of Nephrology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manel Perello
- Department of Nephrology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Hallvard Holdaas
- Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Daniel Serón
- Department of Nephrology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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13
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Brito Zeron P, Sellarés J, Bosch X, Hernández F, Lopez-Casany C, Sanchez M, Ramírez J, Gheitasi H, Kostov B, Santos J, Sisό Almirall A, Agustí C, Ramos-Casals M. SAT0547 Sequential Diagnosis of Sarcoidosis and Malignancy: A close But Complex Association with Four Differential Clinical Scenarios. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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14
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Brito Zeron P, Sellarés J, Bosch X, Hernández F, Lopez-Casany C, Sanchez M, Ramírez J, Gheitasi H, Kostov B, Santos J, Sisό Almirall A, Agustí C, Ramos-Casals M. THU0564 Is Extrathoracic Disease Associated with Mortality in Sarcoidosis? Predicting Survival According to the Epidemiological and Clinical Features at Diagnosis in 170 Patients. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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15
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García Carro C, Azancot MA, Arredondo K, Juliana J, Sellarés J, Perelló M, Cantarell C, Trilla E, Salcedo M, Moreso F, Serón D. FP895USEFULNESS OF KIDNEY PREIMPLANTATION BIOPSIES FROM DECEASED DONORS FOR KIDNEY TRANSPLANT ALLOCATION. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv185.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Halloran PF, Chang J, Famulski K, Hidalgo LG, Salazar IDR, Merino Lopez M, Matas A, Picton M, de Freitas D, Bromberg J, Serón D, Sellarés J, Einecke G, Reeve J. Disappearance of T Cell-Mediated Rejection Despite Continued Antibody-Mediated Rejection in Late Kidney Transplant Recipients. J Am Soc Nephrol 2014; 26:1711-20. [PMID: 25377077 DOI: 10.1681/asn.2014060588] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 09/07/2014] [Indexed: 12/30/2022] Open
Abstract
The prevalent renal transplant population presents an opportunity to observe the adaptive changes in the alloimmune response over time, but such studies have been limited by uncertainties in the conventional biopsy diagnosis of T cell-mediated rejection (TCMR) and antibody-mediated rejection (ABMR). To circumvent these limitations, we used microarrays and conventional methods to investigate rejection in 703 unselected biopsies taken 3 days to 35 years post-transplant from North American and European centers. Using conventional methods, we diagnosed rejection in 205 biopsy specimens (28%): 67 pure TCMR, 110 pure ABMR, and 28 mixed (89 designated borderline). Using microarrays, we diagnosed rejection in 228 biopsy specimens (32%): 76 pure TCMR, 124 pure ABMR, and 28 mixed (no borderline). Molecular assessment confirmed most conventional diagnoses (agreement was 90% for TCMR and 83% for ABMR) but revealed some errors, particularly in mixed rejection, and improved prediction of failure. ABMR was strongly associated with increased graft loss, but TCMR was not. ABMR became common in biopsy specimens obtained >1 year post-transplant and continued to appear in all subsequent intervals. TCMR was common early but progressively disappeared over time. In 108 biopsy specimens obtained 10.2-35 years post-transplant, TCMR defined by molecular and conventional features was never observed. We conclude that the main cause of kidney transplant failure is ABMR, which can present even decades after transplantation. In contrast, TCMR disappears by 10 years post-transplant, implying that a state of partial adaptive tolerance emerges over time in the kidney transplant population.
