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Motter JD, Hussain S, Brown DM, Florman S, Rana MM, Friedman-Moraco R, Gilbert AJ, Stock P, Mehta S, Mehta SA, Stosor V, Elias N, Pereira MR, Haidar G, Malinis M, Morris MI, Hand J, Aslam S, Schaenman JM, Baddley J, Small CB, Wojciechowski D, Santos CA, Blumberg EA, Odim J, Apewokin SK, Giorgakis E, Bowring MG, Werbel WA, Desai NM, Tobian AA, Segev DL, Massie AB, Durand CM. Wait Time Advantage for Transplant Candidates With HIV Who Accept Kidneys From Donors With HIV Under the HOPE Act. Transplantation 2024; 108:759-767. [PMID: 38012862 PMCID: PMC11037099 DOI: 10.1097/tp.0000000000004857] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND Kidney transplant (KT) candidates with HIV face higher mortality on the waitlist compared with candidates without HIV. Because the HIV Organ Policy Equity (HOPE) Act has expanded the donor pool to allow donors with HIV (D + ), it is crucial to understand whether this has impacted transplant rates for this population. METHODS Using a linkage between the HOPE in Action trial (NCT03500315) and Scientific Registry of Transplant Recipients, we identified 324 candidates listed for D + kidneys (HOPE) compared with 46 025 candidates not listed for D + kidneys (non-HOPE) at the same centers between April 26, 2018, and May 24, 2022. We characterized KT rate, KT type (D + , false-positive [FP; donor with false-positive HIV testing], D - [donor without HIV], living donor [LD]) and quantified the association between HOPE enrollment and KT rate using multivariable Cox regression with center-level clustering; HOPE was a time-varying exposure. RESULTS HOPE candidates were more likely male individuals (79% versus 62%), Black (73% versus 35%), and publicly insured (71% versus 52%; P < 0.001). Within 4.5 y, 70% of HOPE candidates received a KT (41% D + , 34% D - , 20% FP, 4% LD) versus 43% of non-HOPE candidates (74% D - , 26% LD). Conversely, 22% of HOPE candidates versus 39% of non-HOPE candidates died or were removed from the waitlist. Median KT wait time was 10.3 mo for HOPE versus 60.8 mo for non-HOPE candidates ( P < 0.001). After adjustment, HOPE candidates had a 3.30-fold higher KT rate (adjusted hazard ratio = 3.30, 95% confidence interval, 2.14-5.10; P < 0.001). CONCLUSIONS Listing for D + kidneys within HOPE trials was associated with a higher KT rate and shorter wait time, supporting the expansion of this practice for candidates with HIV.
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Affiliation(s)
| | - Sarah Hussain
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Diane M. Brown
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sander Florman
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Meenakshi M. Rana
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Peter Stock
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Shikha Mehta
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Sapna A. Mehta
- Department of Medicine, NYU Grossman School of Medicine, New York, NY
| | - Valentina Stosor
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nahel Elias
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Marcus R. Pereira
- Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Ghady Haidar
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Maricar Malinis
- Department of Medicine, Yale School of Medicine, New Haven, CT
| | - Michele I. Morris
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Jonathan Hand
- Department of Medicine, Ochsner Health, New Orleans, LA
| | - Saima Aslam
- Department of Medicine, University of California San Diego, La Jolla, CA
| | - Joanna M. Schaenman
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - John Baddley
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Catherine B. Small
- Department of Medicine/Division of Infectious Diseases, Weill Cornell Medicine, New York, NY
| | | | | | - Emily A. Blumberg
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Jonah Odim
- Division of Allergy, Immunology and Transplantation, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Senu K. Apewokin
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH
| | - Emmanouil Giorgakis
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Mary Grace Bowring
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - William A. Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Niraj M. Desai
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Aaron A.R. Tobian
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L. Segev
- Department of Surgery, NYU Grossman School of Medicine, New York, NY
- Department of Population Health, NYU Grossman School of Medicine, New York, NY
- Scientific Registry of Transplant Recipients, Minneapolis, MN
| | - Allan B. Massie
- Department of Surgery, NYU Grossman School of Medicine, New York, NY
- Department of Population Health, NYU Grossman School of Medicine, New York, NY
| | - Christine M. Durand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Gray HK, Beaird OE, Smith EA, Schaenman JM, Yang S. Domestically Acquired NDM-1-Producing Pseudomonas aeruginosa, Southern California, USA, 2023. Emerg Infect Dis 2023; 29:2382-2385. [PMID: 37877613 PMCID: PMC10617354 DOI: 10.3201/eid2911.230646] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
We describe a case of New Delhi metallo-β-lactamase 1-producing carbapenem-resistant Pseudomonas aeruginosa (CRPA) in a transplant patient with multiple hospitalizations in California, USA. Whole-genome sequencing revealed the isolate was genetically distinctive, despite ≈95% similarity to other global strains. The patient's lack of international travel suggests this CRPA was acquired domestically.
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Ogawa L, Beaird OE, Schaenman JM. Risk factors for infection in patients with a failed kidney allograft on immunosuppressive medications. Front Nephrol 2023; 3:1149116. [PMID: 37675348 PMCID: PMC10479655 DOI: 10.3389/fneph.2023.1149116] [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] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 07/17/2023] [Indexed: 09/08/2023]
Abstract
Patients with a failing kidney allograft are often continued on immunosuppression (IS) to preserve residual kidney function and prevent allosensitization. It has been previously accepted that maintaining patients on immunosuppressive therapy results in an increased risk of infection, hospitalization, and mortality. However, as the management of IS in patients with a failed kidney allograft continues to evolve, it is important to review the data regarding associations between infection and specific immunosuppression regimens. We present a review of the literature of failed kidney allograft management and infection risk, and discuss practices for infection prevention. Fifteen studies, published from 1995 to 2022, which investigated the experience of patients with failed allograft and infection, were identified. Infection was most commonly documented as a general event, but when specified, included infections caused by Candida, Mycobacterium tuberculosis, and Aspergillus. In addition, the definition of reduced "IS" varied from decreased doses of a triple drug regimen to monotherapy, whereas others did not specify which medications patients were receiving. Despite attempts at lowering net immunosuppression, patients with failed allografts remain at risk of acquiring opportunistic and non-opportunistic infections. Although opportunistic infections secondary to IS are expected, somewhat surprisingly, it appears that the greatest risk of infection may be related to complications of dialysis. Therefore, mitigating strategies, such as planning for an arteriovenous (AV) fistula over a hemodialysis catheter placement, may reduce infection risk. Additional studies are needed to provide more information regarding the types and timing of infection in the setting of a failed kidney allograft. In addition, more data are needed regarding specific medications, doses, and timing of taper of IS to guide future patient management and inform strategies for infection surveillance and prophylaxis.
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Affiliation(s)
| | | | - Joanna M. Schaenman
- Division of Infectious Diseases, David Geffen School of Medicine at University of California—Los Angeles, Los Angeles, CA, United States
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4
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Yang S, Multani A, Garrigues JM, Oh MS, Hemarajata P, Burleson T, Green NM, Oliai C, Gaynor PT, Beaird OE, Winston DJ, Seet CS, Schaenman JM. Transient SARS-CoV-2 RNA-Dependent RNA Polymerase Mutations after Remdesivir Treatment for Chronic COVID-19 in Two Transplant Recipients: Case Report and Intra-Host Viral Genomic Investigation. Microorganisms 2023; 11:2096. [PMID: 37630656 PMCID: PMC10460003 DOI: 10.3390/microorganisms11082096] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
Remdesivir is the first FDA-approved drug for treating severe SARS-CoV-2 infection and targets RNA-dependent RNA polymerase (RdRp) that is required for viral replication. To monitor for the development of mutations that may result in remdesivir resistance during prolonged treatment, we sequenced SARS-CoV-2 specimens collected at different treatment time points in two transplant patients with severe COVID-19. In the first patient, an allogeneic hematopoietic stem cell transplant recipient, a transient RdRp catalytic subunit mutation (nsp12:A449V) was observed that has not previously been associated with remdesivir resistance. As no in vitro study had been conducted to elucidate the phenotypic effect of nsp12:A449V, its clinical significance is unclear. In the second patient, two other transient RdRp mutations were detected: one in the catalytic subunit (nsp12:V166A) and the other in an accessory subunit important for processivity (nsp7:D67N). This is the first case report for a potential link between the nsp12:V166A mutation and remdesivir resistance in vivo, which had only been previously described by in vitro studies. The nsp7:D67N mutation has not previously been associated with remdesivir resistance, and whether it has a phenotypic effect is unknown. Our study revealed SARS-CoV-2 genetic dynamics during remdesivir treatment in transplant recipients that involved mutations in the RdRp complex (nsp7 and nsp12), which may be the result of selective pressure. These results suggest that close monitoring for potential resistance during the course of remdesivir treatment in highly vulnerable patient populations may be beneficial. Development and utilization of diagnostic RdRp genotyping tests may be a future direction for improving the management of chronic COVID-19.
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Affiliation(s)
- Shangxin Yang
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Ashrit Multani
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA; (A.M.); (P.T.G.); (O.E.B.)
| | - Jacob M. Garrigues
- Public Health Laboratories, Los Angeles County Department of Public Health, Downey, CA 90242, USA (P.H.); (T.B.); (N.M.G.)
| | - Michael S. Oh
- Division of Hematology-Oncology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA; (M.S.O.); (C.O.); (D.J.W.)
| | - Peera Hemarajata
- Public Health Laboratories, Los Angeles County Department of Public Health, Downey, CA 90242, USA (P.H.); (T.B.); (N.M.G.)
| | - Taylor Burleson
- Public Health Laboratories, Los Angeles County Department of Public Health, Downey, CA 90242, USA (P.H.); (T.B.); (N.M.G.)
| | - Nicole M. Green
- Public Health Laboratories, Los Angeles County Department of Public Health, Downey, CA 90242, USA (P.H.); (T.B.); (N.M.G.)
| | - Caspian Oliai
- Division of Hematology-Oncology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA; (M.S.O.); (C.O.); (D.J.W.)
| | - Pryce T. Gaynor
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA; (A.M.); (P.T.G.); (O.E.B.)
| | - Omer E. Beaird
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA; (A.M.); (P.T.G.); (O.E.B.)
| | - Drew J. Winston
- Division of Hematology-Oncology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA; (M.S.O.); (C.O.); (D.J.W.)
| | - Christopher S. Seet
- Division of Hematology-Oncology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA; (M.S.O.); (C.O.); (D.J.W.)
| | - Joanna M. Schaenman
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA; (A.M.); (P.T.G.); (O.E.B.)
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Lichtenstein B, Zheng Y, Gjertson D, Ferbas KG, Rimoin AW, Yang OO, Aldrovandi GM, Schaenman JM, Reed EF, Fulcher JA. Vascular and Non-HLA autoantibody profiles in hospitalized patients with COVID-19. Front Immunol 2023; 14:1197326. [PMID: 37398658 PMCID: PMC10309004 DOI: 10.3389/fimmu.2023.1197326] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/23/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Severe COVID-19 illness is characterized by an overwhelming immune hyperactivation. Autoantibodies against vascular, tissue, and cytokine antigens have been detected across the spectrum of COVID-19. How these autoantibodies correlate with COVID-19 severity is not fully defined. Methods We performed an exploratory study to investigate the expression of vascular and non-HLA autoantibodies in 110 hospitalized patients with COVID-19 ranging from moderate to critically ill. Relationships between autoantibodies and COVID- 19 severity and clinical risk factors were examined using logistic regression analysis. Results There were no absolute differences in levels of expression of autoantibodies against angiotensin II receptor type 1 (AT1R) or endothelial cell proteins between COVID-19 severity groups. AT1R autoantibody expression also did not differ by age, sex, or diabetes status. Using a multiplex panel of 60 non- HLA autoantigens we did identify seven autoantibodies that differed by COVID-19 severity including myosin (myosin; p=0.02), SHC-transforming protein 3 (shc3; p=0.07), peroxisome proliferator-activated receptor gamma coactivator 1-beta (perc; p=0.05), glial-cell derived neurotrophic factor (gdnf; p=0.07), enolase 1 (eno1; p=0.08), latrophilin-1 (lphn1; p=0.08), and collagen VI (coll6; p=0.05) with greater breadth and higher expression levels seen in less severe COVID-19. Discussion Overall, we found that patients hospitalized with COVID-19 demonstrate evidence of auto-reactive antibodies targeting endothelial cells, angiotensin II receptors, and numerous structural proteins including collagens. Phenotypic severity did not correlate with specific autoantibodies. This exploratory study underscores the importance of better understanding of the role of autoimmunity in COVID-19 disease and sequelae.
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Affiliation(s)
- Brian Lichtenstein
- Division of Hospital Medicine, Department of Internal Medicine, Sharp Rees-Stealy Medical Group, Sharp Healthcare, San Diego, CA, United States
| | - Ying Zheng
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - David Gjertson
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States
| | - Kathie G. Ferbas
- Division of Infectious Diseases, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Anne W. Rimoin
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States
| | - Otto O. Yang
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Grace M. Aldrovandi
- Division of Infectious Diseases, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Joanna M. Schaenman
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Elaine F. Reed
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Jennifer A. Fulcher
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
- Infectious Diseases Section, Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, United States
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6
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Jenkins MM, Phan Tran D, Flores EA, Kupferwasser D, Pickering H, Zheng Y, Gjertson DW, Ross TM, Schaenman JM, Miller LG, Yeaman MR, Reed EF. Longitudinal analysis of SARS-CoV-2 infection and vaccination in the LA-SPARTA cohort reveals increased risk of infection in vaccinated Hispanic participants. Front Immunol 2023; 14:1139915. [PMID: 37153624 PMCID: PMC10154521 DOI: 10.3389/fimmu.2023.1139915] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 04/03/2023] [Indexed: 05/10/2023] Open
Abstract
Introduction SARS-CoV-2 is the etiologic agent of coronavirus disease 2019 (COVID-19). Questions remain regarding correlates of risk and immune protection against COVID-19. Methods We prospectively enrolled 200 participants with a high risk of SARS-CoV-2 occupational exposure at a U.S. medical center between December 2020 and April 2022. Participant exposure risks, vaccination/infection status, and symptoms were followed longitudinally at 3, 6, and 12 months, with blood and saliva collection. Serological response to the SARS-CoV-2 spike holoprotein (S), receptor binding domain (RBD) and nucleocapsid proteins (NP) were quantified by ELISA assay. Results Based on serology, 40 of 200 (20%) participants were infected. Healthcare and non-healthcare occupations had equivalent infection incidence. Only 79.5% of infected participants seroconverted for NP following infection, and 11.5% were unaware they had been infected. The antibody response to S was greater than to RBD. Hispanic ethnicity was associated with 2-fold greater incidence of infection despite vaccination in this cohort. Discussion Overall, our findings demonstrate: 1) variability in the antibody response to SARS-CoV-2 infection despite similar exposure risk; 2) the concentration of binding antibody to the SARS-CoV-2 S or RBD proteins is not directly correlated with protection against infection in vaccinated individuals; and 3) determinants of infection risk include Hispanic ethnicity despite vaccination and similar occupational exposure.