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Affiliation(s)
- Philip F Halloran
- Alberta Transplant Applied Genomics Centre, Edmonton, Alberta, Canada; Department of Medicine, Division of Nephrology and Transplant Immunology and
| | - Jessica Chang
- Alberta Transplant Applied Genomics Centre, Edmonton, Alberta, Canada
| | - Konrad Famulski
- Alberta Transplant Applied Genomics Centre, Edmonton, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Luis G Hidalgo
- Alberta Transplant Applied Genomics Centre, Edmonton, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Arthur Matas
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Michael Picton
- Department of Renal Medicine, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Declan de Freitas
- Department of Renal Medicine, Manchester Royal Infirmary, Manchester, United Kingdom; Department of Renal Medicine, Beaumont Hospital, Dublin, Ireland
| | - Jonathan Bromberg
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Daniel Serón
- Servei de Nefrologia, Hospital Vall d'Hebron, Barcelona, Spain; and
| | - Joana Sellarés
- Servei de Nefrologia, Hospital Vall d'Hebron, Barcelona, Spain; and
| | - Gunilla Einecke
- Department of Nephrology, Medical School of Hannover, Hannover, Germany
| | - Jeff Reeve
- Alberta Transplant Applied Genomics Centre, Edmonton, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
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Torres IB, Salcedo M, Moreso F, Sellarés J, Castellá E, Azancot MA, Perelló M, Cantarell C, Serón D. Comparing transplant glomerulopathy in the absence of C4d deposition and donor-specific antibodies to chronic antibody-mediated rejection. Clin Transplant 2014; 28:1148-54. [DOI: 10.1111/ctr.12433] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2014] [Indexed: 01/15/2023]
Affiliation(s)
- Irina B. Torres
- Department of Nephrology; Hospital Universitari Vall d'Hebron; Universitat Autònoma Barcelona; Barcelona Spain
| | - Maite Salcedo
- Department of Pathology; Hospital Universitari Vall d'Hebron; Universitat Autònoma Barcelona; Barcelona Spain
| | - Francesc Moreso
- Department of Nephrology; Hospital Universitari Vall d'Hebron; Universitat Autònoma Barcelona; Barcelona Spain
| | - Joana Sellarés
- Department of Nephrology; Hospital Universitari Vall d'Hebron; Universitat Autònoma Barcelona; Barcelona Spain
| | - Eva Castellá
- Department of Radiology; Hospital Universitari Vall d'Hebron; Universitat Autònoma Barcelona; Barcelona Spain
| | - M. Antonieta Azancot
- Department of Nephrology; Hospital Universitari Vall d'Hebron; Universitat Autònoma Barcelona; Barcelona Spain
| | - Manel Perelló
- Department of Nephrology; Hospital Universitari Vall d'Hebron; Universitat Autònoma Barcelona; Barcelona Spain
| | - Carme Cantarell
- Department of Nephrology; Hospital Universitari Vall d'Hebron; Universitat Autònoma Barcelona; Barcelona Spain
| | - Daniel Serón
- Department of Nephrology; Hospital Universitari Vall d'Hebron; Universitat Autònoma Barcelona; Barcelona Spain
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Halloran PF, Pereira AB, Chang J, Matas A, Picton M, De Freitas D, Bromberg J, Serón D, Sellarés J, Einecke G, Reeve J. Microarray diagnosis of antibody-mediated rejection in kidney transplant biopsies: an international prospective study (INTERCOM). Am J Transplant 2013; 13:2865-74. [PMID: 24119109 DOI: 10.1111/ajt.12465] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 07/22/2013] [Accepted: 08/01/2013] [Indexed: 01/25/2023]
Abstract
In a reference set of 403 kidney transplant biopsies, we recently developed a microarray-based test that diagnoses antibody-mediated rejection (ABMR) by assigning an ABMR score. To validate the ABMR score and assess its potential impact on practice, we performed the present prospective INTERCOM study (clinicaltrials.gov NCT01299168) in 300 new biopsies (264 patients) from six centers: Baltimore, Barcelona, Edmonton, Hannover, Manchester and Minneapolis. We assigned ABMR scores using the classifier created in the reference set and compared it to conventional assessment as documented in the pathology reports. INTERCOM documented uncertainty in conventional assessment: In 41% of biopsies where ABMR features were noted, the recorded diagnoses did not mention ABMR. The ABMR score correlated with ABMR histologic lesions and donor-specific antibodies, but not with T cell-mediated rejection lesions. The agreement between ABMR scores and conventional assessment was identical to that in the reference set (accuracy 85%). The ABMR score was more strongly associated with failure than conventional assessment, and when the ABMR score and conventional assessment disagreed, only the ABMR score was associated with early progression to failure. INTERCOM confirms the need to reduce uncertainty in the diagnosis of ABMR, and demonstrates the potential of the ABMR score to impact practice.