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Affiliation(s)
- Meagan M. Jenkins
- Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Donna Phan Tran
- Lundquist Institute for Biomedical Innovation at Harbor–University of California, Los Angeles (UCLA) Medical Center, Torrance, CA, United States
| | - Evelyn A. Flores
- Lundquist Institute for Biomedical Innovation at Harbor–University of California, Los Angeles (UCLA) Medical Center, Torrance, CA, United States
| | - Deborah Kupferwasser
- Lundquist Institute for Biomedical Innovation at Harbor–University of California, Los Angeles (UCLA) Medical Center, Torrance, CA, United States
| | - Harry Pickering
- Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Ying Zheng
- Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - David W. Gjertson
- Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, CA, United States
- Department of Biostatistics, University of California Los Angeles, Los Angeles, CA, United States
| | - Ted M. Ross
- Center for Vaccines and Immunology, University of Georgia, Athens, GA, United States
- Department of Infectious Diseases, University of Georgia, Athens, GA, United States
| | - Joanna M. Schaenman
- Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, United States
- Division of Infectious Diseases, Department of Medicine, Harbor-University of California, Los Angeles (UCLA) Medical Center, Torrance, CA, United States
| | - Loren G. Miller
- Lundquist Institute for Biomedical Innovation at Harbor–University of California, Los Angeles (UCLA) Medical Center, Torrance, CA, United States
- Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, United States
- Division of Infectious Diseases, Department of Medicine, Harbor-University of California, Los Angeles (UCLA) Medical Center, Torrance, CA, United States
| | - Michael R. Yeaman
- Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, United States
- Division of Infectious Diseases, Department of Medicine, Harbor-University of California, Los Angeles (UCLA) Medical Center, Torrance, CA, United States
- Division of Molecular Medicine, Harbor–University of California, Los Angeles (UCLA) Medical Center, Torrance, CA, United States
- Institute for Infection & Immunity, Lundquist Institute for Biomedical Innovation at Harbor–University of California, Los Angeles (UCLA) Medical Center, Torrance, CA, United States
| | - Elaine F. Reed
- Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, CA, United States
- *Correspondence: Elaine F. Reed,
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Shino MY, Todd JL, Neely ML, Kirchner J, Frankel CW, Snyder LD, Pavlisko EN, Fishbein GA, Schaenman JM, Mason K, Kesler K, Martinu T, Singer LG, Tsuang W, Budev M, Shah PD, Reynolds JM, Williams N, Robien MA, Palmer SM, Weigt SS, Belperio JA. Plasma CXCL9 and CXCL10 at allograft injury predict chronic lung allograft dysfunction. Am J Transplant 2022; 22:2169-2179. [PMID: 35634722 PMCID: PMC9427677 DOI: 10.1111/ajt.17108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 01/25/2023]
Abstract
Histopathologic lung allograft injuries are putative harbingers for chronic lung allograft dysfunction (CLAD). However, the mechanisms responsible are not well understood. CXCL9 and CXCL10 are potent chemoattractants of mononuclear cells and potential propagators of allograft injury. We hypothesized that these chemokines would be quantifiable in plasma, and would associate with subsequent CLAD development. In this prospective multicenter study, we evaluated 721 plasma samples for CXCL9/CXCL10 levels from 184 participants at the time of transbronchial biopsies during their first-year post-transplantation. We determined the association between plasma chemokines, histopathologic injury, and CLAD risk using Cox proportional hazards models. We also evaluated CXCL9/CXCL10 levels in bronchoalveolar lavage (BAL) fluid and compared plasma to BAL with respect to CLAD risk. Plasma CXCL9/CXCL10 levels were elevated during the injury patterns associated with CLAD, acute rejection, and acute lung injury, with a dose-response relationship between chemokine levels and CLAD risk. Importantly, there were strong interactions between injury and plasma CXCL9/CXCL10, where histopathologic injury associated with CLAD only in the presence of elevated plasma chemokines. We observed similar associations and interactions with BAL CXCL9/CXCL10 levels. Elevated plasma CXCL9/CXCL10 during allograft injury may contribute to CLAD pathogenesis and has potential as a minimally invasive immune monitoring biomarker.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Nikki Williams
- National Institute of Allergy and Infectious Diseases; Washington DC
| | - Mark A. Robien
- National Institute of Allergy and Infectious Diseases; Washington DC
| | | | - S. Sam Weigt
- University of California Los Angeles; Los Angeles, CA
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Chang SY, Price TK, Beaird OE, Gaynor PT, Schaenman JM, Carlson ME, Kubak BM, Yang S, Multani A. Mycoplasma hominis
infections in solid organ transplant recipients: clinical characteristics, treatment outcomes, and comparison of phenotypic and genotypic susceptibility profiles. Transpl Infect Dis 2022; 24:e13822. [DOI: 10.1111/tid.13822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/25/2022] [Accepted: 02/22/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Sandy Y. Chang
- Division of Infectious Diseases Department of Medicine David Geffen School of Medicine at UCLA Los Angeles CA USA
- Division of Infectious Diseases Department of Medicine Loma Linda University Loma Linda CA USA
| | - Travis K. Price
- Department of Pathology and Laboratory Medicine David Geffen School of Medicine at UCLA Los Angeles CA USA
| | - Omer E. Beaird
- Division of Infectious Diseases Department of Medicine David Geffen School of Medicine at UCLA Los Angeles CA USA
| | - Pryce T. Gaynor
- Division of Infectious Diseases Department of Medicine David Geffen School of Medicine at UCLA Los Angeles CA USA
| | - Joanna M. Schaenman
- Division of Infectious Diseases Department of Medicine David Geffen School of Medicine at UCLA Los Angeles CA USA
| | - Margrit E. Carlson
- Division of Infectious Diseases Department of Medicine David Geffen School of Medicine at UCLA Los Angeles CA USA
| | - Bernard M. Kubak
- Division of Infectious Diseases Department of Medicine David Geffen School of Medicine at UCLA Los Angeles CA USA
| | - Shangxin Yang
- Department of Pathology and Laboratory Medicine David Geffen School of Medicine at UCLA Los Angeles CA USA
| | - Ashrit Multani
- Division of Infectious Diseases Department of Medicine David Geffen School of Medicine at UCLA Los Angeles CA USA
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9
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Lee YK, Shukman M, Biniwale R, Ardehali A, Kamath M, Nsair A, Schaenman JM, Goldwater D. Benefits of both physical assessment and electronic health record review to assess frailty prior to heart transplant. Clin Transplant 2022; 36:e14559. [PMID: 34923657 PMCID: PMC9366897 DOI: 10.1111/ctr.14559] [Citation(s) in RCA: 2] [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: 04/20/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Frailty status affects outcomes after heart transplantation, but the optimal way to assess frailty prior to transplant remains unknown. METHODS This single-center, observational study assessed 44 heart transplant candidates for frailty using three methods. The Short Physical Performance Battery (SPPB) and Fried Frailty Phenotype (FFP) were used as two physical assessments of frailty. The Frailty Risk Score (FRS) was used as a chart-review based assessment measuring 20 different biopsychosocial and functional components, including biomarkers, depression, cognitive impairment, and sleep. RESULTS We determined the correlation between FRS, SPPB, and FFP and how each correlated with clinical outcomes. Of 44 participants, mean age was 60 years. FRS correlated with SPPB and FFP (P = .043, P < .001, respectively). Higher frailty as measured by SPPB and FRS was significantly associated with lack of achieving waitlist status (P = .022; P = .002) and not being transplanted (P = .026; P = .008). Higher frailty by SPPB and FFP was also associated with mortality (P = .010; P = .025). CONCLUSION SPPB and chart-review FRS showed potential for predicting waitlist and transplant status of heart transplant candidates, while SPPB and FFP were associated with mortality. Additional studies may serve to validate these observations.
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Affiliation(s)
- Yoon Kyung Lee
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Marina Shukman
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Reshma Biniwale
- Department of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Abbas Ardehali
- Department of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Megan Kamath
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Ali Nsair
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Joanna M. Schaenman
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Deena Goldwater
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA,Division of Geriatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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10
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Pickering H, Sen S, Arakawa-Hoyt J, Ishiyama K, Sun Y, Parmar R, Ahn RS, Sunga G, Llamas M, Hoffmann A, Deng M, Bunnapradist S, Schaenman JM, Gjertson DW, Rossetti M, Lanier LL, Reed EF. NK and CD8+ T cell phenotypes predict onset and control of CMV viremia after kidney transplant. JCI Insight 2021; 6:153175. [PMID: 34609965 PMCID: PMC8663544 DOI: 10.1172/jci.insight.153175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/14/2021] [Accepted: 09/29/2021] [Indexed: 01/08/2023] Open
Abstract
CMV causes mostly asymptomatic but lifelong infection. Primary infection or reactivation in immunocompromised individuals can be life-threatening. CMV viremia often occurs in solid organ transplant recipients and associates with decreased graft survival and higher mortality. Furthering understanding of impaired immunity that allows CMV reactivation is critical to guiding antiviral therapy and examining the effect of CMV on solid organ transplant outcomes. This study characterized longitudinal immune responses to CMV in 31 kidney transplant recipients with CMV viremia and matched, nonviremic recipients. Recipients were sampled 3 and 12 months after transplant, with additional samples 1 week and 1 month after viremia. PBMCs were stained for NK and T cell markers. PBMC transcriptomes were characterized by RNA-Seq. Plasma proteins were quantified by Luminex. CD8+ T cell transcriptomes were characterized by single-cell RNA-Seq. Before viremia, patients had high levels of IL-15 with concurrent expansion of immature CD56bright NK cells. After viremia, mature CD56dim NK cells and CD28–CD8+ T cells upregulating inhibitory and NK-associated receptors were expanded. Memory NK cells and NK-like CD28–CD8+ T cells were associated with control of viremia. These findings suggest that signatures of innate activation may be prognostic for CMV reactivation after transplant, while CD8+ T cell functionality is critical for effective control of CMV.
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Affiliation(s)
- Harry Pickering
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Subha Sen
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Janice Arakawa-Hoyt
- Department of Microbiology and Immunology, Parker Institute for Cancer Immunotherapy, University of California, San Francisco, San Francisco, California, USA
| | - Kenichi Ishiyama
- Department of Microbiology and Immunology, Parker Institute for Cancer Immunotherapy, University of California, San Francisco, San Francisco, California, USA
| | - Yumeng Sun
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Rajesh Parmar
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Richard S Ahn
- Microbiology, Immunology, and Molecular Genetics.,Institute for Quantitative and Computational Biosciences, and
| | - Gemalene Sunga
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Megan Llamas
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Alexander Hoffmann
- Institute for Quantitative and Computational Biosciences, and.,Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Mario Deng
- Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Suphamai Bunnapradist
- Division of Nephrology, David Geffen School of Medicine, Los Angeles, California, USA
| | - Joanna M Schaenman
- Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - David W Gjertson
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, California, USA.,Biostatistics, University of California, Los Angeles, Los Angeles, California, USA
| | - Maura Rossetti
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Lewis L Lanier
- Department of Microbiology and Immunology, Parker Institute for Cancer Immunotherapy, University of California, San Francisco, San Francisco, California, USA
| | - Elaine F Reed
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, California, USA
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11
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Schaenman JM, Diamond JM, Greenland JR, Gries C, Kennedy CC, Parulekar AD, Rozenberg D, Singer JP, Singer LG, Snyder LD, Bhorade S. Frailty and aging-associated syndromes in lung transplant candidates and recipients. Am J Transplant 2021; 21:2018-2024. [PMID: 33296550 PMCID: PMC8178173 DOI: 10.1111/ajt.16439] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 09/24/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 01/25/2023]
Abstract
Many lung transplant candidates and recipients are older and frailer compared to previous eras. Older patients are at increased risk for pre- and posttransplant mortality, but this risk is not explained by numerical age alone. This manuscript represents the product of the American Society of Transplantation (AST) conference on frailty. Experts in the field reviewed the latest published research on assessment of elderly and frail lung transplant candidates. Physical frailty, often defined as slowness, weakness, low physical activity, shrinking, and exhaustion, and frailty evaluation is an important tool for evaluation of age-associated dysfunction. Another approach is assessment by cumulative deficits, and both types of frailty are common in lung transplant candidates. Frailty is associated with death or delisting before transplant, and may be associated with posttransplant mortality. Sarcopenia, cognitive dysfunction, depression, and nutrition are other important components for patient evaluation. Aging-associated inflammation, telomere dysfunction, and adaptive immune system senescence may also contribute to frailty. Developing tools for frailty assessment and interventions holds promise for improving patient outcomes before and after lung transplantation.
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Affiliation(s)
- Joanna M. Schaenman
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Joshua M. Diamond
- Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John R. Greenland
- Department of Medicine, San Francisco VA Health Care System, San Francisco, CA and University of California, San Francisco CA
| | - Cynthia Gries
- Department of Medicine, AdventHealth Transplant Institute, Orlando FL
| | | | | | - Dmitry Rozenberg
- Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan P. Singer
- Department of Medicine, San Francisco VA Health Care System, San Francisco, CA and University of California, San Francisco CA
| | - Lianne G. Singer
- Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Sangeeta Bhorade
- Medical Affairs-Pulmonary, Veracyte Inc, South San Francisco, CA
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12
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Schaenman JM, Rossetti M, Liang EC, Lum E, Abdalla B, Bunnapradist S, Pham PT, Danovitch G, Reed EF, Cole SW. Leukocyte transcriptome indicators of development of infection in kidney transplant recipients. Clin Transplant 2021; 35:e14252. [PMID: 33570750 DOI: 10.1111/ctr.14252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/20/2020] [Revised: 01/18/2021] [Accepted: 01/31/2021] [Indexed: 12/01/2022]
Abstract
After kidney transplantation, infection and death are important clinical complications, especially for the growing numbers of older patients with limited resilience to withstand adverse events. Evaluation of changes in gene expression in immune cells can reveal the underlying mechanisms behind vulnerability to infection. A cohort of 60 kidney transplant recipients was evaluated. Gene expression in peripheral blood mononuclear cells 3 months after kidney transplantation was analyzed to compare differences between patients with infection and those who were infection-free in the first-year post-transplant. Pro-inflammatory genes such as IL1B, CCL4, and TNF were found to be downregulated in post-transplant PBMC from patients who developed infection. In contrast, genes involved in metabolism, HLA genes, and transcripts involved in type I interferon innate antiviral responses were found to be upregulated. Promoter-based bioinformatic analyses implicated increased activity of interferon regulatory factors, erythroid nuclear factor (E2), and CCAAT-enhancer-binding protein (C/EBP) in patients who developed infections. Differential patterns of gene expression were observed in patients who developed infection after kidney transplantation, with patterns distinct from changes associated with patient age, suggesting possible mechanisms behind vulnerability to infection. Assessment of gene expression in blood may offer an approach for patient risk stratification and monitoring after transplantation.