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Affiliation(s)
- P F Halloran
- Alberta Transplant Applied Genomics Center, University of Alberta, Edmonton, AB, Canada; Department of Medicine, Division of Nephrology and Transplant Immunology, University of Alberta, Edmonton, AB, Canada
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Chamorro N, Sellarés J, Millán G, Cano E, Soler N, Embid C, Montserrat J. An integrated model involving sleep units and primary care for the diagnosis of sleep apnoea: Table 1–. Eur Respir J 2013; 42:1151-4. [DOI: 10.1183/09031936.00192812] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Halloran PF, Pereira AB, Chang J, Matas A, Picton M, De Freitas D, Bromberg J, Serón D, Sellarés J, Einecke G, Reeve J. Potential impact of microarray diagnosis of T cell-mediated rejection in kidney transplants: The INTERCOM study. Am J Transplant 2013; 13:2352-63. [PMID: 23915426 DOI: 10.1111/ajt.12387] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 05/30/2013] [Accepted: 06/14/2013] [Indexed: 01/25/2023]
Abstract
We previously developed a microarray-based test for T cell-mediated rejection (TCMR) in a reference set of 403 biopsies. To determine the potential impact of this test in clinical practice, we undertook INTERCOM, a prospective international study of 300 indication biopsies from 264 patients (ClinicalTrials.gov NCT01299168). Biopsies from six centers-Baltimore, Barcelona, Edmonton, Hannover, Manchester and Minneapolis-were analyzed by microarrays, assigning TCMR scores by an algorithm developed in the reference set and comparing TCMR scores to local histology assessment. The TCMR score correlated with histologic TCMR lesions-tubulitis and interstitial infiltration. The accuracy for primary histologic diagnoses (0.87) was similar to the reference set (0.89). The TCMR scores reclassified 77/300 biopsies (26%): 16 histologic TCMR were molecularly non-TCMR; 15 histologic non-TCMR were molecularly TCMR, including 6 with polyoma virus nephropathy; and all 46 "borderline" biopsies were reclassified as TCMR (8) or non-TCMR (38). Like the reference set, discrepancies were primarily in situations where histology has known limitations, for example, in biopsies with scarring and inflammation/tubulitis potentially from other diseases. Neither the TCMR score nor histologic TCMR was associated with graft loss. Thus the molecular TCMR score has potential to add new insight, particularly in situations where histology is ambiguous or potentially misleading.
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Affiliation(s)
- P F Halloran
- Alberta Transplant Applied Genomics Centre, University of Alberta, Edmonton, AB, Canada; Department of Medicine, Division of Nephrology and Transplant Immunology, University of Alberta, Edmonton, AB, Canada
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Sellarés J, Reeve J, Loupy A, Mengel M, Sis B, Skene A, de Freitas DG, Kreepala C, Hidalgo LG, Famulski KS, Halloran PF. Molecular diagnosis of antibody-mediated rejection in human kidney transplants. Am J Transplant 2013; 13:971-983. [PMID: 23414212 DOI: 10.1111/ajt.12150] [Citation(s) in RCA: 208] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 12/06/2012] [Accepted: 12/11/2012] [Indexed: 01/25/2023]
Abstract
Antibody-mediated rejection is the major cause of kidney transplant failure, but the histology-based diagnostic system misses most cases due to its requirement for C4d positivity. We hypothesized that gene expression data could be used to test biopsies for the presence of antibody-mediated rejection. To develop a molecular test, we prospectively assigned diagnoses, including C4d-negative antibody-mediated rejection, to 403 indication biopsies from 315 patients, based on histology (microcirculation lesions) and donor-specific HLA antibody. We then used microarray data to develop classifiers that assigned antibody-mediated rejection scores to each biopsy. The transcripts distinguishing antibody-mediated rejection from other conditions were mostly expressed in endothelial cells or NK cells, or were IFNG-inducible. The scores correlated with the presence of microcirculation lesions and donor-specific antibody. Of 45 biopsies with scores>0.5, 39 had been diagnosed as antibody-mediated rejection on the basis of histology and donor-specific antibody. High scores were also associated with unanimity among pathologists that antibody-mediated rejection was present. The molecular score also strongly predicted future graft loss in Cox regression analysis. We conclude that microarray assessment of gene expression can assign a probability of ABMR to transplant biopsies without knowledge of HLA antibody status, histology, or C4d staining, and predicts future failure.