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Affiliation(s)
- Joanna M Schaenman
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Maura Rossetti
- Department of Pathology and Laboratory Medicine, UCLA Immunogenetics Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Emily C Liang
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Erik Lum
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Basmah Abdalla
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Suphamai Bunnapradist
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Phuong Thu Pham
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Gabriel Danovitch
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Elaine F Reed
- Department of Pathology and Laboratory Medicine, UCLA Immunogenetics Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Steve W Cole
- Department of Medicine, Division of Hematology-Oncology, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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13
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Huang G, Davis MR, Beaird OE, Carlson M, Gaynor P, Multani A, Deng M, Nsair A, Schaenman JM. 1109. Valgancyclovir Dosing for Cytomegalovirus Prophylaxis in Heart Transplant Recipients. Open Forum Infect Dis 2020. [PMCID: PMC7776552 DOI: 10.1093/ofid/ofaa439.1295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Cytomegalovirus (CMV) is one of the most common infections after transplantation and continues to cause significant morbidity and mortality. Current guidelines recommend 3-6 months of post-transplant prophylaxis with 900mg daily of valganciclovir in heart transplant recipients. At our institution, however, the protocol is to use 450mg daily of valganciclovir for 6-12 months for intermediate risk (R+) patients and 900 mg daily for high risk (D+/R-) patients. In this study we aimed to identify underlying patient characteristics associated with detectable viral load above the quantifiable threshold. Table 1. Comparison of patients with a CMV viral above and below 137. ![]()
Methods We retrospectively reviewed medical records of adult (≥ 18 years) heart transplant recipients with detectable CMV viremia from 2016-2018 resulted during routine clinical screening. Results Ninety-seven heart transplant recipients with a detectable CMV viral load were identified. Of those, 38 (37.2%) had a quantifiable viral load above the 137 IU/mL threshold. When compared to the individuals with a detectable viral load below the threshold (< 137 IU/mL), they had similar age at time of transplant, increased likelihood of donor/recipient CMV IgG mismatch, and were more frequently on 900mg daily of prophylaxis at time of viremia. Of the individuals with CMV DNAemia above the threshold, the median time to viremia was 271.4 days and the median peak viral load was 701 IU/mL. When limiting analysis to only recipients who were CMV IgG positive, patients with viremia had similar age and more likely to be on 900mg daily of valganciclovir as prophylaxis when compared to individuals with CMV viremia < 137 IU/mL. When comparing CMV D+/R- patients, age and rates of 900mg valganciclovir as prophylaxis were similar (Table 1). Conclusion We found that despite receipt of CMV prophylaxis, an appreciable number of both R+ and D-/R+ heart transplant recipients developed breakthrough DNAemia despite being on prophylaxis of valganciclovir as recommended by guidelines. Despite receipt of the higher 900 mg daily dose, high risk patients had higher rates of breakthrough DNAemia at our institution compared with R+ intermediate risk patients. More research is needed to evaluate the optimal dose and duration for prophylaxis in heart transplant patients against CMV. Disclosures All Authors: No reported disclosures
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Affiliation(s)
- Glen Huang
- University of California - Los Angeles, Los Angeles, California
| | | | | | | | | | - Ashrit Multani
- David Geffen School of Medicine at UCLA, Los Angeles, California
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14
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Florescu DF, Schaenman JM. Adenovirus in solid organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13527. [PMID: 30859626 DOI: 10.1111/ctr.13527] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [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: 02/11/2019] [Accepted: 02/26/2019] [Indexed: 01/06/2023]
Abstract
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of adenovirus infections after solid organ transplantation. Adenovirus is an important cause of infectious complications in both stem cell transplant and SOT patients, causing a range of clinical syndromes including pneumonitis, colitis, and disseminated disease. The current update of the guidelines highlights that adenovirus surveillance testing should not be performed in asymptomatic recipients. Serial quantitative PCR might play a role in the decision to initiate or assess response to therapy in a symptomatic patient. The initial and most important components of therapy remain supportive care and decrease in immunosuppression. The use of antiviral therapy is not supported by prospective randomized clinical trials. However, intravenous cidofovir is considered the standard practice for treatment of severe, progressive, or disseminated adenovirus disease in most transplant centers. Intravenous immunoglobulin may be beneficial, primarily in a select group of patients with hypogammaglobulinemia. Future approaches to treatment of adenovirus disease may include administration of adenovirus-specific T-cell therapy.
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Affiliation(s)
- Diana F Florescu
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Joanna M Schaenman
- Division of Infectious Diseases, David Geffen School of Medicine, Los Angeles, California
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15
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Schaenman JM, Rossetti M, Lum E, Abdalla B, Bunnapradist S, Pham TP, Danovitch G, Reed EF, Cole S. Differences in Gene Expression in Older Compared With Younger Kidney Transplant Recipients. Transplant Direct 2019; 5:e436. [PMID: 30993190 PMCID: PMC6445656 DOI: 10.1097/txd.0000000000000870] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/16/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND For the growing numbers of older transplant patients, increased incidence of infection and death compared with younger patients may limit the many benefits provided by transplantation. However, little is known about age-associated immune dysfunction in the older transplant recipient. METHODS A cohort of 60 kidney transplant recipients, 23 older (≥ 60y) and 37 younger (30-59y), matched on antithymocyte induction and donor type (living vs deceased) was evaluated. Gene expression in peripheral blood mononuclear cells 3 months after kidney transplantation was analyzed to compare differences between older and younger patients. RESULTS Proinflammatory genes were upregulated in older kidney transplant patients, including cytokines IL1-β and IL-6. Downregulated genes were associated with B-cell and T-cell function, including CCR7 and CD27. Analysis of predicted transcription factor binding suggested an increase in proinflammatory transcription factor CCAAT/enhancer binding protein β-binding sites in older patients, whereas interferon regulatory factor 2 transcription factor binding sites were less prevalent. CONCLUSIONS Older kidney transplant recipients exhibited multiple differences in gene expression compared with younger patients, with upregulation of proinflammatory genes and downregulation of adaptive immune response genes. These findings may explain the mechanism of increased vulnerability to infection and malignancy observed in older transplant patients.
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Affiliation(s)
- Joanna M Schaenman
- Division of Infectious Diseases, Department of Medicine, UCLA Immunogenetics Center, Los Angeles, CA
| | - Maura Rossetti
- Department of Pathology and Laboratory Medicine, UCLA Immunogenetics Center, Los Angeles, CA
| | - Erik Lum
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Basmah Abdalla
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Suphamai Bunnapradist
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Thu-Phuong Pham
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Gabriel Danovitch
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Elaine F Reed
- Department of Pathology and Laboratory Medicine, UCLA Immunogenetics Center, Los Angeles, CA
| | - Steve Cole
- Division of Hematology-Oncology, Department of Medicine, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
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16
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Schaenman JM, Rossetti M, Sidwell T, Groysberg V, Sunga G, Liang E, Vangala S, Chang E, Bakir M, Bondar G, Cadeiras M, Kwon M, Reed EF, Deng M. Association of pro-inflammatory cytokines and monocyte subtypes in older and younger patients on clinical outcomes after mechanical circulatory support device implantation. Hum Immunol 2018; 80:126-134. [PMID: 30445099 DOI: 10.1016/j.humimm.2018.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 05/04/2018] [Revised: 10/29/2018] [Accepted: 11/07/2018] [Indexed: 01/30/2023]
Abstract
Noninvasive immunologic analysis of peripheral blood holds promise for explaining the mechanism of development of adverse clinical outcomes, and may also become a method for patient risk stratification before or after mechanical circulatory support device (MCSD) implantation. Dysregulation of the innate immune system is associated with increased patient age but has yet to be evaluated in the older patient with advanced heart failure undergoing MCSD surgery. Patients pre- and post-MCSD implantation had peripheral blood mononuclear cells (PBMC) and serum isolated. Multiparameter flow cytometry was used to analyze markers of innate cell function, including monocyte subtypes. Multiplex cytokine analysis was performed. MELD-XI and SOFA scores were utilized as surrogate markers of outcomes. Increased levels of pro-inflammatory cytokines including IL-15, TNF-α, and IL-10 were associated with increased MELD-XI and SOFA scores. IL-8, TNF- α, and IL-10 were associated with risk of death after MCSD implantation, even with correction for patient age. Increased frequency of 'classical' monocytes (CD14 + CD16-) were associated with increased MELD-XI and SOFA scores. This suggests that inflammation and innate immune system activation contribute to progression to multiorgan system failure and death after MCSD surgery. Development of noninvasive monitoring of peripheral blood holds promise for biomarker development for candidate selection and patient risk stratification.
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Affiliation(s)
- Joanna M Schaenman
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States.