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Affiliation(s)
- J Sellarés
- Alberta Transplant Applied Genomics Centre, Edmonton, Alberta.,Servei de Nefrologia, Hospital de la Vall d'Hebron, Barcelona, Spain
| | - J Reeve
- Alberta Transplant Applied Genomics Centre, Edmonton, Alberta.,Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - A Loupy
- Kidney Transplant Department, Necker Hospital, Paris, France
| | - M Mengel
- Alberta Transplant Applied Genomics Centre, Edmonton, Alberta.,Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - B Sis
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - A Skene
- Alberta Transplant Applied Genomics Centre, Edmonton, Alberta.,Department of Anatomical Pathology, Austin Hospital, Heidelberg, Victoria, Australia
| | - D G de Freitas
- Department of Renal Medicine, Manchester Royal Infirmary, Manchester, UK
| | - C Kreepala
- Alberta Transplant Applied Genomics Centre, Edmonton, Alberta.,Department of Medicine, Division of Nephrology and Transplant Immunology, University of Alberta, Edmonton, AB, Canada
| | - L G Hidalgo
- Alberta Transplant Applied Genomics Centre, Edmonton, Alberta.,Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - K S Famulski
- Alberta Transplant Applied Genomics Centre, Edmonton, Alberta.,Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - P F Halloran
- Alberta Transplant Applied Genomics Centre, Edmonton, Alberta.,Department of Medicine, Division of Nephrology and Transplant Immunology, University of Alberta, Edmonton, AB, Canada
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Reeve J, Sellarés J, Mengel M, Sis B, Skene A, Hidalgo L, de Freitas DG, Famulski KS, Halloran PF. Molecular diagnosis of T cell-mediated rejection in human kidney transplant biopsies. Am J Transplant 2013; 13:645-55. [PMID: 23356949 DOI: 10.1111/ajt.12079] [Citation(s) in RCA: 168] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 08/22/2012] [Accepted: 09/11/2012] [Indexed: 01/25/2023]
Abstract
Histologic diagnosis of T cell-mediated rejection is flawed by subjective assessments, nonspecific lesions and arbitrary rules. This study developed a molecular test for T cell-mediated rejection. We used microarray results from 403 kidney transplant biopsies to derive a classifier assigning T cell-mediated rejection scores to all biopsies, and compared these with histologic assessments. The score correlated with histologic lesions of T cell-mediated rejection (infiltrate, tubulitis). The accuracy of the classifier for the histology diagnoses was 89%. Very high and low molecular scores corresponded with unanimity among three pathologists on the presence or absence of T cell-mediated rejection, respectively. The molecular score had low sensitivity (50%) and positive predictive value (62%) for the histology diagnoses. However, histology showed similar disagreement between pathologists--only 45-56% sensitivity of one pathologist with diagnoses of T cell-mediated rejection by another. Discrepancies between molecular scores and histology were mostly when histology was ambiguous ("borderline") or unreliable, e.g. in cases with scarring or inflammation induced by tissue injury. Vasculitis (isolated v-lesion TCMR) was particularly discrepant, with most cases exhibiting low TCMR scores. We propose new rules to integrate molecular tests and histology into a precision diagnostic system that can reduce errors, ambiguity and interpathologist disagreement.
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Affiliation(s)
- J Reeve
- Alberta Transplant Applied Genomics Centre, University of Alberta, Edmonton, Alberta, Canada
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Sellarés J, Ferrer M, Torres A. Predictors of weaning after acute respiratory failure. Minerva Anestesiol 2012; 78:1046-1053. [PMID: 22743787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Although weaning predictors have been extensively explored in weaning research, their use is currently under debate. From all the stages of mechanical ventilation, the measurements of weaning predictors have been considered by some authors as imperative in order to progress weaning and initiate a weaning trial. However, this practice is rejected by other authors who considered that these tests are not necessary to perform a weaning trial, based in a meta-analysis study from the American College of Chest Physicians. Among all the weaning predictors, the frequency-to-tidal volume ratio (f/VT) remains the most important predictor of weaning. Other predictors have been defined, but their narrow predictive capacity or the requirement of specific technology, have limited their use. The variability of the results obtained by the efficacy of f/VT is probably explained because in most cases weaning is initiated late, when pre-test probability of weaning success is high. In order to reduce weaning duration, weaning strategies must be performed earlier, when a failed weaning trial probably is poor tolerated and the use of f/VT could have a role. New applications of weaning predictors must be clarified in future research, in order to progress in weaning in the context of new studies. Weaning is still a challenging period during mechanical ventilation.