| | - Maura Rossetti
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Tiffany Sidwell
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Victoria Groysberg
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Gemalene Sunga
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Emily Liang
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Sitaram Vangala
- UCLA Department of Medicine Statistics Core, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Eleanor Chang
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Maral Bakir
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Galyna Bondar
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Martin Cadeiras
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Murray Kwon
- Department of Cardiothoracic Surgery, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Elaine F Reed
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Mario Deng
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
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17
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Bakir M, Jackson NJ, Han SX, Bui A, Chang E, Liem DA, Ardehali A, Ardehali R, Baas AS, Press MC, Cruz D, Deng MC, DePasquale EC, Fonarow GC, Khuu T, Kwon MH, Kubak BM, Nsair A, Phung JL, Reed EF, Schaenman JM, Shemin RJ, Zhang QJ, Tseng CH, Cadeiras M. Clinical phenomapping and outcomes after heart transplantation. J Heart Lung Transplant 2018; 37:956-966. [PMID: 29802085 PMCID: PMC6064662 DOI: 10.1016/j.healun.2018.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 03/12/2018] [Accepted: 03/14/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Survival after heart transplantation (HTx) is limited by complications related to alloreactivity, immune suppression, and adverse effects of pharmacologic therapies. We hypothesize that time-dependent phenomapping of clinical and molecular data sets is a valuable approach to clinical assessments and guiding medical management to improve outcomes. METHODS We analyzed clinical, therapeutic, biomarker, and outcome data from 94 adult HTx patients and 1,557 clinical encounters performed between January 2010 and April 2013. Multivariate analyses were used to evaluate the association between immunosuppression therapy, biomarkers, and the combined clinical end point of death, allograft loss, retransplantation, and rejection. Data were analyzed by K-means clustering (K = 2) to identify patterns of similar combined immunosuppression management, and percentile slopes were computed to examine the changes in dosages over time. Findings were correlated with clinical parameters, human leucocyte antigen antibody titers, and peripheral blood mononuclear cell gene expression of the AlloMap (CareDx, Inc., Brisbane, CA) test genes. An intragraft, heart tissue gene coexpression network analysis was performed. RESULTS Unsupervised cluster analysis of immunosuppressive therapies identified 2 groups, 1 characterized by a steeper immunosuppression minimization, associated with a higher likelihood for the combined end point, and the other by a less pronounced change. A time-dependent phenomap suggested that patients in the group with higher event rates had increased human leukocyte antigen class I and II antibody titers, higher expression of the FLT3 AlloMap gene, and lower expression of the MARCH8 and WDR40A AlloMap genes. Intramyocardial biomarker-related coexpression network analysis of the FLT3 gene showed an immune system-related network underlying this biomarker. CONCLUSIONS Time-dependent precision phenotyping is a mechanistically insightful, data-driven approach to characterize patterns of clinical care and identify ways to improve clinical management and outcomes.
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Affiliation(s)
- Maral Bakir
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine
| | | | | | | | - Eleanor Chang
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine
| | - David A Liem
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine
| | - Abbas Ardehali
- Department of Surgery, University of California, Los Angeles, Los Angeles, California
| | - Reza Ardehali
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine
| | - Arnold S Baas
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine
| | | | - Daniel Cruz
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine
| | - Mario C Deng
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine
| | - Eugene C DePasquale
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine
| | - Gregg C Fonarow
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine
| | - Tam Khuu
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine
| | - Murray H Kwon
- Department of Surgery, University of California, Los Angeles, Los Angeles, California
| | - Bernard M Kubak
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine
| | - Ali Nsair
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine
| | - Jennifer L Phung
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine
| | | | - Joanna M Schaenman
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine
| | - Richard J Shemin
- Department of Surgery, University of California, Los Angeles, Los Angeles, California
| | | | | | - Martin Cadeiras
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine.
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18
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Schaenman JM, Rossetti M, Korin Y, Sidwell T, Groysberg V, Liang E, Vangala S, Wisniewski N, Chang E, Bakir M, Bondar G, Cadeiras M, Kwon M, Reed EF, Deng M. T cell dysfunction and patient age are associated with poor outcomes after mechanical circulatory support device implantation. Hum Immunol 2018; 79:203-212. [PMID: 29409843 DOI: 10.1016/j.humimm.2018.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 08/22/2017] [Revised: 12/27/2017] [Accepted: 01/24/2018] [Indexed: 10/18/2022]
Abstract
Immunologic impairment may contribute to poor outcomes after implantation of mechanical circulatory support device (MCSD), with infection often as a terminal event. The study of immune dysfunction is of special relevance given the growing numbers of older patients with heart disease. The aim of the study was to define which immunologic characteristics are associated with development of adverse clinical outcomes after MCSD implantation. We isolated peripheral blood mononuclear cells (PBMC) from patients pre- and up to 20 days post-MCSD implantation and analyzed them by multiparameter flow cytometry for T cell dysfunction, including terminal differentiation, exhaustion, and senescence. We used MELD-XI and SOFA scores measured at each time point as surrogate markers of clinical outcome. Older patients demonstrated increased frequencies of terminally differentiated T cells as well as NKT cells. Increased frequency of terminally differentiated and immune senescent T cells were associated with worse clinical outcome as measured by MELD-XI and SOFA scores, and with progression to infection and death. In conclusion, our data suggest that T cell dysfunction, independently from age, is associated with poor outcomes after MCSD implantation, providing a potential immunologic mechanism behind patient vulnerability to multiorgan dysfunction and death. This noninvasive approach to PBMC evaluation holds promise for candidate evaluation and patient monitoring.
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Affiliation(s)
- Joanna M Schaenman
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States.
| | - Maura Rossetti
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Yael Korin
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Tiffany Sidwell
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Victoria Groysberg
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Emily Liang
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Sitaram Vangala
- UCLA Department of Medicine Statistics Core, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Nicholas Wisniewski
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Eleanor Chang
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Maral Bakir
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Galyna Bondar
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Martin Cadeiras
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Murray Kwon
- Department of Cardiothoracic Surgery, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Elaine F Reed
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Mario Deng
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
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19
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Schaenman JM, Kumar D, Kotton CN, Danziger-Isakov L, Morris MI. Transplant center support for infectious diseases. Transpl Infect Dis 2017; 19. [PMID: 28699274 DOI: 10.1111/tid.12746] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 12/19/2016] [Revised: 04/18/2017] [Accepted: 04/30/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Transplant Infectious Diseases (TID) is a rapidly growing subspecialty, which has contributed significantly to improving patient outcomes after transplantation. Obtaining institutional support to implement programs that promote excellence in patient care remains a challenge for many non-surgical transplant-related specialties. METHOD We surveyed the membership of the American Society of Transplantation Infectious Diseases Community of Practice to assess characteristics of individual transplant programs and delineate current patterns of institutional support of TID, with a goal of facilitating the exchange of innovative funding ideas between transplant programs. RESULTS Of 53 questionnaires returned, 36 programs reported the existence of a dedicated TID service for adults. Of these, the ratio of dedicated TID providers to the number of solid organ transplant patients transplanted annually ranged from 15:1 to 259:1. A total of 21% of responding programs indicated that they received no support from their institution. Respondents from larger programs were more likely to receive some type of programmatic support. CONCLUSION Given that the presence of expert TID input into patient care can improve outcomes through direct patient management and transplant team education, we suggest that continued support of the unbillable time contributed by TID practitioners is a critical part of ensuring excellent outcomes after transplantation.
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Affiliation(s)
- Joanna M Schaenman
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Deepali Kumar
- Transplant Infectious Diseases, University Health Network, Toronto, ON, Canada
| | - Camille N Kotton
- Transplant and Immunocompromised Host Infectious Diseases, Infectious Diseases Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Michele I Morris
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, USA
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20
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Saullo JL, Schaenman JM. Interpreting positive cultures in asymptomatic lung transplant recipients. Clin Transplant 2016; 30:855-6. [PMID: 27393371 DOI: 10.1111/ctr.12774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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Lum EL, Schaenman JM, DeNicola M, Reddy UG, Shen JI, Pullarkat ST. A case report of CMV lymphadenitis in an adult kidney transplant recipient. Transplant Proc 2015; 47:141-5. [PMID: 25645793 DOI: 10.1016/j.transproceed.2014.09.105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 09/17/2014] [Indexed: 11/28/2022]
Abstract
Cytomegalovirus (CMV) infection following kidney transplantation is associated with increased morbidity and mortality. In this case report we describe a case of a 23-year-old woman with an unusual presentation of diffuse CMV lymphadenitis following kidney transplantation that did not respond to gangiclovir therapy. This case highlights the atypical presentation of CMV disease in a kidney transplant recipient, the importance of CMV hypergammaglobulin in the treatment of CMV infection post kidney transplantation, and the difficulties in transitioning care from pediatric to adult transplant programs.
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Affiliation(s)
- E L Lum
- UCLA David Geffen School of Medicine Department of Medicine, Division of Nephrology, Kidney Transplant, Los Angeles, Califonia, USA.
| | - J M Schaenman
- UCLA David Geffen School of Medicine Department of Medicine, Infectious Diseases, Los Angeles, Califonia, USA
| | - M DeNicola
- UCLA David Geffen School of Medicine Department of Pathology, Los Angeles, Califonia, USA
| | - U G Reddy
- UCLA David Geffen School of Medicine Department of Medicine, Division of Nephrology, Kidney Transplant, Los Angeles, Califonia, USA
| | - J I Shen
- UCLA Harbor Department of Medicine, Division of Nephrology, Los Angeles, Califonia, USA
| | - S T Pullarkat
- UCLA David Geffen School of Medicine Department of Pathology, Los Angeles, Califonia, USA
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22
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Kwon MH, Zhang JQ, Schaenman JM, Cadeiras M, Gjertson DW, Krystal CA, Laks H, Ardehali A, Deng MC, Shemin RJ, Reed EF. Characterization of ventricular assist device-mediated sensitization in the bridge-to-heart-transplantation patient. J Thorac Cardiovasc Surg 2015; 149:1161-6. [PMID: 25702320 DOI: 10.1016/j.jtcvs.2015.01.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 12/19/2014] [Accepted: 01/02/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Ventricular assist devices (VADs) are associated with increased anti-human leukocyte antigen antibody production. The purpose of this study is to characterize differences in sensitization patterns in patients receiving axial flow, implantable VADs versus pulsatile, paracorporeal biventricular assist devices (BIVADs) as bridges to transplantation. METHODS The study is a retrospective review of 68 patients who were bridged to transplantation with either a VAD or a BIVAD, as described, from January 2007 to June 2010, at a university medical center. RESULTS Five of 15 (33.3%) VAD patients became sensitized during treatment, compared with 30 of 53 (56.6%) BIVAD patients, P = .15. Multivariable analysis comparing BIVAD with VAD, while controlling for previous cardiac surgery, pregnancy, and packed red blood cell transfusion produced an odds ratio of 2.99, P = .14. Of sensitized patients, all 5 (100%) of the VAD patients had pre-existing antibodies before VAD placement, compared with 9 of 30 (30.0%) BIVAD patients, P = .006. Maximum cumulative mean fluorescence intensities for BIVAD were 46,259 ± 66,349 versus 42,540 ± 12,840 for VAD, P = .90. Time to maximum antibody expression was shorter for the VAD group (34 ± 28 days vs 5.8 ± 9 days, P = .04). CONCLUSIONS Device type was not a factor in patient sensitization after implantation. However, VAD patients required pre-existing sensitization before implantation to produce antibodies during their treatment interval, whereas more than two thirds of BIVAD patients developed de novo antibodies. These data suggest that the mechanism of sensitization between VAD and BIVAD patients may differ, and further mechanistic studies into the impact of device types on patient sensitization are warranted.
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Affiliation(s)
- Murray H Kwon
- Division of Cardiothoracic Surgery, Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, Calif.
| | - Jennifer Q Zhang
- University of California, Los Angeles Immunogenetics Center, University of California, Los Angeles, Los Angeles, Calif
| | - Joanna M Schaenman
- Division of Immunology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, Calif
| | - Martin Cadeiras
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, Calif
| | - David W Gjertson
- University of California, Los Angeles Immunogenetics Center, University of California, Los Angeles, Los Angeles, Calif
| | - Carolyn A Krystal
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, Calif
| | - Hillel Laks
- Division of Cardiothoracic Surgery, Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, Calif
| | - Abbas Ardehali
- Division of Cardiothoracic Surgery, Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, Calif
| | - Mario C Deng
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, Calif
| | - Richard J Shemin
- Division of Cardiothoracic Surgery, Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, Calif
| | - Elaine F Reed
- University of California, Los Angeles Immunogenetics Center, University of California, Los Angeles, Los Angeles, Calif
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23
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24
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Schaenman JM, Shashidhar S, Rhee C, Wong J, Navato S, Wong RM, Ho DY, Arai S, Johnston L, Brown JM. Early CMV viremia is associated with impaired viral control following nonmyeloablative hematopoietic cell transplantation with a total lymphoid irradiation and antithymocyte globulin preparative regimen. Biol Blood Marrow Transplant 2010; 17:693-702. [PMID: 20736077 DOI: 10.1016/j.bbmt.2010.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 08/16/2010] [Indexed: 10/19/2022]
Abstract
The reconstitution of immune function after hematopoietic cell transplant (HCT) plays an important role in the control of viral infections. Both donor and recipient cytomegalovirus (CMV) serostatus has been shown to contribute to effective immune function; however, the influence of a nonmyeloablative preparative (NMA) regimen using total lymphoid irradiation (TLI) and antithymocyte globulin (ATG) on antiviral immune reconstitution has not yet been described. In 117 recipients of NMA HCT patients following ATG and TLI, not unexpectedly, CMV viremia was seen in approximately 60% of the seropositive patients regardless of donor serostatus, and recipient seropositivity significantly increased the odds of CMV viremia after transplant in a multivariate analysis. The administration of ATG and TLI resulted in a strikingly earlier viremia in the posttransplant period when compared to the previously reported timing of viremia following myeloablative preparative regimens, especially for transplant recipients who were seropositive for CMV with seronegative donors. Furthermore, early viremia in the setting of a CMV naïve donor was associated with a delay in functional antiviral control. These observations demonstrate the dynamic nature of immunity in relation to CMV antigen exposure in the complex environment resulting from NMA conditions where both donor and residual recipient immune response affect viral control.
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Affiliation(s)
- Joanna M Schaenman
- Division of Infectious Diseases, Stanford University Medical Center, Stanford, California 94305-5623, USA.
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25
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Kim JH, Schaenman JM, Ho DY, Brown JMY. Treatment of acyclovir-resistant herpes simplex virus with continuous infusion of high-dose acyclovir in hematopoietic cell transplant patients. Biol Blood Marrow Transplant 2010; 17:259-64. [PMID: 20615475 DOI: 10.1016/j.bbmt.2010.06.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Accepted: 06/26/2010] [Indexed: 10/19/2022]
Abstract
Infection because of herpes simplex virus (HSV) that is resistant to acyclovir (ACV) poses treatment challenges in hematopoietic cell transplant (HCT) patients. We present a series of patients with ACV-resistant HSV following HCT who were successfully treated with continuous infusion high-dose ACV after failing standard treatment regimens for ACV-resistant HSV.
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Affiliation(s)
- Janet H Kim
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
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26
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Schaenman JM, Rosso F, Austin JM, Baron EJ, Gamberg P, Miller J, Oyer PE, Robbins RC, Montoya JG. Trends in invasive disease due to Candida species following heart and lung transplantation. Transpl Infect Dis 2009; 11:112-21. [PMID: 19254327 DOI: 10.1111/j.1399-3062.2009.00364.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although invasive candidiasis (IC) causes significant morbidity and mortality in patients who undergo heart, lung, or heart-lung transplantation, a systematic study in a large cohort of thoracic organ transplant recipients has not been reported to date. Clinical and microbiological data were reviewed for 1305 patients who underwent thoracic organ transplantation at Stanford University Medical Center between 1980 and 2004. We identified and analyzed 76 episodes of IC in 68 patients (overall incidence 5.2% per patient).The incidence of IC was higher in lung (LTx) and heart-lung transplant (HLTx) recipients as compared with heart transplant (HTx) recipients (risk ratio [RR] 1.7, 95% confidence interval [CI] 1.1-2.7).The incidence of IC decreased over time in all thoracic organ transplant recipients, decreasing from 6.1% in the 1980-1986 time period to 2.1% in the 2001-2004 era in the HTx recipients, and from 20% in the 1980-1986 period to 1.8% in the 2001-2004 period in the LTx and HLTx recipients.The most common site of infection differed between the HTx and LTx cohorts, with bloodstream or disseminated disease in the former and tracheobronchitis in the latter. IC in the first year after transplant was significantly associated with death in both HTx (RR 2.9, 95% CI 1.8-4.6, P=0.001) and LTx and HLTx patients (RR 3.0, 95% CI 1.9-4.6, P<0.001). The attributable mortality from IC decreased during the 25-year period of observation, from 36% to 20% in the HTx recipients and from 39% to 15% in the LTx and HLTx recipients. There were a significant number of cases caused by non-albicans Candida species in all patients, with a trend toward higher mortality in the HTx group. In conclusion, the incidence and attributable mortality of IC in thoracic organ transplant recipients has significantly declined over the past 25 years.The use of newer antifungal agents for prophylaxis and treatment, the decrease in the incidence of cytomegalovirus disease, and the use of more selective immunosuppression, among other factors, may have been responsible for this change.