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Affiliation(s)
- J Sellarés
- Servei de Pneumologia, Institut Clínic del Tòrax, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Spain
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Sellarés J, de Freitas DG, Mengel M, Reeve J, Einecke G, Sis B, Hidalgo LG, Famulski K, Matas A, Halloran PF. Understanding the causes of kidney transplant failure: the dominant role of antibody-mediated rejection and nonadherence. Am J Transplant 2012; 12:388-99. [PMID: 22081892 DOI: 10.1111/j.1600-6143.2011.03840.x] [Citation(s) in RCA: 1132] [Impact Index Per Article: 94.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We prospectively studied kidney transplants that progressed to failure after a biopsy for clinical indications, aiming to assign a cause to every failure. We followed 315 allograft recipients who underwent indication biopsies at 6 days to 32 years posttransplant. Sixty kidneys progressed to failure in the follow-up period (median 31.4 months). Failure was rare after T-cell-mediated rejection and acute kidney injury and common after antibody-mediated rejection or glomerulonephritis. We developed rules for using biopsy diagnoses, HLA antibody and clinical data to explain each failure. Excluding four with missing information, 56 failures were attributed to four causes: rejection 36 (64%), glomerulonephritis 10 (18%), polyoma virus nephropathy 4 (7%) and intercurrent events 6 (11%). Every rejection loss had evidence of antibody-mediated rejection by the time of failure. Among rejection losses, 17 of 36 (47%) had been independently identified as nonadherent by attending clinicians. Nonadherence was more frequent in patients who progressed to failure (32%) versus those who survived (3%). Pure T-cell-mediated rejection, acute kidney injury, drug toxicity and unexplained progressive fibrosis were not causes of loss. This prospective cohort indicates that many actual failures after indication biopsies manifest phenotypic features of antibody-mediated or mixed rejection and also underscores the major role of nonadherence.
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Affiliation(s)
- J Sellarés
- Alberta Transplant Applied Genomics Centre, University of Alberta, Edmonton, AB, Canada
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de Freitas DG, Sellarés J, Mengel M, Chang J, Hidalgo LG, Famulski KS, Sis B, Einecke G, Halloran PF. The nature of biopsies with "borderline rejection" and prospects for eliminating this category. Am J Transplant 2012; 12:191-201. [PMID: 21992503 DOI: 10.1111/j.1600-6143.2011.03784.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In kidney transplantation, many inflamed biopsies with changes insufficient to be called T-cell-mediated rejection (TCMR) are labeled "borderline", leaving management uncertain. This study examined the nature of borderline biopsies as a step toward eventual elimination of this category. We compared 40 borderline, 35 TCMR and 116 nonrejection biopsies. TCMR biopsies had more inflammation than borderline but similar degrees of tubulitis and scarring. Surprisingly, recovery of function after biopsy was similar in all categories, indicating that response to treatment is unreliable for defining TCMR. We studied the molecular changes in TCMR, borderline and nonrejection using microarrays, measuring four published features: T-cell burden; a rejection classifier; a canonical TCMR classifier; and risk score. These reassigned borderline biopsies as TCMR-like 13/40 (33%) or nonrejection-like 27/40 (67%). A major reason that histology diagnosed molecularly defined TCMR as borderline was atrophy-scarring, which interfered with assessment of inflammation and tubulitis. Decision tree analysis showed that i-total >27% and tubulitis extent >3% match the molecular diagnosis of TCMR in 85% of cases. In summary, most cases designated borderline by histopathology are found to be nonrejection by molecular phenotyping. Both molecular measurements and histopathology offer opportunities for more precise assignment of these cases after clinical validation.
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Affiliation(s)
- D G de Freitas
- Alberta Transplant Applied Genomics Centre, University of Alberta, Edmonton, Canada
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Sellarés J, Loureiro H, Ferrer M, Amaro R, Farré R, Torres A. The effect of spontaneous breathing on systemic interleukin-6 during ventilator weaning. Eur Respir J 2011; 39:654-60. [PMID: 21778161 DOI: 10.1183/09031936.00037511] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
During the weaning process, spontaneous breathing trials (SBTs) involve cardiopulmonary stress for ventilated patients. As interleukin (IL)-6 is a major modulator of the stress response, we hypothesised that systemic IL-6 increases during a SBT and that this increase is more evident in SBT failure. 49 SBTs of 30-min duration were performed on different mechanically ventilated patients, and classified as SBT failure or success. Blood samples were drawn before and at the end of the SBT. An additional sample was drawn 24 h later in a subset of patients (n = 39). Serum IL-6 levels and other inflammatory mediators commonly associated with stress were determined. IL-6 levels increased from mechanical ventilation to spontaneous breathing in all patients (p = 0.02) and in the chronic obstructive pulmonary disease (COPD) population (p = 0.05) with SBT failure compared with success, but not in non-COPD patients (p = 0.12). After 24 h of SBT stress, IL-6 levels decreased in patients with SBT failure (under mechanical ventilation at that point) (p = 0.02) and those with weaning success (p = 0.04). No changes were observed in the remaining inflammatory mediators. Systemic IL-6 increases during a 30-min, failed SBT, especially in COPD patients. Future studies may corroborate the different IL-6 responses among different populations who initiate weaning, together with the potential clinical implications.