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Affiliation(s)
- J M Schaenman
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California 94305, USA.
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27
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Mancini N, Ossi CM, Perotti M, Clementi M, DiGiulio DB, Schaenman JM, Montoya JG, McClenny NB, Berry GJ, Mirels LF, Rinaldi MG, Fothergill AW. Molecular mycological diagnosis and correct antimycotic treatments. J Clin Microbiol 2005; 43:3584; author reply 3584-5. [PMID: 16000516 PMCID: PMC1169111 DOI: 10.1128/jcm.43.7.3584-3585.2005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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28
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Schaenman JM, DiGiulio DB, Mirels LF, McClenny NM, Berry GJ, Fothergill AW, Rinaldi MG, Montoya JG. Scedosporium apiospermum soft tissue infection successfully treated with voriconazole: potential pitfalls in the transition from intravenous to oral therapy. J Clin Microbiol 2005; 43:973-7. [PMID: 15695722 PMCID: PMC548045 DOI: 10.1128/jcm.43.2.973-977.2005] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
An immunocompromised patient with an invasive soft tissue infection due to Scedosporium apiospermum was successfully treated with voriconazole and surgical debridement. After transition from intravenous to oral therapy, successive adjustments of the oral dose were required to achieve complete resolution. For soft tissue infections due to molds characterized by thin, septate hyphae branching at acute angles, voriconazole should be considered a first-line antifungal agent. The potential usefulness of plasma voriconazole levels for guiding optimal therapy should be investigated.
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Affiliation(s)
- Joanna M Schaenman
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Dr., Rm. S-100, Stanford, CA 94305, USA.
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29
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Singh U, Gilchrist CA, Schaenman JM, Rogers JB, Hockensmith JW, Mann BJ, Petri WA. Context-dependent roles of the Entamoeba histolytica core promoter element GAAC in transcriptional activation and protein complex assembly. Mol Biochem Parasitol 2002; 120:107-16. [PMID: 11849710 DOI: 10.1016/s0166-6851(01)00441-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Transcriptional control of the hgl5 gene of Entamoeba histolytica is mediated through an unusual core promoter composed of TATA, GAAC and Initiator elements. In the hgl5 promoter the GAAC element (AATGAACT) determines the site and rate of transcription initiation. Here we tested the role of the GAAC element in transcription activation from upstream regulatory elements (UREs) in the hgl5 promoter. We also examined the function of the GAAC element in the ferredoxin (fdx) promoter and characterized the protein binding to the GAAC element. Electrophoretic mobility shift assays (EMSA) demonstrated that the GAAC region is necessary for higher-order nuclear protein complex assembly. The function of the GAAC element in transcription activation mediated by UREs revealed that mutation of the GAAC element did not affect transcription activation mediated by the hgl5 URE4 but abrogated activation by the hgl5 URE3. We compared the role of the GAAC elements in the hgl5 and fdx promoters. Competitive gel shift assays were consistent with the same nuclear protein binding to the GAAC elements in both genes. Mutation of the GAAC element in the fdx gene decreased reporter gene expression, however, in contrast to hgl5 gene, had no effect on the site of transcription initiation. These results support a role for the GAAC element in assembly of nuclear proteins at the core promoter and in transcription activation mediated by URE3. The differing effect on transcription initiation in the hgl5 and fdx genes upon mutation of the GAAC element suggests a context-dependence of the GAAC-binding protein in gene expression.
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Affiliation(s)
- Upinder Singh
- Department of Medicine, University of Virginia, Charlottesville, VA 22908, USA.
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30
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Gilchrist CA, Holm CF, Hughes MA, Schaenman JM, Mann BJ, Petri WA. Identification and characterization of an Entamoeba histolytica upstream regulatory element 3 sequence-specific DNA-binding protein containing EF-hand motifs. J Biol Chem 2001; 276:11838-43. [PMID: 11278344 DOI: 10.1074/jbc.m007375200] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The hgl5 gene of Entamoeba histolytica is negatively regulated through the upstream regulatory element 3 (URE3) DNA motif TATTCTATT. This motif is also present and significant in the function of the E. histolytica fdx gene promoter. A yeast one-hybrid screen was used to identify an E. histolytica cDNA encoding a protein (URE3-BP) that recognized this DNA motif. Analysis of the predicted amino acid sequence demonstrated the presence of two EF-hand motifs but identified no canonical DNA binding motifs. URE3-BP, expressed in bacteria, demonstrated Ca(2+)-dependent and sequence-specific recognition of the URE3 DNA sequence as assessed by electrophoretic mobility shift assays. Antibodies raised against URE3-BP blocked the formation of the URE3 DNA-protein complex by native nuclear extracts. The URE3-BP protein was present in the E. histolytica nucleus and cytoplasm with an apparent molecular mass of 22.6 kDa. Our results represent the first use of a yeast genetic screen to identify, on the basis of function, a DNA-binding protein of an early branching eukaryote. Since the URE3 DNA can modulate gene expression in both a positive and negative manner, this protein may have more than one mechanism of interaction with transcriptional machinery. Characterization of URE3-BP should provide insight into transcription regulation and virulence control in this parasite.
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Affiliation(s)
- C A Gilchrist
- Departments of Internal Medicine, Microbiology, and Pathology, University of Virginia, Charlottesville, Virginia 22908, USA
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31
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Schaenman JM, Gilchrist CA, Mann BJ, Petri WA. Identification of two Entamoeba histolytica sequence-specific URE4 enhancer-binding proteins with homology to the RNA-binding motif RRM. J Biol Chem 2001; 276:1602-9. [PMID: 11038357 DOI: 10.1074/jbc.m006866200] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
To study transcriptional regulation in the lower branching eukaryote Entamoeba histolytica, we have identified two sequence-specific DNA-binding proteins that recognize the upstream regulatory element URE4, an enhancer that regulates expression of the Gal/GalNAc lectin heavy subunit gene hgl5. A chromatographic purification of E. histolytica nuclear extracts by gel filtration, cation exchange, and sequence-specific DNA affinity chromatography led to a 700-fold increase in URE4 binding activity and the appearance of two dominant protein species with molecular masses of 28 and 18 kDa. These proteins, termed E. histolytica enhancer-binding proteins 1 and 2 (EhEBP1 and EhEBP2), were sequenced by tandem mass spectroscopy and their corresponding cDNA clones identified. Recombinant EhEBP1 and EhEBP2 were able to bind double-stranded oligonucleotides bearing the URE4 motif in a sequence-specific manner, and antibodies raised against EhEBP1 were able to interfere with the formation of URE4-protein complexes in crude nuclear extracts. Overexpression of EhEBP1 in E. histolytica trophozoites resulted in a 7-fold drop in promoter activity in transiently transfected reporter gene constructs when the URE4 motif was present, confirming its ability to specifically recognize the URE4 motif and suggesting that additional cofactors may be required for transcriptional activation by URE4. Further characterization and identification of binding partners for EhEBP1 and EhEBP2, the first proteins with demonstrated sequence-specific DNA binding activity to be identified in E. histolytica, should provide new insights into transcriptional regulation in this protozoan parasite.
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Affiliation(s)
- J M Schaenman
- Departments of Microbiology, Internal Medicine, and Pathology, University of Virginia, Charlottesville, Virginia 22908, USA
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32
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Schaenman JM, Driscoll PC, Hockensmith JW, Mann BJ, Petri WA. An upstream regulatory element containing two nine basepair repeats regulates expression of the Entamoeba histolytica hgl5 lectin gene. Mol Biochem Parasitol 1998; 94:309-13. [PMID: 9747982 DOI: 10.1016/s0166-6851(98)00081-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- J M Schaenman
- Department of Medicine, University of Virginia, Charlottesville 22908, USA
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