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Affiliation(s)
- J Sellarés
- Servei de Pneumologia, Respiratory Intensive Care Unit,Hospital Clínic–August Pi i Sunyer Biomedical Research Institute, IDIBAPS, Centro de Investigación Biomédica En Red – Enfermedades Respiratorias, Barcelona, Spain.
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Sellarés J, de Freitas DG, Mengel M, Sis B, Hidalgo LG, Matas AJ, Kaplan B, Halloran PF. Inflammation lesions in kidney transplant biopsies: association with survival is due to the underlying diseases. Am J Transplant 2011; 11:489-99. [PMID: 21342447 DOI: 10.1111/j.1600-6143.2010.03415.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Assessment of kidney transplant biopsies relies on nonspecific inflammatory lesions: Interstitial infiltrates (i), tubulitis (t) and intimal arteritis (v). We studied the relationship between inflammation and prognosis in biopsies for clinical indications from 314 patients (median follow-up 25 months). We used a modified Banff classification, separately assessing inflammation (i-) in nonscarred (i-Banff), scarred (i-IFTA) and whole cortex (i-total), plus tubulitis and intimal arteritis. In early biopsies (<1 year), i- and t-lesions had no association with graft survival. In late (>1 year) biopsies, all i-scores correlated with progression to failure, due to the association of these infiltrates with progressive diseases: antibody-mediated rejection (ABMR) and glomerulonephritis. Tubulitis in nonscarred areas had no impact on survival. Severe tubulitis including scarred areas (tis3) was associated with worse survival, but reflected polyoma virus nephropathy or ABMR, not T-cell-mediated rejection. Intimal arteritis (v-lesions) had no association with allograft loss in early or late biopsies. In multivariate analysis, outcome was better predicted by the presence of progressive disease than by inflammation. Thus inflammation in late kidney transplants has no inherent prognostic impact, but predicts reduced survival because inflammation indicates actively progressing diseases. The most important predictor of outcome is the diagnosis of a progressive disease.
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Affiliation(s)
- J Sellarés
- Alberta Transplant Applied Genomics Centre, University of Alberta, Edmonton, Alberta, Canada
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Sellarés J, Reeve J, Sis B, Mengel M, Hidalgo LG, Halloran P. ATTRIBUTION: CLASSIFYING CAUSES OF KIDNEY ALLOGRAFT FAILURE. Transplantation 2010. [DOI: 10.1097/00007890-201007272-01833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Pulmonary varices are uncommon vascular abnormalities that are usually asymptomatic and so they are normally diagnosed by chance from a chest x-ray. They often present as a pulmonary nodule and can be either congenital or acquired. If acquired, they are associated with pulmonary venous hypertension, usually as a result of mitral valve disease. Pulmonary arteriography provides a definitive diagnosis, although the use of new noninvasive imaging techniques is spreading. Treatment is not normally required unless serious complications arise. We present the case of a pulmonary varix located within a pulmonary bulla. This form of presentation has not been previously reported.
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Affiliation(s)
- J Sellarés
- Servei de Pneumologia, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
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Sellarés J, Galán M, Cunillera R, Benavent J, Llobet P, Parellada N. [The teaching health centers of Barcelona. The opinions of residents]. Aten Primaria 1993; 11:357-9. [PMID: 8499551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To examine different aspects of the teaching health centres (THC) in the province of Barcelona as evaluated by the ex-residents (Exc-R) from general practice and community medicine (GP&CM). DESIGN Descriptive study, gathering information by means of a self-administered postal questionnaire, with an addressed reply envelope. SETTING Barcelona teaching unit (BTU). PARTICIPANTS Eighty-one general practitioners whose qualifying years were 1987-89, 1988-90 and 1989-91, and who did their last residents year in the THC of the BTU. MEASUREMENTS AND MAIN RESULTS There are significant differences (p < 0.05) between the various THC, in terms of: quality of teaching material and library; evaluation of the tutor in terms of attendance of classes and comment on medical histories; and average evaluation of tutor by the Ex-R. CONCLUSIONS We propose that anonymous evaluations made by residents of their tutors should be generalised and used for, amongst other purposes, maintaining or revoking the accreditations of specific THC or tutors.
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